Characteristics and Outcomes of COVID-19 during the Third Wave of COVID Pandemic: A Single-center Descriptive Study

Aim: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has been causing a global pandemic of Coronavirus (COVID-19) disease in recurring waves. On November 24, 2021, a new SARS-CoV-2 variant (B.1.1.529) was identified in South Africa. We aimed to study the clinical profile, laboratory parameters, complications, and outcomes in patients hospitalized with COVID-19 infection during the third wave in India. Materials and methods: This was a single-center cross-sectional study conducted from 10th January 2022 to 10th February 2022. Data on demographic profile, clinical symptoms, laboratory findings, complications, and clinical outcome was collected and compared between nonsevere and severe cases. Results: A total of 74 patients were included. Four (5.4%) had a severe disease while 70 (94.6%) had a nonsevere disease. The most common symptoms were fever (60.8%), cough (52.7%), and sore throat (45.9%). There was a significant difference between severe and nonsevere groups in terms of vaccination history (p = 0.0412), and time elapsed from symptom onset to hospitalization (p ?0.001). The severe disease group also had significantly higher levels of leukocyte count, C-reactive protein (CRP), D-dimer, ARDS, sepsis, and a higher need for respiratory support (p < 0.001). A total of 70 (94.6%) patients were discharged while four (5.4%) patients succumbed to complications of COVID-19 infection. Complete vaccination against COVID was associated with significantly lower chances of severe disease [odds ratio (OR) 0.083, 95% confidence interval (CI) 0.0080–0.8632]. Conclusion: As compared to the previous two waves, the current wave of the pandemic had milder symptoms, less severe disease, and fewer ICU admissions and deaths. Successful completion of vaccination against COVID was associated with significantly lower morbidity and mortality.

Neurological Manifestations and Their Effect on Outcome in Second Wave of COVID-19 Pandemic: A Retrospective Cohort Study

Aim: There is a need for a better understanding of the relation of various neurological symptoms and complications with manifestations and outcomes of coronavirus disease 2019 (COVID-19). Hence, we planned this study to get an insight into the relation of neurological manifestations and COVID-19. Materials and methods: This was a retrospective study. All patients ?18 years in age, admitted with reverse transcription-polymerase chain reaction (RT-PCR) confirmed COVID-19 were included in the study. Their clinical records were accessed for collecting demographic and laboratory data. The data collected were analyzed for prevalence and pattern of neurological symptoms at admission and neurological complications developed during hospitalization. It was also analyzed to find the relation of neurological manifestations with duration of hospital stay, requirement of bilevel positive airway pressure (BiPAP) or ventilator, severity of disease, development of neurological complications, and mortality. Results: A total of 440 patients were included. The mean age was 59.28 ± 13.28 years. The most common neurological symptom at presentation was headache while the most common neurological complications were altered sensorium, cerebrovascular stroke, seizure, and encephalitis. Significantly, more patients with neurological complications than those without had severe disease and needed ventilation. Duration of hospitalization was significantly longer (16.26 ± 5.15 vs 12.73 ± 4.89, p = 0.0173) and mortality was also significantly higher (OR 6.59, 95% CI 2.23–19.43; p = 0.0006) in patients with neurological manifestations. Conclusion: The presence of neurological manifestations is associated with greater morbidity and mortality in patients with COVID-19 and thus warrants more aggressive treatment. However, a study of association of individual neurological manifestation with severity of COVID-19 will provide a more meaningful insight regarding the approach to the management of such patients

Type 2 DM An Independent Risk Factor For Poor Outcome In Moderate To Severe COVID-19

Background:Diabetes Mellitus has been shown to be a risk factor for severe COVID-19 disease. Few studies asse ssed effect of diabetes on the outcome exclusively in moderate to severe COVID 19 disease. Objective: To compare the clinical characteristics and outcome of hospitalized moderate and severe COVID-19 disease among patients with and without diabetes. Material And Methods:This retrospective study was conducted at Parul Sevashram Hospital from 1stApril 2021-30thApril 2021. Data on demographic profile, clinical symptoms, laboratory findings, complications and clinical outcome was collected and compared between patients with and without diabetes.Result:Total 319 patients were included with mean age 54.81±11.72 years. 28.5% had diabetes. The most common symptoms were fever, cough and shortness of breath. As compared to patients without diabetes, these patients had significantly higher levels of leucocyte count, CRP, Ferritin, LDH and D-Dimer. They also had more complications like ARDS, secondary infection and stroke and higher need of respiratory support (92.3% vs. 69.7%, P < 0.001). We also observed significantly greater mortality in patients with diabetes compared to those without diabetes (29.7% vs. 13.6%; P = 0.0014). These findings held true even on comparingpatients with only diabetes as comorbidity to those without any comorbidity.Conclusion:The study confirms that diabetes is an independent risk factor for higher inflammatory markers, risk of complications and in hospital mortality during hospitalization with moderate to severe COVID 19. New strategies are needed for more aggressive management of COVID 19 cases with diabetes to improve prognosis in these cases.

Identifying Risk Factors For ICU Admission During The Second Wave Of COVID 19 In A Tertiary Care Centre In Western India

Background:The substantial morbidity and mortality seen during second wave of coronavirus disease 2019 (COVID-19) pandemic necessitated identifying demographic, clinical and laboratory markers to assist the clinicians in early recognition of severe disease. We aimed to identify new factors or confirm previously identified factors for risk of ICU (Intensive care unit) admission during the second wave of COVID-19 infection. Material And Methods:This retrospective, single-centre study was conducted from April 1 2021-May30 2021. Data on demographic profile, clinical symptoms, and laboratory findings on admission was collected and compared between ICU and non-ICU patients. Result:Total 440 patients were included. Among these, 184(41.8%) needed ICU admission. The mean agewas 52.75±14.46years. 283(64.3%) patients were males. The most common symptoms were fever (70.7%), cough (65.5%), and shortness of breath (54.1%). As seen in previous studies, mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidities like diabetes mellitus, COPD, obesity were found more commonly in ICU patients as compared to non-ICU patients. (P= 0.0107, 0.0447 and 0.0314 respectively for diabetes, COPD and obesity). Presence of more than one comorbidity was associated with greater ICU admission (ICU vs. Non-ICU: 92(50%) vs. 99 (38.7%), p=0.0234).Time from symptom onset to hospitalization was also significantly longer in ICU patients (7.5±1.05 days vs 4.0±1.26 days; p=0.004). Conclusion:The study confirms that COVID patients who need ICU admission have significantly higher mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidity. In addition, COVID patients in ICU had significantly lower s. albumin levels and late presentation to hospital.

Scorpion Bite Atypically Presenting As Acute Transverse Myelitis And Sub Arachnoid Hemorrhage: A Case Report And Review

Scorpion bite is an important health issue as it has been reportedthatabout tenpersons are killed by a venomous scorpion for each killed by a venomous snake.Scorpion venom may be cardiotoxic, hemotoxic, nephrotoxic or even neurotoxic. It acts on the autonomic nervous system producing parasympathetic and sympathetic manifestations.However, few have reported sub arachnoid haemorrhage and transverse myelitis occurring due to scorpion venom.Case Report:We are reporting a case of 50year old male who prese nted three days after an episode of scorpion bitewith paraplegia and inability to pass urine and stool due to transverse myelitis and subarachnoid hemorrhage. He was investigatedand treated accordingly. Clinical improvement was seen within tendays after the initiation of therapy. Conclusion:Scorpion sting,though rarely may present as SAH and transverse myelitis which are reversible and easily treatable.Clinical Significance:As scorpion bite is treatable,having high index of suspicion for scorpion sting inpatients of SAH and acute transverse myelitis in whom the cause of their clinical features could not be recognised may help in improving the outcome considerably in these cases.

Dress Syndrome: Time to Define Treatment Guidelines.

Background: DRESS (Drug rash with eosinophilia and systemic Symptoms) syndrome is a drug hypersensitivity syndrome which begins around 2- 6 weeks after exposure to a drug. If treated early, can recover completely and much of morbidity can be avoided. Case: A patient with history of taking carbamazepine for epilepsy, presented with typical features of maculopapular erythematous rash, exfoliative dermatitis and edema over upper and lower extremities, face, and trunk. He had eosinophilia, lymphadenopathy and elevated liver enzymes. His condition rapidly improved after withdrawing carbamazepine and starting steroids. Discussion: The rapid recovery with steroids in this case and in a few cases reported previously also suggests a need of RCT to assess steroids as an established modality for management of this severe but curable entity.

Cubic Spline and Determination of Changes in the Solid Dispersion of Cefuroxime Axetil by Using MATLAB Software.

Studies in pharmaceutical systems are used to pick up the physicochemical properties of drugs, one of them are solid dispersions requiring a carrier to achieve that purpose. Generally hydrophilic agents are used as a carrier, because they have high hydrophilicity and are used in the pharmaceutical industry as excipients. In this work the Urea merges with Cefuroxime Axetil (CFA) for the formation of three solid dispersions, the antibacterial drug (CFA) is insoluble in water, creating problems of bioavailability in the body. Solid Dispersion of CFA was prepared with a ratio of 1:1, 1:2 and 1:3 using Urea. The study of bioactivity of the solid solutions was performed by Differential Scanning Calorimetry (DSC) and showing that part of CFA is retained in the volume (structure) of Urea and some joins the surface. The data analyzed were for the absorbance of each sample that were applied a cubic interpolation to determine differences between the dispersions by using MATLAB software (V.No. R201 1b).