Debridement Of Necrotic Tissue Research Articles

Use of Ultra-high-frequency Ultrasound for Aplasia Cutis Congenita of the Scalp.

Summary:Aplasia Cutis Congenita (ACC) in the scalp is a rare congenital malformation. The treatment for ACC with large defects involving the scalp, bone, and the dura is challenging. Local debridement of necrotic tissue is important to prevent lethal complications such as infection and meningitis. However, debridement has the risk of damaging the sagittal sinus or the dura. Recent developments in ultra-high-frequency ultrasound(US) systems provide frequencies of 70 MHz and capability resolution as fine as 30 μm, which could allow precise imaging of small and thin anatomical structures. The study aimed to describe the methods of precise evaluation of the defect in the scalp and safe debridement using ultra-high-frequency US. This is the first report on direct observation of a newborn’s brain using ultra-high-frequency US. The boy was delivered spontaneously with a large defect of the scalp and bone. After 14 days, due to signs of infection, local debridement was performed carefully under ultra-high-frequency US-based evaluation. The dura, the sagittal sinus, and the small anatomical structures such as arachnoid granulations could be observed. Because the brain herniation gradually aggravated, dural reconstruction using fascia lata and scalp reconstruction using transposition flap was performed. Finally, good skin coverage over the defects was obtained. This method minimizes the risk of damaging the sagittal sinus and the brain parenchyma, which may cause fatal complications. Although further clinical investigations will be required to confirm its efficacy, ultra-high-frequency US has the potential to be a useful device for ACC treatment.

1479 Trench Foot: A Rare and Unusual Presentation of a World War I Disease

Abstract Introduction 'Trench foot' is a serious disorder of the lower limb, involving damage to the skin, nerves, and muscle, previously described in World War I soldiers during trench warfare. We present a rare and unusual case of ‘trench foot' sustained at home in a 20-year-old female. Case Report A 20-year-old woman presented to the Plastic Surgery department with pain and numbness affecting both feet, following failed trials of antibiotics. She managed her symptoms at home by immersing her feet in ice baths for 18-23 hours per day. She was tachycardic with raised inflammatory markers. Examination revealed breakdown of the skin bilaterally, with full thickness eschar. MRI showed extensive subcutaneous oedema and myositis. Initial surgical plan consisted of antibiotics and debridement of necrotic tissue with a view to grafting the skin later. Intra-operative findings included necrosis of the subcutaneous tissues and muscles. The patient deteriorated post-operatively with sepsis and underwent urgent Guillotine-style bilateral amputations. She was discharged home 18 days later. Discussion 'Trench foot' can be mistaken for soft tissue infections or frostbite. It is attributed to vasoconstriction followed by neurovascular changes and repeated cycles of thawing and freezing, acquired above freezing temperatures, unlike frostbite which occurs below freezing temperatures. The patient was initially reviewed by non-specialist teams without a clear diagnosis and sustained more pervasive tissue destruction than was originally apparent on examination. Prevention remains the best cure for ‘trench foot'. It is therefore important to familiarise ourselves with this rare disease. Where prevention or early detection is not possible, amputation can reduce the morbidity and mortality of the ensuing sepsis.

Early the diagnosis, intervention and treatment is key for Covid-19 induced Mucormycosis

The novel corona virus (COVID-19) outbreak declared as a global pandemic. Glucocorticoids are inexpensive, widely available, and have been shown to reduce mortality in hypoxemic patients with COVID-19. With increasing risk of new strains of covid virus infections and now the latest dreadful fungal infection Mucormycosis, the situation is becoming more and more devastating. Survival in mucormycosis depends on early diagnosis, alleviation of basic predisposing factors, aggressive debridement of necrotic tissues, and appropriate systemic antifungal agents.

Cerium(III) Nitrate Containing Electrospun Wound Dressing for Mitigating Burn Severity.

Thermal injuries pose a risk for service members in prolonged field care (PFC) situations or to civilians in levels of lower care. Without access to prompt surgical intervention and treatment, potentially salvageable tissues are compromised, resulting in increases in both wound size and depth. Immediate debridement of necrotic tissue enhances survivability and mitigates the risks of burn shock, multiple organ failure, and infection. However, due to the difficulty of surgical removal of the burn eschar in PFC situations and lower levels of care, it is of utmost importance to develop alternative methods for burn stabilization. Studies have indicated that cerium(III) nitrate may be used to prolong the time before surgical intervention is required. The objective of this study was to incorporate cerium(III) nitrate into an electrospun dressing that could provide burst release. Select dosages of cerium(III) nitrate were dissolved with either pure solvent or polyethylene oxide (PEO) for coaxial or traditional electrospinning set-ups, respectively. The solutions were coaxially electrospun onto a rotating mandrel, resulting in a combined nonwoven mesh, and then compared to traditionally spun solutions. Dressings were evaluated for topography, morphology, and porosity using scanning electron microscopy and helium pycnometry. Additionally, cerium(III) loading efficiency, release rates, and cytocompatibility were evaluated in both static and dynamic environments. Imaging showed randomly aligned polymer nanofibers with fiber diameters of 1161 ± 210 nm and 1090 ± 250 nm for traditionally and coaxially spun PEO/cerium(III) nitrate dressings, respectively. Assay results indicated that the electrospun dressings contained cerium(III) nitrate properties, with the coaxially spun dressings containing 33% more cerium(III) nitrate than their traditionally spun counterparts. Finally, release studies revealed that PEO-based dressings released the entirety of their contents within the first hour with no detrimental cytocompatibility effects for coaxially-spun dressings. The study herein shows the successful incorporation of cerium(III) nitrate into an electrospun dressing.

Post COVID-19 invasive mucormycosis and actinomycosis co-infection: a case report

<p>Actinomyces are commensals of human oropharynx and actinomycosis is considered mainly as an endogenous infection that is triggered by a mucosal lesion. Typically, the disease presents as a slowly progressive painless indurated mass evolving into multiple abscesses with draining sinus tracts sometimes expressing a typical yellow exudate with characteristic sulfur granules. The gold standard of diagnosis is histological examination and bacterial culture of the tissue. Most isolates are susceptible to beta lactams and they are the treatment of choice along with surgical management with drainage of abscesses and excision of recalcitrant fibrotic lesions and debridement of necrotic bone tissue. Here we present a case of 37-year-old male patient who has developed severe COVID-19 infection following which he developed invasive mucormycosis followed by actinomycosis. We postulate that the lymphopenia and the use of immunosuppressants used in treatment of COVID-19 lead to mucormycosis and aggressive debridement used as a strategy in treatment of mucormycosis led to colonization of actinomyces leading to cervicofacial actinomycosis.</p>

“Mucormycosis” The Emerging Global Threat – A Complete Review

Mucormycosis is a life-threatening invasive fungal infection that affects people who are immunocompromised (haematological malignancies, solid organ transplantation, diabetes mellitus). Pulmonary, rhinocerebral, cutaneous, and disseminated infections are the most common. Controlling mucormycosis requires reversing the underlying problems. Treatment for mucormycosis also includes quick and vigorous surgery. Extensive surgical debridement of necrotic tissues is required. Finally, an antifungal treatment is required. High-dose liposomal amphotericin B (5 mg/kg/day) is the first-line treatment for mucormycosis. Antifungal chemotherapy has no set length; instead, it is determined by the remission of all related symptoms and results (usually 6-8 weeks). Posaconazole maintenance therapy/secondary prophylaxis should be recommended in patients who have a persistently weakened immune system. Keywords: Mucormycosis, Diabetes mellitus, Liposomal Amphotericin B.

Mucormycosis: time to address this deadly fungal infection

Mucormycosis: time to address this deadly fungal infection

An Electrospun Poly-Ethylene Oxide/Cerium (III) Nitrate Dressing for Delayed Debridement and Improved Wound Healing of Warfighter Contact Burns

Introduction: Thermal burns account for 5-10% of casualties sustained in present-day conflicts and are expected to be one of the most common wounds to occur in future conflicts. Timely debridement of necrotic burn tissue can greatly reduce the chances of mortality and late-stage complications. However, future conflicts are anticipated to occur in austere environments where surgical debridement may not be plausible and casualty evacuations significantly delayed. Without access to prompt surgical interventions and standard treatment, burn wounds can progress (become deeper and more extensive) and become highly susceptible to infection. Several studies have demonstrated that topical applications of Cerium (III) Nitrate (Cen) can be used to delay the need for surgical eschar removal, a delay which may be forced upon injured warfighters in austere environments. The proof-of-concept studies described herein suggest that an electrospun dressing with a Polyethylene Oxide (PEO) shell and CeN core could prolong the time before surgical intervention is required and/or mitigate late-stage burn pathophysiologies in Prolonged Field Care (PFC) scenarios. Materials and Methods: Coaxially electrospun PEO dressings with a CeN payload were synthesized for application in a swine burn model. Dressings were first evaluated ex vivo using a Lactate Dehydrogenase (LDH) assay to confirm that no cytotoxic effects were present. Then, one female Yorkshire pig was anesthetized and received ten 5 cm x 5 cm contact burns with a brass burn device that was heated to 100°C. The deep-partial thickness wounds were randomly assigned to one of five treatment groups: 1) 1-Layer of the PEO/CeN dressing, 2) 4-Layers of the PEO/CeN dressing, 3) 4-layers of a control electrospun PEO dressing, 4) Flammacerium® cream (silver sulfadiazine 1%, cerium nitrate 2.2%), or 5) the PFC standard of care (SOC; gauze). Wounds were observed over an 18-day period, with surgical debridement occurring on Day 4 for all wounds. Transepidermal water loss, depth to debridement, and histologic measurements of necrosis were utilized to assess the burns. Research was conducted in compliance with the Animal Welfare Act, the implementing Animal Welfare regulations, and the principles of the Guide for the Care and Use of Laboratory Animals, National Research Council. The facility’s Institutional Animal Care and Use Committee approved all research conducted in this study. The facility where this research was conducted is fully accredited by AAALAC International. Experimental design and statistical comparisons were approved by an accredited epidemiologist and biostatistician. Results: The PEO/CeN dressings did not elicit a cytotoxic response ex vivo. Compared to the PFC SOC, treatments containing CeN reduced the amount of necrotic tissue produced by second-degree thermal injuries, as evidenced both histologically and in the depth required to reach viable tissue during surgical debridement. Importantly, the dressing did not adversely impact the live tissue surrounding the burn site. Conclusions: There are currently no field dressings that can delay the need for immediate debridement and thereby promote burn wound healing. This proof-of-concept study strongly suggests that the electrospun PEO/CeN dressing could fulfill this unmet medical need and advocates for further evaluation for use in imminent PFC scenarios.

Maggot debridement therapy for the treatment of diabetic foot ulcers: robbing the rich past to give to the sore

A diabetic foot ulcer (DFU) is a serious complication of diabetes mellitus that results in significant morbidity and mortality. The lifetime risk of a patient with diabetes developing a DFU is 15-25%1. Furthermore, the incidence of DFUs is increasing in line with the growing burden of diabetes worldwide. The number of lower limb amputations secondary to diabetes has reached an all-time high in England, with 26,378 recorded from 2014-2017, an increase of 19.4% from 2010-20132. Maggot debridement therapy (MDT) involves the application of sterile larvae, usually of the species Lucilla sericata (common green bottle fly), which remove devitalised tissue to promote wound healing. This historical therapy re-emerged in the 1990s to combat the increasing incidence of recalcitrant wounds, such as DFUs. Since its reintroduction, there has been ongoing debate in the medical literature regarding the efficacy of MDT in the treatment of DFUs and other chronic wounds. We present the case of a 57-year-old male admitted with diabetic foot sepsis and multiorgan failure and discuss how MDT was used to complement initial surgical and antibiotic management. A 14-day course of MDT improved wound debridement and decreased necrotic tissue burden, after which no further surgical interventions were needed. This case provides further evidence that MDT is effective in the selective debridement of necrotic tissue and can aid the preservation of limb length in DFU patients, thereby highlighting the importance of MDT in multispecialist diabetic foot care.

Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model.

Implant-associated osteomyelitis: Development, characterisation, and application of a porcine model.

Actinomycosis Hard Palate: A Rare Presentation

ABSTRACT Actinomycosis is a gradually evolving infection caused by bacteria of genus Actinomyces. Cervicofacial involvement is the most common presentation and palatal involvement is very rare. Presented below is the case report of a 79-year-old diabetic and hypertensive female who presented with nonhealing ulcer over the hard palate for 10 months, which enlarged and formed a large oroantral fistula within 4 months. Following the diagnosis of actinomycosis by histology, complete debridement and removal of necrotic tissue was done. She was treated with intravenous crystalline penicillin 6th hourly for 4 weeks and was discharged on oral amoxicillin for 12 months with regular follow-up. Only four cases of actinomycosis hard palate have been reported in English literature so far. How to cite this article: Dahiya V, George BR, Ramachandran K, et al. Actinomycosis Hard Palate: A Rare Presentation. Int J Otorhinolaryngol Clin 2019;11(3):73–75.

Calvarial Reconstruction Following Massive Tissue Loss: A Feasible Treatment Strategy and Surgical Technique.

Severe cranial injuries require reconstructive surgeries to protect the underlying brain and to restore cranial contour and scalp integrity, as well as avoid complications such as neurocognitive decline. In cases of full-thickness cranial tissue damage, adept surgical skill in both bone and soft tissue reconstruction is critical for a minimally invasive surgery and successful bone integration without endangering previous soft tissue efforts. Different surgical techniques and materials are beset with various problems. To present a surgical procedure intended for the reconstruction of complex calvarial and associated tissue defects with reduced invasiveness and improved soft tissue healing compared to the existing gold standard. Both soft tissue and bone reconstruction techniques are described in detail due to their intertwined importance for successful full thickness skull and scalp reconstruction. During initial medical care, aseptic wound treatment and temporary wound closure are performed. Two weeks postinjury, extensive necrotic tissue debridement and soft tissue reconstruction lay the foundation for well-vascularized tissue regeneration. Soft tissue healing is followed by minimally invasive cranioplasty using autologous split-rib transplants after approximately 6 mo. With consideration of the established gold standards for treatment, soft tissue regenerated without complications. The minimally invasive insertion of autologous rib grafts underneath the healed soft tissue allowed for quick recovery without requiring further follow-up treatments. We optimized initial scalp wound healing and bone regeneration by making use of minimally invasive procedures and autologous materials, offering a viable treatment alternative to existing methods for treating large cranial bone injuries.

Topical odour management in burn patients

Preventing microbial colonization or infections that cause offensive smells may lead to odor reduction. As both anaerobic and aerobic bacteria cause the release of malodor from wounds, the most direct way of avoiding or eliminating wound odor is to prevent or eradicate the responsible infection through the debridement of necrotic tissues. However, some burn patients with malodorous wounds are unable to undergo debridement due to systemic conditions, especially in the acute stage. Moreover, the optimal drug doses and dressings to ensure the efficacy and cost-effectiveness of odorous burn wound management is unclear. The purpose of this commentary is to outline the odor management options available for burn patients, focusing on topical strategies. Numerous potential therapies for treating odorous wounds after burn injuries are suggested.

Surgical Treatment of Malignant Otitis Externa MOE A New Hope Although Challenging

Objective: Malignant external otitis is an aggressive inflammatory condition of the external auditory canal. Most often affects elderly patients with diabetes mellitus. This is a serious disease which spreads in the skull base associated with cranial nerve complications and high morbidity-mortality rate. Malignant otitis externa requires urgent diagnosis and treatment. The primary and most effective treatment is to control the diabetes and to fight infection with the proper antibiotic in adequate dose and duration. If medical treatment fails aggressive surgical management is the only option to save life. We present a short experience in the management of this disease. The aim of this study was to present our experience with the surgical management of malignant otitis externa. Methods: All patients' records with malignant otitis externa during the last 5 years (2007-2012) were retrieved and reviewed. Diabetes mellitus profile, erythrocyte sedimentation rate, ear swab for culture and sensitivity, computed tomography, were investigated for all patients. Results: During the last 5 years (2014-2019), 5 patients with the diagnosis of malignant otitis externa were admitted to our hospital for investigation and treatment. All between 60 and 70 years of age, with severe persistent otalgia, purulent otorrhea, granulation tissue in the external auditory canal, and diffuse external otitis, and there were 2 patients with facial nerve palsy. Patients were confirmed to have diabetes. Ear swabs for culture and sensitivity usually revealed Pseudomonas aeruginosa. One patient by systemic antibiotic and two patients were treated by Local debridement and systemic antibiotics were sufficient to control the disease. Two patients were treated by aggressive surgical debridement (skull base debridement) with 360degree Facial nerve decompression. Patients were recovered from dreadful necrotizing infection but with facial paralysis. Conclusion: Malignant otitis externa is still a serious disease associated with cranial nerve complications and high morbiditymortality rate. The primary and most effective treatment is to control the diabetes and to fight infection with the proper antibiotic in adequate dose and duration, debridement of necrotic tissue, and sometimes aggressive surgical management. Monitoring of therapy response is done through normalization of erythrocyte sedimentation rate, control of diabetes mellitus.

Necrotizing Fasciitis in Low Income Countries: About 23 Cases of Bujumbura Hospitals

Background: Necrotizing fasciitis is a rapidly spreading soft tissue infection involving the deep facial layers. It can cause secondary necrosis leading to significant morbidity and mortality. The most important predictor of mortality is a delay in diagnosis. In low income countries, that delay must be high and other predictors of morbidity and mortality must be pointed out. Objective: To determine necrotizing fasciitis (NF) prognostic factors in a low income country. Patients and Methods: It is a prospective and descriptive study conducted over a one-year period from November 1, 2017 to November 1, 2018 about 23 cases of necrotizing fasciitis in two hospitals of Bujumbura. Results: The incidence of necrotizing fasciitis in these 2 hospitals (Kamenge Teaching Hospital and Prince Regent Charles Hospital) was 1%. The average age of patients was 41.76 years. Males were predominant with a sex ratio of 1.55. The risk factors for NF were: NSAIDs in 39%; HIV infection in 13%, diabetes mellitus in 4% and high blood pressure in 4%. The average time from symptoms onset to admission was 17.13 days. The mean time from admission to surgical treatment was 4 days with extremes of 1 to 22 days. The most affected site was the lower limb in 82% of cases. All patients (96%) were treated with necrotic tissue debridement. It was associated with skin grafting in 48% of cases. One patient (4%) with diabetes mellitus and HIV infection was amputated. The mortality rate was 22% (n = 5). Among those 5 patients, there was a combination of risk factors (diabetes mellitus, NSAID use and HIV infection) in 80% (n = 4), 60% (n = 3) were over 60 years of age and 60% (n = 3) were operated 10 days after the onset of symptoms. The average time of hospital stay was 101 days with extremes of 14 to 400 days. Conclusion: Necrotizing fasciitis is associated with a high mortality rate in low income countries. The use of NSAIDs; delayed treatment, elderly and immunosuppressive conditions such as diabetes mellitus and HIV are the most prognostic factors in Bujumbura hospitals.

Rise of the phoenix: Mucormycosis in COVID-19 times.

Purpose:Rhino-orbital mucormycosis in times of ongoing COVID-19 pandemic.Aims:The aim of the study was to document cases of rhino-orbital mucormycosis seen at our Regional Institute of Ophthalmology during COVID-19 (coronavirus disease 2019) times.Methods:The study is a retrospective, institutional cohort, interventional study. It was carried out at our Regional Institute of Ophthalmology from September 2020 to mid-March 2021. All patients of biopsy-proven mucormycosis were enrolled in the study. The patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were treated via a multidisciplinary approach with intravenous liposomal amphotericin B and debridement of local necrotic tissue. Exenteration was done when indicated. A minimum 75-day follow-up period was accorded to all study patients. Statistical analysis was done using Chi-square test. A P value ≤0.05 was taken as significant.Results:Thirty-one patients were seen, with a mean age of 56.3 years. The major risk factors included uncontrolled diabetes (96.7%) and COVID-19 positivity (61.2%), with concomitant steroid use in 61.2% patients. The most common presentation was diminution of vision (<6/60 in 80.64% patients) and ophthalmoplegia (77.4%). The most common imaging findings were orbital cellulitis (61.29%) and pansinusitis (77.4%). Intravenous liposomal amphotericin B was given to all patients for an average 18.93 days. Exenteration was required in (n = 4) 12.9% of cases. Twenty-eight patients recovered and were alive on follow-up. Mortality was seen in three patients. The presence of cerebral involvement and a HbA1c value of ≥8 were found to be significant in the prediction of survival of patients with mucormycosis.Conclusion:We present the largest institutional cohort of rhino-orbital mucormycosis patients during the ongoing COVID-19 pandemic era from our unique perspective.

The Effect of Bacterial Colonization and Maggot Debridement Treatment on Wound Healing in Chronic Venous Leg Ulcers.

The debridement of necrotic and infected tissues, which prolong the wound healing process, is important for the preparation of the wound bed. Therefore, wound-bed preparation and debridement are vital components of venous leg ulcer management. We aimed to present a perspective to evaluate the clinical and microbiological efficacy of Maggot Debridement Therapy (MDT) in the treatment of chronic leg ulcers caused by venous insufficiency. Thirty-eight patients with chronic venous leg ulcers who were referred to our unit with an MDT request were included in the study. Lucilia sericata larvae were applied to the wounds two days a week until the necrotic tissue was cleared. Swab samples were regularly taken before and immediately after each larval application for wound culture. Changes in the percentage of wound surface area and growing pathogenic microorganisms were recorded during the follow-up period. The sample consisted of 38 patients with 55 venous leg ulcers. The mean initial ulcer surface area was 99.1 cm2 (range 3 - 500). Complete debridement was achieved in all ulcers in the 2nd week, on average. Twenty-five ulcers (45.5%) were completely debrided with two one-week MDT sessions. Complete wound healing occurred in 42 ulcers (76.4%) after an average of seven MDT sessions. Microorganisms isolated from the wounds significantly decreased immediately after the first MDT session. Although many methods are used in the treatment of venous leg ulcers, they are often not effective. MDT, which is coming into widespread use today, is a simple and effective method in the treatment of these ulcers. Its effects such as biodebridement, disinfection, and growth stimulation can encourage the rapid healing of chronic venous leg ulcers.

Cervicofacial Necrotizing Fasciitis and Candida spp

Cervicofacial necrotizing fasciitis is a rapidly evolving bacterial infection, which can be associated with multiple complications and poor health. However, there are few reported cases that are associated with Candida species, and the studies that report this indicate that it is found mainly in areas such as the pelvis, thorax and to a lesser degree in the arms and legs. The presence of Necrotizing Fasciitis in the cervicofacial region is very rare, which makes the present study relevant. Material and Method: Descriptive, observational and retrospective study of Odontogenic Cervicofacial Necrotizing Fasciitis and the presence of Candida spp., Carried out during one year, in the Maxillofacial Surgery service of the Specialty Hospital, of the National Medical Center "La Raza" (IMSS). Patients older than 18 years, who were diagnosed with Necrotizing Cervicofacial Fasciitis of dental origin, were included in the study, reporting the presence of Candida. Treatment consisted of debridement of necrotic tissue, culture, dressings, intravenous antibiotics, and secondary surgical scrubs. Results: In one year, 7 cases of Cervicofacial Necrotizing Fasciitis of dental origin were obtained, of which 3 patients had associated Candida species, the rest of the cultures were reported polymicrobial. The most associated comorbidities were uncontrolled diabetes mellitus and arterial hypertension, there was a predilection for the male sex, the median age was 63 years, the ranges (min: 24 and max: 83). In addition, it was found that the 3 patients who presented candida species in their cultures were overweight and their evolution was torpid. Conclusion: It is important to perform cultures and biopsies to report the microbial species found in pathologies such as Necrotizing Fasciitis and to be able to provide better treatment specifically to the patient. Candida species do not usually appear associated with Necrotizing Fasciitis, which is why when other non-bacterial species are present, patients must undergo specific and individualized treatment to treat bacterial infections (necrotizing fasciitis) and in this case also the fungal (candida), remembering that the two act synergistically.

Mucor in a Viral Land: A Tale of Two Pathogens.

Purpose:COVID-19 infection, its treatment, resultant immunosuppression, and pre-existing comorbidities have made patients vulnerable to secondary infections including mucormycosis. It is important to understand the presentation, temporal sequence, risk factors, and outcomes to undertake measures for prevention and treatment.Methods:We conducted a retrospective, interventional study on six consecutive patients with COVID-19 who developed rhino-orbital mucormycosis and were managed at two tertiary ophthalmic referral centers in India between August 1 and December 15, 2020. Diagnosis of mucormycosis was based on clinical features, culture, and histopathology from sinus biopsy. Patients were treated with intravenous liposomal amphotericin B with addition of posaconazole and surgical debridement of necrotic tissue.Results:All patients were male, mean age 60.5 ± 12 (46.2–73.9) years, type 2 diabetics with mean blood glucose level of 222.5 ± 144.4 (86–404) mg/dL. Except for one patient who was diagnosed with mucormycosis concurrently with COVID-19, all patients received systemic corticosteroids for the treatment of COVID-19. The mean duration between diagnosis of COVID-19 and development of symptoms of mucor was 15.6 ± 9.6 (3–42) days. All patients underwent endoscopic sinus debridement, whereas two patients required orbital exenteration. At the last follow-up, all six patients were alive, on antifungal therapy.Conclusion:Mucormycosis is a life-threatening, opportunistic infection, and patients with moderate to severe COVID-19 are more susceptible to it. Uncontrolled diabetes mellitus and use of corticosteroids increase the risk of invasive fungal infection with mucormycosis which can develop during the course of the illness or as a sequelae. High index of suspicion, early diagnosis, and appropriate management can improve survival.

OUTCOMES OF OPEN THORACIC SURGICAL DECORTICATION IN PATIENTS WITH TUBERCULOUS EMPYEMA

Objective: To analyze the outcome of open surgical decortication of tuberculous empyema patients at their late presentation.&#x0D; Study Design: Cross sectional study.&#x0D; Place and Duration of Study: Patients (n = 128) with tuberculous empyema were subjected to decortication for one and half year starting from July 2017 to December 2018. Pre, intra, and post-operative characteristics of all patients were studied thoroughly with a 6-month follow up evaluation of the surgical outcomes.&#x0D; Results: Preoperative conditions were as follows: 6.25% patient had Broncho pleural fistula, 90.9% patients were diagnosed with cough, 34.7 with night sweating, 64.2% chest pain and 79.6% chest tightness. Decortication was performed in all cases, with debridement of necrotic tissue and repair of air leaks in some patients. 70 (54.7%) patients went through right side decortication, whereas 56 (43.7%) patients went through left sided decortication and 2 (1.56%) patients had bilateral. Mortality was 2 (1.56%), 1 patient died of septicemia while 1 of pulmonary embolism. Whereas morbidity was 9 (7%), 3 patients had wound infection, 4 had incomplete lung expansion, 1 patient each had prolonged air leak and post-operative bleeding.&#x0D; Conclusions: Delayed referral for surgery causes irreversible changes in the lung, and prolonged disease condition, which causes increased thickness of the pleura and injury to the underlying lung with a delayed recovery. Open decortication gives satisfactory results.