The widespread increase in multiple severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants is causing a significant health concern in the United States and worldwide. These variants exhibit increased transmissibility, cause more severe disease, exhibit evasive immune properties, impair neutralization by antibodies from vaccinated individuals or convalescence sera, and reinfection. The Centers for Disease Control and Prevention (CDC) has classified SARS-CoV-2 variants into variants of interest, variants of concern, and variants of high consequence. Currently, four variants of concern (B.1.1.7, B.1.351, P.1, and B.1.617.2) and several variants of interests (B.1.526, B.1.525, and P.2) are characterized and are essential for close monitoring. In this review, we discuss the different SARS-CoV-2 variants, emphasizing variants of concern circulating the world and highlight the various mutations and how these mutations affect the characteristics of the virus. In addition, we discuss the most common vaccines and the various studies concerning the efficacy of these vaccines against different variants of concern.

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Background: Coronavirus disease 2019 (COVID-19) survivors may continue experiencing diverse symptoms. This study portrays the clinical and laboratory profile of patients with post-acute sequelae of COVID-19’(PASC) at a tertiary care hospital in India. Methodology: This cross-sectional study enrolled patients visiting the post-COVID-19 clinic three weeks after their acute COVID-19 illness. Their clinical, serological, and radiological characteristics were collected and analyzed. Results: Of the 259 participants (age: 48.02±15.27 years; 62.25% men), 168 had PASC manifestations. The most frequently reported symptoms were fatigue (n=71(42.26%)), breathlessness (n=38(22.61%)), and cough (n=35(20.83%)). Patients with PASC had higher body mass index (28.24±5.02 vs. 26.26±3.65; p=0.002), history of hypertension (52 (30.95%) vs. 17 (18.6%); p=0.039), uncontrolled systolic blood pressure (37 (22.03) vs. 14 (15.38); p=0.042), and persistent chest x-ray abnormalities (34 (20.23) vs. 10 (10.98); p=0.048). Conclusion: Fatigue, breathlessness, and cough are common PASC symptoms. Hypertension, obesity, and abnormal chest x-ray findings at follow-up are potential risk factors for developing PASC.

Background and Objectives: The triaging of COVID-19 patients is of paramount importance to plan further management. There are several clinical and laboratory parameters that help in categorizing the disease severity, triaging, and prognostication. Little is known about the prognostic significance of eosinopenia in predicting the severity of COVID-19 from large hospital data, especially from low- and middle-income countries. The objective of this study is to evaluate the level of eosinopenia as an early prognostic marker for assessing the outcomes in COVID-19 patients and to assess the superiority of eosinopenia as a prognostic marker for assessing the outcomes in COVID-19 patients compared to lymphopenia and neutrophil-to-lymphocyte ratio (NLR). Methods: The study was carried out in a tertiary care hospital. A retrospective longitudinal approach was adopted wherein the hospital records of COVID-19 patients were analyzed. In our study, two separate groups of patients were included for analysis to describe the association between initial eosinophil counts of the patients and the clinical outcomes. In the first group, the disease severity in terms of clinical and radiological parameters was compared in patients of COVID-19 presenting with and without the presence of initial eosinopenia. Commonly used markers for triage, namely lymphopenia and NLR, were compared with the presence of initial eosinopenia among the patients who progressed to moderate and severe disease. In the second group, an analysis of eosinopenia was made among the patients who succumbed to the illness. Results: It was seen that 29.6% of patients with eosinopenia had moderate and severe disease compared to those without eosinopenia where only 10.8% had moderate disease, none had severe disease. It was seen that 19.7% of patients with eosinopenia but no lymphopenia had more severe disease compared to patients with lymphopenia but no eosinopenia where 10.8% of the patients had moderate disease, none had severe disease. In patients younger than 60 years who died of COVID-19, it was found that initial eosinopenia was found in 86%, whereas a high NLR >17 was seen in only 25.6% of patients who died, thus implying that is eosinopenia is an important marker of disease severity in COVID-19. Conclusions: Eosinopenia is an important parameter in the evaluation of COVID-19 and the presence of it should alert the clinicians regarding the further progression of the disease. It is not only an important marker but also an early marker for severe disease.

BACKGROUND Brucellosis is a common zoonotic disease that exists worldwide. In India where agriculture is the predominant occupation, people are exposed to livestock and are prone to be infected. The non-specific symptoms that overlap with other diseases make it difficult for the clinician to diagnose, apart from the patient himself presenting late due to mild, non-aggressive symptoms. Brucellosis can also present as a well localized infection. There are not many studies from India focusing on the clinical presentation or other unusual manifestations of the disease and hence the need for this study. The aim of the study was to evaluate the protean manifestations of Brucellosis with special emphasis on organ / localized involvement and to analyze the various lab parameters and treatment practices. MATERIALS AND METHODS This was a retrospective study done during 2012 to 2016 at MS Ramaiah Medical College and Hospitals, Bangalore. Patients diagnosed with brucellosis during this period were included in the study. Their records were analysed for information regarding history, occupation, clinical features, investigations, treatment received and course in the Hospital. RESULTS Records of sixteen patients were selected and studied. The average age of the subjects was 47.75 ± 16.5years. There were 13 (81.25%) male and 3 (18.75%) female patients. There was history of occupational exposure among 8(50%) patients. All subjects had history of fever. Ten (62.5%) had musculoskeletal symptoms. Neurological manifestations were present in 5 (31.25%) subjects. Abdominal examination revealed hepatomegaly (n=2, 12.5%), splenomegaly (n=5, 31.25), hepatosplenomegaly (n=1, 6.25%) and in one (6.25%) patient ascites. Two (12.5%) patients presented with multiple organ involvement. Blood investigations revealed anemia in 13 (81.25%), thrombocytopenia in 9 (56.25%) and elevated ESR in 7 (43.75%) patients. There were eleven (68.75%) patients with an abnormal LFT. Chest X ray was abnormal in 5 (31.25%) patients. Mean Brucella IgM titre was 4.18 ± 3.46 IU/ml. Different treatment protocols were followed. All patients recovered except for one who expired. CONCLUSION Brucellosis may present with multiple non-specific symptoms and signs or with localized organ involvement, often confusing the treating physician. A high index of suspicion is necessary to diagnose this condition.