Background
It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady.
Objective
To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions.
Methodology.
Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month.
Results
Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity.
Conclusion
It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.
ObjectiveTo compare endoscopic assisted powered adenoidectomy with conventional curettage adenoidectomy.MethodsA randomised controlled trial was conducted at a tertiary care teaching hospital. Fifty patients with a symptom complex pertaining to adenoid hypertrophy and requiring adenoidectomy were chosen and divided into 2 groups of 25 each. Patients in group A underwent conventional curettage adenoidectomy and those in group B underwent endoscopic assisted powered adenoidectomy. Comparison was based on the parameters of surgical time, intra-operative bleeding, post-operative pain and completeness of adenoid removal.ResultsThe surgical time was significantly longer with the powered instrument. Mean blood loss was greater in the powered group, but was statistically insignificant. The powered procedure fared significantly better, with lower pain scores and more instances of complete tissue resection.ConclusionA curved microdebrider blade can be used safely and precisely for adenoidectomy under endoscopic vision. It enables complete resection of adenoid tissue. This method also proves to be an excellent teaching aid.
The patients with endonasal anatomical variants have a higher incidence of complications like formation of adhesions and synechaie after endonasal DCR than other patients. Topical MMC is safe and effective agent to decrease the rate of complications when used as an adjunct in endonasal DCR in patients with endonasal anatomical variants.
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