Intensive Care Admission Rates Research Articles

IDF21-0046 Higher rates of DKA and intensive care admission among children newly diagnosed with T1D during the COVID 19 pandemic

Background: The COVID-19 pandemic might have a multifaceted effect on children with Type 1 Diabetes (T1D), either directly through infection itself or indirectly due to measures implemented by health authorities to control the pandemic. Aim: To compare data on children newly diagnosed with T1D in Kuwait during the COVID-19 pandemic to the pre-pandemic period. Method: We analyzed data on children aged 12 years or less registered in the Childhood-Onset Diabetes electronic Registry (CODeR) in Kuwait. Data were incidence rate (IR), Diabetic ketoacidosis (DKA) and its severity and admission to the Pediatric Intensive Care unit (PICU). Results: The IR of T1D was 40.2 per 100,000 (95%CI; 36.0-44.8) during the COVID-19 pandemic period and was not statistically different from pre-pandemic. A higher proportion of incident T1D cases presented with DKA and were admitted to the PICU during the pandemic (52.2% vs 37.8%: p<0.001, 19.8% vs 10.9%; p=0.002 respectively). The COVID-19 pandemic was positively associated with presentation of DKA and admission to PICU (AOR=1.73; 95% CI, 1.13-2.65; p=0.021, AOR=2.04; 95% CI, 1.13-3.67; p=0.018 respectively). Children of families with a positive history for diabetes were less likely to present with DKA and get admitted to the PICU during the COVID-19 pandemic (AOR=0.38; 95% CI, 0.20-0.74; p=0.004, AOR=0.22; 95% CI, 0.08-0.61; p=0.004, respectively). Discussion: High rates of DKA at presentation and admission to PICU in incident T1D cases during the COVID-19 pandemic warrant further studies and effective mitigation efforts through increasing awareness, early detection, and timely intervention.

The clinical significance of antiphospholipid antibodies in COVID-19 infection.

One of the factors that may aggravate the clinical presentation in COVID-19 is the increased level of antiphospholipid antibodies (aPLs) and thrombotic events that can be seen with the disease. In our retrospective study, we aimed to evaluate the effect of aPLs on the clinical findings in patients with a diagnosis of COVID-19. Seventy-three patients diagnosed with COVID-19 and examined for aPLs were included in the study. Patients were divided into two groups according to the test results of aPLs. Clinical and laboratory parameters were compared in both groups to reveal whether there was any difference between the groups. There were 15 patients with a positive aPLs test. Dyspnea, nausea, vomiting, myalgia, and abdominal pain were significantly higher in the aPLs positive group than those with negative aPLs. The duration of hospital stays and the need for oxygen therapy of the patients in the aPLs positive group were significantly higher than the aPLs negative group. However, no difference was found between the two groups in terms of mechanical ventilation need, intensive care admission rate, thrombosis and mortality. In terms of laboratory findings, those with positive aPLs have higher median C-reactive protein (CRP) and ferritin values than those with negative aPLs. In our study group, we could not find a relationship between aPLs positivity and critical complications. According to our hypothesis, it may not be necessary to routinely examine aPLs in patients with a diagnosis of COVID-19 to determine the risk of thromboembolic complications.

Incidence Rate of ALI in COVID-19 Patients

Background: With the outbreak of COVID19, acute lung injury has been detected as the main etiology for intensive care admission and high mortality rate. Among the infected population, there is some percentage of those who tend to develop acute respiratory distress syndrome and respiratory failure. Thus, the intensivist and anesthesiologist must be aware of the of incidence rate of ARDS, risk factors, and try to take measures to reduce its incidence. To define the rate of incidence of acute lung injury and ARDS among COVID 19 patient. Methods: We performed a narrative review via searching in three databases PubMed, Google Scholar and Embase for all studies that mentioned the incidence of acute lung injury among infected patients with COVID19, manual searching also completed. All the selected reviews were limited to the English language and data also. Results: Five searches referred to the exact number of patients and the percentage rate of incidence of ARDS related to COVID 19 infection, other articles are merely reviews and case reports. Conclusion: Incidence of acute lung injury among COVID19 patient was highly reported, and some percentage of these cases tend to develop ARDS especially in those who have preexisting diseases and obesity.

Appendicitis in Far North Queensland: a new take on an old story.

Appendicitis is a leading cause of surgical hospital admission. To date, there have been no published epidemiological studies describing appendicitis in tropical and remote Australia and none specifically documenting appendicitis in Indigenous Australians. This descriptive study used available state data to investigate appendicitis across Far North Queensland (FNQ). Queensland Health hospital admission data for FNQ was analysed to explore appendicitis epidemiology and outcomes in FNQ, 2012-2018. Population data for the same time period provided rates. Over the study period, 3458 hospital presentations for appendicitis were available for analysis. Mean incidence was 178 per 100 000/yr. Median age was 27 years with 50.1% female patients. The annual rate of appendicitis was higher in the Indigenous population. Most patients had a laparoscopic procedure with a low rate of conversion to open surgery (2.6%). More than 80% of patients were discharged from hospital in less than 3 days. Intensive care (ICU) admission rate was low overall (1.1%) although higher for Indigenous people (2.4%). Following discharge, the hospital re-admission rate was 3.8% and all-cause mortality was 0.03%. The incidence of appendicitis in FNQ is higher than that reported in the rest of Australia in both Indigenous and non-Indigenous populations. Despite logistical challenges of health care, clinical outcomes are in line with best practice across the country. Clinicians in FNQ should maintain a high index of suspicion for diagnosing appendicitis in rural and remote settings.

A Review of Phenobarbital for Alcohol Withdrawal Syndrome

Background: Alcohol use disorder represents a serious health problem worldwide which is increasing in pervasiveness. Alcohol withdrawal syndrome is a common clinical problem encountered in emergency departments and inpatient settings, including intensive care units. While benzodiazepines are the most widely used class of medication for the treatment of alcohol withdrawal, in recent years, there is renewed interest in using phenobarbital, a barbiturate, in the treatment of refractory alcohol withdrawal. Objective: This review provides an overview of phenobarbital in the treatment of alcohol withdrawal, as well as clinical outcomes in patients, while also outlining some of the limitations of existing studies in comparing phenobarbital to benzodiazepines. Methods: PubMed, Ovid MEDLINE, and Cochrane databases were searched using the terms phenobarbital, barbiturates, and alcohol withdrawal syndrome. Prospective and retrospective trials comparing phenobarbital with benzodiazepines to treat alcohol withdrawal in English were included. Results: Two prospective randomized controlled and eleven retrospective cohort trials were identified. Phenobarbital is safe alone and as an adjunct to benzodiazepine in the emergency department, intensive care units, general medical units and acute trauma surgery service. In a randomized controlled trial, one dose of phenobarbital in the emergency department significantly reduced the intensive care admission rate. There is some evidence that phenobarbital may be effective in the treatment of benzodiazepine- refractory alcohol withdrawal. Conclusion: Although existing knowledge and practice regarding phenobarbital for the treatment of alcohol withdrawal are increasing, there currently remains limited evidence in support of phenobarbital over benzodiazepines in superior efficacy and outcomes.

Systematic review and meta-analysis of the characteristics and outcomes of readmitted COVID-19 survivors.

The objective of the present study is to investigate the incidence, characteristics and outcomes of patients who were readmitted to hospital emergency departments or required re‐hospitalisation following an index hospitalisation with a diagnosis of COVID‐19. A systematic review of PubMed, EMBASE and pre‐print websites was conducted between 1 January and 31 December 2020. Studies reporting on the incidence, characteristics and outcomes of patients with COVID‐19 who represent or require hospital admission were included. Two authors independently performed study selection and data extraction. Study quality was assessed with the Newcastle‐Ottawa Scale. Discrepancies were resolved by consensus or through an independent third reviewer. Data were synthesised according to the Preferred Reporting Items for Systematic Reviews guidelines. Six studies reporting on 547 readmitted patients were included. The overall incidence was 4.4%, most common in males (57.2%), and due to respiratory distress or prolonged COVID‐19. Readmitted patients had a shorter initial hospital length of stay (LOS) compared with those with a single hospitalisation (8.1 ± 10.6 vs 13.9 ± 10.2 days). The mean time to readmission was 7.6 ± 6.0 days; the mean LOS on re‐hospitalisation was 6.3 ± 5.6 days. Hypertension (odds ratio (OR) = 2.08; 95% confidence interval (CI) 1.69–2.55; P < 0.001; I 2 = 0%), diabetes mellitus (OR = 1.77; 95% CI 1.38–2.27; P < 0.001; I 2 = 0%) and chronic renal failure (OR = 2.37; 95% CI 1.09–5.14; P < 0.001; I 2 = 0%) were more common in these patients. Intensive care admission rates were similar between the two groups; 12.8% (22/172) of readmitted patients died. In summary, readmitted patients following an index hospitalisation for COVID‐19 were more commonly males with multiple comorbidities. Shorter initial hospital LOS and unresolved primary illness may have contributed to readmission.

Outcomes and proportions of pregnant women during the first and consecutive waves of coronavirus disease 2019: observational cohort study

ObjectivesIt has been suggested that pregnant women were affected more severely during the late wave, as opposed to the early wave of the coronavirus disease 2019 (COVID-19) pandemic. The aim of our study was to compare the proportion of pregnant women among hospitalized women of childbearing age, their rate of intensive care (ICU) admission, need for mechanical ventilation and mortality during the waves. MethodsThe study is a retrospective analysis of claims data on women of childbearing age (16–49 years) admitted to 76 hospitals with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. The observation period was divided into first wave (7 March 2020 to 30 September 2020) and second wave (1 October to 17 April 2021). Co-morbidities derived from claims data were summarized in the Elixhauser Co-morbidity Index (ECI). ResultsA total of 1879 women were included, 532 of whom were pregnant. During the second wave, the proportion of pregnant women was higher (29.3% (484/1650) versus 21.0% (48/229), p < 0.01). They were older (mean ± SD 29.1 ± 5.9 years versus 27 ± 6.3 years, p 0.02 in the first wave) and had comparable co-morbidities (ECI mean ± SD 0.3 ± 3.5 versus –0.2 ± 2.0, p 0.30). Of the pregnant women, 6.2% (3/48) were admitted to ICU during the first wave versus 3.3% (16/484) during the second wave (OR 0.51, 95% CI 0.14–1.83, p 0.30), 2.1% (1/48) were ventilated versus 1.2% (6/484, OR 0.60, 95% CI 0.07–5.23, p 0.64). No deaths were observed among the hospitalized pregnant women in either wave. ConclusionsProportionally more pregnant women with COVID-19 were hospitalized in the second wave compared with the first wave but no more severe outcomes were registered.

P-084. Symptomatic SARS-COV-2 infected pregnant patients and preeclampsia: worse outcome?

Background/objectives: Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection and preeclampsia may share some common pathophysiological ground, as the inflammatory changes they impose. Although the clinical course of SARS COV-2 during pregnancy is not completely understood, recent findings suggest an increased risk of preeclampsia with severe features induced by viral infection. The aim of this study is to describe the clinical course of infected pregnant women who developed preeclampsia (PE). Methods: Cohort study of SARS-COV-2 PCR positive symptomatic pregnant patients, with (n=9) and without PE (n=45), followed from admission to hospital discharge. Clinical course, delivery, neonatal and maternal outcomes were analyzed. Results: SARS-Cov-2 women with PE had higher body mass index (41,3 ± 7,8kg/m2 vs 31,6 ± 6,2kg/m2;p<0,001) and higher level of d-dimers (3,47 ± 089 vs 1,97 ± 1,18;p 0,014) than their counterpart without PE. Delivery for maternal deterioration status was also more often in PE group (23,3% vs 75%;p 0,011). No differences were observed in rates of maternal intensive care admission, need of mechanical ventilation, pulmonary image findings, maternal oxygen saturation, gestational age of delivery or neonatal outcomes. Conclusions: Development of preeclampsia in symptomatic SARS-COV-2 infected pregnant women was associated with a higher rate of maternal-indicated deliveries. No differences were found regarding neonatal or maternal clinical outcomes.

The effect of adolescent and advanced-age pregnancies on maternal and early neonatal clinical data

Background This study compared early post-natal clinical data of adolescent and advanced maternal-age mothers and their infants and early post-natal clinical data of mothers 20–34 years old who delivered and their infants. Methods This retrospective study included 1676 newborns who were born at or after 25 gestational weeks and 1638 puerperal women who gave birth at the Health Sciences University Bakırköy Dr. Sadi Konuk Health Practice and Research Center Gynecology and Obstetrics Clinic between January 2017 and January 2018. Maternal demographic and clinical data and neonatal demographic, anthropometric, and early delivery room clinical data of the study group patients were transcribed from clinical file records to electronic records. Results We found that the intensive care admission/2nd- or 3rd-level intensive care referral rates of newborns of advanced-age and adolescent mothers were significantly higher than those of the control group. No significant differences were found between intensive care admission and referral rates among age groups when only healthy pregnancies were considered. Cesarean sections, abortion and smoking rates of mothers with advanced maternal age; LGA rates of newborns of women in this age group; macrosomic rates; and free-flow oxygen requirements were significantly higher than in the other age groups. In advanced-age healthy pregnancies, abortion rates were the same as those in the control group, and there was no significant difference in the LGA rate or free-flow oxygen requirement of newborns in this group. Additionally, the 1-min APGAR scores of the newborns of advanced-age mothers were significantly lower than those of the control newborns, and the pCO2 values measured in the cord or blood gases obtained within the first hour were significantly higher. In healthy pregnancies, no significant differences in APGAR scores or pCO2 values were found between age groups. The cord or blood gas lactate values of newborns who were born from adolescent pregnancies taken within the first hour were significantly higher than those of newborns born in other age groups; considering only healthy adolescent pregnancies, the results did not change. Newborns born from healthy adolescent pregnancies had significantly lower resuscitation needs than those born from other age groups. Conclusions Newborns who are born from adolescent and advanced-age pregnancies are more likely to have risky early post-natal clinical findings than are newborns who were born from mothers 20–34 years of age. The early period clinical approach and follow-up of newborns born from adolescent and advanced-age maternal pregnancies are very important for pediatric management.

The definition of major trauma using different revisions of the abbreviated injury scale

BackgroundA threshold Injury Severity Score (ISS) ≥ 16 is common in classifying major trauma (MT), although the Abbreviated Injury Scale (AIS) has been extensively revised over time. The aim of this study was to determine effects of different AIS revisions (1998, 2008 and 2015) on clinical outcome measures.MethodsA retrospective observational cohort study including all primary admitted trauma patients was performed (in 2013–2014 AIS98 was used, in 2015–2016 AIS08, AIS08 mapped to AIS15). Different ISS thresholds for MT and their corresponding observed mortality and intensive care (ICU) admission rates were compared between AIS98, AIS08, and AIS15 with Chi-square tests and logistic regression models.ResultsThirty-nine thousand three hundred seventeen patients were included. Thresholds ISS08 ≥ 11 and ISS15 ≥ 12 were similar to a threshold ISS98 ≥ 16 for in-hospital mortality (12.9, 12.9, 13.1% respectively) and ICU admission (46.7, 46.2, 46.8% respectively). AIS98 and AIS08 differed significantly for in-hospital mortality in ISS 4–8 (χ2 = 9.926, p = 0.007), ISS 9–11 (χ2 = 13.541, p = 0.001), ISS 25–40 (χ2 = 13.905, p = 0.001) and ISS 41–75 (χ2 = 7.217, p = 0.027). Mortality risks did not differ significantly between AIS08 and AIS15.ConclusionISS08 ≥ 11 and ISS15 ≥ 12 perform similarly to a threshold ISS98 ≥ 16 for in-hospital mortality and ICU admission. This confirms studies evaluating mapped datasets, and is the first to present an evaluation of implementation of AIS15 on registry datasets. Defining MT using appropriate ISS thresholds is important for quality indicators, comparing datasets and adjusting for injury severity.Level of evidencePrognostic and epidemiological, level III.

Determinants of enhanced vulnerability to Covid-19 in U.K. cancer patients: Results from the OnCovid study.

1574 Background: Despite high contagiousness and rapid spread, SARS-Cov-2 has led to heterogeneous outcomes across affected nations. Within Europe, the United Kingdom is the most severely affected country, with a death toll in excess of 100.000 as of February 2021. We aimed to compare the national impact of Covid-19 on the risk of death in UK cancer patients versus those in continental Europe (EU). Methods: We performed a retrospective analysis of the OnCovid study database, a European registry of cancer patients consecutively diagnosed with Covid-19 in 27 centres from February 27 to September 10, 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline, oncological and Covid-19 specific therapy across cohorts and tested these in multivariable Cox regression models to identify predictors of adverse outcome in UK versus EU patients. Results: Compared to EU patients (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p &lt; 0.0001), higher risk of death at 30 days (hazard ratio, HR 1.64 [95%CI 1.36-1.99]) and 6 months after Covid-19 diagnosis (47.64% versus 33.33%, p &lt; 0.0001, HR 1.59 [95%CI 1.33-1.88]). UK patients were more often males, of older age and more co-morbid than EU counterparts (p &lt; 0.01). Receipt of anti-cancer therapy was lower in UK versus EU patients (p &lt; 0.001). Despite equal proportions of complicated Covid-19, rates of intensive care admission and use of mechanical ventilation, UK cancer patients were less likely to receive anti-Covid-19 therapies including corticosteroids, anti-virals and interleukin-6 antagonists (p &lt; 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of patient’s age, gender, tumour stage and status, number of co-morbidities, Covid-19 severity, receipt of anti-cancer and anti-Covid-19 therapy. Rates of permanent cessation of anti-cancer therapy post Covid-19 were similar in UK versus EU. Conclusions: UK cancer patients have been more severely impacted by the unfolding of the Covid-19 pandemic despite societal risk mitigation factors and rapid deferral of anti-cancer therapy. The increased frailty of UK cancer patients highlights high-risk groups that should be prioritised for anti-SARS-Cov-2 vaccination. Continued evaluation of long-term outcomes is warranted.

Value-based care in obstetrics: comparison between vaginal birth and caesarean section

BackgroundHealthcare costs have substantially increased in recent years, threatening the population health. Obstetric care is a significant contributor to this scenario since it represents 20% of healthcare. The rate of cesarean sections (C-sections) has escalated worldwide. Evidence shows that cesarean delivery is not only more expensive, but it is also linked to poorer maternal and neonatal outcomes. This study assesses which type of delivery is associated with a higher healthcare value in low-risk pregnancies.ResultsA total of 9345 deliveries were analyzed. The C-section group had significantly worse rates of breastfeeding in the first hour after delivery (92.57% vs 88.43%, p < 0.001), a higher rate of intensive unit care (ICU) admission both for the mother and the newborn (0.8% vs 0.3%, p = 0.001; 6.7% vs 4.5%, p = 0.0078 respectively), and a higher average cost of hospitalization (BRL14,342.04 vs BRL12,230.03 considering mothers and babies).ConclusionCesarean deliveries in low-risk pregnancies were associated with a lower value delivery because in addition to being more expensive, they had worse perinatal outcomes.

The Effects of Pre-Pregnancy Body Mass Index and Weight Gain During Pregnancy on Perinatal Outcomes: A Retrospective Cohort Study

OBJECTIVE: To investigate the effects of pre-pregnancy body mass index and weight gain during pregnancy on perinatal outcomes and delivery mode. STUDY DESIGN: In this retrospective cohort study, 722 pregnant women giving birth between 2018-2019 were screened from our hospital database. First, they were divided into four groups according to their pre-pregnancy body mass index (low-weight/normal-weight/overweight/obese), and then they were redivided into three groups according to pregnancy weight gain (≤7/8-15/≥16 kg). Prenatal body mass index and pregnancy weight gain were compared concerning maternal-neonatal results and mode of delivery. RESULTS: According to pre-pregnancy body mass index, among the obese pregnant group, gestational diabetes mellitus (p&lt;0.001), preeclampsia (p=0.029), preterm delivery (p=0.011) and cesarean delivery (p=0.061) rates were more common. As the body mass index increases, neonatal intensive care requirement (p=0.0020) and low 1st minute APGAR scores (p=0.019) were detected more frequently. However, as pregnancy weight gain decreased, preterm delivery (p=0.041) increased. Also, birth weight increased (p&lt;0.001) with the weight gain of the pregnant. Pregnant women gaining more than 16 kg were associated either with a lower &lt;2500 g or a higher birth weight risk &gt;4000 g. CONCLUSION: Pre-pregnancy high body mass index is associated with negative obstetric outcomes like gestational diabetes, preeclampsia, preterm delivery, and increased cesarean rates, and poor fetal incidences with a low APGAR score and high neonatal intensive care admission rates.

Determinants of enhanced vulnerability to coronavirus disease 2019 in UK patients with cancer: a European study

BackgroundDespite high contagiousness and rapid spread, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to heterogeneous outcomes across affected nations. Within Europe (EU), the United Kingdom (UK) is the most severely affected country, with a death toll in excess of 100,000 as of January 2021. We aimed to compare the national impact of coronavirus disease 2019 (COVID-19) on the risk of death in UK patients with cancer versus those in continental EU. MethodsWe performed a retrospective analysis of the OnCovid study database, a European registry of patients with cancer consecutively diagnosed with COVID-19 in 27 centres from 27th February to 10th September 2020. We analysed case fatality rates and risk of death at 30 days and 6 months stratified by region of origin (UK versus EU). We compared patient characteristics at baseline including oncological and COVID-19–specific therapy across UK and EU cohorts and evaluated the association of these factors with the risk of adverse outcomes in multivariable Cox regression models. FindingsCompared with EU (n = 924), UK patients (n = 468) were characterised by higher case fatality rates (40.38% versus 26.5%, p < 0.0001) and higher risk of death at 30 days (hazard ratio [HR], 1.64 [95% confidence interval {CI}, 1.36–1.99]) and 6 months after COVID-19 diagnosis (47.64% versus 33.33%; p < 0.0001; HR, 1.59 [95% CI, 1.33–1.88]). UK patients were more often men, were of older age and have more comorbidities than EU counterparts (p < 0.01). Receipt of anticancer therapy was lower in UK than in EU patients (p < 0.001). Despite equal proportions of complicated COVID-19, rates of intensive care admission and use of mechanical ventilation, UK patients with cancer were less likely to receive anti–COVID-19 therapies including corticosteroids, antivirals and interleukin-6 antagonists (p < 0.0001). Multivariable analyses adjusted for imbalanced prognostic factors confirmed the UK cohort to be characterised by worse risk of death at 30 days and 6 months, independent of the patient's age, gender, tumour stage and status; number of comorbidities; COVID-19 severity and receipt of anticancer and anti–COVID-19 therapy. Rates of permanent cessation of anticancer therapy after COVID-19 were similar in the UK and EU cohorts. InterpretationUK patients with cancer have been more severely impacted by the unfolding of the COVID-19 pandemic despite societal risk mitigation factors and rapid deferral of anticancer therapy. The increased frailty of UK patients with cancer highlights high-risk groups that should be prioritised for anti–SARS-CoV-2 vaccination. Continued evaluation of long-term outcomes is warranted.

Addressing the elephant in the room: COVID-19 vaccine hesitancy in Black and Asian communities

The evidence is clear: Black and Asian minority ethnic groups in the UK have experienced poorer outcomes in relation to the COVID-19 pandemic. People of Black and Asian ethnicity have faced higher diagnostic rates, higher intensive care admission rates, and ultimately higher death rates compared to the White population.1–3 Despite comprising the minority of the workforce, Black and Asian healthcare staff make up approximately two-thirds of the deaths observed in this setting.4 In the light of the statistical evidence, there have been increasing calls among experts for the government to categorise Black …

Gastroenterological and hepatic manifestations of patients with COVID-19, prevalence, mortality by country, and intensive care admission rate: systematic review and meta-analysis

Background and aimsPatients infected with the SARS-CoV-2 usually report fever and respiratory symptoms. However, multiple gastrointestinal (GI) manifestations such as diarrhoea and abdominal pain have been described. The aim of...

Cardiovascular view of intermediate and high-risk COVID-19 patients: single-centre experience with low mortality and intensive care hospitalisation rates.

The purpose of this article was to report the low rates of intensive care unit admission and mortality in intermediate- and high-risk COVID-19 patients, and to share our clinical approach with other colleagues. In addition, we sought to reveal the relationship between myocardial injury and clinical outcomes such as death, intensive care unit uptake and hospital stay, and the relationship between inflammatory parameters and cardiac biomarkers in a cardiovascular perspective. Patients admitted to the emergency department in the Department of Internal Medicine, Faculty of Medicine, Istanbul University, with laboratory or clinically and radiologically confirmed COVID-19 were included in this retrospective cross-sectional study, which was conducted from 11 March to 10 April 2020. The demographic (age and gender) and clinical (symptoms, co-morbidities, treatments, complications and outcomes) characteristics, laboratory findings, and results of cardiac examinations (cardiac biomarkers and electrocardiography) of patients during hospitalisation were collected from their medical records by two investigators. Data were analysed using SPSS version 25.0 (IBM). A two-sided p < 0.05 was considered statistically significant. Analysis began on 11 April 2020. Mortality and intensive care unit admission rates were statistically significantly higher in patients with cardiac injury than in those without. There was a positive correlation between levels of high-sensitivity TNT and fibrinogen, D-dimer, ferritin, procalcitonin and C-reactive protein (r = 0.24, p < 0.01; r = 0.37, p < 0.01; r = 0.25, p < 0.01, r = 0.34, p < 0.01; r = 0.31, p < 0.01). The first general data of our 309 patients regarding low mortality and intensive care admission rates, and particular treatment algorithms specific to our centre should be helpful in determining better treatment strategies in the future. Our study emphasises the importance and frequency of cardiovascular outcomes, and the significance of some cardiac biomarkers in predicting COVID-19 prognosis.

Pediatric Coronavirus Disease 2019: Clinical Features and Management

There is a lack of clarity regarding management of COVID-19 infection in children. This review aims to summarize the key clinical presentations and management of Pediatric COVID-19. The Medline database was searched for seminal articles and guidelines on COVID-19 presentation and management in children less than 18 years of age. COVID-19 has a lower incidence (15% of reported cases worldwide), causes milder disease with lower need for intensive care admission and lower mortality rate (00.7%) in children compared with adults. Multisystem inflammatory syndrome is a rare but severe complication in children. Majority of patients require supportive care including adequate hydration, nutrition and antipyretics. Supplemental oxygen therapy should be given in moderate to severe cases with all precautions to prevent air-borne COVID-19 spread. Steroids may be helpful in severe cases. Anticoagulation is indicated in moderate to severe cases with risk factors. More data on the efficacy and safety of antivirals and immunomodulators in children is needed.

Perinatal Outcome in Meconium Stained Amniotic Fluidat Dhiraj General Hospital, a Tertiary Health Care Centre in Rural Gujarat: A Prospective Study

Introduction: Meconium in amniotic fluid is a serious sign of fetal compromise and associated with a perinatal complications and outcome, including low APGAR scores, increased incidence of chorioamnionitis, increased incidence of neonatal intensive care admission and high rate of perinatal death. It is less likely for a fetus to pass meconium before 34 weeks of gestation. After 37 weeks its incidence increases steadily with increasing gestational age. It reflects maturation of fetal myelination and parasympathetic innervations. Aspiration can occur in utero with fetal gasping or with the first breath of life after birth. However most of the infants with meconium in liquor do not have low APGAR score, acidosis or clinical illness compared to the infants born with clear amniotic fluid. Material and method: A prospective observational study was conducted in obstetrics and gynaecology department of Dhiraj Hospital, Sumandeep Vidyapeeth from March 2019 to August 2020. Methodology: After history and clinical examination,all patients were allowed to go in labour and were watched throughout labour. • Patients who had meconium stained liquor on spontaneous or artificial rupture of membrane were taken as cases. • Other patients who did not have meconium stained liquor throughout labour were taken as controls. • Time of meconium passage, consistency of meconium was noted in each case. • Thin meconium and thick meconium cases were seperately identified. • Fetal heart rate patterns were monitored throughout labour. • Type of delivery whether spontaneous, oper-ative vaginal or LSCS was noted in each case. • APGAR scoring at 1 and 5 minutes, need for resuscitation, stomach wash and endotracheal intubation in baby was noted. • Need for NICU admission for complications like respiratory distress syndrome, aspiration pneumonia, birth asphyxia, septicemia, jaundice, convulsion, hypoxic ischemic encephalopathy was noted. • Duration of hospital stay of neonate was noted. Statisical method: As this was a prevalence study, purposive sampling was done. All the categorial variables were analysed with the help of chi square test and fisher’s exact test and all the continuous variables were analysed with independent ‘t test’. Conclusion: Thus to conclude Thick MSL is associated with abnormal CTG changes, higher incidence of LSCS, low apgar score and more NICU admissions due to Meconium Aspiration Syndrome (MAS), Hypoxic ischaemic encephalopathy (HIE), and sepsis as compared to thin MSL.

Clinical Evaluation of Patients with COVID-19 Within the Framework of Comorbidities.

ObjectivesChronic systemic diseases (CSD) and cancer are closely related to the clinical course, severity and mortality of COVID-19 due to the immunosuppressive conditions caused by these diseases. The purpose of this study was to investigate the differences between the effects of cancer and CSD on the clinical and laboratory parameters of patients with COVID-19.MethodsThe study included patients who received inpatient treatment with the diagnosis of COVID-19 at Ondokuz Mayıs University between March 16, 2020, and December 1, 2020. The participants were divided into four groups as follows: Those without comorbidities (Group 1), those with only CSD (Group 2), those with only cancer (Group 3), and those with both CSD and cancer (Group 4). Comparative statistical evaluation was performed in terms of clinical symptoms, biochemical parameters, and admission to intensive care and survival.ResultsIn total, 750 patients were included: 242 patients in Group 1, 442 in Group 2, 27 in Group 3, and 39 in Group 4. The mean age of the patients was 57.1±9.4 years and 53.7% were male. Patients of Group 1 were significantly different from those of the other groups in terms of age, requirement for intensive care and intubation, complications, survival, white blood cell and lymphocyte count, neutrophil/lymphocyte ratio and levels of hemoglobin, lactic acid dehydrogenase, ferritin, D-dimer, and C-reactive protein (for each p<0.001).ConclusionNo difference was observed among laboratory parameters, intensive care admission, intubation need, complication frequency, and survival rates in patients with CSD or cancer. It was detected that all three groups with CSD and cancer were worse than Group 1 in terms of intensive care need, intubation, and survival.