Adjunctive use of saturated solution of potassium iodide (SSKI) with liposomal amphotericin B (L-AMB) in mucormycosis achieves favorable response, shortened dose and duration of amphotericin: A retrospective study from a COVID-19 tertiary care center.

PURPOSE: Second wave of COVID-19 pandemic was associated with an unprecedented rise in cases of mucormycosis, treatment of which has been challenging owing to the availability and side effects associated with amphotericin. METHODS: All patients presenting with rhino-orbital cerebral mucormycosis (ROCM) following COVID-19 infection between April 2021 to June 2021 were included in this retrospective interventional study. Primary objective was to assess the clinical response with combination of intravenous liposomal amphotericin B (4-5 mg/kg/day) and saturated solution of potassium iodide (SSKI) given orally along with surgical debridement. RESULTS: Twenty-five patients of ROCM were treated with the regimen. Mean age and fasting blood sugar levels were 53.48 years and 239.64 mg/dL respectively. All patients had history of intake of steroids with a mean daily dose of 86.39 mg of prednisolone equivalent. 88% of patients had a "proven" diagnosis of mucormycosis. Cultures were positive in 52% of patients with Rhizopus arrhizus as the predominant species. The mean daily dose of amphotericin received was 268 mg/day with a mean duration of 9.52 days. Mean daily dose of SSKI was 2.57 g. 21 patients (84%) had stabilization of disease at week 8 and achieved cure at the end of treatment whereas the mortality rate was 16%. Factors that significantly affected outcome were eye and central nervous system (CNS) involvement on presentation. CONCLUSION: SSKI, with its remarkably low cost and safety profile, makes it a potential adjuvant drug that may help achieve the twin benefits of shortened duration and dose of LAMB.

New Coronavirus (SARS-CoV-2) Crossing Borders Beyond Cities, Nations, and Continents: Impact of International Travel.

The third outbreak of coronavirus in the form of the COVID-19 infection started in Wuhan, China, in December 2019. The early and rapid spread of this infection across borders can be largely attributed to international air travel that has become a part of modern globalization. In this article, we analyze the spread of the novel coronavirus (SARS-CoV-2) along the routes of international travel, both by air and by sea. Pitfalls of various screening methods used at the airports and the importance of optimal aircraft ventilation are discussed. Also, we suggest measures that can be taken to reduce the risk of transmission associated with air travel.

Complicated coexisting pyogenic and tuberculous otitis media affecting the temporozygomatic, infratemporal, and parotid areas: report of a rare entity.

We report an unusual case in which a 28-year-old woman presented with a long-standing history of ear discharge, hearing loss, facial weakness with ipsilateral facial swelling and cellulitis, a postauricular fistula, and an abscess of the temporozygomatic, infratemporal, and parotid areas. The pus stained positive for bacteria and acid-fast bacilli, and culture was positive for Proteus vulgaris and mycobacteria. Based on these findings, a diagnosis of tuberculous otitis media with complications was made. Computed tomography showed extensive destruction of the tympanic and mastoid part of the temporal bone, as well as lytic lesions in the skull. The patient was placed on antituberculosis drug therapy. Although her facial nerve palsy and hearing loss persisted, she otherwise responded well and did not require surgery.

Cemento-ossifying fibroma of the maxilla: a case report.

We report a case of very large ossifying fibroma of the maxilla in a 22-year-old male. It is a bony tumour of the maxilla of possibly odontogenic origin with aggressive behavior and high tendency for recurrence.

Myxoma of the temporal bone: an uncommon neoplasm.

We report the case of an 11-year-old girl who presented with a soft-tissue mass that filled the left external auditory canal and a discharge that resembled chronic suppurative otitis media. The patient underwent mastoid exploration with complete excision of the mass. Findings on the excision biopsy were consistent with a myxoma of the temporal bone. At follow-up 2 years postoperatively, the patient remained disease-free. To the best of our knowledge, this is only the 12th case of a myxoma of the temporal bone to be reported in the English-language literature.

Preoperative computed tomographic evaluation of inferior nasal concha hypertrophy and its role in deciding surgical treatment modality in patients with deviated nasal septum / Evaluación preoperatoria con tomografía computada de la hipertrofia de la concha nasal inferior y su rol en la decisión de la modalidad de tratamiento quirúrgico en pacientes con tabique nasal desviado

Deviated nasal septum is associated with compensatory hypertrophy of the inferior nasal concha on the contralateral side. In the past conventional septoplasty was done for the deviated septum, which would improve the patency on the side of deviation but would worsen it on the opposite side due to reallocation of the septum to the midline. The present study of 50 patients unfolds the anatomical composition of the inferior nasal concha based on the computed tomographic scan and help the otolaryngologist to determine whether to add turbinoplasty to standard septoplasty procedure or not.

Un tabique nasal desviado está asociado con una hipertrofia compensatoria de la concha nasal inferior del lado contra lateral. En el pasado se realizaba septoplastía convencional para el tabique desviado, lo que mejoraraba la permeabilidad en el lado de la desviación, pero agravaba ésta en el lado opuesto, debido a la reacomodación del tabique en el plano mediano. En el presente estudio se evaluó en 50 pacientes la composición anatómica de las conchas nasales inferiores, basado en la exploración a través de tomografía computarizada, y de esta manera ayudar al otorrinolaringólogo a determinar si es necesario o no, añadir la plastía de la concha nasal inferior al procedimiento de septoplastía estándar.

Acute suppurative otitis media: an unusual cause of orbital apex syndrome.

We report the case of a 40-year-old female who presented to us with earache and a rapidly progressive painful ophthalmoplegia involving the right eye with right temporal swelling. A clinical and radiological assessment revealed it to be temporal cellulitis with orbital apex syndrome secondary to acute otitis media. In spite of prompt initiation of treatment, the patient died within 30 hr of presentation. The case is discussed in detail with a brief review of medical literature.

Role of socioeconomic factors in deep neck abscess: A prospective study of 120 patients.

OBJECTIVE: To assess the socioeconomic factors, presentation, aetiological factors, microbiology, and management of deep neck abscesses. DESIGN: Prospective study. SETTING: Tertiary health care centre. PATIENTS AND METHODS: We studied 120 patients with deep neck abscess who were managed in the department of otolaryngology between May 2004 and December 2005. RESULTS: There were 54 male patients (45%) and 66 female (55%) with ages ranging from 18 months to 60 years. Most of the patients were of low socioeconomic status and 84 (70%) were illiterate. None were aware of the predisposing factors and potential complications of deep neck abscess. Ninety-six (80%) had poor orodental hygiene with dental infections and extraction as the most common predisposing factor followed by recurrent oropharyngeal infections. The median duration of delay before the patient presented to us was 1 week, and only 6 (5%) were aware of the primary health services available in their locality. The most common site was the submandibular region. Pain, fever, and dysphagia were the most common presenting symptoms, and Staphylococcus aureus was the most common micro-organism. All patients were treated by incision and drainage, and 10 required emergency tracheostomy. All patients responded with no complications. CONCLUSION: Socioeconomic factors, particularly ignorance, illiteracy, and poverty, are important contributory factors towards the high incidence of deep neck abscess in developing countries.

Parotid gland leiomyosarcoma in a child: an extremely unusual neoplasm.

We report the case of an 8-year-old boy with a parotid mass diagnosed to be a leiomyosarcoma. Considering the unresectable extent of the mass, the patient was subjected to radiotherapy. The patient developed distant metastasis following the course of radiotherapy and was put on chemotherapy. The child was lost to further follow up. To our knowledge, this is the first reported case in the English-language literature of such an entity in the pediatric age group.

Giant cell tumour (osteoclastoma) of the zygoma: an extremely unusual neoplasm.

We report an extremely rare case of a giant cell tumour of the zygomatic bone in a 36-year-old female. The tumour was excised with healthy margins. The patient is asymptomatic without any evidence of recurrence 14 months postoperatively. To our knowledge, this is only the third reported case of this tumour occurring in the zygomatic bone in the medical literature.

Pharyngeal perforation with deep neck abscess secondary to isolated hyoid bone fracture.

We report the case of a 26-year-old man who presented to us with dysphagia secondary to blunt trauma to the neck. The patient was found to have a hyoid bone fracture with pharyngeal perforation and resultant neck abscess. The patient responded to prompt surgical and medical management. We believe this to be the first report of such a case.

Extensive gas-forming infection of the deep neck and laryngeal spaces

We report the case of a 46-year-old diabetic male who presented to us with swelling in the neck associated with dysphagia and respiratory discomfort following dental infection. The CT-scan and soft tissue neck radiograms of the patient revealed an extensive head and neck abscess with gas pockets. Prompt surgical intervention with ntibiotic coverage and control of diabetes led to recovery of the patient. The absence in the literature of any previous report of a laryngeal gasforming abscess resulting from a primary dental infection prompted us to report this case

Extensive gas-forming infection of the deep neck and laryngeal spaces%Infecção formada por gás extenso na profundidade do pescoço e espaços laríngeos

We report the case of a 46-year-old diabetic male who presented to us with swelling in the neck associated with dysphagia and respiratory discomfort following dental infection. The CT-scan and soft tissue neck radiograms of the patient revealed an extensive head and neck abscess with gas pockets. Prompt surgical intervention with ntibiotic coverage and control of diabetes led to recovery of the patient. The absence in the literature of any previous report of a laryngeal gasforming abscess resulting from a primary dental infection prompted us to report this case