Coronavirus disease 2019 convalescent children: outcomes after congenital heart surgery.

BACKGROUND: Children with exposure to coronavirus disease 2019 in recent times (asymptomatic or symptomatic infection) approaching congenital heart surgery programme are in increasing numbers. Understanding outcomes of such children will help risk-stratify and guide optimisation prior to congenital heart surgery. OBJECTIVE: The objective of the present study was to determine whether convalescent coronavirus disease 2019 children undergoing congenital heart surgery have any worse mortality or post-operative outcomes. DESIGN: Consecutive children undergoing congenital heart surgery from Oct 2020 to May 2021 were enrolled after testing for reverse transcription-polymerase chain reaction or rapid antigen test and immunoglobulin G antibody prior to surgery. Convalescent coronavirus disease 2019 was defined in any asymptomatic patient positive for immunoglobulin G antibodies and negative for reverse transcription-polymerase chain reaction or rapid antigen test anytime 6 weeks prior to surgery. Control patients were negative for any of the three tests. Mortality and post-operative outcomes were compared among the groups. RESULTS: One thousand one hundred and twenty-nine consecutive congenital heart surgeries were stratified as convalescence and control. Coronavirus disease 2019 Convalescent (n = 349) and coronavirus disease 2019 control (n = 780) groups were comparable for all demographic and clinical factors except younger and smaller kids in control. Convalescent children had no higher mortality, ventilation duration, ICU and hospital stay, no higher support with extracorporeal membrane oxygenation, high flow nasal cannula, no higher need for re-intubations, re-admissions, and no higher infections as central line-associated bloodstream infection, sternal site infection, and ventilator-associated pneumonia on comparison with coronavirus disease 2019 control children. CONCLUSIONS: Convalescent coronavirus disease 2019 does not have any unfavourable outcomes as compared to coronavirus disease 2019 control children. Positive immunoglobulin G antibody screening prior to surgery is suggestive of convalescence and supports comparable outcomes on par with control peers.

Post Covid-19 water and waste water management to protect public health and geoenvironment

The coronavirus disease 2019 pandemic has posed severe threats to humans and the geoenvironment. The findings of severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2) traces in waste water and the practice of disinfecting outdoor spaces in several cities in the world, which can result into the entry of disinfectants and their by-products into storm drainage systems and their subsequent discharge into rivers and coastal waters, raise the issue of environmental, ecological and public health effects. The aims of the current paper are to investigate the potential of water and waste water to operate as transmission routes for Sars-CoV-2 and the risks of this to public health and the geoenvironment. Additionally, several developing countries are characterised by low water-related disaster resilience and low household water security, with measures for protection of water resources and technologies for clean water and sanitation being substandard or not in place. To mitigate the impact of the pandemic in such cases, practical recommendations are provided herein. The paper calls for the enhancement of research into the migration mechanisms of viruses in various media, as well as in the formation of trihalomethanes and other disinfectant by-products in the geoenvironment, in order to develop robust solutions to combat the effects of the current and future pandemics. © 2021 ICE Publishing: All rights reserved.

Predictors of mortality in patients with severe COVID-19 pneumonia - a retrospective study.

INTRODUCTION: The novel coronavirus pandemic has caused significant mortality throughout the world. This study was done as there is scarce data on mortality predictors in severe COVID-19 pneumonia patients admitted to ICU in the Indian population. MATERIAL AND METHODS: A retrospective study was conducted on COVID-19 pneumonia patients admitted to tertiary care center during June-October 2020. The records of patients admitted to ICU were collected and data included demography, symptoms, comorbidites and vital parameters. Laboratory parameters included complete hemogram, random blood sugar, S.Ferritin, S.LDH, renal function test, liver function test. Treatment-associated information such as the use of remdesivir, timing of initiating rem-desivir after the symptom onset, the use of steroids, use of anticoagulants, use of HFNC, NIV, ventilator were collected. 30 days mortality data post-discharge was collected via telephonic interview. RESULTS: 4,012 confirmed cases of COVID-19 were admitted to hospital, of which 560 (13.95%) with severe pneumonia were included in the study. Mean age was 57.75 ± 13.96 years. The mortality rates were 54.64% among severe COVID-19 cases and 5% among mild to moderate COVID-19 cases. The Cox multinominal regression analysis identified SpO2/FiO2 < 400, age > 50 years, duration of symptom > 4 days, serum ferritin > 450 µg/L, respiratory rate > 23/min, the presence of comorbidities and non-usage of remdesivir were independently associated with increased mortality. Mortality rate at 30 days was 56.60%. CONCLUSION: Severe COVID-19 pneumonia is associated with very high mortality, especially in a resource-constrained setting. The use of remdesivir may have to be considered early in the course of disease to prevent excess mortality related to COVID-19.

Clinical profile and laboratory parameters in patients with moderate-severe COVID-19 pneumonia admitted in tertiary care hospital in South India

Introduction: Coronavirus pandemic has caused significant morbidity and mortality throughout the world. Due to the novelty of this respiratory virus still, it is unclear regarding the clinical and laboratory profile of patients with COVID-19 pneumonia. So, we took up the study to look for the clinical and laboratory profile of patients with moderate to severe COVID-19 infection. Materials and methods: A retrospective study was conducted on moderate-severe COVID-19 pneumonia patients admitted to tertiary care hospitals from June to October 2020. Data included demographic details, symptoms, comorbidities, vital parameters were recorded. Laboratory parameters included complete hemogram, neutrophil-lymphocyte ratio, serum ferritin, serum LDH, renal function test, liver function test, and arterial blood gas. Treatments details like the use of remdesivir, use of steroids and anticoagulants, use of a high-flow nasal cannula, noninvasive ventilation, ventilator were collected. Several ICU and hospital stay were recorded. Results: 4012 confirmed cases of COVID-19 were admitted to hospital, of which 560(13.95%) patients who were of moderate-severe severity were included in the study. Mean age of study population was 57.75 ± 13.96 years. Three sixty five (65.17%) were men. Hypertension (41.25%) was most common co-morbidity. Dyspnea (69.46%) was the most common symptom followed by fever (52.5%) and cough (46.78%). Mean duration of symptoms before admission was 4.11 ± 2.09 days. Mean Spo2 at admission was 78.70 ± 18.72. Mean neutrophil to lymphocyte ratio was 8.02 ± 8.66. Mean serum ferritin and serum Lactate dehydrogenase was 539.66 ± 381.78 and 845.73 ± 593.51 respectively. Mean duration of symptoms before hospitalization was 4.11 ± 2.09 days. Remdesivir was given to 298 (53.21%) patients. Mean duration of starting Remdesivir after symptom onset was 5.58 ± 2.78 days. Steroids were given to 454(81%) of patients and anticoagulation was given to 365(65.17%) of patients. High flow nasal cannula was given to 245(43.7%) patients. Ninety one (61.25%) were put on ventilator. Mean duration of hospital stay was 8.71 ± 7.54. A very high mortality 306(54.64%) was observed at our hospital. Discussions: During the course of this study, we found most of the patients with moderate to severe COVID-19 pneumonia were of an elderly population with male predominance. A north Indian study found the majority of patients below 60 years of age with male predominance. Another North Indian study also found a majority of patients below 60 years. A retrospective study done in Wuhan found male predominance and elderly population affected with COVID-19 pneumonia similar to our study. We found dyspnea to be the most common symptom at presentation. In contrast, fever and cough were the most common symptom in a Chinese study and North Indian study.1-3 We found hypertension and diabetes to be the most common comorbidity similar to a Chinese study. We found a high NLR ratio, high serum ferritin, and serum LDH in our study. A Chinese study done on 110 patients found elevated procalcitonin and D-dimer in severe pneumonia patients. A study was done in New York City also found elevated levels of C-reactive protein and D-dimer in patients with severe COVID-19 pneumonia. We observed a mortality rate of around 54.64% at our hospital. A systematic review done of mortality in patients admitted to ICU found a mortality rate of 37.7% in China, 25.6% in Italy, 23.6% in the US, 29.2% in Spain, 41.2% in Denmark. Another small case series study in western India found a mortality rate of 16.7% in COVID ICU patients. Conclusion: Patients who are elderly with comorbidities like diabetes and hypertension are more likely to have moderate to severe COVID-19 pneumonia requiring hospitalization. Mostpatients had elevated serum LDH and serum ferritin which could be a reliable prognostic indicator. Many patients presented late to the hospital with low oxygen saturation which has resulted in high mortality of 54.64%. Early diagnosis and treatment may decrease mortality in COVID 19 patients.