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OBJECTIVE: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. METHOD: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. RESULTS: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan-Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). CONCLUSION: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.
Subject(s)
COVID-19 , Mucormycosis , Orbital Diseases , Humans , Mucormycosis/drug therapy , Retrospective Studies , Aspirin/therapeutic use , Antifungal Agents/therapeutic use , DebridementABSTRACT
Background:COVID-19 RT-PCR kits of various manufacturers categorize certain samples as inconclusive and repeat testing or re-sampling is advised in those cases to ascertain positivity or a negative result. This is of paramount im- portance because a definite result helps in effective implementation of public health measures, leading to implicit con- tainment. Our study aims to ascertain criteria through which the inconclusive can be definitively categorized as either positive or negative. This will be of help in conserving manpower and resources which are utilized in re -testing of pa- tients with inconclusive RT-PCR result. Methods:Hundred samples which were inconclusive (IC) as per Q-Line Covid-19 RT-PCR kit from 1st September, 2020 to 31st October, 2020 were included in the study. These were classified into 4 groups based on Ct value of N gene;namely A (<25;3 samples), B (25-30.9;31), C (31-34;62) and D (>34;4) and were tested by NIV kit. RNA extracts of these sam- ples were run through ICMR-NIV rRT-PCR screening and confirmatory assay to ascertain a criteria with which inconclu- sives can be definitively reported as either positive or negative. Results:Majority (62%) of IC samples were in group C (Ct 31-34) followed by 31% in group B, 4% in D and 3% in group A (<25). Confirmed positivity by NIV kit was 100% in group A and 51.6%, 20.96% and 25% respectively in B, C & D groups.29% of group B and 24% group C samples remained inconclusive by NIV kit. Majority of confirmed negatives were found in group D (75%), followed by group C (54.83%). Conclusions:All inconclusive samples with Ct values of N gene less than 25 were positive with ICMR -NIV kit, whereas >50% of samples of Ct >30 became negative. Repeat sampling could be avoided in 76% cases by following strategy of repeat testing in NIV kit.
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Background:The Coronavirus disease 2019 (COVID 19) pandemic has resulted in reduced performance of non-emergent surgeries and procedures across the nation. About four-fifth of COVID-19 infections remain asymptomatic. With an incu- bation period of 7-14 days, patients can also remain in the pre-symptomatic stage. Hence, knowledge of the prevalence of disease among the asymptomatic is important to prevent spread of disease to the health care professional as well as for patient safety. The present study sought to assess the frequency of positivity of COVID 19 among pre -procedural/pre-operative patients. Methods:A retrospective study of all asymptomatic pre-procedural cases was conducted from 10th June 2020 till 10th November 2020. Nasal swabs were collected from patients 48 hours before procedures (including elective and emer- gency surgeries, patient scheduled to receive chemotherapy, radiotherapy, patients undergoing biopsy, endoscopy). RT - PCR test was done for all samples. Case-specific data, results of all PCR tests, and answers to screening questions (about symptoms, exposure, and travel) were obtained Results: 5320 tests were conducted during the study period. Of these, data could be analysed for 2117 tests done. 51.1% were male patients and the median age group of the cohort was 46 years. 254 of 2117 (11.9%) belonged to the paediatric age group. Of 2117, 35 samples were rejected because of sample leakage or improper labelling. Out of the remaining 2082 samples;338 were positive;1606 were negative, and 138 inconclusive. We received second sample for 117 of the 138 inconclusive samples of which 18 were positive, 93 were negative and 6 remained inconclusive. Thus, the total positivity was 17.1%. Conclusions:This study confirms the high proportion of asymptomatic patients with COVID -19 positivity;and suggests the value of screening by RT-PCR during COVID-19 pandemics.
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Background:From the day of the detection of 1st case in India on 30th January 2020, COVID -19, has infected 8.96 mil- lion people in India, from around 128 million samples tested. The clinico -epidemiological characteristics of COVID 19 have been varied in different countries. The present study was undertaken to understand the clinico -epidemiological characteristics of COVID-19 in Odisha. Methods:This was a retrospective, single centre study. The epidemiological, demographic & clinical parameters were analysed of the samples tested in AIIMS Bhubaneswar between March 2020 to November 2020. Results:A total of 56,547 samples were tested for SARS CoV-2 by RT-PCR from March 24th 2020 till 15th November 2020. Of the total samples tested, 9754 were tested positive, with an average positivity rate of 17.25%. The mean age of the patients 38.21 years, with male to female ratio of 3:1. Among the various age groups, the majority affected were the middle ages (31-50 years) constituting around 38.77% (n = 3782) of the total cases followed by 15 -30 years (31.48%, n=3071) &> 50 years (23.64% n = 2305) & was least in children (<14years) with 6.11% (n = 596). Among the COVID -19 positives, 64.5% (n=6295) were asymptomatic & only 35.5% (n=3459) were symptomatic. Of the symptomatic patients, 81.1% (n=2805) presented with mild, 17.7 %( n=612) cases moderate, and only around 1.12% (n=39) had severe COVID - 19 disease. Of the severe cases, majority belong to the age group 31-50 (38.46%, n = 17), followed by 15-30 (15.3%, n=11). The monthly trend showed an increasing trend up to September, with maximum positivity rate of 38%, followed by a decline during October (14.7%) & November (5.8%) Conclusions: In this study of 9754 patients with confirmed COVID-19 in Odisha, the characteristic findings included younger age, male predominance, high proportion of asymptomatic patients & a declining trend in the positivity rate over the months
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Background:COVID-19 pandemic is posing a major burden on society. Measures taken to reduce its spread critically de- pend on timely and accurate identification of virus-infected individuals by the most sensitive and specific method availa- ble, i.e. real-time reverse transcriptase PCR (RT-PCR). RT PCR can detect SARS-CoV-2 as early as day one of symptom onset. There are various RT PCR kits approved by FDA & ICMR, performance of which vary widely. Here, we assessed the performance of four PCR kits with the ICMR NIV Screening & Confirmatory assay used for diagnosis of COVID -19 in Od- isha. Methods:A total of 20 samples, which included five positives, one inconclusive & 14 negative samples by NIV assay were evaluated in the four commercially available RT-PCR kits ie;Q-line Molecular (Q-line), Allplex™ 2019-nCoV Assay (Allplex), Liferiver Novel Coronavirus (COVID-19) Multiplex RT PCR (Liferiver), LabGun™ COVID-19 kit (LabGun). Results:The sensitivity of the four PCR kits varied with the high cycle threshold (Ct) value (30-35 by NIV) & the lower Ct value (<30 by NIV). Among the negative results of NIV (n=14), LabGun, Allplex kits showed 100% concordance, while Q - line & Life river were shown to have 92.8% & 50% concordance respectively. In the inconclusive results (n=1), only All- plex Assay documented a concordance of 100% with the NIV assay, while the Q -line (n=6) & Life river (n=7) showed higher number of inconclusive results. The different kits showed lesser variations with positive results (n=5), with Life river, Allplex & LabGun showing 100% concordance for positive results with NIV assay. However, Q -line was able to de- tect only 1 positive out of all positives. Conclusions:PCR kits vary in sensitivity & it is imperial to evaluate the various kits in order to deliver accurate results at optimum time in order to detect the cases to initiate adequate treatment & control measures
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BACKGROUND: An unprecedented rise in the number of COVID-19-associated mucormycosis (CAM) cases has been reported in India. Myriad hypotheses are proposed for the outbreak. We recently reported uncontrolled diabetes and inappropriate steroid therapy as significant risk factors for the outbreak. However, Mucorales contamination of hospital environment was not studied. AIM: To perform a multi-centre study across India to determine possible Mucorales contamination of hospital environment during the outbreak. METHODS: Eleven hospitals from four zones of India representing high to low incidence for mucormycosis cases were included in the study. Samples from a variety of equipment used by the patients and ambient air were collected during May 19th, 2021 through August 25th, 2021. FINDINGS: None of the hospital equipment sampled was contaminated with Mucorales. However, Mucorales were isolated from 11.1% air-conditioning vents and 1.7% of patients' used masks. Other fungi were isolated from 18% of hospital equipment and surfaces, and 8.1% of used masks. Mucorales grew from 21.7% indoor and 53.8% outdoor air samples. Spore counts of Mucorales in air were significantly higher in the hospitals of North and South zones compared to West and East zones (P < 0.0001). Among Mucorales isolated from the environment, Rhizopus spp. were the most frequent genus. CONCLUSION: Contamination of air-conditioning vents and hospital air by Mucorales was found. Presence of Mucorales in these areas demands regular surveillance and improvement of hospital environment, as contamination may contribute to healthcare-associated mucormycosis outbreaks, especially among immunocompromised patients.