ABSTRACT
Background. Invasive aspergillosis(IA) is known to occur in immunocompromised patients including neutropenic patients. But there has been a trend of increasing cases in non-neutropenic host with the emergence of newer risk factors like DM, cirrhosis etc. The aim of this study was to evaluate the clinical features & risk factors of IA in non-neutropenic patients & to look at the clinical utility of galactomannan in diagnosis of IA. Methods. This was a prospective observational study which included the suspected cases of IA, based on the clinical & radiological criteria. Patients with haematological & solid organ malignancy were excluded. In patients with suspected Invasive pulmonary aspergillosis (IPA), serum & BAL, while in patients with suspected CNS IA CSF & serum samples were sent for galactomannan analysis (Platelia ELISA). The clinical features, risk factors, outcomes were analysed. Results. We screened 243 patients with suspected IA, of which 49 nonneutropenic patients with IA (16 Proven & 33 Probable cases) were included. The mean age was 47.8 years. Of all IA cases 69.5% (n=34) were IPA, 20.4% (n=10) were CNS aspergillosis & 10.2% (n=5) showed disseminated form of IA. The common symptoms included Fever (71.4%), cough (71.3%), expectoration (44.7%) & dyspnoea (59.1%) in IPA, while in CNS aspergillosis, presented with fever (73.3%), altered sensorium (53%).The predominant risk factor included previous TB, DM, COVID-19. The radiological manifestations in IPA included the typical cavity (40.4%, n=17), Centrilobular nodules with tree in bud appearance in 56.5% (n=23). The CNS aspergillosis was associated with ring enhancing lesion (41.6%, n=5) with leptomeningeal enhancement (50%, n=6), while cerebral abscess was seen in 16.6% (n=2) patients. The positivity of galactomannan were 24.4%, 91.3% & 87.5% in serum, BALF & CSF respectively. Culture positivity & Direct smear positivity was 18.3% & 28.5% respectively. The overall mortality was 20.4%. Complete response in 3 months follow-up period was seen in 69.3% patients. Conclusion. The clinical manifestations of IA in non-neutropenic are diverse & nonspecific. Also, culture & direct microscopy lack sensitivity, hence diagnostic markers like Galactomannan can be used for early diagnosis of IA in patients with newer emerging risk factors.
ABSTRACT
Background and Aim: Surgical procedures in patients with COVID-19 disease are associated with increased perioperative morbidity and mortality. A retrospective study was conducted to evaluate the demographic and clinical data of surgical patients with suspected or confirmed COVID-19 disease. Methods: After taking hospital ethics committee approval, medical records of surgical patients operated during the period from May 2020 to November 2020 in a COVID-19-designated tertiary care hospital of northern India were assessed. The demographic data such as age, gender, associated comorbidities, type of surgery, intraoperative complications, and data on the postoperative status of the patients were collected and analyzed. Results: Ninety-four patients underwent surgical procedures during the study period. Out of all patients, 87.2% were females. The median age of patients was 28 years (range: 1 month-59 years). The emergency cesarean section was the most common surgery performed. The subarachnoid block was the most commonly used anesthesia technique. Out of 94 patients, 70 patients were confirmed COVID-19 positive, and 24 were suspected cases. Most of the patients were American Society of Anesthesiologists II (83%) and 43.6% of patients had comorbidities. Conclusion: The cesarean section was the most commonly performed surgical procedure. The most common anesthesia technique used was the subarachnoid block. The patients operated under subarachnoid block had a better prognosis and did not require intensive care unit stays in the postoperative period.