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Karna ST, Ahmad Z, Thaware P, Trivedi S, Gouroumourty R, Singh P, Waindeskar V, Sharma JP, Kaushal A, Saigal S. Postoperative Outcomes After Emergency Surgery in COVID-19 Patients: An Ambispective Matched Cohort Study. Cureus 2024; 16:e55845. [PMID: 38590490 PMCID: PMC11001162 DOI: 10.7759/cureus.55845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
Purpose There is limited data from the Indian subcontinent regarding the surgical outcomes of coronavirus disease (COVID-19) patients. In this observational study, we aimed to evaluate the postoperative outcomes after emergency surgery in COVID-19 patients compared to concurrent age and gender-matched controls. We also sought to analyze the possible predictors of postoperative mortality in COVID-19 patients. Methods This matched cohort study was conducted in a tertiary care teaching hospital in central India, between 1st July 2021 and 30th June 2022. COVID-19-positive patients undergoing emergency surgery under anesthesia were recruited as cases. Age and gender-matched COVID-19-negative patients undergoing a similar nature of surgery in the same period served as concurrent controls. The cases and controls were compared for the 30-day mortality and perioperative complications. Results The COVID-19-positive surgical cohort had a 12.3 times greater 30-day postoperative overall mortality risk as compared to a matched cohort of patients with a negative COVID-19 test. A positive COVID-19 status was associated with more postoperative complications of acute respiratory distress syndrome (ARDS), sepsis, shock, and persistent hyperglycemia. On analysis of predictors of mortality, the presence of preoperative dyspnea, ARDS, American Society of Anesthesiologists Physical Status (ASA-PS) Class IIIE/IVE, increase in sequential organ failure assessment (SOFA) score, Quick SOFA>1, higher creatinine, bilirubin, and lower albumin were observed to be associated with increased mortality. Conclusions Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients undergoing emergency surgery is significantly associated with higher postoperative complications and increased 30-day postoperative mortality.
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Affiliation(s)
- Sunaina T Karna
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Zainab Ahmad
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Thaware
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Trivedi
- Anesthesiology, Chirayu Medical College and Hospital, Bhopal, IND
| | - Revadi Gouroumourty
- Community & Family Medicine, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Pooja Singh
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Vaishali Waindeskar
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Jai Prakash Sharma
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Ashutosh Kaushal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
| | - Saurabh Saigal
- Anesthesiology, All India Institute of Medical Sciences, Bhopal, Bhopal, IND
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Bestari R, Nainggolan IRA, Hasibuan M, Ratnanggana R, Rahardjo K, Nastri AM, Dewantari JR, Soetjipto S, Lusida MI, Mori Y, Shimizu K, Kusumawati RL, Ichwan M, Lubis IND. SARS-CoV-2 lineages circulating during the first wave of the pandemic in North Sumatra, Indonesia. IJID REGIONS 2023; 8:S1-S7. [PMID: 37799539 PMCID: PMC10548867 DOI: 10.1016/j.ijregi.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/12/2023] [Accepted: 07/16/2023] [Indexed: 10/07/2023]
Abstract
Objectives To determine the lineage distribution of the virus during the first wave of the pandemic in North Sumatra, Indonesia. Methods A total of 20 samples with positive results based on reverse transcription-polymerase chain reaction were selected for virus culture and then performed whole-genome sequence analysis using next-generation sequencing which was applied by the Illumina MiSeq instrument. Results Whole-genome sequence analysis revealed that the majority of our samples belong to lineages B.1.468 (n = 10), B.1 (n = 5), B.1.1 (n = 2), B.1.1.398 (n = 2), and B.6 (n = 1). Other unique amino acid mutations found in our samples were present in A58T on non-structural protein (NSP3) (70%), P323L on NSP12 (95%), Q57H on NS3 protein (75%), and D614G on S (100%). Conclusion The SARS-CoV-2 lineage B.1.468 may be the main virus variant circulating in North Sumatra at the beginning of the emergence of COVID-19 cases in this province.
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Affiliation(s)
- Ramadhan Bestari
- Faculty of Medicine, Universitas Islam Sumatera Utara, Medan, Indonesia
| | | | - Mirzan Hasibuan
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Rima Ratnanggana
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Krisnoadi Rahardjo
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | | | | | | | - Maria Inge Lusida
- Institute of Tropical Disease, Airlangga University, Surabaya, Indonesia
| | - Yasuko Mori
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Chuo-ku, Japan
| | - Kazufumi Shimizu
- Center for Infectious Diseases, Kobe University Graduate School of Medicine, Chuo-ku, Japan
| | - R Lia Kusumawati
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
| | - Muhammad Ichwan
- Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
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Dhanasooraj D, Viswanathan P, Saphia S, Jose BP, Parambath FC, Sivadas S, Akash NP, Vimisha TV, Nair PR, Mohan A, Hafeez N, Poovullathi JK, Vadekkandiyil S, Govindan SKK, Khobragade R, Aravindan KP, Radhakrishnan C. Genomic surveillance of SARS-CoV-2 by sequencing the RBD region using Sanger sequencing from North Kerala. Front Public Health 2022; 10:974667. [PMID: 36091505 PMCID: PMC9454329 DOI: 10.3389/fpubh.2022.974667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/08/2022] [Indexed: 01/21/2023] Open
Abstract
Next Generation Sequencing (NGS) is the gold standard for the detection of new variants of SARS-CoV-2 including those which have immune escape properties, high infectivity, and variable severity. This test is helpful in genomic surveillance, for planning appropriate and timely public health interventions. But labs with NGS facilities are not available in small or medium research settings due to the high cost of setting up such a facility. Transportation of samples from many places to few centers for NGS testing also produces delays due to transportation and sample overload leading in turn to delays in patient management and community interventions. This becomes more important for patients traveling from hotspot regions or those suspected of harboring a new variant. Another major issue is the high cost of NGS-based tests. Thus, it may not be a good option for an economically viable surveillance program requiring immediate result generation and patient follow-up. The current study used a cost-effective facility which can be set up in a common research lab and which is replicable in similar centers with expertise in Sanger nucleotide sequencing. More samples can be processed at a time and can generate the results in a maximum of 2 days (1 day for a 24 h working lab). We analyzed the nucleotide sequence of the Receptor Binding Domain (RBD) region of SARS-CoV-2 by the Sanger sequencing using in-house developed methods. The SARS-CoV-2 variant surveillance was done during the period of March 2021 to May 2022 in the Northern region of Kerala, a state in India with a population of 36.4 million, for implementing appropriate timely interventions. Our findings broadly agree with those from elsewhere in India and other countries during the period.
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Affiliation(s)
- Dhananjayan Dhanasooraj
- Multidisciplinary Research Unit, Government Medical College, Kozhikode, Kerala, India,Dhananjayan Dhanasooraj
| | - Prasanth Viswanathan
- Virus Research and Diagnostic Laboratory, Government Medical College, Kozhikode, Kerala, India
| | - Shammy Saphia
- Multidisciplinary Research Unit, Government Medical College, Kozhikode, Kerala, India
| | - Beena Philomina Jose
- Department of Microbiology, Government Medical College, Kozhikode, Kerala, India
| | | | - Saritha Sivadas
- Virus Research and Diagnostic Laboratory, Government Medical College, Kozhikode, Kerala, India
| | - N. P. Akash
- Virus Research and Diagnostic Laboratory, Government Medical College, Kozhikode, Kerala, India
| | - T. V. Vimisha
- Virus Research and Diagnostic Laboratory, Government Medical College, Kozhikode, Kerala, India
| | | | - Anuja Mohan
- Virus Research and Diagnostic Laboratory, Government Medical College, Kozhikode, Kerala, India
| | - Nimin Hafeez
- Virus Research and Diagnostic Laboratory, Government Medical College, Kozhikode, Kerala, India
| | | | - Shameer Vadekkandiyil
- Department of General Medicine, Government Medical College, Kozhikode, Kerala, India
| | | | - Rajan Khobragade
- Department of Health and Family Welfare, Government of Kerala, Thiruvananthapuram, India
| | | | - Chandni Radhakrishnan
- Department of Emergency Medicine, Government Medical College, Kozhikode, Kerala, India,*Correspondence: Chandni Radhakrishnan
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Salvatore M, Purkayastha S, Ganapathi L, Bhattacharyya R, Kundu R, Zimmermann L, Ray D, Hazra A, Kleinsasser M, Solomon S, Subbaraman R, Mukherjee B. Lessons from SARS-CoV-2 in India: A data-driven framework for pandemic resilience. SCIENCE ADVANCES 2022; 8:eabp8621. [PMID: 35714183 PMCID: PMC9205583 DOI: 10.1126/sciadv.abp8621] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
India experienced a massive surge in SARS-CoV-2 infections and deaths during April to June 2021 despite having controlled the epidemic relatively well during 2020. Using counterfactual predictions from epidemiological disease transmission models, we produce evidence in support of how strengthening public health interventions early would have helped control transmission in the country and significantly reduced mortality during the second wave, even without harsh lockdowns. We argue that enhanced surveillance at district, state, and national levels and constant assessment of risk associated with increased transmission are critical for future pandemic responsiveness. Building on our retrospective analysis, we provide a tiered data-driven framework for timely escalation of future interventions as a tool for policy-makers.
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Affiliation(s)
- Maxwell Salvatore
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Lakshmi Ganapathi
- Division of Infectious Diseases, Boston Children’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Ritoban Kundu
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
| | - Lauren Zimmermann
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
| | - Debashree Ray
- Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Aditi Hazra
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Sunil Solomon
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ramnath Subbaraman
- Department of Public Health and Community Medicine and Center for Global Public Health, Tufts University School of Medicine, Boston, MA, USA
| | - Bhramar Mukherjee
- Department of Biostatistics, University of Michigan, Ann Arbor, MI, USA
- Center for Precision Health Data Science, University of Michigan, Ann Arbor, MI, USA
- Department of Epidemiology, University of Michigan, Ann Arbor, MI, USA
- Corresponding author.
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Gautam P, Paul D, Suroliya V, Garg R, Agarwal R, Das S, Kaur US, Pandey A, Bhugra A, Tarai B, Bihari C, Sarin SK, Gupta E. SARS-CoV-2 Lineage Tracking, and Evolving Trends Seen during Three Consecutive Peaks of Infection in Delhi, India: a Clinico-Genomic Study. Microbiol Spectr 2022; 10:e0272921. [PMID: 35311567 PMCID: PMC9045110 DOI: 10.1128/spectrum.02729-21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/17/2022] [Indexed: 11/20/2022] Open
Abstract
Since its advent, the pandemic has caused havoc in multiple waves due partly to amplified transmissibility and immune escape to vaccines. Delhi, India also witnessed brutal multiple peaks causing exponential rise in cases. Here we had retrospectively investigated clade variation, emergence of new lineages and varied clinical characteristics during those three peaks in order to understand the trajectory of the ongoing pandemic. In this study, a total of 123,378 samples were collected for a time span of 14 months (1 June 2020 to 3 August 2021) encompassing three different peaks in Delhi. A subset of 747 samples was processed for sequencing. Complete clinical and demographic details of all the enrolled cases were also collected. We detected 26 lineages across three peaks nonuniformly from 612 quality passed samples. The first peak was driven by diverse early variants, while the second one by B.1.36 and B.1.617.2, unlike third peak caused entirely by B.1.617.2. A total of 18,316 mutations with median of 34 were reported. Majority of mutations were present in less than 1% of samples. Differences in clinical characteristics across three peaks was also reported. To be ahead of the frequently changing course of the ongoing pandemic, it is of utmost importance that novel lineages be tracked continuously. Prioritized sequencing of sudden local outburst and community hot spots must be done to swiftly detect a novel mutation/lineage of potential clinical importance. IMPORTANCE Genome surveillance of the Delhi data provides a more detailed picture of diverse circulating lineages. The added value that the current study provides by clinical details of the patients is of importance. We looked at the shifting patterns of lineages, clinical characteristics and mutation types and mutation load during each successive infection surge in Delhi. The importance of widespread genomic surveillance cannot be stressed enough to timely detect new variants so that appropriate policies can be immediately implemented upon to help control the infection spread. The entire idea of genomic surveillance is to arm us with the clues as to how the novel mutations and/or variants can prove to be more transmissible and/or fatal. In India, the densely populated cities have an added concern of the huge burden that even the milder variants of the virus combined with co-morbidity can have on the community/primary health care centers.
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Affiliation(s)
- Pramod Gautam
- Genome Sequencing Laboratory, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Diptanu Paul
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Varun Suroliya
- Genome Sequencing Laboratory, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Rahul Garg
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Reshu Agarwal
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Santanu Das
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Urvinder S. Kaur
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Amit Pandey
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Arjun Bhugra
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Bansidhar Tarai
- Max Super Speciality Hospital, Max Healthcare, New Delhi, India
| | - Chhagan Bihari
- Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - S. K. Sarin
- Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Ekta Gupta
- Department of Clinical Virology, Institute of Liver and Biliary Sciences, New Delhi, India
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