Post COVID sequelae among COVID-19 survivors: insights from the Indian National Clinical Registry for COVID-19.

INTRODUCTION: The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities. METHODS: Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting. RESULTS: Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03). CONCLUSION: Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Clinico-demographic profile of COVID-19 positive patients - first wave versus second wave - an experience in north-east India.

INTRODUCTION: India witnessed two distinct COVID-19 waves. We evaluated the clinico-demographic profile of patients infected during first wave (FW) and second wave (SW) in a hospital in north-east India. METHODOLOGY: Patients who tested positive for severe acute respiratory syndrome-coronavirus-2 specific gene by reverse transcriptase polymerase chain reaction across FW and SW were diagnosed as COVID-19 positive. The clinico-demographic data of these positive patients were retrieved from the specimen-referral-form. Vital parameters including respiratory rate, SpO2, data on COVID-19-associated mucormycosis (CAM), COVID-19-associated acute respiratory distress syndrome (CARDS) were obtained from hospital records for in-patients. Patients were categorized based on disease severity. The data obtained in both waves were analyzed comparatively. RESULTS: Out of a total of 119,016 samples tested, 10,164 (8.5%) were SARS-CoV-2 positive (2907 during FW, 7257 during SW). Male predominance was seen across both waves (FW: 68.4%; SW:58.4%), with more children infected during SW. Patients with travel history (24%) and contact with laboratory confirmed cases (61%) were significantly higher during SW relative to FW (10.9% and 42.1% respectively). Healthcare worker infection was higher in SW (5.3%). Symptoms like vomiting [14.8%], diarrhea [10.5%], anosmia [10.4%] and aguesia [9.4%] were more in SW. More patients developed CARDS in SW (6.7%) compared to FW (3.4%) with 85% and 70% patients expiring across FW and SW respectively. No case of CAM is documented in our study. CONCLUSIONS: This was probably the most comprehensive study from north-east India. Industrial oxygen cylinder usage may have been the source of CAM in the rest of the country.

Clinical and Demographic Profile of COVID-19 Patients: A Tertiary Level Hospital-Based Study From Northeast India.

Background and objective The coronavirus disease 2019 (COVID-19) outbreak, which was first detected in Wuhan, China, has turned into a rapidly spreading global healthcare crisis. The clinical and laboratory features of COVID-19 are associated with significant regional variations. In this study, we aimed to describe the clinical and demographic profile of COVID-19 patients from a tertiary care hospital in Northeast India. Materials and methods This was a hospital-based cross-sectional study that included all laboratory-confirmed COVID-19 cases admitted to the institution from 1st July to 31st October 2020. The information was collected on a predesigned proforma, which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. Results The study included 180 laboratory-confirmed COVID-19 cases. A history of contact with laboratory-confirmed COVID-19-affected individuals was found in 92 (51.1%) patients. The median age of the patients was 37.17 years (range: 18-80 years), and there were 104 (57.78%) males in the cohort. Of the total enrolled patients, 102 (56.67%) were asymptomatic from the time of exposure till their admission. The common presenting complaints were fever (n=55, 70.51%), cough (n=42, 53.85%), and shortness of breath (n=32, 42.02%). The case fatality rate among the admitted cases was 15%. Comorbidities were found in 84 (46.67%) patients with the most common one being diabetes mellitus (n=31, 36.9%) followed by hypertension (n=29, 34.52%). Patients with advanced age (more than 60 years) and coexisting comorbidities were at higher risk of progression of disease and death. Conclusion The COVID-19 pandemic is not only a huge burden on healthcare facilities but also a significant cause of disruption in societies globally. The majority of the patients with COVID-19 infection presenting to our hospital were young and asymptomatic. Patients of advanced age with comorbidities were found to have more complications. An analysis of the trends related to COVID-19 in different hospital and institutional settings will help to achieve better preparedness and lead to improved patient care to combat the COVID-19 pandemic in a more efficient manner.

Utilization of endobronchial electrocautery for removal of an impacted airway foreign body.

Dear Editor, Aspiration of a foreign body into the tracheobronchial tree can occur at any age, though it occurs more commonly in children. In small children, the foreign body commonly gets lodged in the central airways (trachea and mainstem bronchi); hence, the presentation is usually sudden onset of cough and dyspnea or even lifethreatening respiratory failure in an otherwise healthy child. A witnessed aspiration or a history of aspiration can usually be elicited.

Guidelines for diagnostic flexible bronchoscopy in adults: Joint Indian Chest Society/National College of chest physicians (I)/Indian association for bronchology recommendations.

Flexible bronchoscopy (FB) is commonly performed by respiratory physicians for diagnostic as well as therapeutic purposes. However, bronchoscopy practices vary widely across India and worldwide. The three major respiratory organizations of the country supported a national-level expert group that formulated a comprehensive guideline document for FB based on a detailed appraisal of available evidence. These guidelines are an attempt to provide the bronchoscopist with the most scientifically sound as well as practical approach of bronchoscopy. It involved framing appropriate questions, review and critical appraisal of the relevant literature and reaching a recommendation by the expert groups. The guidelines cover major areas in basic bronchoscopy including (but not limited to), indications for procedure, patient preparation, various sampling procedures, bronchoscopy in the ICU setting, equipment care, and training issues. The target audience is respiratory physicians working in India and well as other parts of the world. It is hoped that this document would serve as a complete reference guide for all pulmonary physicians performing or desiring to learn the technique of flexible bronchoscopy.