Lomentospora prolificans is an emerging pathogen that is difficult to treat due to its intrinsic resistance to currently available antifungal agents. Current evidence demonstrates synergy between Azoles and Terbinafine against L. prolificans infections, while adjunct use of antifungal agent-loaded bone cement has also shown favourable outcomes. We report a case of an immunosuppressed adult with rheumatoid arthritis who developed L. prolificans osteomyelitis in his right wrist following trauma and subsequent exposure to commercially available fertiliser. The infection was successfully eradicated via a combination of aggressive, staged surgical source control, antifungal therapy using voriconazole and Terbinafine, and insertion of voriconazole-loaded bone cement into the wrist and carpus. The utility of this approach supports the synergistic effects of voriconazole and Terbinafine and, more broadly, the clinical benefits of antifungal-loaded bone cement, as demonstrated in previous case reports and in vitro studies. As such, combination antifungal therapy and voriconazole-loaded bone cement should be considered the therapy of choice in cases of osteomyelitis where L. prolificans is proven to be the causative organism.

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A comparative study was done with intrathecal bupivacaine of two different baricities. viz., isobaric 0.25% and hyberbaric 0.50%. The study was done in patients who underwent urological procedures. Surgical environment was compared in both groups. Surgeons were satisfied with surgical environment in both groups. Patients were satisfied with anaesthesia in both the groups. No complications were noted in both groups though all were elderly patients. Isobaric bupivacaine had a slower onset of level of block but produced an intense sensory and motor blockade, like hyperbaric bupivacaine. Height of analgesia and the duration of motor and sensory block were similar between the two groups, probably because the mass of bupivacaine injected was the same. Thus, we conclude that the mass of the drug is more important than the concentration in determining the surgical environment.

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