Interesting presentations of mucormycosis in post-COVID patients

Most documented cases of mucormycosishave been reported in patients with uncontrolled diabetes mellitus, neutropenia, or treatment with corticosteroids. Recently, with the second wave of COVID-19, the Indian subcontinent has witnessed a dramatic rise in mucormycosisinfection in patients recovered from COVID-19. This association has been documented in various case reports/case series and institutional studies, and the mortality associated with this fungal infection is emerging as a cause of concern.Pulmonary mucormycosis is the second most common form after rhino-orbito-cerebral mucormycosis(ROCM),but most cases are diagnosed in autopsy specimens. Cutaneous, Gastro-intestinal and disseminated forms are relatively rare. This cases series comprises of 4 cases of mucormycosis in post-COVIDpatients with interesting presentations.We report two cases of combined pulmonary aspergillosis and pulmonary mucormycosis, one case of rhino-orbital-mucormycosis with lymph nodal involvement and one case of rhino-orbital mucormycosis with acute inflammatory demyelinating polyneuropathy(AIDP).

Unilateral Lung Hypoplasia - A Rare Presentation in Adulthood

Lung hypoplasia is one of the developmental anomalies of the lung parenchyma, in which there is a decrease in the number and size of airways, alveoli and vessels. Here is a case of 36-year-old female with a history of fever, cough with expectoration, dyspnoea, with past history of similar complaints suggestive of recurrent respiratory infections. Chest x ray revealed homogenous opacity in left chest. HRCT thorax set the diagnosis of left pulmonary hypoplasia with compensatory hyperinflation of right lung. Patient was treated conservatively and was advised follow up. Lung hypoplasia majority of the times diagnosed immediately after birth, it is associated with severe respiratory failure and high mortality rate. There are less severe, unilateral forms in which they usually survive with compensatory hyperinflation of the opposite lung and may not be diagnosed till adulthood. Patients usually does not have any symptoms, but patients may present with symptoms suggestive of chronic bronchitis and recurrent lower respiratory tract infections. HRCT thorax helps to differentiate it from other congenital or acquired conditions. Treatment will be conservative, surgical resection is indicated in cases with severe cystic changes and severe symptoms.Lung hypoplasia comes under the spectrum of developmental anomalies of lung, which causes incomplete development of lung tissue with decrease in the total number of lung cells, airways and alveoli, which finally leads to reduction in lung size and weight. It may be unilateral or bilateral and can lead to severe respiratory failure and death immediately after birth, which is one of the common causes of perinatal mortality.1The less severe forms of lung hypoplasia can survive and may not be diagnosed till adulthood, many of the times in asymptomatic patients it is detected as an incidental finding on radiological imaging, or while investigating for recurrent respiratory tract infections. HRCT thorax is the diagnostic tool of choice.2 Here we present a case report of a 36-year-old female patient, with unilateral pulmonary hypoplasia and history of recurrent respiratory tract infections since last 10 years.

Pediatric Polysomnographic Studies at a Tertiary-care Hospital in Singapore.

Objectives: To investigate the indications for conducting polysomnography studies and their outcomes. Methods: Retrospective analysis of pediatric polysomnography studies performed over a four-year period (2009-2012). Results: 425 diagnostic studies and 100 non-invasive positive-pressure ventilation titration studies were conducted. Of these, 389 were performed in male children. Obstructive sleep apnea was the most common diagnosis; 49.6% (211 studies). Other diagnoses included central apnea, narcolepsy, and periodic limb movement disorder. Night time symptoms (snoring, frequent night awakenings, restless sleep) were present in 294 children, and 161 children had daytime symptoms (excessive daytime sleepiness, early morning fatigue, poor concentration at school). 13 studies (2.5%) were inadequate for analysis, reflecting the challenges of conducting studies in children. Conclusion: Dedicated pediatric sleep laboratories with properly trained staff are important to minimize failure rates and diagnose these conditions accurately.

Furosemide Infusion in Children with Dengue Fever and Hypoxemia.

Objectives: To study the role of furosemide infusion in the management of Acute respiratory distress syndrome (ARDS) associated with dengue fever. Methods: Children between the ages of 1 month to 18 years, who fulfilled the WHO clinical criteria for dengue infection and American European Consensus Criteria criteria for ARDS with Dengue IgM positivity, were evaluated. Patients were studied as group D (receiving diuretic therapy alone) and group B (both ventilation and diuretics), and compared to a historical control group V (ventilation alone). Furosemide infusion was administered at 0.05-0.1 mg/kg/hour for 48 hours, maintaining a urine output of 2-4 mL/kg/hour. Results: There was a significant difference in survival in the three groups. Significant difference was noted between pre- and postintervention arterial blood gases with respect to PCO2 (P=0.02), pO2 (P=0.003), PaO2/FaO2 ratio (P<0.001) and alveolar-arteriolar oxygen gradient (P=0.002). Conclusion: Diuretic infusion improves outcome in dengue with ARDS.

Retinopathy of Prematurity –Promising Newer Modalities of Treatment.

Retinopathy of prematurity (ROP) is a disorder of neonatal retinal vascularization. The incidence is increasing in developing countries like India in view of the rising numbers of preterm deliveries and improved neonatal care. Traditional modalities of treatment included cryotherapy and laser therapy, which were laborious and required special training. Hence, research is on way to find novel treatment modalities directed at various levels of pathogenesis for this blinding disease. We reviewed the published and unpublished literature on newer methods of ROP management. The pathogenesis of ROP has been studied with respect to the mediators of angiogenesis. Anti vascular endothelial growth factor (Anti-VEGF) therapy has been extensively studied and the studies have demonstrated its promising role early stages of ROP. The role of Insulin like growth factor (IGF), Granulocyte colony stimulating factor (GCSF), and June kinases (JNK) inhibitors are being studied by various researchers across the world. Gene therapy holds promise in the reversal of ROP changes.