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1.
medrxiv; 2022.
Preprint in English | medRxiv | ID: ppzbmed-10.1101.2022.06.22.22276744

ABSTRACT

Objectives This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). Methods NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1 st September 2020 to 26 th October 2021 were examined. Results Analysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n=3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6, 7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4, 0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3, 0.7)] were protected from in-hospital mortality. Conclusions WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.


Subject(s)
Sialic Acid Storage Disease , Dyspnea , Diabetes Mellitus , Kidney Diseases , Chronic Disease , Tuberculosis , COVID-19 , Liver Diseases
2.
Kamal Kajal; Karan Singla; Goverdhan Dutt Puri; Ashish Bhalla; Aparna Mukherjee; Gunjan Kumar; Alka Turuk; Madhumita Premkumar; Varun Mahajan; Thrilok Chander Bingi; Pankaj Bhardwaj; Mary John; Geetha R Menon; Damodar Sahu; Samiran Panda; Vishnu Vardhan Rao; Rajarao Mesipogu; Mohammed Ayaz Mohiuddin; Vinaya Sekhar Aedula; Manoj K Gupta; Akhil D Goel; Vikas Loomba; Maria Thomas; U K Ojha; R R Jha; Veeresh Salgar; Santosh Algur; Ashish Pathak; Ashish Sharma; Manju Purohit; Himanshu Dandu; Amit Gupta; Vivek Kumar; Lisa Sarangi; Mahesh Rath; Tridip Dutta Baruah; Pankaj Kumar Kannauje; Ajit Kumar; Rajnish Joshi; Saurabh Saigal; Abhishek Goel; Janakkumar R Khambholja; Amit Patel; Surabhi Madan; Nitesh Shah; V K Katyal; Deepinder Singh; Sandeep Goyal; Arti Shah; Amit Chauhan; Bhavesh Patel; Kala Yadhav M L; Dayananda V P; Chetana G S; Anita Desai; Manisha Panchal; Mayank Anderpa; Payal Tadavi; Sourin Bhuniya; Manoj Kumar Panigrahi; Shakti Kumar Bal; Sachin K Shivnitwar; Prajakta Lokhande; Srikanth Tripathy; Vijay Nongpiur; Star Pala; Md Jamil; Bal Kishan Gupta; Jigyasa Gupta; Rashmi Upadhyay; Saurabh Srivastava; Simmi Dube; Preksha Dwivedi; Rita Saxena; Mohammed Shameem; Nazish Fatima; Shariq Ahmed; Nehal M. Shah; Soumitra Ghosh; Yogiraj Ray; Avijit Hazra; Arunansu Talukdar; Naveen Dulhani; Nyanthung Kikon; Subhasis Mukherjee; Susenjit Mallick; Lipilekha Patnaik; Sudhir Bhandari; Abhishek Agrawal; Rajaat Vohra; Nikita Sharma; Rajiv Kumar Bandaru; Mehdi Ali Mirza; Jaya Chakravarty; Sushila Kataria; Ratnamala Choudhury; Soumyadip Chatterji; M.Pavan Kumar.
researchsquare; 2022.
Preprint in English | PREPRINT-RESEARCHSQUARE | ID: ppzbmed-10.21203.rs.3.rs-1740554.v1

ABSTRACT

BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.ResultsA total of 5865 patients, with mean age 56±15 years, with 3840/5865 (65.4%) men, were enrolled in the ICMR registry.. Overall mortality was 2535/5865 (43.5%). Non-survivors were older than survivors (58.2±15.4 years vs 53.6 ±14.7 years; P=0.001). Non-survivors had multiple comorbidities (n=1951, 52.9%) with hypertension (47.2%) and diabetes (45.6%) being the most common, higher creatinine (1.6 ± P=0.001, high D-dimer (1.56 vs 1.37, P=0.001), higher CT severity index (16.8±5.2 vs 13.5 ±5.47 ) compared to  survivors. Non survivors had longer hospital and ICU stay (P=0.001). On multivariate regression analysis, high NLR (HR 1.017, 95% CI 1.005- 1.029, P=0.001), high CRP (HR 1.008, 95% CI 1.006- 1.010, P=0.001), high D dimer ((HR 1.089, 95% CI 1.065- 1.113, P=0.001) were associated with mechanical ventilation while younger age, (HR 0.974, CI 0.965-0.983, p=0.001), high D dimer (HR-1.014, CI 1.001-1.027, P=0.035) and use of prophylactic LMWH (HR 0.647, CI 0.527-0.794, p=0.001) were independently associated with mortality. ConclusionIn this large retrospective study of 5865 critically ill COVID 19 patients admitted to ICU, overall mortality was 2535/5865 (43.5%). Age, high D dimer, CT Severity score and use of prophylactic LMWH were independently associated with mortality. 


Subject(s)
COVID-19
3.
ssrn; 2021.
Preprint in English | PREPRINT-SSRN | ID: ppzbmed-10.2139.ssrn.3802514

ABSTRACT

Background & Aims: A procoagulant state with pulmonary micro-thrombosis has been described in COVID-19, which contributes to pathophysiology of respiratory failure along with diffuse alveolar damage. Cytokine storm and systemic inflammation in COVID-19 generates endogenous heparinoids from the endothelium which leads to secondary organ failures. We prospectively studied the dynamic association of the coagulation abnormalities with respiratory failure and mortality in patients with COVID-19.Methods: We did a prospective observational study in adults aged between 18-80 years with COVID 19 pneumonia requiring intensive care (ICU) admissions in a tertiary care hospital in North India. All patients received standard medical therapy based on best available evidence. Patients were categorized based on the oxygen support therapy into low flow, high flow and invasive ventilation groups. In patients considered to be at risk of thromboembolic or bleeding phenomena, paired coagulation tests were performed at days 1 and 3 with, Sonoclot ® (glass beaded and heparinase-treated). All patients were consecutively followed for inflammatory markers, ventilator requirements and survival. Activated clotting time (ACT) <110s and peak amplitude > 75 units were used as the cut-off for hypercoagulable state. The heparin like effect (HLE) was considered by a correction of ≥ 40 s in hACT (heparinized treated ACT). The trial is registered with ClinicalTrials.gov (NCT04668404).Results: A total of 2324 patients with COVID-19 were screened from August 2020 to November 2020. Two hundred and fifteen patients requiring ICU admission were assessed and 74 patients with a median age of 54(42-67) years were enrolled. A procoagulant profile was seen in 45.5%, 32.4% and 20.7% in low-flow, high-flow, and invasive ventilation. Paired Sonoclot ® assays in 33 patients demonstrated HLE in 17 (51.5%) and 20 (62.5%) at days 1 and 3 respectively. In multivariate analysis, the presence of HLE (HR 1.02; CI 1.08-1.6; p < 0.05), C-reactive protein (HR 1.2; CI 1.1-1.4; p=0.014)] and platelet function (HR 0.9; CI 0.7-1.1 p < 0.05) predicted mortality. The presence of HLE at day 1 predicted the need for invasive ventilation (HR 1.4; CI 1.01-1.5; p <0.05). An ACT > 131 s, clot rate < 27.5 units/min and CRP > 96.7 mg/l at admission predicted mortality.Conclusions: HLE contributes to hypocoagulable effect, need for invasive ventilation and mortality in patients with COVID-19.Trial Registration: The trial is registered with ClinicalTrials.gov (NCT04668404).Funding Statement: NoneDeclaration of Interests: NoneEthics Approval Statement: Ethical clearance was obtained from the Institutional Review Board (PGI/IEC/2020/000997 dated 24 August 2020)


Subject(s)
Thromboembolism , Depressive Disorder , Pneumonia , Blood Coagulation Disorders, Inherited , COVID-19 , Inflammation , Respiratory Insufficiency
4.
Journal of Postgraduate Medicine, Education and Research ; 54(3):94-99, 2020.
Article in English | GIM | ID: covidwho-1000488

ABSTRACT

Background: The existing literature on the mental health outcomes of frontline healthcare workers (HCWs) is silent over the psychosocial issues being faced by the housekeeping/hospital attendants (HAs) and sanitary attendants (SAs) who are also actively involved in COVID-19 patient care and in biomedical waste management. This group of HCWs can be considered as the "faceless corona warriors", and their psychosocial issues needs to be focussed upon too. Aim: To evaluate the psychosocial issues and problems related to issues specific to carrying out duties in COVID-19 wards among the HAs and SAs. Materials and methods: An interview-based approach (cross-sectional assessment) conducted by healthcare professionals in the local languages of the HAs and SAs was followed. Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) were used to assess depression and anxiety, respectively. Along with it, a self-designed questionnaire was added to evaluate the different emotional states and problems faced by the HAs and SAs during their COVID-19 duty.

5.
Journal of Postgraduate Medicine, Education and Research ; 54(3):126-133, 2020.
Article in English | GIM | ID: covidwho-1000484

ABSTRACT

Aim: To review the status of various approaches for prophylaxis of coronavirus disease 2019 (COVID-19). Background: The extensive spread of the novel COVID-19 has seen tremendous success over the span of few months. In comparison, our progress in developing an adequate treatment or preventive modality has been sluggish, at most. Review results: Many observational studies and clinical trials are published evaluating chloroquine and hydroxychloroquine as prophylactic measures for COVID-19. Some question its safety, some refute its use while some uphold its beneficial effect. Although some scientific bodies advocated its routine use in some population without adequate evidence, current consensus proposes its prophylactic use in the context of clinical research only. Apart from chemotherapeutic drugs, several vaccines are under various phases of clinical development. Innovative vaccine development faces many hurdles as do the new drugs - from the inception of concept and establishing manufacturing process to time-consuming preclinical and clinical development, regulatory processes, large scale production, and then marketing. There is a lot of hope and expectation from AstraZeneca's candidate vaccine, ChAdOx1-S, and Serum Institute of India's recombinant bacille Calmette-Guerin that are currently in phase III clinical trial. In order to expedite vaccine development, controlled human infection models are also being explored. Some research bodies also suggest using complementary and alternative medicine to supplement the existing and novel prophylactic therapies in preventing the infection. Conclusion and clinical significance: The increase in literature on the management of COVID-19 reflects the demand to address the current pandemic. At the same time, it becomes critical that research community works toward providing best evidence for guiding the clinicians' practice and that clinicians and regulators emphasize on appraising the existing evidence before prescribing and making policies, respectively.

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