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Rhinoentomophthoromycosis caused by Conidiobolus sp commonly presents as a chronic granulomatous lesion that affects the rhinofacial subcutaneous tissue. We present an 18-year-old girl who presented with progressive bilateral proptosis and loss of vision since 2 weeks. Biopsy and fungal cultures confirmed diagnosis of Conidiobolus sp infection of the paranasal sinuses bilaterally with orbital extension and blindness. The clinical picture was complicated by the presence of sputum-positive cavitatory pulmonary tuberculosis, which was diagnosed at the same time. To our knowledge, this is the first such case to be reported from India. We also discuss the management of entomophthoromycosis. Despite many reports of success, there remains no consensus on the treatment of Conidiobolus infections of the nose and the paranasal sinuses with antifungal agents.

There is now considerable evidence from numerous countries that statutory child welfare agencies are being overwhelmed by a massive increase in child protection referrals which require investigation, while there has been a growing failure to develop preventive family support services. This paper describes the changes introduced in Western Australia to address this situation in what has come to be called New Directions in Child Protection and Family Support. The results demonstrate that the changes have led to a significant restructuring of the way the Department of Family and Children’s Services there responds to concerns expressed about children. It is argued that this has had an impact on the proportion of child maltreatment cases which are substantiated and the way responses are prioritized and allocated, and has provided the Department with a more explicit and clearer focus for its work in a period of increasing demand and rapid change.

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