Neurological Manifestations of COVID-19 Feature T Cell Exhaustion and Dedifferentiated Monocytes in Cerebrospinal Fluid.

Patients suffering from Coronavirus disease 2019 (COVID-19) can develop neurological sequelae, such as headache and neuroinflammatory or cerebrovascular disease. These conditions-termed here as Neuro-COVID-are more frequent in patients with severe COVID-19. To understand the etiology of these neurological sequelae, we utilized single-cell sequencing and examined the immune cell profiles from the cerebrospinal fluid (CSF) of Neuro-COVID patients compared with patients with non-inflammatory and autoimmune neurological diseases or with viral encephalitis. The CSF of Neuro-COVID patients exhibited an expansion of dedifferentiated monocytes and of exhausted CD4+ T cells. Neuro-COVID CSF leukocytes featured an enriched interferon signature; however, this was less pronounced than in viral encephalitis. Repertoire analysis revealed broad clonal T cell expansion and curtailed interferon response in severe compared with mild Neuro-COVID patients. Collectively, our findings document the CSF immune compartment in Neuro-COVID patients and suggest compromised antiviral responses in this setting.

Reconstruction of Maxilla with Titanium Mesh and Fascia Lata - A Case Report.

Maxillary defect reconstruction has been a grave challenge which unfortunately has stopped many ENT surgeons from attempting maxillectomy due to the fear of reconstruction. With our technique of reconstructing the maxillary defect with titanium mesh and fascia lata, the need for microvascular assistance is obviated. Here we describe a revision case of ameloblastoma of maxilla in a 33-year-old female for which total maxillectomy with reconstruction was done without the aid of microvascular tissue transfer. The aim of this article is to encourage and alleviate the fear among the ENT surgeons, in attempting maxillectomy and its reconstruction for delivering an equally good aesthetic and functional outcome especially at the centres where the facility of plastic assistance is not readily available.

As the Nasal Spine Goes, So Goes the Septum.

INTRODUCTION: "As the septum goes, so goes the nose". A well-known phrase by Maurice Cottle forms the pillar of septoplasty. Since the inception of septal surgeries, numerous methods of septoplasty have been described. But, if not performed meticulously, may lead to deformity. For a successful surgery, understanding the anatomy and addressing the anterior nasal spine and maintaining the tip integrity is vital. AIM: To study the outcomes of "ROUND ABOUT technique" to correct deviated nasal septum which focuses on the importance of anterior spine and hence maintain the tip integrity. MATERIALS AND METHODS: This was a prospective, single-centre outcome study of 35 patients with symptomatic nasal obstruction. Here, we describe a method of elevating the mucoperichondrial and mucoperiosteal flaps bilaterally, without transecting the quadrilateral cartilage of the septum. The Sino Nasal Outcome Test-22 (SNOT-22) Questionnaire was administered pre-operatively and after 3 months following surgery. The post-operative follow-up period ranged from 3 to 6 months (mean= 4.5 months) to evaluate the functional and aesthetic outcomes of the performed procedure. RESULTS: A total of 35 patients underwent surgery by this technique who presented with deviated nasal septum and variable degrees of nasal obstruction. To assess the statistical outcome, Paired t-test was applied. Mean SNOT-22 scores decreased significantly from 40.02 pre-operatively to 18.65 three months after surgery. The results sustained after 6 months (p-value <0.0001), 85% of these patients had improved breathing post-operatively and none of the patients complained any aesthetic criticisms. The patients were content and the requirement of medications post-operatively were minimal. CONCLUSION: The ROUND ABOUT technique is a very effective and safe method in correcting the septal deviations especially the ones with caudal or dorsal deflections. It also helps in maintaining the tip integrity and addressing the anterior nasal spine. It avoids the complications of conventional septoplasty.

Clostridium difficile infection at a tertiary care hospital in south India.

OBJECTIVE: The objective of this study was to detect C. difficile in patients presenting with Antibiotic Associated Diarrhoea. METHODS: Stool samples from twenty-five patients collected over a period of four months were processed for C. difficile by culture and the isolates were identified following standard methods. C. difficile toxins A and B and C. perfringens enterotoxin were detected by ELISA performed directly on stool specimens. RESULTS: Four patients (16%) were found positive for C. difficile infection. All patients with C. difficile infection received prior treatment with third-generation cephalosporins or beta-lactam/beta-lactamase inhibitor antibiotics. C. perfringens enterotoxin was found in two (8%) patients. Severe colitis was seen in one (25%) of the four patients who had co-infection with C. difficile and C. perfringens. CONCLUSION: This study demonstrated a significant occurrence of C. difficile infection in this hospital population. There is a need to further evaluate the role of C. perfringens in causing antibiotic associated diarrhoea. Good clinical and laboratory studies to generate local epidemiological data are essential to increase awareness among the treating clinicians about C. difficile infection. Also limited and rational use of broad spectrum antibiotics is recommended.