ABSTRACT
Data comparing the clinical spectrum of COVID-19 in kidney transplant recipients (KTRs) during the first and second waves of the pandemic in India is limited. Our single-center retrospective study compared the clinical profile, mortality, and associated risk factors in KTRs with COVID-19 during the 1st wave (1st February 2020 to 31st January 2021) and the second wave (1st March-31st August 2021). 156 KTRs with PCR confirmed SARS-CoV-2 infection treated at a tertiary care hospital in New Delhi during the 1st and the second waves were analyzed. The demographics and baseline transplant characteristics of the patients diagnosed during both waves were comparable. Patients in the second wave reported less frequent hospitalization, though the intensive care unit (ICU) and ventilator requirements were similar. Strategies to modify immunosuppressants such as discontinuation of antinucleoside drugs with or without change in calcineurin inhibitors and the use of steroids were similar during both waves. Overall patient mortality was 27.5%. The demographics and baseline characteristics of survivors and nonsurvivors were comparable. A higher percentage of nonsurvivors presented with breathing difficulty, low SpO2, and altered sensorium. Both wave risk factors for mortality included older age, severe disease, ICU/ventilator requirements, acute kidney injury (AKI) needing dialysis, Chest Computerized Tomographic (CT) scan abnormalities, and higher levels of inflammatory markers particularly D-dimer and interleukin-6 levels. Conclusions. KTRs in both COVID-19 waves had similar demographics and baseline characteristics, while fewer patients during the second wave required hospitalization. The D-dimer and IL-6 levels are directly correlated with mortality.
ABSTRACT
Background: Scourge of ongoing COVID-19 pandemic is a matter of public health concern. New-norm preventive life-style like use of mask, repeated hand washing, social distancing and hygienic way of coughing-sneezing often compromise easy life and personal comfort. Earlier studies established certain epidemiological aspects of COVID-19 mostly in high-end societies, but not many conducted on occurrence of COVID-19 in low-middle-income communities to ascertain the trend. Aims and Objective: Considering a possible upsurge of COVID-19 in Kolkata, it was decided to study the occurrence of COVID-19 in the background of preventive awareness and its application among residents in three different communities in Kolkata. Materials and Methods: Study was conducted in three different communities located in south Kolkata during Apr 20 to Mar 21. Community 1 and 2 were semi-urban clusters and Community 3, a high profile society;having 266, 282 & 360 adults respectively. Consent was taken from authority as well as individual subjects. Questionnaire was made incorporating personal attributes, knowledge of personal protective measures (PPM) & its application;lastly details of COVID-19 patients. Questionnaire was sent to willing members through e-mode;those declined were contacted individually following new-norm. Data collected was coded for confidentiality, tabulated and analysed. Confirmed COVID-19 (RT-PCR+ve) declared by Govt/private hospitals during Apr 20 to Mar 21 were included. Result: Communities studied had analogous demographic traits. Two communities belonged to low-SES group, while other enjoyed high-end-status. Almost 90% of slum/colony dwellers knew all facets of COVID-19 prevention compared to cent-percent of upper class people. 52% in one and around 93-100% in other two groups followed recommended PPM. Occurrence rates of COVID-19 infection were 11.3, 10.6 & 11.1 per 1000 adult of respective communities during study period. Affected were mostly male (90%) of 30-44 year age with 60% from low SES & 40% from the privileged. Many indisposed used masks (70%), washed hands (100%) and followed social distancing (90%). Study unfurled the explicit distinctiveness of COVID-19 infection irrespective of social stand aside idealistic reflective of preventive awareness/application. PPM though renders protection but its circumventing role needs consistent application in back-lore of certain contextual considerations. Conclusion: Further research is recommended to enrich this endeavour to explore facts that may play vital role in COVID-19 prevention in future. [ABSTRACT FROM AUTHOR] Copyright of Asian Journal of Medical Sciences is the property of Manipal Colleges of Medical Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)