CC BY
10
CLINICAL AND EPIDEMIOLOGICAL CHARACTERISTICS OF COVID -19 IN JAIPUR, INDIA _DURING THE PANDEMIC_
Buranchieva A.A., Mayank Sharma
International Higher School of Medicine, Bishkek, Kyrgyz Republic
ABSTRACT
Until now, the problem of coronavirus infection remains pressing, and many issues of this pathology remain open and little studied. The article examines COVID-19 clinical and epidemiological characteristics in Jaipur, India.
Keywords: coronavirus infection, epidemiology, clinic, age, gender, clinical forms, lethality.
Introduction
Among acute respiratory viral infections, coronavirus infection takes a leading place, second to influenza. On January 3, 2020, in Wuhan (Hubei Province, China) Chinese services reported 44 cases of pneumonia to the WHO, and on March 11, 2020 WHO officially declared a pandemic of coronavirus infection. As a result of this large-scale pandemic, as of August 18, 2020 there were about 30 million cases and more than 950,000 deaths worldwide.
This article provides an overview of coronavirus infection in Jaipur (Rajasthan, India).
Objective
To study clinical and epidemiological data of coronavirus infection in Jaipur during a pandemic.
Materials and methods.
The study is based on a retrospective analysis of 275 medical patient records admitted to the Infectious disease hospital (IDH Hospital, Jaipur). Microsoft
Office Excel 2016 (Microsoft, USA) and Statistica 10 (StatSoft Inc., USA) software was used for the statistical analysis.
Results.
The 500-bed Jaipur Infectious Hospital was repurposed into a hospital for patients with COVID-19 during the pandemic. The hospital received patients from Bhilwara, Jhunjhunu, Churu, Ajmer, Dholpur, Tonk, Osmanabad, Mumbai, Alwar, Karauli h other localities. Between February and July 275 patients diagnosed with COVID-19 were admitted to the hospital. Most of the patients (168 patients or 61%) were residents of the city of Jaipur.
Age groups of patients are presented as follows: 014 years - 6 patients (2.1%), 15-20 years - 19 patients (6.9%), 21-30 years - 55 patients (20%), 31-40 years -45 patients (16.4%), 41-50 years -36 patients (13.1%), 51-60 years - 48 patients (17.5%), and 60 plus years -66 patients (24%).
80 60 40 20
71
20 16,4 13,1 17,5 24
2,1 6,9 1 1 I 1
29
0-14 15-20 21-30 31-40 41-50 51-60 > 60 male
female
Figure. 1. Age structure of COVID-19 patients
As the above Fig.1. displays that most patients were between the ages of 21 and 40 years representing 36.4% and those over 51 years old - 41.5%. Men were 81 (71%), women 33 (29%).
Based on the study of epidemiological history 94 patients (82.5%) confirmed contacts with COVID-19 infected people, contact was unknown in 6 patients (17.5%). It should be noted that there were two patients who arrived in February from Italy.
80 60 40 20 0
62
49
9 10 . ■ 1 25 20 13 15 14 13
8 III 10 10 ll
9 11 12 13 14 15 16 17 18 19 20 21 22 23 24
0
Figure. 2. Incidence of COVID-19 in weeks
As the Fig.2. shows, the first patients diagnosed with COVID-19 were registered starting February 29, 2020 (9th week). There was a slight decrease in cases in the 16th and 17th weeks, followed by the increase in 18th week to 25 cases.
Children between the ages of 0 and 14 years were admitted to hospital for observation mainly as contact persons. All observed children had no clinical manifestations related to COVID-19, however the
laboratory PCR showed positive results in all children. As are result, all children were diagnosed with asymptomatic form of COVID-19. There were no deaths among the children.
Patients in the age groups between 15 and 60 years as well as over 60 years were both with clinical symptoms of the disease (60%) and without (40%). (Fig. 3.).
80% 60% 40% 20% 0%
60%
40%
patients with clinical forms asymptomatic forms
Fig. 3. Clinical forms of COVID-19
Asymptomatic forms
80 60 40 20 0
68,4
35,1
.6 >- I
11,6 Ш
0-14
15-20 21-30 31-40 41-50 51-60
> 60
male female
Fig. 4. Age structure of asymptomatic forms of COVID-19
As you can see from the Fig.4. among all the asymptomatic patients 68.4% were men and 31.6% -women. Majority of the asymptomatic patients were young, between 21 and 30 years.
Notably 82.5% of asymptomatic patients confirmed earlier contacts with COVID-19 infected, and 17.5% of the patients the contacts denied.
The diagnosis of asymptomatic form was confirmed by laboratory positive PCR tests. It is very
important to note that in this group of patients there were 4 deaths, mainly due to concomitant pathology of diabetes mellitus, obesity, hypertension, CAD, primary postpartum hemorrhage sepsis, multiple organ dysfunction syndrome, acute kidney injury. All of them were treated in the Intensive care unit without Ventilator.
In a group of patients with clinical symptoms, we observed the following:
Patients with clinical symptoms
80 -74'5
60 I
40 15 5 15 5 23'6 ■ I25'5
_ - ■ 5 Bill
16-20 21-30 31-40 41-50 51-60 >60 male
female
Fig. 5. Age structure of COVID-19 clinical symptoms
Fig.5. shows most patients with clinical forms were over 51 years of age including 74.5% men and 25.5% women.
Notably, 89% of patients reported prior contacts with COVID-19 infected individuals, and 11% of the patients did not have contact.
The diagnosis of COVID-19 in patients with clinical manifestations was also confirmed by laboratory PCR positive results.
Frequent signs (10%)>
Clinical signs
Breathlessness 26.5%
Fever 21%
Dry cough 17%
Occasional signs (10%)<
Clinical signs
Breathlessness, B/L pneumonitis 5.8%
Nausea, vomiting, diarrhea 2,2%
Abdominal distension, abdominal pain 2.2%
Mild chest discomfort 2%
Chills 2%
Hemoptysis 2%
Sore throat 1.8%
Palpitation 1%
Shortness of breath was a frequent symptom of the disease, which was more common in patients over the age of 23.
Clinical manifestations of coronavirus infection such as fever and dry cough were not observed in all patients, only in 21% and 17% respectively.
Infrequent manifestations of the disease included diarrhea syndrome, abdominal syndrome and DIC syndrome. In these cases there were registered comorbidities, such as diabetes mellitus, hypertension, chronic renal disease, mitral stenosis due to rheumatic heart disease, percutaneous transluminal coronary
As can be seen from Tab.1, the highest percentage of mortality in coronavirus infection was observed in the age group over 60 years of age (41%) and in 15-20 years group (26%).
All hospitalized patients were examined by the laboratory diagnostic method of RNA-dependent RNA polymerase, and all the results turned out to be positive.
Conclusions
India (Jaipur, Rajasthan) did not escape the Coronavirus infection. COVID-19 was observed in all age groups, including children and the elderly. Asymptomatic forms were more common in young people, clinical manifestations of infection with complications and deaths were observed in patients over 60 years of age, patients with asymptomatic forms and with typical clinical manifestations, with
angioplasty (PTCA), liver disease, stroke, nephrotic syndrome, multiple organ dysfunction syndrome (MODS), acute kidney injury (AKI).
In the group with clinical manifestations, one in four patients (25.1%) was in the intensive care unit. Of those on a ventilator there were mainly patients older than 50 years of age, 16 patients (or 6%); whereas 18-year-olds were the ones that needed ventilator the least.
14 patients (8.7%) developed complications such as B/L Pneumonitis, B/L Pneumonia, respiratory distress syndrome, coronary artery disease, acute coronary syndrome, shock, altered sensorium.
Table 1
comorbidities, complications and death were registered. The diagnosis of COVID-19 was confirmed by laboratory positive PCR test.
Financing: The study had not sponsorship
Conflict of interest: The authors declare no conflicts of interest.
Our sincere gratitude to the Infectious Diseases Hospital of Jaipur city for provided data.
References
l.Severe Outcomes Among Patients with Coronavirus Disease 2019. 2020. Available from: https://www.cdc.gov/mmwr/volumes/69/wr/mm6912e 2.htm [Last accessed on 2020 May 04]
Age Lethality Comorbidities
0-14 years 0 % no
15-20 years old 26% acute inflammatory demyelinating polyradiculoneuropathy -GBS, nephrotic syndrome, multiple organ dysfunction syndrome, acute kidney injury, primary postpartum hemorrhage sepsis, polytrauma
21-30 years old 7% diabetes mellitus, hypertension, chronic renal disease, post appendicectomy
31-40 years old 6% adenocarcinoma, diabetes mellitus, obesity, malignancy, hypertension, cerebrovascular accident, congestive heart failure
41-50 years old 14% diabetes mellitus, hypertension, chronic renal disease, mitral stenosis due to rheumatic heart disease
51-60 years old 14.6% diabetes mellitus, hypertension, hypothyroidism, br. asthma, acute myocardial infarction
over 60 41% diabetes mellitus, hypertension, post percutaneous transluminal coronary angioplasty, liver disease, stroke
2.Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506.
3.World Health Organization. Coronavirus disease (COVID-2019) situation reports (https://www.who.int/emergencies/ diseases/novel-coronavirus-2019/situation -reports/).
Author's contact:
1.Buranchieva Aisuluu Arifovna Candidate of medical sciences, associate professor of infectious diseases department, International Higher School of Medicine 996772900601
2.Mayank Sharma student of the International Higher School of Medicine.
"EFFECTS OF COVID-19 ON SKIN CONDITION"
Shakirova A. T., Zakirov T.J., Kurmanalieva A. U., Torobekova S.A., Shriyam Bhatt
ISM
Department of infectious diseases and dermatovenerology
I.K. Akhunbaev KSMA Department of dermatovenereology Bishkek, Kyrgyz Republic
SUMMARY
This article provides general information about skin lesions in COVID-19, provides detailed information about the elements of the rash, stages of severity and course. Examples of skin changes during coronavirus infection are given, the most common dermatoses are divided into groups. A skin rash in the presence of this infection can appear in people of any age, and moreover, it can worsen and complicate the course of the primary skin process.
Key words: COVID-19, rash, clinic, course, skin process. An increased background radiation, climate warming, environmental changes, an increase in population density, high migration activity of the population and other factors provoke the emergence and spread of new infections around the world.
The emergence in December 2019 of diseases caused by the new coronavirus has already gone down in history as an emergency of international importance. 02/11/2020 The World Health Organization has officially named the SARS-CoV-2 virus and the disease that is caused by this virus "COVID-19". 03/11/2020 The world organization declared the outbreak of coronavirus a pandemic (epidemic) [1, 2].
Coronaviruses are enveloped viruses with single-stranded "+" RNA, with genome sizes ranging from 25 to 32 thousand nucleotides, causing respiratory and intestinal diseases in animals and humans.
Currently, information on the epidemiology, clinical features, prevention and treatment of the new coronavirus infection caused by the SARS-CoV-2 virus (COVID-19) is constantly being supplemented and updated.
It is known that the most common clinical manifestation of a new infection is pneumonia, as well as respiratory distress syndrome in a significant part of patients. The defeat of the gastrointestinal tract and liver is detected in more than half of patients with COVID-19. In this case, the disease can begin with gastroenterological manifestations, which are subsequently joined by respiratory symptoms. The presence of lesions of the gastrointestinal tract and liver in patients with COVID-19 worsens the prognosis of the disease and increases the risk of mortality .In addition to respiratory failure, symptoms of COVID-19 are disruption of the central nervous system, cardiovascular system, disruption of the intestines, kidneys and other internal organs. Although COVID-19 is not a skin disease, it has a profound effect on dermatological manifestations (2,3). In the case of coronavirus infection, overexpression of pro-
inflammatory cytokines (low-molecular information soluble proteins that provide signaling between cells) can be observed, which leads to an imbalance in the inflammatory response, and this, in turn, can provoke the development of certain skin rashes [3].
For the current period, there are clinical observations describing skin lesions in the new coronavirus infection COVID-19. One of the first descriptions of skin manifestations in COVID-19 was published by the Italian dermatologist Recalcati S. (2020), who cited data on possible types of skin lesions as a variant of the manifestation of a new coronavirus infection COVID-19. While there is no final summarized data on the dermatological manifestations of COVID-19 from around the world, there is information from China, Spain, England and the United States. In these countries, studies were carried out on the basis of national medical centers that treated patients with coronavirus - in total, doctors described more than 350 cases of COVID-19 with skin symptoms [4, 6].
Symptoms of a new coronavirus infection can occur in almost the entire body, including the skin. Skin symptoms in people with coronavirus appear in different ways. Some point to a milder course of COVID-19, while others serve as a marker for a severe variant of the disease. Knowing the skin manifestations in COVID-19 will help diagnose the infection earlier and correctly assess the risks of each patient [5].
The skin best of all reflects the state of processes occurring in the human body, and is a kind of indicator of the state of the body. In many diseases of the internal organs, there are characteristic skin manifestations. A rash can be a symptom of infection with viruses, fungi, bacteria and allergies. Some types of skin rashes are
