Adhesive Capsulitis After COVID-19 Vaccination: A Case Series.

ABSTRACT: Of the many bizarre complications of administration of the COVID 19 vaccine, adhesive capsulitis is almost unheard of, although shoulder injury related to vaccine administration, which by definition has symptom onset within 48 hrs and is caused by faulty injection technique, has been rarely reported. Nine cases of adhesive capsulitis, five males and four females with a mean age of 48.7 ± 12.7 yrs, presenting within 1 mo of intramuscular Covishield vaccine on the ipsilateral deltoid and fulfilling the standard UK FROST Multicenter Study diagnostic criteria are reported. The mean time interval from vaccination until symptom onset was 12.3 ± 3.1 days, and mean symptom duration was 9.4 ± 2.4 wks. Conventional treatment with nonsteroidal anti-inflammatory drugs, followed by intra-articular steroid injection coupled with suprascapular nerve steroid block, improved the pain score and range of movement in 8 wks. The exact pathogenesis remains an enigma, although mechanisms such as local spread via deltoid muscle microvasculature, nerves, or shoulder injury related to vaccine administration causing secondary adhesive capsulitis have been hypothesized. While adhesive capsulitis is a very common diagnosis in the physiatric outpatient setting, the possible association with Covishield vaccination, the Indian version of the Oxford AstraZeneca recombinant ChAdOx1 nCoV-19 vaccine, is almost absent in existing literature and hence likely to be missed by clinicians, which necessitates this report.

The Nicobarese tribes and their coastal fishing activities during the COVID-19 pandemic-related restrictions- preliminary findings.

We interviewed the Nicobarese tribal community (N = 95) of Car Nicobar Island situated in the Andaman and Nicobar archipelago, India to analyze the impact of COVID-19-related restrictions on their coastal fishing activities. Our surveys revealed a significant reduction (p < 0.001) in the average monthly income and fish catches during pre and post-COVID-19 scenarios. Constraints faced during the pandemic-related restrictions and the possible solutions to reinforce the fishing activities were highlighted for sustainable resource management in Car Nicobar Island.

Efficacy of intravenous vitamin C in management of moderate and severe COVID-19: A double blind randomized placebo controlled trial.

Aim: To study the efficacy of intravenous vitamin C in management of moderate and severe COVID-19. Objective: To determine the efficacy of intravenous vitamin C in reducing in-hospital mortality in moderate and severe cases of COVID-19. Design: Parallel, double-blinded randomized controlled trial with placebo. Ethical clearance was obtained from the institutional ethics committee, AIIMS Patna. The trial was registered with the Clinical Trials Registry - India (registration number- CTRI/2020/11/029230.). Setting: A tertiary care centre in Bihar, India. Participants: All patients above the age of 18 years both males and females, admitted in ICU with a diagnosis of moderate and severe COVID-19 (on the basis of a positive reverse transcriptase polymerase chain reaction (RT-PCR) report) at our facility during the study period (01/10/2020-31/12/2020) not having any of the exclusion criteria. Intervention: The patients in the intervention arm were given 1 gram (2 ampoules of 2 ml each containing 500 mg of vitamin C mixed in 100 ml normal saline) intravenous vitamin C 8 hourly for four days. The patients in the placebo arm received similar looking ampoules (2 ampoules of 2 ml sterile water for injection mixed in 100 ml normal saline) intravenously 8 hourly for four days. The rest of the treatment was given as per the standard operating procedure (SOP) of the institute with adjustments as per treating team's judgement. Outcome Measures: Primary outcome was reduction in in-hospital mortality. Secondary outcomes were improvement in qSOFA score, pO2/fiO2 ratio, fall in inflammatory markers, need for mechanical ventilation and vasopressors. Results: Regarding primary outcome, 10 (33.3%) patients died in intervention group compared to 13 (43.3%) in placebo. Worth noting from baseline characteristics is that 86.7% in intervention arm were of severe category compared to 66.7% severe category patients in placebo group. Though number of severe cases were more in intervention arm there has been comparatively less mortality in this group. Regarding secondary outcomes, amongst 30 patients in vitamin C group, 11 (36.7%) required invasive mechanical ventilation compared to 14 (46.7%) out of 30 in placebo group but the difference was not statistically significant. Although there were a greater number of moderate cases in placebo group, invasive ventilation requirement (and NIV requirement) was more in this group, thus it could be considered that vitamin C might have a role in reducing the severity of disease. The need for vasopressor therapy was higher in intervention arm 33.3% compared to 26.7% in placebo but not significant statistically. The secondary outcomes of the study such as improvement in organ failure score (qSOFA Score), fall in level of inflammatory markers, improvement in respiratory index (pO2/fiO2 ratio), need for mechanical ventilation and need for vasopressors also shown encouraging results but not up to the statistically significant level due to moderate dosage of the drug and small sample size. Conclusion: In the current study, by the observations and results of the double-blind placebo controlled randomised trial, we concluded that as the primary outcome of the study, there was reduction in In-hospital mortality and need for mechanical ventilation in the vitamin C intervention group compared to placebo, although these results did not reach statistical significance due to small sample size and use of moderate dose of IV vitamin C. The secondary outcomes of the study such as improvement in organ failure score (qSOFA Score), fall in level of inflammatory markers, improvement in respiratory index (pO2/fiO2 ratio), need for mechanical ventilation and need for vasopressors also shown encouraging results but not up to the statistically significant level due to moderate dosage of the drug and small sample size. In summary, high dose of intravenous vitamin C may reduce inflammatory reaction, improve oxygen support status, and reduce mortality in COVID-19 patients, without adverse events. High dose intravenous vitamin C may be a promising therapy for patients of moderate to severe COVID-19.

Factors Associated With Persistence of Dyspnea and Change in Health-Related Quality of Life in Patients With COVID-19 After Discharge.

Introduction Coronavirus disease 2019 (COVID-19) is a deadly virus affecting multiple organ systems, predominantly the respiratory system. Dyspnea along with the deterioration of health-related quality of life (HRQoL) is common in COVID-19 patients discharged from a dedicated Coronavirus disease (COVID) hospital. Very few studies in India used HRQoL for the assessment of COVID-19 patients after discharge. Our article aims to assess the factors associated with the persistence of dyspnea and HRQoL in discharged patients of COVID-19. Methods A total of 48 patients were included in this prospective observational study. Ethical approval from Institutional Ethics Committee was obtained before the enrolment of patients. Patients having dyspnea at exertion and during discharge were selected for this study. Modified Medical Research Council (mMRC) scale and modified Borg scale were used for assessing dyspnea on activity, and Saint George's Respiratory Questionnaire (SGRQ) was used to assess HRQoL. Data were collected on the day of discharge (D0) and after 60 days (D60) post-discharge. The significance of changes in parameters from D0 to D60 was evaluated by paired t-test. Results The mean mMRC, modified Borg, and SGRQ scores at D0 were 2.38±0.98, 3.15±2.12, and 45.36±27.32, respectively, which were improved to 0.94±0.86, 0.94±1.27, and 19.22±18.96 at D60. Age showed significant positive correlations with initial modified Borg (r=0.292, p=0.044) and SGRQ (r=0.332, p=0.021) scores. Body mass index showed significant positive correlations with initial mMRC (r=0.352, p=0.014) and SGRQ (r=0.419, p=0.003) scores. Conclusion Our study showed that on discharge, many COVID patients have impaired HRQoL. Many of them also have dyspnea on exertion. With the early institution of standard pulmonary rehabilitation protocol, symptoms and HRQoL improves rapidly in a month. Different influencing factors were identified. Long-term follow-up with a bigger sample size is needed to formulate a management strategy for these patients.

Rehabilitation in Coronavirus Disease 2019 positive post-partum haemolysis, elevated liver enzymes and low platelet count syndrome

Haemolysis, elevated liver enzymes and low platelet count (HELLP) syndrome is a rare condition associated with cerebrovascular accidents. It usually happens in the third trimester, although it can also present in the early weeks of pregnancy or the postpartum period. A 24-year-old female presented with 39 weeks of gestation. After 2 days of delivery, she developed generalised convulsions and following that she had burst abdomen with sepsis. She was diagnosed with a case of HELLP syndrome. After that she became coronavirus disease 2019 (COVID-19) positive and was shifted to a COVID-intensive care unit (ICU) where she was provided ventilator support. After 3 months of ICU stay, she was shifted to the rehabilitation unit. In the meantime, she had an episode of stroke with associated quadriparesis, impaired cognition, loss of vision, dysphagia and bladder-bowel involvement. Rehabilitation outcome was partially successful in her case. Post-partum HELLP syndrome associated with COVID-19 can develop severe complications. Medical management combined with goal-oriented customised rehabilitation can lead to a better outcome.

COMMENT: Covid-19: Catalyst for a comprehensive law to combat potential pandemics in India.

Despite the relative decline in communicable diseases, India witnesses hundreds of outbreaks every year. Including the current Covid-19 pandemic, India has suffered through several major pandemics and large-scale epidemics since 1900s. However, the response to most of the epidemics has been inadequate. The Epidemic Diseases Act, enacted in 1897 (EDA 1897), has been in action since and is based on the science and the socio-political environment of the country in the nineteenth century. India has several legal mechanisms to help contain and control the spread of epidemics, but on different platforms. There has been a paradigm shift in the socio-political milieu as well as scientific advancements in the prevention and control of epidemics. The century-old EDA 1897 has not been effective in containing and controlling such epidemics/pandemics, as has been witnessed during the ongoing Covid-19 pandemic. Hence, it needs to be revised to define an appropriate structural scalar chain, provide clear-cut and unambiguous terms/definitions and guidelines, delineate ethics and human rights, determine the duties and responsibilities of the affected population/community, determine the role of the private health sector, and provide for appropriate punitive measures to deter repeated violations.

Sero-epidemiological survey of SARS-Cov2 in urban slums of a capital city: A cross- sectional study.

Introduction: Slums are the most vulnerable settlements for COVID-19 infection due to overcrowding and unsanitary conditions. Thus, this study was undertaken to determine the level of seroprevalence for SARS-CoV-2 infection among slum dwellers. Material and Methods: A community-based cross-sectional seroepidemiological survey was conducted at several slums of Patna over four weeks, that is, January 20-February 20, 2021. A total of 650 participants were recruited in the study by applying a two-stage random sampling technique. Results: Seroprevalence for SARS-CoV-2-specific IgG antibody was found to be 31.5% (95% Confidence Interval (CI): 27.9-35.1). The seropositivity prevalence was found to be statistically higher among participants belonging to the age group of 18-30 years (41.1%), male gender (67.9%), high-risk occupation (70%), below poverty line (BPL) economic status (62.1%), and residing in a hut (51.2%) and kutcha house (42.4%). Further, 262 participants reported having COVID-like symptoms in the preceding 1 month of the survey, which was found to be significantly associated with the seropositivity status. Conclusion: The finding of the study reflects that a moderate seroprevalence level of COVID-19 infection was acquired in the slum settings of Bihar. Unchecked spread in these informal communities will pose a serious threat to the rest of the bigger sections of urban populations. This indirectly calls for early intervention in the form of preference in the roadmap of COVID-19 vaccination.

Investigation of an acute surge of COVID-19 associated mucormycosis (CAM) cases reported to a tertiary health care institution in Bihar, India.

Introduction: Acute surge in coronavirus disease-2019 (COVID)-associated mucormycosis (CAM) cases was reported during mid-May 2021, which was later declared an epidemic in various states of India including Bihar. Objective: We carried out a rapid investigation of CAM cases to describe the epidemiological and clinical profiles and find plausible predictors to guide the initiation of public health actions. Methods: A team of public health specialists contacted all the CAM cases reported to our hospital to collect relevant information using a case-investigation-form. In addition, the team visited the Flu Clinic and Ear, Nose, and Throat (ENT) outpatient department (OPD) to capture CAM cases on daily basis during the period of the acute surge of CAM cases. Results: About 88% of 130 CAM cases reported during the period of the acute surge were in the advanced stage of mucormycosis. The majority of the CAM cases were younger (less than 60 years) [76.2%], diabetics [65.4%], un-vaccinated [86.9%], and had used steroids for management of COVID-19 [64.6%]. Other findings of public health importance were summarized and possible public health actions were recommended for the prevention of outbreaks in future. Conclusion: Optimum management of diabetes including screening for each COVID case, rational use of steroids only when necessary, strict adherence to COVID appropriate behavior by health professionals as well as the public, increasing COVID vaccine coverage, CAM awareness, and setting up a CAM surveillance mechanism may be the key to prevent and control CAM outbreaks in future.

Clinico-Epidemiological Profile of Breakthrough COVID-19 Infection among Vaccinated Beneficiaries from a COVID-19 Vaccination Centre in Bihar, India.

BACKGROUND: When the whole world is fighting in an unprecedented pace against COVID-19 pandemic, the breakthrough COVID infections poise to dampen the rapid control of the same. We carried out this project with two objectives; first, to estimate the proportion of breakthrough COVID-19 infection among completely vaccinated individuals and second, to study the clinico-epidemiological profile of breakthrough COVID-19 infections among them. METHODS: This cross-sectional analytical study was conducted among 2703 fully vaccinated individuals from AIIMS, Patna COVID Vaccination Centre (CVC), Bihar, India. The participants were selected randomly using a systematic sampling technique from the list of beneficiaries maintained at the CVC. Telephonic interviews were made to collect the information by trained data collectors. RESULTS: A total of 274 fully vaccinated beneficiaries [10.1% (95% CI: 9.1%, 11.4%)] were diagnosed with breakthrough COVID-19 infection. The infections were more among males (10.4%) and the individuals aged ≤29 years (12.5%). The beneficiary categories, the healthcare-worker and the frontline-worker, were identified as predictors of the breakthrough COVID infections. Only one in three participants had adopted adequate COVID appropriate behaviour following the full vaccination. The majority of the breakthrough infections occurred during the second wave of COVID-19. The majority of the individuals with breakthrough infections were asymptomatic and no death was reported among them. CONCLUSION: One in every ten fully vaccinated individuals can get the breakthrough COVID infections. The healthcare-worker and the frontline-worker had independent risk of getting the breakthrough infections. Very few with breakthrough infections were serious and no death was reported among them.

Impact of Lockdown due to COVID-19 on lifestyle and diet pattern of college students of Eastern India: A cross-sectional survey.

Background: The emergence of the COVID-19 pandemic and lockdown measures to confine it has disrupted the routine of the public. The impact of such long-term confinements on the lifestyle and diet of students are not known and hence this study was designed to assess the impact of lockdown due to the COVID-19 pandemic on the lifestyle and diet of university students. Methods: An online cross-sectional survey among 622 university students across various educational institutes of east India using a pre-designed questionnaire about lifestyle-diet before and during the lockdown. Results were tabulated and statistical tests like Paired t-test, Wilcoxon Rank sign test, and Mc-Nemar tests were applied and overall significance was attributed to P<0.05. Results: During the lockdown a total of 2.4% (95% CI: 1.4-3.8%) decrease in prevalence of tobacco use, 8.7% (95% CI: 6.6-11%) decrease in physical activity and a 0.8 hour (95% CI: 0.6-0.9 hour) increase in the mean sleep duration was observed. There was a significant increase in use of fresh fruits consumption [Median(IQR)-before:2(1-5);during:3(1-5) days] and a decrease in meat-poultry[Median(IQR)-before: 2(0-3);during: 1(0-3)days] and junk food[Median(IQR)-before:1(0-2);during:0(0-2)days] consumption during the lockdown. Conclusion: A significant proportion of changes in lifestyle and frequency of consumption of certain food items in the dietary pattern during the lockdown.

Assessment of depression, anxiety and stress experienced by health care and allied workers involved in SARS-CoV2 pandemic.

Introduction: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) causing coronavirus disease 2019 (COVID-19) has led to a global health crisis. Health workforce has been working vigorously in COVID-19 management. So, we have planned this study with an aim to assess the psychological profile of healthcare and allied workers involved in SARS-CoV2 pandemic and to look for associated factors. Methodology: A cross-sectional observational study was planned at All India Institute of Medical Sciences, Patna. Study population comprised of Health care workers and allied health care workers involved in COVID-19 management. Results: Data from 254 study participants have been included in the study. The prevalence of severe and extremely severe depression among study participants was 8.3 and 3.1 percent. Severe and extremely severe anxiety prevalence was found to be 9.4 and 13.8 percent. The prevalence of severe and extremely severe stress was 2.4 and 2.4 percent each. Education till post-graduation, unmarried, occupation of doctor, Comorbidity of headache and occurrence of influenza-like illness in last 3 months had a statistically significant association with high depression score. With high Anxiety score and high-stress score statistically significant association was seen in education till postgraduation, unmarried, occupation of doctor, duration of 1 COVID-19 duty of ≥8 hours. Conclusion: The study highlights high psychological comorbidities in the form of depression, anxiety and stress among health care workers and allied health care workers working in COVID-19 pandemic. Prevalence of psychological morbidity is higher among doctors compared to nurses and allied health workers. COVID-19 duty of ≥8 hours have been found to be hampering mental health.

Generalized anxiety and sleep quality among health care professionals during the COVID-19 pandemic: a cross-sectional study from a tertiary healthcare institution in Eastern India.

Objectives: With the emergence of the coronavirus disease 2019 (COVID-19) pandemic, healthcare professionals (HCPs) have experienced high levels of stress and anxiety because of the high risk of infection for themselves and their families. This has led to acute sleep problems for HCP. This study was designed to assess the anxiety and sleep quality of HCPs during the COVID-19 pandemic. METHODS: This cross-sectional study analyzed 370 HCPs employed at All India Institute of Medical Sciences Patna over 3 months, using the standard Generalized Anxiety Disorder 7-item scale (GAD-7) for suspected GAD and the Pittsburgh Sleep Quality Index for sleep quality. Results were tabulated and multivariable binomial logistic regression analysis was done to determine the predictors of poor sleep. Significance was attributed to p<0.05. RESULTS: Of the 370 HCPs screened, 52 (14.1%; 95% confidence interval [CI], 10.8%-18.1%) were found to have GAD and 195 (52.7%; 95% CI, 47.5%-57.9%) were found to be poor sleepers. The presence of any addictive habit (adjusted odds ratio [AOR], 1.833; 95% CI, 1.12-2.8), unprotected contact with COVID-19 cases (AOR, 1.902; 95% CI, 1.1-3.3), and the presence of GAD (AOR, 5.57; 95% CI, 2.5-12.4) were found to be predictors of poor sleep quality among HCPs. Conclusion: A significant proportion of HCPs were found to have suspected GAD and were poor sleepers. This highlights the need for measures to confront this problem.

Pattern of Tobacco Use and Perceived Risk of COVID-19 Following Tobacco Use among the COVID-19 Patients of a Tertiary Health Care Institution in Eastern India.

BACKGROUND: COVID-19 presented an unprecedented situation in which behavioural factors including tobacco use were believed to increase the risk of morbidity and mortality. The objective of the present study was to find the tobacco use pattern among the COVID-19 patients and the perceived risk of developing severe COVID-19 following tobacco use. METHODS: This hospital-based, cross-sectional, analytical study was conducted among 300 COVID-19 patients at the All India Institute of Medical Sciences (AIIMS), Patna, India, during November and December 2020 using a semi-structured, pretested questionnaire. Descriptive and univariate analyses were performed using statistical software and the results were presented as proportion and percentage. FINDINGS: About 27% and 16% of the COVID-19 patients were ever and current tobacco users, respectively. Quit attempts were found to have increased during the COVID-19 pandemic. A majority (65%) of current tobacco users had reduced their amount of tobacco use. Nearly 2 in every 3 patients perceived high risk of developing severe COVID-19 following tobacco use. Perceived risk was significantly higher among tobacco non-users, patients who were aware of the ill health effects of tobacco use, and patients who had noticed anti-tobacco messages or had been advised to quit tobacco. Among the current tobacco users, a significantly higher proportion of patients who perceived high risk of developing severe COVID-19 following tobacco use had made quit attempts or had reduced tobacco consumption during the pandemic (76.7% vs. 40%; P = 0.032). CONCLUSION: A high proportion of COVID-19 patients believed that tobacco use aggravated the COVID-19 condition. Increased quit attempts and reduction in tobacco consumption during this pandemic is a positive sign for tobacco control.

Current Challenges for the Effective Management of the COVID-19 Pandemic.

INTRODUCTION: Within a short period, the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) spread all over the globe and became the first pandemic of the present century. Early diagnostic tools and effective drugs are urgently needed to effectively manage the COVID-19 pandemic. Based on current literature, we provide recent updates on SARS-CoV-2 biology, available diagnostic methods, and therapeutic options for the management of COVID-19 pandemic. METHODS: A literature survey was done using Google and PubMed and Web of Science to summarize the current updates on this topic. RESULTS: Current coronavirus diagnostic tests are reverse transcription polymerase chain reaction (RT-PCR), real-time RT-PCR (qRT-PCR), and reverse transcription loop-mediated isothermal amplification (RT-LAMP) which detects the presence of specific genome sequence of virus. Existing antiviral drugs or new therapeutic options such as neutralizing antibody or plasma therapy are mostly used to restrict the virus growth with a limited success. CONCLUSION: As there is no specific treatment or vaccine available to limit the infection of SARS-CoV-2, we need to rely on the existing way to limit the disease. The first priority to fight COVID-19 is development of early diagnostic tools so that infected persons can be identified and further viral transmission can be blocked. Evaluation of existing drugs or identification of new therapeutic entities becomes the major challenge to deal with the present pandemic.

Radiological Lung Sequelae of Severe COVID-19: A Retrospective Observational Study From a Dedicated COVID Centre of Eastern India.

BACKGROUND: The pulmonary sequelae of severe COVID-19 infection are yet to be fully defined. The authors undertook this study to find out the proportion of severe COVID-19 patients having fibrosis-like lung sequelae during a medium-term follow-up period. MATERIALS AND METHODS: This was a retrospective observational study from a dedicated COVID centre of Eastern India. Severe COVID-19 patients who had undergone chest computerized tomography (CT) during the acute phase of illness and at least one follow-up CT with a gap of minimum two months between the two scans were included in the study. RESULT: A total of 39 patients who had recovered from severe COVID-19 pneumonia and presented to the pulmonary medicine OPD in the months of July and August 2021 were included. Patients with pre-existing lung disease (n-4), mild to moderate (n-11), and due to unavailability of CT scan (n-2) were excluded. A total of 22 patients (thirteen males, nine females) were thus included for analysis. Follow-up scans were performed with a mean of 2.5 months after the onset of the disease. Out of 22 patients, only one patient's follow-up scan was normal. Predominant fibrotic-like features were present in six (27.2%) patients, though some evidence of fibrosis-like changes were seen in 20 out of 22 (90.9%) patients. The remaining 15 (68.2%) patients with abnormal scans had predominant non-fibrotic changes like ground-glass opacities (GGOs), consolidation, cavity, or nodule. The most common presenting symptoms at the follow-up examination were dyspnoea (81.8%), cough (54.1%) followed by fatigue in 40.9% of patients. CONCLUSION: This study concluded that most of the severe COVID-19 patients have some residual radiological findings during medium-term follow-up. Fibrotic-like lesions are present in almost all patients but most of them get resolved with time. True fibrotic features like honeycombing are rarely seen as residual lung sequelae.

Post coronavirus disease-2019 vaccination Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating disorder of the peripheral nerve. Different variants of GBS can produce a wide array of symptoms among which motor weakness, areflexia without bladder-bowel involvement are commonly encountered. ChAdOx1 nCoV-19 is a recombinant Corona Virus Vaccine and it is incorporated into India's coronavirus disease-2019 (COVID-19) vaccination program. Few rare instances of serious neurological complications have been reported following COVID-19 vaccination. Our case received 2 dose of COVID-19 vaccine. After receiving 1st dose he had rapid onset of ascending paralysis without any sensory and bladder bowel involvement. He received Intra Venous Immuno Globulin and Injection prednisolone for 5 days. Following that his lower limb weakness resolved rapidly but there was no improvement in upper limb weakness. Nerve conduction study showed demyelinating etiology and along with clinical features, it was appeared to be a case of GBS. However, more evidence is needed before establishing the causal relationship between COVID-19 vaccines and GBS.

Effectiveness of COVID-19 vaccine in preventing infection and disease severity: a case-control study from an Eastern State of India.

Effectiveness of corona virus disease-19 (COVID-19) vaccines used in India is unexplored and need to be substantiated. The present case-control study was planned to elicit the effectiveness of COVID-19 vaccines in preventing infection and disease severity in the general population of Bihar, India. This case-control study was conducted among people aged ≥45 years during April to June 2021. The cases were the COVID-19 patients admitted or visited All India Institute of Medical Sciences (AIIMS), Patna, Bihar, India, and were contacted directly. The controls were the individuals tested negative for severe acute respiratory syndrome coronavirus-2 (SARS CoV-2) at the Virology laboratory, AIIMS-Patna and contacted telephonically for collection of relevant information. The vaccine effectiveness (VE) was calculated by using the formula (VE = 1 - odds ratio). The adjusted VE for partial and full vaccination were estimated to be 52.0% (95% confidence interval (CI) 39.0-63.0%) and 83.0% (95% CI 73.0-89.0%) respectively for preventing SARS CoV-2 infection. The sub-group analyses of the cases have shown that the length of hospital stays (LOS) (partially vaccinated: 9 days vs. unvaccinated: 12 days; P = 0.028) and the severity of the disease (fully vaccinated: 30.3% vs. partially vaccinated: 51.3% and unvaccinated: 54.1%; P = 0.035) were significantly low among vaccinated compared to unvaccinated individuals. To conclude, four out of every five fully vaccinated individuals are estimated to be protected from contracting SARS CoV-2 infection. Vaccination lowered LOS and chances of development of severe disease.

Clinical and Laboratory Predictors of Mortality in COVID-19 Infection: A Retrospective Observational Study in a Tertiary Care Hospital of Eastern India.

Introduction COVID-19 is associated with huge morbidity and mortality in India. Identification of factors associated with mortality would make a difference in the management of COVID-19 infection-related illness. Objective To assess clinical & laboratory parameters associated with adverse outcomes among 984 patients with COVID-19 infection admitted to a tertiary care hospital in eastern India. Materials and methods All patients with real-time polymerase chain reaction (RTPCR) or rapid antigen positive for COVID-19 admitted at our All India Institute of Medical Sciences (AIIMS) Patna between 1st July to 30th Aug 2020 were included for analysis. Statistical analysis was performed using Stata, version 10 (Stata Corp, College Station, USA). Four subgroup regression models have been analyzed to predict the odds of death. Results A total of 984 COVID-19 cases admitted to our hospital during the given period were analyzed. Out of 984 cases, 762 (77.44%) were males and 222 (22.56%) females. The overall case-fatality rate among admitted cases was 254 (25.81%) [males (26.64%) and females (22.96%)]. The final logistic regression model showed that patients presenting with severe COVID-19 disease (adjusted odds ratio [aOR]: 17.81), cough (aOR: 3.83), dyspnea (aOR:2.35), age 60-75 (aOR:1.47), age >75 years (aOR:3.97), presence of chronic kidney disease (CKD) (aOR:2.95), were found to be significantly associated with a high risk of mortality after controlling for the confounders (p<0.05). Among lab variable, total leukocyte count (TLC) (>10,000/mm3) (aOR: 1.74), neutrophil-lymphocyte ratio (NLR) (>3.3) (aOR:2.37), serum albumin (<3.4 g/dl) (aOR : 2.3), blood urea (>43 gm/dl) (aOR:3.72), ferritin (>322) (aOR:2.39), and D-dimer (>0.5) (aOR:5.58) were significantly associated with higher mortality (p<0.05) Conclusion Age 60 years plus, presence of CKD, and severe covid infection carried the highest risk of mortality. Lab markers such as raised TLC, ferritin, D-dimer, and low albumin were associated with worse outcomes in our subset of COVID-19-related illness.