Fulminant onset COVID-19: predictors and outcome.

PURPOSE: During COVID-19 infection, organ dysfunction such as respiratory failure tends to occur towards the second week of illness; however, in a subset, there may be rapid onset of organ dysfunction as early as symptom onset. We define fulminant onset COVID-19 as rapid onset of organ dysfunction such as acute respiratory failure, acute kidney injury, acute encephalopathy or shock within 4 days of symptom onset. Fulminant onset COVID-19 has not yet been systematically studied. We aimed to identify predictors and prognosis of fulminant onset COVID-19. METHODS: This retrospective study was carried out on patients admitted to a single referral hospital in South India between June 2020 and January 2022. Patients were categorised into fulminant and non-fulminant onset COVID-19. Candidate predictors for fulminant onset were chosen by an intuitive approach and analysed using logistic regression. Then, the outcome of fulminant onset COVID-19 at 30 days was studied. RESULTS: Out of 2016 patients with confirmed COVID-19, 653 (32.4%) had fulminant onset COVID-19. Age>60 years (a-OR 1.57, 95% CI 1.30 to 1.90, p<0.001), hypertension (a-OR 1.29, 95% CI 1.03 to 1.61, p=0.03) and immune-suppressed state (a-OR 5.62, 95% CI 1.7 to 18.7, p=0.005) were significant predictors of fulminant onset COVID-19. Complete vaccination lowered the odds of fulminant onset COVID-19 significantly (a-OR 0.61, 95% CI 0.43 to 0.85, p=0.004). At 30 days, the fulminant onset COVID-19 group had higher odds of mortality and need for organ support. CONCLUSION: Fulminant onset COVID-19 is not uncommon and it carries poor prognosis and deserves recognition as a distinct phenotype of COVID-19.

Lockdown and its impact on food and exercise study

Introduction: The COVID-19 pandemic had enforced several restrictions which were necessary to abate the spread of the virus, however, the blow of these limitations on health behaviors and lifestyles remains vague. Therefore, this study was carried out to assess the behavioral and lifestyle consequences of complete lockdown during the pandemic. Materials and Methods: The Lockdown and its Impact on Food and Exercise study was a pilot study conducted in the form of a questionnaire which was handed out to the public and circulated electronically. The questions regarding exercise were adapted from the International physical activity questionnaire and those regarding food habits were taken from the Public Library of Science and the Self-regulation of Eating Behavior Questionnaire. This survey was conducted from March 28 to April 14, 2020, during which a complete lockdown prevailed. Results: The COVID-19 complete lockdown had a negative impact on all intensity exercise levels, vigorous exercise (64.34% vs. 41.20%, P ≤ 0.00001), moderate exercise (95.67% vs. 84.57%, P ≤ 0.00001), and walking (55.42% vs. 42.89%, P = 0.0003). Food consumption and meal patterns (58.55% vs. 47.95%, P = 0.0022) were also more unhealthy (78.60% vs. 87.94%, P = 0.0096) during complete lockdown with only the consumption of late night snack decreasing significantly. Conclusion: The results of this analysis indicate that physical activity had decreased significantly and eating behaviors were unhealthy. Hence, our survey will help to develop interventions which would potentially alleviate these negative lifestyle and nutrition behaviors.