In its wake, the COVID-19 pandemic has ushered in a surge in the number of cases of mucormycosis. Most cases are temporally linked to COVID-19; hence, the entity is described as COVID-19-associated mucormycosis (CAM). The present systematic review was undertaken to provide an up-to-date summary of the hitherto available literature on CAM. PubMed, Scopus and Google Scholar databases were systematically searched using appropriate keywords till 14 May 2021, to identify case reports/case series pertaining to mucormycosis in patients with COVID-19. Relevant data extracted included demographic characteristics, comorbidity profile, clinical category of mucormycosis, glucocorticoid use, treatment offered and patient outcome. We identified 30 case reports/case series, pooling data retrieved from 99 patients with CAM. Most cases were reported from India (72%). The majority of the patients was male (78%) and had diabetes mellitus (85%). A prior history of COVID-19 was present in 37% patients with mucormycosis developing after an initial recovery. The median time interval between COVID-19 diagnosis and the first evidence of mucormycosis infection or CAM diagnosiswas 15 days. Glucocorticoid use was reported in 85% of cases. Rhino-orbital mucormycosis was most common (42%), followed by rhino-orbito-cerebral mucormycosis (24%).Pulmonary mucormycosis was observed in 10 patients (10%). The mortality rate was 34%; the use of adjunct surgery, which was undertaken in 81% of patients, was associated with better clinical outcomes (p < .001). In conclusion, CAM is an emerging problem necessitating increased vigilance in COVID-19 patients, even those who have recovered.CAM portends a poor prognosis and warrants early diagnosis and treatment.
Purpose To provide a precise summary and collate the hitherto available clinical evidence on the effect of vitamin D supplementation on clinical outcomes in COVID-19 patients. Methods PubMed/MEDLINE, Scopus, and Web of Science databases were systematically searched using appropriate keywords till June 8, 2021, to identify observational studies and randomized controlled trials (RCTs) reporting adverse clinical outcomes (ICU admission and/or mortality) in COVID-19 patients receiving vitamin D supplementation vs. those not receiving the same. Both prior use and use of vitamin D after COVID-19 diagnosis were considered. Unadjusted/adjusted pooled odds ratio (OR) with 95% confidence intervals (CI) were calculated (PROSPERO registration number CRD42021248488). Results We identified 13 studies (10 observational, 3 RCTs) pooling data retrieved from 2933 COVID-19 patients. Pooled analysis of unadjusted data showed that vitamin D use in COVID-19 was significantly associated with reduced ICU admission/mortality (OR 0.41, 95% CI: 0.20, 0.81, p = 0.01, I 2 = 66%, random-effects model). Similarly, on pooling adjusted risk estimates, vitamin D was also found to reduce the risk of adverse outcomes (pooled OR 0.27, 95% CI: 0.08, 0.91, p = 0.03, I 2 = 80%, random-effects model). Subgroup analysis showed that vitamin D supplementation was associated with improved clinical outcomes only in patients receiving the drug post-COVID-19 diagnosis and not in those who had received vitamin D before diagnosis. Conclusions Vitamin D supplementation might be associated with improved clinical outcomes, especially when administered after the diagnosis of COVID-19. However, issues regarding the appropriate dose, duration, and mode of administration of vitamin D remain unanswered and need further research.
Aims, Settings, and Design: The COVID-19 pandemic has forced upon sudden lifestyle changes because of nationwide lockdowns mandating isolation at home, affecting daily habits and lifestyle changes. The present study was conducted with an aim to assess these changes brought about because of COVID-19 lockdown restrictions. Methods: The web-survey aimed to understand the immediate impact of the COVID-19 lockdown on people by using a structured questionnaire collecting demographic, lifestyle, and dietary information. The survey was disseminated online among the literate, urban, adult population with internet access. Results: Of the 1,200 people who received the survey, a total of 1,008 respondents participated in the study, aged between 18 and 81 years (Median- 24). An increase in daily screen time has been observed in 56.7% of the population. A decrease in work-related stress was observed in 43% of the population, sleep pattern improved in 36.7% people, and 27.1% of the inactive population showed increased physical activity. A significant decrease in the proportion of people consuming junk food (73.8%), alcohol (27.6%), and smoking (8.1%) was observed. Conclusions: The present web-based survey study suggests a significant change in the lifestyle and dietary patterns of people brought about because of the COVID-19 lockdown most highly seen as a major increase in screen usage and a decrease in junk food consumption.
Key Clinical Message Clinicians should be aware of the occurrence of deep vein thrombosis following brown recluse spider bite.
Background: Inpatient outcomes in obese patients have been investigated, although regional inequalities in cardiac and cerebrovascular events in young obese patients have not been explored previously. Methods: The National Inpatient Sample 2019 was queried for young obese patients (18-44 years) in 4 regions (Northeast, Midwest, South, West) using ICD-10-CM codes. Baseline characteristics and comorbidities inpatient MACCE including all-cause mortality, AMI, cardiac arrest, and stroke were identified. Results: Young obese cohort (Total n: 1,285,775, median age: 33 years, females: 75.4%) often consisted of admissions in the South (41.1%), followed by the Midwest (22.3%), West (20.7%), and Northeast (20.7%). HTN and DM were more frequent in the Midwest (32.3% and 22.3%) and South (34.4% and 22.8%) respectively, with higher MACCE of South (3.3%) and Midwest (3%) as compared to Northeast (2.3%) and West (2.6%) regions. All regions had comparable median hospital stay (3 days); however, the admissions in the West and Northeast regions (USD 36861 and 31211) had a higher cost burden. After adjusting for sociodemographic and comorbidities, the odds of in-hospital MACCE were higher in the West (aOR 1.15 95%CI 1.02-1.29), and South (aOR 1.16 95%CI 1.04-1.29), (p<0.001) vs. Northeast admissions (Fig. 1) . Conclusion: Cardiovascular comorbidities and MACCE were higher in young obese admissions in the South. This disparity may be due to differences in behavioral risk factors, socioeconomic status and healthcare access/prices. Future prospective studies on regional differences can help identify high-risk young, obese populations for targeted screening.
Background: Traditional cardiovascular disease (CVD) risk factors can increase the risk of Atrial Fibrillation (AF) even in young adults. With rising trends in CVD in the Asian population, we aimed to assess the prevalence and disparities of major modifiable risk factors for CVD and AF in the young Asians hospitalized in the US. Methods: The National Inpatient Sample (2016-2019) was used to estimate the temporal trends in modifiable CVD risk factors among young (18-44 years) Asian hospitalizations and evaluated disparities by sex. Also, we assessed the prevalence of AF in young Asians hospitalized with vs. without atleast one CVD risk factor. Results: From 2016 through 2019, a total of 1,324,259 young Asian admissions (Male 85%, age 18-44 years) were analyzed, the highest increase was noted for Obesity (1.8%) followed by Diabetes (1.3%). Males demonstrated the most prominent prevalence of Obesity (2.1%) and Hypertension (1.7%) as compared to the female population (1.7% and 0.4%), respectively. The incidence of AF in patients with at least one CVD risk factor increased by 0.4% (males 0.9% vs females 0.15%), (OR 2.80, 95%CI 2.44-3.21, p<0.001). Conclusion: The prevalence of modifiable risk factors for CVD are increasing at a steady pace in the young Asian population. There is a need for urgent preventive and curative strategies to decrease the overall burden of CVD in this population.
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