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 : March | Volume : 16 | Issue : 3 | Page : EC19 - EC22 Full Version

Analysis of COVID-19 and Mucormycosis Infection in Vaccinated and Unvaccinated Individuals: A Cross-sectional Study


Published: March 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/53675.16114
Kasturi Kshitija, Teeda Lakshmi Sri Naga Poojitha, Ande Dimple Sree Mounika, Deepak Rosha

1. Associate Professor, Department of Pathology, Bhaskar Medical College and Bhaskar General Hospital, KNR University, Hyderabad, Telangana, India. 2. Junior Resident, Department of Respiratory Medicine, Indraprastha Apollo Hospital, New Delhi, India. 3. MBBS Student, Bhaskar Medical College and Bhaskar General Hospital, KNR University, Hyderabad, Telangana, India. 4. Senior Consultant, Department of Respiratory Medicine, Critical Care and Sleep Medicine, Indraprastha Apollo Hospital, New Delhi, India.

Correspondence Address :
Dr. Teeda Lakshmi Sri Naga Poojitha,
Junior Resident, Department of Respiratory Medicine, Indraprastha Apollo Hospital,
New Delhi-110076, India.
E-mail: poojithadr1@gmail.com

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic unprecedentely led to health crisis in population across the globe. Even though the advent of vaccine has brought the spread of infection under control, shortage in vaccine supply, surge in breakthrough infections and associated mucormycosis in immunosuppressed individuals posed a potential threat.

Aim: To know the incidence and outcome of COVID-19 with superadded mucormycosis in vaccinated and unvaccinated people.

Materials and Methods: The present cross-sectional study undertaken for a period of four months. April to July 2021 in the Department of Respiratory Medicine at Tertiary Care Hospital, New Delhi, India. Hospitalised COVID-19 patients were enrolled in the study. Details of age, gender and co-morbidities were taken into account. In COVID-19 with mucormycosis, glycosylated haemoglobin value and steroid therapy were also noted. Clinical outcome for all the cases were analysed. Statistical analysis of the data collected was done with Statistical Package for the Social Sciences (SPSS) version 20.0 software.

Results: Out of 134 cases, 84 and 50 cases belonged to vaccinated and unvaccinated groups respectively. Isolated COVID-19 infection was noted in 102 cases and COVID-19 with mucormycosis in 32 cases. Diabetes mellitus and steroid therapy showed to be the predisposing factors for development of mucormycosis in COVID-19 cases. High proportion of unvaccinated individuals died due to isolated COVID-19 infection compared to vaccinated individuals and it was found to be statistically significant.

Conclusion: To combat serious threats caused by the COVID-19 pandemic, complete vaccination which offers maximum protection is mandatory.

Keywords

Coronavirus disease-2019, Outcome, Superadded infection, Vaccination

The COVID-19 caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) became a pandemic resulting in loss of human life globally. First incident began at Wuhan city, Hubei province, China in the mid of December 2019 and since then it had rapidly spread across the world (1). In India, COVID-19 infected millions of people following its first confirmed case on 30th January 2020 in Kerala (2). World Health Organisation (WHO) imposed a lockdown worldwide in March 2020 with quarantine polices. To combat the pandemic, pharmaceutical companies started to develop vaccines in mid of 2020. In India, Central Drugs and Standard Committee approved Covishield and Covaxin vaccines which was prepared by Serum Institute of India and Bharat Biotect Limited respectively (3). Vaccination program was initiated on 16th January 2021 targeting frontline healthcare workers and older civilians (4). Indian government on 1st May 2021 announced vaccination for all people above 18 years of age. Due to vaccine shortage and negligence in social distancing, breakthrough COVID-19 infections began to flare up (5). In midst of this crisis, accompanying co-morbidities and immunosuppression following steroid treatment for COVID-19, patients became susceptible to mucormycosis (6). This study aims to know the incidence with the clinical outcome of COVID-19 and concomitant mucormycosis in vaccinated (partial and complete vaccination) and unvaccinated groups.

Material and Methods

This was a cross-sectional study carried out for a period of four months from April-July 2021 in the Department of Respiratory Medicine at Tertiary Care Hospital, New Delhi, India. The study obtained clearance from the Ethical Committee of the Institute with registration number ECR/5/Inst/DL/2013/RR-16. Sample size was accessible population which were 134 in number who were admitted in COVID-19 designated isolated wards of Respiratory Department. The sample size was taken from admission register used for writing down patients’ details admitted in the wards.

Inclusion criteria: The study population comprised of 134 symptomatic COVID-19 patients who gave consent and were admitted in COVID-19 designated isolated wards of Respiratory Department and tested positive by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of nasopharyngeal swab.

Exclusion criteria: Patients who required home isolation were excluded from the study.

Study Procedure

In addition to age and gender, clinical features, pre-existing illness and time interval between vaccination and the manifestations of COVID-19 symptoms were taken into account. People who received first dose of vaccine came under partial vaccination group. Two weeks following second dose of vaccine came under complete vaccination group. Breakthrough infection was infection occurring 14 days after receiving second dose of the vaccine (5). High Resolution Computed Tomography (HRCT) chest findings was done in COVID-19 cases who presented with fever, cough and dyspnoea. The 25-point severity score was graded as mild (<8), moderate (9-15) and severe (>15). In dual infection of COVID-19 and mucormycosis, Glycated Haemoglobin (HbA1c) value and steroid treatment details was documented. Patients were followed for 30 days to know their clinical outcome.

Statistical Analysis

Data was collected with the help of a proforma and managed in Microsoft Excel. Statistical analysis was done with SPSS version 20.0 software.

Results

In a total of 134 cases, 84 (63%) were vaccinated in which 72 (54%) and 12 (9%) cases came under partial and complete vaccinated groups, respectively. The rest 50 (37%) cases belonged to unvaccinated group. From the total, dual infection of COVID-19 and mucormycosis was noted in 32 (24%) cases and isolated COVID-19 infection in 102 (76%) cases. The patient’s age varied between 20-80 years with a median age of 48 years. Females were 48 (36%) and males were 86 (64%).

In vaccinated group, dual infection was seen in 12 (14.3%) cases in which 10 and two cases received partial and complete vaccination respectively. While only COVID-19 infection was seen in 72/84 (86%) cases in which 62 and 10 cases had partial and complete vaccination respectively. In unvaccinated group, dual infection and only COVID-19 infection was noted in 20/50 (40%) and 30/50 (60%) cases, respectively.

In dual infection category, in vaccinated group (Table/Fig 1) the mean time interval between COVID-19 symptoms and onset of mucormycosis was 19 days while in unvaccinated group (Table/Fig 2) it was 15 days. Clinical severity of COVID-19 patients prior to the occurrence of mucormycosis was mild in 8/32 (25%) cases and moderate in 24/32 (75%) cases. In moderate clinical severity cases a cumulative dose of 520 mg of intravenous methylprednisolone was given. Average duration of steroid therapy was 15 days along with nasal oxygen support. Co-morbidities were seen in 28/32 (87.5%) cases and not present in 4/32 (12.5%) cases. Diabetes mellitus was present in all 28 cases. It was associated with hypertension, coronary artery disease and cirrhosis in 10, four and two cases respectively. Common site for mucormycosis was nose and sinus 30/32 (94%) followed by rhino-sino-orbit 16/32 (50%) and maxillary sinus 2/32 (6.25%). Glycosylated haemoglobin value in all the 32 cases was above 7% (Table/Fig 1), (Table/Fig 2). Recovery from dual infection was seen in 26/32 (81.25%) cases. In six cases (6/32,18.75%) who were above 60 years with underlying pre-existing illness and moderate clinical severity died due to COVID-19 pneumonia and multi-organ failure.Of the six cases, two and four belonged to partial vaccinated and unvaccinated groups, respectively.

In COVID-19 infection category, mean time interval between partial and complete vaccination with that of COVID-19 symptoms was found to be 18 days and 32 days, respectively. Common clinical presentation was triad of fever, cough and dyspnoea present in 84 cases. In all these cases HRCT chest showed mild, moderate and severe severity score in 40/84 (48%), 30/84 (36%) and 14/84 (16%) cases, respectively. Combination of fever and sore throat was seen in 16 cases followed by fever and loose stools in two cases.
Co-morbidities such as hypertension, diabetes mellitus, pulmonary tuberculosis, bronchial asthma, malignancy and hypothyroidism were present in 76 cases and not seen in 26 cases. Hypertension was present in all 76 cases. It was associated with diabetes mellitus (88 cases), pulmonary tuberculosis (10 cases), bronchial asthma (eight cases), malignancy (six cases) and hypothyroidism (four cases) respectively. Two cases each of chronic kidney and coronary artery diseases were noted. Recovery from COVID-19 was seen in 72/102 (71%) cases. In 30/102 (29%) cases patients died due to pneumonia and multi-organ failure. From this, 12/30 (40%) and 18/30 (60%) cases belonged to partial vaccinated and unvaccinated group respectively.

Complete vaccinated group showed no mortality. In partial vaccinated group, recovery cases were 58/72 (81%) and mortality cases were 14/72 (19%). In unvaccinated group, recovery and mortality cases were 28/50 (56%) and 22/50 (44%), respectively (Table/Fig 3).

Association between dual infection and outcome was not statistically significant with p-value of 0.815 while that between COVID-19 infection and outcome was statistically significant with p-value of 0.001 (Table/Fig 4), (Table/Fig 5).

Discussion

The COVID-19 infection had an enormous impact on health of people but also caused social and economic disruption. On 11th March 2020, WHO proclaimed this communicable disease as a pandemic across the world (1). COVID-19 and SARS-CoV-2 were officially coined by WHO and International Committee on Taxonomy of Viruses respectively on 11th February 2020 (7).

Vaccination campaigns in India commenced on 16th January 2020 and to vaccinate a population of 1.39 billion was a challenge for the government. As stated by the Delhi government on 31st July 2021, Delhi with a population of 1.5 crore above 18 years of age, people who received complete vaccination were less compared to those who were partially vaccinated (8). In this study, too similar observations were noted. The reason for not being completely vaccinated was due to vaccine shortage (9). It was also due to COVID-19 infection in people who had taken their first dose and did not follow social distancing norms as observed in present study. There were 50 patients in present study who did not choose to get vaccinated and were scared of the side-effects and complications encountered following vaccination (10). There is no vaccine which offers 100% protection from any disease leading to breakthrough infections as seen in this study. According to the statement released by Indian Council of Medical Research (ICMR) on 21st April 2021, 2 to 4 per 10,000 got infected with COVID-19 after vaccinations in India (5). The breakthrough infections may be due to COVID-19 variants bypassing the immunity, lack of social distancing norms and also ability of the vaccinated population to spread the diseases (11). Symptomatic breakthrough infections seen in present study was 12/84 (14.3%)which was comparable with the study done by Kanika T et al., where it was 15/113 (13.3%) (5). In another study done by Moriah B et al., breakthrough infection documented was 2.6% which was low compared to present study (12).

In COVID-19 infection category the common clinical symptom was fever followed by cough and dyspnoea in present study which was consistent with Macera M et al., (13). Sore throat and loose motion seen in present cases were documented in a study done by Kanika T et al., (5). Mean interval between complete vaccination and onset of COVID-19 symptoms in present study was 32 days which was consistent with the studies done by Kanika T et al., and Moriah B et al., where the mean were 34.8 days and 39 days, respectively (5),(12). Co-morbidities seen in this study were also observed in the study done by Macera M et al., with hypertension being the most common one in both the studies (13). HRCT chest severity score was mild in most of the cases which correlated with Ghufran AS et al., study (14).

Recently the prevalence of mucormycosis in India was 0.14 per 1000 and was found out to be higher when compared globally which was 0.005 to 1.7 per million population (15). The use of high dose of steroids with pre-existing illness has increased the susceptibility of opportunistic fungal infection in COVID-19 patients. Singh AK et al., stated 82 cases of mucormycosis in COVID-19 patients were reported from India and present study reported 32 cases (15). Cases of dual infection were documented in studies done by Patel DJ et al., Sen M et al., and Ravani SA et al., as with this study (6),(16),(17). Diabetes mellitus was the common pre-existing illness in dual infection cases along with high HbA1c levels which was consistent with the studies done by Singh AK et al., Sen M et al.,and Ravani SA et al., (15),(16),(17). In unvaccinated group the mean time interval between the COVID-19 symptoms and onset of mucormycosis noted in this study was comparable with that of the Sen M et al., study (16). High dose of steroids for COVID-19 was a risk factor for the development of mucormycosis which was compatible with the study done by Singh AK et al., (15). Commonest site was rhino-sinus region which was consistent with Singh AK et al., study (15).

Median age of present study population was 48 years with men being affected more than women. This correlated with the study done by Kanika T et al., Brown CM et al., and Ghufran AS et al., (5),(11),(14). In another study, the incidence of COVID-19 infection following first dose of vaccine was comparatively more than following complete vaccination (18). Similar observation was noted in this study.

In another study, 0 and 0.4% mortality were reported respectively following breakthrough infection which was comparable with the present study in complete vaccination group (19),(20). According to another study, mortality rate was more in unvaccinated group than in those who were partially vaccinated (21).Similar finding was observed in present study also.

Limitation(s)

The limitation in the present study was only hospitalised COVID-19 patients were taken into account because of easy accessibility.

Conclusion

The COVID-19 pandemic had shown high mortality rates in unvaccinated group compared to vaccinated group. A surge in mucormycosis in COVID-19 cases was noted with risk factors being diabetes mellitus and steroid therapy. The commonest site of mucormycosis was rhino-sinus region. Hypertension was the common co-morbidity in isolated COVID-19 cases. Incidence of breakthrough infections two weeks following second dose of vaccine was 14.2% and all the patients showed complete recovery. Hence, two doses of COVID-19 vaccine which offers 95% of protection is mandatory along with social distancing norms to combat the serious threats of ongoing COVID-19 infection.

References

1.
Cucinotta D, Vanelli M. WHO declares COVID-19 a pandemic. Acta Biomed. 2020;91(1):157-60.
2.
Andrews MA, Areekal B, Rajesh KR, Krishnan J, Suryakala R, Krishnan B, et al. First confirmed case of COVID-19 infection in India: A case report. Indian J Med Res. 2020;151:490-92. [crossref] [PubMed]
3.
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DOI and Others

DOI: 10.7860/JCDR/2022/53675.16114

Date of Submission: Jan 02, 2022
Date of Peer Review: Jan 21, 2022
Date of Acceptance: Jan 25, 2022
Date of Publishing: Mar 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. NA

PLAGIARISM CHECKING METHODS: [Jain H et al.]
• Plagiarism X-checker: Jan 04, 2022
• Manual Googling: Jan 22, 2022
• iThenticate Software: Feb 26, 2022 (3%)

ETYMOLOGY: Author Origin

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