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

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Dr Mohan Z Mani

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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
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 : February | Volume : 16 | Issue : 2 | Page : TC17 - TC20 Full Version

Association of Chest CT Severity Scores and Vaccination Status in COVID-19 Infection: A Cross-sectional Study


Published: February 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/51686.16027
TT Vishwanath, BR Rajalakshmi, KS Sadananda, CN Manjunath

1. Associate Professor, Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. 2. Associate Professor, Department of Pathology, JSS Medical College, Constituent College of JSS Academy of Higher Education and Research, Mysuru, Karnataka, India. 3. Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. 4. Professor and Director, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India.

Correspondence Address :
Dr. B R Rajalakshmi,
Number 15, Block No. 8, First Stage, Jss Layout, Dr. Rajkumar Road,
Mysuru, Karnataka, India.
E-mail: dr.rajalakshmi2011@gmail.com

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) has emerged as a pandemic with substantial morbidity and mortality. While global efforts towards mitigating the infection are focused on the vaccination of population, studies are warranted to prove the efficacy of vaccine in prevention of infection or reducing the severity of infection in affected patients. The 25-point High Resolution Computed Tomography (HRCT) severity score has proved to be an effective tool in estimating the severity of lung infection and correlates with laboratory parameters and disease outcome. The HRCT scores hence provide an objective evidence to prove the efficacy of vaccines in vaccinated individuals by assessing the extent of lung involvement.

Aim: To compare the chest CT severity score in vaccinated and unvaccinated COVID-19 infected patients.

Materials and Methods: This cross-sectional study was conducted in the Department of Radiology, at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. The data of HRCT scores and vaccination status was collected during the month of April 2021 from patients who were suspected to have COVID-19 infection and underwent a chest HRCT scan. The severity of lung infection in vaccinated and unvaccinated individuals were compared based on the HRCT scores and the association between these variables were analysed. The association between the respective variables were studied using Fisher’s-exact and Kruskal-Wallis tests.

Results: The study involved a total of 178 subjects (males were 98), where 127 (71.3%) were unvaccinated and 51 (28.6%) were vaccinated with one or both doses {Covaxin (Bharat Biotech) vaccine or Covishield (Oxford-AstraZeneca) vaccine approved by Emergency Use Authorisation (EUA)}. The frequency of disease was least in 14 (7.9%) among fully vaccinated subjects. Severe COVID-19 associated pneumonia with severity score of 18 or more was seen in 7% of unvaccinated individuals, while none of the partial/fully vaccinated individuals had severe disease. The median CT severity score was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients (p-value=0.001). Fully vaccinated patients had almost low CT severity score indicating mild form of disease.

Conclusion: To the best of authors knowledge, this study was the first to describe the chest CT severity scores of vaccinated individuals in comparison with the unvaccinated COVID-19 infected patients. The disease severity was significantly higher among unvaccinated patients compared to partially or fully vaccinated patients. The present study has provided substantial evidence of vaccine efficacy in reducing the disease severity in COVID-19 infected patients.

Keywords

Coronavirus disease-2019, Computed tomography, Infection, Lung damage, Pandemic, Vaccine efficacy

Coronavirus Disease-2019 (COVID-19) is a pandemic caused by a strain of coronavirus {Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2)} ranging from mild clinical course to severe COVID-19 pneumonia with or without Acute Respiratory Distress Syndrome (ARDS) (1),(2),(3). Measuring the extent and severity of pulmonary involvement in COVID-19 pneumonia is possible by High Resolution Computed Tomography (HRCT) scan of lung. The clinical severity of COVID-19 infection has correlated well with 25-point HRCT score. Recent data has suggested that chest Computed Tomography (CT) score can predict the outcome of COVID-19 disease and also correlates significantly with laboratory parameters and oxygen requirements (4),(5). The use of chest HRCT has been advised by the World Health Organisation (WHO) as part of diagnostic workup of COVID-19 disease whenever Reverse Transcription-Polymerase Chain Reaction (RT-PCR) testing is not available; in case of delayed test results or in suspected cases with initial negative RT-PCR test result (4). The current global strategies are focused on prevention of viral transmission by maintaining social distance, use of masks and promotion of mass vaccination.

Vaccines act by two main mechanisms. They can prevent infection occurring entirely or they can halt the progression to symptomatic disease after infection occurs (6). Though the effectiveness of vaccine has been studied by vaccine trials prior to public use, much of its efficacy can be definitively assessed in patients infected by COVID-19 in postvaccination phase, whether vaccines are effective in preventing infection or are beneficial in reducing the disease severity, thereby preventing mortality. Considering the usefulness of HRCT scores in evaluating the severity of lung involvement, the objectives of the study were, to evaluate the severity of lung involvement in COVID-19 infection through HRCT scan and to compare the chest CT severity score in vaccinated and unvaccinated COVID-19 patients.

Material and Methods

This cross-sectional study was conducted in the Department of Radiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. The data was collected in the month of April 2021 during the second peak of COVID-19 pandemic, from patients who were suspected to have COVID-19 infection and underwent a chest HRCT scan in the Department of Radiology, after obtaining clearance from Institutional Ethical Committee.

Inclusion criteria

1. Clinically suspected symptomatic COVID-19 patients (having one or more of the following: fever, sore throat, cough and shortness of breath) who underwent screening HRCT irrespective of RT-PCR test result.
2. Clinically suspected asymptomatic COVID-19 patients who underwent screening HRCT with positive RT-PCR test result.

Exclusion criteria

1. Suspected asymptomatic patients of COVID-19 infection with negative RT-PCR result and normal screening HRCT scan.
2. Suspected symptomatic/RT-PCR positive cases with normal HRCT scan within 6 days of illness.

Procedure

In accordance with the inclusion and exclusion criteria, 178 patients were included in the study. The information about the real-time Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test result and vaccination status was collected using a proforma. All patients underwent chest HRCT examination at Sri Jayadeva Institute of Cardiovascular Sciences using Philips 128 slice CT scanner. Patients were placed in a supine position and with single breath hold scanning was performed. Sagittal and coronal reformatted images were subsequently obtained. Scanning parameters were as follows: scan direction (craniocaudal), tube voltage (120 kV), tube current (251 mA), slice collimation (64×0.625), no contrast material was used. The results for the chest HRCT images were collected and evaluated using the Picture Archiving and Communication Systems (PACS).

HRCT image analysis: A Radiologist with more than 12 years of experience evaluated the CT images to determine the disease severity score (CO-RAD Score- Coronavirus disease-2019 Reporting and Data System) in each patient. The scans were first assessed whether negative or positive for typical findings of COVID-19 pneumonia (bilateral, multilobe, posterior peripheral ground-glass opacities) (4). Severity was assessed using the 25 point scoring system through visual assessment of each lobe involved.

The severity of lung involvement was assessed using the following scoring system depending on the visual assessment of each lobe involved. The scores of 1 to 5 were assigned for lung involvement of <5%, 5%-25%, 26%-49%, 50%-75% and >75%, respectively. The sum of the lobar scores indicates the overall severity (7):

• Mild disease with score ≤7
• Moderate disease with score 8-17
• Severe disease with total score ≥18

Statistical Analysis

The analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0. Descriptive statistics of patient’s demographics details and vaccination status were reported as numbers and percentage. Frequencies of chest CT scores were calculated. The association between the respective variables were studied using Fisher’s-exact test and Kruskal-Wallis test.

Results

Among 178 subjects included in the present study, majority of the study subjects were males 98 (55.1%) and 80 (44.9%) were females (Table/Fig 1).

Majority 127 (71.3%) of the study subjects who were suffering from COVID-19 (clinically diagnosed and RT-PCR confirmed) were unvaccinated. The frequency of disease was least in 14 (7.9%) among fully vaccinated subjects, while 37 (20.8%) partially vaccinated subjects (taken atleast one dose of either of vaccine either Covishield or Covaxin approved by Emergency Use Authorisation (EUA) were suffering from the disease (Table/Fig 2).

Among 178 subjects included in the study, 139 (78.1%) were RT-PCR positive. Remaining 39 (21.9%) were clinically diagnosed with CT scan features suggestive of COVID-19 with median Coronavirus disease-2019 Reporting and Data System (CO-RADS) score of 6 (Table/Fig 3). The RT-PCR negative cases were either symptomatic or showed CT findings suggestive of COVID-19 pneumonia. It can be observed that, there was no statistically significant association between RT-PCR positivity status and vaccination status of study subjects (Table/Fig 3). This strengthens the hypothesis that, vaccination may not prevent the infection but has definite role in reducing the severity of the disease.

The HRCT scan showed no lung changes in 34 (19%) out of total 178 COVID cases. Among the remaining 144 cases, lung involvement was predominantly bilateral in 131 (91%) cases and peripheral in 120 (83.3%) cases. Both upper and lower lobes were involved in 88 (61.1%) cases out of 144 cases. The patterns of lung changes are depicted in (Table/Fig 4), showing ground glass densities in a majority of 136 out of 178 cases (76%).

The study shows that severe COVID-19 associated pneumonia with CT severity score of 18 or more was seen in 7% of unvaccinated individuals, while none of the partial/fully vaccinated individuals had severe disease (Table/Fig 5). The data (Table/Fig 6) also shows that median CT severity score was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients. Fully vaccinated patients had almost nil CT severity score indicating milder form of disease. The corresponding lung changes of varying severity are shown in (Table/Fig 7), (Table/Fig 8), (Table/Fig 9), (Table/Fig 10).

Discussion

The HRCT of lung has been an effective imaging modality in the diagnosis of COVID-19 associated lung changes, being more sensitive than RT-PCR in suspected cases (98% vs 71%) and also to quantitate the extent of lung involvement in COVID-19 pneumonia (8). Chest CT scan is used to screen for COVID-19 associated viral pneumonia in patients with clinical and epidemiologic features compatible with COVID-19 infection, particularly when results of RT-PCR tests are negative (9).

Various studies have obtained positive correlation of HRCT scores with other laboratory parameters of inflammatory markers and oxygen requirement in defining disease severity (4),(5),(8),(10). The extent of lung abnormalities detected at CT scan is maximum during days 6-11 of illness (11). The lung changes detected by HRCT showed involvement of bilateral and multiple lobes in 91% of patients, with ground glass opacity (Table/Fig 4) being the most common pattern of lung infection. This is similar to the study by Salaffi F et al., where they found 90.9% showing bilateral lung involvement and 76.3% cases with ground glass opacities (8). The study by Hafez MA has also showed ground glass opacities, bilateral lung involvement with peripheral and lower lobe predominance similar to our study (10).

The approximate RT-PCR test sensitivity for COVID-19 infection is reported to be around 50-62% (1). The accuracy of RT-PCR results is affected by number of factors including the respiratory tract viral load, samples source and timing of samples acquisition. The RT-PCR positivity was 71.5% (123 out of 172) in a study by Al-Mosawe AM et al., (1), while in our study, 78.1% of study subjects were RT-PCR positive.

The frequency of disease in the present study was least in 14 (7.9%) of fully vaccinated subjects, compared to 127 (71.3%) unvaccinated COVID-19 infected patients. This is similar to the data by Hall VJ et al., in UK where they found 80 infected participants (3.8%) among vaccinated and 977 (38%) among unvaccinated healthcare workers (12). The study also found 140 (14%) asymptomatic COVID-19 positive cases in the unvaccinated cohort, compared to 15 (19%) asymptomatic in the vaccinated cohort. A single dose of vaccine showed vaccine effectiveness of 70% (95% CI 55-85) after first dose and 85% (74-96) after two doses in the study population (12). Hence, the beneficial role of single dose of vaccine can be inferred from our study as well, where majority were vaccinated with single dose, yet showing asymptomatic cases in 24% in vaccinated group, versus 11% in unvaccinated patients and no severe cases were documented in partially vaccinated group (Table/Fig 5).

Epidemiologists have opined that the threshold to achieve herd immunity is about 70% population protected by vaccination or previous infection. Accordingly, a one-dose strategy has been suggested as best for averting the most mortalities, but higher population immunity to prevent transmission will require a full course of two doses (6). The present study corroborates these studies in proving the efficacy of vaccines in preventing disease severity.

The data in (Table/Fig 5) clearly shows that severe COVID-19 associated pneumonia with severity score of 18 or more was seen in 7% of unvaccinated individuals, while none of the partial/fully vaccinated individuals had severe disease, providing direct evidence on vaccine efficacy in reducing the severity of lung involvement. The incidence of moderate disease is noticed more in unvaccinated group (64%) compared to vaccinated (35%) group. A good number (39%) of vaccinated COVID-19 infected subjects showed no features of COVID-19 pneumonia with a normal CT scan, in contrast to only 11% of unvaccinated subjects. This will prove the hypothesis that vaccines are effective in preventing the disease progression and severity of infection (6). Vaccines have a beneficial role in preventing lung damage and thereby reducing the morbidity and mortality associated with COVID-19 infection.

In SARS-CoV-2 immunity and Reinfection Evaluation (SIREN) study, 40% of the vaccinated SARS-CoV-2 infected patients reported typical COVID-19 symptoms compared with 63% in the unvaccinated group (6). The study inferred that vaccinated subjects were less likely to progress symptomatic illness once infected, which is the second mechanism by which vaccines confer protection (6). The study conducted in Christian Medical College, Vellore, showed that the risk of infection among fully vaccinated Healthcare Workers (HCW) was significantly lower compared to unvaccinated HCWs (13). According to their study, the protective effect of vaccination in preventing infection, hospitalisation, need for oxygen and Intensive Care Unit (ICU) admission were 65%, 77%, 92% and 94%, respectively. Furthermore, subgroup analysis on the efficacy of the two vaccines was not possible as the number of Covaxin recipients were less, similar to the study by Victor PJ et al., (13).

Limitation(s)

The limitation of the present study is less number of fully vaccinated subjects were taken. Hence, studies involving more number of participants with two doses are warranted to support vaccine efficacy in prevention of disease severity. Also, as many of the patients in the present study could not remember the dates of vaccination because of the rural background, the time interval between vaccination and HRCT could not be recorded for all the participants.

Conclusion

Majority of COVID-19 diseased patients were unvaccinated, while the frequency of disease was least in fully vaccinated subjects, proving the protective effect of vaccine against infection. CT severity scores were significantly higher among unvaccinated patients compared to partially or fully vaccinated patients. Fully vaccinated patients showed mild form of disease and less frequency of lung involvement. HRCT must be used in the diagnosis of COVID-19 infection in suspected cases and useful in quantification of lung involvement, thereby giving substantial evidence of disease severity. The present study has proved that vaccines are beneficial in reducing the severity of lung involvement in COVID-19 infected patients. Vaccines have a definite beneficial role in flattening the epidemiological curve of COVID-19 pandemic and save the mankind.

References

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DOI and Others

DOI: 10.7860/JCDR/2022/51686.16027

Date of Submission: Aug 07,2021
Date of Peer Review: Nov 25, 2021
Date of Acceptance: Jan 31, 2022
Date of Publishing: Feb 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: Aug 11, 2021
• Manual Googling: Oct 07, 2021
• iThenticate Software: Nov 08, 2021 (19%)

ETYMOLOGY: Author Origin

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