ABSTRACT
Introduction: The pandemic of COVID-19 in association with mucormycosis would be a deadly fungal infection with high level of mortality and morbidity. Our aim is to evaluate the surgical outcome of patients with rhino-orbito-cerebral mucormycosis to suggest better management strategies. Method(s): A total of 62 cases of COVID-19-associated rhino-orbito-cerebral mucormycosis were admitted to the ear, nose, throat department in Mashhad, Iran, from August 1 to October 15, 2021. All data were analyzed using SPSS version 27.0. Descriptive analysis was used for demographic and clinical characteristics. Result(s): Main predisposing conditions were diabetes mellitus (90%) followed by hypertension (41%). Main symptoms were headache (75%), periorbital or retro-orbital pain (61%), visual loss (45%), and facial numbness (41%). Mucosal and ocular findings showed necrosis (67%), blindness (n=35), ptosis (n=31), proptosis (n=27), ophthalmoplegia (n=25), and chemosis (n=20). Neurologic loss of consciousness (19%) and palsies of cranial nerves (53%) were observed. Endoscopy findings showed necrosis (70%), discharge (61%), and crusting (54%). Imaging enhancement revealed mucosal thickening (69%), opacification of sinus (69%), bony destruction of sinus (35%), and orbital involvement (25%). Debridement surgery was necessary in nearly all patients (96%), dominated by ethmoid sinus (90%), maxillary sinus (87%), middle turbinate (80%), and sphenoid sinus (79%). Based on our follow-up, 25 patients died (42%). Those who survived will suffer from no light perception (35%), cranial nerve palsy (12%), and cerebral vascular accident (1.6%). Conclusion(s): Mucormycosis is an aggressive fungal infection. Diabetes mellitus, COVID-19 complication, inappropriate use of corticosteroids, and delayed vaccination had significantly increased its incidence. As there is an urgent need to address this public health concern, we present our data set from Iran.
ABSTRACT
Today, small-and medium-sized enterprises (SMEs) play an important role in the econ-omy of societies. Although environmental factors, such as COVID-19, as well as non-environmental factors, such as equipment failure, make these industries more vulnerable, they can be minimized by better understanding the concerns and threats these industries face. Only a few SMEs have the capacity to implement the innovative manufacturing technologies of Industry 4.0. The system must be highly adaptable to any equipment, have low costs, avoid the need of doing complex integrations and setups, and have future reliability due to the rapid growth of technology. The goal of this study was to provide an overview of past articles (2010–2020), highlighting the major expectations, re-quirements, and challenges for SMEs regarding the implementation of predictive maintenance (PdM). The proposed solutions to meet these expectations, requirements, and challenges are dis-cussed. In general, in this study, we attempted to overcome the challenges and limitations of using smart manufacturing—PdM, in particular—in small-and medium-sized enterprises by summariz-ing the solutions offered in different industries and with various conditions. Moreover, this literature review enables managers and stakeholders of organizations to find solutions from previous studies for a specific category, with consideration for their expectations and needs. This can be sig-nificantly helpful for small-and medium-sized organizations to save time due to time-consuming maintenance processes. © 2021 by the authors. Licensee MDPI, Basel, Switzerland.