The changing trend of fungal infection in invasive rhinosinusitis in the COVID era.

Background: SARS-COV virus operates as a significant risk factor for invasive fungal aspergillosis and mucormycosis. Successful management of this fulminant infection requires early recognition of the disease and aggressive medical or surgical interventions to prevent the high morbidity and mortality associated with the disease process. Aims and Objective of the Study: 1. To isolate and identify different species of fungi among acute rhinosinusitis patients. 2. To assess the association of risk factors causing fungal rhinosinusitis. 3. To assess the changing trend in fungal rhinosinusitis during the COVID era. Material and Methods: This is a retrospective observational study conducted from May 2020 to October 2022, attending the ENT department and relevant data were collected from the medical records department of ABVIMS and Dr RML Hospital, New Delhi, a Tertiary Care Referral Centre in India. The major risk factors studied were age, gender, COVID-19 infection and underlying diseases (such as diabetes mellitus, ischaemic heart disease, hypertension, malignancies, chronic kidney DISEASES, etc.); details of corticosteroid use of all patients were recorded in the datasheet. The pandemic data was divided into three distinct time periods/waves/eras, i.e., first, second, and third waves, each of which included ten months, to examine the changing trend in fungal rhinosinusitis in the pandemic era of COVID-19. Results: A total of 412 patients out of which 236 patients were clinically diagnosed with fungal sinusitis based on revised EORTC criteria. The most common site involved was the orbit with paranasal sinus and eye 86/236 (36.4%), followed by involvement of nasal and paranasal sinus alone 68/236 (28.8%). The most prevalent age range affected was 40 to 50 years. The most commonly associated comorbidity was diabetes mellitus (DM) in 176 (74.5%), followed by head and neck malignancies in 22 (9.32%) patients. Thirty-eight (50.6%) Rhizopus species and 18 (24%) Aspergillus flavus were the most common isolated fungal species on culture, followed by Mucor spp. 14 (18.6%) and Aspergillus fumigatus 5 (6.6%) in the period. In the second wave of COVID, there was a surge in Zygomycetes cases 36 (45%) and after the second wave, the Aspergillus cases increased by 14 (19%) during Jan-Oct 2022. Conclusion: With the continuing coronavirus pandemic, there is an unprecedented and discernible rise in the prevalence of acute invasive fungal sinusitis certainly a spike in cases of Aspergillus infection was observed, probably due to unprecedented usage of Amphotericin B for the treatment of mucormycosis during the third wave This underlines the importance of the need to tailor our treatment protocol as per the etiological agents hence the right antifungal drugs combined with urgent surgical procedures on a case-to-case basis may certainly increase the chances of survival.

Comparison of Maxillary Molar Roots with Maxillary Sinus in High-resolution CBCT: A Retrospective Study.

Background: The maxillary sinus is a pyramidal-shaped osseous cavity, and maxillary molars are found to be in close proximity to the sinus floor or even protruding into it. The present study was conducted to measure the relation between the roots and sinus floor and also the thickness of the bone using CBCT to determine age and gender differences. Materials and Methods: The individuals were separated into two groups based on age: Those under 40 and those over 40 years. There were 25 men and 25 females in the study. Axial, coronal, and sagittal slices of the CBCT images were obtained. Results: The first molar root distance and cortical bone thickness varied significantly between men and women, as well as across different ages. Mesiobuccal root with sinus floor was shown to have a substantial mean value for both sexes (P = 0.049 and P = 0.003). In females, the thickness of the buccal plate was 1.291 mm, whereas, in men, it was 2.447 mm (P = 0.000). There was a substantial difference in the thickness of the buccal plate between men and women who were at least 40 years old (P = 0.000). Conclusion: This study suggests how important it is to look at anatomical features and bone thickness when determining a person's age and gender.

Mefloquine as a prophylaxis for malaria needs to be revisited.

According to WHO, 2019 witnessed 229 million cases of malaria globally, of which Africa accounted for 94% of cases. Early diagnosis and treatment are the basis of malaria management, and the need for good chemoprophylaxis especially for people travelling to endemic areas is vital. There are a number of drug options available for the prophylaxis of malaria, mefloquine being one of the drugs used. Mefloquine has been around from the 1970s, and was developed in the United States keeping in mind the soldiers that were being deployed to areas where chloroquine resistant strains of Plasmodium were discovered. Mefloquine was preferred for its once a week dosage. Within a decade of its introduction, reports of the side effects associated with its long-term use surfaced. Mefloquine is now reported to cause a myriad of neuropsychiatric side effects including anxiety, sleep disturbance, depression, dizziness and frank psychosis, especially in patients with pre-existing psychiatric disorders. Many countries like the United States and the United Kingdom have updated their drug boxes to include the warning of these potential neuropsychiatric effects. This paper reviews the side effects of mefloquine and why there is a need to revisit its use in Indian drug policy.

Study of stress-induced temporomandibular disorders among dental students: An institutional study.

AIM AND OBJECTIVES: The aim and objectives of this study are to investigate the various types of stress-inducing factors, most prevalent etiological factor and to determine the correlation between stress and temporomandibular disorders (TMDs) in Dental students in Modinagar, Ghaziabad, Uttar Pradesh. MATERIALS AND METHODS: A sample of 450 students were selected for the study divided into two groups of undergraduate (UG) and postgraduate (PG) students further subdivided into UG (1st, 2nd, 3rd, and 4th, interns) and PG (1st, 2nd, 3rd year). Study includes clinical evaluation of temporomandibular joint (TMJ) system (TMJ sounds, muscles of mastications, mouth opening, and range of mandibular motion) and questionnaire which covers demographic data (i.e., age, sex, and academic year), TMD symptoms and TMD signs along with standardized scales related to stress dental environmental stress scale and perceived stress scale (PSS). RESULTS: Most of the students included into study are mostly of 21-25 years of age (64.3%), males (52.7%), females 47.3% with more number of UGs (91.4%) predominantly 1st year students (23.9%). Headache was found to be the most prevalent TMD symptom (26.2%) followed by clicking (24.9%), pain on clicking (5.5%), jaw lock (3.4), and difficulty in mouth opening (0.9%). Clicking was found to be the most prevalent TMD sign (24.9%) among dental students followed by deviation (16.3%), muscle tenderness (14.3%), and TMJ pain (5.7%). The most prevalent TMD was disc displacement 22.6% followed by myofascial pain dysfunction syndrome (MPDS) with disc displacement (13.5%) and MPDS (3.8%). TMD was higher in UG females students of 21--25 years of age group, dental environment stress scale score and PSS score shows statistically significant results. CONCLUSION: Stress is a significant etiologic factor involved in initiation and maintenance of TMDs in Dental students.

Tracking and debriefing birth data at scale: A mobile phone application to improve obstetric and neonatal care in Bihar, India.

AIM: This analysis assessed changes over time in skill and knowledge related to the use of evidence-based practices associated with quality of maternal and neonatal care during a nurse midwife mentoring intervention at primary health clinics (PHCs) in Bihar, India. DESIGN: Nurse midwife mentors (NMMs) entered live birth observation data into a mobile App from 320 PHCs. METHODS: The NMMs completed prompted questions in the App after every live birth witnessed. The App consisted of questions around three main themes, "What went well?", "What needed improvement?" and "What can be done differently next time?". RESULTS: Observational data from 5,799 births was recorded by 120 NMMs in 320 PHCs. Knowledge and skill during normal spontaneous vaginal deliveries and complicated deliveries with either a postpartum haemorrhage or non-vigorous infant all showed statistically significant improvement (p < .001) over time using a Chi-squared test for trend with a mean increase of 41% across all indicators.

Management of myofascial pain by therapeutic ultrasound and transcutaneous electrical nerve stimulation: A comparative study.

OBJECTIVE: The present comparative study was aimed to determine the effectiveness of Th US and TENS in the management of myofascial pain in TMD patients. MATERIALS AND METHODS: The present randomized comparative study was on 90 patients who were further assigned in three different groups each having 30 patients; Group I was healthy control patients, Group II was receiving Th US therapy, and Group III was receiving TENS therapy. All the 90 patients were further evaluated for maximum inter incisor subjective evaluation regarding muscle pain, impediment to daily life, massage impression on visual analog scale (VAS) scale, and intensity and duration used in Th US massage. RESULTS: The masseter muscle thickness in control group was 12.00 (standard deviation [SD] ±1.1) mm when compared with TMD patient of 13.00 (SD ± 1.1) mm before treatment. Statistical significant findings on VAS score of muscle pain, impediment to daily life, and massage impression were observed in Th US. After treatment, the anechoic areas disappeared or were reduced in Th US group by 95.6% and in TENS by 74.4%. CONCLUSION: Th US appeared to be subjectively better which was related to VAS score of massage impression, muscle pain, and impediment to daily life after treatment as well as sonographically related to existence of anechoic areas.

Eagle's syndrome veiling as pain of odontogenic origin: Report of two cases with cone beam computed tomography illustration.

Eagle's syndrome, also known as an elongated styloid process, is a condition that may be the source of craniofacial and cervical pain. It is infrequently reported but is probably more common than generally considered. The symptoms related to Eagle's syndrome can be confused with those attributed to a wide variety of facial neuralgia and or oral, dental, and temporomandibular joint diseases. In this paper, there are two cases, which reported to the Department of Oral Medicine, Diagnosis, and Maxillofacial Radiology, with a chief complaint of radiating pain in the preauricular region of the face. After radiographic investigation, these cases are considered as a case of Eagle's syndrome because of increase in the size of the styloid process.

Computed Tomography in Diagnosis of Admantinoma.

CONTEXT: Admantinoma is second most common benign odontogenic tumor which clinically appears as an aggressive odontogenic tumor, often asymptomatic and slow growing, associated with symptoms such as swelling, dental malocclusion, pain, and paresthesia of the affected area. The radiographic appearance may vary from unilocular to multilocular radiolucencies, imparting a characteristic honey comb, soap bubble appearance or may resemble a caricature of spider. CASE REPORT: This report highlights the importance of conventional and advanced imaging in the diagnosis of large and invasive lesions. Patient reported with complaint of swelling in jaw, which progressively increased; and was found to be bony hard, both intra- and extraorally. Radiographs revealed large multilocular radiolucency on left body and ramus of mandible with soap bubble pattern and knife edged root resorption. Computed tomographic examination evaluated the extent of the lesion, internal structure, and relation to adjacent structures; further a reconstructed image was obtained to evaluate extent of destruction in three dimensions. CONCLUSION: Computed tomography has an important role in the diagnosis and treatment planning is imperative as it is superior in revealing the cortical destruction and extension into the neighboring soft tissues than conventional radiography.