Perspective Covid-19 ARDS: challenges in care, recommendations & review of research / Covid-19: Desafíos, recomendaciones, revisión e investigación

Though physicians and care providers are familiar with the management of ARDS, however, when it occurs as a sequale of COVID-19, COVID-19 ARDS has different features and there remains uncertainty on the consensus of management. To answer this question on how it compares and contrasts with ARDS from other causes, we deliver a review of the published literature and our own clinical experience from managing patients with COVID-19 ARDS in DR Congo and India. A PubMed search was conducted on 05-7-2020 using the systematic review filter to identify articles that were published using MeSH terms COVID-19 and ARDS. Systematic reviews or meta-analyses were selected from a systematic search for literature containing diagnostic, prognostic and management strategies in MEDLINE/PubMed. Those were compared and reviewed to the existing practices by the various treating specialists and recommendations were made. Specifically, we discuss the COVID-19 ARDS, its risk factors and pathophysiology, lab diagnosis, radiological findings, rational of recommendation of drugs proposed so far, oxygenation and ventilation strategies and the psychological ramifications of the disease. Because of the high mortality in mechanically ventilated patients, the above recommendations and findings direct the potential for improvement in the management of patients with COVID-19 ARDS.

Aunque los médicos y los proveedores de atención están familiarizados con el manejo de ARDS, cuando ocurre una complicación de COVID-19, existe incertidumbre sobre el manejo y curso que va a seguir. Para responder a esta pregunta sobre cómo se compara y contrasta con el SDRA por otras causas, entregamos una revisión de la literatura publicada y nuestra propia experiencia clínica en el manejo de pacientes con SDRA COVID-19 en la República Democrática del Congo e India. Se realizó una búsqueda en PubMed el 05 de julio de 2020 utilizando el método sistemático con filtro de revisión para identificar artículos que se publicaron utilizando términos MeSH COVID-19 y SDRA. Se seleccionaron revisiones sistemáticas o metanálisis de una búsqueda sistemática de literatura que contenga diagnóstico, pronóstico y manejo estrategias en MEDLINE / PubMed. Aquellos fueron comparados y revisados para las prácticas existentes por los diversos especialistas en tratamiento y recomendaciones que fueron hechos. Específicamente, discutimos el ARDS COVID-19, sus factores de riesgo, fisiopatología, diagnóstico de laboratorio, hallazgos radiológicos, racionalidad de recomendación de los fármacos propuestos hasta el momento, las estrategias de oxigenación y ventilación y las complicaciones psicológicas de la enfermedad. Debido a la alta mortalidad de los paciente en ventilación mecánica las recomendaciones y los hallazgos anteriores se dirigen a la potencial de mejora en el manejo de pacientes con COVID-19.

A study of relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight

Background: An observational study was undertaken to study the relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight.Methods: This study was done on 569 patients to study the relationship between maternal serum vitamin D levels during peripartum period and neonatal birth weight. The data included was maternal serum samples (taken during peri-partum period) and neonatal birth weight. The primary objective of this project was to assess the vitamin D levels in maternal serum and to study its relationship, if any, with birth weight in the neonates.Results: A total of 569 samples of maternal serum were analyzed for serum 25(OH)D levels out of which 457(80%) mothers were found to have sufficient, 101(18%) insufficient and 11(2%) deficient Vitamin D levels as per US Endocrinological society guidelines. Out of total 569 newborns, 104 (18.27%) were low birth weight (LBW) and 465 (81.27%) were normal birth weight (NBW). Out of total LBW (104), 19(18.27%) were born to vitamin D deficient (VDD) mothers and 85 (81.72%) were born to vitamin D sufficient (VDS) mothers. Out of total NBW(465), 86(18.45%) were born to VDD mothers and 379 (81.17%) were born to VDS mothers. These results were not statistically significant (p=0.76456749).Conclusions: Maternal 25(OH)-vitamin D status during late pregnancy did not have any statistically significant effect on the neonatal birth weight.