ABSTRACT
Objectives: To present details of a case series of fungal co-infection (aspergillosis and mucormycosis) including clinical course, laboratory diagnosis, treatment, and outcome. Method(s): Clinical histories of 7 cases of fungal co-infection (3 pulmonary, 4 rhino-orbito-cerebral or sino-nasal) were collected by chart review, and reports of samples sent to the mycology laboratory for direct microscopy and fungal culture were retrieved from laboratory records.Presence of septate and aseptate hyphae in direct microscopy of clinical samples and/or growth of Aspergillus spp and Mucorales in culture was considered as evidence of probable co-infection with mucormycosis and aspergillosis (as per EORTC guidelines). Result(s): Mechanical ventilation, cavitary lung disease, and renal failure with metabolic acidosis were unique risk factors observed for pulmonary co-infection, while use of systemic corticosteroids for treatment of SARS-CoV-2 infection was common in rhino-orbito-cerebral (ROC) or sino-nasal (SN) co-infection. Diabetes mellitus was a common risk factor for both groups of cases. Fever, cough, chest pain, and shortness of breath were the most common features in pulmonary fungal co-infection cases, while headache, facial swelling and pain, nasal stuffiness, decreased vision, and altered sensorium were the most common features in ROC/SN co-infection. Consolidation or collapse, bronciectasis, cavitatory changes in and nodules were the most frequent radiological features in pulmonary fungal co-infection cases, while mucosal thickening in multiple paranasal sinuses, and involvement of orbit and cavernous sinuses were the most frequent features in ROC or SN co-infection. Presence of aseptate and septate hyphae in direct microscopy was seen in tissue samples from all ROC/SN cases, which enabled early intervention. However direct microscopy was not indicative of co-infection in any of sputum samples from pul-monary cases, and diagnosis was only established by culture, leading to delayed initiation of treatment or no treatment. Lipo-somal amphotericin B (lAMB) ranging from 50-200 mg/day was used for treatment of fungal co-infection, with posaconazole 600-800 mg/day as step-down therapy or if lAMB was not tolerated. Out ofthree pulmonary fungalco-infection cases, onlyone received appropriateantifungal treatment butexpired nonethe-less. Out of the two untreated patients, one expired, and one was discharged against medical advice without resolution of symptoms. Surgical intervention was not done for any patient. In comparison, 3 out of 4 cases of ROC/SN co-infection were appropriately managed with immediate surgical debridement and survived. The remaining patient received appropriate anti-fungals but refused surgical intervention and expired. Conclusion(s): Fungal co-infection with aspergillosis and mucormycosis is a serious condition requiring early intervention. This is facilitated by high sensitivity of direct microscopy in tissue samples used for diagnosis in ROC/SN co-infection, but hindered by low sensitivity of direct microscopy in sputum/BAL samples used for diagnosis in pulmonary cases rather than lung biopsy. Robust clinical advisory services, early diagnosis, and combined surgical and pharmacological approaches are crucial to a favorable outcome.
ABSTRACT
Aim: The study aims to assess the change in knowledge, awareness, and perception about COVID-19 among the dentists in Belagavi city, Karnataka. Materials and methods: A cross-sectional study was conducted among 212 dentists in Belagavi city, Karnataka. A self-designed questionnaire consisting of eight close-ended and five open-ended questions was used for the data collection in two phases, once in June 2020 and once in December 2020. All the data relating to demographic details followed by knowledge, awareness, and perception of dentists regarding COVID-19 were recorded. Descriptive statistics, Chi-square test, and McNemar test were used. Results: A total of 212 dentists participated in both phases of the study in June 2020 and December 2020. Most of them (39.6%) belonged to the age-group of 35–45 years, and 41.5% had more than 5 years of working experience in a private clinic. In phase 1 of the assessment of June 2020, almost 86.3% of the dentists agreed that dentists should use personal protective equipment kits for treatment, but only 35.8% knew what was included. There was a change in the knowledge, awareness, and perception in the second phase in December 2020 which was statistically significant. Conclusion: The knowledge, awareness, and perception of the dentists regarding COVID-19 in Belagavi city in December 2020 have increased when compared to June 2020. The ready availability of information and easy acquirement of knowledge, leading to better adaptability were the major reasons behind it. Clinical significance: The knowledge, awareness, and perception type of assessment regarding COVID-19 among the dentists in Belagavi city is important to analyze and evaluate their readiness to restart dental practices and how prepared they are in doing so. © The Author(s). 2022.
ABSTRACT
Introduction: It is necessary to prioritize occupational welfare, safety of dental students and health professionals to reduce coronavirus transmission, to offer the best benefit for patients. Aim: To assess knowledge regarding standard operating procedures to be adhered in clinical setting during pandemic amongst undergraduate, postgraduate dental students and dental interns of dental colleges in northwest region, Karnataka. Materials and Methods: This observational cross-sectional study was undertaken in dental colleges in northwest region, Karnataka from January 2021 to February 2021. Sample size was estimated to be 360 based on a pilot study. Participants were selected by the simple random sampling technique and were interviewed using a questionnaire comprising of 20 close-ended questions. The questionnaire was evaluated for reliability with Cronbach's α value of 0.82, face validity 0.85%, and content validity ratio 0.76. The collected data was entered in MS Excel and analysed using Statistical Package of the Social Science (IBM-SPSS) statistics-version 21 using descriptive analysis, Chi-square analysis, spearman's correlation coefficient test, and regression. Results: The mean age of the participants was 24.6±1.35 years with marked gender distribution of 261 (72.5%) females and 99 (27.5%) males. Overall knowledge score for the standard operating procedure to be adhered during the pandemic was found to be 10.92±1.96 (undergraduates), 12.68±1.80 (postgraduates) and 11.55±1.82 (interns). More than half of the respondents 57.78% displayed a moderate level of knowledge. Spearman's correlation coefficient test revealed a high statistically significant difference between awareness about Coronavirus disease 2019 (COVID-19) among participants and recommended masks during the procedure. Conclusion: Postgraduate students had higher knowledge regarding standard operating procedures to be adhered in dental clinics compared to undergraduate students and interns. It's necessary that dental students are aware of latest infection control guidelines and implement them into their practices right from beginning.