Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) in Delhi: Demographics and risk factors in a single-centre consecutive cohort of 200 inpatients.

Background There was a dramatic rise in the incidence of rhino-orbito-cerebral mucormycosis associated with the 2021 Covid-19 wave in India. We aim to document the demographic characteristics and risk factors of a consecutive cohort of inpatients with Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) during the surge of April-June 2021. Methods We included all patients of CAROM treated at our tertiary referral facility from 1 April to 14 June 2021. We prospectively gathered details with regard to Covid-19 illness and treatment, CAROM presentation, comorbid conditions and risk factors. Results Our prospective cohort consisted of 200 consecutive patients, of which 146 (73%) patients tested positive on the Covid-19 RT-PCR test at presentation. CAROM occurred concurrent with the Covid-19 infection in 86%, and delayed CAROM after seeming recovery from Covid-19 was seen in 14%. Covid-19 was classified as mild, moderate and severe in 54%, 33% and 13%. The surge of CAROM followed the population peak of Covid-19 infections by about 3 weeks. Advanced disease at presentation was frequent with ocular involvement in 56.6% (111/196) and central nervous system involvement in 20% (40/199). One or more comorbid conditions were identified in 191/200 (95.5%) patients. The dominant associations were with diabetes (189/200; 94.5%) and uncontrolled hyper-glycaemia (122/133; 91.7%), recent steroid use (114/ 200; 57%), which was often considered as inappropriate in dosage or duration, lymphopenia (142/176; 80.7%), and increased ferritin levels (140/160; 87.5%). No evidence supported the role of previous oxygen therapy or previous nasal swab testing as risk factors for CAROM. Conclusion The inpatient volumes of CAROM were noted to parallel the Covid-19 incidence curve by about 3 weeks. Covid-19 infection may directly predispose to CAROM by way of lymphopenia and increased ferritin levels. Uncontrolled hyperglycaemia is identified as a near-invariable association. Recent steroid use is noted as very frequent and was often received in excess of treatment advisories.

Lewis Base Adducts of Phosphine-Stabilized Pb(II) Cations: Synthesis and Catalytic Hydroamination of Alkynes.

Phosphine-stabilized Pb(II) cations, generated by chloride abstraction from chloroplumbylene 1, readily react with Lewis bases (L) such as phosphines and amines to give the corresponding donor-acceptor complexes 3. These complexes 3 react with phenylacetlylene via alkyne insertion into the Pb-L bond to afford the corresponding vinylplumbylenes 4. Of particular interest, the stable complex 4-HNiPr2 (with a secondary amine) can be used as a hydroamination catalyst of phenylacetylene.

Negative 68Ga-Prostate-Specific Membrane Antigen PET/CT Scan on a Recurrent Juvenile Nasopharyngeal Angiofibroma.

ABSTRACT: We present the case of a left-sided recurrent juvenile nasopharyngeal angiofibroma (JNA) in a 16-year-old boy who underwent endoscopic excision 2 years back. The preoperative contrast-enhanced MRI and histopathology were in favor of JNA. The follow-up 68Ga-prostate-specific membrane antigen (PSMA) PET/CT scan at 3-month interval revealed complete clearance of disease. Currently, the patient presented with recurrent bleeding and nasal endoscopic examination, and contrast-enhanced MRI revealed a presence of a recurrent tumor. The tumor did not show any uptake on 68Ga-PSMA PET/CT, and postoperative histopathology evaluation confirmed the presence of JNA. Although regarded as a criterion-standard imaging modality for assessment of recurrent or residual JNA, 68Ga-PSMA PET/CT is never 100% specific.

Trace Elements Levels in Serum of Patients with Recurrent Respiratory Papillomatosis.

Recurrent respiratory papillomatosis (RRP) is a chronic airway disease characterized by unpredictable recurrences and relapses. Our study aimed to identify the role of trace elements, a proven risk factor for various malignancies, in the development of papilloma and to correlate their serum levels with various disease parameters. 32 RRP patients with 20 age-matched controls were recruited in the study. Analysis of serum trace elements was performed by atomic absorption spectrophotometry in whole blood samples from cases and controls. The serum levels of trace elements were correlated with age of onset, history of previous surgeries, tracheostomy status, Derkay's score, and presence of dysplasia. Among the 32 cases there were 18 males and 14 females with a mean age of 20.85 years (range: 3-60 years). The mean serum levels of Thallium, Zinc, and Gallium were higher among cases compared to their controls whereas the levels of Arsenic, Copper, Cobalt, Selenium, Cadmium, and Lead were higher in control subjects compared to RRP patients. There was a statistically significant correlation of serum level of Cobalt with more than 3 surgeries per year (p = 0.02), Gallium and Thallium with Derkay's score of more than 20 (p = 0.04 and 0.05) and Lead, Arsenic and Gallium with presence tissue dysplasia (p = 0.05, 0.04 and 0.04). Our study had shown a variable association of trace elements in RRP patients. The usefulness of these values need to be completely elucidated and our study calls for future investigations to identify the casual association of various trace elements in the pathogenesis of RRP.

Outcomes of Tracheostomy in COVID-19 Patients: A Single Centre Experience.

The rapid emergence of COVID-19 has led to increase in the number of patients requiring prolonged ventilation and tracheostomy. Though global guidelines are evolving, there is a paucity of literature about optimal timing and outcome after tracheostomy in COVID-19 patients. We set out to assess the clinical characteristics and outcome of COVID-19 patients who underwent tracheostomy.This single-center, prospective observational cohort study analyzed all the consecutive tracheostomy performed on COVID-19 patients from April 1 2020 to January 31, 2021. The primary outcome measure was the 30-day mortality rate following tracheostomy and association with various prognostic risk factors. The secondary outcome measures included various tracheostomy-related events, perioperative complications, and decannulation rate.The study included 51 patients with a median age of 52 years and the majority were male (62.74%). 62.74% (32 of 51) tracheostomies were done early (within 10 days of intubation) and the mean duration from endotracheal intubation to tracheostomy was 10.27 days. The 30-day mortality rate was 66.66% (34 of 51) with no tracheostomy-related mortality and the mean duration between tracheostomy and death was 8.29 days. The presence of sepsis was associated with a higher rate of mortality (p = 0.002) while the timing of tracheostomy was not related to increased mortality (p = 0.365). The most common perioperative complication was tracheostoma bleeding (16.64%). At a median follow-up of 7.5 months, only four patients were decannulated.Though associated with a higher rate of 30-day mortality rate, tracheostomy among COVID-19 patients is a safe and an effective weaning tool.

The impact of pediatric tracheostomy on the quality of life of caregivers.

OBJECTIVE: Pediatric tracheostomy is a challenge in otolaryngology practice and it is associated with greater morbidity and mortality than in adults; hence, constant vigilance by the designated family caregiver is critical. This study was designed to assess the impact of on quality of life of caregivers in a homecare setting as a result of the presence of child with a tracheostomy. METHODS: This was a combined retrospective and prospective cohort study with caregivers of children younger than 16 years who had undergone a tracheostomy, had been discharged home with a tracheostomy tube and completed 6 months of domiciliary tracheostomy care. The consenting primary caregivers were assessed for their quality of life based on the PedsQL v 4.0 questionnaires across various domains. RESULTS: We identified the primary caregivers of 85 children who had undergone a tracheostomy during the study period. The children's median age was 3.5 years (range, 9 months to 14 years). The mean caregiver health-related quality of life (HRQOL) score was 59.3, the mean family functioning score was 62.8, and the mean total family impact score was 54.7 with relative deficits seen in caregiver's social functioning (56.9) and emotional functioning (53.2). Good or average quality of physical and social function was seen among 74 % and 65 % of caregivers respectively while only 55 % were reported having good or average emotional function. Emotional disturbance, interfering with everyday family activities, and sleep disturbance were the major concerns among caregivers. CONCLUSION: The biopsychosocial consequences of caring for a child with a tracheostomy are profound for the family, affecting the quality of life of caregivers and adding to the emotional and social burden of the child's family.

Sinonasal polyposis complicated with extradural abscess and lateral rectus palsy.

Sinogenic intracranial and orbital complications are infrequent complications of chronic rhinosinusitis with nasal polyposis (CRSwNP), leading to potentially fatal intracranial and orbital sequelae. The mortality and morbidity associated with these complications remain high despite the widespread use of antibiotics. We report a patient with CRSwNP presenting with acute onset extradural empyema and sixth nerve palsy in whom the diagnosis was delayed, necessitating early surgical intervention. Our case shows that delay in management and underdiagnosis of sinusitis with nasal polyposis can lead to devastating complications. A high index of suspicion, early recognition of the clinical findings and radiological evaluation with contrast-enhanced CT of paranasal sinuses, orbit and brain are essential to rule out fatal complications associated with CRSwNP. Timely endoscopic intervention and the use of antibiotics can lead to good outcomes, even in complicated cases.

Unusual manifestation of Koch's disease: Gradenigo-Lannois syndrome.

Gradenigo-Lannois syndrome or petrous apicitis is an uncommon but a morbid complication of otitis media. Traditionally treated by surgery, recent advances in imaging and antibiotics have favoured a more conservative approach. Although pyogenic organisms are the leading aetiological agent, petrous apicitis due to Koch's bacilli is not rare. We report two cases of tubercular petrositis presenting as Gradenigo's syndrome with triad of ear discharge, deep-seated retro-orbital pain and diplopia. The first patient represented a mixed infection with pyogenic organism and tuberculosis, which was successfully treated with antibiotics and antitubercular therapy. The second patient showed an acute presentation of Gradenigo's syndrome with chronic otitis media having contact with an active tuberculosis case and showed dramatic response with antitubercular treatment. Tubercular petrous apicitis must be suspected and diagnosed promptly as only specific treatment will lead to symptomatic resolution and avoid complications.