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COVID-19 due to SARS-CoV-2 is a global pandemic that presents a serious challenge from many angles for healthcare professionals. The virus causes a potentially fatal disease that is easily transmitted among patients and caregivers, hence specific dead body care is required for such patients. Our study was conducted to identify knowledge, attitude, and practice regarding COVID-19 dead body care among hospital nursing personnel. A cross sectional survey-based study was performed involving 282 nurses who worked in COVID-19 units during data collection from July 2020 to September 2020. The online structured questionnaire was based on world health organization guidelines, institutional infection control protocols, and course material regarding emerging respiratory diseases including COVID-19. We found that work experience in the COVID-19 unit had a significant impact on knowledge and practice regarding COVID-19 dead body care. Similarly, we observed that training improved the knowledge and practice of nursing personnel regarding dead body care. Good knowledge, attitude, and practice were observed in experienced and trained nurses (p-value <0.005). No significant changes were observed with age, gender, and education qualification. Overall knowledge, attitude, and practice regarding COVID-19 dead body care were moderate to good. Adequate training among nurses should prevent the transmission of disease due to occupational exposure.Copyright © 2023, Science Publications. All rights reserved.
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Since the COVID-19 pandemic, the world began a frantic search for possible prophylactic options. We conducted a study to assess the role of hydroxychloroquine for COVID-19 prophylaxis in health-care workers. The study was a prospective cohort with four arms (high, medium, low dose, and control) of HCQ prophylaxis. Participants were grouped as per their opting for any one arm on a voluntary basis as per institute policy. The outcomes studied were COVID-19 positivity by RT-PCR and its severity assessed by WHO COVID-19 severity scale. Total 486 participants were enrolled, of which 29 (6%) opted for low dose, 2 (<1%) medium dose, and none for high dose HCQ while 455 (93.6%) were in the control arm. Of the 164 participants who underwent RT-PCR, 96 (58.2%) tested positive. Out of these 96 positive cases, 79 [82.3%] were ambulatory and were managed conservatively at home. Only 17.7% participants, all from the control group, required hospitalization with the mild-moderate disease. None of the participants had severe disease, COVID-related complications, ICU stay, or death. The difference in the outcome was statistically insignificant (p value >0.05). This single-centre study demonstrated that HCQ prophylaxis in healthcare workers does not cause a significant reduction in COVID-19 as well as mitigating its severity in those infected. At present, most of the trials have not shown any benefit. Though COVID-19 vaccines have reduced the need for prophylaxis, the search for a safe and reasonable chemoprophylaxis should continue until a large population of individuals gets vaccinated, especially in underdeveloped countries.
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Introduction: Scrub typhus is tropical zoonotic disease, commonly presented with multi organ dysfunction and high mortality rate in untreated patients. This study was done to identify clinical features commonly associated with scrub typhus during COVID pandemics, parameters associated with severe scrub typhus and mortality. Methods: This retrospective study was done in a tertiary care hospital with a total of 52 admitted scrub typhus positive patients in October 2020 to February 2022. Diagnosis was established by scrub IgM ELISA or Rapid antigen test. The clinical and laboratory data, duration of hospital stay and outcomes were collected. Common clinical and laboratory findings were of descriptive analysis. Factors associated with mortality were analysed using Chi-square test. Results: Fever was the most common presenting symptoms on admission (94.2%) followed by respiratory abnormalities (38.46%). Acute kidney injury was the most common organ failure on admission (67.3%), followed by acute liver injury (46.2%) and thrombocytopenia (32.7%). MODS was seen in 46.15%. Of the total, 30.8% were admitted in ICU. Mortality was seen in 7.7% of all patients. On Chi-square analysis, altered mental status and coagulopathy were associated with significant mortality with p value <0.05. Conclusion: Scrub typhus can manifest with potentially life-threatening complications such as acute kidney injury, acute liver injury, thrombocytopenia and MODS. The overall case-fatality rate was 7.7%, and presence of altered mental status and coagulopathy were associated with higher mortality. As per literature, COVID has changed few clinical profiles of scrub typhus compared to same center experience before.
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BACKGROUND: SARS-CoV-2 infection that led to the COVID-19 pandemic has changed human health and the economy globally. SARS CoV-2 is a type of Coronaviruses that has caused pneumonia and its complications with many deaths over the past two years. The use of hydroxychloroquine and chloroquine, accepted as generally safe for patients with autoimmune diseases or malaria, was attempted in many trials for COVID-19 treatment. Nigella sativa (NS) (black caraway, also known as black cumin, nigella or Kalonji) is an annual flowering plant of the Ranunculaceae family, chemically composed of the main constituent natural Thymoquinone (TQ) (30%- 48%) in forms of thymohydroquinone, dithymoquinone (Nigellone) is a native to wider regions, including parts of eastern Europe, west Asia, North of Africa and east of Myanmar. In this review, we explored the Randomized Controlled Trial, Controlled Trial, and Systematic review studies that support Nigella sativa Thymoquinone-targeted SARS-CoV-2 targeting. Therefore, A literature search was performed for publications published on the electronic databases (PubMed, Embase, Scopus, CNKI, and Google Scholar) for Nigella sativa, black seeds, Kalonji, coronavirus, SARS-CoV -2 and COVID-19. This review aimed to find relevant evidence of Nigella sativa preferences as a natural feasible remedy with no side effects in COVID-19. Studies reported the benefits of NS as beneficial, another appropriate remedy for patients with COVID-19. However, all studies have shown limitations, such as limiting clinical symptom outcomes due to regulations imposed by isolation policies and lack of adequate funding. Therefore, the evidence suggests that the chemical contents of NS are a safe and possible treatment for COVID-19 patients that helps to improve COVID-19 infection in patients with no side effects. CONCLUSION: Nigella sativa seeds were one of the well-documented herbal products. Three reviewed randomized controlled trials reported that NS reduced covid-19 risk and could improve immune function. It was also helpful in upper respiratory infections such as asthma and bronchitis, with one RCT showing that honey and NS significantly improved symptoms, viral clearance, and mortality of COVID-19 patients. This review concludes that NS has a positive barrier effect on people at risk of acquiring a COVID-19 infection.
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BACKGROUND AND AIMS: COVID19 vaccines are now accessible to all Indian citizens. Infection with COVID19, on the other hand, continues to spread continuously. Our study aimed to determine the number of persons who had COVID-19 infections despite receiving the recommended number of doses of the COVID 19 vaccination at AIIMS Rishikesh, a tertiary care facility in Uttarakhand, India. METHODS: We analysed meticulously preserved data regarding COVID-19 vaccination, COVID-19 infection, Clinical symptoms, and RT-PCR testing among all HCWs in our healthcare institution during period from 16 January 2021 to 30th June 2021.. RESULTS: During this period, 5273 (90.3%) HCWs received two doses of COVID-19 vaccine, while 566 (9.7%) received only one dose. 628 HCWs (10.8%) were BBV152 recipients and 5211(89.2%) AZD1222 (ChAdOx1-S) recipients. 423 HCWs (7.2%,confidence interval of 95% - 13.8, 22.0) reported COVID-19 infections.274(5.19% of total vaccinated HCWs ) breakthrough infections and 149 non-breakthrough COVID-19 infections reported in HCWs who had previously received a single dose of the COVID-19 vaccination. . CONCLUSION: Viral infections sepecially breakthrough infections following adequate vaccination are a cause for concern, but there is a lack of data on these infections in the actual world. Therefore, the primary focus of research should be on the emergence of illness in India following the completion of a full vaccine course.
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The need for an antiviral against COVID-19 prompted clinical trials worldwide and based on initial promising trends, remdesivir was widely used, including in India (compassionate use). Subsequent trials have been conflicting in their results and the utility of the drug has been widely debated. This is a record-based retrospective cohort study in a 1000-bedded government teaching hospital in North India. We reviewed the medical e-records of the COVID-19 positive patients admitted between June and November 2020. After assessing eligibility and making the necessary exclusions, 112 patients were retrospectively included in the remdesivir cohort and 85 in the standard care cohort. All the baseline characteristics of relevance and hospital admission details were collected. The following outcomes were assessed: All-cause mortality until discharge-stratified as per baseline oxygen support, age, gender, and co-morbidities;the proportion of severe and non-severe patients progressing to mechanical ventilation later on;and time to clinical recovery in survivors. We found a statistically significant association of higher mortality with the administration of remdesivir (odds ratio, OR 2.3, p-value 0.008) with a Cox regression hazard ratio of 1.590 (CI 0.944-2.679). The trend towards poorer outcomes in the remdesivir cohort persisted even after sub-stratification for age, gender, baseline severity (oxygen need), and co-morbidities but failed to reach statistical significance in most strata. Similarly, remdesivir administration was associated with higher rates of progression to mechanical ventilation amongst those severe and non-severe patients who were not on mechanical ventilation at admission (49% versus 15%, p-value <0.001, OR 5.2). This association was significant overall as well as for severe category patients when assessed separately (56% versus 26%, p-value 0.04, OR 3.1). There was, however, no difference in the days taken for clinical recovery between the two groups (13.23 days versus 12.8 days, p-value 0.77). Remdesivir administration was associated with overall worse clinical outcomes. This study contradicts the benefits shown with remdesivir in previous clinical trials done in controlled settings and highlights the challenges that newer therapies face in real-life hospital settings. There is a need to include diverse ethnic groups in the future clinical trials of the drug if to be used.
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Objectives: Anti-interleukin-6 monoclonal antibody, tocilizumab, has produced mixed results in clinical trials for effectiveness against coronavirus disease 2019 (COVID-19). We conducted a retrospective cohort study to compare outcomes at 28 days of a cohort of patients with severe COVID-19 treated with tocilizumab and standard care, with those receiving standard care only. Materials and Methods: In this record-based retrospective cohort study, patients hospitalised with COVID-19 were classified into non-severe and severe disease as per institutional protocol. One cohort received tocilizumab with standard care and the second cohort received only standard care. Few patients also received high-dose steroids as ‘pulse’ steroids on initial clinical deterioration. Data were collected for the treatment given including oxygen interface, steroids, antimicrobials, duration of hospital stay in survivors, requirement of mechanical ventilation, and day of intubation from symptom onset. The primary outcome was to compare the all-cause mortality between the two groups. The effect of pulse steroid therapy on all-cause mortality was studied in the secondary outcome. Results: There was statistically significant mortality in the tocilizumab cohort as compared to standard care alone (HR 2.43, 95% CI 1.54–3.89). The need for mechanical ventilation was more in the tocilizumab cohort (85% vs. 18%, P < 0.001). Tocilizumab cohort had a delay in the day of intubation by a mean of 2.29 days from the day of symptom onset (P < 0.05). Pulse steroid administration showed increased all-cause mortality (HR 1.94, 95% CI 1.18–3.20) and risk of mechanical ventilation. Conclusion: Tocilizumab cohort showed higher mortality and need for mechanical ventilation in our study which contrasts the result of a few previous trials. Our study warrants the need for future clinical trials on this subject to ensure better treatment strategies in upcoming COVID-19 waves.
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Introduction: Severe Acute Respiratory Syndrome-Coronavirus (SARS-CoV-2) infection, also known as Coronavirus Disease-2019 (COVID-19) is the global pandemic, first described in Wuhan city of China in December of 2019. Its diagnosis depends upon real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR). On chest Computerised Tomography (CT), it is almost similar to other viral pneumonia with extensive parenchymal involvement. Semiquantitative scores depicting this extensiveness of involvement could correlate with disease severity, laboratory parameters, mortality, like Intensive Care Unit (ICU) admission, requirements of ventilatory support and longer hospital stay. Aim: To define role of chest CT score in determining disease severity, predicting poor prognosis and mortality of COVID-19 pneumonia in short-term follow-up. Materials and Methods: This prospective study enrolled all admitted real-time RT-PCR positive patients for COVID-19 at All India Institute of Medical Sciences, Rishikesh, India between 15th April and 31st May 2021. All patients were assigned semiquantitative CT scores based on the extent of lung parenchymal involvement of 20 lung regions in chest CT. Clinical severity was matched with chest CT scoring and laboratory findings. Survival curves along with univariate and multivariate analysis were applied to define the role of CT scoring in predicting short term prognosis. Results: Total 547 subjects were included in the study, of which the chest CT score showed a significant association with clinical seventies (p-value <0.001). CT score were correlating significantly with increased serum C-Reactive Protein (CRP) (p-value=0.001) and D-dimer (p-value=0.01), and decreased lymphocyte count (p-value=0.003). A CT score >= 31 was found to be associated with an increased risk of mortality in both univariate and multivariate analysis {Odd Ratio (OR)=276.8;95% Confidence Interval (CI). 45.21-1695.43;p-value <0.001}. Conclusion: Chest CT score can be imaging measure of disease severity and predict a higher probability of mortality in score >= 31. It can also predict other defined variables of short-term prognosis. So, it has an advantage in speedy diagnostic workflow of symptomatic cases, timely referral of patients to higher centre, and better management of critical care resources.
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Pseudomonas is an uncommon cause of community-acquired pneumonia in immunocompetent patients. It is an opportunistic pathogen resulting in serious infection in patients who are hospitalised, mechanically ventilated, or immunocompromised. A 47-year-old male, forest worker without any co-morbidities presented with a history of chronic cough, fever, and shortness of breath complicated with pseudohemoptysis for 45 days. This patient was admitted and treated as a lower respiratory tract infection. Work-up for tuberculosis, invasive fungal balls, was negative but sputum culture revealed Pseudomonas aeruginosa growth. This case report demonstrates a rare Pseudomonas infection which can also cause chronic indolent respiratory illness in immunocompetent.
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The severe acute respiratory syndrome coronavirus (SARS-CoV-2) pandemic of 2019 forced widespread use of face coverings as a mandatory step towards reducing infection by the virus. The face mask acts as a barrier for transmission of infected aerosols among its user and surrounding people. This has propelled pace of research and development of face masks around the world. This short review is an effort to present advances in materials and designs used for face masks. Details available in scientific literature and company brochures have been accessed and the use of nanomaterials and designs for the new generation of face masks have been discussed. Special attention was given to the face masks based on electrospun nanofiber-based membrane materials due to their nano-sized pores, light weight, and high filtration efficiency; therefore, they are commercially viable and popular among various products available in the market. Incorporation of metal organic framework (MOFs) and graphene have opened avenues to more advanced/multi-functional, reusable, and high capacity adsorption filtration membranes. Rapid prototyping/3-dimensional (3-D) printing techniques have been applied to shorten the time of manufacture of face masks. This review is expected to be very helpful for engineers, scientists, and entrepreneurs working on development of novel face masks required in plenty during this pandemic period.
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With the number of new cases and mortality continuing to rise exponentially, India and the world are not out of the woods as yet. The benefit of the current nationwide lockdown is evident and clearly outweighs the inconveniences caused in day-to-day life. Measures still need to continue, and perhaps tightened in specific focus areas, until there is evidence of flattening the curve of infection rate. We should also focus on lateral thinking to find innovative ways to exit from the lockdown, when it becomes possible. The economy will need our combined effort to stimulate growth. How to effectively implement sliding scale lockdown strategies with partial opening of the manufacturing, financial, and agriculture sector while also enforcing curfew lockdown for hot spots will be a delicate balancing act. Utilization of this "Golden Time" to ramp up medical infrastructure for effective and swift management of the patients holds the key to face the forthcoming health sector challenges. We must try to shift the battlefields away from hospitals, who can easily become hotspots for COVID-19 positivity. The community needs to be taught how to practice social distancing and adequate hygiene measures in a more effective manner. It is time community leaders show that they need step up and take responsibility for their own health. May we all use our wisdom to choose the right path at this crossroad.
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On January 30th, 2020, the World Health Organization announced the COVID-19 outbreak as a Public Health Emergency of International Concern. In the view of this pandemic, early diagnosis is the mainstay for halting the disease progression. Quantitative real-time Reverse Transcriptase-Polymerase Chain Reaction (RT-qPCR) has been established as the cornerstone for the diagnosis of COVID-19. However, the significance of RT-qPCR positivity in asymptomatic cases with travel history, mass screening purposes, or close contact tracing remains debatable as their period of infectivity is unknown. We present a case series of 42 asymptomatic patients, who tested positive for COVID-19 and were subjected to hospitalization until they tested negative as per Government guidelines. Through our case series, we have tried to establish that RT-qPCR testing as a diagnostic criterion for asymptomatic patients with no known contact history can lead to increased psychological and economic burden on the Government, the patient as well as his family. It also overburdens the health care resources and therefore, raises the question about its necessity among this cohort of asymptomatic cases and thus the possible role of other methods in the diagnosis and isolation of such cases.
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Introduction: Following the pandemic, screening suspected individuals on a large scale is imperative to curtail the spread of the disease to a large extent. The walk-in kiosk is an ideal example of an innovation that is time and labour efficient and safe to use. Methodology and review of literature: Embase, Google Scholar, and PubMed were used to extract scholarly articles about the subject published worldwide. The Walk-in kiosk concept was an idea taken from the biosafety chamber used in advanced microbiology laboratories. Results: This ergonomic design enabled the HCW to perform better without bending forward or reaching out for the oropharyngeal or nasopharyngeal swabs. It avoids a great deal of inconvenience for both HCW and the patient.
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Coronavirus Disease 2019 (COVID-19) pandemic has stirred up chaos in the whole world. After prolonged lockdowns, finally, society is opening again for business and day-to-day life. Mass gatherings are undoubtedly again expected to start, but carry additional risks for transmission of the virus. We designed a concept model that was validated in about 1000 people gathering in a convocation ceremony at the beginning of the COVID-19 outbreak. A protocol was made, a risk assessment was done, and attendees followed-up. The emphasis on thermal screening, hand hygiene, physical distancing, open-air ventilation, refusing attendees having Influenza-Like Illnesses (ILI), and other preventive measures were the means to contain the potential transmission in an organised mass gathering of this magnitude. The dictum “prevention is better than cure” held amidst this outbreak. As a result of this well-structured mass gathering, the event was quite successfully conducted. Further event planning in the COVID-19 scenario or other outbreaks of similar infections must be managed in this way for the prevention of spread.
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The global COVID-19 pandemic has given us an opportunity to introspect. While it has also thrown up challenges that no one anticipated, it has also given birth to innovative solutions. One aspect is how face to face has been replaced with virtual. It is well known that virtual meeting platforms such as Zoom, Skype, Microsoft Teams, and JioMeet have become household names. As far as primary school students are concerned, lack of suitable hardware (laptop, tablet, and smartphone) or requirement for numerous devices per household to be shared by "working from home" parents and their kids, and internet connectivity (bandwidth, consistency, and frequent disconnection) have been some of the major challenges. Easy distractions (there have been several photographs doing the rounds on social media where students have been photographed fast asleep or playing games instead of concentrating on what the teacher is saying) as well as compromised attention span and comprehensibility issues have also been affecting effective online learning. The COVID-19 pandemic has led to unexpected challenges and unique solutions. The transition to the virtual teaching platform is no different. As our experience increases, we have come across an entire spectrum of distinct advantages and disadvantages. Deep introspection is vital to enhance the viability and usability of this virtual learning tool and we believe the points discussed in the table will encourage further discussions in this regard.