Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors / Rinosinusitis fúngica invasiva asociada con COVID-19: cambios clínicos y predictores de pronóstico

Background This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes. Methods It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management. Results Forty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity. Conclusions According to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis. (AU)

Antecedentes Durante el periodo de la pandemia de COVID19, ha habido un aumento en la tasa de casos de rinosinusitis fúngica invasiva aguda (RSFIA), siendo cada vez más evidente la asociación entre ambas entidades. EL objetivo de este estudio ha sido analizar la evolución de los pacientes con rinosinusitis fúngica invasiva aguda asociado con la infección por COVID-19, analizando los factores determinantes en la evolución y pronóstico de la enfermedad. Métodos Fue un estudio observacional retrospectivo que incluyó casos de cuatro instituciones de referencia de tercer nivel entre noviembre de 2020 y febrero de 2022. Se incluyeron sesenta y seis pacientes que padecían RSFIA asociado a COVID-19 confirmado. Observamos el pronóstico de todos los pacientes incluidos con un seguimiento de seis meses. Correlacionamos el pronóstico con muchos factores, como los datos demográficos, las condiciones médicas, las investigaciones de sangre, las características de las infecciones fúngicas y el manejo. Resultados Cuarenta y dos pacientes (64%) sobrevivieron después de la RSFIA asociada a COVID-19, y veintidós pacientes (36%) fallecieron. Las dosis altas de corticoides con uso prolongado fueron los principales factores que afectaron el comportamiento de la RSFIA asociada a la COVID-19. HbA1c fue un buen predictor del pronóstico; un nivel inferior al 9,35 % puede indicar supervivencia con una sensibilidad del 87.5%. Conclusiones Según este estudio multicéntrico, la mortalidad de la RSFIA asociada a la COVID-19 fue alta. El comportamiento se vio afectado por el control glucémico, el tipo de especie fúngica y el tipo de terapia antifúngica. El desbridamiento quirúrgico temprano, una combinación de Amphotericin B con Voriconazole y anticoagulantes ayudaron a mejorar el pronóstico. (AU)

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors.

BACKGROUND: This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes. METHODS: It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022. We included sixty-six patients who suffered from AIFRS associated with confirmed COVID-19. We observed the prognosis of all included patients with a six-month follow-up. We correlated the prognosis with many factors, such as demographic data, medical conditions, blood investigations, the features of fungal infections, and management. RESULTS: Forty-two patients (64%) survived after the AIFRS associated with COVID-19, and twenty-two patients (36%) died. High doses of corticosteroids with prolonged use were the main factors that affected the behavior of the AIFRS associated with COVID-19. HbA1c was a good predictor of the prognosis; a level less than 9.35% may indicate survival with 87.5% sensitivity. CONCLUSIONS: According to this multi-center study, the mortality of the AIFRS associated with COVID-19 was high. The behavior was affected by glycemic control, the type of fungal species, and the type of antifungal therapy. Early surgical debridement, a combination of Amphotericin B with Voriconazole, and anticoagulants helped improve the prognosis.

Radiological Analysis of the Facial Recess: Impact on Posterior Tympanotomy Difficulty During Pediatric Cochlear Implantation.

OBJECTIVES: We analyzed several radiological features of the facial recess to correlate them with the intraoperative findings to highlight the most reliable predictors of posterior tympanotomy difficulty. STUDY DESIGN: Retrospective observational cohort study. SETTING: Multicenter study at tertiary referral institutions. METHODS: We included 184 pediatric patients who underwent cochlear implantation through the posterior tympanotomy approach. The correlation was attempted between 8 radiological features in the preoperative high-resolution computed tomography scan and intraoperative surgical difficulty. RESULTS: Posterior tympanotomy was straightforward in 136 (73.9%) patients. In contrast, it was challenging in 48 (26.1%) patients. The facial recess was aerated in 74.5% of patients. The mean (SD) posterior tympanotomy depth was 3.98 (0.867) mm. The mean (SD) chorda-facial angle was 27.67° (3.406°). The mean (SD) chorda-facial to stylomastoid length was 3.898 (0.6304) mm. The mean (SD) facial nerve second genu angle was 94.54° (6.631)°. Deep-unaerated facial recess wall was associated with the most difficulty. There was a statistically significant difference in the unchallenging and challenging posterior tympanotomy groups regarding the surgical duration (P < .0001). CONCLUSIONS: According to this analytic study, the chorda-facial angle, the facial recess aeration, and the chorda-facial to stylomastoid length were respectively the strongest preoperative radiological predictors of the surgical difficulty of posterior tympanotomy during cochlear implantation. Chorda-facial angle <25.5° was associated with difficult posterior tympanotomy. The oblique parasagittal cut was essential for the radiological analysis of the facial recess.

Incidence and Risk Factors of Rachitic Genu Varus in Preschool Children in a Paediatric Health Institute in Egypt as One of the Developing Countries.

BACKGROUND: Rachitic genu varus is one of the common conditions among the Egyptian children, despite the shinning sun of Egypt all the year. PURPOSE: The aim of the study was to estimate the incidence of rachitic genu varus among the Egyptian children, and to assess the risk factors contributing to it. PATIENTS AND METHODS: This prospective study recruited a total of 250 consecutive children, being 130 males and 120 females, with rachitic bow legs or genu varus, between 2 - 4 years of age, together with 250 controls of the same age group, out of a total number of 1900 children with other types of rickets, and other children's orthopaedic diseases, who presented to the National Institute of Neuromotor System in Egypt between September 2014 to September 2015. The cases and the controls were subjected to clinical, laboratory biochemical, and plain radiographic examinations. Their parents were subjected to epidemiological, maternal, and nutritional questionnaires. RESULTS: The calculations revealed high incidence (13.1%) of rachitic genu varus. The risk factors were low socioeconomic status, insufficient family income, poor housing conditions, lack of exposure to sunlight due to cultural practices, sole breast feeding, and inadequate supplementation of vitamin D to the children and the pregnant women. The p value was <0.05. CONCLUSION: Vitamin D deficiency rachitic genu varus is a multifactorial condition in Egypt. Raising the standard of living, level of education, housings, and dietary supplementation of vitamin D to the pregnant women and infants are the solution.

Double column osteotomy for correction of residual adduction deformity in idiopathic clubfoot.

INTRODUCTION: Adduction of the forefoot is the most common residual deformity in idiopathic clubfoot. The 'bean-shaped foot', which is a term used to describe a clinical deformity of forefoot adduction and midfoot supination, is not uncommonly seen in resistant clubfoot. SUBJECTS AND METHODS: Fifteen children (20 feet) with residual forefoot adduction in idiopathic clubfeet aged 3-7 years were analyzed clinically and radiographically. All of the cases were treated by double column osteotomy (closing wedge cuboid osteotomy and opening wedge medial cuneiform osteotomy) with soft tissue releases (plantar fasciotomy and abductor hallucis release), to correct adduction, supination and cavus deformities. Pre-operative measurements of certain foot angles were compared with their corresponding postoperative values. RESULTS: A grading system for evaluation of the results using a point scoring system was suggested to evaluate accurately both clinical and radiographic results after a follow-up period of an average of 2.3 years. Eight feet (40%) had excellent, eight (40%) good, three (15%) fair, and one (5%) poor outcome. There was no major complication. There was significant improvement in the result (P > 0.04). CONCLUSIONS: Double column osteotomy can be considered superior to other types of bone surgeries in correction of residual adduction, cavus and rotational deformities in idiopathic clubfoot.

Great toe metatarsophalangeal arthrodesis for hallux valgus deformity in ambulatory adolescents with spastic cerebral palsy.

BACKGROUND: Hallux valgus deformity is a common sequel of spastic cerebral palsy. METHODS: Twenty ambulatory patients (24 feet) suffering hallux valgus deformity, with painful forefoot and restricted footwear, secondary to spastic cerebral palsy acquired perinatally, were treated with great toe metatarsophalangeal (MTP) arthrodesis using percutaneous K-wires for fixation. The mean age at the time of surgery was 16.2 years (range 14-18 years). They were retrospectively evaluated for the results after arthrodesis at a mean interval of 3 years and 4 months (range 3-4 years) by physical examination and radiographs. RESULTS: All patients had a stable painless aligned great toe, with <10 degrees valgus, <20 degrees dorsiflexion and neutral rotation after arthrodesis, evidenced by improvement in pain, cosmesis, functional activity, footwear, callosities and hygiene, as well as by significant improvement in the measures of the MTP and the intermetatarsal angles (IMA) by postoperative radiographs. Neither non-union (pseudoarthrosis) nor recurrence of the deformity developed. Complications included superficial wound slough in a single case. Using the modified American Orthopaedic Foot Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale, 18 feet (75%) were classified as excellent and six feet (25%) as good. Neither fair nor poor cases were recorded. CONCLUSION: Hallux valgus deformity in adolescents with spastic cerebral palsy is best treated by great toe MTP arthrodesis to improve segmental foot malalignment and dynamic foot deviation.