Rhino Orbital Cerebral Mucormycosis in Covid-19 Crisis

Rhino-Orbital cerebral Mucormycosis (ROCM) an angioinvasive fungal infection commonly seen in diabetic and immunocompromised patients. In recent days, due to COVID 19 pandemic mucormycosis has been significantly increased (Smith et al. in Radiol Cardiothorac Imaging 2(5):e200280, 2020). In this study we evaluate the involvement, clinical features, contributing risk factors and outcome of post covid Rhino orbital cerebral mucormycosis. A cross sectional descriptive study was conducted on post covid rhino orbital cerebral mucormycosis patients from May 2021 to October 2021 in Otorhinolaryngology department of Stanley Medical college Chennai. We collected detailed history of Covid-19 hospital stay, treatment taken, co morbidities, Endoscopic findings, management and outcome. 243 cases analysed with median age 51 years (range 28–75 years) and male predominance with M:F ratio 1.6. The median time interval between covid and ROCM was 20 (15–35) days. Based on involvement 111 (46%) Stage-II, 87 (36%) Stage-I, 37 (15%) stage III and 8 (3%) stage IV disease observed. with overall mortality of 5.7%. Among which 230 (94.6%) patients had diabetes mellitus, 111 (45.8%) patients received steroid and 134 (54.3%) had immunomodulators during covid management. Despite of surgical debridement and antifungal therapy 14 (5.8%) patients died from mucormycosis. we conclude that covid be the predisposing factor for mucormycosis especially in patients with diabetes and increased usage of steroids. Treatment needs multimodality approach with antifungals and surgical debridement with surveillance fir good outcome.

An Evaluation of Efficacy and Safety of Tofacitinib, A JAK Inhibitor in the Management of Hospitalized Patients with Mild to Moderate COVID-19 - An Open-Label Randomized Controlled Study

Several systemic anti-inflammatory and immunomodulatory agents were tried in the management of hyper inflammatory manifestations of COVID 19. JAK inhibitors have been widely deployed in rheumatology due to their benefits in managing uncontrolled inflammation. Tofacitinib is one of the most widely studied immunomodulators in rheumatology. We assessed the safety and efficacy of Tofacitinib in an open-labeled randomized control study, in addition to the standard of care (SOC) in hospitalized adults with mild to moderate COVID-19 pneumonia. Patients (n=100) with COVID 19 pneumonia admitted during October-December 2020 were randomly assigned to either control (N=50) (SOC treatment alone) or to study groups (N=50) receiving Tofacitinib in addition. Patients, reporting positive RT-PCR for SARS-COV2 and radiological evidence of pneumonia were hospitalized for over 7 days. The study group received Tofacitinib for 14 days irrespective of the discharge status and was followed up to 28 days. There was a greater relative reduction in levels of important markers of inflammation in the Tofacitinib group than in the control group (CRP:78% vs 45%;Ferritin:15% vs 10%;D. Dimer: 37% vs 15%) although there were no differences in duration of hospitalizations or oxygen requirement. Tofacitinib, 10 mg was well-tolerated and was devoid of any serious adverse event. We are the first to record the benefits of Tofacitinib in India to our knowledge although a Brazilian study conducted around the same time showed mortality benefit in severe COVID. We conclude that Tofacitinib use is safe and aids in the reduction of the overwhelming inflammatory response during COVID-19 infections. © 2021 Journal of Association of Physicians of India. All rights reserved.