Browsing by Author "Pradhananga, RB"
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Publication Sinonasal Mucormycosis Amidst the Second Wave of COVID-19 Pandemic; Clinical Spectrum and Outcome in a Tertiary Care Center in Nepal(Kathmandu University, 2024) Gurung U; Dongol K; Paudel S; Thapa, NM; Pradhananga, RB; Gyawali, BR; Shrestha GSABSTRACT Background Mucormycosis is an angioinvasive opportunistic fungal infection which surged during the second wave of COVID-19 pandemic. Objective This study assessed patient demographics, risk factors, clinical characteristics, and outcomes of sinonasal mucormycosis during the second wave of COVID-19 pandemic. Method The clinical records of patients with histologically proven sinonasal mucormycosis, admitted between May 2021 to October 2021, in a tertiary center were reviewed. Result There were 25 patients (18 males, 7 females). The age ranged from 16 to 70 years (mean 51 ± 9.5 years). Uncontrolled diabetes mellitus detected in 23 patients was the most common co-morbidity. COVID-19 infection was documented in 20 patients. The mean time of diagnosis was 12 days after the onset of COVID-19 infection. Based on the disease extent, six patients had sino-nasal, seven had rhino-orbital, and 12 had rhino-orbital-cerebral involvement. The most common first presenting symptom was orbital (17/25) followed by facial (5/25) and orodental (3/25). All patients received intravenous amphotericin B for 2 to 8 weeks. Maintenance with posaconazole ranged from 3 to 9 months. Sixteen patients underwent surgical debridement. Out of the 25 patients, 14 (56%) had good recovery. Poor outcome was observed mostly with intracranial involvement. Conclusion Uncontrolled diabetes mellitus was a common risk factor. Advanced disease at presentation was frequently encountered due to rapid extrasinus spread. Nearly 50% of patients had good recovery whilst poor outcome was observed, mostly with intracranial involvement. Adequate blood sugar control, early administration of antifungals, and aggressive surgical debridement are the mainstay of treatment. KEY WORDS COVID-19, Hyperglycemia, Mucor, Mucormycosis, PandemicPublication Success Rate of Simple Underlay Myringoplasty in Smaller Perforation of Tympanic Membrane(Institute of Medicine, 2014) Pradhananga, RBAbstract Introduction: The objective of the study was to compare the success rate of Simple Underlay Myringoplasty (SUM) in smaller perforation of tympanic membrane (TM) with that of Conventional Underlay Myringoplasty. Methods: It was a prospective, longitudinal study on 46 patients of more than 15 years of age with Chronic Otitis Media Mucosal type with the small and medium sized perforations. The patients with average hearing loss more than 30 dB were excluded from the study. The patients were randomized into two groups: group A- who underwent SUM (26 patients) and group B-who underwent Conventional Myringoplasty (20 patients). The patients were followed up on 6th, 8th and 10th post operative week for the assessment of the status of the graft. The status was described as; intact TM, graft with residual pin point perforation and total rejection of the graft with remaining perforation. Results: There was no statistical difference in graft status between SUM and Conventional Myringoplasty in all the three post operative follow up (p value = 0.121, 0.279 and 1.0 in 6th, 8th and 10th week of follow up respectively). Conclusion: Simple Underlay Myringoplasty has comparable success rate (88.46%, 23/26) as Conventional Underlay Myringoplasty (90.0%, 18/20). Keywords: Chronic Otitis Media mucosal type, Underlay Myringoplasty, Tympanic Membrane