Is Mucormycosis an inevitable complication of Covid-19 in India?

ABSTRACT Mucormycosis or black fungus infection is a less common disease but highly fatal infection, infecting the immunocompromised individuals. The site of predilection of the fungus is found to be lungs and brain in addition to its sequestration in sinusoidal spaces. Presently with the ongoing COVID 19 pandemic, the prevalence of this infection is found to be high in the Indian population. The fungus establishes itself by affecting the compromised immune system of an individual and thereby making the individual susceptible to other diseases/ infection. The reasons attributed to the sudden upsurge are steroidal therapeutics abuse, tocilizumab therapy and diabetes mellitus.To avert the cytokine storm, the medical health workers are necessitated to include steroid drugs in COVID 19 treatment protocol however inclusion of these drugs in patients who do essentially require steroids can have their immune system debilitated and permit the invasion of this fungus. According to International Diabetes Federation (IDF), 77 million Indians are known to be diabetic, cautioning the physicians to be vigilante of the impending black fungus infection in the event of COVID19 affliction in such individuals. There is causal relationship between anti-hyperglycemic drugs and weakened immune system and opportunity for the fungus invasion. This review attempts to explain the inter-relatedness of COVID19 infection, its treatment and eventual black fungus infection risk.

Risk Factors for Anemia in Non-pregnant Women across the Agroecological Zones of Nepal.

Objectives: Describe the prevalence of anemia in Nepali non-pregnant women of reproductive age by agroecological zone and potential risk factors. Methods: We randomly sampled 21 Village Development Committees, each with 3 wards, proportionate to size across the mountains, hills and terai. In 4509 households with children <5 years or newlyweds we assessed anthropometry, 7-day diet frequency, morbidity, participation in health services and altitude-adjusted hemoglobin measurement (n=887). Household SES and empowerment questions were asked. Regression analyses were used to evaluate risk factors of anemia. Results: Anemia affected 53.3% of all women, and 42.3%, 35.8% and 66.1% in the mountains, hills and terai, respectively. Lowest vs. higher castes in the terai were at higher risk of anemia (OR=1.58, CI: 1.04-2.40). A secondary education (6-9 years) and overweightness (BMI > 24.9) appeared protective against anemia (OR=0.59, CI: 0.39-0.90 and OR=0.49, CI: 0.27-0.90, respectively). Women who accessed skilled health care workers in the past year had an increased risk of anemia (OR=1.36, CI: 0.99-1.85), likely reflecting their illness. Knowledge of deworming and iron-folic acid supplementation, SES and diversity of recent diet were unrelated to anemia risk. Conclusions: Approximately half of women of reproductive age have anemia in Nepal, with the highest risk in the terai. Anemia was less likely in educated, higher caste and better nourished women. Lack of association with recent diet may reflect inadequate duration of assessment with 7- day frequencies or causes of anemia other than iron deficiency. Health care providers are more likely to see anemic women, representing an opportunity to screen and treat anemia.