Prevalence, distribution and correlates of pain in patients with mucormycosis-A cross-sectional study.

Context: COVID-19 has led to a spate of rhino-orbital-cerebral mucormycosis cases in India, the epidemiology of which was least understood before. Only a few case series and case reports discuss the symptomatology of mucormycosis. Aims: The primary objective of our study was to estimate the prevalence of pain in patients with mucormycosis. The secondary objectives include the type, regional distribution, characteristics and determinants of pain in patients with mucormycosis. Settings and Design: A cross-sectional study was conducted on consecutive adult patients with mucormycosis in our hospital. Materials and Methods: Following recruitment, a preplanned written questionnaire that was tested for validity with peers, with closed-ended queries was filled on a sole visit by an anesthesia postgraduate based on the response by the patient. Statistical analysis used: Categorical variables were summarized as proportion and percentage. To compare quantitative variables, Chi-square test was used. Results: A total of 69 out of the 80 patients recruited complained of pain (P value = 0.468). A total of 76.8% of patients had pain in the supraorbital region with 84% of the patients complaining of throbbing pain and 98.6% needing analgesics. Gender, pre-existing diabetes mellitus, organs affected due to mucormycosis, prior steroid usage, prior COVID illness, surgical intervention, and previous experience of pain in the same region had no influence on the presence or severity of pain. Conclusions: Pain is one of the presenting symptoms in patients with mucormycosis which is usually in the supraorbital and maxillary region, nociceptive type and throbbing in nature, and moderate to severe in intensity usually managed with simple analgesics.

Inferior Turbinate Reduction: Diode LASER or Conventional Partial Turbinectomy?

Hypertrophy of inferior nasal turbinate is one of the most common causes for nasal obstruction (NO). As diode laser has proven to be as effective as any other lasers, our objective was to study various primary outcomes of its use of diode laser like improvement in NO, intraoperative bleeding, postoperative pain, and rapidity of healing. The study was undertaken to compare the various outcomes by diode laser turbinate reduction (LTR) and conventional partial inferior turbinectomy (PIT). A nonrandomized controlled trial was conducted on 2 groups: One group (30 cases) underwent LTR and PIT was performed in the other group (30 cases). The improvement in NO was measured postoperatively up to 6 months. Intraoperative bleeding was measured and postoperative pain scores were assessed each day up to fifth postoperative day. Lastly, rapidity of healing was evaluated until 6 months. Subjective relief of NO was 90.8% in LTR group, whereas it was 65% in PIT group at 6-month follow-up, which was statistically significant (P < .05). Pain scores were higher until 5 days in PIT group compared to LTR group (P = .0001). Intraoperative bleeding mean scores (milliliters) were 8.03 in LTR group compared to 23.29 in PIT group (P = .00001). Rapidity of healing was faster in LTR group with mean scores of 3.03 weeks in comparison to PIT group where it was 6.33 weeks (P = .00001). Compared to the conventional technique, the outcomes were better with diode laser and caused less morbidity.

Inferior turbinate reduction: Diode laser or conventional partial turbinectomy?

Hypertrophy of the inferior nasal turbinate is one of the most common causes of nasal obstruction. The diode laser has proven to be as effective as other lasers for this indication. Our objective was to study various outcomes associated with the use of the diode laser, such as improvements in nasal obstruction and postoperative pain, reduction in intraoperative bleeding, and rapidity of healing. A nonrandomized, controlled trial was conducted in which outcomes were compared between diode laser turbinate reduction (LTR) and conventional partial inferior turbinectomy (PIT) in 60 patients, 30 who underwent LTR and 30 who underwent PIT. The improvement in nasal obstruction was measured postoperatively up to 6 months. Intraoperative bleeding was measured and postoperative pain scores were assessed each day up to the fifth postoperative day. Rapidity of healing was evaluated until 6 months postoperatively. Subjective relief of nasal obstruction occurred in 90.8% of the LTR group and 65% of the PIT group at 6 months (p < 0.05). Pain scores were significantly higher until 5 days postoperatively in the PIT group compared with the LTR group (p = 0.0001). Intraoperative bleeding mean scores (ml) were 8.03 in the LTR group and 23.29 in the PIT group (p = 0.00001). Healing was faster in the LTR group at a mean of 3.03 weeks compared with 6.33 weeks in the PIT group (p = 0.00001). Outcomes with the diode laser were better and diode LTR caused less morbidity compared with the conventional technique.

Renal infarction due to lupus vasculopathy.

In the ISN/RPS 2003 classification of lupus nephritis (LN) renal vascular lesions are not mentioned. We present a patient with postpartum lupus vasculopathy. The renal biopsy in our patient showed concentric intimal thickening with narrowed lumen. No inflammatory changes were found. It also revealed immunoglobulin and complement deposition on the wall of the arteriole. These changes indicate lupus vasculopathy. The glomeruli revealed diffuse proliferative glomerulonephritis, with wire loops and cellular crescent in one glomerulus. The patient showed improvement with immunosuppression.