SPECIAL ARTICLE COVID-19: Covid-19-Related Acute Invasive Fungal Sinusitis: Clinical Features and Outcomes

Abstract Introduction There is a noticeable increase in the incidence of acute invasive fungal sinusitis which coincides with the ongoing coronavirus pandemic. It is a potentiallylethal fungal infection, with the most common form being the rhino-orbito-cerebral presentation. Objectives The aim of the present study is to discuss the different epidemiological factors, risk factors, clinical presentations and outcomes of acute invasive fungal sinusitis which is noticeably related to the coronavirus disease 2019 (Covid-19) pandemic. Methods The present cross-sectional cohort study included 22 adult patients who presented with Covid-19-related acute invasive fungal sinusitis. The diagnosis of acute invasive fungal sinusitis was confirmed by histopathological biopsy. All data, including demographics, risk factors, clinical findings, different lines of treatment and their outcomes, were recorded and analyzed. Results All patients had diabetes mellitus (100%), and 17 (77.3%) had been submitted to systemic steroids. All patients (100%) had unilateral sinonasal disease. Proptosis was found in 15 patients (68.2%), ophthalmoplegia was observed in 12 patients (54.5%), and intracranial affection occurred in 10 patients (45.5%). A total of 20 patients (90.9%) received liposomal amphotericin B. Surgical debridement was performed in 18 patients (45.5%). Non-septated mycelia was present in 19 biopsies (86.4%), while 3 (13.6%) showed septated mycelia. Total improvement was achieved in 10 patients (45.5%), while the mortality rate was of 27.3% (6 out of 22 participants). Conclusion Diabetes mellitus is the most common preexisting medical condition associated with Covid-19-related acute invasive fungal sinusitis. Systemic corticosteroid therapy is considered a predisposing factor. It is necessary to raise the level of awareness to diagnose this condition, especially in patients with Covid-19 infection or those who have recently recovered from it.

Chronic diseases and outcome in critically ill elderly admitted to ICU

Background: Elderly patients are a significant and increasing proportion of ICU patients. With advancing age, the comorbidities critically ill elderly patients have substantial mortality. The early recognition of patients at high risk of mortality is needed to plan care in advance and to control healthcare costs

Aim: To find out the relation between chronic diseases and outcome in critically ill elderly admitted to ICU

Study design: A prospective study

Participants: seventy elderly patients aged 60 years and above

Method: This study was performed in Geriatric ICU in Ain Shams University Hospitals including 70 critically ill elderly patients admitted for 24 hours or more. Each patient was subjected to on admission clinical assessment including detailed history taking, in addition to laboratory investigations

Results: The results of our study showed that ischemic heart disease was the only chronic diseases that had significant statistical effect on mortality in critically ill elderly admitted to ICU with p. value= 0.002

Conclusion: In the current study we found that mortality was associated with history of ischemic heart disease

Frequency of pulmonary tuberculosis in cirrhotic patients with resistant chest infection

24 cirrhotic patients with resistant chest infection were selected for this study. Full clinical assessment, liver function tests, abdominal ultrasonography, and tuberculin skin test were done for all patients. Also, bacteriological examination of sputum for acid fast bacilli [AFB] by direct stained film and cultured on Lowenstein-Jensen [L-J] medium for mycobacteria PCR to search for mycobacterium tuberculosis complex DNA using primer set for DNA segment of the IS 6110 was performed for all cases. The prevalence of tuberculosis among the 24 patients was 29.2% by one or more employed technique. Direct microscopy alone showed 2 positive cases [8.3%] for AFB, and L-J cultures were positive in 5 cases [20.8%] whereas PCR revealed 5 [20.8%] patients, 2 of them were negative by direct microscopy and L-J culture. The sensitivity and specificity of direct stained film were 40% and 100% respectively. Whereas the sensitivity and specificity of PCR in diagnosing tuberculosis were 100% and 89.5%. There were significant difference between tuberculous and non tuberculous patients as regard prolonged fever and elevated enzymes whereas no significant difference as regard other studied parameters. In pulmonary tuberculosis is not uncommon cause of resistant chest infection in cirrhotic patients and should be considered as an important cause of such resistance. PCR is rapid, sensitive, specific and valuable tool for diagnosing pulmonary tuberculosis especially in immunocompromised patients

Chlamydia pneumoniae infection as a risk factor for coronary heart disease

Eighty male patients were selected for this study. Forty of them were diagnosed as having coronary artery disease [CAD] as documented by coronary angiography the remaining 40 patients were confirmed to have acute myocardial infarction. Twenty control healthy persons were included in the study. All sujects were studied by history, clinical examination and investigated for blood sugar, liver and renal function, lipid profile, plasma fibrinogen and chlamydia pneumoniae IgM and IgG. The results showed that C. pneumoniae IgG was statistically significantly higher in patients than control. On the other h and the distribution of IgM in studied cases was 10% in infarction cases and 2.5% in angina cases which are all non significant. As regard patients with other risk factors for coronary heart disease [CHD] in this study as diabetes mellitus, hypertension or high blood lipids, we found that there is no correlation with IgG sero positivity to C. pneumoniae in either angina or infarction groups