{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:20:03Z","timestamp":1787840403296,"version":"build-2784847793"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T00:00:00Z","timestamp":1720656000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:sec>\n                    <jats:title>Context:<\/jats:title>\n                    <jats:p>Effect of serum ferritin on severity of coronavirus disease 2019 (COVID-19)-associated rhino-orbito-cerebral mucormycosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To study the association between increased serum ferritin and severity of orbital disease in COVID-19\u2013associated rhino-orbito-cerebral mucormycosis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings and Design:<\/jats:title>\n                    <jats:p>A cross-sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Hundred (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      ) out of 155 treatment-naive patients of COVID-19 infection presenting with the signs and symptoms of rhino-orbito-cerebral mucormycosis were enrolled in study. Based on the classification proposed by Honavar, the study patients were classified into four stages: Stage 1: involvement of the nasal mucosa (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 11), Stage 2: involvement of paranasal sinuses (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 14), Stage 3: involvement of the orbit (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 37), Stage 4: involvement of the central nervous system (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 38). Stage 3 was further divided into four substages: 3a: nasolacrimal duct, medial orbit, vision unaffected (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 4); 3b: diffuse orbital involvement (&gt;1 quadrant or &gt;2 structures), vision unaffected (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 15); 3c: central retinal artery occlusion or ophthalmic artery occlusion, superior ophthalmic vein thrombosis, involvement of superior orbital fissure, inferior orbital fissure, orbital apex, diminution or loss of vision (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 13); 3d: bilateral orbital involvement (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 5). Fasting blood sugar (FBS), postprandial blood sugar (PPBS), and inflammatory markers (serum ferritin, interleukin-6, C-reactive protein, and D-dimer) were assessed. Serum level of ferritin was analyzed by using chemiluminescence immunoassay method.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Mean FBS (mg\/dl) was 165.03 \u00b1 70.43 for stage 1, 185.67 \u00b1 64.82 for stage 2, 159.05 \u00b1 68.60 for stage 3, and 158.20 \u00b1 62.05 for stage 4. Mean PPBS (mg\/dl) was 238.70 \u00b1 141.29 for stage 1, 252 \u00b1 103.69 for stage 2, 257.09 \u00b1 103.48 for stage 3, and 229.53 \u00b1 76.81 for stage 4. Mean serum ferritin (\u03bcg\/l) was 302.67 \u00b1 266.95 in stage 1, 444.19 \u00b1 116.36 in stage 2, 504.85 \u00b1 205.99 in stage 3, and 825.95 \u00b1 777.30 in stage 4. A statistically significant increase in serum ferritin levels with severity of disease (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.005) was noted. Similar trend was observed in substages of stage 3. Pearson correlation analysis showed a positive correlation between serum ferritin and severity of disease (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0007).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Increased serum ferritin was significantly independently associated with severity of orbital disease in COVID-19\u2013associated rhino-orbito-cerebral mucormycosis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijo.ijo_574_23","type":"journal-article","created":{"date-parts":[[2024,7,11]],"date-time":"2024-07-11T12:09:28Z","timestamp":1720699768000},"page":"223-227","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Increased serum ferritin is associated with severity of orbital disease in COVID-19\u2013associated rhino-orbito-cerebral mucormycosis: A quantitative analysis"],"prefix":"10.4103","volume":"73","author":[{"given":"Shashi","family":"Tanwar","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nibha","family":"Mishra","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prachi","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Apjit","family":"Kaur","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, King George Medical University, Lucknow, Uttar Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,7,11]]},"reference":[{"key":"R1-20250314","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1097\/IIO.0b013e31803776db","article-title":"Invasive fungal infections of the orbit","volume":"47","author":"Kirszrot","year":"2007","journal-title":"Int Ophthalmol Clin"},{"key":"R2-20250314","doi-asserted-by":"crossref","first-page":"S23","DOI":"10.1093\/cid\/cir866","article-title":"Epidemiology and clinical manifestations of mucormycosis","volume":"54","author":"Petrikkos","year":"2012","journal-title":"Clin Infect Dis"},{"key":"R3-20250314","doi-asserted-by":"crossref","first-page":"265","DOI":"10.3390\/jof6040265","article-title":"Epidemiology and diagnosis of mucormycosis: An update","volume":"6","author":"Skiada","year":"2020","journal-title":"J Fungi"},{"key":"R4-20250314","doi-asserted-by":"crossref","first-page":"102146","DOI":"10.1016\/j.dsx.2021.05.019","article-title":"Mucormycosis in COVID-19: A systematic review of cases reported worldwide and in India","volume":"15","author":"Singh","year":"2021","journal-title":"Diabetes Metab Syndr"},{"key":"R5-20250314","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.4103\/ijo.IJO_1565_21","article-title":"Epidemiology, clinical profile, management, and outcome of COVID-19-associated rhino-orbital-cerebral mucormycosis in 2826 patients in India\u2013Collaborative OPAI-IJO study on mucormycosis in COVID-19 (COSMIC), report 1","volume":"69","author":"Sen","year":"2021","journal-title":"Indian J Ophthalmol"},{"key":"R6-20250314","doi-asserted-by":"crossref","first-page":"249","DOI":"10.4103\/ijo.IJO_1699_22","article-title":"A cross-sectional study to describe the spectrum of ocular manifestations and risk factors of mucormycosis presenting to a tertiary hospital of East India","volume":"71","author":"Raj","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"R7-20250314","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1086\/432579","article-title":"Epidemiology and outcome of zygomycosis: A review of 929 reported cases","volume":"41","author":"Roden","year":"2005","journal-title":"Clin Infect Dis"},{"key":"R8-20250314","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1056\/NEJM199707243370407","article-title":"Fungal sinusitis","volume":"337","author":"DeShazo","year":"1997","journal-title":"N Engl J Med"},{"key":"R9-20250314","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1007\/s12663-021-01532-1","article-title":"SARS-CoV-2, uncontrolled diabetes and corticosteroids\u2014an unholy trinity in invasive fungal infections of the maxillofacial region? 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