In India, COVID-19 has led to a surge in cases of a potentially fatal fungal infection called mucormycosis, popularly known as “black fungus.” Intravenous amphotericin B is the only available drug for salvage therapy. Efforts to improve its therapeutic efficacy and decrease its nephrotoxicity have focussed on the reformulation of AmB in three new lipid formulations such amphotericin B lipid complex (Abelcet), amphotericin B colloidal dispersion (Amphotec), and liposomal amphotericin B (AmBisome). The aim of this study is (1) to evaluate the adverse drug reaction of various formulations of amphotericin B used for the treatment of rhinooculocerebralmucormycosis in Indian population. (2) to evaluate the adverse drug reaction of injectable form of posaconazole. This prospective observational study was done on a random sample of 110 patients who got admitted for the management of rhinooculocerebral mucormycosis in a tertiary care centre of middle india… The patients were assessed for the adverse reactions following the administration of various antifungal medication and the findings were analysed. All the 110 patients had received two forms of Amphotericin B (liposomal Amphotericin B and Amphotericin B lipid complex) and Posaconazole injection. 60 patients had received all three forms of Amphotericin B. Out of the 110 patients who received Liposomal amphotericin B, only 2 patients developed adverse drug reaction while in 110 patients who received Amphotericin B Lipid complex, 7 patients had adverse drug effects. Lyophilised amphotericin B had been administered to 60 patients in which 51 patients developed adverse drug reaction and in them one patient went to congestive cardiac failure. Injection posaconazole had been administered to 110 patients in which 72 patients developed drug reaction. In spite of its proven track record of Amphotericin B, its well-known side effects and toxicity will sometimes require discontinuation of therapy despite a life-threatening systemic fungal infection. Lipid formulations of AmB are better tolerated than AmB deoxycholate but infusional drug reactions have been reported in lipid formulation too. So improved strategies for the management of infusion related adverse events are required.

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<p class="abstract">Cochlear implant is a small, complex electronic device to restore some hearing in profoundly deaf or severely hard-of hearing people when organ of corti is not developed or destroyed by injury to such an extent that no hearing can be obtained by hearing aids. Many classifications have been proposed for cochlear implant related problems .We report a case of post cochlear implant child who reported to OPD with complaint of progressive weakness of both upper and lower limb which developed 1 year after surgery ,which parents attributed it as a complication of surgery. On retrospective analysis all patient preop investigations were normal. After detailed examination of the child, neurophysician concluded that child is suffering from global developmental delay with dystonic cerebral palsy. MRI brain and cochlea which was done before the surgery which showed T1 hypointense,T2 and FLAIR hyperintense ,bilateral symmetrical foci with high ADC values are seen in bilateral lentiform nuclei .It has been reported that the bithalamic hyperdensities on CT and/or MRI in severely asphyxiated neonates, were suggested of a distinctive pattern of brain injury which might be useful as an early predictor of status marmoratus,afrequent pathological correlate of dyskinetic cerebral palsy. Approximately 1% of infants who survived perinatal asphyxial HIE would develop delayed-onset dystonia in the course of 7 to 13 years (median 10 years) after birth.</p>

<p><strong>Background:</strong> The rapid global spread of Coronavirus disease led to declaration of COVID-19 as a pandemic on March 11,2020. Secondary infections are reportedly common in hospitalized, severely ill COVID-19 patients, encompassing between 10 and 30% of cases, fungal being 10 times more common. Mucormycosis is amongst the most fulminant form of zygomycosis caused by mucorales species of the phylum zygomycota and currently referred as COVID associated mucormycosis (CAM). The aim of this study is to evaluate   the extend and pattern of destruction in nose, paranasal sinus and orbit found during the surgical debridement of post COVID hyperglycemic patients of mucormycosis.</p><p><strong>Methods:</strong> This prospective observational study was done on a random sample of 86 patients who came to ENT OPD of a tertiary care centre of middle India with clinical, radiological or histological findings suggestive of CAM. These patients underwent aggressive surgical debridement followed by antifungals and strict control of diabetic mellitus. The extend and pattern of destruction caused by CAM in nose, paranasal sinus and orbit noticed peroperatively were analysed.</p><p><strong>Results:</strong> Out of the 86 patients who got operated, there are 62 males and 24 females patients aged from 28 to 86 years. The left side was involved in 41 patients, and the right side in 66 patients. Among the nasal involvement, middle turbinate (56) was maximally involved followed by inferior turbinate (52), superior turbinate (1), septum (17) with posterior septum mostly involved, floor of nose was involved in (4) patients. The orbit was involved in 28 cases in which lamina papyracea was eroded in all cases followed by inferior orbital wall, orbital muscles, optic nerve. Cribriform plate was eroded in 3 patients. The overall extent of involvement of mucormycosis is as follows maxilla (86), ethmoid (71), frontal (29), sphenoid (30), septum (17), orbit (28), alveolus (5), palate (10), intracranial (9), subcutaneous phycomycosis (10).</p><p><strong>Conclusions:</strong> Management of CAM is really challenging which needs a multidisciplinary approach that includes aggressive surgical debridement, aggressive medical therapy with Amphotericin B and correction of the predisposing factors primarily diabetics mellitus</p>

<p class="abstract"><strong>Background: </strong>Coronaviruses (CoV) disease caused by the seventh member of enveloped RNA coronavirusdisease. The COVID-19 is presented mainly by lower respiratory tract related symptoms such as fever, cough, dyspnea and chest tightness that could progress rapidly to acute respiratory distress syndrome (ARDS) whereas the different upper respiratory tract related symptoms include nasal congestion, sore throat and smell dysfunction. The aim of this study is to contribute to current knowledge about COVID-19 and to study about the otorhinolaryngological manifestations and its effects in COVID-19 patients.</p><p class="abstract"><strong>Methods:</strong> This prospective observational study was done on 644 patients who got admitted to COVID suspect ward of a tertiary care centre in middle India. The patients were assessed for the signs and symptoms and the findings were analysed.</p><p class="abstract"><strong>Results: </strong>Within the included 664 cases, 423 (64%) were males and 241(36%) were females. The maximum number of patients in 50 to 60 years of age ,128(19%). Among which 97% (646) from urban area and 3% (18) from rural area. 564 (85%) were symptomatic with 459 patients had symptoms for 1-4 days,112 patients for 5-10 days,4 patients between 11-15 days. The most common symptoms with which these patients presented were cough (68%), fever (62%), signs of breathlessness (61%). The most common ENT manifestations were sore throat 333 (59%), nasal discharge 120 (12%), anosmia 65 (12%), ear discharge 46 (8%).</p><p class="abstract"><strong>Conclusions: </strong>Even though the most common manifestations of COVID-19 were cough, fever, breathlessness significant proportions of patients do manifest with ENT symptoms like sorethroat, nasal discharge, anosmia, ear discharge which may go unnoticed. Recognizing the cases and addressing them properly is important for curbing the rapid spread of COVID-19 pandemic.</p>