Aim Recently, with the second wave of COVID-19, the Indian subcontinent has witnessed a dramatic rise in mucormycosis infection in patients recovered from COVID-19. This association has been documented in various case reports/case series and institutional experiences, and the mortality associated with this fungal infection is emerging as a cause of concern. The aim of the present paper is to provide a scientific overview on the pathogenesis of mucormycosis in COVID-19 beyond the conventional understanding of the disease process, which may not otherwise explain the increased incidence of mucormycosis in SARS-CoV-2. Methodology This paper is structured as a narrative review of the published literature on the pathogenesis of COVID-19 which contributes to the development of mucormycosis. Apart from the acknowledged role of ketoacidosis, high blood sugar, and iron metabolism in the pathogenesis of mucormycosis, other factors involved in pathophysiology of COVID-19 which might alter or enhance the mucormycosis infection such as (1) the role of ferritin, (2) high serum iron, (3) free radical-induced endothelitis, (4) hepcidin activation, (5) upregulation of glucose receptor protein (GRP78) are discussed in the pathophysiology of COVID-19-associated mucormycosis. Conclusion A new proposal for the pathogenesis based on the ferritin, viral mimicry of hepcidin and GRP78–CotH3 interaction, which clearly explains the surge in mucormycosis in SARS-CoV-2 infection, has been explained.
Maternal influenza infection is known to cause substantial morbidity and mortality among pregnant women and young children. Many professional healthcare bodies including the World Health Organization (WHO) have identified pregnant women as a priority risk group for receipt of inactivated seasonal influenza vaccination. However influenza prevention in this group is not yet a public health priority in India. This literature review was undertaken to examine the Indian studies of influenza among pregnant women. Eight Indian studies describing influenza burden and/or outcomes among pregnant women with influenza were identified. In most studies, influenza A (pH1N1) was associated with increased maternal mortality (25–75%), greater disease severity, and adverse fetal outcomes as compared to nonpregnant women. Surveillance for seasonal influenza infections along with higher quality prospective studies among pregnant women is needed to quantify disease burden, improve awareness among antenatal care providers, and formulate antenatal influenza vaccine policies.
Background & Aim: Gun-shot trauma inflicted to the maxillofacial region results in multiple injuries which significantly impacts management and reconstructive options. The authors investigated the efficacy/outcomes of primary management of maxillofacial trauma inflicted in ballistic injuries. Methods: This is a retrospective descriptive study carried out solely at 15 Corps Dental Unit, a tertiary care military hospital at Srinagar between the year 2016 & 2017. At the time of enrolment age, gender, extent of injury and definitive diagnosis were recorded. Other information such as type of surgery, hospital stay was taken from in-patient hospital record documents. An informed consent was taken from all patients. Results: A total of 16 patients (all males) with a mean age of 29.6 ± 4.2 years were part of our study. The average time interval between trauma and surgery was 7 to 10 days. There was striking high prevalance of mandibular injuries in 62.5% patients, 18.7% patients having combined maxilla-mandibular defects and 12.5% patients with injuries around the mid-face. Complications such as immediate airway compromise were seen in 50% of the patients who suffered direct airway trauma necessitating tracheostomy. The 43.7% patients suffered nerve injuries at the time of presentation while 56.2% patients suffered scar contracture noted at follow-up of 1 year. One patient suffered a stellate wound with ragged and torn edges and also trauma to the parotid gland. Other salivary gland injuries were also noted in 18.7% patients. Reconstruction using local flaps was done in 3 patients of our series. The mean duration of hospital stay was 43.3 ± 33.5 days. An average follow up ranged from 12 ± 6 months. Conclusions: Early and appropriate intervention to preserve and stabilise the facial skeleton and reconstruction of the facial soft tissue envelope in high-velocity ballistic injuries is highly effective and yields superior functional and esthetic outcomes.
The purpose of this study was to evaluate the various options of autogenous and alloplastic reconstruction modalities available for posttraumatic temporomandibular joint (TMJ) ankylosis. In a retrospective study of 22 patients, various autogenous/alloplastic materials were used based on type and severity of ankylosis and age of patient. Final outcome of reconstruction was critically evaluated in terms of maximal mouth opening, occlusion, and facial symmetry. Fourteen patients (63.63%) developed TMJ ankylosis due to road traffic accidents and eight patients (36.36%) had a history of fall. The mean age was 15.61 years. The mean preoperative maximum interincisal mouth opening (MIMO) for the entire series was 3.39 mm ± 2.16 and postoperative MIMO was 43.69 mm ± 2.63. Costochondral grafts were used in seven children, whereas titanium reconstruction plate with condylar head was used in five adults and interpositional arthroplasties using temporalis muscle, temporalis fascia, and relocation of the articular disc were used in the rest of the ten patients. We conclude that all these age-specific treatment modalities yield clinically comparable results in terms of postoperative mouth opening and facial symmetry with no evidence of reankylosis in a follow-up ranging from 24 to 96 months.
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