ABSTRACT
Treatment of COVID-19 patients is an immense administrative as well as clinical challenge. The setting up of a dedicated COVID-19 care centre within a short time span, adequate manpower deployment, healthcare worker education and training, provision of facilities for donning and doffing and waste disposal were some of the unique administrative problems. On the other hand, as clinicians we faced enormous hurdles in attempting to treat a disease on which there was no established knowledge and no defined, well-proven treatment protocols and which could strike anyone, anywhere in myriad ways. Coupled with this difficulty in diagnosis and treatment was the challenge of serving COVID-19 patients of every age and clinical requirement, under one roof. Healthcare workers faced a tough time, handling physical discomfort while working for long hours in PPE, along with the fear and apprehension of contracting the infection in the line of duty, and carrying it back home. Mental health issues abounded, both amongst the patients and their caregivers, due to heightened fear, anxiety and loneliness. We share our experience in dealing with the pandemic, the administrative and clinical challenges we faced and some of the ways we overcame them. We further share some of the insights we gleaned from this experience, which may help in better preparation for the future. © The Author(s), under exclusive licence to Springer Nature Singapore Pte Ltd. 2021.
ABSTRACT
The clinical picture of COVID-19 ranges from asymptomatic to mild, moderate or severe disease sometimes leading to death. Differences in the interaction between SARS-CoV-2 Spike (S) protein and angiotensin converting enzyme 2 (ACE2) protein may lead to differences in disease severity. We studied whether ACE2 polymorphisms are associated with disease severity and outcome. We recruited 114 patients between July 2020 - March 2022 confirmed positive by RTPCR for COVID-19 with different degrees of severity (21 mild, 29 moderate, 34 severe, 30 death) and 30 controls (10 non-vaccinated+ 20 vaccinated) who were RT-PCR negative inspite of high-risk contact. Next-gen sequencing was done on MiSeq (Illumina) using amplicon-based targeted sequencing approach using a custom-designed panel to sequence all the exons of ACE2 gene. SPSS ver.26 was used for analysis. The following ACE2 variants were identified on the Local Run Manager (LRM) software from Illumina: (i) rs2285666 (c.439+4G>A) splice region variant, in controls (60%) and Patients (45.8%), (ii) rs4646140 (c.802+24G>A) intronic variant in 4/114 patients and 1/30 controls, (iii) rs41303171 ( c.2158A>G) missense variant in 2/114 patients, (iv) rs536749578 (c.2114+9T>C) intron variant, (v) rs763994205 (c.868A>C) missense variant and (vi) rs7595907 (c.656G>A) missense variant in 1/114 patient each only. rs2285666 was observed in equal frequency ( 60%) in vaccinated and non-vaccinated controls. rs2285666 was observed amongst different severity groups: Mild (80.95%), Moderate (37.93%), Severe (44.11%), and Death (56.67%) revealing association with disease severity, probably having a protective effect. However, these results need to be confirmed on larger sample sizes.
ABSTRACT
Background and Aims: There is a marked inclination towards cesarean sections as the preferred mode of delivery in parturients with COVID-19 disease. However, the challenges associated with planning and performing a surgery in the COVID-19 setup are considerable. These factors may lead to widespread changes in obstetric decision-making, operative planning, and perioperative outcomes. Thus, our study aimed to study the clinical and logistical factors involved in cesarean sections in COVID-19 parturients. Material and Methods: This was a retrospective observational study performed at a dedicated COVID-19 tertiary care center in India. All women undergoing cesarean section in the specially earmarked operating room between 1st May 2020 and 31st December 2020 were included in the study. The clinical characteristics, operative details, and neonatal details, along with maternal and fetal outcomes were noted and analyzed. Results: A total of 44 women underwent cesarean section during the study period, with elective and emergency surgeries numbering 22 each. No indication, apart from COVID-19 status, was listed in over one-fourth of the women (13/44). The most common preoperative comorbidity was hypothyroidism (12/44). Median surgical duration was 117.5 min (IQR 100-133), with a median of 7.5 (IQR 6-8.25) healthcare personnel in the OT. Over one-fourth (12/44) of the delivered babies had low birth weight, while 4.5% (2/44) tested positive for SARS-CoV-2. Conclusion: COVID-19 status alone continues to be a common indication for cesarean section. Operative time is increased, but the number of healthcare personnel involved can be trimmed with proper planning. Maternal and fetal outcomes are largely positive, with low transmission rates, but a considerable proportion of low-birth-weight neonates.
ABSTRACT
Clinical manifestations of coronavirus disease 2019 (COVID-19) range from mild self-limiting illness to multi-organ dysfunction and acute respiratory distress syndrome (ARDS). Also, leptospirosis manifests as mild or asymptomatic infection, and only a small number of patients progress to ARDS and develop systemic manifestation. COVID-19 and leptospira co-infection can have fatal outcomes because of augmented pathophysiological manifestations of both the disease. We here describe a case of leptospira and COVID-19 coinfection in a patient who had poor results due to multi-organ involvement
ABSTRACT
Assisted reproductive technology (ART) is used primarily to address the treatment of infertility which includes medical procedures such as in vitro fertilisation (IVF), intra-cytoplasmic sperm injection (ICSI), gamete intra-fallopian transfer (GIFT) or zygote intra-fallopian transfer (ZIFT). IVF has revolutionised infertility treatment and is nowadays widely accepted all over the world. The IVF is carried out as a daycare procedure and many anaesthetic regimens have been studied, tried and tested so far. An anaesthesiologist's role mainly comes into play during trans- vaginal oocyte retrieval and embryo transfer (ET) process of IVF. Various techniques of anaesthesia are practised which include general or regional anaesthesia, conscious sedation or monitored anaesthesia care, patient-controlled analgesia, acupuncture and transcutaneous electrical nerve stimulation (TENS). The anaesthetic management needs careful consideration of the effect of drugs on the maturation of oocytes or embryonic development, fertilisation and pregnancy rates. In view of the Coronavirus disease-19 (COVID-19) pandemic, ART clinics have been affected and due to the ambiguity of its effects on the reproductive outcome, anaesthesiologists need to be vigilant and cautious with anaesthetic management during pandemic times. This review includes a discussion of various anaesthetic options and agents along with their advantages or disadvantages if any. The literature sources for this review were obtained via PubMed, Medline, Cochrane Library and Google Scholar. The results of 82 out of 110 articles discussing different methods of anaesthesia for ART procedures over 25 years were compiled.
ABSTRACT
Coronavirus disease 2019 (COVID-19) co-infection in patients with myasthenia gravis has not been well described. Our primary aim is to describe the course of illness of a myasthenia patient who developed repeated episodes of myasthenic crisis along with severe COVID-19 infection. This case highlights the need to monitor the immune response to the infection accurately, and treatment of myasthenia gravis with COVID-19 should be tailored to the individual patient.
ABSTRACT
Introduction: The spectrum of clinical manifestations of COVID-19 in children is expanding since the global emergence of the COVID-19 pandemic from early reports in January 2020 depicting respiratory distress to a severe multisystem inflammatory syndrome (MIS-C) within various pediatric clusters. There is a paucity of data from resource-poor countries with respect to follow-up outcomes, particularly for coronary artery abnormalities. Considering this, we conducted a single centre prospective longitudinal study to describe the clinical, laboratory, echocardiographic findings and follow-up of children with MIS-C. Objectives: To study the clinical and laboratory characteristics and outcomes of multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19. Methods: All children meeting the WHO case definition of MIS-C were prospectively enrolled. Baseline clinical and laboratory parameters were compared between survivors and non-survivors. Enrolled subjects were followed up for 4-6 weeks for evaluation of cardiac outcomes using echocardiography. The statistical data were analyzed using the SPSS version 12 software. Results: 31 children with MIS-C were enrolled in an eleven-month period. Twelve children had preexisting chronic systemic comorbidity. Fever was a universal finding;gastrointestinal and respiratory manifestations were noted in 70.9% and 64.3%, respectively, while 57.1% had a skin rash. Fifty-eight % of children presented with shock, and 22.5% required mechanical ventilation. The median (IQR) duration of hospital stay was 9 (6.5-18.5) days. Four children with preexisting comorbidities succumbed to the illness. The serum ferritin levels (ng/ml) [median (IQR)] were significantly higher in nonsurvivors as compared to survivors [1061 (581,2750) vs 309.5 (140,720.08), p value=0.045] (table 1). Six children had coronary artery involvement: 5 recovered during follow-up, while one was still admitted. Twenty-six children received immunomodulatory drugs, and five improved without immunomodulation. The choice of immunomodulation (steroids or intravenous immunoglobulin) did not affect the outcome (table 1). Conclusion: Most children with MIS-C present with acute hemodynamic and respiratory symptoms. The outcome is favourable in children without preexisting comorbidities. Raised ferritin level may be a poor prognostic marker. The coronary outcomes on followup were reassuring.
ABSTRACT
Peripartum services are indispensable notwithstanding the COVID-19 pandemic. Providing safe and quality obstetric anesthesia is quite demanding as most signs and symptoms of COVID-19 are non-specific and overlap with the constitutional signs of pregnancy. Overloaded viral testing facilities, urgency of caesarean delivery, limited resources, capricious evidence-base, and potential exposure risk to healthcare providers further add to the challenge imposed by COVID-19. In this discourse we attempt to provide a summary of the current evidence and recommendations concerning the practice of obstetric anesthesia and analgesia.