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Background It is an incontrovertible fact that the Rhino Orbital Cerebral Mucormycosis (ROCM) upsurge is being seen in the context of COVID-19 in India. Briefly presented is evidence that in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 and injudicious use of corticosteroids may be largely responsible for this malady. Objective To find the possible impact of COVID 19 infection and various co-morbidities on occurrence of ROCM and demonstrate the outcome based on medical and surgical interventions. Methodology. Prospective longitudinal study included patients diagnosed with acute invasive fungal rhinosinusitis after a recent COVID-19 infection. Diagnostic nasal endoscopy (DNE) was performed on each patient and swabs were taken and sent for fungal KOH staining and microscopy. Medical management included Injection Liposomal Amphotericin B, Posaconazole and Voriconazole. Surgical treatment was restricted to patients with RT PCR negative results for COVID-19. Endoscopic, open, and combined approaches were utilized to eradicate infection. Follow-up for survived patients was maintained regularly for the first postoperative month. Results Out of total 131 patients, 111 patients had prior history of SARS COVID 19 infection, confirmed with a positive RT-PCR report and the rest 20 patients had no such history. Steroids were received as a part of treatment in 67 patients infected with COVID 19. Among 131 patients, 124 recovered, 1 worsened and 6 died. Out of 101 known diabetics, 98 recovered and 3 had fatal outcomes. 7 patients with previous history of COVID infection did not have any evidence of Diabetes mellitus, steroid intake or any other comorbidity. Conclusion It can be concluded that ROCM upsurge seen in the context of COVID-19 in India was mainly seen in patients with uncontrolled diabetes, a dysfunctional immune system due to SARS-COV-2 infection and injudicious use of corticosteroids.

Genitourinary myiasis, associated with ulcerating lesions and poor hygiene of the local site, has been infrequently reported. We report a case of 45 year-old urinary incontinent female suffering from carcinoma cervix, who presented with genitourinary myiasis. The larva was identified as of Chrysomyia bezziana Villeneuve (C. bezziana). Key words: Genitourinary myiasis, Chrysomyia bezzianaMyiasis, defined as infestation of vertebrate animals with dipterous larvae, can cause massive destruction in neglected patients accompanied by marked inflammatory reactions and secondary bacterial infections. Cutaneous myiasis is the most common form. Genitourinary involvement is rare and usually presents as pruritus and pain at the site of infection. Chrysomyia has been reported to cause myiasis in manand domestic animals in the tropics. Species implicated are C.bezziana(most common and the only known obligatory agent of myiasis), C.megacephala and C.rufifacies.2 The present case is of genitourinary myiasis caused by larvae of Old World screw-worm fly C. bezziana. Case ReportA 45 year-old female, belonging to a poor family, residing in suburban area of Delhi, reported to the radiotherapy out patient department (OPD) of a tertiary care hospital in NewDelhi, India with complaints of pruritus and gnawing pain in the periuretheral area since two days. Before visiting the clinic, she was able to manually remove a small organism from the uretheral orifice, which alleviated the pain. The patient was suffering from carcinoma cervix (grade III), since two years. Three weeeks back, she developed urinary incontinence, due to the spread of the malignancy and since then had been living in poor sanitary conditions. The organism received in the laboratory was white, measured 5mm in length and had tough but not sclerotic integument. It was mounted in chloral -gum medium and kept over a hot plate (for clearing) for a week. A subsequent examination of the urine and stool sample of the patient did not reveal any pathogen. The patient was advised to attend to the gynaecology OPD for physical examination, management of urinary incontinence and antibiotic treatment. The patient could not be followed up.

Background: A definitive diagnosis of multiple sclerosis (MS), as distinct from a clinically isolated syndrome, requires one of two conditions: a second clinical attack or particular magnetic resonance imaging (MRI) findings as defined by the McDonald criteria. MRI is also important after a diagnosis is made as a means of monitoring subclinical disease activity. While a standardized protocol for diagnostic and follow-up MRI has been developed by the Consortium of Multiple Sclerosis Centres, acceptance and implementation in Canada have been suboptimal. Methods: To improve diagnosis, monitoring, and management of a clinically isolated syndrome and MS, a Canadian expert panel created consensus recommendations about the appropriate application of the 2010 McDonald criteria in routine practice, strategies to improve adherence to the standardized Consortium of Multiple Sclerosis Centres MRI protocol, and methods for ensuring effective communication among health care practitioners, in particular referring physicians, neurologists, and radiologists. Results: This article presents eight consensus statements developed by the expert panel, along with the rationale underlying the recommendations and commentaries on how to prioritize resource use within the Canadian healthcare system. Conclusions: The expert panel calls on neurologists and radiologists in Canada to incorporate the McDonald criteria, the Consortium of Multiple Sclerosis Centres MRI protocol, and other guidance given in this consensus presentation into their practices. By improving communication and general awareness of best practices for MRI use in MS diagnosis and monitoring, we can improve patient care across Canada by providing timely diagnosis, informed management decisions, and better continuity of care.