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.

A study on Instinctive Feelings, Perceived Stressors and Factors that helped in reducing Stress during COVID 19 pandemic among Health Care Workers

Background: Healthcare workers at the forefront of the battle against COVID 19 are not only putting their own health and lives at risk but are also fighting to keep their own worries and emotional stress at bay. Aim & Objective: To evaluate emotions, perceived stressors, and factors that helped in reducing stress of healthcare workers who worked during a COVID19 pandemic. Settings and Design: This cross sectional study was conducted among Health Care staff involved in COVID 19 duty in tertiary care hospital of Gujarat. Methods and Material: Google form link was shared though what’s up and mail. The questionnaire was completed online. Consent for voluntarily participation was also obtained through online Google form. Statistical analysis used: Data was entered and analysed through Microsoft Excel 2010. Results: Total 106 participants responded to the questionnaire. It was extremely stressful for health care workers to see their colleagues getting infection, as well as the fear that they could transmit the disease to their families or friends. Main factors that helped to reduce the stress were positive attitude from colleagues, improvement of patients conditions and availability of protective equipment. Conclusions: Personal safety, the protection of family members and unpredictability of pandemic were the main concerns. Hospitals should prioritise stress monitoring for health care workers and provide targeted psychological guidance for HCWs during the pandemic.

Young onset colorectal cancer: How does it differ from its older counterpart?

BACKGROUND

Colorectal cancer in the young has been a debated topic in literature with conflicting reports as to its pattern of occurrence and survival as compared to the older age group.

MATERIALS AND METHODS

Retrospective study to analyze the clinicopathological characteristics, treatment modalities and survival of sporadic young-onset colorectal cancer (YOCR) patients (<40 years) and compare them with the older group (>40 years).

RESULTS

Of 172 patients managed, 72 (42%) were in the YOCR group. Among 72 patients, six were excluded because of hereditary syndromes. Incontinence (P = 0.02) and obstruction at time of presentation (P = 0.03) was significantly more common in the YOCR group. Left sided disease was more common in YOCR group (47/66) compared to the older group (65/100), but the difference was not statistically significant (P = 0.45). The proportion of rectal cancers was significantly more in the YOCR group (39/47) compared to the older group (39/65) (P = 0.01). Significant difference in resectability was noted in the left sided (YOCR 26/47 vs. older 49/65 P = 0.04) and the rectal cancers (YOCR 18/39 vs. Older 29/39 P = 0.02). The survival was similar among the two groups.

CONCLUSIONS

Sporadic colorectal cancers in the young are more advanced and less resectable when compared to older population. Genetic studies are needed to elaborate the reasons for left sided predominance and aggressiveness of sporadic colorectal cancers in the younger subgroups.

Myocardial infarction-induced ventricular aneurysm in the presence of complete left bundle branch block: a case report suggesting a new electrocardiographic diagnostic criterion

A 65-year-old man who had suffered an anterior myocardial infarction (MI) 10 years ago, complicated by a ventricular aneurysm (VA), and subsequently many years later developed complete left bundle branch block (LBBB), is described, with main emphasis on the feasibility of the electrocardiographic (ECG) diagnosis of VA in the presence of this conduction abnormality. Ventricular aneurysm in our patient was repeatedly confirmed by echocardiography over the intervening years. During the time the patient maintained normal intraventricular conduction, the ECG showed persisting ST-segment elevations in the precordial leads. After the development of LBBB, the ECG displayed accentuated ST-segment elevations in the precordial leads with predominantly negative QRS complexes, and ST elevation in V5, despite its primarily positive QRS complex. The authors extend the findings from the previous literature on the diagnosis of acute MI in patients with LBBB or right intraventricular pacing, and the concept of primary and secondary repolarization changes, to the diagnosis of VA in the presence of LBBB.