Novel Grading System Based on Nasal Endoscopy: Our Experience with 650 Mucormycosis Cases.

Rhinocerebralmucormycosis, is a progressive fungal invasion of a hard palate, paranasal sinuses, orbit, and brain. Post covid the huge number of mucor cases reported in our institute. To combat them a uniform assessment scale was needed as multiple healthcare workers were involved. Thus, a novel linear grading system on nasal endoscopy was developed for the early management of patients to prevent morbidity and mortality. A Prospective study of 650 patients in Epidemic duration from April to June 2021 in a tertiary health center, Central India. Patients subjected to Nasal Endoscopy with 0degree 4 mm Telescope and classified into 5 categories according to the severity of the disease. In a novel grading system, minimum patients were of grade 0, maximum was in Grade I. Maxillary sinus was most commonly involved. This novel grading system on nasal endoscopy makes the management of patients much easier in an epidemic, reducing human errors, morbidity, and mortality of the fulminant disease.

Minimizing the Recurrence Rate in Covid Associated Mucormycosis: Our Experience in 500 Patients.

Mucormycosis is an aggressive, fatal fungal infection. The fungal organisms are ubiquitous and easily affect immunocompromised patients. The main aim of this article is to emphasize over the knowledge of different diagnostic methods (diagnostic nasal endoscopy, ct/ contrast mri pns + orbit + brain, Wet KOH mount), the importance of practising an aggressive surgical resection, medical treatments (liposomal amphotericin B, amphotericin gel, tablet posaconazole, nasal douching, retrorbital amphotericin injection), suction cleaning and regular follow up of the patient after surgical management. This can greatly help in minimizing the recurrence of mucormycosis even in immunocompromised patients in a population. The study performed was a prospective study conducted from April 2021 to July 2021 in which we included 500 patients who presented to the OPD & Department of ENT or Emergency Department of Maharaja Yashwantrao Hospital with complaints suggestive of mucormycosis. The patients who were surgically fit were operated. Out of the 500 patients who were diagnosed with Mucormycosis, from April 2021 to July 2021 complete cure was achieved in 456 patients( 91.2%) and only 44 patients (8.8%) have shown recurrence due to various causes (specially those who did not came for regular follow up). Rhinorbital was the most common site to be involved. In the study it was found that most of the patients which showed recurrence were male, post covid and immunocompromised. Diabetes mellitus was found to be most common among immunocompromised patients. The recurrence in patients with mucormycosis can be minimise by educating the masses regarding importance of public and personal hygiene, and multidisciplinary management with regular follow up offers a better approach to treat this life-threatening condition. The study shows the importance of clinical diagnosis, concurrent surgical treatment, medical treatment, post op care, suction cleaning and regular follow up advice. It is necessary us to take the step forward in this regard, so that in the future we will be better prepared for such type of epidemic.

Mucormycosis Epidemic in Covid Era: A Sinister Superinfection.

In this study, we attempt to look at the various presentations, comorbidities and association of the recent epidemic of rhino-orbital cerebral mucormycosis with Covid-19 in central India. A prospective study of 612 patients diagnosed with mucormycosis from April to July 2021. Detailed history was taken and thorough clinical examination was done. The relation of mucormycosis with Covid-19 and other morbidities was studied. Nasal endoscopy, imaging and management findings were tabulated and analyzed. Male predominance of the disease was noted. The most common age group affected was found to be 41-50 years group having 33.1% of all patients. 83.2% patients had history of Covid-19 infection. Majority of the patients (41.6%) had mucormycosis symptoms within 1 month of Covid-19 symptom onset. Nasal symptoms predominated with 61.1% patients having one or more of the several nasal symptoms. Most common comorbidity was diabetes mellitus (75.8% cases). Nasal and sinus debridement was performed in 584 patients (95.4%). Mucormycosis turned into a widespread epidemic during the second wave of Covid-19 in India. Diabetes mellitus was the most common associated comorbidity that increased the risk of mucormycosis in patients with history of Covid-19 infection. A high index of suspicion in patients presenting with early symptoms in the context of Covid-19, along with prompt diagnosis using radiological, endoscopic and microbiological tools will help reduce mortality to a great extent. Mainstay of treatment is aggressive surgical and medical management, controlling comorbidities and adequate post-operative care.

Evaluating Hearing Loss in Patients Undergoing Second Line Anti Tubercular Treatment.

To estimate the prevalence of Sensorineural hearing loss and evaluate the severity of hearing impairment in patients undergoing second line injectable antitubercular treatment. To study the effects of duration of treatment, dose schedule and demographic factors which aggravates anti TB drug induced ototoxicity. Design-prospective and retrospective study Setting-ENT & TB clinic at our hospital and TB Hospital of Subject-18-50 year age , diagnosed MDR or XDR TB Method-baseline puretone audiometry was done of all patients. all patients divided in 3 group depending on aminoacid (amikacin , kanamycin, capreomycin). Follow up PTA was done at 3rd month, 6th month and 6 month after stopping treatment 35.48% of Group 1 (kanamycin) patients show High frequency hearing loss and 16% of patient have both high and low frequency hearing loss High frequency hearing loss 21% of Group 2 (amikacin) patients show High frequency hearing loss and 5% of patient have both high and low frequency hearing loss 20% of Group 3 (capreomycin) patients show High frequency hearing loss with no patient resulted low frequency loss Patients treated FOR MDR-TB develop significant adverse effects. Clinicians must consider risk benefit analysis during treatment as ototoxicity of injectable aminoglycoside ATT is permanent. Early detection of hearing loss through pure tone audiometry helps preventing and progression of hearing loss without compromising the treatment.

Comparison of outcome and toxicity of two different regimes of neoadjuvant chemotherapy followed by external beam radiotherapy in stages III and IV larynx and laryngopharyngeal malignancies in years 2013-2014.

INTRODUCTION: Both induction chemotherapy (ICT) followed by irradiation and concurrent chemotherapy and radiotherapy have been reported as valuable alternatives to total laryngectomy in patients with advanced larynx/hypopharynx cancer. MATERIALS AND METHODS: Of the 60 enrolled patients, randomly assigned into two groups (30 in each group) previously untreated patients with stages III to IV larynx/hypopharynx squamous cell carcinoma were assigned to received two cycles of ICT with interval of 3 weeks (a) Group A paclitaxel 175 mg/m 2 on day 1 and carboplatin 450 mg on day 2 (PC), (b) Group B docetaxel and cisplatin 75 mg/m 2 each on day 1 and ifosfamide 2 g/m 2 on day 1-3 along with mesna (docetaxel-ifosfamide-cisplatin). Both groups were followed by conventional radiotherapy (60-70 Gy/5#/week). Primary end point was a response after ICT. Secondary endpoints included acute toxicities and overall response. RESULTS: Baseline patient and tumor characteristics were well balanced between both groups, the response after ICT seen was 80% in Group A complete response (CR) 36.6% and partial response (PR) 43.3% and in Group B 79% response, CR 33% and PR 46%; whereas toxicities in Group B grade 3/4 neutropenia and grade 2/3 vomiting more severe than Group A. Radiation therapy was well tolerable to both groups with mild side effects. CONCLUSIONS: Definite role of neoadjuvant chemotherapy in locally advanced larynx/laryngopharyngeal cancer as organ preservation therapy. The efficacy found was quite similar and improved response in both groups except toxicity profile of Group B more severe, requiring the use of colony stimulating factors and supportive care along with.