Want to know why #Mucormycosis is more common post #COVID19 and not so common after leukemia's or other illnesses treated with steroids ?
Read on !!
These are the major reasons in my opinion:
1. The NUMBER of #COVID19 pts is far GREATER than the number of leukemia pts we treat in a year. Thus a lot more people are getting steroids at this point in time and thus a lot more are at risk of steroid related complications.
Let's say 1/5k steroid treated pts get mucor, now if we treat 500k pts with steroids we will definitely have 100 mucor cases. SIMPLE MATH !!
Not convinced, read on.
2. A great number of #COVID19 pts have underlying CO-MORBIDITIES like diabetes which are WORSENED by steroids
So there are a lot of people asking about the risk factors for #mucor post #covid.
The biggest risk factor isn't the steroid itself, it's the hyperglycemia that it causes. If the sugars are well controlled using insulin the risk is almost negligible. So STOP freaking out !!
The 2nd major risk factor is prolonged NEUTROPENIA but that's a problem in our #Hematology patient population and not in #covid patients, so we can safely ignore that for now.
Bring us back to hyperglycemia due to steroids. The sure shot way to prevent it is frequent monitoring of sugar levels and NOT self medicating with steroids. Steroids anyway don't have any benefit if one isn't hypoxic so don't use it because ur aunt/uncle/friend used it.
#FERRITIN is being widely ordered these days. Let's dive into the details and learn more about this protein. A short thread for those interested. Covers some history, biology and practical aspects about FERRITIN.
It was discovered in 1937 by Laufbérger but it wasn't until 1972 that an assay was devised to measure serum ferritin.
Ferritin is present in 2 forms
👉 Intra-cellular (in the cytosol)
It is a ~450kDa protein.
Has 24 subunits of 2 major types
👉 H : gene on chr 11q
👉 L : gene on chr 19q
Mucormycosis is caused by fungi of order "MUCORALES" which includes rhizopus/mucor/licthemia/cunninghemela species. But DON'T WORRY species identification doesn't change treatment so we don't need to get to that.
Coming to the PRACTICAL POINTS that need to be remembered.
➡️IMAGING even at the slightest suspicion of mucor coz it's RAPIDLY PROGRESSIVE and kills quick.
➡️CT PNS/Orbits/ MRI Brain
➡️HRCT chest as per presentation
So how safe is #Ibrutinib ?
A very relevant question given that it needs to be administered indefinitely.
41% discontinuation rate in the "real world", most d/t toxicity.
So what are the major adverse events anyway ? 1. A fib 2. ⬆️ Risk of bleeding 3. ⬆️ Infections 4. Arthralgias 5. Htn 6. Diarrhoea 7. Pneumonitis
A very common concern is tox no.1 and 2 .
⬆️A .fib = anticoag for stroke prophylax. but that's when tox no.2 comes into play.
Very difficult to ⚖️ it out .
In RESONATE trial >grade 3 afib in 3% of pts.
Most events occur within 3 mts of starting #ibrutinib