Aditi Jhunjhunwala

Abstract

Background: Retinopathy of prematurity is a multi factorial vaso-proliferative disease that is the most common cause of preventable childhood blindness worldwide. This study aims to determine the frequency, clinical course and risk factors of ROP in premature infants treated in the Neonatal Intensive Care Unit (NNICU) of our hospital. Materials and Methods: In this retrospective observational study the case records of 243 infants who visited our ROP clinic between January 2020 and august 2021 were reviewed. Observation: The mean GA was 33.4 weeks and the mean birth weight was 1.3 kg. A total of 55 (22.82%) patients developed ROP. low birth weight (p value = Conclusion: Our study shows less gestational age, low birth weight and supplemental oxygen along with sepsis as biggest risk factor for development of ROP in our set –up and multiple pregnancy for severity. Keywords: ROP, Prematurity, Oxygen, Low GA, Sepsis

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Abstract

Background: The second wave of covid 19 in our country has seen rhino orbital cerebral mucormycosis reach an epidemic level. It is an opportunistic fungal infection with high morbidity and mortality. Objective: This study aimed to determine the patient’s demographics, risk factors, symptoms and signs, treatment and the outcome at our tertiary care centre. Materials and Methods: In this retrospective observational study the case records of 43 patients with biopsy/culture proven invasive rhino-orbital mucormycosis who were admitted in the post covid phase between May 2021 and July 2021 were reviewed. Observation/Result : Mean age was 52.4 years with 65.11% of patients being male. 83.7% belonged to the rural background. 37 (86.05%) had history of diabetes while 25 (58.15%) used steroids and only 13 (30.23%) patients needed oxygen. Only 3 (6.97%) had RBS below 200mg/dl with 2 patient showing HbA1C level below 6.4. All patients had proptosis and ptosis while only 28 had chemosis and 26 had loss of vision. Chemosis showed significant association in our study with HbA1c with significant p value of 0.000126. and loss of vision showed a significant association with steroid use (p value 0.03) and oxygen requirement (p value 0.008). All the patients had involvement of orbit. Treatment included IV liposomal amphotericin B in all patients, Retrobulbar amphotericin B and endoscopic orbital debulking in. Significant improvement was seen in patients with stage >3b with Retrobulbar amphotericin B and orbital debulking. Conclusion: Patients with rhino orbital mucormycosis can be managed with orbital debulking with perilesional, intralesional and Retrobulbar amphotericin B with IV amphotericin B and functional endoscopic sinus surgery to avoid distressing surgery like exenteration.   Keywords: Retrospective, Epidemiology, Clinical, Management, Mucormycosis

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Abstract

Aim: Rhino orbital cerebral mucormycosis is an opportunistic fungal infection with high morbidity and mortality which has seen the rise during the second wave of covid 19 in our country. Aim of our study was to study the clinical course, diagnosis and management of patient of rhino orbital mucormycosis in post covid phase presenting at our tertiary care centre. Materila and Methods: 4 cases of rhino-orbital mucormycosis who presented to us in post covid phase was followed and details recorded and analyzed to study its clinical course, diagnosis and management. Observation: 4 patients presented to us in post covid phase with signs of orbital cellulitis like periorbital swelling with pain, drooping of eyelids, proptosis, restriction of extraocular movements, decrease and loss of vision and sluggish reacting pupil. MRI/CT of the patients showed intraconal and extraconal involvement suggestive of orbital cellulitis. Diagnostic Nasal Endoscopy (DNE) was done and tissue sent for KOH mounting, culture and histopathology. After KOH mount showed fungal hyphae, patients were started on IV liposomal amphotericin B and retrobulbar amphotericin B. Patients were then taken up for endoscopic debridement and significant improvement in proptosis, ptosis, peribulbar swelling and pain was seen in immediate post op period. Conclusion: significant improvement was seen in patients with IV amphotericin B, retrobulbar amphotericin B and endoscopic debridement. Key Message: Patients with rhino orbital mucormycosis can be managed with amphotericin and endoscopic debridement when exenteration is not possible.   Keywords: Clinical course, Covid ­19, Fungal infection, Mucormycosis

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