The Impact of COVID-19 on Healthy Related Issues, A structured Review

Coronavirus: (COVID-19) is a recently discovered viral disease caused by a new strain of coronavirus. The majority of patients with corona-virus infections will have a mild-moderate respiratory disease that recovers without special care. Most often, the elderly, and others with chronic medical conditions such as asthma, coronary disease, respiratory illness, and malignancy are seriously ill. COVID-19 is spread mostly by salivary droplets or nasal secretions when an infected person coughs or sneezes. COVID-19 causes severe acute respiratory illness (SARS-COV-2). The first incidence was recorded in Wuhan, China, in 2019. Since then it spreads leading to a pandemic. The typical incubation time for COVID-19 infection is 2-14 days (normally 5). The common features include fever, cough, tiredness, difficulty in breathing, loss of smell or taste. Occasionally, signs are absent. COVID-19 complications include renal failure, syndrome of cytokine release, pneumonia, respiratory failure, lung fibrosis.

Plasma gp96 is a Novel Predictive Biomarker for Severe COVID-19

Early and effective identification of severe COVID-19 may allow us to improve the outcomes of associated severe acute respiratory illness with fever and respiratory symptoms. Some heat shock proteins (Hsps) are released during oxidative stress, cytotoxic injury, and viral infection and behave as danger-associated molecular patterns (DAMPs).

A Review of Candidate Therapies for Beta Coronavirus a Molecular Research

Coronavirus disease 2019 (COVID-19) is an infectious illness caused by the coronavirus 2 that causes severe acute respiratory illness (SARS-CoV-2). The first instance of this virus was reported on November 17th, 2019 in Wuhan, China. The COVID-19 outbreak is evidenced with devastating consequences such as 34.9% rate of mortality in 27 countries. The metastasizing of COVID-19 all over the world is alarmed to cause significant losses of human life, and for this there is no specific vaccination or therapy for COVID-19 in particular. The therapies suggested at this time are adapted from the treatments of Severe Acute Respiratory Syndrome (SARV-CoV). For instance, the development for a particular therapy or vaccination for COVID-19 is an urgent requirement. The pattern of study is based on investigating the research papers for the period of 2012-2020, identifying all the potential aspects of medical research contributing for the development of treatment against diverse families of coronavirus. By analyzing this approach, this study is aimed to provide a directed approach for developing appropriate therapy for COVID-19.

EP.TU.838Educating the ITU Nursing Staff during the COVID-19 Pandemic: A Quality Improvement Project

Aims The nursing staff always plays a crucial role in the management of patients. This pandemic had put the ITUs under an undue burden, and the nurses faced an altogether new challenge. There was extensive use of various oxygen delivery systems and fastly emerging guidelines. So, there is an increased demand for the nursing staff to stay abreast with the situation. Hence a teaching program was organized for the ITU nurses. Methods Five academic sessions were conducted as a part of the first cycle of QIP in November 2020 under the guidance of nursing tutors and ITU consultants. These topics covered the respiratory system, including Severe Acute Respiratory Illness, Non-invasive and Invasive ventilation techniques, and ARDS. Feedback forms were collected and analysed after each session, which focused on the usefulness and relevance of content, teaching style, and the overall confidence in the topics. Results Audit of the feedback forms showed globally positive feedback and improvement in understanding amongst the nursing staff. Also, the confidence of nurses in these topics increased abundantly. Many of them expressed interest in attending similar sessions in the future. Conclusions Keeping the nursing staff up-to-date with the latest management guidelines is quintessential for patient safety. More so during this pandemic, where academic activities are becoming scarce, and protocols are rapidly changing. Further sessions on relevant topics will continue to enhance learning.

Mortality in children aged <5 years with severe acute respiratory illness in a high HIV-prevalence urban and rural areas of South Africa, 2009–2013

Background Severe acute respiratory illness (SARI) is an important cause of mortality in young children, especially in children living with HIV infection. Disparities in SARI death in children aged <5 years exist in urban and rural areas. Objective To compare the factors associated with in-hospital death among children aged <5 years hospitalized with SARI in an urban vs. a rural setting in South Africa from 2009–2013. Methods Data were collected from hospitalized children with SARI in one urban and two rural sentinel surveillance hospitals. Nasopharyngeal aspirates were tested for ten respiratory viruses and blood for pneumococcal DNA using polymerase chain reaction. We used multivariable logistic regression to identify patient and clinical characteristics associated with in-hospital death. Results From 2009 through 2013, 5,297 children aged <5 years with SARI-associated hospital admission were enrolled; 3,811 (72%) in the urban and 1,486 (28%) in the rural hospitals. In-hospital case-fatality proportion (CFP) was higher in the rural hospitals (6.9%) than the urban hospital (1.3%, p<0.001), and among HIV-infected than the HIV-uninfected children (9.6% vs. 1.6%, p<0.001). In the urban hospital, HIV infection (odds ratio (OR):11.4, 95% confidence interval (CI):5.4–24.1) and presence of any other underlying illness (OR: 3.0, 95% CI: 1.0–9.2) were the only factors independently associated with death. In the rural hospitals, HIV infection (OR: 4.1, 95% CI: 2.3–7.1) and age <1 year (OR: 3.7, 95% CI: 1.9–7.2) were independently associated with death, whereas duration of hospitalization ≥5 days (OR: 0.5, 95% CI: 0.3–0.8) and any respiratory virus detection (OR: 0.4, 95% CI: 0.3–0.8) were negatively associated with death. Conclusion We found that the case-fatality proportion was substantially higher among children admitted to rural hospitals and HIV infected children with SARI in South Africa. While efforts to prevent and treat HIV infections in children may reduce SARI deaths, further efforts to address health care inequality in rural populations are needed.

Study of hypokalemia and correlation with severity of disease in patients with COVID-19 positive severe acute respiratory illness and COVID-19 negative severe acute respiratory illness

Background: Although the coronavirus disease-2019 (COVID-19) pandemic is creating a major global health crisis, the risk factors for mortality and the detailed clinical course of disease has not yet established. Clinical spectrum of the disease varies from mild symptoms to ARDS. The main objective of this study was to determine hypokalemia and correlation of severity of disease with hypokalemia in patients with COVID-19 positive SARI (severe acute respiratory illness) and COVID-19 negative SARI patients.Methods: The study was a cross-sectional study conducted on 265 SARI patients who were admitted in hospitals attached to BMCRI from April 2019 to December 2019. History was taken, general and systemic examination was done. Patients were categorized and selected patients with moderate and severe illness. RT-PCR for COVID-19 patients done using throat and nasal swab. Potassium levels were estimated and correlated with severity of illness in patients with COVID-19 positive and COVID-19 negative status.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. Patients categorized into moderate and severe SARI. Mean age of subjects with COVD-19 positive (severe) was higher, 58.70±15.598 followed by COVID-19 positive (moderate), 55.13±14.480. About 30% (N=90) belonged to severe SARI group, Chi square test showed statistical significant association with respect to age. In this study there was no statistically significant hypokalemia found between COVID-19 positive SARI patients (N=20, 14.81%) and COVID-19 negative SARI patients (N=17, 13.07%). However hypokalemia COVID-19 positive SARI patients 14.81% (N=20) and COVID-19 negative SARI patients 13.07% (N=17). And also there is no statistically significant hypokalemia between SARI severe and SARI moderate cases.Conclusions: However in this study there is no statistically significant hypokalemia found between COVID-19 positive SARI patients and COVID-19 negative SARI patients. And also there is not statistically significant hypokalemia between SARI severe and SARI moderate cases. Hypokalemia is found in both in both COVID-19 positive SARI patients and COVID-19 negative SARI patients and relatively more in COVID-19 positive patients. Hypokalemia is one of the treatable condition and early detection and treatment reduces mortality.

Comparison of neutrophil-lymphocyte ratio among severe acute respiratory illness COVID-19 positive and negative patients and to correlate with disease severity

Background: COVID-19, a pandemic caused by SARS-CoV-2, has caused a wide impact globally. Clinical spectrum of COVID-19 ranges widely including asymptomatic infection, mild upper respiratory tract infection, severe pneumonia, ARDS, MODS and even death. Neutrophil-lymphocyte (NL) ratio is an indicator of systemic inflammatory response. Many previous studies have shown NL ratio to be good prognostic marker for COVID-19 pneumonia.Methods: A study was conducted on 265 SARI (severe acute respiratory illness) patients who were admitted in hospitals attached to BMCRI between May 2020 and September 2020. History was taken, general and systemic examination was done. Patients were categorized into moderate and severe illness. RT-PCR for all patients was done using throat and nasal swab. Total WBC counts and differential counts were estimated. NL ratio was correlated with pneumonia severity and compared between COVID-19 positive and negative SARI.Results: The study included 265 SARI patients, of which 135 were COVID-19 positive patients and 130 were COVID-19 negative. The patients were further sub-categorised into moderate and severe SARI. Mean age for COVID-19 positive severe SARI was higher than the moderate SARI. Males were majority of the subjects. Out of 265, 99 patients (37.4%) had diabetes. Out of this, 34 (42%) were COVID-19 positive (severe) followed by 28 (51.9%) COVID-19 positive (moderate). Mean NL ratio was higher in COVID-19 positive (severe) subjects 15.95±10.31 followed by COVID-19 positive (moderate) subjects 8.99±6.22. There was significant difference with respect to NL ratio between COVID-19 positive and negative subjects. NL ratio levels were high in subjects having diabetes in COVID-19 positive severe sub group and COVID-19 positive severe hypertension sub group as compared to other sub groups.Conclusions: NL ratio was higher in patients with COVID-19 positive SARI as compared to COVID-19 negative SARI. There was significant correlation between increase in NL ratio and disease severity of COVID-19 positive pneumonia. We found that increase in NL ratio was associated with co-morbidities like diabetes mellitus and hypertension.

Strategies to provide care to Non-COVID Patients in the COVID Era: An Experience from a Tertiary Care Institute in Northern India

With the COVID-19 pandemic the health system is facing dual burden of cases, one being the COVID-19 or Severe Acute Respiratory Illness (SARI) cases and the second being the other Non-COVID cases. The Non-COVID cases due to the burden of the SARI cases became almost neglected by the Health System increasing the sufferings of the Non-COVID cases. In the current COVID times All India Institute of Medical Sciences, Gorakhpur continued to provide the health care to the Non-COVID cases. The current manuscript provides the detailed strategy and results of the various strategies used to provide care to such Non-COVID patients with minimum risk to the healthcare staff.

The impact of SARS-Cov-2 on the Nervous system and Mental Health

: The World Health Organization declared the pandemic situation caused by SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus-2) in March 2020, but the detailed pathophysiological mechanisms of Coronavirus disease 2019 (COVID-19) are not yet completely understood. Therefore, to date, few therapeutic options are available for patients with mild-moderate or serious disease. In addition to systemic and respiratory symptoms, several reports have documented various neurological symptoms and impairments of mental health. The current review aims to provide the available evidence about the effects of SARS-CoV-2 infection on mental health. The present data suggest that SARS-CoV-2 produces a wide range of impairments and disorders of the brain. However, a limited number of studies investigated the neuroinvasive potential of SARS-CoV-2. Although the main features and outcomes of COVID-19 are linked to severe acute respiratory illness. The possible damages on the brain should be considered, too.

MO391RISK FACTORS OF ACUTE KIDNEY INJURY IN SEVERE ACUTE RESPIRATORY ILLNESS DURING CORONAVIRUS DISEASE 2019 PANDEMIC

Background and Aims Acute Kidney Injury (AKI) is associated with poor outcome in severe acute respiratory illness (SARI) during Coronavirus Disease 2019 (COVID 19) pandemic. This study aim at detetction of risk factors for AKI among patients admitted for SARI at our Center for COVID 19 screening. Method Restrospective study by reviewing admission notes from March 2020 until December 2020 at our district center. Patient aged more than 18 year old who admitted for SARI as defined by World Health Organisation and AKI as defined by Kidney Disease Improving Global Outcome (KDIGO) guideline were included. Chronic kidney disease and End stage Renal Failure as defined by KDIGO were excluded. Results A total 230 ( 56%) patients out of 410 patients with SARI had AKI during hospitalisation. The mean age was 72 years old (SD 13.8), 130 (56.5%) were male and 100 ( 43.5%) were female. SARI patients with AKI took mean 5 days ( SD 0.9) to be admitted at our center from the first day of illness. The mean body mass index (BMI) was 27.2 kg/m2 . The mean arterial pressure was 52.1 ( SD 3.7) mmhg upon admission. The mean neutrophils lymphocytes ratio ( NLR ) was 22.4 (SD 2.4). The independant Risk factors for AKI in SARI are Male gender ( OR 0.95; 95% CI 0.35-2.6), smoking ( OR 0.72 ;95% CI 0.23- 2.3), ischaemic heart disease (OR 0.48; 95% CI 0.06-3.8), diabetes mellitus ( OR 1.15; 95% CI 0.39-3.38) and hypertension ( OR 1.58; 95% CI 0.58-4.25). Conclusion Non modifiable risk factors for AKI in SARI include male gender and advance age. The modifiable risk factors for AKI in SARI are over weight, smoking, ischemic heart disease, diabetes mellitus and hypertension. NLR play a role in predicting AKI among SARI patients. Delay hospitalisation and hypoperfusion predispose to AKI in SARI. Early recognition of risk factors is crucial in preventing deterioration of kidney function in SARI patients during the inital screening for COVID 19 infection.