Background With the looming threat of recurrent waves of COVID-19 in the presence of mutated strains, its of paramount importance to understand the demographic and clinical attributes of COVID-19 related mortalities in each pandemic waves. This could help policy makers, public health experts, and clinicians to better plan preventive and management strategies to curb COVID-19 related mortality. Method This was a hospital record based, retrospective cross-sectional descriptive study, at a tertiary care hospital in Rishikesh, India. The study included all deceased patients between March 2020 and January 2021 (first wave) who tested positive for SARS-CoV-2 by RT-PCR and were hospitalized. The study was done to describe demography, clinical presentation, laboratory parameters, treatment given and associated complications of all COVID-19 deaths. Result Out of 424 mortalities, 298 (70.38%) were males and 126 (29.62%) were females. Mean age of patients was 55.85 (SD=16.24 years), out of which 19.5 percent were less than 45 years old, 33.6 percent were 45 to 60 years old and 41.8% were more than 60 years old. Comorbidity in the form of type 2 diabetes mellitus was present in 41.4% [95% CI (41.4-51.1)], hypertension in 39.8% [95% CI (35.1-44.6)], and coronary artery disease in 15.2% [95% CI (11.8-18.8)]. At the time of presentation, shortness of breath was present in 73.6% [95% CI (69.1-77.7)], fever in 64.92% [95% CI (60.1-69.4)], and cough in 46.1%, [95% CI (41.1-50.8)]. Deranged laboratory parameters were lymphopenia in 90.2% [95% CI (86.8-92.7)], transaminitis in 59.7% [95% CI (54.8-64.3)], and hypercreatinemia in 37.7% [95% CI (33.1-42.5)]. Complications manifested were acute respiratory distress syndrome in 78.3% [95% CI (74-82.1)] and shock in 54.7% [95% CI (49.8-59.5)]. Median time duration between onset of symptom and hospital admission was 5 days (IQR = 3-5 days) and median length of hospital stay was 9 days (IQR = 4-14 days). Conclusion During first pandemic wave, COVID-19 related mortality was 2.37 times higher among males, 2.14 times in age group >60 than <45 years. Most common associated comorbidities (>40%) were type 2 diabetes mellitus and hypertension. Most common associated symptoms (>60%) were shortness of breath and fever. Lymphopenia was seen in >90% cases while liver involvement in 60% and kidney in 38% cases. Median hospital stay was doubled the pre-hospital illness.
A bstract Background With the looming threat of recurrent waves of coronavirus disease-2019 (COVID-19) in the presence of mutated strains, it is of paramount importance to understand the demographic and clinical attributes of COVID-19 related mortalities in each pandemic wave. This could help policy makers, public health experts, and clinicians to better plan preventive and management strategies to curb COVID-19 related mortality. Materials and methods This was a hospital record-based, retrospective cross-sectional descriptive study, at a tertiary care hospital in Rishikesh, India. The study included all deceased patients between March 2020 and January 2021 (first wave) who had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by reverse transcription polymerase chain reaction (RT-PCR) and were hospitalized. The study was done to describe demography, clinical presentation, laboratory parameters, treatment given, and associated complications of all COVID-19 deaths. Result Out of 424 mortalities, 298 (70.38%) were males and 126 (29.62%) were females. Mean age of patients was 55.85 ± 16.24 years, out of which 19.5% were less than 45 years old, 33.6% were 45–60 years old, and 41.8% were more than 60 years old. Comorbidity in the form of type II diabetes mellitus was present in 41.4% [95% CI (41.4–51.1)], hypertension in 39.8% [95% CI (35.1–44.6)], and coronary artery disease (CAD) in 15.2% [95% CI (11.8–18.8)]. At the time of presentation, shortness of breath was present in 73.6% [95% CI (69.1–77.7)], fever in 64.92% [95% CI (60.1–69.4)], and cough in 46.1%, [95% CI (41.1–50.8)]. Deranged laboratory parameters were lymphopenia in 90.2% [95% CI (86.8–92.7)], transaminitis in 59.7% [95% CI (54.8–64.3)], and hypercreatinemia in 37.7% [95% CI (33.1–42.5)]. Complications manifested were acute respiratory distress syndrome (ARDS) in 78.3% [95% CI (74–82.1)] and shock in 54.7% [95% CI (49.8–59.5)]. Median time duration between onset of symptom and hospital admission was 5 days (interquartile range (IQR) = 3–5 days) and median length of hospital stay was 9 days (IQR = 4–14 days). Conclusion During the first pandemic wave, COVID-19 related mortality was 2.37 times higher among males, 2.14 times in the age group >60 than <45 years. The most common associated comorbidities (>40%) were type II diabetes mellitus and hypertension. The most common associated symptoms (>60%) were shortness of breath and fever. Lymphopenia was seen in >90% cases while liver involvement in 60% and kidney in 38% cases. Median hospital stay was doubled the prehospital illness. How to cite this article Tendulkar P, Pandey P, Panda PK, Bhadoria AS, Kulshreshtha P. Descriptive Epidemiology of COVID-19 Deaths during the First Wave of Pandemic in India: A Single-center Experience. Indian J Crit Care Med 2022;26(1):71–75.
The aim of the study was to determine the efficacy of prokinetic agents in diabetic gastroparesis patients. MethodThis was a randomized open-label trial conducted on 50 patients with type 2 diabetes experiencing diabetic gastroparesis, which was diagnosed with the lactulose hydrogen breath test. After randomization, all 50 patients were divided into four arms (cinitapride, metoclopramide, levosulpiride, and domperidone) of different prokinetics and followed up for four weeks; after which, repeat gastroparesis cardinal symptom index score and orocecal transit time were recorded in order to assess the response to the treatment. ResultThere was no statistically significant difference among the four groups in terms of all the baseline characteristics except for gender (p=0.032). The follow-up gastroparesis cardinal symptom index was collected for 50 patients but repeat orocecal transit time could be performed only in 37 patients. In all four groups, there was a statistically significant (p<0.05) improvement in terms of orocecal transit time and gastroparesis cardinal symptom index scores. But there was no statistically significant difference in relative efficacy amongst these study groups. ConclusionOur study showed statistically significant improvement with four prokinetics drugs in terms of gastroparesis cardinal symptom index score and orocecal transit time, but there was no statistically significant benefit of one prokinetic drug over the other. Our study showed promising results with regard to prokinetic use in diabetic gastroparesis.
BackgroundThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously evolving and many mutant variants of the virus are circulating in the world. Recurrent waves of COVID-19 have caused enormous mortality all over the world. It is of utmost importance for a health expert to understand the demographic and clinical attributes between the first and second waves of COVID-19 induced deaths.MethodThis was a hospital record based comparative study of baseline demographic, clinical and laboratory parameters of the first and second wave of COVID-19 in a tertiary care hospital in Uttarakhand, India. The study included all deceased patients admitted to the hospital during the first and second wave of COVID-19, i.e., between March 2020 to January 2021 and between March 2021 to June 2021, respectively.ResultThe study showed that there were more casualties in the second wave compared to the first, 475 (19.8%) and 424 (24.1%) respectively. There was no significant difference in terms of age. A male preponderance of mortality was evident in both the waves. The median duration of hospital stay was 5 (3-10) days in the second wave, which is significantly different from the corresponding duration in first wave (p<o.ooo). The most common clinical manifestation among the deceased were dyspnoea in both the waves, followed by fever and cough, the difference was statistically significant for cough (p< 0.000) The most prevalent comorbidity was diabetes mellitus (DM), followed by hypertension (HTN), with significant difference for HTN (p<0.003). The most frequently deranged lab parameter was lymphopenia with a significant difference across both the waves (p<0.000).ConclusionIn both the first and second COVID-19 waves, older males (>45 years) with comorbidities like HTN and DM were most susceptible for COVID-19 related mortality. The study also demonstrated that most of the baseline demographic and clinical characteristics which are attributed to the mortality were more common during the second wave of COVID-19.
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is continuously evolving, and many mutant variants of the virus are circulating in the world. Recurrent waves of COVID-19 have caused enormous mortality all across the globe. Considering the novelty of the virus, it becomes crucial for healthcare experts and policymakers to understand the demographic and clinical attributes of inpatient deaths in the first and second waves of COVID-19. MethodsThis hospital record-based comparative study was conducted at a tertiary care hospital in Uttarakhand, India. The study included all COVID-19 RT PCR-positive patients admitted to the hospital during the first wave, from 1 st April 2020 to 31 st January 2021, and the second wave from 1 st March 2021 to 30 th June 2021. Comparisons were made with respect to demographic, clinical, laboratory parameters, and course of hospital stay. ResultsThe study exhibited 11.34% more casualties in the second wave, with the number of deaths being 424 and 475 for the first and second waves, respectively. A male preponderance of mortality was evident in both waves with significant differences (p=0.004). There was no significant difference in age between the two waves (p=0.809). The significantly different comorbidities were hypertension (p=0.003) and coronary artery disease (p=0.014). The clinical manifestations demonstrating a significant difference were cough (p=0.000), sore throat (p=0.002), altered mental status (p=0.002), headache (p=0.025), loss of taste and smell (p=0.001), and tachypnea (p=0.000). The lab parameters with a significant difference across both waves were lymphopenia (p=0.000), elevated aspartate aminotransferase (p=0.004), leukocytosis (p=0.008), and thrombocytopenia (p=0.004). During the hospital course of the second wave, in terms of intensive care unit stay, the need for non-invasive ventilation and inotrope support was higher. The complications manifesting in the form of acute respiratory distress syndrome and sepsis were observed more in the second wave. A significant difference was discerned in the median duration of hospital stay in both waves (p=0.000). ConclusionDespite being of shorter duration, the second wave of COVID-19 culminated in more deaths. The study demonstrated that most of the baseline demographic and clinical characteristics attributed to mortality were more common during the second wave of COVID-19, including lab parameters, complications, and duration of hospital stays. The unpredictable nature of COVID-19 waves calls for instituting a well-planned surveillance mechanism in place to identify the surge in cases at the earliest possible time and prompt response, along with developing infrastructure and capacity to manage complications.
Introduction: Diabetes adversely affects sexual health with its negative consequences on well-being in both males and females. Literature is scanty regarding female sexual dysfunction (FSD) in diabetic women, furthermore reported literature is lacking regarding the differential impact on different domains of sexual health, especially in Indian females. In the present analysis, we aim to study the prevalence of sexual dysfunctions in diabetic women as well as different domains affected by diabetes. Materials and Methods: This cross-sectional study was carried out at a tertiary care teaching centre in North India over a duration of 6 months (January 2021 to June 2021). A total of 100 married females were enrolled including 50 diabetics and 50 healthy non-diabetic females. All the participants were subjected to a validated female sexual function index (FSFI) questionnaire for sexual function assessment. Results: FSD was seen in 35 diabetic females (70%) with desire being the most affected domain (92%) in comparison to 15 healthy subjects (30%) with an overall mean FSFI of 23.5 in diabetics and 29.2 in the control group. Mean FSFI in diabetic females with sexual dysfunction was 21.04 ± 9. All domains of FSFI were affected significantly ( P value < 0.05) in the diabetic group in comparison to the control group except for the satisfaction domain. There was no significant association of different domains of FSFI seen with the duration of diabetes and other comorbidities. A significant association of arousal and pain domain was seen with the glycaemic (HbA1C) index ( P value-0.006 and 0.031, respectively). Conclusion: Females with diabetes mellitus (DM) have a higher prevalence of sexual dysfunction affecting all domains. Glycosylated haemoglobin is associated independently with arousal and pain domains of FSFI as well as desire being the most affected domain, although further randomized studies with larger sample sizes are needed to authenticate our findings. To improve the quality of life of diabetic females, clinicians should focus on this aspect also while treating diabetes.
Leptospirosis is a bacterial infection caused by spirochaete. It's a gram-negative bacterium. It spreads Through animal urine or soil or water contaminated with Animal urine (Rat), when coming into contact with mouth, nose, eyes or breach in the skin. It is more common in farmers and people involved in water sports. In leptospirosis symptoms can range from mild muscle pains, headache and fever to severe forms including jaundice and renal failure (Clavel et al., 2010;MoHFW, 2021). This is a case report of a 23-year-old male with no previous co-morbidity presented to us in severe ARDS. Due to COVID-19 pandemic 1st possibility of COVID-19 related ARDS was considered, but after repeated negative RT-PCR tests and COVID serology, work up for other causes was done. On further investigating the patient, his Leptospira IgM came positive. Diagnosis of Leptospira induced ARDS was made and treated for the same. But despite of best-efforts patient expired during hospital stay.
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