A STUDY OF COMORBIDITIES AND OUTCOME IN COVID-19 PATIENTS AT A DEDICATED COVID HOSPITAL

Introduction: In December 2019, COVID-19 was ?rst identi?ed in Wuhan, China, as a respiratory tract infection causing symptoms, such as fever, chills, dry cough, fatigue, and shortness of breath. The ?rst case in India was reported on 27 January 2020 from Kerala, while the ?rst case in the city where this study was conducted, was reported on 15 March 2020. The study was conducted at a Dedicated COVID Hospital (DCH). We assessed the co-morbidities and other demographic details of COVID positive patients admitted in the ?rst 10 months of the pandemic. Methods: 3187 COVID-19 positive patients admitted in the ?rst wave of COVID-19 from April 2020 to 31 December 2020 were selected, and their demographic details, duration of hospital stay and co-morbidities were studied. Patient details were entered in a spreadsheet and analysis was done using OpenEpi program. Results And Discussion: Of the 3187 patients included in the study, 943 patients died, whereas 2244 patients were discharged from our hospital. Amongst the 943 deaths, 612(65%) were males and 331(35%) were females. The age distribution of the patients who died showed maximum patients in age group of 61-80 years (452 patients, 47.3%). Maximum deaths occurred in September which were 200 (21.20%). When the interval between date of admission and date of death was calculated, it was observed that maximum deaths occurred in the group of 1-5 days (452 deaths, 47.93%). Maximum patients who died had some comorbidity (650, 69%), whereas 293 (31%) patients did not have any comorbidity. Hypertension was the most commonly occurring comorbidity in patients who died, with 108 patients being exclusively hypertensive, and 308 patients having hypertension along with some other comorbidity. Diabetes mellitus (DM) was the second most commonly observed comorbidity in the patients who died, with 86 patients having DM alone, and 245 having DM along with other comorbidities. Amongst the 2244 patients who were discharged, 1354 (60%) were male and 80 (40%) were female. Maximum patients discharged were from the age group of 41-60 years(918 patients, 40.90%). Maximum discharges were done in September (506, 22.54%). When the interval between date of admission and date of discharge was calculated, it was observed that maximum discharges were in the group of 1-10 days (1173 discharges, 52.27%). Maximum patients who were discharged did not have any comorbidity (1548, 69%), whereas 696 (31%) patients had some comorbidity. Hypertension was the most commonly occurring comorbidity in patients who were discharged, with 175 patients being exclusively hypertensive, and 254 patients having hypertension along with some other comorbidity. DM was the second most commonly observed comorbidity in the patients who were discharged, with 127 patients having DM alone, and 236 having DM along with other comorbidities. Conclusion: Some groups appear to be at higher risk of serious disease progression & increased mortality due to COVID-19. In patients without co-morbidities, 69% recovered whereas 31% died, while in patients with co-morbidities, 69% died whereas 31% recovered. Hypertension was most common co-morbidity observed in dead as well as recovered patients followed by DM. Outcome was poorer in patients with chronic kidney disease, cerebrovascular accidents, ischemic heart disease, and cancer. The ratio of discharges & death in ?rst 10 days of hospital stay was 1.7 & in next 10 days (i.e. day 11-20) was 4.5, i.e. outcome was better in the group of 11-20 days stay in the hospital than ?rst 10 days. Most common age group in patients who died was 61-80 years, while most common age group amongst recovered was 41-60 years. Multiple strategies can be devised to speci?cally target these high risk groups to prevent mortality due to COVID-19. Additionally, further studies relating to the pathophysiological processes of COVID-19 especially in high risk groups need to be undertaken which can contribute to development of possible prevention and treatment strategies.

Medley of infections-a diagnostic challenge

We present a rare case of multiple infections coexisting together. This is one of the rarest cases of four infections which coexisted together in our patient. It is an alarming for the physicians to be aware of such infections as early prompt diagnosis can be lifesaving.

Splenic complications in malaria: a case series.

Splenic complications in malaria may be either simple asymptomatic enlargement or serious conditions, such as splenic infarction, rupture, hematoma or abscess, which can be fatal. Only a few cases have been reported in the literature since 1960. The true incidence of splenic complications is not known because of underdiagnosis and underreporting. We report here four cases which were successfully treated conservatively.

Immunoscintigraphy of MCF7 rat mammary tumour xenograft using monoclonal antibody.

A transplantable, ER+ mammary carcinoma has been induced in virgin female Wistar rats by an 'air-pouch' technique by xenografting MCF7 cells. An air pouch induced by injecting sterile air subcutaneously into the mammary fat pad was primed with pristane and 17 beta estradiol (10 micrograms) in peanut oil prior to injection of 2-5 x 10(7) MCF7 cells fresh from culture. Solid tumours developed within 1-3 months (0.5-3.4 cm diam.) well encapsulated, pediculated tumours with histology of adenocarcinoma (> 80%) and fibroadenoma (< 10%), the former tumour being estrogen-dependent and transplantable. Monoclonal antibody 15C3 generated against MCF7 cells in this laboratory has been used for Tc-99m immunoscintigraphic studies by "SPECT" analysis of this mammary carcinoma and revealed selective localization of Tc-99m resulting in highly distinct tumour images.

Lymphoma associated antigen (LAA)--a unique biomarker for lymphomas.

A lymphoma associated antigen (LAA) isolated from pooled lymph nodes of confirmed Hodgkin's and non-Hodgkin's lymphomas has been purified and characterized. Using a xenogenic rabbit anti-serum, enzyme-linked immunosorbent assay (ELISA) and RIA were developed for LAA. LAA was detected in the sera of all confirmed lymphomas, the test being negative for normals, for patients with benign lymphadenitis and various other types of cancers. Except for a very few false positive results, no false negative was observed. LAA was identified in urine, CSF, saliva and gastric juice of a few lymphoma patients, and the test proved to be of diagnostic potential, as for a few patients it had a lead time of a few months over the histological diagnosis. In order to render the LAA test more precise and specific, monoclonal antibodies were generated by both in vitro and in vivo immunization procedures. Seven monoclonals were generated, viz. 7D6, 7D2, 7G2, 7C5, 6G2, 23B7 and 23G11, which exhibited cytoplasmic staining of frozen sections of malignant lymphoid tissues of B cell derived non-Hodgkin's lymphomas. Two of these monoclonal antibodies, 7D6 and 23B7, revealed strong cytoplasmic staining of frozen sections, impression smears and cytospin specimens of B cell non-Hodgkin's lymphomas. The reactivity was very weak or negative for T cell lymphomas. The test was negative for Hodgkin's disease and controls. These results were confirmed by dot blotting, immunoprecipitation and immunofluorescence study. By ELISA with a sensitivity of 15 ng/ml, serum LAA levels for lymphomas were in the range 72-1250 ng/ml. LAA could not be detected in the sera of normals and controls.(ABSTRACT TRUNCATED AT 250 WORDS)