The first series on “Black Fungus” mucormycosis courtesy Prof. VP Pandey Indore. 210 patients.
Antibiotics had been used in 100% patients, steroids NOT used in 14%, 21% were NOT diabetic, 36% were @ home, oxygen only by 52%, Zinc status not checked.
See thread for details. 1/n
Immensely grateful to Prof. VP Pandey HOD Medicine at MGMMC Indore for analysing this series of 210 mucormycosis patients.
Clearly there are factors beyond steroid use & diabetes here.
The obvious question is, what other forms of treatment did these patients receive? 👇
2/8
3 potential offenders that must be looked for in studies:
1. Concurrent antibiotic use: not indicated in viral infections like COVID-19.
Azithromycin, Doxycycline , even carbapenems are seen on prescriptions. Antibiotics are known to increase risk of fungal infections. 👇
3/8
Superinfections in COVID-19 after antibiotic use, see Marco Falcone’s series from Italy
The 3 potential factors listed above are considering the new case series (see whole thread) that showed diabetes, steroid use, O2 & hospitalised care are NOT MANDATORY in new mucormycosis cases.
These 3 factors apply to those who are taking care of mild COVID19 at home too.
8/8
Tweet on Zinc as a potential risk factor that needs investigation
Disseminated mucormycosis found on autopsy in a 22 year old man who died a year ago in the UK from severe COVID-19 causing multi-system complications. He was obese, but not described as a diabetic. See post mortem no.5 in the attached appendix. thelancet.com/cms/10.1016/S2…
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Steam inhalation can have serious side effects both on skin and in our respiratory tract. See thread.
Apart from perceived symptomatic relief in cough, it has no scientific benefit in COVID-19.
A boy suffered burns from steam inhalation @
Hyderabad. 1/5 thehindu.com/news/cities/Hy…
Every year, an average of 3 people are hospitalized in Burn Centres in Netherlands for burns resulting from a popular home-remedy: steam inhalation. Most victims were children; needing skin grafting more than adults. See thread for a report from India. 2/5 ncbi.nlm.nih.gov/pmc/articles/P…
This report from Ireland is again about children suffering severe burns as a result of steam inhalation as a home remedy. See thread. 3/n ncbi.nlm.nih.gov/pmc/articles/P…
Are Zinc supplements to blame for "Black Fungus"? (this is an interesting hypothesis, NOT an assertion) See thread for summaries of papers from 1996, 2013.
Fact: Fungi feed on Zinc.
Mammalian cells try to escape fungal invasion by "starving" the fungus of zinc, by hiding it.
1/9
Thread
Vertebrate cells (includes mammals) keep zinc "out of sight" of fungi.
In fact, some fungi dispatch "zinc-fetching molecules" ("Zincophores") into the vicinity, which search for "any zinc that's lying around" & bring it back.
See 2012 paper: 2/9 ncbi.nlm.nih.gov/pmc/articles/P…
These self-defence processes against invading fungi, collectively known as "nutritional immunity" help us limit microbial growth, and enhance killing of the invader. Successful pathogens have developed strategies to counteract this and acquire essential micronutrients.
3/9
"Black Fungus" is the wrong term for Mucormycosis. The back color refers to tissues turning dark from destruction of blood supply. Risk factors include immunosuppression by uncontrolled diabetes, chemotherapy, transplantation, steroids.
See thread.
1/11 ncbi.nlm.nih.gov/pmc/articles/P…
The above 2019 review article by Dr Arunaloke Chakrabarti of PGI Chandigarh is a comprehensive resource on mucormycosis.
The current situation, linked with COVID-19, requires systematic (and really quick) review of all the cases.
The details must be made available ASAP.
2/11
Will post a quick thread on "Black Fungus" see above.
1. Until an audit of all the present cases are done, it will be impossible to make firm statements. Speculation is not always accurate.
2. The fungus attacks blood vessels, and does not respect anatomical boundaries.
P-hacking is an unethical research practice where non-significant results are dressed-up to appear “significant” - like it really matters. Not all research is ethical; this thread explains. Without knowledge of biostatistics, it is easy to be fooled by the authors ‘conclusions’.
This paper explains p-hacking in detail. I will add some easy tips to escape being fooled by fraudulent research. See below Also see Dr Gohel’s thread above.
b) These were samples collected from self-referred people; from relatively higher socioeconomic class.
c)Their clinical detail is unknown.
d) 41% of those who tested in December were seropositive, up from 18% in July.
e)Faster rise in + rate in younger age groups (<44)
2/8
f)Different cities had different 'peak' phase of the pandemic e.g. Delhi had 2 peaks June & December; Chennai had one peak in July, Pune in September. Overall peak for India was mid September.
g)Pune had the highest: 69%. These 12 cities accounted for 1/3 of cases in India.
3/8
Profile of 18 neonatal COVID-19 patients from Mumbai, February 2021. 4 were preterm. Only 50% had COVID-positive mother/caregiver. Ventilation required for 6. Four were repeatedly test-positive, of whom 3 were critical on ventilator. Death occurred in 3. iapindia.org/pdf/Indian-Ped…
Series of 3 neonatal COVID-19 from KEM hospital Mumbai. All had good outcomes. Remarkably, the NP swabs remained positive even in the 4th week in 2 of them, prolonged shedding is possible. This is consistent with impaired ability to clear the virus.
Large series of 182 neonatal COVID-19 from 20 Indian centres compiled by PGI Chandigarh finds neonates are more likely to be symptomatic (5x), have respiratory symptoms, & other neonatal morbidities. However, mortality is not increased significantly. 1/2 indianpediatrics.net/COVID29.03.202…