Clinical Profile and Short-Term Outcome of Children with Acute SARS-CoV-2 Infection During the First and Second Waves of the Pandemic

Objectives To compare the clinical profle and short-term outcome of children admitted with acute SARS-CoV-2 infection during the frst and second waves of the Coronavirus Disease (COVID-19). Methods This retrospective study was conducted in a tertiary care setting. A retrospective medical record review of all pediatric patients admitted with confrmed SARS-CoV-2 infection between March 2020 and September 2021 was conducted. Patients’ demographic data, pre-existing comorbidities, mode of presentation, and clinical course in the hospital were noted. The outcome measures were in-hospital mortality, need for intensive care, and invasive mechanical ventilation, duration of ICU, and hospital stay. Results One thousand and twenty-four children were recruited, 592 of the frst wave and 432 of the second wave. In the second wave, more children were admitted with respiratory distress (OR=3.38) and neurological manifestations (OR=4.61). There was a higher requirement of intensive care (OR=4.2) and invasive mechanical ventilation (OR=4.17). In-hospital mortality of the second wave was also increased (1.4% vs. 0.1%), but the diference was not statistically signifcant. Children with neurological comorbidities (OR=8.73), malnutrition (OR=3.01), and preterm babies (OR=6.8) were associated with severe COVID. Conclusion The clinical profle of the second wave of COVID-19 in children was diferent from the frst wave, with more respiratory distress and neurological manifestations at presentation. In the second wave, a signifcant increase in the incidence of severe infections requiring ICU care was observed.

The outcome of partial pulpotomy in traumatized permanent anterior teeth – A systematic review and meta-analysis

Background: Partial pulpotomy is a procedural intervention that can maintain the vitality of pulp during the management of traumatized permanent teeth with pulpal involvement. Aim: To evaluate whether partial pulpotomy can be considered a reliable conservative treatment option for treating traumatized permanent anterior teeth with pulpal involvement. Methodology: A computerized systematic search was performed in PubMed, Science Direct, Cochrane, and LILACS databases from 1980 to May 2021. Five studies were included in the final analysis. Quality assessment, Meta?analysis, and Publication bias of the studies were evaluated. This systematic review was registered in PROSPERO (ID – CRD42021262031). Result: The comprehensive Meta?Analysis Software was used. The test of the heterogeneity was analysed using Cochran’s Q statistics. The Q value was 7.186 (df = 6) with a P value of 0.3 and I2 as 16.5%. The studies were considered homogenous, and the fixed?effect model showed an overall point estimate of 0.89 with a 95% confidence interval (0.86–0.91). The Begg and Egger funnel plot indicated that there was no publication bias in the included studies. Conclusion: Evidence indicates that partial pulpotomy may be considered a reliable definitive treatment option in asymptomatic traumatized permanent anterior teeth with exposed pulp rather than total pulpotomy.

Covid 19, the Kerala experience: an observational, single centre retrospective study of outcome in covid positive pregnancies

Background: Covid 19 has spread across the world at an alarming rate. Approximately 4.05 million people have got infected worldwide resulting in around 279,000 deaths. Over 1 million people have recovered worldwide. Aim of this study was to determine whether course and severity of covid 19 is altered in pregnant women and whether covid 19 seemed to worsen the prognosis in pregnant women.Methods: Around 50 covid positive patients were admitted to this study hospital, a tertiary care referral hospital and medical college, between march and May 2020, 11 were pregnant. Authors collected their data retrospectively to understand the course of their disease till the period of recovery.Results: There were 6 patients above 31 weeks of whom one had elective repeat caesarean section, one had full term vaginal delivery, one is under follow up. Three patients had foetal distress necessitating emergency caesarean section. Of the remaining 5 patients with periods of gestation between 9-13 weeks, 1 of 24 weeks, 6 patients above 31 weeks, one had a miscarriage. Rest pregnancies are continuing and under follow up. 6 women had been symptomatic at admission, with mild symptoms of low-grade fever, sore throat and rhinitis. All were treated with hydroxychloroquine (HCQs). Those with respiratory symptoms like cough were also treated with oseltamivir. In view of high prevalence of H1N1 in the region. None of the women developed severe disease. The disease did not appear to worsen prognosis in pregnant women. The rate of recovery in pregnant women was similar to that seen in non-pregnant women and also men under the age of 40 years admitted in this study hospital.Conclusions: Covid 19 did not seem to worsen the prognosis in pregnant individuals when compared to rest of the population. The foetal outcomes also seemed favorable. However larger studies are required before concrete guidelines could be formulated for management of the disease in pregnancy.

Postoperative morbidity following Whipple’s procedure for periampullary carcinoma: a retrospective study spanning 5 years

Background: The morbidity rates for Whipple’s procedure has remained high even as mortality rates were coming down. This study was intended to assess postoperative morbidity rates in  a tertiary care centre and to compare it with other centres.Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated.Results: There were 48 patients and half of them developed morbidity. Surgical site infection was the most common complication (18.8%) followed by pulmonary complications (12.5%) and bile leak (6.25%). Half of the patients having pulmonary complications died while nobody with surgical site infection or bile leak died.Conclusions: In this study the morbidity rates were comparable to other centres. Hypoalbuminemia is a significant predictor of morbidity. Surgical site infection was the most common morbidity. Pulmonary complications were the most common cause for death. Morbidity rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where the study was conducted.

Postoperative Mortality Rate Following Whipple’s Procedure for Periampullary Carcinoma: A 5 Year Cohort Study

The mortality rates for Whipple’s procedure has come down during the last few years. This study was intended to assess perioperative mortality rates in a tertiary care centre and to compare it with other centres. Methods: Data was collected from various registers and medical records for this retrospective cohort study. All Whipple’s procedures for 5 years were included in the study. Statistical analysis was done using R statistical software and the results were tabulated. Results: There were 48 patients and 8 of them died. A median serum bilirubin level of 16.9 mg% was found statistically significant with respect to mortality. Similarly placed was median serum albumin levels of 2.71 gm% and poor differentiation of tumour. Conclusion: In this study the mortality rates were comparable to other centres. Hypoalbuminaemia is a significant predictor of mortality. Tumour size of more than 3 cm is associated with high mortality. High serum bilirubin levels is an independent predictor of mortality. Several studies also show similar predictors of death in Whipple’s procedure. Pulmonary complications were the most common cause for death. Mortality rate is comparable to other centres and Whipple’s procedure is a safe surgery in the tertiary centre where it was studied.