Increased incidence of rhino-orbital mucormycosis in an educational therapeutic hospital during the COVID-19 pandemic in western Iran: An observational study.

BACKGROUND: COVID-19 patients, especially the patients requiring hospitalisation, have a high risk of several complications such as opportunistic bacterial and fungal infections. Mucormycosis is a rare and opportunistic fungal infection that mainly affects diabetic and immunocompromised patients. An increase has been observed in the number of rhino-orbital mucormycosis in patients with COVID-19 admitted to Imam Khomeini Hospital, Kermanshah, Iran, since October 2020. This is a report of the frequency, risk factors, clinical manifestations, treatment and prognosis of COVID-19 associated with mucormycosis infection. METHODS: The medical records of COVID-19 patients with rhino-orbital mucormycosis who were diagnosed in an educational therapeutic hospital in Kermanshah, west of Iran were surveyed. Several parameters were analysed including demographic, clinical, therapeutic and laboratory characteristics. RESULTS: Twelve patients with COVID-19-associated rhino-orbital mucormycosis were identified from 12 October to 18 November 2020. All cases reported as proven mucormycosis had a history of hospitalisation due to COVID-19. Comorbidities mainly included diabetes mellitus (83.33%) and hypertension (58.33%). Seventy-five per cent of patients received corticosteroids for COVID- 19 treatment. The sites of involvement were rhino-sino-orbital (83%) and rhino-sino (17%). Amphotericin B/liposomal amphotericin B alone or in combination with surgical debridement or orbital exenteration was used as the first-line therapy. The overall mortality rate was 66.7% (8/12). CONCLUSIONS: We found a high incidence of mucormycosis among COVID-19 patients. Diabetes mellitus and corticosteroid use were the dominant predisposing factor of mucormycosis. Mucormycosis is a life-threatening and opportunistic infection; therefore, physicians should know the signs and symptoms of the disease so that a timely diagnosis and therapy can be performed.

Agreement between cone-beam computed tomography and functional endoscopic sinus surgery for detection of pathologies and anatomical variations of the paranasal sinuses in chronic rhinosinusitis patients: A prospective study.

PURPOSE: The diagnosis of chronic rhinosinusitis requires a comprehensive knowledge of the signs and symptoms of the disease and an accurate radiographic assessment. Computed tomography (CT) is the superior imaging modality for diagnosis of chronic rhinosinusitis. However, considering the lower dose and higher resolution of cone-beam computed tomography (CBCT) compared to CT, this study aimed to assess the agreement between the findings of CBCT and functional endoscopic sinus surgery (FESS). MATERIALS AND METHODS: This descriptive prospective study evaluated 49 patients with treatment-resistant chronic rhinosinusitis who were candidates for FESS. Preoperative CBCT scans were obtained before patients underwent FESS. The agreement between the CBCT findings and those of FESS was determined using the kappa correlation coefficient. The frequency of anatomical variations of the paranasal sinuses was also evaluated on CBCT scans. RESULTS: Significant agreement existed between pathological findings on CBCT scans and those of FESS, such that the kappa correlation coefficient was 1 for mucosal thickening, 0.644 for nasal deviation, 0.750 for concha bullosa, 0.918 for nasal polyp, 0.935 for ostiomeatal complex (OMC) obstruction, and 0.552 for infundibulum thickening. Furthermore, 95.9% of patients had 1 or more and 79.6% had 2 or more anatomical variations, of which nasal deviation was the most common (67.3%). CONCLUSION: Considering the significant agreement between the findings of CBCT and FESS for the detection of pathological changes in the paranasal sinuses, CBCT can be used prior to FESS to detect chronic rhinosinusitis and to assess anatomical variations of the OMC.

The Effect of Scaling and Root Planning on Salivary TNF-α and IL-1α Concentrations in Patients with Chronic Periodontitis.

OBJECTIVE: Periodontitis is one of the main diseases in the oral cavity that causes tooth loss. The host immune response and inflammatory factors have important role in periodontal tissue. The current study was done with the objective to determine the effect of scaling and root planning on the salivary concentrations of tumor necrosis factor-alpha (TNF-α) and interleukin-1-alpha (IL-1α). METHODS: In this quasi-experimental clinical trial, 29 patients with chronic periodontitis and 29 healthy subjects without periodontitis were studied. Clinical examination findings and salivary TNF-α and IL-1α (using ELISA method) were compared before and after scaling, root planning. RESULTS: Before starting treatment, salivary TNF-α and IL-1α concentrations were higher in healthy control group than in periodontitis group (P< 0.05). Non-surgical treatment increased the concentration of these two biomarkers in the saliva. However, increase in IL-1α concentration was not statistically significant (P= 0.056). There was a negative relationship between TNF-α and IL-1α levels with pocket depth and attachment loss (P< 0.05). CONCLUSION: Scaling and root planning improved periodontal disease indices and salivary TNF-α and IL-1α levels.