A case of hoarseness of voice following COVID-19 infection

Mucormycosis is a fatal angio-invasive fungal infection associated with a high mortality. Apart from the traditional risk factors, COVID-19 infection and steroid therapy for the same have been recently identified to predispose to this life-threatening infection. Usual presentations of mucormycosis include rhino-orbito-cerebral, pulmonary, gastrointestinal, renal and cutaneous involvement. We report an unusual case of mediastinal involvement by mucormycosis in a patient recovering from moderate COVID-19 pneumonia. Early diagnosis, prompt initiation of antifungal therapy accompanied by timely surgical debridement were pivotal in averting morbidity and mortality in this patient

Flexible bronchoscopic insertion of self-expanding metal stents in malignant tracheal lesions without fluoroscopic guidance

Background: Self-expanding metal stents (SEMS) are a well-accepted treatment modality for malignant tracheobronchial obstruction or malignant tracheoesophageal fistulae (TEFs). The traditional approach to SEMS insertion in central airway obstruction (CAO) has been rigid bronchoscopy performed under general anesthesia. Fluoroscopic guidance is sometimes utilized. Safe and accurate placement of tracheobronchial SEMS has also been described using flexible bronchoscopy. We herein describe our experience with tracheal SEMS insertion using flexible bronchoscopy without fluoroscopic guidance. Methods: A retrospective analysis of the bronchoscopy records was undertaken for the duration June 2012 to June 2014. Patients with malignant CAO or malignant TEF who underwent tracheal SEMS insertion using flexible bronchoscopy were included. Procedures were performed under mild sedation. Fluoroscopic guidance was not utilized. Results: Eleven patients were identified. The mean age was 60.9 (12.8) years. There were 6 males and 5 female patients. Most common indication for tracheal SEMS was CAO (9/11) followed by TEF (2/11). Stent deployment could be accomplished successfully and at the desired location in all the patients. All patients reported immediate symptomatic relief. Two patients experienced peri-procedural respiratory failure that recovered within 24 h. There was no procedure related mortality or other major complications. Conclusion: Insertion of tracheal SEMS in patients with malignant CAO/TEF using flexible bronchoscopy under minimal sedation is a safe and efficacious modality that can be performed without fluoroscopic guidance

Fractional exhaled nitric oxide is a useful adjunctive modality for monitoring bronchial asthma

Background and Objective: To evaluate the utility of fractional exhaled nitric oxide (FeNO) in monitoring asthma control. Materials and Methods: Steroid naïve nonsmoking asthmatics were recruited and followed for 6–8 weeks on standard treatment. Serial measurements of FeNO, peak expiratory flow rate (PEFR) variability, forced expiratory volume in 1 s (FEV1), bronchodilator reversibility (BDR), and asthma control test (ACT) score were measured at baseline and after 6–8 weeks of treatment. Results: One hundred and fifty-one patients were recruited over an 18-month period. These comprised 79 males (52.3%) with mean (standard deviation) age of 34.2 (11.6). Mean (SD) FeNO levels at baseline and after therapy were 45.4 (35.9) and 38.4 (23.7) ppb, respectively (P = 0.01). Baseline FeNO correlated strongly with FEV1 (r = −0.78, P < 0.001), ACT score (r = −0.76, P < 0.001), PEFR variability (r = −0.74, P < 0.001), and moderately with BDR (r = 0.50, P < 0.001). After treatment with inhaled steroids, the correlation remained strong with ACT score (r = −0.68, P < 0.001) but weakened with PEFR variability (r = −0.34, P = 0.01) and FEV1 (r = −0.36, P = 0.01). Conclusions: FeNO may be useful as an adjunctive noninvasive modality to assess asthma control in both steroid naïve asthmatics and asthmatics on treatment. However, the suboptimal sensitivity and specificity may limit its utility as a point-of-care single monitoring tool