ABSTRACT
Objective: This study aims to describe the epidemiology, predisposing factors, clinical manifestations, management, and outcome of post-COVID rhino-cerebralorbital mucormycosis. Methods: This is a prospective observational study of patients with post-COVID RCOM conducted tertiary care hospital during May-June 2021. Results: The mean age of patients was 49.58±15.12 years and majority (64.80%) were male. The majority of patients were rural, Hindu and illiterate. Diabetes was present 78.10% patients, glucocorticoids were required in 66.30%, and supplemental oxygen was used in 27.60% of patients. Most of the patients developed symptoms of RCOM within 15 days of COVID-19. Majority of patients (46.67%) had stage 3 disease and orbit was involved in 60% of patients. All patients received intravenous antifungal drugs and combined antifungal drugs and surgical debridement was performed in 77.10% patients. Predictor associated with poor outcome were RCOM stage 3c or above and qSOFA score ≥2 at presentation. Conclusion: Diabetes and glucocorticoids are the most important risk factors for post-COVID RCOM. COVID-19 patients must be followed closely for 2-4 weeks to detect mucormycosis as earlier as possible. Antifungal drugs should be started immediately if clinico-radiological feature suggest RCOM before microbiological confirmation. Combined medical and surgical treatment significantly reduces mortality. © 2021 Journal of Association of Physicians of India. All rights reserved.
ABSTRACT
Objective: To assess the knowledge, attitude, and practice (KAP) regarding COVID-19 among COVID-19 patients and their relation with the outcomes. Methods: This cross-sectional study was carried out among COVID-19 patients (18-year-old or older) consecutively admitted to a dedicated COVID-19 hospital located in northwest Rajasthan, India. Data regarding socio-demographic parameters, KAP, and primary composite outcome (admission to intensive care unit, mechanical ventilation, or in-hospital death) were collected. KAP scores were compared between different demographic variables and primary composite outcomes. Association between different demographic variables, primary composite outcomes, and KAP scores were determined through multivariate linear regression. Besides, the correlation among KAP scores was analyzed. Results: Out of the total 222 patients, most of them (65.76%) had average KAP scores towards COVID-19. The mean scores for knowledge were 7.88, with an overall correct rate of 71.63%;the mean attitude scores were 2.42, with an overall correct rate of 60.50%;the mean practice scores were 5.12, with an overall correct rate of 64.00%. Patients who met the primary composite outcomes had higher knowledge scores, but lower attitude and practice scores. The result showed a significant positive correlation between the level of education, socioeconomic class, and knowledge, attitude, and practice towards COVID-19. Knowledge towards COVID-19 was significantly associated with a positive attitude and good practice. Conclusions: Our findings show that adult COVID-19 patients have average KAP towards COVID-19 among COVID-19 patients. Poor attitude and practice towards COVID-19 are associated with adverse outcomes, so it is suggested to strengthen attitude and practice towards COVID-19 to improve the outcomes.
ABSTRACT
Objective: To describe the clinical, laboratory and radiological characteristics and outcomes of moderate-to-severe coronvirus disease 2019 (COVID-19) patients. Methods: We retrospectively analyzed 43 RT-PCR confirmed moderate-to-severe COVID-19 patients who were admitted to a tertiary care center. The primary composite outcomes were admission to intensive care unit, requirement of mechanical ventilation, and death. Results: The median age of the patients was 50 years, and 62.8% of the patients were male. Out of 43 patients, 15 (34.88%) were categorized as severe. A total of 26 (60.47%) patients had 1 or more comorbidities [diabetes (34.88%) and hypertension (30.23%)]. The median duration from the onset of symptoms to admission was 3 days, and the most common symptoms were dyspnoea (90.7%), cough (79.07%), fever (69.77%), and body ache (46.51%). Leucopenia was presented in 14 (32.56%) patients, lymphopenia in 26 (60.47%) patients, and monocytosis in 7 (16.28%) patients. Besides, 40 (93.02%) patients had bilateral patchy nodular or interstitial infiltration on chest X-ray. The primary outcomes occurred in 20 patients (46.5%), among whom 8 required mechanical ventilation. The patients who had met the primary outcomes were older. They were prone to have at least 1 comorbidity (P=0.004), diabetes (P=0.01), hypertension, higher sequential organ failure assessment score, more tachycardia, lower SpO2, lower PaO2/FiO2, more thrombocytopenia, and more pancytopenia. Conclusions: This retrospective study identified several risk factors for poor outcomes in adults with COVID-19. In particular, older age, tachycardia, high SOFA score, low SpO2, low PaO2/FiO2, presence of comorbidities in form of diabetes and hypertension, thrombocytopenia, and pancytopenia at admission were associated with higher odds of ICU admission, a requirement of mechanical ventilation and in-hospital death.