Study of Clinical Spectrum of Severe COVID-19 Infection in Elderly Patients and its Outcome-A Major Mumbai Tertiary Care Hospital Observations

Background: At 140 million, India has the second largest population of old people in the world, as per the 2011 census. 1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic. Method: This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death. Results: Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission. Conclusions: Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave.

Comparison of insertion characteristics between LMA- Supreme and Laryngeal tube with suction in patients undergoing short duration surgery: a prospective analytical cohort study

Background and Objective: A number of supraglottic airway devices [SADs] are being used for airway management and newer devices are being introduced. This study compared insertion characteristics of two SADs namely LMA Supreme [LMAS] and Laryngeal tube with suction [LTS] in short duration surgery, including insertion success rate, ease of insertion, time taken to insert and the number of attempts required to secure the airway

Methodology: This prospective analytical cohort study compared the insertion characteristics for two devices in short duration surgeries. Sixty six ASA Class I and II patients were divided into two groups of 33 each. Insertion characteristics of the two airway devices were assessed for insertion success rate, ease of insertion, number of insertion attempts, time required for successful insertion and leak pressure. Ease and time for insertion of Ryle's tube, hemodynamic and respiratory parameters during and immediately post insertion as well as postoperative airway morbidity [sore throat, dysphagia and hoarseness] was also compared. Data was analyzed with SPSS statistical software. Statistical significance: p value < 0.05 was considered to be statistically significant

Results: Both LMAS and LTS secured effective airway in less than 30 sec. LTS was inserted in first attempt in 69.7% patients compared to 84.8% in LMAS group. LTS was easy to insert with no resistance in 42.4% patients and LMAS in 69.7% patients. Mean time for establishment of an effective airway was 24.06 +/- 2.54 sec and 20.39 +/- 2.19 sec with LTS and LMAS respectively while for Ryle's tube [RT] insertion it was 18.70 +/- 2.40 and 17.27 +/- 2.30 sec. LMAS was associated with lower leak pressure and thus lower incidence of laryngotracheal complications

Conclusion: Both LMAS and LTS are useful alternatives to endotracheal intubation and provide effective and safe airway within 30sec. Success rate of insertion at first attempt is higher with LMAS. The LMAS was easier and faster to insert than the LTS and RT insertion was easier and faster through LMAS. The airway leak pressure was higher with LTS. Both devices are associated with minimal hemodynamic response. Incidence of post-operative airway morbidity was less with LMAS. LMAS was found to be a reliable and better airway management option for patients undergoing short surgical procedures under general anesthesia

Organic anion transporter protein (OATP1B1) encoded by SLCO1B1 gene polymorphism (388A>G) & susceptibility in gallstone disease.

BACKGROUND & OBJECTIVES: Organic anion transport protein 1B1 (OATP1B1) is a major transporter protein for bile salt uptake in the enterohepatic circulation of bile salts. As the role of SLCO1B1 gene (encodes OATP1B1 or liver specific transporter-1) 388 A>G polymorphism in susceptibility towards gallstone disease is unclear the prevalence of this polymorphism in healthy north Indian population was investigated. METHODS: Peripheral venous blood of 270 unrelated northern Indian patients with symptomatic gallstone disease and 270 unrelated healthy control subjects was screened for SLCO1B1 gene 388 A>G polymorphism by PCR-RFLP method and genotyping was done on 12 per cent polyacrylamide gel. The cross-sectional data on accrual of cases and controls were collected and odds ratio with 95 per cent CI calculated as for case-control design. RESULTS: Allele frequencies of 388 G were 45 per cent in gallstone cases and 44 per cent in controls with no statistical significance. Genotype frequencies in gallstone cases and controls for, genotype AA were 30 and 32 per cent; AG: 51 and 47 per cent and GG: 16 and 21 per cent respectively. No significant association of any allele or genotype with gallstone disease was found. INTERPRETATION & CONCLUSION: Although the prevalence of SLCO1B1 gene 388A>G polymorphism in north Indian population in high, yet this polymorphism does not appear to play a significant role in susceptibility to gallstone formation.

Amnioinfusion in thick meconium.

OBJECTIVE: There are conflicting reports regarding the results of amnioinfusion in the management of meconium passage in utero. This study was done to evaluate transcervical amnioinfusion for meconium stained amniotic fluid during labour. METHODS: 196 women at term in early labour with meconium were randomized to receive either transcervical intrapartum amnioinfusion with saline (96) or routine obstetrical care (100). Transcervical amnioinfusion of one liter saline infused over 30-45 minutes. End points were relief of decelerations, incidence of vaginal delivery, presence of meconium below the neonatal cords, and X-ray evidence of meconium aspiration. RESULTS: Amnioinfusion resulted in relief of decelerations in 75% of cases as compared to 7% in the control group. Eighty-eight percent of patients delivered vaginally as compared to 58% in the control group (p< 0.001). Neonatal outcome was significantly better in the infusion group. The incidence of meconium below the vocal cords was reduced from 48% to 17% (p< 0.004) using amnioinfusion with positive X-rays for meconium aspiration in only 12.5% versus 26% (p < 0.5). CONCLUSIONS: We concluded that transcervical intrapartum amnioinfusion is a safe, simple and inexpensive technique that reduces operative intervention and improves neonatal outcome, and is of tremendous relevance in developing countries.