IMAGING IN RHINOCEREBRAL MUCORMYCOSIS

Corona epidemic has brought many infections to the fore one of these is mucormycosis. It is a fungal disease which occurs in patients with underlying conditions such as diabetes, malignancies, patients who have undergone organ transplantation and patients on long term steroid administration are susceptible to mucormycosis. Infection commonly occurs through inhalation of fungal spores from air. Mucormycosis is not contagious, that is it does not spread from one person to another. Recently, several patients have reported to hospital around the 3rd week after onset of symptoms of COVID-19 with features suggestive of sinonasal disease. It is suspected that the increase in number of cases of mucormycosis in these patients is possibly due to misuse or overuse of steroids that leads to uncontrolled hyperglycemia. Some clinicians have suggested that use of industrial oxygen instead of medical oxygen, unhygienic humidiers, prolonged ICU stay and unwarranted administration of antibiotics may have predisposed the patients to develop mucormycosis. The diagnosis and treatment is based on imaging by CT Scan and MRI. Here we describe imaging ndings in patients of rhinocerebral mucormycosis presenting to department of Radiodiagnosis.

Comparative Outcomes by Surgical Approach in Patients with Malignant Sinonasal Disease

Objective There is a paucity of data on comparative outcomes for open versus endoscopic surgery for patients with malignant sinonasal pathology. Most of the available studies are limited by a sample size <100 patients. Design This is a retrospective cohort study. Setting The findings of this study come from a single-institution tertiary care center from 2008 to 2019. Participants In total, 199 patients who underwent surgery for malignant sinonasal disease participated in this study. Main Outcome Measures The main outcome measures were perioperative complications and reoperation. Results Patients in our sample had a mean age of 59.7 years (SD, 20.4). In total, 62% were male and 72% were white. An endoscopic-only approach was used in 41% of patients and an open or combined approach in 59% of patients. Squamous cell carcinoma was the most common pathology (43.0%), followed by sarcoma (9.5%), skin cancer (6.5%), sinonasal undifferentiated carcinoma (6.5%), and adenocarcinoma (5.5%). The all-cause complication rate was 14.6%. Patients with an open resection had a higher rate of intraoperative complications (5.9 vs. 0%; p = 0.043), postoperative complications (19.5 vs. 3.7%; p = 0.001), and all-cause complications (21.0 vs. 3.7%; p < 0.001). The likelihood of early reoperation (<6 months) or late reoperation (>6 months) did not significantly differ by surgical approach (p = 1.000 and 0.741, respectively). Conclusion The endoscopic approach for resection of malignant sinonasal disease is viable for select patients and may be associated with a favorable complication rate compared with the open approach.

Removal of an Extensive Nasal Polyp in a Standing Horse, Using a Direct Approach to the Nasal Cavity Through a Bone Flap

Nasal polyps are not very common in horses, comprising of just about 2,5 % of equine sinonasal disease (Tremaine and Dixon, 2001). However, nasal polyps can develop into extensive masses, obstructing partially or totally air flow thus giving dramatic clinical presentations. The aim of this report was to present a surgical technique used to successfully remove a massive nasal polyp in a standing mare. A 9 year old mixed-breed mare was referred to the equine teaching hospital of the Faculty of Veterinary Medicine in Cluj –Napoca for the evaluation of an extensive, unilateral nasal mass. Upon inspection, a cauliflower-appearing mass was protruding from the right nostril. A decision was made to try to surgically remove the mass using a direct approach through a nasal bone flap. Classic approach through the opening of the nostril was impossible due to the extent of the mass. The surgery was performed with the mare standing under sedation and regional anesthesia. The mass was approximately 30 cm by 7 cm and was described histologically as a nasal polyp. The mare made a full recovery, and there was no recurrence in the next three years after surgery.

Olfactory Impairment Among Rural-Dwelling Chinese Older Adults: Prevalence and Associations With Demographic, Lifestyle, and Clinical Factors

Objective: Olfactory impairment (OI) refers to decreased (hyposmia) or absent (anosmia) ability to smell. We sought to estimate the prevalence and correlates of OI among rural-dwelling Chinese older adults.Methods: This population-based cross-sectional analysis included 4,514 participants (age ≥65 years; 56.7% women) from the Multidomain Interventions to Delay Dementia and Disability in Rural China (MIND-China). The 16-item Sniffin' Sticks identification test (SSIT) was used to assess olfactory function. Olfactory impairment was defined as the SSIT score ≤10, hyposmia as SSIT score of 8–10, and anosmia as SSIT score &lt;8. Multivariable logistic regression models were used to examine factors associated with OI.Results: The overall prevalence was 67.7% for OI, 35.3% for hyposmia, and 32.5% for anosmia. The prevalence increased with age for OI and anosmia, but not for hyposmia. The multivariable-adjusted odds ratio (OR) of OI was 2.10 (95% CI 1.69–2.61) for illiteracy and 1.41 (1.18–1.70) for elementary school (vs. middle school or above), 1.30 (1.01–1.67) for current smoking (vs. never smoking), 0.86 (0.74–0.99) for overweight and 0.73 (0.61–0.87) for obesity (vs. normal weight), 4.21 (2.23–7.94) for dementia, 1.68 (1.23–2.30) for head injury, and 1.44 (1.14–1.83) for sinonasal disease. Illiteracy in combination with either male sex or diabetes was significantly associated with an over two-fold increased OR of OI (p for interactions &lt;0.05).Conclusion: Olfactory impairment is highly prevalent that affects over two-thirds of rural-dwelling older adults in China. OI is correlated with illiteracy, current smoking, dementia, head injury, and sinonasal disease, but negatively associated with overweight or obesity. Olfactory impairment as a potential clinical marker of neurodegenerative disorders among older adults deserves further investigation.

Visual analogue score and endoscopic domain analysis to assess the outcome of microdebrder in sinonasal diseases

<p class="abstract"><strong>Background: </strong>The use of microdebrider in various sinonasal diseases have been sparingly understood. The present study aims to find out the effectiveness of a microdebrider in different sinonasal diseases by using each domain of visual analogue scale (VAS) and confirming the findings by diagnostic nasal endoscopy.</p><p class="abstract"><strong>Methods: </strong>A prospective observational study was done among patients with sinonasal disease between January 2019 to March 2020 in our tertiary care hospital. A subjective visual analogue scale (VAS) was completed by every patient for all domains according to Lund and Mackay symptom scoring system. Using Lund Kennedy scoring, polyp, edema and discharge were assessed preoperatively. Patients were followed up for 1 week, 6 weeks and 3 months. At 3 months both VAS and Lund Kennedy scoring was done. Post operatively scarring and crusting were assessed separately.</p><p class="abstract"><strong>Results: </strong>There was a significant improvement in domains post operatively in all the diseases considered (p=0.001). In Lund Kennedy endoscopic scoring system there was significant improvement in all the domain that was taken into consideration (p=0.001). Inter-disease domain comparison was also made.</p><p class="abstract"><strong>Conclusions:</strong> The study substantiates the use of microdebrider in various sinonasal disease. Microdebrider being a modern multipurpose instrument plays a significant role in complete clearance of the disease with good postoperative outcome.</p>