Post-Covid Orofacial Mucormycosis: A Clinico-Radiological Classification System and Management Protocol.

Background: In the wake of the second wave of the COVID-19 pandemic, a substantial number of individuals were afflicted by orofacial mucormycosis post-COVID. The immunocompromised state rendered by the SARS-COV2 (Severe Acute Respiratory Syndrome Corona Virus 2) infection provides a breeding ground for the opportunistic mucor invasion. Corticosteroid and COVID-induced hyperglycemia contribute to the unhindered progress of the mucor infection in these patients. The sino-nasal region serves as the entry point and rapid progress of the disease to the oral cavity, mid-face, orbits, and ultimately the brain proves fatal. Aim and Objectives: The aim of this study was to present a definitive clinico-radiological staging/classification system for patients of post-covid mid-face mucormycosis based on combined radiographic and clinical features for subsequent convenient staging of maxillofacial mucormycosis. The objectives are being to lay down a comprehensive management protocol for these patients. Methods: This retrospective study consisted of a cohort of 31 patients presenting to a tertiary care center over a 12-month period and diagnosed as post-covid mucormycosis. Their clinical features at the time of presentation along with radiographic presentation/extent of anatomical destruction were combined to create a clinico-radiological staging system. Further, a comprehensive management protocol including cultures, surgery and chemotherapy has been laid down. Results: This included 18 males and 13 females. Average age of the patients was 53.5 years. As per the clinico-radiological system formulated by the authors, 2 patients (1 males and 1 females) displayed features of Stage 0, 12 patients (7 males and 5 females) of Stage 1-A, 8 patients (5 males and 3 females) of Stage 1-B, 6 patients (4 males and 2 females) and 3 patients (1 male and 2 females) of Stage 3. Conclusion: The lacuna of a comprehensive staging/classification system for patients of maxillofacial mucormycosis was felt by the authors while treating those affected by post-covid mucormycosis along with a detailed algorithm for management of the study population. It is to this effect that this clinic-radiological classification system has been suggested by the authors along with a management protocol.

Comparative Evaluation of Success in Cases of Synovial Chondromatosis of Temporomandibular Joint Treated with Temporomandibular Joint Arthroscopy: A Case Series.

Introduction: Synovial chondromatosis of the temporomandibular joint (TMJ) is characterized by the formation of multiple nodules of cartilage with varying sizes due to metaplastic development of the synovial membrane. Aetiology revolves with primary lesion, and pathogenesis is still unknown with multiple factors, which includes low-grade trauma or internal derangement. This condition remains undiagnosed and leads to therapeutic challenges from clinical manifestations which are non-specific and needs various tools to diagnose with combination of radiologic and histopathological examination. Materials and Method: We report a case series of five cases which were diagnosed as cases of TMD of the temporomandibular joint. Diagnostic arthroscopy including lysis and lavage with Ringers lactate, hyaluronic acid was carried out. Intra-operative findings were suggestive of synovial chondromatosis. Sample taken for histopathological examination confirmed the diagnosis of synovial chondromatosis of TMJ. Postoperative status of mouth opening and pain was assessed at 15 days, one month, 3 months, 6 months and one year during the review to evaluate the success of arthroscopy of TMJ. Results: All patients reported success with the modality of arthroscopy lysis and lavage at 12 months of follow-up with improvement at every follow-up visit in terms of range of motion and reduction of pain score on VAS. Hence, arthroscopy with lysis and lavage came out to be a promising alternative for open joint surgery in cases of synovial chondromatosis of the TMJ with same outcomes in relieving patients who complain of reduced maximum inter-incisal opening and pain. Conclusion: Thus, arthroscopic procedures can be considered an alternative and effective modality for successful management of cases of synovial chondromatosis of temporomandibular joint.

A study on oxidative stress and antioxidant status of agricultural workers exposed to organophosphorus insecticides during spraying.

Oxidative stress status and Acetylcholinesterase (AChE) activity were studied in blood samples obtained from 61 agricultural workers engaged in spraying organophosphorus (OP) insecticides in the mango plantation, with a minimum work history of one year, in the age range of 12-55 years. Controls were age-matched, unexposed workers, who never had any exposure to OP pesticides. They were evaluated for oxidative stress markers MDA (end product of lipid peroxidation), reduced glutathione (GSH), and Acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) levels in blood. The results showed a marked inhibition of the AChE and BChE activities in the sprayers as compared to the controls. The malondialdehyde(MDA), the last product of lipid peroxidation was found to be increased significantly in sprayers(p<0.05), while depletion in the concentration of antioxidant glutathione(GSH) was also observed in the sprayers but the difference was statistically not significant. It was concluded on the basis of biochemical analysis that pesticides sprayers are exposed to more oxidative stress as evidenced by the changes in antioxidant status. The measurement of the AChE and BChE activities in agricultural workers who spray OPs could be a good biomonitoring factor and is recommended to be performed on a regular basis.

Protective effect of flavonoids against aging- and lipopolysaccharide-induced cognitive impairment in mice.

Flavonoids, naturally occurring polyphenolic compounds, are known to inhibit both lipopolysaccharide (LPS) stimulated tumor necrosis factor alpha and interleukin 6 release which modulate the proinflammatory molecules that have been reported in many progressive neurodegenerative disorders, including Alzheimer's disease (AD), viral and bacterial meningitis, AIDS dementia complex, and stroke. The present experiments were performed to study the possible effects of exogenously administered flavonoids (apigenin-7-glucoside and quercetin) on the cognitive performance in aged and LPS-treated mice (an animal model for AD) using passive avoidance and elevated plus-maze tasks. Aged and LPS-treated mice showed poor retention of memory in step-through passive avoidance and in plus-maze tasks. Chronic administration of the flavonoids apigenin-7-glucoside (5-20 mg/kg i.p.) and quercetin (25-100 mg/kg i.p.) dose dependently reversed the age-induced and LPS-induced retention deficits in both test paradigms. However, flavonoids after chronic administration in young mice did not show any improvement of memory retention in both paradigms. Apigenin-7-glucoside showed more efficacy as compared with quercetin in both models that may be probably due to its greater efficacy to inhibit cyclooxygenase-2 and inducible nitric oxide synthase. Chronic treatment with flavonoids did not alter the locomotor activity in both young and aged mice; however, aged mice showed improvement of performance on Rota-Rod test. The results showed that chronic treatment with flavonoids reverses cognitive deficits in aged and LPS-intoxicated mice which suggests that modulation of cyclooxygenase-2 and inducible nitric synthase by flavonoids may be important in the prevention of memory deficits, one of the symptoms related to AD.

External septo-rhinoplasty- our experience.

Septo-Rhinoplasty is a fascinating surgical procedure to both the surgeon and the patient. Both hope to obtain good results. Consciousness of the nasal profile along with the function led the Rhinologists to adopt various techniques to give better access to the nasal bone and cartilages. External Septo-Rhinoplasty gives excellent approach to the intranasal and nasal structures. The authors describe their experience with external Septo-Rhinoplasty.