Spotlight on the Mucormycosis Outbreak: A Deadly Fungal Infection That Followed the COVID-19 Pandemic.

BACKGROUND: The COVID-19 pandemic along with its treatment has brought myriad potential complications including the heightened risk of secondary fungal infections like mucormycosis. Mucormycosis is a rare angioinvasive fungal infection that has traditionally been highly fatal despite surgical intervention and antifungal medications. AIM: To re-evaluate the risk factors, epidemiology, and possible COVID-19-associated conditions on a larger sample size than the existing data. METHODOLOGY: We studied the possible risk factors, clinical presentations, treatment, and outcome of 203 patients with mucormycosis in a single-center retrospective-prospective observational study for three months at a tertiary care hospital after obtaining due permission from the institutional ethics committee. RESULTS: The mean age of patients was 52 ± 11.5 years, and 92.61% had a history of COVID-19 infection. Around 86.7% of patients were suffering from diabetes mellitus with 50% being already known cases whereas the other 50% developed post-COVID-19 infection; 65.02% of patients were administered corticosteroids during their COVID-19 treatment. About 51.72% of patients required hospital admission and among them, 16.25% of patients required ICU support. The mean oxygen saturation (SpO2) levels on admission were 84.61 ± 12.96%, and 38.92% of patients required mechanical respiratory support. The mean duration between COVID-19 infection and the onset of mucormycosis was 18.80 ± 16.61 days. The most common clinical presentations were facial pain and swelling (26.6%) and ophthalmic symptoms including eye swelling, pain, and ptosis (25.12%). Antifungal treatment was given to all the patients and 89.36% of the patients underwent surgical debridement of fungal mass. At the end of three months, 60.59% of the 188 patients survived with improvement, 13.30% had no improvement and/or deterioration of health, and 18.72% succumbed to mucormycosis. Intracranial involvement and leukocytosis were positively associated with mortality whereas surgical intervention was significant for positive outcomes at the end of three months in patients with mucormycosis (p<0.05). CONCLUSION: The sudden rise of mucormycosis during the second wave of COVID-19 can be attributed to uncontrolled blood sugar levels along with high corticosteroid usage as well as various nosocomial factors during the COVID-19 treatment. Early and aggressive treatment with surgical intervention and antifungal drugs can improve disease outcomes.

Sinonasal Inverted Papilloma: A Narrative Review.

Inverted papilloma (IP) is a relatively rare sinonasal benign lesion, peculiar in its etiology, clinical presentation and treatment. Its resemblance to other sinonasal pathologies and varied approaches, makes it an interesting disease. Recently there have been several advances in the management of IP. This article aims to summarize the contemporary developments thus enabling the readers to understand the years of research behind IP. To integrate the available literature on IP and study the current scenario in its management. A comprehensive literature review was done on Google Scholar and PubMed database using the following key words: "inverted papilloma", "Schneiderian", "sinonasal", "medial maxillectomy". Articles published in English were used. Articles published till May 2020 were reviewed. Years of research have aimed to gain more information regarding the epidemiology, histopathology, staging systems and surgical management of IP. To briefly summarize the research so far, it is safe to say that there exists an association between Human Papilloma Virus and IP. The Krouse staging system is the most commonly used. The treatment itself has changed from a conservative approach to a more aggressive excision with or without external approach and with or without chemoradiotherapy. In IP, whether or not associated with SCC, complete surgical removal of the tumour is advocated as the treatment of choice. With the advancements in endoscopic technique, surgeons have been using it to their advantage for the surgical evaluation and cure of IP, depending upon the stage. Endoscopic treatment is preferred, whereas for lesions less accessible endoscopically, or in those with peripheral extension, open surgery is indicated. Every patient requires counselling before discharge and thorough examination during the follow-up to detect any evidence of recurrence.

A Review on Esthesioneuroblastoma.

Background Esthesioneuroblastoma (ENB) is a rare, aggressive and malignant sinonasal tumour. This tumour makes for a very interesting study because ever since its mention in medical literature, although quite a lot of research has been put into it, a lot is yet to be known about it. Aim To summarize the available literature & document an article on the contemporary practises in the management of ENB. Methods A comprehensive literature review was done using Google Scholar and PubMed database with the key words: "esthesioneuroblastoma", "olfactory neuroblastoma", "Kadish" and "Hyams". Articles published in English were used. Articles published till April 2021 were reviewed. Conclusion ENB has a diverse histological appearance. This tumour has a bimodal age distribution without any gender predilection. Prompt identification and treatment is required for a favourable outcome and requires close collaboration of radiology, pathology, and rhinology. Staging, management and prognosis are determined by regional involvement in non-metastatic cases due to its proximity to neurological structures and locally destructive nature. Immunohistochemistry is a must for accurate diagnosis. Uni-modality of treatment has high chances of local recurrence. Multi-modality provides good results even in advanced stage. A combination of surgery and radiotherapy seems to be the optimum approach to treatment. The exact role of chemotherapy in treatment protocols is still unclear. Cervical lymph node metastases are commonly studied, however its management in patients who present without apparent nodal involvement is not yet clear. An extended follow-up period is recommended in all patients of ENB patients.

Occult Primary with Cervical Secondary-Role of CT Scan and Evaluation Under Anesthesia.

The potential of CT, MRI or both to detect a primary tumor ranges from 9.3 to 23% rising to 60% when suspicious radiological findings direct subsequent endoscopic biopsies (Zhuang et al. in Mol Clin Oncol 2:917-922, 2014). Prospective case Study. To know the sensitivity, specificity accuracy rate and P value of CT scan and upper aero digestive tract endoscopy with palpation of nasopharynx and oropharynx to search the primary site of cancer. 53 patient of occult primary with FNAC proved metastatic squamous cell carcinoma were evaluated to find out the sensitivity, specificity, accuracy rate and P value of imaging study and rigid endoscopic examination of upper aero digestive tract with through palpation of oropharynx, nasopharynx and evaluation under anesthesia (EUA). Punch biopsies were taken from suspicious areas and sent for histopathology examination (HPE). Taking HPE as a gold standard (Ishak et al in Rawal Med J 35:209-213, 2010) sensitivity of both EUA and imaging was found to be 100%, Specificity and diagnostic accuracy of EUA and imaging were 96.77, 83.87, 98.11 and 90.57% respectively. P value was <0.0000001 which is highly significant.