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1.
Thyroid ; JOUR:A105-A106, 32(Supplement 1).
Article in English | EMBASE | ID: covidwho-2097291

ABSTRACT

The effect of SARS-CoV-2 vaccine on the thyroid is not well understood. There are increasing reports of varying effects of the vaccine on the thyroid with the most common presentation being subacute thyroiditis. Rarely, Graves' disease following SARS-CoV- 2 has been observed. We present two cases of the development of Graves' disease after SARS-CoV-2 vaccination. A 37-year-old male presented to the office with weight loss, palpitations, tremors, diarrhea, and insomnia within a month of receiving the third dose of the SARS-CoV-2 vaccine. On physical exam he had bilateral periorbital edema. His TSH was <0.005 uIU/mL, free T4 21 ng/dl, total T3 651 ng/dl, and thyroid stimulating immunoglobulin (TSI) was positive, consistent with Graves' disease. He was started on methimazole and propranolol with improvement in thyroid function tests and symptoms noted. Similarly, a 56-year-old female presented to the office with weight loss, tremors, palpitations, and insomnia that began a few weeks after the third dose of the SARS-CoV-2 vaccine. Her TSH was <0.005 uIU/mL, free T4 > 7.77 ng/dl, total T3 > 651 ng/dl, and TSI was positive. She was initiated on methimazole but due to development of ageusia, she was trialed on propylthiouracil. She failed biochemical response to propylthiouracil, and thus was transitioned back to methimazole with subsequent improvement in thyroid function tests and symptoms. Notably, both patients were previously clinically and biochemically euthyroid. Neither patient had predisposing risk factors, such as personal or family history of autoimmune diseases, personal or family history of Graves' disease/thyroid dysfunction, preceding infection, contrast exposure, or amiodarone use. There are only five documented cases of Graves' disease after the SARS-CoV-2 vaccine. These two additional cases add to the emerging evidence of an association between Graves' disease and the SARS-CoV-2 vaccine, particularly after the third dose. One proposed mechanism is that the mRNA vaccine acts as an adjuvant, triggering an autoimmune response in genetically susceptible individuals. Please note that association does not mean causation. More studies are needed to further investigate the relationship between the thyroid and SARS-CoV-2 vaccine. It is essential for healthcare providers to identify Graves' disease following the SARS-CoV-2 vaccine even in patients with no risk factors and promptly initiate treatment to prevent hyperthyroid complications.

2.
NeuroQuantology ; 20(10):5656-5667, 2022.
Article in English | EMBASE | ID: covidwho-2067304

ABSTRACT

Against the backdrop of Indian companies, this paper aims to understand the challenges faced by leaders in managing employees within a hybrid workplace. While a few organizations have adopted a remote work strategy, others are opting for a hybrid model that includes some in-office work. This paradigm shift in the method of doing work in the wake of the pandemic has led to a conspicuous change in employee behaviour. The paper, based on a review of literature, broadly addresses three aspects related to this transformation: first, the differing perceptions of the employees and the management as regards telework and conflicts due to a restructuring of the work environment;second, the impact of new work arrangements on employee attitudes and on their psychological well-being, and third, the skills required for effective leadership in the changed scenario. Apart from demands on the economic resources in terms of investment in technology and employee learning and development, there is a pressing need to maintain the social capital of the firm. Leadership with its pervasive impact on organizational culture and employee behaviour has a decisive role to play in contemporary times. The paper highlights how the leaders in India who display a paternalistic style need to imbibe new skills in order to stay effective and presents a conceptual framework in this regard.

3.
Lung India ; 39(SUPPL 1):S137, 2022.
Article in English | EMBASE | ID: covidwho-1857381

ABSTRACT

Background: COVID-19 pandemic has affected majorly the lungs besides many other organs. Many of the patients later developed pulmonary-fibrosis. This study was planned to know the determinants resulting in pulmonary-fibrosis in post COVID survivors. Methods: Hospital-based, cross-sectional study done over a period of one year. A pre-designed proforma used to collect necessary information and follow-up HRCT and other investigations were evaluated. Results: Out of 87 patients 41.3% (n=36) developed pulmonary fibrosis among which majority i.e., 66.6% (n=24) were males. Out of 87 patient 49.42% (n=43) belonged to the age group of 51-70 years among which 48.83% (n=21) developed fibrosis. Infection was more common in urban 63.2% (n=55), middle-class family 55.17% (n=48), non-smoker 65.51% (n=57), homemaker and office worker 49.4% (n=43). Out of 87 patients 57.47% (n=50) had different comorbidities out of which 52% (n=26) developed pulmonary fibrosis. The proportion of fibrosis among diabetic patients was 67.7% (n=21, p=0.036). A total of 27 patients were treated in ICU, out of which 66.67% (n=18) developed pulmonary fibrosis. About 57.14% (n=28) of the patient with leucocytosis developed pulmonary fibrosis. Pulmonary fibrosis developed more in which steroid are not used 9/19, 47% (n=9) compared to those where was steroid used 27/68, 39.7% (n=27). Majority of the patient i.e.,>90% fibrotic patient had raised inflammatory marker. Higher CT severity score and consolidation are predictive for post covid fibrosis Conclusion: Post-COVID-19 pulmonary-fibrosis was observed in about half of the survivors. This study emphasized the relation of pulmonary-fibrosis with many factors like age, comorbidities, ICU-admission, steroid usage, inflammatory-markers and secondary-infections.

4.
European Respiratory Journal ; 58:2, 2021.
Article in English | Web of Science | ID: covidwho-1700224
5.
Chest ; 160(4):A504-A505, 2021.
Article in English | EMBASE | ID: covidwho-1457656

ABSTRACT

TOPIC: Chest Infections TYPE: Original Investigations PURPOSE: The controversy surrounding the association of ACE inhibitor (ACEi) use in the COVID-19 pandemic has been well documented. Since then, studies have been published refuting the findings. While there was a recent study in France on hypertensive patients on one of ACEi, angiotensin II receptor blocker (ARB) or calcium channel blocker (CCB), we performed a retrospective study reviewing the outcomes (i.e. admissions, readmission and mortality) associated with COVID-19 patients and their use of anti-hypertensive medications (anti-HTNs), specifically ACEi/ARB, thiazides, beta blocker (BB) and CCB, to look at the outcomes associated with their use, regardless of their roles in anti-hypertensive management. METHODS: We performed a retrospective study on patients with a positive COVID-19 RT-PCR test since January 2019. 606 adult patients were randomly selected. Data on demographics, co-morbidities, admission status, length of stay, types of anti-hypertensives and outcomes were collected and reviewed. RESULTS: Our study demonstrated the use of ACEi (24.1%) and thiazides (17.5%) had a reduced rate of admission when compared to patients on BB (32.3%) or CCB (32.4%). It should be noted thiazides were not as widely used (n = 63) in our population. Thus, it was not possible to comment on whether its use had a role in preventing hospitalization. Among the agents, ACEi is widely used for a multitude of diseases. As a result, it is often a first line agent employed by many, which was consistent with the data (n = 294) collected in this study. Interestingly, when assessing readmission rates, ACEi had the lowest percentage (8.1%;6/74) among the classes (BB 13.3%;8/60, CCB 18.4%;7/38, Thiazide 15.4%;2/13). Its judicious use and lower rates of admission and readmission were perhaps a compliment to the fine work by the physicians involved in their care.For mortality, there was a minimal percentage difference across the classes (ACEi 25.7%, BB 23.3%, CCB 23.7%, thiazides 23.1%). While there was a difference in number of patients across all four medications, the similar mortality suggested the co-morbidities, rather than the medications, may have a stronger influence on the outcomes in these patients. CONCLUSIONS: Our study demonstrated ACEi had a reduced rate of admission and the lowest rate of readmission compared to patients on BB or CCB. There was no difference in mortality across all four anti-hypertensive classes. We believe studies assessing co-morbidities while controlling for anti-hypertensive use could be beneficial in further our understanding in predicting outcomes of COVID-19 patients. CLINICAL IMPLICATIONS: ACEi use did not appear to have higher admission rates than other anti-hypertensives. Its use resulted in the lowest re-admission rates. The use of specific anti-hypertensive class had no bearing on mortality rates of COVID-19 patients. DISCLOSURES: No relevant relationships by Ali AKRAM, source=Web Response No relevant relationships by Vernon Chan, source=Web Response No relevant relationships by Dana Daoud, source=Web Response No relevant relationships by Olufunmilayo Folaranmi, source=Web Response No relevant relationships by Christopher Hemsley, source=Web Response No relevant relationships by Hafiza Wajeeha Javaid, source=Web Response No relevant relationships by Sarah Maurice, source=Web Response No relevant relationships by Junaid mir, source=Web Response No relevant relationships by Aisha Parihar, source=Web Response No relevant relationships by Britney Plotnick, source=Web Response No relevant relationships by Jayaram Thimmapuram, source=Web Response

6.
J Assoc Physicians India ; 69(8):11-12, 2021.
Article in English | PubMed | ID: covidwho-1396309
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