A retrospective study to find out factors affecting maternal mortality in a tertiary care hospital in Ahmedabad city, Gujarat

Background : Data pertaining to preventable causes of maternal mortality are valuable in each set up to design interventional steps for the significant reduction of the maternal mortality ratio. Objectives : (1) To study the trend on Maternal Mortality Rate (MMR);(2) To find out the factors for the Maternal Mortality. Material and Methods : A retrospective cross-sectional study of maternal death was conducted in the Obstetrics Department of Tertiary Care Hospital of Ahmedabad city. The data of total 9 years from 1st April 2013 to 31st January 2021 were taken in the study. Epidemiological factors and causes affecting maternal mortality were assessed through pretested questionnaire that includes parity, duration between admission and mortality etc. Results: Maternal Mortality Rate (MMR) was 180.2 per 1 lac live births during the study period. Young mothersaged 20 to 30 years (78.5%), and rural residence (76.6%), multiparous mothers (66.7%)were at risk for Maternal Mortality. Obstetric haemorrhage (25.8%) was the most common cause whereas COVID-19 pandemic later on were indirect causes contributing to Maternal Mortality. Conclusion: Great Care should be taken for high-risk pregnancy like young age, multiparous women and also of postpartum women. Postpartum haemorrhage was the commonest direct cause of Maternal Mortality. Strengthening of existing obstetric care facilities, facility for easy transport, appropriate referral linkages are keys to reduce Maternal Mortality to further extent.

Inflammatory Marker Variations in Predicting Deaths in COVID-19

Introduction. Patients with coronavirus illness experienced a cytokine storm as a major cause of morbidity and mortality in 2019. (COVID-19). The goal of the study was to ascertain the predictive value of pro-inflammatory cytokines with regard to the overall prognosis of COVID-19 patients. Methods. This study was conducted by the Department of Microbiology, Santosh Medical College & Hospital, Ghaziabad, Uttar Pradesh from April to July 2021. We followed 189 patients hospitalized for suspected or confirmed COVID-19 from the day of hospitalization to the day of discharge or death. We measured serum IL-6, CRP, D - Dimer, Ferritin levels upon admission and correlated these results with clinical and laboratory markers of disease severity and with disease outcome. Results. Most of the patients were males and greater than 60 years of age. The mean ferritin level prior to the terminal event (survival or death) among non-survivors was 746 ng/mL as compared to 294 ng/mL among survivors and this difference was statistically significant (p-value <0.05). A decrease in ferritin levels prior to the terminal event (survival or death) and at admission were associated with a greater probability of survival. Ferritin levels prior to the terminal event were more strongly correlated with death than ferritin levels at baseline. Mean CRP level at admission among non-survivors was 69 mg/L as compared to 283 mg/L among survivors and this difference was not statistically significant (p >0.05). Conclusion. In patients with COVID-19, inflammatory markers have prognostic value, with higher levels being associated with worse outcomes.

Molecular docking studies on the phytoconstituents as therapeutic leads against SARS-CoV-2

Because of the present pandemic researchers are seeking for phytocandidates that can inhibit or stop SARS-CoV-2. The main protease (Mpro) of SARS-CoV-2 and spike glycoprotein (S) are both suppressed by bioactive compounds found in plants that work by docking them together. The Mpro proteins 6LU7 (complex with an inhibitor N3) and 5C3N (space group C2221) were employed in docking research. PyRx and AutoDock Vina software were used as docking engine. 22 identified phytoconstituents were selected from IMPPAT, a manually curated database, on the basis of their antiviral effects. Docking studies showed that phytoconstituents β-amyrin (-8.4 kcal/mol), withaferin A (-8.3 kcal/mol), oleanolic acid (-7.8 kcal/mol), and patentiflorin A (-8.1 kcal/mol) had the best results against 5C3N Mpro protein whereas kuwanon L (-7.1 kcal/mol), β-amyrin (-6.9 kcal/mol), oleanolic acid (-6.8 kcal/mol), cucurbitacin D (-6.5 kcal/mol), and quercetin (-6.5 kcal/mol) against 6LU7 Mpro protein. All the compounds were examined for their ADMET characteristics using SwissDock. Present research reports that the phytoconstituents along with docking score will be helpful for future drug development against Covid-19. © 2022 Industrial Chemistry Research Institute. All rights reserved.

Are we adequately prepared to handle the anticipated 3rd peak of COVID-19: A KAP survey among HCWs

Experts in the field are predicting a third COVID-19 peak very soon in coming times, it is important to assess recent knowledge, attitude in view of prolonged exhaustion and adherence to preventive practices of HCWs. This cross-sectional study involved 168 HCWs (42 doctors, 42 nurses, 42 paramedical staff and 42 ANMs). Data was collected through online survey tool Google forms in July and August 2021. First section included sociodemographic information and infection with SARS-CoV-2, section 2 assessed recent knowledge, section 3 practices of COVID-19 appropriate behavior and section 4 assessed attitude of HCWs. Shapiro Wilk test was used to determine normality of distribution of variables. Kruskal-Wallis and Mann-Whitney U tests were used to determine the association between two variables. Pairwise comparison was done following a significant Kruskal-Wallis test using Bonferroni's correction. 42.9% of the HCWs and family members of 44.6% HCWs were infected with SARS-CoV-2. 54.1% of infected HCWs were infected during the March-May 2021 peak. 85.1% HCWs had taken COVID-19 vaccine. Mean knowledge, attitude, practice scores were 7.88 +/- 3.03(maximum score: 12), 20.35 +/- 3.2 (maximum score: 25), 69.89 +/- 9.39 (maximum score: 85) respectively. Only 48.8% HCWs had good knowledge about more recent COVID-19 information. A significant association was observed between profession and knowledge scores (p<0.001). Over 85% HCWs had good scores for attitude towards COVID-19 and 88.7% HCWs scored good in COVID-19 appropriate behavior practices. Our HCWs need to be better equipped with the more recently available knowledge about COVID-19 to improve our preparedness for the next anticipated peak.

Test, Track, and Treat Ameliorative Strategy to Contain Severe Acute Respiratory Syndrome Coronavirus 2: An Indian Perspective

Ever since in January 2020, the WHO declared an international public health emergency, emerged as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease-19) pandemic which has devastated human race with its human-to-human transmission, mutation, and mortality with complex pathogenicity mechanism. Earlier theories postulated it to have emerged from "Wet Market," Huanan Seafood Wholesale Market in Wuhan city of Hubei Province in China. Based on initial speculations, this pandemic was suggested to be of enzootic origin, considerably bats and pangolins as connecting link between human-animal transmissions, which were later refuted. Time bound and effective Test, Track, and Treat policy initiatives taken by Indian Government proved to be a benchmark in controlling the pandemic, up to certain extent. Molecular diagnostics have witnessed a scaled up trend in terms of reverse transcription polymerase chain reaction and Rapid Antigen Tests to detect the contagion in oro-pharyngeal and naso-pharyngeal swabs. It is imperative that frequent mutations in SARS-CoV-2 lead to development of new serotypes making screening for novel therapeutics or repurposing of drugs cumbersome. With an effort to consummate existing clinico-pharamaceutical gaps to curb SARS-CoV-2, ardent remains the fact that plants have been considered as medicinal power houses. Green therapeutics are formulation of active phyto components when administered, enhance the bio-availability through different drug delivery systems. Exploration of medicinal plants for their bio-active ingredients to develop immune-boosters as an antiviral prophylactic tool against SARS-CoV-2 remains a preferred choice among health-care practitioners, pharmacologists, and life sciences fraternity at large. In addition, indigenous vaccines have been granted approval for Emergency Use Authorization which would help lower the rates of transmission and mortality by significant numbers in times to come.

Clinical effect of the combination therapy of hydroxychloroquine, azithromycin and ivermectin in patients with COVID-19

Background: The ongoing pandemic has highlighted the need for an effective treatment of COVID-19 patients and prevention of SARS-CoV-2 community transmission.Methods: We conducted a prospective observational study on a cohort of 85 COVID-19 patients (80% males, median age 46 years, range 18–80 years). Patients were treated with a triple drug therapy: ivermectin 12 mg once a week, hydroxychloroquine 400 mg twice a day on the first day and 200 mg twice a day for the next 4 days, and azithromycin 500 mg once a day for 5 days. Endpoints were assessed by clinical outcomes, death, negative SARS-CoV-2 RNA-PCR test on the tenth day, and length of the hospital stay.Results: All patients improved except one 70-year-old female, who died on the third day of admission. The clinical outcome was considered good as 95.24% (80/84) of patients presented a negative SARS-CoV-2 RNA-PCR test on the tenth day of admission and 90.48% (76/84) were discharged in stable condition.Conclusions: The response must focus on immediate isolation of COVID-19 patients and their early treatment to prevent irreversible severe respiratory injury. Our study shows the beneficial effect of triple drug therapy in terms of clinical recovery, shorter duration of viral carriage, community spread prevention, and minimal cost of therapy.

COVID-19 reinfection: A case series

Coronovirus Disease 2019 (COVID-19) manifests with a varied spectrum of symptoms ranging from asymptomatic disease to Acute Respiratory Distress Syndrome (ARDS) and death. Contrary to the expectation of the herd immunity in controlling the pandemic, reinfection with COVID-19 poses a new threat in the control of the pandemic. Authors hereby have described three cases who developed COVID-19 infection for the second time after complete recovery from the first infection. All three patients were less than 50 years of age with no co-morbidities. First case developed the second infection three weeks after having recovered from the first infection whereas second and third case developed repeat infection after two and four months of recovery respectively. The severity of the repeat infection along with the duration between the two infections has been discussed in this article.

Global impact of COVID-19 pandemic on acute stroke and mechanical thrombectomy-an international survey

Introduction: The COVID-19 pandemic has strained the healthcare systems across the world but its impact on acute stroke care is just being elucidated. We hypothesized a major global impact of COVID-19 not only on stroke volumes but also on thrombectomy practice. Methods: A 19-item questionnaire survey aimed to identify the changes in stroke volumes and treatment practices seen during COVID-19 pandemic was designed using Qualtrics software. It was sent to stroke and neuro-interventional physicians around the world who are part of the executive committee of a global coalition, Mission Thrombectomy 2020 (MT2020) between April 5 to May 15 , 2020. Results: There were 113 responses across 25 countries. Globally there was a median 33% decrease in stroke admissions and a 25% decrease in mechanical thrombectomy (MT) procedures during COVID-19 pandemic compared to immediately preceding months (Figure 1A-B). This overall median decrease was despite a median increase in stroke volume in 4 European countries which diverted all stroke patients to only a few selected centers during the pandemic. The intubation policy during the pandemic for patients undergoing MT was highly variable across participating centers: 44% preferred intubating all patients, including 25% centers that changed their policy to preferredintubation (PI) vs 27% centers that switched to preferred-conscious-sedation (PCS). There was no significant difference in rate of COVID-19 infection between PI vs PCS (p=0.6) or if intubation policy was changed in either direction (p=1). Low-volume (<10 stroke/month) compared with high-volume stroke centers (>20 strokes/month) are less likely to have neurointerventional suite specific written personal protective equipment protocols (74% vs 88%) and if present, these centers are more likely to report them to be inadequate (58% vs 92%). Conclusion: Our data provides a comprehensive snapshot of the impact on acute stroke care observed worldwide during the pandemic.(Figure Presented).

Gold nanoparticle based lipoidic oral vaccine against respiratory viruses including sars-cov 2

Defective functioning of the primary immune cells is now considered as the most important cause of the delayed response and hyper-inflammatory lung reactions seen in the patients that become seriously ill during infection with SARS CoV-2. These immune defects are seen either in the inefficient recognition of PAMPs by the Dendritic cells or manifested in the delayed and hyper-inflammatory cytokine release by the macrophages in the lung. The innate immune system response is now being postulated as the critical factor in the body‘s ability to survive the attack by the virus. Gold Nanoparticles (GNP) have been studied over past few years because of their ability to act as carriers of vaccines and chemotherapeutic agents. Use of GNP in rats has been noticed to increase lymphocyte cell populations and cause enhanced activation of macrophages and dendritic cells. Gold ash (elemental gold) formulations have been used in India for ages, for medical conditions ranging from fevers and senility to memory loss . If employed with suitable modifications, such formulations can play the significant role of oral vaccine against the vast range of influenza and corona viruses.. © 2021, Annals of R.S.C.B. All rights reserved.

Air travel in COVID-19 pandemic

To limit the spread of coronavirus, most of the countries had applied lockdown, restricting movement of people, ban on public transport and air travel. The World Health Organization (WHO) advises against the application of travel or trade restrictions in countries experiencing COVID-19 outbreaks for a longer period of time. These lockdowns should be short in duration and be regularly reviewed as the situation evolves. After lockdown, most of the countries have started airline services again, but society in general is sceptical about safety of air travel and the spread of disease in the present COVID time. Aircraft appears to be airtight chamber with passengers sitting very close to each other, so people get worried about getting infection from fellow travellers. Unfortunately, most of the regulations are on chemical contaminants in the flight cabin but are silent on bacteriological, viral and other microbial contamination of air in the cabin. Still, it has been observed that the risk of infection in flight is comparable to train and car and might be much lesser. To maintain air quality, airplanes have High-Efficiency Particulate Air filters which can capture 99.9% of particles (bacteria, fungi and larger viruses or virus clumps) of 0.1-0.3 μm in diameter. Low concentrations of bacteria and fungi have been found in air cabin at levels that are not thought to pose any health risk. Air is replaced with fresh air every 2-4 min in the aircraft. Besides that, ventilation systems on planes are set up in zones;air is shared between a small group of people only. Although the risk of catching something, airborne on a plane is lower than in many other confined spaces because of the filters and air exchange ratio but risk of infection through contact is still possible, so if a person fly observe contact precautions, for example, hand hygiene and use face cover.