Clinico-epidemiological and vaccination profile of patients attending flu clinic of a tertiary health care institution in Eastern India during the third wave of COVID-19 pandemic

Introduction and aim. With the third wave of COVID-19 hitting the country, there is an urgent need to systematically document the clinical-epidemiological and vaccination details of the patients to formulate evidence-based decisions. So, this study was planned to describe the profile of patients attending the flu clinic of a tertiary care hospital in eastern India. Material and methods. This hospital-based cross-sectional study was done for 6 weeks (Jan-Feb 2022) among 623 patients using a pre-tested, structured questionnaire related to COVID-19. An unadjusted odds ratio was calculated and statistical significance was attributed to a p-value <0.05. Results. Out of 623 patients, almost 90% of the patients were vaccinated against COVID-19 with at least one dose of any vaccine. Cough (57.8%) was the most common complaint. Patients aged > 60 years and those having one or more than one comorbidity suffered from moderate-severe COVID-19 infection when compared to their counterparts (p<0.001). Also, 2.1% of fully vaccinated, 3.8% of one dose vaccinated and 10.9% of unvaccinated patients suffered from moderate-severe COVID-19. Conclusion. During the third wave of the COVID-19 pandemic, a smaller number of elderlies compared to the previous two waves were affected indicating age shifting. The severity of COVID-19 was less among vaccinated individuals compared to unvaccinated highlighting the importance of COVID-19 vaccination. © 2022 Universidad Nacional de Colombia, , Department of Linguistics. All rights reserved.

Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

BACKGROUND: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. METHODS: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. RESULTS: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. CONCLUSIONS: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Knowledge, Attitude and Practice Related to the Use of Nutraceuticals for Prophylaxis against COVID-19 among Undergraduate Medical and Nursing Students in a Tertiary Care Teaching Hospital, Bihar, India

Introduction: Nutritional supplements modify immune response and protect against viral infections. Health related behaviour of medical and nursing students governs their attitude towards counselling patients. This study assessed the differences in the Knowledge, Attitude, and Practice (KAP) between undergraduate medical and nursing students regarding the role of nutraceuticals in Coronavirus Disease-2019 (COVID-19). Aim: To assess the differences in the KAP between undergraduate medical and nursing students regarding the role of nutraceuticals in COVID-19. Materials and Methods: An analytical cross-sectional study was conducted in a tertiary care teaching hospital, Patna, Bihar, India in September 2020. A questionnaire was administered to assess the KAP of 265 medical and 150 nursing undergraduates regarding nutraceuticals. The total knowledge score varied between 0 and 12. The score of the attitude was based on 5 points Likert scale. The data was collected through self-administered google forms. Chi-square test and Fisher's exact test was used to compare the difference in categorical data. results: There were total 273 (65.8%) participants with good knowledge and only 47 (11.3%) with positive attitude. About 68.7% medical students and 82.7% nursing students felt that regular intake of nutraceuticals has a positive role in protecting against COVID-19 (p=0.007). Out of 415, 264 participants (63.6%) had used nutraceuticals. About 156 (58.9%) medical students and 103 (68.7%) nursing students felt that the safety of nutraceuticals is a grave concern. Two- fifth of the participants (202, 48.7%) had consumed a dietary supplement to maintain good health. conclusion: Although the knowledge score was good, but positive attitude was lacking. Thus, Health Care Personnels (HCP)s should be trained regarding proper usage and recommendations of nutraceuticals.

Problems associated with usage of PPE Kits during COVID19 pandemic: Experience of Healthcare workers of a tertiary care center from Eastern India

Background: Frontline healthcare workers play a critical role in the containment of the coronavirus disease-2019 (COVID-19) pandemic, and as they are wearing personal protective equipment to minimize cross-transmission and acquire confidence in fighting the pandemic (PPE) they face health problems and discomfort as well because of long duty hours. Objectives: To explore the health issues associated with use of PPE among healthcare front liners and to find out the possible solutions for the identified problems. Methodology: A cross sectional observational study involving a group of medical staff was done using a pre tested semi structured questionnaire using google forms at a tertiary care teaching hospital. Results: Maximum people said that Goggles and gowns are the most uncomfortable part of the PPE and the problems/health conditions faced most frequently was fog in goggles/shield and feeling hot and suffocating. Females, Intern Doctors and those with indefinite/not fixed duty were mostly unsatisfied with the PPE that was given. Conclusion: To alleviate healthcare workers’ burnout and job pressures, effective strategies for increasing comfort at workplace is required. More training regarding donning /doffing and comfortable and adequate supply of PPE is needed in order to get uninterrupted and quality service from the healthcare workers.

Clinicodemographic profile and predictors of poor outcome in hospitalised COVID-19 patients: a single-centre, retrospective cohort study from India.

OBJECTIVES: Primary objective was to study the clinicodemographic profile of hospitalised COVID-19 patients at a tertiary-care centre in India. Secondary objective was to identify predictors of poor outcome. SETTING: Single centre tertiary-care level. DESIGN: Retrospective cohort study. PARTICIPANTS: Consecutively hospitalised adults patients with COVID-19. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome variable was in-hospital mortality. Covariables were known comorbidities, clinical features, vital signs at the time of admission and on days 3-5 of admission, and initial laboratory investigations. RESULTS: Intergroup differences were tested using χ2 or Fischer's exact tests, Student's t-test or Mann-Whitney U test. Predictors of mortality were evaluated using multivariate logistic regression model. Out of 4102 SARS-CoV-2 positive patients admitted during 1-year period, 3268 (79.66%) survived to discharge and 834 (20.33%) died in the hospital. Mortality rates increased with age. Death was more common among males (OR 1.51, 95% CI 1.25 to 1.81). Out of 261 cases analysed in detail, 55.1% were in mild, 32.5% in moderate and 12.2% in severe triage category. Most common clinical presentations in the subgroup were fever (73.2%), cough/coryza (65.5%) and breathlessness (54%). Hypertension (45.2%), diabetes mellitus (41.8%) and chronic kidney disease (CKD; 6.1%) were common comorbidities. Disease severity on admission (adjusted OR 12.53, 95% CI 4.92 to 31.91, p<0.01), coagulation defect (33.21, 3.85-302.1, p<0.01), CKD (5.67, 1.08-29.64, p=0.04), high urea (11.05, 3.9-31.02, p<0.01), high prothrombin time (3.91, 1.59-9.65, p<0.01) and elevated ferritin (1.02, 1.00-1.03, p=0.02) were associated with poor outcome on multivariate regression. A strong predictor of mortality was disease progression on days 3-5 of admission (adjusted OR 13.66 95% CI 3.47 to 53.68). CONCLUSION: COVID-19 related mortality in hospitalised adult patients at our center was similar to the developed countries. Progression in disease severity on days 3-5 of admission or days 6-13 of illness onset acts as 'turning point' for timely referral or treatment intensification for optimum use of resources.

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.

Evidences suggesting a possible role of Vitamin D in COVID 19: The missing link.

The severe acute respiratory syndrome coronavirus 2 is spreading like wildfire with no specific recommended treatment in sight. While some risk factors such as the presence of comorbidities, old age, and ethnicity have been recognized, not a lot is known about who the virus will strike first or impact more. In this hopeless scenario, exploration of time-tested facts about viral infections, in general, seems to be a sound basis to prop further research upon. The fact that immunity and its various determinants (e.g., micronutrients, sleep, and hygiene) have a crucial role to play in the defense against invading organisms, may be a good starting point for commencing research into these as yet undisclosed territories. Herein, the excellent immunomodulatory, antiviral, and anti-inflammatory roles of Vitamin D necessitate thorough investigation, particularly in COVID-19 perspective. This article reviews mechanisms and evidence suggesting the role Vitamin D plays in people infected by the newly identified COVID-19 virus. For this review, we searched the databases of Medline, PubMed, and Embase. We studied several meta-analyses and randomized controlled trials evaluating the role of Vitamin D in influenza and other contagious viral infections. We also reviewed the circumstantial and anecdotal evidence connecting Vitamin D with COVID-19 emerging recently. Consequently, it seems logical to conclude that the immune-enhancing, antiviral, anti-inflammatory, and lung-protective role of Vitamin D can be potentially lifesaving. Hence, Vitamin D deserves exhaustive exploration through rigorously designed and controlled scientific trials. Using Vitamin D as prophylaxis and/or chemotherapeutic treatment of COVID-19 infection is an approach worth considering. In this regard, mass assessment and subsequent supplementation can be tried, especially considering the mechanistic evidence in respiratory infections, low potential for toxicity, and widespread prevalence of the deficiency of Vitamin D affecting many people worldwide.

IgG immune response to SARS-CoV-2 vaccination in people living with multiple sclerosis within MS PATHS

Background: Data on the effects of multiple sclerosis (MS) disease modifying therapies (DMTs) on SARS-CoV-2 vaccine response are needed. Initial studies suggest CD20 cell depleting therapies and fingolimod attenuate IgG response to SARS-CoV-2 vaccination in MS patients (pts), consistent with previous studies of vaccine responses in pts treated with those DMTs. Methods: Participants with MS enrolled in the MS PATHS network in the US, Germany, and Spain were asked to provide blood serum samples up to 30 days pre-SARS-CoV-2 vaccination and 28-90 days post final vaccine dose. The goal is to obtain & ge;45 post-vaccination samples per approved DMT and among pts not currently treated with a DMT. Semi-quantitative measures of SARS-CoV-2 IgG response to spike protein (Siemens SARSCoV- 2 IgG assay) and nucleocapsid protein (Abbott SARS-CoV-2 IgG assay) will be used to distinguish humoral responses to vaccination vs prior infection. The impact of demographic factors, MS disease subtype and duration, disability level, DMT type, vaccine type, and time since last DMT dose, and vaccine dose on IgG response will be evaluated. Results: As of May 17, 2021, 379 unique pts provided a serum sample: CD20 DMTs (n=139), S1P DMTs (n=31), natalizumab (n=39), other DMTs (n=117), and no DMT (n=53);183 pts have a pre-vaccination sample awaiting a post-vaccination sample, 186 have only a post-vaccination sample, and 10 have both. Prevaccination samples were collected at a mean (SD) of 4.5 (7.5) days prior to the first vaccine dose, and post-vaccination samples were collected 46.6 (15.2) days after the last dose, 91.8% following an mRNA vaccine. Pt (n=379) characteristics were: age 50.3 (12.5) yrs, 67% female, disease duration 16.6 (9.6) yrs, 27.7% progressive MS, and Patient Determined Disease Steps 2.0 (2.3). Reactive IgG rates (IgG index & gt;1) from initial post-vaccination testing were CD20 DMTs 21/41 (51%), S1P DMTs 4/8 (50%), and 100% for all other groups, including natalizumab (n=9), fumarates (n=8), interferons (n=8), glatiramer acetate (n=8), teriflunomide (n=2), alemtuzumab (n=1) and no DMT (n=17). Conclusions: Preliminary results, based on a limited sample size, suggest CD20 and S1P DMTs may reduce IgG response to SARS-CoV-2 vaccination. Quantifying post-vaccination IgG response across DMTs is crucial to optimize MS management. Data from ongoing sample collection will be presented at the meeting.

Does bcg vaccine prevent contract and severity of covid-19 infection in india? A situational analysis

Background: The COVID-19 pandemic has created worldwide emergency with morbidities, mortality and panic. The BCG vaccine, usually given to prevent childhood tuberculosis, surfaced as an option as suggested by some ecological observations. However, some others studies could not establish and explain the protective effects of BCG vaccination against COVID-19 pandemic. India is one country with high BCG vaccination coverage and is among the countries with lowest COVID-19 case fatality rate. Aims and Objectives: We examine the relationship between the BCG coverage and COVID-19 burden in various states/UTs of India. Materials and methods: The information on BCG coverage and morbidity and mortality of COVID-19 was obtained from NFHS and www.covid19India.org respectively. Results: The analysis suggested very weak positive relationship of BCG coverage with cases and deaths due to COVID-19. Moderate positive relationship was observed between BCG coverage and COVID-19 case fatality rate even after adjusting for health system performance. Conclusion: The conclusion of the study is against the role of BCG vaccination in containing the COVID-19 pandemic. The positive correlation which is not significant may be spurious and affected by many confounding factors like co-morbid conditions, testing strategies, population level immunity for other viral infections etc. Hence, the states and UTs should not be complacent by the hypothesized role of BCG vaccine in COVID-19 control. Rather, they should continue with the principles of social distancing, contact tracing, treating and surveillance of COVID-19. © 2021, Indian Association of Preventive and Social Medicine. All rights reserved.

Epidemiological and Clinical factors associated with mortality of confirmed COVID-19 cases admitted and treated in a tertiary care hospital of Patna, Bihar

Background: A significant proportion of the individuals having the illness of moderate to severe nature due to COVID-19 infection require immediate critical care. High incidence of mortality among elderly population or those with comorbid conditions were reported. Objectives: The study was carried out with objectives to assess the epidemiological and clinical factors associated with mortality among the COVID-19 cases admitted and treated in AIIMS, Patna. Methods: This was a hospital -based cross-sectional analytical study of epidemiological and clinical features of COVID-19-positive patients admitted and treated during the outbreak from March 20, to August 31, 2020. Results: The median age of COVID-19 cases was 51.5 years (IQR : 37-62 years) which was significantly higher (p-value = 0.001) as compared to females. Male-female ratio of cases was 2.88:1. Out of 1696 cases, the case fatality rate was 309 (18.22%). The mean age of cases who died due to COVID-19 was significantly higher (pvalue=0.001) as compared to those who survived. The odds of mortality was significantly higher in males as compared to females (Adjusted OR = 1.534, 95% CI = 1.10 - 2.13, p=0.011). The odds of mortality showed a significant increasing trend with increasing age (Mantel-Hanszel p-value for trend = 0.015). The covariates like gender, age groups 45-59, 60-74 and 75>=, breathlessness and CKD were found to be significantly associated with mortality after controlling for the confounders. Conclusions: Factors like gender, higher age, lower oxygen saturation causing breathlessness and chronic kidney diseases could be attributed to high risk of mortality in COVID-19 patients.

Socio-economic inequality in national incidence and mortality rates of COVID-19 in India: An Ecological Study

Background: There are sufficient evidences on the association of epidemiological and clinical features of the patients with COVID-19 but still there are paucity of evidences on socio-economic aspects of this disease. An ecological study has been carried out with aim to assess the associations of the Human Development Index (HDI) and its components of each states and Union territories in India with incidence and mortality from COVID-19. Methods: Information on confirmed cases and deaths have been extracted from the data on the website of Covid India Organization and the data on HDI and its components have been extracted from various national and international agencies. Regression analysis was performed which showed a direct significant association (p-values<0.05) of incidence and mortality rates with HDI and its components at the national level. Concentration index was estimated to measure socio-economic inequality in COVID-19 incidence and mortality rates with 95% confidence interval (CI), which were 0.41 (0.27-0.54) and 0.42 (0.26-0.58) for incidence and mortality rates of COVID-19 respectively. Results: The high incidence and mortality rates of COVID-19 in states and union territories of India with high HDI and its components warrant priority for interventions by the national health policy-makers. Cases detection and screening facilities need to be scaled up in states and UTs with low incidence and mortality rates to minimize the under-reporting of the cases.