Uncontrolled Diabetes Mellitus Research Articles

Treatment of patients with periprosthetic infection

The review article presents the main questions of pathogenesis, early diagnosis, and surgical management of patients with paraprosthetic infection that developed after surgery for fractured limb bones and deforming arthrosis. The main factors that influenced the occurrence of purulent complications and the ways of their prevention, treatment, taking into account the current ideas about wound infection, are indicated. Pathogenetic mechanisms of paraprosthetic infection development are directly related to the presence of hematoma in the operated joint. Risk factors for large joint arthroplasty can be divided into three conditional types: general and local patient status; conditions for the operation; features of surgery. To detail the risk factors associated with the general or local status of the patient, two subtypes are highlighted — primary and secondary. The main subtype includes: 1) focus infection, located in the operated joint; 2) focus infection, located in the paraarticular tissues of the operated joint; 3) generalization of the infectious process — sepsis. The additional subtype includes: 1) history of previous joint surgery; 2) critical changes in body mass index; 3) uncontrolled diabetes mellitus; 4) presence of systemic diseases associated with prolonged administration of glucocorticosteroids and cytostatics and others. Two-stage revision endoprosthesis in patients with chronic periprosthetic infection is the gold standard to date. In many ways, the success of treatment depends on the correctness of all stages, on the adequacy of diagnostic measures, the scrupulousness of compliance with surgical technique and is determined by the surgeon’s experience, as well as the equipment of the hospital.

Effect of antifungal drugs against mucormycosis and impact on human health

Mucormycosis, a fungal infection caused by fungi Rhizopus oryzae belongs to family Mucorales. These fungi are commonly found in the environment and can be transmitted through inhalation, ingestion, or contact with spores. Healthcare-associated transmission can occur through the use of contaminated medical equipment, such as gauges, spatulas, linens, or faulty air filters that have not been properly disinfected. Certain individuals are at a higher risk of developing mucormycosis, including those with uncontrolled diabetes mellitus in ketoacidosis, cancer patients, organ transplant recipients, and individuals with weakened immune systems lacking phagocytes. These risk factors make them more vulnerable to the infection.The present study aims to provide an overview of various antifungal drugs used against mucormycosis. It also explores the clinical manifestations of mucormycosis and its impact on human health, with a focus on case studies conducted in different countries after the COVID-19 pandemic. These case studies examine the types of mucormycosis cases, the methods of diagnosis, and the systemic effects of the disease. Overall, this study sheds light on the treatment options available for mucormycosis, the diverse clinical presentations of the infection, and its implications for human health. The case studies provide valuable insights into the specific scenarios and challenges faced in different regions of the world, aiding in a better understanding of mucormycosis and its management.

Glycolyzed Hemoglobin as a Poor Prognostic Factor in Diabetic COVID-19 Patients

Background: Diabetes mellitus (DM) seems to be conveying increased risk in Coronavirus disease-2019 (COVID-19). We aimed to evaluate the effect of glycemic control on the risk of prevalence and mortality in diabetic COVID-19 patients. Materials and Methods: In this retrospective observational study, the data from diabetic patients admitted to our hospital with the diagnosis of COVID-19 between March 2020 and March 2021 were reviewed. The demographic, clinical, laboratory, and radiological data, and the course and outcomes were recorded. Results: The records of 352 diabetic patients were compared to 333 non-diabetic controls. The mean age of 184 male and 168 female patients was 63.7±13.0 (30–91). The length of hospital stay, rate of Intensive care unit (ICU) admission, and mortality were higher in the diabetic population compared to the non-diabetic counterparts. ICU admission and mortality rates were significantly higher in the group with HbA1c higher than 7%. The rate of ICU admission and mortality was significantly higher in participants with elevated HbA1c Conclusions: Uncontrolled DM is among detrimental comorbidities contributing to the severity of SARS-CoV-2 infection and good control of serum glucose levels will improve prognosis in COVID-19. The diabetic population with poor glycemic control succumbed more to COVID-19.

Clinico-epidemiological profile of Mucormycosis patients admitted in VIMS hospital, Ballari: Case series

Background: Mucormycosis is caused by the fungi belonging to the order Mucorales. Humans acquire the infectionpredominantly by inhalation of sporangiospores, occasionally by ingestion of contaminated food or traumaticinoculation. In the backdrop of COVID-19 expression, there has been notable increase in the incidence of invasivefungal infection (IFI), namely Mucormycosis and aspergillosis. In the present study we aim to know the Clinicoepidemiologicalprofile of Mucormycosis patients admitted in Vijayanagar institute of medical sciences (VIMS),Ballari, Karnataka.Methodology: A descriptive study was carried out at VIMS Hospital, Ballari, Karnataka after obtaining ethicalclearance. The data was collected using structured questionnaires through interview and case records on riskfactors, clinical profile and management of patients who were suspected of Mucormycosis. Frequencies andProportion were used to describe the variables. Study period was from April 2021-June 2021.Results: Out of 52 patients, 45(86.5%) were male and 7(13.5%) were female. Age group between 41-50 years(40.4%) were most commonly affected followed by 31-40 years (28.8%) and 50% were positive for COVID 19,26.9% were post COVID and 23.1% were NON COVID. Twenty two patients were on steroids, 21 (95.5%) ofthem due to COVID 19 and 1(4.5%) due to asthma. Comorbid conditions like diabetes mellitus 38(73.1%) andhypertension 12(23.1%) were most commonly present. 12(31.6%) out of 38 patients had uncontrolled diabetesmellitus. Mucormycosis was confirmed by KOH and histopathological results and were positive in 21(43.7%) and27(77.1%) patients respectively. Management of Mucormycosis included both medical and surgical intervention.Conclusion: Mucormycosis is a life threatening fungal infection. The present study emphasizes the need forfurther understanding of the disease and to take aggressive measures for early diagnosis and management.

The population at low risk of atherothrombotic disease

Background: There are two approaches to the determination of the population at risk of atherothrombotic disease: the herd approach and the targeted approach. In the former scenario, all people are treated, usually with lifestyle changes, but also with medications at times. In the latter scenario, only those deemed at risk of atherothrombotic disease are treated. The author has always favored the latter approach, but for the target approach to be effective, one must know the population at low risk of atherthrombotic disease. Objectives: The purpose of this manuscript is to demonstrate that the population at low risk of atherothrombotic disease can be readily identified and needless treatment can be avoided. Methods: The author has conducted a chart review of his family practice patients roster and separated out the cohort of those who developed some form of atherothrombtic disease from the general population cohort. Results: The author has shown that three major risk factors for atherothrombotic disease can accurately define the population at low risk of atherothrombotic disease: no use of cigarettes, lack of dyslipidemia, and lack of hypertension. Dyslipidemia is defined in terms of the Cholesterol retention Fraction, defined as the difference between low-density lipoprotein cholesterol and high-density lipoprotein cholesterol, that difference divided by the low-density lipoprotein cholesterol, but also whenever low-density lipoprotein cholesterol exceeds 170mg/dl. Hypertension is defined as a systolic blood pressure of 140mmHG or higher or any blood pressure that is being treated. Additionally, the author has shown that in the absence of these three major risk factors, the presence of diabetes mellitus is not associated with early onset atherothrombotic disease. Conclusions: People who do not manifest the three major risk factors for atherothrombotic disease (cigarette smoking, dyslipidemia, and hypertension)are not at risk of early or middle-age onset atherothrombotic disease. Such people do not require therapy though the high blood sugar levels of uncontrolled diabetes mellitus will require treatment to prevent microvascular disease.

Assessment of Knowledge, Attitudes and Practices Regarding Chronic Kidney Disease in at-Risk Individuals

Background: Chronic kidney disease (CKD) is a global health problem, with a worldwide prevalence of around 9.1 per cent (as of 2017). In India, its prevalence was found to be around 17.2%. There are several risk factors of CKD, out of which the presence of underlying longstanding uncontrolled diabetes mellitus (DM) and hypertension are common. Certain previous studies have tried to assess the level of knowledge, attitudes and practices of such a ‘high risk’ group for developing CKD but there is a paucity of literature on it. Hence, this study was undertaken to assess these domains in individuals at risk for developing CKD. Patients and Methods: It is an observational cross-sectional study conducted from October 2020 to December 2021 at a tertiary care teaching and referral hospital in India. A total of 215 patients who were at risk of developing CKD, were enrolled and were given a CKD Screening Index questionnaire to fill and scoring was done for all three components-knowledge, attitudes and practices. Results: The mean age was found to be 49.21 ± 13.49 years with a male: female ratio of 1.4:1. Nearly three-a fourth of the patients were having DM while one-fourth of the participants had a previous history of hypertension. The mean scores on the knowledge, attitude and practices scales were found to be 11.80 ± 5.31, 50.18 ± 8.23 and 30.83 ± 7.53 respectively. The study results revealed that the majority of patients had ‘low’ levels of knowledge scores but ‘average’ levels of attitude and practice scores. A significant correlation was found amongst knowledge and attitude scores (r = 0.226, P = 0.001), knowledge and practice scores (r = 0.153, P = 0.025) and practice and attitude scores (r = 0.295, P = 0.000) of our patients. Conclusion: There is a need of improving awareness at least amongst the population at risk of getting CKD. Improving knowledge would help in inculcating positive attitudes and healthier practices amongst these, thus delaying the onset of this disease.

COVID-19 associated Mucormycosis (CAM): Implications for perioperative physicians - A narrative review.

Mucormycosis once considered a rare disease with an incidence of 0.005 to 1.7 per million, has become one of the greatest menaces during the coronavirus disease (COVID-19) pandemic. India alone has contributed to nearly 70% of the global caseload of COVID-associated mucormycosis (CAM) and it had even been declared as a notifiable disease. Second wave of COVID-19 pandemic saw a steep rise in the incidence of mucormycosis and these patients have been presenting to anesthesiologists for various surgical procedures due to its primary or secondary sequelae. Rhino-orbito-cerebral mucormycosis (ROCM) is the commonest manifestation and is caused by Rhizopus arrhizus. Injudicious use of corticosteroids in vulnerable patients could have been a major contributing factor to the sudden rise in ROCM during the pandemic. Concerns related to anesthetic management include COVID-19 infection and post COVID sequalae, common presence of uncontrolled diabetes mellitus, possibility of difficult mask-ventilation and/or intubation, various drug therapy-associated adverse effects, and interaction of these drugs with anesthetic agents. Thorough preoperative optimization, multidisciplinary involvement, perioperative care, and vigilance go a long way in improving overall outcomes in these patients.

Coronavirus Disease 2019-Associated Cerebral Mucormycosis in an Immunocompetent Child

AbstractMucormycosis is a rare opportunistic fungal infection observed in immunocompromised individuals or in those with uncontrolled diabetes mellitus. During the coronavirus disease 2019 (COVID-19) pandemic, there has been a steep increase in the incidence of mucormycosis among adults. However, the infection is extremely rare in the pediatric population, and its occurrence post-COVID-19 infection has been reported in very few cases. We present a case of cerebral mucormycosis in a 6-year-old immunocompetent girl that was histopathologically confirmed by stereotactic brain biopsy. The fungal infection occurred following asymptomatic COVID-19 infection. This report describes the diagnostic journey and management. It highlights the unusual presentation of cerebral mucormycosis in our case and the role of posaconazole in the successful treatment.

PENGARUH EKSTRAK DAUN EKOR NAGA (Rhaphidophora pinnata (L.f) Schott) TERHADAP KADAR MALONDIALDEHID DARAH PADA TIKUS DIABETES YANG INDUKSI ALOKSAN

Ekor Naga (Rhaphidophora pinnata (L.f) Schott) leaves is a traditional medicinal plant that contains secondary metabolites of alkaloids, flavonoids, saponins, and tannins, which have antioxidant effects. Uncontrolled diabetes mellitus will be one of the triggers for high free radicals in the body. This study aims to determine the effect of the effect of ekor naga leaves extract which has potentian as an antioxidant on malondialdehyde levels as a prooxidant marker in alloxan-induced diabetes mellitus rats. The reseaech method used a post test only control group design. The test animals used were 20 animals, each group of 5 test animals. Group 1: Positive Control (Glibenclamide 10 mg/Kg BW), Group 2: Negative Control (Na CMC 0,5%), Group 3: Ekor Naga Leaf Extract 250 mg/Kg BW, and Group 4: Ekor Naga Leaves Extract 500 mg/Kg BW. The data taken is the level of malondialdehyde in the blood. The results were analyzed using One-way ANOVA with a 95% confidence level. The results showed that the ethanolic extract of the ekor naga leaves had a role in reducing Malondialdehyde or lipid peroxide in the blood in diabetic rats where the best dose is 500 mg/Kg with malondialdehyde yield of 0,569 nmol/mL. Followed by a dose of 250 mg/Kg BW with malondialdehyde value of 2,144 nmol/mL.

Assessment of Glycemic Control in Patients With Diabetes in Northern Sudan Using Calculated HbA1c.

Diabetes mellitus (DM) significantly burdens health services worldwide. As a simple and cost-effective method, the mathematical calculation of HbA1c is coming to be of value in areas with scarce resources. This study aimed to use calculated HbA1c to ascertain the prevalence of uncontrolled DM and correlate it with the risk factors for DM. In the River Nile State of northern Sudan, a cross-sectional study was conducted in five leading cities from May to August 2021. Patients diagnosed and recorded as having type 2 or type 1 DM were included in this study. Enzymatic methods were used to assess fasting blood glucose (FBG). We used the mean of three FBG readings for three months to calculate HbA1c using the equation {HbA1c = (FBG mg/dl) x 0.03+2.6}, which was used to compute the estimated mediocre blood sugar over the course of three months. A total of 2047 diabetic patients from northern Sudan were studied for their DM control. Nearly two-thirds (65.2%) had uncontrolled DM. Of the patients studied, uncontrolled DM was significantly positivelyassociated with older age, history of ischemic heart disease, and being a housewife. Multivariate regression analysis showed significant correlations between uncontrolled DM, an inactive lifestyle, and obesity. The prevalence of uncontrolled DM among known patients with diabetic in northern Sudan is high (65.2%). The inactive lifestyles of housewives and freelance workers, having type 1 DM, and being hypertensive and obese are risk factors significantly associated with uncontrolled DM and its related complications.

Co-infection by Mycobacterium Tuberculosis And Klebsiella Pneumoniae in an Elderly Male With Multiple Co-morbidities: A Rare Entity With High Mortality

Klebsiella pneumoniae and Mycobacterium tuberculosis coinfection is one of the most lethal combinations with high mortality specially if there is delay in diagnosis and proper management. Patients with uncontrolled diabetes mellitus are prone to develop this type of serious infection.There is a considerable overlap in the clinical presentation of these critical pulmonary infections hence there is need for a high index of clinical suspicion, appropriate judicious investigations, and promt management to improve survivality. Here, we have presented Mycobacterium tuberculosis and Klebsiella pneumonia co-infection presenting as cough, chest pain, and shortness of breath in an elderly male with multiple co-morbidities, like uncontrolled diabetes mellitus, hypertension, prosthetic aortic valve in situ (for aortic stenosis)& previous history of ishchaemic stroke. This combination is rare and to the best of our knowledge not reported in the literature from Bangladesh. Bangladesh J Medicine 2022; 33: 52-57

Vulvovaginal candidiasis (VVC): A review of the literature

Vulvovaginal candidiasis (VVC) is the second most common cause of vaginitis after bacterial vaginosis. VVC often occurs in women of reproductive age (20-40 years). Risk factors for VVC can be divided into two, such as host factors (pregnancy, hor-mone replacement, uncontrolled diabetes mellitus, immunosuppression, antibiotics, use of glucocorticoids, genetic influences) and behavioral factors (oral contracep-tives, sexual habits, hygiene, and clothes that are used). To diagnose VVC in a per-son, evaluation from anamnesis and clinical manifestation can be conducted. It can also be confirmed by laboratory examination. The management is based on the clas-sification. Uncomplicated VVC is most effectively treated with topical azoles, but a single dose of fluconazole can also be given orally. Treatment of VVC with compli-cations can be given fluconazole 150 mg for 3 days or topical azole for 7 days. However, when the VVC case that caused by non-albicans Candida not responding to conventional treatment such as antimycotics, the amphotericin B can be given to cure the disease. VVC caused by Candida glabrata can be given topical boric acid or flucytosine. This article consists of several theoretical references that have been viewed to have a better understanding of candidiasis vulvovaginitis.

Early use of airway pressure release ventilation in acute respiratory distress syndrome induced by coronavirus disease 2019: a case report

BackgroundCoronavirus disease 2019 is a highly transmissible and pathogenic viral infection caused by severe acute respiratory syndrome coronavirus 2, a novel coronavirus that was identified in early January 2020 in Wuhan, China, and has become a pandemic disease worldwide. The symptoms of coronavirus disease 2019 range from asymptomatic to severe respiratory failure. In moderate and severe cases, oxygen therapy is needed. In severe cases, high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation are needed. Many ventilation methods in mechanical ventilation can be used, but not all are suitable for coronavirus disease 2019 patients. Airway pressure release ventilation, which is one of the mechanical ventilation methods, can be considered for patients with moderate-to-severe acute respiratory distress syndrome. It was found that oxygenation in the airway pressure release ventilation method was better than in the conventional method. How about airway pressure release ventilation in coronavirus disease 2019 patients? We report a case of confirmed coronavirus disease 2019 in which airway pressure release ventilation mode was used.Case presentationIn this case study, we report a 74-year-old Chinese with a history of hypertension and uncontrolled diabetes mellitus type 2. He came to our hospital with the chief complaint of difficulty in breathing. He was fully awake with an oxygen saturation of 82% on room air. The patient was admitted and diagnosed with severe coronavirus disease 2019, and he was given a nonrebreathing mask at 15 L per minute, and oxygen saturation went back to 95%. After a few hours with a nonrebreathing mask, his condition worsened. On the third day after admission, saturation went down despite using noninvasive ventilation. We decided to intubate the patient and used airway pressure release ventilation mode. Finally, after 14 days of being intubated, the patient could be extubated and discharged after 45 days of hospitalization.ConclusionEarly use of airway pressure release ventilation may be considered as one of the ventilation strategies to treat severe coronavirus disease 2019 acute respiratory distress syndrome. Although reports on airway pressure release ventilation and protocols on its initiation and titration methods are limited, it may be worthwhile to consider, given its known ability to maximize alveolar recruitment, preserve alveolar epithelial integrity, and surfactant, all of which are crucial for handling the “fragile” lungs of coronavirus disease 2019 patients.

Successful Treatment of Acute Invasive Rhino-Orbito-Cerebral Mucormycosis Associated with COVID -19: Case Report and Literature Review

Background and Aim: Mortality associated with post-coronavirus disease 2019 (COVID-19) rhino-orbital cerebral mucormycosis (ROCM) is an evolving concern. Association of COVID-19, corticosteroid therapy, and uncontrolled diabetes mellitus (DM) are considered predisposing factors for ROCM. We present two cases of successful treatment leading to patient survival for post-COVID-19, stage 4c-ROCM. Case Presentation: Two middle-aged men with poorly controlled DM were referred to our hospital for post-COVID-19 ROCM. They had received intravenous antivirals and dexamethasone as treatment in a primary center. Both patients had unilateral oculofacial pain and swelling followed by acute visual loss, unilateral proptosis, facial palsy, and trigeminal hypoesthesia. A computed tomography scan revealed opacity and bony erosion of paranasal sinuses (PNS). Obtained specimens confirmed mucormycosis agent on histopathological examination. After the failure of conservative treatments, retrobulbar injections of liposomal-amphotericin B, PNS debridement, and orbital exenteration, both patients developed blurred consciousness owing to the extension of the infection into the intracranial cavity. Brain magnetic resonance imaging revealed a right frontal lobe abscess in case 1 and a left frontal sinus abscess and involvement in case 2. Both underwent transcranial debridement and resection of necrotic tissue and drainage of the abscess. At follow-up, the patients were in good condition, and the fungal cultures were negative for mucormycosis agents. Conclusion: ROCM may be a complication of COVID-19 in high-risk patients. Control of the patient’s underlying systemic condition and prompt treatment with antifungal agents, along with timely aggressive resection of cerebral abscess and necrotic paranasal tissues, are the mainstays of management for ROCM.

Ecocardiografia na hipertensão pulmonar: avaliação das câmaras cardíacas direitas e artéria pulmonar

Introduction: Pulmonary Hypertension (PH) is defined as an increase in mean pulmonary artery (PA) pressure above 25mmHg at rest and an increase of 30mmHg with exertion. In more advanced pathological stages, structural changes may occur in the cardiac chambers due to hemodynamic changes. Objectives: To verify if PH patients present with right-side hemodynamic and structural changes. Material and Methods: The study was carried out using a database of the cardiology service of a local health unit in the central region of mainland Portugal. Patients studied were those with PH and those without PH. Although patients with PH were included, those presenting with uncontrolled arterial hypertension, diabetes mellitus and/or congenital cardiac alterations were excluded. Results: The sample consisted of 113 individuals, of which 35 had PH (31.0%) and 68 did not have PH (69.0%). It was observed that in the group with PH there was a growing increase in the cardiac chambers and PA. It was also observed that the higher the Pulmonary Artery Systolic Pressure (PASP), the higher the value obtained in the cardiac chambers and PA. There was also a decrease in the tricuspid annular plane systolic excursion (TAPSE) value as a function of the increase in PASP, compared to lower values. The tricuspid regurgitation velocity (TRV) did not increase much in regards to the increase in PASP, with a greater accentuation of the 2.9-3.4m/s parameter in this correlation. Conclusion: Our study verified that structural and hemodynamic changes in the right heart chambers and PA occur in the presence of PH.

Effect of HbA1c Level on Hearing Sensitivity Among Patients with Diabetic Mellitus

Diabetes Mellitus (DM) appears to be a risk factor for hearing loss. Meta-analyses of cross-sectional studies reported that diabetes had a greater risk of hearing impairment. Hearing loss and hemoglobin A1c (HbA1c), a glycemic management biomarker, have been linked in a few studies. HbA1c and hearing impairment as measured by a pure-tone average threshold of frequencies (500 Hz, 1 kHz, and 2 kHz), while the other two found a link between HbA1c and high-frequency hearing impairment. The goal of this study is to see if the amount of HbA1c level is linked to the occurrence of hearing loss. Participants were 430 of both genders between the ages of 21 to 60 years and based on the duration of HbA1c level. Results indicated that the higher HbA1c level patient had high-frequency hearing loss when compared to speech frequencies in both ears. As the HbA1c level increases an increase in the high-frequency hearing loss was also noticed. A positive correlation exists between the duration of diabetics and high-frequency hearing loss. Moreover, when diabetic duration increases, the hearing loss is more affected in extended high frequency, high frequency followed by speech frequency among uncontrolled DM than controlled DM in both ears. These findings suggest that proper glycemic management might help avoid diabetic hearing loss.

Fungal osteomylitus in diabetic patients and COVID-19

Background: COVID-19 pandemic has become a big medical problem worldwide. In this era, COVID-19 patients’ along with diabetes mellitus are at an increased risk of developing opportunistic infections. This study demonstrate association of COVID-19 infection in patients having uncontrolled diabetes with the fungal osteomyelitis.
 Subjects and methods: This prospective cross-sectional study was done at a Nishter Institute of Dentistry, Multan. Patients diagnosed with fungal osteomyelitis of jaw bones presented during April to December 2021 were included in this study. Data was collected from the patients regarding history of the disease, clinical diagnosis, imaging findings by plain radiographs and CT scans, histopathology. Association of disease process with diabetes and COVID-19 was analyzed in SPSS.
 Results: Between the period April 2021 to December 2021, 23 cases presented in Nishter Institute of Dentistry Multan with fungal osteomylitus were diagnosed clinically and fungal organism was identified by immunohistochemical studies by PAS and GMA stains. 22/23 (95.6%) patients were with uncontrolled diabetes mellitus and 18/23(78.2%) gave the history of Covid 19 infection 2 to 3 months before with moderate to severe symptoms.11/23 (47.8%) gave the history of treatment with systemic steroid. Age range was 38-72 years of age with mean age 53.26. 12/23(52.1%) were males and 11/23 (47.8%) were females. 17/23 (73.9%) patients presented with pain in jaws with exposed bone and 6/23(23%) complained of pain and loose teeth in arch. In 22/23 (95.6%) involved jaw was maxilla. In one patient associated medical condition was hepatitis C virus infection also with diabetes. 2 patients were cardiac and 3 were hypertensive along with diabetes. One patient was previously treated with radiotherapy of mandible due to alveolar cancer. Only one (0.04%) patient was non diabetic.
 Conclusion: There is increased incidence of fungal osteomyelitis of jaws mostly maxilla in diabetic and COVID-19 infected patients.

Post COVID-19 Mucormycosis-The Horizon.

Acute Invasive Fungal Rhinosinusitis is a rare condition which recently has gained attention due to its increased occurrence in the post COVID-19 patients past the second wave. The current study retrospectively evaluates the occurrence of Acute Invasive Fungal Rhinosinusitis (Mucormycosis) in post COVID-19 (Corona Virus Disease-19) patients. A descriptive study included patients diagnosed with Acute Invasive Fungal Rhinosinusitis (Mucormycosis) after recent COVID-19 infection. 110 patients were evaluated retrospectively with histopathological confirmation of Mucormycosis. Surgical treatment was restricted to patients who tested Real Time Polymerase Chain Reaction (RT PCR) negative for COVID-19 except for three patients who were tested positive. Antifungal agents were given to patients following surgery. A total of 110 patients with a mean age of 48.42 years were included. The most common risk factor was diabetes mellitus (88.2%). Sino-nasal, orbital, palatal and intracranial involvement were 57.9%, 48.5%, 12.7% and 5.6% respectively. Histopathological confirmation revealed mucormycosis. The most common reported symptoms were periorbital oedema (20.5%), headache (20.3%), gingival swelling (18.5%) facial pain (18.4%) and facial swelling (18.2%). All the patients were treated with surgical debridement and antifungal medications. The overall survival rate was 95.32%. Acute Invasive Fungal Rhinosinusitis is a life-threatening opportunistic infection. Patients with moderate to severe COVID-19 infection are more susceptible to it. Uncontrolled diabetes mellitus and intake of corticosteroids increase the risk of developing Acute Invasive Fungal Rhinosinusitis. Early diagnosis and timely management can improve survival rates of the patients.

321: OUTPATIENT DIABETES MANAGEMENT INFLUENCES GLYCEMIC CONTROL IN ICU PATIENTS DURING NUTRITION SUPPORT

Introduction: Appropriate glycemic control improves clinical outcomes during critical illness. We proposed that outpatient diabetes management would influence glycemic control in critically ill patients who require nutrition support (NS). Methods: Adult patients admitted to the trauma intensive care unit (ICU), who required NS, and exhibited hyperglycemia (blood glucose concentration (BG) > 150 mg/dL) or had diabetes mellitus (DM), were retrospectively evaluated. Outpatient DM pharmacotherapy was discontinued upon ICU admission. NS was initiated on day 3 + 3 following ICU admission. A serum hemoglobin (Hgb) A1c was obtained on day 3 + 3. The daily amount/mode of insulin therapy, carbohydrate intake, and point of care BGs for the first 7 days of NS were recorded. Patients were classified as controlled DM (Hgb A1c < 7%), uncontrolled DM (Hgb A1c >/= 7%), or as hyperglycemic patients without DM (Hgb A1c < 6.5%). Target BG was 70 to 150 mg/dL. Hypoglycemia was defined as a BG < 70 mg/dL. Regular human insulin sliding scale (SSI), subcutaneous NPH insulin with concurrent SSI, or continuous intravenous insulin infusion (CIVI) were used for glycemic control at the discretion of the NS service or primary service. Continuous data were given as mean + S.D. Chi-square analysis or ANOVA were used to compare groups. Results: Seventy-eight (14 controlled DM, 21 uncontrolled DM, and 43 non-DM) patients were studied. Maximum BG prior to initiation of NS was significantly different between groups (201 + 54 vs. 334 + 192 vs. 191 + 57 mg/dL, respectively, P < 0.001). The proportion of patients who required higher intensity insulin therapy (NPH + SSI or CIVI) was different among groups (50% vs. 86% vs. 15%, respectively, P < 0.001). The amount of insulin given per gram of carbohydrate intake was 0.45 + 0.50, 1.24 + 1.21, and 0.15 + 0.21 units/g, respectively, P < 0.001. Time within the target BG range was 11 + 6, 12 + 5, and 17 + 6 hrs/day, respectively, P < 0.001. Hypoglycemia occurred in 1 (7%), 5 (24%), and 3 (7%) patients, respectively (P = 0.120). Conclusions: Glycemic control during NS in the ICU is more challenging for those patients whose outpatient DM was uncontrolled compared to those with controlled DM and those with stress-induced hyperglycemia without DM.

318. A Pain in the Neck: Cervical Pyomyositis, a Rare Case of Extraintestinal Nontyphoidal Salmonellosis Further Characterized by Whole-Genome Sequencing.

Abstract Background Nontyphoidal salmonellosis (NTS) is the second-most common foodborne illness in the US, but extraintestinal manifestations are rare. We describe a case of sternocleidomastoid (SCM) pyomyositis, a rare entity, caused by Salmonella enterica, further delineated by whole-genome sequencing (WGS). A 55 year old male with liver cirrhosis and uncontrolled type-II diabetes mellitus presented with a six-day history of an enlarging left-sided neck mass. He had no fevers, chills, night sweats, nausea, vomiting or diarrhea. He had recently returned from Saudia Arabia with exposures to camels, bats and lemurs. He did not consume raw foods or dairy products. Physical exam revealed normal vital signs and a large firm neck mass. Labs were notable for leukocytosis and hyperglycemia. Neck computed tomography revealed a 6 cm heterogeneous mass inseparable from the left SCM. He required repeated drainage procedures; histopathology revealed skeletal muscle with inflammation, but no malignancy. Blood and procedural cultures grew Salmonella group B. He was treated with ceftriaxone then trimethoprim-sulfamethoxazole. Follow-up 4 weeks after presentation revealed only residual induration. Methods WGS was performed using Illumina MiSeq. Genotype and antimicrobial resistance markers were identified using MLST, KmerFinder and ResFinder on Center of Genomic Epidemiology. Virulence factors were identified using VFanalyzer. Results The bacteria was identified as Salmonella enterica subspecies enterica serovar Typhimurium and typed as ST19, the major phylogroup of Typhimurium globally. Characteristics associated with invasive NTS (iNTS) identified by WGS included genes encoding Type III secretion system and Invasin A. Other virulence factors included fimbrial adherence determinants, macrophage inducible genes, and an intracellular toxin SpvB. Resistance genes included aac(6')-Iaa, which confers resistance to tobramycin and amikacin, and qnrB19, which predicts resistance to ciprofloxacin. However, no quinolone resistance-related mutations were detected in gyrA, gyrB, parC and parE genes. AMR Genes Antimicrobial resistance genes identified by whole-genome sequencing of the Salmonella isolate. Conclusion Patients with uncontrolled diabetes are at increased risk of iNTS with or without associated diarrhea. WGS can identify additional factors that may influence morbidity and resistance. Disclosures All Authors: No reported disclosures.