Satellite Epidemic of Covid-19 Associated Mucormycosis in India: A Multi-Site Observational Study.

BACKGROUND: Sudden upsurge in cases of COVID-19 Associated Mucormycosis (CAM) following the second wave of the COVID-19 pandemic was recorded in India. This study describes the clinical characteristics, management and outcomes of CAM cases, and factors associated with mortality. METHODS: Microbiologically confirmed CAM cases were enrolled from April 2021 to September 2021 from ten diverse geographical locations in India. Data were collected using a structured questionnaire and entered into a web portal designed specifically for this investigation. Bivariate analyses and logistic regression were conducted using R version 4.0.2. RESULTS: A total of 336 CAM patients were enrolled; the majority were male (n = 232, 69.1%), literate (n = 261, 77.7%), and employed (n = 224, 66.7%). The commonest presenting symptoms in our cohort of patients were oro-facial and ophthalmological in nature. The median (Interquartile Range; IQR) interval between COVID diagnosis and admission due to mucormycosis was 31 (18, 47) days, whereas the median duration of symptoms of CAM before hospitalization was 10 (5, 20) days. All CAM cases received antifungal treatment, and debridement (either surgical or endoscopic or both) was carried out in the majority of them (326, 97.02%). Twenty-three (6.9%) of the enrolled CAM cases expired. The odds of death in CAM patients increased with an increase in HbA1c level (aOR: 1.34, 95%CI: 1.05, 1.72) following adjustment for age, gender, education and employment status. CONCLUSION: A longer vigil of around 4-6 weeks post-COVID-19 diagnosis is suggested for earlier diagnosis of CAM. Better glycemic control may avert mortality in admitted CAM cases.

Rhino-orbito-cerebral mucormycosis during Covid-19 pandemic- a prospective observational study.

OBJECTIVE: An unprecedented rise in mucormycosis cases; apparently called 'an epidemic within a pandemic' was seen worldwide. Therefore, the following study was conducted to know the epidemiology, underlying risk factors, diagnostic approach, and possible outcome of mucormycosis during the Covid-19 pandemic. METHODS: A prospective observational study was conducted on patients with a high index of clinical suspicion of mucormycosis Data about demographics, co-morbidities, laboratory investigations, radiology, management, and outcomes were collected. RESULTS: We got 45 cases of proven Rhino-orbital-cerebral-mucormycosis (ROCM) from clinically suspected cases. Covid-19 was the most common underlying risk factor (n â€‹= â€‹41, 91.11%) followed by Diabetes mellitus (DM) (n â€‹= â€‹39; 86.67%). Steroids and oxygen usage were noted in 53.66% (n â€‹= â€‹22) and 41.46% (n â€‹= â€‹17) respectively. Among the 51 suspected cases of mucormycosis, 47 were supported by radiodiagnosis. Histopathology diagnosed the highest number of mucormycosis cases (n â€‹= â€‹44; 97.78%), followed by KOH examination (n â€‹= â€‹36; 80%) and Culture (n â€‹= â€‹28; 62.22%). The most common species isolated from the tissue samples was Rhizopus species (n â€‹= â€‹17; 60.71%), followed by Mucor species (n â€‹= â€‹7; 25%). The mortality rate was 17.14%. CONCLUSION: DM, Covid-19, and corticosteroids are the chief underlying risk factor for ROCM. Rhizopus spp. was the most dominant etiological agent. Early diagnosis and management with combined medical & surgical intervention have a better survival rate.

Effect of resveratrol on the biomarkers of oxidative stress and inflammation in monocyte cultures from PBMC’s of patients with myocardial infarction

Globally, one of the major causes of mortality and morbidity is ischemic heart disease (IHD). It has been established that in cardiac disorders, there exists a synergistic correlation between the oxidative stress and inflammatory cytokines. The stabilization and regulation of the oxidative stress and inflammatory cytokines in these patients is essential for the better management of the disease. Hence, the aim of this study was to study the effect of natural antioxidant, resveratrol, on the oxidative stress and inflammatory biomarkers in cultures of monocytes isolated from peripheral blood mononuclear cells (PBMCs) from the patients with myocardial infarction. Monocytes isolated from peripheral blood mononuclear cells (PBMC’s) of patients with myocardial infarction (MI) and healthy controls were employed in culture studies (with and without resveratrol). The 24 h cultures were subjected to evaluation of cytokine/ interleukins levels i.e. TNF-α, IL-1 and IL-6 as well as oxidative stress markers like MDA and Glutathione. The patient’s samples exhibited a significantly decreased level of intramonocyte glutathione as compared to samples of healthy subjects. On the other hand, significantly increased levels of MDA were observed in culture supernatants of monocytes isolated from PBMC’s of patients with MI in comparison to those of healthy controls. A significant degree of amelioration in intramonocyte glutathione levels coupled with decreased MDA levels (culture supernatants) were observed in cultures treated with resveratrol (20 ug/mL). Furthermore, 24 h culture supernatants of untreated patients cells exhibited augmented levels of IL-1, IL-6, and TNF-α. However, co-culturing with resveratrol exhibited a significant decrease in the levels of all the IL-1, IL-6 and TNF-α. Resveratrol—a potent polyphenol from grapes and also a natural antioxidant regulates the oxidative stress and inflammatory biomarkers and may be used as a prophylactic antioxidant in high risk patients.