Epidemiology,Clinical Features and Management of Rhino Orbital Mucormycosis in Post COVID 19 Patients

COVID 19 infections may be associated with a wide range of bacterial and fungal co-infections. Mucormycosis is a fungal infection primarily affecting immunocompromised individuals. We have observed sudden rise of mucormycosis cases in post COVID 19 patients. Here we have reported 100 cases of mucormycosis associated with COVID 19. To study epidemiology and clinical features of rhino orbital mucormycosis in post COVID 19 patients. To evaluate efficacy of medical as well as surgical treatment in such patients. This was an observational mixed (retrospective + prospective) study with a duration of 2 months. After noting demographic data, necessary radiological investigation was advised and representative tissue was sent for KOH and histopathological examination. Medical and surgical treatment was planned accordingly. Most patients (55%) presented with complaint of headache and facial pain. Hard palate involvement was observed in 45% patients. Unilateral presentation (68%) was more common. Only 25% patients who presented early had normal vision. We reported 22 patients with complete loss of vision. Eye movements were restricted in 58% patients. Diabetes mellitus is most common predisposing factor (65%). 9 patients required orbital exentration. Only 18% patients required Amphotericin for more than 14 days. Immune dysregulation caused by COVID 19 infection in addition to widespread use of steroids and broad-spectrum antibiotics may lead to the development mucormycosis. Diabetes Mellitus type II is another important risk factor and the presence of both have additional effect in causing mucormycosis. Headache and facial pain should be considered highly suspicious of mucormycosis. Early diagnosis with efficient treatment can improve prognosis.     

Mucormycosis of nose and paranasal sinuses with orbital complication in young diabetic

A case report of mucormycosis of nose and paranasal sinuses with sudden loss of vision in a young diabetic with good recovery after endoscopic debridement, systemic and topical amphotericin B and control of Diabetes mellitus.     

Isolated Oculomotor Nerve Palsy: An Unusual Presentation of Glioblastoma Multiforme. Case Report and Review of the Literature

The authors present a case of a very unusual clinical presentation of an intra-axial supratentorial glioblastoma multiforme (GBM) in a 63 year old diabetic female patient presenting with a three week history of left progressive complete oculomotor nerve palsy. CT scan and magnetic resonance imaging of the head revealed a left intra-axial mesial temporal glioblastoma multiforme. Operative resection and microscopic examination of a tissue specimen confirmed the diagnosis. The nature of the tumor, the pattern of spread and the postulated mechanisms of such a presentation are discussed. The authors suggest including the diagnosis of GBM in the differential diagnosis of patients with isolated complete oculomotor nerve palsy at the appropriate age group.     

Isolierte Cerebrale Mucormykose bei Leukämie: Isolated Cerebral Mucormycosis in a Patient with Leukemia

Zusammenfassung: Mucormykosen stellen seltene Infektionen dar. Bei Diabetikern findet man vor allem die rhinocerebrale, bei immungeschwächten Patienten dagegen die pulmonale und disseminierte Form. Wir berichten über eine Patientin im Stadium der Vollremission einer akuten lymphatischen Leukämie, die klinisch an einer Meningo-Encephalitis mit Hirnnervenbeteiligung ohne bekannte Ätiologie verstarb. Bei der Obduktion zeigte sich eine Thrombosierung der Arteria vertebralis links, die durch eine Mucorinfiltration bedingt war und zu einer hämorrhagischen Erweichung im Kleinhirn und in der Medulla oblongata führte. Außer dieser cerebralen Mucormykose wurden keine weiteren Infektionsherde gefunden.
Summary: Mucormycosis is a rare infection. In patients with diabetes mellitus a rhinocerebral form predominates, while in the immunocompromised host mucormycosis is mostly pulmonary or disseminated. We report on a patient in remission of an acute leukemia, who died clinically of a meningo-encephalitis with involvement of cranial nerves of unknown etiology. At autopsy a thrombosis of the left arteria vertebralis caused by mucor was found with hemorrhagic necrosis of the cerebellum and the medulla oblongata. Except of this cerebral mucormycosis no further foci of infection were detected.     

Cranial irradiation in children with lymphoblastic acute leukemia: results and damages.

From 1973 to 1976, 81 children with lymphoblastic acute leukemia were treated with cranial prophylactic irradiation at the Istituto di Radioterapia “L. Galvani” dell'Universitá di Bologna. We divided the patients into 6 groups according to different characteristics. At the beginning of 1978 the survival rate was 82%; 60 patients (74%) were in complete continuous remission. We studied the encephalic post irradiation syndrome that is present in children over 2 years of age only when doses are higher than 2500 rad and in children under 2 years of age when doses exceed 2000 rad. This complication occurs frequently in the experience of other authors; however, it is absent under certain doses with which it is possible to obtain the same good results.We feel that among the different techniques and methods, the best radiological treatment is daily bilateral cranial irradiation for patients early in remission; we recommend doses of 2400 rad for children above 2 years of age and 1950 rad for those under 2 years.     

The Role of Prophylactic Cranial Irradiation in Patients With Extensive Stage Small Cell Lung Cancer: A Systematic Review and Meta-Analysis

Introduction

The role of prophylactic cranial irradiation (PCI) is controversial in patients with extensive stage small cell lung cancer. The aim of this study was to determine the impact of PCI in these patients.

Sphenoid Sinus Mucocoele and Cranial Nerve Palsies in a Patient with a History of Nasopharyngeal Carcinoma: May Mimic Local Recurrence

We report the case history of a patient with a sphenoid sinus mucocoele detected by computed tomography and medical resonance imaging. The patient had a history of nasopharyngeal carcinoma, which was treated by radiotherapy more than 10 years previously. He presented with bilateral twelfth and sixth cranial nerve palsies. Local tumour recurrence was suspected. Further investigations showed that the cranial nerve palsies were caused by radiation damage and the sphenoid sinus mucocoele was an incidental finding. Sphenoid sinus mucocoele is a possible rare late complication of radiotherapy in patients with nasopharyngeal carcinoma.     

手术治疗鼻咽癌放射性后组颅神经麻痹的严重吞咽困难——附15例经验

背景与目的:鼻咽癌放射性后组颅神经麻痹并发严重吞咽困难是放疗后的严重并发症之一,以言语不清、进食呛咳、吞咽困难和吸入性肺炎为主要表现,严重影响患者的生存质量,最终多因并发肺炎、恶病质死亡。该类患者的处理少见详尽的报道。为此,本研究探讨鼻咽癌放射性后组颅神经麻痹的严重吞咽障碍的外科治疗方式有效性及可行性。方法:选择1994年11月至2006年12月于中山二院耳鼻咽喉科治疗的鼻咽癌放射性后组颅神经麻痹的严重吞咽障碍的患者15例为研究对象,回顾性分析其临床资料、症状及体征、手术治疗方法和效果。结果:11例接受单程放疗者出现后组颅神经损害的严重吞咽困难的潜伏期为24～144个月,中位潜伏期60个月。4例再程放疗者潜伏期分别为6～36个月。舌下和迷走神经同时损伤最常见11例,其次为三对后组颅神经损伤3例、四对后组颅神经损伤1例。给予足量敏感抗生素控制吸入性肺炎后,进行手术治疗,包括12例局麻下经皮内镜下胃造瘘术和胃造瘘术,气管切开插管行全喉切除术2例和喉隔绝术1例。若有III度呼吸困难者行气管切开术。所有患者均于术后第二日经造瘘口进食顺利,1例患者出现造瘘口感染,经抗炎缓解。所有吸入性肺炎被治愈。术后患者生存质量均明显提高。结论:外科手术是治疗鼻咽癌放射性后组颅神经麻痹的严重吞咽困难的有效手段,经皮内镜下胃造瘘术或胃造瘘术值得推荐,早期及时治疗可以明显改善患者的生存质量。     

Parotidectomy: A Review of 112 Patients Treated at a Teaching Hospital in Pakistan

Objective: The purpose of this study was to analyze the clinical presentation, histopathology and complications following parotid surgery. Methods: We retrospectively reviewed the charts of 112 patients who underwent parotidectomy from January 2000 to February 2010. Data including age, sex, clinical signs and symptoms, histology and complication were collected from medical records. Results: Of the total, 82 (74%) had benign lesions, 30 (36%) had malignant tumors. The most common benign tumor was pleomorphic adenoma (57%), and the most common malignant tumor was mucoepidermoid carcinoma (16%). Analysis of the correlation between fine-needle aspiration cytology and final histology revealed that fine-needle aspiration sensitivity, specificity and accuracy to 86.6%, 97.56% and 94.64% respectively. The most common complication following parotidectomy was transient facial nerve palsy (18.7%). Conclusion: Superficial parotidectomy is associated with a decrease incidence of transient facial nerve dysfunction compared with that of total parotidectomy. High grade or advanced tumour is a predictor of poor outcome which may require adjuvant therapy.     

Double Primary Cancers in Extragastric Sites with Gastric Cancer: Report of Six Cases and Literature Review

OBJECTIVE To explore the clinical features, pathologic characteristics and prognosis of double primary malignant tumors with involvement of the stomach and an extragastric site. METHODS We reviewed the records of 496 patients who underwent surgery for gastric cancer in our department from January 2004 to December 2006. Synchronous double primary cancer was defined as an extragastric cancer diagnosed within a 6-month interval before the detection of gastric cancer; any gastric cancer metastasis to other areas of the body was excluded. RESULTS Synchronous and metachronous double primary cancers were identified in 1 and in 5 patients, respectively. The extragastric sites of the primary tumors in patients with gastric cancer were esophagus in 1 case, right colon in 1, rectum in 1, breast in 2 and lung in 1. Following gastric surgery, 5 patients died (within 2 mon, 24 mon, 30 mon, 48 mon and 60 mon). Only 1 patient has survived and remains disease free. CONCLUSION The prognosis of patients with gastric cancer and a second primary is relatively poor. It is necessary to perform regular esophagogastroduodenoscopy (EGD) on patients who have been diagnosed with extragastric cancer, regardless of their symptoms.     

食管癌颈部吻合术后喉返神经损伤24例分析

[目的]探讨食管癌颈部吻合术后喉返神经损伤的原因及其防治措施。[方法]对2005～2010年415例行食管癌颈部吻合术的患者资料进行回顾性分析,其中术后并发喉返神经损伤24例。[结果]24例喉返神经损伤包括22例单侧损伤和2例双侧损伤。喉返神经损伤与肿瘤T分期和TNM分期无关。颈段、胸上段食管癌患者较胸中段及下段食管癌患者易发生损伤（P〈0.05）;上纵隔淋巴结转移的食管癌患者较无淋巴结转移患者更易发生损伤（P〈0.05）。[结论]喉返神经损伤与肿瘤位置及上纵隔淋巴结转移相关。     

Mucormycosis of the Middle Ear: A Case Report with Review of Literature

Mucor is a saprophytic organism and commonly invades the nose and paranasal sinuses of immunocompromised and diabetic patients involvement of the middle ear and mastoid in a nondiabetic patients is very rare and this may be the first case report clinical presentation of ear pain with reference to the mastoid and upper neck may be the early symptoms unlike the foul smelling ear discharge as seen in atticoantral disease. Radical debridement in the form of M.R.M with or without the use of amphotericin B may suffice in non-diabetic patients this case is reported to highlight the point that mucormycosis can also involve middle ear and mastoid in nondiabetic patients.     

Comprehensive Review of Cranial Chordomas Using National Databases in the USA

AimsThe management of cranial chordomas is controversial. We provide a comprehensive review of the evolving patterns of care of cranial chordomas in the USA.Materials and methodsWe analysed the National Cancer Database (NCDB) and the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2014 for clinical characteristics and long-term survival, and the National Surgical Quality Improvement Program (NSQIP) dataset between 2005 and 2016 for perioperative characteristics and surgical morbidity.ResultsIn total, 936 patients were identified from the NCDB, 405 patients from SEER and 64 patients from the NSQIP. Most patients were men (56.2, 54.8 and 57.8% in NCDB, SEER and NSQIP, respectively) and White (80.9 and 83.2% in NCDB and SEER, respectively). Surgery was the preferred treatment modality (87.3% in NCDB and 86.2% in SEER). Surgery was carried out alone (41.8% in NCDB and 40.7% in SEER) or in combination with radiation (42.1% in NCDB and 45.4% in SEER). Proton therapy was the most common type of radiation (32.2% in NCDB), particularly after 2011. The median operative time, median hospital length and postoperative morbidity were significantly higher in chordoma patients compared with patients who underwent other skull-base procedures. The 5-year survival rate was 79.8% in NCDB and 76.9% in SEER. There was a trend towards longer survival in patients receiving surgery and radiation, which has been increasingly used since 2004. Patients younger than 60 years had a decreased risk of mortality.ConclusionsOur analysis reflects patterns of care in the USA. The use of surgery and radiation is increasing, with a trend towards longer survival. Surgery is complicated with long operative time, hospital stay and a higher rate of complications.     

Sintilimab-Induced Diabetic Ketoacidosis in a Patient with Radiation and Multichemorefractory Penile Cancer: A Case Report and Literature Review

Penile squamous cell carcinoma (PSCC) is a rare disease. The treatment options for advanced penile cancer are often limited, and the prognosis remains poor. We reported a 52-year-old male recurrent and metastatic PSCC patient with high PD-L1 expression (90%) and TMB (14.4 muts/Mb). He had undergone penectomy, bilateral inguinal lymph node dissection, and excision of the abdominal wall mass. Despite cisplatin-based concurrent chemoradiotherapy and sequential chemotherapy with docetaxel plus cisplatin then being carried out, the carcinoma still progressed. The patient then obtained progression-free survival with continuous sintilimab, although he experienced the new onset of ICI-induced diabetes after 24 cycles of sintilimab and required sustained insulin treatment. He had negative type 1 diabetes-associated autoantibodies and the susceptible HLA genotype DR3-DQ2 haplotype. This is the first patient with radiation and multichemorefractory PSCC who has obtained the remarkable anti-tumor effect of partial regression exceeding 32 months during continuous sintilimab and anlotinib treatment.     

Epistaxis Due to Leech Infestation in Nose: A Report of Six Cases and Review of Literature

The aim of this study is to report unusual cause of epistaxis due to leech infestation in nose in hilly area and its management. The study was carried out for a period of 4 years (2008–2012) in a secondary level hospital in hilly area of Darjeeling, West Bengal, India with data collected from the OPD and Emergency register of the patients. This retrospective case series consisted of six cases. All the cases presented with unilateral recurrent epistaxis and foreign body nose. Anterior rhinoscopy revealed fleshy greenish brown mobile mass inside the nasal cavity which was removed by forceps. The animate foreign body was identified as leech in all the cases. To conclude, in hilly areas leech infestation can present as animate foreign body in nose and it should be considered as important cause of epistaxis.     

Successful Treatment of Rhinocerebral Mucormycosis with Liposomal Amphotericin B and Surgery in Two Diabetic Patients with Renal Dysfunction

Abstract

The zygomycetes are a class of fungi that can cause a variety of infections in humans. Rhinocerebral mucormycosis is a rare disease and usually affects diabetic or immunosuppressed patients. The disease progresses rapidly and is usually fatal despite aggressive surgical and medical therapy. We report the management of two cases of rhino-sinusal and orbital mucormycosis in diabetic patients on treatment with corticosteroids, and mild renal impairment, successfully treated with a combination of aggressive surgical debridement and liposomal amphotericin B.     

Association of Delta-6-Desaturase Expression with Aggressiveness of Cancer,Diabetes Mellitus,and Multiple Sclerosis: A Narrative Review

Background: The phosphatidylinositol 3-kinase/ protein kinase B /mammalian target of rapamycin (PI3K/Akt/mTOR) signaling regulates multiple cellular processes and organizes cell proliferation, survival, and differentiationwith the available nutrients, in particular, fatty acids. Polyunsaturated fatty acids (PUFAs) are cytotoxic to cancer cellsand play a critical role in the treatment of multiple sclerosis (MS) and diabetes mellitus (DM). PUFAs are produced inthe body by desaturases and elongases from dietary essential fatty acids (EFAs), primarily involving delta-6-desaturase(D6D). D6D is a rate-limiting enzyme for maintaining many aspects of lipid homeostasis and normal health. D6D isimportant to recognize the mechanisms that regulate the expression of this enzyme in humans. A lower level of D6D wasseen in breast tumors compared to normal tissues. Interestingly, the elevated serum level of D6D was seen in MS andDM, which explains the critical role of D6D in inflammatory diseases. Methods: We searched databases of PubMed,Web of Science (WOS), Google Scholar, Scopus and related studies by predefined eligibility criteria. We assessedtheir quality and extracted data. Results: Regarding the mTOR signaling pathway, there is remarkable contributions ofmany inflammatory diseases to attention to common metabolic pathways are depicted. Of course, we need to have theinsights into each disorder and their pathological process. The first step in balancing the intake of EFAs is to preventthe disruption of metabolism and expression of the D6D enzyme. Conclusions: The ω6 and ω3 pathways are two majorpathways in the biosynthesis of PUFAs. In both of these, D6D is a vital bifunctional enzyme desaturating linoleic acidor alpha-linolenic acid. Therefore, if ω6 and ω3 EFAs are given together in a ratio of 2: 1, the D6D expression will bedown-regulated and normalized.     

Prediction of Cranial Radiotherapy Treatment in Pediatric Acute Lymphoblastic Leukemia Patients Using Machine Learning: A Case Study at MAHAK Hospital

Background: Acute Lymphoblastic Leukemia (ALL) is the most common blood disease in children and is responsible for the most deaths amongst children. Due to major improvements in the treatment protocols in the 50-years period, the survivability of this disease has witnessed dramatic rise until this date which is about 90 percent. There are many investigations tending to indicate the efficiency of cranial radiotherapy found out that without that, outcome of the patients did not change and even it improved at some cases. Methods: the main aim of this study is predicting cranial radiotherapy treatment in pediatric acute lymphoblastic leukemia patients using machine learning. Scope of this paper is intertwined with predicting the necessity of one of the treatment modalities that has been used for many years for this group of patients named Cranial Radiotherapy (CRT). For this purpose, a case study is considered at Mahak charity hospital. In this paper, our focus is on ALL patients aged 0 to 17 treated at Mahak hospital, one of the best centers for treatment of childhood malignancies in Iran. Dataset analyzed in this study is gathered by the research team from patient’s paper-based files. Our dataset consists of 241 observations on patients with 31 attributes after the data cleaning process. Our designed machine learning model for predicting cranial radiotherapy treatment in pediatric acute lymphoblastic leukemia patients is a stacked ensemble classifier of independently strong models with a meta-learner to tune the weights and parameters of the base classifiers. Results: The stacked ensemble classifier show highly reasonable performance with AUC of 87.52%. Moreover, the attributes are ranked based on their predictive power and the most important variable for CRT necessity prediction is the disease relapse. Conclusion: In order to conclude, derived from previous studies regarding CRT it is not only cost-effective but also more healthy to eradicate the use of CRT for the treatment of childhood ALL. Furthermore, it is valuable to increase the clinical databases by creating more synthetic health databases not only for research purposes but also for physicians to keep track of their patient’s status.