Can imaging suggest the aetiology in skull base osteomyelitis? : a systematic literature review

Purpose: To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. Material and methods: A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. Results: Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group - 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidenceof orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. Conclusions: Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement

Blood transfusion practices in obstetrics and gynecology: study of indications as a measure to prevent maternal morbidity and mortality

Background: This is a study of rational use of blood transfusion in a tertiary care center. So, this study was done to find out the indications of blood transfusion in department of obstetrics and gynaecology and measures to minimize the requirement of blood transfusion to reduce maternal mortality and morbidity.Methods: This is a retrospective study in department of obstetrics and gynaecologyin Muzaffarnagar Medical College, Muzaffarnagar, U.P. in collaboration with the department of pathology including blood bank for the duration of 1 year i.e. 1st January, 2017 to 31st December, 2017.  Total transfusions in 1 year were 706 of which 406 were in obstetrics and 300 were in gynecology.Results: In our study maximum 16.20% blood transfusions were given during cesarean section in third trimester in unbooked cases who came with severe anemia in labour. Others were APH (12%) and abortions (13.05%). This shows that anemia is still a major cause of maternal mortality and morbidity in India. In Gynecological cases blood transfusion was more in third parity and above indicating that perimenopausal women were also more susceptible for anemia due to disease of perimenopausal age group like AUB and fibroid.Conclusions: Maximum number of transfusions specially PRBC in obstetrics were of moderate to severe anemia, mainly to the patients who were term or in labor and of high-risk pregnancies, who were unbooked with no antenatal care. In Gynecology cases, blood transfusion was of perimenopausal or menopausal group with moderate anemia. This comes to the conclusion that all preventive measures should be taken in females from womb to tomb to correct anemia and this will indirectly help to prevent maternal and perinatal morbidity and mortality

Ciprofloxacin-Resistant Neisseria meningitidis, Delhi, India

Decreased susceptibility of Neisseria meningitidis isolates to ciprofloxacin emerged from an outbreak in Delhi, India. Results of antimicrobial susceptibility testing of the meningococcal isolates to ciprofloxacin and further sequencing of DNA gyrase A quinolone-resistance–determining region confirmed the emergence of ciprofloxacin resistance in the outbreak

Endovascular uterine artery interventions

Percutaneous vascular embolization plays an important role in the management of various gynecologic and obstetric abnormalities. Transcatheter embolization is a minimally invasive alternative procedure to surgery with reduced morbidity and mortality, and preserves the patient's future fertility potential. The clinical indications for transcatheter embolization are much broader and include many benign gynecologic conditions, such as fibroid, adenomyosis, and arteriovenous malformations (AVMs), as well as intractable bleeding due to inoperable advanced-stage malignancies. The most well-known and well-studied indication is uterine fibroid embolization. Uterine artery embolization (UAE) may be performed to prevent or treat bleeding associated with various obstetric conditions, including postpartum hemorrhage (PPH), placental implantation abnormality, and ectopic pregnancy. Embolization of the uterine artery or the internal iliac artery also may be performed to control pelvic bleeding due to coagulopathy or iatrogenic injury. This article discusses these gynecologic and obstetric indications for transcatheter embolization and reviews procedural techniques and outcomes

Incidence of gall stone formation in acromegalic patients on octreotide therapy

Objective: Octreotide, a long-acting synthetic somatostatin analog, has been widely used for ac-romegalic patients. Gastrointestinal (GI) side effects and gall stones are predominant side effects. We report incidence of gall stones in our cohort of acromegalic patients treated with octreotide therapy. Design: Retrospective case observational study. Setting: Endocrinology Unit, Dr. Ram Manohar Lohia, Hospital, New Delhi. Materials and Methods: Patients of acromegaly on primary or secondary octreotide therapy. Intervention: Patients were enquired regarding complaints related to the GI system and their medical records were reviewed. Ultrasound films at various intervals while on octerotide therapy were evaluated by the radiologist for presence of sludge and development of gall stones. Results: Of seven patients, five developed gallstones and sludge was seen in three patients at intervals ranging from 11 to 36 months postoctreotide initiation. Conclusion: A high incidence of gall stone formation in the present study as compared to the West was noted, the reasons for which are not clear

Spontaneous reduction of prolactinoma post cabergoline withdrawal

Prolactinomas are common pituitary tumors usually highly responsive to dopamine agonists. Around 70-90% of the prolactinomas exhibit decrease in tumor size, though variably with these agents. Uncommonly, there may be little or no shrinkage in pituitary tumor. In the absence of medical therapy, pituitary apoplexy may also result in tumor shrinkage, albeit rarely. We report here a case showing only modest reduction in prolactinoma with cabergoline given for a period of one and a half years. Surprisingly, this tumor showed a 40% reduction in the tumor size 3 months after cabergoline withdrawal in the absence of clinical or radiological evidence of apoplexy

Effect of octreotide on endometriosis in acromegaly: Case report with review of literature

Objective: To study the effect of octreotide therapy on endometriotic lesions in a patient with coexisting endometriosis and acromegaly. Intervention: Patient: A 34-year-old female was diagnosed with acromegaly and coexisting endometriosis. Post-surgical resection of the tumor, patient was initiated on octreotide therapy. Results: There was improvement in menstrual bleeding as IGF1 levels decreased with Octreotide therapy. Resolution of the endometriotic lesions was observed during follow up. Conclusion: In this unusual case, the treatment of acromegaly concurred with regression in the endometriotic lesions. Causal or incidental association cannot be inferred from the present case