Mental health of health care workers during the hour of crisis - A study from tertiary care hospital in North India.

Background and Aims: This cross-sectional study aimed to analyze the psychosocial, behavioral, and sleep impact of coronavirus disease-19 (COVID-19) pandemic on healthcare workers (HCWs) at a tertiary-care hospital in Northern India. Materials and Methods: An online questionnaire including three psychological scales - peritraumatic distress inventory (PDI), insomnia Severity Index (ISI), and Depression anxiety stress scale was circulated among the HCWs at a tertiary-care hospital in Northern India. Results: Three hundred and ninety-six HCWs (Mean age standard deviation: 34.8 [8.1%] years; 181 females) responded. Place of posting was active COVID area (27.2%), reserve active COVID team (23.2%), trained reserve pool (29.5%), and non-COVID areas (19.9%). More than half of all the respondents (51%) had abnormal PDI score (>14) with a propensity to develop posttraumatic stress disorder. Furthermore, there was a significantly higher prevalence of abnormal PDI scores in those involved in active COVID care units (74%) versus non-COVID care unit (24%, P = 0.001). More than 60% of all the respondents had abnormal ISI score suggesting significant insomnia. Stress was seen in 71% of all the respondents while 82% were anxious and 77% participants had depressive symptoms. Hence, the psychological morbidity among the HCWs was high. Conclusion: Our study found a much higher prevalence of peritraumatic distress, insomnia, anxiety, stress, and depression among the HCWs, more so in those working in COVID areas. Factors indigenous to Indian population in terms of psychological health must be studied and addressed to reduce this psychological morbidity since the battle with COVID is long.

Management of chronic respiratory diseases during viral pandemics: A concise review of guidance and recommendations.

Coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an acute respiratory disease that can lead to respiratory failure and death. Although anticipated that patients with chronic respiratory diseases would be at increased risk of SARS-CoV-2 infection and more severe presentations of COVID-19, it is striking that these diseases appear to be underrepresented in the comorbidities reported for patients with COVID-19. The first wave of COVID-19 has taught us important lessons concerning the enormous burden on the hospitals, shortage of beds, cross infections and transmissions, which we coped together. However, with the subsequent waves of COVID-19 or any other viral pandemic, to ensure that patients with respiratory illnesses receive adequate management for their diseases while minimizing their hospital visits for their own safety. Hence, we prepared an evidence-based summary to manage outpatients and inpatients suspected or diagnosed with COPD, asthma and ILD based on the experience of the first wave of COVID-19 and recommendations by expert societies and organizations.

Clinical profile, risk factors, and therapeutic outcome of cavitating fungal pneumonia coinfection in COVID-19 patients: A retrospective analysis.

Background An end to the novel coronavirus disease 2019 (COVID-19) pandemic appears to be a distant dream. To make matters worse, there has been an alarming upsurge in the incidence of cavitating invasive fungal pneumonia associated with COVID-19, reported from various parts of the world including India. Therefore, it remains important to identify the clinical profile, risk factors, and outcome of this group of patients.

Methods Out of 50 moderate to severe COVID-19 inpatients with thoracic computed tomographic (CT) evidence of lung cavitation, we retrospectively collected demographic and clinical data of those diagnosed as fungal pneumonia for further investigation. We observed these patients for a total of 60 days from identification of fungal pneumonia and determined the association between risk factors related to 30-day and 60-day mortality.

Results Of the 50 COVID-19 patients with cavitating lung lesions, 22 (44 %) were identified to have fungal pneumonia. Most of these patients (n=16, 72.7 %) were male, with a median (range) age of 56 (38-64) years. On chest CT imaging, the most frequent findings were multiple cavities (n=13, 59.1 %) and consolidation (n=14, 63.6 %). Mucormycosis (n=10, 45.5 %) followed by Aspergillus fumigatus (n=9, 40.9 %) were the common fungi identified. 30-day and 60-day mortality was seen in 12 (54.5 %) and 16 (72.7 %) patients, respectively. On subgroup analysis, high cumulative prednisolone dose was an independent risk factor associated with 30-day mortality (p=0.024).

Conclusion High cumulative prednisolone dose, baseline neutropenia, hypoalbuminemia, multiple cavities on CT chest, leukopenia, lymphopenia and raised inflammatory markers were associated with poor prognosis in severe COVID-19 patients with cavitating fungal pneumonia.

SARS-CoV-2 infection is associated with increased odds of insomnia, RLS and dream enactment behavior.

Background: Literature suggests that the COVID-19 pandemic has resulted in poor sleep quality, especially among the infected population. However, literature regarding the effect of COVID-19 pandemic and SARS-CoV-2 infection on occurrence of insomnia, restless legs syndrome and dream enactment behavior is either scarce or unavailable. Methods: This study was planned to assess the effect of SARS-CoV-2 infection on the occurrence of insomnia, restless legs syndrome (RLS) and dream enactment behavior (DEB). For this cross-sectional study, a questionnaire comprising of items related to demographic details, past medical history, and information related to SARS-CoV-2 infection was distributed through social media. Insomnia was diagnosed using clinical criteria. RLS, DEB, sleep quality, depression and anxiety were assessed using a validated questionnaire. Information regarding the use of hypnotic medications was also gathered. Results: Of the 1596 respondents, 37.2% reported disturbed sleep while insomnia was reported by 22.6% respondents. 27.3% of respondents reported RLS and 17.4% suffered DEB. The odds of insomnia were greater among males (OR = 1.27; 95% CI: 1.03-1.58; P < 0.02) and among those who had SARS-CoV-2 infection (OR = 1.76; 95% CI = 1.42-2.19; P < 0.001). Similarly, SARS-CoV-2 infection was also associated with increased odds of RLS (OR = 2.48; 95% CI = 1.98-3.11; P < 0.001) and DEB (OR = 1.58; 95%CI = 1.21-2.06; P < 0.001). Insomnia, RLS and DEB were more frequent among respondents who required oxygen therapy, those who experienced loss of taste and/or smell, depression and anxiety. Prevalence of insomnia, DEB and RLS was higher than said prevalence among respondents with no history of SARS-CoV-2 infection, but lower than that of those with positive history of SARS-CoV-2 infection. 5.3% of respondents reported taking hypnotic medications before infection, 7% during infection and 5.3% after infection. Conclusion: SARS-CoV-2-infection-related factors in association with environmental factors have increased the prevalence of insomnia, DEB and RLS among subjects having infection. SARS-CoV-2-associated immunological changes, hypoxia and neurotropism may play a role in occurrence of insomnia, DEB and RLS.

Post-COVID-19 Immune-Mediated Neurological Complications in Children: An Ambispective Study.

BACKGROUND: The neurological manifestation following a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is varied, and till now, only a few studies have reported the same. METHODS: We used retrospective data from May to July 2021 and prospective study data from August to September 2021, including that from children aged between one month and 18 years who presented to a tertiary care referral center with the neurological manifestation and had a history of coronavirus disease 2019 (COVID-19) infection or exposure and positive SARS-CoV-2 serology. The neuroradiological manifestations were further categorized as in a predesigned proforma. RESULTS: Case records of the 18 children who fulfilled the criteria were included in the study; among them, seven (38.8%) were male and 11 (61.1%) were female. Predominant presentation in our study group was status epilepticus (six of 18) and Guillain-Barré syndrome (five of 18). Other manifestations included stroke (two of 18), demyelinating syndromes (three of 18), and autoimmune encephalitis (two of 18). Most of the children had favorable outcomes except for one mortality in our cohort. CONCLUSIONS: Delayed complications following SARS-CoV-2 infection are seen in children. A temporal correlation was noted between the COVID-19 infection and the increasing number of neurological cases after the second wave. Steroids could be beneficial while treating such patients, especially in the presence of high inflammatory markers. Testing for SARS-CoV-2 serology during the pandemic can give a clue to the underlying etiology. Further multicentric studies are required to understand the varied neurological manifestations following SARS-CoV-2 infection in children.

COVID-19 in Children with West Syndrome: An Ambispective Study.

OBJECTIVES: To study the course of West syndrome (WS) and coronavirus disease-19 (COVID-19) in children with WS who contracted SARS-CoV-2 infection. METHODS: This ambispective study was conducted at a tertiary-care center in North India between December 2020 and August 2021 after approval from the Institute Ethics Committee. Five children with WS, positive for COVID-19 based on RT-PCR, fulfilled the inclusion criteria. RESULTS: One child with COVID-19 during the first wave was retrospectively included while four children (of the 70 children screened) were prospectively enrolled. The median age at onset of epileptic spasms was 7 mo (2 boys), and that at presentation with COVID-19 was 18.5 mo. Three had underlying acquired structural etiology. Three were in remission following standard therapy, while two had ongoing spasms at the time of COVID-19 illness. During the illness, two of those in remission continued to be in remission while one child had a relapse. The children with ongoing epileptic spasms had variable course [one had persistent spasms and other had transient cessation lasting 3 wk from day 2 of COVID-19 illness, but electroencephalography (on day 8 of COVID-19 illness) continued to show hypsarrhythmia]. Fever was the most typical symptom (and sometimes the only symptom) of COVID-19, with a duration ranging from 1-8 d. Two children had moderate COVID-19 illness requiring hospitalization, while the rest had a mild illness. All the affected children had complete recovery from COVID-19. CONCLUSION: The severity of COVID-19 illness in children with WS is often mild, while the subsequent course of WS is variable.

Disseminated Intravascular Coagulation Score and Sepsis-induced Coagulopathy Score in Prediction of COVID-19 Severity: A Retrospective Analysis.

BACKGROUND: The novel disseminated intravascular coagulation (DIC) score (platelet count, prolonged prothrombin time, D-dimer, and fibrinogen) and sepsis-induced coagulopathy (SIC) score (platelet count, international normalized ratio, and sequential organ failure assessment score) are markers of coagulopathy, which, for the first time, are explored in line with the coronavirus disease-2019 (COVID-19) disease outcomes. The correlation of D-dimer with these findings is also studied. MATERIALS AND METHODS: A retrospective analysis of hospital-based records of 168 COVID-19 patients was done. Data including D-dimer, routine investigations, DIC, and SIC scorings (all within 3 days of admission) were collected and correlated with the outcomes. The study was conducted in a tertiary care center catering to North India's population. RESULTS: Higher DIC score (1.59 ± 1.18 vs 0.96 ± 1.18), SIC score (1.60 ± 0.89 vs 0.63 ± 0.99), and D-dimer titers (1321.33 ± 1627.89 vs 583·66 ± 777.71 ng/mL) were significantly associated with severe COVID-19 disease (p <0.05). DIC score and SIC score ≥1, and D-dimer ≥1315 ng/mL for severe disease; DIC score ≥1, SIC score ≥2, and D-dimer ≥600 ng/mL for pulmonary embolism (PE); and DIC score and SIC score ≥1, and D-dimer level ≥990 ng/mL for mortality were the respective cutoff values we found from our study. CONCLUSION: Higher DIC scores, SIC scores, and D-dimer values are associated with severe COVID-19 disease, inhospital mortality, and PE risk. They can serve as easily accessible early markers of severe disease and prioritize hospital admissions in the presently overburdened scenario and may be used to develop prognostic prediction models. HOW TO CITE THIS ARTICLE: Kapoor M, Panda PK, Saini LK, Bahurupi Y. Disseminated Intravascular Coagulation Score and Sepsis-induced Coagulopathy Score in Prediction of COVID-19 Severity: A Retrospective Analysis. Indian J Crit Care Med 2021;25(12):1357-1363.

Impact of COVID-19 pandemic on sleep in children and adolescents: a systematic review and meta-analysis.

OBJECTIVE: This systematic review and meta-analysis were conducted to study the prevalence and pattern of sleep disturbances in children and adolescents during the COVID-19 pandemic. METHODS: MEDLINE, EMBASE, and Web of Science were searched for original studies describing sleep abnormalities in children and adolescents with or without pre-existing neurobehavioral disorders during the COVID-19 pandemic. The pooled estimates for various sleep abnormalities were calculated using a random-effect model. RESULTS: Of 371 articles screened, 16 studies were included. Among these, five studies were in preschool children, two were in children with pre-existing neurobehavioral disorders and the remaining were in school going children and adolescents. The outcome measures used for sleep were markedly heterogeneous across the studies. The pooled prevalence of any sleep disturbance in children during the pandemic was 54%(95%CI:50-57%). Interestingly, the prevalence in pre-school children was lower than pre-pandemic times (RR = 0.87; 95% CI:0.58-1.30) but this was not statistically significant. The pooled prevalence of children not meeting sleep recommendation was 49% (95%CI: 39-58%). CONCLUSION: The prevalence of sleep problems in children and adolescents during the COVID-19 pandemic is alarming. Pre-school children had a trend towards relatively fewer sleep disturbances due to home confinement measures in comparison with pre-pandemic times. Sleep duration recommendations were not met in nearly half of healthy children. However, these conclusions need to be seen in light of limited literature on the topic, few included studies done in heterogenous populations, and dubious quality of inferences drawn from these studies which were predominantly online surveys. PROSPERO REGISTRATION ID: CRD42020213788.

Flexible bronchoscopy during the COVID-19 pandemic: A concise clinical review and practical recommendations.

Bronchoscopy is an extremely useful diagnostic and therapeutic procedure that finds an invaluable place in Pulmonology practice. Due to aerosol generation, bronchoscopy carries a high risk of infection transmission to health care workers and other patients. This fact is even more important in the present times of COVID-19 pandemic owing to its droplet- (and possibly aerosol-) mediated spread. With this background, a working group extracted literature through electronic search of PubMed and Google Scholar databases. All relevant documents were comprehensively reviewed and consensus recommendations formulated based on the level of available evidence. Where evidence was insufficient, Usual Practice Points were formulated based on expert opinion. This resultant document attempts to present clinical recommendations for performing flexible bronchoscopy in COVID-19 suspect/confirmed patients. It outlines important general considerations for bronchoscopy in these cases, provides an algorithmic approach to patient selection for bronchoscopy during these extraordinary times, and enlists critical do's and don'ts that should be followed before, during, and after the procedure. To conclude, flexible bronchoscopy must be cautiously performed amid the COVID-19 crisis. Judicious case selection and meticulous contact and airborne precautions are important to minimise infection transmission.

Status of the practice of sleep medicine in India during the COVID-19 pandemic.

STUDY OBJECTIVES: Like other medical branches, the practice of sleep medicine has been affected by the COVID-19 pandemic; however, the actual impact is not known. This study was planned to assess the status of the practice of sleep medicine in India during the COVID-19 pandemic and lockdown. METHODS: This was an online questionnaire-based descriptive study. A 25-item questionnaire was developed to assess the functioning of sleep laboratories, use of telemedicine, and positive airway pressure therapy during the COVID-19 pandemic in India. The questionnaire was sent to the sleep physicians of 2 major sleep medicine societies of India. Responses were analyzed. RESULTS: In this study, the response rate was 64.6%. During this pandemic, 72% of physicians reported that they had closed sleep laboratory, whereas 24% reported shifting to home sleep apnea testing. Only half of the sleep physicians confirmed awareness of the disinfection guidelines proposed by the American Academy of Sleep Medicine to prevent COVID-19 infection in the sleep laboratory. However, almost all of them reported taking preventive measures like the use of protective gear. Sixty-one percent of physicians advised mitigating strategies as a temporary measure to their patients of obstructive sleep apnea. A total of 58.6% opined that auto-positive airway pressure might be used for uncomplicated obstructive sleep apnea without diagnostic polysomnography during the pandemic. Eighty-four percent of physicians reported that they were continuing their services through a telemedicine facility. Physicians reported that consultations for insomnia and circadian rhythm sleep disorders increased during the pandemic. CONCLUSIONS: Sleep laboratories were reportedly closed during the COVID-19 pandemic, and most of the sleep physicians were providing services through telemedicine. The majority reported that auto-positive airway pressure without diagnostic polysomnography could be an effective option for uncomplicated obstructive sleep apnea. Consultation for insomnia and circadian rhythm sleep disorders reportedly increased during the lockdown.

Psychological Morbidity among People in Quarantine.

Objective This study aimed to evaluate psychological distress of persons in quarantine and compare the same with a group of persons, who are currently in lockdown. Methodology Forty-four persons in quarantine and 45 subjects currently in lockdown were evaluated on Depression Anxiety Stress Scale II. Results About three-fourth (77.3%) of the participants in the quarantine group and one-third (37.8%) in the comparator group had depression. About one fourth (22.7%) in the quarantine group and one-third (35.6%) in the lockdown group had anxiety. Conclusion The present study suggests that lockdown and being in quarantine are associated with significantly higher psychiatric morbidity, especially anxiety.

Clinical Features and Outcome of SARS-CoV-2 Infection in Children: A Systematic Review and Meta-analysis.

OBJECTIVE: Knowledge about COVID-19 in children is limited due to the paucity of reported data. The pediatric age group comprises only less than 5% of total COVID-19 worldwide, therefore, large studies in this population are unlikely in the immediate future. Hence, we planned to synthesize the current data that will help in a better understanding of COVID-19 in children. EVIDENCE ACQUISITION: Four different electronic databases (MEDLINE, EMBASE, Web of Science, and CENTRAL) were searched for articles related to COVID-19 in the pediatric population. We included studies reporting disease characteristics and outcomes of COVID-19 in patients aged less than 19 years. We performed a random-effect meta-analysis to provide pooled estimates of various disease characteristics. RESULTS: 27 studies (4857 patients) fulfilling the eligibility criteria were included in this systematic review, from a total of 883 records. About half of the patients had each of fever and cough, 11% (6-17%) had fast breathing, and 6-13% had gastrointestinal manifestations. Most of the patients had mild to moderate disease, and only 4% had a severe or critical illness. Leukopenia was the commonest reported laboratory abnormality. CONCLUSIONS: Even among the symptomatic COVID-19 cases, severe manifestations are seen in very few children. Though fever and respiratory symptoms are most common, many children also have gastrointestinal manifestations.