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

Users Online : 19237

AbstractConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

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

Reviews
Year : 2022 | Month : September | Volume : 16 | Issue : 9 | Page : DE01 - DE05 Full Version

A Review on COVID-19 Pandemic


Published: September 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57182.16909
Vinita Choudhary, Chetan Choudhary, Ayushi Sharma, Vinod Sharma, Pushpendra Saraswat

1. Assistant Professor, Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India. 2. Assistant Professor, Department of Emergency Medicine, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India. 3. Demonstrator, Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India. 4. Demonstrator, Department of Microbiology, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India. 5. Lab Director, Central Research Laboratory, Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India.

Correspondence Address :
Ms. Ayushi Sharma,
RIICO Institutional Area, Sitapura, Mahatma Gandhi University of Medical Sciences & Technology, Jaipur, Rajasthan, India.
E-mail: ayushisharma183@gmail.com

Abstract

Coronavirus associated with Severe Acute Respiratory Syndrome (SARS) has been identified as Coronavirus Disease-2019 (COVID-19) Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2), first detected in Wuhan, Hubei province, China, the National Health Commission of China received reports of 27 cases of pneumonia, including seven severe cases of unknown origin, on 30th December 2019. In order to diagnose COVID-19, the virus responsible for the pandemic, SARS-CoV-2, was analysed for its Ribonucleic Acid (RNA). It is possible to detect specific sequences of genes encoding the RNA dependent RNA polymerase (RdRP), nucleocapsid (I#INI?I), envelope (I#IEI?I), and spike (I#ISI?I) proteins of viruses using Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). There are four major groups of drugs recommended by treatment guidelines worldwide: antiviral drugs (eight drugs), antimalarial drugs (two drugs), systemic corticosteroids (five drugs), and immune-based therapy (seven drugs). The recommendations for the treatment with these drugs in all of the guidelines differ depending on the severity of the case and the health conditions of the patient. A successful preventative vaccine is the most important and time-sensitive measure in combating the COVID-19 pandemic. There were 12 SARS-CoV-2 vaccines approved/authorised for full or emergency use in various parts of the world as of 25th February 2021, with more than 200 million doses administered worldwide. Because the disease is still relatively new and healthcare is under considerable pressure, many questions remain unanswered. There is a lack of publications regarding the effectiveness and safety of these drugs in COVID-19 patients. In addition, community members with limited financial resources must still consider the costs associated with some of the proposed treatment regimens.

Keywords

Coronavirus disease-2019, Pneumonia, Vaccine

Acute respiratory disease caused by SARS-CoV-2 caused an explosive catastrophic pandemic which affected almost all part of the world produced significant loss of lives and the worst financial crisis recorded ever, since World War II. SARS-CoV-2 comprises of a nucleocapsid, surrounded by an envelope, measures 120 nm in size; has a helical symmetry (1),(2). Therefore, to diagnose COVID-19, early identification of SARS-CoV-2 infection is important. Also, to develop rapid diagnostic methods in outpatient clinics and regional medical facilities are also important in order to prevent and control the pandemic, besides improving high-throughput accurate diagnostic technology in big laboratories. To find out the origin of the COVID-19 pandemic, one should also consider intelligent medicine as an emerging technology in healthcare (1),(3). In this review, authors have explored the diagnostic information provided by each diagnostic tool and some known shortcomings, as well as the way each diagnostic tool complements the others to provide more comprehensive clinical guidance (1).

A few of the new detection technologies are summarised that have already been adopted or that may find applications in COVID-19, and the kinds of technologies that have been employed in commercial products. The concept of “intelligent medicine” for infectious epidemics is conceived to offer more options for anti-infectious disease management now or in the future (1).

EPIDEMIOLOGY

SARS-CoV-2 originated from China had spread rapidly to affect rest the world over a period of three-four months. First identified in December 2019 in Wuhan, China produced a large cluster of pneumonia cases initially called as the ‘Wuhan Virus’. Subsequently-named as the 2019-novel coronavirus (2019-nCoV). On 11th February 2020, World Health Organisation (WHO) announced the official name ‘COVID-19’ for this new coronavirus disease also renamed the virus as SARS-CoV-2. On 11th March 2020, WHO declared it as a global pandemic and India was one among those countries where the COVID-19 pandemic had a slower growth curve to reach its peak. Globally, as 15th July 2022, there have been 557,917,904 confirmed cases of COVID-19, including 6,358,899 deaths, reported to WHO. As of 11th July 2022, a total of 12,130,881,147 vaccine doses have been administered. Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), and Delta (B.1.617.2)-coronaviruses have been identified (4).

The WHO was informed by South Africa on November 24, 2021, of a new COVID-19 variant, omicron (B1.1.529). The first detection of omicron (B.1.1.529) occurred on November 11, 2021, in Botswana and on November 14, 2021, in South Africa (5).

TRANSMISSION

Primarily transmitted via respiratory droplets and contact routes.

Droplet and aerosol transmission: Occurs when a person is in close contact (within one meter) with an infected person. Occurs through coughing, sneezing or very close personal. Use of mask can prevent droplet transmission. Spread of the infected droplet nuclei beyond one meter-not documented yet. Specific settings in which aerosol-generating procedures are performed (e.g. endotracheal intubation), aerosol transmission of the COVID-19 virus may be possible. Use of N95 respirator-important to prevent this type of transmission.

Contact transmission: COVID-19 virus can spread directly via contact with infected people, or indirectly. In direct or indirect contact, the virus can only be transmitted by touching the contaminated surfaces and those who already infected. Frequent hand hygiene following potential contact exposure is crucial to prevent this type of transmission.

Presymptomatic transmission: Defined as the transmission of the COVID-19 virus from a person who is infected and shedding the virus but has not yet developed symptoms. Observed in people 1-3 days before the onset of their symptom (4).

Vertical transmission: The high expression of Angiotensin Converting Enzyme-2 (ACE-2) receptors in the human maternal-foetal interphase may allow COVID-19 to be transmitted vertically. People suffered with COVID-19 in pregnancy are at high-risk for complications that can affect the pregnancy and the developing embryo. For example, COVID-19 during pregnancy increases the risk of delivering a preterm (earlier than 37 weeks) and/or a stillborn infant. When comparing pregnant women in pre-Delta period aged 15-44 (January 1, 2020-June 26, 2021) with those in the Delta period (June 27, 2021-December 25, 2021), it was observed that,

• The risk of admission to an Intensive Care Unit (ICU) was 41% higher in the Delta period.
• The risk of invasive ventilation or Extracorporeal Membrane Oxygenation (ECMO) was 83% higher in the Delta period.
• The risk of death in the Delta period was 3.3 times the risk in the pre-Delta period.

The emergence of the Delta variant in June of 2021 in pregnant people was associated with severe outcomes including a rise in ICU admissions, an increase in required medical interventions such as invasive ventilation and ECMO, and an increased mortality that was previously seen in the pre-Delta period (January 1, 2020-June 26, 2021).

DIAGNOSIS OF COVID-19

Clinical symptoms: COVID-19 patients have reported mild to severe symptoms ranging from flu-like symptoms to other severe illnesses. There may be 2-14 days between exposure to the virus and the onset of symptoms. COVID-19 may be present in people with these symptoms (5). Most common symptoms are fever, cough, tiredness, loss of taste or smell. Less common symptoms are sore throat, headache, aches and pains, diarrhoea, a rash on skin, or discolouration of fingers or toes, red or irritated eyes. Serious symptoms are difficulty breathing or shortness of breath, loss of speech or mobility, or confusion, chest pain. If patient presents with serious symptoms, seek medical attention immediately. Before visiting the doctor, always call ahead. Mild symptoms should be managed at home by people who are otherwise healthy. An infection with the virus typically takes 5-6 days to manifest its symptoms, but it can take up to 14 days (5).

LABORATORY DIAGNOSIS

Non specific Laboratory test: Test for COVID-19 cases include Complete Blood Count (CBC),C-reactive Protein (CRP), Random Blood Sugar Test (RBS), Haemoglobin A1C (HbA1C), D-Dimer, Lactate Dehydrogenase (LDH), Serum Ferritin, High-Resolution Computed Tomography (HRCT) Chest on day five of symptom onset tests related to pre-existing illness Repeat CBC/Liver Function Test (LFT)/Renal Function Test (RFT)/Electrolytes/CRP/D-Dimer every 72 hours case based: Procalcitonin, Interleukin-6 (IL6), AQT Panel, Arteria Blood Gas (ABG) (6),(7).

Monitoring: Clinical: Haemodynamic, work of breathing, change in O2 requirement, Serial: chest X-Ray (CXR)/HRCT if worsening, Lab: CRP, D-Dimer 48-72 hourly, CBC, Electrolytes, Kidney function test KFT, LFT 24-48 hourly, IL6 if patient deteriorating (6),(7).

Specific Test

RT PCR Test: A COVID-19 diagnosis is based primarily on epidemiological data, clinical symptoms, as well as some adjuvant technologies, such as nucleic acid detection and immunological testing. In addition, in order to ensure personnel safety, SARS-CoV-2 isolation requires high-throughput equipment (biosafety level-2) (8). In order to diagnose COVID-19, the virus responsible for the pandemic, SARS-CoV-2, is analysed for its RNA. It is possible to detect specific sequences of genes encoding the RdRP, N, E, and S proteins of viruses using RT-PCR (8).

Heating methods that do not require extraction, such as those that lyse viral particles to release RNA for subsequent analysis, are more convenient and suitable for point-of-care testing (9).

The genes encoding N, E, and S proteins, open reading frame 1ab (Orf1ab), and RdRP are targets for the detection of SARS-CoV-2. It is important to choose the targets carefully, since the E gene is highly conserved throughout all beta coronaviruses while the N gene is cross-reactive with other coronaviruses. SARS-CoV-2 can be distinguished from SARS-CoV by analyzing its RdRP gene. The S gene is also useful for distinguishing SARS-CoV-2 from other coronaviruses because of its high divergence (10).

Cycle Threshold (CT) values less than 40 are considered positive for SARS-COV, while CT values of 40 or more are considered negative for SARS-COV (11).

It is recommended that commercial RT-PCR-based tests be used under Biosafety Level 2 conditions, under notification of Drug Controller General of India (DCGI) and Ministry of Health and Family Welfare (MoH and FW), with appropriate biosafety precautions. Indian Council of Medical Research (ICMR) also validates commercial testing kits (RT-PCR, CRISPR, NAAT, Rapid antigen, IgG ELISA etc.) before they are used in mass testing. The tests are validated at the National Institute of Virology (NIV), Pune, and at 14 other ICMR-approved validation centers (12).

CLINICAL MANAGEMENT

Clinical Severity of COVID-19 (13)

Mild disease: Iinfluenza-Like Illness (ILI): Patients with uncomplicated upper respiratory tract infection with mild symptoms (fever, cough, sore throat, nasal congestion, malaise, headache without evidence of breathlessness or hypoxia).

Moderate disease: Pneumonia with no signs of severe disease-dyspnoea, fever and cough hypoxia, SpO2<94%, respiratory rate ≥24 per minute.

Severe disease: Called as severe acute respiratory illness (SARI).

Severe pneumonia: Clinical signs of pneumonia plus one of the following sign of severe respiratory distress: (i) Respiratory rate>30/min or (ii) SpO2<90%.

Acute Respiratory Distress Syndrome (ARDS): Symptoms: Onset of new or worsening respiratory symptoms within one week. Chest imaging: Shows bilateral opacities, not fully explained by effusions, lobar or lung collapse, or nodules decreased PaO2/FiO2 (normal value?500): ARDS can be classified into-mild (<300), moderate (<200), and severe (<100); (when Positive End Expiratory Pressure (PEEP) or Continuous Positive Airway Pressure (CPAP) is maintained at ≥5 cm H2O).

Sepsis: Acute life-threatening multiorgan dysfunction: Clinically diagnosed by Sequential Organ Failure Assessment (SOFA) score.

Septic shock: Persisting hypotension despite volume resuscitation, requiring vasopressors to maintain mean arterial pressure ≥65 mm Hg and serum lactate level >18 mg/dL (Table/Fig 1) shows clinical management in Mahatma Gandhi University of Medical Sciences, Jaipur, Rajasthan, India (6),(14).

VACCINATION

SARS-CoV-2 vaccines are targeting the viral S glycoprotein. The coronavirus was also the target for the development of vaccines against other coronaviruses, and attempts were made in the past to develop vaccines against SARS and MERS based on S glycoproteins (15). In viral replication, the S glycoprotein is responsible for binding to the ACE-2 receptor on the host cell, as well as fusion of the host cell membrane with the viral membrane. Therefore, it is believed that vaccines based on S glycoproteins should elicit antibodies that block viral genome attachment and uncoating from receptors (16). The S glycoprotein’s immunogenicity and ability to bind to the ACE2 receptor are not affected by the presence or absence of other viral glycoproteins, making it a strong candidate for vaccine development (17). There is also consideration of developing a ‘pan-CoV’ vaccine due to the genetic homogeneity among coronaviruses. There is evidence that the S glycoproteins of SARS-CoV-1 and SARS-CoV-2 contain different residues; as a result, antibodies produced against SARS-CoV-1 may not be effective against SARS-CoV-2 (18).

The COVID-19 vaccine is currently approved for full use by six countries and authorised for limited use by another six (19). Details on each of the approved/authorised vaccines are provided in (Table/Fig 2) (20),(31). The vaccines are inactivated, recombinant adenovirus vaccines (human and nonhuman), and novel mRNA vaccines. There has been considerable evidence that many of these vaccines offer significant protection against severe COVID-19 (often up to 100%), and to a lesser degree, symptomatic COVID-19. The side effects of these vaccines are generally mild to moderate and acute (20),(21),(22),(23),(24),(25),(26),(27),(28),(29),(30),(31). However, there is no data on their long-term efficacy or effectiveness in preventing transmission (sterilising immunity).

Conclusion

The COVID-19 pandemic is becoming more severe, with an increase in infections and deaths. The pandemic prompts the use of off-label or consideration of pharmacologic treatments throughout the world. Various drugs were recommended for treating patients with COVID-19 infection.

In most of the guidelines, these drug classes were mentioned, either with compressions on their use or with restrictions for their use only in clinical trials. Generally, there is a big difference between these guidelines. These included indications for using drugs, types of drugs, dosage regimen, period of treatment, and safety of use among different patient groups. The recommendations for the treatment with these drugs in all of the guidelines differ depending on the severity of the case and the health conditions of the patient.

References

1.
Yüce M, Filiztekin E, Özkaya KG. COVID-19 diagnosis-A review of current methods. Biosens Bioelectron. 2021;172:112752. Doi: 10.1016/j.bios.2020.112752. Epub 2020 Oct 24. PMID: 33126180. [crossref] [PubMed]
2.
World Health Organization WHO site. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed date 20.01.2020.
3.
World Health Organization (WHO), Middle East respiratory syndrome, 2021. http://www.emro.who.int/health-topics/mers-cov/mers-outbreaks.html (Accessed 7 March 2021).
4.
Rahman HS, Abdulateef DS, Hussen MH, Salih A, Hemn Othman H, Abdulla TM, et al. Recent advancements on COVID-19. A comprehensive review. Int J Gen Med. 2021;14:10351-72. Doi: https://doi.org/10.2147/IJGM.S339475. PMID: 34992449. [crossref] [PubMed]
5.
Centre for Disease Control CDCsite.https://www.cdc.gov/coronavirus/2022ncov/symptomstesting/symptoms.html Symptoms of COVID-19 Updated Mar. 22, 2022.
6.
World Health Organization WHO site. https://www.who.int/emergencies/diseases/novel-oronavirus2022. Accessed date 22.03.2022.
7.
Centre for Disease Control https://www.cdc.gov/coronavirus/2019-ncov/testing/diagnostic-testing.html. Accessed date 20.03.2020.
8.
Sample collection guidelines by ICMR-NIE. https://nie.gov.in/cov. Accessed date 07.04.2020.
9.
QiaAmp Viral RNA Extraction manual. https://www.qiagen.com/dk/resources/resourcedetail?id=c80685c0-4103-49ea-aa72-8989420e3018&lang=en. Accessed date 07.09.2020.
10.
Allplex™ 2019-nCoV (SARS-CoV-2) kit literature. http://www.seegene.com/upload/product/IFU_FDA_COVID19_Seegene.pdf. Accessed date 08.04.2020.
11.
Perkin Elmer Chemagic 360 Operational manual. https://www.google.com/search?q=Perkin+Elmer+Chemagic+360+Operational+manual.&oq=Perkin+Elmer+Chemagic+360+Operational+manual+.&aqs=chrome..69i57j0i22i30.8446j0j7&sourceid=chrome&ie=UTF-8. Accessed date 20.04.2020.
12.
Artus SARS-CoV-2 Prep & Amp UM Kit Instructions for Use (Handbook) 04/2021. Accessed date 20.04.2020.
13.
Clinical Management Protocol For COVID-19 (In Adults) Government of India Ministry of Health and Family Welfare Version 6 24.05.21. Accessed date 20.02.2022.
14.
Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. https://www.covid19treatmentguidelines.nih.gov/about-the-guidelines/whats-new/. Accessed date 20.02.2022.
15.
Yang ZY, Kong WP, Huang Y, Roberts A, Murphy BR, Subbarao K, et al. A DNA vaccine induces SARS coronavirus neutralization and protective immunity in mice. Nature. 2004;428(6982):561-64. Doi: 10.1038/nature02463. PMID: 15024391. [crossref] [PubMed]
16.
Du L, He Y, Zhou Y, Liu S, Zheng B-J, Jiang S. The spike protein of SARS-CoV-a target for vaccine and therapeutic development. Nat Rev Microbiol. 2009;7(3):226-36. Doi: https://doi.org/10.1038/nrmicro2090. PMID:19198616. [crossref] [PubMed]
17.
Kim MH, Kim HJ, Chang J. Superior immune responses induced by intranasal immunization with recombinant adenovirus-based vaccine expressing full-length Spike protein of Middle East respiratory syndrome coronavirus. PLoS ONE. 2019;14(7):0220196. Doi: https://doi.org/10.1371/journal.pone.0220196. PMID: 31329652. [crossref] [PubMed]
18.
Burton DR, Walker LM. Rational vaccine design in the time of COVID-19. Cell Host Microbe. 2020;27(5):695-98. Doi: https://doi.org/10.1016/j.chom.2020.04.022. PMID: 32407707. [crossref] [PubMed]
19.
Corum J, Grady D, Wee SL, Zimmer C. Coronavirus vaccine tracker. The New York Times. 2020;5:4440-56.
20.
Baden LR, El Sahly HM, Essink B, Kotloff K, Frey S, Novak R, et al. Efficacy and safety of the mRNA-1273 SARS-CoV-2 vaccine. N Engl J Med. 2021;384(5):403-416. Doi: 10.1056/NEJMoa2035389. Epub 2020 Dec 30. PMID: 33378609. [crossref] [PubMed]
21.
Chen W. A Phase III clinical trial for inactivated novel coronavirus pneumonia (COVID-19) vaccine (Vero cells) Wuhan Institute of Biological Products: Chinese Clinical Trials Registry. 2020;5:0-19.
22.
Halperin SA, Zhu F, Angley JM. Phase III trial of a COVID-19 vaccine of adenovirus vector in adults 18 years old and above (NCT04526990). ClinicalTrials.gov. 2021;5:348-458.
23.
Kuzubov VI. Study of the safety, reactogenicity and immunogenicity of "EpiVacCorona" vaccine for the prevention of COVID-19 (EpiVacCorona). ClinicalTrials.gov. 2021;4:5678-88.
24.
Logunov DY, Dolzhikova IV, Shcheblyakov DV, Tukhvatulin AI, Zubkova OV, Dzharullaeva AS, et al. Safety and efficacy of an rAd26 and rAd5 vector-based heterologous prime-boost COVID-19 vaccine: An interim analysis of a randomised controlled phase 3 trial in Russia. Lancet. 2021;397(10275):671-681. Doi: https://doi.org/10.1016/S0140-6736(21)00234-8. [crossref]
25.
Palacios R. Clinical trial of efficacy and safety of sinovac’s adsorbed COVID-19 (Inactivated) vaccine in healthcare professionals (PROFISCOV). ClinicalTrials.gov. 2021;3:245-55.
26.
Polack FP, Thomas SJ, Kitchin N, Absalon J, Gurtman A, Lockhart S, et al. Safety and efficacy of the BNT162b2 mRNA COVID-19 vaccine. N Engl J Med. 2020;383(27):2603-15. Doi: https://doi.org/10.1056/NEJMoa2034577. PMID: 33301246. [crossref] [PubMed]
27.
Products CFSCfRaDoIaB. The control of the first batch of CoviVac vaccine will be completed in the second half of March. Sciences RAo. 2021;3:400-15.
28.
Technology P. Bharat Biotech’s Covid-19 vaccine shows interim efficacy of 81%. 2021. Accessed date 09.11.2021.
29.
Vaccines J, BV P. A study of Ad26. COV2. S for the prevention of SARS-CoV-2-mediated COVID-19 in adult participants (ENSEMBLE). Clinical Trials gov: NCT04505722 2020. Accessed date 11.12.2020
30.
Xia S. A randomized, double-blind, placebo parallel-controlled phase I/II clinical trial for inactivated Novel Coronavirus Pneumonia vaccine (Vero cells). 2021.
31.
Status of COVID-19 Vaccines within WHO EUL/PQ evaluation process Guidance Document 02 April 2022. Accessed date 04.05.2021.

DOI and Others

DOI: 10.7860/JCDR/2022/57182.16909

Date of Submission: Apr 19, 2022
Date of Peer Review: May 13, 2022
Date of Acceptance: Jul 23, 2022
Date of Publishing: Sep 01, 2022

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

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Apr 23, 2022
• Manual Googling: Jul 21, 2022
• iThenticate Software: Aug 26, 2022 (24%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com