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

INTRODUCTION

The effects of COVID-19 infection persist beyond the active phase. Comprehensive description and analysis of the post COVID sequelae in various population groups are critical to minimise the long-term morbidity and mortality associated with COVID-19. This analysis was conducted with an objective to estimate the frequency of post COVID sequelae and subsequently, design a framework for holistic management of post COVID morbidities.

METHODS

Follow-up data collected as part of a registry-based observational study in 31 hospitals across India since September 2020-October 2022 were used for analysis. All consenting hospitalised patients with COVID-19 are telephonically followed up for up to 1 year post-discharge, using a prestructured form focused on symptom reporting.

RESULTS

Dyspnoea, fatigue and mental health issues were reported among 18.6%, 10.5% and 9.3% of the 8042 participants at first follow-up of 30-60 days post-discharge, respectively, which reduced to 11.9%, 6.6% and 9%, respectively, at 1-year follow-up in 2192 participants. Patients who died within 90 days post-discharge were significantly older (adjusted OR (aOR): 1.02, 95% CI: 1.01, 1.03), with at least one comorbidity (aOR: 1.76, 95% CI: 1.31, 2.35), and a higher proportion had required intensive care unit admission during the initial hospitalisation due to COVID-19 (aOR: 1.49, 95% CI: 1.08, 2.06) and were discharged at WHO ordinal scale 6-7 (aOR: 49.13 95% CI: 25.43, 94.92). Anti-SARS-CoV-2 vaccination (at least one dose) was protective against such post-discharge mortality (aOR: 0.19, 95% CI: 0.01, 0.03).

CONCLUSION

Hospitalised patients with COVID-19 experience a variety of long-term sequelae after discharge from hospitals which persists although in reduced proportions until 12 months post-discharge. Developing a holistic management framework with engagement of care outreach workers as well as teleconsultation is a way forward in effective management of post COVID morbidities as well as reducing mortality.

Investigation of community outbreak of enteric fever associated with drinking water in Borsad, Anand, Gujarat

Background:  Enteric fever is an endemic health problem and frequently associated with outbreaks. Objectives: Investigate sudden surge in gastroenteritis cases to confirm the outbreak, describe it in terms of time place and person, identify source of infection, modes of transmission and suggest remedial measures. Material & Methodology: Field visit was undertaken by the rapid response team (RRT) at Borsad town of Anand district in Gujarat for investigating suspected typhoid outbreak. This involved gathering information from local authorities, hospital admissions and home visits; collection of blood samples and water samples. Result:  Of 30 suspected cases, 19 (63.3%) tested Widal positive. Common presenting symptoms were fever, vomiting followed by diarrhea and abdominal pain. Chlorine levels at source and end users were inadequate. 5 leakage points in water supply were identified in areas around the clustered cases. Conclusion and Recommendations: Leakage in piped water supply coupled with inadequate chlorination lead to contaminated drinking water and subsequent Typhoid epidemic. Corrective steps in form of rapid surveys to identify cases, household chlorination and appropriate engineering measures were recommended and implemented.

Surveillance of pregnant women with potential exposure to Zika virus following travel

AIM

To describe the experience of a single fetal medicine unit in evaluating pregnant women with potential exposure to Zika virus (ZIKV) following travel.

METHOD

Between February 2016 and June 2017, a multidisciplinary team evaluated pregnant women by developing a local pathway based on Public Health England guidance. All pregnant women were offered serial fetal ultrasound scans (USS). If they presented with a history of clinical symptoms consistent with ZIKV infection during or within two weeks of travel or fetal USS was suggestive of microcephaly, reverse transcriptase polymerase chain reaction (RT PCR) and/or serology was used.

RESULTS

69 women were referred. Eight patients reported symptoms consistent with ZIKV infection (11.6%) and six (8.7%) patients reported mosquito bites. Maternal exposure was mainly during the preconception period and the first trimester in 35 (50.8%) and 19 (27.5%) women, respectively. Prenatally, there was no evidence of microcephaly in any of the 69 referrals. Sixty-two live births and seven miscarriages were reported. One patient had serology confirming ZIKV infection during pregnancy. At birth, 57 babies had normal head circumference (HC) measurements, including the baby born to the Zika positive mother. Two babies had small HC measurements but were not infected and were small for gestational age.

CONCLUSIONS

One case of maternal ZIKV infection was detected but without any fetal congenital abnormalities postnatally. The number of potentially infected patients referred to our unit is a demonstration of the concern regarding perinatal ZIKV infection in the pregnant population.

[Morphologic and molecular neuropathology of Alzheimer's disease]

Alzheimer disease lesions include the abnormal accumulation of two proteins normally present in neurons: tau protein and Abeta peptide. Tau protein aggregates into fibrils in the cell body of neurons (neurofibrillary tangles), in dendrites (neuropil threads) and in degenerating axons that constitute the corona of the senile plaque. Tau pathology progresses in the brain areas in a stereotyped manner and in parallel with the clinical symptoms. Abeta extracellular deposits may be diffuse or focal. The Abeta focal deposit constitutes the core of the senile plaque. Progression of the Abeta lesions, which initially affect the isocortex, then the hippocampus, basal ganglia, various brainstem nuclei and cerebellum, is not directly correlated with symptoms. Mutations involving the genes implicated in Abeta peptide metabolism are responsible for familial Alzheimer disease. Mutations of the tau gene are not associated with Alzheimer disease but with frontotemporal dementia. The link between altered Abeta peptide metabolism and tau pathology has not been fully elucidated. Animal models mimic several aspects of the disease and have contributed to a better understanding of the mechanisms of the lesions.

The p16(INK4A) protein and flavopiridol restore yeast cell growth inhibited by Cdk4

Cyclin-dependent kinase 4 (Cdk4) activity is misregulated in most cancers. Loss of Cdk4 regulation can occur through overexpression of Cdk4 catalytic subunit or its regulatory partner cyclin D1, or if the Cdk4-specific inhibitory protein p16(INK4A) is inactive. We have attempted to express the two human subunits, Cdk4 and cyclin D1, in the yeast Saccharomyces cerevisiae. Surprisingly, expression of Cdk4 alone, under control of the strong GAL promoter, inhibits cell growth. Coexpression of both subunits allows formation of an active Cdk4-cyclin D1 complex which accentuates growth arrest. In cells expressing Cdk4 only, growth is restored by overexpressing human Cdc37, a Cdk4-binding molecular chaperone. Interestingly, the effect of Cdk4 on yeast is also overcome by both p16- and p21-families of Cdk-inhibitory proteins. Moreover, flavopiridol, a compound which inhibits Cdk4 enzyme activity, restores cell division. The fact that p16(INK4A) and flavopiridol negate Cdk4-mediated suppression of yeast cell growth implies that this simple system can be used as a screen for identifying Cdk4-specific antagonists which may mimic p16(INK4A) in the cancer cell cycle.