ABSTRACT
The course of coronavirus disease-2019 (COVID-19) in pregnancy is unpredictable with outcome trends ranging from milder disease with zero mortality to severe forms and deaths in different parts of the world. We did a comprehensive review of the literature to understand maternal deaths due to COVID-19 in detail. The search was conducted in the PubMed, Embase, and Google Scholar databases, using the keywords "maternal mortality", "maternal death", "COVID-19", "septic shock" and "DIC". The search included original articles, review articles, case reports published till date. We found varying case fatality rates ranging from 0.1% to 12.9%. There are various predictors of maternal death, notably the presence of symptoms, comorbidities, severe disease with cytokine storm and multi-organ dysfunction. We also report higher maternal deaths from low-resource regions owing to gaps in expected and delivered maternal care. While reviewing our institutional data, we found 3 maternal deaths related to COVID-19 in pregnancy. We discussed our experience at our institute of three COVID-19 related maternal mortalities to add evidence to the present data. Most maternal deaths occurred in postpartum period. Late referral, loss to follow-up and inadequate care were important determinants of maternal mortality. We concluded that pregnancy cases with or without complications must be considered high risk and addressed judiciously beginning from infection prevention, early diagnosis, disease categorization, and multidisciplinary approach of management to prevent morbidity and mortality. We strongly suggest strengthening the health care delivery system to save pregnant women from dying, particularly in low-resource countries.
ABSTRACT
Background In contrast to the first wave, the second COVID-19 wave has taken a huge toll affecting maternal outcomes adversely. The aim of this study was to investigate the consequences of the severity of maternal disease on perinatal outcomes and the risk of vertical transmission and to find out the factors associated with adverse fetomaternal outcomes. Materials and methods This was an ambispective observational study including COVID-19 infected pregnant patients;20-40 years of age irrespective of gestational age admitted at Government Institute of Medical Sciences, UP, India. The patients were divided into two groups: CW 1 (COVID-19 Wave 1): Patients admitted between April 1, 2020 and December 31, 2020 and CW 2 (COVID-19 Wave 2): Patients admitted between April 1, 2021 to May 31, 2021. Data in two groups were compared and analyzed with respect to the clinical profile, laboratory parameters, fetomaternal outcome and the risk of vertical transmission of COVID-19 infection. Results We included 134 eligible patients in the CW1 group and 58 in the CW2 group. Significantly more patients were symptomatic in CW2 (23.1% versus 60.3%, p= <0.001). In CW2, maternal neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP) and D-Dimer were significantly raised along with abnormal chest x-rays. There was a significant increase in maternal mortality in CW2 (1.5% vs 13.7%;p≤0.001). A total of 76 patients delivered in CW1 and 26 in CW2 with increased incidence of cesarean section (43.4%;42.3%), preterm deliveries (28.2%;37%) and low birth weight (34.6%;25.9%) in both waves, the difference among two groups being statistically insignificant. Compared to CW1, perinatal mortality was significantly increased in CW2 (2.2% vs 15.5%;p<0.001). Though nasopharyngeal swab tested positive in four neonates in CW1 and two neonates in CW2, no evidence of vertical transmission was observed even with increased severity of maternal illness. On regression analysis, D-Dimer and CRP were found to have a positive association with maternal and perinatal mortality. Conclusion The severity of maternal illness proportionately affects the neonatal outcome with no impact on the risk of vertical transmission of infection. D-Dimer and CRP have emerged as independent predictors for maternal and perinatal mortality and hence can be utilized in obstetrics decision-making.
ABSTRACT
With the advancement in technology, the approach to learning has also been modified. “Standardization” and “One-size-fits-all” has become an outdated concept. To adjust to the changing learning approaches, e-learning came into being, but this was not as per the knowledge and intelligence of users. This created a hurdle in the achievement of better learning and acquisition of skills. This calls for the provision of personalization in e-learning. Successful implementation of personalized e-learning in the present education system will lead to better and faster learning by adapting as per the preferences and knowledge of students. The core idea behind this research is to make an application using Android, which provides a personalized and adaptable route of e-learning using Ant Colony Optimization and recommendations from similar peers. This research will cater to the needs of many students, and it will help in decreasing the time taken to complete any subject or course. It will also help in attaining better and efficient learning as the learning route is determined as per the user. Also, the collection of records of every user will help in improving efficiency and accuracy in the determination of the learning path. The developed app aiming for adaptative e-learning can act as a promising solution during the Covid-19 scenario.
ABSTRACT
BACKGROUND: Protective role of estrogen in COVID-19 was speculated once the epidemiological studies reported increased susceptibility of estrogen-deficient population - males and postmenopausal females to severe disease category and involvement of angiotensin-converting enzyme 2 receptors and renin-angiotensin- aldosterone system in pathophysiology. MATERIALS & METHODS: An open-label randomized controlled trial was planned to assess the efficacy of short-course oral estradiol in preventing the clinical progression to severe disease and reduce case-fatality rate and the hospital stay duration in estrogen-deficient postmenopausal women. The intervention group (n = 40) received 2 mg per day of estradiol valerate per orally for 7 days along with the standard care, while the control group (n = 40) received only the standard care. RESULTS: A significant difference was observed in the rate of reverse transcriptase-polymerase chain reaction negativization in the intervention versus control group at day 5 and day 7 of admission (42.5% vs. 15%, P = 0.007; 72.5% versus 50%, P = -0.026). No significant difference was noted in the duration of hospitalization (P = 0.213). A significant decrease was noted in the mean values of inflammatory biomarkers - D-dimer, lactate dehydrogenase, and C-reactive protein on day 5 in the intervention group. Interleukin-6 also showed a declining trend on day 5 in the intervention group, while a rising trend was noted in the control arm. Only one case (2.5%) in the intervention group while seven in the control group (17.5%) progressed to the moderate category; however, the difference was not statistically significant (P = 0.057). CONCLUSION: Oral estradiol in postmenopausal females can be a novel and efficient option for managing nonsevere COVID-19 infection.
ABSTRACT
BACKGROUND: COVID-19 has shown a definite association with gender, a predilection for males in terms of morbidity and mortality. The indirect evidence of the protective effect of estrogen has been shown by Channappanavar, in the animal model and Ding T. in a multihospital study from China, suggesting menopause as independent risk factor and estrogen is negatively correlated with severity. OBJECTIVE: Study the clinical profile and outcomes in premenopausal and menopausal. Covid-19-infected women and analyzed the effect of menstrual status on the outcome. MATERIALS AND METHODS: A retrospective cohort study conducted on 147 mild and moderate category COVID-19 females admitted between May and August 2020 using hospital records and telephonic follow-up. Two groups formed based on menstrual status: group-1 (premenopausal/estrogenic) and Group-2 (menopausal/hypoestrogenic). Hospital stay duration was considered as primary, while the category of disease on admission, clinical course, the requirement of oxygen, and mortality and residual symptoms were taken as a secondary outcome to compare the groups. RESULTS: Overall Group-1 had significantly more of mild disease, while Group-2 had moderate cases (39 [76.5%] vs. 14 [14.6%] P < 0.01). Menopausal group has significantly more requirement of oxygen (32 [62.7%] vs. 20 [20.8%]), ventilation (14 [27.5%] vs. 1 [1%]) progression-to-severe disease (23.5% vs. 7.3%) and prolonged hospital stay ([14.1 ± 8.9 vs. 8.6 ± 3.9 days] P < 0.01). However, multivariate logistic regression failed to show a significant association between hospital stay and progression with menopause. Ferritin and residual symptoms found significantly higher in menopausal. CONCLUSIONS: No definite association was found between menopause and COVID-19 outcome with hospital stay duration or disease progression in our study.