Clinical profile of recent progressive illnesses in patients with mucormycosis: a comprehensive analysis

Background: The COVID-19 pandemic, in its omnipresence, descended an unprecedented blow on the reeling facilities nationwide, which at its stabilising junction posed another threat – mucormycosis. Potentially immunodeficient cases, diabetes and excessive rampancy of steroids propagated this neo-epidemic, currently challenging the fretting mortality rate. Aim of the study was to analyse the clinical profile elaborating the recent illnesses and progression in patients admitted with mucormycosis in a dedicated ‘mucor-care’ centre.Methods: Total 195 admitted patients were evaluated based on their COVID protocol management and oxygen therapy administered with special emphasis on hygiene maintenance in view of mask support, oral care and hospitalisation course with duration and medications provided. Type and duration of glucocorticoids, injectable or oral, dispensed to the patients were duly logged and analysed.Results: Half cases (50%) were found COVID reverse transcriptase-polymerase chain reaction (RT-PCR) positive with 69% patients suffering from moderate ailment and above. Patients averaged 25-30 days at onset of post-COVID mucormycosis symptomatology with 78% (172) cases having h/o hospitalisation. 90% patients required oxygen therapy in variable magnitudes with meagre 38% receiving ‘remdesivir’ complete course dosages. Despite being prudent, 58% did not maintain adequate sanitation while 72% denied having oxygen humidified. Steroids were pivotal with 84% affirmative prevalence; dexamethasone being commonest, averaging 15 days of therapy, which supplementing immune-compromised modalities, promulgated this epidemic.Conclusions: The deadly trinity of diabetes, rampancy of steroids in a background of COVID-19 caused havoc in recent times. Only astute usage of resources and prudent education can curb this menace in a better way.

Coping with Drought in Rice Farming in Asia: Insights from a Cross-Country Comparative Study

Drought is a major constraint affecting rice production especially in rainfed areas of Asia. Despite its importance in rice growing areas, the magnitude of economic losses arising from drought, its impact on farm households and farmers' drought coping mechanisms are poorly understood. This paper provides insights into these aspects of drought based on a cross-country comparative analysis of rainfed rice growing areas in China, India and Thailand. The economic cost of drought is found to be substantially higher in eastern India than in the other two countries. Higher probability and greater spatial covariance of drought and less diversified farming systems with rice accounting for a large r share of household income are likely to be the main reasons for this higher cost of drought in eastern India. Farmers deploy various coping mechanisms but such mechanisms are largely unable to prevent a reduction in income and consumption, especially in eastern India. As a result, welfare consequences on poor farmers are substantial with a large number of people falling back into poverty during drought years. The overall implications for technology design and for policy improvements for drought mitigation and drought relief are discussed in the light of the empirical findings of the study.Drought, Economic cost, Coping mechanisms, Poverty, Crop Production/Industries, D1, I3, Q1,

Curbing COVID-19: the quest continues in time

The menace of Coronavirus Disease-19 (COVID-19) has made life more and more challenging throughout the world. Amidst these difficult times, doctors have proved their exceptional worth. They have performed their duties with notable dedication, diligence, resilience, and compassion. Here we share our experiences from the State of Rajasthan in Northern India. We were benefitted by very early lockdown by the Government, preventive strategies of containment, and the most effective contact tracing program. The creation of hundreds of surveillance teams and rapid response teams (RRT) was instrumental for the containment program. This was coupled with outstanding medical care exemplified by Sawai Man Singh Medical College Hospital (SMSMCH) at Jaipur, the capital city of Rajasthan. The mortality rate-limiting to 1.98% in Rajasthan has been an outcome of the amalgamation of brisk administrative action, government support, and visionary action and the best of health care facilities. Our COVID-19 management program strategy was based on the advanced treatment guidelines from the Indian Council of Medical Research, New Delhi, India, and the Ministry of Health and Family Welfare, Government of India.   References Gao Y, Li T, Han M, Li X, Wu D, Xu Y, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-796. https://doi.org/10.1002/jmv.25770. Covid-19 data for Rajasthan, India. Available from: https://www.covid19india.org/state/RJ. [Accessed on 17 July 2020]. Clinical Management Protocol: Covid-19. Version 5, 03/07/20. Available from: http://www.rajswasthya.nic.in/PDF/COVID%20-19/FOR%20HOSPITALS/03.07.2020.pdf. [Accessed on 17 July 2020] Brown BL, McCullough J. Treatment for emerging viruses: Convalescent plasma and COVID-19. Transfus Apher Sci. 2020;59(3):102790. https://doi.org/10.1016/j.transci.2020.102790. Bhatnagar T, Murhekar MV, Soneja M, Gupta N, Giri S, Wig N, et al. Lopinavir/ritonavir combination therapy amongst symptomatic coronavirus disease 2019 patients in India: Protocol for restricted public health emergency use. Indian J Med Res. 2020;151(2 & 3):184-189. https://doi.org/10.4103/ijmr.IJMR_502_20

Lopinavir/ritonavir: is early administration better in Covid-19?

Background: To share the data of coronavirus 2019 (Covid-19) patients started on lopinavir-ritonavir (lopi/r) in relation to time period from the onset of symptoms.Method: Observational descriptive study of 23 Covid-19 patients admitted in a tertiary care center in India from March 2020 to May 2020. Patients categorized into 2 groups based on the timing of initiation of lopi/r from the onset of symptoms. Group 1 were given the drug early (≤7 days) and group 2 late (>7 days). The clinical events (oxygen requirement days and ICU stay) and outcomes of hospital stay between the two groups were evaluated.Results: Patients were started on lopi/r for a period of 14 days on admission, out of which 12 patients were in group 1 and 11 patients in group 2. Underlying co-morbidities were present in 15 patients (65.21%). The mean duration from onset of symptoms to lopi/r initiation was 4 days and 11.1 days in Group 1 and 2 respectively. Requirement for oxygen support (2.16 versus 6.54 days), mean duration of hospitalization (8.58 versus 11.54 days) and mean duration of obtaining first Covid-19 negative report from the onset of symptoms (10.5 versus 19.57 days) were all significantly lesser in group 1 (p<0.05). All patients belonging to Group 1 and eight patients of group 2 recovered completely and were discharged whereas 3 patients of group 2 expired. Diarrhea was the most commonly observed adverse effect of lopi/r in our patients.Conclusion: With no approved weapon to tackle the Covid-19 pandemic, we should keep lopi/r in our armamentarium of drugs and use it at the earliest. More clinical trials are needed in future to ascertain if lopi/r can reduce hospital stay, prompt faster recovery and result in better clinical outcome

Use and inappropriate use of proton pump inhibitors in hospitalized patients

Background: The discovery of Helicobacter pylori infection in etiology of peptic ulcer disease and proton pump inhibitors (PPI) in management of upper gastrointestinal diseases had been the milestones in medical science. PPI are currently being both overused and misused. In countries like India, where over 500 branded formulations of PPI are available, probability of misuse and abuse increases exponentially. The aim of the study was to find out inappropriate use of PPI, among hospitalized patients.Methods: In order to find answer to the research question a cross sectional study was conducted in indoor patient of a tertiary care private hospital at Jaipur, Rajasthan. Patients of either sex, aged 18 years or above belonging to rural and urban communities were participating in study. The sample size was 500.Results: It was noted that Inappropriate PPI use was observed in most of the hospital admitted patients (78%). Most common diagnosis among inappropriate PPI use was dengue fever (due to increased number of dengue cases during study period), followed by cerebrovascular accidents and urinary tract infection. Most common indication for appropriate PPI use was stress ulcer prophylaxis, again in dengue case (due to cardinal manifestation of thrombocytopenia).Conclusions: Almost all patients were once prescribed PPI after admission and discharged on PPI (99.2%). Thus, we recommend evidence-based prescription of PPI, to reduce side effects and excess cost

The sequel to COVID-19: the antithesis to life

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. &nbsp; References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observatio

Polder Tidings, Volume 1, Number 1, May 2016

United States Agency for International Developmen

Trifecta and pentafecta outcomes following robot-assisted partial nephrectomy in a multi-institutional cohort of Indian patients

INTRODUCTION: The literature on studies reporting trifecta or pentafecta outcomes following robot-assisted partial nephrectomy (RAPN) in Indian patients is limited. The primary aim of this study was to report and evaluate the factors predicting trifecta and pentafecta outcomes following RAPN in Indian patients using the multicentric Vattikuti collective quality initiative (VCQI) database. METHODS: From the VCQI database for patients who underwent RAPN, data for Indian patients were extracted and analyzed for factors predicting the achievement of trifecta and pentafecta following RAPN. Trifecta was defined as the absence of complications, negative surgical margins, and warm ischemia period shorter than 25 min or zero ischemia. Pentafecta covers all the trifecta criteria as well as \u3e90% preservation of estimated glomerular filtration rate (eGFR) and no stage upgrade of chronic kidney disease at 12 months. RESULTS: In this study, among 614 patients, the trifecta was achieved in 374 patients (60.9%) and pentafecta was achieved in 24.2% of the patients. Patients who achieved trifecta had significantly higher mean age (54.1 vs. 51.0 years, P = 0.005), body mass index (BMI) (26.7 vs. 26.03 kg/m 2, P = 0.022), and smaller tumor size (38.6 vs. 41.4 mm, P = 0.028). The preoperative eGFR (84.2 vs. 91.9 ml/min, P = 0.012) and renal nephrometry score (RNS) (6.96 vs. 7.87, P ≤ 0.0001) were significantly lower in the trifecta group. Comparing patients who achieved pentafecta to those who did not, we noted a statistically significant difference between the two groups for tumor size (36.1 vs. 41.5 mm, P = 0.017) and RNS (6.6 vs. 7.7, P = 0.0001). On multivariate analysis, BMI and RNS were associated with trifecta outcomes. Similarly, only RNS was identified as an independent predictor of pentafecta. CONCLUSIONS: RNS and BMI were independent predictors of the trifecta. At the same time, RNS was identified as an independent predictor of pentafecta following RAPN

Evidence-based decision making and covid-19: what a posteriori probability distributions speak

Background: In the absence of any pharmaceutical interventions, the management of the COVID-19 pandemic is based on public health measures. The present study fosters evidence-based decision making by estimating various “a posteriori probability distributions" from COVID-19 patients.&nbsp; Methods: In this retrospective observational study, 987 RT-PCR positive COVID-19 patients from SMS Medical College, Jaipur, India, were enrolled after approval of the institutional ethics committee. The data regarding age, gender, and outcome were collected. The univariate and bivariate distributions of COVID-19 cases with respect to age, gender, and outcome were estimated. The age distribution of COVID-19 cases was compared with the general population's age distribution using the goodness of fit c2 test. The independence of attributes in bivariate distributions was evaluated using the chi-square test for independence. Results: The age group ‘25-29’ has shown highest probability of COVID-19 cases (P [25-29] = 0.14, 95% CI: 0.12- 0.16). The men (P [Male] = 0.62, 95%CI: 0.59-0.65) were dominant sufferers. The most common outcome was recovery (P [Recovered] = 0.79, 95%CI: 0.76-0.81) followed by admitted cases (P [Active]= 0.13, 95%CI: 0.11-0.15) and death (P [Death] = 0.08, 95%CI: 0.06-0.10). The age distribution of COVID-19 cases differs significantly from the age distribution of the general population (c2&nbsp; =399.04, P &lt; 0.001). The bivariate distribution of COVID-19 across age and outcome was not independent (c2 =106.21, df = 32, P &lt; 0.001). Conclusion: The knowledge of disease frequency patterns helps in the optimum allocation of limited resources and manpower. The study provides information to various epidemiological models for further analysis

Evidence-based decision making and covid-19: what a posteriori probability distributions speak

Background: In the absence of any pharmaceutical interventions, the management of the COVID-19 pandemic is based on public health measures. The present study fosters evidence-based decision making by estimating various “a posteriori probability distributions" from COVID-19 patients.&nbsp; Methods: In this retrospective observational study, 987 RT-PCR positive COVID-19 patients from SMS Medical College, Jaipur, India, were enrolled after approval of the institutional ethics committee. The data regarding age, gender, and outcome were collected. The univariate and bivariate distributions of COVID-19 cases with respect to age, gender, and outcome were estimated. The age distribution of COVID-19 cases was compared with the general population's age distribution using the goodness of fit c2 test. The independence of attributes in bivariate distributions was evaluated using the chi-square test for independence. Results: The age group ‘25-29’ has shown highest probability of COVID-19 cases (P [25-29] = 0.14, 95% CI: 0.12- 0.16). The men (P [Male] = 0.62, 95%CI: 0.59-0.65) were dominant sufferers. The most common outcome was recovery (P [Recovered] = 0.79, 95%CI: 0.76-0.81) followed by admitted cases (P [Active]= 0.13, 95%CI: 0.11-0.15) and death (P [Death] = 0.08, 95%CI: 0.06-0.10). The age distribution of COVID-19 cases differs significantly from the age distribution of the general population (c2&nbsp; =399.04, P &lt; 0.001). The bivariate distribution of COVID-19 across age and outcome was not independent (c2 =106.21, df = 32, P &lt; 0.001). Conclusion: The knowledge of disease frequency patterns helps in the optimum allocation of limited resources and manpower. The study provides information to various epidemiological models for further analysis