ABSTRACT
Purpose: The second wave of coronavirus disease 2019 (COVID-19) pandemic triggered a mucormycosis epidemic in India. Diabetes mellitus and dysregulated immune response were contributors, and rhino-orbital-cerebral mucormycosis (ROCM) was the most common presentation. It is however not known whether bio-chemical parameters at presentation correlate with stage of ROCM or final outcome in terms of vision or mortality. Methods: This retrospective, hospital-based study included all in-patients of mucormycosis with ophthalmic manifestations at presentation admitted during June 1, 2021 to August 31, 2021. It aimed to evaluate the association between severity of infection, serum levels of HbA1c, ferritin, interleukin-6 (IL-6), C-reactive protein (CRP), and D-dimer levels at presentation and outcome. Results: There were altogether 47 eligible cases having a mean age of 48.8 ± 10.9 years with a male:female ratio of 2.6:1; forty-two (89.4%) had pre-existing diabetes, and five (10.6%) had steroid-induced hyperglycemia. The mean HbA1c among diabetics was 9.7 ± 2.1. HbA1c and serum CRP showed an increase over subsequent stages, which was not statistically significant (P = 0.31). IL-6 values for all stages were similar (P = 0.97). Only serum ferritin levels showed a statistically significant increase over stages (P = 0.04). IL-6 was significantly lower (P = 0.03) in patients who survived, whereas CRP levels were significantly lower in patients who had final visual acuity (VA) better than only perception of light (P = 0.03). Conclusion: Uncontrolled diabetes mellitus is a significant association of ROCM. Serum ferritin levels at presentation best correlate with extent of the disease. CRP levels are best to prognosticate cases that will have sufficient VA to carry on activities of daily living, whereas IL-6 levels are best associated with survival.
Subject(s)
COVID-19 , Eye Diseases , Mucormycosis , Orbital Diseases , Humans , Female , Male , Adult , Middle Aged , Mucormycosis/diagnosis , Mucormycosis/epidemiology , Tertiary Care Centers , Cross-Sectional Studies , Activities of Daily Living , Glycated Hemoglobin , Interleukin-6 , Retrospective Studies , COVID-19/complications , COVID-19/epidemiology , C-Reactive Protein , Ferritins , Orbital Diseases/diagnosisABSTRACT
Background: Lung ultrasound is an im-portant tool for distinguishing between causes and therapies of cardiorespiratory diseases in emergency departments (ED). Aim and method: Based on a case report, the importance of point-of-care ultrasound (POCUS) in the context of emergency di-agnostics and intensive care therapy will be illustrated. Case report: A 78-year-old male presented to the ED with dyspnea und weakness. A double mRNA-Covid vaccination was completed 3 months before. His medical history revealed multiple myeloma. Using POCUS, a severe Covid-19 pneumonia could be suspected, and at the same time other differential diagnoses were ruled out. PCR confirmed a SARS-CoV-2 infection. The patient was admitted to our intensive care unit with severe Covid-19 pneumonia fol-lowed by a complicated and ultimately le-thal course. Conclusion(s): In immunocompro-mised patients, there is still a high risk of a severe and complex course despite vaccina-tion. POCUS allows evaluation of probable Covid-19 pneumonia and rapid exclusion of possible differential diagnoses. Copyright © 2022 Dustri-Verlag Dr. K. Feistle.
ABSTRACT
Patients with lymphoid malignancies are at a higher risk of coronavirus disease 2019 (COVID-19) infection due to their immunocompromised state and results in higher mortality rates in these patients. Anti-CD 20 therapy is one of the leading causes of immunosuppression that worsens in COVID-19 cases. COVID-19 vaccines, on the other hand, appear to be less beneficial to these patients. App-ropriate treatment and recommendations are required for these COVID-19 patients with lymphoid malignancies.