A Rare Case of Non-rheumatic Streptococcal Acute Myocarditis

Non-rheumatic Streptococcal Acute Myocarditis, also known as Strep Pharyngitis Acute Myocarditis (SPAM) occurs in young adults, typically within five days of the initial streptococcal pharyngitis, and is characterized by typical cardiac symptoms, abnormal electrocardiography, and elevated cardiac biomarkers in the absence of obstructive coronary artery disease.

Patients may also report myalgias, arthralgias, and constitutional symptoms. Although a rare complication of Group A and G streptococcal infections, prompt recognition is important to ensure appropriate management.

This article discusses the case of a 33-year-old male who presented with substernal chest pain and monoarticular arthralgia two days after diagnosis with streptococcal pharyngitis, and reviews available literature on the evaluation and management of SPAM.

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Microbial Prevalence and Antimicrobial Resistance in Children and Adolescents with Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a common multifactorial upper respiratory disease with a key role of microbes in worsening of disease and its associated co-morbidities. Further, significant region specific variation in patient demographics and antibiotic resistance of causative bacteria are reported to pose difficulty in diagnosis and treatment.

In India, studies on the etiology and antibiotic resistance in chronic rhinosinusitis are very meager, especially in children. The present study aimed to determine the prevalence of common causative microbes and their antibiotic resistance in children and adolescents with chronic rhinosinusitis in South Indian population.

Subjects and methods: The present study was conducted on 89 children and 99 adolescents with chronic rhinosinusitis who visited MAA ENT Institute, Hyderabad, South India. The study samples were collected under the nasal endoscopic guidance from the middle meatus at first visit and sinuses at surgery.

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Orbital Involvement in Primary Paranasal Sinus Space Occupying Lesions

Orbit is an innocent bystander that is afflicted by lesions of the Paranasal Sinuses (PNS). Orbits share 3 walls with the sinuses, frontal sinuses on the supero-medial aspects of the orbits, ethmoid sinuses medially and maxillary sinuses inferiorly.

Between the ethmoids and the orbits, there is lamina papyraecea which is a very thin bone. Between the maxillary sinus and the floor of the orbit, the bone is weakened by the passage of the infraorbital nerve. The periorbita or the periosteum of the orbit is a tough structure that resists invasion by tumors.

Once the tumor transgresses this robust layer, it spreads to the orbital spaces easily due to lack of barriers that check tumor spread. There is also rich vascular communication between the sinuses and the orbit, which acts as a conduit for spread of infections and tumors. The last but not the least is the communication between the nasal cavity and the orbit through the Nasolacrimal Duct.

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The Dilemma of Rhinitis

Rhinitis is a widespread condition that causes significant morbidity worldwide and profoundly affects patients' quality of life. Given its prevalence and relative chronicity, the economic impact of rhinitis is significant.

It has been demonstrated that allergic rhinitis is a strong risk factor for the onset of asthma in adults. This led to the development of the United Airways Concept. Despite this prevalence, rhinitis is still an ill-defined disease that is associated with many controversial entities and few proven facts. The term “rhinitis’’ is, in itself, controversial as it implies an inflammatory disease of the nasal mucous membrane.

Clinical experience however has showed that the common symptoms of itching, sneezing, discharge, and blockage may exist without actual inflammation. Therefore, strictly speaking, the term “rhinopathy” is a more correct term, but it is rarely used.

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The Benefit and Tolerability of Adjuvant Chemotherapy in Elderly Stage III Colon Cancer Patients

The benefit of adding oxaliplatin to adjuvant fluoropyrimidine chemotherapy in patients >70 years is controversial. This retrospective audit investigated usage, benefit and tolerability of adjuvant chemotherapy for colon cancer in older adults. Materials and methods: Patients aged >60 years with stage III colon cancer referred for adjuvant chemotherapy between 2010–2012 were identified from a tertiary hospital oncology database.

Data were collected on demographics, chemotherapy received, completion rates, toxicities, relapse and survival. Comparison was made between the older group (age >70 years) and the younger group (age 60-70 years). Results: 95 eligible patients were identified; 50 in the older group (median age 76), 45 in the younger group (median age 66), 56% male, 82% NZ European and 5% Maori.

Older patients were less likely to receive adjuvant chemotherapy (76% and 91% in the older and younger group respectively, p=0.0017), especially oxaliplatincontaining regimens (14% and 47% of older and younger groups, respectively). Similar proportions in each group completed >80% of planned chemotherapy doses with no significant difference in early discontinuation due to toxicities.

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Death and Dying in the ICU- The Chamber of Torture

When patients get sick and seek medical attention, they expect doctors will help them get back to “normal”. Contrary to what many television shows depict, many ICU patients are those with chronic or incurable diseases; often in the terminal stage.

When you walk through the ICU what you actually see are patients connected to ventilators, dialysis machines, numerous IV pumps and restraints to prevent them from removing all that equipment. Families seldom see their loved ones attempting to remove their endotracheal tube, or grimacing as nursing staff adjust those tubes that have been placed into the lungs or stomach, or when they are being treated for bed sores from prolonged immobilization.

Patients too often suffer in vain attempts to prolong life, because of the mandate to “do everything.” Death and dying does not happen to us, but to someone else”. We have a “replacement mentality” and therefore “Americans not only don’t want to die, they are unwilling to accept the reality of death”. Fact is we all are going to die.

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Combined Ultrasound and Electric Field Stimulation Aids the Healing of Chronic Pressure Ulcers

All around  the  world  geriatric population  is increasing. This is accompanied by its unique  problems including issues of senescence and  frailty, and  at  times  complicated  by  multi-morbidities.  For  a graceful ageing it’s about  time that  we start  to explore meaningful newer  ideas, concepts  and  research  that  is aimed  towards  helping geriatric population.

Journal of Gerontology and Geriatric Research is perhaps doing a yeoman’s service for the mankind and for the geriatric research. Our  journal has come a long way from its inception, and from its first online open access issue in March 2012.The current issue has a bouquet of interesting original peer reviewed researches, short communications, commentaries, review articles, case reports, and letters to editor.

The views expressed are of the authors, and as an editor it is my privilege to guide you through  this latest edition of our journal. I would like to thank all the authors for their nice contributions, and wish them the very best. To read the complete article, please click on the links below.

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