Mucormycosis in COVID Diabetic Patients: A Horrifying Triad!

Infectious diseases with the coronavirus disease-2019 (COVID-19) can be linked to various microbial and fungal coinfections. Mucormycosis is an invasive opportunistic infection that enters as inhalation of fungal spores through the nose or paranasal sinuses in diabetic and immunocompromised patients. We present our experience of managing seven cases of recent COVID-19 infection with uncontrolled diabetes who developed rhino-orbital mucormycosis. All patients were diagnosed by clinical examination and imaging and managed by emergency surgical debridement and liposomal amphotericin-B. A lethal triad of impaired immunity due to COVID-19 infection, state of hyperglycemia, increased use of steroids, or rampant broad-spectrum antimicrobials works as fertile soil and may assist in the growth or alleviation of a fungal infection. Healthcare professionals must be aware of the potential of secondary invasive fungal infections in diabetic patients with moderate to severe category of COVID-19 infectious disease, especially on steroid therapy. HOW TO CITE THIS ARTICLE: Panwar P, Gupta A, Kumar A, Gupta B, Navriya SC. Mucormycosis in COVID Diabetic Patients: A Horrifying Triad! Indian J Crit Care Med 2021;25(11):1314-1317.

Monstrous Invasion of Placenta Percreta and Previa: Multidisciplinary Management of a Case, the Role of a Urologist, and a Literature Review.

In rare situations, pregnant women may experience life-threatening bleeding due to the placenta's aberrant invasion of the bladder. A 28-year-old pregnant female with two previous cesarean deliveries presented with the chief complaint of abdominal pain at the earlier scar site. Ultrasound imaging was suggestive of placenta percreta with bladder invasion. The patient underwent elective cesarean section with a uterine-preservation strategy. A healthy male baby was delivered by classical cesarean section, and bilateral uterine artery ligation was done. The patient developed severe postoperative hemorrhage, for which she was re-explored, and the urology team was called for intraoperative assistance. The area of placental invasion into the bladder was resected entirely with bladder reconstruction. Placenta percreta is a life-threatening condition that can involve adjacent uterine structures. Successful management involves a multidisciplinary strategy involving experienced obstetricians, urologists, anesthesiologists, blood bank teams, and neonatologists.