Outcomes of Open Fronto-Facial Resection for Fungal Osteomyelitis of Frontal Bone.

INTRODUCTION: The second wave of coronavirus disease 2019 (COVID-19) led to the resurgence of opportunistic infections due to the injudicious use of steroids. Sinonasal mucormycosis was declared an epidemic in India during the pandemic. Mucormycosis was managed effectively by surgical debridement along with systemic amphotericin B. Currently, a resurgence of mucormycosis following initial treatment, in the form of fungal osteomyelitis of the frontal bone, is being seen in India. METHODS: This prospective study included 10 patients with fungal osteomyelitis of the frontal bone due to mucormycosis. All patients underwent surgical debridement of the sequestrum and involucrum, with systemic antifungal pharmacotherapy. RESULTS: The average duration of time until mucormycosis recurrence was 22 days following initial treatment (range 10-33 days). Patients presented with extracranial bossing following outer frontal cortex erosion (n=3), bicortical erosion (n=3), bifrontal involvement (n=2), dural involvement (n=3), and involvement of the brain parenchyma and prefrontal cortex (n=2). All cases underwent debridement of the entire sequestrous bone and involucrum until normal bone could be identified. The mean admission duration was 4 weeks (range 3-6 weeks). All treated patients are currently alive and without disease, confirmed by contrast-enhanced computed tomography. CONCLUSION: Based on our experience, the successful treatment of fungal osteomyelitis due to mucormycosis requires a four-pronged approach: early detection, multidisciplinary management of comorbidities, surgical debridement of necrotic bone, and adequate systemic antifungal therapy.

Managing subglottic stenosis with Montgomery tube - Our experience.

Background: The purpose of this retrospective study is to evaluate the outcome of Montgomery T-tube insertion in our institution (AIIMS, Raipur). This study also throws light on its indications and complications. Methods: This is a retrospective study of 10 patients who presented with laryngotracheal stenosis and managed by Laryngofissure with Montgomery Tube insertion in the Department of Otorhinolaryngology, Head and Neck Surgery atAll India Institute of Medical Sciences (AIIMS) Raipur, India, during the period of January 2018- JUNE 2020. Results: The most common cause of laryngotracheal stenosis was prolonged intubation as seen in 80% patients.Majority of patients (40%) in this study were in the 3rd decade. In this study all the patients underwent tracheostomy prior to treatment for stenosis. The most common complication seen was surgical emphysema in post-operative period seen in 6 patients (60%) followed by crusting in 4 patients (40%), secondary granulation tissue formation in 4 patients (40%). Montgomery tube reinsertion had to be done in 2 patients (20%). Conclusions: Laryngotracheal stenosis (LTS) has always been and will remain a challenge to the otolaryngologistsand a multidisciplinary approach is required to tackle it.A multitude of surgeries have been described for the management of Laryngotracheal stenosis ranging from Endoscopic dilatation and cricotracheal resection with anterior and posterior grafting and anastomosis but many of them require specialized training and expertise,prolonged ICU care and have morbidity and mortality. 'Laryngofissure and Montgomery Tube stenting provides a safe and easy treatment option which can be done at most centres provided appropriate case selection has been done.

Mortality pattern in otorhinolaryngology ward: A 5 years retrospective study at an urban tertiary health care center in India.

BACKGROUND: To recognize deaths in the otorhinolaryngology indoor wards, determine the reason behind the mortalities and recommend modifications for betterment of patient care and surgical outcomes. METHOD: Data was collected from the mortality register, operation theatre registers, ward registers and case notes of patients declared dead at an urban tertiary health care center in India for a period of 5 years; from January 2012 to December 2016. The data included date of admission, age, sex, educational status, residence, and clinical diagnosis, course of hospital stay and medical cause of death. Data acquired was reviewed and statistically interpreted and presented in graphical and descriptive formats. RESULTS: 6157 admissions were made in otorhinolaryngology (ENT) ward in the 5 year period which included 3969 males and 2188 female patients. 58 deaths were recorded during this period which gives overall death per admission crude mortality rate of 9.42% at an average of about 12 (11.60) deaths per year. The major causes of death were malignancy and septicemia. CONCLUSION: The significance of health education, aggressive healthcare campaigns, enhancement of healthcare services and wide accessibility of healthcare services to remote areas has been emphasized. Role of structured study and protocols in the management of serious cases is highlighted along with the need for prompt referral and better interdepartmental cooperation.

Acute viral hepatitis e is associated with the development of myocarditis.

Myocarditis, an inflammatory disease of heart muscle, is an important cause of dilated cardiomyopathy worldwide. Viral infection is an important cause of myocarditis. This condition presents with various symptoms, ranging from minimally symptomatic cases to fatal arrhythmia and cardiogenic shock, and may develop chronic myocarditis and dilated cardiomyopathy in some patients. We report the case of a 26-year-old patient with acute viral hepatitis E who developed symptomatic myocarditis. As far as we could search, this is probably the 3rd case report of this rare association.

Elemental analysis of some ethnomedicinaly important hydrophytes and marsh plants of India used in traditional medicine

Objective: To study the elemental content of some ethnomedicinaly important hydrophytes and marsh plant of Tripura, India. Methods: With the help of standardize d questionnaires, 10 informants were interviewed on the medicinal use of hydrophytes and marsh plants of Tripura, India during 2009-2010.The elemental content of those plants were determined using Atomic Absorption Spectrophotometer. Results: A total of 8 plant species belonging to 8 different genera and 8 family were reported with their ethnomedicinaly uses. Among the different plant part used leaves and young tender shoots are most frequently used for the treatment of different disease. The hydrophytes and marsh plants are mostly used for the treatment of dysentery and other hepatic disorder. Different elemental constituents at trace levels of plants play an effective role in the medicines prepared. Elemental composition of eight ethno-medicinally important hydrophytes and marsh plants of Tripura, India have been determined using Atomic Absorption Spectrophotometer (AAS). A total of 11 elements K+, Mg+2, Ca+2, Na+ , Fe+2, Mn+2, Cu+3, Mn+2, Cu+3, Cr+3, Zn+2, Pb+4 and Cd+2 have been measured. Their concentrations were found to vary in different samples. Toxic elements Cd and Pb were also found but at very low concentration. Medicinal properties of these plant samples and their elemental distribution have been correlated. These results can be used to set new standards for prescribing the dosage of the herbal drugs prepared from these plant materials in herbal remedies and in pharmaceutical companies. Conclusions: The data obtained in the present work will be useful in synthesis of new herbal drugs with various combinations of plants, which can be used in the treatment of different diseases at global level.