The Nasal Microarchitecture: How Does Tracheostomy Affect it?

This study aims to evaluate the histological changes in the nasal mucosa post Tracheostomy. A prospective observational study was done on 30 patients undergoing Tracheostomy after obtaining written informed consent from patients/legally accepted representatives. Prior to Tracheostomy, anterior rhinoscopy was done, and findings were noted; nasal mucosal biopsy was obtained from the inferior turbinate. The patients enrolled were followed up for four weeks, and in the patients still having Tracheostomy, repeat inferior turbinate biopsies were taken and compared. Statistically significant atrophy of lining epithelium was seen in 80% of the subjects, i.e., pseudostratified lining epithelium at Baseline with multilayered appearance changed to a single layer of flattened cells at follow-up. There was also a marked reduction in the number of seromucinous glands in the stroma at follow-up in 80% of the subjects. Additionally, fibrosis in the stroma was noted in 43.3% of subjects at follow-up. The results from this study indicate that Tracheostomy, likely as a result of nasal airflow deprivation, brings about significant changes in the microanatomy of the nasal airway. The extent of this causation and its implication in nasal pathology must be studied in larger populations with extended follow-up periods.

Establishment of a Rapid Response, 100-Bedded COVID-19 Hospital With General Wards and Intensive Care Unit Within 35 Days in North Karnataka, India: Report From the Field.

In the state of Karnataka, India, the first case of coronavirus disease (COVID-19) was diagnosed on March 9, 2020. As stated by the WHO, around 15% of COVID-19 patients require treatment in the Intensive Care Unit (ICU). Keeping this in mind, along with the increase in COVID-19 patients in Karnataka, it was predicted that the prevailing general wards and ICUs would be overburdened with the added non-COVID-19 diseases and infirmities. Hence, it was decided to set up a separate infrastructure to reduce the chances of transmission among the patients within the hospital. Thus, the board at SDM College of Medical Sciences & Hospital, Dharwad, Karnataka, took the responsibility to establish a fully equipped 100-bedded hospital in its premise as part of the national and state services to combat the outbreak. The aim of the study was to establish an isolated, fully functional hospital, equipped with all necessary diagnostic and critical care facilities to treat patients diagnosed with COVID-19 in North Karnataka, India.

Invasive Aspergillosis of Nose and Paranasal Sinus in COVID-19 Convalescents: Mold Goes Viral?

Invasive Aspergillosis of the paranasal sinus is an aggressive illness, particularly affecting the immunocompromised and rarely, the immunocompetent. COVID-19 has been shown to cause a derangement of immune parameters both during active infection and the convalescent period. A retrospective study was done from June 10th 2021 to September 10th 2021 on patients who underwent endoscopic debridement of the involved sinuses for post COVID fungal rhinosinusitis. This study included the patients who had Aspergillus infection from the isolated nasal tissue samples. Patient's information, complaints, history of COVID infection, clinical findings, investigations and treatment details were obtained from the records. 13 patients with post-COVID Invasive Fungal Sinusitis were identified. Symptom onset usually occurred within 1 month of COVID 19 diagnosis in all the patients. Nasal obstruction (84%) and headache (61%) were the most common symptoms. Computerized tomography imaging showed maxillary sinus involvement in all patients followed by ethmoid sinus in 76% of patients. Microbiological diagnosis and histopathological confirmation of Aspergillus species was done. All 13 patients underwent endoscopic debridement of the involved sinuses followed by anti-fungal therapy with Posaconazole. All responded well to the treatment with no recurrence till date. Admist an infinite number of Mucormycosis cases in this era of COVID-19 pandemic, we experienced a surge of Aspergillus infection during this second wave. Presentation at a young age, with no known co-morbidities, with minimal symptoms and history of COVID-19 infection are some of the important aspects to be considered in this series. A better morbidity outcome is expected when early detection and treatment is made in patients with post Covid-19 viral illness with Aspergillosis of nose and paranasal sinus.

Prevalence of Oral Mucosal and Extraoral Lesions among Cleft Lip and Cleft Palate Patients Attending to a Private Hospital, India.

Aim of the Study : To assess the prevalence of oral mucosal and extraoral lesions among the cleft lip and/or palate subjects aged between 3 and 18 years, and to compare with those of noncleft controls. Methodology : A cross sectional survey was conducted during the period of March 2004 to September 2004. A select sample of 150 cases consisted of cleft lip and/or palate subjects aged between 3 and 18 years reporting to Outpatient Department, Plastic and Reconstructive Surgery, private Hospital and Medical Research Center, Belgaum. A sample of 450 matched noncleft subjects (Controls) was selected based on convenience from general population. Oral health assessment form as prescribed in Basic Oral Health Surveys, WHO, was used to record the data. Results : Approximately 43% of cleft subjects had abnormalities of upper lip. 7% of clefts and 5% of noncleft controls presented enlarged lymph nodes on palpation in the head and neck region. Both the cleft subjects and noncleft controls had ulcerations in the buccal mucosa. However, there was no significant difference between them. Among few cleft subjects abscess formation was observed in the sulcus region (1.33%) as well as gingiva (2.66%) adjacent to cleft. Similarly among controls also few abscess in sulcus and gingival region were observed. Conclusions : On intra-and extraoral examination of cleft and noncleft subjects for any lesions revealed that clefts as well as noncleft subjects exhibited few intraoral lesions, however clinically or statistically significant differences were not observed.