Mucor and Rhizopus cause life-threatening infections primarily involving the lungs and sinuses, which disseminate very rapidly by necrosis and infarction of the contiguous tissues. We present a case of a 64-year-old African American posttransplant patient who presented with a productive cough and weight loss. He had a past surgical history of renal transplant for renal cell carcinoma and was on dual immunosuppressive therapy, that is, mycophenolate and tacrolimus. During his hospital stay, he developed a pneumopericardium due to the direct extension of a lung lesion. The diagnosis was made by radiological imaging and PCR result which was consistent with Mucor species. He was treated with antifungal therapy. The purpose of this report is to highlight the unusual association of mucormycosis with pneumopericardium.
Epidermal nevus syndrome (ENS) is a term used to describe the occurrence of an epidermal nevus in association with other extra-cutaneous developmental anomalies, most commonly involving the nervous and musculoskeletal systems. The nevus is classified on the basis of the main component which may be keratinocytic, sebaceous, follicular, apocrine, or eccrine. Most patients who present with ENS is at the time of birth, though some become apparent later in life. This case describes a young female who presented with seizures and cognitive impairment along with a linear epidermal nevus on the midline of her face. The presence of the nevus prompted brain imaging which showed cortical dysplasia, multiple hamartomas in the temporal lobe, thalamus, and periventricular regions along with cerebellar atrophy and Dandy-Walker variant. To our knowledge, this is the first case in which three different types of brain lesions were found in the same patient.
Background: Investigating the burden of access to infertility treatment has primarily been conducted in high-income countries, with little known for low- and middle-income countries, which comprise 80% of the world's population. The objective of this study was to investigate access to infertility care in Mexico. Methods: This was a cross-sectional analysis in the Mexican Teachers' Cohort (MTC), a prospective cohort study of 115,307 Mexican female public school teachers from 12 states in Mexico. Log-binomial models, adjusted for age, hormonal contraceptive use, teaching in a rural school, and speaking an indigenous language, were used to estimate the prevalence ratio (PR) and 95% confidence intervals (95% CI) of accessing medical care for infertility among women reporting a history of infertility. Results: 19,580 (17%) participants reported a history of infertility. Of those who experienced infertility, 12,470 (63.7%) reported seeking medical care for infertility, among whom 8,467 (67.9%) reported undergoing fertility treatments. Among women who reported a history of infertility, women who taught in a rural school (PR:0.95;0.92-0.97), spoke an indigenous language (PR:0.88; 0.84-0.92), or had less than a university degree (PR:0.93; 0.90-0.97) were less likely to access medical care for fertility. Women who had ever had a mammogram (PR:1.07; 1.05-1.10), had a pap-smear in the past year (PR:1.08;1.06-1.10), or who had utilized private healthcare regularly or in times of illness were more likely to access medical care for fertility. Conclusion: Utilization of infertility care varied by demographic and access characteristics, including speaking an indigenous language, teaching in a rural school, and having a private healthcare provider.
School Health Services (SHS) are school health programs that promote health in school children. The value of SHS is recognized globally and practices around SHS vary with different regions. Its positive outcomes are already acknowledged by high-income countries, where education ministries are typically involved in cultivating comprehensive School Health Services. Low-income countries remain hesitant to implement SHS, due to various constraints. In Pakistan, SHS have been introduced and restructured several times, but never comprehensively executed. Private schools in Pakistan offer better health programs than public schools but none of the schools follow standardized school health guidelines. This paper aims to analyze the role of SHS in Pakistan and provide several recommendations regarding the establishment of SHS in local schools. The proposed suggestions revolve around establishing model clinics in schools, which would be central to subsequent school-based health programs in Pakistan. If properly designed and equipped, school clinics can support a wide range of health outcomes, from emergency first aid care, to immunizations, to health education. The involvement of ministries and national authorities is encouraged for smooth delivery of SHS and compliance with public health guidelines.
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