COVID-associated rhinocerebral mucormycosis: a retrospective analysis of presentation and outcomes.

OBJECTIVES: To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. METHODS: A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. RESULTS: A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. CONCLUSION: Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. LEVEL OF EVIDENCE: Level 4.

Effect of hyperbaric oxygen on bone healing after enucleation of mandibular cysts: a modified case control study.

INTRODUCTION: Mandibular cysts may require enucleation, resulting in large cavities compromising mandibular strength and functions. We investigated the effects of hyperbaric oxygen therapy (HBOT) on healing after enucleation of mandibular cysts. PATIENTS AND METHODS: Fourteen healthy individuals in whom no modifiers of wound healing were present received a median of 20 post-operative HBOT. The rate of filling of the defect was derived from the number of pixels in the residual cavity after transformation of the area of the lesion in orthopantomograms taken immediately after surgery and at six months postoperatively. Modifications in bone density, detected on panoramic radiographs, were defined through a gray scale of 256 tonalities. The radiolucency of a healthy tooth was used as a reference to control for differences between radiographs taken at different times in the same patient. Both the rate of filling and changes in bone density were compared with corresponding data from a previous study of 27 healthy subjects who healed spontaneously without HBOT. RESULTS: At six months postoperatively, the HBO-treated group showed 55 ± 9% reduction in the size of the residual cavity and 55 ± 17% increase in bone density compared to immediate postoperative values. Corresponding values in the control study were 12 ± 4% and 37 ± 23%, respectively. These differences were significant (t = -16.95; P = 1.21E-11 [x 10-11] for the reduction in cavity size and t = -2.39; P = 0.029 for bone density). CONCLUSIONS: HBOT merits a place as a useful adjunct in the surgical management of defects of the mandible.

Autonomic modulations during 5 hours at 4574 m (15,000 ft) breathing 40% oxygen.

INTRODUCTION: This study was done to evaluate the effects of exposure to hyperoxic hypobaria on the autonomic reactivity and hence G tolerance of high-performance aircraft aircrews. METHODS: Heart rate variability (HRV) indices and traditional measures of autonomic functions were measured during normobaric baseline, hourly at hyperoxic hypobaria for 5 h, and during normobaric recovery in 15 subjects at an equivalent altitude of 4574 m breathing 40% oxygen. RESULTS: Supine and resting-sitting R-R interval, E:I ratio, and time domain indices of HRV increased significantly, with no change in Valsalva ratio. Power in both low- (LF) and high-frequency (HF) bands of HRV spectra increased significantly, which persisted even after normalization with mean R-R2 (LF 1177 +/- 801 at baseline to 1837 +/- 1032 at 5 h and HF 944 +/- 683 at baseline to 1545 +/- 1095 at 5 h). Pressor response to handgrip was attenuated, as evident from a significant interaction between the effects of handgrip and hypobaria. DISCUSSION: Increases in R-R interval, E:I ratio, and all the time domain indices of HRV and HF power suggest an increase in parasympathetic influences. Increase in LF power is explained by the ability of the parasympathetic system to modulate the HRV spectrum in regions lower than respiratory frequency. Attenuation of pressor response to isometric handgrip contraction could have resulted from an increase in the transmural pressure gradient across the carotid sinuses due to hypobaria, which can adversely affect the anti-G straining maneuver.