C-reactive Protein Kinetics During In-Patient Treatment of COVID-19-Associated Rhino-Orbito-Cerebral Mucormycosis: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

COVID-associated rhino-orbito-cerebral Mucormycosis (CA-ROCM), henceforth referred to as Covid-Associated Mucormycosis (CAM), is a serious and fatal condition unless treated promptly and completely. The main treatment of the CAM is complete surgical debridement and administration of systemic antifungals. The first line antifungal recommended for CAM is Amphotericin-B. Since Amphotericin-B has systemic side effects mainly on the renal system, a timely decision to start and end Amphotericin-B therapy is very essential. Besides the Computed Tomography (CT) scan, serum levels of C-reactive protein (CRP) levels are a good indicator of CAM-associated inflammation levels in the patient's body. By monitoring the CRP levels, we can titrate amphotericin treatment to cause minimal harm to the kidneys. Our study was done to analyze the kinetics of C-reactive protein in patients of CAM admitted in a tertiary-care hospital and compare it with the CRP levels in COVID-associated non-Mucormycosis Sinusitis patients. Aim and objective To study the kinetics of serum C-reactive protein (CRP) levels among patients undergoing in-patient care for COVID-associated rhino-orbito-cerebral mucormycosis and compare with serum CRP levels in COVID-19 patients suffering from sinusitis without rhino-orbito-cerebral mucormycosis.  Materials and methods This was a retrospective cohort study. The source of data was post-COVID sinusitis patients who were admitted during 2nd wave of COVID-19 in India in our hospital whose medical records were accessed by the Medical Records Department. The subjects were recruited into the two study groups namely the Mucormycosis group and the non-Mucormycosis group based on the histopathological report of the nasal biopsy specimen. The medical records of each member of the two groups were studied for the levels of serum C-reactive protein measured at the time of admission and every 5(+1) days thereafter till the time of discharge. The kinetics of serum C-reactive protein levels, which is a marker of inflammation is studied in each of the two groups and compared using statistical methods. Results There was a significant difference between Mucormycosis and Non-Mucormycosis groups in CRP-level kinetics. However, there was no significant trend of decrease or increase over time in Mucormycosis as well as non-Mucormycosis cases. Conclusion CRP is an important biomarker in assessing the septic response to COVID-associated rhino-orbito-cerebral mucormycosis. Detection of raised CRP levels helps in prompt early initiation of anti-fungal treatment. Also, monitoring the levels of serum CRP will guide in deciding the time to stop the antifungals at an appropriate time. CRP monitoring is commonly available and affordable. Hence, we recommend CRP monitoring of in-patients of CAM.

Anatomical Basis of Obstructive Sleep Apnoea: A Review of Randomized Controlled Trials.

Repeated obstruction and closure of the upper airway, sporadic hypoxic episodes, and sympathetic activity are symptoms of obstructive sleep apnea (OSA). Obstructive sleep apnoea is due to a combination of altered upper airway structure and muscular function, a low arousal threshold and increased loop gain. Although recurrent upper airway (UA) collapse during sleep is the most frequent clinical hallmark of OSA, the exact cause of this collapse is unknown. Furthermore, while continuous positive airway pressure aids in the management of OSA, many patients find it intolerable. As a result, a better knowledge of the causes of OSA may result in more effective treatments. We did a review of randomized controlled trials that were done in this regard in the last 10 years and whose full-text version is available on the PubMed database. A total of 20 articles were finalized for review after applying our criteria. The articles have proposed different theories regarding the anatomical basis responsible for obstructive sleep apnoea. The theories proposed by different studies in the last decade include reduced genioglossus and hypoglossal nerve activity, the pharyngeal muscles' failure to keep the airway open or tighten it, tonsils and adenoid hypertrophy, an oversensitive ventilatory control system and low respiratory arousal threshold, mandibular position, pharyngeal muscles' high sympathetic drive, cephalometric alterations such as mandibular and hyoid bone position and the length of the soft palate, obesity, and neck fat and fluid re-distribution in the body, from the lower to the upper parts while reclining. Given the diverse etiological characteristics of OSA patients and to increase our knowledge of the condition, additional study into this group is required. Filling any knowledge gaps that may exist in the anatomical basis of the onset of OSA is the main objective of this review paper.

Sinonasal and Orbital Imaging Findings in COVID-Associated Rhino-Orbito-Cerebral Mucormycosis During the Second Wave of COVID-19: A Retrospective Cohort Study in a Tertiary Hospital in Central India.

Background Mucormycosis is a consequence of the angioinvasive disease caused by filamentous fungi that belong to the order Mucorales, particularly Mucor, Rhizopus, and Rhizomucor. Rhizopus oryzae is the most prevalent form. The invading hyphae lead to damage of blood vessels leading to thrombosis and consequent tissue necrosis. The incidence of this disease entity witnessed a significant rise during the second wave of the coronavirus disease 2019 (COVID-19) pandemic. Timely diagnosis and prompt treatment are crucial to diminish both the mortality and morbidity associated with this disease. Imaging plays a pivotal role in diagnosing the ailment, evaluating its extent, identifying complications such as thrombosis, and facilitating surgical planning. It demonstrates exceptional sensitivity in detecting the disease at its early stages, often before symptoms manifest. Due to the angioinvasive nature of Mucor, early detection assumes utmost importance as it necessitates intensive antifungal therapy and the removal of devitalized tissue through debridement. Methodology We conducted a retrospective cohort study to analyze computed tomography (CT) imaging findings in patients with COVID-associated rhino-orbito-cerebral mucormycosis (ROCM) confirmed by histopathological examination. We compared these findings with CT findings of the nose and paranasal sinuses in patients without mucor following COVID-19 sinusitis (non-ROCM). Results All 16 cases in the non-ROCM group were in stage 1 disease. In contrast, in the ROCM group, three patients had stage 1 disease, five patients had stage 2 disease, and 10 patients had stage 3 disease (p = 0.0001). The pterygopalatine fossa was significantly affected in 10 of 18 ROCM patients and in none of the non-ROCM patients. Conclusions Imaging plays a crucial role in the early detection of mucormycosis. It assists treating physicians in initiating prompt and aggressive treatment, thereby improving the prognosis of this frequently fatal disease.

The Role of Basal Ganglia and Its Neuronal Connections in the Development of Stuttering: A Review Article.

Dysfluent speech has the potential to lower one's standard of living drastically. Although there is a lot of theoretical support for basal ganglia dysfunction in developmental stuttering, there isn't any imaging data to back it up. According to several studies, there is a difference in gray matter volume between people who stammer and those who don't. According to studies, the right inferior longitudinal fasciculus and the uncinate fasciculus have higher fractional anisotropy (FA) than fluent controls. A high fractional anisotropy means good white matter integrity in these areas. In children who stutter, grey matter volume was higher in the Rolandic operculum, middle frontal gyrus, superior temporal gyrus, and inferior parietal lobule. These regions are found to be more active in adults who stammer as their speech fluency improves. Stuttering is previously linked to structural deficiencies in the corpus callosum. However, there are differences in the directionality of the findings between studies, which are unknown. According to current theories, stuttering is caused by a breakdown in the integration of auditory data in speech motor planning, which affects behavior tasks that rely on basal ganglia structures. According to some studies, connectivity in the left inferior frontal gyrus (IFG) and basal ganglia of persons with stuttering (PWS) was significantly reduced. Still, it was more robust in the left supplementary motor cortex (SMC) and premotor cortex (PMC) (primary motor cortex). In the Broca's region, there was also decreased perfusion and spectroscopic indicators of neuronal density. Spontaneous speech is more affected by stuttering than conversation, reading, sentence repetition, or singing. As per the dual process theory of language formation, the basal ganglia are essential for formulaic phrases, but the left hemisphere is important for innovative, freshly constructed sentences. According to current theories on their functional traits and connections to cortical areas of control, the basal ganglia are the complex networks in charge of organizing, initiating, carrying out, and controlling motor behaviors.  Given the distinct neuroanatomical characteristics of people who stutter, more research into this cohort is required to further our understanding of the illness. The primary goal of this review article is to fill in any knowledge voids between the neuroanatomical structure of the basal ganglia and the onset of stuttering.

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

BACKGROUND: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. METHODS: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. RESULTS: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. CONCLUSIONS: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Symptomatology and Relationship Between Symptoms and Duration Among COVID-19 Patients in a COVID-19 Care Hospital in Central India.

The COVID-19 pandemic has affected the world population across the globe. India has the second largest number of cases and the third largest number of deaths due to COVID-19 in the world. There have been close to 4.4 lakh deaths due to COVID-19 in India alone. The second wave in India has led to devastating consequences, particularly among the young population. The initial clinical symptoms of COVID-19 are similar to all types of viral pneumonia, with varying degrees of severity. The cases' clinical manifestations include fever, nonproductive cough, dyspnea, myalgia, and fatigue. This study was undertaken with the purpose of identifying the relationship between the symptoms and duration in COVID-19-affected patients. The common presenting symptoms were fever (44.5%), sore throat (38.7%), and cough (36.12%). Most of the cases presented with a combination of fever with cough (35%) and fever with sore throat (33%). The duration of symptoms varied from one to 17 days with a mean of 5.75 days. Despite vaccination being started, the risk of the imminent third wave in the country is existential. Mutations in the coronavirus pose a threat to the vulnerable population. It is important to identify the combination of symptoms most predictive of COVID-19 to help guide recommendations for self-isolation, testing, and preventing further spread of the disease. Further studies using these models can yield better results in surveillance and containing this infectious disease.