Comparison of Obstetric Outcomes in First and Second COVID-19 Waves: Analysis from a COVID-19-dedicated Tertiary Care Hospital

Introduction: The physiological changes in the respiratory and cardiovascular systems in the immunosuppressed state of pregnancy may exacerbate clinical features and deteriorate outcomes due to COVID-19 infection. We aimed to compare the maternal and neonatal adverse effects in the first and second COVID-19 waves. Methodology: This study was a prospective cohort study conducted in a tertiary care COVID-19-dedicated hospital. In total, 104 (group A) and 96 (group B) COVID-19-positive pregnant women admitted during the first and second waves, respectively, were included in the study. Data on baseline variables, associated comorbidities, clinical presentations, management strategies, and neonatal and maternal outcomes were collected and compared using parametric and nonparametric tests and analyzed. Result(s): Around 2.08% in group A and 6.72% in group B of COVID-19-infected pregnant women, respectively, had moderate-to-severe disease and required intensive care unit stay. Almost 1.04% in group A and 3.84% in group B had maternal mortality, 13.4% and 19.8% babies of groups A and B required admission in neonatal intensive care units, and 8.6% and 7.3% of newborns in groups A and B had COVID-19-positive reports by reverse transcriptase polymerase chain reaction (RT-PCR) at birth, respectively. Of them, 2.1% newborns in group B had RT-PCR positive on day 7 of life and beyond, whereas none had positive RT-PCR reports on 7 days and beyond in group A. Conclusion(s): Dreadful maternal outcomes like requirement of ICU and mechanical ventilator and persistence of neonatal infections were higher during the second wave.Copyright © The Author(s). 2023.

Addressing Well-Being, Burnout, and Professional Fulfillment in Child and Adolescent Psychiatry Trainees During the COVID-19 Pandemic Through Implementation of a Virtual Balint-Like Group: A Pilot Study

Objectives: Physicians, including psychiatrists and psychiatry trainees, are at higher risk of burnout compared to the average working population. The COVID-19 pandemic heightens this risk. This pilot aims to enhance professional fulfillment and support while decreasing the risk and prevalence of burnout in child and adolescent psychiatry trainees through virtual delivery of a Balint-like group incorporating a brief emotional awareness curriculum. Methods: Six child and adolescent psychiatry trainees participated. Eight 60-minute sessions held every 2 weeks were co-facilitated by a psychologist and psychiatrist who developed the curricular content. Each semistructured session combined a brief emotional awareness–enhancing module with a Balint-based approach to case review. The authors assessed trainee well-being, professional fulfillment, and sense of professional support pre- and postintervention with the Well-Being Index (WBI), Stanford Professional Fulfillment Index (PFI), and the authors’ own supplemental survey. Descriptive statistics were reported. Results: Trainees found the curriculum feasible and useful. Pre- and postintervention surveys showed a 23.3% reduction in burnout (p = 0.03) as well as significant improvements in happiness at work, enthusiasm toward work, sensitivity to others, and connectedness with colleagues. There were positive trends in additional aspects of professional fulfillment and sense of professional support. Conclusions: A novel well-being curriculum focused on combining brief emotional awareness–enhancing modules with a Balint-like approach enhances professional fulfillment and a sense of professional support and decreases the risk and prevalence of burnout, even when delivered virtually to a group of child and adolescent psychiatry fellows. Results support the planned expansion of this low-cost, high-value intervention for trainee well-being. WL, AC, REST

Municipal solid waste management under Covid-19: Challenges and recommendations

Covid-19 is proving to be an unprecedented disaster for human health, social contacts and the economy worldwide. It is evident that SARS-CoV-2 may spread through municipal solid waste (MSW), if collected, bagged, handled, transported or disposed of inappropriately. Under the stress placed by the current pandemic on the sanitary performance across all MSW management (MSWM) chains, this industry needs to re-examine its infrastructure resilience with respect to all processes, from waste identification, classification, collection, separation, storage, transportation, recycling, treatment and disposal. The current paper provides an overview of the severe challenges placed by Covid-19 onto MSW systems, highlighting the essential role of waste management in public health protection during the ongoing pandemic. It also discusses the measures issued by various international organisations and countries for the protection of MSWM employees (MSWEs), identifying gaps, especially for developing countries, where personal protection equipment and clear guidelines to MSWEs may not have been provided, and the general public may not be well informed. In countries with high recycling rates of MSW, the need to protect MSWEs' health has affected the supply stream of the recycling industry. The article concludes with recommendations for the MSW industry operating under public health crisis conditions. © 2021 ICE Publishing: All rights reserved.

PLASMA EXCHANGE IN THE TREATMENT OF THROMBOTIC MICROANGIOPATHY ASSOCIATED WITH COVID-19 INFECTION: A CASE REPORT

SESSION TITLE: Medical Students/Residents' COVID-19 SESSION TYPE: Med Student/Res Case Report PRESENTED ON: October 18-21, 2020 INTRODUCTION: The novel Coronavirus-2019 pandemic brings a largely unfamiliar landscape and continual quest for understanding of the spectrum of presentation for this disease. Recent studies have shown endothelial injury as the trigger for the cytokine storm seen in Covid-19 infection. Hypercoagulability and excessive complement activation can lead to a diffuse thrombotic angiopathy and organ dysfunction CASE PRESENTATION: 40 year old Hispanic male with no past medical history presented to the emergency room with weakness, AMS, recurrent hematemesis. Upon arrival, he was immediately intubated for airway protection. On exam pertinent findings included fever of 102°F, response to noxious stimuli only, and scleral icterus. Laboratory data revealed creatinine 8.08 mg/dL, LDH >2500 IU/L, haptoglobin <10 mg/dL, bilirubin 1.2 mg/dL, hemoglobin 6.8 g/dL, platelets 7,000/L with presence of 3+ schistocytes and positive test for COVID-19. PCR was negative for STEC and shigella. Given a PLASMIC score of 7, a presumptive diagnosis of thrombotic thrombocytopenic purpura (TTP) was made and daily plasma exchange (PEX) with dialysis was urgently initiated. A normal ADAMTS13 level led to discontinuation of PEX after 3 sessions;however, after 4 days hemolysis worsened with low C3 complement, therefore PEX was restarted. A complement panel was suggestive of alternative pathway dysregulation. Patient underwent 15 additional sessions of PEX with resolution of hemolysis, improved renal function and mental status. DISCUSSION: Endothelial injury results in exposure of collagen, vWF, fibrinogen. This serves as a trigger for the hypercoagulability and TMA. TMA encompasses a group of disorders characterized by MAHA, thrombocytopenia with varying degrees of end organ damage. One subtype is TTP usually relating to endothelial dysfunction with formation of microthrombi from large platelet-vWF subunits. Another entity is hemolytic uremic syndrome, which is characterized by excessive complement activation often caused by shigella-toxin. Neither of which were seen in this patient. We suspect this patient’s presentation to be a manifestation of complement mediated TMA (CM-TMA) due to COVID. Previous review articles propose the possibility of viral infections including H1N1 causing dysregulation of complement cascade leading to TMA. Autoantibodies can form to complements that regulate complement cascade such as Factor H or Membrane Cofactor Protein. This can lead to dysregulation leading to C3 consumption, endothelial damage and formation of platelet microthrombi. His improvement with PEX poses a probable mechanism of removing cytokines, activated complements and antibodies. CONCLUSIONS: Complement mediated thrombotic microangiopathy could be the final pathway in critical illness. Our case shows that PEX may provide therapeutic benefit by normalization of the complement pathway while awaiting clearance of COVID viremia. Reference #1: Lopes R. Viral-associated thrombotic microangiopathies. Hematol Oncol Stem Cell Ther. 2011;4:51-9. Reference #2: Bitzan M, Zieg J. Influenza-associated thrombotic microangiopathies. Pediatr Nephrol. 2018;33:2009-25. Reference #3: Magro C, Mulvey J, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: a report of five cases. Transl Res. 2020;S1931 5244(20)30070-0. DISCLOSURES: No relevant relationships by Usha Anand, source=Web Response No relevant relationships by John French, source=Web Response No relevant relationships by Mehrin Jawaid, source=Web Response No relevant relationships by Danielle Logan, source=Web Response No relevant relationships by Vijay Nath, source=Web Response