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
BACKGROUND: The spread of novel coronavirus diseases-2019 (COVID-19) across the world and its associated morbidity and mortality confronted the nations by various means. COVID19 pandemic had significant psychological effects not only on the general population but also on health-care workers (HCWs). Hence, we aimed to found the level of anxiety and depression among health-care professionals amidst coronavirus. MATERIALS AND METHODS: This is a cross-sectional study conducted on 829 participants including doctors and nurses and other medical staff who were posted in the COVID ward and COVID intensive care unit using a well-structured questionnaire through the Google Forms. The two scales used to measure anxiety and depression among the HCWs were the Hamilton anxiety scale (HAM-A) and the Patient Health Questionnaire (PHQ-9), Cronbach's alpha of HAM A is 0.921 and Cronbach's alpha of PHQ 9 is 0.851. Data analysis was done using SPSS 26, Chi-square test and Fisher's exact test were used to establish the association between categorical independent and dependent variables. RESULTS: The results of this study demonstrate that anxiety and depression were significantly higher in doctors and staff nurses as compared to other medical staff. According to HAM-A, 65.1% of respondents were in the mild category, 22.0% mild to moderate, and 12.9% moderate to severe. The HAM-A (P = 0.022) and PHQ-9 (P = 0.001) for anxiety and depression respectively were significantly higher in females. The means of the scales got increased after postings in the corona wards. CONCLUSION: Concerning the high occurrence of anxiety and fear among health-care professionals, appropriate psychological/psychiatric intervention necessitates and emphasizes the need to implement urgent measures to prevent further progress to severe mental health disorder.
ABSTRACT
Corona virus disease 2019 (COVID-19) has posed a mounting threat to public health with worldwide outbreak caused by a novel virus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Recently, remdesivir (RDV) has been approved by Food and Drug Administration (FDA) for treating COVID-19 patients ≥12 years old requiring hospitalization. To the best of our knowledge, a simple method to estimate RDV in the pharmaceutical formulations using high-performance liquid chromatography (HPLC) is still unexplored, highlighting the need for a precise analytical method for its quantification. The prime purpose of the current investigation was to develop and validate a well-grounded HPLC method for quantification of RDV in pharmaceutical formulations. The best chromatogram was obtained by means of an Inertsil ODS-3V column using a mobile phase of milli-Q water modified to pH 3.0 with o-phosphoric acid and acetonitrile (50:50, % v/v) at a flow rate of 1.2 mL/min and wavelength of detector set at 246 nm with retention time being achieved at 6.0 min. The method was validated following International Council for Harmonization of Technical Requirements for Pharmaceuticals for Human Use (ICH) Q2 (R1) guidelines for various parameters such as specificity and selectivity, system suitability, linearity, precision, accuracy, limits of detection and quantification, and robustness. The method developed for the quantification of RDV was found to be linear in the concentration range of 25-2,500 ng/mL with limit of detection and limit of quantification of 1.95 and 6.49 ng/mL, respectively. Assay value of 102% ± 1% was achieved for marketed injectable dosage form when estimated by the validated method. Therefore, in this study a simple, rapid, sensitive, selective, accurate, precise, and robust analytical method was developed and validated for the quantification of RDV using HPLC. The established method was successfully employed for quantification of RDV in marketed pharmaceutical formulation.