Clinico-Demographic Profile of Covid-19 Patients Admitted in COVID- HDU and its Association with Conjunctivitis

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INTRODUCTION
The coronavirus disease 2019 (COVID-19) has emerged as a severe pandemic, claiming more than 0.8 million lives worldwide between December 2019 till August 2020. 1 Viral analysis of the outbreak of SARS showed that bats are the natural reservoir for SARS-COVs. 2 As societies around the world begin to reopen after many months of lockdown a worrying shift is emerging in the demography of Covid-19 cases towards individuals aged younger than 40 years. According to the analysis of 6 million cases between February and July 2020, the number of infected people aged 15-24 years. increased from 4.5% to 15% possibly resulting from a combination of increased socializing

Original Article
Clinico-Demographic Profile of Covid-19 Patients Admitted in COVID-HDU and its Association with Conjunctivitis in younger age groups and reversion to previous routines. 3 SARS-COV-is thought to be transmitted from person to person mainly through respiratory droplets as close contacts. 4 Patients infected with coronavirus SARS-COV-2 have an incubation period of 3-14 days with a mean period of 5 days the most common symptom of COVID-19 include fever, cough other symptoms include taste change, headache, abdominal pain, diarrhea, G.I bleeding. 5 The ocular surface is exposed to the outside environment which many become a potential gateway for pathogens such as viruses to invade the human body. 6 More over ACE-2 is a cellular receptor for SARS -Cov 2 which has been detected in human conjunctiva epithelia. 7 Although the incidence of conjunctivitis is low, studies have shown that SARS-COV-2 has shown a capacity to use the eye as a portal of entry and cause ocular disease.
The majority of the population contracting coronavirus are asymptomatic but a significant number of patients experience fever, cough, headache, malaise, has loss of smell and taste and a minority of patients also experience red-eye as well but not many studies have been done to prove the relationship of corona-virus with conjunctivitis.

MATERIALS AND METHODS
This was a prospective, single-center study where the data regarding epidemiology, demography, common clinical presentation as well as management and outcome of COVID-19 patients admitted in tertiary care hospitals in western Nepal was evaluated. Data collection was done from 14 th April 2021 till 30 th June 2021. The information was collected on a pre-designed Performa which included patients' demographic profiles, clinical presentations, and outcomes as per treatment by trained doctors. The study included 238 laboratory-confirmed Covid-19 affected individuals and it was approved by the institutional review committee. Data analysis was done in SPSS Software 17.

RESULTS
Total 238 patients were admitted to the HDU of Rapti Academy of Health Sciences. Among the study population, 226 patients were from Dang followed by 4 patients from Pyuthan, Rolpa, and Salyan which are the neighboring areas of Dang valley. Among 238 patients, 145 (60.1%) were male and 95 (39.9%) were female. Regarding age group, the most common age group was 41-65 years (78 patients) followed by 46 patients in the age group 19-45 years and 17 patients were 65 years and older there were 95% female patients in females also the most common age group was 41-65 years (52 patients) followed by 22 patients in the age group 19-40 years. Table 1 depicts the frequency of various signs and symptoms among the study population. Dyspnoea was the most common symptom in 160 patients (67.2%) followed by fever in 192 patients (59.7%) with cough in 101 patients (42.4%). Other symptoms were diarrhea, myalgia, and headache. Reading the red-eye about 9 patients among the 238 patients had this ocular manifestation which comprised of 3.8% by which we can assume that although conjunctivitis could be one of the manifestations of Covid but not a common symptom of Covid 19. The average length of hospital stay was 5.93 ± 4.52 days among the study population. Determining factor for the length of hospital stay was not conjunctivitis.

DISCUSSION
A study conducted in India by Sonil et.al. 8 showed the median age of patients was 33.5 years and male patients comprised 66% in comparison to 48% female patients. Similarly, a study done in north India by Mohan et. al. 9 regarding the clinic-demographic profile of patients admitted in a tertiary care center showed that out of 144 patient mean age was 40.1 ±13.1 years with 93% males which is similar to our result where we also have male preponderance and the common age group was 41 -65 years. COVID-19 hit this age group more commonly as this in the most productive group and the group to socialize more as compared to the other age group. A study by H Agrawal et. al. 10 on assessment on impact of COVID-19 infection in a gender-specific manner suggested that male patients were more likely to be affected by COVID-19 because of a higher rate of smoking and the role of testosterone which is immunosuppressive could be the result of higher incidence of COVID-19 in the male gender. A study in Northeast India showed the median time from the time of admission in the hospital to discharge was about 8 days. 11 Our study showed the mean length of the hospital towards 5.93 days.
A study by Chen et. al. 11 in china regarding ocular manifestation and clinical characteristics of 535 cases of COVID-case in Wuhan china showed 27 patients (5%) presented with conjunctival congestion and the most common clinical symptom were fever, cough, and fatigue they suggested that frequent hand-eyes contact may be the risk factor for conjunctiva congestion in COVID-19 patients. An observational study reported an apparent protective effect against SARS-COVID-2 transmission from routinely wearing spectacles for more than 8 hours per day. 12 Similarly, in a study in India by Sindhuja et.al. 13 regarding the clinical profile 37.80% had URTI Symptoms 15.75% had a systemic illness, and 8 patients (6.29%) had conjunctival congestion. 3/8 patients had developed conjunctival congestion before the manifestation of definite COVID-19 symptoms. In our study, the most common symptom was dyspnoea followed by fever and cough. Only nine patients out of 238 patients had conjunctival congestion which is almost similar to the study by Sindhuja et.al. done in India.

Limitation of the study
As this study was limited to the in-hospital clinical courses only and follow-up detail were not taken into consideration, thus information on slipcase was not reported.