Study of Clinical Profile and Outcome among COVID-19 Patients during Hospitalization in a Tertiary Care Hospital in Central India

Background: The COVID-19 outbreak in 2019 has presented in the form of pneumonia of unknown etiology in Wuhan. The complete clinical profile including the prevalence of different clinical symptoms of COVID-19 infection among Indian patients who develop a severe disease is largely unknown. This study is aimed to provide a detailed clinical characterization of the cohort of patients who visited our institute with signs and symptoms of COVID-19. Material(s) and Method(s): This was for inpatient hospital (inpatient) based prospective cohort study involving 520 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. Result(s): Total 520 participants enrolled in the study, (6.9%) participants died, (8.3%) participants required ICU and (5.5%) participants required mechanical ventilation. only signs and symptoms suggestive of severe respiratory system involvement or widespread infection were associated with adverse outcomes, T presence of dyspnoea, cyanosis and hypoxia. The most common chronic disease among patients with adverse outcomes were diabetes, hypertension and pre-existing respiratory disease, personal habit both smoking, and alcoholism was also associated with adverse clinical outcome. Conclusion(s): The adverse clinical outcome among COVID-19 patients is determined by several factors including advanced age, multi-morbidities, and the presence of severe respiratory symptoms.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

Radiological Features on HRCT Associated with Poor Outcomes among COVID-19 Patients

Background: Ever since the beginning of the COVID-19 pandemic, physicians started investigating the clinical features and lab markers that can assist in predicting the outcome among hospitalized COVID-19 patients. Aim(s): This study aimed to investigate the association between initial chest CT scan findings and adverse outcomes of COVID-19. Material(s) and Method(s): This was a single centre;hospital (inpatient) based prospective cohort study involving 497 COVID-19 patients admitted to the hospital. The adverse outcome included death and mechanical ventilation. We collected data about 14 identifiable parameters available for the HRCT scan. Result(s): Among 14 studied parameters, only 8 features differed significantly among the patients who had favourable and unfavourable outcomes. These features included number of lobes of lungs involved (3 versus 5, p = 0.008), CT Severity score (16 versus 20, p = 0.004), air bronchogram (p=0.003), crazy paving (p=0.029), consolidation (p=0.021), and pleural effusion (p=0.026). We observed that high CT scores coupled with the diffuse distribution of lung lesions were responsible for poor prognosis in most patients. Conclusion(s): Several features of HRCT when combined can accurately predict adverse outcomes among participants and help in triaging the patient for admission in ICU.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.

PERSONAL PROTECTIVE EQUIPMENT (PPE) STEWARDSHIP: PROMOTING EFFICIENCY AND INCREASING COMPLIANCE

STATEMENT OF PROBLEM/QUESTION: Personal protective equipment (PPE) has allowed medical students to return to the hospital to continue their clinical responsabilities during the COVID-19 pandemic, however problems with use remain. Throughout the pandemic, stewardship of personal protective equipment has been an immense challenge. Multiple surveys have shown that less than 40% of healthcare providers wore all mandatory PPE during a patient encounter. One potential explanation for challenges in compliance, is that no standardized practices exist for keeping track of an individual's PPE during the work day. As a result, resources can be lost or mixed up between individuals, ultimately increasing exposure risks and decreasing compliance with hospital PPE use guidelines. In response, this study sought to design two innovative and inexpensive solutions to promote the effective use of masks and safety glasses in compliance with hospital guidelines. The aim was to determine if providing stewardship devices would increase compliance. DESCRIPTION OF PROGRAM/INTERVENTION: Seventy-eight medical students in their third and fourth year clinical rotations at the Icahn School of Medicine at Mount Sinai participated in the study. The study lasted three weeks. Each intervention week, participants were provided with a new set of PPE stewardshp devices. Device one was a disposable eye protection lanyard. Device two was a breathable and water-dissolvable PPE pocket storage device that could be attached to a hospital gown. MEASURES OF SUCCESS: To monitor whether the devices increased PPE compliance, participants were administered a pre-survey consisting of 21 questions. Three identical surveys were administered each subsequent intervention week, to assess effectiveness of the devices on PPE compliance. The surveys used a likert scale model to measure whether students' PPE use and ease of use and availability differed pre- and post-intervention. FINDINGS TO DATE: These interventions helped students better adhere to hospital PPE guidelines- 75% for lanyard wearers and 44% for PPE pocket users. Our results further showed 86% of participants reported that PPE was more accessible when provided with lanyards. The attachable pocket similarly increased PPE compliance, however there was a high attrition rate with its usage. KEY LESSONS FOR DISSEMINATION: PPE has served as an incredibly effective tool for limiting the spread of COVID-19. These results suggest that providing medical students with a PPE lanyard device can increase the compliance of eye protection use.

TELEUROLOGY: EXPANDING HORIZONS TO INPATIENT ECONSULTS

INTRODUCTION AND OBJECTIVE: Telemedicine use rapidly increased during the COVID-19 pandemic. However, the efficacy of telemedicine in the inpatient setting has yet to be addressed. To this end, we measured patient and provider satisfaction with video and faceto- face (FTF) consults for inpatient urology consultations and sought to identify the urologic conditions most suitable for video consults. METHODS: New inpatient urology consults between August 2021-October 2021 were randomized to either video or FTF consult. Patient surveys were administered within 24 hours to assess satisfaction and perceived quality of care during the consult (3-point ordinal Likert scale). Survey results were analyzed using Mann- Whitney U tests. Participating urology attendings completed a survey assessing satisfaction and utility of both consultation mediums (3- point ordinal Likert scale), and suitability of video consults for common urologic consultation conditions (5-point ordinal Likert scale). RESULTS: A total of 48 patients were included;23 (48%) received video consult and 25 (52%) FTF consults. There were no significant differences in age or race between the cohorts. The most common reasons for consultation were acute urinary retention (Video: 5 [22%], FTF: 5 [20%]) and urolithiasis (Video: 5 [25%], FTF: 3 [12%]). Both cohorts agreed that they were overall satisfied with their visit (Video: 22 [95.7%], FTF: 25 [100%];p=0.297), received high-quality care (Video: 22 [95.7%], FTF: 23 [92.0%];p=0.61), and would accept the visit modality again in the future (Video: 21 [91.3%], FTF: 25 [100%];p=0.14). Urologists agreed on the utility of both consultation mediums, including ability to gather complete information (Video: 7 [100%], FTF: 7 [100%]) and manage the patient (Video: 6 [85.7%], FTF: 7 [100%];p=0.71). Physician satisfaction was lower for video consult than FTF (Video: 5 [71.4%], FTF: 7 [100%];p=0.38), and physicians were less likely to agree that video consults were satisfactory compared to FTF visits (4 [57.1%]). The most suitable urologic conditions for video consultation were elevated PSA and urinary retention (4.85±0.38), followed by urinary incontinence and nephrolithiasis (4.71±0.49). The least suitable was scrotal wall swelling (2.71±0.76). CONCLUSIONS: With increasing telemedicine utilization, video consults offer an alternative to FTF rounding that may combat difficulties of urologist shortages. Video consults enable urologists to see a wide variety of inpatient consults without hindering patient satisfaction. However, adoption of this tool will rely on physician preference and competence with video technology.

Particulate Matter Pollution in Urban Cities of India During Unusually Restricted Anthropogenic Activities

The outbreak of COVID-19 is a global public health challenge and has affected many countries, including India. The nationwide lockdown was imposed in India from March 25 to May 31, 2020 to prevent the transmission of COVID-19. The study intends to assess the impact of the absence of major anthropogenic activities during the various phases of the COVID-19 lockdown (LDN) period on the daily mean concentrations of PM2.5 and PM10 in six populated cities of Jaipur, Jodhpur, Kota, Udaipur, Ajmer, and Alwar in the state of Rajasthan. Investigation has been done for the different periods, including the pre-lockdown—PRELD (January 1–March 4, 2020), partial lockdown—PLDN (March 5–24, 2020), COVID-19 lockdown—LDN (March 25–May 31, 2020), and unlocking—ULC (June 1–August 31, 2020) phases. We have also compared the mean concentrations of PM2.5 and PM10 with the same period of the year 2019. A significant improvement in air quality during the COVID-19 LDN period was noticed in all cities compared to 2019 and for the same period of the year 2020. However, the levels of PM2.5 and PM10 were seen to rise during the second, third, and fourth LDN phases compared to the first LDN, indicating that the subsequent lockdowns started with some relaxations and dusty conditions. On the other hand, wind-blown dust is another vital source of PM10, resulting in high concentrations in the summer months (April–May). Significant reductions in PM2.5 (~25–50%) and PM10 (20–37%) in all six cities during the LDN period compared with PRELD were estimated. However, with significant variations from city to city, the lowest reductions in PM2.5 (~25%) and PM10 (~20%) were measured in Jodhpur and Ajmer, respectively. It was noticed that the episodes of rainfall and transport of oceanic air masses resulted in a reduction of particles during the ULC period compared to the LDN period. The air quality index was, more or less, in the “good to satisfactory” category during the first 3 LDN periods, whereas it was moderate for Jodhpur, Jaipur, and Ajmer during the last LDN period. The study will be helpful to determine mitigation policies to minimize air pollution, especially in developing regions. Copyright © 2022 Yadav, Vyas, Kumar, Sahu, Pandya, Tripathi, Gupta, Singh, Dave, Rathore, Beig and Jaaffrey.

Mental Health Analysis of Indians During Pandemic

The Covid-19 pandemic has severely affected many countries around the globe in terms of physically as well as mentally. During the initial months of the pandemic have reported India’s deficient cases, but eventually the cases were proliferated as the time progress. The government’s decision to impose a lockdown without warning has a wide-ranging impact, affecting everyone from low-wage workers to huge corporations. As a result, there is a negative impact on people’s mental health and emotions. The people had suffered from depressions, anxiety, fatigue and so forth. Many wide varieties of the people had expressed their thoughts, viewpoints, and their mental conditions in the form of tweets over the Twitter, a social media platform. Hence, in this paper, we have statistically analysed the data of tweeted tweets to elicit the meaningful insights. The data was analysed using the unsupervised clustering strategy–K-means and LDA–and the results were reinforced and validated using the pre-trained supervised classification approach–Text to Text transformer. The anticipated data depicted that the fear was the most common state of mind at the end of the lockdown, followed by joy, anger, and sadness. Furthermore, the deduced insights will be highly beneficial in decision-making process when such an epidemic or pandemic situation re-surges. © 2021, Springer Nature Switzerland AG.

Study on awareness, psychosocial predictors and vaccine acceptance for COVID-19 in health care workers in central India

Background: The outbreak of novel coronavirus disease (COVID-19) first seen in December 2019 in China, became an international emergency and has been a global pandemic since then. Various vaccines are in development to help encounter this pandemic, and multiple vaccine have been given emergency approval for use. With announcement of new vaccines, vaccine awareness should be analyzed. We plan to assess the awareness, psychosocial predictors, factors that might lead to refusal or delay in vaccination for our better understanding and utilization of vaccines.

COVID-19 associated acute demyelination masquerading as stroke: a case report

Background: During the recent outbreak of COVID-19, various atypical extrapulmonary manifestations are being seen, including neurological ones. Reported cases mainly include encephalopathy, myelitis, and cranial nerve involvement. This case describes uncommon neuroradiological finding in the context of COVID-19. Case presentation: We report an atypical case of COVID-19 presenting with stroke-like episode, with MRI brain showing isolated bilateral posterior internal capsule involvement. This has rarely been reported in literature. Conclusion: As the numbers of COVID-19 cases are increasing, such atypical presentations should be kept in mind. © 2021, The Author(s).