Perception Toward Use Of Face Mask During Covid 19 Pandemic Among Adults In Khordha District A Cross Sectional Study

Background: Hygienic mask use plays a significant role in effectively preventing contagious respiratory disease. COVID pandemic had made wearing masks mandatory for all. All need to follow mask hygienic practice to avoid respiratory infection. Though wearing a mask all time may also lead to discomfort and difficulties. Objective(s): The objective of the study was to assess the perception towards use of face mask among adults Material(s) and Method(s): Conveniently 306 adults were chosen for conducting the study from UPHC Nayapalli and CHC Mendhasala of Khordha district. Participants were asked to fill the perception towards use of face mask (PEM tool) Results: 75.8% strongly agreed that wearing mask keeps a person safe from respiratory infections. 84.3% subjects strongly agreed for wearing a mask in public spaces. . Most 51% strongly disagree that face mask can make the person feel embarrassed. . 44.4% strongly disagree that its feel like to remove mask while talking. Conclusion(s): Present study shows that people are having good perception. They know the importance of mask wearing but sometime they are not able to follow the social guidelines due to various difficulties encountered while wearing mask. Continuous awareness programme is necessary to motivate them. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Association of the prognostic biomarkers for COVID-19 with grade of Hyperglycemia in T2DM with Mild to Moderate COVID-19 managed through Teleconsultations- A Two Center Cohort Study

Objective: Uncontrolled hyperglycaemia is associated with poor clinical outcomes among patients with COVID-19. Diabetes mellitus and hyperglycemia at presentation, are independent risk factors for disease severity and worse outcome of COVID-19 infection. Methods: We evaluated the association of biomarkers of COVID-19 (CRP, D-Dimer and Ferritin) with the random blood sugar (RBS) as reported through SMBG by the patients who were already under regular care, across two dedicated diabetes centres. We compared the levels of CRP, D-Dimer and Ferritin across the groups with RBS < 200 and with RBS ≥ 200, Normal values: CRP 0-5 mg/L, D-Dimer < 0.5 mg/dl, Ferritin 30-400 ng/mL Results: The mean age of the patients was 59 years (SD±13, 95% CI 58 to 60). 256 were male. In our cohort, 378 (87%) were mild cases and 56 (12.9%) were moderate cases. The mean RBS in mild cases at the first consultation was 198 mg/dL (SD±45, 95% CI 170 to 231). The mean CRP (mg/dl), D-Dimer (mg/L) and Ferritin (mg/L) in mild cases were 6.7 (SD±3, 95% CI 5.5 to 7.3), 0.62 (SD±2, 95% CI 0.57 to 6.6) and 485 (SD±34, 95% CI 455 to 516), respectively. The mean RBS in moderate cases at the first consultation was 225 mg/dL (SD±32, 95% CI 196 to 259). The mean CRP (mg/dl), D-Dimer (mg/L) and Ferritin (mg/L) in moderate cases cases were 12.1 (SD±4, 95% CI 6.2 to 13.9), 1.3 (SD±2, 95% CI 0.9 to 1.7) and 655 (SD±42, 95% CI 588 to 691), respectively. There were 92 patients (21.1%) who were initiated on Premixed Analog insulin regimen to achieve glycemic control. Mild cases were managed by standard care approach for diabetes care, including oral drugs. 58 patients (63%) needed uptitration of insulin regimen as the RBS was over 300mg/dL, as a predefined threshold. Discussion/Conclusion: We observed that the T2DM patients with higher grade of hyperglycemia had higher concentrations of prognostic biomarkers. This might have happened due to inflammatory reactions and related tissue destruction. COVID-19 vaccination program should also target those populations with higher RBS to improve their outcomes. We could not quantify the grade of insulin resistance and obesity that would have independently deteriorated the glycemic control with accelerated transition of mild to moderate COVID-19. Our study highlights the need to evaluate COVID-19 biomarkers guided by higher RBS and accordingly predict the progress of mild to moderate cases and timely intervene to manage these patients, while optimally utilising the resources for management of COVID-19.

Risk of Post-COVID-19 Dyspnea and Interstitial Lung Disease (ILD) in a Real-World Cohort of Patients Hospitalized with COVID-19 in the United States

Background. While COVID-19 carries substantial morbidity and mortality, the extent of long-term complications remains unclear. Reports suggest that acute lung damage associated with severe COVID-19 can result in chronic respiratory dysfunction. This study: (1) estimated the incidence of dyspnea and ILD after COVID-19 hospitalization, and (2) assessed risk factors for developing dyspnea and ILD in a real-world cohort of patients hospitalized with COVID-19 using US electronic health records (EHR). Methods. Patients in the Optum de-identified COVID-19 EHR database who were hospitalized for COVID-19 (lab confirmed or diagnosis code) between February 20 and July 2020 and had at least 6 months of follow-up were eligible for analysis. Dyspnea and ILD were identified using diagnosis codes. The effects of baseline characteristics and hospitalization factors on the risk of incident dyspnea or ILD 3 to 6 months' post discharge were evaluated. Results. Among eligible patients (n=26,339), 1705 (6.5%) had dyspnea and 220 (0.8%) had ILD 3 to 6 months after discharge. Among patients without prior dyspnea or ILD (n=22,613), 110 (0.5%) had incident ILD (Table 1) and 1036 (4.6%) had incident dyspnea (Table 2) 3 to 6 months after discharge. In multivariate analyses, median (IQR) length of stay (LOS;5.0 [3.0, 9.0] days in patients who did not develop ILD vs 14.5 [6.0, 26.0] days in patients who developed ILD;RR: 1.12, 95% CI: 1.08, 1.15;P=4.34 x 10-10) and age (RR: 1.02, 95% CI: 1.01, 1.03;P=4.63 x 10-3) were significantly associated with ILD. Median (IQR) LOS (5.0 [3.0, 9.0] days in patients who did not develop dyspnea vs 7 [4.0, 14.0] days in patients who developed dyspnea;RR: 1.04, 95% CI: 1.02, 1.06;P=8.52 x 10-4), number of high-risk comorbidities (RR: 1.18, 95% CI: 1.12, 1.24;P=3.85 x 10-9), and obesity (RR: 1.52, 95% CI: 1.25, 1.86;P=2.59 x 10-4) were significantly associated with dyspnea. Conclusion. In a real-world cohort, 4.6% and 0.5% of patients developed dyspnea and ILD, respectively, after COVID-19 hospitalization. Multivariate analyses suggested that LOS, age, obesity, and comorbidity burden may be risk factors for post-COVID-19 respiratory complications. Limitations included sensitivity of diagnosis codes, availability of labs, and care-seeking bias.

Prevalence of Influenza Co-infection in a Real-world Cohort of COVID-19 Patients in the U.S

Background. Over 29 million people have been infected with COVID-19 in the U.S. alone. While COVID-19 carries serious morbidity and mortality, potential for co-infection with other respiratory infections remains unclear. We aimed to: (1) estimate co-infection prevalence of COVID-19 and influenza, and (2) compare demographics and clinical outcomes of co-infected patients to those of COVID-19 singly-infected patients using U.S. electronic health records (EHR). Methods. Patients in the Optum De-identified COVID-19 EHR database diagnosed with COVID-19 (lab-confirmed or ICD code) between February 2020 and January 2021 were eligible. Influenza co-infection was defined as an influenza diagnosis (lab-confirmed or ICD code) within ±10 days of COVID-19 diagnosis. We report co-infection prevalence for all COVID-19 patients and for a subset of hospitalized COVID-19 patients. Results. Among all COVID-19 patients (N = 549,532), 1,794 (0.3%) were co-infected with influenza. Among the hospitalized subset (N = 80,192), 242 (0.3%) were co-infected with influenza. In sensitivity analyses restricting to lab-confirmed influenza, co-infection prevalence was 0.1% overall and 0.2% among hospitalized patients. No meaningful differences were observed in baseline demographics between co-infected and singly-infected patients. Among hospitalized patients, univariate analysis suggested higher likelihood of invasive ventilation (12.8% vs. 9.8%;p=0.14), respiratory failure (56.2% vs. 46.6%, p< 0.01), and ICU stay (27.3% vs. 23.1%, p=0.13), but no meaningful difference in mortality (13.3% vs. 13.0%, p=0.97), for co-infected as compared to singly-infected COVID-19 patients. Conclusion. In a real-world cohort, we observed a low proportion (0.3%) of COVID-19 patients co-infected with influenza. Co-infected patients had similar baseline characteristics but higher likelihood of hospitalization severity as compared to singly-infected COVID-19 patients. Limitations include low prevalence of circulating influenza and potential missing data bias.

Risk Factors for COVID-19 Disease Severity Using Electronic-Health Records in a Real-World Cohort in the United States

Background. Over 32 million cases of COVID-19 have been reported in the US. Outcomes range from mild upper respiratory infection to hospitalization, acute respiratory failure, and death. We assessed risk factors associated with severe disease, defined as hospitalization within 21 days of diagnosis or death, using US electronic health records (EHR). Methods. Patients in the Optum de-identified COVID-19 EHR database who were diagnosed with COVID-19 in 2020 were included in the analysis. Regularized multivariable logistic regression was used to identify risk factors for severe disease. Covariates included demographics, comorbidities, history of influenza vaccination, and calendar time. Results. Of the 193,454 eligible patients, 36,043 (18.6%) were hospitalized within 21 days of COVID-19 diagnosis, and 6,397 (3.3%) died. Calendar time followed an inverse J-shaped relationship where severe disease rates rapidly declined in the first 25 weeks of the pandemic. BMI followed an asymmetric V-shaped relationship with highest rates of disease severity observed at the extremes. In the multivariable model, older age had the strongest association with disease severity (odds ratios and 95% confidence intervals of significant associations in Figure). Other risk factors were male sex, uninsured status, underweight and obese BMI, higher Charlson Comorbidity Index, and individual comorbidities including hypertension. Asthma and overweight BMI were not associated with disease severity. Blacks, Hispanics, and Asians experienced higher odds of disease severity compared to Whites. Conclusion. Odds of hospitalization or death have decreased since the start of the pandemic, with the steepest decline observed up to mid-August, possibly reflecting changes in both testing and treatment. Older age is the most important predictor of severe COVID-19. Obese and underweight, but not overweight, BMI were associated with increased odds of disease severity when compared to normal weight. Hypertension, despite not being included in many guidelines for vaccine prioritization, is a significant risk factor. Pronounced health disparities remain across race and ethnicity after accounting for comorbidities, with minorities experiencing higher disease severity.

Evolution of Treatment Patterns for Patients Hospitalized with COVID-19 in the United States

Background. COVID-19 remains a threat to public health, with over 30 million cases in the US alone. As understanding of optimal patient care has improved, treatment guidelines have continued to evolve. This study characterized real-world trends in treatment for US patients hospitalized with COVID-19, stratified by whether patients required invasive ventilation. Methods. US patients diagnosed and hospitalized with COVID-19 between March 23 and December 31, 2020, in the Optum de-identified COVID-19 electronic health record (EHR) data set were identified. Both drug and procedure codes were used to ascertain medications, and both procedure and diagnostic codes were used to detect invasive ventilation during hospitalization. Medication trends were estimated by computing proportions of hospitalized patients receiving each drug weekly during the study period. Results. In this cohort of 71,366 hospitalized patients, the largest observed change in care was related to chloroquine/hydroxychloroquine (HCQ) (Figure). HCQ usage peaked at 87% of patients receiving invasive ventilation (54% without ventilation) in the first week of this study (March 23-29), but declined to < 5% of patients, regardless of ventilation status, by the end of May. In contrast, dexamethasone usage was 10% at baseline in patients receiving ventilation (1% without ventilation) and increased to a steady state of >85% of patients receiving ventilation ( >50% without ventilation) by the end of June. Similarly, remdesivir usage increased sharply from a baseline of 2% of patients and continued to rise to a peak of 79% of patients receiving invasive ventilation (44% without ventilation) in November before declining. Conclusion. Meaningful shifts in treatments for US patients hospitalized with COVID-19 were observed from March through December 2020. A dramatic decline was observed for HCQ use, likely owing to safety concerns, while usage of dexamethasone and remdesivir increased as evidence of their efficacy mounted. Across medications, usage was substantially more prevalent among patients requiring invasive ventilation compared with patients with less severe cases.

Update to Perinatal-Neonatal Management of COVID-19 Guidelines

The guidelines for diagnosing and managing perinatal SARS-CoV-2 infection for the Indian context were last updated in May 2020. Newer evidence, the evolution of the pandemic, and its significant impact on mother-infant dyads led us to review and revise the guideline. This article summarizes the salient changes in the perinatal-neonatal management of COVID-19.

Outcomes of Neonates Born to Mothers With Coronavirus Disease 2019 (COVID-19) - National Neonatology Forum (NNF) India COVID-19 Registry

BACKGROUND: Limited evidence exists on perinatal transmission and outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in neonates. OBJECTIVE: To describe clinical outcomes and risk factors for transmission in neonates born to mothers with perinatal SARS-CoV-2 infection. DESIGN: Prospective cohort of suspected and confirmed SARS-CoV-2 infected neonates entered in National Neonatology Forum (NNF) of India registry. SUBJECTS: Neonates born to women with SARS-CoV-2 infection within two weeks before or two days after birth and neonates with SARS-CoV-2 infection. OUTCOMES: Incidence and risk factors of perinatal transmission. RESULTS: Among 1713 neonates, SARS-CoV-2 infection status was available for 1330 intramural and 104 extramural neonates. SARS-CoV-2 positivity was reported in 144 intramural and 39 extramural neonates. Perinatal transmission occurred in 106 (8%) and horizontal transmission in 21 (1.5%) intramural neo-nates. Neonates roomed-in with mother had higher transmission risk (RR1.16, 95% CI 1.1 to 2.4;P=0.01). No association was noted with the mode of delivery or type of feeding. The majority of neonates positive for SARS-CoV2 were asymptomatic. Intra-mural SARS-CoV-2 positive neonates were more likely to be symptomatic (RR 5, 95%CI 3.3 to 7.7;P<0.0001) and need resuscitation (RR 2, 95%CI 1.0 to 3.9;P=0.05) compared to SARS-CoV-2 negative neonates. Amongst symptomatic neonates, most morbidities were related to prematurity and perinatal events. CONCLUSIONS: Data from a large cohort suggests perinatal transmission of SARS-CoV-2 infection and increased morbidity in infected infants.

Outcomes of Neonates Born to Mothers with Coronavirus Disease 2019 (COVID-19) - National Neonatology Forum (NNF) India COVID-19 Registry

BACKGROUND: Limited evidence exists on perinatal transmission and outcomes of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection in neonates. OBJECTIVE: To describe clinical outcomes and risk factors for transmission in neonates born to mothers with perinatal SARS-CoV-2 infection. DESIGN: Prospective cohort of suspected and confirmed SARS-CoV-2 infected neonates entered in National Neonatology Forum (NNF) of India registry. SUBJECTS: Neonates born to women with SARS-CoV-2 infection within two weeks before or two days after birth and neonates with SARS-CoV-2 infection. OUTCOMES: Incidence and risk factors of perinatal transmission. RESULT: Among 1713 neonates, SARS-CoV-2 infection status was available for 1330 intramural and 104 extramural neonates. SARS-CoV-2 positivity was reported in 144 intramural and 39 extramural neonates. Perinatal transmission occurred in 106 (8%) and horizontal transmission in 21 (1.5%) intramural neonates. Neonates roomed-in with mother had higher transmission risk (RR1.16, 95%CI 1.1 to 2.4;P=0.01). No association was noted with the mode of delivery or type of feeding. The majority of neonates positive for SARS-CoV2 were asymptomatic. Intramural SARS-CoV-2 positive neonates were more likely to be symptomatic (RR 5, 95%CI 3.3 to 7.7;P<0.0001) and need resuscitation (RR 2, 95%CI 1.0 to 3.9;P=0.05) compared to SARS-CoV-2 negative neonates. Amongst symptomatic neonates, most morbidities were related to prematurity and perinatal events. CONCLUSION: Data from a large cohort suggests perinatal transmission of SARS-CoV-2 infection and increased morbidity in infected infants.

Impact of COVID 19 pandemic on tuerculosis

Covid19 is the most dreaded pandemic of the century causing wide spread and on the other hand Tuberculosis is an age old disease killing billions. Tuberculosis is an air borne infection while Covid spreads via droplet spread and through fomite as well. Tuberculosis and complications related to it may lead to increased mortality due to poor lung compliance. Moreover Tuberculosis control programmed may get affected due to the ongoing pandemic. To decrease the adverse outcome of Covid19 on Tb strict measures like proper social distancing, hand hygiene, compliance to Anti Tubercular drugs, domiciliary Tb care and strengthening immune system may prove important. © 2020, Institute of Medico-Legal Publications. All rights reserved.

Review on COVID-19 disease: Its outbreak and current status

Coronavirus (COVID-19) is diversely found in human beings and wild animals. It is an enveloped RNA virus. There are a total six species which cause disease in humans. They commonly infect respiratory, neurological, enteric, and hepatic systems. There is history of endemic outbreaks in past in the form of Middle East respiratory syndrome coronavirus (MERSCoV) and severe acute respiratory syndrome related coronavirus (SARS-CoV).We have seen another outbreak due to a new strain called the SARS-CoV-2 virus which presented as a pneumonia of unknown etiology in patients in Wuhan, China. The epicenter of infection was linked to seafood and exotic animal wholesale markets in the city. It is highly contagious and has resulted in a rapid pandemic of COVID-19. As the number of cases continue to rise, it is clear that these viruses pose a threat to public health. This review will describe clinical features and treatment of COVID-19 patients and raise awareness among healthcare workers and general population during the current pandemic. This review article aims at giving up-to-date information about the disease and counselling of patients. © 2020, Institute of Medico-Legal Publications. All rights reserved.

Impact of COVID 19 pandemic on tuerculosis

Covid19 or SARS COV 2 is the most dreaded pandemic of the century, causing widespread mortality and morbidity. On the other hand, tuberculosis is an age-old disease killing billions around the globe every year. Both the diseases have caused a significant loss of human lives along with socio-economic constraints. While SARS Cov 2 is a very new disease, tuberculosis is known to humanity for thousands of years. Tuberculosis is an airborne infection while Covid spreads via droplet spread and through fomite as well. Tuberculosis and complications related to it may lead to increased mortality due to poor lung compliance. Moreover, Tuberculosis control programmed may get affected due to the ongoing pandemic. To decrease the adverse outcome of Covid19 on Tb strict measures like proper social distancing, hand hygiene, compliance to Anti Tubercular drugs, domiciliary Tb care and strengthening immune system may prove important. Measures like the use of masks, proper cough hygiene and repeated washing of hands may play a role in decreasing the spread of tuberculosis as well and might also play a role in the elimination of tuberculo-sis. The article also highlights the measures taken in a rural hospital in central India for the management of COVID 19 and Tuberculosis and the possible dif-ficulties faced in the management of tuberculosis during the Covid pandemic.