India Unburdening the Pandemic: Jabs and Talks.

The impact of COVID-19 on the global healthcare system was detrimental, and India was not an exception. A crucial part of India's fight during the pandemic was the nation's astonishing vaccination delivery. From actively curbing the spread of COVID-19 and managing the affected to initiatives for the vaccination of our vast country, India faced numerous challenges in the healthcare delivery system during the pandemic. India's compassionate initiative to supply COVID-19 vaccines across the globe was remarkable. With the rising caseload and increasing case fatality, healthcare workers (HCWs) worked tirelessly to fight the battle against COVID-19. This left gruesome effects on their mental health, leading to various mental health problems. To alleviate such concerns, the government and many renowned institutions in India put forth recommendations, services, and assistance to those suffering. In a nutshell, the healthcare system in India faced countless challenges during the COVID-19 pandemic, but the course of action taken to combat those challenges was truly extraordinary.

Comparison of Framingham Risk Scores (FRS), Joint British Society (JBS3), and American College of Cardiology/American Heart Association (ACC/AHA) Cardiovascular Risk Scores Among Adults With First Myocardial Infarction.

INTRODUCTION: The prevalence of myocardial infarction (MI) among young Indian adults is on the rise with reports suggesting 32.7% of all deaths in men and 32.6% of all deaths in women between 2010-13 were due to cardiovascular diseases (CVDs). Though various long-term cohort studies have established risk assessment scores none of them are specific to the Indian population. In this study, we look to establish which scoring system among the American College of Cardiology (ACC), Joint British Society (JBS3) and Framingham Risk Scores (FRS) would be reliable for the Indian population. A timely intervention based on the most reliable score can help mitigate cardiovascular diseases. MATERIALS AND METHODS: In this cross-sectional study, we included Indian adults, aged more than 40 years, with first MI. Patients previously on lipid lowering drugs were excluded. Demographic data, history, clinical information, laboratory data and other investigations were noted. Subsequently the predicted cardiovascular risk scores based on JBS3, ACC, and FRS were calculated and divided into low risk, intermediate and high risk based on the categorization of the risk scores individually. RESULTS: There were 102 (79.1%) males and 23 (17.8%) females with a mean age of 51.01 years (standard deviation [SD]=12.82, p value <0.001). There was considerable prevalence of type 2 diabetes mellitus with 56 (47.1%) of the subjects being known diabetics. The mean 10-year risk of MI based on ACC was 12.42% (SD=10.45), mean JBS3 score was 14.45% (SD=12.67) and mean FRS score was 15.75% (SD=14.71). FRS scores when categorized, 48 (40.3%) patients had low risk, 30 (23.3%) had medium risk and 43 (33.3%) had high risk. As for ACC score, 39 (35.8%) patients were in low risk and 29 (26.6%) in intermediate risk, borderline in 18 (16.5%) and high risk in 23 (21.1%). In JBS3 scores, 53 (46.5%) patients were in low risk, 32 (28.1%) were in moderate risk and 29 (25.4%) in high risk. CONCLUSION:  The absolute value of 10-year risk scores was highest for FRS scores. The proportion of patients whose scores were under the category of high risk was highest for FRS.

Study of early warning efficiency of different laboratory markers in predicting progression of disease in COVID-19.

Introduction: COVID 19 pandemic has given rise to several challenges to clinicians and one of the keys in this is to predict the set of patients who progress from mild disease to moderate and severe. Apart from the symptomatology and signs, there are several lab parameters varying from biochemical, hematological to radiological parameters which help us in stratifying the stage of disease and also in deciding on which set of patients need close and vigilant monitoring. This would help us in better stratification of disease and utilize the available infrastructure and resources in an optimum way for better management of the disease. Aim: To analyze the early warning efficiency of laboratory parameters individually or in combination in predicting the progress of disease in patients from mild to moderate/severe disease. Materials and Methods: This was taken up as a retrospective study with 100 cases and 100 controls. The demographic details, inflammatory markers, biochemical markers and hematological markers were analyzed. Test of significance was employed to compare categorical variables while student t-test was employed to test the difference in the mean value such as age between case and control (Mann-Whitney U-test in parameters not having normal distribution). Receiver operating characteristic (ROC) curve was constructed for these parameters using cases and controls and area under the curve (AUC) were estimated which was used as an indicator of sensitivity and specificity of the parameter in their early warning efficiency. The critical values for each of the parameters either individually or in combination was estimated as well. Results: Among the parameters C reactive protein (CRP), d-dimers and eosinopenia have the best early warning efficiency. The area under the ROCs curve for neutrophil lymphocyte ratio (NLR), CRP. Ferritin, lactate dehydrogenase, Eosinopenia was 0.609, 0.947, 0.614, 0.554, 0.617 respectively at triage. However, a combination of eosinopenia with CRP (AUC-0.732) or NLR with CRP (AUC-0.728) have a good sensitivity and specificity in predicting the outcome regarding the progression of the disease. Conclusions: Among the parameters, CRP, d-dimers, Eosinopenia and NLR have the best early warning efficiency. However, a combination of Eosinopenia and CRP at triage should also serve as a red flag sign in patients apart from the well-known NLR and IL6 values.

Résumé Introduction: La pandémie covide 19 a relevé plusieurs défis aux cliniciens et l'une des clés dans ce domaine est de prédire l'ensemble des patients qui passent d'une maladie légère à modérée et sévère. Outre la symptomatologie et les signes, plusieurs paramètres de laboratoire variant des paramètres biochimiques, hématologiques à radiologiques qui nous aident à stratifier le stade de la maladie et également à décider quel ensemble de patients nécessite une surveillance étroite et vigilante. Cela nous aiderait à mieux stratification des maladies et à utiliser l'infrastructure et les ressources disponibles de manière optimale pour une meilleure prise en charge de la maladie. Objectif: Analyser l'efficacité d'alerte précoce des paramètres de laboratoire individuellement ou en combinaison pour prédire les progrès des maladies chez les patients d'une maladie légère à modérée / sévère. Matériaux et méthodes: Ceci a été considéré comme une étude rétrospective avec 100 cas et 100 contrôles. Les détails démographiques, les marqueurs inflammatoires, les marqueurs biochimiques et les marqueurs hématologiques ont été analysés. Le test de signification a été utilisé pour comparer les variables catégorielles tandis que le test T des étudiants a été utilisé pour tester la différence de valeur moyenne telle que l'âge entre le cas et le contrôle (test U Mann - Whitney dans les paramètres n'ayant pas de distribution normale). La courbe des caractéristiques de fonctionnement du récepteur (ROC) a été construite pour ces paramètres en utilisant les cas et les contrôles et la zone sous la courbe (AUC) ont été estimés qui ont été utilisés comme indicateur de sensibilité et de spécificité du paramètre dans leur efficacité d'alerte précoce. Les valeurs critiques pour chacun des paramètres individuellement ou en combinaison ont également été estimées. Résultats: Parmi les paramètres C Protein réactif (CRP), les D - dimères et l'éosinopénie ont la meilleure efficacité d'alerte précoce. La zone sous la courbe ROCS pour le rapport lymphocyte des neutrophiles (NLR), CRP. La ferritine, la lactate déshydrogénase, l'éosinopénie était de 0,609, 0,947, 0,614, 0,554, 0,617 respectivement au triage. Cependant, une combinaison d'éosinopénie avec CRP (AUC - 0,732) ou NLR avec CRP (AUC - 0,728) a une bonne sensibilité et spécificité pour prédire le résultat concernant la progression de la maladie. Conclusions: Parmi les paramètres, le CRP, les D - dimères, l'éosinopénie et le NLR ont la meilleure efficacité d'alerte précoce. Cependant, une combinaison d'éosinopénie et de CRP au triage devrait également servir de signe du drapeau rouge chez les patients en dehors des valeurs NLR et IL6 bien connues. Mots-clés: C Protéine réactive, efficacité d'alerte précoce, éosinopénie, progression de la maladie dans Covid ­ 19.

A study to evaluate the role of eosinophil count as a prognostic marker for assessing the outcome in patients with COVID-19 infection.

Background and Objectives: The triaging of COVID-19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID-19 from large hospital data, especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID-19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID-19 patients compared to lymphopenia and neutrophil-to-lymphocyte ratio (NLR). Methods: The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID-19 patients were analyzed. In our study, two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID-19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage, namely lymphopenia and NLR, were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. Results: It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8% had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID-19, it was found that initial eosinopenia was found in 86%, whereas a high NLR >17 was seen in only 25.6% of patients who died, thus implying that is eosinopenia is an important marker of disease severity in COVID-19. Conclusions: Eosinopenia is an important parameter in the evaluation of COVID-19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.

A study to evaluate the role of eosinophil count as a prognostic marker for assessing the outcome in patients with COVID 19 infection.

The triaging of COVID 19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID 19 from large hospital data especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID 19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID 19 patients compared to lymphopenia and neutrophil: lymphocyte ratio (NLR). MATERIAL: The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID 19 patients were analysed. Two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID 19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage namely lymphopenia and NLR were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. OBSERVATION: It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8 % had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID 19, it was found that initial eosinopenia was found in 86 % whereas a high neutrophil: lymphocyte ratio >17 was seen in only 25.6% of patients who died. Thus, implying that is eosinopenia is an important marker of disease severity in COVID 19. CONCLUSION: Eosinopenia is an important parameter in the evaluation of COVID 19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.

Association Between Blood Lead Levels and Hypertension in a South Indian Population: A Case-Control Study.

Background Exposure to lead and its accumulation in the body can lead to progressive adverse effects, including increased blood pressure which is associated with the onset of cardiovascular diseases. In this study, we aimed to determine the relationship between blood lead levels and blood pressure. In addition, we compared blood lead levels between hypertensives and normotensives to determine relationships, if any, between lead exposure and high blood pressure. Methodology This was a hospital-based, case-control study. In total, 102 individuals (hypertensives = 51, normotensives = 51) were included in this study. Hypertensive patients (defined as systolic blood pressure (SBP) of ≥140 mmHg, diastolic blood pressure (DBP) of ≥90 mmHg, or taking antihypertensive medication for regulating blood pressure) were considered to be study cases and normotensive individuals were considered to be study controls. Blood lead levels were compared between the two groups, and the effects of blood lead levels on SBP and DBP were estimated. The blood lead levels were measured using optical emission spectrometry. Results The mean blood lead level among hypertensive individuals (5.5743 ± 1.77 µg/dL) was significantly higher compared to normotensive individuals (4.5029 ± 1.3213 µg/dL, P = 0.001). A positive correlation was detected between blood lead levels and SBP (r = 0.304, P = 0.002). However, no significant correlation was found between blood lead levels and DBP. Conclusions Blood lead levels were significantly higher in hypertensive patients compared to normotensive individuals. A significant positive correlation was observed between blood lead levels and SBP.

Innate Immune Cytokine Profiling and Biomarker Identification for Outcome in Dengue Patients.

Background: Early biomarkers of progression to severe dengue are urgently required to enable effective patient management and control treatment costs. Innate immune cells, which comprise the earliest responders to infection and along with the cytokines and chemokines they secrete, play a vital role in orchestrating the subsequent adaptive immune response and have been implicated in the enhancement of infection and "cytokine storm" associated with dengue severity. We investigated the early innate immune cytokine profile of dengue patients during acute phase of disease in a prospective blinded study that included subjects with acute dengue and febrile controls from four major hospitals in Bengaluru, India along with healthy controls. We used intracellular cytokine staining and flow cytometry to identify innate immune biomarkers that can predict progression to severe dengue. Results: Dengue infection resulted in enhanced secretion of multiple cytokines by all queried innate immune cell subsets, dominated by TNF-α from CD56+CD3+ NKT cells, monocyte subsets, and granulocytes along with IFN-γ from CD56+CD3+ NKT cells. Of note, significantly higher proportions of TNF-α secreting granulocytes and monocyte subsets at admission were associated with mild dengue and minimal symptoms. Dengue NS1 antigenemia used as a surrogate of viral load directly correlated with proportion of cytokine-secreting innate immune cells and was significantly higher in those who went on to recover with minimal symptoms. In patients with secondary dengue or those with bleeding or elevated liver enzymes who revealed predisposition to severe outcomes, early activation as well as efficient downregulation of innate responses were compromised. Conclusion: Our findings suggested that faulty/delayed kinetics of innate immune activation and downregulation was a driver of disease severity. We identified IFN-γ+CD56+CD3+ NKT cells and IL-6+ granulocytes at admission as novel early biomarkers that can predict the risk of progression to severity (composite AUC = 0.85-0.9). Strong correlations among multiple cytokine-secreting innate cell subsets revealed that coordinated early activation of the entire innate immune system in response to dengue virus infection contributed to resolution of infection and speedy recovery.