Rhinocerebral mucormycosis (RCM): To study the clinical spectrum and outcome of 61 cases of RCM managed at a tertiary care center in India.

Background: Mucormycosis is a life-threatening infection of the paranasal sinuses and nasal cavities that can easily spread to the orbit and the brain. It is caused by fungi of the family Mucoraceae. We present a case series of 61 patients diagnosed and treated for rhinocerebral mucormycosis (RCM) at a single tertiary health care center. Methods: After obtaining ethical clearance, all patient files with a final diagnosis of RCM were thoroughly analyzed in departmental records and a master chart was prepared. The study evaluated the etiology, clinical spectrum, diagnosis, management, complications, and outcome at 3 months of RCM cases. Results: About 93.4% of the RCM cases were diabetic and an equal number had a past history of COVID infection. About 85.2% had received steroids for the treatment of coronavirus disease 2019 infection. The most common presentation of RCM was temporal lobe abscess (25.7%) followed by frontal lobe abscess (16.6%). At 3 months post-diagnosis, mortality in our study was 42.6%. About 26.2 % of the RCM cases had no disease, 23% had a static disease, and 8.2% had progressive disease at the end of 3 months. Conclusion: We report the largest single-center case series of RCM, comprising 61 patients. This case series underscores the importance of the early diagnosis and prompt treatment for a better prognosis for this dreadful disease. The three pillars of treatment for RCM cases include reversal of the immunosuppressive state, administration of antifungal drugs, and extensive surgical debridement. In spite of all this, mortality remains high.

A review on post-COVID-19 pulmonary fibrosis and the role of nintedanib in its management

[...]the current evidence is limited and more evidence is awaited from the ongoing randomized clinical trials evaluating the safety and efficacy of nintedanib in the management of post-COVID-19 pulmonary fibrosis. Angiotensin II (1-10 amino acid long) has a number of profibrotic effects on lung parenchymal cells such as the induction of growth factors like TGF-ß1 for mesenchymal cells, ECM molecules, cytokines like IL-1, and increased motility of lung fibroblasts. [22] Antifibrotic Agent-Nintedanib Nintedanib, an indolinone derivative, also known by its developmental code BIBF1120, is a small molecule inhibitor of receptor tyrosine kinase of fibroblast growth factor receptor (FGFR)-1, platelet derived growth factor receptor (PDGFR)-a and ß, and vascular endothelial growth factor receptor (VEGFR-2). [29] Therefore, it appears that nintedanib by inhibiting the receptor tyrosine kinase of all the above mentioned growth factors is shown to have an effect in the treatment of idiopathic pulmonary fibrosis.