A Novel Study of Correlation of Lipid Parameters with Clinical Profile, Staging and Onset of Rhino Orbito Cerebral Mucormycosis Covid 19 Pandemic.

Mucormycosis is an angioinvasive disease caused by mold fungi of the genus Rhizopus, Mucor. India has reported surge in cases of COVID 19 associated Mucormycosis over the past few months due to the increasing frequency of risk factors like corticosteroid therapy, uncontrolled diabetes, neutropenia and obesity. Studies have shown that eukaryote cell membrane contains cholesterol and fungal cell wall contains ergosterol with lanosterol being precursor for both and ergosterol is essential for mitochondrial DNA maintenance in fungi, as cholesterol is in humans. The current study is based on the hypothesis that fungi can use human cholesterol as a raw material to maintain its cell function and accentuate its own multiplication and this can indirectly be shown by the association between deranged lipid parameters in an individual with severity of Mucormycosis. Thus present study aims to estimate the lipid parameters and correlate the serum lipid parameters with clinical profile, stage of the disease and duration of onset of mucormycosis in patients with COVID associated Mucormycosis. MATERIAL: This is a cross sectional study conducted on 103 patients diagnosed with COVID 19 associated mucormycosis admitted to the hospitals attached to BMCRI from July 2021 to September 2021. Serum fasting lipid profile and other biochemical parameters were determined. The correlation of lipid levels with clinical profile, onset and staging of mucormycosis patients were obtained. OBSERVATION: The age distribution varied from 22yrs to 75yrs of whom majority were males (83.4%). Among patients with mucormycosis of all severity stages, nasal block (79.6%) was found to be most common symptom followed by headache(75.7%). Among patients with mucormycosis most frequent associated comorbidity was Diabetes mellitus (DM) followed by hypertension (HTN) followed by DM and HTN followed by Ischemic Heart Disease (IHD) followed by DM,HTN and IHD. The study showed statistically significant correlation such that severity of mucormycosis increased with progressive worsening lipid parameters. It also showed statistically significant correlation such that patients with increasing TC,LDL,VLDL,TG levels had shorter COVID 19 onset to mucormycosis onset duration. CONCLUSION: The study showed a positive correlation between serum lipid profile and staging of mucormycosis and negative correlation between lipid levels with duration between onset of COVID 19 to onset of mucormycosis. Hence serum lipid profile can be used as an excellent marker to predict the severity and prognosis of COVID 19 associated mucormycosis.

Clinical Radiological and Biochemical Profile of Moderate to Severe Covid-19 Pregnant Females and its Correlation with Clinical Outcome.

Since December 2019, severe acute respiratory syndrome corona virus 2 has been recognized as the causal factor in a series of severe cases of pneumonia originating in Wuhan, China which has been named Corona virus disease 2019 (COVID-19) by WHO. The physiological and mechanical changes associated with pregnancy increase maternal susceptibility to infections in general and is a state of relative immunosuppression. MATERIAL: 49 pregnant COVID-19 moderate to severe Pneumonia patients classified as per MHFW, GOI were taken into the study for a period of 3 months at Bowring & Lady Curzon Hospital. Clinical history, duration of illness, co-morbidities, q-sofa score, basic blood panel and inflammatory markers, were done at the time of admission and co-related with the pregnancy and Covid -19 outcomes. OBSERVATION: Among 49 patients, 13 were in the age group of 20-25 years, 24 in 26-30 years and 12 in 31-41 years. 27 patients (55.1%) recovered whereas 22 patients (44.9%) died. 69.4% had cough and breathlessness as presenting complaint followed by fever in 59.2 %, fatigue in 30.6%, headache in 26.5% and diarrhoea in 28.6%. 4 patient had gestational diabetes, 2 had hypothyroidism, 2 had pre eclampsia. Comparison between biochemical parameters and clinical out come showed statistically significant result with total leucocyte count, D-dimer, LDH, CRP and pro calcitonin. All 13 subjects with moderate disease recovered and out of 36 severe disease 22 died and 14 recovered. 24 Patients were primigravida of which 16 recovered and 8 died, 25 patients were multigravida of which 11 recovered and 14 died. Correlation between chest radiograph score and q sofa score with clinical outcome showed statistically significant result. CONCLUSION: Compared to first wave of COVID-19 infection second wave showed significant mortality and morbidity among COVID-19 positive pregnant women. Pregnancy is a state of relative immunosuppression and hence close monitoring and early intervention and multidisciplinary care is of importance in order to prevent severe COVID-19 infection and mortality.