Background The second COVID‐19 wave in India has been associated with an unprecedented increase in cases of COVID‐19 associated mucormycosis (CAM), mainly Rhino‐orbito‐cerebral mucormycosis (ROCM). Methods This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all‐cause mortality due to CAM. Results 59 patients were diagnosed with CAM. Median duration from the first positive COVID‐19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID‐19. 56% patients were prescribed steroids for non‐hypoxemic, mild COVID‐19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID‐19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. Conclusions CAM is a rapidly progressive, angio‐invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.

Several studies are going on to study the effects of transfusing stored RBCs on recipients. Several biochemical changes occur in stored blood, which may have some medical effects on the recipients. The biochemical changes may vary from donar to donar as well as from Blood bank to Blood bank. Also effects of transfused RBCs will vary from recipient to recipient. Lot of clinical trial should be taken before assessing the safety of stored RBCs. OBJECTIVESTo study the various biochemical changes occurring in a stored whole blood. MATERIAL AND METHODSAnalysis of biochemical changes occurring in stored whole blood in 20 voluntary donars was done in a Blood bank of a Tertiary Hospital. RESULTSOf the 6 biochemical parameters studied, only significant changes were seen in potassium and albumin after storage. There was a significant decrease in albumin concentration and steady increase in potassium values. CONCLUSIONCertain biochemical changes do occur in stored whole blood over a duration of storage. As the demand for blood is high due to various medical conditions, the treating consultant should be aware of the biochemical changes seen in stored whole blood.

Background: Globally, 2.6 (2.5-2.8) million newborns died in 2016-i.e. nearly 7,000 every day. Neonatal deaths accounted for 46 % of all under-five deaths, increasing from 41 % in 2000. Five countries accounted for half of all newborn deaths including India. NFHS 4 data suggests that neonatal mortality rate (NMR) declined to 30 deaths per 1,000 live births.Methods: Present observational study was conducted at district hospital, Parbhani. Study period was Jan 2017 to Dec 2017. All the admitted babies to NICU were included into study. Data was collected by interview method using a predesigned, semi-structured questionnaire. Various morbidities and reasons for mortality were included.Results: There were total 2471 admission during year of 2017. There was slightly higher admission rate for Males 1432 (57.95%) than females 1039 (42.05%). Pre-term admissions were 501 (20.28%). Majority of admissions were due to low birth weight 1170 (47.35%).Conclusions: In the year of 2017, total 2472 NICU admissions took place. Out of these, 126 (5.09%) died. Respiratory distress syndrome, low birth weight, birth asphyxia were accounting for mortalities. The neonatal jaundice, preterm and low birth weight babies had significantly high mortality even with standard intensive care.

Cytokine release syndrome (CRS) or cytokine storm is thought to be the cause of inflammatory lung damage, worsening pneumonia and death in patients with COVID-19. Steroids (Methylprednislone or Dexamethasone) and Tocilizumab (TCZ), an interleukin-6 receptor antagonist, are approved for treatment of CRS in India. The aim of this study was to evaluate the efficacy and safety of combination therapy of TCZ and steroid in COVID-19 associated CRS.This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India between April 2 and November 2, 2020. All patients administered TCZ and steroids during this period were included. The primary endpoint was incidence of all cause mortality. Secondary outcomes studied were need for mechanical ventilation and incidence of systemic and infectious complications. Baseline and time dependent risk factors significantly associated with death were identified by Relative risk estimation.Out of 2831 admitted patients, 515 (24.3% females) were administered TCZ and steroids. There were 135 deaths (26.2%), while 380 patients (73.8%) had clinical improvement. Mechanical ventilation was required in 242 (47%) patients. Of these, 44.2% (107/242) recovered and were weaned off the ventilator. Thirty seven percent patients were managed in wards and did not need intensive care unit (ICU) admission. Infectious complications like hospital acquired pneumonia, blood stream bacterial and fungal infections were observed in 2.13%, 2.13% and 0.06% patients respectively. Age ≥ 60 years (P = .014), presence of co-morbidities like hypertension (P = .011), IL-6 ≥ 100 pg/ml (P = .002), D-dimer ≥ 1000 ng/ml (P < .0001), CT severity index ≥ 18 (P < .0001) and systemic complications like lung fibrosis (P = .019), cardiac arrhythmia (P < .0001), hypotension (P < .0001) and encephalopathy (P < .0001) were associated with increased risk of death.Combination therapy of TCZ and steroids is likely to be safe and effective in management of COVID-19 associated cytokine release syndrome. Efficacy of this anti-inflammatory combination therapy needs to be validated in randomized controlled trials.

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