Ectopic Supernumerary Tooth as a Nidus for Rhinolith Formation

Rhinolith is a calcified irregular mass around an exogenous or endogenous nidus. Factors responsible for the formation of rhinolithare chronic inflammation around nidus, deposition of mineral salts and enzymatic activity of bacterial pathogens. We report the caseof a 53-year-old patient with a hard radio-opaque mass in the nasal cavity and complaints of nasal obstruction and foul-smelling nasaldischarge. On imaging, it was found out to be formed around an ectopic single cusp tooth in the nasal cavity and which is rarest.Endoscopic removal was performed and the patient was relieved and asymptomatic after the procedure. Hence, endogenous etiologyof the ectopic supernumerary tooth should be kept in mind

Upregulation of Psoriasinin Cholesteatoma associated with inflammation, bone destruction and severity of disease: Histo-cyto-chemical and ultrastructural studies

624-631Cholesteatoma remains a mystery and the factors triggering and propagating it unknown. This study was aimed to evaluate the role of Psoriasin and pro-inflammatory cytokines in progression of middle ear cholesteatoma. In this study 18 patients (12 cases of cholesteatoma and six cases of posterosuperior retraction pocket (PSRP) without cholesteatoma) were included in the study. Clinical aggressiveness was evaluated on-table under operative microscope by evaluating erosion of ossicles, invasion of surrounding structures. The classification of disease was also based on the radiological (CT-scan) findings. Based on clinical aggressiveness, the cholesteatoma cases were divided into mild, moderate, and severe. The tissues were processed for histopathological, ultrastructural and immunohistochemical analysis. The Psoriasin expression in cholesteatoma tissues was significantly higher (P< 0.05) compared to the PSRP tissue and increased with the increasing severity of the disease. The pro-inflammatory cytokines (IL-6 and IL-1β) were also upregulated along with vascular endothelial growth factor and Matrix metalloproteinase-13 in cholesteatoma cases compared to control. Transmission Electron Microscopic images of ultra-thin sections of the tissues showed numerous secretory vesicles, most likely containing cytokines and a unique ultrastructural feature of bacterial localization within the membrane pocket was seen, which gave direct evidence of bacterial infection in the middle ear cholesteatoma

Mucormycosis in COVID-19 Patients: A Case-Control Study

(1) Background: During the second wave of COVID-19, India faced a rapid and sudden surge of not only COVID19-delta variant cases but also mucormycosis, making the infection even more fatal. We conducted a study to determine factors associated with the occurrence of mucormycosis in patients with COVID-19. (2) Methods: This case&ndash;control study comprised 121 patients; 61 cases (mucormycosis with COVID-19) and 60 controls. Patients were included from April 10, 2021 onwards. Follow-up was conducted after about 90 days and health status was recorded based on the modified Rankin Scale (mRS). (3) Results: Mucormycosis with COVID-19 cases had a median (IQR) age of 49 (43&ndash;59) years with 65.6% males and were older (95% CI 1.015&ndash;1.075; p = 0.002) than in the control group with median (IQR) 38 (29&ndash;55.5) years and 66.6% males. Baseline raised serum creatinine (OR = 4.963; 95% CI 1.456&ndash;16.911; p = 0.010) and D-dimer (OR = 1.000; 95% CI 1.000&ndash;1.001; p = 0.028) were independently associated with the occurrence of mucormycosis in COVID-19 patients. Additionally, diabetes mellitus (OR = 26.919; 95% CI 1.666&ndash;434.892; p = 0.020) was associated with poor outcomes and increased mortality in patients with mucormycosis with COVID-19 as per the multivariable analysis. A total of 30/61 mucormycosis patients had intracranial involvement. (4) Conclusions: The study observed elevated levels of baseline raised creatinine and D-dimer in mucormycosis pa-tients with COVID-19 as compared to the control group. However, future studies may be conducted to establish this cause&ndash;effect relationship