Clinical and epidemiological profile of Indian COVID-19 patients from Jaipur: a descriptive study.

We analyzed the data of 102 confirmed patients with novel Coronavirus 2 infection (COVID-19) during the early period of nationwide lockdown announced in India after the declaration of pandemic. We analyzed epidemiological, clinical characteristics and outcome of hospitalization in 102 patients with positive results for novel corona virus (SARS-CoV-2) RNA testing which were traced on the basis of history of travel, contact with a confirmed COVID-19 case, resident of hotspot areas or presence of symptoms, thus providing an accurate estimate of the proportion of asymptomatic cases in the initial population. Of 102 patients enrolled in the study, 83.3% (85/102) were asymptomatic and 16.67% (17/102) were symptomatic. Seventy-seven (75.49%) were males and 24.50% (25/102) were females. Eighteen (17.6%) patients had associated comorbidities, the most prevalent of which were diabetes mellitus 10.8% (11/102), hypertension 7.8% (8/102), chronic obstructive pulmonary disease (COPD) in 3.92% (4/102), chronic kidney Disease (CKD) 0.98% (1/102), coronary artery Disease (CAD) 0.98% (1/102) and cerebro-vascular disease (CVD) 0.98% (1/102). The clinical spectrum among symptomatic COVID-19 patients varied from dry cough and fever to respiratory failure and multi-organ failure. Twelve (11.76%) patients were kept in intensive care unit (ICU). Ninety-nine (97.05%) patients recovered while three (2.94%) died during hospital stay. With majority of COVID-19 cases in India being asymptomatic, changes in biochemical and inflammatory profile were small and insignificant in asymptomatic patients when compared to symptomatic patients. Elevated NLR, lymphopenia, age and presence of comorbidities were associated with increased severity and poor outcome.

Palliative care provision at a tertiary cancer center during a global pandemic.

COVID-19 was first reported in Wuhan, China, in December 2019; it rapidly spread around the world and was declared a global pandemic by the World Health Organization in March 2020. The palliative care program at the Princess Margaret Cancer Centre, Toronto, Canada, provides comprehensive care to patients with advanced cancer and their families, through services including an acute palliative care unit, an inpatient consultation service, and an ambulatory palliative care clinic. In the face of a global pandemic, palliative care teams are uniquely placed to support patients with cancer who also have COVID-19. This may include managing severe symptoms such as dyspnea and agitation, as well as guiding advance care planning and goals of care conversations. In tandem, there is a need for palliative care teams to continue to provide care to patients with advanced cancer who are COVID-negative but who are at higher risk of infection and adverse outcomes related to COVID-19. This paper highlights the unique challenges faced by a palliative care team in terms of scaling up services in response to a global pandemic while simultaneously providing ongoing support to their patients with advanced cancer at a tertiary cancer center.

Clinical Profile of Covid-19 Infected Patients Admitted in a Tertiary Care Hospital in North India.

BACKGROUND: The novel coronavirus (Covid-19) continues to wreck havoc across China, European countries, USA and now seems to gain a strong foothold in India. The aim of this report is to describe the clinical profiles of these Covid-19 infected patients admitted in Sawai Mansingh Hospital(S.M.S), Jaipur ranging from their age, sex, travel history, clinical symptoms, laboratory evaluation, radiological characteristics, treatment provided along with common side effects and the final outcome. The described cases are one of the earliest cases of Covid-19 in the Indian subcontinent. METHODS: Epidemiological, clinical, laboratory, and radiological characteristics and treatment and outcomes data were obtained with data collection forms from electronic medical records and history given by 21 Covid-19 infected patients admitted in S.M.S., Jaipur. Patients were tested for Covid-19 by real-time reverse transcription polymerase chain reaction (RT-PCR) assay of 2019-nCoVRNA. RESULTS AND DISCUSSION: During the course of this study 21 Covid-19 positive patients were admitted in S.M.S Hospital, Jaipur. Male patients constituted 66.66% of total patients and majority of the patients (80.90%) were below 60 years of age. Most of the patients (71.40%) were either foreigners or had a history of foreign travel suggesting that these cases were not community acquired except for 4 cases from textile producing district Bhilwara (known as Manchester of India), an epicenter of North India. Approximately 33.33% patients were completely asymptomatic and of those who were symptomatic cough was the most common symptom (85.71%) followed by fever (78.57%), myalgia (64.28%), headache (28.57%) and dyspnea (28.57%). Three patients (14.28 %) had underlying co morbidity in the form of hypertension, diabetes mellitus, hypothyroidism, chronic kidney disease or coronary artery disease. 11 patients (52.38%) had lymphopenia in their hemogram during the course of admission. 3 patients (14.28%) had leucocytosis and 4 patients (19.04%) presented with thrombocytopenia. All 4 patients in the severe category had raised FDP, D-Dimer levels and they needed oxygen support. These patients had deranged liver functions and had elevated pro-calcitonin levels, serum ferritin levels and LDH levels. 1 out of the these 4 cases went into ARDS during the course of treatment. 10 patients yielded negative results for Covid-19. The mean duration from admission to getting 1st Covid-19 sample negative was 8.3 days. 18 patients (85.71%) are still under treatment. CONCLUSION: Clinical investigations in initial Covid-19 patients in the Indian subcontinent reveal lymphopenia as predominant finding in hemogram. Patients with older age and associated comorbid conditions (COPD and diabetes) seem to have greater risk for lung injury thereby requiring oxygen support during the course of disease and these patients also had greater derangement in their biochemical profile.