ABSTRACT
Introduction: Coronavirus Disease-19 (COVID-19) has been creating havoc worldwide since the first report in December, 2019. Vaccination against the disease was thought to bring respite, reducing the severity of disease, morbidity and mortality. However, considering the fact that no vaccine is fully efficient, people may get COVID-19 even after full vaccination. Aim: To determine the clinical, laboratory, radiological features of COVID-19 including the outcome and compare these between vaccinated and unvaccinated patients. Materials and Methods: The prospective observational study was conducted in a dedicated COVID-19 hospital in Odisha, India, from May 2021 to June 2021. Detailed history including symptoms and vaccination status, laboratory parameters, and radiological investigations were collected from 200 patients. The cases were classified as mild, moderate and severe as per the Ministry of Health and Family Welfare (MoHFW) guidelines. All the patients were followed till the end of hospital stay. The results were expressed as the mean±standard deviation and percentages. Chi-square test was used to compare the categorical variables, and unpaired t-test was used to compare two discrete variables. A p-value of less than 0.05 was considered significant. Results: Majority of the patients were unvaccinated (65%) and belonged to the age group of 39-59 years (58.5%). Among the non vaccinated patients, 32.3% had moderate disease, while 35.4% had severe disease. In the vaccinated group, 51.4% had moderate disease, whereas only 28.6% patients developed severe disease. Increased Neutrophil to Lymphocyte Ratio (NLR), D-dimer levels, and radiological evidence of pneumonia in chest radiology were witnessed in both groups. Inflammatory markers between the vaccinated and unvaccinated groups did not show any statistical significance (p>0.05). A total of 12 (6%) patients died, out of which five were vaccinated (p=0.6). Conclusion: Vaccination is found to be protective in terms of disease severity and mortality. Vaccination of all individuals is recommended to curb the wrath of the virus.
ABSTRACT
Background: The second wave of the COVID-19 pandemic created a havoc everywhere, especially in developing countries. There was a dearth of hospital beds, oxygen supply and healthcare personnel. The overpopulation and improper implementation of containment strategies led to prevalence of a no. of mutated strains in India;B.1.351, B.1.1.7, Brazilian strain P.1 and double mutant strain B.1.617 to name a few. These strains were responsible for high morbidity and mortality especially in young individuals. Aims and Objectives: In this study, we tried to determine the various factors associated with mortality in COVID-19 patients in a tertiary care COVID hospital during the second wave of the pandemic. Results: The hospital recorded a total of 555 deaths with a male to female ratio of 2.05:1. The mean age of these patients was 57.41±15.19 yrs. The mean duration of hospital stay was 8.39±7 days. Diabetes mellitus and hypertension were the commonest co-morbidities reported in 142 (25.6%) and 106 (19.1%) cases respectively. Inflammatory parameters were markedly raised in these patients;the mean CRP was 189.58±117.64 mg/ml while the mean d-dimer was4.7965±3.5969 ng/ml. There was a significant correlation when comparing the lymphocyte count between patients with and without co-morbidities (p=0.000). The mean neutrophil to leukocyte ratio (NLR) was 19.26± 13.93. Conclusion: The second wave of COVID-19 has affected people with a comparatively lower age. The inflammatory markers still play an important role in depicting the severity and outcome of the disease.
ABSTRACT
Introduction Toward the end of 2019, a novel coronavirus was identified as the causative organism of a cluster of pneumonia cases in Wuhan, China, spreading rapidly resulting in an epidemic throughout China, followed by a global pandemic. The initial radiological findings of coronavirus disease 2019 (COVID-19) pneumonia at the early stage on a computed tomography (CT) scan include multiple small patchy shadows and interstitial inflammation, predominantly distributed in the peripheral one-third of the lungs. Gradually, it develops into multiple ground glass opacities and infiltrates in the lungs. Furthermore, pulmonary consolidation is observed, but pleural effusion is rare. Objective From time of presentation to complete recovery, CT scans show significant morphological changes in the lesions, but very few literatures have reported cavitary lesion in the lungs. We present the case of a 64-year-old patient with COVID-19 pneumonia who had typical manifestations of the disease on a CT scan along with constantly changing small cavity in the lung. Discussion Delayed cavitation is a rarely described radiological manifestation of COVID-19. Atypical presentations of COVID-19 raise possibility of other infections or additional diagnoses. Bacterial and fungal infection should be excluded, as well as cavity-causing organisms. Although the proper mechanism of cavitation in COVID-19 pneumonia is not known, it may be due to intra- alveolar hemorrhage, diffuse alveolar damage, and necrosis of parenchymal cells based on findings of autopsy reports. Early and late complications associated with COVID-19 are yet to be defined. Conclusion Common causes of cavitary lesions must be investigated properly in all patients. Most cases are self-limited hence managed conservatively. The clinical spectrum of disease due to COVID-19 continues to evolve. Physicians must be aware of evolving radiological findings of COVID-19 and must conduct regular follow-up of convalescent patients with COVID-19 to ensure complete recovery.
ABSTRACT
Introduction More than 80 million people have been infected with coronavirus disease 2019 (COVID-19) infection worldwide till date with more than 17,00000 fatalities. Although COVID-19 commonly affects respiratory system in the form of cough and dyspnea, a neurotropic presentation has been described in one-third of patients. Objective We report an atypical case of COVID-19 with mild symptoms who presented to our hospital with features suggestive of severe Guillain-Barre syndrome (GBS). Discussion The mechanisms by which severe acute respiratory syndrome coronavirus 2 causes neurologic damage are multifactorial, including direct damage to specific receptors, cytokine-mediated injury, secondary hypoxia, and retrograde travel along nerve fibers. The pathogenesis of GBS secondary to COVID-19 is not yet well understood. It is hypothesized that viral illnesses-related GBS could be mediated due to autoantibodies or direct neurotoxic effects of viruses. Conclusion In this ongoing era of pandemic, it is very important for the clinicians to be aware of association of GBS with COVID-19, as early diagnosis and treatment of this complication could have gratifying results. It is also very important to differentiate GBS from critical illness neuropathy and respiratory distress secondary to COVID-19 itself, as treatment to the above conditions is quite different and inability to correctly diagnose could lead to significant increase in morbidity and mortality.