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.
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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
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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.
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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
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,
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,
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
(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)
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.
On April 2011

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
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : August | Volume : 16 | Issue : 8 | Page : DC07 - DC11 Full Version

Clinical Manifestations and Sequelae of COVID-19 in First and Second Wave among Nursing Officers of a Tertiary Care Centre, New Delhi, India

Published: August 1, 2022 | DOI:
Suman R Kashyap, Suman Luthra, Nishat Hussain Ahmed

1. Nursing Superintendent, Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India. 2. Senior Nursing Officer, Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India. 3. Additional Professor, Department of Microbiology (Ocular Section), All India Institute of Medical Sciences, New Delhi, India.

Correspondence Address :
Dr. Nishat Hussain Ahmed,
Additional Professor, Department of Microbiology (Ocular Section), Dr. R.P. Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India.


Introduction: There are lot of challenges involved in studying the multiorgan manifestations and sequelae of acute Coronavirus Disease 2019 (COVID-19), that too in face of fighting the pandemic, which has led to fall short of resources and restriction in activities for prevention of transmission. The literature on persisting manifestations and sequelae of COVID-19 in the patients recovered in the first and second waves is scarce.

Aim: To study the presenting and persistent manifestations after acute COVID-19 illness in first and second wave among Nursing Officers (NOs) of a tertiary care Medical Institute.

Materials and Methods: This was a cross-sectional study conducted in Dr. Rajendra Prasad Centre for Ophthalmic Sciences at All India Institute of Medical Sciences, New Delhi, India, from 15th May 2021 to 31st October 2021. Total 103 nurses, who had recovered after testing positive for COVID-19 in the first and second wave were followed-up for persisting symptoms. Statistical analysis was done using Pearson Chi-square test.

Results: Total of 103 subjects were recruited in the study, 36 in the first wave and 67 in the second. Fever (72.82%), bodyache (67.96%) and fatigue (66.99%) were found to be the most common presenting manifestations in the study subjects having mild to moderate COVID-19 infection. Bodyache (p-value=0.048), headache (p-value=0.044) and fatigue (p-value=0.025) were seen in significantly more subjects in second wave as compared to first wave. Persistence of symptoms for more than four weeks was seen in 45.63% subjects. There was no statistically significant difference between persisting symptoms in the two waves, except sleep disturbances which were found to be persisting in significantly more subjects in second wave than those in first wave.

Conclusion: The data of current study will add to the literature of presenting signs and sequelae of coronavirus, and pave the way for more elaborate and multispecialty studies for enhanced understanding of the disease.


Bodyache, Coronavirus disease 2019, Fever, Headache, Sleep disturbance

Novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) has led to a worldwide pandemic of Coronavirus Disease 2019 (COVID-19). Classic cases present with respiratory symptoms and fever. However, wide range of other manifestations including gastrointestinal and neurological involvement has been observed (1). It has also been observed across the globe that all the symptoms of all patients who suffer from SARS-CoV-2 infection do not get resolved with their recovery from acute infection; there is a subset of patients having persisting symptoms. Sequelae of COVID-19 are the symptoms reported by the patient after recovering from COVID-19, which are not explained by alternative diagnosis. In the absence of universally accepted definition, in mild and moderate COVID-19 cases, signs and symptoms that develop or persist after end of quarantine or discharge are taken as sequelae of COVID-19 (2),(3),(4),(5). While there are a lot of studies unraveling the structure and pathogenicity of SARS-CoV-2 (6),(7),(8),(9),(10), and quite a few highlighting the clinical manifestations and complications of COVID-19, not many have looked into the sequelae (10),(11),(12),(13).

Due to their proximity to patients, Healthcare Workers (HCWs) including nurses remain at extraordinary risk of acquiring infections; the risk is amplified in the current pandemic due to the fact that HCWs are supposed to be working even when there is lockdown for preventing transmission of infection in populations at large (14),(15),(16). Some studies have looked into sequelae and quality of life after COVID-19 in HCWs (16),(17),(18). Nursing assistance is the cornerstone of all medical care; during the pandemic, nurses are working round the clock to aid in maintaining the essential healthcare services (18). Except for one study from India on psychological sequelae of COVID-19 in HCWs including nurses (18), there have been no studies on sequelae of COVID -19 in Nursing Officers (NOs). Despite taking all precautions and maintaining COVID-19 appropriate behaviour, many nursing officers at the centre got infected. The symptomatic NOs were followed-up for the sequelae of COVID-19. This study was aimed to assess the presenting and persistent manifestations of COVID-19 illness in first and second wave, among nursing officers of a tertiary care Medical Institute, Delhi, India.

Material and Methods

This was a cross-sectional study conducted in Dr. RP Centre for Ophthalmic Sciences at All India Institute of Medical Sciences, New Delhi, Delhi, India, from 15th May 2021 to 31st October 2021. Approval of Institute Ethics Committee was obtained before commencement of the study (IEC-230/09.04.2021, RP-02/2021) and the methods were in agreement with the Helsinki Declaration of 1975, as revised in 2000. All the study participants were given an information sheet regarding the study to read, and a written informed consent was obtained for participation in the study.

Inclusion criteria: All nursing officers working in the specialty centre who had recovered after testing positive for COVID-19 in the first wave (March 2020 to February 2021) or second wave (March 2021 to May 2021) were included in the study (13).

Exclusion criteria: The NOs who were asymptomatic, whose COVID-19 test result was indeterminate, or who were tested positive for COVID-19 from a laboratory not approved by Indian Council of Medical Research (ICMR) were excluded from the study.

As per the guidelines circulated by Ministry of Health and Family Welfare, India, a positive COVID-19 test was defined as a positive result from any Indian Council of Medical Research (ICMR) approved laboratory in India in (19),(20),(21):

• Reverse Transcription-Polymerase Chain Reaction (RT-PCR) or
• Cartridge Based Nucleic Acid Amplification Test (CBNAAT) or
• Rapid Antigen Test (RAT),

The ICMR approval was given to a laboratory after quality assessment of kits and procedures of the laboratory; and all the three tests were considered valid for diagnosing symptomatic cases of COVID-19 (21)

Study Procedure

A proforma regarding their COVID-19 illness to be filled was given to all participants, and the data obtained was entered in Microsoft excel sheets and analysed. The proforma was based on authors’ experience with COVID-19 patients, various national grand rounds and daily review meetings and discussions with COVID-19 task force. To decrease the subjective variation of symptoms reported by the participants, the definitions/meanings of all medical symptoms/ terms were put on backside of the proforma and the participants were instructed to mark their answers accordingly (22),(23),(24):

Weakness/Fatigue: Sense of a low energy level, or the feeling that near exhaustion is reached after relatively little exertion.
Disturbance in sleep: Difficulty in initiating or maintaining sleep.
Stress: Feeling discomfort/troubled/overwhelmed/threatened by the circumstances and events of day to day life.
Breathing difficulty: Subjective experience of breathing discomfort. Consisting of sensations like feeling suffocated, intense tightening in the chest, air hunger. Sensations may vary in intensity from person to person.
Difficulty in concentration: Not being able to focus on a particular task.
Anorexia: Lack of appetite for food.

The language of proforma was chosen to be English, as it could be understood by all the NOs who hail from different states of the nation.

Statistical Analysis

Statistical analysis was done using Pearson Chi-square test of association and Fischers-exact test using Statistical Package for Social Sciences (SPSS) IBM, statistics for windows, version 21.0, Armonk, NY: IBM Corp statistics. A p-value <0.05 was considered significant.


In the first wave, out of total 225, 36 nursing officers (16%) and in the second wave, 67 out of 190 (35.3%), had mild to moderate symptoms and were positive for COVID-19. This difference in COVID-19 positive cases in the two waves was statistically significant (p-value=0.043). Thus, a total of 103 subjects were recruited in the study, 36 in the first wave and 67 in the second. In the first wave, nine (25%) participants had moderate symptoms and 27 (75%) had mild symptoms. In the second wave three (4.5%) participants had moderate symptoms and 64 (95.5%) had mild symptoms (p-value=0.455).

The age of the participants ranged from 26-60 years (26-59 years in first and 26-60 years in second wave); and the mean age was 41.4 years (42.6 years in first and 40.1 years in second wave). Out of 103, 96 participants were females. The study subjects of the first wave had years of experience ranging from 1-33 years, and those of second wave had experience of 4 months to 36 years.

Duties of the NOs were in Operation Theatres, Wards, Outpatient Departments and Casualty of the Ophthalmic Centre, as well as in COVID-19 care areas of the institute. In the first wave, all 36 of the study subjects were in the ophthalmic centre duty at the time of contracting COVID-19 (positive). In the second wave, 19 out of 67 COVID-19 positive NOs were on COVID-19 duty at the time of becoming COVID-19 positive.

The most common co-morbidity in the study population was hypertension (9, 8.74%). This was followed by diabetes and bronchial asthma, each present in 6 (5.83%) subjects and arthritis and hypothyroidism, each present in 3 (2.91%) of the subjects. There was no statistically significant difference in co-morbidities in the study subjects from first and second waves of COVID-19 (Table/Fig 1).

(Table/Fig 2) shows the clinical manifestations of COVID-19 in the two waves. Fever was the most common manifestation- present in 75 (72.82%) subjects, followed closely by bodyache and fatigue seen in 70 (67.96%) and 69 (66.99%) subjects, respectively. Other common manifestations were sore throat, cough, headache, dysgeusia, parosmia and weight loss. Diarrhoea, rhinitis and conjunctivitis were less common manifestations. While chest pain, dizziness, gastritis, anorexia and fluctuations in blood pressure were rare (each seen in one study subject). Bodyache (p-value=0.048), fatigue (p-value=0.025) and headache (p-value=0.04) were more common in second wave as compared to first wave. Other manifestations did not show any statistically significant difference. Out of 36, 9 (25%) subjects needed hospitalisation due to moderate symptoms in first wave. Whereas only three out of 67 (4.48%) needed hospitalisation in second wave (p-value=0.002). None of the subjects had severe disease and there was no mortality.

In present study, 7 (6.80%) subjects completely recovered and showed no persistence of symptoms after minimum isolation and resolution of acute phase of COVID-19. One or more symptoms persisting for 1-2 weeks and 2-4 weeks were seen in 26 (25.24%) and 23 (22.33%) subjects, respectively. While 47 (45.63%) subjects reported one or more persistent symptoms for more than four weeks. Of the Postacute Sequelae of COVID-19 (PASC), most common was fatigue seen in 88.35% of subjects; this was followed by sleep disturbance, stress, breathing difficulty, difficulty in concentration and anorexia seen in 57.28%, 54.39%, 50.49%, 41.75% and 36.89% subjects, respectively. The subjects of second wave having disturbance in sleep were significantly more than those of first wave (p-value=0.049); the difference of other sequelae between the two waves did not show any statistical significance (Table/Fig 3).


Coronavirus disease 2019, though a respiratory illness, affects almost all systems of the body. A thorough follow-up would thus involve multispecialty clinical examination and investigations. However, with restrictions in outdoor activities and limited medical resources, workup for a complete understanding of all sequelae of COVID-19 may be a remote objective to realise. Hence, authors decided to initiate a follow-up of NOs who had joined back after recovering from COVID-19.

In the present study, with the common denominator of the total nursing officers of the centre, significantly more number of NOs (35.3%) got mild to moderate COVID-19 in the second wave as compared to those in first wave (16%) (p-value=0.043). Fever, bodyache and fatigue were found to be the most common presenting manifestations in the study subjects. Bodyache, fatigue and headache were seen in significantly more subjects in second wave as compared to first wave. Sarkar A et al., in their analysis of SARS-CoV-2 in the two waves in India have observed that emergence of SARS-CoV-2 clade G was one of the prime reasons for the onset of the second wave and associated increase of COVID-19-positive cases in India. Their analysis explored the link between gradual changes in clade distribution due to virus mutations and the emergence of new variants of SARS-CoV-2. Mutations in spike gene, ORF1a, ORF1b, ORF3a, ORF8, N gene, E gene and M gene led to formation of different clades (G, GH, GR, GRY) which had 9different degrees of virulence. Clade distribution in India varied over time, with a rise of the G clades from 21.6% in first wave to 46% in March 2021 and an escalation to 82.34% by the end of May 2021 (13). The G clade has been reported to be associated with a higher viral load than other clades, hence the rapid rising of the G clade in India during the second wave might have played a significant role in augmenting the number of cases and varied manifestations of COVID-19 infection (25). Bakhshandeh B et al., have interpreted in their review that many factors remain unknown regarding the varied clinical manifestations and outcome of COVID-19, however, host genetic susceptibility, and mutations and genetic variability of the virus have a critical impact on variable clinical features of COVID-19 (26).

In the present study, persistence of symptoms for more than four weeks was seen in 45.63% subjects and fatigue was found to be the most common sequela, persisting in 88.35% of the participants. Significantly greater number of subjects had persisting sleep disturbances in second wave than those of first wave. The present study findings correlate with those of authors from other countries.

In a large study from Wuhaan, China, Huang C et al., followed-up 1733 patients recovered from COVID-19 for six months. They found fatigue or muscle weakness (63%) to be the most common persistent symptom, followed by sleep difficulties (26%) and anxiety or depression (23%) (27). Findings of a multicentric study involving patients’ responses from 56 countries have been reported by Davis HE et al., found that fatigue, and memory and cognitive dysfunctions persisted in 89% and 88% of subjects recovered from COVID-19 and approximately 50% of the patients experiencing PASC were still experiencing significant symptom burden after seven months of resolution of acute phase (28).

Tabacof L et al., have reported negative impacts of PASC on physical and cognitive functions in their study population of 156 patients, who sought consultation in a PASC clinic in United States of America. They have found that fatigue was the most common persistent symptom (82%) followed by brain fog (67%) and headache (60%) (29). In another study from USA, Logue JK et al., have reported that persistent symptoms were present in 30% of the patients recovered from mild COVID-19, and fatigue was the most common persistent symptom (30). Carfi A et al., from Italy have reported persistence of one or two symptoms in 32%, three or more in 55%, and worsened quality of life in 44.1% of patients after two months of recovery of COVID-19 (31). In a study from France, Garrigues E et al., have reported that the most frequently reported persistent symptoms at 110 days of follow-up were fatigue (55%) and dyspnoea (42%); followed by loss of memory (34%), sleep disorders (30.8%) and difficulty in concentration (28%) (32). In their meta-analysis on PASC, Groff D et al., have found that more than 50% of patients recovered from acute COVID-19 experienced PASC six months post recovery. They found functional mobility impairments, pulmonary abnormalities, and mental health disorders to be the most common sequelae (33).

In their questionnaire based study of persistent symptoms of COVID-19 in 138 Healthcare Workers (HCW), authors from England have observed that 32% of HCWs had one or more persistent symptoms 3-4 months following the acute phase. Fatigue was the most common disabling symptom (39%), followed by mild-to-moderate shortness of breath, anxiety and sleep disturbance (16). In a study from India on psychological sequelae of COVID-19 in frontline HCWs, it was observed that 69.7% HCWs had higher perceived stress, psychological distress was seen in 53%, and definitive post-traumatic stress disorder was found in 34.8%. Higher perceived stress was seen most commonly in nursing officers (77.7%), followed by postgraduates and interns (70% in each) (18).

Development of sequelae in a subset of patients recovering from acute COVID-19 is multifactoral, having contribution from a range of biological factors which mutually interact in complex ways. While in acute phase, the virus might cause tissue injury in one or more organs leading to chronicity of specific symptoms. There may be persistent reservoirs of SARS-CoV-2 in certain tissues, or there may be re-activation of latent infections under conditions of COVID-19 immune dysregulation. During the illness, there may be interactions of SARS-CoV-2 with host microbiome/virome communities; or the cytokine response to the virus might be interfering with coagulation pathways, nerve signalling and ongoing immune activity in the body. Autoimmunity occurring due to molecular mimicry between pathogen and host proteins may be the reason for persistence of certain manifestations. The varied nature of sequelae and different factors contributing to it suggest that different therapeutic approaches may be required for best management of patients experiencing sequelae of COVID-19 (2).


The present study endures many limitations. The follow-up was done based on answers provided by the participants to the questions in the proforma; no follow-up clinical examinations or investigations could be done due to the diversion of resources for COVID-19 care and the requirement of keeping other activities of the institute to a minimum for preventing transmission. There may be potential bias due to self reporting of symptoms by the participants. Also, although all categories of healthcare workers were affected by COVID-19; authors could follow only NOs, as they were supposed to come for work every day and had an understanding of the medical terminology used in the proforma.


This study indicates the spectrum of manifestations in mild and moderate cases of COVID-19 and throws light on persistence of symptoms even among those who experienced mild illness. To the best of our knowledge, our study is the first from India comparing the clinical manifestations of COVID-19 and PASC in the first and second wave. The observations and results will add to the literature of presenting manifestations and sequelae of COVID-19, and pave the way for more elaborate and multi specialty studies for enhanced understanding of the disease.


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DOI and Others

DOI: 10.7860/JCDR/2022/56024.16707

Date of Submission: Mar 03, 2022
Date of Peer Review: Mar 28, 2022
Date of Acceptance: May 23, 2022
Date of Publishing: Aug 01, 2022

• 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? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

• Plagiarism X-checker: Mar 09, 2022
• Manual Googling: May 21, 2022
• iThenticate Software: Jul 20, 2022 (7%)

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