Risk Factors Associated with Mortality in Patients with Mucormycosis Post Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2) Infection.

To study the potential risk factors associated with mortality in patients with mucormycosis. A retrospective study of 490 patients with diagnosis of sinonasal mucormycosis was done. They were divided in two groups-Group A included 87 patients that expired during the study period and Group B included 403 control patients. All the demographic, clinical and outcome parameters were collected from the patient's record files and noted in a structured case proforma and were analysed. During the mean hospital stay of 22 ± 6 days, 17.7% patients expired during the treatment course. Multiple risk factors like uncontrolled diabetes, dyselectrolytemia, underlying renal disease and extensive nature of the disease involving orbit, intracranium and with pulmonary dissemination, all were associated with high mortality in Mucormycosis. Early recognition and appropriate management of the secondary factors can grossly reduce the risk of mortality in patients with mucormycosis.

Isolated Frontal Sinus Mucormycosis Post Covid 19-external Approaches Revisited!

Background: Isolated frontal sinus involvement in mucormycosis is seen very infrequently. Recent technological advances including image guided navigation and angled endoscopes have shifted paradigm towards minimally invasive surgeries. Open approaches are still relevant for the disease of frontal sinus with lateral extension where effective clearance cannot be obtained if approached endoscopically. Objectives: The objective of this study was to describe the presentation and management of patients of mucormycosis with isolated frontal sinus involvement with help of external approaches. Materials and methods: The available records of the patients were retrieved and analysed. The literature, the associated contributory clinical features and management techniques were reviewed. Results: 4 patients presented with isolated frontal sinus mucor involvement. 3 out of 4 patients had history of diabetes mellitus (75%). All patients had history of covid-19 infection (100%). 3 out of 4 patients had unilateral frontal sinus involvement and were operated by Lynch Howarth approach. Mean age of presentation was 46 years with male predominance. Bicoronal approach was used in one case with bilateral involvement. Conclusion: Although conservative endoscopic surgeries are preferred nowadays for frontal sinus clearance but the extensive bony destruction with lateral extension in our series of patients with isolated frontal sinus mucormycosis warranted the need for open procedures.

Secondary Cutaneous Mucormycosis - Retrospective Analysis From Tertiary Care Hospitall.

Background: Covid-19 infection increases the risk of opportunistic infections like mucormycosis. Cutaneous mucormycosis can occur primarily by direct inoculation or secondary to involvement of the underlying structures. Cutaneous manifestations include tender, erythematous, indurated lesions and necrotic plaques. As the disease evolves, cutaneous features manifest progressively. Objectives: To study the manifestations of the cutaneous signs of sinonasal mucormycosis and management of such cases based on severity of involvement. Materials and methods: A retrospective analysis of 21 patients with diagnosis of cutaneous mucormycosis secondary to sinonasal involvement was done with assessment of their skin lesion, area involved and their clinical stage being noted at the time of admission and after 24 h. Treatment consisted of combination of surgical debridement, daily dressing and liposomal amphotericin B. Observations and Results: Out of total 21 patients, there were 10 males and 11 females. Among risk factors, 14 cases had history of covid 19 infection, 5 had history of steroid intake, 6 had history of ICU stay and all had deranged blood sugar levels. Among disease prognosis, excellent outcomes appeared in stage I and stage III showed worst outcome. Conclusion: Since initial clinical presentation is similar to cellulitis and other soft-tissue infections, early recognition is difficult. In this cohort, the prognosis of secondary cutaneous mucormycosis remained poor, especially in ICU patients and those with numerous predisposing factors. Such patients presented in late stages of the disease and mortality rate was very high in such group.

Comparative Study of Inlay and Overlay Cartilage Perichondrium Composite Graft Myringoplasty.

To compare results of inlay and overlay cartilage-perichondrium composite graft myringoplasty. The present study was conducted in the department of otorhinolaryngology, Pt. B. D. Sharma PGIMS, Rohtak. The study was conducted on 40 patients of either sex in age group of 15-50 years having unilateral or bilateral inactive (mucosal) chronic otitis media with dry ear over a period of at least 4 weeks without use of topical or systemic antibiotics after obtaining their informed and written consent. Mean age in group I was 25.25 ± 7.27 years and in group II was 25.95 ± 9.06 years. Maximum number of patients in both groups were in the age group 15-24 years. Out of the total patients, 60% were males and 40% were females. At 6 months post operatively, 95% cases in group I had successful graft take-up compared to 85% cases in group II. However, at long term follow up for 24 months, graft success rate was statistically significant in group I. In group I, 100% graft uptake was seen in large size perforation of 4 and 5 mm along with 2 mm as compared to group II, with 100% graft uptake for only small size perforation of 2 mm. The mean hearing threshold gain was 16.50 ± 5.52 dB in group I as compared to 13.03 ± 6.44 dB in group II. Mean postoperative improvement in air bone (AB) gap of 16.50 ± 5.52 dB was seen in group I as compared to 13.07 ± 6.44 dB seen in group II. The graft take up rate was found to be better in long term with inlay cartilage- perichondrium composite graft myringoplasty technique compared to over lay technique with both the groups showing significant hearing improvement post-operatively. This high success rate for graft uptake and ease to perform under local anaesthesia makes in-lay cartilage perichondrium composite graft myringoplasty technique relatively optimal to use for office based myringoplasty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03487-w.

Normocalcemic Parathyroid Adenoma with Brown's Tumor Maxilla: A Rare Case.

Introduction: Primary hyperparathyroidism due to parathyroid adenoma commonly causes raised serum calcium and focal giant cell lytic lesions in bones known as Brown's tumors. It is more common in females in the post-menopausal age group. Case Report: We report a case of a 29-year-old female patient with Brown's tumor maxilla in a clinical setting of normocalcemic primary hyperparathyroidism. The patient presented to us with facial and palatal swelling for which FNAC was done. Cytology revealed hemosiderin-laden macrophages suspicious for Brown's tumor. On further imaging studies such as CT Neck, Tc99 Sestamibi scan, and other biochemical tests like parathyroid hormone assay and serum calcium level, the diagnosis of a hyperfunctioning parathyroid gland with normal calcium level was made. Parathyroidectomy was performed and parathyroid adenoma came out to be the primary pathology. On post-operative follow up there was regression of the swelling on the face and palate relieving the patient symptomatically. Conclusion: The diagnostic suspicion of primary hyperparathyroidism should be kept in mind whenever a young female presents with suspected Brown's tumor, even with normal serum calcium levels, for appropriate management. Ours was a highly uncommon case that was a diagnostic challenge and had a successful treatment outcome. Very few such cases have been reported in the literature to date to the best of our knowledge.

Biphenotypic Sinonasal Sarcoma with Intracranial Extension - A Case Report with Review of Literature.

Rationale: Biphenotypic sinonasal sarcoma is a rare malignant tumour exclusively involving the sinonasal cavity. These tumours have variable and atypical presentations. Early approach and correct treatment modalities are key factors in the management of such cases. Patient Concern: A 48-year-old male patient presented with left-sided nasal obstruction and intermittent nasal bleeding for one year. Diagnosis: Biphenotypic sinonasal sarcoma confirmed on histopathological examination and immunohistochemistry. Treatment: The patient underwent surgical excision with left lateral rhinotomy and bifrontal craniotomy with skull base repair. The patient also received postoperative radiotherapy. Outcome: The patient is on regular follow-up with no similar complaints. Take-Away Lesson: Treating team should keep the diagnosis of biphenotypic sinonasal sarcoma in mind while investigating a patient with nasal mass. Surgical management is the treatment of choice, due to its local aggressive nature and proximity to the brain and eyes. Postoperative radiotherapy is vital to prevent tumour recurrence.

Rare Cause of CSOM: Langerhans Cell Histiocytosis.

Langerhans cell histiocytosis (LCH) is a proliferation of dendritic mononuclear cells with infiltration into organs locally or diffusely. Most cases occur in children. LCH can also present as chronic otitis media and otitis externa due to involvement of the mastoid and petrous portions of the temporal bone with partial obstruction of the auditory canal. A 4 year old male child presented with complaints of bilateral ear discharge for 4 months and inability to walk and giddiness for 2 days. On otoscopic examination, in right ear, polypoidal tissue was present in the external auditory canal which bled on touch. CECT head and MRI brain was done which showed large altered intensities in the region of bilateral external and middle ears involving the temporal bone. It also showed a well defined ovoid expansile lesion involving the skull vault in left high parietal region. Biopsy was taken from the polypoidal tissue in the right EAC which on HPE showed features suspicious for LCH. On IHC, the tissue was found out to be immunoreactive for CD 68, CD 1a and S-100 with score of 4+ for all three of the IHC markers. Patient was later put on chemotherapy and steroids which resulted in disease remission.

Treatment of Tympanic Membrane Retraction Pockets by Excision and Cartilage Tympanoplasty: A Prospective Study.

To assess the role of cartilage tympanoplasty in management of retraction pockets of the pars flaccida. This was a prospective study at a tertiary care centre. Twenty patients having grade III or grade IV retraction pockets were included in the study. Retraction pockets were treated by excision and cartilage tympanoplasty. Findings noted on follow-up were recorded and analysed. Graft was taken up in 18 (90%) cases with residual perforation in 2 (10%) cases. Recurrence of retraction pockets was observed in 6 (30%) cases. Hearing was improved up to 15 dB in 16 (80%) cases. It is concluded that grade III and IV retraction pockets can be well managed by excision and cartilage tympanoplasty.