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1.
Medicina (Kaunas) ; 58(7)2022 Jul 15.
Article in English | MEDLINE | ID: covidwho-1938900

ABSTRACT

Background and Objectives: Starting in early December 2019, the novel Coronavirus Disease (COVID-19) from infection with COVID-19 has caused a global pandemic. Many aspects of its pathogenesis and related clinical consequences are still unclear. Early diagnosis and dynamic monitoring of prognostic factors are essential to improve the ability to manage COVID-19 infection. This study aimed to provide an account of the role played by vitamins C and D on the onset, progression and severity of COVID-19. Clinical features and infection-related risk factors are also briefly discussed. Material and Methods: In March 2022, the main online databases were accessed. All the articles that investigate the possible role of vitamins C and D on COVID-19 susceptibility, severity and progression were considered. Results: The current evidence on vitamin C and D supplementation in patients with COVID-19 infection is inconsistent and controversial. In some studies, vitamins were used as coadjuvant of a formal experimental therapy, while in others as main treatment. Ethnicity and hospital setting (inpatient/outpatient) were also variable. Moreover, there was no consensus between studies in administration protocol: high heterogeneity in dosage, administration, and duration of the treatment were evident. Finally, some studies administered vitamins pre- and/or during COVID infection, in patients with different risk factors and infection severity. Conclusions: While waiting to develop a targeted, safe and effective therapy, it is important to investigate individual predisposition and proper disease management. Concluding, available data on the use of nutraceuticals in COVID-19 are inconsistent. However, there is a lack of evidence-based guidelines which recommend vitamin C and D supplementation in patients with COVID-19, and results from high quality randomised controlled trials (RCTs) are inconsistent. Current investigations so far are mostly observational, and include a relatively small sample size which can lead to biased results. Large-scale multicentre studies are therefore needed.


Subject(s)
Ascorbic Acid , COVID-19 , Vitamin D , Vitamins , Ascorbic Acid/therapeutic use , COVID-19/therapy , Disease Susceptibility , Humans , Pandemics , SARS-CoV-2 , Vitamin D/therapeutic use , Vitamins/therapeutic use
2.
Postgrad Med J ; 98(1159): 319-320, 2022 May.
Article in English | MEDLINE | ID: covidwho-1832541
4.
Indian J Orthop ; 54(4): 526-528, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-1706026
5.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-323145

ABSTRACT

Background: The healthcare workers (HCWs) have been on the frontline in combating the pandemic and were prioritized for vaccination when COVID-19 vaccines became available. Although vaccines effectively prevent infection in most cases, some cases of post-vaccination infections have been reported, raising concerns about vaccine efficacy. This study investigated the efficacy of COVID-19 vaccines in preventing and reducing the severity of post-vaccination infections (PVI) among HCWs.Methods: This observational study examined 28342 vaccinated HCWs with SARS-CoV-2 (symptomatic severe acute respiratory syndrome coronavirus 2) infections during the initial five months of vaccination (January 16-June 15, 2021). They worked at 43 Apollo Group hospitals in 24 Indian cities. PVI was investigated after recombinant ChAdOx nCOV-19 (Recombinant) or the whole virion inactivated Vero cell vaccines were administered. Various parameters were evaluated such as age, sex, time to infection, type of vaccine, infections after a single and two doses, monthly and regional case distribution, clinical severity of infection, hospitalization and intensive care unit (ICU) requirement, and death.Findings: Symptomatic PVIs occurred in a low percentage of vaccinated cohorts (5⸱07%, p<0⸱001), and these were predominantly mild and did not result in hospitalization, ICU admissions (p<0⸱0001), or death. Both vaccines provided similar protection, with PVI incidences of 5⸱11% and 4⸱58%, following ChAdOx nCOV-19 (Recombinant) and the whole virion inactivated Vero cell vaccines, respectively (p<0⸱001). Nursing and Clinical staff and cohorts>50 years significantly contracted more infections(p<0⸱001 and p=0⸱001, respectively). Two-dose vaccination has significantly lower odds of developing PVI (0.83, 95%CI – 0.72 to 0.97). Maximum infections occurred during the peak of the second COVID-19 wave from mid-April to May 2021 (p<0⸱001). No significant difference existed in the infection between sex, vaccine type, and the number of vaccine doses received (p≥0⸱05).Interpretation: PVI occurred in a small percentage of HCWs. Vaccination protected them significantly from the infection but also severe disease.Funding Information: None.Declaration of Interests: None.Ethics Approval Statement: This study was approved by an Ethical Institutional Committee (EIC), and a consent waiver was given by the EIC.

6.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-317173

ABSTRACT

The SARS-CoV-2 B.1.617.2 (Delta) variant was first identified in the state of Maharashtra in late 2020 and has spread throughout India, displacing the B.1.1.7 (Alpha) variant and other pre-existing lineages. Mathematical modelling indicates that the growth advantage is most likely explained by a combination of increased transmissibility and immune evasion. Indeed in vitro, the delta variant is less sensitive to neutralising antibodies in sera from recovered individuals, with higher replication efficiency as compared to the Alpha variant. In an analysis of vaccine breakthrough in over 100 healthcare workers across three centres in India, the Delta variant not only dominates vaccine-breakthrough infections with higher respiratory viral loads compared to non-delta infections (Ct value of 16.5 versus 19), but also generates greater transmission between HCW as compared to B.1.1.7 or B.1.617.1 (p=0.02). In vitro, the Delta variant shows 8 fold approximately reduced sensitivity to vaccine-elicited antibodies compared to wild type Wuhan-1 bearing D614G. Serum neutralising titres against the SARS-CoV-2 Delta variant were significantly lower in participants vaccinated with ChadOx-1 as compared to BNT162b2 (GMT 3372 versus 654, p<0001). These combined epidemiological and in vitro data indicate that the dominance of the Delta variant in India has been most likely driven by a combination of evasion of neutralising antibodies in previously infected individuals and increased virus infectivity. Whilst severe disease in fully vaccinated HCW was rare, breakthrough transmission clusters in hospitals associated with the Delta variant are concerning and indicate that infection control measures need continue in the post-vaccination era.

7.
EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-313787

ABSTRACT

Introduction: In Coronavirus disease 2019 (COVID-19), early identification of patients with a high risk of mortality can significantly improve triage, bed allocation, timely management, and possibly, outcome. The study objective is to develop and validate individualized mortality risk scores based on the anonymized clinical and laboratory data at admission and determine the probability of Deaths at 7 and 28 days. Methods: Data of 1393 admitted patients (Expired – 8.54%) was collected from six Apollo Hospital centers (from April to July 2020) using a standardized template and electronic medical records. Over 50 Clinical and Laboratory parameters were studied based on the patient’s initial clinical state at admission and laboratory parameters within the first 24 hours. The Machine Learning (ML) modelling was performed using Gradient Boosting Algorithm. ‘Time to event’ using Cox Proportional Hazard Model was used and combined with Gradient Boosting Algorithm. The prospective validation cohort was selected of 977 patients (Expired - 8.3%) from six centers from July to October 2020. The Clinical API for the Algorithm is http://20.44.39.47/covid19v2/page1.php being used prospectively. Results: Out of the 63 clinical and laboratory parameters, Age [Adjusted Hazard Ratio (HR)– 2.31;95%CI 1.52 – 3.53], Male Gender [HR–1.72, 95%CI 1.06 – 2.85], Respiratory Distress [HR–1.79, 95%CI 1.32 – 2.53], Diabetes Mellitus [HR – 1.21, 95%CI 0.83 – 1.77], Chronic Kidney Disease [HR– 3.04, 95%CI 1.72 – 5.38], Coronary Artery Disease [HR– 1.56, 95%CI – 0.91 – 2.69}, Respiratory Rate >24/min [HR–1.54, 95%CI 1.03 – 2.3], Oxygen Saturation below 90% [HR–2.84, 95%CI 1.87 – 4.3], Lymphocyte% in DLC [HR– 1.99, 95%CI 1.23 – 2.32], INR [HR–1.71, 95%CI 1.31 – 2.13], LDH [HR–4.02, 95%CI 2.66 – 6.07 ] and Ferritin [HR–2.48, 95%CI 1.32 – 4.74 ] were found to be significant. The performance parameters of the current model is at AUC ROC Score of 0.8685 and Accuracy Score of 96.89. The validation cohort had the AUC of 0.782 and Accuracy of 0.93. Conclusion: The model for Mortality Risk Prediction provides insight into the COVID Clinical and Laboratory Parameters at admission. It is one of the early studies, reflecting on ‘time to event’ at the admission, accurately predicting patient outcomes.

9.
2021.
Preprint in English | Other preprints | ID: ppcovidwho-295504

ABSTRACT

The SARS-CoV-2 B.1.617.2 (Delta) variant was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha). In vitro , B.1.617.2 is 6-fold less sensitive to serum neutralising antibodies from recovered individuals, and 8-fold less sensitive to vaccine-elicited antibodies as compared to wild type Wuhan-1 bearing D614G. Serum neutralising titres against B.1.617.2 were lower in ChAdOx-1 versus BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies against the receptor binding domain (RBD) and N-terminal domain (NTD), in particular to the clinically approved bamlavinimab and imdevimab monoclonal antibodies. B.1.617.2 demonstrated higher replication efficiency in both airway organoid and human airway epithelial systems as compared to B.1.1.7, associated with B.1.617.2 spike being in a predominantly cleaved state compared to B.1.1.7. Additionally we observed that B.1.617.2 had higher replication and spike mediated entry as compared to B.1.617.1, potentially explaining B.1.617.2 dominance. In an analysis of over 130 SARS-CoV-2 infected healthcare workers across three centres in India during a period of mixed lineage circulation, we observed substantially reduced ChAdOx-1 vaccine efficacy against B.1.617.2 relative to non-B.1.617.2. Compromised vaccine efficacy against the highly fit and immune evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era.

10.
Diabetes Metab Syndr ; 15(6): 102306, 2021.
Article in English | MEDLINE | ID: covidwho-1446574

ABSTRACT

BACKGROUND AND AIMS: During the COVID-19 vaccination program in India, the healthcare workers were given the first priority. There are concerns regarding the occurrence of breakthrough infections after vaccination. We aimed to investigate the effictiveness of COVID-19 vaccines in preventing and reducing the severity of post-vaccination infections. METHODS: This retrospective test-negative case-control study examined 28342 vaccinated healthcare workers for symptomatic SARS-CoV-2 infections between January 16 to June 15, 2021. They worked at 43 Apollo Group hospitals in 24 Indian cities. These cohorts received either ChAdOx nCOV-19 (Recombinant) or the whole virion inactivated Vero cell vaccines. Various demographic, vaccination related and clinical parameters were evaluated. RESULTS: Symptomatic symptomatic post-vaccination infections occurred in a small number of vaccinated cohorts (5.07%, p < 0.001), and these were predominantly mild and did not result in hospitalization (p < 0.0001), or death. Both vaccines provided similar protection, with symptomatic infections in 5.11% and 4.58%, following ChAdOx nCOV-19 (Recombinant) and the whole virion inactivated Vero cell vaccines, respectively (p < 0.001). Nursing and Clinical staff and cohorts >50 years contracted more infections (p < 0.001). Two-dose vaccination has significantly lower odds of developing symptomatic infection (0.83, 95%CI - 0.72 to 0.97). Maximum infections occurred during the peak of the second COVID-19 wave from mid-April to May 2021 (p < 0.001). No significant difference existed in the infection between sex, vaccine type, and the number of vaccine doses received (p ≥ 0.05). CONCLUSION: Symptomatic infections occurred in a small percentage of healthcare workers after COVID vaccination. Vaccination protected them from not only infection but also severe disease.


Subject(s)
COVID-19 Vaccines/administration & dosage , COVID-19/epidemiology , Health Personnel/statistics & numerical data , Hospitalization/statistics & numerical data , SARS-CoV-2/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/prevention & control , COVID-19/virology , Case-Control Studies , Female , Follow-Up Studies , Humans , India/epidemiology , Male , Middle Aged , Prognosis , Retrospective Studies , Vaccination , Young Adult
11.
J Clin Orthop Trauma ; 22: 101608, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1440168

ABSTRACT

BACKGROUND: The COVID-19 pandemic has resulted in an infodemic about the novel coronavirus SARS-CoV-2 outbreak to build knowledge and develop mitigation strategies. In addition, scientific journals across the world have studied the impact of COVID-19 on trauma and orthopaedics. METHODS: A cross-sectional, bibliometric analysis of the literature was undertaken on COVID-19 related articles from three Pubmed and Scopus indexed orthopaedic journals from India, namely, Indian Journal of Orthopaedics(IJO),Journal of Clinical Orthopaedics and Trauma(JCOT), and Journal of Orthopaedics (JOO), in May 2021. All the article types and study designs were included for this review. The authors, institutions, countries, keywords, and co-authorship mapping were studied. RESULTS: A total of 112 COVID-19 related documents were retrieved. Period of these publications was from 2nd April 2020 to 31st May 2021. Vaishya R. (n = 16) was the most cited author, and Indraprastha Apollo Hospitals (n = 16) was the most cited research Institution. India led the list of countries in academic publication output. On keyword mapping, telemedicine was the most prominent Medical Subject Headings (MeSH) search word. CONCLUSION: The Indian orthopedic journals have addressed the impact of COVID-19 on orthopaedic practice in India and aborad whilst continuing to publish knowledge about basic science and clinical orthopaedic research studies. The JCOT has outperformed and become the most leading orthopaedic journal from India during the pandemic. COVID -19 articles have been fast tracked, open accessed and attracted more citations in reduced duration of time compared to non-COVID-19 papers.

15.
J Clin Orthop Trauma ; 22: 101590, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1401593

ABSTRACT

BACKGROUND: The Journal of Clinical Orthopaedics and Trauma (JCOT) is one of the top three orthopaedic journals from India. We set out to analyse the top 50 cited articles from JCOT since indexing in PubMed and Scopus. METHODS: We looked into the bibliometrics of the top 50 cited articles and compared citations from PubMed and Scopus, and depicted outputs from VOS viewer analysis on co-authorship and keywords. RESULTS: Total citations for top-cited articles were 1076 in numbers, with a maximum of 103.2016 and 2018 were the most productive years. The major contribution was from India with 74%, followed by the USA. New Delhi published maximally at 72%. Clinical topics and narrative reviews were the most common types of studies. Trauma and Adult reconstruction was the most common sub-specialities, and Level 4 was the most frequent level of study. The basic science and COVID-19 related articles received the maximum citations. The authors from Indraprastha Apollo Hospitals published the maximum number of top-50 cited articles in the JCOT. CONCLUSIONS: There is a steady increase in the number of publications in the JCOT, with an increasing number of citation counts. Both the Indian and foreign authors have been publishing in this journal at a comparative rate. Although the citation counts in Scopus are more than those in PubMed for given articles, more than 80% of articles are listed in both databases as top 50 cited articles. The majority of top-cited articles belonged to trauma and adult reconstruction, level III studies, and narrative reviews.

16.
Nature ; 599(7883): 114-119, 2021 11.
Article in English | MEDLINE | ID: covidwho-1392870

ABSTRACT

The B.1.617.2 (Delta) variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in the state of Maharashtra in late 2020 and spread throughout India, outcompeting pre-existing lineages including B.1.617.1 (Kappa) and B.1.1.7 (Alpha)1. In vitro, B.1.617.2 is sixfold less sensitive to serum neutralizing antibodies from recovered individuals, and eightfold less sensitive to vaccine-elicited antibodies, compared with wild-type Wuhan-1 bearing D614G. Serum neutralizing titres against B.1.617.2 were lower in ChAdOx1 vaccinees than in BNT162b2 vaccinees. B.1.617.2 spike pseudotyped viruses exhibited compromised sensitivity to monoclonal antibodies to the receptor-binding domain and the amino-terminal domain. B.1.617.2 demonstrated higher replication efficiency than B.1.1.7 in both airway organoid and human airway epithelial systems, associated with B.1.617.2 spike being in a predominantly cleaved state compared with B.1.1.7 spike. The B.1.617.2 spike protein was able to mediate highly efficient syncytium formation that was less sensitive to inhibition by neutralizing antibody, compared with that of wild-type spike. We also observed that B.1.617.2 had higher replication and spike-mediated entry than B.1.617.1, potentially explaining the B.1.617.2 dominance. In an analysis of more than 130 SARS-CoV-2-infected health care workers across three centres in India during a period of mixed lineage circulation, we observed reduced ChAdOx1 vaccine effectiveness against B.1.617.2 relative to non-B.1.617.2, with the caveat of possible residual confounding. Compromised vaccine efficacy against the highly fit and immune-evasive B.1.617.2 Delta variant warrants continued infection control measures in the post-vaccination era.


Subject(s)
Immune Evasion , SARS-CoV-2/growth & development , SARS-CoV-2/immunology , Virus Replication/immunology , Antibodies, Neutralizing/immunology , COVID-19 Vaccines/immunology , Cell Fusion , Cell Line , Female , Health Personnel , Humans , India , Kinetics , Male , Spike Glycoprotein, Coronavirus/metabolism , Vaccination
18.
Indian J Med Res ; 153(5&6): 550-554, 2021.
Article in English | MEDLINE | ID: covidwho-1339655

ABSTRACT

BACKGROUND & OBJECTIVES: COVID-19 pandemic has taken a significant toll on the health of the people across the globe, including India, and is still continuing with its rapidly evolving second wave. Although the COVID-19 vaccines effectively prevent infection, yet some cases of infections have been reported post-vaccination, raising concerns about their efficacy and safety. This study was aimed to investigate the occurrence of SARS-CoV-2 infection among the symptomatic-vaccinated healthcare workers (HCWs) and to analyze the severity of their disease. METHODS: This retrospective study was done at a single multispecialty hospital, on the HCWs who have had COVID-19 vaccination, during the initial period of the vaccination drive (January 16 to April 24, 2021). The symptomatic post-vaccination infections in these HCWs were evaluated. RESULTS: Eighty five of 3235 (2.63%) vaccinated HCWs acquired the SARS-CoV-2 infection after vaccination, during the study period. Of these, 65 (76.5%) were fully vaccinated (FV), and 20 (23.5%) were partially vaccinated (PV) and the protection rate of vaccination was 97.4 per cent [95 % confidence interval (CI)=96.8-97.9]. The odds ratio of acquiring infection among females was higher at 1.84 (95% CI=1.17-2.88; P=0.008) mainly because of their greater involvement in the patient care as nursing personnel. The chances of infections were the highest in the medical and nursing personnel, as compared to paramedical, administrative and supporting staff (P<0.001). Among the HCWs studied, only two required hospitalization (0.06%), none needed an intensive care unit (ICU) admission and there were no deaths. INTERPRETATION & CONCLUSIONS: The COVID-19 infection after vaccination occurred in a smaller subset (2.63%) of HCWs, in both PV and the FV groups. These infections were primarily minor and did not lead to severe disease. Overall, the vaccination with ChAdOx1 nCoV-19 vaccine (recombinant) prevented SARS-CoV-2 severe infection in the HCWs, leading to ICU admission and deaths.


Subject(s)
COVID-19 , SARS-CoV-2 , COVID-19 Vaccines , Female , Health Personnel , Humans , Pandemics , Pilot Projects , Retrospective Studies , Vaccination
20.
Lung India ; 38(4): 379-381, 2021.
Article in English | MEDLINE | ID: covidwho-1302651
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