Severe Acute Lung Disease Research Articles

COVID-19 impact in early pregnancy losses: A retrospective study

Background: Severe acute lung disease, known as coronavirus disease 2019 [COVID-19] had multifaced impacts on human lives especially in pregnant women. However, no clear-cut consensus have been made on the effect of COVID 19 on pregnancy and fetal effects due to limited data. Aim: To study pregnant women presenting to our department with missed miscarriages or early fetal demise in the COVID pandemic time for a period of 2 years (April 2020 to March 2022) and to assess the risk of early pregnancy loss due to COVID 19 infection if any. Materials and Methods: A Retrospective comparative study was carried out among pregnant women attending the department of Obstetrics & Gynaecology for MTP at SVS Medical College, Mahabubnagar in view of miscarriages both embryonic and anembryonic and early fetal demise till 20weeks Gestational age in the period April2020 to March 2021 and a control group of pregnant ladies who presented for MTPs before 20 weeks for miscarriages and early IUFDs till 20 weeks gestational age in the period of April 2019 to march 2020 were taken. Results: A total of 232 women were registered during pre-pandemic period and 180 women were registered during pandemic period for the study. The two groups were similar in demographic characteristics including the mean maternal age in both the groups which were 22+/-2 and 23+/-2yrs. Parity affected in both the study groups i.e, precovid which were 38.2% in primigravida and 61.7% in multigravida and the pregnancy loss during covid-there were 44.6% in primigravida and 55.3% in multigravida, showing no significant difference in pregnancy loss during and before covid. The percentages of missed miscarriages, early IUFDS less than 20 weeks Gestational age, MTPs done for various congenital anomalies also showed only marginal changes in both the groups. Conclusion: In our study, we did not find any significant difference between the early fetal demise, missed miscarriages, MTPs done for congenital anomalies during the pre-covid and COVID periods. Though some studies support early pregnancy loss due to COVID infection, because of our small sample size, we could not find attribute the marginal changes in the study group i.e, during COVID pandemic due to small sample size and also many studies reporting no significant difference, large multicentric studies are needed to evaluate any association between the COVID-19 SARS virus infection and its effect on fetal demise, any miscarriages or congenital anomalies.

The value of Caprini thrombosis risk assessment in postoperative patients with lung cancer

Objective To analyze the effectiveness of Caprini thrombosis risk assessment model in the screening of patients with non-metastatic lung cancer after venous thromboembolism (VTE). Methods A retrospective analysis of 136 patients with postoperative lung cancer who were admitted to our department between October 2015 and October 2017 was followed up for 2 months. According to the follow-up results, the patients were divided into VTE group and non-VTE group. The VTE group was further divided into the PE group and the deep venous thrombosis (DVT) group according to the embolization type. Comparisons were made between the two groups for general clinical data, surgically related parameters, and differences in Caprini scores. Univariate analysis was used to assess the risk factors associated with postoperative VTE in the relevant clinical parameters in the Caprini thrombosis risk assessment model. Statistically significant parameters in the single factor were included in multivariate analysis to assess independent risk parameters for VTE. Results There were 39 cases in VTE group and 97 cases in non-VTE group. Among them, 28.2% (11/39) of VTE events occurred after discharge. The hospitalization time and Caprini risk scores in VTE group were (16.3±3.6) days, (10.5±2.4) points, which were significantly higher than (8.9±3.4) days, (9.3±2.1) points in non-VTE group (t=11.287, 2.891, P<0.01). In the VTE event, the onset time in the PE group was significantly advanced (P=0.019), and both the length of hospital stay and Caprini score were significant. It was worse than DVT group (P<0.05). When Caprini's high-risk risk cut-off was 9 points, the accuracy was 76.5%, the positive predictive value was 58.1%, the negative predictive value was 84.9%, and the sensitivity and specificity were 64.1% and 81.4%, respectively. Multivariate analysis of relevant clinical parameters in the caprini thrombosis risk assessment model showed swelling in the lower extremities (P<0.01), varices (P<0.01), sepsis (P<0.01), and severe acute lung disease (P<0.01). Congestive heart failure (P<0.01), central venous catheter (P<0.01), and VTE history (P<0.01) were all independent risk factors associated with VTE events. The risk of developing VTE in postoperative patients with moderate-and high-risk lung cancer was 3.5 and 8.4 times higher than that in low-risk patients. Conclusion Combining the Caprini thrombosis risk assessment model during postoperative care is most likely to predict the risk of developing VTE in postoperative patients with lung cancer, and the use of 9 points as a high-risk cutoff for the Caprini Thrombotic Risk Score has better sensitivity and Specificity. Key words: Lung neoplasms; Postoperative complicatlons; Venous thromboembolism; Caprini thrombosis risk assessment model

Breastfeeding Prevents Severe Disease in Full Term Female Infants With Acute Respiratory Infection

Breastfeeding is a well-known protective factor against severe respiratory tract infections. Recently, a gender specific role for human milk has been described in very low birth weight infants and neonates: breast milk protected girls but not boys. To determine whether the protective effect of breastfeeding on the severity of acute respiratory infections in full term infants is different for girls and boys. A prospective cross-sectional study of infants seeking medical care for acute respiratory infection. The protective role of breastfeeding against viral pneumonia and hospitalization were assessed by univariate and multivariate analyses. Analyses were adjusted for important confounders. A total of 323 patients were enrolled in this study. Breastfeeding protected girls against pneumonia and hospitalization, but did not protect boys. Nonbreastfeeding females were particularly susceptible to severe acute respiratory infections. Breastfeeding had a protective effect against severe disease in infant girls experiencing their first symptomatic respiratory infection. Nonbreastfeeding females are at significant risk for severe acute lung disease and should be targeted intensively by breastfeeding campaigns.

Differential Gender Response to Respiratory Infections and to the Protective Effect of Breast Milk in Preterm Infants

The protective role of breastfeeding against severe acute lung disease in infants is well established, but its mechanism is unclear. Most hypotheses assume that breastfeeding confers similar passive protection to every infant; however, a few observations have suggested that the benefits of breast milk against severe lung disease may differ according to gender. The objective of this study was to determine whether the effect of breastfeeding on susceptibility to severe acute lung disease among infants at high risk is different for girls and boys. A cohort was analyzed prospectively by use of 2 different strategies: (1) predictors of first episode of rehospitalization by univariate and multivariate analyses using robust Poisson regression and (2) mean number of rehospitalizations between groups using multiple regression negative binomial models. A total of 119 high-risk, very low birth weight infants were enrolled. Breast milk protected girls but not boys against severe acute lung disease. The interaction between breastfeeding and gender was clinically and statistically significant, even after adjustment for variables that can affect severity of acute lung disease. Disease was most severe in formula-fed girls (versus formula-fed boys). Breastfeeding decreased the risk for severe acute lung disease in girls but not in boys. These findings suggest that breast milk protection is not universally conferred by passive transfer of humoral immunity (which should be gender indifferent), show that respiratory symptoms may be amenable to nonspecific modulation, and identify nonbreastfed preterm infant girls as an at-risk group for severe acute lung disease.

Randomised trial of erythromycin on the development of chronic lung disease in preterm infants

AIMSTo determine if erythromycin given from birth reduces the inflammatory response and the incidence and severity of chronic lung disease.METHODSSeventy five infants less than 30 weeks of gestation and ventilated...

NEONATAL AND INFANT PROBLEMS OF LOW BIRTH WEIGHT

New therapies are being developed to improve survival of low-birth-weight infants, especially those weighing less than 1000 g. The most exciting new development is the use of surfactant replacement therapy for treatment of respiratory distress syndrome. This therapy results in less severe acute lung disease and has decreased mortality from respiratory distress syndrome. As more infants survive, consideration of long-term sequelae including chronic lung disease and neurologic outcome are of paramount importance. This review covers strategies for prevention and treatment of respiratory distress syndrome (including surfactant replacement). New and evolving treatments for amelioration of chronic lung disease and issues in neurologic outcome for the low-birth-weight infant (including prevention of intraventricular hemorrhage) are addressed.