Burden of Long COVID-19 in a Cohort of Recovered COVID-19 Patients in Delhi, India.

BACKGROUND: The long COVID phase is characterized by signs and symptoms persisting for at least three months after recovery from acute COVID-19 illness. There is limited data on comprehensive long-term clinical follow-up of COVID-19 patients. AIMS: This study aims to explore the burden and symptomatology of long COVID syndrome and its association with various health parameters. SETTINGS AND DESIGN: This prospective observational study was conducted in Delhi from May 2022 to March 2023. METHODS AND MATERIAL: A total of 553 adult patients who had recovered from COVID-19 were enrolled in the study. A sociodemographic and clinical profile was obtained using validated questionnaires, along with an evaluation of biochemical parameters to assess the associated factors. STATISTICAL ANALYSIS USED: Chi-square test, unpaired t-test, and bivariate regression analysis were applied using Statistical Product and Service Solutions (SPSS, version 28; IBM SPSS Statistics for Windows, Armonk, NY). A p value of <0.05 was considered significant. RESULTS: A total of 252 patients (45.6%) had long COVID syndrome, which was significantly associated with the presence of any pre-existing comorbidity (OR=1.46 (1.02-2.09); p=0.039), previous history of hypertension (OR=1.82 (1.07-3.09); p=0.027), and vaccination against COVID-19 (OR=1.392 (1.171-1.656); p=0.003). The most common symptoms reported were persistent fatigue (33.3%) and persistent dry cough (28.5%). Patients with long COVID syndrome are also reported to have poorer sleep quality. Biochemical findings showed abnormal T lymphocytes (9.3%) and raised HbA1c (11.9%). CONCLUSIONS: Multiple risk factors and symptoms associated with long COVID syndrome were identified in this study. Research efforts and knowledge regarding the pattern of illness will aid in long-term monitoring and development of interventional strategies and guidelines for the care of recovered COVID-19 patients.

Dairy intake and risk of hip fracture in prospective cohort studies: non-linear algorithmic dose-response analysis in 486 950 adults.

Previous studies on the relationship between dairy consumption and hip fracture risk have reported inconsistent findings. Therefore, we aimed to conduct an algorithmically driven non-linear dose-response meta-analysis of studies assessing dairy intake and risk of developing incident hip fracture. Meta-analysis from PubMed and Google Scholar searches for articles of prospective studies of dairy intake and risk of hip fracture, supplemented by additional detailed data provided by authors. Meta-regression derived dose-response relative risks, with comprehensive algorithm-driven dose assessment across the entire dairy consumption spectrum for non-linear associations. Review of studies published in English from 1946 through December 2021. A search yielded 13 studies, with 486 950 adults and 15 320 fractures. Non-linear dose models were found to be empirically superior to a linear explanation for the effects of milk. Milk consumption was associated with incrementally higher risk of hip fractures up to an intake of 400 g/d, with a 7 % higher risk of hip fracture per 200 g/d of milk (RR 1⋅07, 95 % CI 1⋅05, 1⋅10; P < 0⋅0001), peaking with 15 % higher risk (RR 1⋅15, 95 % CI 1⋅09, 1⋅21, P < 0⋅0001) at 400 g/d versus 0 g/d. Although there is a dose-risk attenuation above 400 g/d, milk consumption nevertheless continued to exhibit elevated risk of hip fracture, compared to zero intake, up to 750 g/d. Meanwhile, the analysis of five cohort studies of yoghurt intake per 250 g/d found a linear inverse association with fracture risk (RR 0⋅85, 95 % CI 0⋅82, 0⋅89), as did the five studies of cheese intake per 43 g/d (~1 serving/day) (RR 0⋅81, 95 % CI 0⋅72, 0⋅92); these studies did not control for socioeconomic status. However, no apparent association between total dairy intake and hip fracture (RR per 250 g/d of total dairy = 0⋅97, 95 % CI 0⋅93, 1⋅004; P = 0⋅079). There were both non-linear effects and overall elevated risk of hip fracture associated with greater milk intake, while lower risks of hip fracture were reported for higher yoghurt and cheese intakes.

SARS-CoV-2 Seroprevalence in Delhi, India, During September-October 2021: A Population-Based Seroepidemiological Study.

Background A previous community-based severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serosurvey in Delhi in January 2021 reported a seroprevalence of 50.52%. We conducted a repeat serosurvey to obtain a recent estimate of the seroprevalence of IgG SARS-CoV-2 in the general population of Delhi, India. Methods This cross-sectional study was conducted from September 24 to October 14, 2021, in 274 wards of Delhi among 27,811 participants through a multistage sampling technique. Results The crude seroprevalence was 89.5% (95% CI 89.1, 89.8), weight for age and sex was 88% (95% CI 87.6, 88.4), and after adjustment for assay performance was estimated as 97.5% (95% CI 97.0, 98.0). On adjusted analysis, the odds of seroconversion in the participants vaccinated with at least one dose of either COVID-19 vaccine (Covishield/Covaxin) was more than four times compared to the unvaccinated ones (aOR 4.2 (3.8, 4.6)). 86.8% of the seropositive individuals had a SARS-CoV-2 signal/cut-off ≥4.0 although it was significantly lower in the pediatric age group. Post-second wave (August to October 2021), on average there were daily 39 new COVID-19 cases and 0.44 deaths which during Omicron driven the third wave in January to March 2022 increased to daily 4,267 cases and 11.6 deaths. Conclusion A high prevalence of IgG antibodies against SARS-CoV-2 with likely higher antibody titres in the vaccinated compared to the unvaccinated groups with evidence of hybrid immunity in a majority of the population was protective against severe disease during transmission of subsequent omicron variants.

COVID-19 Vaccine Acceptance and Its Determinants in the General Population of Delhi, India: A State Level Cross-Sectional Survey.

OBJECTIVE: To ascertain the COVID-19 vaccination acceptance and the factors contributing to vaccine hesitancy and vaccine confidence in the adult population, and the intention for vaccination of their children. METHODS: This cross-sectional analysis reports the ancillary results of a population-based SARS-CoV-2 serosurvey conducted in Delhi, India, from September 24 to October 14, 2021. Data were collected from 20312 adult participants through a multistage sampling method from all the 274 wards in the 11 districts of the national capital territory region. RESULTS:  We enrolled 12093 (59.3%) females and 8219 (40.5%) male participants with mean (SD) age of 40.3 (14.6) years. The vaccine acceptance rate in the participants was 67.7% (95% CI 67.1, 68.4), with 6031 (43.8%) having received one dose and 7727 (56.2%) having received two vaccine doses. On adjusted analysis, lack of vaccine acceptance was independently associated with female gender aOR 1.15 (95% CI 1.1, 1.23), younger age-group (18-49 years) aOR 1.85 (95% CI 1.71, 2.0), low educational status aOR 1.88 (95% CI 1.77, 2.0), in those with no history of COVID-19 aOR 1.81 (95% CI 1.69, 1.95), non-healthcare workers aOR 2.1 (95% CI 1.7, 2.53), and in the absence of hypertension comorbidity aOR 1.22 (1.1, 1.38). Lack of awareness of COVID-19 vaccines, including doubts on vaccine efficacy and long-term safety, were primary drivers of vaccine hesitancy in the unvaccinated subgroup. Only 35.6% participants reported a positive intention to vaccinate their children. CONCLUSIONS: One in three adults lacked vaccine acceptance. High prevalence of delay in second dose vaccination was also observed.

Neutralizing antibody responses to SARS-CoV-2: A population based seroepidemiological analysis.

This study (August-September 2021) estimated the seroprevalence of SARS-CoV-2 neutralizing antibodies in the general population of Delhi and correlated it with their anti-SARS-CoV-2 IgG levels. Samples were selected by simple random sampling method. The neutralizing capacity was estimated by performing a surrogate virus neutralization test (sVNT) (GenScript), Piscataway, NJ, USA. A total of 2233 (87.1%, 95% C.I. 85.7, 88.3) of the 2564 SARS-CoV-2 IgG seropositive samples had detectable SARS-CoV-2 neutralizing antibodies. In samples with S/CO â€‹≥ â€‹4.00, the neutralizing antibodies ranged from 94.5% to 100%. The SARS-CoV-2 neutralizing antibody seroprevalence strongly correlated with the S/CO range of IgG SARS-CoV-2 (r â€‹= â€‹0.62, p â€‹= â€‹0.002).

Seroprevalence of immunoglobulin G antibodies against SARS-CoV-2 in children and adolescents in Delhi, India, from January to October 2021: a repeated cross-sectional analysis.

OBJECTIVES: The aim of this study was to assess changes in the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) seroprevalence among children and adolescents in Delhi, India from January 2021 to October 2021. METHODS: This was a repeated cross-sectional analysis of participants aged 5 to 17 years from 2 SARS-CoV-2 seroprevalence surveys conducted in Delhi, India during January 2021 and September to October 2021. Anti-SARS-CoV-2 IgG antibodies were detected by using the VITROS assay (90% sensitivity, 100% specificity). RESULTS: The seroprevalence among 5- to 17-year-old school-age children and adolescents increased from 52.8% (95% confidence interval [CI], 51.3%-54.3%) in January 2021 to 81.8% (95% CI, 80.9%-82.6%) in September to October 2021. The assay-adjusted seroprevalence was 90.8% (95% CI, 89.8%-91.7%). Seropositivity positively correlated with participants' age (p<0.001), but not sex (p=0.388). A signal to cut-off ratio ≥4.00, correlating with the presence of neutralization antibodies, was observed in 4,814 (57.9%) participants. CONCLUSION: The high percentage of seroconversion among children and adolescents indicates the presence of natural infection-induced immunity from past exposure to the SARS-CoV-2 virus. However, the lack of hybrid immunity and the concomitant likelihood of lower levels of neutralization antibodies than in adults due to the absence of vaccination warrants careful monitoring and surveillance of infection risk and disease severity from newer and emergent variants.

Hesitancy for Adult Vaccines Among Healthcare Providers and their Family Members in Delhi, India: A Cross-Sectional Study.

Objectives: Adult immunisation has recently emerged as an area of emphasis in research and policy. Increasing life expectancy, outbreaks like COVID-19, and the endemic nature of diseases like dengue, malaria have underscored its importance. Therefore, this study was carried out to assess hesitancy and the factors influencing the uptake of vaccines in adults. Methods: A descriptive cross-sectional study was conducted among the medical students and doctors affiliated to a medical college and tertiary care hospital in Delhi, India and their immediate family members in January 2021. Online data collection was done using the Google Form platforms. Data on awareness and perceptions regarding adult vaccination and immunisation status of participants was collected. The dataset was exported in the Microsoft Excel format and analysed with IBM SPSS Version 25 (Armonk, NY: IBM Corp). Results: A total of 461 adults responded to the survey. The most common reasons for vaccine hesitancy were fear of side effects (51.41%), lack of awareness of vaccines (49.46%), and the lack of national guidelines on adult vaccination (32.97%). Hesitancy for vaccines among those who were informed by healthcare workers of vaccine availability was highest for zoster vaccine (97.80%) and least for tetanus toxoid (57.62%). Significant hesitancy was also observed for pneumococcal, human papillomavirus, influenza and varicella vaccines. Conclusions: Reduced vaccine uptake due to vaccine hesitancy in adulthood is a major health concern. Framing national guidelines for adult vaccination in India and awareness generation to create a public demand for adult vaccination warrants prioritization.

Breakthrough Infection With Severe Acute Respiratory Syndrome Coronavirus 2 Among Healthcare Workers in Delhi: A Single-Institution Study.

Introduction This study aimed to determine the breakthrough infection rate of coronavirus disease 2019 (COVID-19) (severe acute respiratory syndrome coronavirus 2 {SARS-CoV-2}) infection in healthcare workers (HCWs) vaccinated with either BBV152 or AZD1222 (ChAdOx1-S) vaccine. Methods A cross-sectional analysis was conducted at a medical college and hospital complex in Delhi, India, through telephonic interviews among HCWs who had received at least one dose of a COVID-19 vaccine during January-March 2021. Breakthrough infections were operationally defined as the occurrence of COVID-19 infection ≥14 days after administration of two doses of either COVID-19 vaccine. Data were entered in Epidata 3.1 (Odense, Denmark: EpiData Association) (single entered) and analyzed with IBM SPSS version 25 (Armonk, NY: IBM Corp.). A p-value < 0.05 was considered statistically significant. Results We enrolled 325 HCWs with a mean (SD) age of 29.1 (9.9) years including 211 (64.9%) males and 114 (35.1%) females. A total of 37 (13.3%, 95% CI 9.8, 17.7) COVID-19 breakthrough infections were observed in the HCWs. Additionally, 20 (6.1%) non-breakthrough infections were reported in the HCWs who were vaccinated with at least a single dose of a COVID-19 vaccine, or both doses, but prior to 14 days since the administration of the second dose. Most breakthrough infections were mild without needing supplemental oxygen for recovery. Conclusion Nearly one in seven HCWs experienced a COVID-19 breakthrough infection in the present study. A history of SARS-CoV-2 natural infection followed by at least one dose of COVID-19 vaccination was associated with significant protection against breakthrough infections.

Dietary Supplement Use Among Adults: United States, 2017-2018.

Dietary supplement use is common in the United States (1). The additional nutrients provided by dietary supplements can help meet recommended nutrient targets but can also potentially lead to excess intakes (2,3). This report describes recent prevalence estimates for dietary supplement use among U.S. adults, the distribution of the number of dietary supplements used, and the most common types of dietary supplements used. Trends in dietary supplement use from 2007-2008 through 2017-2018 are also reported.

Special Diets Among Adults: United States, 2015-2018.

To help achieve and maintain a healthy body weight, support nutrient adequacy, and reduce the risk of chronic disease, the 2015-2020 Dietary Guidelines for Americans recommend following a healthy eating pattern across the lifespan (1). Some people adhere to specific eating patterns, otherwise known as special diets, for the purposes of weight loss or other health-related reasons. This report shows the percentage of U.S. adults who, on a given day, were on any special diet and specific types of special diets in 2015-2018 and trends from 2007-2008 through 2017-2018.

Dietary Supplement Use in Children and Adolescents Aged ≤19 Years - United States, 2017-2018.

Dietary supplement use is common among children and adolescents. During 2013-2014, approximately one third of children and adolescents (persons aged ≤19 years) in the United States were reported to use a dietary supplement in the past 30 days, and use varied by demographic characteristics (1,2). Dietary supplements can contribute substantially to overall nutrient intake, having the potential to both mitigate nutrient shortfalls as well as to lead to nutrient intake above recommended upper limits (3). However, because nutritional needs should generally be met through food consumption according to the 2015-2020 Dietary Guidelines for Americans, only a few dietary supplements are specifically recommended for use among children and adolescents and only under particular conditions (4). The most recently released data from the National Health and Nutrition Examination Survey (NHANES) during 2017-2018 were used to estimate the prevalence of use among U.S. children and adolescents of any dietary supplement, two or more dietary supplements, and specific dietary supplement product types. Trends were calculated for dietary supplement use from 2009-2010 to 2017-2018. During 2017-2018, 34.0% of children and adolescents used any dietary supplement in the past 30 days, with no significant change since 2009-2010. Use of two or more dietary supplements increased from 4.3% during 2009-2010 to 7.1% during 2017-2018. Multivitamin-mineral products were used by 23.8% of children and adolescents, making these the products most commonly used. Because dietary supplement use is common, surveillance of dietary supplement use, combined with nutrient intake from diet, will remain an important component of monitoring nutritional intake in children and adolescents to inform clinical practice and dietary recommendations.

Clinical and epidemiologic profile of the initial COVID-19 patients at a tertiary care centre in India.

COVID-19 has now become a pandemic. It has spread from Wuhan, China, in December 2019 to a large number of countries within three months. The objective of this work is to report the initial experience with epidemiologic and clinical features, as well as with the management of COVID-19 patients in India. This is a descriptive case series of the first 21 COVID-19 infected patients confirmed with polymerase chain reaction (PCR) and admitted to a tertiary care centre in India from 01.02.2020 to 19.03.2020. Clinical, laboratory, and radiologic data were collected, including age, sex, nationality, travel history, symptoms, duration of stay, and comorbidities. The mean age of the population was 40.3 years with a male preponderance. Thirteen (62%) patients had recent travel history outside India in the previous 30 days, two thirds of whom had travelled to Italy. The most common symptoms were fever and cough (42.9%) followed by sore throat, headache and breathlessness. Vital and laboratory parameters were preserved in all patients and none of them required ventilatory support. Among the first 21 patients diagnosed with COVID-19 infection in India, the typical clinical presentation consisted in a mild upper respiratory tract infection predominantly affecting the young male population. One patient required supplemental oxygen. All patients recovered with no residual symptoms.   *The Safdarjung Hospital COVID 2019 working group: Nitesh Gupta, Sumita Agrawal, Pranav Ish, Suruchi Mishra, Rajni Gaind, Ganapathy Usha, Balvinder Singh, Manas Kamal Sen, Shibdas Chakrabarti (Consultant and Head, Pulmonary Medicine); NK Gupta (Professor, Pulmonary medicine); Dipak Bhattacharya (Consultant, Pulmonary medicine); Rohit Kumar (Assistant Professor, Pulmonary Medicine); Siddharth R. Yadav (Assistant Professor, Pulmonary Medicine); Rushika Saksena (Specialist, Microbiology); Rojaleen Das (Assistant Professor, Microbiology); Vikramjeet Dutta (Assistant Professor, Microbiology); Anupam Kr Anveshi (Senior Resident, Microbiology); Santvana Kohli (Assistant Professor, Anaesthesiology); Naveen KV (Assistant Professor,  Anaesthesiology); Amandeep Jaswal (Assistant Professor, Anaesthesiology).

Association between dietary protein intake and grip strength among adults aged 51 years and over: What We Eat in America, National Health and Nutrition Examination Survey 2011-2014.

INTRODUCTION: Distributing daily protein intake evenly across meals (∼25-30g/meal) has been suggested to improve muscle mass. The aim of this research is to examine the association between grip strength, total protein intake and its distribution across day's meals in older adults. METHODS: Nationally representative dietary intake data of adults aged 51 years and older (n = 4,123) who participated in What We Eat in America, NHANES 2011-2014 were analyzed. Protein intake per day and per eating occasion (breakfast, lunch, dinner, and snack) were determined. Combined grip strength was calculated and expressed in kilograms. Grip strength of individuals consuming ≥25g protein at 1 eating occasion was compared with those consuming same level of protein at 2 and 3 or more eating occasions. Grip strength of individuals in quartile 1 of daily protein intake was compared to those in the other quartiles. All associations were examined without and with adjustment for age, race/ethnicity, physical activity, health status, and smoking status. The comparison involving eating occasions and protein intake quartiles were further adjusted for daily protein intake and energy intake, respectively. RESULTS: Only 33% of men and 19% of women had protein intake of ≥25g at 2 or more eating occasions. These individuals also had higher grip strength and daily protein intake. Grip strength was positively associated with consumption of ≥25g protein at 2 eating occasions as compared to consumption of same level of protein at 1 eating occasion (p<0.05) in unadjusted model, but not when adjusted. Grip strength was positively associated with daily protein intake among women in quartiles 3 and 4 (p<0.05) of protein intake in both unadjusted and adjusted models compared to lowest protein intake. Among men, grip strength was associated with daily protein intake in quartiles 3 and 4 (p<0.05) in the unadjusted model, but not when adjusted. CONCLUSION: In a nationally representative sample of older adults, consuming ≥25g protein at 2 or more eating occasions was not associated with grip strength. However, higher daily protein intake was positively associated with grip strength in women.

The Association of Serum Leptin with Mortality in Older Adults.

OBJECTIVE: Elevated levels of serum leptin are associated with increased adiposity and production of pro-inflammatory cytokines. Both cytokines and body adiposity have been shown to predict cardiovascular events and mortality. The primary objective of the present study is to explore the associations between serum leptin and all-cause mortality and mortality from cardiovascular disease (CVD) over a span of 10 years, controlling for body adiposity and proinflammatory cytokines. METHODS: The Health, Aging and Body Composition (Health ABC) study is a prospective cohort of 3,075 older adults aged 70 to 79 years. This analysis includes 2,919 men and women with complete serum leptin and vital status data. Data on all-cause mortality and incident cardiovascular events (including Coronary Heart Disease and Congestive Heart Failure) were collected over 10 years of follow-up (mean 8.4 years). RESULTS: Women with leptin in quartile 2 and 3 were at lower risk of all-cause mortality, and those with leptin in quartile 2 were at lower risk of mortality from CVD as compared to women with lowest leptin values when adjusted for age, race, site, years of education, alcohol use, smoking, and physical activity. When these associations were additionally adjusted for body fat, C-reactive protein and pro-inflammatory cytokines, women with leptin values in quartile 3 were at lower risk of all-cause mortality and women with leptin in quartile 2 and 3 were at lower risk of mortality from CVD than women with lowest leptin values. These associations were not significant among men after adjusting for body fat and cytokines. CONCLUSIONS: The present study suggests that moderately elevated concentrations of serum leptin are independently associated with lower risk of all-cause mortality and CVD-related mortality among older women. Among men, serum leptin is not associated with reduced risk of all-cause and CVD mortality after controlling for body fat and cytokines.

A multicenter randomized controlled trial of a nutrition intervention program in a multiethnic adult population in the corporate setting reduces depression and anxiety and improves quality of life: the GEICO study.

PURPOSE: To determine whether a plant-based nutrition program in a multicenter, corporate setting improves depression, anxiety, and productivity. DESIGN: A quasi-experimental study examined the impact of diet on emotional well-being and productivity. SETTING: The study was conducted in 10 corporate sites of a major U.S. insurance company. SUBJECTS: There were 292 participants (79.8% women, 20.2% men), with body mass index ≥25 kg/m(2) and/or previous diagnosis of type 2 diabetes. INTERVENTION: Either weekly instruction in following a vegan diet or no instruction was given for 18 weeks. MEASURES: Depression and anxiety were measured using the Short Form-36 questionnaire. Work productivity was measured using the Work Productivity and Activity Impairment questionnaire. ANALYSIS: Baseline characteristics were examined by t-test for continuous variables and χ(2) test for categorical variables. Analysis of covariance models were adjusted for baseline covariates. Paired t-tests were used to determine within-group changes and t-tests for between-group differences. RESULTS: In an intention-to-treat analysis, improvements in impairment because of health (p < .001), overall work impairment because of health (p = .02), non-work-related activity impairment because of health (p < .001), depression (p = .02), anxiety (p = .04), fatigue (p < .001), emotional well-being (p = .01), daily functioning because of physical health (p = .01), and general health (p = 0.02) in the intervention group were significantly greater than in the control group. Results were similar for study completers. CONCLUSION: A dietary intervention improves depression, anxiety, and productivity in a multicenter, corporate setting.

Hyperleptinemia, adiposity, and risk of metabolic syndrome in older adults.

Background. Abdominal adiposity and serum leptin increase with age as does risk of metabolic syndrome. This study investigates the prospective association between leptin and metabolic syndrome risk in relation to adiposity and cytokines. Methods. The Health, Aging, and Body Composition study is a prospective cohort of older adults aged 70 to 79 years. Baseline measurements included leptin, cytokines, BMI, total percent fat, and visceral and subcutaneous fat. Multivariate logistic regression was used to determine the association between leptin and metabolic syndrome (defined per NCEP ATP III) incidence after 6 years of follow-up among 1,120 men and women. Results. Leptin predicted metabolic syndrome in men (P for trend = 0.0002) and women (P for trend = 0.0001). In women, risk of metabolic syndrome increased with higher levels of leptin (compared with quintile 1, quintile 2 RR = 3.29, CI = 1.36, 7.95; quintile 3 RR = 3.25, CI = 1.33, 7.93; quintile 4 RR = 5.21, CI = 2.16, 12.56; and quintile 5 RR = 7.97, CI = 3.30, 19.24) after adjusting for potential confounders. Leptin remained independently associated with metabolic syndrome risk after additional adjustment for adiposity, cytokines, and CRP. Among men, this association was no longer significant after controlling for adiposity. Conclusion. Among older women, elevated concentrations of leptin may increase the risk of metabolic syndrome independent of adiposity and cytokines.