We report a patient who presented to the ENT service complaining of nasal obstruction, exophthalmos, edema and ipsilateral facial congestion. Imaging studies revealed an aggressive noncalcified solid mass centered in the left nasoethmoidal region and heterogeneous avid enhancement following contrast media injection. Subsequently, a biopsy confirmed the presence of solid alveolar rhabdomyosarcoma. The patient was treated with chemoradiation therapy for 7 weeks. Due to the advanced stage of the disease, the patient was enrolled in a palliative care and pain control program.
s gate the prevalence of fluoroquinolones resistant TB and its molecular characterization in rural areas of eastern China.Methods: Deqing and Guanyun, two rural Chinese counties in neighboring provinces (zhejiang and Jiangsu), were selected as the field site, where 164 and 187 isolates were collected from the pulmonary TB patients registered in local TB dispensaries during 2004/2005. The susceptibility to 1st line anti-TB drug and Fluoroquinolones was determined by the proportion methods. IS6110 restricted fragment polymorphism (RFLP) was performed for genotyping and DNA sequencing on hotspot region of gyrA gene was performed as well.Results: Fluoroquinolones resistance was detected in 31 of 351 isolates including 24(6.8%), 11(3.1%) and 10(2.8%) resistant to ciprofloxacin, ofloxacin and levofloxacin respectively. Fluoroquinolones resistance was equally distributed in MDR-TB(15.8% and 11.8%), other combination(8.5% and 9.1%) and 1st line drug susceptible group(6.3% and 7.7%) both in Deqing and Guanyun. And the similar proportion of fluoroquinolones resistance has also been observed in groups of subjects with different social-demographic, clinical and bacteriological features. Mutations in the quinolone resistance determining regions (QRDRs) of gyrA were found in 17 of 31 fluoroquinolones resistant isolates in codon 94(45.2%), 90(12.9%) and 74(3.2%). IS6110-RFLP identified 2 clusters within fluoroquinolones resistant isolates and 3 clusters composed by both fluoroquinolones resistant isolates and fluoroquinolones susceptible isolates. The geographic distribution of the fluoroquinolones resistant TB patients noted their mainly distributed in central town areas of rural counties both in two counties, with 6(42.9%) from Deqing and 8(47.1%) from Guanyun respectively.Conclusion: Fluoroquinolones resistance has emerged in M.TB circulating in rural China and mainly related to the mutation in QRDR region of gyrA. The selective growth of fluoroquinolones resistant strain might be the main cause for the epidemic of fluoroquinolones resistant TB in rural China. And the TB patients from central town areas deserve the special concern for the development of fluoroquinolones resistance.
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