1. EpImpact of the use of digital devices on e of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India – Collaborative OPAI-IJO Study on Mucormycosis in COVID-19 (COSMIC), Report 1
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SantoshG Honavar, Mrittika Sen, Sabyasachi Sengupta, Raksha Rao, Usha Kim, Mukesh Sharma, Mahipal Sachdev, AshokK Grover, Abhidnya Surve, Abhishek Budharapu, AbhishekK Ramadhin, AbhishekKumar Tripathi, Adit Gupta, Aditya Bhargava, Animesh Sahu, Anjali Khairnar, Anju Kochar, Ankita Madhavani, AnkurK Shrivastava, AnujaK Desai, Anujeet Paul, Anuradha Ayyar, Aparna Bhatnagar, Aparna Singhal, ArchanaSunil Nikose, Arun Bhargava, ArvindL Tenagi, Ashish Kamble, Ashiyana Nariani, Bhavin Patel, Bibbhuti Kashyap, Bodhraj Dhawan, Busaraben Vohra, Charuta Mandke, Chinmayee Thrishulamurthy, Chitra Sambare, Deepayan Sarkar, DevanshiShirishbhai Mankad, Dhwani Maheshwari, Dilip Lalwani, Dipti Kanani, Diti Patel, FairoozP Manjandavida, Frenali Godhani, GarimaAmol Agarwal, Gayatri Ravulaparthi, GondhiVijay Shilpa, Gunjan Deshpande, Hansa Thakkar, Hardik Shah, HareRam Ojha, Harsha Jani, Jyoti Gontia, JyotikaP Mishrikotkar, Kamalpreet Likhari, Kamini Prajapati, Kavita Porwal, Kirthi Koka, KulveerSingh Dharawat, LakshmiB Ramamurthy, Mainak Bhattacharyya, Manorama Saini, MaremC Christy, Mausumi Das, Maya Hada, Mehul Panchal, Modini Pandharpurkar, MohammadOsman Ali, Mukesh Porwal, Nagaraju Gangashetappa, Neelima Mehrotra, Neha Bijlani, Nidhi Gajendragadkar, NitinM Nagarkar, Palak Modi, Parveen Rewri, Piyushi Sao, PrajaktaSalunkhe Patil, Pramod Giri, Priti Kapadia, Priti Yadav, Purvi Bhagat, Ragini Parekh, Rajashekhar Dyaberi, RajenderSingh Chauhan, Rajwinder Kaur, RamKishan Duvesh, Ramesh Murthy, RaviVarma Dandu, Ravija Kathiara, Renu Beri, Rinal Pandit, RitaHepsi Rani, Roshmi Gupta, Ruchi Pherwani, Rujuta Sapkal, Rupa Mehta, Sameeksha Tadepalli, Samra Fatima, Sandeep Karmarkar, SandeepSuresh Patil, Sanjana Shah, Sankit Shah, Sapan Shah, Sarika Dubey, Saurin Gandhi, Savitha Kanakpur, Shalini Mohan, Sharad Bhomaj, Sheela Kerkar, Shivani Jariwala, Shivati Sahu, Shruthi Tara, ShrutiKochar Maru, Shubhda Sharma, Shweta Gupta, Shwetha Kumari, Sima Das, Smita Menon, Snehal Burkule, SonamPoonam Nisar, Subashini Kaliaperumal, Subramanya Rao, Sudipto Pakrasi, Sujatha Rathod, SunilG Biradar, Suresh Kumar, Susheen Dutt, Svati Bansal, SwatiAmulbhai Ravani, Sweta Lohiya, SyedWajahat Ali Rizvi, Tanmay Gokhale, TatyaraoP Lahane, Tejaswini Vukkadala, Triveni Grover, Trupti Bhesaniya, Urmil Chawla, Usha Singh, VaishaliL Une, Varsha Nandedkar, Venkata Subramaniam, Vidya Eswaran, VidyaNair Chaudhry, Viji Rangarajan, Vipin Dehane, VivekM Sahasrabudhe, Yarra Sowjanya, Yashaswini Tupkary, and Yogita Phadke
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medicine.medical_specialty ,business.industry ,Mortality rate ,Mucormycosis ,Disease ,Functional endoscopic sinus surgery ,medicine.disease ,Surgery ,Ophthalmology ,Amphotericin B ,Diabetes mellitus ,Epidemiology ,medicine ,Stage (cooking) ,business ,medicine.drug - Abstract
Purpose: COVID-19-associated rhino-orbital-cerebral mucormycosis (ROCM) has reached epidemic proportion during India's second wave of COVID-19 pandemic, with several risk factors being implicated in its pathogenesis. This study aimed to determine the patient demographics, risk factors including comorbidities, and medications used to treat COVID-19, presenting symptoms and signs, and the outcome of management. Methods: This was a retrospective, observational study of patients with COVID-19-associated ROCM managed or co-managed by ophthalmologists in India from January 1, 2020 to May 26, 2021. Results: Of the 2826 patients, the states of Gujarat (22%) and Maharashtra (21%) reported the highest number of ROCM. The mean age of patients was 51.9 years with a male preponderance (71%). While 57% of the patients needed oxygen support for COVID-19 infection, 87% of the patients were treated with corticosteroids, (21% for > 10 days). Diabetes mellitus (DM) was present in 78% of all patients. Most of the cases showed onset of symptoms of ROCM between day 10 and day 15 from the diagnosis of COVID-19, 56% developed within 14 days after COVID-19 diagnosis, while 44% had delayed onset beyond 14 days. Orbit was involved in 72% of patients, with stage 3c forming the bulk (27%). Overall treatment included intravenous amphotericin B in 73%, functional endoscopic sinus surgery (FESS)/paranasal sinus (PNS) debridement in 56%, orbital exenteration in 15%, and both FESS/PNS debridement and orbital exenteration in 17%. Intraorbital injection of amphotericin B was administered in 22%. At final follow-up, mortality was 14%. Disease stage >3b had poorer prognosis. Paranasal sinus debridement and orbital exenteration reduced the mortality rate from 52% to 39% in patients with stage 4 disease with intracranial extension (p < 0.05). Conclusion: : Corticosteroids and DM are the most important predisposing factors in the development of COVID-19-associated ROCM. COVID-19 patients must be followed up beyond recovery. Awareness of red flag symptoms and signs, high index of clinical suspicion, prompt diagnosis, and early initiation of treatment with amphotericin B, aggressive surgical debridement of the PNS, and orbital exenteration, where indicated, are essential for successful outcome.
- Published
- 2021
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