Upper Gastrointestinal Manifestations of SARS-CoV-2 Infection in the United States: A Population-Based Study

Introduction: Extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Infection are frequently reported and correlate with disease severity and mortality. In the last two years, we identified patients with a Systemized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of “COVID-19”. A comparison of the baseline characteristics and upper gastrointestinal conditions and symptoms of patients with and without COVID-19 infection COVID-19 patients (n, %) Non-COVID-19 patients (n, %) OR CI p-value Demographics Age: 18-65 23,030 (66%) 47,926,050 (68%) 0.92 0.90 to 0.94 < 0.0001 Age: >65 11,730 (34%) 21,254,620 (30%) 1.18 1.15 to 1.21 < 0.0001 Male 15,620 (45%) 31,412,530 (45%) 1.01 0.99 to 1.04 0.1954 Female 19,060 (55%) 38,452,220 (55%) 1.01 0.99 to 1.03 0.3521 Caucasian 16,680 (48%) 37,840,470 (54%) 0.79 0.78 to 0.81 < 0.0001 African American 8,440 (24%) 7,023,300 (10%) 2.9 2.83 to 2.97 < 0.0001 Upper GI Conditions and Symptoms Gastritis 800 (2%) 376,990 (0.5%) 4.38 4.08-4.70 < 0.0001 GERD 3,140 (9%) 1,142,660 (1.6%) 6.02 5.81-6.25 < 0.0001 Esophagitis 250 (0.7%) 132,790 (0.2%) 3.84 3.39-.35 < 0.0001 Duodenitis 110 (0.3%) 45,130 (0.01%) 4.95 4.11-5.97 < 0.0001 Upper GI bleed 160 (0.5%) 66,230 (0.1%) 4.91 4.21-.74 < 0.0001 Nausea and vomiting 740 (3%) 370,390 (0.5%) 4.12 3.83-4.43 < 0.0001 Abdominal pain 2,240 (7%) 1,286,290 (1.8%) 3.70 3.55-3.87 < 0.0001 Loss appetite 230 (0.7%) 143,250 (0.2%) 3.27 2.87-3.72 < 0.0001 Weight loss 350 (1%) 239,400 (0.3%) 2.98 2.69-3.31 < 0.0001 Dysphagia 760 (2%) 132,790 (0.2%) 11.84 11.01-12.72 < 0.0001 Univariate analysis used to calculate OR.

Secondary Cutaneous Mucormycosis Post-COVID-19: Case Series from a Tertiary Center.

Background: Mucormycosis is an angioinvasive mucorales fungal infection. Cutaneous type formed 10.5% of cases in India in precovid-19 era. Glucocorticoid-induced immunosuppression and hyperglycemia, reusable oxygen humidifiers in COVID-19 therapy, and preexisting uncontrolled diabetes mellitus contribute to post-COVID-19 mucormycosis. However, for post-COVID-19 cutaneous mucormycosis, sufficient data is not available. Aim: To study factors related to post-COVID-19 cutaneous mucormycosis. Methodology: Clinical and investigation details of six patients admitted in tertiary center with post-COVID-19 cutaneous mucormycosis. Results: Among six patients, three were males and three females; all in 45-60 years age group from districts under tertiary center. Site of eschar was face (four) and lips (two). All six were positive for COVID-19 10-12 days prior to admission for mucormycosis. All had intravenous steroids and supportive humidified oxygen therapy for minimum 1 week under COVID-19 treatment. They presented to emergency with ophthalmic/ENT complaints; subsequently, they developed cutaneous manifestations within 2-3 days. All six had diabetes mellitus, with above 400 mg/dL sugar levels at admission. Conclusion: This study's findings correlated with various studies across the country and elsewhere. Preexisting diabetes mellitus and steroid therapy for COVID-19 increase the risk of mucormycosis. Caution for early diagnosis, maintaining blood glucose levels, and judicious use of steroids for treatment of COVID-19 are indicated.

SARS-CoV-2 and Influenza Virus Co-Infection Cases Identified through ILI/SARI Sentinel Surveillance: A Pan-India Report.

SARS-CoV-2/influenza virus co-infection studies have focused on hospitalized patients who usually had grave sequelae. Here, we report SARS-CoV-2/influenza virus co-infection cases from both community and hospital settings reported through integrated ILI/SARI (Influenza Like Illness/Severe Acute Respiratory Infection) sentinel surveillance established by the Indian Council of Medical Research. We describe the disease progression and outcomes in these cases. Out of 13,467 samples tested from 4 July 2021-31 January 2022, only 5 (0.04%) were of SARS-CoV-2/influenza virus co-infection from 3 different sites in distinct geographic regions. Of these, three patients with extremes of age required hospital admission, but none required ICU admission or mechanical ventilation. No mortality was reported. The other two co-infection cases from community settings were managed at home. This is the first report on SARS-CoV-2/Influenza virus co-infection from community as well as hospital settings in India and shows that influenza viruses are circulating in the community even during COVID-19. The results emphasize the need for continuous surveillance for multiple respiratory pathogens for effective public health management of ILI/SARI cases in line with the WHO (World Health Organization) recommendations.

Impact of COVID-19 Pandemic on Post-Graduate Medical Education and Training in India: Lessons Learned and Opportunities Offered.

Hands-on or practice-based learning is the foundational objective of postgraduate teaching and training. A skilled and competent postgraduate resident is critical to the country's health needs and is more relevant in the ongoing COVID-19 pandemic. The postgraduate medical training in India is speciality-specific and based on a structured curriculum and syllabus to achieve precise educational goals and objectives. The impact of this pandemic on postgraduate medical education and training is controversial, challenging, unknown, and far-reaching. The exceptional contagious nature of the virus and country-wide lockdowns have tremendously decreased hospital visiting patients. Abolition of outpatient and inpatient services, disruptions in clinical postings, curtailment of elective operations and procedures have adversely affected the training of residents and fellowship students in India and abroad. Apart from this, research work, mentoring, academic conferences, and workshops that offer learning experiences to these residents have been cancelled or suspended, thus denying them a chance to achieve domain knowledge and enhance their skills. Although this pandemic has offered new learning modes like teleconsultation, videoconferencing, virtual simulations, digital podcasts, etc., how much actual knowledge transfer and skill gain will be achieved is unanswered. Despite this disruption, this pandemic has offered a golden opportunity to relook at the current PG resident education and training programme. The lessons learned from this adversity offer medical universities, medical educators, and regulatory authorities many opportunities to develop a novel and innovative curriculum that enables the current and future residents to achieve the necessary proficiency and competency.