Secondary Cutaneous Mucormycosis - Retrospective Analysis From Tertiary Care Hospitall.

Background: Covid-19 infection increases the risk of opportunistic infections like mucormycosis. Cutaneous mucormycosis can occur primarily by direct inoculation or secondary to involvement of the underlying structures. Cutaneous manifestations include tender, erythematous, indurated lesions and necrotic plaques. As the disease evolves, cutaneous features manifest progressively. Objectives: To study the manifestations of the cutaneous signs of sinonasal mucormycosis and management of such cases based on severity of involvement. Materials and methods: A retrospective analysis of 21 patients with diagnosis of cutaneous mucormycosis secondary to sinonasal involvement was done with assessment of their skin lesion, area involved and their clinical stage being noted at the time of admission and after 24 h. Treatment consisted of combination of surgical debridement, daily dressing and liposomal amphotericin B. Observations and Results: Out of total 21 patients, there were 10 males and 11 females. Among risk factors, 14 cases had history of covid 19 infection, 5 had history of steroid intake, 6 had history of ICU stay and all had deranged blood sugar levels. Among disease prognosis, excellent outcomes appeared in stage I and stage III showed worst outcome. Conclusion: Since initial clinical presentation is similar to cellulitis and other soft-tissue infections, early recognition is difficult. In this cohort, the prognosis of secondary cutaneous mucormycosis remained poor, especially in ICU patients and those with numerous predisposing factors. Such patients presented in late stages of the disease and mortality rate was very high in such group.

Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India - Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1.

Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.

Case Series on Four Treated Cases of Embryonal Rhabdomyosarcoma in Children.

We report four cases of embryonal rhabdomyosarcoma treated successfully with multimodality therapy which included surgery, chemotherapy and radiotherapy. Our first case was a 2 year old who admitted with the chief complaint of swelling of the upper lip. Biopsy was taken, which showed embryonal rhabdomyosarcoma. It was followed by a CT scan (face + neck), MRI face, USG abdomen and bone scan of the patient. Pre operatively chemotherapy was given. After completion of chemotherapy regimen, wide local excision of the lesion along with a reverse fan flap and bilateral modified radical neck dissection type 3 was done. This was followed by post operative chemotherapy and radiotherapy. There was no recurrence at 6 months post operatively. The second patient was 6 years old with similar complaints, after undertaking all the investigations as in the previous case, patient was given neoadjuvant chemotherapy following which wide local excision of the lesion along with reconstruction with the help of bilateral nasolabial flap was done. This was followed by post operative chemotherapy. No recurrence was present 6 months post operatively. The third patient was a 17 year old male presenting with complaints of left sided nasal obstruction and left nasal swelling. Examination revealed left sided nasal mass which on biopsy turned out to be embryonal rhabdomyosarcoma. The patient underwent surgery followed by chemoradiation. At 6 months the patient had no evidence of recurrence. The fourth patient was 16-year-old male who presented with complaints of right sided nasal swelling and nasal obstruction. Radiological investigation showed the tumor involving the right sinonasal cavity with extension to anterior cranial fossa and with neck nodes. Patient was given concurrent chemoradiation. Patient was followed up for 6 months when the patient presented with recurrence of disease with distant metastasis. Patient is currently on palliative chemotherapy. To summarise, embryonal rhabdomyosarcoma in young children when treated aggressively with surgery and chemotherapy has better prognosis than with chemo-radiation alone.

The Use of the Schizonticidal Agent Quinine Sulfate to Prevent Pond Crashes for Algal-Biofuel Production.

Algal biofuels are investigated as a promising alternative to petroleum fuel sources to satisfy transportation demand. Despite the high growth rate of algae, predation by rotifers, ciliates, golden algae, and other predators will cause an algae in open ponds to crash. In this study, Chlorella kessleri was used as a model alga and the freshwater rotifer, Brachionus calyciflorus, as a model predator. The goal of this study was to test the selective toxicity of the chemical, quinine sulfate (QS), on both the alga and the rotifer in order to fully inhibit the rotifer while minimizing its impact on algal growth. The QS LC50 for B. calyciflorus was 17 µM while C. kessleri growth was not inhibited at concentrations <25 µM. In co-culture, complete inhibition of rotifers was observed when the QS concentration was 7.7 µM, while algal growth was not affected. QS applications to produce 1 million gallons of biodiesel in one year are estimated to be $0.04/gallon or ~1% of Bioenergy Technologies Office's (BETO) projected cost of $5/gge (gallon gasoline equivalent). This provides algae farmers an important tool to manage grazing predators in algae mass cultures and avoid pond crashes.