Depression
Selegiline is also delivered via a transdermal patch used as a treatment for major depressive disorder. Administration of transdermal selegiline bypasses hepatic first pass metabolism. This avoids inhibition of gastrointestinal and hepatic MAO-A activity, which would result in an increase of food-borne tyramine in the blood and possible related adverse effects, while allowing for a sufficient amount of selegiline to reach the brain for an antidepressant effect.A quantitative review published in 2015 found that for the pooled results of the pivotal trials, the number needed to treat (a sign of effect size, so a low number is better) for the patch for symptom reduction was 11, and for remission, was 9. The number needed to harm (inverse of the NNT, a high number here is better) ranged from 387 for sexual side effects to 7 for application site reaction. With regard to the likelihood to be helped or harmed (LHH), the analysis showed that the selegiline patch was 3.6 times as likely to lead to a remission vs. a discontinuation due to side effects; the LHH for remission vs. incidence of insomnia was 2.1; the LHH for remission vs. discontinuation due to insomnia was 32.7. The LHH for remission vs. insomnia and sexual dysfunction were both very low. Special populations
For all human uses and all forms, selegiline is pregnancy category C: studies in pregnant lab animals have shown adverse effects on the fetus but there are no adequate studies in humans.
Order Mucorales (mucormycosis)
Family Mucoraceae
Absidia (Absidia corymbifera)
Apophysomyces (Apophysomyces elegans and Apophysomyces trapeziformis)
Mucor (Mucor indicus)
Rhizomucor (Rhizomucor pusillus)
Rhizopus (Rhizopus oryzae)
Family Cunninghamellaceae
Cunninghamella (Cunninghamella bertholletiae)
Family Thamnidiaceae
Cokeromyces (Cokeromyces recurvatus)
Family Saksenaeaceae
Saksenaea (Saksenaea vasiformis)
Family Syncephalastraceae
Syncephalastrum (Syncephalastrum racemosum)
Order Entomophthorales (entomophthoramycosis)
Family Basidiobolaceae
Basidiobolus (Basidiobolus ranarum)
Family Ancylistaceae
Conidiobolus (Conidiobolus coronatus/Conidiobolus incongruus)

Epidemiology
Zygomycosis has been found in survivors of the 2004 Indian Ocean earthquake and tsunami and in survivors of the 2011 Joplin, Missouri tornado. Symptoms
In the primary cutaneous form, the lesions are usually painful and necrotic, with black eschar, accompanied by a fever. Patients will usually present with a history of poorly controlled diabetes or malignancy. Myocutaneous infections may lead to amputation. Pulmonary tract infections seen with lung transplant patients, who are at high risk for fatal invasive mycoses. Rhinocerebral infection is characterized by paranasal swelling with necrotic tissues. Patient may have hemorrhagic exudates (tissue fluid from lesions tinged with blood) from the nose and eyes as the fungi penetrate through blood vessels and other anatomical structures. Diagnosis
Diagnosis is done with potassium hydroxide (KOH) preparation in tissue. On light microscopy, there will be broad, ribbon-like septate hyphae with 90 degree angles on branches. KOH wet mount of the black eschar will show aseptate fungal hyphae with right angle branching. Periodic Acid Schiff (PAS) staining will reveal similar broad hyphae in the dermis and cutis. Fungal culture can also confirm the organism. Diagnosis remains difficult due to the lack of laboratory tests as mortality remains high.