Hemorrhagic PRES: A Rare Neurological Manifestation of COVID -19 Infection.

As of August 2021, the COVID -19 pandemic has affected approximately 200 million cases worldwide. Most of the reported medical literature about the COVID-19 infection discusses its respiratory and haematological manifestations, with limited information about its neurological complications. Encephalitis, meningitis, acute disseminated encephalomyelitis, stroke and encephalopathy have been reported in patients with COVID-19 infection. Symptomatology of CNS involvement includes dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia, and seizures. Encephalopathy is encountered commonly in patients with severe disease, multi-organ dysfunction and elevated inflammatory markers. Acute cerebrovascular disease is another major manifestation of COVID -19 infection and is mainly due to occlusion of large vessels, hypercoagulability and a pro-inflammatory state. In this report, we discuss the diagnosis and outcome of a 30-year-old patient detected with Posterior Reversible Encephalopathy Syndrome (PRES) as a complication of COVID-19 infection. We hope this report will provide physicians with a useful framework for understanding pathophysiology and imaging findings of PRES in COVID-19 infection.

To Study Adverse Effect following Immunization (AEFI) and COVID-19 Infection amongst COVID-19 Vaccine Benefeciaries.

COVID-19 vaccines have been rolled out recently in several parts of the world. Little is known about the post-vaccination experience outside of clinical trial conditions. The aim of this study was to investigate the adverse effects and infection rate of vaccinated people in a community scenario. It will help to educate the public, dispel misinformation and reduce vaccine hesitancy. AIM AND OBJECTIVES: Assessing total beneficiaries of COVID-19 vaccination and finding among them COVID-19 infection and AEFI after vaccination. SUBJECT AND METHODS: Cross sectional Study at COVID-19 Vaccination centre at DCH in Mumbai, since 1st February2021-31st July 2021, Data was collected by calling telephonically the registered beneficiaries in Vaccination Centre, data was collected and analysed in MS-excel sheet and SPSS using CHI-square test. RESULTS: 49.68% of the beneficiaries were from the age group of 45-60 years followed by >60 years age group (34.70%). 97.08% beneficiaries were from Mumbai. 3593(43.59%) had taken both the doses of COVID-19 vaccine while 4650(56.41%) had taken only first dose of COVID -19 vaccine. 36(0.44%) had contracted COVID-19 infection after vaccination. 88.71% had no AEFI after taking vaccine. 1.65% had mild AEFI 9.63% had moderate AEFI. CONCLUSION: Very few had contracted COVID-19 infection after vaccination. Out of all AEFI maximum were mild to moderate.

Assessment of Risk Factors for COVID-19 in Health Care Workers: A Nested Case-Control Study.

OBJECTIVES: To study the risk factors for SARS-CoV-2 infection in health care workers (HCWs) exposed to COVID-19 patients. MATERIAL AND METHODS: This was a nested case-control study of health care workers(HCWs) in a Dedicated COVID Hospital(DCH). The data collection was done from Dec 2020 to Feb 2021. The study was part of an international multicenter study by the World Health Organisation (WHO).2 The Doctors, nurses, housekeeping staff, clerks, and other staff working in this DCH were considered as HCWs. HCWs working in this DCH with confirmed COVID-19 were recruited as cases and other HCWs working in this DCH in the same Ward/ICU/office without infection were recruited as controls (incidence density sampling). Three controls were taken per case. The questions were in the Likert scale. RESULTS: There were 25 cases and their 75 controls. There was no significant difference between cases and controls with respect to age, sex, occupation, education, and comorbidities and all controls were negative for antibodies at the time of the interview. Most (70%) of the HCWs were doctor by profession followed by nurses (19%). All HCWs were trained in IPC (infection Prevention and Control). Most (96%) HCWs reported that PPE (personal protective equipment) is available in sufficient quantity. There was no significant difference between cases and controls with respect to those having direct contact with the patient's materials, surroundings, and following hand hygiene. CONCLUSION: Adequate availability of PPE, IPC training of HCWs are important for preventing COVID-19 but do not completely reduce risk among HCWs.

SARS-CoV-2 Antibody Response Following COVID-19 Vaccination, a Longitudinal Study.

Background: The objective was studying the antibody response following immunization with COVID-19 vaccines. Material and Methods: It was a longitudinal study of healthcare workers (HCWs). Two groups were taken, Group 1 had taken first dose of the COVID-19 vaccine, at least 3 weeks have passed. Group 2 had taken two doses of COVID-19 vaccine and at least 2 weeks have passed. A quantitative test for antibodies to SARS-CoV-2 spike protein was done. Follow-up of both groups was done after 3 months of collection of the first sample. Results: The antibody titre of the 57 HCWs in Group 1, decreased significantly 125 days after the first dose [median = 2,013 U/ml] as compared to the titre 30 days after the first dose of Covishield vaccine[median = 9,965.26 U/ml]. The median interval between two doses of vaccine was 34 days. In Group 2, the antibody titre of the 60 HCWs in Group 2, decreased significantly 114 days after second dose[median = 1,411 U/ml] as compared to the titre 19.5 days after second dose of Covishield vaccine [median = 2,377.5]. There was no significant difference in the antibody titre in follow-up samples of HCWs with and without side effects. Conclusion: The antibody titre decreases after 13 to 17 weeks post the second dose of Covishield vaccination. The decision of the Government of India to increase the interval between two doses of Covishield is justified. Low antibody titre can be the reason for breakthrough infections. The antibody titre was not related to side effects post-vaccination.

Evaluation of 'Normal' Cognitive Functions and Correlation With MRI Volumetry: Towards a Definition of Vascular Cognitive Impairment.

Introduction It is important to establish criteria to define vascular cognitive impairment (VCI) in India as VCI is an image-based diagnosis and magnetic resonance imaging (MRI) changes resulting from age with prevalent vascular risk factors may confound MRI interpretation. The objective of this study was to establish normative community data for MRI volumetry including white matter hyperintensity volume (WMHV), correlated with age-stratified cognitive scores and vascular risk factors (VRFs), in adults aged 40 years and above.  Methods We screened 2651 individuals without known neurological morbidity, living in Mumbai and nearby rural areas, using validated Marathi translations of Kolkata Cognitive Battery (KCB) and geriatric depression score (GDS). We stratified 1961 persons with GDS ≤9 by age and cognitive score, and randomly selected 10% from each subgroup for MRI brain volumetry. Crude volumes were standardized to reflect percentage of intracranial volume.  Results MRI volumetry studies were done in 199 individuals (F/M = 90/109; 73 with body mass index (BMI) ≥25; 44 hypertensives; 29 diabetics; mean cognitive score 76.3). Both grey and white matter volumes decreased with increasing age. WMHV increased with age and hypertension. Grey matter volume (GMV) decreased with increasing WMHV. Positive predictors of cognition included standardized hippocampal volume (HCV), urban living, education, and BMI, while WMHV and age were negative predictors. Urban dwellers had higher cognitive scores than rural, and, paradoxically, smaller HCV.  Conclusion In this study of MRI volumetry correlated with age, cognitive scores and VRFs, increasing age and WMHV predicted lower cognitive scores, whereas urban living and hippocampal volume predicted higher scores. Age and WMHV also correlated with decreasing GMV. Further study is warranted into sociodemographic and biological factors that mutually influence cognition and brain volumes, including nutritional and endocrine factors, especially at lower cognitive score bands. In this study, at the lower KCB score bins, the lack of laboratory data pertaining to nutritional and endocrine deficiencies is a drawback that reflects the logistical limitations of screening large populations at the community level. Our volumetric data which is age and cognition stratified, and takes into account the vascular risk factors associated, nevertheless constitutes important baseline data for the Indian population. Our findings could possibly contribute to the formulation of baseline criteria for defining VCI in India and could help in early diagnosis and control of cognitive decline and its key risk factors.

An observational study to find association between Hypertension and severe and fatal COVID-19 infection in COVID dedicated hospital, Mumbai.

Introduction: World Health Organization (WHO) has declared COVID-19 outbreak as a "public health emergency of international concern" on January 31, 2020. After that the epidemic spread rapidly around the world. Chronic non-communicable diseases were identified as risk factors for SARS-CoV-2. Hypertension (HTN) is one of the most common cardiovascular diseases with a prevalence ranging from 10% to 20% among adult population. After COVID-19 outbreak, identification of risk factors for severe or fatal disease is necessary to allocate limited resources. For primary care physicians, this is of vital importance to know the association between hypertension and severe and fatal COVID-19 infection as hypertension is affecting millions of people all over the world and primary health care is of immense importance in a country like India. Duration of stay in hospital which will be taken as proxy measure of duration of illness, symptomatic status, need of ICU care and death will be taken as indicators of severe and fatal COVID-19 infection. There are few researches to find an association between Hypertension and severe and fatal COVID-19 infection. There is a need to assess the same. Objectives: To find an association of hypertension and severe and fatal COVID-19 infection. Methodology: A hospital-based cross-sectional study was carried out at a COVID dedicated hospital, Mumbai in 9 months from 1 April 2020 to 31 December 2020. All patients admitted in hospital were included in the study by universal sampling. Ethical Approval: The permission to conduct the study was taken by Institutional Ethics Committee. Results: There was a significant association between hypertension and severe and fatal COVID-19 infection defined by more duration of stay in hospital, admission to ICU and mortality. Conclusions: It is concluded from this study that hypertension is associated with severe and fatal COVID-19 infection. It gives a clear idea for primary care physicians to give more focus towards patients with hypertension with COVID-19 infection. Blood pressure monitoring should be strictly practiced during COVID-like illnesses. Special attention is to be given as far as treatment and early referral to higher centre with ICU is concerned for better outcome. Hypertensive patients should be protected more by adopting COVID appropriate behaviour.

Death analysis of COVID-19 patients admitted in dedicated COVID hospital in Mumbai.

Introduction: COVID-19 poses a great threat globally and also a huge burden on developing countries due to its expensive, less effective, and toxic treatment. India is one of the countries with large number of confirmed cases. This study is done to assess the death due to COVID-19 on various parameters so that necessary action can be taken to reduce the disease burden of COVID-19. Aim and Objective: I) To find sociodemographic and other factors associated with mortality. II) To study various comorbidities related to the death due to COVID-19 infection. III) Recommendation for reducing mortality in COVID-19 patients. Material and Method: Data related to COVID-19 death was taken from MRD (Medical Record Department) & e-Health records from HMIS and was analyzed by Bivariate analysis in SPSS. Results: Results showed that people with 1--2 comorbidity have 62% death. Mortality was found to be more in elderly, that is, >60 years age group with 67.5% of total mortality. And in males (68.6%) as compared to female. Conclusion: People with comorbidities have significant association. Also, it showed that death was more common in male and elderly age group as compared to female and youngsters.

A comparative cross-sectional analysis on outcomes of Covid-19 patients requiring dialysis.

CONTEXT: Coronavirus Disease 2019 (COVID-19) was declared as a pandemic by the World Health Organization (WHO) on March 11, 2020. COVID-19 disproportionately affects patients with pre-existing comorbidities including those undergoing dialysis at intermittent intervals. These patients requiring renal replacement therapy like intermittent hemodialysis have a preponderance to go into severe clinical states. Hence, this study was planned to analyze the outcomes of such patients requiring dialysis and suffering from the COVID-19 disease. OBJECTIVES: This study was carried out to compare the outcomes of the COVID-19 patients requiring hemodialysis with those not requiring hemodialysis. MATERIALS AND METHODS: This cross-sectional observational study was carried out between April 2020 and August 2020 at a dedicated COVID-19 hospital and included COVID-19 patients requiring hemodialysis at the time of admission and an equal number of controls matched for age and sex. RESULTS: The study included 271 COVID-19-positive patients requiring dialysis and 271 COVID-19-positive controls without the requirement of a dialysis matched for age and sex; 10.3% cases needed intensive care. There were 18.8% deaths in cases as opposed to 8.9% among controls. Multivariate analysis showed that advancing age (OR 2.6 in cases and 1.06 in controls) need for intensive care (OR 27.9 in cases and 331 in controls), and diabetes alone and with other comorbidities were significant predictors of mortality. CONCLUSIONS: This study showed that the mortality proportions were more in cases as compared to controls; and advancing age, diabetes, and need for intensive care unit (ICU) were significant predictors. The study also highlighted the crisis faced by patients who require dialysis at regular intervals due to this COVID-19 pandemic.

Epidemiological study to assess the impact of COVID-19 pandemic on the occurrence of monsoon-related diseases in the city of Mumbai.

BACKGROUND: The onset of monsoons in Mumbai poses an additional health disease burden in the form of rising vector-borne and water-borne diseases such as dengue, malaria, leptospirosis, hepatitis, typhoid, chikungunya, and acute gastroenteritis. These monsoon-related illnesses are preventable with hygienic and sanitation measures that are likely to have been adopted during COVID-19 pandemic. AIM: To assess the impact of COVID-19 pandemic on the occurrence of monsoon-related diseases in the city of Mumbai and find out determinants of variations if any. MATERIAL AND METHODS: This was a retrospective descriptive study. Universal sampling was done using secondary data collected from the Epidemiological Cell of Municipal Corporation of Greater Mumbai (MCGM). Data mining was performed to obtain the trends of the monsoon-related diseases in Mumbai. RESULTS: COVID-19 pandemic has remarkably affected the city of Mumbai with approximately 3 lakh cases till December 2020. MCGM has taken a lot of efforts resulting in a recovery rate of close to 95% with less than 3% mortality. With the effective use of social behavior change communication, which focused on masks, frequent hand washing, and social distancing, there seems to be a decline in monsoon-related illnesses in the year 2020 as compared to the previous two years of 2018 and 2019. CONCLUSION: Monsoon-related illnesses are impacted by behavior and lifestyle modifications like hygiene and environmental sanitation practiced during the COVID-19 pandemic. This study highlights the importance of these universal hygienic practices and their utility in the long-term reduction of monsoon-related illnesses.

Alarming levels of drug-resistant tuberculosis in HIV-infected patients in metropolitan Mumbai, India.

BACKGROUND: Drug-resistant tuberculosis (DR-TB) is a looming threat to tuberculosis control in India. However, no countrywide prevalence data are available. The burden of DR-TB in HIV-co-infected patients is likewise unknown. Undiagnosed and untreated DR-TB among HIV-infected patients is a major cause of mortality and morbidity. We aimed to assess the prevalence of DR-TB (defined as resistance to any anti-TB drug) in patients attending public antiretroviral treatment (ART) centers in greater metropolitan Mumbai, India. METHODS: A cross-sectional survey was conducted among adults and children ART-center attendees. Smear microscopy, culture and drug-susceptibility-testing (DST) against all first and second-line TB-drugs using phenotypic liquid culture (MGIT) were conducted on all presumptive tuberculosis patients. Analyses were performed to determine DR-TB prevalence and resistance patterns separately for new and previously treated, culture-positive TB-cases. RESULTS: Between March 2013 and January 2014, ART-center attendees were screened during 14135 visits, of whom 1724 had presumptive TB. Of 1724 attendees, 72 (4%) were smear-positive and 202 (12%) had a positive culture for Mycobacterium tuberculosis. Overall DR-TB was diagnosed in 68 (34%, 95% CI: 27%-40%) TB-patients. The proportions of DR-TB were 25% (29/114) and 44% (39/88) among new and previously treated cases respectively. The patterns of DR-TB were: 21% mono-resistant, 12% poly-resistant, 38% multidrug-resistant (MDR-TB), 21% pre-extensively-drug-resistant (MDR-TB plus resistance to either a fluoroquinolone or second-line injectable), 6% extensively drug-resistant (XDR-TB) and 2% extremely drug-resistant TB (XDR-TB plus resistance to any group-IV/V drug). Only previous history of TB was significantly associated with the diagnosis of DR-TB in multivariate models. CONCLUSION: The burden of DR-TB among HIV-infected patients attending public ART-centers in Mumbai was alarmingly high, likely representing ongoing transmission in the community and health facilities. These data highlight the need to promptly diagnose drug-resistance among all HIV-infected patients by systematically offering access to first and second-line DST to all patients with 'presumptive TB' rather than 'presumptive DR-TB' and tailor the treatment regimen based on the resistance patterns.

Health problems among migrant construction workers: A unique public-private partnership project.

BACKGROUND: Construction sector is a booming industry and involves many hazardous activities. Migrant labor in the industry is susceptible to various health and occupational hazards. In a unique public-private partnership project, a medical team from a public sector teaching hospital in Mumbai provided comprehensive on-site health care services to the construction workers of a private construction company. OBJECTIVE: To study socio-demographic profile and morbidity pattern of construction workers. SETTING AND DESIGN: A cross-sectional study at construction site Vidyavihar (West), Mumbai, was carried out over the period of May to November 2010. MATERIALS AND METHODS: A medical team provided comprehensive on-site health care services, and a Health Card was devised to maintain the record of socio-demographic, occupational details, and complete physical examination findings of the workers who participated in the study. STATISTICAL ANALYSIS USED: Statistical analysis was done using SPSS 15.0. RESULTS: Of the 1337 workers (all males) examined, 1289 (96.4%) belonged to 15-45 years age group. The mean age of the workers was 26.25 ± 8.49 years. A third of the migrants belonged to West Bengal. The average number of health problems in the workers was 1.41. Regular consumers of tobacco and alcohol were 50.48 and 14.65%, respectively. Nearly one-fifth of the workers had febrile illness, of which 20.71% had suspected malaria; 12.6% had respiratory infections, while 3.4% were found to have hypertension. There was a statistically significant association (P < 0.05) between type of occupation and morbidity status.