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 : 2022 | Month : May | Volume : 16 | Issue : 5 | Page : OC12 - OC16 Full Version

Clinical, Laboratory and Radiological Profile of COVID-19 Patients during the Second Wave with Special Reference to Vaccination Status


Published: May 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/52586.16338
Debasis Behera, C Mohan Rao, Suman Kumar Jagaty, Nipa Singh, Saswat Subhankar, Vivek D Alone, Akash Deep, Sanghamitra Pati

1. Assistant Professor, Department of Respiratory Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 2. Associate Professor, Department of Respiratory Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 3. Assistant Professor, Department of Respiratory Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 4. Associate Professor, Department of Microbiology, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 5. Assistant Professor, Department of Respiratory Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 6. Senior Resident, Department of Respiratory Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 7. Postgraduate Resident, Department of Respiratory Medicine, Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. 8. Director, Regional Medical Research Centre, Bhubaneswar, Odisha, India.

Correspondence Address :
Dr. Saswat Subhankar,
Department of Respiratory Medicine, KIMS, Campus-5, Patia-751024, Bhubaneswar, Odisha, India.
E-mail: saswat.kmc04@gmail.com

Abstract

Introduction: Coronavirus Disease-19 (COVID-19) has been creating havoc worldwide since the first report in December, 2019. Vaccination against the disease was thought to bring respite, reducing the severity of disease, morbidity and mortality. However, considering the fact that no vaccine is fully efficient, people may get COVID-19 even after full vaccination.

Aim: To determine the clinical, laboratory, radiological features of COVID-19 including the outcome and compare these between vaccinated and unvaccinated patients.

Materials and Methods: The prospective observational study was conducted in a dedicated COVID-19 hospital in Odisha, India, from May 2021 to June 2021. Detailed history including symptoms and vaccination status, laboratory parameters, and radiological investigations were collected from 200 patients. The cases were classified as mild, moderate and severe as per the Ministry of Health and Family Welfare (MoHFW) guidelines. All the patients were followed till the end of hospital stay. The results were expressed as the mean±standard deviation and percentages. Chi-square test was used to compare the categorical variables, and unpaired t-test was used to compare two discrete variables. A p-value of less than 0.05 was considered significant.

Results: Majority of the patients were unvaccinated (65%) and belonged to the age group of 39-59 years (58.5%). Among the non vaccinated patients, 32.3% had moderate disease, while 35.4% had severe disease. In the vaccinated group, 51.4% had moderate disease, whereas only 28.6% patients developed severe disease. Increased Neutrophil to Lymphocyte Ratio (NLR), D-dimer levels, and radiological evidence of pneumonia in chest radiology were witnessed in both groups. Inflammatory markers between the vaccinated and unvaccinated groups did not show any statistical significance (p>0.05). A total of 12 (6%) patients died, out of which five were vaccinated (p=0.6).

Conclusion: Vaccination is found to be protective in terms of disease severity and mortality. Vaccination of all individuals is recommended to curb the wrath of the virus.

Keywords

Coronavirus disease-2019, Morbidity, Mortality, Vaccines

The second surge of COVID-19 has hit various parts of the world, with many countries reporting more patients in intensive care or high dependency units. Many deaths have been attributed to lack of timely hospitalisation, oxygen support, medicines, and physician care (1),(2). Some places like Northern Italy, however, have reported a lesser in-hospital mortality and use of mechanical ventilation during the second wave (3). The second surge of cases in India started around March 2021, after a brief period of recession in the number of reported cases (4). The number of cases in India rose sharply between March and May, 2020 and became the third leading country by April 10, 2021 (5). The increase in COVID-19 transmission in India was due to several potential factors like increase in cases of Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2) variants with increased transmissibility, along with reduced adherence to public health and social measures (6).

In its weekly epidemiological update released on 11th May, 2020, the World Health Organisation (WHO) declared the B.1.617 lineage of the virus as a ‘variant of concern’. The lineage was first reported in India in October 2020 (7). In addition, the B.1.1.7 variant from the UK was also circulating throughout India, along with the P.1 lineage from Brazil, and the B.1.351 lineage from South Africa (7). Moreover, the Indian SARS-CoV-2 Consortium on Genomics (INSACOG) was formed on 25th December, 2020 to carry out genomic sequencing and analysis of circulating COVID-19 viruses. It reported mutations in variants that could evade immunity and had increased infectivity (7). These new variants have also contributed to the surge of the second wave of COVID-19 infection in India. In Odisha, where the index study was conducted, as on 23rd May 2021 there were 6,92,382 confirmed cases with 5,89,610 recoveries (8).

To mitigate the health hazards due to COVID-19, the Government of India started the vaccination programme on 16th January, 2022 with population above 60 years getting the first priority (9). In India, as on May 23, 2021, a total of 10.9 percent of population has been vaccinated for the first time and three percent population have obtained full vaccination (10). The risk of COVID-19 recurrence or re-infection is currently unknown, although few have been described in case reports (11),(12). Studies from western countries have reported lesser hospitalisation, requirement of invasive ventilation and death in vaccinated people (13),(14). A study from India also revealed lower mortality among vaccinated group (15).

The study was aimed to determine the clinical, laboratory and radiological features of COVID-19 confirmed cases admitted in a dedicated COVID-19 hospital during the second wave of the pandemic and to compare these data between vaccinated and non vaccinated patients.

Material and Methods

The single centre, prospective observational study was conducted at a tertiary care hospital at Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha, India. The study spanned between May, 2021 and June, 2021.

The study was approved by the Institutional Ethics Committee (vide letter number KIIT/KIMS/IEC/678/2021 dt. 31.05.21) (CTRI registration: CTRI/2021/06/034269).

Inclusion criteria: All COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR)-tested patients ≥18 years of age who were admitted to the dedicated COVID-19 hospital, KIMS during the study period were included.

Exclusion criteria: Pregnant females were not included in the study.

Study Procedure

A detailed clinical history including clinical features, co-morbidities and vaccination status against COVID-19 was recorded. All patients were evaluated for complete blood picture, biomarkers like C-reactive Protein (CRP), d-dimer, chest radiograph and/or High Resolution Computed Tomography (HRCT) thorax. The patients were triaged as mild, moderate and severe as per MoHFW criteria and treated as per WHO guided standard protocol for COVID-19 illness in wards or intensive care units (8). The cases were defined as follows:

Mild disease: Symptomatic patients meeting the case definition for COVID-19 without evidence of viral pneumonia or hypoxia.

Moderate disease: Adolescent or adult with clinical signs of pneumonia (fever, cough, dyspnoea, fast breathing) but no signs of severe pneumonia, including SpO2 ≥90% on room air.

Severe disease: Adolescent or adult with clinical signs of pneumonia (fever, cough, dyspnoea, fast breathing) plus one of the following: respiratory rate >30 breaths/min; severe respiratory distress; or SpO2 <90% on room air.

All patients were followed-up till the end of their hospital stay. The discharge criteria for patients included:

- Three days of being afebrile
- No supplemental O2 requirement
- Haemodynamic stability
- Normal or reducing biomarkers

Statistical Analysis

The results are expressed as the mean±standard deviation and percentages. All statistical analyses were performed using Statistical Package for the Social Sciences (SPSS) version 19.0. The chi square test was used to compare the categorical variables. The unpaired t-test was used to compare two discrete variables. The one way analysis of variance will be used to compare more than two discrete variables. A p-value of less than 0.05 was considered significant.

Results

Among the 200 cases included in the study, 130 (65%) were unvaccinated, while 70 (35%) were vaccinated with either single or both doses of COVID-19 vaccine. Males predominated both the groups (70% and 74.3%, respectively). Majority of the patients belonged to the age group of 39-59 years (Table/Fig 1). Severe disease was predominantly seen in the unvaccinated group (35.4%), while the vaccinated group commonly had a moderate disease (51.4%). The mean duration between vaccination and onset of symptoms was 5.8±2.23 days in mild disease, 4.35±1.65 days in moderate disease, and 6.23±3.3 days in severe disease (p=0.71).

Cough and breathlessness were the most common pulmonary complaints, which were more so in patients with severe disease. Fever was the most common extrapulmonary symptom. Diabetes mellitus and hypertension were the most common co-morbidities reported.

Mean NLR and biomarkers like CRP, and D-dimer were least in patients with mild disease and increased with disease severity. The comparison of these values between vaccinated and unvaccinated group was not statistically significant (Table/Fig 2), (Table/Fig 3), (Table/Fig 4), (Table/Fig 5).

The HRCT thorax was done for patients at the time of admission. A Computed Tomography (CT) severity score of more than 15 was predominantly seen in patients with severe disease (60.6%) (Table/Fig 4).

A total of 12 (6%) deaths were reported, out of which 7 (58.3%) were unvaccinated, while 5 (41.7%) were vaccinated. Most deaths in the vaccinated group occurred within 14 days of symptom onset (Table/Fig 6).

Discussion

The second surge in COVID-19 cases spread fast in India. There were, however, several differences noted in comparison to the first wave of the pandemic in India. The former affected the younger population and symptoms like shortness of breath were more commonly reported. Newer symptoms like gastro-intestinal and neurological came into picture (16). Moreover, a part of the population was already vaccinated during the second wave (16). Although no significant increase in death rate was noted during the second wave, the death rates were alarmingly high owing to the high number of infections (17). The present study aimed to determine the clinical, laboratory and imaging features of COVID-19 confirmed cases admitted in a dedicated COVID-19 hospital during the second wave of the pandemic and to compare these data between vaccinated and non vaccinated patients.

This study included males and females in the ratio 2.5:1. Majority of the patients belonged to the age group of 39-59 years, with a mean age of 49.96±12.32 years. A study published by Reddy MM et al., from eastern UP reported the mean age of patients during the second wave to be 46.1±16.8 years. A significantly large number of patients belonged to the age groups of 30-44 years, and 45-59 years as compared to the first wave (18). The study also showed higher number of males being affected during both waves of the pandemic (18). Kumar G et al., also reported the mean age of patients to be lower during the second wave (48.7 years; p<0.001) with majority of patients belonging to <20 years and 20-34 years. A lesser number of males were affected during the second wave (p=0.02) (19). The lower mean age of patients during the second wave were also reported in other countries (20),(21). The higher number of males affected during the first wave was also reported by Rao CM et al., (22).

Cough and shortness of breath were the predominant symptoms, which could be due to the pulmonary involvement. Increased symptomatology in patients during the second wave has been reported previously as well (23). Kumar G et al., also reported shortness of breath to be a major complaint during the second wave (48.6%; p<0.003) (19). Extrapulmonary symptoms like gastrointestinal were reported during the second wave of the pandemic (23).

Majority of the patients in the index study had mild (p=0.06) and moderate (p=0.0083) symptoms in both the vaccinated and unvaccinated groups. Severe disease was more common in the non vaccinated group (p=0.32). Singh C et al., reported that severity of disease (30.3% in vaccinated, 51.3% in partially vaccinated and 54.1% in non vaccinated; p=0.035) was significantly lower among vaccinated individuals (24).

Increased levels of inflammatory markers like CRP and D-dimer have been associated with severity of infection (25),(26). A raised NLR has also been associated with severity of disease (27). This study also showed a similar trend in the above inflammatory markers. There was however no significant correlation between the vaccinated and non vaccinated patients.

Disease enhancement due to vaccine has been studied previously. The proposed mechanism involves a suboptimal humoral response with increased binding to neutralising antibodies thus leading to increased deposition of immune complexes and increased inflammatory response. This could well explain the higher level of CRP in the vaccinated group in our study (28),(29),(30).

The recorded mortality was 3.5% in this study. A higher case fatality rate during the second wave has been reported in a report from Chennai (31). The study by Nath R et al., also supports our study (32). However, Bogam P et al., reported a lower case fatality rate during the second wave in comparison to the first wave of the pandemic (1.8 per 1000 during first wave and 0.77 per 1000 in second wave) (33). More deaths were recorded in the unvaccinated group (p=0.6).

Limitation(s)

The study was limited by its small sample size and short duration of only two months during the pandemic.

Conclusion

The second wave of the COVID-19 pandemic affected the adult and young population, a scenario much different from the first wave. The usefulness of inflammatory markers like CRP, D-dimer and NLR in predicting disease severity has been well documented. Vaccinated group of people were found to have less chance of developing severe disease. The findings will improve the acceptance of vaccination among the general population. However, COVID appropriate measures and proper control of underlying co-morbidities are indispensable and need to be followed by every individual.

References

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Graichen H. What is the difference between the first and the second/third wave of Covid-19? - German perspective. Journal of Orthopaedics. 2021;24:A1-A3. https://doi.org/10.1016/j.jor.2021.01.011. [crossref] [PubMed]
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Contou D, Fraissé M, Pajot O, Tirolien J, Mentec H, Plantefève G. Comparison between first and second wave among critically ill COVID-19 patients admitted to a French ICU: no prognostic improvement during the second wave? Critical Care. 2021;25(1). [crossref] [PubMed]
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Borghesi A, Golemi S, Carapella N, Zigliani A, Farina D, Maroldi R. Lombardy, Northern Italy: COVID-19 second wave less severe and deadly than the first? A preliminary investigation. Infectious Diseases. 2021;53(5):370-75. [crossref] [PubMed]
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Joshi S, Pandit R, Parikh P, Gulia A. Containing COVID-19 second surge in India. Indian Journal of Medical Sciences. 2021;73:01-03. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/52586.16338

Date of Submission: Sep 27, 2021
Date of Peer Review: Dec 13, 2021
Date of Acceptance: Feb 21, 2022
Date of Publishing: May 01, 2022

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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 28, 2021
• Manual Googling: Jan 20, 2022
• iThenticate Software: Mar 05, 2022 (10%)

AUTHOR DECLARATION: Author Origin

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