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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.
RESUMO
The primary goal of this study was to assess the prevalence of oral involvement and, secondarily, the likely variables in patients with confirmed COVID-19 accompanied by mucormycosis infection. The study design was a cross-sectional descriptive sort that was performed at a tertiary centre. The non-probability convenience sampling approach was used to determine the sample size. Between May 2021 and July 2021, all patients who presented to our tertiary care centre with suspected mucormycosis were considered for the investigation. The research only included individuals with proven mucormycosis after COVID-19. The features of the patients, the frequency of intraoral signs/symptoms, and the possible variables were all noted. Of the 333 COVID-19-infected patients, 47 (14%) were diagnosed with confirmed mucormycosis. The mean (SD) age of the patients was 59.7 (11.9) years. Of the 47 patients with confirmed mucormycosis, 34% showed sudden tooth mobility, 34% expressed toothache, 8.5% reported palatal eschar, 34% presented with jaw pain, 8.5% had tongue discoloration, and 17% had temporomandibular pain. About 53% of the patients were known cases of type 2 diabetes mellitus, 89% of patients had a history of hospitalization due to COVID-19 infection, 89.3% underwent oxygen support therapy, and 89.3% were administered intravenous steroids during hospitalization due to COVID-19 infection. About 14% of the suspected cases attending the mucormycosis out-patient department (OPD) had been confirmed with definite mucormycosis. Oral involvement was seen in 45% of cases of CAM (COVID-associated mucormycosis). The most frequent oral symptoms presented in CAM were sudden tooth mobility and toothache. Diabetes and steroids were the likely contributing factors associated with CAM.
RESUMO
BACKGROUND: The purpose of this study was to assess the efficiency of performing pulmonary procedures in the endoscopy unit in a large teaching hospital. METHODS: A prospective study from May 20 to July 19, 2013, was designed. The main outcome measures were procedure delays and their reasons, duration of procedural steps starting from patient's arrival to endoscopy unit, turnaround time, total case durations, and procedure wait time. RESULTS: A total of 65 procedures were observed. The most common procedure was BAL (61%) followed by TBLB (31%). Overall procedures for 35 (53.8%) of 65 patients were delayed by ≥ 30 minutes, 21/35 (60%) because of "spillover" of the gastrointestinal and surgical cases into the time block of pulmonary procedure. Time elapsed between end of pulmonary procedure and start of the next procedure was ≥ 30 minutes in 8/51 (16%) of cases. In 18/51 (35%) patients there was no next case in the room after completion of the pulmonary procedure. The average idle time of the room after the end of pulmonary procedure and start of next case or end of shift at 5:00 PM if no next case was 58 ± 53 minutes. In 17/51 (33%) patients the room's idle time was >60 minutes. A total of 52.3% of patients had the wait time >2 days and 11% had it ≥ 6 days, reason in 15/21 (71%) being unavailability of the slot. CONCLUSIONS: Most pulmonary procedures were delayed due to spillover of the gastrointestinal and surgical cases into the block time allocated to pulmonary procedures. The most common reason for difficulty encountered in scheduling the pulmonary procedure was slot unavailability. This caused increased procedure waiting time. The strategies to reduce procedure delays and turnaround times, along with improved scheduling methods, may have a favorable impact on the volume of procedures performed in the unit thereby optimizing the existing resources.
