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BACKGROUND: Persons with Coronavirus Disease 2019 (COVID-19) infection have an increased risk of pregnancy-related complications. However, data on acute cardiovascular complications during delivery admissions remain limited. OBJECTIVE(S): To determine whether birthing individuals with COVID-19 have an increased risk of acute peripartum cardiovascular complications during their delivery admission. METHOD(S): This population-based retrospective cohort study used the National Inpatient Sample (2020) by utilizing ICD-10 codes to identify delivery admissions with a diagnosis of COVID-19. A multivariable logistic regression model was developed to report an adjusted odds ratio for the association between COVID-19 and acute peripartum cardiovascular complications. RESULT(S): A total of 3,458,691 weighted delivery admissions were identified, of which 1.3% were among persons with COVID-19 (n=46,375). Persons with COVID-19 were younger (median 28 vs. 29 years, p<0.01) and had a higher prevalence of gestational diabetes mellitus (GDM), preterm births and Cesarean delivery (p<0.01). After adjustment for age, race/ethnicity, comorbidities, insurance, and income, COVID-19 remained an independent predictor of peripartum cardiovascular complications including preeclampsia (aOR 1.33 [1.29-1.37]), peripartum cardiomyopathy (aOR 2.09 [1.54-2,84]), acute coronary syndrome (ACS) (aOR 12.94 [8.85-18.90]), and cardiac arrhythmias (aOR 1.55 [1.45-1.67]) compared with no COVID-19. Likewise, the risk of in-hospital mortality, AKI, stroke, pulmonary edema, and VTE was higher with COVID-19. For resource utilization, cost of hospitalization ($5,374 vs. $4,837, p<0.01) was higher for deliveries among persons with COVID-19. CONCLUSION(S): Persons with COVID-19 had a higher risk of preeclampsia, peripartum cardiomyopathy, ACS, arrhythmias, in-hospital mortality, pulmonary edema, AKI, stroke, and VTE during delivery hospitalizations. This was associated with an increased cost of hospitalization. Keywords: COVID-19, Pregnancy, GDM, PCOS, Preeclampsia, CVD, Cardiovascular Disease Abbreviations: COVID-19: Coronavirus disease-2019, GDM: Gestational Diabetes Mellitus, PCOS: Polycystic Ovary Syndrome, National Inpatient Sample: NIS, AHRQ: Agency for Healthcare Research and Quality, HCUP: the Healthcare Cost and Utilization Project Funding and Conflicts of Interest Dr. Michos reports Advisory Board participation for Amgen, AstraZeneca, Amarin, Bayer, Boehringer Ingelheim, Esperion, Novartis, Novo Nordisk, and Pfizer. The remaining authors have nothing to disclose.Copyright © 2023
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Background: The COVID-19 pandemic resulted in large-scale public health restrictions and lockdowns across many countries. There is an increasing literature on the varied impact of such lockdowns in autistic adults. However, there is very little research on how the pandemic and related public health measures may impact the willingness of autistic people in engaging and taking part in research. The aim of this qualitative study was to explore autistic adults' experiences of the COVID-19 lockdown and how the pandemic may affect future research participation.Methods: We conducted in-depth interviews with 31 autistic adults between March and July 2020. Transcripts were analyzed thematically within a critical realism framework.Results: Participants identified positive aspects of lockdown such as enjoying the lack of social pressures and using their well-developed skills for dealing with uncertainty. Autistic people also shared challenges of adjusting to lockdown, for example, rapid change in daily routines. While hopeful about the freedom gained from easing restrictions, participants were concerned about the inconsistent communication and application of rules during the transition out of lockdown. This may have exacerbated already rising mental health issues among autistic people. The participants viewed research participation and engagement with increased relevance during the pandemic and welcomed efforts to conduct research using online methods of communication.Conclusion: The COVID-19 lockdown had a varied effect in the lives and routines of autistic people. However, health care providers and researchers need to be mindful of rising mental health issues in the aftermath of the pandemic, especially for people who were already vulnerable. The response to the pandemic may have offered opportunities for innovation in research processes enabling more autistic people to engage with research and making studies more inclusive.
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Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic infection to critical illness. About 80% of COVID-19 infections are mild or asymptomatic, 15% are associated with severe infection requiring oxygen and 5% are critical infections, requiring ventilation support. Patients with mild illness usually recover at home, with supportive care and isolation. But most of the mild COVID-19 patients have been prescribed off-label medication such as Hydroxychloroquine, Azithromycin, Ivermectin, Doxycycline, Favirapivir, Vitamin C, Vitamin D, an oral and inhaled corticosteroid. Literature showed that the sale of all these medications increased in this pandemic The newer cocktail regimen which is a combination of monoclonal antibody Bamlanivimab and Etesevimab showed very promising results. The newer oral antiviral drug Molnupiravir is also showing very good efficacy in terms of reduction in hospitalization and death. This narrative review looked at evidence regarding each drug for its effect on recovery time, viral clearance, and the risk of progression or hospitalization. Among all these, Ivermectin only shows a promising result. The newer cocktail antibody and antiviral drug Molnupiravir is effective in reducing hospitalization and may be a game changer for the patient with mild-moderate COVID-19 infection. There is a lack of evidence for the use of other drugs in the mild case of COVID 19. Only symptomatic treatment with antipyretic with hydration is enough to combat mild COVID-19 infection. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow.
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The COVID-19 outbreak and the subsequent lockdown have had a negative impact on agriculture and other allied activity i.e. food, livestock, dairy etc. The most important and essential aspect of a unsustainable turn of events due to COVID-19 is dairy sector. When it comes to supplying products to clients, dairy suppliers are facing a difficult situation. These disruptions have a sudden impact on the dairy supply chain system and the process can collapse if necessary and immediate actions are not taken. The pandemic and its associated lockdown have not only made it difficult for a large number of poor and marginal dairy farmers but have also had an impact on the livestock feed industry, dairy industry, and related supply value chains of the dairy sector. This review article features different elements of the effects, specifically decreased popularity of various products, wastage of products, supply market chains, work absenteeism due to shortage of labor, and recovery strategy taken by the authorities to recover livestock and dairy sector. This review article provides a comprehensive view of the overall situation, a methodical report gathering critical data across the country and the impact on every sub-area of the dairy sector and associated value supply chains.
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Vertical transmission of acute respiratory syndrome involving coronavirus-2 in pregnant women with COVID-19 (serious acute respiratory syndrome, coronavirus-2 [SARS-CoV-2]) and variations in the progression of maternity complications, including abortion, fetal malformations, impaired fetal development, and/or stillbirth. According to the clinical literature, vertical transmission of SARS-CoV-2 is rare, but even if a SARS-CoV-2-negative neonatal test is administered, there is still a risk of infection and persistent abnormalities including fetal and maternal vascular dysfunction, major SARS-CoV-2 receptors are known to be an enzyme converting to angiotensin 2 (ACE2) and are highly expressed in maternal fever cells. Endothelial cells, smooth muscle vascular primary and secondary chorionic cells. However, it is not possible to eliminate other routes of placental infection. CoV-2 is often contaminated by fusion trophoblasts, but fetuses are seldom affected. The existence of the placental barrier is suggested by these findings, even if it is not fully successful. Intensive health research, such as repeated ultrasonography and fetal heart rate tracking, is strongly advised during pregnancy. Women infected with COVID-19 can carefully evaluate placental specimens after delivery through morphological and molecular techniques, as the extent and molecular mechanisms of intrauterine vertical transmission of SARS-CoV-2 are yet to be established. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Introduction: Severe acute respiratory syndrome by coronavirus 2 (SARS-CoV-2) pandemic first time started from Wuhan in China in December 2019, the World Health Organization on February 11, 2020, officially named this infection, coronavirus disease 2019 (COVID-19) and the virus as SARS-CoV-2. Clinical assessment is indispensable, but laboratory markers, or biomarkers, can provide additional, objective information which can significantly impact many components of patient care. There are several studies and meta-analyses that showed the relation between potential biomarkers to outcomes like mortality, need for ICU admission, mechanical ventilation, and duration of hospital stay. However, the temporal variation of biomarkers along the course of the illness is important to ascertain disease progression and therapeutic response. Objective of study: 1. Trends of blood biomarkers in critically ill patients require prolonged hospitalization. 2. Relation between temporal variation in blood biomarker and course of illness. Materials and methods: This was a retrospective hospitalbased observational study, conducted between 1st May and 30 June, 2021, we included all adult patients aged >18 years with RTPCR or antigen positive COVID-19 infections, admitted in intensive care unit for at least 30 days, and discharged from the hospital. All patients admitted to our institute are investigated and treated as per the COVID treatment protocol of our institute. Blood biomarkers such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), and D-dimer level tested at various intervals during hospitalisation details were noted along with clinical severity. To look for a trend, we took four levels of blood biomarkers at an interval of 10 days and compared then mean value (Day 1-5, Day 10-15, Day 20-25, and Day 30-35). Clinical severity is measured on basis of type of respiratory support like mechanical ventilation, non-invasive ventilation, oxygen through a non-reservoir mask or simple face mask or nasal prong. Results: Total nine patients (six males and three females) were discharged from Intensive care after >30 days of hospitalisation. Among CRP, LDH, ferritin, and D-dimer, only LDH fall and below the baseline level at the time of discharge (Table 1). Other markers have a wide fluctuation in their level and found either similar or higher levels at discharge compared to baseline level. D-dimer found to be increased during the course of illness and raised from the baseline level of 2.1-7.7 at the time of discharge. Wide fluctuation in their level found for CRP followed by LDH and lowest for ferritin during hospitalisation. CRP and ferritin initially fall around day 10 of ICU while LDH increased during the same period (Fig. 1). Out of nine patients, seven patients were on NIV support, one patient on HFNC, and one patient on a simple face mask. Even after 30 days of hospitalisation, one patient was on NRM support, five patients require oxygen through a face mask, and one patient was through nasal prong (Table 1). Conclusion: There is no association between temporal variation in blood biomarkers with the clinical course of COVID-19 disease. Among CRP, LDH, ferritin, and D-dimer, LDH is most closely associated with the clinical course of the disease.
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Introduction: This retrospective observational study has been designed to identify clinical characteristics, treatment outcomes and factors associated with severe illness in 813 COVID-19 patients hospitalised in an Indian tertiary care hospital. Material and methods: This was a retrospective analysis of patient admitted between 1st July to 15th Aug 2020 with COVID-19 infections. Logistic regression was performed to explore the association of clinical characteristics and laboratory parameters with the risk of severe disease and mortality. The statistical significance level was set at 0.05 (two-tailed). Results: Out of 813 study patients, 630 (77.50%) patients were categorised with mild to moderate while 183 (22.50%) patients as severe Covid infection. Mortality was significantly higher in severe Covid patients as compared to mild moderate cases (66.21% vs. 10.31%. p<0.0001. Patients with severe infection were significantly more likely to have diabetes hypertension, chronic kidney disease (CKD) and had significantly higher Neutrophil count, serum creatinine, C-reactive protein (CRP), ferritin, D-Dimer and decreased haemoglobin, lymphocyte and serum calcium than patients with mild-moderate infection. In Multivariate analysis, age more than 60 years [AOR: 2.114, 95% CI (1.05-4.254), 0.036], NLR more than 3.3 [AOR: 1.082, 95% CI (1.030-1.137), 0.002] and D-Dimer >1 mu g/mL [AOR: 2.999 (1.464-6.146), 0.003] were found significantly associated with severe disease (p < 0.05). Factors associated with mortality were age more than 60 years, presence of breathlessness, severe disease or presence of chronic kidney disease. Conclusions: Factors like elderly age (age > 60 years), elevated NRL, CRP, D-Dimer and serum ferritin were associated with significantly higher risk to develop severe COVID-19 infections. Elderly, and patients with CKD were associated with worse outcome.
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The world is facing an unprecedented situation because of spread of coronavirus that causes the disease COVID-19 which is totally new, where no one can see light at the end of the tunnel. In last 3 months, this pandemic has spread to 204 countries, regardless of its being developed, developing or under developed. In comparison to developed countries and being a developing nation, India has to date curtailed the spread of virus to stage 2 of local transmissions by limiting its progression. The Government of India together with its States has taken stringent actions to prevent its spread, including a nationwide lockdown. The sudden lockdown in country of 1.3 billion has brought in many unseen challenges, which has created panic, confusion and inconvenience to the general public at large. Though the remedial steps are taken, but that may cause collateral damage in the long run, if not planned earlier. The main objective of the study is to apprise the world about certain hard realities, ignored situations and unseen challenges that are being faced by world’s 2nd most populous country due to sudden lock down. © 2021, World Research Association. All rights reserved.
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This report is the first expert panel report on the management of post-COVID-19 patients from India. The report contains high risk groups, post-COVID-19 patient management at primary care level, general principles of medical management of post-COVID-19 in primary care settings, management of post-COVID-19 symptoms in primary care settings, recommendations for inclusion and exclusion into the Pulmonary Rehabilitation Programme, post-COVID-19 patient management at tertiary care level, post-COVID-19 complete assessment and management, and respiratory disease-specific conditions requiring expert opinion and further research.
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Introduction Veno-venous extracorporeal membrane oxygenation (VV-ECMO) as bridge to recovery in critically ill COVID-19 continues to be commonly utilized strategy in cases with persistent respiratory failure refractory to traditional ventilation support Case Report We report 5 cases of severe acute respiratory syndrome coronavirus-2 infection (SARS-CoV-2) who were treated with ECMO (Table 1). All 5 cases presented with fever, cough and shortness of breath and a positive nasopharyngeal swab for SARS-CoV-2 on admission. Case 1, 2, 3 and 5 patients were hypoxemic with saturation less than 90% on admission and decompensated rapidly, whereas Case 4 decompensated after day 14. Mechanical ventilation failed to provide adequate oxygenation in all 5 cases;case 2,3 and 5 were started on recruitment measures with proning while it was not possible for case 1 owing to morbid obesity. Proning was not possible in the case 4 as patient became severely hypoxemic while patient was undergoing mechanical thrombectomy. The case 1-4 remained on ECMO for 19, 17, 17 and 2 days respectively. All except case 2 had improvement in APACHEII and SOFA score after ECMO initiation. All 5 patients had elevated inflammatory markers of serum ferritin, D-dimer, Lactate dehydrogenase (LDH), C-reactive protein (CRP) which trended down after a few days of ECMO initiation All 5 patients received high dose steroids during their stay in the ICU. Case 4 and 5 passed away after compassionate extubation. Case 1-3 had prolonged hospital course with complication of hospital acquired pneumonia requiring multiple courses of broad-spectrum antibiotics. Summary Our observational report of 5 patients reports the use of ECMO in critically ill SARS-CoV-2 with ARDS and difficult to maintain saturation despite mechanical ventilation and proning with recovery for 3 patients. However, given the lack of ECMO centers;this is not a readily available option. Further studies are warranted to investigate the role of ECMO in SARRS-CoV-2 and careful identification of appropriate candidates.
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Introduction We present a case of COVID-19 causing hypercoagulability and inflammatory stress leading to STEMI in a patient who went on to develop persistent cardiogenic shock requiring LVA) implantation. Case Report 57-year-old lady developed COVID-19 infection in May 2020. In June 2020, she presented with chest pain, was noted to have STEMI on EKG, complicated by cardiac arrest with ROSC in 14 minutes. She was in cardiogenic shock as well and was started on veno-arterial ECMO. She underwent left anterior descending artery stent placement. Further hospitalization was complicated by persistent cardiogenic shock and complete heart block and underwent pacemaker and cardiac-defibrillator implantation. She developed pulmonary edema, acute kidney injury requiring hemodialysis, shock liver, and persistent cardiogenic shock. She was weaned off VA-ECMO after 4 days but continued to have severely reduced cardiac function. RHC revealed severe volume overload, pulmonary venous hypertension, low cardiac output, and right heart dysfunction. Echo showed severe LV dysfunction with an EF of 15%. A femoral intra-aortic balloon pump(IABP) was placed on July 7, 2020. An attempt was made to wean her off of IABP on July 10th,however, it was unsuccessful and she was transitioned to axillary intra-aortic balloon pump. She remained IABP dependent thereafter and on July 15th, given persistent cardiogenic shock, decision was made to pursue advanced heart failure therapies. After multi-disciplinary discussion, the decision to pursue LVAD implantation was made. She underwent a successful LVAD implantation on July 20th . She failed an extubation trial and underwent tracheostomy on July 23rd . Post LVAD, she developed atrial fibrillation and was started on digoxin and amiodarone. Her symptoms improved and she was subsequently discharged to rehabilitation in late August on amiodarone, digoxin, metoprolol, prasugrel, warfarin, spironolactone and lisinopril. The detailed timeline is shown in figure 1. Summary Hypercoagulability and severe inflammatory stress leading to life-threatening illness is a significant complication of COVID-19 infection. A low threshold for suspecting and treating hypercoagulability and inflammatory induced myocardial ischemia and injury and cardiogenic shock is a reasonable strategy to decrease acute as well as chronic morbidity and mortality.
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With the growing understanding of coronavirus disease-2019 (COVID-19) pathogenesis, different therapeutic targets are being considered for the management of COVID-19. The development of new drugs is a time-consuming process;hence, many drugs acting on similar therapeutic targets/sites in the COVID-19 treatment are repurposed in COVID-19. In this article, an expert panel deliberated on the existing evidence on the immunopathogenesis, therapeutic targets under consideration for treatment of COVID-19, and the place of mefenamic acid in the therapy landscape of COVID-19. The expert panel has also provided recommendations regarding the dose and regimen of mefenamic acid in different phases of the COVID-19 disease.
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Introduction: Heart failure patients with difficult to manage volume status and recurrent heart failure exacerbation benefit from CardioMemsTM placement. This helps in remote monitoring of pulmonary artery (PA) pressure and diuretic dosing can be changed on the basis of these readings preventing hospitalizations. During the COVID-19 pandemic, a stay-at-home order was issued by the state government, which may have led to heart failure deterioration secondary to poor follow up and change in dietary habits. Hypothesis: We aim to evaluate changes in the mean PA pressure during stay-at-home order during COVID-19 pandemic as patients are not seen in clinic and there are presumed changes in dietary habits. Methods: We identified 26 patients with a history of CardioMemsTM implant using our heart failure clinic database. We extracted their daily available PA pressure reading before the COVID-19 pandemic and during pandemic. Results: The characteristics of the patients are described in Table 1. 26 cases with were identified with sufficient CardioMemsTM readings. Average age was 69.7 years with 38.5% females. There were 54% patients with systolic heart failure. Number of COVID-19 cases rose to almost 700 in 1 month. With regression analysis, we observed a trend towards increase in the mean PA pressure readings during the pandemic (R2 = 0.09, P-value<0.05). The patients also developed symptoms of heart failure exacerbation and were managed remotely with the changes in their medications (57% of cases). The trend of the change in the mean PA pressure readings during pandemic is presumably attributed to decreased activity and dietary changes as patients are staying at home and possibly consuming more canned food. However, none of these patients were hospitalized for heart failure exacerbation suggesting patients being scared of coming to the hospital because of the risk of transmission of COVID-19. Conclusions: There is an increase in the mean PA pressure during pandemic compared to that of before pandemic likely because of lack of proper food resources and restriction on exercise activity.