A Clinical Analysis of COVID Associated Mucormycosis in a Tertiary Care Hospital

Background: With an increase in the spread of the pandemic, ailments related to the COVID illness started to appear. Patients with COVID - 19 infection experienced a worse outcome with an increase in the prevalence of opportunistic infections in the infected person especially Mucormycosis. It was recognized that people with diabetes, cancer, patients undergoing chemotherapy and other immune-compromised conditions can develop Mucormycosis. Systemic steroids and other immune-modulating agents which are the mainstay of treatment for COVID-19 predisposes to the chance of developing invasive fungal infections. Methodology: Here we provide a retrospective analysis in which out of 212 patients who were subjected to screening 13 individuals were KOH mount positive with unique clinical characteristics as well as demographic and therapeutic profile. The information was gathered retrospectively at a single facility that serves a sizable group of patients with varying severity of the Corona virus infection. Results: Of the total in-patients taken into consideration 13 were diagnosed with mucormycosis post COVID-19 infection. The median age was greater among individuals who survived the infections (49.5 years) and those with severe COVID had high chance of dying (23.8), with an overall mortality rate of 64.3 percent. Additionally 61.5 percent of patients had diabetes mellitus and 75% of them died. 11 patients (84.6%) had previously been on steroids for COVID-19. Both the individuals who survived and succumbed to the disease had same level of hyperglycemia. Conclusion: The prevalence of mucormycosis among COVID-19 patients appears to be rising, which may be attributed to increasing usage of steroid, a potential immunocompromised state brought about by the virus per se and the co-morbid conditions. A high index of suspicion and early diagnosis is necessary to bring down the mortality rate This is in addition to the preventive measures and sensible use of immunemodulators. [ FROM AUTHOR] Copyright of Journal of Pharmaceutical Negative Results is the property of ResearchTrentz and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Comments on "Optimal control analysis of a COVID-19 and tuberculosis co-dynamics model".

Study of dynamics of COVID-19 and its co-infection with other diseases through mathematical models is the major focus of recent advancement in mathematical modeling of infectious diseases. There are numerous mathematical models on COVID-19 which describe its dynamics for different geographic regions. However, there are very few research papers dealing with co-infection of COVID-19 and TB. As both TB and COVID-19 are infectious diseases of same nature it becomes very difficult to predict the co-dynamics of these two diseases. The formulation of a correct mathematical model is very important in any kind of modeling and if the mathematical model is not proper then any prediction based on this may not be valid. This letter highlights the important limitations in the proposed mathematical model of co-dynamics of COVID-19 and TB by [1].

Factors affecting uptake of COVID 19 vaccines - a case of Mbala district, Northern Zambia

The desire to control Covid 19 pandemic has continued to exist in the Mbala district of Zambia, with the latest trend showing a significant increase in a number of people testing positive, with a corresponding increase in vaccines (AZ, JJ) hesitancy resulting in a low (2.8%) vaccination rate in the district. Thus, the need to probe further on covert factors under acceptability (myths, AEFs) and accessibility (vaccines availability, adequacy of vaccination sites) that could be reducing Covid 19 vaccine uptake in Mbala district. The study used a cross-sectional survey, a mixed (quantitative & qualitative) method in eliciting information from data sources covering a period of six months (April - September 2021). In all, 341 research respondents were interviewed through self-administered questionnaires. Data were analysed using descriptive statistics and binary logistic regression under SPSS v16. Study Findings Provide Sufficient Evidence That High Myth (89.8%) Reduced Acceptability Levels, While A Low Number Of Vaccination Sites (59%) Reduced Accessibility, Resulting In A Low Uptake Rate In Mbala District. Therefore, The Study Recommended;Building Up Of Well-Financed District Covid 19 Task Forces With Educational Aims On Acceptability And Accessibility, Governments To Introduce Specific Funding Lines For Covid 19 Vaccination Campaign And Enshrine It Into Monthly Grants For Routine-Outreach Covid 19 Vaccination Services, And Local Governments Through The Directorate Of Public Health To Introduce By-Laws On Mandatory Covid 19 Vaccination Passports For The Public. With Proper Implementation Of All These Study Recommendations, Covid 19 Vaccination Coverage Rates Can Increase Drastically Across All Districts Of Northern Zambia.

Effect of Nation-wide Lockdown on Palliative Care Services in a Tertiary Care Centre in India: A Retrospective Observational Study.

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-19) pandemic has affected all the aspects of life of mankind, posing unique challenges for health-care services. In order to contain the spread of the virus, a countrywide mass lockdown has been imposed in India. Although the lockdown has modified the epidemic trajectory, it has affected the lives of many non-COVID patients. Patients in need of care could not approach hospitals. METHODS: This retrospective observational study was conducted in the Department of Onco-Anaesthesia and Palliative Medicine at a tertiary care center in India. The yearly data of patient flow for the year 2019 was compared with that during the lockdown. RESULTS: The single-day average of out-patients, in-patients, and other department consultation requests requiring palliative care decreased drastically during the lockdown in comparison to the previous year. The single-day average of teleconsultations increased more than double during the lockdown. CONCLUSION: Although lockdown decreases the spread of the epidemic, it increases the suffering of other patients who require medical care. Various steps have to be adopted in the regular working pattern of hospitals to cater to the needs of the patients requiring care, without increasing the risk of contracting COVID-19.

Awake Proning for Nonintubated Adult Hypoxic Patients with COVID-19: A Systematic Review of the Published Evidence.

Objective: Awake proning is an intervention that is being advocated for COVID-19 patients and has been suggested to improve the oxygenation, thereby decreasing oxygen requirements. We performed this systematic review with the aim of appraising the latest published evidence on the clinical effectiveness of awake proning in COVID-19 patients. Data sources: PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, Google Scholar, and one trial registry were searched until September 23, 2020, for studies on the use of awake proning for nonintubated COVID-19 patients. Study selection: Published or in-press peer-reviewed randomized control trials, case-control trials, and prospective or retrospective cohort studies in English language only were sought, assessing the effectiveness of awake proning for nonintubated patients diagnosed with COVID-19. Data results: We included 21 published studies (19 single arm and 2 with comparison group). Twenty-three registered clinical trials were identified. No randomized clinical trial has been published so far. Conclusions: Awake proning is probably safe and effective in enhancing oxygenation in nonintubated COVID-19 patients; however, there is insufficient evidence. Further high-quality clinical trials are urgently needed to assess the effectiveness of awake proning on a variety of patient-centered outcomes. How to cite this article: Parashar S, Karthik AR, Gupta R, Malviya D. Awake Proning for Nonintubated Adult Hypoxic Patients with COVID-19: A Systematic Review of the Published Evidence. Indian J Crit Care Med 2021;25(8):906-916.

Single-cell meta-analysis of SARS-CoV-2 entry genes across tissues and demographics.

Angiotensin-converting enzyme 2 (ACE2) and accessory proteases (TMPRSS2 and CTSL) are needed for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) cellular entry, and their expression may shed light on viral tropism and impact across the body. We assessed the cell-type-specific expression of ACE2, TMPRSS2 and CTSL across 107 single-cell RNA-sequencing studies from different tissues. ACE2, TMPRSS2 and CTSL are coexpressed in specific subsets of respiratory epithelial cells in the nasal passages, airways and alveoli, and in cells from other organs associated with coronavirus disease 2019 (COVID-19) transmission or pathology. We performed a meta-analysis of 31 lung single-cell RNA-sequencing studies with 1,320,896 cells from 377 nasal, airway and lung parenchyma samples from 228 individuals. This revealed cell-type-specific associations of age, sex and smoking with expression levels of ACE2, TMPRSS2 and CTSL. Expression of entry factors increased with age and in males, including in airway secretory cells and alveolar type 2 cells. Expression programs shared by ACE2+TMPRSS2+ cells in nasal, lung and gut tissues included genes that may mediate viral entry, key immune functions and epithelial-macrophage cross-talk, such as genes involved in the interleukin-6, interleukin-1, tumor necrosis factor and complement pathways. Cell-type-specific expression patterns may contribute to the pathogenesis of COVID-19, and our work highlights putative molecular pathways for therapeutic intervention.

COVID-19 tissue atlases reveal SARS-CoV-2 pathology and cellular targets.

COVID-19, which is caused by SARS-CoV-2, can result in acute respiratory distress syndrome and multiple organ failure1-4, but little is known about its pathophysiology. Here we generated single-cell atlases of 24 lung, 16 kidney, 16 liver and 19 heart autopsy tissue samples and spatial atlases of 14 lung samples from donors who died of COVID-19. Integrated computational analysis uncovered substantial remodelling in the lung epithelial, immune and stromal compartments, with evidence of multiple paths of failed tissue regeneration, including defective alveolar type 2 differentiation and expansion of fibroblasts and putative TP63+ intrapulmonary basal-like progenitor cells. Viral RNAs were enriched in mononuclear phagocytic and endothelial lung cells, which induced specific host programs. Spatial analysis in lung distinguished inflammatory host responses in lung regions with and without viral RNA. Analysis of the other tissue atlases showed transcriptional alterations in multiple cell types in heart tissue from donors with COVID-19, and mapped cell types and genes implicated with disease severity based on COVID-19 genome-wide association studies. Our foundational dataset elucidates the biological effect of severe SARS-CoV-2 infection across the body, a key step towards new treatments.

A single-cell and spatial atlas of autopsy tissues reveals pathology and cellular targets of SARS-CoV-2 (preprint)

The SARS-CoV-2 pandemic has caused over 1 million deaths globally, mostly due to acute lung injury and acute respiratory distress syndrome, or direct complications resulting in multiple-organ failures. Little is known about the host tissue immune and cellular responses associated with COVID-19 infection, symptoms, and lethality. To address this, we collected tissues from 11 organs during the clinical autopsy of 17 individuals who succumbed to COVID-19, resulting in a tissue bank of approximately 420 specimens. We generated comprehensive cellular maps capturing COVID-19 biology related to patients demise through single-cell and single-nucleus RNA-Seq of lung, kidney, liver and heart tissues, and further contextualized our findings through spatial RNA profiling of distinct lung regions. We developed a computational framework that incorporates removal of ambient RNA and automated cell type annotation to facilitate comparison with other healthy and diseased tissue atlases. In the lung, we uncovered significantly altered transcriptional programs within the epithelial, immune, and stromal compartments and cell intrinsic changes in multiple cell types relative to lung tissue from healthy controls. We observed evidence of: alveolar type 2 (AT2) differentiation replacing depleted alveolar type 1 (AT1) lung epithelial cells, as previously seen in fibrosis; a concomitant increase in myofibroblasts reflective of defective tissue repair; and, putative TP63+ intrapulmonary basal-like progenitor (IPBLP) cells, similar to cells identified in H1N1 influenza, that may serve as an emergency cellular reserve for severely damaged alveoli. Together, these findings suggest the activation and failure of multiple avenues for regeneration of the epithelium in these terminal lungs. SARS-CoV-2 RNA reads were enriched in lung mononuclear phagocytic cells and endothelial cells, and these cells expressed distinct host response transcriptional programs. We corroborated the compositional and transcriptional changes in lung tissue through spatial analysis of RNA profiles in situ and distinguished unique tissue host responses between regions with and without viral RNA, and in COVID-19 donor tissues relative to healthy lung. Finally, we analyzed genetic regions implicated in COVID-19 GWAS with transcriptomic data to implicate specific cell types and genes associated with disease severity. Overall, our COVID-19 cell atlas is a foundational dataset to better understand the biological impact of SARS-CoV-2 infection across the human body and empowers the identification of new therapeutic interventions and prevention strategies.

Unraveling the Role of Palliative Surgery in the Era of COVID-19 Pandemic.

Palliative surgery forms an important pillar of palliative treatment to provide holistic care to cancer patients in the form of providing relief from pain, local control of disease, hemorrhage, and for the purpose of rehabilitation. During the COVID-19 pandemic, we report the successful management of two cases of colorectal cancer which came under the category of high priority and underwent palliative surgery to provide relief from pain.