Clinical profile and in-hospital outcomes of COVID-19 among adolescents at a tertiary care hospital in India.

Introduction: We aimed to describe the clinical profile and risk factors for severe disease in adolescents hospitalised with coronavirus disease 2019 (COVID-19). Methods: A retrospective analysis of an admitted cohort of COVID-19 patients was performed at a tertiary hospital in North India. Adolescents aged 12-18 years who were hospitalised during the first wave (March-December, 2020) and the second wave (March-June, 2021) were included. Data on the demographic details, clinical presentation, laboratory parameters, disease severity at admission, treatments received, and in-hospital outcomes were retrieved. Results: The study included 197 adolescents with a median [inter-quartile range (IQR)] age of 15 (13-17) years, of whom 117 (59.4%) were male. Among these, 170 (86.3%) were admitted during the first wave. Underlying co-morbidities were present in nine (4.6%) patients. A total of 60 (30.9%) patients were asymptomatic. In the severity grading, 148 (84.6%) had mild, 16 (9.1%) had moderate, and 11 (6.3%) had severe disease. Fever (14.9%) and cough (14.9%) were the most commonly encountered symptoms. The median (IQR) duration of hospital stay was 10 (8-13) days, and six (3.1%) patients died in the hospital. Conclusion: Adolescents admitted with COVID-19 had predominantly asymptomatic or mild disease, and the mortality rate was 3.1%.

Utility of walk tests in progression of mild COVID-19 infection at a tertiary hospital in North India.

INTRODUCTION: There have been 214 million confirmed cases of COVID-19 worldwide with a total death tally of 4.4 million. The current study aims to determine the predictive value of various scores in assessment of progression of mild COVID-19 infection at a tertiary care hospital in North India. METHODS: The study population consisted of adults (age more than 18 years) with a confirmed diagnosis of COVID-19 by RT-PCR on nasopharyngeal specimens. Patients with only mild illness were enrolled. After the patients were admitted to the isolation ward, the presenting history, comorbidity status, vital signs and laboratory parameters were recorded. The 3 and 6 minute walk test was performed daily from admission till discharge or progression of severity of COVID-19 and it was used to calculate Borg dyspnoea score (BDS) and National Early Warning Score (NEWS2) scores. RESULTS: Our study consisted of 50 patients with 34 (68%) males and the mean (SD) age of the patient population being 28.1 (6.4) years. The most common symptoms were fever, sore throat, and cough. All laboratory parameters were within normal ranges for all the patients. 96% recovered without progression, while only 4% of them progressed to moderate illness. Results of the 3 and 6 minutes walk tests, BDS and NEWS2 scores showed improvement over the course of hospital stay. CONCLUSIONS: Although the walk tests and the scores improved over time, they failed to predict the disease progression.

Impact of various hematological and biochemical parameters on mortality in coronavirus disease 2019 (COVID-19): A single-center study from North India.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronavirus disease 2019 (COVID-19), has rapidly evolved into a pandemic, affecting more than 90 million people and more than 1.9 million deaths worldwide. Despite extensive study, the prognostic role of various hematological and biochemical parameters remains unclear. Methods: This study was carried out at a COVID care facility in Delhi. The demographic and clinical information, laboratory parameters (hematological, biochemical, and inflammatory), and the treatment of admitted COVID-19 patients during first wave were collected from electronic medical records and were subsequently analyzed. Results: Between March 2020 and November 2020, a total of 5574 patients were admitted to hospital due to COVID-19. Majority (77.2%) were male and had a mean (standard deviation [SD]) age of 38.9 (14.9) years. The mean (SD) duration of hospital stay was significantly higher in nonsurvivors. Out of the entire cohort, 8.7% of the patients had comorbidities, whereas 47.1% of the patients were asymptomatic at presentation. Compared to the survivors, the nonsurvivors had a significantly higher proportion of comorbidities and were more likely to be symptomatic. Patients who died during hospital stay had significantly higher relative neutrophil percent and neutrophil-lymphocyte ratio and lower lymphocyte percent. The patients who died had significantly higher levels of ferritin, D-dimer, and fibrinogen. Conclusions: Analysis of various hematological and inflammatory parameters can provide useful prognostic information among COVID-19-affected patients. It can also help in identifying patients who merit aggressive institutional care and thereby potentially mitigate the mortality.

Risk factors for Coronavirus disease-associated mucormycosis.

BACKGROUND: The epidemiology of the Coronavirus-disease associated mucormycosis (CAM) syndemic is poorly elucidated. We aimed to identify risk factors that may explain the burden of cases and help develop preventive strategies. METHODS: We performed a case-control study comparing cases diagnosed with CAM and taking controls as recovered COVID 19 patients who did not develop mucormycosis. Information on comorbidities, glycemic control, and practices related to COVID-19 prevention and treatment was recorded. Multivariate regression analysis was used to identify independent predictors. RESULTS: A total of 352 patients (152 cases and 200 controls) diagnosed with COVID-19 during April-May 2021 were included. In the CAM group, symptoms of mucormycosis began a mean of 18.9 (SD 9.1) days after onset of COVID-19, and predominantly rhino-sinus and orbital involvement was present. All, but one, CAM cases had conventional risk factors of diabetes and steroid use. On multivariable regression, increased odds of CAM were associated with the presence of diabetes (adjusted OR 3.5, 95% CI 1.1-11), use of systemic steroids (aOR 7.7, 95% CI 2.4-24.7), prolonged use of cloth and surgical masks (vs. no mask, aOR 6.9, 95%CI 1.5-33.1), and repeated nasopharyngeal swab testing during the COVID-19 illness (aOR 1.6, 95% CI 1.2-2.2). Zinc therapy was found to be protective (aOR 0.05, 95%CI 0.01-0.19). Notably, the requirement of oxygen supplementation or hospitalization did not affect the risk of CAM. CONCLUSION: Judicious use of steroids and stringent glycemic control are vital to preventing mucormycosis. Use of clean masks, preference for N95 masks if available, and minimizing swab testing after the diagnosis of COVID-19 may further reduce the incidence of CAM.

Evaluation of the dose-effect association between the number of doses and duration since the last dose of COVID-19 vaccine, and its efficacy in preventing the disease and reducing disease severity: A single centre, cross-sectional analytical study from India.

AIMS: To evaluate the dose-effect association between COVID-19 vaccination and probability of turning RT-PCR positive and to assess the correlation between disease severity and vaccination status. METHODS: A single centre cross-sectional study was conducted amongst 583 individuals presenting to COVID-19 testing clinic and 55 hospitalized COVID-19 patients. Vaccination status was assessed by the number of doses and duration since the last dose. Disease severity was evaluated by the requirement of hospitalisation and ICU admission/death. The association between the vaccination status and development of disease and its severity were statistically analyzed. RESULTS: The mean age of the population was 36.6 years and 82.6% had no comorbidities. The odds of turning RT-PCR positive was 0.17(95% CI: 0.11-0.27) among the clinical suspects who had taken both doses of the vaccine at least 14 days before (fully vaccinated). The odds of hospitalisation was 0.12(95% CI: 0.03-0.45) and ICU admission/death was 0.07(95% CI: 0.01-0.36) among fully vaccinated individuals. The protective role of vaccination was observed to start 14 days after receiving the first dose. CONCLUSIONS: COVID-19 vaccination provides dose-dependent protection against the development of the disease. It also lowers the risk of hospitalisation and ICU admission/death in RT-PCR positive patients in a dose-dependent manner.

Socio-behavioural impact of COVID-19 on general population: A cross-sectional survey of one thousand seventy-nine participants across India between the first and the second wave of pandemic.

BACKGROUND AND AIMS: COVID-19 is expected to have a significant impact on the socio-behavioural aspect of citizens' lives, although the effects are expected to manifest differently in different population groups. The current study was conducted to assess the socio-behavioural impact of COVID-19 among the general population across India between the first and the second wave of pandemic. METHODS: A web-based cross-sectional study was conducted from 15th March -25th March 2021 using a pre-validated validated questionnaire upon the general population using e-survey, telephonic and face-to-face interview. The participants were recruited from the different regions of India by the purposive and snowball sampling technique following the principle of maximum diversity. Appropriate statistical tests were applied to study the association between the various sociodemographic variables and different behaviours. RESULTS: A total of 1079 responses were analysed for the study. Almost half of the participants feared contracting the COVID-19 infection. Overall, female participants, elderly people (more than 60 years of age) and urban dwellers reported a greater fear in the survey. More than half of the participants (53.39%) reported significant difficulties due to home confinement. People have become more inclined to adopt healthy lifestyles. There are mixed responses in the area of following preventive practices. CONCLUSION: People have a significant amount of fear and anxiety related to the pandemic, leading to several social and behavioural changes that might have a considerable impact on their everyday lives.