Quality of life in patients treated for COVID-19–associated mucormycosis at a tertiary care hospital

Objectives Coronavirus disease 2019 (COVID-19)–associated mucormycosis (CAM) has emerged as a formidable infection in patients with COVID-19. The aggressive management of CAM affects quality of life (QOL); thus, this study was designed to assess the QOL in patients with CAM at a tertiary healthcare institution. Methods This cross-sectional study of 57 patients with CAM was conducted over 6 months using a semi-structured standard questionnaire (the abbreviated World Health Organization Quality of Life questionnaire [WHO-BREF]) and a self-rated improvement (SRI) scale ranging from 0 to 9. Cut-off values of ≤52 and <7 were considered to indicate poor QOL and poor improvement, respectively. The correlations of QOL and SRI scores were evaluated using Spearman rho values. Results In total, 27 patients (47.4%; 95% confidence interval [CI], 34.9%–60.1%) and 26 patients (45.6%; 95% CI, 33.4%–58.4%) had poor QOL and poor SRI scores, respectively. The overall median (interquartile range) QOL score was 52 (41–63). Headache (adjusted B, −12.3), localized facial puffiness (adjusted B, −16.4), facial discoloration (adjusted B, −23.4), loosening of teeth (adjusted B, −18.7), and facial palsy (adjusted B, −38.5) were significantly associated with the QOL score in patients with CAM. Conclusion Approximately 1 in 2 patients with CAM had poor QOL and poor improvement. Various CAM symptoms were associated with QOL in these patients. Early recognition is the key to optimal treatment, improved outcomes, and improved QOL in patients with CAM

Identification and Role of Antimicrobial Susceptibility Patterns of Aerobic Bacteria in the Management of Refractory Chronic Suppurative Otitis Media – A Tertiary Hospital-based Retrospective Study

Objectives: This study identifies aerobic bacteria that cause refractory chronic suppurative otitis media (CSOM) and compares the treatment outcomes of patients treated with antibiotic sensitivity testing (AST) directed antibiotics against those treated with empirical antibiotics. Methods: This retrospective study was conducted at the departments of ENT and Microbiology, AIIMS, Patna. Data were collected from clinical and microbiological laboratory records of patients with complaints of persistent ear discharge from September 2018 to February 2020. Ear discharge samples were cultured and AST data from all patients were examined. Antibiotics were administered to those patients diagnosed with refractory CSOM based on their AST report. Patients were followed up, and their treatment responses were assessed and recorded. Data were analyzed by using IBM SPSS Statistics software Version 20.0. Descriptive analysis was performed and Pearson Chi-square tests were applied and p-values were determined to draw relevant conclusions. Results: A total of 90 patients were examined, of which 70 showed significant bacterial growth and were prescribed AST-directed antibiotics. The remaining 20 patients with insignificant growth were treated empirically. Common microorganisms isolated in our study were P. aeruginosa and S. aureus. Gram-negative and Gram-positive isolates were highly resistant to commonly used fluoroquinolones. Among intravenous (IV) formulations, piperacillin-tazobactam and cefoperazone-sulbactam had the highest sensitivity (&gt;80%) against Gram-negative isolates. There was a statistically significant (p &lt; 0.05) difference in cure rates between patients treated with AST-directed antibiotics (n = 54; 77.1%) and empirical therapy (n = 9; 45%). Route of antibiotic administration (oral versus IV) had no statistically significant effect on treatment outcomes (p &gt; 0.05). Conclusion: In the management of refractory CSOM, AST-directed antibiotic therapy is more effective than empirical treatment. Oral and IV antibiotics were equally effective when combined with aural toileting and ototopical antibiotics. Therefore, when treating such cases, AST-directed antibiotics should always be used to prevent widespread antibiotic resistance caused by injudicious antibiotic use

Study of bacteria and yeast pathogens causing sore throat in a tertiary care centre in Patna

Introduction- Sore throat is a common diagnosis in clinical practice and is mostly caused by viruses followed by bacteria and fungi. Proper management of sore throat depends on identification of the causative organism and judicious use of correct antimicrobials which is often ignored in daily clinical practice and is resulting in treatment failure and antimicrobial resistance. Healthy population carrying pathogenic organisms can be important source of sore throat, especially in the hospital environment. Aim- The objective of this study was to determine the profile and antimicrobial susceptibility pattern of bacteria and yeast pathogens causing sore throat and to evaluate the colonization of such pathogens in apparently healthy population. Materials and Methods- This prospective study was conducted for 2 years among 2 groups: cases (103 clinically diagnosed patients) and controls (42 individuals with no clinical diagnosis of sore throat). 145 pairs of throat swab samples were collected and processed for staining, culture and antimicrobial susceptibility testing. Statistical calculation was done using MS Excel sheet (V. 2007) Results- Adolescent and young adults (11-40 years) constitute majority of the cases i.e., 55.3% with an overall male predominance with a male:female ratio of 2.1:1. The causative organisms vary in different age groups with gram-positive organisms being the most prevalent among children and young adults. Most of the cases (53.4%) are seen in months between November to April, indicating a seasonal variation in the incidence of sore throat. Clinically significant isolates from cases like Staphylococcus aureus showed 100% sensitivity against vancomycin and linezolid. Group A Streptococci showed good sensitivity (>80%) against penicillin and ampicillin. Gram-negative isolates showed good sensitivity (>50%) against amikacin, piperacillin-tazobactam and imipenem. Neisseria gonorrhoeae showed good sensitivity against ceftriaxone (100%). Conclusion- Sore throat is needed to be treated by identifying the causative pathogen depending on the clinical and epidemiological profile of the patient. Surveillance of apparently healthy patient’s throat flora in the hospital environment may reduce the spread of such organism among susceptible population and contribute in hospital infection control practices

Smartphone Otoscopy Sans Attachment: A Paradigm Shift in Diagnosing Ear Pathologies

Objective To study the validity of smartphone otoscopy. Setting Ear, nose, and throat (ENT) outpatient clinic of a tertiary care hospital in eastern India. Study Design Experimental study design to compare the efficacy of smartphone otoscopy with otoendoscopes. Subjects and Methods One hundred tympanic membranes (TMs) of 50 patients were examined and photographed by third-year senior residents (6 years of ENT training) using a zero-degree otoendoscope. The same 100 ears were then examined using a smartphone. Assistive light of the phone was used to illuminate the ear canal. The camera of the phone was focused to visualize and photograph the TM. Results Compared with the gold-standard otoendoscopes, smartphones could correctly diagnose 75% of the cases. Sensitivity and specificity of smartphone otoscopy were 87.8% and 80%, respectively. Positive predictive value was 90.6%, whereas negative predictive value was 75%. Smartphone otoscopy could correctly diagnose 88.57% of normal TMs, 86.36% of retracted TMs, and 82.85% of perforated TMs. Conclusion This modality of “smart otoscopy” has no added cost and can be used by most doctors after minimal training. It is an excellent teaching tool and can be used universally even in resource-limited settings

Posterior fossa giant adenoid cystic carcinoma with skull base invasion mimicking glomus jugulare: A case report and review of literature

The author describes a rare case of giant adenoid cystic carcinoma (ACC) mimicking large paraganglioma with lower cranial nerve palsy. A 60-year-old female presented with a progressive increase in postauricular swelling with unilateral hearing loss, facial deviation, difficulty in swallowing, and hoarseness of voice. MRI brain showed highly vascular infiltrating and osteolytic mass suggestive of large glomus jugulare versus sarcoma. It was completely engulfing the jugular foramen and lower cranial nerves with bony erosion of the jugular foramen and occipital condyle. The whole mastoid was filled with the tumor. On digital subtraction angiography the majority of blood supply was from the occipital branch of the external carotid artery and vertebral artery. The patient underwent percutaneous embolization followed by external carotid ligation and resection of the mass. The postoperative course was uneventful. Histopathology was suggestive of mixed ACCs. The patient received radiotherapy. After 1 year of follow up no recurrence or distant metastasis was noted

Investigation of an acute surge of COVID-19 associated mucormycosis (CAM) cases reported to a tertiary health care institution in Bihar, India

Introduction: Acute surge in coronavirus disease-2019 (COVID)-associated mucormycosis (CAM) cases was reported during mid-May 2021, which was later declared an epidemic in various states of India including Bihar. Objective: We carried out a rapid investigation of CAM cases to describe the epidemiological and clinical profiles and find plausible predictors to guide the initiation of public health actions. Methods: A team of public health specialists contacted all the CAM cases reported to our hospital to collect relevant information using a case-investigation-form. In addition, the team visited the Flu Clinic and Ear, Nose, and Throat (ENT) outpatient department (OPD) to capture CAM cases on daily basis during the period of the acute surge of CAM cases. Results: About 88% of 130 CAM cases reported during the period of the acute surge were in the advanced stage of mucormycosis. The majority of the CAM cases were younger (less than 60 years) [76.2%], diabetics [65.4%], un-vaccinated [86.9%], and had used steroids for management of COVID-19 [64.6%]. Other findings of public health importance were summarized and possible public health actions were recommended for the prevention of outbreaks in future. Conclusion: Optimum management of diabetes including screening for each COVID case, rational use of steroids only when necessary, strict adherence to COVID appropriate behavior by health professionals as well as the public, increasing COVID vaccine coverage, CAM awareness, and setting up a CAM surveillance mechanism may be the key to prevent and control CAM outbreaks in future