Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2021 | Month : July | Volume : 15 | Issue : 7 | Page : LC09 - LC12 Full Version

Epidemiological Profile and Clinical Outcome of COVID-19 Patients in a Tertiary Care Hospital, Pune, India


Published: July 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/49154.15153
Prachi D Sondankar, Shubhangi U Agawane, Abhay B Mane, Parvinder S Chawla

1. Assistant Professor, Department of Community Medicine, Smt. Kashibai Navale Medical College and GH, Pune, Maharashtra, India. 2. Associate Professor, Department of Community Medicine, Smt. Kashibai Navale Medical College and GH, Pune, Maharashtra, India. 3. Professor, Department of Community Medicine, Smt. Kashibai Navale Medical College and GH, Pune, Maharashtra, India. 4. Professor and Head, Department of Community Medicine, Smt. Kashibai Navale Medical College and GH, Pune, Maharashtra, India.

Correspondence Address :
Prachi D Sondankar,
Assistant Professor, Department of Community Medicine, Smt. Kashibai Navale
Medical College and GH, Narhe, Pune-411041, Maharashtra, India.
E-mail: prachisondankar@gmail.com

Abstract

Introduction: The COVID-19 caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), has spread throughout the world from its place of origin in Wuhan city of China. From origin in December 2019 till May 2021, this disease affected 222 countries in the world with 152,534,452 confirmed cases. As on May 2021, India is the second worst affected country in the world.

Aim: To know the epidemiological profile and clinical outcome of COVID-19 positive patients to help in understanding the disease dynamics.

Materials and Methods: It was a cross-sectional, record based study at a tertiary care hospital. All the COVID-19 laboratory confirmed positive patients admitted from 15th June, 2020 to 15th September, 2020 were included in the study. Sample size was 1146. All the required data regarding patients were collected and analysed subsequently with the help of percentages, Z-test for proportion, Chi-square test and Odds ratio.

Results: The mean age of the patients was 47.06±17.4 years ranging from 1 to 92 years. Males were significantly higher in numbers than females. 30.19% patients had some or other co-morbidities. 89.8% patients were discharged and 9.2% patients died. More number of deaths occurred in higher age group and highest death rate was seen in the patients who had multiple co-morbidities.

Conclusion: The study concludes that most of the COVID-19 patients were middle aged and males were significantly more affected than females. Most of the patients were asymptomatic at the time of admission. It can be concluded that maximum patients had favourable clinical outcome as around 90% patients being discharged and case fatality rate was 9.2%. High rate of mortality was significantly associated with higher age and presence of co-morbidities.

Keywords

Coronavirus Disease-2019, Pandemic, Severe acute respiratory syndrome

In December 2019, a new respiratory tract infecting agent emerged in Wuhan city of China, known as SARS-CoV-2 (Severe Acute Respiratory Syndrome-Coronavirus-2) (1),(2),(3). World Health Organisation (WHO) under International Health Regulations declared this outbreak as a “Public Health Emergency of International Concern” (PHEIC) on 30th January 2020. WHO subsequently declared COVID-19 as a pandemic on 11th March, 2020 (4). From origin in December 2019 till May 2021, this disease affected 222 countries in the world with 152,534,452 confirmed cases. As on May 2021, India is the second worst affected country in the world (5).

In India, since the beginning highest cases were found in the state of Maharashtra (6). Pune city from Maharashtra emerged as a Corona capital with 1,61,945 confirmed cases in August 2020 and remained the number one district in Maharashtra till date with highest number of cases and deaths (7). Most people infected with the SARS-CoV-2 will experience mild to moderate respiratory illness and recover without requiring special treatment. But people with co-morbidities may land up in serious illness or it may lead to mortality in the affected individuals (8). As part of a comprehensive strategy, case identification, isolation, testing and care, and contact tracing and quarantine, are critical activities to reduce transmission and control the epidemic (9).

As the disease has evolved, our knowledge regarding the disease aetiology, pathogenesis, diagnosis, treatment and prevention has also evolved. Various data generated from various parts of the world have helped the researchers and scientists to analyse the information related to the coronavirus. Evidence generated through different research studies have helped in decision making and there has been a lot of improvement in case management as well as it has helped in clearing the present misconceptions about the disease through the time period (10). Thus, there is a need of generating evidence related to COVID-19 disease in all the possible aspects.

Study objective:

• To study the epidemiological profile of COVID-19 positive patients admitted in the tertiary care hospital.
• To know the clinical presentation and outcome of these patients.

Material and Methods

The study design was a cross-sectional, record based study at Smt. Kashibai Navale Medical College and GH, Pune, Maharashtra, India. The study was retrospective in aspect where all required data were taken from the Medical Records Department (MRD) of a tertiary care hospital. All medical records of patients were stored in electronic data form. Data of COVID-19 positive patients admitted in the hospital from 15th June, 2020 to 15th September, 2020 were taken for the study. COVID-19 Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) was used for diagnosis of COVID-19 disease. Various data regarding patients like demographic data, clinical presentation and their outcome was collected through preformed questionnaire and analysed.

Permission for data collection from MRD and conduct of study was obtained from head of the institute. Institutional Ethical Committee approval was taken prior to study (Ref. SKNMC/Ethics/App/2020/684 dated 15/10/2020). Confidentiality and anonymity was maintained throughout the study.

Inclusion criteria: All the COVID-19 laboratory confirmed positive patients with the COVID-19 RT-PCR test who were admitted in the tertiary care hospital during 15th June, 2020 to 15th September, 2020 i.e. three months duration were included in the study. Total 1146 patients were included in the study.

Exclusion criteria: Patients admitted with suspected COVID-19 infection during the above duration were excluded.

Data of 1146 patients were gathered from Medical Records Department (MRD). Secondary data about age and sex distribution, geographical distribution, presence of symptoms, data regarding various co-morbidities and clinical outcome of the patients was extracted from MRD. The study investigators checked the data and reviewed it for any missing data/inconsistent data. Necessary corrections were done with the help of staff from MRD.

Statistical Analysis

Data was collected and entered in Microsoft Excel spread sheet after coding. It was further processed and analyzed using Epidemiological Information (EPI-INFO) TM Version 7 Software. Mean, percentage, proportion and standard deviation was calculated based on type of data. Appropriate tests of significance like Z test for proportion, Chi-square test, Odds ratio were used. A p-value of <0.05 was considered as statistically significant.

Results

Total of 1146 patients were included in the study. The mean age of the patients was 47.06±17.4 years ranging from 1 to 92 years. Maximum patients were in the age group of 41 to 60 years. Total number of males were 705 (61.5%) and females were 441 (38.5%). Males were affected significantly more than females (z=10.969, p-value <0.001) (Table/Fig 1).

As per the geographic distribution of these patients, 616 (53.75%) patients were from urban area of Pune district, 509 (44.42%) were from rural area of Pune district and 21 (1.83%) were from area out of Pune District. Total 616 (53.8%) patients were asymptomatic at the time of admission while 530 (46.2%) were symptomatic or critical at the time of admission. Patients on ventilators at the time of admission were 47 (4.1%).

In the study, out of total 1146 patients, majority 800 (69.81%) patients had no co-morbidities. A 97 (8.46%) patients had diabetes mellitus and 82 (7.16%) patients had hypertension. Total 65 (5.67%) patients had both diabetes mellitus and hypertension, 67 (5.85%) patients had multiple co-morbidities and 35 (3.05%) patients had other single co-morbidities (Table/Fig 2).

In the clinical outcome of patients, 1028 (89.8%) patients were discharged, 106 (9.2%) died, 7 (0.6%) were Discharged Against Medical Advice (DAMA) and 5 (0.4%) were referred to other COVID care centres (Table/Fig 3).

Chance of death was significantly associated with the higher age group (χ2=129, p<0.001). No deaths were seen in <20 years age group (Table/Fig 4).

Deaths among males were 71 (66.98%) and among females were 35 (33.02%). Gender was not significantly associated with mortality (χ2=1.54, p=0.213). Maximum deaths (97.21%) were associated with co-morbidities. Only 2.79% deaths occured in the group without co-morbidities. Among the various co-morbidity groups, highest mortality was observed in the multiple co-morbidities group (Odds Ratio (OR)=23.5, Confidence Interval (C.I.)=12.31-44.86, p<0.001). Most significant single co-morbidity associated with death was hypertension (OR=9.79, C.I.=4.99-19.19, p<0.001) followed by diabetes (OR=4.45, C.I.=2.08-9.49, p<0.001) (Table/Fig 2).

Discussion

The mean age of the patients was 47.06±17.4 years ranging from 1 to 92 years and total number of males were 61.5% and females were 38.5% with male preponderance with a statistically significant difference. In study done in Pune by Tambe MP et al., (2), majority i.e., 109 (55.4%) were between the age group of 31-60 years; mean age was 45.8±17.3 years; ranging from four months to 85 years and there was a slight male preponderance with M:F ratio of 1:1.2. Also in the study in North India by Mohan A et al., (11),the mean age of the patients were 40.1±13.1 years, with 93.1% males. Similar findings were seen in the study done by Gupta N et al., (12) in tertiary care hospital in Delhi, where the mean age of the population was 40 years with a slight male predominance and also in the Sherwal BL et al., study (13) where the median age of participants was 48 years (09-95 years) and men to women ratio was 3.4:1 with a statistically significant difference. The findings can be attributed to the theory that middle-aged people are at more risk of exposure as they go out to work/ jobs or for other household work. Same reason can explain more male preponderance as they have higher risk of exposure than females. Bwire GM (14) mentioned that the biological differences in the immune systems do exist between men and women which may impact the ability to fight an infection including SARS-2-CoV-2 and author also quoted “Generally, females are more resistant to infections than men, and this is possibly mediated by several factors including sex hormones and high expression of coronavirus receptors (ACE 2) in men but also life style, such as higher levels of smoking and drinking among men as compared to women. Additionally, women have more responsible attitude towards COVID-19 pandemic than men. This may reversibly affect the undertaking of preventive measures such as frequent hand washing, wearing of face mask, and stay at home orders (14).

As per the geographic distribution of these patients, 53.75% patients were from urban area of Pune district, 44.42% patients were from rural area of Pune district and 1.83% were from area out of Pune District. Most of the patients were from the same district and few were referred from outside district for better management as this is a tertiary care hospital.

Majority i.e. 53.8% patients were asymptomatic at the time of admission while 46.2 % were symptomatic at the time of admission. Tambe MP et al., (2) mentioned 22.8% patients were asymptomatic from exposure to admission whereas Mohan A et al., (11) in North India mentioned a significant proportion of patients had no symptoms (44.4%). Majority of the patients were symptomatic in studies done by Gupta N et al., (12) and Sherwal BL et al., (13). WHO also states most people infected with the COVID-19 virus will experience mild to moderate respiratory illness (8).

In the study, majority i.e. 69.81% patients had no co-morbidities while 30.19% had some or other co-morbidity. Most common co-morbidity found was diabetes mellitus (8.46%) followed by hypertension (7.16%), 5.67% patients had both diabetes mellitus and hypertension and 5.85% patients had multiple co-morbidities. In a study by Tambe MP et al., (2) done in Pune, 52.8% had no history of any co-morbidity while 47.2% reported one or the other co-morbidity; hypertension being the most common one followed by diabetes. Mohan A et al., (11) found co-morbidities present in 15.9% patients, of which diabetes mellitus was the most common similar to present study. Sherwal BL et al., (13) study also showed 38.6% had various preexisting co-morbidities, most commonly diabetes mellitus (35.0%) and hypertension (34.0%). Diabetes mellitus and hypertension were the most common co-morbidities in COVID patients.

In present study, out of total patients, 89.8% patients were discharged, 9.2% died, 0.6% were DAMA and 0.4% were referred to other COVID care centres. Case fatality in present study was 9.2%. In Tambe MP et al., (2) study, case fatality rate of 29.4% was calculated and 37.6% recovered and were discharged. As the pandemic progressed throughout the world, better management protocols were developed through various researches and it reduced case fatality rate of the infection over the time.

In the present study, it was found that chance of death was significantly associated with the higher age group (p<0.001). Highest death rate was seen among above 80 years age group followed by 61-80 years age group. No deaths were seen in <20 years age group. In Tambe MP et al., (2) study, no deaths were seen in age group of 0-20 years and highest death rate of 45.4% was seen in age group 71-80 years followed by age group 51-60 years 41.6% similar to the present study. Sherwal BL et al., (13) in their study, also mentions that chance of death was significantly associated with the higher age group (p=0.005). In COVID-19 infection as age factor increases, rate of mortality also increases. In the present study, gender was not significantly associated with mortality (p=0.20), though more number of deaths occurred in males. In Tambe MP et al., (2) study overall male preponderance was seen among deaths. It can be assumed that, as males are more commonly infected with COVID-19 than females, hence mortality figures also show male preponderance but male gender is not significantly associated with the risk of death.

In the present study, maximum were discharged (97.21%) had no co-morbidity and only 2.79% deaths occured in the group without co-morbidities. Among the various co-morbidity groups, highest mortality was observed in the multiple co-morbidities group (OR=23.5, C.I.=12.31-44.86, p<0.001). Most significant single co-morbidity associated with death was hypertension (OR=9.79, C.I.=4.99-19.19, p<0.001) followed by diabetes (OR=4.45, C.I.=2.08-9.49, p<0.001). Tambe MP et al., (2) mentioned that out of 58 patients who died due to COVID 19, co-morbidity was one of the significant risk factor for death (Odds Ratio [OR]=16.8, 95% confidence interval [CI]=7.0-40.1, p<0.0001) similar to the present study.

The WHO (8) also states that older people, and those with underlying medical problems like cardiovascular disease, diabetes, chronic respiratory disease, and cancer are more likely to develop serious illness. Similar findings are seen in various other systematic review and meta-analysis studies done in various parts of the world by Sanyaolu A et al., (15), Zhou Y et al., (16), Yang J et al., (17).

The present study gives detailed insight regarding demographic and clinical parameters of COVID-19 affected individuals and their clinical outcome in a certain geographic area i.e. Pune, Maharashtra, India. This will be a valuable addition to the expanding COVID-19 knowledge base and will help in further research on this topic.

Limitation(s)

The study was record based study so available secondary data was used in the study. The study provides a general overview of the few disease aspects in the study area during study period, but it can not be generalisable as disease presentation, management and case fatality have changed from the start of the pandemic till date in different ways in different parts of the world.

Conclusion

This study presented a data of 1146 COVID-19 positive admitted patients in a tertiary care hospital in Pune. Epidemiological profile of patients showed that maximum patients were from the Pune district.It also showed most of the COVID-19 patients were middle aged and males were more affected than females. Most of the patients were asymptomatic at the time of admission. It can be concluded that maximum patients had favourable clinical outcome. Around 90% patients were discharged and case fatality rate was 9.2%. High rate of mortality was significantly associated with higher age and presence of co-morbidities.

Acknowledgement

The authors would like to acknowledge Medical Records Department for their help.

References

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DOI and Others

10.7860/JCDR/2021/49154.15153

Date of Submission: Feb 25, 2021
Date of Peer Review: May 14, 2021
Date of Acceptance: May 27, 2021
Date of Publishing: Jul 01, 2021

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? NA
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: May 05, 2021
• Manual Googling: Apr 28, 2021
• iThenticate Software: Jun 14, 2021 (15%)

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