An Unusual Presentation of Rhino-Orbital Mucormycosis with MDR-TB: an Unforeseen Challenge for Treatment Post COVID-19.

ROCM is an invasive fungal infection that has seen a substantial rise in the post covid-19 patients. Here we present an intriguing case of ROCM existing as a coinfection with MDR-TB. The purpose of this manuscript is to highlight the dilemma faced by the clinicians whether to take the risks associated with standard treatment protocols of mucormycosis contraindicated due to coexisting MDR-TB or to play safe and face the consequences of inadequate management.

Microbiology of Chronic Otitis Media and Shifting Trends of Its Antibiotic Susceptibility: A Prospective Observational Study in a Tertiary Care Institute of Western Rajasthan.

COM is a prevalent disease in lower socio-economic group mainly of a developing country. COM in active stage presents with a discharging ear. The mucopus from an active ear, when put through microbiological culture, yields a variety of aerobic and anaerobic bacteria as well As fungi. Antibiograms provide us with culture specific antibiotics. The study aims to identify prevalent microbes in our region and their sensitivity towards respective antibiotics. A total of 100 patients diagnosed with active COM in the E.N.T. outpatient department of M.D.M. Hospital, Jodhpur from July 2019 to December 2019 were enrolled. 100 swabs were obtained, one from each patient, using sterile cotton swabs and cultured for microbial flora. Antibiotic susceptibility testing of bacterial isolates was done using Kirby-Bauer disc diffusion method. The most common organism isolated were Pseudomonas spp. (58%) and Staphylococcus aureus (25%), while 8% were fungal isolates. The sensitivity pattern of Pseudomonas spp. was maximum for meropenem while that of Staphylococcus species was maximum for linezolid and vancomycin. Both were fairly sensitive to amikacin, cephalosporins and Quinolones. Culture specific antibiotics help us achieve dry ear faster and better. There is a drifting trend in antibiotic susceptibility of both aerobic and anaerobic species, towards higher group of antibiotics. Thereby suggesting emergence of multi-drug resistant strains.

Olfactory and Gustatory Dysfunction in Covid-19: An Observational Study in a Tertiary Care Institute of Western Rajasthan.

Coronavirus causes damage to chemosensory receptors resulting in olfactory and gustatory dysfunction. This study reports our observations on anosmia and ageusia in symptomatic COVID-19 positive patients admitted in the COVID centre of Western Rajasthan. A total of 98 symptomatic, RT-PCR positive COVID-19 patients admitted in the M.G. Hospital during November 2020 were evaluated with detailed history regarding symptoms along with duration and resolution including response to antiviral therapy. Olfactory and Gustatory dysfunction was seen in 53.1% patients. Both anosmia and ageusia coexisted in 61.5% patients followed by isolated anosmia (25%), while isolated ageusia was rare. History of preceding fever was present in 69.2% cases. 100% of the patients with ageusia had loss of salty and sour taste, while 90.1% did not feel sweet taste. Bitter taste sensation was altered only in 63.6%. Symptoms reversed within 7 days in 94.2% cases and after 15 days in 5.8% cases irrespective of antiviral therapy. Chemosensory dysfunction has no racial predominance. It is a self-limiting manifestation and a useful screening symptom. Co-existence of anosmia and ageusia is more common than isolated dysfunction. In ageusia, salty and sour is the most commonly lost taste sensation followed by sweet.

Risk Factors for Procurence of Mucormycosis and its Manifestations Post Covid-19: a Single Arm Retrospective Unicentric Clinical Study.

To assess the risk factors causative of ROCM post COVID-19. To determine the clinical manifestations, causative factors leading to surge in ROCM & factors contributing to poor prognosis in ROCM cases occurring in Western Rajasthan post COVID-19. In a Retrospective observational study, 56 post COVID-19 ROCM patients were analyzed from 'May-June 2021' at M.D.M. Hospital, Jodhpur. All patients after onset of disease were assessed as per selection criteria, included patients were examined for risk factors and clinical manifestations & then were statistically evaluated. Median age was 53 years with male to female ratio 2.7:1. Uncontrolled diabetes was noted in at least 85% patients. Steroid use was seen in 66%. Other major contributing factor to ROCM was the occupation; Out of 56 patients 69% were FARMERS.72% had no history of COVID-19 vaccination. Only 3% had no underlying disease. Overall mortality rate was 16% .2 determinants were associated with poor prognosis: higher HbA1c-Out of 7 cases of orbital exenteration, 6 (85%) had HbA1c > 12. 36% took immoderate amounts of Steam inhalation. Maxillary sinuses were the most involved sites (94%). Orbital involvement was seen in 33 and 12% were PL negative. Palatal involvement & intracranial involvement were seen in 14% and 7% respectively. Bilateral disease was seen in 28%. Uncontrolled DM & Humid working conditions came out to be the main predisposing factors for ROCM. Facial pain is considered to be the most common presenting complain. Maxillary sinus is the most involved site.

Orbital Cellulitis: Defining Multidisciplinary Approach as the Need of the Hour.

The aim of the study is to determine epidemiological profile of cases admitted with suspicion of pre or post septal cellulitis and to define and evaluate the various factors associated with the aetiology, presentation, diagnosis and management of orbital and preseptal cellulitis via a one year study of ten cases presenting to a tertiary care hospital in western Rajasthan, India. All patients presenting to our department or being transferred from other departments to us with the diagnosis of pre/post septal cellulitis from the March of 2017 to February 2018 were considered for this case series. Data compilation of these patients was done which included age, sex, chief complain, duration of illness, associated co-morbidities, time of presentation, management plan undertaken and associated radiological findings. All these aspects were then evaluated. Our study included 10 cases. Of these 8 were less than 14 years and 2 were over 50 years. Both the adults were female and were positive for Diabetes Mellitus type two. 80% of these patients presented between the duration of November to February with maximum (40%) in the month of December. In 7 of these 10 patients, the cellulitis was associated with underlying sinusitis. Six patients were admitted directly from ENT OPD while other 4 were being managed in other ward before being transferred to us. All patients were managed conservatively except 1 who required surgical intervention. Pre/post septal cellulitis is a dangerous condition in which prompt intervention needs to be undertaken as it can be difficult to predict what course it will follow. Radiological evaluation should be done in all cases as most cases are associated with an underlying sinus infection. Also, it is more common in paediatric age group and the patient may initially be referred to an ophthalmologist or a paediatrician in which case it becomes very important that a good working interdepartmental collaboration be present so that correct management plan can be followed.