Utility of Early Tracheostomy in Critically Ill Covid-19 Patients: A Systematic Review.

COVID 19 has proven itself to be an agent of cataclysm and caused an uproar worldwide due to consistent strain on the finite resources available to tackle the situation. With the rapidly mutating viral nature, resultant disease is becoming more severe over time, causing significant numbers of critical cases needing invasive ventilatory support. Available literature dictates that tracheostomy might reduce the stress over healthcare infrastructure. Our systematic review is aimed towards understanding the influence of tracheostomy timing, over the course of the illness, by analyzing the relevant literature, thus aiding in decision making while managing critical COVID 19 patients. With predefined inclusion and exclusion criteria, PubMed data was explored using search terms like 'timing', 'tracheotomy'/'tracheostomy' and 'COVID'/'COVID-19'/'SARS CoV2' and 26 articles were finalised for formal review. 26 studies (3527 patients) were systematically reviewed. 60.3% and 39.5% patients underwent percutaneous dilational tracheostomy and open surgical tracheostomy respectively. We report 7.62%, 21.3%, 56% and 46.53% as approximate estimates, of complication rate, mortality rate, rate of mechanical ventilation weaning and rate of decannulation following tracheostomy in COVID 19 patients, respectively taking into account underestimation of the data. Provided that appropriate preventive measures and safety guidelines are strictly followed, moderately early tracheostomy (between 10 and 14 days of intubation) can prove quite efficacious in management of critical COVID 19 patients. Also, early tracheostomy was associated with early weaning and decannulation, thus reducing the enormous competition for intensive care unit beds.

Changing Teaching Trends During Covid-19 And Its Impact On Ent Residency Program In India: A Cross Sectional Study.

Introduction: The COVID-19 pandemic has presented an unmatched challenge to the ENT residency programs to adapt to a form of web-based learning process and stimulation-based training. It also focuses on the mental stress underwent and the viewpoint of the residents to the paradigm shift in clinical care and academics. Methods: An anonymous questionnaire was created in an online survey generator with 22 questions with limited options (yes/no) and was circulated through email and what's app which has been responded to by 240 ENT residents throughout the country. The questionnaire was divided into five sections, demographics, knowledge about COVID-19 and its management, impact on clinical activity, academics and mental well-being section. Results: Out of 240 respondents, 190(79.2%) were junior residents and 50(20.8%) were senior residents. Although many of them knew the necessary precautions to be taken, 94(39.8%) turned out to be positive themselves with the high fear of transmitting to their family members. Three-fourth participants suggested extending the training period after graduation for the loss incurred. However, half of them sought an opportunity to train themselves for the management of communicable disease, 95% of the residents opined that they are having a negative impact on the job performance due to loss of surgical hands-on which has been drastically reduced. Conclusion: The issues mentioned have been addressed through STEPs - Safety of the residents, Time utilisation by research, Education continuation by online web learning and stimulatory programs, psychological support for mental well-being. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03377-7.

Wave of Invasive Fungal Disease on the Shores of COVID-19: A Case Series of COVID-19 Associated Rhino-Orbital Fungal Rhinosinusitis and Literature Review.

Coronavirus disease 2019 (COVID-19) may be associated with a wide range of bacterial and fungal co-infections. Acute invasive fungal sinusitis is an aggressive infection affecting immunocompromised patients and high mortality rate. Here, in this case series, we have reviewed three cases of COVID-19 associated rhino-orbital invasive fungal disease. Patients with COVID-19 associated pneumonia with diabetes mellitus are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Concurrent glucocorticoid therapy probably heightens the risk of mucormycosis. Physicians should be aware of and should have high index of suspicion of possible fungal infection in post COVID-19 patients. Aggressive management both medical and surgical, is required to improve outcomes of secondary invasive fungal infections in patients with COVID-19 infection. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-022-03213-y.