Novel risk factors for Coronavirus disease-associated mucormycosis (CAM): a case control study during the outbreak in India

BackgroundThe epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies. MethodsWe performed a case-control study comparing cases diagnosed with CAM and those who had recovered from COVID-19 without developing mucormycosis (controls). Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded. Results352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases carried conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95%CI 1.1-11), use of systemic steroids (aOR 7.7,95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6,95% CI 1.2-2.2). Zinc therapy, probably due to its utility in immune function, was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM. ConclusionJudicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.

Development of a self-assessment tool for resident doctors’ communication skills in India / 보건의료교육평가

Purpose@#Effective communication skills are essential for resident doctors to provide optimum patient care. This study was conducted to develop and validate a questionnaire for the self-assessment of resident doctors’ communication skills in India. @*Methods@#This was a mixed-methods study conducted in 2 phases. The first phase consisted of questionnaire development, including the identification of relevant literature, focus group discussions with residents and experts from clinical specialties, and pre-testing of the questionnaire. The second phase involved administering the questionnaire survey to 95 residents from the Departments of Medicine, Emergency Medicine, Pediatrics, and Surgery at the All India Institute of Medical Sciences, New Delhi, India in April 2019. Internal consistency was tested and the factor structure was analyzed to test construct validity. @*Results@#The questionnaire consisted of 3 sections: (A) 4 items on doctor-patient conflicts and the role of communication skills in avoiding these conflicts, (B) 29 items on self-assessment of communication skills in different settings, and (C) 8 items on barriers to practicing good communication skills. Sections B and C had good internal consistency (Cronbach α: 0.885 and 0.771, respectively). Section C had a 2-factor solution, and the barriers were classified as ‘training’ and ‘infrastructure’ factors. @*Conclusion@#This appears to be a valid assessment tool of resident doctors’ communication skills, with potential utility for identifying gaps in communication skills and developing communication skills modules.