Olfactory and Taste Dysfunction in Indian Population with COVID-19: A Study on 300 Patients.

The novel coronavirus disease 2019 is an ongoing pandemic and a global health emergency. Since the main portal of entry for the virus is the nose, olfactory and taste dysfunction have gained attention as important symptoms in COVID-19. The primary objectives are to assess the prevalence of olfactory and taste dysfunction in patients affected with COVID-19. And to determine whether anosmia and ageusia are early predictors of COVID-19. A prospective study was conducted on 300 patients who were laboratory diagnosed cases of COVID-19 admitted in tertiary care centre and a covid care centre. A written informed consent was taken. All patients underwent olfactory and taste examination and the details were noted in a case-record proforma. The prevalence of olfactory dysfunction in COVID-19 patients was 21% and that of taste dysfunction was 26.6%. Majority of the affected individuals were males and mainly of the younger age group. These symptoms lasted for a duration of 7-9 days and 97% of the patients showed complete recovery. Acute sudden onset olfactory and taste dysfunction seems to be a useful indicator for early diagnosis of patients thus helping in early isolation, timely management of the illness and controlling the spread of the disease.

Decreased Speech Comprehension and Increased Vocal Efforts Among Healthcare Providers Using N95 Mask.

AIM: N95 masks are recommended for the healthcare providers (HCPs) taking care of patients with coronavirus disease 2019. However, the use of these masks hampers communication. We aimed to evaluate the effect of N95 masks on speech comprehension among listeners and vocal efforts (VEs) of the HCPs. MATERIALS AND METHODS: This prospective study involved 50 HCPs. We used a single observer with normal hearing to assess the difficulty in comprehension, while VE was estimated in HCPs. The speech reception threshold (SRT), speech discrimination score (SDS), and VEs were evaluated initially without using N95 mask and then repeated with HCPs wearing N95 mask. RESULTS: The use of masks resulted in a statistically significant increase in mean SRT [4.25 (1.65) dB] and VE [2.6 (0.69)], with simultaneous decrease in mean SDS [19.2 (8.77)] (all p-values < 0.0001). Moreover, demographic parameters including age, sex, and profession were not associated with change in SRT, SDS, and VE (all p-values > 0.05). CONCLUSION: Though use of N95 masks protects the HCPs against the viral infection, it results in decreased speech comprehension and increased VEs. Moreover, these issues are universal among the HCPs and are applicable to the general public as well.

CT and MRI Findings of Invasive Mucormycosis in the Setting of COVID-19: Experience From a Single Center in India.

An increasing incidence of rhinoorbitocerebral mucormycosis (ROCM) among patients with COVID-19 has recently been reported in India. We report the imaging findings for 25 patients with COVID-19 and invasive ROCM at a single hospital in India. Findings included sinus wall erosions (n = 20), air within bony sinus structures (n = 11), and focal mucosal nonenhancement (n = 8). Orbital, vascular, and intracranial complications were also observed. Radiologists should recognize the increasing incidence of ROCM among patients with COVID-19 to facilitate early diagnosis.

Incidental chest computed tomography findings in asymptomatic Covid-19 patients. A multicentre Indian perspective.

In December 2019, an unprecedented outbreak of pneumonia of unknown etiology emerged called COVID-19. A vast number of people affected by this disease are asymptomatic and yet contagious with up to 79% of COVID-19 infections reportedly caused by undocumented infections. Surprisingly, these asymptomatic subjects are also known to quietly harbor pneumonia changes on CT scans. RT-PCR, the definitive test for COVID-19, maybe false negative in patients with COVID-19 pneumonia on CT. Incidental findings highly suspicious of COVID-19 pneumonia on CT chest of asymptomatic patients may increase as the community transmission of the virus rises and isolation restrictions are released. It is advisable to be aware of its appearances and the challenges associated with it.

Tocilizumab improves survival in severe COVID-19 pneumonia with persistent hypoxia: a retrospective cohort study with follow-up from Mumbai, India.

BACKGROUND: Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. METHOD: This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above (N = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. RESULTS: Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427-0.903, P 0.013) and higher oxygen saturation. CONCLUSION: Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.

Does CT help in reducing RT-PCR false negative rate for COVID-19?

BACKGROUND: Early detection is the key to contain the ongoing pandemic. The current gold standard to detect SARS CoV2 is RT-PCR. However, it has a high false negative rate and long turnaround time. PURPOSE: In view of the high sensitivity of CT in detection of lower respiratory tract pathologies, a study of 2581 patients comparing RT-PCR status with CT findings was undertaken to see if it augments the diagnostic performance. MATERIALS AND METHODS: A multi centre prospective study of consecutive cases was conducted. All CT studies suggestive of COVID 19 pneumonia were collated and evaluated independently by three Radiologists to confirm the imaging diagnosis of COVID-19 pneumonia. The RT-PCR values were retrospectively obtained, based on the RT-PCR values, CT studies were categorised into three subgroups, positive, negative and unknown. CT features from all three groups were compared to evaluate any communality or discordance. RESULTS: Out of the 2581 patients with positive CT findings for COVID pneumonia, 825 were females and 1,756 were males in a wide age group of 28-90 years. Predominant CT features observed in all the subgroups were Ground glass densities 94.8%, in mixed distribution (peripheral and central) (59.12%), posterior segments in 92% and multilobar involvement in 70.9%. The CT features across the three subgroups were statistically significant with a P value <0.001. CONCLUSION: There was a communality of CT findings regardless of RT-PCR status. In a pandemic setting ground glass densities in a subpleural, posterior and basal distribution are indicative of COVID 19. Thus CT chest in conjunction to RT PCR augments the diagnosis of COVID 19 pneumonia; utilization of CT chest may just be the missing link in closing this pandemic.

Where have all the diseases gone during the COVID-19 pandemic?

This article focuses on a marked drop in volumes in the lockdown period during the COVID-19 pandemic across all modalities X-ray, sonography, CT scan and MRI scans and compares the volumes of data between a private and public hospital in Mumbai. This trend has been witnessed globally also. Even with easing of lockdown this has not reflected in an increase in numbers. Imaging volumes of a 1900-bed public hospital and a 220-bed private hospital in Mumbai were collated for all modalities, i.e., X-ray, sonography, CT and MRI for the months January, February 2020- Prelockdown, March 2020 Peri-lockdown, April, May 2020- Lockdown, June Unlock 1.0, July Unlock 2.0. The imaging volumes during lockdown, Unlock, were compared with prelockdown values. It was initially felt that this was due to a fear of visiting hospitals that are considered hotbeds of SARS-CoV-2. However, the same status has persisted over the 2 months of lockdown and the 2 months of unlocking. What is the cause of this huge drop in imaging volumes?

Dermatomyositis during COVID-19 Pandemic (A Case Series): Is there a Cause Effect Relationship?

Viruses have been shown to modify the clinical picture of several autoimmune diseases, including type 1 diabetes, systemic lupus erythematosus (SLE), rheumatoid arthritis and multiple sclerosis. Viral infections have also been considered as a possible trigger for autoimmune disorders like myositis through myositis specific antibodies. Dermatomyositis is an acquired inflammatory myopathy which is relatively rare with incidence of 9.3 per 1 million persons. Usually we come across 1-2 patients of dermatomyositis per year, amongst 800-1000 new patients in our tertiary care rheumatology services. A surge in the incidence was noted this year during the months of April-August of 2020, the period coinciding with the occurrence of corona virus (COVID-19) pandemic in the city of Mumbai, the total number of cases encountered being five in a span of six months. The following case series includes five such cases with review of available literature on virus-triggered autoimmunity with special reference to SARS-CoV-2 and the challenges of immunosuppression during this pandemic.