A comprehensive overview on COVID-associated mucormycosis

In recent times, numerous reports of systemic fungal infections have been a major concern. The angioinvasive fungal infection, mucormycosis has surged in patients with COVID-19 due to various factors, mainly uncontrolled diabetes and inappropriate corticosteroid use. The prevalence of this acute and fatal fungal infection caused by Mucorales-related fungal species has been highest in the Indian population. COVID-associated mucormycosis (CAM) has a propensity for contiguous spread, and exhibits high morbidity as well as mortality. Unless promptly detected and treated, it is associated with a poor prognosis. A high index of suspicion, aggressive surgical debridement and use of systemic antifungal agents continue to be the standard of care for CAM. Moreover, there is an imperative need to address this public health issue by increasing public awareness and education. This article provides a comprehensive overview on the emergence of CAM during the pandemic, the current burden, pathophysiology, diagnostic interventions and management of CAM in Indian clinical practice.

Post-COVID multisystem inflammatory syndrome in adults: a study from a tertiary care hospital in south India.

Background & objectives: There are limited data from India on the post-COVID multisystem inflammatory syndrome in adults (MIS-A). The objective of the present study was to evaluate the clinical profile of patients with MIS-A admitted to a tertiary care centre in southern India. Methods: This single-centre retrospective study was conducted from November 2020 to July 2021, and included patients aged >18 yr admitted to the hospital as per the inclusion and exclusion criteria. Results: Nine patients (5 male, mean age 40±13 yr) met the criteria for MIS-A. Five patients had proven COVID-19 infection or contact history 36.8±11.8 days back. All patients were positive for SARS-CoV-2 IgG antibody, negative for COVID-19 PCR, and had negative blood, urine and sputum cultures. All patients had fever and gastrointestinal (GI) symptoms, and five patients had left ventricular dysfunction. All patients had neutrophilic leucocytosis at presentation and elevated biomarkers such as C-reactive protein serum procalcitonin, D-dimer and ferritin. The majority of the patients (7/9 i.e. 77.78%) were treated with intravenous hydrocortisone (50-100 mg q6h-q8h). Six patients recovered completely whereas three patients expired. Interpretation & conclusions: Fever and GI symptoms were the most common presentation of MIS-A. Elevated serum procalcitonin may not be useful in differentiating bacterial sepsis from MIS-A. Most patients responded to corticosteroids.

Humoral Immune Response to Bbv152 (Covaxin) Sars-Cov2 Vaccine in Patients on Haemodialysis

BACKGROUND: Chronic Kidney Disease (CKD) Stage V patients on hemodialysis are a vulnerable group who have reported high rates of morbidity and mortality with Covid-19 infection. Covid-19 vaccination has been reported to be immunoprotective, and these patients are prioritized for Covid-19 vaccination. It is reported that dialysis patients develop lower seroconversion to vaccines. Indeed, this lower postvaccine response led to the adaptation of hepatitis B and influenza immunization schedules. Data are lacking on the humoral immune response to indigenously manufactured BBV152 (inactive) vaccine. In this study, we estimate the serologic response to BBV152 vaccine in hemodialysis patients in our Nephrology unit AIM OF THE STUDY: 1. To estimate the humoral immune response (conversion from seronegative to seropositive state) to inactivated SARS CoV2 vaccine administered as per The Government of India protocol in CKD stage V patients on maintenance HD 2. To correlate demographic clinical and biochemical/hematologic parameters with the humoral response METHODS: This study was a cross-sectional observational study conducted between September 2021 and March 2022 at the Department of Nephrology Tirunelveli Medical College Hospital. Ethics Committee approval was obtained. All CKD V patients on maintenance HD for at least three months who were willing to take BBV152 vaccine were enrolled in the study. Patients suffering from intercurrent illness those who had a prior PCR confirmed diagnosis of Covid-19, and patients who had positive baseline antibody titers were excluded from the study. Sample size was calculated according to the standard sample size calculator for observational study with a qualitative variable which computed a minimum sample size of 82. Detailed history taking clinical examination hematological and biochemical investigations assessment of nutritional status was performed as per structured questionnaire. For each patient, the following parameters were noted: Age, gender, BMI, native kidney disease comorbidities whether on immunosuppressant drugs, Hb absolute lymphocyte count, ESR serum albumin, and adequacy of dialysis by calculating spKt/V. Patients were then administered two doses of COVAXIN. Antibody titers were measured at baseline and four weeks after the first and second dose. Anti-SARS-CoV-2 IgG antibodies were measured using Access 2 Immunoassay System - Beckman Coulter by Chemiluminescence Microparticle Immunoassay which detects neutralizing antibodies against Receptor-Binding Domain of spike protein with a high sensitivity and specificity. The result of antibody titer was reported as nonreactive or reactive based on S/CO (Signal/Cut-Off ratio). S/CO 0.8 was nonreactive and S/CO 1 was reactive. Data was collected in MS-Excel, and IBM SPSSv26.0 was used for statistical analysis. RESULT(S): A total of 119 patients were enrolled out of which 107 patients completed the study. 75.7% (81 out of 107) patients achieved seroconversion after two doses of BBV152 which is lesser than seen in healthy controls. The rate of seroconversion was 66.4% after the first dose. Analysis of factors associated with poor seroconversion in this study showed increasing age, presence of diabetes, atherosclerotic cardiovascular disease, severe anemia, higher ESR, and severe hypoalbuminemia (Serum albumin < 2.5 g/dl) to be statistically significant. Patients who had lower BMI and spKt/V >1.2 showed a better seropositivity response in this study. HD vintage and absolute lymphocyte counts were not significantly associated with serologic response. Poor seroconversion is generally associated with immunosuppressant therapy, but this was not seen in our study which could be due to the small number (4 patients) in the study. Unique association of diabetes and severe anaemia with poor seroconversion was noted in this study CONCLUSION(S): 75.7% patients on maintenance hemodialysis achieved seroconversion after two doses of inactivated SARS CoV2 BBV152 vaccine. Increasing age, presence of diabetes, atherosclerotic cardiovascular disease, ana mia, inadequate hemodialysis, and hypoalbuminemia were associated with a lesser antibody response to the vaccine in this study. Revising future vaccine strategies with an aim at improving immunologic response in patients on hemodialysis with high-risk factors like diabetes mellitus brought out in our study could prove worthwhile.

Pre and Posttransplant Vaccination for Solid Organ Transplant Recipient and in South Asia - Expert Group Opinion

Infections are common after solid organ transplantation (SOT) and are an important cause of significant morbidity and mortality. Many of these infections can be prevented or their severity reduced by vaccination in pre and posttransplantation period. It is better to complete the vaccination before transplantation as protection and seroconversion is better, and live vaccines are mostly contraindicated after SOT. Live vaccines should be given at least 4 weeks before transplantation but killed vaccines can be given up to 2 weeks before the planned transplantation. Vaccination for some diseases which are endemic in South Asia should be given, along with usual vaccinations. Serological monitoring is required for some vaccines to check their efficacy. Similarly, some vaccines are recommended for SOT recipients traveling to various endemic regions. Copyright © 2022 Indian Journal of Transplantation Published by Wolters Kluwer - Medknow.

A Cross-Sectional Study on the Mental Health of Professionals Working from Home in Tamilnadu, India, during the Covid-19 Pandemic

BACKGROUND The Covid pandemic situation has brought drastic changes in workplace environments around the world with many organizations shifting to work from home (WFH) models. So, an online survey was conducted in India among professionals working from home to evaluate their mental health and determine as to how they were coping with working from home during this pandemic. METHODS An online survey was conducted with an invitation to professionals working from home to participate in the study. The survey questionnaire contained statements regarding their level of comfort in working from home and the statements from the Depression, Anxiety and Stress Scale (DASS - 21) and the acceptance and action questionnaire (AAQ - II). A total of 912 responses were statistically analysed. RESULTS Results showed that 63.9 % of the participants were experiencing various levels of stress, with 8.6 % having severe levels of stress;while 62.9 % had some level of anxiety, 6.9 % of the participants had severe levels of anxiety. 31 % of the respondents had some level of depression while 1.2 % had levels indicative of severe depression. Only 40.5 % of the respondents reported being comfortable working from home and 55 % of the people reported they could not work without disturbances at home. The nature of job, age, gender and parental status all influenced the levels of stress, anxiety and depression while WFH. CONCLUSIONS People who are working from home are stressed, anxious and have various levels of depression as clearly evidenced in this study.