Background and Purpose: Invasive mucormycosis is a fatal disease caused by Mucorales species. Treatment therapy for CAM includes aggressive surgical debridement and systemic antifungals in Amphotericin B and Posaconazole as step-down therapy in the follow-up period. Despite being on oral antifungal Posaconazole therapy, patients have been observed to have a recurrence of mucormycosis in the follow-up period. Experimental Approach: An ambispective cohort study was done in the department of ENT and Pharmacology of All India Institute of Medical Sciences (AIIMS), Bhubaneswar, from April 2021 to September 2022. It includes patients on follow-up on the step-down therapy of Posaconazole. Medication adherence was measured based on the half-life of Posaconazole and participants not skipping a single dose. Key Results: The demographic data between the recurrence and non-recurrence groups, including age, sex and duration of stay, was not significant. Recurrence in mucormycosis was not found to be associated with medication adherence. By both methods of calculating medication adherence, the results were statistically insignificant. The difference in onset of recurrence of the disease between the two groups was statistically significant, with a p-value of 0.027 in patients who did not skip a single dose of Posaconazole with a hazard ratio of 3.887. There was a statistically significant difference in cost-effective analysis with a p-value of 0.042 between groups. Conclusion and Implications: Posaconazole medication adherence in the postoperative period does not affect the recurrence of mucormycosis during step-down therapy. However, it helps prolong the onset of disease recurrence in patients adhering to the medication.

Objectives: To compare the efficacy of temporalis fascia myringoplasty using platelet rich plasma(PRP) {MP-PRP} and conventional temporalis fascia myringoplasty(MP-C) in treatment of moderate to large central tympanic membrane(TM) perforation . STUDY DESIGN: Randomized-Control-Trial SETTING: Tertiary-Health-Centre SUBJECTS AND METHODS:We randomly assigned eighty patients with COM-mucosal-type with medium to large central TM perforation and conductive hearing loss planned for primary myringoplasty to receive either MP-PRP orMP-C. Myringoplasty was performed through post-auricular approach underlay graft using temporalis fascia. Primary outcome was graft uptake (an intact TM) at 6 months postoperatively. Secondary outcome was the post-operative hearing improvement measured by pure-tone-audiometry (PTA). RESULTS: Eighty myringoplasties (MP-PRP group-40, MP-C group-40) done for 80 patients (male=41; female=39,age-group=18-45-years) were included in analysis. At 6months postoperatively graft uptake rate was 94.4% in MP-PRP and 92.1%% in MP-C group. There was no statistically significant difference in graft uptake between the two groups(p=0.358).Success in terms of hearing gain (≥10dB) was achived in 34 patients (89.5%) in MP-C and 37 patients (94.9%) in MP-PRP group.At 6months follow-up; mean-PTA-average improved from 35.10±5.401dB to 27.74±5.660dB and mean ABG improved from 24.00±5.204dB to17.42±5.559dB in MP-C group. At 6months follow-up; mean-PTA-average improved from 37.00±6.144dB to 26.65dB and mean air bone gap(ABG) improved from 25.98±5.736dB to 16.21±4.318dB in MP-PRPgroup. No statistically significant differences in improvement in PTA-values were observed between both groups. (p=0.336).Postoperative complications were similar in both groups. Conclusion: Graft uptake, hearing outcomes and complications of MP-PRP were similar to MP-C. MP-PRP offers no advantages over MP-C for treatment of TM perforation.