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 : 2021 | Month : August | Volume : 15 | Issue : 8 | Page : OC22 - OC26 Full Version

Clinico-epidemiological Profile and Outcomes of COVID-19 Patients Admitted in Jawaharlal Nehru Medical College and Hospital: A Retrospective Study


Published: August 1, 2021 | DOI: https://doi.org/10.7860/JCDR/2021/50659.15210
Syed Haider Mehdi Husaini, Shaad Abqari, Obaid Ahmad Siddiqui, Abu Nadeem, Urfi, Shah Mohammad Abbas Waseem, Shahid Ali Siddiqui, Haris Manzoor Khan

1. Assistant Professor, Department of Medicine, JN Medical College, Aligarh, Uttar Pradesh, India. 2. Associate Professor, Department of Paediatrics, JN Medical College, Aligarh, Uttar Pradesh, India. 3. Associate Professor, Department of Anaesthesiology, JN Medical College, Aligarh, Uttar Pradesh, India. 4. Associate Professor, Department of Anaesthesiology, JN Medical College, Aligarh, Uttar Pradesh, India. 5. Assistant Professor, Department of Community Medicine, JN Medical College, Aligarh, Uttar Pradesh, India. 6. Associate Professor, Department of Physiology, JN Medical College, Aligarh, Uttar Pradesh, India. 7. Professor, Department of Radiotherapy, JN Medical College, Aligarh, Uttar Pradesh, India. 8. Professor, Department of Microbiology, JN Medical College, Aligarh, Uttar Pradesh, India.

Correspondence Address :
Dr. Syed Haider Mehdi Husaini,
Assistant Professor, Department of Medicine, JN Medical College, Aligarh Muslim
University, Aligarh, Uttar Pradesh, India.
E-mail: dr.haiderhusaini2k@gmail.com

Abstract

Introduction: Coronavirus Disease-2019 (COVID-19) has taken the world by storm since its detection in China. The pandemic swept across the globe and affected India. The presence or absence of co-morbidities may determine the clinical outcome. Clinical manifestations include cough, fever and dyspnoea mainly.

Aim: To elucidate epidemiological findings, clinical features, co-morbidities of COVID-19 disease and clinical outcomes in first 500 COVID-19 patients admitted at a tertiary care teaching hospital in Northern India.

Materials and Methods: The retrospective observational study was conducted at Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University, Aligarh, Uttar Pradesh, India, from 21st April to 27th October 2020 on first 500 Reverse Transcription-Polymerase Chain Reaction (RT-PCR)/Rapid Antigen or TruNatBeta positive patients. During January to March 2021 period data was collected and analysed. Data was analysed for epidemiological parameters, symptoms and clinical hospital outcomes of patients. Data was analysed using Statistical Package for the Social Sciences (SPSS) version 21.0 IBM and p-value <0.05 was taken as significant.

Results: Out of total patients, 284 (56.80%) and 216 (43.20%) were males and females respectively and 11.12% of females were pregnant. Difference in mean ages of males and females was significant (p-value <0.001). The results show that 434 patients (86.80%) recovered fully and were discharged (more males were discharged), whereas 47 (9.40%) patients died. Out of total 500 patients 75.60% patients stayed in the hospital for more than 72 hours and 24.40% stayed for less than 72 hours. The mean age of patients who stayed for less than 72 hours was 48.85±17.93 as compared (44.23±17.45) to those who stayed for more than 72 hours and the difference was significant (p-value=0.012). Most common symptom was fever (58%) followed by cough (32%) and dyspnoea (31%). The association between the duration of stay and clinical outcome was significant (p-value <0.001).

Conclusion: Gender, advancing age, duration of stay and associated co-morbidities appear to play role in infection and outcome of COVID-19.

Keywords

Association, Co-morbidities, Coronavirus disease-2019, Duration of stay, Discharge, Gender, Mortality, Trends

The Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) took the world by storm after appearing the first time in Wuhan, Hubei Province, China in December 2019 (1). Since, then it has spread globally and as per latest World Health Organisation (WHO) reports there were 188,655,968 confirmed cases as on 16/07/2021 with over 4,067,517 deaths. After the first case of COVID-19 that was reported on 31/1/20 in India 31,026,829 active cases have been detected so far with 412,531 confirmed deaths as reported by WHO on 16/07/21 (2),(3),(4). Fever and cough were the main symptoms in COVID-19 patients as reported by a study from India (5).

A prospective observational study of 235 COVID-19 patients admitted at the Intensive Care Unit (ICU) of All India Institute of Medical Sciences (AIIMS), New Delhi between May and June 2020 described the epidemiological data, clinical features, co-morbidities and ICU outcomes of patients admitted there. Nearly half of their patients presented with severe COVID-19 disease and required high flow oxygen therapy or mechanical ventilation. Those patients who presented for the first time with Severe Acute Respiratory Illness (SARI) and had deranged haematological parameters were found to have worse prognosis and higher mortality making these two parameters important predictors of early death than epidemiological features and co-morbidities (6). The objectives of our study were to further elucidate demographic findings, clinical features, co-morbidities and clinical outcomes of patients admitted at a tertiary care teaching hospital in Northern India.

Material and Methods

This retrospective observational study was conducted on first 500 COVID-19 patients admitted between 21st April 2020 to 27th October 2020 at Jawaharlal Nehru Medical College and Hospital (JNMCH), Aligarh Muslim University, Aligarh, Uttar Pradesh, India, which was designated as an L2 hospital by the Uttar Pradesh Government. The data was analysed between January 2021 to March 2021. The Institutional Ethics Committee approval was taken (ECR/1418/Inst/UP/2020). Written/telephonic consent was taken.

Inclusion and Exclusion criteria: Study included first 500 patients admitted during the period of study. Patients who were positive on Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) or Rapid Antigen COVID-19 Detection Test or TruNatBeta test were included in the study. Patients not willing to participate in the study were excluded.

Study Procedure

The data of first 500 consenting patients was analysed for the following:

1. Epidemiological parameters such as age, gender and residential zone (within the city or from other adjoining areas).
2. Symptoms at the time of presentation and presence of co-morbidities like diabetes, systemic Hypertension (HTN), Chronic Obstructive Pulmonary Disease (COPD)/asthma, tuberculosis, chronic kidney/liver disease, cancer etc., at presentation.
3 Clinical hospital outcomes: Discharged, expired and referred.

Statistical Analysis

The data of first 500 patients admitted in hospital was analysed using Descriptive statistics using SPSS version 21.0 IBM. Data was represented in terms of number (N), percentage (%) and mean±standard deviation. Number and percentage of mortality from COVID-19 was also represented. Descriptive data was analysed using Analysis of Variance (ANOVA) and unpaired t-test. Chi-square test was used to find association between the clinical outcome and study variables like gender, age-group, duration of stay in the hospital and locality (i.e., within the city and adjoining areas). The p-value of <0.05 was taken as statistically significant.

Results

The mean age of the first 500 patients was found to be 45.36±17.67 years. The mean age (years) of males and females were 48.28±17.17 and 41.53±17.61, respectively. Out of first 500 patients admitted, 56.80% were males and 43.20% were females (out of which 11.12% were pregnant). Mortality percentage was 9.40% and 19/500 i.e., 3.80% were referred. The mean age of patients who stayed for less than 72 hours was 48.85±17.93 as compared (44.23±17.45) to those who stayed for more than 72 hours and the difference was significant (p-value=0.012). In present study, 19 patients i.e., 3.80% were referred. Patients were referred mainly due to unavailability of certain drugs during most initial parts of the pandemic (situation improved a lot due to timely intervention of the administration and Government as pandemic progressed and case load started to increase in India) (Table/Fig 1).

At the time of admission the most common symptom was fever (58%) followed by cough (32%) and dyspnoea (31%). Descriptive analysis showed that top three co-morbidities were Diabetes Mellitus (DM) (22%), systemic HTN (20.20%) and cardiac diseases (9.80%) (Table/Fig 2), (Table/Fig 3).

The difference in mean age of males and females was found to be significant (p-value <0.001). The difference in age groups between males and females was found to be significant at p-value <0.001 (Table/Fig 4).

Results show that overall the percentage distribution of males was significantly higher in all age groups as compared to females (p-value=0.001). The results also show that higher percentage of patients admitted were from within the city (males 55.70% and females 44.30%) (Table/Fig 5).

The association between the duration of stay and clinical outcome was found to be significant (p-value <0.001). The results showed that out of total 47 deaths, majority i.e., 35/47 (74.47%) were within 72 hours of the stay (Table/Fig 6). Analysis of 47 deaths showed that 36.17% deaths occurred in 0-45 years of age. Out of 47 deaths the mean age of patients who died within 72 hours was 50.57±17.70 as compared to those who died after 72 hours (45.83±16.89) and the difference was insignificant (p-value=0.423, un paired t-test). The mean age of males and females were 53.04±12.73 and 45.83±20.67 years respectively (Table/Fig 7).

Discussion

The results of the study show that 284 (56.80%) of first 500 patients admitted were males. Female reproductive hormones oestrogen have inhibitory role on translation of TMPRSS2 microRNA (mRNA), thereby hindering the COVID-19 infection and progesterone shifts the balance towards anti inflammatory cytokines like Interleukin 10 and 4 (IL 10 and 4), thereby preventing the severity of infection (7). These two factors may be the possible explanation for lower infection in females as compared to males. The preponderance of COVID-19 in males could possibly be due to customary and cultural characteristic features of the region (8). Other possible explanation could be higher prevalence of smoking as well as higher expressions of ACE-2 in males (9),(10).

A 86.80% patients were discharged after recovery and testing COVID-19 negative. The overall recovery rate was 86.17% in India till mid October 2020 as per the Ministry of Health and Family Welfare statistics (11). Overall mortality percentage was 9.40% i.e., 47/500. Gender wise break up in different age groups showed that ten females died in age group 0-45 and nine males died in age group 46-60 years. The higher risk of mortality in females has been reported earlier due to socio-economic factors (12).

Mortality was present in 9 (11.12%) males out of 81 admitted in age group 46-60 years, whereas in females out of 32 admitted in age group greater than 60 years 7 (21.87%) died. Thus, out of total 47 deaths, mortality was higher in age group 46-60 years and greater than 60 years in males and females respectively. Results of earlier study have shown that the risk of COVID-19 patients is equal in both males and females but the mortality is higher in former gender (13). Review of literature suggests that in males, T-cell responses not only weaken with age but the immune responses to antigen are also not as strong as compared to females (14).

Mahajan P and Kaushal J found that 59% of infection is present in age group 20-49 years and 25% in age group 50-69 years and that majority of cases were present in males. Contradictory findings as far as gender is concerned were reported from across various countries. Das AK and Gopalan SS analysed the data of around 3500 confirmed cases of COVID-19 in North Korea between January 2020 to April 2020 and found that majority of the cases were females (15),(16). The difference in findings could be attributed to social differences in terms of travel and also due to testing of cases (15).

Study has shown higher levels of IL-10 and lower levels of Tumour Necrosis Factor (TNF-α) in females thus preventing aggressive immune responses. Hormonal effects result in higher expression of Angiotensin Converting Enzyme-2 (ACE-2) in males as compared to females. Animal studies have shown that expression of ACE-2 increases during pregnancy thus increasing vulnerability to infection (17).

Twenty four females were pregnant at the time of admission as per the data of present study. The data is however inconclusive to comment upon the risk of COVID-19 in pregnant females. Moreover, there appears varying reports about the susceptibility of pregnant females to COVID-19 infections. Sun J et al., reported that there was no evidence that pregnant females were at higher risk (18). Since, the hospital where present study was conducted is referral centre thus, pregnant COVID-19 positive females were sent for antenatal care and further management.

Results indicated that fever was the most common presentation followed by cough and dyspnoea. Similar results were reported from earlier study as well (19). In COVID-19 patients admitted in our hospital, DM and HTN were the leading co-morbidities. Sharma R et al., in their review article reported that fever was the most common clinical presentation in COVID-19 followed by cough, fatigue/ malaise, difficulty in breathing, headache, loose stools and vomiting (20). However, country wise variations in presenting features have been reported. Cough was reported to be the chief symptom in countries like Australia and certain regions of United States of America (USA) (21). Severe infections are reportedly more likely to be associated with male gender and presence of co-morbidities like DM, HTN, cardiovascular diseases and COPD. Elderly and those with co-morbidities are at higher risk owing to dwindling immunity and not so strong T and B cell immune responses and also due to greater inflammation and D dimers (22).

Laxminarayan R et al., reported that male gender and higher age groups were at higher risk of mortality. Also, they found that in decreasing order the commonly associated co-morbidities were diabetes (45%), elevated blood pressure (36.2%), coronary artery disease (12.3%) and renal diseases (8.2%), respectively (23).

The presence and absence of co-morbidities and racial differences play role in severity of infection, mortality and clinical features. Studies have reported that DM, COPD, asthma, HTN, CVD, CLD, CKD are associated with severity of COVID-19 infection (24),(25),(26). Racial differences and severity of the disease are associated with the presenting symptoms. Reportedly, loose stools, vomiting, nausea and dyspnoea were more common in New York as compared to China (27). In present study, loose stools/vomiting (present in 30 i.e., 6%) and GIT complaints (present in 20 i.e., 4%) was present in overall 50/500 i.e., 10% of patients. Thus, racial differences appear to be a factor. In this study, loss of smell was present in 1.80% of patients. Previous study has reported anosmia as non specific symptom in 14.8% patients (28). The difference may possibly due to sample size. We analysed the first 500 patients as compared to 74 analysed in the study. Another argument for lower percentage in our study could be that the anosmia may not be noted by the patients (28) and hence may remain under reported.

In present study, 122 patients stayed in the hospital of less than 72 hours and 378 stayed for more than 72 hours. Out of total 47 deaths, 35 occurred in those who stayed for less than 72 hours whereas mortality in later group was 12. Thus, 35/47 deaths occurred within 72 hours of stay and the association was found to be significant (p-value<0.001). Previous study has shown that duration of stay was reportedly shorter in patients who died as compared to those who were discharged from hospital (29). Results of the present are suggestive that patients who died within 72 hours had low oxygen saturation, were referred late, were sick or died due to complications from co-morbidities.

The difference in mean age of patients having shorter duration of stay was significant (p-value=0.012) as compared to those who had stayed longer. The results indicate that age may not be the only criterion deciding the duration of stay, but other factors like co-morbidities also play contributory role. Similarly, even younger patients may suffer mortality owing to factors like presence and absence of co-morbidities (30). Since, during initial outbreaks duration of stay could have been longer due to strict discharge criterions and need to isolate patients from healthy population to contain the spread of virus, thus much inference and conclusion may not be drawn from the observed trend in our study.

Association between the clinical outcome and clinical features at the time of admission was found to be significant in our study. Research indicates that the risks of mortality include age, associated co-morbidities and occurrence of symptoms like difficulty in breathing and abdominal discomfort (31).

Limitation(s)

Analysis of data of patients admitted after October 2020 helped to draw conclusions about the observed trends. Division of cases on the basis of severity, socio-economic status, dietary history, smoking, education status, inflammatory markers, radiological findings and blood reports were not studied.

Conclusion

It was concluded that gender, advancing age, duration of stay and associated co-morbidities appear to play role in infection and outcome of COVID-19.

Acknowledgement

Authors acknowledge the efforts of the medical and paramedical staff of the Hospital, Government of India, Uttar Pradesh Government, local and University administration in managing the COVID-19 crisis.

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DOI and Others

10.7860/JCDR/2021/50659.15210

Date of Submission: Jun 02, 2021
Date of Peer Review: Jul 06, 2021
Date of Acceptance: Jul 21, 2021
Date of Publishing: Aug 01, 2021

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. No

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