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Although children with COVID-19 make up a small proportion of patients and have milder symptoms than adults, liver damage is a well-documented side effect of COVID-19 infection. Most liver damage caused by COVID-19 is modest. In this report, a case of a 6-year-old child who was hospitalised to a paediatric intensive care unit (PICU) with COVID-19 manifested as acute liver failure is de-scribed. © 2022 Nawghare et al.
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Background: Hepatic encephalopathy (HE) in acute-on- chronic liver failure (ACLF) is associated with significant morbidity and mortality. There is paucity of data regarding HE management in patients with ACLF and most of the evidence is extrapolated from patients with cirrhosis. We conducted a prospective, randomized controlled clinical trial to study the efficacy of intravenous branched chain amino acids (IV-BCAA) with lactulose versus lactulose alone for improvement in HE scores at 24h, day 3 & day 7. Duration of ICU stay and survival at days 7 and 28 was compared. Method(s): CANONIC ACLF patients with HE grades >= 2 were assessed for eligibility and randomized into two groups -experimental arm (IV-BCAA -500mL/ day for 3 days + Lactulose;n=39) and comparator arm (Lactulose alone;n=37). Six patients developed COVID-19 after randomization & were excluded (4-experimental arm & 2-comparator arm). Grade of HE was assessed by West Haven Classification and Hepatic Encephalopathy Scoring Algorithm (HESA). ACLF severity was determined by CLIF-C ACLF and MELD scores. All patients received standard of care for HE and ACLF management. Result(s): Both groups were similar in baseline characteristics including grade of HE (2.85 +/- 0.75 vs 2.82 +/- 0.66;P = 0.864) and CLIF-C ACLF score (54.19 +/- 5.55 vs 54.79 +/- 5.74;P = 0.655). Overall survival was 40% at 28 days (48.5% vs 31.4%;P=0.143). Significant improvement in HESA score by >=1 grade at 24h was seen in 14 patients (40%) in BCAA arm and 6 patients (17.14%) in control group (P=0.034) which translated to a shorter ICU stay in the BCAA arm (Table 1). Median change in HESA score at 24h was significantly more in BCAA arm than control arm (P=0.006), however, this was not sustained at day 3 or 7. Ammonia levels did not correlate with the grade of HE (Spearman's correlation coefficient(rho) = -0.0843;P=0.295). Conclusion(s): Intravenous BCAA leads to early but ill-sustained improvement in grade of HE and reduced ICU stay in ACLF.
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Remote learning has become increasingly prevalent in the past decade. The current covid climate has provided an exponential boost for concurrent usage with video conferencing, specifically remote learning. For a good learning experience, the system needs to provide consistent performance and responsiveness of all applications in the concurrent use case while also delivering a good battery life to keep students engaged. Additionally, the education PC segment is typically budget conscious and fan-less, with a thermal design power of 6 Watts. Customers prefer to reuse existing chassis, thermal solutions and avoid high-cost bill of material, which comes with power-saving features. In this paper, we present the approach to optimizing video conferencing use case within the constraints of the education PC segment, which comes with the challenge of maintaining perf/watt. We also present pursued optimizations and associated learnings for design, software, and system tuning to enhance performance and battery life and provide a good user experience for video conferencing and concurrent use cases. © 2022 IEEE.
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Background and Aim: Hepatic encephalopathy (HE) in acute-on-chronic liver failure (ACLF) is associated with significant morbidity and mortality. There is limited evidence regarding HE management in patients with ACLF. We conducted a prospective, randomized controlled clinical trial to study the efficacy of intravenous branched chain amino acids (IV-BCAA) with lactulose versus lactulose alone for improvement in HE at 24h, day 3 & day 7. Duration of ICU stay and survival at days 7 and 28 was compared. Methods: CANONIC ACLF patients with HE grades>=2 were randomized into two groups - experimental arm (IV-BCAA - 500mL/day for 3 days + Lactulose;n=39) and comparator arm (Lactulose alone;n=37). Six patients developed COVID-19 after randomization & were excluded (4-experimental arm & 2-comparator arm). HE Grade was assessed by West Haven Classification and Hepatic Encephalopathy Scoring Algorithm (HESA). ACLF severity was determined by CLIF-C ACLF and MELD scores. All patients received standard of care. Results: Both groups were similar in baseline characteristics including grade of HE (2.85 ± 0.75 vs 2.82 ± 0.66;P = 0.864) and CLIF-C ACLF score (54.19 ± 5.55 vs 54.79 ± 5.74;P = 0.655). Overall survival was 40% at 28 days (48.5% vs 31.4%;P=0.143). Significant improvement in HESA score by 1 grade at 24h was seen in 14 patients (40%) in BCAA arm and 6 patients (17.14%) in control group (P=0.034) which translated to shorter ICU stay in the BCAA arm. Median change in HESA score at 24h was significantly more in BCAA arm than control arm (P=0.006), however, this was not sustained at day 3 or 7. Ammonia levels did not correlate with HE grade (Spearman correlation coefficient (-0.0843;P=0.295). Conclusion: Intravenous BCAA leads to early but ill-sustained improvement in grade of HE and reduced ICU stay in ACLF.
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Introduction Vaccines have emerged as our primary line of defence against the scourge of COVID-19. Patients with cirrhosis have a higher risk of severe COVID-19 and mortality and are thus high priority patients for vaccination. However, cirrhotics were excluded from the phase 2 and 3 trials of COVID-19 vaccines. Hence, we aimed to assess the seroconversion rate and safety of currently available COVID-19 vaccines in India, namely COVISHIELD (ChAdOx1 nCoV-19) and COVAXIN (BBV 152), in patients with cirrhosis. Methods All patients who had attended tele-hepatology services at our institute from March 2020 to June 2021 and diagnosed with cirrhosis as per their medical records were telephonically interviewed in July 2021 using a pre-specified questionnaire. Patients who had completed full course of vaccine (with the 2nd dose being administered at least 2 weeks back) and without history of documented COVID-19 infection (pre or post vaccination) were tested for SARS-CoV-2 IgG antibodies using an automated chemiluminescent assay (Orthoclinical Diagnostics). Our primary outcome was seroconversion in patients with cirrhosis who had received complete COVID-19 vaccination. Secondary outcomes included vaccine acceptance, documented COVID-19 infection post-vaccination and adverse effects of COVID-19 vaccines in cirrhosis. Results We identified and interviewed 784 patients with cirrhosis [compensated: 213 (27.2%), decompensated 561 (72.8%)] with a mean age of 51.07 ± 8.53 years. Two eighty-three (36.1%) patients had received at least 1 dose of COVID-19 vaccine [COVISHIELD: 231 (29.5%), COVAXIN: 52 (6.6%)] and 159 (20.3%) patients had completed full course of vaccination with 2 doses [COVISHIELD: 134 (17.1%), COVAXIN: 25 (3.2%)]. Documented COVID-19 (on RT-PCR) was reported in 3.2% (9/283) patients who had received at least one dose of COVID-19 vaccine while breakthrough COVID-19 (at-least 2 weeks after administration of 2nd dose) was reported in 3.1% (5/159). Adverse events were reported by 19.8% (56/283) patients with the most common being fever (13.1%), myalgia (5.6%) and sore throat (1.1%). No grade III/IV adverse events were reported. So far, 100 fully vaccinated patients (COVISHIELD: 88, COVAXIN: 12) have been tested for seroconversion. Seroconversion rate with COVISHIELD and COVAXIN were 92% (81/88) and 91.7% (11/ 12), respectively. Seropositive patients were divided into high, moderate, and low antibody responses based on the observed signal/cut-off response and no differences were observed between patients with compensated and decompensated cirrhosis (Table 1). There was no correlation between antibody signal/cut-off ratios and CTP (tau: 0.07, p=0.32) or MELD (tau: 0.08, p=0.29) scores. Conclusion Our preliminary data suggests that currently available COVID-19 vaccines in India are safe with high seroconversion rates in patients with cirrhosis. (Table Presented)
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Objective: To determine the demography and clinical profile including severity, radiology, therapy, complications and outcome in hospitalized children with SARS-CoV-2 infection. Methods: This observational study enrolled 100 children, aged 1 month to 12 year with confirmed SARS-CoV-2 infection, admitted consecutively from 21st April to 19th August 2020. The above parameters were described, analyzed and the association of age, gender and underlying comorbidity with the severity of disease was assessed. Results: The study enrolled 100 children, 63 boys (boys:girls ratio=1.7:1) with median age of presentation being 2 year (IQR: 0.64 years to 7.25 years). Thirty-three children were below the age of 1 year, 32 were between 1 and 5 years while 35 were >5 years. Sixty-three children had non-severe and 37 had severe disease. Thirty children had underlying comorbidities. The most common symptom was fever and the most common systems involved were respiratory system followed by gastro-intestinal. Twenty-two children had abnormal chest radiograph. Eighty-two children received antibiotics. Fifteen children suffered from complications of COVID-19. The median duration of hospital stay for children with severe disease was 8 d (IQR 5-12 d). There were 3 deaths and 97 were discharged. Age and gender had no association with severity of disease. The severity of disease had significant association with co morbidities and number of underlying comorbidities (p-value<0.01). Conclusion: Children can have varied presentation of SARS-CoV-2 infection and need monitoring with optimum care. © 2021, Scientific Publishers of India. All rights reserved.
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Background: Reinfection/reactivation of SARS-CoV-2 has been a matter of great interest from the immunological and vaccine perspective. However, little is known about the clinical presentation of such reinfection/reactivation. We report a case series of 9 COVID-19 patients having experienced two clinically- and/or virologically-confirmed episodes of COVID-19. Methods: Epidemiological and clinical characteristics of 9 healthcare workers (HCWs) with two episodes of SARS-CoV-2 are described. Results: The incidence of reinfection/reactivation amongst the HCWs was 2% (9 out of 491) with an average remission period of 66 days (range 43-78 days). Amongst the cases of reinfection 4/9 were asymptomatic in first episode were symptomatic in second episode. There is negative correlation between numbers of days the patients took to become SARS-CoV-2 negative by RT-CPR and/or clinically recover in the first episode and the second episode irrespective for the time spent in remission. Conclusion: Shorter durations of SARS-COV-2 infection in the first episode are associated with longer time to recovery in the second episode in patients with re-infection/reactivation.
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Background: COVID-19 has been a pandemic and global disaster since the beginning of 2020. However, there is a lack of city/locale based studies on status and trends of COVID-19 in India. Aim: The study aims to report the tests, total cases, cases per age group, zone wise confirmed cases and the status of hospitalization / home quarantining for COVID-19 for the smart city of Vadodara. Methods: A retrospective secondary data analysis conducted on all the COVID-19 cases reported from 3rd April to 15th September 2020 for the city of Vadodara. Data were accessed through the Website of Vadodara Municipal Corporation and analyzed on cumulative number of tests, positive cases, deaths and patients’ recovery for comparison of Vadodara with the State, National and International statistics. Results: COVID-19 was found to be more prevalent among males. The age group of 51-60 years had the highest number of cases. The number of deaths was highest in the age group of 61-70 years. Nonetheless, case fatality rate was highest in the age group of 71-80 years. Vadodara also has shown a steady decrease in test positivity rate and fared better in terms of recovery rate as compared to Gujarat, India and the world. However, 15 day moving average of positive cases and deaths indicated that there will be an increase of the cases in near future. Conclusion: Vadodara showed positive trends in managing the COVID-19 pandemic. Vadodara administration had managed to reduce the case fatality rate as compared to Gujarat, India and rest of the world.
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The important reasons for the rapid spread of the novel coronavirus (2019-nCoV) was the lack of awareness of infected individuals about their health due to the 14 day incubation period of the virus and the subsequent un-intentional transmission, large scale ignorance of social distancing guidelines, and improper sanitary precautions and health. In this paper, we describe the development process of a system based solution for individuals to do Covid-19 susceptibility test using the SpO2 oxygen level detection test, to detect symptoms with higher levels of accuracy. We also discuss various other implementation features to prevent the unaware spread of the virus including providing details to the user regarding government guidelines related to containing transmission of the virus, alerts to the user about periodic maintenance of sanitary guidelines, social distancing, and notifying the user on non-compliance of above features. Finally, we discuss possible future extensions to stricter the measures taken up by the user to prevent any mistakes- like a front-camera based mask authentication approach, and alerting the user on entering crowded areas based on Bluetooth crowd sensing. Also, this system will be further developed into a mobile application.
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To control the spread of the coronavirus (COVID-19) pandemic, the Government of India imposed various phases of lockdown starting from the third week of March 2020. Improvement in city air quality has emerged as a benefit of this lockdown in India. The objective of this paper is to quantify the health benefits due to this lockdown. PM2.5 concentrations in nonattainment cities (NACs) in Uttar Pradesh and the Delhi-National Capital Region (NCR) in North India were studied. Data from prelockdown and the various lockdown phases were compared, with 2019 as a benchmark. Compared with those in 2019, the PM2.5 concentrations during lockdown Phase 1 were approximately 44.6% lower for cities in Uttar Pradesh and approximately 58.5% lower for the Delhi-NCR. The health impacts of particle inhalation were quantified using the multiple-path particle dosimetry and AirQ+ models, which revealed that the most considerable improvement was during lockdown Phase 1. Among the prelockdown and lockdown phases, Phase 1 exhibited the minimum PM2.5 concentration and thus the greatest health benefits. For the selected cities, the concentration of particle deposition in the tracheobronchial region of human lungs showed its maximum reduction during lockdown Phase 1(30.14%). Furthermore, the results highlighted a decrease of 29.85 deaths per 100,000 persons during lockdown Phase 1, primarily due to the reduction in PM2.5 concentrations. This quantification of the health benefits due to a decrease in PM2.5 may help policymakers implement suitable control measures, especially for NACs, where the respirable particulate matter concentrations remain very high. © 2021, AAGR Aerosol and Air Quality Research. All rights reserved.
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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rapidly spreading in India and across the world. Healthcare workers (HCWs) are at increased risk of contracting COVID-19 due to direct or indirect exposure to COVID-19 patients, and require special attention. Limited information is available about its effect in HCWs. Secondary transmission from HCWs is a possibility among patients, family members, and the community. Therefore, it is important to investigate the infection risk of HCWs and the clinical characteristics of affected cases and possible source of infection with exposure details. The aim of this study is to analyze the medical records of HCWs with COVID-19 retrospectively and carry out the analysis of the data of HCWs with COVID-19 at TNMC and BYL Nair Charitable Hospital (NH, COVID-19 Hospital) in Mumbai. Interim analysis was carried out for the data collected from 6th April to 20th August 2020. Total 3711 HCWs (frontline, 74.32%, non-frontline, 25.68%) are working at NH Mumbai. We observed 11% prevalence of SARS-CoV-2 infection among HCWs, 4% co-infection and 1% mortality. Majority (85%) of the HCWs with COVID-19 were symptomatic and 15% were asymptomatic. Comorbidities were reported in 19% of HCWs with COVID-19. Hypertension and Diabetes Mellitus were the most common co-morbidities reported. More than 4% percent of HCWs with COVID-19 were also positive for plasmodium vivax Malaria. The results of the study will be useful for determining the impact of COVID-19 and adverse outcomes in HCWs, identifying probable mode of acquiring SARS-CoV-2 infection in HCWs. This is required for planning the strategies to handle the epidemic of COVID-19 among HCWs in Mumbai region, and at Maharashtra state level.