Purpose
Rhinocerebral mucormycosis is a rapidly progressive angioinvasive fungal infection commonly seen in diabetics. In the COVID-19 pandemic we have witnessed a sudden surge in these cases. We aimed to evaluate the disease presentation, patterns of spread, and any association with the COVID-19 virus.
Methods
This prospective study was conducted on mucormycosis patients operated between March and July 2021. The diagnosis was confirmed either on KOH staining, fungal culture or histopathological examination.
Results
Thirty one cases (21 males, 10 females) with a mean age of 53.3 years were included, of which 9 (29.1%) were COVID positive on presentation, 17 (54.8%) were post-COVID, while 5 (16.1%) had radiological evidence of COVID sequelae. Most common symptoms were cheek numbness (87.1%), headache (83.9%), visual disturbances (77.4%), and palate involvement (58.1%). Blackening of turbinates was uncommon (22.6%). Ethmoid sinus was involved in all patients. Pterygopalatine fossa involvement was present in 77.4%, and was accurately diagnosed on contrast enhanced MRI scan. There were 8 (25.8%) deaths, while the remaining are discharged or under treatment.
Conclusion
An increase in the incidence of mucormycosis in the COVID-19 pandemic is probably due to a compromise in host immunity along with a synergistic effect in thrombotic microangiopathy. Spread of infection to the soft tissues of the infratemporal fossa, orbit or palate occur via neurovascular structures rather than by bone erosion. The pterygopalatine fossa is involved in most individuals.
<p class="abstract"><strong>Background:</strong> Tracheostomy is a life saving procedure, which when performed correctly greatly impacts the final outcome of the patient. Although uncommon, fatal complications have been known to occur. The present study was conducted to observe the incidence of early complications of tracheostomy in a tertiary care centre.</p><p class="abstract"><strong>Methods:</strong> 100 consecutive patients subjected to tracheostomy were enrolled, and data pertaining to the indication, and intraoperative and early postoperative complications was collected. </p><p class="abstract"><strong>Results:</strong> The overall incidence of complications was 77%, with 53% cases of intraoperative bleeding and 13% tube obstruction. A higher incidence of complications was noted in emergency procedures and pediatric tracheostomies. No mortality was seen in the present series.</p><p><strong>Conclusions:</strong> Serious complications may be associated with tracheostomies, many of which can be avoided by meticulous surgical technique and postoperative care.</p>
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