COVID-19

To study the correlation between smoking (pack years) and CT severity score in COVID 19 RTPCR positive patients – Short retrospective study and also study It’s effect on COVID 19 biomarkers

Mansha Grover, Anil Saxena, Bl Bansiwal

Department of Respiratory Medicine, GMC, Kota, Rajasthan, India. E-mail: grover.mansha58@gmail.com

Background: Coronavirus Disease 2019 (COVID-19) is a contagious disease caused by SARS (SARS-COV2). It is a large family of virus that are known to cause illnesses ranging from common cold to pneumonia to Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS). The effect of smoking on COVI D 19 is under consideration. This study is aimed to evaluate the relationship between smoking (Pack years) and CT severity score and its effect on COVID 19 linked biomarkers in COVID-19 RTPCR positive patients.

Materials and Methods: This is a retrospective study conducted between March 2021 to July 2021 on 50 adult COVID-19 RTPCR positive patients admitted in COVID ward and ICU in GMC, Kota. Their CTSS and biomarkers (CRP, D-Dimer, LDH, IL-6 and S. Ferrtin) were obtained at the time of admission and smoking history was obtained for the study.

Results: The CT severity score was found to be high in patients with more pack years. The Pearson Correlation ‘r’ value was calculated as 0.575475 with a p-value of 0.000012 at 5% level of significance which is highly significant. COVID-19 linked biomarkers and its association with pack years was also evaluated. P-values at 5% level of significance for the biomarkers are CRP=0.03359, D-Dimer=0.219884, LDH=0.000028, IL-6=0.186538 and Serum Ferritin=0.00001.

Conclusion: CT severity score is high in smokers and shows significant p-Value at 0.05 and is associated with poor prognosis. CRP, LDH and S. Ferritin are found to be significantly raised in smokers suffering from COVID 19 disease, out of which S. Ferritin is more significantly raised as compared to other significant markers.

Clinico-radiological correlation of COVID 19 - First wave patients

Ashish Kumar Prakash, Nishant Guta, Bornali Datta, Anand Jaiswal

E-mail: akp_vpci@yahoo.com

Background: COVID 19 causes a spectrum of disease. Majority affected are asymptomatic or have febrile mild upper respiratory symptoms. Pulmonary involvement leads to moderate and severe disease. The clinical symptoms range from mild cough and breathlessness to florid ARDS. Early inflammatory pulmonary phase is characterised by alveolitis and acinar shadows (consolidation and organising pneumonia).

Methods: This is a prospective observational cohort study of 193 consecutive adult patients who were admitted with RT-PCR confirmed COVID-19 pneumonia to a tertiary hospital in Delhi NCR from March to December 2020, and subsequently presented for clinical follow-up. Demographic, clinical, laboratory parameters, radiological parameters and treatment details were recorded at the time of admission; HRCT Thorax was done at admission (CT1) and at 4-8 week follow up (CT2) in this group of 193 patients. A subset of patients with more severe disease had a follow up CT (CT3) which was done approximately 3 months after CT1.

Treatment and Outcome: The treatment given to the patients, depending on the severity of their disease, as per national guidelines was recorded during admission and included the following – Level of oxygen support, steroid, HCQs, Ivermectin, Doxycycline, Remdesivir, Tocilizumab, plasma, LMWH. Oxygen support by the following modes – Nasal prongs, face mask, HFNC (High flow nasal canula), noninvasive ventilation (BiPAP) and ventilatory support was recorded. The outcome of patients was recorded – Those who recovered and those who did not survive. The correlation between clinical variables with clinical severity as well as with extent of lung disease was made.

Pulmonary mechanics measured by forced oscillation technique (FOT) in post-acute COVID-19 period over 1 year- A prospective observational study.

Nagesh D Dhadge

Central Health Services. E-mail: ndhadge@hotmail.com

Introduction: Lung functions impairment in covid-19 pneumoniasurvivors cause continued symptoms.Forced oscillation technique (FOT) and impulse oscillometry are valuable in serial monitoring and management of post-covid respiratory symptoms. We aimed to study changes in pulmonary mechanics over 1 year period in covid-19 survivors.

Methods: Covid-19 survivors of mixed severity of 18-80 age group underwent serial measurements of FOT using Antlia Caltech© device: on the first follow-up post-discharge, second at 4 weeks after the first and third one-year post-diagnosis of Covid-19. Demographic details, pulse oximetry at rest and modified medical research council scale (mMRC) for dyspnea were recorded at each visit. Pre and post-bronchodilator resistance and reactance were analysed.

Results: Out of 94 patientsenrolled,17 completed 1-year follow-up post-covid. 3 patients had moderate, 1 severe and 13 mild covid-19 disease.Age group of participant was 45-75 years (Mean= 58.1±2.2) consisting of 13 males and 4 females. 4 had diabetes and an equal number had hypertension. Rest were without any comorbidity. Small airway resistance R5-R20 was0.87±0.57, [0.25—2.03] (Mean±SD, Range. (n=17), p=0.047), 0.79±0.52, [0.01—1.93] and 0.66±0.49, [-0.05 – 1.59] similarly reactance—X5 was -0.18±0.12, [-0.43—(-0.04)], -0.16±0.1, [-0.36 – 0.001] and -0.16±0.13, [-0.47—(-0.03)] at first visit, 4 weeks and after 1 year respectively. Results of post-bronchodilator change in small airways are depicted in Figure-1.

Conclusion: We found statistically significant change towards improvement in small airway resistance R5-R20. Reactance at 5Hz—X5during monitoring period showed decremental change over a year. Some post-bronchodilator reversibility persisted at the end of 1 year.

Impact of comprehensive post Covid-19 rehabilitation at a tertiary care hospital

Sachin Kumar¹, Ajay Handa¹, B. M. Maheswarappa², Arjun Satpute¹, A. Komal¹, S. Saril¹

¹Department of Pulmonology and Sleep Medicine, Sakra World Hospital, Bengaluru, Karnataka, India, ²Sakra Institute of Rehabilitation Sciences, Sakra World Hospital, Bengaluru, Karnataka, India. E-mail: sachin.drk@gmail.com

Background: Post COVID-19 pulmonary complications are the leading cause of morbidity. There is very limited information on the benefits of comprehensive rehabilitation in such patients.

Outcome measures	Measuring tool (unit)	n	Mean	SD	P
Breath holding time	In seconds	48	7.75	10.85	0.0001
Inspiratory muscle strength	Power breathe K5 (cmH2O)	48	34.69479	18.92824	0.0001
Upper limb endurance	6PBRT (number of rings)	48	114.458	52.683	0.0001
Functional capacity	6MWD (m)	48	125.42	75.981	0.0001
Functional strength - Lower extremity	30 s sit to stand test	48	3.729	1.83	0.0001
Postural stability	Biodex balance master	48	0.54688	0.91274	0.0001
Dynamic balance	Timed up and Go-TUG (s)	48	7.92271	6.32986	0.0001
Fall risk score	Biodex balance master	48	0.31812	0.94115	0.023
Fatigue	Fatigue Severity Scale	48	3.90255	1.58958	0.0001
Anxiety	HADS	48	6.354	3.588	0.0001
Depression	HADS	48	4.458	2.509	0.0001
Performance	COPM	48	4.14479	2.27921	0.0001
Satisfaction	COPM	48	4.31563	2.21921	0.0001
Health related quality of life	SGRQ (total score)	48	21.07542	18.85864	0.0001
Patient perceived symptoms	SGRQ (symptoms subscore)	48	17.74708	21.14871	0.0001
Activity limitation	SGRQ (activity subscore)	48	20.42042	21.56615	0.0001
Disease impact	SGRQ (disease subscore)	48	23.90354	21.76715	0.0001

6MWD: 6-min walk distance, 6PBRT: 6 min peg board and ring test, HADS: Hospital Anxiety and Depression Scale, TUG: Timed up and go, COPM: Canadian occupational performance measure, SGRQ: Saint George respiratory questionnaire, SD: Standard deviation

Methodology: A retrospective review was conducted of the patients with Post Covid-19 sequel who underwent multi-disciplinary rehabilitation program at Sakra World Hospital.

Study Type and Setting: (1) Type of study design: Retrospective analysis. (2) Sample size: 48. (3) Sampling: Convenient sampling. (4) Setting: Sakra World Hospital, Bangalore, India. (5) Intended intervention: Multi-disciplinary Rehabilitation.

Process Flow:

Results:

Conclusion: Comprehensive Pulmonary Rehabilitation has shown significant improvement in the patients’ ability to perform daily activities, respiratory mechanics and overall quality of life.

Eastern India collaboration on multi-system inflammatory syndrome in children (eicomisc): A multi-centre observational study

Rashmi Ranjan Das¹, Snehamayee Nayak², Prakash Chandra Panda³, Basudev Biswal⁴

¹Department of Pediatrics, All India Institute of Medical Science, Bhubaneswar, Odisha, India, ²Sardar Vallabhbhai Patel Post Graduate Institute of Paediatrics, SCB Medical College, Cuttack, Odisha, India, ³Department of Pediatrics, Veer Surendra Sai Institute of Medical Sciences and Research, Sambalpur, Odisha, India, ⁴Department of Pediatrics, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India. E-mail: rrdas05@gmail.com

Background: Few single centre studies from resource-poor settings have reported about the epidemiology, clinical feature and outcome of multisystem inflammatory syndrome in children (MIS-C). However, larger data from multi-centre studies on the same is lacking including from Indian setting.

Methods: This retrospective collaborative study constituted of data collected on MIS-C from five tertiary care teaching hospitals from Eastern India. Children ≤15 years of age with MIS-C as per the WHO criteria were included. Primary outcome was death or LAMA (leaving against medical advice).

Results: A total of 134 MIS-C cases were included (median age, 84 months; males constituted 66.7%). Fever was a universal finding. Rash was present in 40%, and conjunctivitis in 71% cases. Gastro-intestinal and respiratory symptoms were observed in 68% and 53% cases, respectively. Co-morbidity was present in 23.9% cases. Shock at admission was noted in 35%, and 27.38% required mechanical ventilation. Nearly 13% children met the primary outcome. The coronary abnormalities got normalized during follow-up in all except in one child. Initial choice of immunomodulation had no effect on the outcomes. Presence of underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia are the factors significantly associated with the occurrence of primary outcome.

Conclusions: MIS-C has myriad of manifestations. Underlying co-morbidity, lymphopenia, thrombocytosis, hyponatremia, increased LDH (>300 U/L), and hypoalbuminemia were associated with the occurrence of primary outcome (death or LAMA). No difference in outcome was noted with either steroid or IVIG or both. Coronary artery abnormalities resolved in nearly all cases.

Pulse steroid therapy in patients with severe COVID-19 pneumonia

Mohammad Yousoof Dar

Chest Diseases Hospital Government Medical College, Srinagar, Jammu and Kashmir, India. E-mail: yousufhumi@gmail.com

Background: COVID-19 disease manifest with a wide spectrum of illness ranging from asymptomatic disease to life threatening COVID pneumonia. In subjects with severe COVID -19 disease, the affected individual develops hyper-acute inflammatory reaction which leads to multi-organ damage and ARDS. Corticosteroids are one of the main drugs which have shown to reduce morbidity and mortality in COVID pneumonia by suppressing the inflammatory reaction and minimizing organ damage.

Aim: We aimed to evaluate whether pulse steroid therapy improves survival compared to standard dose steroids in patients with severe COVID-19 pneumonia.

Materials and Methods: This retrospective study included 198 patients of severe COVID-19 admitted and managed from June 2020 to December 2020 at Government Chest disease hospital, Srinagar. In this study patients (n=101) who received standard low dose of steroids (6 mg dexamethasone or equivalent) were compared with patients (n=97) who received pulse steroid therapy (methyl prednisolone 500mg -1000mg for 3-5 days).

Results: Patients in pulse steroid group had significantly higher CT severity index (CTSI) as well as pro-inflammatory markers (IL-6, CRP) compared to standard dose steroid group. Pulse steroid therapy significantly reduced mortality in severe CVOVID-19 pneumonia patients (RR 0.5 [95% CI 0.35-0.73], P <0.001) and 31% patients were discharged without need for oxygen supplementation in pulse group compared to only 4% in standard dose steroids group with p <0.001). In terms of effect on proinflammatory markers, pulse steroid therapy significantly reduced CRP and IL-6 levels in survivors compared to nonsurvivors.

Conclusion: Pulse steroid therapy in patients with severe COVID-19 is associated with improved survival and need for oxygen therapy at the time of discharge is reduced compared to standard low dose steroids.

Post COVID-19 lung sequelae: Six month follow up study at a tertiary institute

Saurabh Karmakar, Priya Sharma, Ameet Harishkumar, Manohar Kumar

All India Institute of Medical Sciences, Patna, Bihar, India. E-mail: drsaurabhkarmakar@gmail.com

Background: COVID-19 pandemic has been an unprecedented health crisis. Post COVID-19 lung sequelae comprise respiratory disease occurring after recovery from COVID-19.

Objective: (1) To determine the baseline characteristics. (a) Inflammatory marker levels. (b) Spirometric values. (c) 6 minute walk distance. (d) Radiological parameters. (2) To assess the differences in above mentioned parameters, during follow up.

Methods: All consecutive recovered patients of moderate to severe COVID-19 attending Post COVID-19 clinic were subjected to history taking of grade of dyspnea and preexisting co morbidities. At baseline visit, inflammatory markers (ESR, CRP, d-Dimer, Ferritin and LDH), Spirometry, 6MWD and HRCT thorax findings were determined. Spirometry and 6MWD were repeated in follow up visits (0, 3, 12, 24 weeks).

Results: Of the 468 patients, 196 (41.9%) had moderate and 272 (58.1%) had severe disease. Ever smokers comprised 58 (16.2%) patients. 348 (74.3%) had comorbidities, most common being hypertension (192, 41%). The mean value of ESR, CRP, d-Dimer, LDH and Ferritin levels was higher in severe patient group, compared to moderate patient group (although statistically insignificant). Statistically significant decline was seen in ESR, CRP, ferritin and LDH levels in 1st follow up. Spirometric parameter, absolute FVC was higher in moderate group compared to severe group and statistically significant. Most common radiological finding was ground glass opacity (GGO), and treated with OCS. In OCS treatment arm, statistically significant increment in 6MWD was seen as compared to antifibrotic arm.

Conclusion: Long recovery period should be expected in patients of moderate to severe COVID-19.

Role of artificial-intelligence powered digital-health in reducing strain on health-care-system: First of its kind experience in COVID-19 pandemic

Manjunath B. Govindagoudar, Monika Mehta, Pawan Kumar Singh, Dhruva Chaudhry

E-mail: bgmanzu@gmail.com

Background: The second wave of COVID19-Pandemic was associated with massive case surge causing overwhelming of health-care-system. Early monitoring and identification of at-risk patients through digital mode, can reduce mortality and judicious use of hospital-resources.

Objectives: To study the efficacy of CareShare®-application in predicting hospital-admission for home-isolated-mild-COVID19-patients (HIMCP).

Methods: CareShare® an android-application, designed in collaboration, to follow-up HIMCP. A baseline-profile is entered on first contact and includes demography, co-morbidities, and current symptoms. Application generated a baseline-symptom-score for follow-up. Subjects were automatically reminded to refill their symptom-severities on daily basis. Change in symptoms-score led to one of the three-flags: Red (critical), Orange (review) and Green (Safe).

Results: Over 2 months, 550 patients were screened and 485 were enrolled on the application-platform with 2511 entries. Most-common reason for missing out was lack of an android-phone. The mean age was 35.1±12 years with 40.8% being females and 82.1% from urban background. Average number of entries/ patients were 5.18±4.9 (1 to 22). 1072 daily entries were given orange-flag, 298 were reviewed on call and remaining were reclassified as false-warnings. Out-of-298, 16 were called in hospital and 6 were admitted. 690 entries were given a red-flag, leading to urgent-review, and calling of 108. 86 cases were called for in-person review, leading to admission of 27 patients. Out of 33, 27 required ICU admission. There was no mortality in the study population.

Conclusion: CareShare® is a reliable method of symptom-monitoring of HIMCP taking pressure off overwhelmed health care system.