Single-cell Masked Autoencoder: An Accurate and Interpretable Automated Immunophenotyper (preprint)

High-throughput single-cell cytometry data are crucial for understanding immune system\'s involvement in diseases and responses to treatment. Traditional methods for annotating cytometry data, specifically manual gating and clustering, face challenges in scalability, robustness, and accuracy. In this study, we propose a single-cell masked autoencoder (scMAE), which offers an automated solution for immunophenotyping tasks including cell type annotation. The scMAE model is designed to uphold user-defined cell type definitions, thereby facilitating easier interpretation and cross-study comparisons. The scMAE model operates on a pre-train and fine-tune approach. In the pre-training phase, scMAE employs Masked Single-cell Modelling (MScM) to learn relationships between protein markers in immune cells solely based on protein expression, without relying on prior information such as cell identity and cell type-specific marker proteins. Subsequently, the pre-trained scMAE is fine-tuned on multiple specialized tasks via task-specific supervised learning. The pre-trained scMAE addresses the shortcomings of manual gating and clustering methods by providing accurate and interpretable predictions. Through validation across multiple cohorts, we demonstrate that scMAE effectively identifies co-occurrence patterns of bound labeled antibodies, delivers accurate and interpretable cellular immunophenotyping, and improves the prediction of subject metadata status. Specifically, we evaluated scMAE for cell type annotation and imputation at the cellular-level and SARS-CoV-2 infection prediction, secondary immune response prediction against COVID-19, and prediction the infection stage in the COVID-19 progression at the subject-level. The introduction of scMAE marks a significant step forward in immunology research, particularly in large-scale and high-throughput human immune profiling. It offers new possibilities for predicting and interpretating cellular-level and subject-level phenotypes in both health and disease.

MDA5-autoimmunity and Interstitial Pneumonitis Contemporaneous with the COVID-19 Pandemic (MIP-C) (preprint)

BackgroundAnti-MDA5 (Melanoma differentiation-associated protein-5) positive dermatomyositis (MDA5+-DM) is characterised by rapidly progressive interstitial lung disease (ILD) and high mortality. MDA5 senses single-stranded RNA and is a key pattern recognition receptor for the SARS-CoV-2 virus. MethodsThis is a retrospective observational study of a surge in MDA5 autoimmunity, as determined using a 15 muscle-specific autoantibodies (MSAs) panel, between Janurary 2018-December 2022 in Yorkshire, UK. MDA5-positivity was correlated with clinical features and outcome, and regional SARS-CoV-2 positivity and vaccination rates. Gene expression patterns in COVID-19 were compared with autoimmune lung disease and idiopathic pulmonary fibrosis (IPF) to gain clues into the genesis of the observed MDA5+-DM outbreak. ResultsSixty new anti-MDA5+, but not other MSAs surged between 2020-2022, increasing from 0.4% in 2019 to 2.1% (2020), 4.8% (2021) and 1.7% (2022). Few (8/60) had a prior history of confirmed COVID-19, peak rates overlapped with regional SARS-COV-2 community positivity rates in 2021, and 58% (35/60) had received anti-SARS-CoV-2 RNA vaccines. Few (8/60) had a prior history of COVID-19, whereas 58% (35/60) had received anti-SARS-CoV-2 RNA vaccines. 25/60 cases developed ILD which rapidly progression with death in 8 cases. Among the 35/60 non-ILD cases, 14 had myositis, 17 Raynaud phenomena and 10 had dermatomyositis spectrum rashes. Transcriptomic studies showed strong IFIH1 (gene encoding for MDA5) induction in COVID-19 and autoimmune-ILD, but not IPF, and IFIH1 strongly correlated with an IL-15-centric type-1 interferon response and an activated CD8+ T cell signature that is an immunologic hallmark of progressive ILD in the setting of systemic autoimmune rheumatic diseases. The IFIH1 rs1990760TT variant blunted such response. ConclusionsA distinct pattern of MDA5-autoimmunity cases surged contemporaneously with circulation of the SARS-COV-2 virus during COVID-19. Bioinformatic insights suggest a shared immunopathology with known autoimmune lung disease mechanisms.

Epidemiological and clinical profile of COVID-19 cases attending rural health training centre of one of the medical colleges of Ahmedabad, Gujarat, India

Introduction : Understanding the epidemiological and clinical profile of COVID-19 cases and pattern of disease is very much required for future preparedness. Objective : To assess the epidemiological and clinical profile of cases of COVID 19 Method : Cross sectional descriptive study was carried out at a Rural Health Training Centre (RHTC). All cases reported in the month of January 2022were included in the study. The information about the epidemiological and clinical profile was collected from RHTC records by conducting telephonic interview. Results : Total 83 cases were reported. Among them, 43 (54.4%) cases were in age group 20-39 years. Male: Female ratiowas 1.37:1. Therewas one death and patient had ovarian cancer as co-morbidity. Total 71 patients could be contacted for telephonic interview. Fever was most common symptom andwas presenting symptom on first day followed by cough/cold and sore throat. None had shortness of breath or chest pain. Hospitalization rate was 5.63% and none required oxygen supplementation or intensive care. Recovery period was 3-5 days. Out of total, 90% cases were fully vaccinated and 95.8% had knowledge of CAB. Diabetes and hypertension were most common comorbidities andwere statistically significantlymore in age > 40 years. Conclusions : The COVID-19 cases in the beginning of year 2022 had clinical presentation different than the earlier waves. Periodic situational analysis can guide in policymaking for handling this pandemic in future.

Covid 19 Associated Idiopathic Intracranial Hypertension and Acute Vision loss.

Headache is a frequent complaint in COVID-19 while intracranial hypertension leading to acute vision loss is unusual. A 49-years-old female presented with persistent headache and vision loss and was found Covid 19 positive. Investigations suggested Covid 19 associated intracranial hypertension. She improved with medical management but again presented with acute vision loss. The visual loss was managed by endoscopic optic nerve fenestration surgery. She had significant recovery in vision during follow up period. Persistent headache in Covid 19 should have a high index of suspicion for idiopathic intracranial hypertension to avoid irreversible vision loss.

Effect of P2Y12 Inhibitors on Organ Support-Free Survival in Critically Ill Patients Hospitalized for COVID-19: A Randomized Clinical Trial.

Importance: Platelet activation is a potential therapeutic target in patients with COVID-19. Objective: To evaluate the effect of P2Y12 inhibition among critically ill patients hospitalized for COVID-19. Design, Setting, and Participants: This international, open-label, adaptive platform, 1:1 randomized clinical trial included critically ill (requiring intensive care-level support) patients hospitalized with COVID-19. Patients were enrolled between February 26, 2021, through June 22, 2022. Enrollment was discontinued on June 22, 2022, by the trial leadership in coordination with the study sponsor given a marked slowing of the enrollment rate of critically ill patients. Intervention: Participants were randomly assigned to receive a P2Y12 inhibitor or no P2Y12 inhibitor (usual care) for 14 days or until hospital discharge, whichever was sooner. Ticagrelor was the preferred P2Y12 inhibitor. Main Outcomes and Measures: The primary outcome was organ support-free days, evaluated on an ordinal scale that combined in-hospital death and, for participants who survived to hospital discharge, the number of days free of cardiovascular or respiratory organ support up to day 21 of the index hospitalization. The primary safety outcome was major bleeding, as defined by the International Society on Thrombosis and Hemostasis. Results: At the time of trial termination, 949 participants (median [IQR] age, 56 [46-65] years; 603 male [63.5%]) had been randomly assigned, 479 to the P2Y12 inhibitor group and 470 to usual care. In the P2Y12 inhibitor group, ticagrelor was used in 372 participants (78.8%) and clopidogrel in 100 participants (21.2%). The estimated adjusted odds ratio (AOR) for the effect of P2Y12 inhibitor on organ support-free days was 1.07 (95% credible interval, 0.85-1.33). The posterior probability of superiority (defined as an OR > 1.0) was 72.9%. Overall, 354 participants (74.5%) in the P2Y12 inhibitor group and 339 participants (72.4%) in the usual care group survived to hospital discharge (median AOR, 1.15; 95% credible interval, 0.84-1.55; posterior probability of superiority, 80.8%). Major bleeding occurred in 13 participants (2.7%) in the P2Y12 inhibitor group and 13 (2.8%) in the usual care group. The estimated mortality rate at 90 days for the P2Y12 inhibitor group was 25.5% and for the usual care group was 27.0% (adjusted hazard ratio, 0.96; 95% CI, 0.76-1.23; P = .77). Conclusions and Relevance: In this randomized clinical trial of critically ill participants hospitalized for COVID-19, treatment with a P2Y12 inhibitor did not improve the number of days alive and free of cardiovascular or respiratory organ support. The use of the P2Y12 inhibitor did not increase major bleeding compared with usual care. These data do not support routine use of a P2Y12 inhibitor in critically ill patients hospitalized for COVID-19. Trial Registration: ClinicalTrials.gov Identifier: NCT04505774.

Case report of SARS-CoV-2 with secondary Clostridioides difficile infection

There has been an overuse of antibiotics in most patients suffering from COVID-19 which predisposes patients to hospital acquired C. difficile Infection (CDI). Also, COVID infection of the gastrointestinal tract also predisposes the patient to CDI. We here present a fatal case of SARS-CoV-2 coinfection with CDI.

Hope, Belief in Just World and Trust in Government: An Interaction Amidst Covid-19 Pandemic in India.

The outbreak of COVID 19 has brought about changes in all spheres of human life. In the present times of pandemic, human life has suffered not only from physical stresses but also encountered and endured several mental stresses. In recent times people adopted several measures to bring positivity to their life. The present study explores the relationship between- Hope, Belief in Just World, Covid -19, and Trust in the Government in India, during the Covid-19 Pandemic. Data was collected online from young adults, via Google forms, using the tools- Adult Hope scale, Covid Anxiety scale, Belief in Just world scale, and Trust in Government. Results showed a significant correlation between the three variables. Hope, Belief in Just World, and Trust in government. Regression analysis found these three variables to significantly impact Covid anxiety. Further, Belief in Just World was found to mediate the relationship between Hope and Covid anxiety. During challenging times, it is important to boost mental health in the right direction. Implications have been further discussed in the article.

Differential in-hospital mortality and intensive care treatment over time: Informing hospital pathways for modelling COVID-19 in South Africa.

There are limited published data within sub-Saharan Africa describing hospital pathways of COVID-19 patients hospitalized. These data are crucial for the parameterisation of epidemiological and cost models, and for planning purposes for the region. We evaluated COVID-19 hospital admissions from the South African national hospital surveillance system (DATCOV) during the first three COVID-19 waves between May 2020 and August 2021. We describe probabilities and admission into intensive care units (ICU), mechanical ventilation, death, and lengths of stay (LOS) in non-ICU and ICU care in public and private sectors. A log-binomial model was used to quantify mortality risk, ICU treatment and mechanical ventilation between time periods, adjusting for age, sex, comorbidity, health sector and province. There were 342,700 COVID-19-related hospital admissions during the study period. Risk of ICU admission was 16% lower during wave periods (adjusted risk ratio (aRR) 0.84 [0.82-0.86]) compared to between-wave periods. Mechanical ventilation was more likely during a wave overall (aRR 1.18 [1.13-1.23]), but patterns between waves were inconsistent, while mortality risk in non-ICU and ICU were 39% (aRR 1.39 [1.35-1.43]) and 31% (aRR 1.31 [1.27-1.36]) higher during a wave, compared to between-wave periods, respectively. If patients had had the same probability of death during waves vs between-wave periods, we estimated approximately 24% [19%-30%] of deaths (19,600 [15,200-24,000]) would not have occurred over the study period. LOS differed by age (older patients stayed longer), ward type (ICU stays were longer than non-ICU) and death/recovery outcome (time to death was shorter in non-ICU); however, LOS remained similar between time periods. Healthcare capacity constraints as inferred by wave period have a large impact on in-hospital mortality. It is crucial for modelling health systems strain and budgets to consider how input parameters related to hospitalisation change during and between waves, especially in settings with severely constrained resources.

Baricitinib Treatment of Coronavirus Disease 2019 Is Associated With a Reduction in Secondary Infections.

We performed a secondary analysis of the National Institutes of Health-sponsored Adaptive COVID-19 Treatment Trial (ACTT-2) randomized controlled trial and found that baricitinib was associated with a 50% reduction in secondary infections after controlling for baseline and postrandomization patient characteristics. This finding provides a novel mechanism of benefit for baricitinib and supports the safety profile of this immunomodulator for the treatment of coronavirus disease 2019.

Examining the Impact of Virtual Animal Stimuli on College Students' Affect and Perception of their Academic Advising Experience.

The benefits of animal-assisted interventions (AAI) involving animals in therapy are widely accepted. The presence of animals in therapy can decrease a patient's reservation about therapy and promote a sense of comfort and rapport during the therapy process. Using survey data from college students (n = 152) attending a large public four-year institution, this study is the first to investigate the benefits of virtual animal stimuli during academic advising appointments. It posits that exposure to virtual animal stimuli can influence positive mental health and well-being in academic advising settings. Specifically, the research questions explored how different types of video content influence students' affect and how virtual animal stimuli impact students' perception of their advisor and university. College students were randomly assigned to watch one of four types of virtual stimuli (wild animals, companion animals, nature, and a control) prior to their advising session. Subjective measures were collected at baseline and after the advising session. Results indicated animal stimuli increase positive affect, and companion animal stimuli influence the student's perception of the advisor. This study supports the notion that companion animal videos positively impact students' well-being and interactions with their advisors and may have broader implications beyond the academic setting.

The Impact of Covid-19 Containment Lockdowns on MSMEs in India and Resilience of Exporting Firms☆

This study uses data from a survey of micro, small, and medium enterprises in India to document the impact of Covid-19 containment lockdowns on firms, their responses, and adaptation strategies. We find that the profits and sales declined substantially for the majority of firms. Temporary closures, pay cuts, and temporary lay-offs were the key measures utilized by firms to cope with the shock. Firms did not have adequate liquidity to last beyond six months, albeit the majority expected the pandemic to be over within that period. Micro-enterprises were the most fragile. Using a retrospective panel and matching-based difference-in-differences strategy, we show that exporting firms were able to cushion themselves from the domestic market contractions resulting from the lockdown.

Comparing Sustainable Procurement in Green Supply Chain Practices Across Indian Manufacturing and Service Sectors

After COVID, Original equipment manufacturers (OEMs), suppliers, and distributors are seeking to streamline their local, and global supply chains, the issue has gained attention in how they identify, analyze and manage their procurement and supply chain processes with stakeholders. The use of supply chain adoption with green technology has been found to be preferred in international trade, which is forcing the Indian manufacturing, and services sector to realign their CSR (Corporate social responsibility) goals. Interviews have been conducted with a mix of manufacturing and service firms in India to map their sustainable procurement in green supply chain practices. The use of MAXQDA software for conducting thematic analysis to support the inductive theory and trend-building practices to know "what, why, and how” from interview responses. Each sector, manufacturing, and service showed distinct trends that divorce their approach to green SCM, and supply chain strategy for sustainable procurement though they have spread awareness about sustainable procurement with stakeholders, emphasizing economic benefits. Additionally, they pursued jointly to address environmental issues and extend societal benefits as a CSR effort. Variances in approaches in manufacturing are market-linked, time-based, and demand-driven while services firms showed green technology pledges as CSR initiatives along with an environmental emphasis in downstream SCM activities. © 2023 K.J. Somaiya Institute of Management Studies and Research.

Eating habits and nutritional adequacy of the transgender (Hijra) community residing in and around Mumbai

For centuries, the Hijra enjoyed a special respect in the Hindu and Islamic cultures however, over the time, stigmatization took its toll and today the community is pushed to live on extreme societal margin. The present study was undertaken to assess the nutritional status of 304 transgender (Male to Female) residing in and around Mumbai using a mixed method approach. Participants were selected using a purposive sampling technique with the help of three Community Based Organisations (CBOs) working in close association with transgender. Data related to their nutritional status was collected before the pandemic using Food Frequency Questionnaire, 24-hr Recall and anthropometric measurements. Data related to impact of COVID-19 pandemic on food habits of transgender was collected from eight key informants working with CBOs using in-depth telephonic interviews. Results indicated that consumption of calorie dense junk foods was high and that of immunity building micronutrient dense foods such as fruits, vegetables and milk was notably low. Mean intake of macronutrients was adequate but that of micronutrients was lower for the majority. BMI assessment showed that 13 and 49% were underweight and overweight /obese respectively. COVID-19 pandemic further worsened nutritional status. The findings of the study may serve as basis for formulation of effective nutrition intervention programmes for transgender community.

Severity and mortality associated with COVID-19 among children hospitalised in tertiary care centres in India: a cohort study

Background It is critical to identify high-risk groups among children with COVID-19 from low-income and middle-income countries (LMICs) to facilitate the optimum use of health system resources. The study aims to describe the severity and mortality of different clinical phenotypes of COVID-19 in a large cohort of children admitted to tertiary care hospitals in India, Methods Children aged 0-19 years with evidence of SARS-CoV-2 infection (real time polymerase chain reaction or rapid antigen test positive) or exposure (anti-SARS-CoV-2 antibody, or history of contact with SARS-CoV-2) were enrolled in the study, between January 2021 and March 2022 across five tertiary hospitals in India.. All study participants enrolled prospectively and retrospectively were followed up for three months after discharge. COVID-19 was classified into severe (Multisystem Inflammatory Syndrome in Children (MIS-C), severe acute COVID-19, ‘unclassified') or non-severe disease. The mortality rates were estimated in different phenotypes. Findings Among 2468 eligible children enrolled, 2148 were hospitalised Signs of illness were present in 1688 (79%) children with 1090 (65%) having severe disease. High mortality was reported in MIS-C (18·6%), severe acute COVID-19 (13·3%) and the unclassified severe COVID-19 disease (12·3%). Mortality remained high (17·5%) when modified MIS-C criteria was used. Non-severe COVID-19 disease had 14·1% mortality when associated with comorbidity. Interpretation Our findings have important public health implications for low resource settings. The high mortality underscores the need for better preparedness for timely diagnosis and management of COVID-19. Children with associated comorbidity or coinfections are a vulnerable group and need special attention. MIS-C requires context specific diagnostic criteria for low resource settings. It is important to evaluate the clinical, epidemiological and health system-related risk factors associated with severe COVID-19 and mortality in children from LMICs. Funding Department of Biotechnology, Govt of India and Department of Maternal, Child and Adolescent Health and Aging, WHO, Geneva.

Functional Analogies Increase Trust in Black-Box AI Systems Among Lay Consumers: The Case of GeNose C-19

We present a case study of a black-box artificial intelligence-based COVID-19 detection product, GeNose C-19, developed by the Indonesian government. We find that explaining how GeNose works using functional analogies increases both Indonesian and American lay consumers' trust in GeNose.

The National COVID-19 Epi Model (NCEM): Estimating cases, admissions and deaths for the first wave of COVID-19 in South Africa.

In March 2020 the South African COVID-19 Modelling Consortium was formed to support government planning for COVID-19 cases and related healthcare. Models were developed jointly by local disease modelling groups to estimate cases, resource needs and deaths due to COVID-19. The National COVID-19 Epi Model (NCEM) while initially developed as a deterministic compartmental model of SARS-Cov-2 transmission in the nine provinces of South Africa, was adapted several times over the course of the first wave of infection in response to emerging local data and changing needs of government. By the end of the first wave, the NCEM had developed into a stochastic, spatially-explicit compartmental transmission model to estimate the total and reported incidence of COVID-19 across the 52 districts of South Africa. The model adopted a generalised Susceptible-Exposed-Infectious-Removed structure that accounted for the clinical profile of SARS-COV-2 (asymptomatic, mild, severe and critical cases) and avenues of treatment access (outpatient, and hospitalisation in non-ICU and ICU wards). Between end-March and early September 2020, the model was updated 11 times with four key releases to generate new sets of projections and scenario analyses to be shared with planners in the national and provincial Departments of Health, the National Treasury and other partners. Updates to model structure included finer spatial granularity, limited access to treatment, and the inclusion of behavioural heterogeneity in relation to the adoption of Public Health and Social Measures. These updates were made in response to local data and knowledge and the changing needs of the planners. The NCEM attempted to incorporate a high level of local data to contextualise the model appropriately to address South Africa's population and health system characteristics that played a vital role in producing and updating estimates of resource needs, demonstrating the importance of harnessing and developing local modelling capacity.

Gestational Mild COVID-19 Infection Associated Neonatal Hearing Loss: A Case-Control Study from North India.

COVID-19 infection during pregnancy is potentially dangerous to neonatal hearing, as it is the period of organogenesis, and associated hyperthermia may cause vascular damage, disruption of cell migration, and death of the dividing neuroblasts. To investigate the possible association between neonatal hearing loss and gestational mild COVID-19 infection. A prospective case-control study was conducted at a tertiary healthcare centre in North India from March 2020 to Oct 2022. Cases included the neonates born to COVID-19-positive mothers were subjected to hearing screening at 1, 3 and 6 months using otoacoustic emission (OAE) and automated auditory brainstem response (AABR). Similar protocol was applied to controls, i.e., neonates borne to mothers with no gestational history of COVID infection. Results were analyzed statistically. Our study reported that the statistical difference between groups A (n = 942) and B (n = 942) for gestational COVID-19 infection and neonatal hearing loss was insignificant at 1 month (p-value 0.272 for OAE and p-value 0.634 for AABR) and also insignificant at 3 and 6 months (p-value 0.679 for AABR, for both). The association between gestational mild COVID-19 infection during gestation and neonatal hearing loss is statistically insignificant at initial screening as well as sequential screenings.

Battling the emerging epidemic of rhino-orbital-cerebral mucormycosis (ROCM) in COVID-19 pandemic: an interventional study.

PURPOSE: The most recent challenge being faced by the healthcare system during the worldwide COVID-19 pandemic is increase in the incidence rate of coinfection or superinfection; one of the most fatal being mucormycosis. This study aimed to estimate the risk factors, symptoms and signs, treatment outcome and prognosis of COVID-19-associated mucormycosis (CAM) patients. METHODS: This is an interventional study of 35 patients diagnosed and managed as CAM at a tertiary care centre in New Delhi, India. RESULTS: The mean age of patients was 40.45 ± 6 years with a male preponderance. CAM did not affect healthy individuals; the major risk factors included diabetes in 65.7% and injudicious steroid use in 51.4% patients. Orbital/facial edema was the most common presenting symptom (25.7%) as well as sign (28.57%). 68.5% patients were stage 3 (involvement of orbit) at presentation; 33.3% showed medial wall involvement. Treatment included intravenous Amphotericin and oral Posaconazole in all patients, paranasal sinus (PNS) debridement in 94.2%, orbital exenteration was done in 8 patients. Adjuvant retrobulbar Amphotericin B injection was administered in 12 patients with radiological resolution seen in 50% after 1 cycle. In patients with Stage 4 disease who underwent exenteration along with PNS debridement, survival rate was 100% at 30 days, and disease reduction occurred in 87.5% patients (P < 0.01). Overall, 68.5% responded to therapy, 8.5% showed progression and mortality rate was 22.85%, at a mean follow up period of 59.5 days. CONCLUSION: A multidisciplinary and aggressive approach is essential in the management of CAM patients.

A conceptual reappraisal of risks in the implementation of BRI after COVID-19: Best strategies to learn for CMNEs in BRI projects

This study is aimed to propose a quantitatively supported framework regarding different types of risks involved in BRI and strategic solutions to neutralize the risks. The conceptual model and related propositions are advanced, based on bibliometric and science mapping analysis of 367 articles published over 6 years about risk, success, failure and dissent about the projects, and strategies to mitigate these risks. The descriptive statistics and science mapping approaches using co-citation analysis were performed with VOSviewer software. A co-citation analysis, coupled with content analysis of most co-cited articles, uncovered four underlying research streams, including "Infrastructural expansion and political & economical risks,” "Investment choice through impact assessment and cultural risks,” "Environmental risks,” and "Real outcomes of BRI projects and viewpoint of host countries.” Among the four strategies identified, developing trust in the Chinese system can be created through National Branding by Chinese MNEs to mitigate the geo-political risks. Second, Guanxi neutralizes the reputation risks and cultural friction in collaborative projects and positively affects BRI project implementation. Third, the localization of management and processes can also help in offsetting the environmental risks in post COVID scenario. Lastly, increasing multilateral funding for sustainable infrastructure can be used to boost financial capacity building and mitigate financial risk to a certain extent. The present study has been a novel attempt to relate current research themes to emerging areas under BRI. This study is one of its kind which focuses on reshaping the views of practitioners, researchers, and policymakers on the multifaceted areas and themes in the BRI research field, to examine the risks and a roadmap for future research. © 2023 Wiley Periodicals LLC.

COVID-Associated Sinonasal Mucormycosis: Radiological Pathological Correlation and Prognostic Value of MR Imaging

Purpose  Our aim was to assess the sinonasal magnetic resonance imaging (MRI) features of acute invasive fungal rhinosinusitis (AIFRS) in coronavirus disease (COVID)-associated mucormycosis (CAM) and to correlate these with histopathology and patient outcome in terms of duration of hospital stay and survival at 10 weeks. Methods  Twenty patients with histopathologically confirmed sinonasal CAM underwent MRI (including postcontrast T1-weighted and diffusion-weighted imaging). Histopathological findings (presence of coagulative necrosis, granulomatous reaction, and fungal burden) were recorded and all patients were followed up at 6 and 10 weeks. Statistical analysis was done using chi-square test and Fischer's exact test. Results  Enhancement patterns seen in our subjects included homogeneous, heterogeneous, and lack of contrast enhancement (LOC), with LOC being the most common (65%). Diffusion restriction was found in 90% patients. Statistically significant correlation was found between LOC pattern and presence of coagulative necrosis ( p -value = 0.007), extent of fungal hyphae ( p -value = 0.047), and duration of hospital stay ( p -value = 0.004). Restricted diffusion was also seen to correlate with a high fungal load ( p -value = 0.007). Conclusion  Our study describes the MRI findings of AIFRS in CAM and highlights the imaging features which may be surrogate markers for coagulative necrosis and fungal burden.