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BACKGROUND There was a dramatic rise in the incidence of rhino-orbito-cerebral mucormycosis associated with the 2021 Covid-19 wave in India. We aim to document the demographic characteristics and risk factors of a consecutive cohort of inpatients with Covid-19-associated rhino-orbito-cerebral mucormycosis (CAROM) during the surge of April–June 2021. METHODS We included all patients of CAROM treated at our tertiary referral facility from 1 April to 14 June 2021. We prospectively gathered details with regard to Covid-19 illness and treatment, CAROM presentation, comorbid conditions and risk factors. RESULTS Our prospective cohort consisted of 200 consecutive patients, of which 146 (73%) patients tested positive on the Covid-19 RT-PCR test at presentation. CAROM occurred concurrent with the Covid-19 infection in 86%, and delayed CAROM after seeming recovery from Covid-19 was seen in 14%. Covid-19 was classified as mild, moderate and severe in 54%, 33% and 13%. The surge of CAROM followed the population peak of Covid-19 infections by about 3 weeks. Advanced disease at presentation was frequent with ocular involvement in 56.6% (111/196) and central nervous system involvement in 20% (40/199). One or more comorbid conditions were identified in 191/200 (95.5%) patients. The dominant associations were with diabetes (189/200; 94.5%) and uncontrolled hyper-glycaemia (122/133; 91.7%), recent steroid use (114/ 200; 57%), which was often considered as inappropriate in dosage or duration, lymphopenia (142/176; 80.7%), and increased ferritin levels (140/160; 87.5%). No evidence supported the role of previous oxygen therapy or previous nasal swab testing as risk factors for CAROM. CONCLUSION The inpatient volumes of CAROM were noted to parallel the Covid-19 incidence curve by about 3 weeks. Covid-19 infection may directly predispose to CAROM by way of lymphopenia and increased ferritin levels. Uncontrolled hyperglycaemia is identified as a near-invariable association. Recent steroid use is noted as very frequent and was often received in excess of treatment advisories.
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Background: A large number of persons with psychiatric disorders are not seeking treatment due to various reasons, thus contributing to the huge treatment gap. One of the ways to bring these people into treatment is through telephonic helplines. Materials and Methods: Following a large number of suicides in the city of Chandigarh in 2003, The department of Psychiatry, GMCH, Chandigarh was designated as nodal center for the prevention of suicide. A 24-hour suicide prevention helpline was set up as an immediate measure to help persons in crisis. Apart from providing telephonic counseling to persons in crisis, the helpline coordinated with police, media, schools, radio stations etc., to reduce the number of suicides in the city. Results: Majority of the callers were males (65.93%), between 20 to 39 years old (56.34%), married (79.50%), had less than 12 years of formal education (60.68%), and were earning less than Rs. 5000/month (56.80%). 72.96% callers had contacted the mental health services for the first time. A significant number of persons (434, 13.26%) called the helpline for marital, academic, stress-related problems. Majority of the calls were received between 8 A.M. and 2 P.M. The number of suicides in the city of Chandigarh showed a decline in the following years since the helpline was set up. Conclusions: The telephonic helpline seems to be a very effective way of getting persons into contact with health services. They are cost-effective, the person can maintain his confidentiality and devoid of stigma.
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Background & objectives: In recent years, health-related quality of life (QOL) has been regarded as the most important dimension of outcome in schizophrenia. Recent research has shown that atypical antipsychotics improve QOL in patients with schizophrenia. Importance of electroconvulsive therapy (ECT) has been demonstrated in restoring function and health related quality of life in depressed patients. However, there are no data on patients of schizophrenia. The objective of the present study was therefore, to assess the improvement in quality of life after ECT in treatment resistant schizophrenia. Methods: Thirty consecutive patients of treatment resistant schizophrenia were given ECT sessions twice a week and assessments were made with Positive and Negative Syndrome Scale of Schizophrenia (PANSS), WHO QOL Bref, Global Assessment of Functioning Scale and Clinical Global Impressions. Results: The group improved significantly on all the domains of quality of life scale except the domain named satisfaction with social relations. There was also significant change in the total score of PANSS after 6 ECT sessions (mean at baseline = 86.7, mean after 6 ECT = 65.5, P< 0.001) as well as on different subscales of PANSS. The score on the global assessment of functioning also changed significantly (mean 26.3 at baseline to 44.5 after 6 ECT sessions). Interpretation & conclusions: The present findings showed that ECT in addition to improvement in symptomatology led to improvement in QOL in patients of treatment resistant schizophrenia.