Tanima Dwivedi - Academia.edu (original) (raw)
Papers by Tanima Dwivedi
The Evaluation of Laboratory Parameters as Predictors of Disease Severity and Mortality in COVID-19 Patients: A Retrospective Study From a Tertiary Care Hospital in India
Cureus
Evaluation of hematological parameters in covid-19 infected patients
Indian Journal of Hematology and Blood Transfusion, 2020
Indian Journal of Gastroenterology
Background The information on seroprevalence of severe acute respiratory syndrome coronavirus 2 (... more Background The information on seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in patients with IBD and healthy controls (HCs). Methods Patients with IBD and HCs (contact of patients) underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Siemens kit IgG against antigen-S1RBD) between July 2020 and April 2021. Information on demography, disease characteristics, drug history and past history of SARS-CoV-2 infection were noted. Patients on 5-aminosalicylic acid or no treatment were considered not on immunosuppressants and those who had received steroids, thiopurines or methotrexate within six months of inclusion were considered being on immunosuppressants. Results A total of 235 patients (51.9%, males; mean age, 38.7 ± 12.4 years; median disease duration, 60 months [interquartile range, IQR: 36-120]) (ulcerative colitis [UC]: 69.4%, Crohn's disease [CD]: 28.9%, IBD unclassified [IBDU]: 1.7%) and 73 HCs (mean age, 39.6 ± 10.9 years, 80% males) were enrolled. Of the 235 patients, 128 (54.5%) patients were on immunosuppressants and 107 (45.5%) were not on immunosuppressants. Seventy-four (31.5%) patients were seropositive, of which two (0.9%) had previous history of SARS-CoV-2 infection and none received coronavirus disease-19 (COVID-19) vaccine. Seroprevalence between IBD patients and HCs (32% vs. 27%, p > 0.05) and between patients with and without immunosuppressants (28.1% vs. 36%, p > 0.05) was similar. Age, gender, disease type, duration and activity in the last six months; and medication use were similar between patients with positive and negative serology. There was a progressive increase in seroprevalence from July 2020 to April 2021. Conclusion Up to 1/3rd of patients with IBD were seropositive for immunoglobulin G (IgG) SARS-Cov-2 antibody indicating high seroprevalence in patients with IBD from Northern India.
Human Reproduction
Study question Does immune response to COVID-19 vaccination affect the clinical outcome in fully ... more Study question Does immune response to COVID-19 vaccination affect the clinical outcome in fully vaccinated infertile women undergoing IVF/ICSI cycles? Summary answer COVID-19 IgG antibodies are present in follicular fluid post vaccination and higher immune response increases duration of gonadotrophins required and negatively impacts the IVF outcome. What is known already Recent studies assessed the influence of COVID-19 infection and mRNA COVID-19 vaccine on the stimulation cycle characteristics and embryological variables of patients undergoing IVF cycle and found no effect on the IVF outcome in their immediate IVF cycle after recovery, except for a decreased number of top quality embryos. One study reported infection or mRNA vaccine results in rapid formation of anti-COVID IgG which can be detected in follicular fluid. This immune response did not lead to any significant negative effect on ovarian follicular function. There is a possibility that COVID-19 infection might affect nu...
Silent Hypoxia in Coronavirus disease-2019: Is it more dangerous? -A retrospective cohort study
Lung India
BackgroundHypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Sile... more BackgroundHypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterized by the presence of hypoxia without dyspnea.. Silent hypoxia has been shown to affect the outcomes in previous studies.Research QuestionAre the outcomes in patients presenting with silent hypoxia different from those presenting with dyspneic hypoxia?Study design and MethodsThis was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory, and treatment parameters in patients with silent hypoxia and dyspneic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality.ResultsAmong 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2<94% at the time of presentation. 174 (21.45%) did not have dyspnea since the onset of COVID-19 symptoms. 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspneic hypoxic patients (P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851).InterpretationSilent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively. Since home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry at the home setting to identify these patients.
Impact of various hematological and biochemical parameters on mortality in coronavirus disease 2019 (COVID-19): A single-center study from North India
Lung India
Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronaviru... more Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronavirus disease 2019 (COVID-19), has rapidly evolved into a pandemic, affecting more than 90 million people and more than 1.9 million deaths worldwide. Despite extensive study, the prognostic role of various hematological and biochemical parameters remains unclear. Methods: This study was carried out at a COVID care facility in Delhi. The demographic and clinical information, laboratory parameters (hematological, biochemical, and inflammatory), and the treatment of admitted COVID-19 patients during first wave were collected from electronic medical records and were subsequently analyzed. Results: Between March 2020 and November 2020, a total of 5574 patients were admitted to hospital due to COVID-19. Majority (77.2%) were male and had a mean (standard deviation [SD]) age of 38.9 (14.9) years. The mean (SD) duration of hospital stay was significantly higher in nonsurvivors. Out of the entire cohort, 8.7% of the patients had comorbidities, whereas 47.1% of the patients were asymptomatic at presentation. Compared to the survivors, the nonsurvivors had a significantly higher proportion of comorbidities and were more likely to be symptomatic. Patients who died during hospital stay had significantly higher relative neutrophil percent and neutrophil–lymphocyte ratio and lower lymphocyte percent. The patients who died had significantly higher levels of ferritin, D-dimer, and fibrinogen. Conclusions: Analysis of various hematological and inflammatory parameters can provide useful prognostic information among COVID-19-affected patients. It can also help in identifying patients who merit aggressive institutional care and thereby potentially mitigate the mortality.
Gastroenterology
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Journal of Crohn's and Colitis, 2022
The information on seroprevalence rates of COVID-19 infection among patients with inflammatory bo... more The information on seroprevalence rates of COVID-19 infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in immunocompromised and immunocompetent IBD patients and healthy controls. Patients with IBD under follow-up at the IBD clinic, All India Institute of Medical Sciences, New Delhi, were included. After obtaining informed consent, patients underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Seimens kit IgG against antigen S1RBD) and information on demography, drug history, past history of COVID infection and vaccination status were noted. Patients with IBD on 5-aminosalicylic acid or not on any treatment were considered immunocompetent and those who had received steroids, thiopurines or methotrexate within 6 months of sample collection were considered immunocompromised. 235 patients (51.9%-males; mean age at enrolment-38.7±12.4 years; median disease duration-60 months ...
ImportanceBoth vaccination and natural infection lead to immunity and may augment mutual immune r... more ImportanceBoth vaccination and natural infection lead to immunity and may augment mutual immune response against SARS-CoV-2. There is a need for an evidence-driven booster vaccination policy depending on durability of immune response.ObjectiveTo determine the durability of humoral immune response with varying age, vaccine type, duration, and previous natural infection at least six months after complete vaccination with ChAdOx1 nCov-19 or BBV152.DesignCross-sectional observational study conducted between November 2021 and January 2022.SettingParticipants were drawn from a DBT COVID-19 Research Consortium cohort in Delhi National Capital Region, India.ParticipantsWe included 2003 individuals who had completed six months after complete vaccination: (i) vaccination with ChAdOx1 nCoV-19 and aged 18-59 years, (ii) vaccination with ChAdOx1 nCoV-19 and aged ≥60 years (iii) vaccination with BBV152 and aged 18-59 years (iv) vaccination with BBV152 and aged ≥60 years (v) vaccination with eithe...
Robust and sustained antibody response to SARS‐CoV‐2 in a child pre and post autologous hematopoietic stem cell transplant
Pediatric Blood & Cancer, 2020
To the Editor: The coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory... more To the Editor: The coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been evolving rapidly, and till date has resulted in over a million deaths worldwide. Previous reports have suggested that the severity of the disease is mild and self-limiting upper respiratory tract infection in most children.1 The characterization of COVID-19 in pediatric cancer and hematopoietic stem cell transplant (HSCT) patients is limited in the available literature. The effects of COVID-19 infection on the outcomes of HSCT in children are still being explored. Children with malignancies and those post HSCT have persistent immunealterations evenmonths after treatment completion. Lowantibody concentrations have been demonstrated in amajority of patients, regardless of the malignancy and chemotherapy regimen.2 This has compounded the uncertainties in the management of pediatric HSCT patients. The antibody response in the immunosuppressed population may not be robust, and delayed clearance of the live virus could be a problem. Uncertainty exists on when a child could be fit for intensive chemotherapy and HSCT after an infection with SARS-CoV-2. The European blood andmarrow transplant (EBMT) society guidelines state that if a transplant candidate is diagnosed with COVID-19, a deferral of HSCT by at least 3months is advisable.3 Here, we report the case of a child who was able to mount a good antibody response to the novel coronavirus despite being on chemotherapy in the recent past, and the response was sustained during and after his successful autologous HSCT. A 3-year-old child with n-myc gene amplified, high-risk, stageIII, left-sided suprarenal neuroblastoma achieved complete remission after induction chemotherapy on theOPEC/OJECprotocol.4 His autologous stem cells had been previously harvested and stored. Due to delay in admission for his autologous HSCT, caused because of the lockdown imposed during the COVID-19 pandemic, he received two extra cycles of irinotecan and temozolomide. Two months post his last chemotherapy cycle, he was taken up for consolidation with an autologous HSCT. Before admission for HSCT, the child underwent a mandatory screening test for the SARS-CoV-2 and was found to be positive by the cartridge-based nucleic acid amplification test (CBNAAT). After 2 weeks of home isolation, during which time the child remained asymptomatic, the child tested negative by CBNAAT, on the 17th day. His total serum SARS-CoV-2 antibody titers (IgG and IgM), estimated using chemiluminescent immunoassay, were reactive with an index of >10 (>1 taken as reactive). The child was started (6 days after testing negative) on his HSCTconditioning regimen consisting of busulfan at a dose of 1 mg/kg intravenously every 6 h for 4 days (day −6 to day −3) and melphalan at a dose of 140mg/m2 intravenously on day−2. Hewas infusedhis prestored stemcells onday0, and theCD34+ cell dose given was 1 × 106/kg. Post his stem cell infusion, the child developed complications of mucositis, febrile neutropenia, and Clostridium difficile colitis, which were managed with supportive care and appropriate antibiotics. The child also developed rapid respiration, low-grade fever, and facial puffiness on day+16, whichwas attributed to engraftment syndrome. He received 3 days of low-dose oral steroids for the same. Neutrophil engraftment was achieved on day +18, and platelet engraftment occurred on day +24. His SARS-CoV-2 antibody titers that were repeated on day 0 and day+22 (ie, on the 37th and 55th day from initial positivity) were reactive, with titer indices being greater than 10 each time. The total leucocyte count (TLC) and absolute neutrophil count (ANC) in relation to the antibody titers are shown in Figure 1. The child was discharged after a successful HSCT. The immune response to the SARS-CoV-2 infection is varied in different population groups. Children who are post chemotherapy and HSCT are immunosuppressed and are considered high-risk groups. Chemotherapy and HSCT, both allogeneic and autologous, cause defects in humoral and cell-mediated immunity. It is established that they have decreased antibody titers against common infections and vaccine-preventable diseases.5 Hypogammaglobulinemia secondary to chemotherapy and HSCT is a common complication and is found more in younger children.6 Antibodies are important in defense against viruses. Virus-elicited antibodies provide lifelong surveillance and protection from future infections.7 Imunoglobulin (Ig) M and IgG antibodies to SARS-CoV-2 develop between the first and second week of infection in most cases. In mild cases, the antibody response may take longer and in a minority the antibodies may not be detected at all. The detection of antibodies to SARS-CoV-2 does not indicate directly protective immunity parameters for protection are yet unestablished.8 Unlike the experience in the SARS-CoV-1 infection where about half of the patients…
Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers & implications of infection control practice in India
Indian Journal of Medical Research, 2021
Background & objectives: Healthcare workers (HCWs) are considered to be at a high risk of con... more Background & objectives: Healthcare workers (HCWs) are considered to be at a high risk of contracting COVID-19 infection. Besides, control of nosocomial infections transmitted from HCWs to the patients is also a cause of concern. This study was undertaken to investigate the seroprevalence of antibodies against the SARS-CoV-2 virus among the hospital staff of a tertiary care health facility in north India. Methods: The HCWs were tested for SARS-CoV-2 serology (IgG+IgM) using chemiluminescence immunoassay between June 22 and July 24, 2020. Venous blood (2 ml) was collected and tested for SARS-CoV-2 IgG and IgM antibodies. Results: Of the 3739 HCWs tested, 487 (13%) were positive for total SARS-CoV-2 antibodies. The highest seroprevalence was observed in administrative staff (19.6%) and least in physicians (5.4%). The staff who used public (20%) and hospital transportation (16.9%) showed higher seroprevalence compared to staff using personal transportation (12.4%). No difference was observed between HCWs posted in COVID versus non-COVID areas. All seropositive symptomatic HCWs in our study (53.6%) had mild symptoms, and the remaining 46.4 per cent were asymptomatic. The antibody positivity rate progressively increased from 7.0 per cent in the first week to 18.6 per cent in the fourth week during the study. Interpretation & conclusions: The presence of antibodies to SARS-CoV-2 in a significant number of asymptomatic HCWs, association with the use of public transport, relatively lower seroprevalence compared with the non-HCWs and rising trend during the period of the study highlight the need for serosurveillance, creating awareness for infection control practices including social distancing and study of infection dynamics in the community for effective control of an infectious pandemic.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
A 25-year-old primigravida was referred at 20 weeks of gestation for ultrasound examination. On e... more A 25-year-old primigravida was referred at 20 weeks of gestation for ultrasound examination. On examination, foetal cardiac activity was present with normal placenta with three vessel cords and amniotic fluid volume was reduced. However, there was absence of cranial vault, cerebral hemispheres and diencephalic structures. The facial structures and orbits were present. Findings were consistent with "acrania-anencephaly sequence". During pregnancy, several tests conducted like HIV, VDRL, routine urine examination, haematological profile, thyroid function tests were found to be within normal limits. As antenatal findings were incompatible with life, the patient was offered for termination of pregnancy. Abortus was sent to pathology department for postmortem examination.
Fryns syndrome: A rare case report with review of literature
Journal of Dr. NTR University of Health Sciences, 2018
Fryns syndrome is a rare multiple congenital anomaly syndrome with incidence of 0.7-1 in 10,000 b... more Fryns syndrome is a rare multiple congenital anomaly syndrome with incidence of 0.7-1 in 10,000 births. Characteristic features of this syndrome are congenital diaphragmatic hernia, lung hypoplasia, unusual facial features, limb defects and parental consanguinity. Here we report a case of Fryns syndrome of consanguineous parents at the gestation age of 27 week old. Mother presented to department of obstetrics and gynaecology with inability to perceive fetal movements. Ultasonography revealed polyhydramnios, intrauterine growth retardation, and congenital anomaly of diaphragm and absence of fetal heart sound. Based on ultrasound findings, clinical diagnosis of congenital diaphragmatic hernia was made for which therapeutic abortion was performed and a still born fetus was delivered which was sent for post mortem study. On autopsy, diagnosis of Fryns syndrome was made.
A Randomis ed Control Trial of Statin and Asp irin as Adjuvant Therapy in Patients with SARS-CoV-2 Infec tion (RESIST Trial)
SSRN Electronic Journal, 2021
Background: Statins and aspirin have been advocated for treatment of Covid-19 owing to anti-infla... more Background: Statins and aspirin have been advocated for treatment of Covid-19 owing to anti-inflammatory and anti-thrombotic properties and have shown favorable results in observational studies. There is a need for randomized controlled trial.Methods: We conducted a single-center, four-arm parallel design, open-label randomized controlled trial on RT-PCR positive Covid-19 patients, ≥ 40 years and < 75 years of age, requiring hospitalization [World Health Organization (WHO) Ordinal Scale for Clinical Improvement 3 to 5]. Patients were randomly assigned to either atorvastatin 40 mg (group A), aspirin 75 mg (group B), or both (group C) in addition to standard of care for 10 days or until discharge whichever was earlier or only standard of care (group D). The primary outcome variable was clinical deterioration to WHO Ordinal Scale for Clinical Improvement ≥ 6. The secondary outcome was change in serum inflammatory markers (C-reactive protein and Interleukin-6), and Troponin I.Finding...
Cureus, 2021
Background There is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis i... more Background There is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis infection (LTBI). Methodology We analyzed data of admitted COVID-19 patients evaluated for LTBI to examine the impact of LTBI on severity, laboratory parameters, and COVID-19 outcome. Prospectively collected data were analyzed for 60 patients who were administered the Mantoux tuberculosis skin test (TST) using five tuberculin units of purified protein derivative. All patients were administered TST irrespective of Bacille Calmette-Guérin (BCG) vaccination status. Comorbidities, clinical features, radiologic involvement, laboratory parameters, and clinical course were analyzed concerning LTBI. Results The mean age was 45.9 (±15.2) years, and 35 (58.3%) patients had non-severe disease. The vast majority (n = 56/60; 93.3%) had been vaccinated with single-dose BCG in infancy or early childhood, as per national immunization guidelines. LTBI was diagnosed in 15 (25%) patients. LTBI prevalence was lower in severe (n = 1/25; 4%) than non-severe (n = 14/35; 40%) COVID-19 (p = 0.01) patients. LTBI patients had lower percentage neutrophil count, higher lymphocyte percentage, higher monocyte count, lower neutrophillymphocyte (NL) ratio, lower alanine aminotransferase, lower C-reactive protein, and lesser radiologic involvement compared to those without LTBI (p < 0.05). Similarly, among the mild COVID-19 subgroup, those with LTBI had higher lymphocyte and monocyte counts and lesser radiologic involvement than those without LTBI (p < 0.05). Conclusions LTBI patients appear to have milder disease, higher lymphocyte and monocyte count, higher NL ratio, and lesser radiographic involvement. This observation needs to be studied in larger studies using interferon release assays.
A rare case of leukemia cutis in T-cell acute lymphoblastic leukemia (T-ALL) in an elderly patient
Annals of Pathology and Laboratory Medicine, 2016
Primary cutaneous involvement in T-cell acute lymphoblastic leukemia (ALL) is rare in elderly pat... more Primary cutaneous involvement in T-cell acute lymphoblastic leukemia (ALL) is rare in elderly patients. Here we present a case of 65 years old male admitted to a metropolitan tertiary care hospital because of maculo-papular lesions on chest and back for last 3 months as chief complaint along with on and off history of fever, fatigability and anorexia. On general examination, there was no lymphadenopathy. Per-abdomen examination revealed hepato-splenomegaly. CT scan of chest and abdomen showed para-tracheal, pre-tracheal, carinal, hilar and abdominal lymphadenopathy. Peripheral blood smear and bone marrow aspiration showed more than 80% of lymphoblasts. Flow cytometry of the bone marrow aspirate showed CD7, CD5, CD45 and TdT positivity indicating T–cell origin. Skin biopsy from maculo-papular lesion revealed secondary leukemic infiltration of the skin. Corroborating all the above findings, a final diagnosis of T-cell ALL with leukemia cutis was made. Thereafter patient was given chem...
Eosinophilic Cholecystitis with Lipomatosis: a rare case report and review of literature
Annals of Pathology and Laboratory Medicine, 2016
Eosinophilic cholecystitis and Lipomatosis of gallbladder are two different diseases, rarely occu... more Eosinophilic cholecystitis and Lipomatosis of gallbladder are two different diseases, rarely occurring together. Both are diagnosed histopathologically. A 45 years old female who underwent routine elective laparoscopic cholecystectomy for chronic cholecystitis was diagnosed eosinophilic cholecystitis with cholelithiasis and lipomatosis on histopathological examination of gall bladder. This could be first case report of this unique combination . The rarity of the condition prompted us to report this case.
Journal of Biosciences and Medicines, 2021
Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they... more Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.
Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): A single-centre randomized, placebo-controlled trial
Journal of Infection and Chemotherapy, 2021
Introduction Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe a... more Introduction Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load. Hence, Ivermectin is under investigation as a repurposed agent for treating COVID-19. Methods In this pilot, double blind, randomized controlled trial, hospitalized patients with mild-to-moderate COVID-19 were assigned to a single oral administration of an elixir formulation of Ivermectin at either 24 mg or 12 mg dose, or placebo in a 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment. Safety outcomes included total and serious adverse events. The primary outcomes were assessed in patients who had positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes were assessed in all patients who received the intervention (intention-to-treat population). Results Among the 157 patients randomized, 125 were included in modified intention-to-treat analysis. 40 patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%; 12 mg arm, 35.0%; and placebo arm, 31.1%; p-value = 0.30). The decline of viral load at day 5 was similar in each arm. No serious adverse events occurred. Conclusions In patients with mild and moderate COVID-19, a single oral administration of Ivermectin did not significantly increase either the negativity of RT-PCR or decline in viral load at day 5 of enrolment compared with placebo.
BackgroundThe second wave of the COVID-19 pandemic hit India from early April 2021 to June 2021 a... more BackgroundThe second wave of the COVID-19 pandemic hit India from early April 2021 to June 2021 and more than 400,000 cases per day were reported in the country. We describe the clinical features, demography, treatment trends, baseline laboratory parameters of a cohort of patients admitted at the All India Institute of Medical Sciences, New Delhi with SARS-CoV-2 infection and their association with the outcome.MethodsThis was a retrospective cohort study describing the clinical, laboratory and treatment patterns of consecutive patients admitted with SARS-CoV-2 infection. Multivariate logistic regression models were fitted to identify the clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay and death.FindingsA total of 2080 patients were included in the study. The case fatality rate was 19.5%. Amongst the survivors, the median duration of hospital stay was 8 (5-11) days. Out of 853 (42.3%%) of patients who had COVID-19 Acute respiratory di...
The Evaluation of Laboratory Parameters as Predictors of Disease Severity and Mortality in COVID-19 Patients: A Retrospective Study From a Tertiary Care Hospital in India
Cureus
Evaluation of hematological parameters in covid-19 infected patients
Indian Journal of Hematology and Blood Transfusion, 2020
Indian Journal of Gastroenterology
Background The information on seroprevalence of severe acute respiratory syndrome coronavirus 2 (... more Background The information on seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in patients with IBD and healthy controls (HCs). Methods Patients with IBD and HCs (contact of patients) underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Siemens kit IgG against antigen-S1RBD) between July 2020 and April 2021. Information on demography, disease characteristics, drug history and past history of SARS-CoV-2 infection were noted. Patients on 5-aminosalicylic acid or no treatment were considered not on immunosuppressants and those who had received steroids, thiopurines or methotrexate within six months of inclusion were considered being on immunosuppressants. Results A total of 235 patients (51.9%, males; mean age, 38.7 ± 12.4 years; median disease duration, 60 months [interquartile range, IQR: 36-120]) (ulcerative colitis [UC]: 69.4%, Crohn's disease [CD]: 28.9%, IBD unclassified [IBDU]: 1.7%) and 73 HCs (mean age, 39.6 ± 10.9 years, 80% males) were enrolled. Of the 235 patients, 128 (54.5%) patients were on immunosuppressants and 107 (45.5%) were not on immunosuppressants. Seventy-four (31.5%) patients were seropositive, of which two (0.9%) had previous history of SARS-CoV-2 infection and none received coronavirus disease-19 (COVID-19) vaccine. Seroprevalence between IBD patients and HCs (32% vs. 27%, p > 0.05) and between patients with and without immunosuppressants (28.1% vs. 36%, p > 0.05) was similar. Age, gender, disease type, duration and activity in the last six months; and medication use were similar between patients with positive and negative serology. There was a progressive increase in seroprevalence from July 2020 to April 2021. Conclusion Up to 1/3rd of patients with IBD were seropositive for immunoglobulin G (IgG) SARS-Cov-2 antibody indicating high seroprevalence in patients with IBD from Northern India.
Human Reproduction
Study question Does immune response to COVID-19 vaccination affect the clinical outcome in fully ... more Study question Does immune response to COVID-19 vaccination affect the clinical outcome in fully vaccinated infertile women undergoing IVF/ICSI cycles? Summary answer COVID-19 IgG antibodies are present in follicular fluid post vaccination and higher immune response increases duration of gonadotrophins required and negatively impacts the IVF outcome. What is known already Recent studies assessed the influence of COVID-19 infection and mRNA COVID-19 vaccine on the stimulation cycle characteristics and embryological variables of patients undergoing IVF cycle and found no effect on the IVF outcome in their immediate IVF cycle after recovery, except for a decreased number of top quality embryos. One study reported infection or mRNA vaccine results in rapid formation of anti-COVID IgG which can be detected in follicular fluid. This immune response did not lead to any significant negative effect on ovarian follicular function. There is a possibility that COVID-19 infection might affect nu...
Silent Hypoxia in Coronavirus disease-2019: Is it more dangerous? -A retrospective cohort study
Lung India
BackgroundHypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Sile... more BackgroundHypoxia in patients with COVID-19 is one of the strongest predictors of mortality. Silent hypoxia is characterized by the presence of hypoxia without dyspnea.. Silent hypoxia has been shown to affect the outcomes in previous studies.Research QuestionAre the outcomes in patients presenting with silent hypoxia different from those presenting with dyspneic hypoxia?Study design and MethodsThis was a retrospective study of a cohort of patients with SARS-CoV-2 infection who were hypoxic at presentation. Clinical, laboratory, and treatment parameters in patients with silent hypoxia and dyspneic hypoxia were compared. Multivariate logistic regression models were fitted to identify the factors predicting mortality.ResultsAmong 2080 patients with COVID-19 admitted to our hospital, 811 patients were hypoxic with SpO2<94% at the time of presentation. 174 (21.45%) did not have dyspnea since the onset of COVID-19 symptoms. 5.2% of patients were completely asymptomatic for COVID-19 and were found to be hypoxic only on pulse oximetry. The case fatality rate in patients with silent hypoxia was 45.4% as compared to 40.03% in dyspneic hypoxic patients (P=0.202). The odds ratio of death was 1.1 (95% CI 0.41-2.97) in the patients with silent hypoxia after adjusting for baseline characteristics, laboratory parameters, treatment, and in-hospital complications, which did not reach statistical significance (P=0.851).InterpretationSilent hypoxia may be the only presenting feature of COVID-19. Since the case fatality rate is comparable between silent and dyspneic hypoxia, it should be recognized early and treated as aggressively. Since home isolation is recommended in patients with COVID-19, it is essential to use pulse oximetry at the home setting to identify these patients.
Impact of various hematological and biochemical parameters on mortality in coronavirus disease 2019 (COVID-19): A single-center study from North India
Lung India
Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronaviru... more Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), which causes coronavirus disease 2019 (COVID-19), has rapidly evolved into a pandemic, affecting more than 90 million people and more than 1.9 million deaths worldwide. Despite extensive study, the prognostic role of various hematological and biochemical parameters remains unclear. Methods: This study was carried out at a COVID care facility in Delhi. The demographic and clinical information, laboratory parameters (hematological, biochemical, and inflammatory), and the treatment of admitted COVID-19 patients during first wave were collected from electronic medical records and were subsequently analyzed. Results: Between March 2020 and November 2020, a total of 5574 patients were admitted to hospital due to COVID-19. Majority (77.2%) were male and had a mean (standard deviation [SD]) age of 38.9 (14.9) years. The mean (SD) duration of hospital stay was significantly higher in nonsurvivors. Out of the entire cohort, 8.7% of the patients had comorbidities, whereas 47.1% of the patients were asymptomatic at presentation. Compared to the survivors, the nonsurvivors had a significantly higher proportion of comorbidities and were more likely to be symptomatic. Patients who died during hospital stay had significantly higher relative neutrophil percent and neutrophil–lymphocyte ratio and lower lymphocyte percent. The patients who died had significantly higher levels of ferritin, D-dimer, and fibrinogen. Conclusions: Analysis of various hematological and inflammatory parameters can provide useful prognostic information among COVID-19-affected patients. It can also help in identifying patients who merit aggressive institutional care and thereby potentially mitigate the mortality.
Gastroenterology
Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on ... more Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre-including this research content-immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
Journal of Crohn's and Colitis, 2022
The information on seroprevalence rates of COVID-19 infection among patients with inflammatory bo... more The information on seroprevalence rates of COVID-19 infection among patients with inflammatory bowel disease (IBD) and its comparison to healthy controls is sparse. We compared the seroprevalence rates in immunocompromised and immunocompetent IBD patients and healthy controls. Patients with IBD under follow-up at the IBD clinic, All India Institute of Medical Sciences, New Delhi, were included. After obtaining informed consent, patients underwent SARS-CoV-2 antibody testing (chemiluminescent immunoassay: Seimens kit IgG against antigen S1RBD) and information on demography, drug history, past history of COVID infection and vaccination status were noted. Patients with IBD on 5-aminosalicylic acid or not on any treatment were considered immunocompetent and those who had received steroids, thiopurines or methotrexate within 6 months of sample collection were considered immunocompromised. 235 patients (51.9%-males; mean age at enrolment-38.7±12.4 years; median disease duration-60 months ...
ImportanceBoth vaccination and natural infection lead to immunity and may augment mutual immune r... more ImportanceBoth vaccination and natural infection lead to immunity and may augment mutual immune response against SARS-CoV-2. There is a need for an evidence-driven booster vaccination policy depending on durability of immune response.ObjectiveTo determine the durability of humoral immune response with varying age, vaccine type, duration, and previous natural infection at least six months after complete vaccination with ChAdOx1 nCov-19 or BBV152.DesignCross-sectional observational study conducted between November 2021 and January 2022.SettingParticipants were drawn from a DBT COVID-19 Research Consortium cohort in Delhi National Capital Region, India.ParticipantsWe included 2003 individuals who had completed six months after complete vaccination: (i) vaccination with ChAdOx1 nCoV-19 and aged 18-59 years, (ii) vaccination with ChAdOx1 nCoV-19 and aged ≥60 years (iii) vaccination with BBV152 and aged 18-59 years (iv) vaccination with BBV152 and aged ≥60 years (v) vaccination with eithe...
Robust and sustained antibody response to SARS‐CoV‐2 in a child pre and post autologous hematopoietic stem cell transplant
Pediatric Blood & Cancer, 2020
To the Editor: The coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory... more To the Editor: The coronavirus disease (COVID)-19 pandemic caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been evolving rapidly, and till date has resulted in over a million deaths worldwide. Previous reports have suggested that the severity of the disease is mild and self-limiting upper respiratory tract infection in most children.1 The characterization of COVID-19 in pediatric cancer and hematopoietic stem cell transplant (HSCT) patients is limited in the available literature. The effects of COVID-19 infection on the outcomes of HSCT in children are still being explored. Children with malignancies and those post HSCT have persistent immunealterations evenmonths after treatment completion. Lowantibody concentrations have been demonstrated in amajority of patients, regardless of the malignancy and chemotherapy regimen.2 This has compounded the uncertainties in the management of pediatric HSCT patients. The antibody response in the immunosuppressed population may not be robust, and delayed clearance of the live virus could be a problem. Uncertainty exists on when a child could be fit for intensive chemotherapy and HSCT after an infection with SARS-CoV-2. The European blood andmarrow transplant (EBMT) society guidelines state that if a transplant candidate is diagnosed with COVID-19, a deferral of HSCT by at least 3months is advisable.3 Here, we report the case of a child who was able to mount a good antibody response to the novel coronavirus despite being on chemotherapy in the recent past, and the response was sustained during and after his successful autologous HSCT. A 3-year-old child with n-myc gene amplified, high-risk, stageIII, left-sided suprarenal neuroblastoma achieved complete remission after induction chemotherapy on theOPEC/OJECprotocol.4 His autologous stem cells had been previously harvested and stored. Due to delay in admission for his autologous HSCT, caused because of the lockdown imposed during the COVID-19 pandemic, he received two extra cycles of irinotecan and temozolomide. Two months post his last chemotherapy cycle, he was taken up for consolidation with an autologous HSCT. Before admission for HSCT, the child underwent a mandatory screening test for the SARS-CoV-2 and was found to be positive by the cartridge-based nucleic acid amplification test (CBNAAT). After 2 weeks of home isolation, during which time the child remained asymptomatic, the child tested negative by CBNAAT, on the 17th day. His total serum SARS-CoV-2 antibody titers (IgG and IgM), estimated using chemiluminescent immunoassay, were reactive with an index of >10 (>1 taken as reactive). The child was started (6 days after testing negative) on his HSCTconditioning regimen consisting of busulfan at a dose of 1 mg/kg intravenously every 6 h for 4 days (day −6 to day −3) and melphalan at a dose of 140mg/m2 intravenously on day−2. Hewas infusedhis prestored stemcells onday0, and theCD34+ cell dose given was 1 × 106/kg. Post his stem cell infusion, the child developed complications of mucositis, febrile neutropenia, and Clostridium difficile colitis, which were managed with supportive care and appropriate antibiotics. The child also developed rapid respiration, low-grade fever, and facial puffiness on day+16, whichwas attributed to engraftment syndrome. He received 3 days of low-dose oral steroids for the same. Neutrophil engraftment was achieved on day +18, and platelet engraftment occurred on day +24. His SARS-CoV-2 antibody titers that were repeated on day 0 and day+22 (ie, on the 37th and 55th day from initial positivity) were reactive, with titer indices being greater than 10 each time. The total leucocyte count (TLC) and absolute neutrophil count (ANC) in relation to the antibody titers are shown in Figure 1. The child was discharged after a successful HSCT. The immune response to the SARS-CoV-2 infection is varied in different population groups. Children who are post chemotherapy and HSCT are immunosuppressed and are considered high-risk groups. Chemotherapy and HSCT, both allogeneic and autologous, cause defects in humoral and cell-mediated immunity. It is established that they have decreased antibody titers against common infections and vaccine-preventable diseases.5 Hypogammaglobulinemia secondary to chemotherapy and HSCT is a common complication and is found more in younger children.6 Antibodies are important in defense against viruses. Virus-elicited antibodies provide lifelong surveillance and protection from future infections.7 Imunoglobulin (Ig) M and IgG antibodies to SARS-CoV-2 develop between the first and second week of infection in most cases. In mild cases, the antibody response may take longer and in a minority the antibodies may not be detected at all. The detection of antibodies to SARS-CoV-2 does not indicate directly protective immunity parameters for protection are yet unestablished.8 Unlike the experience in the SARS-CoV-1 infection where about half of the patients…
Seroprevalence of antibodies to SARS-CoV-2 in healthcare workers & implications of infection control practice in India
Indian Journal of Medical Research, 2021
Background & objectives: Healthcare workers (HCWs) are considered to be at a high risk of con... more Background & objectives: Healthcare workers (HCWs) are considered to be at a high risk of contracting COVID-19 infection. Besides, control of nosocomial infections transmitted from HCWs to the patients is also a cause of concern. This study was undertaken to investigate the seroprevalence of antibodies against the SARS-CoV-2 virus among the hospital staff of a tertiary care health facility in north India. Methods: The HCWs were tested for SARS-CoV-2 serology (IgG+IgM) using chemiluminescence immunoassay between June 22 and July 24, 2020. Venous blood (2 ml) was collected and tested for SARS-CoV-2 IgG and IgM antibodies. Results: Of the 3739 HCWs tested, 487 (13%) were positive for total SARS-CoV-2 antibodies. The highest seroprevalence was observed in administrative staff (19.6%) and least in physicians (5.4%). The staff who used public (20%) and hospital transportation (16.9%) showed higher seroprevalence compared to staff using personal transportation (12.4%). No difference was observed between HCWs posted in COVID versus non-COVID areas. All seropositive symptomatic HCWs in our study (53.6%) had mild symptoms, and the remaining 46.4 per cent were asymptomatic. The antibody positivity rate progressively increased from 7.0 per cent in the first week to 18.6 per cent in the fourth week during the study. Interpretation & conclusions: The presence of antibodies to SARS-CoV-2 in a significant number of asymptomatic HCWs, association with the use of public transport, relatively lower seroprevalence compared with the non-HCWs and rising trend during the period of the study highlight the need for serosurveillance, creating awareness for infection control practices including social distancing and study of infection dynamics in the community for effective control of an infectious pandemic.
JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH, 2018
A 25-year-old primigravida was referred at 20 weeks of gestation for ultrasound examination. On e... more A 25-year-old primigravida was referred at 20 weeks of gestation for ultrasound examination. On examination, foetal cardiac activity was present with normal placenta with three vessel cords and amniotic fluid volume was reduced. However, there was absence of cranial vault, cerebral hemispheres and diencephalic structures. The facial structures and orbits were present. Findings were consistent with "acrania-anencephaly sequence". During pregnancy, several tests conducted like HIV, VDRL, routine urine examination, haematological profile, thyroid function tests were found to be within normal limits. As antenatal findings were incompatible with life, the patient was offered for termination of pregnancy. Abortus was sent to pathology department for postmortem examination.
Fryns syndrome: A rare case report with review of literature
Journal of Dr. NTR University of Health Sciences, 2018
Fryns syndrome is a rare multiple congenital anomaly syndrome with incidence of 0.7-1 in 10,000 b... more Fryns syndrome is a rare multiple congenital anomaly syndrome with incidence of 0.7-1 in 10,000 births. Characteristic features of this syndrome are congenital diaphragmatic hernia, lung hypoplasia, unusual facial features, limb defects and parental consanguinity. Here we report a case of Fryns syndrome of consanguineous parents at the gestation age of 27 week old. Mother presented to department of obstetrics and gynaecology with inability to perceive fetal movements. Ultasonography revealed polyhydramnios, intrauterine growth retardation, and congenital anomaly of diaphragm and absence of fetal heart sound. Based on ultrasound findings, clinical diagnosis of congenital diaphragmatic hernia was made for which therapeutic abortion was performed and a still born fetus was delivered which was sent for post mortem study. On autopsy, diagnosis of Fryns syndrome was made.
A Randomis ed Control Trial of Statin and Asp irin as Adjuvant Therapy in Patients with SARS-CoV-2 Infec tion (RESIST Trial)
SSRN Electronic Journal, 2021
Background: Statins and aspirin have been advocated for treatment of Covid-19 owing to anti-infla... more Background: Statins and aspirin have been advocated for treatment of Covid-19 owing to anti-inflammatory and anti-thrombotic properties and have shown favorable results in observational studies. There is a need for randomized controlled trial.Methods: We conducted a single-center, four-arm parallel design, open-label randomized controlled trial on RT-PCR positive Covid-19 patients, ≥ 40 years and < 75 years of age, requiring hospitalization [World Health Organization (WHO) Ordinal Scale for Clinical Improvement 3 to 5]. Patients were randomly assigned to either atorvastatin 40 mg (group A), aspirin 75 mg (group B), or both (group C) in addition to standard of care for 10 days or until discharge whichever was earlier or only standard of care (group D). The primary outcome variable was clinical deterioration to WHO Ordinal Scale for Clinical Improvement ≥ 6. The secondary outcome was change in serum inflammatory markers (C-reactive protein and Interleukin-6), and Troponin I.Finding...
Cureus, 2021
Background There is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis i... more Background There is limited data on coronavirus disease 2019 (COVID-19) and latent tuberculosis infection (LTBI). Methodology We analyzed data of admitted COVID-19 patients evaluated for LTBI to examine the impact of LTBI on severity, laboratory parameters, and COVID-19 outcome. Prospectively collected data were analyzed for 60 patients who were administered the Mantoux tuberculosis skin test (TST) using five tuberculin units of purified protein derivative. All patients were administered TST irrespective of Bacille Calmette-Guérin (BCG) vaccination status. Comorbidities, clinical features, radiologic involvement, laboratory parameters, and clinical course were analyzed concerning LTBI. Results The mean age was 45.9 (±15.2) years, and 35 (58.3%) patients had non-severe disease. The vast majority (n = 56/60; 93.3%) had been vaccinated with single-dose BCG in infancy or early childhood, as per national immunization guidelines. LTBI was diagnosed in 15 (25%) patients. LTBI prevalence was lower in severe (n = 1/25; 4%) than non-severe (n = 14/35; 40%) COVID-19 (p = 0.01) patients. LTBI patients had lower percentage neutrophil count, higher lymphocyte percentage, higher monocyte count, lower neutrophillymphocyte (NL) ratio, lower alanine aminotransferase, lower C-reactive protein, and lesser radiologic involvement compared to those without LTBI (p < 0.05). Similarly, among the mild COVID-19 subgroup, those with LTBI had higher lymphocyte and monocyte counts and lesser radiologic involvement than those without LTBI (p < 0.05). Conclusions LTBI patients appear to have milder disease, higher lymphocyte and monocyte count, higher NL ratio, and lesser radiographic involvement. This observation needs to be studied in larger studies using interferon release assays.
A rare case of leukemia cutis in T-cell acute lymphoblastic leukemia (T-ALL) in an elderly patient
Annals of Pathology and Laboratory Medicine, 2016
Primary cutaneous involvement in T-cell acute lymphoblastic leukemia (ALL) is rare in elderly pat... more Primary cutaneous involvement in T-cell acute lymphoblastic leukemia (ALL) is rare in elderly patients. Here we present a case of 65 years old male admitted to a metropolitan tertiary care hospital because of maculo-papular lesions on chest and back for last 3 months as chief complaint along with on and off history of fever, fatigability and anorexia. On general examination, there was no lymphadenopathy. Per-abdomen examination revealed hepato-splenomegaly. CT scan of chest and abdomen showed para-tracheal, pre-tracheal, carinal, hilar and abdominal lymphadenopathy. Peripheral blood smear and bone marrow aspiration showed more than 80% of lymphoblasts. Flow cytometry of the bone marrow aspirate showed CD7, CD5, CD45 and TdT positivity indicating T–cell origin. Skin biopsy from maculo-papular lesion revealed secondary leukemic infiltration of the skin. Corroborating all the above findings, a final diagnosis of T-cell ALL with leukemia cutis was made. Thereafter patient was given chem...
Eosinophilic Cholecystitis with Lipomatosis: a rare case report and review of literature
Annals of Pathology and Laboratory Medicine, 2016
Eosinophilic cholecystitis and Lipomatosis of gallbladder are two different diseases, rarely occu... more Eosinophilic cholecystitis and Lipomatosis of gallbladder are two different diseases, rarely occurring together. Both are diagnosed histopathologically. A 45 years old female who underwent routine elective laparoscopic cholecystectomy for chronic cholecystitis was diagnosed eosinophilic cholecystitis with cholelithiasis and lipomatosis on histopathological examination of gall bladder. This could be first case report of this unique combination . The rarity of the condition prompted us to report this case.
Journal of Biosciences and Medicines, 2021
Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they... more Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.
Single-dose oral ivermectin in mild and moderate COVID-19 (RIVET-COV): A single-centre randomized, placebo-controlled trial
Journal of Infection and Chemotherapy, 2021
Introduction Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe a... more Introduction Ivermectin is an antiparasitic drug which has in-vitro efficacy in reducing severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) viral load. Hence, Ivermectin is under investigation as a repurposed agent for treating COVID-19. Methods In this pilot, double blind, randomized controlled trial, hospitalized patients with mild-to-moderate COVID-19 were assigned to a single oral administration of an elixir formulation of Ivermectin at either 24 mg or 12 mg dose, or placebo in a 1:1:1 ratio. The co-primary outcomes were conversion of RT-PCR to negative result and the decline of viral load at day 5 of enrolment. Safety outcomes included total and serious adverse events. The primary outcomes were assessed in patients who had positive RT-PCR at enrolment (modified intention-to-treat population). Safety outcomes were assessed in all patients who received the intervention (intention-to-treat population). Results Among the 157 patients randomized, 125 were included in modified intention-to-treat analysis. 40 patients each were assigned to Ivermectin 24 mg and 12 mg, and 45 patients to placebo. The RT-PCR negativity at day 5 was higher in the two Ivermectin arms but failed to attain statistical significance (Ivermectin 24 mg, 47.5%; 12 mg arm, 35.0%; and placebo arm, 31.1%; p-value = 0.30). The decline of viral load at day 5 was similar in each arm. No serious adverse events occurred. Conclusions In patients with mild and moderate COVID-19, a single oral administration of Ivermectin did not significantly increase either the negativity of RT-PCR or decline in viral load at day 5 of enrolment compared with placebo.
BackgroundThe second wave of the COVID-19 pandemic hit India from early April 2021 to June 2021 a... more BackgroundThe second wave of the COVID-19 pandemic hit India from early April 2021 to June 2021 and more than 400,000 cases per day were reported in the country. We describe the clinical features, demography, treatment trends, baseline laboratory parameters of a cohort of patients admitted at the All India Institute of Medical Sciences, New Delhi with SARS-CoV-2 infection and their association with the outcome.MethodsThis was a retrospective cohort study describing the clinical, laboratory and treatment patterns of consecutive patients admitted with SARS-CoV-2 infection. Multivariate logistic regression models were fitted to identify the clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay and death.FindingsA total of 2080 patients were included in the study. The case fatality rate was 19.5%. Amongst the survivors, the median duration of hospital stay was 8 (5-11) days. Out of 853 (42.3%%) of patients who had COVID-19 Acute respiratory di...