Knowledge and Compliance of Hydroxychloroquine Prophylaxis for Severe Acute Respiratory Syndrome Coronavirus 2 Infection among Indian Health-Care Workers.

Objective: In the initial days of the coronavirus disease 2019 (COVID-19) pandemic, the Indian Council of Medical Research (ICMR) recommended the use of hydroxychloroquine (HCQ) as chemoprophylaxis for health-care workers (HCWs) involved in the care of COVID-19 patients. The present survey aimed to assess the knowledge and compliance of HCQ prophylaxis as per the ICMR recommendations among Indian HCWs during the first wave of the pandemic. Methods: A validated 19-item questionnaire-based survey was distributed to HCWs in our apex tertiary care institute who had completed their duties in the COVID-19 wards to assess the knowledge, attitude, and compliance of all sections of HCWs regarding the ICMR-recommended HCQ prophylaxis. Participation in the survey was voluntary, and anonymity was maintained. Data obtained from the responses were collated and analyzed. Findings: Two hundred and fourteen out of 250 HCWs completed the survey (85.6% response rate). Among 214 participants, 87.9% were below the age of 40 years. 83.2% were aware of the use of HCQ for possible prevention of COVID-19 infection, while only 24.6% took HCQ for 7 weeks as was recommended during that period. The main reasons given by 37.3% of the HCWs for not taking HCQ were their knowledge and research on HCQ, where side effects were prominent. Side effects were reported by 35% of the respondents, of which the most notable was nausea/vomiting (14%) followed by gastritis (12%). Conclusion: The poor compliance with HCQ prophylaxis by HCWs was influenced by their knowledge and research, lack of strong scientific evidence, and drug-associated adverse effects.

New insights into development and mortality of COVID-19-associated pulmonary aspergillosis in a homogenous cohort of 1161 intensive care patients.

BACKGROUND: COVID-19-associated pulmonary aspergillosis (CAPA) has been widely reported but homogenous large cohort studies are needed to gain real-world insights about the disease. METHODS: We collected clinical and laboratory data of 1161 patients hospitalised at our Institute from March 2020 to August 2021, defined their CAPA pathology, and analysed the data of CAPA/non-CAPA and deceased/survived CAPA patients using univariable and multivariable models. RESULTS: The overall prevalence and mortality of CAPA in our homogenous cohort of 1161 patients were 6.4% and 47.3%, respectively. The mortality of CAPA was higher than that of non-CAPA patients (hazard ratio: 1.8 [95% confidence interval: 1.1-2.8]). Diabetes (odds ratio [OR] 1.92 [1.15-3.21]); persistent fever (2.54 [1.17-5.53]); hemoptysis (7.91 [4.45-14.06]); and lung lesions of cavitation (8.78 [2.27-34.03]), consolidation (9.06 [2.03-40.39]), and nodules (8.26 [2.39-28.58]) were associated with development of CAPA by multivariable analysis. Acute respiratory distress syndrome (ARDS) (2.68 [1.09-6.55]), a high computed tomography score index (OR 1.18 [1.08-1.29]; p < .001), and pulse glucocorticoid treatment (HR 4.0 [1.3-9.2]) were associated with mortality of the disease. Whereas neutrophilic leukocytosis (development: 1.09 [1.03-1.15] and mortality: 1.17 [1.08-1.28]) and lymphopenia (development: 0.68 [0.51-0.91] and mortality: 0.40 [0.20-0.83]) were associated with the development as well as mortality of CAPA. CONCLUSION: We observed a low but likely underestimated prevalence of CAPA in our study. CAPA is a disease with high mortality and diabetes is a significant factor for its development while ARDS and pulse glucocorticoid treatment are significant factors for its mortality. Cellular immune dysregulation may have a central role in CAPA from its development to mortality.

A questionnaire-based study on quality and adequacy of clinical communication between physician and family members of admitted Covid-19 patients.

OBJECTIVE: To assess adequacy of present means of clinical communication between physicians and (Covid-19) patients' family members, to analyse their perspectives and recommend felicitous practices for virtual conversation during ongoing pandemic. METHODS: Cross-sectional questionnaire-based (20 questions) anonymous online survey was conducted including patient's relatives (Group-1) and treating physicians (Group-2), through Google Forms. RESULTS: Response Rate was 82.5%. Group-1 and Group-2 included 155 and 204 respondents respectively. Group-1 preferred update by resident doctors (39%), twice a day (41.9%), daily case-summaries (80%) and hand-written document/electronic messages (53%,31%) as consent. Whereas Group-2 favored update by senior consultants (63%), daily one appraisal (55.9%) and scanned copies of hand written consent (81%) before high-risk procedures. The groups broadly agreed on the desired duration for a fruitful discussion (5-10 min) and designating one responsible person from the family for daily appraisal. CONCLUSION: Use of modern techniques/technologies of communication (voice/video calls, texts) during the ongoing pandemic is acceptable to majority. PRACTICE IMPLICATIONS: Study proposes a senior physician should communicate to a designated responsible family member at-least once a day for stable and twice a day for critical covid patients (more if patient's health condition changes), either by voice or video calls for 5-10 min.

A novel epidemiological scoring system for the prediction of mortality in COVID-19 patients.

BACKGROUND: Most of the reported risk score models for coronavirus disease 2019 (COVID-19) mortality are based on the levels of inflammatory markers, comorbidities or various treatment modalities, and there is a paucity of risk score models based on clinical symptoms and comorbidities. METHODS: To address this need, age, clinical symptoms and comorbidities were used to develop a COVID-19 scoring system (CSS) for early prediction of mortality in severe COVID-19 patients. The CSS was developed with scores ranging from 0 to 9. A higher score indicates higher risk with good discrimination quality presented by Mann Whitney U test and area under receiver operating characteristic curve (AUROC). RESULTS: Patient age of ≥60 y, cough, breathlessness, diabetes and any other comorbidity (with or without diabetes) are significant and independent risk factors for non-survival among COVID-19 patients. The CSS showed good sensitivity and specificity (i.e. 74.1% and 78.5% at CSS≥5, respectively), with an overall diagnostic accuracy of 82.8%, which was close to the diagnostic accuracy detected in the validation cohort (81.9%). In the validation cohort, high (8-9), medium (5-7) and low (0-4) CSS groups had 54.80%, 28.60% and 6.5% observed mortality, respectively, which was very close to the predicted mortality (62.40%, 27.60% and 5.2%, respectively, by scoring cohort). CONCLUSIONS: The CSS shows a positive relationship between a higher score and proportion of mortality and, as its validation showed, it is useful for the prediction of risk of mortality in COVID-19 patients at an early stage, so that referral for triage and admission can be predetermined even before admission to hospital.

Non-COVID Surgical Emergency During the Nationwide Lockdown due to Corona Pandemic: a Critical Appraisal

The World Health Organization (WHO) declared corona infection as a pandemic in February 2020. A nationwide lockdown was enforced by Indian government on 25 March 2020. Separate health facilities were developed to handle the confirmed and suspected cases of COVID-19 (coronavirus disease). Other than emergency services and care of cancer patients, all remaining healthcare activities were curtailed. Through this study, we intend to assess any change in number and pattern of non-COVID surgical emergencies during the lockdown as well as the interventions required. This was an observational study which included all patients with surgical emergencies who presented during the study period (25 March to 24 April 2020) after two stage screenings for corona infection (group 2). The results obtained from analysis of prospectively collected database were compared with a similar period (group 1) prior to the onset of pandemic in India using appropriate statistical tests. In group 2, an increase (17%) in number of patients was noted. The need of organ support was more than 4 times the usual period. An upsurge in neurosurgical emergencies was noted, though the number of interventions decreased by 40%. A significant decrease in hospital stay was also documented (7 days vs 12 days). The nationwide lockdown led to an increase and change in pattern of surgical emergencies, though the interventions required were less. Effective management entails appropriate preparedness.