Importance Coronavirus disease (COVID‐19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID‐19 infection. Methods This prospective, observational, multi‐centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID‐19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID‐19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded. Results Of the 2567 COVID‐19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID‐19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate‐to‐severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad‐spectrum antibiotics while most (n = 37, 78.7%) received at least one anti‐viral medication. Mean time elapsed from COVID‐19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre‐existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate‐to‐severe pneumonia, requiring oxygen supplementation and mechanical ventilation. Conclusions Mucormycosis can occur among COVID‐19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad‐spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high‐risk populations.

Background: Saroglitazar, a novel dual peroxisome proliferator activated receptor (PPAR) agonist, in clinical trials, has shown an improvement in lipid and glycemic parameters through the PPAR-α and γ agonist actions, respectively. It was granted marketing authorization in India in 2013 for diabetic dyslipidemia. This review was conducted to summarize the effects of Saroglitazar in patients with diabetic dyslipidemia in real world clinical studies conducted after marketing authorization in India. Methods: In this review, we selected real world clinical studies of Saroglitazar published as manuscripts and abstracts presented at scientific conferences. In all these studies, patients with diabetic dyslipidemia were treated with Saroglitazar 4 mg once daily for at least 12 weeks and different lipid and glycemic parameters were measured at the baseline and end of the study. Results: In 18 selected studies (5 published manuscripts and 13 abstracts), a total of 5824 patients with diabetic dyslipidemia were prescribed Saroglitazar 4 mg for a duration ranging from 12 to 58 weeks. Across all the studies, mean age of patients ranged from 49.6 to 59.1 years and the proportion of female patients ranged from 22% to 42%. Across all the studies, there was a consistent mean reduction in triglyceride levels (~ 45% to 62%), total cholesterol levels (~ 17% to 26%), non-high-density lipoprotein cholesterol levels (~ 21% to 36%), low-density lipoprotein cholesterol levels (~ 11% to 27%), and glycosylated hemoglobin levels (~ 0.7% to 1.6%) with an increase in mean high-density lipoprotein cholesterol levels (up to 9%) from baseline to end of the study. Saroglitazar also improved alanine aminotransferase levels and fatty liver (evaluated by FibroScan ™) in non-alcoholic fatty liver disease patients with diabetic dyslipidemia. Body weight remained unchanged and no significant adverse events (AEs) were reported in the studies. Conclusion: Saroglitazar effectively improved lipid and glycemic parameters without significant AEs in patients with diabetic dyslipidemia in real-world clinical studies of up to 58 weeks duration.

Objective: Diabetic dyslipidemia is highly atherogenic as it is associated with high triglyceride (TG), high small dense low-density lipoprotein (sd-LDL) particles and low High-Density Lipoprotein Cholesterol (HDL-C). Saroglitazar, a dual peroxisome proliferator activated receptor agonist (predominant PPAR-α agonist and modest PPAR-γ agonist), is approved in India for the management of diabetic dyslipidemia. The GLIDDER study was done to evaluate the effects of Saroglitazar 4 mg on non HDL-C as the primary endpoint and sd-LDL particles as a secondary endpoint in diabetic patients with dyslipidemia. Methods: This study was a 24 weeks, prospective, multicentre, single arm study conducted in 104 patients with diabetic dyslipidemia (TG ≥ 200 mg/dL) inadequately controlled with diet, exercise, and statins. It was conducted from April 2015 to November 2017 at three Indian centres. All the selected patients were given Saroglitazar 4 mg once daily before breakfast for 24 weeks. Efficacy evaluations of non HDL-C (calculated as Total Cholesterol (TC) minus HDL-C) (primary endpoint) and other lipid parameters (sd-LDL particles, TC, TG, HDL-C) and glycemic parameters (glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG)) were conducted after 24 weeks and compared to the baseline levels. Results: Total 104 patients (22% female) with mean age of 59.1 ± 11.4 years were enrolled in this study. In the perprotocol population, there was a significant reduction in non HDL-C (from 142.3 ± 59.3 mg/dL (baseline) to 109.9 ± 45.5 mg/dL (week-24); p<0.0001) and sd-LDL (from 32.5 ± 11.3 mg/dL (baseline) to 25.9 ± 11.8 mg/dL (week-24); p<0.0001). There was a significant reduction in TG, TC, HbA1c, and FPG with a significant increase in HDL-C at week-24 from baseline levels (p<0.05). Conclusion: Saroglitazar effectively reduces non HDL-C and sd-LDL particles in patients with diabetic dyslipidemia.

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COVID-19 is a respiratory illness that affects the human body in many different ways. The disease carries both thrombotic and hemorrhagic complications, especially in those patients who are anticoagulated to prevent the thromboembolic manifestations. In this report, we discuss a case of retroperitoneal hemorrhage in a patient treated with therapeutic anticoagulation which ultimately led to the patient’s death. The literature highlights the importance of anticoagulation because it reduces mortality in patients hospitalized with COVID-19. Although, more recent studies suggest that patients treated with therapeutic anticoagulation are at a higher risk of hemorrhage and increased mortality. Therefore, our case stresses the importance of active monitoring of these patients to detect any suspected case of hemorrhage early to reduce mortality. Overall, more research should be conducted to determine the optimal dosing of anticoagulation that balances safety and efficacy.