COVID-19

Liver abnormalities in patients with COVID-19

Archita Makharia, Manoj Lakhotia, Vineet Tiwari, K. G. Barupal

Department of Medicine, Mahatma Gandhi Hospital, Dr. SN Medical College, Jodhpur, Rajasthan, India. E-mail: archita.makharia@gmail.com

Background: Other than respiratory tract, many other organs, including liver, are affected in COVID-19. COVID-19 can lead to deterioration of preexisting liver disease or can lead to hepatocellular damage. In a prospective, we reviewed the liver function abnormalities in patients with COVID-19.

Methods: In a prospective study, we recruited 185 hospitalized patients with COVID 19. The diagnosis of COVID 19 was made on the basis of a positive RT-PCR report. Their clinical characteristics and the laboratory parameters were recorded in a proforma.

Results: The mean age of patients was 52.7+16.2 years (66 females), 66 (34.2%) of whom were of age more than 60 years. Based on the clinical criteria 70.4%, 20.9% and 8% patients had mild, moderate and severe COVID-19 infection, respectively. The mean haemoglobin was 12.4+2.1 g/dL. 57.8% patients had elevated levels of either alanine aminotransferase (ALT) or aspartate aminotransferase (AST). 35.1 % had an elevation of ALT and 32.4 % had an elevation in both ALT and AST. Serum bilirubin was elevated in 10.6% and 48.9% had low serum albumin. While a correlation was observed between low albumin and severity of COVID-19, there was no correlation between severity of COVID-19 and hypertransaminasemia.

Conclusion: One third of patients with COVID-19 had raised transaminases and half of them had low albumin. There was a correlation between low albumin and severity of COVID 19 infection.

Reversible platypnea orthodeoxia syndrome in COVID-19: A rare entity

Avishek Layek, Arjun Kumar, Mihir Gangakhedkar, Girish Sindhwani

Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India. E-mail: avilayek.nrsmc@gmail.com

Background: Platypnea-orthodeoxia syndrome (POS) is defined by orthostatic increase of dyspnea and drop in arterial oxygen saturation of more than 5% or PaO2 more than 4 mmHg. COVID-19 can present with a myriad of symptoms ranging from trivial flu-like illness to fatal severe ARDS and one sparsely reported symptom in this spectrum is POS.

Case Study: We observed POS in 2 cases of basal-predominant severe COVID-19 pneumonia and both reported resolution in their POS symptoms on follow-up with conservative treatment.

Discussion: The pathogenesis of POS might be explained by gravitational redistribution of pulmonary blood flow causing an increased basal arteriovenous shunting and upper zone dead space ventilation due to the predominantly basal lung involvement in some cases of COVID-19 disease. Two events are mandatory to cause orthostatic hypoxemia in POS: first is the mixing of deoxygenated venous blood with the oxygenated arterial blood through a shunt and second is that the same shunt is to be functional in the upright and closed in the supine position. POS is classified into intracardiac, extracardiac and miscellaneous causes based on the site of the shunt. Hypothesis is POS in COVID-19 is of extracardiac type and is seen when the deoxygenated blood shunts via the diseased basal lung regions.

Conclusion: POS in COVID-19 is a rather rare clinical manifestation & all healthcare personnel should be aware of the possibility and mechanism for POS at COVID-19 care facilities. Its diagnosis can reduce unnecessary investigations, improve patient safety and allow for adjustments in their pulmonary rehabilitation process.

How did we manage long COVID with CAPA (COVID Associated Pulmonary Aspergillosis) and DVT: A case report

Anshu Priya, Kartikya Joshi, Amita Athavale

Department of Pulmonary Medicine, EPRC, Seth G S Medical College and KEM Hospital, Mumbai, Maharashtra, India. E-mail: dranshupriya.ap@gmail.com

Introduction: The invasion of lung tissue by a commensal like aspergillus after severe viral infection has been known.[¹] But coronavirus has multiple fangs like immune dysfunction, precipitates new onset diabetes and hypercoagulability.[²] We hereby present a case of long COVID with pulmonary aspergillosis and deep vein thrombosis (DVT).

Case Study: A 46 year old male presented with one and half month history of fever, cough with expectoration, hemoptysis. He had tested positive for COVID and diabetes two months before and had required intensive care treatment. The Chest Xray [Figure 1a] showed left upper lobe opacity. Chest CT Scan [Figure 2] showed cavity with central hypodense component within anterior segment of left upper lobe (bird’s nest appearance). BAL from that segment grew aspergillus. The patient was started on voriconazole, hemoptysis was controlled and subsequently discharged. But 15 days later, he was readmitted with hemoptysis and left side calf pain and swelling. Lower limb venous doppler showed thrombosis of parts of Left Superficial femoral vein and popliteal vein. CTPA (CT Pulmonary Angiography) didn’t show any filling defect. Patient was started on anticoagulation. After 8 weeks patient improved with significant clearing of lung lesion on chest X Ray [Figure 1b].

Figure 1.

(a) Chest X ray on presentation. (b) Chest X ray after 8 weeks of antifungal treatment

Figure 2.

CT scan showing bird in nest appearance

Discussion: Studies from Wuhan, China, reported secondary fungal infections in 35.3% critically ill patients.[³] Our patient, apart from other risk factors had received corticosteroids and the dose was more than 0.3 mg/kg/d and the duration was upto 4 weeks.[⁴]

Conclusion: Post COVID cases with hemoptysis should be investigated properly considering the multiple pathogenic pathways that are implicated by this virus.

Seroprevalence of COVID-19 among patients with Chronic Respiratory Diseases (CRD) in the waning phase of the pandemic

Jefferson Daniel, Barney Thomas Jesudason Isaac, Balamugesh Thangakunam, Solomon Rajasekar, Mahesh Moorthy, Devasahayam Jesudas Christopher

Department of Pulmonary Medicine and Department of Virology, CMC Vellore, Tamil Nadu, India. E-mail: jefferson.daniel@cmcvellore.ac.in

Background: Unexpectedly, COVID-19 is less prevalent in Chronic Respiratory Disease(CRD) than in the general population.[¹-⁴] The vaccine and infection-related immune status of CRD patients are unknown. We performed a cross-sectional COVID-19 seroprevalence study among our CRD patients.

Methods: Patients with Asthma, COPD, ILD, PTB-sequelae and restrictive lung diseases attending the pulmonology OPD were recruited. Relevant clinical and laboratory information were captured. The Roche Elecsys SARS-CoV-2 assay was used to detect anti-N and anti-S antibodies.

Results: We recruited 364 patients (Asthma & COPD -100 each, Bronchiectasis, ILD & PTB-sequelae - 50 each and restrictive diseases-14 ). The overall seroprevalence in CRD (Anti-S) was 85.16%, significantly higher than the 4^th national serosurvey data of 67.60% (p = 0.001).[⁵] Asthma had a higher seroprevalence than COPD [93% vs 78%, p=0.027] and bronchiectasis [93% vs 80%, p=0.018]. Prevalence of antibody through natural infection as assessed by Anti-N was nearly 5 folds higher (67.62%) than those with PCR confirmed COVID-19 (13.74%). PTB-sequelae patients had higher natural infections than COPD. [48 (75%) vs 57 (59.37%), p=0.065]. Seroprevalence dropped with age: <40 years: 93%, 41-60 years: 87% and 61+ years: 77% (p=0.004). Those on inhaled-steroids had higher seroprevalence than those without (89% vs 80%, p = 0.026). Patients on inhaled-anticholinergics had lower seroprevalence (79%vs 89%; p=0.013) and lower confirmed COVID (6% vs 19%, p<0.001) than no-anticholinergics.

Conclusion: The COVID-19 overall seroprevalence is higher in CRD than in the general population.

Can neglegence toward COVID-19 symptoms initiate third wave of COVID-19 in India?

Debkanya Dey¹, Debraj Roy¹, Premananda Bharati², Parthasarathi Bhattacharyya³

¹Department of Biotechnology, Dr. B. C Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, West Bengal, India, ²Biological Anthropology unit, Indian Statistical Institute, Kolkata, West Bengal, India, ³Institute of Pulmocare and Research, Kolkata, West Bengal, India. E-mail: titirdey1@gmail.com

Background: The second wave of Covid-19 had a huge number of asymptomatic, false negative (indeterminant) and symptomatic untested cases (query Covid).

Objective: The aim is to understand the dynamics among these groups to know their impact on the spread of the diseases.

Methods: In a prospective online survey we collected data using snowball sampling method via social media, from in and around Kolkata with the help of Google forms. The data included Covid related symptoms, evaluation, and behavior related to treatment during first and second wave of the disease. The discrepancies and duplicities were first excluded, and 989 respondents’ data were statistically analyzed using SPSSver26.

Results: The percentage of RT-PCR confirmed symptomatic and asymptomatic Covid cases were 21.84% (n=216) and 2.12% (n=21) respectively. Symptomatic but unconfirmed cases (query Covid) were 17.18% (n=170) and symptomatic false-negative cases (indeterminant) were 93 (9.40%). Rest 489 (49.44%) did not have any symptoms or never tested positive. The analysis revealed the reasons for doing RT-PCR test include a) less symptoms severity (47.06%), b)considering test unnecessary (22.94%),c) home collection unavailability(14.71%) and d)longer waiting time for results(8.82%). According to regression analysis, compared to confirmed Covid symptomatic group, only 47% [OR: 0.13(0.57-0.30) p<0.0001] of query covid patients consulted doctor for test or treatment and 21% [OR:9.55 (1.97-46.16), p<0.001] of indeterminant cases took medicine based on advice of friends/ relatives.

Conclusion: There is a high percentage of untested (query Covid) and probable false negative cases (indeterminant) likely going unreported. The reasons for poor testing and seeking medical attention inadequately needs to be addressed and further investigated.

Spontaneous pneumothorax in patients of COVID 19 pneumonia

Yash Kedia, Yash Kedia, N. T. Awad, Dipak Patil, Sruthi Vijayan

Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and Government Hospital, Mumbai, Maharashtra, India. E-mail: yskedia@gmail.com

Background: COVID 19 pandemic has put a massive strain on healthcare all over the world. Various complications are being reported in patients of COVID 19 Pneumonia. One such complication is pneumothorax and pneumomediastinum.

Objective: To study the incidence, clinical profile, management and outcome of patients with pneumothorax in COVID 19 pneumonia.

Method: We studied 476 diagnosed patients of COVID 19 pneumonia at our hospital between May 2020 and May 2021. All patients were treated as per standard COVID 19 protocol at the time. Clinical examination and serial chest X-Ray and/or CT Chest were done to look for pneumothorax/pneumomediastinum.

Results: Out of the 476 patients, 18 (3.78%) had developed pneumothorax and/or pneumomediastinum. While most of these patients were on some form of positive pressure ventilation (13 out of the 18), some of them had a HRCT Chest suggestive of either air trapping and/or cyst formation. Three patients had developed bilateral pneumothoraces while on non-invasive ventilator. Nine of the 18 patients expired and nine were discharged.

Conclusion: Through this article, we would like to emphasize that an acute deterioration in hypoxemia in a COVID-19 patient could indicate a pneumothorax. Pneumothorax as well as pulmonary thromboembolism are reported complications in COVID-19 and clinician vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.

Excess mortality in India during the COVID 19 pandemic

Subramanian Natarajan, Poonam Subramanian

E-mail: cnsubu@gmail.com

Introduction: COVID 19 has proven to be the worst pandemic in the history of mankind. While the pandemic still continues to perplex the scientists globally, attempts are being made to quantify the mortality caused by the pandemic. The official Covid-19 figures in India grossly understate the true scale of the pandemic in the country.

Definitions: A COVID-19 death is defined for surveillance purposes as a death resulting from a clinically compatible illness in a probable or confirmed COVID-19 case, unless there is a clear alternative cause of death that cannot be related to COVID-19 disease (e.g. trauma). Excess mortality is defined as the difference in the total number of deaths in a crisis compared to those expected under normal conditions.

Methods: We researched multiple papers on Pubmed, Medline, Embase, MedRxiV pre print.

Discussion: All the studies showed that the excess mortality was to the tune of almost three times the official figures. The model based excess mortality assumptions showed higher deaths as compared to the data based. However, there were lot of discrepancies in the data provided by various states along with variations observed in between the two waves as well. Health survey data suggested higher mortality rate as compared to data compiled from the civil registration system.

Conclusion: Official COVID-19 deaths have entirely failed to capture the scale of pandemic excess mortality in India. The under-ascertainment of COVID-19 deaths has been high, with around 8-10 excess deaths for every been high for every recorded COVID-19 death.

COVID 19 pneumonias with negative rt-PCR testing

Shubhangini Kumar, Suchismita Pattnaik, Shekhar, Vidya Sanjay Nagar

Department of General Medicine, Sir Jj Group Of Hospitals, Mumbai, Maharashtra, India. E-mail: shubhanginikumar@gmail.com

Background: The COVID 19 pandemic caused by the betacoronavirus SARS-CoV-2 with its virulence and contagiousness is a public health emergency. The prefferred method of diagnosis is the FDA aprroved RT-PCR testing of nasopharyngeal swabs with 65% sensitivity, with false negative rates of <5% to 40%. Clinical diagnosis should supplant when there is high suspicion with labs and imaging consistent with COVID’19 and negative RT-PCR does not rule out the disease. Here we report one such case.

Case Report: 45-year-old female with nil comorbidities presented with fever and breathlessnesss since 7 days with tachypnoea (46 breaths/min), hypoxia (spo2 75% room air) and bilateral coarse crepitations on auscultation. ABG & CXR suggested severe ARDS. CT Thorax revealed CTSI 21/25.CORADS 5.Two nasopharyngeal swabs 24 hours apart tested negative for COVID’19. Lab investigations suggested deranged inflammatory markers (ferritin 910ng/mL; CRP 121.2ng/L ; D-dimer 660ng/mL).Presumed diagnosis of COVID 19 was established based on early CT findings and lab parameters consistent with COVID’19 Pneumonitis,the patient was immediately isolated and received treatment as per COVID’19 treatment protocols (steroids,LMWH,Remdesivir). After 6th week patient showed clinical and radiological improvement.Subsequently she also developed post-covid fibrosis and discharged on pirfenidone and home based low-flow o2.

Discussion and Conclusion: Fever, sore throat and breathlessness are common symptoms of Covid’19, most of which are virtually present in any viral LRTI, however in the setting of current pandemic maintain high index of suspicion for Covid’19 especially in the presence of radiological evidence even with negative RT-PCR.

Cock tail for COVID 19 disease - Experience from a teritiary hospital in South India

Vimi Varghese, Prince James, T.V. Rajagopal

Interventional Pulmonology and Respiratory medicine, Naruvi Hospitals, Vellore, Tamil Nadu, India. E-mail: vimi.v@naruvihospitals.com, viminvarghese@gmail.com

Background: REGEN-COV is a combination of 2 monoclonal antibodies (casirivimab and imdevimab) that bind to two different sites on the receptor binding domain of the SARS-CoV-2 spike protein, and thus stops the progression of disease. We aim to evaluate the safety and efficacy of REGEN COV in patients presenting with Mild to moderate Covid 19 disease.

Methodology: This is a retrospective observational study done in a tertiary hospital in South India. Patients admitted with RTPCR confirmed SARS COV 2 infection and within 10 days of symptoms onset were included in the trial. All patients received 1,200 mg each of casirivimab and imdevimab as a single intravenous infusion. All the patients were followed up for a period of 30 days with weekly telephonic consultation.

Results: Between June 1 , 2021 and October 15 ,2021 , 30 patients got enrolled into the study and the mean age of patients was 60 years. The median duration from symptom onset to Regen Cov treatment was 5 days. Only 2 (10%) patients had adverse events and 83% of patients (25/30) had no symptoms after Regen Cov administration and 86% of patients (26/30) had no progression of clinical symptoms for up to 30 days after discharge.

Conclusion: The monoclonal antibody combination of casirivimab and imdevimab (REGEN-COV) successfully prevented the progression of disease in 86% of patients presented with mild to moderate COVID 19 disease. Our study also underlined the safety of Regen Cov treatment with no major adverse event occurred in any of the patients.

Correlation of CT severity score and inflammatory markers to predict the disease severity in COVID-19 patients

Abhijeet Lonsane, R. K. Chopra

Department of Pulmonary Medicine, Ruby Hall Clinic, Pune, Maharashtra, India. E-mail: drabhilon009@gmail.com

Background: Computed Tomography (CT) thorax and blood inflammatory markers play an important role in predicting COVID-19 disease severity. LDH, CRP and lymphocyte count could be useful to predict disease severity when CT is unavailable.

Objective: To find correlation between blood inflammatory markers and CT severity score to predict extent of COVID-19 pneumonitis.

Materials and Methods: A total of 240 patients more than 18 years of age hospitalized from 01/10/2020 to 31/05/2021 with COVID-19 confirmed diagnosis either by RT PCR test or by Rapid Antigen Test were assessed in this monocentric prospective observational study at a Tertiary care center, Pune, India. CT thorax and blood parameters such as Complete blood count, IL-6, D-dimer, Ferritin, LDH and hsCRP levels done on the day of admission. The total CT score was the sum of five individual lobar scores and defined as: 0, none; 1–5, minimal; 6–10, mild; 11–15, moderate; and 16–20, severe lung involvement.

Results: Mean age of 240 (Male 156 and Female 84) study sample was 52.42 years (SD - 15.28) with maximum 87 years & minimum 20 years old. As per WHO COVID-19 Clinical Management Guidelines, 180 (75%) patients with Non severe, 31 (12.9%) patients with Severe and 29 (12.1%) patients were having Critical clinical presentation on admission. hsCRP & LDH were having more correlation coefficient than other markers with CT score (0.599 & 0.570 respectively).

Conclusion: hsCRP and LDH levels can be used to predict extent of lung involvement in COVID-19 disease especially in resource limited settings.

Rare and interesting case of solitary peripheral pulmonary artery aneurysm

S. V. Jagmohan¹, Madhusudana Narayana², Nagesh Basavaraj², Smitha Nagaraju³

¹Department of Pulmonary Medicine, Sri Devraj Urs Medical College, Kolar, Karnataka. India, ²Department of Cardiothoracic Surgery, BGS Global Hospital, Bengaluru, Karnataka, India, ³Department of Pathology, BGS Global Hospital, Bengaluru, Karnataka, India. E-mail:drjagmohan99@gmail.com

Background: We report a rare case of solitary peripheral pulmonary artery aneurysm in a patient who was evaluated for haemoptysis. Incidentally, his total antibodies were positive for Coronavirus 2019 infection. Patient underwent right lower lobectomy uneventfully. Peripheral pulmonary artery aneurysms arising from segmental or intrapulmonary branches are extremely rare. Untreated, the majority end fatally due to sudden rupture and exsanguination. The purpose of this article is to report our rare case and review the pertinent literature.

Case Study: A 40-year-old man presented with an episode of haemoptysis. He had a history of intermittent mild grade fever, cough and dyspnea lasting for a month. He had no history of haemoptysis in the past. He had no pre-existing medical conditions or Coronavirus 2019 (COVID-19) infection. His clinical examination was unremarkable. Blood investigations were within normal limits. Reverse transcription polymerase chain reaction test was negative for COVID-19 infection, but his total antibodies test was elevated -117 (biologicalreference range <1.0). 2D Echocardiography was normal. Chest radiography showed a solitary pulmonary lesion in the right lower lung zone [Figure 1a].A computed tomography of the chest plain and contrast confirmed the presence of a 3.7 cm_3.6 cm, well-defined, circumscribed and densely enhancing lesion in apicoposterior segment of right lower lobe. It is seen along the course of descending branch of the right pulmonary artery. Areas of consolidation are also seen in apicoposterior segment. Postcontrast study shows heterogenous enhancement of this lesion suggestive of an aneurysm. The rest of lung parenchyma was normal [Figure 1b and c].The diagnosis of a solitary peripheral pulmonary artery aneurysm (PAA) was considered and right lower lobectomy was performed through posterolateral thoracotomy.

Discussion: The estimated incidence of PAA is 1 in 14 000 autopsies, and these lesions can be central aneurysms and peripheral aneurysm. An aneurysm can be true or pseudo aneurysm. In this patient, an aneurysm is a true aneurysm and origin may be idiopathic or post-inflammatory with superadded fungal infection in thrombus, post-COVID-19 infection. Long-term follow up is required to observe the future course

Conclusion: True solitary peripheral PAA is an extremely rare entity. A high degree of suspicion is needed for diagnosing PAAs on imaging. Intervention is mandatory as soon as the diagnosis is made, to prevent rupture and death. PAA has been managed most often by lobectomy but occasionally by pulmonary artery repair or endovascular approach.

Risk of COVID-19 for frontline health care workers during the current pandemic

Mathew Varghese Nellimootil¹, Darpanaryanan Hazra¹, K. P. P. Abhilash¹, Mahesh Moorthy²

¹Department of Emergency Medicine, Vellore, Tamil Nadu, India, ²Department of Clinical Virology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India. E-mail: mathew3786@gmail.com

Background: Covid-19 pandemic has exhausted health systems across the world due to the sheer magnitude of patients presenting to the hospitals. Healthcare workers (HCW) are constantly in contact with a highly transmissible novel virus and hence at high risk.

Methods: In this study, we studied the outcome of exposure to Covid-19 among HCWs in high-risk areas and low risk areas. Clinical data such as the duration of exposure to Covid patients, presence of comorbid illnesses, vaccination against COVID-19, need for admission and treatment received were collected. The study period is from May 2020 – August 2021, the data was collected using a cross-sectional, interviewer administered questionnaire. Blood samples for measuring Immunoglobulin levels were collected in 5 different time periods.

Results: 299 people were included in the study, 89% were high risk HCW and 11% low risk HCW. 39.7% of the high risk HCWs tested positive for Covid-19 as opposed to 9% of low risk HCWs. 46.2% and 50% of high and low risk HCWs received vaccination prior to testing positive for COVID-19. There was no significant difference in home isolation or hospital admission rates between the two groups. Only 1 High risk HCW required Oxygen with no mortality. High risk HCW had higher Nucleocapsid antibody positivity.

Conclusion: Absolute risk reduction of confirmed Covid-19 between high and low risk HCWs was 84.2%. Factors such as age, gender, workplace exposure, seniority of staff and comorbidity did not affect seropositivity rates. Following strict infection prevention and control measures and vaccination helped decrease severe illness.

Recovery in patients with COVID-19 infections at level2 COVID centres

Mandeep Singh, Parul Chaudhary, Ritesh Singh

E-mail: drsingh.mandeep@gmail.com

Aim: During Covid-19 pandemic outburst hospitals were categorised to manage patients as per severity of disease. At Level-2 hospitals which were equipped with Oxygen and NIV requirements, patients with moderate severity were kept. This study aims to statistically analyse patients admitted during 2^nd phase of Covid-19. Aim is to understand factors involved in recovery of such patients.

Methods: During study, symptoms, CT score, requirements of NIV, Oxygen Flow and Demographic details were recorded. During recovery phase, PFT, 6MWDT and residual symptoms were analysed. For this study, 30 patients between 38-65 years of age, admitted between April-June 2021 and followed for next four months were enrolled.

Results:

It was observed:

• a. 50% of patients were having comorbidities, DM Type2 was common

• b. Fever and breathlessness were common symptoms

• c. As per CT score

  • a. 80% of patients had moderate to severe lung involvement
  • b. Higher CT score, lower was 6MWDT value (p0.45)
  • c. Days of hospitalization and recovery time were not related
  • d. PFT and Walk Test values were significantly corelated. Lower was their values, longer was hospital stay and time to recovery (p0.047)
  • d. Patients on NIV had longer hospital stay and time to recovery, although having similar CT score and functional capacity.

Conclusions: Elderly with comorbidities and Novel Covid 19 pneumonitis had significantly longer hospital stay. Patients on NIV support had longer recovery time. If CT scores were high, lower was 6MWDT score. Longer hospital stays, lower FEV1 values.

Radiological analysis of follow up CT of COVID Patients – Is scarring or fibrosis??

Ashish Kumar Prakash, Sudhkar, Bornali Datta, Ganesh Raghu

E-mail: akp_vpci@yahoo.com

Background: Covid 19 causes a spectrum of disease. Early changes may present radiologically as traction bronchiectasis, architectural lung distortion, crazy paving or thickened interlobular septa. Analogy from other fibrotic interstitial pneumonia suggest up regulation of TGF B, FGF and PDGF leading to lung fibrosis (1). Early data of post covid 19 pneumonia shows a residual restrictive pattern on pulmonary function testing (2). Also radiological persistence of GGO has been observed (3). The autopsy studies from acute COVID 19 pneumonia has demonstrated feature of Diffuse Alveolar Damage (DAD) and fibrotic organising pneumonia (4). The epidemics of SARS and MERS showed similar features, suggestive of developing lung fibrosis (5). The present study is designed to study the clinical and CT radiographic patterns at presentation and their outcome on follow up, which will enhance our current understanding of covid 19 manifestations and outcome with this prospective observational study.

Methods: The CT scans (admission & 4-8 weeks follow up) were collected from Medanta the Medicity, and de-identified in the local image archive system (PACS). Three chest radiologists with > 15 years of experience, from three tertiary care centres performed independent reporting of the CT scans, to pre-specified radiologic criteria. They were blinded to the clinical severity of disease. For the reading process, the radiologists reviewed the cases online via screen sharing (Zoom).

Results: A composite score of the density of lesions and the extent of lung involvement has been proposed to provide a more comprehensive picture of the radiological severity and its impact on clinical severity and outcome of disease. Final result yet to be analyzed.

Evaluation of spirometry and 6-minute walk test in post COVID-19 pneumonia patients at 6 months follow up

Ruchi Thakur, K. Prashanth Kumar, N. Usha Rani, A. Sai Kumar

Department of Respiratory Medicine, Malla Reddy Institute of Medical Sciences, Hyderabad, Telangana, India. E-mail: sairuchi.ssdn@gmail.com

Background: The COVID-19 pandemic is an ongoing global health care challenge. Upto 1/3rd of hospitalised patients develop severe pulmonary complications and ARDS. Our study aims to evaluate the pulmonary function in COVID-19 pneumonia patients at 6 months follow up.

Methods: Prospective cohort study in 30 hospitalised patients with a confirmed diagnosis of COVID-19 pneumonia; belonging to mild, moderated, severe categories - 6 months after discharge. The study consists of assessing the pulmonary function with pre and post bronchodilator spirometry and 6-minute walking test for post exercise desaturation.

Results: Lung function test results showed 27% patients had a normal FEV1/FVC ratio with reduction in FVC (forced vital capacity). The mean basal saturation before the 6-MWT was 96+ or - 2%. Exercise oxygen desaturation was observed in 6% cases.

Conclusion: This study shows that post infection with SARS-CoV-2, severe or critical covid-19 pneumonia patients showed higher prevalence of abnormal spirometry , with a mainly restrictive pattern when compared to non severe pneumonia patients.

A retrospective study on association between clinical parameters, neutrophil-lymphocyte ratio, CT severity score and mortality in patients with Covid-19

Akkupalli Sreekanthyadav, B. Neeharika, P. Yugandhar

E-mail: 1994sreekanth1994@gmail.com

Background: There is a great uncertainty on disease progression in covid-19. Multiple factors play a role in progression of disease to severe form and these factors are not uniform in all patients. There are multiple researches for the early prediction of outcome using various prognostic factors.

Methods: Data of 112 patients from ASRAM medical college was collected retrospectively. The clinical parameters like age, gender, oxygen saturation and comorbidities at the time of admission, lab parameters like Neutrophil-Lymphocyte Ratio (NLR) and radiological parameters like CT severity score were taken. This data was analyzed to predict the association with mortality.

Results: These 112 patients consisted of age ranging from 20-90 years. Males were 70(62.5%) and females were 42 (37.5%). Mortality was more in the age group of 61-80, that is 13 deaths (40.6%) (p= 0.023). Higher mortality was seen in patients with oxygen saturation less than 90%, deaths 25(35.2%) (p=0.001). Mortality was more in patients with comorbidities (66.7%) (p=0.000). Number of deaths in patients with NLR more than 3.5 were 25(27.2%) (p=0.01). Patients with CT severity score more than 15 had higher mortality (44.2%) (p=0.000).

Conclusion: Though CT severity score is a good predictor of mortality in patients with covid-19, initial assessment of patients for clinical parameters like age, oxygen saturation, comorbidities and easily available laboratory parameter like NLR are also good predictors of mortality and severe form of disease.

Early experience of nutralizing antibodies cocktail (casirivimab and imdevimab) in the management of mild to moderate COVID 19 infection: A case serise of 10 patients

S. Adhikari, Vikas Marwah, Robin Choudhary, T. Ajai Kumar

Department of Respiratory Medicine and Critical Care, AICTS, Pune, Maharashtra, India. E-mail- drasudip@gmail.com

Background: Neutralizing antibodies cocktail (Casirivimab and Imdevimab) has received conditional recommendation by FDA and WHO for mild to moderate COVID infection in specific high-risk groups. Persons with underlying chronic illnesses are at high risk of developing severe disease. The effectiveness of various repurposed drugs approved for the management is variable. Antibodies cocktail has shown promising results in preventing progression to severe disease. But the data about its use and safety from India is scarce. Herein, we present a retrospective analysis of 10 patients who were administered with the antibodies cocktail between Aug 2021 and Oct 2021.

Methodology: We conducted an observational retrospective analysis of clinico-radiological, inflammatory parameters, progression of the disease, and outcome amongst ten mild and moderate COVID 19 patients treated with antibodies cocktail.

Results: Ten patients were administered the antibodies cocktail (casirivimab 600 mg and Imdevimab 600 mg). The median age was 63.5 years, and four patients were partially vaccinated, and the rest were unvaccinated. Diabetes and hypertension were the commonest comorbidities; hematological and solid organ malignancies were other comorbidities. The median CRP level on admission was 91.5 mg/dL. Other inflammatory markers like neutrophil: lymphocytes ratio, ferritin, and LDH were higher than normal limits. None of our patients required supplemental oxygen or progressed to severe ARDS nor has any adverse reactions. All patients were discharged in a stable condition within six days of the therapy. Four patients had radiological opacities consistent with COVID 19 pneumonia and had shown regression after the therapy. The observation indicates that this therapy may also be effective in the early pulmonary phase of the disease.

Conclusions: The neutralizing antibodies cocktail has shown encouraging results in our analysis in preventing progression to severe disease and is not associated with severe adverse reaction.

A comparative study of clinical characteristics and outcomes in the first and second waves of COVID-19 pandemic in Northern India

Sumit Kumar Pahariya, Ashish Kumar Prakash, Pinky Goyal, Bornali Datta

Medanta The Medicity, Gurugram, Haryana, India. E-mail: spaharia88@gmail.com

Introduction: Coronavirus disease-19 (COVID-19)has become a global pandemic, giving rise to a serious health threat worldwide. So far, several countries have seen a two-wave pattern of reported cases.

Methodology: This was a retrospective study of all hospitalized cases of SARS-CoV-2. All the patients admitted between March to December 2020 were considered to be in first wave and those admitted from April to June 2021were considered to be in second wave. All hospitalized patients had SARS-CoV-2 infection confirmed by RT-PCR.

Results and Discussion: Total 4581 patients in first wave & 1565 in second wavetested positive for SARS-CoV-2 infection using RT-PCR at the hospital.In the first wave highest admissions occurred in the month of November 2020. In the second wave, the highest admissions occurred in the month of April 2021. In first wave 71% were male and 29% were female while in second wave 67% male and 33% were female. The mean age of first and second wave was 54.9±16.6 and 55.2±15.5. CT severity scores were 18.8±9.9 in wave 1 versus 21.4±10.4 in wave 2.(p=0.0001)A total of 54 (1.2%) deaths occurred in the first wave and 26 (1.7%) in the second wave.

Conclusion: Lung involvement on CT scan was more extensive in wave 2 compared to wave. A large number of patients were admitted during the second wave, they were younger and fewer number of deaths was reported corresponding with results reported by previous research in several countries.

Outcome of COVID-19 and tuberculosis coinfection

Dipak Patil, Dipak Patil, Yash Kedia, Shruti Vijayan, Pranavi amin, N. T. Awad, Jairaj Nair

Department of Respiratory Medicine, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra, India. E-mail: patildipak9521@gmail.com

Background: Covid 19 and Tuberculosis are the infectious diseases primarily affecting the lung. Both of them present with cough, fever and difficulty in breathing but Tuberculosis has a longer incubation period and onset of disease is slower. The patients of Tuberculosis are more likely to have comorbidities (malnutrition, diabetes mellitus, Human Immunodeficiency Virus) that increases their vulnerability to covid-19.

Aim: To study the clinical profile, course, management and outcome in patient presented with covid-19 and tuberculosis in covid pandemic in Mumbai.

Methods: We studied the 323-patient admitted in covid Intensive Care Unit and ward who were proven covid 19 positives by Reverse Transcriptase Polymerase Chain Reaction, Cartridge Based Nucleic Acid Amplification Test or rapid antigen test. All patients were given standard medical care, ventilatory support if required as per covid19 protocol. The chest x-ray, blood investigation and sputum investigation were studied till the time of discharge or death.

Results: Out of 323 patients studied 14 had Tuberculosis. Out of those 14 patients 10 patient had pulmonary tuberculosis, 3 had Tuberculous pleural effusion and one had abdominal tuberculosis. All of them had pneumonia on chest x-ray which can be attributed to covid-19 or Tuberculosis.

Conclusion: In our study all 14 patients were survived and discharged. As there is high burden of tuberculosis the covid-19 only helped in exposing the tip of the iceberg of the grave problem of undiagnosed tuberculosis in community. It seems that there is just coincidental occurrence of tuberculosis and covid19 coinfection than a causal association.

Clinical characteristics of asymptomatic COVID-19 (SARS-CoV-2) patients admitted at a tertiary care centre

Siddhesh Suhas Bharadi, Sushama Dugad

Department of Respiratory Medicine, DR. Vasantrao Pawar Medical College and Hospital, Nashik, Maharashta, India. E-mail: sidbharadi@gmail.com

Background: We prospectively studied 160 patients of asymptomatic covid 19 infection for their clinical course and outcome.

Methods: Demographic and clinical characteristics from the 160 asymptomatic SARS-CoV-2 positive patients were obtained over a period of 3 months.

Results: Overall, mean age of the patients was 35.66 years. HYPERTENSION was the commonest comorbidity. However, 142 patients (88.75%) were found to be without any co-morbidities.17 patients (10.6%) developed symptoms on 3^rd day whereas 7.5%, 6.8%, 3.7% and 1.2% became symptomatic on 2^nd, 4^th, 1^st and 5^th day respectively.

Conclusion: Cough was the most common symptom seen followed by fever, sore throat, generalized weakness and dyspnea. Asymptomatic patients were mostly without any comorbidities and hence remained asymptomatic and overall outcome was better.

Profile of severe covid-19 ARDS patients in ICU

Vijayan, N. T. Awad, Pranavi Kishore Amin, Dipak Patil

E-mail: sruthi.vijayan11@gmail.com

Background: COVID-19, an infectious disease caused by SARS-CoV-2 virus has reported to be a global pandemic. About 5% of the total develop severe ARDS.

Aim: To study the clinical profile, comorbidities and outcome including mortality rate in severe Covid- 19 ARDS patients.

Methodology: 40 cases of severe COVID 19 infection (P/F ratio<300) admitted in tertiary care ICU treated with standard covid protocol were included in the study. Their demography, severity of hypoxia, mode of ventilation and outcome analysed.

Results: Out of the 40 patients admitted, 29 (72%) were discharged with 11 patients (38%) requiring home oxygen therapy. The most common comorbidities were diabetes mellitus (30%) and hypertension (22.5%). Mean hospital stay was 17 days, and 35 patients (87.5%) required ventilation of which 80% on NIV and 20% on Mechanical ventilation. The mortality rate was 27.5%. The P/F ratio and CRP values was statistically significant with mortality rate (p-value<0.05). Three patients (7.5%) on positive pressure ventilation developed pneumothorax. One patient (2.5%) developed pulmonary thromboembolism.14 patients (35%) were in MODS out of which 8 patients died.

Conclusion: Mortality rate was less in patients with a high P/F ratio and low CRP levels at the time of admission. Severe COVID 19 patients admitted in the ICU had developed additional complications requiring interventions. Patients in MODS had high mortality rate. Most common comorbidity associated was diabetes mellitus.

CO- morbidities in first and second wave of COVID-19 and their outcomes

Pranavi Amin, N. T. Awad, Sruthi Vijayan, Yash Kedia

E-mail: pranavi.amin@gmail.com

Background: SARS-CoV-2 virus is the cause of the most recent pandemic that has affected the world since December 2019.

Objective: To study the outcome of Covid patients along with the associated co-morbidities during the First and Second Covid wave in a Respiratory Covid ward (including ICU) at a tertiary care centre.

Methods: We studied 214 Covid patients in the First Covid wave and 97 patients in the Second Covid wave. Patients mainly had complaints of dyspnea, fever, cough, generalized weakness as the main symptoms. All patients with and without co-morbidities with Covid-19 were given standard treatment as per protocol. Outcome (Discharge/ Death) of all the patients were studied in both the Covid waves.

Results: Out of the 214 patients in the First Covid wave, 30.8% (66) patients died. Of these, 60% (40) had co-morbidities. The major co-morbidities in dead patients were diabetes (33.33%) followed by hypertension (24.2%). In patients with underlying respiratory diseases, COPD (12.1%) was followed by Post Tuberculosis OAD (3%) and Tuberculosis (3%). As compared with the First Covid wave, the Second wave had a mortality of 48.5% (47). The major co-morbidities in dead patients were hypertension (38.3%) followed by diabetes (25.5%). In patients with underlying respiratory diseases, COPD (4.3%) was the most common cause of death.

Conclusion: In both the Covid waves, diabetes, hypertension and COPD (underlying respiratory disease) were the leading co-morbidities associated with death.

The impact of age, gender and comorbidities in the prognosis of patients with moderate to severe COVID-19

Dasyam Meghana

E-mail: drdasyammeghana@gmail.com

Background: Coronavirus disease (COVID-19) patients can present with mild disease or suddenly deteriorate and develop life threatening complications leading to mortality. Biomarkers and radiological findings have played an important role in clinical decision making. Impact of age, gender and comorbidities should be assessed to give clinicians a tool to group patients and predict prognosis.

Objective: This study is to assess the impact of age, gender and comorbidities on prognosis.

Methods: This was a prospective analysis of 100 COVID-19 confirmed cases in Kamineni Academy of Medical Sciences and Research Centre, Hyderabad. Data was collected from patients diagnosed as moderate to severe COVID 19. The outcomes of interest were death or discharged from facility. The Chi-square test was applied to analyse categorical data. P-value ≤0.05 and 95% confidence Interval for Odds Ratio were used to test significance.

Results: Patients with age >40 years were associated with significantly increased risk of mortality. The prevalence of COVID-19 was higher in males (N=69) compared with females. Females had significantly higher mortality (P=0.04). 85% of the cases had breathlessness while 73% had fever. Hypertension (40%) and diabetes (34%) were the most common comorbidities. Hypertension [OR-3.64, CI-95% (1.47-8.99), P<0.004], Diabetes mellitus [OR-2.38, CI-95% (0.97-5.81), P<0.04], Coronary heart disease [OR-4.72, CI-95% (1.04-21.27), P<0.04], chronic kidney diseases [OR-18.36, CI-95% (2.08-159.73), P<0.002] were associated with significantly increased risk of mortality.

Conclusion: Implementation of adequate management and early hospitalisation particularly in female patients, patients with age ≥40 years and in patients with comorbidities like hypertension, Diabetes mellitus, chronic kidney disease and Coronary heart disease may help in reducing mortality.

A case of pulmonary mucormycosis in a 45-year-old man, with unusual ancillary manifestations

Ankita Mandal¹, Anand Srivastava¹, Rajiv Garg¹, Prashant Gupta²

¹Department of Respiratory Medicine, KGMU, Lucknow, Uttar Pradesh, India, ²Department of Microbiology, KGMU, Lucknow, Uttar Pradesh, India. E-mail: lona.sonu@gmail.com

Background: Mucormycosis is an invasive-fungal infection, often associated with extremely severe complications in immuno-compromised patients. The prevalence of mucormycosis in India is about 80 times higher than other developed countries. But the clinical presentation of pulmonary mucormycosis has wide diversity.

Case Study: We are reporting a case of a 45-year-old man admitted to our side as a case of post-COVID sequelae in the setting of a new left sided loculated pyo-pneumothorax. He is a known case of type 2 diabetes and hypothyroidism for 1.5 years and 3 years respectively. Prior to our rescue, he underwent pigtail insertion in the loculated collection, but there was no output. So, the drain was removed and the patient was planned for pneumonectomy. On visiting to our side, appropriate investigation and interventions were done. On bronchoscopy a large fungating fragile blackish growth was seen coming out from left main bronchus. Histopathological report of the endobronchial biopsy revealed mucormycosis. The patient was planned for Liposomal Amphotericin-B (LAMB) but unfortunately developed anaphylaxis. He was managed accordingly and was taken on oral Posaconazole therapy. On follow up visit remarkable clinical and radiological improvement was noted.

Discussion: The above-mentioned case showed the management of a not so mimicking case of usual pulmonary mucormycosis without opting for surgical intervention. Thus, limiting the patient from the post-surgical complications.

Conclusion: This case illustrates the heterogeneousness of mucormycosis, regardless of patient profile. Bronchoscopic findings and mycology report helped us to rule out other differential diagnosis.

A case of bilateral spontaneous pneumothorax post COVID -19 infection

Sandhya Balasundaram. M. G. Krishnamoorthy

Department of Pulmonology, Gandhi Medical College Hospital, Secunderabad, Hyderabam India. E-mail- sandhyabalasundrm17@gmail.com

Background: Development of spontaneous pneumothorax and pneumomediastinum is one of the complication of COVID-19 viral pneumonitis. This has been described in both mechanically ventilated patients or on non invasive/ high flow nasal cannula oxygen support. The Macklin effect can been proposed as a possible etiology owing to the propensity to the damage to type2 pneumocytes, alveolar rupture secondary to direct alveolar injury.

Case: 32 year male, non smoker, non alcoholic with no comorbidities presented to emergency with sudden onset of shortness of breath, left chest pain. HRCT chest done showed left pneumothorax with mediastinal shift. Intercostal drainage tube(ICD) was placed on the left side and patient was stabilised. Patient has had similar complaints one week back for which right sided ICD was placed. Patient had history of COVID-19 infection one month back. He did not require any supplemental oxygen or ventilatory support. Right side ICD was removed 1 week later as there was no air leak. Left side had persistent air leak, with non expanding lung. Patient was put on supplemental oxygen. He was treated with antibiotics, other supplemental oxygen and repeat HRCT chest showed loculated hydropneumothorax with bronchopleural fistula (BPF) on the left side. The patient was discharge with ICD. After improving the general condition, the air leak was surgically corrected with left lobe decortication and BPF closure.

Conclusion: COVID 19 infection renders more propensity to damage type 2 pneumocytes. The alveolar rupture is secondary to alveolar injury causing increased tendency for air leak without obviously increased pressures.

A study of determinants of pulmonary fibrosis in covid-19 survivors

Raj Kumar¹, Rajiv Garg¹, Surya Kant¹, Anit Parihar²

¹Department of Respiratory Medicine, KGMU, Lucknow, Uttar Pradesh, India, ²Department of Radio-diagnosis, KGMU, Lucknow, Uttar Pradesh, India. E-mail: me.raju1995@gmail.com.

Background: COVID-19 pandemic has affected majorly the lungs besides many other organs. Many of the patients later developed pulmonary-fibrosis. This study was planned to know the determinants resulting in pulmonary-fibrosis in post COVID survivors.

Methods: Hospital-based, cross-sectional study done over a period of one year. A pre-designed proforma used to collect necessary information and follow-up HRCT and other investigations were evaluated.

Results: Out of 87 patients 41.3% (n=36) developed pulmonary fibrosis among which majority i.e., 66.6% (n=24) were males. Out of 87 patient 49.42% (n=43) belonged to the age group of 51-70 years among which 48.83% (n=21) developed fibrosis. Infection was more common in urban 63.2% (n=55), middle-class family 55.17% (n=48), non-smoker 65.51% (n=57), homemaker and office worker 49.4% (n=43). Out of 87 patients 57.47% (n=50) had different comorbidities out of which 52% (n=26) developed pulmonary fibrosis. The proportion of fibrosis among diabetic patients was 67.7% (n=21, p=0.036). A total of 27 patients were treated in ICU, out of which 66.67% (n=18) developed pulmonary fibrosis. About 57.14% (n=28) of the patient with leucocytosis developed pulmonary fibrosis. Pulmonary fibrosis developed more in which steroid are not used 9/19, 47% (n=9) compared to those where was steroid used 27/68, 39.7% (n=27). Majority of the patient i.e.,>90% fibrotic patient had raised inflammatory marker. Higher CT severity score and consolidation are predictive for post covid fibrosis

Conclusion: Post-COVID-19 pulmonary-fibrosis was observed in about half of the survivors. This study emphasized the relation of pulmonary-fibrosis with many factors like age, comorbidities, ICU-admission, steroid usage, inflammatory-markers and secondary-infections.

Study to estimate levels of oxidative stress biomarkers in long COVID patients

Nandini Dikshit¹, Surya Kant¹, Ajay Kumar Verma¹, Kausar Mahmood Ansari²

¹Department of Respiratory Medicine, KGMU, Lucknow, Uttar Pradesh, India, ²Food Toxicology Laboratory, CSIR – Indian Institute of Toxicology Research, Uttar Pradesh, India. E-mail: andinidixitser@gmail.com

Background: We estimated levels of oxidative stress biomarkers (Lipid peroxidation (LPO) via Malondialdehyde MDA concentration , Superoxide dismutase (SOD), Glutathione Reductase (GR) and Total antioxidant activity (TAA) in patients who were symptomatic beyond 4 weeks of COVID infection.

Methods: It’s a single centre, hospital based case control study in which levels of oxidative stress biomarkers in 40 Long COVID patients and 40 healthy controls were compared and analysed with their clinico-radiological profile.

Results:

• 1. Lipid peroxidation (MDA) was significantly higher (1155.9 ± 204.82nmole/ml) in Long COVID patients as compared to control (715.5 ± 85.51nmole/ml) (p value 0.0405)

• 2. SOD in Long COVID patients was lower (18.05 ± 2.83 unit/mg) as compared to control (27.36 ± 2.18 unit/mg) (p value 0.0096)

• 3. GR was reduced in Long COVID patients (10.2 ± 1.26 unit/min/mg of protein) as compared to control (15.7 ± 1.42 unit/min/mg of protein) (p value 0.0356)

• 4. TAA was also moderated in Long COVID patients (94.61 ± 16.40mM) as compared to control (241.64 ± 12.95mM) , (p value 0.0486)

• 5. LPO was directly and remaining markers were inversely proportional to the Severity of COVID and Xray Severity score

• 6. The patients with added comorbidities showed even higher oxidative stress than those with no comorbidities (p value 0.05)

• 7. Lipid peroxidation was significantly high in patients who developed neurological sequelae after COVID infection (p value 0.0083).

Conclusion: A subset of patients develop a sequelae to COVID infection and in those patients oxidative stress plays a major role.

Cardiac Temponade post COVID-19 vaccination due to reactivation of tuberculosis

Anjali Sachin Khalane¹, Sudha Desai², Gaurav Ganeshwala³

¹Ruby Hall Clinic Hospital, Pune, Maharashtra, India, ²Rajeev Gandhi Infotech Park, Pune, Maharashtra, India, ³Department of Respiratory Medicine and Critical Care, Pune, India.

Email: anjaliparhar@gmail.com

Background: 35yrs female, without comorbidities hospitalised in emergency in icu due to sudden severe breathlessness and chest pain, fever, weakness, cold, throat pain, vomiiting of 4 to 5 days duration.

Case Study: H/o 1st dose covid vaccination received 4 to 5 days ago. Latest COVID RT-PCR negative. Patient required o2 support as her Spo2 on admission was 87%.All necessary lab done. 2DECHO done by cardiologist s/o moderate pericardial effusion causing temponade, also dilated RA/RV, RV dysfunction, septal buging s/o effussion/constrictive pericarditis. Hence emergency pericardiocentesis was done under fluroscopic guidence. 500ml pale yellow fluid aspirated and pigtail was placed. Fluid was sent for testing. It showed on Gene Xpert detection of mycobacterium tuberculosis and no resistance to rifampicin. Pulmonary embolism and other systemic causes of pericardial effusion ruled out. Patient gave history of Miliary tuberculosis and completed treatment 1 month ago with HRCT chest after treatment completed showing normal lung parenchyama. All symptoms started on the day of vaccination in evening. She also had associated bilateral moderate pleural effusion L>>R. Left sided pleural fluid tapping done and sent for examination. Pt was started on 1st line anti-TB drugs along with diuretics, steroids. She responded well to treatment. Subsequent follow up 2DECHO screening and CXR showed resolution of effusion. Pigtail pericardial catheter removed, O2 tapered off and patient discharged home. Called for follow up after 1 week for 2DECHO screening. Pericardial fluid TB liquid culture was sent which showed no growth after 8 weeks.

Discussion: Reactivation of tuberculosis doesn’t occur in all cases who has received covid-19 vaccination but we noted in 1 of our case.

Conclusion: Reactivation of tuberculosis causing life threatning complication post COVID-19 vaccination.

Rasmussen’s Aneurysm - A fatal and rare complication in post COVID-19 pneumonia

Anmary Royson, Jyoti Bajpai, Ajay K. Verma, Surya Kant

Department of Respiratory Medicine KGMU, Lucknow, Uttar Pradesh, India. E-mail: anmary322@gmail.com

Background: Post COVID -19 infection has wide range of presentation, cavitation and fungal infections were very common in these patients especially when they are immune compromised. This is a case study of a post covid patient with cavitary consolidation and Rasmussen’s aneurysm secondary to invasive aspergillus infection.

Case Study: A 62 year old gentleman, hypertensive, diabetic and survivor of severe COVID-19 infection presented with low grade fever, breathlessness and cough with expectoration. The CT scan showed bilateral cavitary consolidation . Sputum examination showed aspergillus growth and MTB negative. Serum galactomannan was positive. While getting treated with antifungal therapy for invasive aspergillus infection, he had one episode of massive haemoptysis. CT angiography showed Rasmussen aneurysm and planned for bronchial artery embolization. But the patient was not willing for any urgent intervention and got discharged on request after stabilisation, warning signs were explained. After 5 days patient had massive haemoptysis followed by circulatory collapse. Patient could not be saved even after resuscitation measures and emergency intubation.

Discussion: Rasmussen’s aneurysm is a pseudo-aneurysmal dilatation of a branch of pulmonary artery secondary to chronic inflammation in a contiguous cavity. The reported incidence of such pathology is around 5% in cavitary lesions. It may ruptures into the cavity, producing massive haemoptysis.

Conclusion: Rasmussen aneurysm itself is a very dangerous entity irrespective of its etiology. Early interventions to prevent the fatal haemoptysis is the management strategy as conservative treatment may not give us enough time to act at the time of emergency.

Real time case of cardiac and vascular complications of COVID -19 infection from the State of Jharkhand

Verma, Asish Kant

Ex- HOD HEC Hospital, Ranchi, Jharkhand, India. Email: vermadrak@gmail.com

As of December 2021, India has over 34.8 million cases of COVID 19, an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It has been a massive problem to society with variable manifestations in human, and there has been numerous reported cases of covid 19 patients presenting with broad spectrum of cardiovascular (CV) manifestations. This case abstract presented 3 patients with CV complication of COVID 19 leading to vascular ischemia, cardiac tamponade and ST elevated myocardial infarction All patients presented with chief complaint of high grade fever and shortness of breath. The first patient was a healthy and young 24-year-old male having pain in the right thigh with swelling. Doppler ultrasound of limbs showed poor venous flow indicating vascular ischemia. 2^nd patient was 60-year-old women with upper respiratory symptoms diagnosed with Covid 19 and had progressive dyspnoea. She was found to have a hemorrhagic pericardial effusion with echocardiographic signs of tamponade and grade 2 cardiomegaly. Third patient was a 59 years old diabetic male diagnosed with ST elevated myocardial infraction represented by elevated cardiac enzymes, raised troponin I, ST elevation in anterior and septal leads and akinesia in the region of left anterior descending coronary artery (LAD). Covid 19 infection has common respiratory foot prints identified by knowledge of clinical presentation however, it has also extra- pulmonary cardiac and Vascular Stigmas which can be of serious consequences.

Clinical characteristics and comorbidities in second wave of COVID-19 patients -An experience from tertiary care centre in India

Jyoti Bajpai¹, Surya Kant¹, Ajay Kumar Verma¹, Ajay Kumar Patwa²

¹Department of Respiratory Medicine King George’s Medical University, Lucknow, Uttar Pradesh, India, ²Department of Medicine King George’s Medical University, Lucknow Lucknow, Uttar Pradesh, India. E-mail: jyotibajpai33@gmail.com

Background: Coronavirus disease 2019 (COVID-19) is a novel infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that emerged in Wuhan and has quickly spread worldwide. The mortality rate in critically ill patients with COVID-19 is high. This study analyzed clinical comorbidities in different groups to early identify harsh or critical patients.

Objective: To identify different clinical symptoms and comorbidities in CIVID 19 patients.

Methods: In this single-center, cross-sectional study, 142 COVID-19 patients were enrolled. Clinical characteristics and comorbidities were assessed.

Results: Of the 142 patients, 92(64.8%) were male, with a mean age of (56.00±14.81)years. The patients were elderly above 60(n = 62,43.7%) and adults (n = 80). Of these, 92 (64.7%) had comorbidities. Patients with severe COVID pneumonia 102(71.8%)were admitted to the intensive care unit (ICU), and 12(8.5%) patients have died. On admission, the main clinical manifestations were Fever (90.1%), dyspnea (83.8%), cough (78.2%), Anosmia (19%),alteration of taste (13.4%), haemoptysis (10.6%),headache (5.6%)and conjunctivitis (3.5%). Common comorbidities were diabetes mellitus(42.3%),hypertension (27.5%),Obesity (10.6%),heart failure (6.3%),COPD (3.5%),Asthma (2.5%),coronary artery disease (2.1%), ILD (2.1%),Post tubercular (1.4%),and CKD,CLD less than one perent.19% patients had history of contact COVID 19 cases. Smoking was present in 8.5% of cases. One comorbidity has been seen in 46, two in 28, and more than two in 5 patients. Patients were divided into four groups: no comorbidities, one comorbidity, two comorbidities, and more than two comorbidities. ANOVA test was used and showed that the value of serum creatinine (p=.017), serum bilirubin (p=.006), and serum SGOT (P=.009) were significantly associated.

Conclusion: Severe COVID 19 disease had the worst outcome. In addition, serum creatinine and serum bilirubin values differed significantly in different comorbidities groups.

Pulmonary sequel of COVID-19 infection – 6 month follow-up observational cohort study

Y. Gayatri Devi¹, V. Sowmya²

¹Department of Pulmonary Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India, ²Department of Preventive and Social Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. E-mail: gayatriyellapu@gmail.com

Background: Covid – 19disease is a heterogeneous disease but most common presentation being due to involvement of respiratory system. Most patients experience mild illness and spontaneous recovery but some require hospitalization for pneumonia and other complications. This study aimed to evaluate the pulmonary sequel after covid-19 infection.

Methods: Prospective observational study from tertiary care hospital. Both out and inpatients between April 2021 and May 2021 were enrolled. All were followed up at 3 and 6 months with CXR or HRCT chest and spirometry, exercise desaturation to assess residual parenchymal and functional impairment.

Results: A total of 322 cases (mild-137, moderate- 77, severe-108) were followed for 6 months following covid-19 infection. Mean age of patients was 47.48 +/- 14.58. The mean CT scores of mild, moderate and severe cases were 4.49+/-1.5, 11.26+/-1.9, 18+/-2.3 respectively. Mean SPO2 scores 97.6+/-0.9, 91.6+/-3.4 and 84.6+/-5.9 respectively. At 3 month follow up in mild and most of the moderate cases no parenchymal residual or functional impairments. In severe cases at 3 months 66%, at 6 months 22% had residual parenchymal abnormalities. Restrictive functional impairment observed at 3 months in severe cases but at 6 months significant difference between mild, moderate and severe cases with mild restrictive impairment in severe cases. The sequel observed in severe cases were, lung fibrosis (22%), secondary bacterial infections (2.7%), PTB (2.7%), Mucor mycosis (1.8%), deaths (6.4%).

Conclusion: No lung fibrosis or other complications in Mild and Moderate cases. 22.2% of severe cases have minimal residual lung fibrosis with mild restrictive functional impairment.

A case of pulmonary mucormycosis in a post COVID patient treated in a different scenario

Induri Bala Mamatha Reddy, Raj Kumar, A. Vinay Kumar,

Department of Pulmonology, Chalmeda Anand Rao Institute of Medical Sciences Karimnagar, Telangana, India. E-mail: balamamathareddy@gmail.com

Background: Pulmonary Mucormycosis was rare pulmonary fungal disease ,which was difficult to diagnose early and lack effective treatment but during COVID-19 pandemic the testing modalities have become handy , usually it used to occur in immune compromised patients , present days post Covid pulmonary mucor has become common.

Case Study: A case of 60yrs old male patient , hypertensive, post Covid presented with cough associated with black coloured sputum, also with streaky haemoptysis and sob on exertion ,CT chest revealed left upper lobe thick walled cavity with reverse halo sign with lower septated cavity , with post covid lung fibrosis.

Discussion: Pulmonary Mucormycosis may develop by inhalation of spores or by hematogenous or lymphatic spread, mostly seen in immune compromised patient, the sequelae include angioinvasion and direct tissue injury it may cause severe morbidity and mortality sputum and BAL cultures and radiological investigations are the crucial modalities for diagnosis sputum and BAL cytology may be inconclusive however early diagnosis will prevent the patient from life threatening complications and at times alternative drugs in unavoidable situations can prevent patient from life threatening complications.

Conclusion: Different scenarios may be challenging.

Pulmonary function and radiological assessment in post Covid 19 patients

Javied Malik, Rajesh Agrawal, Amit Kumar, Rishi Saini

Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. E-mail: drjavied13@gmail.com

Introduction: The COVID-19 has affected millions globally. The most common residual symptoms are shortness of breath, cough, fatigue and myalgia. Common complications include respiratory failure, thromboembolic events and new onset diabetes.

Aim: To evaluate the respiratory functions and radiological assessment in post covid 19 patients.

Material and Methods: All post COVID-19 patients were evaluated by Spirometry, DLCO and CT thorax at 4 and 8 weeks follow up.

Results: Out of 50 patients, 66% were male and 34% were females.28% patients had mild disease, 20% had moderate and 52% had severe disease. Dyspnoea, cough, fatigue were common symptoms on follow up. Common comorbidities included new onset diabetes and hypertension. At 4 weeks of follow up spirometry was normal in all patients with mild disease and 60% patients with moderate disease. Restrictive pattern was observed in 40% patients with moderate and 100% patients with severe disease. At 8 weeks follow up, persistent restrictive pattern was observed in 25% patients with moderate disease and 76% patients in severe disease. At 4 weeks follow up, abnormal CT findings (GGO) were observed in 50% of patients. At 8 weeks ,29.4% patients showed complete resolution while interlobular with septal thickening (23.5%) was most common residual finding.

Conclusion: COVID-19 pneumonia may result in significant impairment of pulmonary function and residual CT abnormality. Majority of the patients had resolution in pulmonary function and CT finding on 8 weeks follow-up. Significant number of patients still had physiologically relevant CT abnormalities and impairment of diffusion capacity on PFT who need further follow-up.

Improved oxygen saturation and reduced rebreathing with Bains circuit compared to NRBM in covid-19 patients awaiting NIV support

Varun Gupta, Asma Habib, Eblow Choudhary, Abdul Wahab Mirza

E-mail: septembervarun@gmail.com

Background: In the wake of rise in COVID patients in the country, world is experiencing an acute shortage of mechanical ventilators and medical oxygen to an extent that many hypoxic patients are not able to get oxygen support. The need of the hour is a more efficient Oxygen Delivery device which can be easily accessible to most of remote health setups that are devoid of ICU beds or Ventilators. Moreover with the growing Oxygen Crisis, we also need devices that can help in Oxygen conservation.

Objective: To assess the efficiency of bains circuit compared to NRBM in covid -19 patients awaiting NIV support based on SpO2 and PaO2.

Methodology: Prospective study conducted on patients presenting with moderate to severe COVID 19 Disease. The study subjects will be randomly assigned to the experimental group. Baseline data (spO2 levels, PaO2 levels) will be collected, the experimental group will be Oxygenated via NRBM then shifted to Bains Circuit on same oxygen flow rates. SpO2 and PaO2 levels will be compared in the same group. Also, the total Oxygen consumption by each patient of same group will be compared.Assuming acute shortage of Oxygen, ventilator beds and ICU beds in most parts of India, the use of Bains Circuit, if proven efficient over NRBM can be a major help to most of the rural and low resource setups. It can be a useful device for transportation of severely hypoxic patients to higher DCHCs.

Results: A common trend was seen in patients maintaining sufficient respiratory efforts but reduced SpO2 on NRBM, as soon as shifted on Bain’s circuit (connected via a BiPaP mask), a sudden jump in SpO2 and PaO2 (approx. 15-20%) was seen at same oxygen flow rates.

Conclusion: As we anticipate 3rd wave of Covid 19, keeping Bain’s circuit as choice for oxygen therapy can be a lifesaving alternative for patients awaiting non invasive ventilator support.

Vitamin d3 and its association with covid-19 disease severity: A prospective study

Ankita Mohanty, Gopal Purohit, C. R. Choudhary, Ashok Kuwal, Hemant Borana

Department of Pulmonary Medicine, Dr. SN Medical College, Jodhpur, Rajasthan, India. E-mail: thatsoankita@gmail.com

Background: Vitamin D3 has shown immunomodulatory properties influencing cell signalling pathways in chronic respiratory disorders. There is limited evidence concerning the role of Vitamin D3 and its influence on the COVID-19 disease severity. This study aims to determine the association between Vitamin D3 levels and disease severity and possible outcomes.

Methods: This prospective study included 80 hospitalised RT-PCR positive patients. Patients were stratified into two groups based on oxygen saturation (<90% and >90%) at admission. Vitamin D3 was stratified as deficient (<12 ng/ml), insufficient (12-20 ng/ml) and sufficient (>20 ng/ml).

Results: A total of 80 patients were included, 40 at room air (median age, 50; 62.5%male) and 40 on oxygen support (median age, 57; 65.8% male). Vitamin D3 deficiency was found in 22 (55%) patients on oxygen as compared to only 6 (15%) patients on room air (p<0.001). The mean vitamin D3 levels for patients on oxygen was significantly lower as compared to patients at room air (14.78 ± 10.33, 26.49 ± 19.06, respectively; p= 0.0009). Adverse outcome reported was more in vitamin D3 deficient patients (25% vs 11.3%). Mean Vitamin D3 among patients who died was less (14.3±9.90) as compared to those who survived (21.7±16.9), but not statistically significant (p= 0.18).

Conclusion: Vitamin D3 deficiency showed significant association with COVID disease severity. Being one of the modifiable risk factors, early identification and corrective measure could alleviate a severe course of illness.

Pulse rate in long COVID: what does it signify?

Sayoni Sengupta, Sikta Mukherjee, Mintu Paul, Parthasarathi Bhattacharyya

Institute of Pulmocare and Research, Kolkata, West Bengal, India. E-mail: sayoni.sengupta@gmail.com

Background: The multisystem involvement of covid-19 lingers in post-covid phase. The significance of baseline resting pulse rate was looked for in long-covid relating to symptoms in acute phase, 2-chair test response, and echocardiography.

Methods: Serial long-covid patients attending out-patient department were included. They were evaluated on demographic (age, height, weight, and BMI), characteristics, symptom score in acute phase (symptom severity in 0 to 5 scale X duration of symptoms), variables (pulse-rate and SpO2 changes) related to 2 chair test and resting Doppler echocardiography (LV ejection fraction, TSAPSE, left and right ventricular free wall GLS, and LV filling pressure. Two groups with pulse rate below or above 90/minute were compared.

Results: The mean duration of acute illness for both the group is computed to be (118.44±95.95 vs. 152.77±102.25, p- value= 0.42) respectively. The baseline pulse rate were significantly different between those above (n=12) and below 90 (n=23) per minute (101±5.83 vs.72.85±8.14; p<0.0001); so is the post-exercise maximum pulse rate (p<0.004). Subjects with lower pulse rate had better height (p=0.05), weight (p=0.06), and higher anosmia (p=0.005) but lower total symptoms score (26.4±51.02 vs.29.66±66.12; p=0.008). The spirometric parameters (FVC, FEV1, FWV1/FVC) were better (although not significant) in those with lower pulse rate. The echocardiographic parameters as LVEF, TAPSE, LVFP were similar; the free wall GLS of both RV and LV were reduced in both the groups but that of RV (and LV were affected more in lower and higher pulse rate group respectively.

Conclusion: Baseline pulse-rate in post covid subjects is likely related to neuro-inflammatory symptoms (anosmia) and poor LVGLS suggesting LV myocardial dysfunction.

A rare case of five times reactivation of COVID-19 in a patient with thymoma

Krishnapriya S. Kumar

Department of Respiratory Medicine, SMS Medical College, Jaipur, Rajasthan, India. E-mail: krishna.skumarpriya@gmail.com

Background: Recurrent COVID-19 infection is a new entity and is underdiagnosed. Despite the improvement of our knowledge about this virus, it is still challenging and controversial whether all patients with SARS-CoV-2 infection will reactivate the illness and which risk factors predict eventual recurrence. Recurrence of COVID-19, whether reactivation or reinfection pose a major public health concern since it could significantly contribute to the spread of virus. Better understanding about this can improve our knowledge of the COVID-19 pathogenesis and ways to control the transmission.

Case Study: A 41 year old male with no known comorbidities was admitted five times during a period of 7 months each time after being detected RTPCR positive for SARS-CoV-2 and more symptomatic than previously. He had no contact with other COVID-19 patients and was asymptomatic in between admissions. Despite this, he never developed antibodies against SARS-CoV-2. Later on, he was diagnosed with thymoma on biopsy of the anterior mediastinal mass. Patient’s condition deteriorated on last hospitalization and he died, despite the treatment. Here we present an interesting case on multiple times recurrent COVID-19 infection, probably a case of reactivation and different plausible explanations on the role of thymoma.

Conclusion: Acknowledging the potential of SARS-CoV-2 to cause recurrence is very important during the pandemic as a part of long term transmission mitigation. This case shows that previous infection does not guarantee complete immunity from COVID-19, especially in immuno-compromised patients. Hence, despite the status of prior infection, vulnerable individuals who recovered from COVID-19 should be under surveillance.

Serum ferritin levels as a predictor of severity in COVID 19 patients in a tertiary hospital

Kopuri Monica, B. Bhanu Rekha, Sireesha Puvvadi

Department of Respiratory Medicine, Dr. Pinnamaneni siddhartha Institute of Medical Sciences and Research Foundation, Dr. NTR University of Health sciences, Vijayawada, Andhra Pradesh, India. Email: monu.k2443@gmail.com

Background: COVID 19 has become pandemic globally. Elevated inflammatory markers are observed as common pathophysiological response to acute illness. High ferritin levels can cause pro-inflammatory changes and immune suppression. The aim of the study is to assess if ferritin can be used as an independent biomarker to predict severity in COVID 19.

Methods: A cross sectional study was conducted at a tertiary care hospital from May 2021 to November 2021 and a convenience sample of 525 was included. The following variables were collected sociodemographic determinants, co-morbidities, clinical presentation, laboratory results, and durations of intensive care unit (ICU) and in-hospital stay. The data collected was entered into MS excel version 10 and statistically analysed using SPSS software.

Result: In the current study, 54.8% belong to age group 41-60 years, males were 63.5 % compared to 36.3% females. 32.4 % study subjects stayed for longer duration (>14 days) and 67.6% have raised serum ferritin levels (>250 ng/ml), among them 29% have more than 1000ng/ml. longer duration of hospital stay was found to have statistically significant association with increased ferritin levels. Among study subjects having ferritin levels > 1000ng/ml, 64.7% stayed for longer duration (chi-square = 60.151, df =1, p=0.00). Mortality was found to be 29%.

Conclusion: Increased ferritin levels in COVID 19 patients is associated with longer duration of hospital stay, ICU admissions and mortality. Serum ferritin is cost effective and accessible even at peripheral settings for better risk stratification, monitoring and timely intervention.

Do the surgical outcomes differ between Non-COVID pulmonary mucormycosis and COVID associated pulmonary mucormycosis after surgical resection? A comparative analysis

Mohan Venkatesh Pulle, Sukhram Bishnoi, Harsh Vardhan Puri, Belal Bin Asaf, Arvind Kumar

Institute of Chest Surgery, Medanta – The Medicity, Gurguram, Haryana, India. E-mail: mohanvenkateshpulle@gmail.com

Table 1.

Demographic details and disease characteristics of surgical group (n=25)

Male, n (%)	16 (64)
Female, n (%)	9 (36)
Age in years (mean±SD)	54.8±15.1
Duration of symptoms in weeks (mean±SD)	1.1±1
Co-morbidities, n (%)
Diabetes mellitus	17 (68)
No co-morbidities	6 (24)
Chronic kidney disease	2 (8)
Supplemental oxygen support, n (%)
Yes	8 (32)
No	17 (68)
Performance scale (ECOG)
1	6
2	13
3	3
4	3
Side of the disease, n (%)
Right side	16 (64)
Left side	9 (36)
Radiological features, n (%)
Cavitation	21 (84)
Pneumonia	3 (12)
Diffuse infiltrates	1 (4)

SD: Standard deviation

Table 2.

Peri-operative details of surgical cohort (n=25)

Extent of surgery
Nonanatomical wedge, n (%)	5 (20)
Right upper lobe	1
Right middle lobe	1
Left lower lobe	1
Right upper, middle and lower lobe	1
Right upper and lower lobe	1
Lobectomy, n (%)	18 (72)
Right upper lobe	2
Right middle lobe	1
Right upper + middle lobe	3
Right lower lobe	4
Right middle + lower lobe	2
Left upper lobe	4
Left lower lobe	2
Pneumonectomy, n (%)	2 (8)
Right	0
Left	2
Method of surgery, n (%)
Open	19 (76)
VATS	6 (24)
Postoperative ICD duration (days) (mean±SD)	8.3±4.2
Postoperative hospital-stay (days) (mean±SD)	18.1±8.3
Postoperative complications, n (%)	8 (32)
Peri-operative mortality (<90 days), n (%)	5 (20)

SD: Standard deviation

Objectives: This study aims at reporting the surgical outcomes of COVID Associated Pulmonary Mucormycosis (CAPM) with special emphasis on surgical mortality. This study also compares the surgical outcomes between Non-COVID Pulmonary Mucormycosis (NCPM) and CAPM.

Methods: This prospective observational study was conducted in a dedicated thoracic surgical unit in Gurugram over 18 months which includes 25 patients. An analysis of demography, perioperative variables including complications were carried out. Various parameters were analysed to assess the factors affecting mortality.

Results: Out of 25 patients, male-female ratio was 16:9 (64%:36%), with a mean age of 54.8 years (range, 33–72 years). Diabetes was the most common predisposing factor in 17 patients (68%). A total of 8 patients (32%) were on supplemental oxygen (1-4 lit/min) at the time of surgery. Extent of surgery was non-anatomical wedge resection in 5 patients (20%), lobectomy/bi-lobectomy in 18 patients (72%) and pneumonectomy in 2 patients (8%). Commonest complication was prolonged air leak (> 7 days) in 5 patients (20%). There were 5 peri-operative deaths (20%), all due to persistent fungal sepsis. ECOG scale > 2 (P = <0.001) and pneumonectomy (P = 0.02) were the predictors of mortality. On comparison with NCPM, no difference in the postoperative complications (P = 1.00) and mortality (P = 1.00) was observed.

Table 3.

Analysis of factors affecting mortality in surgical Cohort (n=25)

Variables	Characteristics	Number	Mortality	OR*	P*
Age of patient (years)	≤60	17	3	1.55	0.66
	>60	8	2
ECOG#	>2	6	4	36	<0.001
	≤2	19	1
Surgery	Pneumonectomy	2	2	18.2	0.02
	Lobectomy/wedge	23	3
Oxygen support	Yes	8	3	4.5	0.15
	No	17	2

OR: Odds ratio

Table 4.

Comparison of non-COVID pulmonary mucormycosis versus COVID associated pulmonary mucormycosis

Characteristics	PM (non-COVID) (n=15)	CAPM (n=25)	P
Male, n (%)	11 (73.3)	16 (64)	0.73
Female, n (%)	4 (26.7)	9 (36)
Age in years (mean±SD)	43.8±12.1	54.8±15.1	0.02
Duration of symptoms in weeks (mean±SD)	2.1±2.4	1.1±1.0	0.07
Side of the disease, n (%)
Right side	11 (57.8)	16 (64)	0.73
Left side	4 (21.1)	9 (36)
Radiological features, n (%)
Pneumonia	9 (47.3)	3 (12)	-
Cavitation	8 (42.1)	21 (84)
Diffuse infiltrates	2 (10.5.)	1 (4)
Mycotic aneurysm, n (%)	0	3 (12)	0.27
Postoperative ICD duration (days) (mean±SD)	6.1±3.2	8.3±4.2	0.08
Hospital stay (days) (mean±SD)	8.1±4.3	18.1±8.3	<0.001
Postoperative complications, n (%)	5 (33.3)	8 (32)	1.0
Peri-operative mortality (<90 days), n (%)	3 (20)	5 (20)	1.0

SD: Standard deviation, PM: Pulmonary mucormycosis, CAPM: COVID associated PM

Conclusion: Aggressive surgical resection with clear margins should be offered in CAPM whenever feasible. In appropriately selected patients, surgical resection is safe and efficacious. Surgery for CAPM was not associated with higher post-operative complications including mortality compared to NCPM.

Air leak syndrome in COVID -19 survivors: A retrospective study

Vamshikrishna, C. Nagaraja, B. P. Raghu, J. S. Akshata

Department of Pulmonary Medicine, SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India. E-mail: vamshikrishnajinka@gmail.com.

Background: Air - leak syndrome is one of the dreaded complication in COVID -19 viral pneumonia. It has been described in severe cases during acute COVID -19 Infection. Spontaneous pneumothorax after mild COVID-19 disease has been rarely reported.

Methods: A retrospective descriptive study was conducted in SDS TRC AND RGICD, Bangalore. All patients presenting to our hospital from May 2021 to October 2021 with air -leak syndrome with a prior history of COVID -19 infection were included. Details obtained from the medical records included the demographics, radiology, laboratory investigations and outcome.

Results: 24 patients presented with air- leak syndrome. Median age was 54 years with male predominance (84%). 33% had severe COVID disease, 29% had moderate and 37% were mild COVID cases. Median duration of presentation with air -leak syndrome from covid-19 infection was 29 days (Range- 8-90). 58% had Hydro-pneumothorax and 41% had pneumothorax. Pleural fluid analysis was suggestive of para-pneumonic effusion in 11cases while three had tubercular hydro-pneumothorax. Mean duration of ICD in-situ was 24days . Chest radiography showed consolidation in 21 patients and 3 patients had no consolidation, pneumatocele was observed in 2 patients . one patient developed BPF, 3 patients succumbed and the rest were discharged.

Conclusion: Air-leak syndrome is a life threatening complication of COVID-19 infection which can manifest even after a mild disease and with out NIV use . Multiple factors lead to development of air -leak syndrome. Prompt recognition of the same is crucial to avoid mortality.

Scars of a long battle – A rare case of post covid vanishing lung

Aparna suresh, G. N. Srivastava

Institute of Medical Sciences, BHU, Varanasi, Uttarpradesh, India. E-mail: aparnasuresh18@gmail.com

Introduction: Vanishing lung syndrome , a primary bullous disease of the lung is defined as a large bulla occupying at least one third of a hemithorax. Usually it associated with riskfactors of smoking, marijuana abuse, alpha 1 antitrypsin deficiency. Here we present a rare case of vanishing lung syndrome developed in a post covid patient without any comorbidities making it a rare presentation.

History: A 35year,male with no significant cigaratte smoking presented with acute onset dyspnoea along with dry cough and right sided chest pain for 1 week duration .no history of any recent trauma Past history of COVID 19 one month back, he was hospitilized was put on NIV and HFNC and was discharged on domicillary oxygen and other medications.

Clinical Findings: On examination there was hyperresont note in right side along with diminished air entry in all areas in right side along with left side mammary, infraaxillary, infrascapular areas.

Diagnosis and Management: Diagnosis was made with the help of contrast enchanced computed tomography aided by other serological and microbilogical workup. Patient was managed conservatively antibiotics ,analgesics and other supportive measures.

Learning Points: We are well aware of lung fibrosis post covid , our intention was to throw light into the new entity of bullous lung disease Bullous lung disease (with or without pneumothorax) should be part of differential diagnosis in a patient returning with chest pain and dyspnoea after SARS-Cov-2 infection.CT imaging essential to differentiate radiographically presumed complex pneumothoraces from large bullae to prevent erroneous chest drain insertion into a bulla.

Clinical profile and radiological pattern in follow up study of patients treated for moderate to severe COVID-19 pneumonia

Ravi Apoorva, Vijayakumar

Department of Respiratory Medicine, Shri. B. M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. E-mail: apoorvaraavi@gmail.com

Background: COVID-19 complications have been the biggest challenge, especially the pulmonary fibrosis that has been associated with moderate to severe infection. While early administration of antifibrotics have been implicated in the treatment and prevention of post COVID fibrosis, the degree of resolution varies amongst patients post discharge.

Case Study: Four patients with documented COVID-19 infection with HRCT Thorax suggestive of moderate to severe COVID-19 pneumonia based on CT severity scores, were followed for a period of six months post discharge. They were treated with antivirals, anticoagulants, short course of steroids and empirical antibiotics. They were discharged with antifibrotics and were followed up monthly. An improvement in six minute walk test was observed in all patients, serial chest X- rays showing near complete resolution of fibrotic bands. HRCT Thorax was repeated at an interval of three months post discharge which also showed improvement in the fibrotic areas with a reduced CT Severity score.

Discussion: Pulmonary fibrosis was a common finding in almost all patients who recovered from a severe COVID-19 infection. There was significant improvement in fibrosis scores 30 days, 60 days and 90 days after discharge, confirming that pulmonary fibrosis was likely to resolve post- COVID-19 infection. Meanwhile, in some cases, the fibrosis did not completely resolve within 90 days, and whether additional anti-fibrotic treatment could accelerate the process is worthy of further investigation.

Conclusion: Radiological resolution of non-homogenous opacities over a period of time raises hope for complete recovery in the minds of patients as well as physicians.

Pulmonary cavity- An aftermath of the recent apocalypse

V. Pranavi, Keertivardhan D. Kulkarni

Department of Respiratory Medicine, Shri. B. M. Patil Medical College, Hospital and Research Centre, Bijapur, Karnataka, India. E-mail: pranavireddy94@gmail.com

Background: Post COVID-19 complications have been a matter of concern because of various presentations with unknown mechanisms underlying the condition. While the common complications ranged from fatigue, dyspnoea to thromboembolic events and pulmonary fibrosis, lung cavitation was an uncommon finding on CT thorax.

Case Study: Four patients, with diabetes mellitus and documented COVID-19 infection developed cavitatory lesions in lung during the course of their recovery from the viral illness. With the rise in number of sino-orbital mucormycosis cases during the second wave, a possibility of pulmonary mucormycosis could not be ruled out. One patient had a bacterial infection known to cause cavitation, while fungal infection was documented in one case, and the rest yielded no results, probably owing to the antibiotic cover provided. All were referred to a thoracic surgeon for further management of lung cavitations.

Discussion: Cavitatory lung lesions are usually related to fungal, mycobacterial, autoimmune or neoplastic etiologies, uncommonly caused by viral pneumonias, but have been observed in COVID-19 patients. The velocity of development of cavitatory lesions can be atypical to mycobacterial infections, and hence regarded as a complication of COVID-19 pneumonia.

Conclusion: The development of lung cavitations in COVID- 19 infected individuals, warrants vigilant monitoring through regular follow ups, especially the immuno-compromised, for early recognition and definitive treatment of the disease. Further studies are needed to determine the causative factors. It also warrants the clinicians to be aware of the evolving CT findings in COVID-19 and appropriate follow-up of convalescent patients to ensure complete recovery.

Pneumothorax in COVID -19 – Expect the unexpected!

Pranay M. Walade, T. Pramod Kumar, G. Nalini, V. Kartheek Rao

Department of Pulmonary Medicine, Government General and Chest Hospital, Hyderabad, Telangana, India. E-mail: pranaysinghw@gmail.com

Background: COVID-19 has been in the spotlight since December 2019. It mainly affects the lungs and common symptoms are fever, cough and shortness of breath. Pneumothorax, although rarely may complicate the course of COVID-19. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. The occurrence of pneumothorax in COVID-19 leads to clinical deterioration and worsening of respiratory symptoms.

Case Study: In the present series we report 3 patients who were presented with pneumothorax while having COVID-19 infection. Contrary to the presumed mechanism of pneumothorax, none of them had severe cough as a presenting symptom that could have caused alveolar rupture leading to air leak. The first patient had a fibrosed left lung secondary to old tuberculosis but presented with right sided pneumothorax and pneumomediastinum. The second patient had sequential development of bilateral pneumothorax. The third patient presented with isolated pneumomediastinum. The first two patients had a favorable outcome despite having severe COVID-19, unfortunately the third patient succumbed to his illness.

Discussion: The present study is a reminder that an acute deterioration with hypoxia in a Covid-19 patient could indicate a pneumothorax which may occur even in the absence of severe cough. Therefore, pneumothorax may be a presenting feature in COVID-19. High vigilance is required during assessment of patients, as both share the common symptom of breathlessness and therefore can mimic each other.

Conclusion: Pneumothorax is a known complication in COVID-19 and should be suspected in a patient who does not respond to treatment.

COVID-19 associated mixed mold infection: a rare case report of aspergillosis and mucormycosis

Narendra, Pravati Dutta, Rekha Manjhi, Aurobindo Behera

Department of Pulmonary Medicine, Veer Surendra Sai Institute of Medical science and Research, Sambalpur, Odisha, India. E-mail: narendratengli28@gmail.com

Background: Fungal epidemic was announced amid COVID pandemic with several cases of COVID-associated Mucormycosis and Aspergillosis being reported however there is not sufficient data regarding mixed fungal infection.

Case Study: A 54-year-old male patient diagnosed with severe COVID 19 pneumonia and diabetes 1-month back presented to OPD with C/O of chest pain and breathlessness for two days associated with haemoptysis, heaviness and congestion of right nostril but no fever. O/E patient was tachypnoeic, hypoxic and in shock, Neutrophil count 87%, RBS-530 mg/dl, urine ketone body was absent. Chest x-ray showed opacity over the left upper and mid-zone, HRCT-thorax showed a bird-nest-sign noted in the left upper lobe S/O invasive fungal infection. MRI PNS showed mucosal thickening S/O sinusitis, Fungal infection. Sino-nasal mucosa KHO-mount and fungal culture showed mixed infection of Rhizopus species and aspergillus flavus. Right nasal HP study showed mixed invasive moulds infection. Initially, the patient was treated conservatively later on inj. amphotericin-B was started. The patient’s condition worsened on day-18 and succumbed a day later.

Discussion: Uncontrolled diabetes-mellitus, and corticosteroids leading to hyperglycaemia, extensive use of broad-spectrum antibiotics increases the risk of invasive Moulds. In our case study, patients suffered from COVID-pneumonitis and had uncontrolled diabetes leading to damage of airway epithelium inviting an invasion of tissues by moulds.

Conclusion: Mixed fungal infections as COVID-19 sequelae may be an emerging issue and seen particularly in post-COVID patients with uncontrolled diabetes, and on steroids. The focus should be on prompt management: hit hard approach with both medical and surgical treatment.

Case series of pneumothorax in patients with COVID 19 pneumonia

Tanna Mounika, A. Prem Kumar, B. M .S. Patrudu, S. Praveena

E-mail: mounika.tanna22@gmail.com

Background: Pneumothorax has been noted to be a complication of covid19 pneumonia caused by SARS-COV2 requiring hospitalization and increasing mortality.

Case Study: A series of 10 cases of spontaneous pneumothorax in patients with covid19 pneumonia either RTPCR positive or radiological positive admitted into a tertiary care centre from April 2021 to September 2021.

Discussion: Of 10 cases of pneumothorax, 8 were confirmed covid19 positive by RTPCR and 2 were radiologically diagnosed based on CT imaging. None of them had previous lung disease, 2 were smokers and 1 had prolonged biomass fuel exposure. 3 of them were kept on NIV support and others required oxygen with facemask. All patients had moderate to severe disease with bilateral GGOs. All of them had acute onset of chest pain, drop in saturation and increased respiratory rate. All the patients were managed with ICD insertion and oxygen supplementation. Out 10 patients, 5 patients had favorable outcome and discharged and death occurred in 5 patients.

Conclusion: Acute deterioration in a patient with covid19 pneumonia indicate a pneumothorax which may occur even in the absence of pre-existing lung disease and mechanical ventilation. Early diagnosis and management of this complication is necessary to prevent the risk of mortality.

Outcome of COVID19 pneumonia in diabetes mellitus patients

Tanna Mounika, A. Prem Kumar, B. M. S. Patrudu, S. Praveena

E-mail: mounika.tanna22@gmail.com

Background: Diabetes mellitus significantly increases the severity, risk of hospitalization and mortality in covid19 pneumonia.

Methods: A retrospective study was conducted in 248 patients tested positive for covid19 by RTPCR admitted into a tertiary care centre between april 2021 and june 2021 to know the severity assessed by the oxygen requirement and outcome assessed by duration of hospitalization and death rates of covid19 pneumonia in patients with diabetes mellitus.

Results: Out of 248 patients, 152 (61.2%) were non-diabetic, 96(38.7%) were diabetic, of which 74 (77%) being previously diagnosed, 22 (22.9%) diagnosed as de novo . Out of 96 diabetics, 24 (25%) were vaccinated with two doses, 20(20.8%) with first dose and 52(54.1%) not vaccinated. Among 96 diabetics, 36 (37.5%) required oxygen, 22 (22.9%) required HFNC support, 19 (19.7%) required NIV support. Among 96 diabetics, 62 (64.5%) were discharged of which 26 (41.9%) required oxygen and death occurred in 34 (35.4%). Out of 34 deaths, 26(76.4%) were not vaccinated and 8 (23.5%) were vaccinated.

Conclusion: There is increased severity, mortality and length of hospital stay in patients of covid19 pneumonia with diabetes mellitus. However in vaccinated, risk of mortality is significantly low compared to non-vaccinated patients.

Covid immune response and viral clearance

Tushar Sahasrabudhe, M. A. Nirmala, Harshmeet Singh Gujral

Dr. D. Y. Patil Medical College and Hospital, Dr. D.Y. Patil University, Pune, Maharashtra, India. E-mail: harshmeetsingh26@gmail.com

Background: The clinical manifestations of Covid-19 range from mild disease to severe ARDS. It is a matter of debate whether it is the excess viral load or the dysregulated immune response that leads to severe inflammation. It is also not clear whether the excess immune response is successful in rapid clearance of the virus. This study aims to understand the relationship between immune response, viral clearance and severity of illness in patients suffering from COVID-19.

Methods: This was a cross sectional observational study wherein 65 SARS Cov2 RT-PCR positive participants were enrolled between 10^th to 14^th day of their illness and were selected from 2 distinct clinical groups as defined by ICMR guidelines. Group A consisted of Mild cases and Group B consisted of severe cases. A repeat throat swab for SARS Cov2 RT-PCR and blood levels of Covid specific antibodies, CRP and D-dimer were measured on day 14 of the illness.

Results: On day-14, 2/34 (5.88%) tested RT-PCR negative (Ct value cut-off above 35) in group A compared to 5/31(16.13%) in group B which was not statistically significant. In groups A and B respectively, mean antibody titer was 35390.47 and 36426.11, mean CRP values were 4.91 and 31.01 mg/dl, D-dimer levels were 895 and 2896 ng/ml.

Conclusion: Severe covid cases had dysregulated immune response which did not significantly help in viral clearance. Also most patients remained RT-PCR positive on day 14.

Clinico-radiological profile of tuberculosis in post-covid patients

Vijayalakshmi, J. S. Akshata, B. P. Raghu, Swathi Karanth

Department of Pulmonary Medicine, SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India. Email-sharadhaurs@gmail.com

Background: Tuberculosis(TB) is one among the various respiratory pathologies affecting post-covid patients. We intend to describe clinico-radiological characteristics of tuberculosis in post-covid patients.

Methods: Retrospective descriptive study, conducted at SDS TRC and RGICD, Bengaluru from May 2020 to November 2021 with inclusion criteria of Tuberculosis with history of COVID in last 6 months. Clinico-radiological characteristics of them were retrieved from medical records section.

Results: 13 patients were included in our study. Male predominance (69%), with mean age of 50.7years noted. Patient with co-morbidity were 61.53%, majority were diabetics. 46% severe, 15%moderate covid cases received corticosteroids during covid illness and 38% were mild who didn’t receive corticosteroids. Mean duration of TB diagnosis after covid was 2 months. 5 patients were diagnosed as pulmonary tuberculosis with cough, fever, weight loss as presentation, 6 presented with air-leak in which 4 had hydropneumothorax, 2 had pneumothorax with dyspnea as presentation and 2 had pleural effusion. 69% of chest radiograph revealed cavity. Rest showed nodules, consolidation. Bandim-TB score was assigned. 4 were mild and rest 11 were of moderate to severe category. AFB Sputum smear / CBNAAT-positive in 85% cases. Among 2 pleural effusions, pleural fluid CBNAAT was positive in 1 and in other biochemical analysis was suggestive of tuberculosis. 15% were Rifampicin resistant TB. All except 1 were newly diagnosed tuberculosis. 2 patients succumbed to the disease and rest were discharged on appropriate anti-tubercular regimen.

Conclusion: Post-covid patients when presents with persistent or worsening respiratory symptoms, tuberculosis should be excluded especially in endemic countries like India.

Association of monocyte count alterations with COVID-19 severity

Carol Hannah Babu, N. Huliraj, M. K. Raghavendra, R. Deepak Kumar

Department of Respiratory Medicine, KIMS, Bengaluru, Karnataka, India. E-mail: carolhannahbabu@gmail.com

Background: COVID-19 caused by SARS-CoV-2 has led to an ongoing pandemic with massive global health and socioeconomic consequences. Monocytes are recruited under pathological conditions like viral infections to the affected tissue to defend the organism against invading pathogens and to aid in efficient resolution of inflammation. Some studies had suggested a significant decrease of monocytes in COVID-19 patients with severe or critical disease whereas some others suggested monocytosis.

Aim of the Study: To find the association of Monocyte count alterations with the severity of COVID-19. Methods: This is a retrospective study conducted in Dept of Respiratory Medicine, KIMS Hospital and Research Centre, Bengaluru. A total of 1000 COVID patients were taken in the order of their admission from Jan-May 2021. Monocyte count in the blood at the time of admission was collected. Ethical clearance was obtained from the institutional ethical committee. Results: Higher monocyte count was seen in the younger age group, particularly in Category B COVID-19 patients. Statistically significant association was found between low monocyte count and the disease severity and mortality in patients with COVID-19. Conclusion: It is inferred that monocytes proliferate to eliminate the viruses in mild patients, while the loss of monocytes in the critical patients suggest that innate immunity might be suppressed to a certain extent in critical COVID-19. Deviation in monocytes count from the normal is a valuable discriminator for diagnosis of COVID-19 and suitable anticipator of overall spectrum of adverse consequences.

Study of clinical profile of covid-19 in patients with underlying respiratory illness

Bhumika Madhav, T. K. Jayalakshmi, Gokul Bhate, Dhanaji Revande

Department of Pulmonary Medicine, Apollo Hospitals Navi Mumbai, Maharashtra, India. E-mail: bhumikamadhav@yahoo.com

Background: It is feared that patients of covid-19 with preexisting respiratory illnesses get more serious infections. Aim was to study profile of patients with various respiratory illnesses in patients affected with covid-19. To document the co-existing comorbidity, symptoms and treatment received by these patients.

Methods: Samples of 100 consecutive patients with respiratory illness affected by covid-19 in months from May 2020 to April 2021 was studied and retrospective analysis of indoor papers of these patients was done.

Results: Male and female covid-19 patients were comparable in number. Only 2.3 % of the total covid-19 admissions during the year had underlying respiratory illness. Asthmatics (47%) were maximum among the respiratory illnesses admitted, 20% had COPD,13% had OSA, 10 % had TB,8 % had ILD and 3% suffered from other illnesses like malignancy.67% of total patients had comorbidities such has diabetes mellitus, hypertension, hypothyroidism, stroke etc. The most common symptoms were Fever in 81% of patients admitted with covid 19 illness, followed by cough in 77% and breathlessness in 63 % The other symptoms such as body pain, abdominal pain, throat irritation and chest pain was present in 15 to 30% of patients. Among patients admitted 48% received inj remdesivir, followed by tab faviparavir.

Conclusion: Among patients admitted with respiratory illness, patients with bronchial asthma were maximum in number. The most common symptoms presented by the patients were fever, cough and breathlessness. Maximum number of patients had other comorbidities. Only 2.3 % of the total covid-19 admissions during the year had underlying respiratory illness.

Incidence of acute kidney injury in hospitalized COVID-19 patients from a tertiary care hospital

Carol Hannah Babu, N. Huliraj, M. K. Raghavendra, R. Deepak Kumar

Department of Respiratory Medicine, KIMS, Bengaluru, Karnataka, India. E-mail: carolhannahbabu@gmail.com

Background: Novel coronavirus disease caused by SARS-CoV-2, primarily manifest as an acute respiratory illness; however, it can also affect multiple organs, such as kidneys, heart, digestive tract, hematological and the nervous system. Acute kidney injury (AKI) has been reported in up to 25% of critically-ill patients with SARS-CoV-2 infection, especially in those with underlying comorbidities.

Aim of the Study: To study the incidence of Acute Kidney Injury in hospitalized COVID-19 patients.

Methods: This is a retrospective study conducted in Dept of Respiratory Medicine, KIMS Hospital and Research Centre, Bengaluru. A total of 1000 COVID patients were taken in the order of their admission to the hospital from Jan –May 2021. Blood urea and serum creatinine levels at the time of admission was collected. Ethical clearance was obtained from the institutional ethical committee.

Results: Statistically significant correlation was found between the incidence of AKI and the COVID-19 disease severity and mortality. Correlation by Pearson 2 tailed shows a positive correlation with a value of 0.713. Patients with renal involvement had higher overall mortality compared with patients without renal involvement. Adverse short-term outcomes of renal involvement were associated with severity of COVID-19 pneumonia

Conclusion: AKI could be used as a clinical characteristic in severity classification and risk stratification. Further investigation of the underlying mechanism of renal disease in COVID-19 would be needed to clarify possible therapeutic targets.

To study the correlation of clinical, radiological and laboratory parameters with the outcome in covid-19 patients treated with HFNC

S. Abinaya, A. mahilmaran, C. Palaniappan

Madras Medical College, Chennai, Tamil Nadu, India. E-mail: abi22vasan@yahoo.com

Background: High-flow nasal cannula (HFNC) has been reported to be effective in improving oxygenation in COVID pneumonia patients with hypoxemic respiratory failure. This observational study aims to correlate the clinical, radiological and laboratory parameters with the outcome of HFNC therapy.

Materials and Methods: Clinical data including symptoms, age, gender, respiratory rate, heart rate and Spo2 on admission, comorbidities, CT chest, laboratory data such as NLR, serum Ferritin, CRP, D-dimer were correlated with HFNC therapy outcome.

Results: 152 patients with COVID pneumonia treated with high flow nasal cannula oxygen therapy were studied. Among them, 98(64.5%) patients had a successful outcome and 54 (35.5%) patients had a failure outcome. The mean age was 58 years and the majority were male (62.5%). Breathlessness was the major symptom found in 132 (86.8%) patients, followed by fever (78.9%), cough (57.9%), myalgia (34.2%), and GI symptoms(9.9%). There was a statistically significant association between CT severity at the time of admission and outcome (p-value 0.0002). D-dimer and ferritin were significantly associated with poor outcome (p-value 0.0005) of which D-dimer had more sensitivity and specificity (90.8% & 90.7%).

Conclusion: Our data suggest that HFNC plays an important role in patients with COVID-19 related hypoxemic respiratory failure. There was a statistically significant association between CT severity, clinical and laboratory parameters with the HFNC outcome.

Diagnostic accuracy of serum ferritin, C-reactive protein, lactate dehydrogenase and D-dimer in COVID-19

Narendra, Pravati Dutta, Rekha Manjhi, Aurobindo Behera

Department of Pulmonary Medicine, Veer Surendra Sai Institute of Medical science and research, Sambalpur, Odisha, India. Email: narendratengli28@gmail.com

Background: The Utility ofserum biomarker in the Diagnosis of COVID-19 cases has not been studied thoroughly.

Aims and Objective: Tofind outthe diagnostic accuracy of serum ferritin, c-reactive protein, lactate dehydrogenase and d-dimer with RT-PCR positive moderate to severe covid-19 patients.

Methods: This diagnostic accuracy study was conducted on suspected COVID-19 SARI patients and were divided into two groups based on the results of RT-PCR for COVID-19 and to minimise false-negative RT-PCR in the control group patientshaving HRCT-thorax CORADS-5 were excluded, and the accuracy of different serum biomarker in predicting cases withpositive RT-PCR was evaluated using the area under the ROC curve (AUC),In thisstudy, AUC 0.9 to 1 was defined as excellent accuracy, 0.8 to0.9 as very good, 0.7 to 0.8 as good, 0.6 to 0.7 as sufficient, 0.5to 0.6 as bad, and < 0.5 as poor(useless test).

Results: 126 cases with the mean age of 47.2(range: 19-84) years were studied (73% male). The result of RT-PCR for COVID-19 waspositive in 62(49.2%) cases. Patients with positive RT-PCR had significantly higher C-reactive protein (CRP) (p = <0.001),D-dimer (p=0.001), lactate dehydrogenase (LDH) (p = <0.001) and non-significantly Serum ferritin (p=0.188).AUC of CRP(AUC=0.832), LDH (AUC=0.809), D-Dimer (AUC=0.667) and serum ferritin(AUC=0.568).

Conclusion: Our findings suggest that levelsof Serum Ferritin as bad,D-DIMER as sufficient,CRPand LDH as very good biomarker to predict the results of the COVID-19 test. CRP and LDH can help in the detection of COVID-19 patients.

Survival and outcomes of tocilizumab use in severe and critically ill COVID-19 patients not responding to steroids Background

Sumit Bharti, Shiraz Mohammed, Deepak Bhasin

Max Superspeciality Hospital, Mohali, Punjab, India. E-mail: dr.sumitbharti@gmail.com

Background: Mortality and morbidity are highest in severe and critically ill patients with COVID -19 pneumonia. Recently corticosteroids have shown a definite mortality benefit in these patients. In this study we used interleukin-6 inhibitor, tocilizumab in patients who failed to show any clinical improvement after initial treatment with steroids.

Patients and Methods: This is a retrospective observational study in Severe and critical COVID 19 patients, who got admitted to intensive care unit and subsequently received tocilizumab were included. Patients who worsened clinically or had no change in oxygen requirement even after 24hrs of receiving Intravenous methylprednisolone at a dose of 1-2mg/kg/day had received tocilizumab (maximum total dose of 800mg) intravenously. All-cause mortality and progression to mechanical ventilation at day 28 were the primary outcome measures. Clinical improvement and oxygen requirements after tocilizumab administration along with trends in inflammatory markers were secondary outcome. Secondary infections rates and other drug related side effects were also noted.

Results: A total of 51 patients who did not show clinical improvement even after 24 hours of intravenous steroids and received tocilizumab were included. In these patients, there was a significant decrease in oxygen requirement by day 3 and clinical improvement by day 7 of tocilizumab administration. Among the inflammatory markers, we observed elevated median baseline values of CRP (114.2 mg/L) , IL-6 (55.4 pg/ml) and Neutrophil to Lymphocyte Ratio (12.4). Out of these only CRP showed a significant decrease after the drug administration. 13 (26.5%) of the 49 patients who were on non-invasive or conventional oxygen support progressed to mechanical ventilation. The day 28 all-cause mortality rate was 10/51(19.6%). 10(19.6%) of the 51 patients had life threatening infections, 1 patient had colonic perforation and 1 patient had transaminitis following tocilizumab administration.

Conclusion: Early and timely administration of tocilizumab is a viable option in selected severe and critical covid 19 patients who do not respond to initial steroids. When given along with steroids, incidence of life threatening infections seems to increase, hence a high suspicion of secondary infection should be kept.

Clinico-radiological profile of tuberculosis in post-covid patients

Vijayalakshmi, J. S. Akshata, B. P. Raghu, Swathi Karanth

Department of Pulmonary Medicine, SDS TRC and Rajiv Gandhi Institute of Chest Diseases, Bengaluru, Karnataka, India. Email-sharadhaurs@gmail.com

Background: Tuberculosis(TB) is one among the various respiratory pathologies affecting post-covid patients. We intend to describe clinico-radiological characteristics of tuberculosis in post-covid patients.

Methods: Retrospective descriptive study, conducted at SDS TRC and RGICD, Bengaluru from May 2020 to November 2021 with inclusion criteria of Tuberculosis with history of COVID in last 6 months. Clinico-radiological characteristics of them were retrieved from medical records section.

Results: 13 patients were included in our study. Male predominance (69%), with mean age of 50.7years noted. Patient with co-morbidity were 61.53%, majority were diabetics. 46% severe, 15%moderate covid cases received corticosteroids during covid illness and 38% were mild who didn’t receive corticosteroids. Mean duration of TB diagnosis after covid was 2 months. 5 patients were diagnosed as pulmonary tuberculosis with cough, fever, weight loss as presentation, 6 presented with air-leak in which 4 had hydropneumothorax, 2 had pneumothorax with dyspnea as presentation and 2 had pleural effusion. 69% of chest radiograph revealed cavity. Rest showed nodules, consolidation. Bandim-TB score was assigned. 4 were mild and rest 11 were of moderate to severe category. AFB Sputum smear / CBNAAT-positive in 85% cases. Among 2 pleural effusions, pleural fluid CBNAAT was positive in 1 and in other biochemical analysis was suggestive of tuberculosis. 15% were Rifampicin resistant TB. All except 1 were newly diagnosed tuberculosis. 2 patients succumbed to the disease and rest were discharged on appropriate anti-tubercular regimen.

Conclusion: Post-covid patients when presents with persistent or worsening respiratory symptoms, tuberculosis should be excluded especially in endemic countries like India.

Chest X-ray scoring systems as a tool in predicting severity of COVID -19 pneumonia

Inex ann joseph, K. V. V. Vijayakumar, J. V. Praveen, K. Preethi

Department of Pulmonary Medicine, Visakhapatnam, Andhra Pradesh, India. E-mail: inexannjoseph@gmail.com

Background: Even though very useful a routine of CT scan Is not feasible in a pandemic setting due to the large number of patients and lack resources. Therefore if we are able to use chest x-ray scores for assessing the severity of covid-19 pneumonia it could be very useful in taming the pandemic.

Methods: A Retrospective study was conducted using data from 118 confirmed cases of covid -19 pneumonia admitted to our hospital from march to august 2021.Chest x-ray of each patient was scored using RALE Score, BRIXIA score and modified chest x-ray score developed at Dr. Soetemo general hospital, Surabaya, Indonesia. These scores were compared with clinical severity of the desease.

Results: Among the 118 patients selected 65 (55%) were males and 53(45%) were females. All three scoring systems are significantly correlated with the clinical severity of the disease, with the strengths of correlation in order from the strongest to weakest as rale score (p< 0.01, correlation coefficient 0.865), brixia score (p< 0.01, correlation coefficient 0.852), and Dr. Soetomo General Hospital score (p< 0.01, correlation coefficient 0.804). All three scoring systems correlate significantly with each other. Dr. Soetomo General Hospital score correlates more towards Brixia score (p< 0.01, correlation coefficient 0.808) than RALE score (p< 0.01, correlation coefficient 0.836). Brixia to RALE score correlates with a coefficient of 0.857 (p< 0.01).

Conclusion: All the three chest x-ray scoring systems are equally useful for aassesing the severity of COVID-19 pneumonia.

Association between CT severity score and lung age in patients of COVID 19 pneumonia –a cross sectional hospital based study

Nikita Talaulikar, Sanjivani Keny, Afshan Ai Shaikh, Uday Chimno Kakodkar

Department of Respiratory Medicine, Goa Medical College, Bambolim Goa. E-mail: sailytalauliker@gmail.com

Background: Long term respiratory complications seems to be a major concern in patients treated for COVID 19 infection.

Objectives: To study the association between CT severity and lung age in patients treated for COVID 19 infection and to thereby study the impact of COVID 19 infection on pulmonary functions of patients.

Methodology: This cross sectional hospital based study was conducted on 147 patients in the Department of Pulmonary Medicine, Goa Medical College for 6 months. Patients confirmed to be COVID 19 positive by either molecular test or antigen test were subjected to 128 slice CT machine for assessing CT severity score at admission. Based on clinical and radiological parameters patients were called for follow up at 6 weeks for assessment of lung Age , FEV1 and FEV6 using a Vitalograph lung age monitor device

Results: Patients with severe CT severity score (CTSS) had a higher mean lung age (102.4) at follow up than patients with mild and moderate CTSS ,who had lung age of 48.3 and 87 respectively. Thus as CT severity progresses there will be an accelerated decline in lung function.

Conclusion: The Vitalograph lung Age monitor is a hand held device which is easily available OPD level/ bed side to assess the limitations of pulmonary functions/ extent of damage in suspected cases of post covid fibrosis .This method of assessment will avoid the unnecessary radiation exposure in our patients (in the form of follow up CT thorax) and ultimately help in better rehabilitation of patients.

A case series on bullous lung disease in post COVID patients

Aparna Suresh, G. N. Srivastava

Institute of Medical Sciences, BHU, Varanasi, Uttarpradesh, India. E-mail: aparnasuresh18@gmail.com

Introduction: After the aftermath of covid 19 we are left to learn and understand the multiple respiratory manifestations of post covid 19 sequele The presence of bullous lung disease in post covid patients is one such a rare entity ,has been infrequently reported, studied Eventhough the exact mechanism of formation of bullae in post covid 19 are unknown, an emerging association has been observed. .A bulla is an air containing space within the lung parenchyma that arises from destruction dilatation and confluence of airspaces distal to terminal bronchioles and is larger than 1 cm in diameter .Its wall are composed of attenuated and compressed parenchyma. Here in this case series we describe this unique presentation of bullous lung diseases in post covid 19 patients.

Case Series: Here wepresent a case series of 7 patients without any known comorbidities who were diagnosed with post covid bullous lung disease Diagnosis was made with the help of contrast enchanced computed tomography aided by other serological and microbilogical workup. Patient was managed conservatively antibiotics, analgesics and other supportive measures.

Learning Points: We are well aware of lung fibrosis post covid, our intention was to throw light into the new entity of bullous lung disease in post covid period. Bullous lung disease (with or without pneumothorax) should be part of differential diagnosis in a patient returning with chest pain and dyspnoea after SARS-Cov-2 infection. CT imaging essential to differentiate radiographically presumed complex pneumothoraces from large bullae to prevent erroneous chest drain insertion into a bulla.

Vanishing lung cysts- A rare post-COVID sequelae

S. Abinaya, A. Mahilmaran, A. Sundararajaperumal

Madras Medical College, Chennai, Tamil Nadu, India. E-mail: abi22vasan@yahoo.com

Background: Cavities and cystic lesions on chest CT, a rare presentation in COVID-19, can be caused by various causes including COVID-19 infection itself or secondary to other concurrent illnesses.

Case Study: A 37-year-old female with no comorbidities presented with complaints of fever and breathlessness for 1 week duration and tested RT-PCR positive for COVID-19, with bilateral peripheral ground-glass opacities with basal predominance in CT thorax. Repeat CT thorax after one month showed multiple cysts in bilateral lung fields with air-fluid levels. The patient was managed conservatively. Subsequently performed cross-sectional imaging of the chest shows a significant reduction in the size and thickness of the cysts with near complete resolution at 6 months.

Discussion: Cysts may complicate the course of COVID-19 disease. The alveolar epithelial cell damage caused by SARS-CoV2 together with the associated cytokine storm makes the alveoli prone to rupture with subsequent air leakage and formation of cystic lesions, the majority of which may resolve spontaneously over time.

Conclusion: This case emphasises the necessity of recognising cyst formation in COVID-19 pneumonitis and understanding that patient worsening may be caused by pneumothorax or pneumomediastinum.

To study outcome of hospitalized COVID patients with underlying respiratory illness

Bhumika Madhav, T. K. Jayalakshmi, Gokul Bhate, Dhanaji Revande

Department of Pulmonary Medicine, Apollo Hospitals Navi Mumbai, Maharashtra, India. E-mail: bhumikamadhav@yahoo.com

Background: It is feared that patients with pre-existing respiratory illnesses would get more serious covid-19 infection since it primarily affects the lungs. Aim was to study outcome of covid-19 patients with underlying respiratory illness and their requirement of ICU, oxygen requirement and recovery.

Methods: Retrospective analysis of 100 patients with prior respiratory illness affected by covid-19 in May 2020 to April 2021 was done.

Results: Among patients admitted with covid-19 illness, 38% required intensive care admission. 50 % of patients with ILD, 40 % with COPD and Tuberculosis, 38% with OSA and 28% with bronchial asthma required intensive care admission. Maximum oxygen requirement was in the ILD subgroup 80% followed by COPD 45% and asthma 45%. Mortality was higher in males. Mortality in respiratory group was 12% compared to 7.5% in non-respiratory group. Total death among patients with bronchial asthma, COPD and ILD was 38%, 8 % and 8% respectively. Higher oxygen utilization, ICU requirement and death were seen in ILD subgroup. All 3 patients with neoplasm expired. Maximum deaths occurred in the first 2 weeks after admission, 75% of them had comorbidities. 67% of deaths occurred in 61-80 age group. Total cases admitted during this period was 4216 death rate was 7.2% in whole group and 12% in respiratory illness group

Conclusion: It was found that around 40% of patients with pre-existing respiratory illness required ICU admission. They had high incidence of oxygen requirement, non-invasive ventilation, and mechanical ventilation. The death rate was higher in these subgroup of patients.

Factors affecting mortality after surgery for COVID-19 related empyema

Sukhram Bishnoi, Mohan Venkatesh Pulle, Harsh Vardhan Puri, Belal Bin Asaf, Arvind Kumar

Institute of Chest Surgery, Medanta – The Medicity, Gurguram, Haryana, India. E-mail: dr_sukhs5@yahoo.com

Introduction: Crores of people worldwide have been afflicted with Covid 19 since the pandemic started in 2019. Pleural Empyema in Covid 19 patients is a challenging problem and requires a multidisciplinary approach for adequate management. There are very few published studies in the literature that evaluated this issue. In this study, we aim to report the surgical outcomes of post covid pleural empyema and to analyse factors predicting mortality.

Methods: This study is a retrospective analysis of prospectively maintained data of cases of post covid empyema operated between May 20 to November 2021. A total of 37 patients were included for analysis. The demographic characteristics along with intra and post-operative variables were recorded including post-operative complications. Mortality was the primary outcome measure.

Results: A total of 37 patients aged 22-68 years underwent surgery for Pleural Empyema during the study period. All patients underwent VATS decortication. There were 32 males and 5 females. The mean operative time was 284 minutes with the mean intraoperative blood loss of 522 ml. Average chest tube removal time was 9.5 days with an average hospital stay of 8.2 days. No recurrence was noted in any of the patients. Postoperative mortality 8.1% and morbidity was observed in 13.51% of patients.

Conclusion: Post covid pneumothorax can be safely and effectively managed in selected patient with failed conservative management. The timing of the surgical intervention, requirement of ventilatory support and high oxygen requirement (>5 lit) were found to factors that significantly affect the mortality.

Neutrophil to albumin ratio VS Neutrophil lymphocyte ratio as a marker of disease severity and outcome in moderate to severe COVID 19 infection

Abhishek Udaykumar, B. Archana, Kolla Vinod, Ponnathota Vindhya

Department of Pulmonary Medicine. E-mail: drabhishekudaykumar@gmail.com

Introduction: COVID-19 disease has spread worldwide from December 2019. The early stage of this disease can be associated with elevated levels of circulating biomarkers that can represent inflammation and immune status are potential predictors for the prognosis of COVID-19 patients.

Aim: 1. To compare NAR (Neutrophil Albumin Ratio) and NLR (Neutrophil Lymphocyte Ratio) as marker of disease severity and outcome in COVID 19 infection.

Methodology: Present study is a prospective Observational study carried out on 150 RTPCR confirmed Covid 19 positive moderate to severe category patients admitted in Rajarajeswari Medical College and Hospital during period May- July 2021. Detailed history and physical examination was done. Complete blood count, neutrophil count, lymphocyte count and serum albumin were recorded. NAR and NLR was correlated with severity of the disease. The outcome of each patient (Recovery/Death) was correlated with the NAR and NLR.

Results and discussion: Serum Albumin (p=0.012) was significantly associated with severity. Vaccination status co related well with outcome and was statistically significant (p=0.03) NLR (p=<0.005) was found to be statistically significant and was better predictor of mortality than NAR overall. NAR (p=0.0001) was found to be statistically significant in predicting mortality of severe patients. The AUC was highest for NLR (0.634) was able to predict mortality with sensitivity and specificity of 77.78% and 48.28% respectively with cutoff at >5.32 whereas NAR (AUC 0.548)showed sensitivity and specificity of 68.25% and 43.68% respectively with cutoff at >1940.74.

Comparison of Covid SeveriTy score PReDiCTOR 50 and CURB 65 in prognostic assessment of patients with COVID 19 illness

Manjari, Archana, Vivek, Parinita

Department of Pulmonary Medicine, Rajarajeshwari Medical College and Hospital, Kambipura, Karnataka, India. E-mail: manjarirajagopalan@yahoo.com

Background: The greatest difficulty during the COVID pandemic was in effective triaging of patients. A new scoring system was developed by our center in order to provide a holistic assessment of the illness including systemic manifestations. This study was to evaluate the effectiveness of the scoring system in comparison to CURB 65, the most commonly used screening tool for prognostic assessment of pneumonia.

Aim: To compare CURB 65 and Covid Severity Score Predictor 50 in measuring prognosis in patients with COVID 19 illness

Methods: 150 Patients with COVID 19 illness were enrolled . The COVID severity score PReDiCTOR 50 was designed in our set up during the pandemic to assess prognosis of disease. This is retrospective analysis to compare the efficacy of the predictor against CURB 65 in assessing prognosis of COVID 19 illness using receiver operator characteristic curves and associated area under the curve. \

Results: We studied 150 patients with COVID 19 illness. 35 died and 103 were discharged. The ability to predict ICU admission was higher for our scoring system (AUC 0.875 ) as compared to CURB 65 ( AUC 0.83).

Conclusion: The Covid SeveriTy Score PReDiCTOR 50 was found to be more effective in prognostic assessment of COVID 19 illness in comparison to CURB 65, indicating the importance of holistic assessment of COVID.

Pulmonary complications among discharged Covid-19 patients- A prospective study

Akshaya Anil Kumar, Suhail, Dhwani, Unais

Department of Respiratory Medicine, MES Medical College, Angadipuram, Kerala, India, KUHS, Thrissur, Kerala, India, TCMC, Thiruvananthapuram, Kerala, India. E-mail: akshayaanil94@gmail.com

Background: There is a need for a unified pathway & structure for the respiratory follow-up of patients with COVID-19 pneumonia.

Introduction: The long- term complications of COVID-19 pneumonia-Pulmonary Fibrosis, Pulmonary vascular disease, Bronchial Hyper-reactivity, Pleural effusion are real.

Aims and Objectives:

• 1. To estimate the prevalence of post covid-19 pulmonary complications

• 2. To study the risk factors& long-term outcome of post covid pulmonary fibrosis.

Methods: Prospective study; Study Period: November 2020-January 2021; All patients with history of COVID-19 attending post covid clinic of MES Medical College during the study period.

RESULTS

• • Out of the 300 patients studied,most common outcome was post covid pulmonary fibrosis- 10.7%; followed by death 9%, Pleural effusion (2%), Bronchial hyper-reactivity (1.3%), Pulmonary embolism (.3%), Anosmia (.3%), Pneumothorax (.3%) and Organizing Pneumonia (.3%)

• • Follow up study of patients with post covid pulmonary fibrosis, showed clearance in serial chest-xray.

Conclusion: Most of the complications were seen among Cat-C patients, the most common being post covid pulmonary fibrosis which showed a serial decrement in the chest-xray scores suggesting favourable outcome.

Study of comparison between presence of dysnatremia and severity of COVID 19

K. R. Santosh Kumari, N. Huliraj, M. K. Raghavendra, R. Deepak Kumar

Department of Respiratory Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. E-mail: santoshi.hunny@gmail.com

Background: Patients with Coronavirus disease 2019 (COVID-19), caused by SARS-COV2 infection, can develop a potentially fatal rapid-onset pneumonia. In fact, mortality in patients hospitalized with COVID-19 can be as high as 20.3–27.9%.This study aimed to determine whether hyponatremia and hypernatremia are associated with a poor prognosis in patients admitted with COVID-19.

Methods: Retrospective study conducted in Department of Respiratory Medicine, KIMS hospital and Research center, Bangalore , with a sample size of 1000 COVID 19 patients.

Results: According to the above study, dysnatremia was found more in Category-C COVID19 patients, than cat A and Cat B, with 48.1% of patients in Cat C having dysnatremia, 29.9 % of Cat B and 24.3%of Cat C. In dysnatremia, hyponatremia was found was predominant among patients of Cat C COVID 19.

Conclusion: Patients admitted with COVID 19, have risk of dysnatremia with increasing severity of the disease and it has significant impact on the morbidity and outcome of the patients.

Study on characterization of post covid symptoms and duration

K. R. Santhosh Kumari, N. Huliraj, M. K. Raghavendra, R. Deepak Kumar

Department of Respiratory Medicine, Kempegowda Institute of Medical Sciences, Bengaluru, Karnataka, India. E-mail: santoshi.hunny@gmail.com

Background: Post COVID-19 symptoms and diseases appeared on many survivors from COVID-19 which are similar to that of the post-severe acute respiratory syndrome (SARS) fatigue. Hence, the study aims to investigate and characterize the manifestations which appear after eradication of the coronavirus infection and its relation to disease severity.

Methods: About 428 COVID 19 survivors were included in the study, they were questioned and data was collected regarding their post covid manifestations and presence of any comorbidities.

Results: Amongst the 428 patients 15% of them had post COVID symptoms and fatigue and cough were predominantly seen.

Conclusion: All subjects recovered from COVID-19 should undergo long-term monitoring for evaluation and treatment of symptoms and conditions that might be precipitated with the new coronavirus infection.

Study of COVID 19 infection in post vaccinated patients in a dedicated COVID care center

Kapa Pavan Kumar, Gogineni Sujatha, V. M. Kiran Ogirala

Department of Respiratory Medicine, Dr. Pinnamaneni siddhartha Institute of Medical Sciences and Research Foundation, Dr. NTR University of Health sciences, Vijayawada, Andhra Pradesh, India. E-mail: pavankumarkapa@gmail.com

Background: COVID-19 vaccines shows good efficacy in the course of COVID19 pandemic, but some people still become infected with SARS-CoV-2 even after vaccination. The present study is to identify the disease progression in SARS –CoV2 infection among post-vaccinated patients with first and second dose of vaccinations.

Methods: This is a retrospective observational study of 108 vaccinated, hospitalized confirmed covid-19 patients at tertiary care hospital from July,2021 to August,2021. Patients data in terms of vaccine status, type of vaccine, duration from last dose, inflammatory markers , co-morbidities, severity of illness are collected and analyzed.

Result: Total 500 patients of which 21% (108) got vaccinated. 68% (74) patients received single dose of vaccination and remaining 32% (34) patients completed two doses. 74% (80) patients were diagnosed through RAT/RTPCR and 26% (28) patients based on HRCT-Chest. 59% (64) patients had co-morbidities of which 65% (42) patients taken single dose and 35% (22) patients completed two doses. 35% (38) patients required O2 support, out of which 73% (28) has taken single dose and 27% (10) completed two doses. Average duration of hospital stay is 7 days in non oxygen dependent patients, 13 days in O2 / NIV support patients. Total 8%(8)deaths were reported of which 50%(4) received single dose of vaccination and 50%(4)completed two doses.

Conclusion: In vaccinated patients disease severity is mild. In patients with co-morbidities who received single dose, requirement of O2/NIV was more when compared to patients who received both doses. Mortality is seen in patients with co-morbidities, even with complete vaccination.

Study on Postcovid pulmonary complications in patients attending tertiary care centre

Sura Renu Sri, Renu Sri Sura, Prem Kumar Allena, B. Madhusudhana Patrudu, Praveena

Department of Respiratory Medicine, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India. E-mail: 127renu@gmail.com

Background: SARS-COV-2 has caused morbidity and mortality at an unprecedented scale globally. During recovery, several patients are found to have functional impairment and radiological abnormalities.

Case Study: An observational study done on 54 post-covid patients attending our center during July to November. A detailed history, radiology and clinical data during acute and post-covid visit were analyzed.

Aims: To document various post-covid complications, assessing risk factors for complications

Discussion: Mean age group of presentation 49.2years, mean time of follow-up presentation is 66.4 days. Incidence is higher in males (64.8%) than females (35%),83.3% are having one or more existing comorbidities during acute covid mainly diabetes 61%, hypertension 38%, Both in 25%, copdin 7.4%, tuberculosis in 3.7%, HIV in 1.85 %. About 79.6% had more than 3 weeks of hospital stay,46.2% are on NIV support during acute covid. Majority of post-covid patients came with dyspnea -75.9%, cough -74%, fatigue -31.4%, productive cough -14%, fever -9%, chest pain -7%. Resting hypoxia is seen in 29.6% of patients. Of post-covid patients,88% presented with pulmonary fibrosis,12.9% with pnemothorax,12.9%with lung cavity,3.6%with necrotizing pneumonia and 1.8%with lung abscess. Both pneumothorax and fibrosis are seen in 9.25%, both cavity and fibrosis in 5.5%. post-covid pulmonary cavities (7) were due to tuberculosis, klebsiella, pseudomonas, E. coli, fungal itology.Comparativelyradiological improvement is seen in 86% of the patients

Conclusion: Diabetes,nonvaccinating, severe covid at admission, mechanical ventilation, older age contributes to severe post-covid complications.Regularfollow up,rehabilitation therapy, screening for tuberculosis is to be considered.

Hematological and biochemical changes associated with COVID 19

S. Chinchu¹, N. Suhail¹, Sadakathulla Unais², Dhwani Gopinath²

¹Department of Pulmonary Medicine, MES Medical College, Angadipuram, Kerala, India, ²MES Medical College, Angadipuram, Kerala, India. E-mail: chinchunrd44@gmail.com

Introduction: Severe acute respiratory syndrome coronavirus causing coronavirus disease 2019 has rapidly evolved from an epidemic outbreak in Wuhan, China, into a pandemic affecting more than 1 million individuals worldwide. It is associated with leucopenia , thrombocytopenia, deranged LFT and elevated inflammatory markers including CRP , D-DIMER , LDH and ferritin

Aims and Objectives:

• 1. To find the proportion of hematopoietic and biochemical changes in category A, B, C patients

• 2. To find the proportion of inflammatory markers elevated in category C patients.

Methods: A cross sectional study among 500 COVID 19 patients who were diagnosed with RT PCR admitted in MES medical college hospital. Routine investigations along with inflammatory markers are analysed.

Results: In the hemogram, 38 % had leukocytosis , 8 % had leucopenia, 7 % had thrombocytopenia , 85% had elevated CRP, 61 % had elevated D- dimer, 37 % had elevated Ferritin and 24 % had elevated LDH.

Conclusion: Analyzing the inflammato.y markers, hematological and biochemical derangements, and how they correlate with disease severity.

Tracheoesophageal fistula: A rare complication after tracheostomy in Covid-19

Meenakshi Bhakare¹, Ashwini Handal², Anuradha Kelkar³, Dhanjay Sanjekar⁴

¹Department of Respiratory Medicine, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed Univeristy), Pune, Maharashtra, India, ²Department of ENT, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed Univeristy), Pune, Maharashtra, India, ³Department of Radiology, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed Univeristy), Pune, Maharashtra, India, ⁴Department of Anesthesia, Symbiosis Medical College for Women, Symbiosis University Hospitals and Research Centre, Symbiosis (Deemed Univeristy), Pune, Maharashtra, India. E-mail: hod.respiratorymedicine@smcw.siu.edu.in

Background: Tracheoesophageal fistula (TEF) is a rare condition that can be congenital or acquired. Patients of COVID-19 remain intubated for prolonged periods that can give rise to a multitude of complications. We came across a case where patient develop TEF after 7 days of tracheostomy.

Case Study: 34 years female admitted with Covid pneumonia. Patient required ICU care for respiratory distress, required intubation. Patient was treated with standard treatment and kept on controlled ventilation. Patient underwent tracheostomy on day 12 of intubation. On day 17 of patient had an episode of sudden severe respiratory distress, desaturation, hypotension tachycardia not generating tidal volumes and rising peak pressures on ventilator. Patient developed bilateral tension pneumothorax immediately bilateral intercostal drainage tubes insertion done and patient settled. On day 19 patient had persistent cough with RT feeds coming through tracheostomy tube and site. Suspecting TEF CT neck with thorax was done. A rent is seen in the tracheal and esophageal walls close to the bulb of tracheostomy tube. with a TEF. Long tracheostomy tube was inserted as conservative management.

Discussion: COVID-19 patients with severe pneumonia may require and remain on prolonged mechanical ventilation. The sudden deterioration of respiratory status, gastric distension and food particles in intubated tube are suspicious to TEF.

Conclusion: Early tracheostomy can prevent some complications of prolonged intubation. If a patient develops sudden desaturation, gastric distension and food particles in tracheostomy tube then TEF should always be in the differential diagnosis.

Characterization of post covid-19 clinical manifestations among patients visiting a post COVID clinic in a tertiary care center – A descriptive study

Sivaselvi Chellamuthu, Manju Rajaram, Vishnukath Govindharaj, Jayalakshmi

Department of Pulmonary Medicine, JIPMER, Puducherry, India. E-mail: sivaselvisaran33@gmail.com

Background: On 21 December 2019, a pneumonia-like outbreak of an unknown cause was found to be emerging in Wuhan, China. The Clinical presentations of COVID 19 infection may vary from asymptomatic to multiorgan failure. Most of the infected people have recovered from the disease, this recovery could be confirmed by negative RTPCR or absence of symptoms for several days. But some patients have been found to have symptoms at post discharge follow-up.

Methods: A descriptive study was started on August 2021 at a tertiary care hospital after institutional ethics committee clearance. All patients who tested positive for COVID-19(RTPCR or Rapid antigen test (RAT) diagnosed or radiographically diagnosed COVID-19(CORADS 5) attending post COVID clinic were recruited. The proportion of people developing post COVID 19 manifestations, and categorization of symptoms in post COVID 19 and the differences in post COVID symptoms between hospitalized and non-hospitalized patients was studied.

Results: We enrolled 227 Post COVID patients who has come for post COVID clinic, with a mean age of 48 years (48 ± 2.2, and a male to female ratio of 126/101(1.24). Among 227 patients, 164(72%) had exertional dyspnea, 109(48%) had cough with expectoration,96(42.2%) with fatigue,28(12.33%) had myalgia,18(7.92) had fever, and 42(18%) had others. Among 227, 142(62.5%) patients were admitted in hospital for acute COVID 19 and 85(37.4) patients were in home isolation.

Conclusion: From this descriptive study high prevalence of post COVID symptoms noted like post SARS-syndrome. Mostly Researchers and clinicians have focused on the acute COVID 19, but long-term follow-up with multidisciplinary evaluation and treatment needed in all patients who recovered from acute COVID 19.

Assessing the sleep and psychological problems due to the COVID-19 pandemic among Healthcare Workers of Employees State Insurance Corporation in India

Ramesh Singh Pal¹, Ram Babu Sah¹, Tanishk Pal², Vrijesh Tripathi³

¹Department ofPulmonary Medicine, ESIPGI MSR Basai Darapur New Delhi, India. ²Sri Devraj Urs Medical College, Kolar, Karnataka, India., ³Department of Mathematics and Statistics, Faculty of Sciences and Technology, The University of the West Indies, St. Augustine, Trinidad and Tobago. E-mail: drrameshspal@gmail.com

Background: The COVID-19 pandemic has inflated the risks faced by healthcare workersand may increase their susceptibility to sleep and psychological problems. This cross-sectional observational study assessed the sleep and psychological problems due to the COVID-19 pandemic among healthcare workers of Employees State Insurance Corporation, an organized sector under the Ministry of Labour and Employment, India.

Method: Logistic regression was used to evaluate factors associated with symptoms of anxiety, depression, insomnia and perceived stress among 492 healthcare workers in Employees State Insurance Corporation hospitals and dispensaries in Delhi and the National Capital Territory Region, India.

Results: Logistic regression determined that factors of workplace type and frequency of hand washing were associated with anxiety; workplace type, job profile, occupation, formal COVID-19 training and adequate personal protective equipment were predictors of perceived stress; job profile was a common predictor of depression and insomnia; workplace type and formal COVID-19 training were associated with depression and insomnia, respectively.

Limitations: This study was limited to healthcare workers in Employees State Insurance Corporation of Delhi and NCR which limits its generalizability to other regions of India.

Conclusions: Healthcare workers are exposed to increased risk in the execution of their duties and require support to secure their wellbeing. Policies, systems for early detection of sleep and psychological problems, training, preparedness and efficacy in crisis management are suggested to reduce and prevent the occurrence of these problems among HCWs.

Dengue- COVID 19 co-infection: An uphill battle

Ankur Gupta, Kranti Garg, Vishal Chopra, Rahul Suri

Department of Pulmonary Medicine, GMC, Patiala, Punjab, India. E-mail: saikapankur@gmail.com

Background: COVID-19 and dengue infection both are caused by single-stranded RNA viruses of the families’ coronaviridae and flaviviridae respectively. Both diseases share various clinical and laboratory parameters, making them difficult to distinguish from one another. In these times of covid-19 where dengue is already a public health concern, this co-infection poses great threat to already burdened healthcare system.

Case Study: So, here we report a case of 76 year old male with complaints of high grade fever and dyspnea for 2 days diagnosed with COVID-19 who was simultaneously diagnosed with dengue infection and later died of ARDS and sepsis delineating the rarity and severity of this co-infection.

Discussion: In the tropical counties, there is an emerging threat of dengue-covid co-infection. They have overlapping clinical presentations, also share several laboratory parameters like elevated liver enzymes, leukopenia and thrombocytopenia. Aggressive fluid resuscitation has a key role in dengue which may worsen oxygenation in COVID-19 patients. Also, the use of LMWH in COVID-19 settings can have a devastating effect in the setting of thrombocytopenia in case of dual infection.

Conclusion: As we wait for more data, it is emphasized the need for early detection of the dual infection by testing all covid 19 patients for dengue in endemic areas as the disease can be more severe or one pathology can be misdiagnosed for the other.

Correlation of CRP and d-dimer levels in critical ill patients of COVID 19 disease during first and second wave of COVID 19 pandemic in tertiary care hospital of North India

Aarti Mishra¹, Abhishek Srivastava¹

¹Mayo Institute of Medical Sciences, Barabanki, Uttar Pradesh, India, E-mail: mishraaarti2222@gamil.com

Introduction: Many countries have seen a two-wave pattern in reported cases of coronavirus disease-19 during the 2020 pandemic and the dynamic changes of D-dimer and Hs-CRP levels during disease progression to evaluate their value for thrombo-embolic events and severity of disease during wave I and wave II of COVID 19 disease in critically ill patients became significant.

Methods: In this study using data from two equal periods of 5 months, the first wave, between 20th July to 30th Nov and the second, between March to 30th July, characteristics are compared of hospitalised patients in Intensive Care Unit.

Results: In this study, we reported 50 confirmed COVID 19 disease patients from wave I and wave II respectively. Patients in the second wave were younger and the duration of hospitalization and case fatality rate were higher than those in the first wave. These results might help to understand the characteristics of the second wave and the behaviour and danger of SARS-CoV-2 with the risk of thrombosis and bleeding.

Conclusion: The second wave was more severe and yet more data required to study seasonal trend and severity of different COVID-19 strain.

Post COVID 19 fungal lung infections: Experience from a tertiary care Institute

Priya Sharma, Manohar Kumar, Vatsal Bhushan Gupta, Gaurav Kumar, Saurabh Karmakar

All India Institute of Medical Sciences, Patna, Bihar, India. E-mail: priyasharma26292@gmail.com

Background: COVID-19 and its treatment with corticosteroids and immunosuppressive therapy, mechanical ventilation, contaminated oxygen humidifier systems, prolonged hospital stay and uncontrolled diabetes mellitus increase the risk of fungal infections.

Methodology: Inclusion criteria were patients with (i) recovery from moderate to severe COVID 19 & (ii) new onset cavitary lung lesions. Exclusion criteria were rhino orbito cerebral mucormycosis (ROCM).

Results: Of all the 44 patients, (40, 90.9%) were males and never smoker (32, 72.7%). Mean age was 59.7 years. Co-morbidities were DM (20, 45.4%) with HbA1c>5.4% in 16 (36.3%) and HTN (16, 36.3%). Mean ESR was 81.5 mm/1 hr & CRP was 112 mg/L. 22 (50%) underwent mechanical ventilation. Presenting symptoms were fever (34, 77.27%) and hemoptysis (28, 63.6%). Mean d-dimer was 1.93 g/dL. Sputum yielded growth on fungal smear culture in 8 (18.18%). BAL galactomannan was raised in 26(59.1%) patients. 30 (68.2%) had cavitatory lesion in right lung with upper lobe involvement in (16, 53.3%). 36 (81.8%) patients underwent FOB. Most common endobronchial appearance was thick whitish mucoid secretions. 2 (4.5%) had endobronchial mass adherent to bronchial wall.BAL fungal culture yielded growth in 18(40.9%). TBLB yielded abnormal histopathology on 8(18.8%) patients. BAL showed mucormycosis in 14 (31.8%), MTB detected by CBNAAT in 8 (18.8%), aspergillosis in 8(18.8%) and candidiasis in 2(4.5%). During antifungal treatment, 12 (27.2%) died.

Conclusion: After excluding ROCM, pulmonary mucormycosis followed by aspergillosis were the common fungal lung infections, in patients presenting to Pulmonary Medicine department of a tertiary care centre after recovery from COVID 19.

Case series on post COVID pneumothorax

Divyanjali, Sravan Kumar, Phani Kumar

Kakatiya Medical College, Warangal, Telangana, India. E-mail: divyanjalidepu@gmail.com

Introduction: Spontaneous pneumothorax can be post covid complication.

Case 1: A 27yr male came with complaints of sudden onset of shortness of breath since 2days.patient had history of hospitalization due to moderate covid one month back. Patient no past history of hypertension,diabetes , Tuberculosis. No history of smoking. On physical examination-absent breath sounds on right hemithorax, oxygen saturation was 86% room air . HRCT chest showing pneumothorax with pulmonary fibrotic opacities(post covid fibrosis).Chest tube was placed in 5^th intercostal space ,patient improved.

Case2: A 56yr male old male came with complaints of SOB -5days , Patient had history of covid -2months back and was under home quarantine. No past history of Tuberculosis, hypertension, diabetes. HRCT chest showing right pneumothorax with pulmonary fibrotic opacities. Chest tube was inserted in 5^th intercostal space. And patient improved.

Case 3: A28yr old male came with complaints of sudden onset SOB, chest pain -3 days . patient had history of hospitalizated for 1week for moderate covid -19 10days back.Patient had no history of smoking , tuberculosis.HRCT chest showing bilateral pneumothorax and pneumomediastinum with bilateral parenchymal fibrotic opacities. Bilateral chest tube was inserted.

Conclusion: The present case demonstrates that fibrotic-like lung opacities and spontaneous pneumothorax can be seen as of late complications of COVID-19. Both these complications should be kept in mind in patients with previous COVID-19 infection who present with abrupt onset of shortness of breath

Correlation of CT severity score with percentage desaturation and 6 minute walk distance in COVID-19 survivors

S. Vishnu Kumar, K. N. Mohan Rao, Dharitri Thakkar, N. Kiran

Department of Pulmonary Medicine, Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, Karnataka, India. E-mail: drvk96@gmail.com

Background: The impact of the severity of the COVID-19 on potential long-term consequences is currently not well documented. With a 6-minute walk test, we followed up on 30 patients who were COVID 19 survivors with varied CT-Severity scores. The aim was to correlate the CT-Severity score with 6 minute walk distance and percentage desaturation.

Methods: Data of post COVID-19 patients who presented to our hospital from January to June 2021 were collected. Patients who had undergone a HRCT scan during their admission time were chosen and followed up with 6 minute walk test and data was analyzed.

Results: In the 30 patients, whose data was analyzed, 19 were male and 11 were female. Of the 30 patients whose reports were analyzed, 15 (50%) had CT-Severity score between 6-14 (moderate). Only 10 (33.3%) patients had CT-Severity score more than 15 (severe) and of them only 3 had desaturation more than 10% on 6MWT. While only 3 patients had desaturation between 5-10%, majority of the patients (24/30) had less than 5% desaturation on 6MWT. More than half the patients (17/30; 56.7%) walked more than 350 metres in 6 minutes, while 11 patients walked between 150-350 metres and only 2 patients walked less than 150 metres.

Conclusion: In COVID-19 survivors, we conclude that CT-Severity has minimal effect on exercise tolerance.

Post COVID Cavitatory Lung Lesions: Individualised Approach

Vishnu Gireesh, Mahavir M. Modi

Department of Chest Medicine, Ruby Hall Clinic, Pune, Maharashtra, India E-mail: vishnugireeshambika@gmail.com

Background: A patient presenting with cavitatory lung lesions offers a variety of differential diagnosis to the treating chest physician. It varies from acute and chronic infections, systemic illnesses and malignancy.[¹] Arriving at a proper diagnosis and proceeding to next step of management is very challenging.

Case Study:

Case 1: 27 male, day 10 of COVID-19 infection, presented with hemoptysis. HRCT Thorax showed bilateral cavitatory lung lesions. Serum Aspergillus IgM and sputum Galactomannan positive. He was started on Injectable liposomal Amphotericin-B. Patient improved.

Case 2: 48 male, post COVID, presented with breathlessness and headache. He was diagnosed with Right maxillary mucormycosis. HRCT Thorax showed right lung cavitatory lesion. Started on Injectable liposomal Amphotericin-B. The patient underwent Right side Bilobectomy as there was no improvement. Antifungal medications continued and patient improved.

Case 3: 42 year old male, post COVID, presented with headache and fever and diagnosed as left maxillary mucormycosis. Chest X-ray showed right side cavitatory lung lesion. Started on liposomal Amphotericin-B and Posaconazole. Patient was inoperable as he developed bilateral pneumothorax, for which left sided ICD inserted. Patient improved with antifungal therapy.

Discussion: Case 2 required surgical intervention, while case 1 and case 3 improved with medical management. A multidisciplinary team was involved in the management. Early diagnosis is the cornerstone for management.

Conclusion: Each patient of post COVID cavitatory lung lesion should be assessed properly and to be treated by individualised approach rather than a generalised approach. Newer antifungals and combination antifungals should be further explored along with surgical management.

Reference

• 1. Parkar AP, Kandiah P. Differential diagnosis of cavitary lung lesions. J Belg Soc Radiol 2016;100:100.

Cytomegalovirus pneumonia in patients with severe covid-19 disease

Mriganka Juneja, Prashant Saxena, Nandani Gulati

Department of Pulmonology and Sleep Medicine, Max Smart Super Speciality Hospital, Saket, New Delhi, India. E-mail: drmrigankajuneja@gmail.com

Background: 70–90 % of the adult population carries latent cytomegalovirus (CMV), which may be reactivated by inflammation and immune suppression. CMV reactivation has been seen in up to one-third of critically ill patients, and is associated with worse clinical outcomes. Here, the authors present two challenging cases, wherein the management of severe COVID-19 disease was complicated by CMV pneumonia.

Case Reports: Our patients presented with severe COVID-19 pneumonia with acute respiratory distress syndrome and were admitted in the intensive care unit (ICU). The patients received immunosuppressive therapy, either tocilizumab or methylprednisolone pulse therapy. Both the patients had a prolonged hospital stay, and showed an initial improvement followed by clinical deterioration, with recurrence of fever, worsening respiratory failure, and development of consolidations on CT thorax. A thorough work up for opportunistic infections revealed CMV infection. Both patients were treated with intravenous Ganciclovir and showed marked improvement.

Discussion: The use of steroids and other immunomodulatory therapies in the treatment of severe COVID-19 disease, along with immune suppression caused by severe COVID-19 itself, predisposes patients to reactivation of CMV. Furthermore, CMV reactivation is associated with a longer ICU length of stay, prolonged mechanical ventilation, increased risk of secondary infections, and mortality.

Conclusion: These cases highlight the importance of considering CMV disease as a differential diagnosis in critically ill patients with COVID-19 with unexplained worsening, especially in the setting of immunomodulatory therapies, as early treatment may prevent adverse clinical outcomes and mortality.

Severe progressive fibrosing interstitial lung disease post COVID 19 infection

Anitha S. Menon, N. Nalini Jayanthi, S. Subramanian

Department of Respiratory Medicine, SRM Medical College Hospital and Research Centre, Kanchipuram, Tamil Nadu, India. E-mail: dranithamenon10@gmail.com

Background: Majority of COVID 19 patients that are hospitalized are with respiratory illness including pneumonia and ARDS.The acute manifestations of COVID 19 has been well documented however long-term sequelae from acute COVID 19 remain speculative. Chronic lung disease including IPF is a risk factor for poorer prognosis in COVID 19 infection.

Case Study: A 52-year-old male patient presented to emergency department with history of dyspnea on and off for past 6 months increased over last two days, cough with expectoration for past 2 months. Eight months back he was treated for COVID 19 pneumonia with dexamethasone and maximal oxygen requirement of 2L via nasal cannula. CT chest showed diffuse GGO’s in bilateral upper and lower lobes with CT severity score of 20/25. Patient was discharged with no oxygen requirement with saturation of 96% on room air. On arrival to the hospital, patient was tachypneic and in type 1 respiratory failure, requiring 10L of oxygen. CT chest showed honeycombing with consolidation and traction bronchiectasis.

Discussion: Advanced fibrosis and poor lung function are associated with severe disease and poorer prognosis in COVID 19 infection. CD 209L receptors has been implied in the pathogenesis of progressive ILD in COVID 19 infection.

Conclusion: Early detection of potential cases of post-COVID 19 pulmonary fibrosis may give a chance to prevent or at least modify such disabling complication.

COVID-19 coagulopathy related gangrene

Rahul Mittal, N. Nalini Jayanthi, Subramanian Suriyan

Department of Respiratory Medicine SRM Medical College Hospital and Research Centre, , Kancheepuram, Chennai, Tamil Nadu, India. E-mail: drrahul5964@gmail.com

Background: SARS -COV-2 has presented with varied symptoms and a number of factors determine clinical outcome. While hypoxemic respiratory failure remains main cause of morbidity and mortality, a hyper-inflammatory state induced endothelial injury and hypercoagulability leading to thromboembolism also is a leading cause of mortality.

Case Sudy: A 60-year-old diabetic, hypertensive, non- smoker, male presented with complaints of cough, fever and breathlessness since 3 days. Patient presented with tachypnea and maintaining saturation of 85% on room air, CT severity score was 13/25. Patient was treated in ICU with Non-invasive ventilation, prophylactic Enoxaparin, Remdesivir and steroids. Patient’s respiratory status was deteriorating and was intubated, kept on mechanical ventilator and later tracheostomy was done. During the course of illness patient developed pain over right foot which progressed to gangrene and ischemia over left foot .CT- Aortogram done showed complete occlusion of infra-renal abdominal aorta.

Discussion: Patient developed progressive elevation of D-dimer even after thromboprophylaxis with enoxaparin. However gangrene progression was irreversible once set in, even though patient was switched over to high dose anticoagulants, with antiplatelet along with Phosphodiesterase inhibitor, implying that high degree of coagulation cascade disruption is potentially irreversible.

Conclusion: To start increased dose of initial thromboprophylaxis in patient with high CT severity.

Utility of cat score for assessment of post covid-19 patients in our tertiary care centre

Piyali Sarkar, Rajesh Agrawal

Department of Respiratory Medicine, Rohilkhand Medical College and Hospital, Bareilly, Uttar Pradesh, India. E-mail:drpiyalisarkar.monty@gmail.com

Background: With increasing number of patients recovered, significant detrimental long-term effects of post-COVID-19 infection has been recognized.CAT score in COPD is a great tool to assess symptoms severity, same may be used in post COVID patients.

Objective: 1.Assess the use of CAT scores in post COVID-19 patients.2.Use CAT score as a predictor of long term effects.

Methods: An observational study conducted between October 2020-November 2021. RT-PCR/TruNAT COVID-19 positive post COVID patients were included,their symptoms severity were evaluated based on CAT score. Patients with high CAT score were evaluated for long term effects.

Results: Out of 89 patients, 50 (56%) were male,39 (44%) were female. 66(74.15%) smokers, 15(16.8%) non-smokers. 51 (57.3%) were COPD, 31(34.83%) Asthma, 62 (69.7%) Diabetic, 45(50.5%) Hypertensive patients. On 1 month follow-up, >30 CAT score in 11(12.3%), 33 (37%) had CAT score 21-30, 27(30.33%) CAT score 10-20, 18(20.22%) CAT <10.3months, CAT >30 in 5 (5.6%), CAT 21-30 in 19(21.3%), CAT 10-20 in 22 (24.7%), <10 CAT was in 43 (48.3%).6 months, CAT >30 in 6 (6.14%), CAT 21-30 in 13 (14.6%), CAT 10-20 in 33(37.7%), CAT <10 in 37 (41.5%).Patients CAT >10, spirometry revealed FVC <60%, should be evaluated for ILD by CT scan after 8 weeks and for long term pulmonary fibrosis.

Conclusion: CAT score, effective tool in COPD find its use to assess post COVID-19 patients. It’s a ready -made tool, less cost-expenditure, easy to use in rural ,urban set up to assess patients symptom ,long term effect.

The first and the second waves of Covid-19; difference in clinical dynamics as regards the symptoms- an appraisal

Srijita Sen¹, Debkanya Dey², Sayoni Sengupta¹, Sudip Ghosh¹, Rajat Banerjee³, Parthasarathi Bhattacharyya¹

¹Institute of Pulmocare and Research, Kolkata, West Bengal, India, ²ICMR-SRF, Biotechnology and Dr. B. C Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, West Bengal, India, ³Biotechnology and Dr. B. C. Guha Centre for Genetic Engineering and Biotechnology, Ballygunge Science College, University of Calcutta, Kolkata, West Bengal, India. E-mail: srijitatitli96@gmail.com

Background: Covid-19 affected our population in multiple waves. We have looked for the differences in frequency and the weight/impact of symptoms between the first and the second waves.

Method: The post-covid-19 subjects attending our out-patient department for post-covid-19 problems after the 1^st and he 2^nd waves were enquired retrospectively about the demography with the frequency and severity of different symptoms (cough, breathlessness, throat pain, nasal discharge, fever, body-ache, weakness, diarrhoea, constipation, pedal/finger swelling, headache, expectoration. anosmia, and loss of taste) that they suffered from. The weight/impact of a symptom was derived by multiplying the duration of symptoms (in days) with the severity (in Likert scale; “0” to “5”; “0”=none and “5”=maximum possible symptoms). The data was analysed statistically using unpaired ‘t-test’ and ‘chi-square test’ to compare between the two covid-19 waves.

Result: 185 and 222 subjects’ data were included for the 1^st and the 2^nd waves of covid-19 respectively. The gender ratio was similar but the mean age was significantly lower in the victims of the second wave (56.17±13.64, 51.32±15.59; p=0.0017). As regards the symptom-frequency, fever (p=0.0154), constipation (p=0.0243), headache (p=0.0014), anosmia (p=<0.0001) and loss of taste (p=0.0009) were significantly worse in the 2^nd wave. The symptom severity of cough (p=0.0184), throat pain (p=0.039), mild weakness (p=0.0063), anosmia (p=0.0004) and loss of taste (p=0.0026) were also higher in the 2^nd wave of Covid-19.

Conclusion: It appears that each wave of the pandemic was distinct as regards the symptomatology. Such peculiarity in the clinical dynamics of Covid-19 needs to be noticed and followed in future.