Epidemiological and Clinical Profile of COVID-19 Patients Admitted in a Tertiary Care Hospital in Western India

Introduction:

Ahmedabad city reported the highest number of cases and deaths. In order to guide various interventions and monitor future trends, evidence is required. Hence, we conducted the present study to explore the epidemiological determinants, clinical profile, risk factors, and predictors of mortality of COVID-19.

Methods:

This was a retrospective record-based descriptive study of 2268 confirmed COVID-19 patients admitted in a designated COVID hospital of Ahmedabad city from March to July 2020.

Results:

The median age of patients was 54 years, and 60.9% of them were males. Majority (83.27%) had comorbidities; the most common comorbidity was hypertension (62.59%) followed by diabetes (44.76%). The most common symptoms reported were fever (69.76%), breathlessness (55.47%), and cough (53.18%). Majority (61.12%) of the patients showed lymphocytopenia, and in one-third (34.85%), D-dimer levels were elevated (>1 μg/ml). Odds of inhospital deaths were higher in patients having breathlessness and gastrointestinal symptoms and comorbidities. More of the deceased had leukocytosis and lymphocytopenia, high D-dimer levels, C-reactive protein, and altered liver function tests as compared to the survivors.

Conclusion:

While making decisions such as prevention of exposure of high-risk population to the infection, control of the existing comorbid condition, and prioritization of this population for vaccination, criteria of case definition for surveillance keeping in mind the typical and atypical manifestations of the disease, require robust evidence which the current study could provide insight to.

A multicentric observational study of imaging findings in COVID-19-related rhino-orbito-cerebral mucormycosis: a new Pandora’s box

Background

There is a sudden rise of fungal infection with corona virus disease. This is attributed to the immunomodulation by the disease and the drugs used, diabetes mellitus, steroid use, oxygen inhalation using dirty water, use of zinc and iron supplements, etc. Early diagnosis and prompt medical and surgical intervention is the mainstay of treatment. This can greatly reduce the high morbidity and mortality associated with this disease. The objective of the study is to describe the imaging findings of acute invasive rhino-orbito-cerebral mucormycosis (ROCM) in 25 patients with severe acute respiratory syndrome corona virus 2, from three different centers with proven mucormycosis. Special emphasis is placed on the signal enhancement patterns of sinonasal mucosa, the earliest and most common findings. Statistical analysis was performed using descriptive statistics.

Results

Computed tomography (CT) and magnetic resonance imaging (MRI) of 25 patients showed most commonly involved sinuses as maxillary and ethmoid sinuses (19, 76%) together. Sino-nasal mucosal thickening was the most common finding (24, 96%). Periantral infiltration (18, 72%) preceded before orbital (15, 60%), cerebral (5, 20%) and vascular (2, 8%) complications, with grossly intact bones. Sinus wall erosions were seen in only 2 patients (8%). Palatal (22%) and maxillary alveolar arch erosion (39%) were frequent findings. CT showed minimally enhancing hypodense soft tissue thickening as the predominant finding in involved areas, while MRI showed T1 and T2 iso- to hypointense mucosal thickening (62%) and intense (43%) and no (33%) contrast enhancement as the main finding.

Conclusions

Contrast enhanced MRI is better at demonstrating early mucosal abnormalities, turbinate necrosis, non-enhancing devitalized tissues, orbital apex involvement and intra-cerebral extension. Imaging findings of inflammatory tissue infiltration adjacent to the paranasal sinuses in premaxillary, retroantral fat, facial muscles, pterygopalatine fossa, temporal, infratemporal fossa and extraconal orbital fat along with typical patterns of sinonasal mucosal enhancement should raise the suspicion of acute invasive fungal etiology given the short duration of history and immunocompromised status. High incidence of periantral and orbital extension of the disease is suggestive of acute invasive form of fungal infection. Also the rapidly progressive inflammatory changes without much bone involvement should suggest the suspicion of ROCM. Bony, cerebral and vascular involvements are relatively late complications.

Supplementary Information

The online version contains supplementary material available at 10.1186/s43055-021-00631-w.

A Review of the Quiz, as a New Dimension in Medical Education

Over the years, medical education delivery has seen a change from teacher-centric to student-centric teaching-learning methods. Educators are constantly looking to develop interactive and innovative teaching-learning tools. One such supplementary tool is the use of the quiz for medical education. The Quiz has been used traditionally as a feedback assessment tool, but lately, it has found its way into the medical curriculum, mostly informally. The few available documented studies on the Quiz as a teaching and learning tool illustrate its acceptance and impact on the stakeholders. It could be one of the solutions to the endless search for a student-centric and engaging tool to deliver the medical curriculum. Commonly, the format for medical quiz is either on a case-based or image-based approach. Such an approach helps bridge the gap between traditional classroom teaching and clinical application. The Quiz is a readily acceptable tool that complements didactic lectures and improves students' learning and comprehension. Being an interactive student-centric tool, it enhances active student participation and encourages regular feedback mechanisms. It promotes healthy competition and peer-assisted learning by encouraging active discussion among students, hence improving student performance in standard examination techniques, along with teacher satisfaction. This literature review aims to enumerate the various formats of the Quiz, their role in improving the understanding and retention of knowledge among the students and assess their acceptability among the stakeholders.

Epidemiological and diagnostic aspects of feline leishmaniasis with emphasis on Brazil: a narrative review

The leishmaniases are a group of diseases caused by the protozoan parasite belonging to the genus Leishmania. In the New World, although dogs are considered the main parasite reservoir, in the last two decades, several studies have confirmed the role of cats (Felis catus) in the epidemiology of the disease and feline leishmaniasis (FeL) is now considered to be an emerging disease. The present review summarizes the current knowledge about FeL, focusing on important immunopathological aspects, epidemiology, and diagnostic methods applied for felines in Brazil. Cats are infected with the same species of Leishmania found in dogs (i.e., Leishmania infantum). Like dogs, skin lesions are the most common in cats with clinical FeL, mainly affecting the cephalic region and less frequently the legs which may be accompanied by generalized signs or visceral involvement. Information on the immune response of cats to Leishmania infection is scarce; however, efficient infection control is seen in most cases. For diagnosis, generally, the same methods as those in dogs are used, mainly serological tools. But there is a lack of studies focusing the performance of these methods for diagnosing FeL. The estimated overall prevalence of FeL in Brazil is 8%, with L. infantum being the most prevalent species. However, infections with Leishmania braziliensis and Leishmania amazonensis have also been reported. In conclusion, although there has been an increase in the publication related to FeL in Brazil in recent years, there is a lack of research relating immune response and diagnosis of these animals. Cats have been shown to be competent hosts for Leishmania parasites, and their role in the epidemiology of the disease cannot be underestimated, especially in areas of Brazil where the disease is historically endemic.

How Has the Pandemic Affected Women in Medicine? A Survey-Based Study on Perceptions of Personal and Career Impacts of COVID-19

Background: Gender inequity is apparent for women in medicine. With the onset of the COVID-19 pandemic, there are concerns about how women physicians are personally and professionally impacted. Materials and Methods: Participants of the Women in Medicine Summit were anonymously surveyed about their perspectives about COVID-19 affecting women in medicine. Questions were centered around perceived gender bias, productivity expectations, and stressors. Results: At the Women in Medicine Summit, 454 attendees were invited to complete the survey with a response rate of 27% (n = 124). Of those participants, 46% of participants perceived gender bias in the workplace, with 39% citing further inequities with intersectional identities (p < 0.05). Productivity expectations were reported to be higher than before the pandemic in 41% of survey participants. The majority of respondents (70%) reported experiencing high levels of stress during the pandemic, compared with only 16% reporting high levels of stress before the pandemic (p < 0.05). Discussion: It is clear that women physicians are experiencing the pandemic differently. Gender bias is a common occurrence, especially by individuals with intersectional identities. These stressors are not new to women in medicine, but with the overriding impact of the pandemic, higher expectations for productivity, and increased personal responsibilities, employers should focus on preventing further exacerbations of gender inequity in medicine.

Safety and efficacy of COVID-19 vaccination in patients receiving systemic anticancer therapy

245

Background: Patients with cancer who have been treated with systemic anticancer therapy are at increased risk of morbidity and mortality from COVID-19 and have been considered a high-priority group for COVID-19 vaccination in the United States. There is limited guidance and data on the appropriate timing of COVID-19 vaccination relative to receipt of systemic anticancer therapy. Methods: We queried the electronic medical record at the University of Illinois Hospital for patients with gastrointestinal, breast, lung, genitourinary, and head and neck tumors who had received intravenous systemic anticancer therapy between January 1, 2021 and May 25, 2021. Baseline variables were obtained as well as details of cancer treatment, vaccination timing relative to cancer treatment, and clinical outcomes. Results: A total of 274 patients received intravenous systemic anticancer therapy during the study period, of which 161 (58.8%) received at least one vaccine dose, and 138 (42.7%) were fully vaccinated. Of the 122 patients who received cancer treatment within 30 days of any vaccine dose, the median age was 64, and 72 (59%) were female gender. Race distribution was 50% Black, 15.6% White, 3.3% Asian; ethnicity was 24.6% Hispanic and 73% not-Hispanic. Treatment regimens consisted of 37.7% chemotherapy, 25.4% immunotherapy, 27.9% combination therapy, and 9.0% targeted therapy. For those who received anticancer therapy within 30 days of a vaccine, median time between any vaccination and treatment was 10 days (range 0-29 days). For those who had at least 60 days of follow-up after first vaccination, all-cause hospitalization rate was 22.4% (23/106). There was no statistical difference in all-cause 60-day hospitalization rate between those who received vaccination within 5 days of anticancer therapy versus those who received it between 6 and 30 days from anticancer therapy (14.3% vs 28.1%, p = 0.1). One patient (0.8%) developed a COVID-19 illness after any vaccine and did not require hospitalization. Conclusions: We observed safe and efficacious COVID-19 vaccination of patients with cancer receiving systemic IV anticancer therapy. COVID-19 infection after vaccination was rare, with no cases requiring hospitalization for COVID-19 illness post-vaccination in this cohort. All-cause hospitalization rates were similar among patients who received a vaccine within or after 5 days of receiving systemic anticancer therapy, suggesting vaccination side effect tolerability. Further quality improvement studies are needed on interventions to increase vaccination rates in this vulnerable population.

Comparative evaluation of ventilator-associated pneumonia in critically ill COVID- 19 and patients infected with other corona viruses: a systematic review and meta-analysis

The Coronavirus disease 19 (COVID-19) pandemic is associated with an unprecedented requirement for intensive care unit (ICU) admission, invasive mechanical ventilation, and thereby significantly increasing the risk of secondary nosocomial pneumonia, Ventilator-Associated Pneumonia (VAP). Our study aims to identify the overall incidence of VAP, common organisms associated with it, and outcome in COVID-19 patients in comparison to the non-SARS-CoV-2 infected critically ill ventilated COVID-19 patients. A comprehensive screening was conducted using major electronic databases), from January 1st 2020 to May 31st 2021, as per the PRISMA statement. In our rapid review, we included a total of 34 studies (involving 8901 cases. Overall VAP was reported in 48.15 % (95% CI 42.3%-54%) mechanically ventilated COVID-19 patients and the mortality rate was 51.4% (95% CI 42.5%-60%). COVID-19 patients had increased risk of VAP and mortality in comparison to other non-SARS-CoV-2 viral pneumonia (OR=2.33; 95%CI 1.75-3.11; I2=15%, and OR=1.46; 95%CI 1.15-1.86; I2=0% respectively). Critically ill COVID-19 patients are prone to develop VAP, which worsens the outcome.

An Adrenocortical Carcinoma Evolving After Nine Years of Latency From a Small Adrenal Incidentaloma

Adrenal incidentalomas (AIs) are common incidental findings in medical practice with clinical significance. Although most AIs are nonsecretory and nonmalignant, they require a short course of follow-up over one to two years to rule out malignancy or hormonal secretion according to clinical practice guidelines. However, this can result in some adrenocortical carcinomas (ACCs) being missed if they transform at a later stage or evolve slowly. Here, we report one such case of an AI, which although remained indolent, eventually transformed into an ACC many years after the initial detection.

High spatial-density, cladding-pumped 6-mode 7-core fiber amplifier for C-band operation

We present a C-band 6-mode 7-core fiber amplifier in an all-fiberized cladding-pumped configuration for space division multiplexed transmission supporting a record 42 spatial channels. With optimized fiber components (e.g. passively cooled pump laser diode, pump coupler, pump stripper), high power multimode pump light is coupled to the active fiber without any noticeable thermal degradation and an average gain of 18 dB and noise figure of 5.4 dB are obtained with an average differential modal gain of 3.4 dB.

Creation and Translation of IMPACT (Illinois Medical Professional Action Collaborative Team) to Amplify and Address Disparities in COVID ‐19: The Case of Vaccine Delivery

Research Objective

During the COVID‐19 pandemic, novel infrastructure is needed to 1) assess disparities in care delivery 2) address these needs through rapid dissemination of rapidly‐evolving, evidenced‐based information 3) connecting people to resources and 4) advocating for policy change.

Study Design

An interdisciplinary coalition of health care professionals on social media created the organization IMPACT. IMPACT (www.impact4hc.com) leverages social media and novel non‐profit/for‐profit partnerships to 1) identify and amplify public health needs and disparities in care delivery 2) address needs and gaps by rapidly disseminating evidence‐based information, 3) connecting groups to resources, and 4) advocating for science‐based policy. IMPACT and Oak Street Health (OSH) [a value based primary care system for low income seniors and medicare enrollees] identified a critical gap in Phase 1a vaccinations in Illinois: limited access to COVID‐19 vaccination for health care workers not affiliated with health systems. IMPACT worked with OSH to 1) identify the gap 2) leverage the partnership to vaccinate 3) amplify the messaging to disseminate resources for vaccine sign ups and 4) approach city leadership for policy change.

Population Studied

A case study of healthcare workers in Illinois awaiting vaccination in 01/2021.

Principal Findings

Disparities in vaccination needs were rapidly identified through multiple sources (twitter, Chicago facebook groups for healthcare workers, emails and messages to IMPACT) for health care workers (HCWs1a) not affiliated with health systems. An IMPACT clearinghouse for vaccine information (registration, interest surveys) was created procuring information rapidly through social media and professional networks. Given high levels of interest (1342 views/10 days, avg 127/daily), IMPACT‐OSH partnered to highlight need (twitter, facebook, policy statement), while OSH created a vaccination clinic with web‐based vaccine registration for non‐system affiliated HCWs. Targeted posts on facebook (2 closed HCW groups [2.2 K members/each], 1 closed general group [15.1 K]) were used to disseminate clearinghouse and OSH vaccine clinic information. Facebook posts alone reached 1650 HCWs, general member group posts reached >3.2 K in 7 days. In the first 7 days of the campaign, 5800 HCWs signed up for the OSH vaccine clinic, with >1800 vaccinated. In the first 48 hours of the social media campaign (over weekend) approx. 2000 HCWs signed up. Of a subgroup of OSH vaccinated HCWs (N = 1500), 50% reported receiving information through social media or web‐based link. In response to these concerns, the local health departments encouraged all health care entities to vaccinate non‐system affiliated HCWs, and the work was highlighted in the mayor's weekly press conference.

Conclusions

By leveraging novel methods of communication and dissemination (social media, partnerships), IMPACT and Oak Street Health were able to assess and address the gap in care delivery of vaccinations to HCWs in a rapid time frame.

Implications for Policy or Practice

Novel partnerships and utilization of social media made it possible to identify and then rapidly address a critical gap in HCW vaccination in the short term while laying groundwork for longer‐term policy solutions. These findings have future implications for further vaccine rollout.

A coordinated strategy to develop and distribute infographics addressing COVID-19 vaccine hesitancy and misinformation

Background

Visual communication strategies are becoming increasingly prevalent for conveying information to health professionals as well as to the general public. The potential of social media for rapid knowledge dissemination using infographics was recognized early in the coronavirus disease (COVID-19) pandemic by health professionals.

Objective

The purpose of this study was to describe a coalition of health professionals’ approach to developing infographics about COVID-19 vaccines and the reach and engagement of those infographics when shared through social media.

Methods

Infographics were created by a core team within the coalition following a stepwise approach. Each underwent a multistep review process, readability evaluation, and translation into Spanish. Infographics were then shared through multiple social media platforms. They were grouped into 1 of 3 categories for this analysis: COVID-19 vaccine series, myth debunkers, or other.

Results

All infographics had greater outreach, impressions, and engagement on Twitter than they did on other platforms. When comparing the 3 groups, no 1 infographic type was consistently performing higher than the others.

Conclusion

Each infographic reached thousands to tens of thousands of people. We do not know whether those who viewed these infographics changed their perspective on vaccination, so we are unable to draw a conclusion about their impact on vaccine hesitancy based on this study alone.

Multicentric Hospital-Based Surveillance of Pertussis Amongst Infants Admitted in Tertiary Care Facilities in India

OBJECTIVE

To estimate the disease and economic burden of pertussis amongst hospitalised infants in India.

DESIGN

Multicentric hospital-based surveillance study.

PARTICIPANTS

Hospitalised infants with clinical suspicion of pertussis based on predefined criteria.

OUTCOME MEASURES

Proportion of infants with laboratory-confirmed pertussis, economic burden of pertussis amongst hospitalised infants.

RESULTS

693 clinically suspected infants were recruited of which 32 (4.62%) infants had laboratory-confirmed pertussis. Progressive cough with post-tussive emesis (50%) and pneumonia (34%) were the common clinical presentations; apnea in young infants was significantly associated with pertussis. Infants with pertussis were more likely to be younger (median age 102.5 days vs.157 days) and born preterm (42.9% vs 24.5%). Almost 30% infants with pertussis had not received vaccine for pertussis with 50% of these infants aged less than 2 months. Pertussis was associated with higher costs of hospitalisation, pharmacy and loss of working days by caregivers as compared to non-pertussis cases.

CONCLUSIONS

Younger infants, those born preterm and those inadequately immunised against pertussis are at higher risk of pertussis infection. Timely childhood immunisation and introduction of maternal immunisation for pertussis can help in reducing the disease burden.

Patient Expectations From Consultation and Treatment of Spine Pain in a Private Spine Rehabilitation Clinic in Urban India

Despite high prevalence of spine pain among the Indian population, patient expectations regarding consultation and its treatment are unknown. We aimed to determine consultation and treatment expectations among patients visiting a spine rehabilitation clinic in urban India. We included 194 consecutive patients who completed a consultation expectation (CE) and treatment outcome expectation (OE) questionnaires and the Patient-Centered Outcome Questionnaire (PCOQ). To learn about the most suitable treatment for their problem (98%), and to know what kind of activities they could do and should avoid (96%) were the most important CEs, and to achieve complete relief of symptoms (96%), and prevent recurrence of pain (95%) were the most important OEs. For successful treatment, patients expected PCOQ pain levels of 2.0 (96.5% reduction) and interference levels of 1.5 (96% reduction). Patients expected to know the most suitable treatment, activities they could do and avoid after consultation, and to achieve complete relief of symptoms and prevent recurrence after treatment. Incorporating and addressing these expectations may help improve outcomes and satisfaction with the consultation and treatment of spine pain.