COVID 19: Respiratory Management by Non Invasive Ventilation

Background:During this long COVID-19 pandemic outbreak, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are being widely used to treat of NIV in COVID-19 acute respiratory distress syndrome (ARDS) are lacking, and for this reason it is extremely important to accurately determine the outcomes of this strategy. This study aimed to evaluate clinical data and outcomes of NIV in patients with COVID-19 ARDS.Material And Methods:This is retrospective observation study conducted at government hospital during April 2020 to July 2020. The study was approved by local ethical committee.We analyzed patients with the laboratory confirmed case of COVID-19 infection admitted in intensive care unit who require positive pressure ventilation and perfusion which are not able to maintain on simple O2 masks/ nasal cannula /NRBM. Data related to clinical features and co-morbidities were recorded at admission and clinical laboratory data were recorded at start of NIV and respiratory parameter were recorded at the time of admission, start of NIV and at the time of weaning or shift to invasive ventilation.Result:Out of 119 patients 42 patients were successfully weaned off from non invasive ventilation while remaining were shifted to invasive mechanical ventilation. The patients who were shifted to invasive ventilation were all died. Low P/F ratio, high CRP, high D-dimer, high LDH and high ferritin levels were related to conversion to invasive ventilation and high mortality among the group.Conclusion:Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients. Indirectly, non-invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.

Study Of Malformations And Down Syndrome In India (SOMDI) : Baroda Region.

This was a period prevalence study carried out in 4 hospitals in Baroda from October 93 to February 97 covering over 30,000 deliveries. This study, a part of the multicentric SOMDI Project, aimed at dermining the prevalence of malformations in the population and the overall risk figures for Down Syndrom (DS) as well as its maternal age specific prevalence. The hospitals chosen for the study had delivery rates such that the study in the end was expected to comprise of 50% Government i.e. poor socioeconomic strata (SES) and 50% Private sector i.e, an upper SES. Total number of births recorded were 31,775, with the Government Sector having 15,652 and the Private sector have 16,123. The total number of malformations was 651 with the overall incidence of malformation being 2.05% and the incidence the Government and private sectors being 2.57% and 1.54% respectively. The significantly lower incidence in the private sector was probably because of an upper SES and because of early detection and termination. Increasing maternal age showed a rising trend in the percentage of malformations with incidence in the age group from 15-19 years being 2.07% that at an age more than or equal to 40 being 4.92%. Still births had 6.3 times higher incidence of malformations than that in live births (10.43% in still births Vs 1.68% in live births). Malformations were found to be significantly higher in rural (3.1%) compared to urban (1.8%) populations and in children of Consanguinous (5.0%) compared to non-consanguinous marriages (2.06%). Pre terms had a significantly higher (5.6%) incidence of malformations compared to term (1.75%) babies. In male and female babies, incidence of malformations was not significantly different (2.12% and 1.75% respectively). A previous history of malformations was present in 53 incidences (out of total deliveries); out of 53, as many as 31 had a previous history of a neural tube defect (NTD) and in 2 of these there was a recurrence of NTD in this particular pregnancy. In the systemwise distribution of malformation, CNS anomalies were the most common, followed by the musculoskeletal system and gastrointestinal system. An interesting association noted was a large number of babies having a combination of midline defects viz. cleft lip and/or cleft palate and NTD and/or hyrocephalus. A total of 33 Down syndrome cases were encountered with an overall prevalence of 1.04% per 1000 and an overall risk of DS of 1 per 962 births. Maternal age specific prevalence of DS increased from 0.54/1000 at age 15-19 years to 15.6/1000 at age > 40 years. The corresponding age specific risks for DS were 1/1825 births and 1/64 births respectively.

Breastfeeding and childhood cancer.

Total duration of breastfeeding and of exclusive breastfeeding was studied and compared in 99 childhood cancer cases and 90 controls. The difference between the average duration of breastfeeding in cases and controls was significant (p < 0.05), but when average duration of exclusive breastfeeding was compared in cases and controls the difference was highly significant (p < 0.001). In lymphoma cases and controls the difference between the average duration of breastfeeding was moderately significant (p < 0.01). However, when average duration of exclusive breastfeeding was compared in lymphoma cases and controls the difference was highly significant (p < 0.001). When other cancer groups and controls were compared with respect to their total duration of breastfeeding and duration of exclusive breastfeeding the differences when insignificant (p > 0.05). Cases and controls were not different with respect to their age, sex, birth year, birth order, age and educational status of mothers, smoking of fathers and socioeconomic status. However, a positive family history of cancer was obtained in 4 (4%) of cases whereas in controls it was obtained in only 1 (1.1%).

Maternal determinants of intra-uterine growth retardation.

Forty mothers with full term low birth weight babies and 30 age-matched mothers with full term normal birth weight babies were studied to find out the relative incidence of common maternal aetiological factors in the causation of intra-uterine growth retardation (IUGR). Attention was focussed to find out the relevance of the following factors: Age of the mother, weight of the mother, incidence of toxaemias of pregnancy, haemoglobin and serum protein values. It was observed that there was a statistically significant correlation between the incidence of IUGR and maternal weight of less than 45 kg and of toxaemia of pregnancy. Also, there was an increased association of IUGR with decreased value of haemoglobin and serum protein in mothers.