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ObjectiveLarge data on the clinical characteristics and outcome of COVID-19 in the Indian population are scarce. We analysed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma.DesignSecondary analysis of data from a Phase II, Open Label, Randomized Controlled Trial to Assess the Safety and Efficacy of Convalescent Plasma to Limit COVID-19 Associated Complications in Moderate Disease.Setting39 public and private hospitals across India during the study period from 22 April to 14 July 2020.ParticipantsOf the 464 patients recruited, two were lost to follow-up, nine withdrew consent and two patients did not receive the intervention after randomisation. The cohort of 451 participants with known outcome at 28 days was analysed.Primary outcome measureFactors associated with all-cause mortality at 28 days after enrolment.ResultsThe mean (SD) age was 51±12.4 years; 76.7% were males. Admission Sequential Organ Failure Assessment score was 2.4±1.1. Non-invasive ventilation, invasive ventilation and vasopressor therapy were required in 98.9%, 8.4% and 4.0%, respectively. The 28-day mortality was 14.4%. Median time from symptom onset to hospital admission was similar in survivors (4 days; IQR 3–7) and non-survivors (4 days; IQR 3–6). Patients with two or more comorbidities had 2.25 (95% CI 1.18 to 4.29, p=0.014) times risk of death. When compared with survivors, admission interleukin-6 levels were higher (p2/FiO2 ratio 10 (9.97, 3.65–27.13, p1.0 mg/L (2.50, 1.14–5.48, p=0.022), ferritin ≥500 ng/mL (2.67, 1.44–4.96, p=0.002) and lactate dehydrogenase ≥450 IU/L (2.96, 1.60–5.45, p=0.001) were significantly associated with death.ConclusionIn this cohort of moderately and severely ill patients with COVID-19, severity of illness, underlying comorbidities and elevated levels of inflammatory markers were significantly associated with death.Trial registration numberCTRI/2020/04/024775.

Introduction: Hypertension (HTN) and diabetes frequently coexist, imposing significant cardiovascular risk that is normally studied in terms of brachial blood pressure (bBP). Direct and superior parameters like central haemodynamics and arterial stiffness are studied scarcely. Pulse wave analysis (PWA) offers a non-invasive measurement of the same that we studied in diabetic hypertensives. Materials and Methods: We conducted a case-control study on 333 treated diabetic hypertensive cases and 333 euglycaemic normotensive controls. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Aachen, Germany). Parameters were further analysed in relation to gender, physical activity, body mass index (BMI), glycaemic control, blood pressure control, and disease duration (cut-off 5 years). Multiple linear regressions were done to find significant associations. Results: Cases had significantly higher brachial haemodynamics (blood pressure, heart rate (HR), and rate pressure product); arterial stiffness measures (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification), and central haemodynamics (central blood pressure, cardiac output, stroke work) than controls. In the case group, female gender, BMI ≥23, and uncontrolled blood pressures were significant factors that affected the results while other factors such as glycaemic control, physical activity, and duration did not. HR was significantly associated with study parameters. Brachial pressures were not significantly associated with corresponding aortic pressures. Conclusion: Diabetic hypertensives had adverse profile of cardiovascular parameters beyond bBP, related to female gender, and HTN and its control, more than that of diabetes. This baseline work suggests further study on these potential parameters.

Introduction: Hypertension is the most prevalent noncommunicable disorder, studied in terms of brachial blood pressure. Direct parameters like central hemodynamics and arterial stiffness, though superior, are not studied much. The same can be studied by pulse-wave analysis (PWA) and we did that in euglycemic treated hypertensives. Materials and Methods: A case-control study was conducted in 258 treated euglycemic hypertensives and 258 matched controls. Oscillometric PWA was accomplished by Mobil-O-Graph (IEM, Germany). Parameters were further analyzed for the effect of gender, physical activity, body mass index (BMI) (cutoff 23), blood pressure control, and duration (cutoff 5 years). Multiple linear regressions were used to find significant predictors. P < 0.05 was taken as statistically significant. Results: Cases had significantly higher brachial arterial parameters (blood pressure, heart rate, rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse-wave velocity, total arterial stiffness, pulse pressure amplification), and central hemodynamics (central blood pressure, cardiac output, stroke work) compared to age, gender, and BMI-matched controls. In the case group, female gender, BMI ≥ 23, and uncontrolled blood pressure were significant factors affecting results. Heart rate and pulse pressure were major predictors of study parameters. Central pressure parameters were not predicted significantly by corresponding brachial pressure parameters. Conclusion: PWA revealed the adverse profile of arterial stiffness and central hemodynamics in treated Gujarati hypertensives, associated with female gender, BMI, and blood pressure control, predicted mainly by heart rate and pulse pressure, independent of brachial blood pressure. It indicates both potential and further study of these parameters.

Objective: To assess the impact of concomitant use of aspirin, BB (metoprolol), statin (atorvastatin), and metformin on central haemodynamics and arterial stiffness parameters in treated hypertensive patients. Materials and Methods: We did a cross-sectional study on 476 treated hypertensives. Oscillometric PWA was accomplished by Mobil-o-Graph (IEM, Germany) and groups were stratified using low-dose aspirin, statin, BB, or metformin. Parameters studied were brachial hemodynamics (BP, heart rate, and rate pressure product), arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification), and central hemodynamics (central BP, cardiac output, and stroke work). Results: All pairs were matched by or comparable for major confounding factors except concomitant use of drugs. The use of BB, aspirin, and statin had favorable effect on brachial and central hemodynamics. Metformin use had effect more on central than brachial hemodynamics. BB and metformin had negative, statin had indifferent, and aspirin had positive effect on arterial stiffness. Only few of these differences had statistical significance. Frequency of central pulse pressure ≥40 was insignificantly affected by drugs studied. Conclusions: Concomitant aspirin, BB, and metformin in hypertensives have favorable effects on hemodynamics, brachial more than central. Arterial stiffness has positive impact of metformin and negative impact of BB use. These effects must be considered in studies focusing hypertensive therapies. It remains inconclusive whether these results are due to drugs or their indication.

Background Thirty-four CCHF cases (17 fatal; 17 survived) were confirmed from Gujarat state, India during the year 2019. We aimed to find out the viral load, antibody kinetics, cytokine profile and phylogenetic analysis between fatal and non- fatal cases. Methods Thirty four cases were included in this study. Blood and urine samples were collected from all the cases on the day of admission to hospital. Non-fatal cases were followed weekly for understanding the profile of viral kinetics, anti-CCHFV IgM and IgG antibodies. We also quantified the cytokines in both fatal and non-fatal cases. For epidemiological correlation, livestock were screened for anti-CCHF IgG antibodies and the tick pool specimens were tested by real time RT-PCR. Virus isolation was attempted on tick pools and human specimens and phylogenetic analysis performed on human and ticks complete genome sequences. Results CCHF cases were detected throughout year in 2019 with the peak in August. Out of 34 cases, eight secondary CCHF cases were reported. Cases were predominantly detected in males and in 19–45 years age group (55.88%). The persistence of viremia was observed till 76th POD (post onset date) in one case whereas anti-CCHFV IgM and IgG was detected amongst these cases from the 2nd and 20th POD respectively. Positivity observed amongst livestock and tick pools were was 21.57% and 7.4% respectively. The cytokine analysis revealed a significant increase in the level of serum IL-6, IL-10 and IFN-γ during the acute phase of the infection, but interestingly IL-10 lowered to normal upon clearance of the virus in the clinically recovered case. Fatal cases had high viral RNA copy numbers. Bleeding from one or two mucosal sites was significantly associated with fatality (OR-16.47;p-0.0034 at 95% CI). We could do CCHF virus isolation from two cases. Phylogenetic analysis revealed circulation of re-assortment of Asian-West African genotypes in humans and ticks. Conclusions The persistence of CCHF viral RNA was detected till 76th POD in one of the survivors. The circulation of a re-assortment Asian-West African genotype in a CCHF case is also reported first time from India., Author summary Crimean Congo hemorrhagic fever is a zoonotic tick-borne viral hemorrhagic disease. This disease is reported from Europe, Mediterranean, north-western China, central Asia, Africa, and the Middle East. Several outbreaks of CCHF were reported from Gujarat and Rajasthan states, India from 2011 to 2019. In this study, we discuss the clinical, molecular, serological, and the cytokine data of 34 CCHF cases (17 fatal and 17 survived) which were detected from Gujarat state in the year 2019. A sequential weekly follow up of the CCHF survivors was performed to understand the viral kinetics and the antibody profile. Interestingly, the presence of persistence CCHF viral RNA was observed till 76th POD in one of the survivors. To our knowledge, we are reporting this long term persistence of viremia for the first time. We also observed that the anti-CCHFV IgM detection in the serum samples starts as soon as 2nd POD but anti-CCHFV IgG antibody could be detected in the majority of the cases only after the 28th POD. The cytokine analysis revealed a significant increase in the level of serum IL-6, IL-10 and IFN-γ during the acute phase of the infection, but interestingly IL-10 lowered to normal upon clearance of the virus in the clinically recovered case. We did the phylogenetic analysis and concluded the circulation of the Asian-West African re-assortment genotype in humans, which has not been reported from India prior to this study.

Objective: To study the effect of different classes and combinations of antihypertensive agents on arterial stiffness and central hemodynamic parameters. Materials and Methods: A cross-sectional study was conducted in 446 treated apparently healthy hypertensives. Oscillometric PWA was performed by Mobil-o-Graph (IEM, Germany) to derive cardiovascular parameters that were further analyzed in groups stratified by antihypertensive used. Study parameters were brachial hemodynamics (blood pressure (BP), heart rate, and rate pressure product); arterial stiffness (augmentation pressure, augmentation index, pulse wave velocity, total arterial stiffness, and pulse pressure amplification); and central hemodynamics (central BP, cardiac output, and stroke work). Statistical significance was kept at P

BackgroundCo-existence of hypertension is known in three quarter of Indian type 2 diabetics, this duo having adverse additive effect on cardiovascular health including dysautonomia. Later can be measured by simple 5min heart rate variability (HRV) using simple electrocardiogram, which if reduced indicates cardiac risk.ObjectiveWe compared HRV parameters between hypertensive and normotensive type 2 diabetics, looking for significant difference if any.Materials and methods98 hypertensive and 40 normotensive type 2 diabetics treated as outpatients were evaluated for disease control and risk stratification. 5min resting HRV was measured by Variowin HR, software based instrument, using standard protocols to record time domain, frequency domain and Poincare plot parameters. They were compared between groups for difference with p