ABSTRACT
Since the COVID-19 pandemic, the world began a frantic search for possible prophylactic options. We conducted a study to assess the role of hydroxychloroquine for COVID-19 prophylaxis in health-care workers. The study was a prospective cohort with four arms (high, medium, low dose, and control) of HCQ prophylaxis. Participants were grouped as per their opting for any one arm on a voluntary basis as per institute policy. The outcomes studied were COVID-19 positivity by RT-PCR and its severity assessed by WHO COVID-19 severity scale. Total 486 participants were enrolled, of which 29 (6%) opted for low dose, 2 (<1%) medium dose, and none for high dose HCQ while 455 (93.6%) were in the control arm. Of the 164 participants who underwent RT-PCR, 96 (58.2%) tested positive. Out of these 96 positive cases, 79 [82.3%] were ambulatory and were managed conservatively at home. Only 17.7% participants, all from the control group, required hospitalization with the mild-moderate disease. None of the participants had severe disease, COVID-related complications, ICU stay, or death. The difference in the outcome was statistically insignificant (p value >0.05). This single-centre study demonstrated that HCQ prophylaxis in healthcare workers does not cause a significant reduction in COVID-19 as well as mitigating its severity in those infected. At present, most of the trials have not shown any benefit. Though COVID-19 vaccines have reduced the need for prophylaxis, the search for a safe and reasonable chemoprophylaxis should continue until a large population of individuals gets vaccinated, especially in underdeveloped countries.
ABSTRACT
Introduction: Scrub typhus is tropical zoonotic disease, commonly presented with multi organ dysfunction and high mortality rate in untreated patients. This study was done to identify clinical features commonly associated with scrub typhus during COVID pandemics, parameters associated with severe scrub typhus and mortality. Methods: This retrospective study was done in a tertiary care hospital with a total of 52 admitted scrub typhus positive patients in October 2020 to February 2022. Diagnosis was established by scrub IgM ELISA or Rapid antigen test. The clinical and laboratory data, duration of hospital stay and outcomes were collected. Common clinical and laboratory findings were of descriptive analysis. Factors associated with mortality were analysed using Chi-square test. Results: Fever was the most common presenting symptoms on admission (94.2%) followed by respiratory abnormalities (38.46%). Acute kidney injury was the most common organ failure on admission (67.3%), followed by acute liver injury (46.2%) and thrombocytopenia (32.7%). MODS was seen in 46.15%. Of the total, 30.8% were admitted in ICU. Mortality was seen in 7.7% of all patients. On Chi-square analysis, altered mental status and coagulopathy were associated with significant mortality with p value <0.05. Conclusion: Scrub typhus can manifest with potentially life-threatening complications such as acute kidney injury, acute liver injury, thrombocytopenia and MODS. The overall case-fatality rate was 7.7%, and presence of altered mental status and coagulopathy were associated with higher mortality. As per literature, COVID has changed few clinical profiles of scrub typhus compared to same center experience before.
ABSTRACT
The need for an antiviral against COVID-19 prompted clinical trials worldwide and based on initial promising trends, remdesivir was widely used, including in India (compassionate use). Subsequent trials have been conflicting in their results and the utility of the drug has been widely debated. This is a record-based retrospective cohort study in a 1000-bedded government teaching hospital in North India. We reviewed the medical e-records of the COVID-19 positive patients admitted between June and November 2020. After assessing eligibility and making the necessary exclusions, 112 patients were retrospectively included in the remdesivir cohort and 85 in the standard care cohort. All the baseline characteristics of relevance and hospital admission details were collected. The following outcomes were assessed: All-cause mortality until discharge-stratified as per baseline oxygen support, age, gender, and co-morbidities;the proportion of severe and non-severe patients progressing to mechanical ventilation later on;and time to clinical recovery in survivors. We found a statistically significant association of higher mortality with the administration of remdesivir (odds ratio, OR 2.3, p-value 0.008) with a Cox regression hazard ratio of 1.590 (CI 0.944-2.679). The trend towards poorer outcomes in the remdesivir cohort persisted even after sub-stratification for age, gender, baseline severity (oxygen need), and co-morbidities but failed to reach statistical significance in most strata. Similarly, remdesivir administration was associated with higher rates of progression to mechanical ventilation amongst those severe and non-severe patients who were not on mechanical ventilation at admission (49% versus 15%, p-value <0.001, OR 5.2). This association was significant overall as well as for severe category patients when assessed separately (56% versus 26%, p-value 0.04, OR 3.1). There was, however, no difference in the days taken for clinical recovery between the two groups (13.23 days versus 12.8 days, p-value 0.77). Remdesivir administration was associated with overall worse clinical outcomes. This study contradicts the benefits shown with remdesivir in previous clinical trials done in controlled settings and highlights the challenges that newer therapies face in real-life hospital settings. There is a need to include diverse ethnic groups in the future clinical trials of the drug if to be used.
ABSTRACT
On January 30th, 2020, the World Health Organization announced the COVID-19 outbreak as a Public Health Emergency of International Concern. In the view of this pandemic, early diagnosis is the mainstay for halting the disease progression. Quantitative real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-qPCR) has been established as the cornerstone for the diagnosis of COVID-19. However, the significance of RT-qPCR positivity in asymptomatic cases with travel history, mass screening purposes, or close contact tracing remains debatable as their period of infectivity is unknown. We present a case series of 42 asymptomatic patients, who tested positive for COVID-19 and were subjected to hospitalization until they tested negative as per Government guidelines. Through our case series, we have tried to establish that RT-qPCR testing as a diagnostic criterion for asymptomatic patients with no known contact history can lead to increased psychological and economic burden on the Government, the patient as well as his family. It also overburdens the health care resources and therefore, raises the question about its necessity among this cohort of asymptomatic cases and thus the possible role of other methods in the diagnosis and isolation of such cases.