S econdary infections are known to complicate the clinical course of coronavirus disease . Bacterial infections are the most common secondary infections, but increasing reports of systemic fungal infections are causing concern. In the early part of the COVID-19 pandemic, <1% of secondary infections reported in COVID-19 patients were fungal (1,2). Preexisting conditions, indiscriminate use of antimicrobial and glucocorticoid drugs, and lapses in infection control practices are putative factors contributing to the emergence of systemic fungal infections in severe COVID-19 cases (3). After incidence of candidemia and invasive aspergillosis in COVID-19 patients increased (4,5), awareness of possible fungal co-infections increased among clinicians and microbiologists. One study reported invasive fungal infections in ≈6% of hospitalized COVID-19 patients (6). Occasional reports of COVID-19-associated mucormycosis (CAM) from various centers (7,8) and a series of 18 cases from a city in South India increased our concerns about CAM (9). India has a high burden of mucormycosis among patients with uncontrolled diabetes mellitus, and many severe COVID-19 patients have diabetes (8,10). India also is one of the countries worst affected by the COVID-19 pandemic. Thus, we would expect India to have many CAM cases. We conducted a nationwide multicenter study to evaluate the epidemiology and outcomes of CAM and compare the results with cases of mucormycosis unrelated to COVID-19 (non-CAM). Methods Study Design and SettingWe conducted a retrospective observational study involving 16 healthcare centers across India (Figure 1).

Introduction – An unprecedented rise in number of COVID-19 associated mucormycosis (CAM) cases has been reported in India. Myriad hyptheses are proposed for the outbreak. We recently reported uncontrolled diabetes and inappropriate steroid therapy as significant risk factors for the outbreak. However, Mucorales contamination of hospital environment was not studied. We, therefore, planned this multi-centre study across India to determine possible Mucorales contamination of hospital environment during the outbreak. Methods Eleven hospitals from four zones of India representing high to low incidence for mucormycosis cases were included in the study. Samples from a variety of equipment used by the patients and ambient air were collected during May 19, 2021 through August 25, 2021. Results None of the hospital equipment sampled was contaminated with Mucorales. However, Mucorales were isolated from 11.1% air-conditioning vents and 1.7% of patients’ used masks. Other fungi were isolated from 18% hospital equipment and surfaces, and 8.1% used masks. Mucorales grew from 21.7% indoor and 53.8% outdoor air samples. Spore counts of Mucorales in air were significantly higher in the hospitals of North and South zones compared to West and East zones ( P < 0.0001). Among Mucorales isolated from the environment Rhizopus spp. were the commonest genus. Conclusion – We found contamination of air-conditioning vents and hospital air by Mucorales. Presence of Mucorales in these areas demands regular surveillance and improvement of hospital environment, as contamination may contribute to healthcare associated mucormycosis outbreaks, especially among immunocompromised patients.

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A B S T R A C TBackground: There exist various studies on the cause and determinants of infant mortality in developing countries. However, to best of our knowledge, none of the studies have seen the effect of institutional delivery and infant's birth size on infant mortality in Bangladesh. Methods: Data for this study comes from Bangladesh Demographic and Health survey 2014, which is a nationally representative cross-sectional survey. This study uses information on 7,886 infants to analyze the effect of institutional delivery and birth size on infant mortality. Bi-variate and cox regression technique were applied for analyzing the cross-sectional data drawn from representative survey. Results: Infant mortality was significantly higher in mothers who did not deliver baby at institutions and did not take any antenatal checkups. A significant high infant mortality was found among mothers who belonged to poor wealth status than middle and rich. In addition, infants who had small and very small birth size at the time of delivery had significantly high mortality. The mortality was significantly high in male than female infants. Conclusion: Infant mortality is low among those who delivers baby at institutions, takes antenatal checkups and have higher wealth status. Infants with average birth size and female have less mortality. To reduce the infant mortality in Bangladesh, institutional delivery, antenatal care, baby birth size, child sex and wealth index are important factors. There is urgent need to focus into these factors to reduce infant mortality in the country.

ObjectiveThe objective of the sub-analysis of data from centers across urban areas in India of the Global Asthma Network (GAN) was to study the 1) prevalence of symptoms of asthma in children and adults, 2) change in prevalence of asthma and its trigger factors since the International Study of Asthma and Allergies in Childhood (ISAAC), and, 3) current asthma treatment practice.MethodsIn this cross–sectional, multicenter, school-based, and self-administered questionnaire, responses from children aged 6–7 years, 13–14 years, and their respective parents were analysed.ResultsThe GAN phase I study included 20084 children in the 6–7-year-age group, 25887 children in the 13–14-year-age group, and 81296 parents. The prevalence of wheeze in the past 12 months was 3.16%, 3.63%, and 3.30% in the three groups respectively. In comparison to the ISAAC studies, there was a significant reduction in the prevalence of current wheeze (p<0.001). Bivariate analysis revealed a significant reduction in the prevalence of trigger factors. Almost 82% of current wheezers and 70% of subjects with symptoms of severe asthma were not clinically diagnosed as having asthma. The daily use of inhaled corticosteroid (ICS) was less than 2.5% in subjects with current wheeze and those with symptoms of severe asthma but less than 1% used daily ICS when asthma remained undiagnosed.ConclusionThe prevalence of current wheeze and its causal factors showed a significant reduction compared to previous ISAAC studies. Among subjects with current wheeze and symptoms of severe asthma, the problem of under-diagnosis and under-treatment was high.

Background: There exists a number of studies on the causes and determinants of childhood mortality in the developing world. However, to best of our knowledge, none of the existing studies have examined the effect of wealth and birth interval on childhood mortality in Nigeria. This study is an attempt to fill that gap. Methods: Data for this study comes from the Nigeria Demographic and Health Survey 2013, which is a nationally representative cross-sectional survey. This study uses information on 119,386 under-5 children to analyze the effect of wealth and birth interval on childhood mortality. Bi-variate and Cox regression technique were applied for analyzing the cross-sectional data drawn from representative survey. Results: Under-5 mortality was higher in mothers who were poor, illiterate and working either as a professional/ technical worker or as an agricultural worker. Children whose mothers were illiterate and had less than two years of the birth interval had the highest under-5 mortality. Younger mothers (aged less than 20 years) lost more children. Under-5 deaths were more among those mothers who were poor and had less than two years of birth interval. The child mortality was significantly high in poor households with low birth interval. Conclusion: Under-5 mortality is low among those who had higher wealth status and more than two years of birth interval. In order to reduce or eradicating the effect of birth interval and wealth effect, there is burning need to control the economic inequality and birth interval.

As the COVID-19 pandemic marches exponentially, epidemiological data is of high importance to analyse the current situation and guide intervention strategies. This study analyses the epidemiological data of COVID-19 from 17 countries, representing 85 per cent of the total cases within first 90 days of lockdown in Wuhan, China. It follows a population-level observational study design and includes countries with 20,000 cases (or higher) as of 21 April 2020. We sourced the data for these 17 countries from worldometers. info, a digital platform being used by several media and reputed academic institutions worldwide. We calculated the prevalence, incidence, case fatality rate and trends in the epidemiology of COVID-19, and its correlation with population density, urbanisation and elderly population. The analysis represents 85 per cent ( N = 2,183,661) of all cases within the first 90 days of the pandemic. Across the analysed period, the burden of the pandemic primarily focused on high- and middle-income countries of Asia, Europe and North America. While the total number of cases and deaths are highest in USA, the prevalence, incidence and case fatality rates are higher in the European countries. The prevalence and incidence vary widely among countries included in the analysis, and the number of cases per million and the case fatality rate are correlated with the proportion of the elderly population and to a lesser extent with the proportion of the urban population.