ABSTRACT
BACKGROUND Constant mutation in the SARS-COV2 virus genetic material is resulting in the appearance of new variants frequently hence the overall virulence, treatment resistance, replication modalities, transmissions rates and COVID-19 signs & symptoms are all changing regularly. METHODOLOGY: From 1 January 2021 to 30 August 2022, the clinical lab at Fatima Jinnah General & Chest Hospital Quetta, Balochistan, determined a total of 3375 individuals to be COVID-19 positive because RT-PCR detected ORF, N, and E genes or their various Bi & Tri combinations in their samples. A questionnaire-based interview was conducted with each participant during sample collection. Body temperature more than 370c was recorded as Fever/Chill. Age, Comorbidities, A-symptomatic individuals & Vaccination status were all neglected during this study. Frequency tables were generated using MS-excel 2016, while Odds ratios were calculated using Chi-square test of association whereby 2x2 contingency tables between Mono, Bi & Tri combinations for ORF, N & E genes were cross associated with various generalized nonspecific COVID -19 signs and symptoms using Epi-info software. Absence of Genetic sequencing was the major limitation. RESULTS: The study showed that individually the presence of ORF gene was found to be strongly associated Shortness of Breath/Difficulty in Breathing, Diarrhea, Head ache & Vomitting. While the presence of N-gene was found to be strongly associated with Loss of smell & taste, Head ache,Presistant Chest Pain & Bluish lips/Face. Where as the presence of E-gene was found to be strongly associated with Cough, Shortness of breath/ Difficulty in breathing, Sore throat, Diarrhea, Head ache & Laziness. In addition, the study also found that different Bi & Tri combinations of ORF, N & E genes in a COVID-19 positive patient expressed generalized non-specific COVID-19 signs & symptoms differently. DISCUSSION & CONCLUSION: The presence of various SARS-COV2 genetic markers significantly alters the clinical presentation of COVID-19.
Subject(s)
Pain , Diarrhea , Dyspnea , Fever , Chest Pain , COVID-19ABSTRACT
Purpose of Review More than half a billion people have been infected and 6.2 million killed by the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) since the start of the pandemic in 2019. Systemic glucocorticoids are a double-edged sword, on the one hand, life-saving in treating COVID-19 complications while on the other hand, potentially leading to life-and-limb-threatening opportunistic fungal infections. Mucormycosis (MM) is caused by the mucormycetes family. Although rare, it is characterized by high mortality and significant morbidity. The gross similarities observed with other fungal infections which respond to different treatment regimens have made it all the more imperative to quickly and sensitively diagnose and treat MM. This review discusses the epidemiology of MM before and during the COVID-19 pandemic, associated risk factors, COVID-19-associated MM, diagnosis, and current therapeutic interventions. Recent Findings There has been a widespread and worrisome trend of rising in cases of MM, worldwide, but more so in the Indian subcontinent, where it is nicknamed the “black fungus.” This upsurge has picked up the pace ever since the start of the COVID-19 pandemic. Necrosis is secondary to the angio-invasive and pro-thrombotic nature of the mold resulting in extensive lesions presenting mostly as rhino-orbital MM (ROM) and rhino-orbito-cerebral MM (ROCM). Infection is mostly observed in subjects with underlying risk factors such as uncontrolled diabetes, those receiving hematopoietic stem cell transplant, and/or on corticosteroid or immunosuppressive therapy, although it is widely suspected that other factors such as iron and zinc may play a role in the pathogenesis of MM. The “One world one guideline” strategy advocates both prophylactic anti-fungal therapy along with aggressive, prompt, and individualized treatment with anti-fungal drugs such as amphotericin B in addition to vigorous surgical intervention. High-risk groups need particularly rapid diagnosis although empirical anti-fungal therapy may not be delayed. Speeding diagnostic turnaround times are essential to institute early therapy, and there is much scope for newer modalities such as PCR, matrix-assisted laser desorption ionization-time of flight mass spectrometry, and whole-genome sequencing in such endeavors. The results of strict monitoring of blood glucose levels along with rational and limited use of steroids and immunomodulatory drugs have proven to be a significant preventive measure. Summary The significant rise in cases of MM worldwide has necessitated viewing each case with a strong index of suspicion. Adoption of rapid diagnostics, early antifungal therapy, and prompt surgical interventions are essential, while high-risk groups need particular focused care which may include prophylactic anti-fungal therapy, limited steroid use, and meticulous control of the underlying disease. Developing quicker and more sensitive diagnostic modalities has great potential to improve the detection and management of MM.
ABSTRACT
Efforts aimed at minimizing the spread of COVID-19 and "flattening the curve" may be affecting clinical care delivery for non-COVID-19 cases that include otolaryngologic and orbital conditions. We are witnessing changes in the manner that patients present, as well as modifications in clinical management strategies. An improved understanding of these phenomena and the contributing factors is essential for otolaryngologists to provide sound clinical care during this unprecedented pandemic.