ABSTRACT
Introduction: COVID-19 pandemic is posing a challenge not only with sheer number of people infected but also with the large number of patients with persistent symptoms of COVID-19 infection. A proper understanding of the magnitude and associated factors of persistent COVID-19 symptoms will go a long way in planning treatment and control strategies. Aim: To determine the proportion of patients who have persistent symptoms post-acute COVID-19 infection and to determine the factors associated with it, among those who have been discharged from Government Medical College, Thrissur. Materials and Methods: The current cross-sectional study was conducted among 335 patients who were admitted and discharged with COVID-19 infection in Government Medical College, Thrissur, Kerala, a tertiary care institution in southern India between December 2020 and February 2021. They were contacted through a telephonic interview 28 days from symptom onset through a semi-structured interview schedule. The questions included basic demographic details, symptomatology at admission, persistent symptoms at 28 days after onset and other clinical details including comorbidities. For defining post-COVID-19 symptom persistence National Institute for Health and Care (NICE) guidelines were used. Association between persistent symptoms and selected factors was done by Chi-square test. Results: Out of the 335 patients, the persistence of symptoms of COVID-19 infection after 28days of symptom onset was 221 (66%) C.I -60.7-70.8%). Persistence of two or more COVID-19 symptoms after 28 days of onset was seen in 120 (35.8%). The most common persistent symptoms among the patients were fatigue in 109 (32.5%) of people followed by dyspnoea in 77 (23%), cough in 45 (13.4%) and myalgia in 37 (11%) patients Highest persistence was seen in Category C patients where symptoms were persisting in 75%. Persistence was also higher in those with diabetes mellitus, those who received oxygen support and those who were in Intensive Care Unit (ICU) or ventilator and the association was statistically significant(p-value<0.05). Conclusion: The study shows that 2/3rd of patients still continues to have persistent symptoms even after 28 days of symptom onset. Health systems should be prepared to face the consequences of morbidities caused by post COVID-19 syndrome.
ABSTRACT
Research, collaboration, and knowledge exchange are critical to global efforts to tackle antimicrobial resistance (AMR). Different healthcare economies are faced with different challenges in implementing effective strategies to address AMR. Building effective capacity for research to inform AMR-related strategies and policies is recognised as an important contributor to success. Interdisciplinary, intersector, as well as international collaborations are needed to span global to local efforts to tackle AMR. The development of reciprocal, long-term partnerships between collaborators in high-income and in low- and middle-income countries (LMICs) needs to be built on principles of capacity building. Using case studies spanning local and international research collaborations to codesign, implement, and evaluate strategies to tackle AMR, we have evaluated and build upon the ESSENCE criteria for capacity building in LMICs. The first case study describes the local codesign and implementation of antimicrobial stewardship (AMS) in the state of Kerala in India. The second case study describes an international research collaboration investigating AMR surgical patient pathways in India, the UK, and South Africa. We describe the steps undertaken to develop robust, agile, and flexible AMS research and implementation teams. Notably, investing in capacity building ensured that the programmes described in these case studies were sustained through the current severe acute respiratory syndrome coronavirus pandemic. Describing the strategies adopted by a local and an international collaboration to tackle AMR, we provide a model for capacity building in LMICs that can support sustainable and agile AMS programmes.