“Impact of covid 19 pandemic on maternofetal outcome in pregnant women with severe anemia:a retrospective case control study” (preprint)

Objective: To study the impact of COVID 19 pandemic on the prevalence, clinical profile, and pregnancy outcomes of women with severe anaemia. Design: Retrospective Case Control study Setting: Department of Obstertrics ,Tertiary care hospital of Delhi Population:Antenatal women >26 weeks and Hemoglobin<7 gm% Methods: After satisfying inclusion and exclusion criteria, cases were taken for a duration of six months during COVID pandemic, covid cases and controls from period six months post covid. Main outcome measures: Prevalence of anemia, Anemia indices and maternofetal outcome. Results: Total 4031 women delivered in study period compared to 6659 in control period. 74.7% and 51.6% were anaemic in study and control groups respectively (p < 0.001). Mean hemoglobin level was significantly lower in cases compared to the controls. Microcytic hypochromic anemia was most common morphological type of anemia in both groups. Serum ferritin, serum iron, serum B12 and folic acid levels among cases were significantly (p<0.05) lower as compared to controls. Odds of foetal growth restriction was 48% higher among cases as compared to controls. The odds ratio of new-born complications such as low birth weight 2.49 (95%CI: 1.04-5.91) and need for nursery or NICU admission 4.84 (95%CI: 0.48-48.24) was higher in cases as compared to controls. Low birth rate was higher in cases and was found to be statistically significant. Conclusion: India needs to focus on minimizing the indirect effects of the pandemic on the maternal and perinatal outcomes. Funding: none

Impact of Diabetes on COVID-19 Mortality and Hospital Outcomes, a Global Perspective: An ONTOP Systematic Review and Meta-Analysis (preprint)

Background: To date, COVID-19 has claimed 4.9 million lives. Diabetes has been identified as an independent risk factor of serious outcomes in people with COVID-19 infection. Whether that holds true across world regions uniformly has not been previously assessed.Methods: This study offers the first ONTOP systematic review and meta-analysis to analyse the collective and geographically stratified mortality, ICU admission, ventilation requirement, illness severity and discharge rate among patients with diabetes. Five databases were searched from inception to 30 th of August 2021. Prospective and retrospective cohort studies, reporting the association between diabetes and one or more COVID-19 hospitalization outcomes, were included. This meta-analysis was registered on PROSPERO, CRD42021278579.Findings: Overall, 158 observational studies were included, with a total of 270212 of participants, median age 59 [53-65 IQR] of who 56.5 % were male. A total of 22 studies originated from EU, 90 from Far East, 16 from Middle East, and 30 from America. Data were synthesised with mixed heterogeneity across outcomes. Pooled results highlighted that patients with diabetes were at a higher risk of COVID-19-related mortality, OR 1.87 [95%CI 1.61, 2.17]. ICU admissions were increased across all studies for patients with diabetes, OR 1.59 [95%CI 1.15, 2.18], a result that was mainly skewed by Far East-originating studies, OR 1.94 [95%CI 1.51, 2.49]. Ventilation requirements were also increased amongst patients with diabetes worldwide, OR 1.44 [95%CI 1.20, 1.73] as well as their presentation with severe or critical condition, OR 2.88 [95%CI 2.29, 3.63]. HbA1C levels under < 70 mmol and metformin use constituted protective factors in view of COVID-19 mortality, while the inverse was true for concurrent insulin use.Interpretation: Whilst diabetes constitutes a poor prognosticator for various COVID-19 infection outcomes, variability across world regions is significant and may skew overall trends.Registration Details: This meta-analysis was registered on PROSPERO, CRD42021278579.Funding Information: No funding was received for the presented work.Declaration of Interests: The authors have no conflict of interest to declare.

First 12 patients with coronavirus disease 2019 (COVID-19) in the United States (preprint)

Introduction: More than 93,000 cases of coronavirus disease (COVID-19) have been reported worldwide. We describe the epidemiology, clinical course, and virologic characteristics of the first 12 U.S. patients with COVID-19. Methods: We collected demographic, exposure, and clinical information from 12 patients confirmed by CDC during January 20-February 5, 2020 to have COVID-19. Respiratory, stool, serum, and urine specimens were submitted for SARS-CoV-2 rRT-PCR testing, virus culture, and whole genome sequencing. Results: Among the 12 patients, median age was 53 years (range: 21-68); 8 were male, 10 had traveled to China, and two were contacts of patients in this series. Commonly reported signs and symptoms at illness onset were fever (n=7) and cough (n=8). Seven patients were hospitalized with radiographic evidence of pneumonia and demonstrated clinical or laboratory signs of worsening during the second week of illness. Three were treated with the investigational antiviral remdesivir. All patients had SARS-CoV-2 RNA detected in respiratory specimens, typically for 2-3 weeks after illness onset, with lowest rRT-PCR Ct values often detected in the first week. SARS-CoV-2 RNA was detected after reported symptom resolution in seven patients. SARS-CoV-2 was cultured from respiratory specimens, and SARS-CoV-2 RNA was detected in stool from 7/10 patients. Conclusions: In 12 patients with mild to moderately severe illness, SARS-CoV-2 RNA and viable virus were detected early, and prolonged RNA detection suggests the window for diagnosis is long. Hospitalized patients showed signs of worsening in the second week after illness onset.