Baseline findings of a multicentric ambispective cohort study (2021-2022) among hospitalised mucormycosis patients in India

In India, the incidence of mucormycosis reached high levels during 2021-2022, coinciding with the COVID-19 pandemic. In response to this, we established a multicentric ambispective cohort of patients hospitalised with mucormycosis across India. In this paper, we report their baseline profile, clinical characteristics and outcomes at discharge. Patients hospitalized for mucormycosis during March-July 2021 were included. Mucormycosis was diagnosed based on mycological confirmation on direct microscopy (KOH/Calcofluor white stain), culture, histopathology, or supportive evidence from endoscopy or imaging. After consent, trained data collectors used medical records and telephonic interviews to capture data in a pre-tested structured questionnaire. At baseline, we recruited 686 patients from 26 study hospitals, of whom 72.3% were males, 78% had a prior history of diabetes, 53.2% had a history of corticosteroid treatment, and 80% were associated with COVID-19. Pain, numbness or swelling of the face were the commonest symptoms (73.3%). Liposomal Amphotericin B was the commonest drug formulation used (67.1%), and endoscopic sinus surgery was the most common surgical procedure (73.6%). At discharge, the disease was stable in 43.3%, in regression for 29.9% but 9.6% died during hospitalization. Among survivors, commonly reported disabilities included facial disfigurement (18.4%) and difficulties in chewing/swallowing (17.8%). Though the risk of mortality was only 1 in 10, the disability due to the disease was very high. This cohort study could enhance our understanding of the disease's clinical progression and help frame standard treatment guidelines.

Advancing Solar Energy for Primary Healthcare in Developing Nations: Addressing Current Challenges and Enabling Progress Through UNICEF and Collaborative Partnerships

This comprehensive document explores the intersection of Sustainable Development Goals (SDGs) and the global transition to renewable energy, with a particular focus on solar energy. The text emphasizes the critical role of reliable and sustainable energy, especially solar power, in achieving health-related SDGs, particularly in low- and middle-income countries (LMICs). It discusses the challenges faced by healthcare facilities in these regions, emphasizing the importance of uninterrupted electricity for critical medical equipment and services. The document highlights the increasing significance of solar energy globally and its potential to address challenges in the healthcare sector. The International Energy Agency's (IEA) estimation that solar photovoltaic (PV) energy has become the cheapest source of electricity is discussed, along with the World Bank's active role in supporting solar energy projects in developing countries. The document presents the current status of solarization, emphasizing the exponential growth of solar capacity and generation. It also discusses global initiatives such as Mission Innovation and the contribution of various international aid organizations, including Sustainable Energy for All (SEforALL), Power Africa, Lighting Global, SolarAid, UNDP - Solar for Health (S4H), and the World Bank. A significant portion of the document focuses on the role of solar energy in healthcare, detailing successful solarization projects in India, sub-Saharan Africa, and other regions. It addresses the challenges of implementing solar PV projects in healthcare facilities, emphasizing the importance of maintenance and proper management. The document also provides insights into the contributions of United Nations Children's Fund (UNICEF) in advancing solar-powered health systems, emphasizing its support to over 80 countries in solarization and off-grid energy solutions for healthcare. In conclusion, this article emphasizes the need for collaboration among international aid organizations, governments, and development partners to ensure universal access to reliable and sustainable electricity, particularly in healthcare facilities. It underscores the importance of long-term planning, sustainability, innovative business models, and awareness campaigns to achieve scalable and impactful results in the intersection of solar energy and healthcare delivery.

Management of Ludwig's Angina at a Tertiary Care Hospital in Western Region of India

Introduction

Ludwig’s angina is cellulitis of submandibular space, submental space, and sublingual space. The main causative factors include dental infections (dental caries with atypical periodontitis, pericoronitis, and dental procedures). Other predisposing conditions include poor dental hygiene, dental caries, malnutrition, diabetes mellitus, AIDS, and various other immunocompromised states. It presents as an acute onset and spreads very rapidly causing bilateral diffuse neck swelling, edema of floor of mouth, pain, fever, trismus, foul-smelling pus discharge, difficulty in swallowing, airway edema, and tongue displacement creating a compromised airway with stridor. So it requires early diagnosis and aggressive management.

Material and methods

Clinical data of all patients with clinical diagnosis of Ludwig’s angina managed at the Department of Otorhinolaryngology-Head and Neck Surgery, Sir Takhatsinhji (T) General Hospital and Government Medical College, Bhavnagar, India, from 2015 to 2019 were analyzed retrospectively in this study.

Result

Over the review period, 30 cases were diagnosed as Ludwig’s angina, out of which 12 (40%) were males and 18 (60%) were females; male to female ratio was 1:1.5. The age of the patients ranged from six months to 64 years, with a mean age of 38.86 years. Fever, neck swelling, and neck pain were present in all patients.

In 16 patients, incision and drainage were done under general anesthesia while the rest five patients required only local anesthesia. In six patients (20%), for maintenance of airway, tracheostomy was required. The most common complication was necrotizing fasciitis and death followed by septicemia. Mortality was observed in three patients (10%) in this study.

Conclusion

Despite improved outcomes compare to pre-antibiotic era, Ludwig's angina still remains a potentially life-threatening disease in ENT at present. Dental caries, uncontrolled diabetes mellitus, and malnutrition are commonly associated conditions. With early diagnosis, close airway observation, aggressive intravenous antibiotic treatment, and timely surgical intervention, morbidity, and mortality can be reduced.

Study of Clinical Outcome and Healthcare Modalities of COVID-19 Patients Treated With Remdesivir at a Tertiary Care Teaching Hospital

Background

Effective treatment for COVID-19 infection is still under evaluation. Remdesivir is an approved drug for COVID-19 treatment and major countries have released guidelines on the use of remdesivir. Still, many factors are under evaluation which can determine the future use of remdesivir.

Aim

To study the clinical outcome and healthcare modalities of COVID-19 patients treated with remdesivir.

Materials and methods

A retrospective study was conducted through the clinical records of patients admitted to the tertiary care hospital between August 2020 and December 2020. All the patients who were administered remdesivir intravenously as per standard protocol were included in the study. Data were analyzed for statistical association between health care modalities and patient characteristics.

Results

Among 166 patients included, the mean age of patient who received remdesivir was 57.51 ± 12.98 years (95% confidence interval (CI), 30-84). The mean duration of stay and duration of oxygen requirement were 12.80 ± 5.99 (95% CI, 5-30) and 9.41 ± 7.47 (95% CI, 0-39) days, respectively. A total of 12 (7.23%) required assisted ventilation and the cure rate was 89.76% (149/166). Out of 166 patients, 105 (63.25%) had comorbidities, among which hypertension and diabetes were the most common. Significantly >60 year age group had a higher duration of oxygen requirement (u=2,639.5, p=0.01), while ≤60 year age group had a higher cure rate (X²=4.23, p=0.03) and a higher requirement for assisted ventilation (X²=4.77, p=0.02). Differences and associations in the above-mentioned health care modalities were not statistically significant for gender and comorbidity except that non-comorbid had a higher cure rate (X²=3.97, p=0.04). The odds ratio of comorbidity and cure rate was 1.07, while the association of the number of comorbidities with the duration of stay (p=0.62) and duration of oxygen requirement (p=0.35) was not statistically significant.

Conclusion

In remdesivir-treated patients, age affects utilization of health care modalities. Female, non-comorbid, and younger patients have better clinical outcomes.