COVID-19–associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic’s second wave in India

Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19–induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19–associated mucormycosis in India.

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Relative contribution of leaving home for work or education, transport, shopping and other activities on risk of acquiring COVID-19 infection outside the household in the second wave of the pandemic in England and Wales

10.1101/2021.12.08.21267458 ◽

2021 ◽

Author(s):

S Hoskins ◽

S Beale ◽

RW Aldridge ◽

AMD Navaratnam ◽

C Smith ◽

...

Keyword(s):

Public Transport ◽

Risk Groups ◽

Mitigation Strategies ◽

Or Education ◽

Leaving Home ◽

Household Transmission ◽

Increased Risk ◽

Wide Range ◽

Household Activities ◽

Second Wave

AbstractBackgroundWith the potential for and emergence of new COVID-19 variants, such as the reportedly more infectious Omicron, and their potential to escape the existing vaccines, understanding the relative importance of which non-household activities increase risk of acquisition of COVID-19 infection is vital to inform mitigation strategies.MethodsWithin an adult subset of the Virus Watch community cohort study, we sought to identify which non-household activities increased risk of acquisition of COVID-19 infection and which accounted for the greatest proportion of non-household acquired COVID-19 infections during the second wave of the pandemic. Among participants who were undertaking antibody tests and self-reporting PCR and lateral flow tests taken through the national testing programme, we identified those who were thought to be infected outside the household during the second wave of the pandemic. We used exposure data on attending work, using public or shared transport, using shops and other non-household activities taken from monthly surveys during the second wave of the pandemic. We used multivariable logistic regression models to assess the relative independent contribution of these exposures on risk of acquiring infection outside the household. We calculated Adjusted Population Attributable Fractions (APAF - the proportion of non-household transmission in the cohort thought to be attributable to each exposure) based on odds ratios and frequency of exposure in cases.ResultsBased on analysis of 10475 adult participants including 874 infections acquired outside the household, infection was independently associated with: leaving home for work (AOR 1.20 (1.02 – 1.42) p=0.0307, APAF 6.9%); public transport use (AOR for use more than once per week 1.82 (1.49 – 2.23) p<0.0001, APAF for public transport 12.42%); and shopping (AOR for shopping more than once per week 1.69 (1.29 – 2.21) P=0.0003, APAF for shopping 34.56%). Other non-household activities such as use of hospitality and leisure venues were rare due to restrictions and there were no significant associations with infection risk.ConclusionsA high proportion of the second wave of the pandemic was spent under conditions where people were being advised to work from home where possible, and to minimize exposure to shops, and a wide range of other businesses were subject to severe restrictions. Vaccines were being rolled out to high-risk groups. During this time, going to work was an important risk factor for infection but public transport use likely accounted for a lot of this risk. Only a minority of the cohort left home for work or used public or shared transport. By contrast, the majority of participants visited shops and this activity accounted for about one-third of non-household transmission.

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PSYCHOSOCIAL FACTORS AS RISK FACTOR IN SUICIDAL POISONING: A CROSS-SECTIONAL STUDY

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i8.18983 ◽

2017 ◽

Vol 10 (8) ◽

pp. 284

Author(s):

Asawari Raut ◽

Kavya Shaj ◽

Atmaram Pawar

Keyword(s):

Psychosocial Factors ◽

Treatment Strategies ◽

Risk Groups ◽

Cross Sectional Study ◽

Agricultural Products ◽

Epidemiological Surveillance ◽

Health Concern ◽

Toxic Agent ◽

Cross Sectional ◽

Increased Risk

Objective: Suicide is known to be a phenomenon in low-, middle-, and high-income countries and occurs in all sociodemographic groups. It ranges from acute to fatal lethal attempts which occur in the context of a social crisis. Deliberate self-poisoning for suicide is a growing public health concern with frequent emergency department admissions. An epidemiological surveillance is essential for every region to understand the pattern, underlying psychological factors, and the scope of preventive measures.Methods: The 2-year retrospective study describes the epidemiology and influencing factors of suicides by self-poisoning in patients admitted to a Government Hospital and a Teaching Hospital in Pune, Maharashtra, from January 1, 2014 to December 31, 2015.Result: Out of 1010 poisoning cases reported, 539 were suicidal self-poisoning. Significantly males more than females were brought to the hospitals due to deliberate self-poisoning (1:0.86, χ2=38.05; p<0.001). The age group most recorded was 20-35 years (67.7%). Psychosocial factors were associated with increased risk of suicidal self-poisoning attempts (risk ratio 4.76, 95% confidence interval 4.07-5.57; p<0.001). Psychosocial factors were interpersonal conflict (52.4%), stress (30.4), dissatisfaction in life (6%), and alcoholism or mental disorders (11.1%). Household and agricultural products (71.8%) were the popular choices of the toxic agent in self-poisoning with phenols (20%) being the most common. 19 cases (3.5%) were severe, out of which 15 cases lead to death (2.8% mortality).Conclusion: There is an urgent need to develop and implement preventative and treatment strategies for high-risk groups attempting suicide by self-poisoning.

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Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316293 ◽

2020 ◽

pp. bjophthalmol-2020-316293

Author(s):

Puneet Jain ◽

Paul T Finger ◽

Maria Fili ◽

Bertil Damato ◽

Sarah E Coupland ◽

...

Keyword(s):

Local Recurrence ◽

Local Excision ◽

External Beam Radiotherapy ◽

Staging System ◽

Primary Treatment ◽

Excision Biopsy ◽

Conjunctival Melanoma ◽

Recurrence Rates ◽

Increased Risk ◽

Eighth Edition

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.

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Pharmacological Interventions for Pulmonary Involvement in Rheumatic Diseases

Pharmaceuticals ◽

10.3390/ph14030251 ◽

2021 ◽

Vol 14 (3) ◽

pp. 251 ◽

Cited By ~ 1

Author(s):

Eun Ha Kang ◽

Yeong Wook Song

Keyword(s):

Rheumatic Diseases ◽

Treatment Options ◽

Treatment Strategies ◽

Pulmonary Involvement ◽

Current Treatment ◽

Targeted Agents ◽

Pharmacological Interventions ◽

Inflammatory Processes ◽

Pulmonary Arterial ◽

Epidemiologic Features

Among the diverse forms of lung involvement, interstitial lung disease (ILD) and pulmonary arterial hypertension (PAH) are two important conditions in patients with rheumatic diseases that are associated with significant morbidity and mortality. The management of ILD and PAH is challenging because the current treatment often provides only limited patient survival benefits. Such challenges derive from their common pathogenic mechanisms, where not only the inflammatory processes of immune cells but also the fibrotic and proliferative processes of nonimmune cells play critical roles in disease progression, making immunosuppressive therapy less effective. Recently, updated treatment strategies adopting targeted agents have been introduced with promising results in clinical trials for ILD ad PAH. This review discusses the epidemiologic features of ILD and PAH among patients with rheumatic diseases (rheumatoid arthritis, myositis, and systemic sclerosis) and the state-of-the-art treatment options, focusing on targeted agents including biologics, antifibrotic agents, and vasodilatory drugs.

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Online Opioid Stewardship Training for Long-Term Care Staff

Innovation in Aging ◽

10.1093/geroni/igaa057.1721 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

pp. 533-533

Author(s):

Linda Edelman ◽

Troy Andersen ◽

Cherie Brunker ◽

Nicholas Cox ◽

Jorie Butler ◽

...

Keyword(s):

Staff Training ◽

Long Term Care ◽

Treatment Strategies ◽

Care Staff ◽

Video Content ◽

Opioid Use ◽

Term Care ◽

Increased Risk ◽

Pain Management Strategy

Abstract Opioids are often the first-line chronic pain management strategy for long-term care (LTC) residents who are also at increased risk for opioid-related adverse events. Therefore, there is a need to train LTC providers and staff about appropriate opioid use and alternative treatment strategies. Our interdisciplinary team worked with LTC partners to identify staff educational needs around opioid stewardship. Based on this need’s assessment, we developed eight modules about opioid use and risks for older adults, including those with dementia, recommendations for de-prescribing including other pharmacological and non-pharmacological alternatives, SBIRT, and motivational interviewing to determine “what matters”. Each 20-minute module contains didactic and video content that is appropriate for group staff training or individuals and provides rural LTC facilities access to needed training in their home communities. Within the first month of launching online, the program received over 1100 hits and LTC partners are incorporating modules into clinical staff training schedules.

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Application of integrated treatment strategies for explosive industry wastewater—A critical review

Journal of Water Process Engineering ◽

10.1016/j.jwpe.2020.101232 ◽

2020 ◽

Vol 35 ◽

pp. 101232 ◽

Cited By ~ 5

Author(s):

Pallvi Bhanot ◽

S. Mary Celin ◽

T.R. Sreekrishnan ◽

Anchita Kalsi ◽

S.K. Sahai ◽

...

Keyword(s):

Critical Review ◽

Treatment Strategies ◽

Integrated Treatment ◽

Industry Wastewater

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Nightingale Theory and Intentional Comfort Touch in Management of Tinea Pedis in Vulnerable Populations

Journal of Holistic Nursing ◽

10.1177/0898010110373655 ◽

2010 ◽

Vol 28 (4) ◽

pp. 244-250 ◽

Cited By ~ 3

Author(s):

Maeve Howett ◽

Ann Connor ◽

Elizabeth Downes

Keyword(s):

Vulnerable Populations ◽

Access To Health Care ◽

Fungal Growth ◽

Foot Care ◽

Limited Access ◽

Clinical Encounters ◽

Secondary Infections ◽

Increased Risk ◽

Migrant Farm ◽

Working And Living Conditions

Vulnerable populations, specifically migrant farm workers and persons experiencing homelessness, are often at an increased risk for foot infections. This risk is related to their working and living conditions, socioeconomic status, limited access to health care, frequent exposure to wet environments, limited access to clean and dry socks and shoes, bathing or laundry facilities, and daily routines that requires them to be on their feet for long periods of time. After years of caring for these populations and hundreds of clinical encounters, an evidence-based, effective method of foot care that incorporates intentional comfort touch has been developed. This article describes methods for mitigating the severity of fungal growth, decreasing the risk of secondary infections, and improving skin integrity by manipulating the micro-environment of the patients’ feet. This includes fundamental aspects of hygiene as described by Florence Nightingale’s Environmental Theory that suggests that direct sunlight, fresh air, and cleanliness improves health.

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Hemorrhagic and Cystic Brain Metastases Are Associated With an Increased Risk of Leptomeningeal Dissemination After Surgical Resection and Adjuvant Stereotactic Radiosurgery

Neurosurgery ◽

10.1093/neuros/nyy436 ◽

2018 ◽

Vol 85 (5) ◽

pp. 632-641 ◽

Cited By ~ 6

Author(s):

Robert H Press ◽

Chao Zhang ◽

Mudit Chowdhary ◽

Roshan S Prabhu ◽

Matthew J Ferris ◽

...

Keyword(s):

Brain Metastases ◽

Stereotactic Radiosurgery ◽

Surgical Resection ◽

Cumulative Incidence ◽

Postoperative Radiotherapy ◽

Multivariable Analysis ◽

Treatment Strategies ◽

Competing Risk ◽

Leptomeningeal Dissemination ◽

Increased Risk

Abstract BACKGROUND Brain metastases (BM) treated with surgical resection and focal postoperative radiotherapy have been associated with an increased risk of subsequent leptomeningeal dissemination (LMD). BMs with hemorrhagic and/or cystic features contain less solid components and may therefore be at higher risk for tumor spillage during resection. OBJECTIVE To investigate the association between hemorrhagic and cystic BMs treated with surgical resection and stereotactic radiosurgery and the risk of LMD. METHODS One hundred thirty-four consecutive patients with a single resected BM treated with adjuvant stereotactic radiosurgery from 2008 to 2016 were identified. Intracranial outcomes including LMD were calculated using the cumulative incidence model with death as a competing risk. Univariable analysis and multivariable analysis were assessed using the Fine & Gray model. Overall survival was analyzed using the Kaplan-Meier method. RESULTS Median imaging follow-up was 14.2 mo (range 2.5-132 mo). Hemorrhagic and cystic features were present in 46 (34%) and 32 (24%) patients, respectively. The overall 12- and 24-mo cumulative incidence of LMD with death as a competing risk was 11.0 and 22.4%, respectively. On multivariable analysis, hemorrhagic features (hazard ratio [HR] 2.34, P = .015), cystic features (HR 2.34, P = .013), breast histology (HR 3.23, P = .016), and number of brain metastases >1 (HR 2.09, P = .032) were independently associated with increased risk of LMD. CONCLUSION Hemorrhagic and cystic features were independently associated with increased risk for postoperative LMD. Patients with BMs containing these intralesion features may benefit from alternative treatment strategies to mitigate this risk.

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OsteoporosAtlas: a human osteoporosis-related gene database

PeerJ ◽

10.7717/peerj.6778 ◽

2019 ◽

Vol 7 ◽

pp. e6778 ◽

Cited By ~ 3

Author(s):

Xun Wang ◽

Lihong Diao ◽

Dezhi Sun ◽

Dan Wang ◽

Jiarun Zhu ◽

...

Keyword(s):

Complex Disease ◽

Treatment Strategies ◽

Osteoporotic Fractures ◽

Relevant Information ◽

Extensive Literature ◽

Mineral Density ◽

Common Complex Disease ◽

Increased Risk ◽

Prevention And Treatment ◽

Pathway Analyses

Background Osteoporosis is a common, complex disease of bone with a strong heritable component, characterized by low bone mineral density, microarchitectural deterioration of bone tissue and an increased risk of fracture. Due to limited drug selection for osteoporosis and increasing morbidity, mortality of osteoporotic fractures, osteoporosis has become a major health burden in aging societies. Current researches for identifying specific loci or genes involved in osteoporosis contribute to a greater understanding of the pathogenesis of osteoporosis and the development of better diagnosis, prevention and treatment strategies. However, little is known about how most causal genes work and interact to influence osteoporosis. Therefore, it is greatly significant to collect and analyze the studies involved in osteoporosis-related genes. Unfortunately, the information about all these osteoporosis-related genes is scattered in a large amount of extensive literature. Currently, there is no specialized database for easily accessing relevant information about osteoporosis-related genes and miRNAs. Methods We extracted data from literature abstracts in PubMed by text-mining and manual curation. Moreover, a local MySQL database containing all the data was developed with PHP on a Windows server. Results OsteoporosAtlas (http://biokb.ncpsb.org/osteoporosis/), the first specialized database for easily accessing relevant information such as osteoporosis-related genes and miRNAs, was constructed and served for researchers. OsteoporosAtlas enables users to retrieve, browse and download osteoporosis-related genes and miRNAs. Gene ontology and pathway analyses were integrated into OsteoporosAtlas. It currently includes 617 human encoding genes, 131 human non-coding miRNAs, and 128 functional roles. We think that OsteoporosAtlas will be an important bioinformatics resource to facilitate a better understanding of the pathogenesis of osteoporosis and developing better diagnosis, prevention and treatment strategies.

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Development and validation of a 13-m6a related lncRNA prognostic signature for lung adenocarcinoma

10.21203/rs.3.rs-771653/v1 ◽

2021 ◽

Author(s):

Pingfan Wu ◽

Xiaowen Zhao ◽

Ling Xue ◽

Xiaojing Yang ◽

Yuxiang Shi ◽

...

Keyword(s):

Gene Expression ◽

Lung Adenocarcinoma ◽

Treatment Strategies ◽

Risk Groups ◽

Gene Expression Omnibus ◽

High Risk Group ◽

The Cancer Genome Atlas ◽

Prognostic Signature ◽

P53 Signaling ◽

Selection Operator

Abstract Considerable evidence suggests that N6-methyladenosine (m6A) is involved in the regulation of long non-coding RNA (lncRNA), whichparticipates in the occurrence, development and prognosis of tumorscancerBut the relationship between m6A regulators-related lncRNA (mRlncRNA) and lung adenocarcinoma (LUAD) remains unclear. This study aims to determine a feature based on mRlncRNA for prognostic evaluation of LUAD patients. By integrating the gene expression data of LUAD and normal samples from the Cancer Genome Atlas (TCGA) and the Gene Expression Omnibus (GEO) database, the m6A gene and mRlncRNA with imbalanced expression were screened out. Then we used the least absolute shrinkage and selection operator (LASSO) to obtain the 13-lncRNA prognostic signature in the TCGA training cohort. Patients were divided into two risk groups based on the risk score of lncRNAs characteristics, and their overall survival (OS) was significantly different. The predictive power of this signature was verified in TCGA testing cohort and entire TCGA cohort. These landmark lncRNAs were involved in several biologiocal processes and pathways related to cell cycle, DNA replication, P53 signaling pathway and mismatch repair. Besides, the high-risk group was low-response to cisplatin, while high-response to mitomycin, docetaxel and immunotherapy. In conclusion, we identified a 13-mRlncRNA model associated with prognosis and treatment sensitivity in LUAD, which may provide clues about the influence of m6A on lncRNA in LUAD and promote the further improvement of LUAD individualized treatment strategies.

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