Background Increased occurrence of mucormycosis during the second wave of COVID-19 pandemic in early 2021 in India prompted us to undertake a multi-site case–control investigation. The objectives were to examine the monthly trend of COVID-19 Associated Mucormycosis (CAM) cases among in-patients and to identify factors associated with development of CAM. Methods Eleven study sites were involved across India; archived records since 1st January 2021 till 30th September 2021 were used for trend analysis. The cases and controls were enrolled during 15th June 2021 to 30th September 2021. Data were collected using a semi-structured questionnaire. Among 1211 enrolled participants, 336 were CAM cases and 875 were COVID-19 positive non-mucormycosis controls. Results CAM-case admissions reached their peak in May 2021 like a satellite epidemic after a month of in-patient admission peak recorded due to COVID-19. The odds of developing CAM increased with the history of working in a dusty environment (adjusted odds ratio; aOR 3.24, 95% CI 1.34, 7.82), diabetes mellitus (aOR: 31.83, 95% CI 13.96, 72.63), longer duration of hospital stay (aOR: 1.06, 95% CI 1.02, 1.11) and use of methylprednisolone (aOR: 2.71, 95% CI 1.37, 5.37) following adjustment for age, gender, occupation, education, type of houses used for living, requirement of ventilatory support and route of steroid administration. Higher proportion of CAM cases required supplemental oxygen compared to the controls; use of non-rebreather mask (NRBM) was associated as a protective factor against mucormycosis compared to face masks (aOR: 0.18, 95% CI 0.08, 0.41). Genomic sequencing of archived respiratory samples revealed similar occurrences of Delta and Delta derivates of SARS-CoV-2 infection in both cases and controls. Conclusions Appropriate management of hyperglycemia, judicious use of steroids and use of NRBM during oxygen supplementation among COVID-19 patients have the potential to reduce the risk of occurrence of mucormycosis. Avoiding exposure to dusty environment would add to such prevention efforts.

AIM: This study is aimed to assess vitamin D status in asthmatic patients and to assess the relationship between vitamin D level and asthma severity. INTRODUCTION:Asthma is heterogeneous disease, usually characterized by variable airflow obstruction and bronchial hyper-responsiveness. The world health organization stated that approximately 300 million people have asthma. Recently the effects of vitamin D appear to have regulatory effect on every part of immune system, vitamin D deficiency being linked to an array of immunologically based disease focusing on asthma. METHOD:The present study included 50 patients diagnosed as bronchial asthma. The asthmatic patient group was divided into group A, asthma in between attack and group B, exacerbated asthma, that was again divided in subgroup (I), (II), and (III) mild , moderate and severe exacerbated asthma according to symptoms and FEV1. Serum 25 hydroxy vitamin D3 level in all groups was measured by radio immunoassay method and compared between these groups. RESULT:This study shows statistically significant correlation between vitamin D level and severity of asthma. The mean levels of serum 25 hydroxy vitamin D3 in asthmatic patients are: Group A-28.24 ± 1.35 ng/ml, mild persistent-22.6 ± 11.5 ng/ml, moderate persistent -18.33 ± 1.31 ng/ml, and severe persistent -10.45 ± 1.84 ng/ml. P value is <0.01, which is highly significant. CONCLUSION:Lower level of vitamin D is associated with higher severity of asthma. Keyword: VITAMIN D DEFICIENCY, SEVERITY OF ASTHMA, ADULT ATIENTS INTRODUCTION:Asthma is heterogeneous disease, usually characterized variable airflow obstruction, chronic airway inflammation and bronchial hyper-responsiveness (1). Until recently bronchospasm was considered cardinal feature of asthma but now in addition to bronchospasm, airway inflammation is recognized as an essential component of the disease. Asthma prevalence is rising in both the developed and developing world with >3 million people affected worldwide (2,3) . Vitamin D is fat soluble nutrient and a secosteroid hormone produced endogenously in the skin from sun exposure or obtained from foods that naturally contain vitamin D including cod liver oil. Vitamin D deficiency is diagnosed by the concentration of blood S.25 (OH) D3 (vitamin D) level, the primary circulatory form of vitamin D and then 1, 25(OH) D3. Low serum level of vitamin D has been linked to increased risk of asthma exacerbation in children and adults.

Background: Menarche is a significant milestone in women's life. It affects the reproductive healthand well being of women. This study aims to find out the age at menarche of adolescent girls ofIndore city and its relation to various factors. Method: This was a cross-sectional study conductedin six schools of urban areas of Indore city the study group included 492 school girls of age 11 to 18years. After taking written informed consent from the parents, data was collected on the date ofbirth, family size, birth order, dietary intake, social-economic status, menarcheal age.Anthropometric measurements were done and data was analyzed. Results: Mean age at menarchewas found to be 13.2+1.24 years. It was found to be significantly associated with socioeconomicstatus, BMI and birth order. Conclusion: The mean age at menarche in this study is comparable tothat found in other Indian studies. It is found to be significantly associated with BMI andsocioeconomic status of the girls

Background: Patients with chronic obstructive pulmonary disease are also prone to exacerbation with progression of their disease, which often lead to hypercapnic respiratory failure. Noninvasive ventilation has shown to have good outcomes in terms of reduction in mortality, reduction in need for intubation and mechanical ventilation and decreased duration of stay in the hospital in patients with COPD Aims & objectives: To study the efficacy of Non Invasive Ventilation, to check demographic profile, to measure the serial arterial blood gas analysis and to monitor respiratory status in patients with acute exacerbation of chronic obstructive pulmonary disease. Material & methods: A total of 50 patients were included in this prospective cross-sectional study. Detail history, clinical examination was done. Arterial blood gas analysis and laboratory parameters were studied before and after non-invasive ventilation. Results: 86% of patients belonged to 46-75 years of age. 78% of patients were male. 78% of patients were addicted to tobacco in any form. Significant improvement was found in pH, pO2, pCO2 value in arterial blood gas analysis and SpO2 value after four hours of noninvasive ventilation. Conclusion:Noninvasive ventilation is well tolerated in patients with acute exacerbation of chronic obstructive pulmonary disease.

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