Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India.

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

Preparation and assessment of agar/TEMPO-oxidized bacterial cellulose cryogels for hemostatic applications.

In this work, we have demonstrated agar and oxidized bacterial cellulose cryogels as a potential hemostatic dressing material. TEMPO-oxidized bacterial cellulose (OBC) was incorporated into the agar matrix, improving its mechanical and hemostatic properties. The oxidation of bacterial cellulose (BC) was evidenced by chemical characterization studies, confirming the presence of carboxyl groups. The in vitro blood clotting test conducted on agar/OBC composite cryogels demonstrated complete blood clotting within 90 seconds, indicating their excellent hemostatic efficacy. The cryogels exhibited superabsorbent properties with a swelling degree of 4200%, enabling them to absorb large amounts of blood. Moreover, the compressive strength of the composite cryogels was appreciably improved compared to pure agar, resulting in a more stable physical structure. The platelet adhesion test proved the significant ability of the composite cryogels to adhere to and aggregate platelets. Hemocompatibility and cytocompatibility tests have verified the safety of these cryogels for hemostatic applications. Finally, the material exhibited remarkable in vivo hemostatic performance, achieving clotting times of 64 seconds and 35 seconds when tested in the rat tail amputation model and the liver puncture model, respectively. The experiment results were compared with those of commercial hemostat, Axiostat, and Surgispon, affirming the potential of agar/OBC composite cryogel as a hemostatic dressing material.

A Unique Case of Unilateral Vocal Cord Palsy Following an Electrocution Injury.

Electric injuries (in the form of lightning or electric shock) may lead to various implications in the human body, the most important of which include neurological insults. The damage caused is influenced by the route of its entry into the body, its strength, and the duration of exposure. The muscles of the larynx receive motor supply from the recurrent laryngeal nerve (RLN) (except cricothyroid, which gets innervation from the external laryngeal nerve). Recurrent laryngeal nerve (RLN) palsy leading to vocal cord palsy is seen in several pathologies, but after thorough research of existing literature, we could only find a single case of vocal cord palsy following electric injuries, which was also lost in follow-up. In this report, we present a case of unilateral vocal cord palsy following an electric injury on the ipsilateral arm of a young male. He presented to the emergency department of our center soon after the accident. A multidisciplinary team was engaged in the overall management of the patient (in view of pleural effusion, acute kidney injury, and burn injury). He was started on steroids, speech therapy, and other supportive management. On follow-up, his condition improved, and laryngeal endoscopy showed positive signs. This case highlights a unique but rare possibility of vocal cord palsy following electric injuries and may help in the prompt diagnosis and management of the same.

Aortic Pseudoaneurysm as an Unusual Cause of Vocal Palsy.

The recurrent laryngeal nerve travels a variable course on either side due to the differences in the structures related during development. The nerve is at risk of injury due to a number of pathologies in any of these structures. We came across a very rare pathology causing vocal palsy in a 62-year-old male with hoarseness of voice. Laryngoscopy examination showed left vocal cord palsy without any obvious laryngeal mass. Contrast-enhanced computed tomography study of the neck and chest revealed aortic arch pseudoaneurysm with left vocal cord palsy.

Nose to Brain Delivery of Transferrin conjugated PLGA nanoparticles for clonidine.

The present work focuses on the development of surface modified transferrin PLGA nanoparticles loaded with clonidine for nose to brain delivery. The CLD-Tf-PLGA-NPs were developed using double emulsification, followed by solvent evaporation and characterization. Particle size, PDI and Zeta potential of the nanoparticles was 199.5 ± 1.36 nm, 0.291, -17.4 ± 6.29 mV respectively with EE% 86.2 ± 2.12 %, and DL%, 7.8 ± 0.48 %. TEM, SEM and FTIR analysis were carried out to confirm the size and transferrin coating over the surface of nanoparticles. In-vitro drug release profile were studied in PBS (pH 7.4) and SNF (pH 5.5) for 72 h and highest release was observed in PBS 89.54 ± 3.17 %. Cellular assays were conducted on Neuro-2a cells to check the cytotoxicity and uptake of Tf-modified PLGA nanoparticles and the cell viability% was obtained to be 61.85 ± 4.48 % even at maximum concentration (40Cmax) with uptake of approximately 97 %. Histopathological studies were also performed to identify the cytotoxicity on nasal epithelium along with in-vivo biodistribution and pharmacodynamics studies to assess the concentration of drug in the mice brain and behavioural responses after intranasal delivery of surface modified nanoparticles. The results showed significant increase in concentration of drug in brain and behavioural improvements in mice (p < 0.05).

Metastasis to Thyroid Gland from Neuroendocrine Carcinoma of Endometrium: A Rare Entity.

Neuroendocrine tumors of endometrium [NECE] are rare malignancy, representing 0.8% of endometrial cancers, having early lymphatic and hematogenous spread with distant metastasis to lungs and brain.

Occipital Artery-Based Fascio-Cutaneous Pedicle Flap in Reconstruction of Head and Neck Defects: A Saviour Under Challenging Times.

Head and Neck cancer management has undergone many changes in the past few decades. Primarily advancements in reconstructive surgery for complex head and neck defects after extensive ablative surgeries. Many factors need to be considered in deciding the type of reconstruction. Any reconstruction is not without complications. We wish to present the reconstructive challenges we faced in recent times to reconstruct composite head and neck defects, situation where a salvage flap has to be chosen in a failed regional flap. An occipital artery-based pedicled fascio cutaneous flap is one such rescuer flap. It is a retrospective study of case records from January 2018 to January 2021 at our institute. Reviewed the clinical data of Cases in which occipital artery-based flap was used to reconstruct the composite head and neck defects. In the era of microvascular flap reconstruction, utilization of regional flaps is still a choice of reconstruction in the resource constraint setting. A less explored occipital artery-based flap is a reliable regional flap can be used in select cases with a good success.

Autonomous face mask detection using single shot multibox detector, and ResNet-50 with identity retrieval through face matching using deep siamese neural network.

The COVID-19 pandemic poses a global health challenge. The World Health Organization states that face masks are proven to be effective, especially in public areas. Real-time monitoring of face masks is challenging and exhaustive for humans. To reduce human effort and to provide an enforcement mechanism, an autonomous system has been proposed to detect non-masked people and retrieve their identity using computer vision. The proposed method introduces a novel and efficient method that involves fine-tuning the pre-trained ResNet-50 model with a new head layer for classification between masked and non-masked people. The classifier is trained using adaptive momentum optimization algorithm with decaying learning rate and binary cross-entropy loss. Data augmentation and dropout regularization are employed to achieve best convergence. During real-time application of our classifier on videos, a Caffe face detector model based on Single Shot MultiBox Detector is used to extract the face regions of interest from each frame, on which the trained classifier is applied for detecting the non-masked people. The faces of these people are then captured, which is passed on to a deep siamese neural network, based on VGG-Face model for face matching. The captured faces are compared with the reference images from the database, by extracting the features and calculating cosine distance. If the faces match, the details of that person are retrieved from the database and displayed on the web application. The proposed method has secured best results where the trained classifier has achieved 99.74% accuracy, and the identity retrieval model achieved 98.24% accuracy.

Cross-Sectional Analysis of Videonystagmography (VNG) Findings in Balance Disorders.

OBJECTIVE: To understand the videonystagmography (VNG) findings in various balance disorders in 67 patients who presented to the outpatient department of an otorhinolaryngology clinic. MATERIALS AND METHODS: This cross-sectional study was conducted in the outpatient department of the otorhinolaryngology clinic of a tertiary care center. A total of 67 patients between the age group of 18 and 70 years with balance disorders were included in the study. VNG findings in different balance disorders were observed and analyzed. RESULTS: A total of 67 patients were enrolled in the study. Findings like caloric inversion and optokinetic nystagmus do not always indicate a central balance disorder due to technical errors and other limitations during the test. However, abnormal saccades seem to be a more relevant finding in central disorders. Rare variants of benign paroxysmal positional vertigo (BPPV) like multiple canal BPPV were also diagnosed using VNG. CONCLUSION: VNG has come out as a very useful test in our study aiding in 75% of diagnoses. The overall benefits of VNG in balance disorders are immense and necessitate their inclusion in every vertigo clinic.

Blockchain-Internet of Things Applications: Opportunities and Challenges for Industry 4.0 and Society 5.0.

Today, blockchain is becoming more popular in academia and industry because it is a distributed, decentralised technology which is changing many industries in terms of security, building trust, etc. A few blockchain applications are banking, insurance, logistics, transportation, etc. Many insurance companies have been thinking about how blockchain could help them be more efficient. There is still a lot of hype about this immutable technology, even though it has not been utilised to its full potential. Insurers have to decide whether or not to use blockchain, just like many other businesses do. This technology keeps a distributed ledger on each blockchain node, making it more secure and transparent. The blockchain network can operate smart contracts and convince others to agree, so criminals cannot make mistakes. On another side, the Internet of Things (IoT) might make a real-time application work faster through its automation. With the integration of blockchain and IoT, there will always be a problem with technology regarding IoT devices and mining the blockchain. This paper gives a real-time view of blockchain-IoT-based applications for Industry 4.0 and Society 5.0. The last few sections discuss essential topics such as open issues, challenges, and research opportunities for future researchers to expand research in blockchain-IoT-based applications.

Financial toxicity and mental well-being of the oral cancer survivors residing in a developing country in the era of COVID 19 pandemic - A cross-sectional study.

OBJECTIVES: The primary outcome measures evaluated the financial toxicity and mental well-being of the oral cancer survivors. METHODS: A cross-sectional study of oral cancer survivors who were disease-free for more than 6 months after treatment and visited the hospital for a routine follow-up is included in the study. Mental well-being and financial toxicity were evaluated using the Depression, Anxiety, and Stress Scale - 21 (DASS 21) and Comprehensive Score for financial Toxicity (COST- Functional Assessment of Chronic Illness Therapy) questionnaires. A literature review was done to compare the results with financial toxicity and mental health in cancer patients from the pre-pandemic era. RESULTS: A total of 79 oral cancer survivors were included in the study, predominantly males (M: F = 10:1). The age ranged from 26 to 75 years (The median age is 49). The full-time employment dropped from 83.5% in the pre-treatment period to 21.5% post-treatment. Depression was observed in 58.2% and anxiety in 72.2%. Unemployed survivors were observed to have more depression (OR = 1.3, 95% confidence interval (CI) = 0.3-5.4, p = 0.6), anxiety (OR = 3.5, 95% CI = 0.3-21.2, p = 0.1) and stress (OR = 1.6, 95% CI = 0.3-6.6, p = 0.5) than rest of the cohort. On univariate analysis, unemployed survivors (M = 11.8 ± 3.8, p = 0.01) had significantly poorer financial toxicity scores. Survivors with depression (M = 16.4 ± 7.1, p = 0.06) and stress (M = 14.4 ± 6.8, p = 0.002) had poor financial toxicity scores. On multifactorial analysis of variance, current employment (p = 0.04) and treatment modality (p = 0.05) were significant factors impacting the financial toxicity. CONCLUSION: There is a trend towards increased incidence of depression, anxiety, and stress among oral cancer survivors compared to the literature from the pre-COVID era. There is significant financial toxicity among either unemployed or part-time workers. This calls for urgent public/government intervention to prevent the long-term impact of financial toxicity on survival and quality of life.

Microscopic Parotidectomy: A Prospective Study.

To assess the parameters' setting of the microscope during parotidectomy and the impact of microscopic parotidectomy on facial nerve functional status. A prospective study was conducted on 28 patients in a tertiary care center, who underwent microscopic parotidectomy. Microscope's settings' like magnification, focal length, diameter of the visualized field, and clock position were recorded. Facial nerve functional status was also recorded. All surgeries were performed by right-handed surgeons using Leica F 20 M525 microscope. Clock position of microscope for right parotidectomy ranged between 7 and 10 o clock and for left, it ranged between 7 and 12 o clock. Magnification ranged between 1.3 × and 3.2 ×; magnifications of 1.3 × and 1.8 × were preferred from incision to separation of parotid from sternocleidomastoid muscle, 1.8 × and 2 × for dissection of the facial nerve trunk, and 2 × and 3.2 × for individual branches of the facial nerve. Focal length ranged between 251 and 410 mm and the diameter of the visualized field ranged between 7 and 14.7 cm. Out of 24 cases of benign lesions, 2 (8.3%) developed facial paresis which resolved in 3 months. Two out of four cases of malignancy developed permanent palsy as nerve branches were sacrificed to achieve tumor clearance. Using a microscope for parotidectomy is advantageous for facial nerve dissection, reducing chances of facial paralysis. The microscope was also found to be useful for teaching. The use of appropriate microscopic parameters avoids the glitch of transition from open to microscopic approach.

Novel Modifications to Total Maxillary Swing Approach in Extensive Nasopharyngeal Angiofibroma to Minimize Complications.

Maxillary swing approaches provide excellent exposure of the anterior, mid, and anterolateral skull base offering a wide window to approach nasopharyngeal neoplasms; however, they are also associated with complications. The present study aimed to evaluate the results of a modified total maxillary swing (TMS) approach developed to minimize postoperative complications. The modified TMS approach was used to treat five patients who had extensive juvenile nasopharyngeal angiofibromas between March and October 2019 at our tertiary care center. Surgical technique, preoperative image findings, and intra-operative findings were recorded. In the postoperative follow-up, patients were examined to rule out all possible complications associated with the procedure according to the literature. A retrospective analysis was performed to assess tumor extensions, surgical modifications, and postoperative complications. All tumors had orbital and infratemporal (lateral limit) involvement while four had intracranial involvement. No per-operative complications were reported, and postoperative clinical and endoscopic evaluation was performed at 1, 2, and 3 months. There was no evidence of complications including residue, recurrence, maxillary necrosis, ophthalmoplegia, epiphora, palatal fistula, or jaw malocclusion. Besides, minor complications such as infraorbital margin skin retraction, infraorbital serous collection, maxillo-zygomatic abscess, and unsightly scar were also not seen. Only one case presented with maxillary osteomyelitis which was resolved with mini-plate removal and antibiotics. A modified TMS approach is a prudent option to ensure complete removal of juvenile nasopharyngeal angiofibromas with negligible complications.

First Report on Concomitant Infection of Nasal Myiasis and Trichosporonosis in an Uncontrolled Diabetic Patient: Case Report.

Myiasis is an infestation of living tissue of animals or humans by fly larvae. It is quite common in tropical countries due to hot and humid climates. Trichosporonosis is an invasive disseminated fungal infection caused by Trichosporon species. Disseminated trichosporonosis is usually a fatal disease with poor prognosis. The aim of this manuscript is to report a clinical case of concomitant nasal myiasis and Trichosporonosis infection in an uncontrolled diabetic patient which was treated successfully by two weeks of Voriconazole therapy.

Isolated Acute Sphenoid Fungal Sinusitis with Cavernous Sinus Thrombosis: Our Experience.

Isolated lesions of the sphenoid sinus are uncommon. Cavernous sinus thrombosis is generally sought due to a systemic disease rather than a local pathology. It may be due to hidden primary pathology like isolated acute sphenoid fungal rhinosinusitis. In present study, we  have discussed the early management of such hidden lesions with complication. A retrospective review of 5 cases of isolated acute sphenoidal fungal rhinosinusitis leading to cavernous sinus thrombosis was carried out. All cases were managed as emergency cases. Diagnostic nasal endoscopy was normal in all cases, with sinus disease evident in radiology in only 60% cases. Diagnostic endoscopic sinus surgery was performed in 40% cases. All patients underwent urgent surgical debridement along with IV antifungals. Complete recovery was seen in ocular movements in 40% and partially in 40%, whereas only 25% had complete improvement in vision. While four cases showed favourable outcome, one patient could not be saved despite all efforts. Exploring the sinus in cavernous sinus syndrome or orbital apex syndrome despite non-conclusive imaging, is warranted as early intervention may significantly impact the chances of survival. "Time is vision" in cases with acute fungal sinusitis and is equal to the aphorism of cardiologists i.e. "time is muscle.

Subjective and Objective Assessment of Effect of Allergic Rhinitis on Voice in Indian Patients.

To perform a subjective and objective assessment of vocal complaints in patients of allergic rhinitis (AR) using voice handicap index and video-stroboscopy respectively and find the association of their parameters with severity of the disease. Cross-sectional-observational study design. Outpatient department of Otorhinolaryngology of a tertiary centre. Seventy-five adult patients diagnosed with AR and classified according to 'Allergic Rhinitis and its Impact on Asthma' guidelines were compared with same number of normal subjects as controls, with the same age and sex, to ensure uniformity. Both the groups were asked to fill a self-answered questionnaire called Voice Handicap Index (VHI) and underwent laryngeal examination with Video-Stroboscopy (VS). The mean VHI score of the AR group (29.45 ± 32.11) was significantly higher (p < 0.05) than that of controls (12.07 ± 16.62). VS parameters including amplitude, supraglottic activity, vocal edge and phase closure also showed significant difference between cases and controls (p < 0.05). VHI scores increased, but the VS findings did not change significantly with the severity of the disease. AR patients show subjective and objective derangements of voice quality. VHI scores show increase, while VS parameters do not change with the severity of AR.

A Preliminary Pharmacodynamic Study for the Management of Alzheimer's Disease Using Memantine-Loaded PLGA Nanoparticles.

Alzheimer's disease is becoming a common disorder of the elderly population due to shrinkage of the brain size with age and many other neurological complications. To provide an effective treatment option, memantine-encapsulated polymeric nanoparticles were prepared in the study. The nanoparticles were prepared by using nanoprecipitation followed by homogenization and ultrasonication methods, characterized on the basis of particle size, polydispersity index, and zeta potential. Further, in vitro release profile, cytotoxicity analysis, and Giemsa staining were conducted. To observe the efficacy of nanoparticles in scopolamine-induced Alzheimer models in vivo studies were also carried out. The results showed that nanoparticles were in the nano range with a particle size of 58.04 nm and - 23 mV zeta potential. The in vitro release was also sustained till 24 h with ~ 100% release in selected media phosphate buffer saline, simulated nasal fluid, and artificial cerebrospinal fluid. The cytotoxicity results with ~ 98 to 100% cell viability and no morphological changes through Giemsa staining indicated that nanoparticles were not leading to cell toxicity. The gamma scintigraphy studies showed higher uptake of the drug in the target site through the intranasal route and pharmacodynamic studies indicated that nanoparticles were able to inhibit the spatial memory impairment significantly as compared to the control group. The findings clearly indicated that the developed memantine nanoparticles could act as an alternative approach for the management of Alzheimer's disease.

Unilateral Sensorineural Hearing Loss (USNHL): A Retrospective Study of Incidence.

This retrospective study was carried out to know the incidence of unilateral sensorineural hearing loss (USNHL) (type and degree). (1) To know the incidence of USNHL (other ear being normal) in patients undergoing Pure Tone Audiometry (PTA) for hearing loss (HL). (2) To establish the type and degree of USNHL in patients. Study was conducted over a period of more than 4 years to find out the incidence and pattern of USNHL (other ear being normal) in the patients attending ear, nose, and throat outpatient department (OPD) with a complaint of HL. Pure tone audiometry data of 10,000 cases between August 2014 and December 2018 with HL were analyzed for this study. Demographic characteristics were compared with types and degrees of unilateral sensorineural hearing impairment. A total of 10,000 OPD cases who had a complaint of HL and had undergone pure tone audigram (PTA) in a period of more than 4 years in the Department of Otorhinolaryngology and Head and Neck Surgery were studied. SNHL type was the highest with 3935 cases (39.3%). Out of 3935 cases of SNHL, 1436 (36.50%) were USNHL-out of which, only 872 cases (60.72%) had USNHL with other ear being normal; this constituted the study group, i.e., 872 cases (8.72%) out of 10,000 PTA and 872/3935 (22.16%) of SNHL cases. Hence, incidence of USNHL (with other ear being normal) is 8.72% among all cases of HL and 22.16% among cases of SNHL. Age of cases ranged from 8 to 76 years (mean age - 39.5 years). Male:Female ratio was 1.6:1.0. Both ears were almost equally involved. 35.6% cases had profound (> 90 dB) hearing loss, followed by mild (25-40 dB) in 32.1%.

The Clinical-Audiological Cross Sectional Study of Deaf-Mute Patients in a Tertiary Care Centre of Uttarakhand State and Literature Review.

Deafmutism affects communication and wholesome development of an individual. India has a significant burden of deafness in the country. Even fourteen years after the launch of a National Program for Prevention and Control of Deafness in year 2006, we lack detailed data about the disability from most regions of the country. This study aims at finding out the prevalence, clinical history-examination and audiological profile of deaf-mute patients visiting the Out Patient Department (OPD) of a tertiary care institute in Uttarakhand, and compare the results with similar studies published during last 20 years from India to generate a literature review. Out of 46,049 patients that visited OPD of the institute during the given period of 24 months, 73 cases were short-listed clinically to be enrolled in the study. However, only 55 (75%) of them completed the questionnaire and audiological testing. All information was extracted from the patients/relatives with the help of a questionnaire in the Hindi language. The prevalence of deafmutism in patient presenting in our OPD in the study period was 0.3%. The history of pre-, peri- and post-natal risk factors was present in high percentage (58.2%, 78.2% and 34.5% respectively) of patients. This warrants review of our maternal and child healthcare strategies. The literature review revealed lack of uniform and standardized tool in conducting and reporting of studies on deafmutism. The questionnaire used in this study can be further improved and modified in the future as per the requirements of data collection.

Clinical Characteristics of 100 Patients With COVID-19-Associated Mucormycosis From a Tertiary Care Center in North India.

Background Fungal infection in patients with coronavirus disease 2019 (COVID-19) has emerged as a new challenge in healthcare facilities. This study aimed to describe the demographic and clinical characteristics of COVID-19-associated mucormycosis (CAM). Methodology This retrospective, single-center case series included patients who were hospitalized and diagnosed with COVID-19 and mucormycosis at the All India Institute of Medical Sciences, Rishikesh (North India) from April 15, 2021, onwards and last followed up on June 30, 2021. Demographic, clinical, laboratory, radiological, microbiological, pathological, and outcome data were then collected and analyzed. Results Of the 100 consecutive inpatients with CAM, 95 (95%) had diabetes mellitus. At the onset of illness, the most common manifestations were facial swelling (85%), eye swelling (83%), headache (68%), pain around the eyeball (67%), malaise (57%), and fever (50%). The most common organ involved on examination was the nose and paranasal sinus (96%), followed by the orbit (83%), palate (19%), and cranial nerves (7%). Pulmonary involvement was seldom observed (1%). Predominant pathological findings were the presence of aseptate hyphae (75%), necrosis (75%), angioinvasion (36%), and perineural invasion (2.6%). During the last follow-up, 13 patients died, with 11 (84.6%) having severe COVID-19 and two (15.3%) having moderate COVID-19. Conclusions Steroid use and diabetes mellitus are the significant risk factors of CAM. Patients with CAM usually present with face/eye swelling with radiological involvement of the nose and sinus and may die because of severe COVID-19.