ABSTRACT
Introduction : The Coronavirus disease 2019 (COVID-19) primarily involves respiratory system but may also affect the Cardiovascular System leading to abnormal ECGs. Its early recognition is crucial as it may be associated with increased mortality. Hence we aimed to find out various Electrocardiographic (ECG) manifestations of COVID- 19 patients admitted in a Tertiary Care Hospital and its relation to disease severity. Methods : We performed a hospital-based retrospective observational study between April, 2021 to November 2021 and analyzed the ECG changes at admission by three Cardiologists according to standard definitions and diagnostic criteria. Results : Out of 579 patients, ECG of 473 was available for analysis. ECG was normal in 227 (48%) and abnormal in 246 (52%) patients. Most common abnormal ECG finding in COVID19 patients was Sinus Tachycardia(19.5%) and less common findings were Sinus Bradycardia (5.3%), Incomplete Right Bundle Branch Block (RBBB) (3.2%), atrial fibrillation (2.5%), complete RBBB (2.3%), atrial premature complexes (2.3%), S1Q1T3 pattern (2.1%), first degree AV block (1.5%), ST-T wave changes (1.3%), Atrial flutter (1.1%). In mechanically ventilated patients, incidence of acute Right Ventricular Pressure Overload (RVPO) related ECG findings were more frequent. Conclusion : There is a wide spectrum of ECG manifestations in COVID-19 patients which varies depending upon the severity of COVID as well as prior Cardiovascular status, associated comorbidities and need for ventilatory support. Knowledge of ECG changes might help in risk stratification and triaging of COVID-19 patients.
ABSTRACT
BackgroundSevere Corona virus disease (COVID-19) is associated with high mortality. Although single centre intensive care units (ICU) have reported clinical characteristics and outcomes, no large scale multicentric study from India has been published. The present retrospective, multi-centre study was aimed to describe the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian council of Medical Research (ICMR), India.MethodsProspectively collected data from multiple participating institutions was entered in the electronic National Clinical Registry of COVID 19. We enrolled patients aged>18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative RT PCR, death within 24 hours of ICU admission, or patients with incomplete data in the registry Their demographic characteristics, laboratory variables, ICU severity indices, treatment strategies and outcomes were analysed.ResultsA total of 5865 patients, with mean age 56±15 years, with 3840/5865 (65.4%) men, were enrolled in the ICMR registry.. Overall mortality was 2535/5865 (43.5%). Non-survivors were older than survivors (58.2±15.4 years vs 53.6 ±14.7 years; P=0.001). Non-survivors had multiple comorbidities (n=1951, 52.9%) with hypertension (47.2%) and diabetes (45.6%) being the most common, higher creatinine (1.6 ± P=0.001, high D-dimer (1.56 vs 1.37, P=0.001), higher CT severity index (16.8±5.2 vs 13.5 ±5.47 ) compared to survivors. Non survivors had longer hospital and ICU stay (P=0.001). On multivariate regression analysis, high NLR (HR 1.017, 95% CI 1.005- 1.029, P=0.001), high CRP (HR 1.008, 95% CI 1.006- 1.010, P=0.001), high D dimer ((HR 1.089, 95% CI 1.065- 1.113, P=0.001) were associated with mechanical ventilation while younger age, (HR 0.974, CI 0.965-0.983, p=0.001), high D dimer (HR-1.014, CI 1.001-1.027, P=0.035) and use of prophylactic LMWH (HR 0.647, CI 0.527-0.794, p=0.001) were independently associated with mortality. ConclusionIn this large retrospective study of 5865 critically ill COVID 19 patients admitted to ICU, overall mortality was 2535/5865 (43.5%). Age, high D dimer, CT Severity score and use of prophylactic LMWH were independently associated with mortality.
Subject(s)
COVID-19ABSTRACT
Background Despite the success of adult vaccination against COVID-19, providing vaccines to children remains a challenge for policymakers globally. As parents are primary decision-makers for their children, we aimed to assess parents perceptions and intentions regarding COVID-19 vaccination in India. Methods A cross-sectional web-based study was designed, parents or caregivers (N=770) were recruited through snowball sampling using Google form. Cross-tabulation was performed by parents intention to vaccinate their children against COVID-19 virus with sociodemographic characteristics and their risk perception towards COVID-19, trust in the healthcare system, and their history of vaccine hesitancy behavior. Multivariable logistic regression analysis was performed to compute the predictors of child vaccination intention among Indian parents. Results Seven hundred seventy parents across the country have completed the survey. Of the 770 participants, 258 (33.5%) have shown intent to vaccinate their children. The stated likelihood of child vaccination was greater among parents who had a bachelors degree or higher education (aOR: 1.98, 95% CI: 1.15-3.51); as well as among parents who intended to vaccinate themselves (aOR: 2.35, 95% CI: 1.30-4.67). Parental concerns centered around vaccine safety and side effects. Conclusion Indian parents reported high knowledge of the COVID-19 virus and were aware of the development of a novel vaccine. However, about one-third of parents intended to vaccinate their children, and about half of them were not sure whether to vaccinate their children or not against the COVID-19 virus. The study highlighted the need for health promotion strategies that promote vaccine uptake among parents.
Subject(s)
COVID-19ABSTRACT
Background: Vaccine hesitancy is of considerable concern as it threatens the great potential of a vaccine against COVID-19. Community health workers (CHWs) bridge the gap between the community and the health care system. Their intention to get vaccinated will not only affect them but will also affect the community’s perception of the vaccine. This study aims to understand the intention to get vaccinated against COVID-19 among community health care workers in India and its determinants.Methods: A web-based, cross-sectional study was conducted among 357 community health workers using snowball sampling. A self-administered anonymous questionnaire was shared with study participants across major geographical regions in India through social media during the first wave (November-December 2020).Results: Among 357 community health workers, 208 (58%) responded positively regarding their intention to get a COVID-19 vaccine. Graduate [aOR 2.26 (95% CI: 1.27-4.01), p=0.006] and post-graduate participants [aOR 2.85 (95% CI: 1.43-5.68), p=0.003], those with lower risk perception [aOR 1.86 (95% CI: 1.03-3.35), p=0.038] and respondents who trusted the healthcare system [aOR 2.60 (95% CI:1.59-4.26), p<0.001] were more likely to get vaccinated. Respondents who were exposed to COVID-19 cases were less likely to uptake the hypothetical vaccine [aOR 0.57 (95% CI: 0.34-0.96), p=0.034].Conclusions: Increasing knowledge regarding the COVID-19 vaccine might not be enough to improve vaccine acceptance rates. Enhancing trust among community health workers in the healthcare system and regarding the available vaccines seem necessary. In addition, targeted interventions addressing socio-demographic determinants related to COVID-19 vaccination should help improve acceptance of the vaccine.