COVID-19 infection and maternal morbidity in critical care units in Scotland: a national cohort study.

BACKGROUND: Previous research has shown that, in comparison with non-pregnant women of reproductive age, pregnant women with COVID-19 are more likely to be admitted to critical care, receive invasive ventilation, and die. At present there are limited data in relation to outcomes and healthcare utilisation following hospital discharge of pregnant and recently pregnant women admitted to critical care. METHODS: A national cohort study of pregnant and recently pregnant women who were admitted to critical care in Scotland with confirmed or suspected COVID-19. We examined hospital outcomes as well as hospital re-admission rates. RESULTS: Between March 2020 and March 2022, 75 pregnant or recently pregnant women with laboratory-confirmed COVID-19 were admitted to 24 Intensive Care Units across Scotland. Almost two thirds (n=49, 65%) were from the most deprived socio-economic areas. Complete 90-day acute hospital re-admission data were available for 74 (99%) patients. Nine (12%) women required an emergency non-obstetric hospital re-admission within 90 days. Less than 5% of the cohort had received any form of vaccination. CONCLUSIONS: This national cohort study has demonstrated that pregnant or recently pregnant women admitted to critical care with COVID-19 were more likely to reside in areas of socio-economic deprivation, and fewer than 5% of the cohort had received any form of vaccination. More targeted public health campaigning across the socio-economic gradient is urgently required.

Corticosteroid treatment in influenza virus and SARS-CoV-2 co-infected patients

Background. Co-infections with SARS-CoV-2 and influenza virus may become more prevalent now that many countries are easing restrictions to reduce the spread of SARS-CoV-2. Co-infected patients are more likely to receive invasive mechanical ventilation (IMV) and have higher odds of in-hospital mortality. In the RECOVERY trial, dexamethasone was found to reduce the risk of 28-day mortality in hospitalised COVID-19 patients. On June 16, 2020, corticosteroids were included in clinical guidelines for the treatment of COVID-19 patients requiring supplemental oxygen. However, corticosteroid treatment in severe influenza virus infection may increase mortality. The effect of steroids in influenza and COVID-19 co-infected patients is unknown. Methods. Adult patients with RT-PCR confirmed SARS-CoV-2 and influenza virus co-infection were evaluated. Patients without supplemental oxygen during admission were excluded. Patients who were hospitalised prior to June 16, 2020 were included in the 'early' group and patients who were hospitalised on or after June 16, 2020 were included in the 'late' group. Results. 171 co-infected patients were included, 123 patients in the early group (table 1) and 48 in the late group (table 2). In the early group, 25 patients received steroids. In the late group, 40 patients received steroids. In the early group, the proportion of patients who were admitted to critical care was slightly lower in the group that received steroids. IMV was similar in both groups. In-hospital mortality was slightly higher in the group treated with steroids. In the late group, critical care admission and receipt of IMV were higher in the group not treated with corticosteroids than the group with corticosteroid treatment. In-hospital mortality was slightly lower in the group not treated with steroids. Conclusion. There are differences between co-infected patients who were treated and not treated with corticosteroids and differences between the early and late groups. A limitation is that no dates were collected for the start of steroid treatment, making it impossible to draw conclusions on the causality of the need for IMV and treatment with steroids in this analysis. Future research should focus on the effect of steroids in COVID-19 and influenza co-infected patients.

An improved heamagglutination inhibition test for rapid diagnosis and stereotyping of avian infectious bronchitis virus

Infectious bronchitis virus (IBV) causes an acute, highly contagious viral respiratory disease in poultry with huge economic impact and extremely difficult to control due to its multiple serotypes. The disease could be prevented by rapid diagnosis either molecular or serological test. However, the later test is inexpensive such as heamagglutination inhibition test (HI), but IBV fail to give Heamagglutination (HA) reaction without pretreatment. Therefore, we designed this study for preparation of IBV antigen by treating with different enzymes for HA reaction. IBV local isolates were characterized by SDS-PAGE and RT-PCR. The indigenous isolate HA antigens were treated with different proteolytic enzymes trypsin, neuraminidase and phospholipase C. The prepared antigen were stored at -86oC and used for HA test. All antigen prepared by different enzyme were found to give significant HA titer up to 7 log2 . During stability test antigen prepared by phospholipase C were found most stable up to six month by giving constant 7 log2 HA titer, while neuraminidase induced antigen were stable up to five months (7 log2). Trypsin treated antigen were readily lost its activity from 7 log2 to 2 log2 after two months of incubation. During specificity test all antigens showed specific effect on IBV by eliciting agglutination of RBCs while other avian viruses avian influenza (AI), new castle disease virus (NDV) and infectious bursal disease virus (IBDV) were not affected by enzymatic inductions. Therefore, the antigen prepared by phospholipase C has been found to be more effective for HI test for rapid diagnosis of IBV during infection.