Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India

Introduction

Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors.

Materials and methods

An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done.

Results

367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics.

Conclusion

Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

Epidemiology and pattern of injury of pediatric trauma patients in level l trauma centre of Northern India

Introduction

Uttar Pradesh ranks first in India as far as trauma deaths are concerned with 40% of victims under 18 years of age. In spite of such high mortality and morbidity no national portal for trauma registry data exists. This study was conducted to evaluate the profile of injured pediatric patients, to provide baseline knowledge for further research, management and development of pediatric injury prevention programmes.

Methods

A retrospective observational study was conducted in the only Level 1Trauma Centre of the most populous state of India. Children aged less than 18 years of age admitted to the trauma centre were analysed for mechanism, type and severity of injury, the mode of management and outcome.

Result

In a 2 year period 916 children were admitted and their data analysed. Most were boys (73%) and the most common age group was 12–18 years. Half of injuries were caused by road traffic accidents, and blunt injuries were commonest. Blunt abdominal trauma then head injury were the commonest areas injured; 20% of children had life-threatening injuries. Nearly half (47%) had moderate to severe trauma according to the Pediatric Trauma Score. 507 patients (55.4%) were managed conservatively and 409 children (44.6%) required surgery; 657 (71%) were successfully discharged and 39 children (4.25%) unfortunately died.

Conclusion

This study identifies the need for dedicated trauma registries, training of trauma team according to standard operating procedures, the development of paramedical teams for in-the-field management of patients and development of injury prevention programmes according to both age and gender.

Impaled roadside guardrail in the neck: Case of a failed motorcycle stunt

Trauma is currently the leading cause of death in the age group 15 to 44 years globally, with road trauma now representing the sixth leading cause of death worldwide. We present a case of a young male, who was brought to the apex trauma centre of the province with a metallic roadside guardrail impaled in his neck up to his oral cavity, which had to be cut to transport him to the hospital. A meticulous local exploration resulted in the successful removal of the spiked guardrail, with no damage to critical structures. We discuss the paradigm changes in and the expertise required for the management of such penetrating neck injuries (PNIs). For family physicians, this case represents one of the wide variety of cases they will be called to help upon and administer prehospital care. Thus, utilization of principles of basic life support, recognition of the severity of road trauma cases, and ensuring urgency of referral by general practitioners are all critical.