COVID-associated rhinocerebral mucormycosis: a retrospective analysis of presentation and outcomes.

OBJECTIVES: To comprehensively analyse the disease presentation and mortality of COVID-associated rhino-orbito-cerebral mucormycosis. METHODS: A retrospective analysis of the demographics, clinical and radiographic findings was performed. A binary logistic regression analysis was performed to examine the survival of patients with mucormycosis from hypothesised predictors. RESULTS: A total of 202 patients were included in this study. Statistical significance was demonstrated in the predilection to the male gender, recent history of SARS-COV-2, history of use of corticosteroid and hyperglycemia in this cohort of CAM. The mortality rate was 18.31%. Advanced age, raised HbA1c and intra-orbital extension were found to be predictors adversely affecting survival. CONCLUSION: Early diagnosis, aggressive surgical therapy, early and appropriate medical therapy can help improve outcomes. LEVEL OF EVIDENCE: Level 4.

Sex- and Gender-Based Reporting in Antihypertensive Medication Literature Informing Hypertension Guidelines.

BACKGROUND: Hypertension is the leading modifiable cardiovascular risk factor with recognized sex- and gender-based differences. We assessed the incorporation of sex and gender reporting in the antihypertensive medication literature informing hypertension guidelines. METHODS AND RESULTS: Literature cited in the International Society of Hypertension (2020), European Society of Cardiology/European Society of Hypertension (2018), American College of Cardiology/American Heart Association (2017), Latin American Society of Hypertension (2017), Pan-African Society of Cardiology (2020), and Hypertension Canada (2020) guidelines was systematically reviewed. Observational studies, randomized controlled trials, and systematic reviews involving antihypertensive medications were included. Studies with participants of a single sex, guidelines, and commentaries were excluded. Data on study participation-to-prevalence ratio by sex, analysis of baseline demographics and study outcomes by sex, and stratification of adverse events by sex were extracted. Of 1659 unique citations, 331 studies met inclusion criteria. Of those, 81% reported the sex of participants, and 22% reported a male-to-female participation-to-prevalence ratio of 0.8 to 1.2. Three percent of studies stratified baseline characteristics by sex, and 20% considered sex during analysis through statistical adjustment or stratification. Although 32% of studies reported adverse events, only 0.6% stratified adverse events by sex. Most (58%) studies reporting sex/gender used sex and gender terms interchangeably. CONCLUSIONS: Incorporation of sex- and gender-based considerations in study population, analysis, or reporting of results and adverse events is not common in the antihypertensive medication literature informing international hypertension guidelines. Greater attention to sex- and gender-based factors in research is required to optimally inform management of hypertension.

Clinico-Epidemiological Profile of Dialysis Services in Karnataka, India - A Multicentric Exploratory Study.

Introduction: New challenges in dialysis care delivery confront caregivers with the rise in dialysis numbers. There are significant lacunae in the knowledge and efficient application of dialysis therapy in the absence of a dialysis registry. This multicentric study was conducted by the Nephrology Association of Karnataka to systematically study patient demographics and dialysis characteristics in Karnataka state, India, as a basis for a statewide dialysis registry. Material and Methods: Data were collected from the consenting dialysis centers after institutional ethics board clearances. Residents of Karnataka state, who were confirmed prevalent patients with end-stage renal disease, on either maintenance hemodialysis (HD) or peritoneal dialysis were included. Demographic data of patients and details of dialysis as well as dialysis facilities were collected on an online platform. Statistical analysis was done using SPSS software Version 16. Results: Thirty-two centers contributed to the data of 2,050 patients (males 70.3%, mean age 53.49 ± 14.09 years). Most patients were on HD (95.3%). Diabetes was the commonest cause of chronic kidney disease. About 72% of patients had temporary venous catheters as initial vascular access. In all, 1,156 patients (59.9%) were on thrice weekly HD. Around 65% of the centers were in private hospitals. The majority (90%) of the centers reused dialyzers, 56% reprocessed dialyzers mechanically, and 66% tested viral serology quarterly. Conclusions: This study was one of the initial attempts to capture dialysis data across Karnataka, and it offers useful insight into the existing dialysis demographics and care delivery. Participation of more centers and continued effort to form a dialysis registry for deriving meaningful clinico-epidemiological insight are desirable.