COVID-19 and pregnancy- review of cases from a tertiary public hospital in Mumbai

Background: In December 2019 a novel strain of coronavirus, was first isolated by the Chinese Center for Disease Control and Prevention. This strain connected to the cluster of acute respiratory illness cases from Wuhan, China was later officially named as severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). On 30th January 2020, WHO declared the outbreak of SARS-Cov-2 a public health emergency of international concern, and on 11th March 2020 declared it to be a pandemic. Pregnant women are known to be at higher risk of severe morbidity and mortality from respiratory infections such as influenza and SARS, making a strong case for pregnant women to be considered an at-risk population for COVID-19. This study aimed to assess the clinical picture, obstetric outcome and neonatal outcome in COVID positive pregnant cases.Methods: We did a retrospective observational cohort study in the department of Obstetrics and Gynecology at a tertiary teaching hospital in Mumbai.Results: In the study duration, 148 were diagnosed as COVID positive (~12%). 9 patients had COVID related symptoms on admission. The obstetric outcome in symptomatic patients was noted to be good. We noted 79.01% of the pregnancies reached term. Cesarean section rate in COVID positive patients was comparable to non-COVID patients in the study duration. Neonatal outcome was only 4 babies of COVID positive mothers were diagnosed positive.Conclusions: Our study shows pregnancy outcomes are not significantly worsened by the COVID-19 infection in spite of the risk factors associated with pregnancy per se and influenza infection in pregnancy.

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Effect of a novel coronavirus in human and its clinical diagnosis and implications by students of community pharmacy

International Journal of Basic & Clinical Pharmacology ◽

10.18203/2319-2003.ijbcp20202956 ◽

2020 ◽

Vol 9 (7) ◽

pp. 1140

Author(s):

Kanamala Arun Chand Roby ◽

Singamala Lakshmi Bhargavi ◽

Gali Devi Sri ◽

Avula Madhuri ◽

Sannadi Kamakshi ◽

...

Keyword(s):

Respiratory Infections ◽

Specific Treatment ◽

Respiratory Illness ◽

Respiratory Illnesses ◽

Runny Nose ◽

Corona Virus ◽

Respiratory Tract Illnesses ◽

Control And Prevention ◽

Novel Coronavirus ◽

Corona Viruses

Coronavirus are coming under a broad family of virus that can cause respiratory illnesses such as the common cold, according to the centers for disease control and prevention (CDC). They are usual in many different species of animals, including camels and bats. Unusually, these corona viruses can evolve and infect humans and then spread between humans. Recent examples of this include SARS-CoV and MERS-CoV. 2019 Novel Corona virus (2019-nCoV) is a virus identified as the cause of an outbreak of respiratory illness first detected in Wuhan, China. In some cases, the viruses can cause lower-respiratory tract illnesses such as pneumonia and bronchitis. In human corona viruses are currently classified into seven types that are HCoV-229E, HCoV-OC43, HCoV-NL63, SARS-CoV, HKU1, MERS-CoV and 2019-nCoV. These two types of corona virus (MERS-CoV and SARS-CoV) are more dangerous. Some of corona viruses like HCoV-229E, HCo-OC43, HCoNL63 and HKU1 that are continuously circulate in the population of human and cause respiratory infections in human either may children and adults world-wide. They are generally transmitted between animals and humans through sneezing, coughing, touching or shaking hands and making contact with a surface or object. The symptoms of corona virus are sneezing, cough, fatigue, runny nose, sore throat, breathing difficulty and exacerbated. In more severe cases SARS, kidney failure, pneumonia and even death. Diagnosis can be carried out by healthcare provider in laboratory test on respiratory specimens and serum to detect human corona virus. For this virus no specific treatment like vaccines and antiviral drugs but symptoms can be treated.

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Contribution of Nanotechnologies to Vaccine Development and Drug Delivery against Respiratory Viruses

PPAR Research ◽

10.1155/2021/6741290 ◽

2021 ◽

Vol 2021 ◽

pp. 1-28

Author(s):

Mahdi Ftouh ◽

Nesrine Kalboussi ◽

Nabil Abid ◽

Souad Sfar ◽

Nathalie Mignet ◽

...

Keyword(s):

Drug Delivery ◽

Vaccine Development ◽

Respiratory Infections ◽

Antiviral Drug ◽

Respiratory Illness ◽

Short Review ◽

Respiratory Viruses ◽

Control And Prevention ◽

Viral Illness ◽

Syncytial Virus

According to the Center for Disease Control and Prevention (CDC), the coronavirus disease 2019, a respiratory viral illness linked to significant morbidity, mortality, production loss, and severe economic depression, was the third-largest cause of death in 2020. Respiratory viruses such as influenza, respiratory syncytial virus, SARS-CoV-2, and adenovirus, are among the most common causes of respiratory illness in humans, spreading as pandemics or epidemics throughout all continents. Nanotechnologies are particles in the nanometer range made from various compositions. They can be lipid-based, polymer-based, protein-based, or inorganic in nature, but they are all bioinspired and virus-like. In this review, we aimed to present a short review of the different nanoparticles currently studied, in particular those which led to publications in the field of respiratory viruses. We evaluated those which could be beneficial for respiratory disease-based viruses; those which already have contributed, such as lipid nanoparticles in the context of COVID-19; and those which will contribute in the future either as vaccines or antiviral drug delivery systems. We present a short assessment based on a critical selection of evidence indicating nanotechnology’s promise in the prevention and treatment of respiratory infections.

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Impact of Novel Coronavirus (COVID-19) on Pregnant Women: A Review

Coronaviruses ◽

10.2174/2666796701999201116123457 ◽

2020 ◽

Vol 01 ◽

Author(s):

Saima Habeeb ◽

Manju Chugani

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Respiratory Infections ◽

Age Groups ◽

Well Being ◽

Fetal Outcome ◽

Global Public Health ◽

Coronavirus Infection ◽

Novel Coronavirus ◽

The Impact

: The novel coronavirus infection (COVID‐19) is a global public health emergency.Since its outbreak in Wuhan, China in December 2019, the infection has spread at an alarming rate across the globe and humans have been locked down to their countries, cities and homes. As of now, the virus has affected over 20million people globally and has inflicted over 7 lac deaths. Nevertheless, the recovery rate is improving with each passing day and over 14 million people have recuperated so far. The statistics indicate that nobody is immune to the disease as the virus continues to spread among all age groups; newborns to the elders, and all compartmentsincluding pregnant women. However, pregnant women may be more susceptible to this infection as they are, in general, highly vulnerable to respiratory infections. There is no evidence for vertical transmission of the COVID-19 virus among pregnant women, but an increased prevalence of preterm deliveries. Besides this, the COVID-19 may alter immune response at the maternal-fetal interface and affect the well-being of mothers as well as infants. Unfortunately, there is limited evidence available in the open literature regarding coronavirus infection during pregnancy and it now appears that certain pregnant women have infected during the present 2019-nCoV pandemic. In this short communication, we study the impact of the COVID-19 infection on vertical transmission and fetal outcome among pregnant women.

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1718. Respiratory Syncytial Virus (RSV) Surveillance in the Department of Veterans Affairs (VA), 2010-2018

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1896 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S843-S843

Author(s):

Cynthia Lucero-Obusan ◽

Patricia Schirmer ◽

Gina Oda ◽

Mark Holodniy

Keyword(s):

Respiratory Syncytial Virus ◽

Respiratory Infections ◽

Diagnostic Testing ◽

Fold Increase ◽

Respiratory Illness ◽

Veterans Affairs ◽

Department Of Veterans Affairs ◽

Management And Development ◽

Syncytial Virus ◽

National Trends

Abstract Background Respiratory Syncytial Virus (RSV) is an increasingly recognized cause of acute respiratory illness in older adults, leading to an estimated 177,000 hospitalizations and 14,000 deaths each year in the US. In adult populations, diagnostic testing for RSV has historically been underutilized. Herein, we examine national trends in RSV testing and infection across the Veterans Affairs (VA) healthcare system. Methods Electronic RSV laboratory testing results, ICD-coded hospitalizations and outpatient encounters were obtained from VA’s Praedico Surveillance System (1/1/2010-12/31/2018). Patients were reviewed for positive results, repeat testing, and demographics. Antibody tests were excluded. Results A total of 102,251 RSV results were included. Overall, 4,372 (4.3%) specimens from 4,263 unique individuals were positive with a median age of 67 years (range 0-101) and 90% were male. 1,511 individuals (35.4%) also had an RSV-coded hospitalization. RSV type was specified for only 7.8% of positives (Table). During 2010-2018 there were 2,522 RSV-coded hospitalizations (median length of stay = 4 days) among 2,444 unique individuals, which included 413 ICU stays (16.4%) and 98 deaths (3.9%) during the RSV-coded hospitalization. Approximately 78% of RSV-coded hospitalizations within VA (excluding all non-VA hospitalizations) had a documented positive test result. A greater than 15-fold increase in RSV tests performed, hospitalizations and outpatient encounters was observed from 2010-2018, although the percent testing positive remained relatively stable (Figure, Table). Figure. Testing for Respiratory Syncytial Virus (RSV), Department of Veterans Affairs, 2010-2018. Table. Select RSV Surveillance Metrics, Department of Veterans Affairs, 2010-2018 Conclusion RSV testing and identification of patients with RSV infection increased dramatically during the time period analyzed, likely due to increased availability of PCR-based multi-pathogen panels and duplex assays. While the percentage of tests positive for RSV remained relatively stable, the rise in coded hospitalizations may be due to increased testing for RSV among hospitalized Veterans with severe respiratory infections. These surveillance data may allow for further characterization of RSV disease burden estimates which can help inform clinical management and development of interventions for adults, such as vaccines and antiviral therapies. Disclosures All Authors: No reported disclosures

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143. Initial Impact of COVID-19 on Ambulatory Antibiotic Prescribing for Respiratory Viral Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.188 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S82-S82

Author(s):

Zahra Kassamali Escobar ◽

Todd Bouchard ◽

Jose Mari Lansang ◽

Scott Thomassen ◽

Joanne Huang ◽

...

Keyword(s):

Primary Care ◽

Viral Infections ◽

Respiratory Infections ◽

Urgent Care ◽

Antibiotic Prescribing ◽

Specific Rate ◽

Inclusion Criteria ◽

Diagnosis Codes ◽

Control And Prevention ◽

Viral Respiratory Infections

Abstract Background Between 15–50% of patients seen in ambulatory settings are prescribed an antibiotic. At least one third of this usage is considered unnecessary. In 2019, our institution implemented the MITIGATE Toolkit, endorsed by the Centers for Disease Control and Prevention to reduce inappropriate antibiotic prescribing for viral respiratory infections in emergency and urgent care settings. In February 2020 we identified our first hospitalized patient with SARS-CoV(2). In March, efforts to limit person-to-person contact led to shelter in place orders and substantial reorganization of our healthcare system. During this time we continued to track rates of unnecessary antibiotic prescribing. Methods This was a single center observational study. Electronic medical record data were accessed to determine antibiotic prescribing and diagnosis codes. We provided monthly individual feedback to urgent care prescribers, (Sep 2019-Mar 2020), primary care, and ED providers (Jan 2020 – Mar 2020) notifying them of their specific rate of unnecessary antibiotic prescribing and labeling them as a top performer or not a top performer compared to their peers. The primary outcome was rate of inappropriate antibiotic prescribing. Results Pre toolkit intervention, 14,398 patient visits met MITIGATE inclusion criteria and 12% received an antibiotic unnecessarily in Jan-April 2019. Post-toolkit intervention, 12,328 patient visits met inclusion criteria and 7% received an antibiotic unnecessarily in Jan-April 2020. In April 2020, patient visits dropped to 10–50% of what they were in March 2020 and April 2019. During this time the unnecessary antibiotic prescribing rate doubled in urgent care to 7.8% from 3.6% the previous month and stayed stable in primary care and the ED at 3.2% and 11.8% respectively in April compared to 4.6% and 10.4% in the previous month. Conclusion Rates of inappropriate antibiotic prescribing were reduced nearly in half from 2019 to 2020 across 3 ambulatory care settings. The increase in prescribing in April seen in urgent care and after providers stopped receiving their monthly feedback is concerning. Many factors may have contributed to this increase, but it raises concerns for increased inappropriate antibacterial usage as a side effect of the SARS-CoV(2) pandemic. Disclosures All Authors: No reported disclosures

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Maternal Resources, Pregnancy Concerns, and Biological Factors Associated to Birth Weight and Psychological Health

Journal of Clinical Medicine ◽

10.3390/jcm10040695 ◽

2021 ◽

Vol 10 (4) ◽

pp. 695 ◽

Cited By ~ 1

Author(s):

David Ramiro-Cortijo ◽

María de la Calle ◽

Andrea Gila-Díaz ◽

Bernardo Moreno-Jiménez ◽

Maria A. Martin-Cabrejas ◽

...

Keyword(s):

Life Satisfaction ◽

Birth Weight ◽

Pregnant Women ◽

Maternal Depression ◽

Psychological Health ◽

Neonatal Outcome ◽

P Value ◽

Linear Regression Models ◽

Psychological Outcome ◽

Biological Variables

Cognitive maternal adaptation during pregnancy may influence biological variables, maternal psychological, and neonatal health. We hypothesized that pregnant women with numerous general resources and less negative emotions would have a better coping with a positive influence on neonatal birth weight and maternal psychological health. The study included 131 healthy pregnant women. A blood sample was obtained in the first trimester to assess biological variables (polyphenols, hematological and biochemical parameters). Psychological variables (negative affect, anxiety, optimism, resilience, family–work conflicts, pregnancy concerns, general resources, and life satisfaction) were evaluated at several time points along gestation, and birth weight was recorded. Hierarchical linear regression models were used to associate the above parameters with maternal psychological outcome at the end of gestation (depression, resilience, and optimism) and neonatal outcome (birth weight). Maternal depression was associated with leukocytes (β = 0.08 ± 0.03, p-value = 0.003), cholesterol (β = 0.01 ± 0.002, p-value = 0.026), and pregnancy concerns (β = 0.31 ± 0.09, p-value = 0.001). Maternal resilience was associated with leukocytes (β = −0.14 ± 0.09, p-value = 0.010) and life satisfaction (β = 0.82 ± 0.08, p-value = 0.001), and maternal optimism was associated with polyphenol levels (β = 0.002 ± 0.001, p-value = 0.018) and life satisfaction (β = 0.49 ± 0.04, p-value = 0.001). Birth weight was associated with maternal resilience (β = 370.2 ± 97.0, p-value = 0.001), red blood cells (β = 480.3 ± 144.4, p-value = 0.001), and life satisfaction (β = 423.3 ± 32.6, p-value = 0.001). We found associations between maternal psychological, blood variables, and birth weight and maternal depression. This study reveals the relevance of psychological health during pregnancy for maternal and neonatal outcome, and it emphasizes the need to consider it in preventive policies in the obstetric field.

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SARS-CoV-2 in pregnancy: maternal and perinatal outcome data of 34 pregnant women hospitalised between May and October 2020

Journal of Perinatal Medicine ◽

10.1515/jpm-2020-0499 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Mirijam Hall ◽

David Endress ◽

Susanne Hölbfer ◽

Barbara Maier

Keyword(s):

Critical Care ◽

Pregnant Women ◽

Critical Care Unit ◽

Birth Rate ◽

Total Population ◽

Neonatal Outcome ◽

Mode Of Delivery ◽

Outcome Data ◽

High Risk Population ◽

Retrospective Data Collection

AbstractObjectivesTo report clinical data on maternal outcome, mode of delivery and immediate neonatal outcome in women infected with COVID-19.MethodsRetrospective data collection.ResultsA total of 8.6% of the total population of hospitalised SARS-CoV-2 positive pregnant women were admitted to a critical care unit. The premature birth rate for births before 34+0 weeks of gestation among pregnant women who tested positive for SARS-CoV-2 was 7.1%. One newborn (3.6%) tested positive for SARS-CoV-2 two days after birth and showed symptoms.ConclusionsPregnant women with COVID-19 seem to be at higher risk of invasive ventilation, admission to a critical care unit and preterm birth, and should therefore be considered a high-risk-population.

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Modernizing Perinatal Substance Use Management

Policy Politics & Nursing Practice ◽

10.1177/1527154420981945 ◽

2020 ◽

pp. 152715442098194

Author(s):

Brayden N. Kameg

Keyword(s):

Substance Use ◽

Pregnant Women ◽

Registered Nurses ◽

Treatment Strategies ◽

Analytical Framework ◽

Prevention Policy ◽

Opioid Use ◽

Health Crisis ◽

State Regulations ◽

Control And Prevention

The increase in prescription and illicit opioid use since 2000 has become an urgent public health crisis. While the opioid epidemic spans racial, regional, and socioeconomic divides, women have surfaced as one demographic affected by opioid use and related sequelae. Certain federal and state regulations, secondary to the Child Abuse Prevention and Treatment Act, strip pregnant women with opioid use disorders of the ability to engage autonomously with their health care clinician while simultaneously impeding their ability to achieve and sustain recovery. The purpose of this article is to explore current health policy that impacts pregnant women who use opioids. Recommendations to improve care, broadly, will be highlighted to include access to contraceptive services, universal screening for perinatal substance use, and access to appropriate treatment strategies. Policy modifications to facilitate these recommendations are discussed. The Centers for Disease Control and Prevention Policy Analytical Framework was utilized to derive recommendations. The recommendations are relevant to advanced practice registered nurses and midwives who have the potential to treat substance use in women, to women’s health and pediatric registered nurses, and to nursing administrators who are involved in decision-making in obstetric and pediatric settings.

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Clinical Features and Maternal-fetal Results of Pregnant Women in COVID-19 Times

Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics ◽

10.1055/s-0041-1729145 ◽

2021 ◽

Vol 43 (05) ◽

pp. 384-394

Author(s):

Ana Paula Nogueira Godoi ◽

Gilcelia Correia Santos Bernardes ◽

Leilismara Sousa Nogueira ◽

Patrícia Nessralla Alpoim ◽

Melina de Barros Pinheiro

Keyword(s):

Pregnant Women ◽

Vertical Transmission ◽

Postpartum Period ◽

Scientific Literature ◽

Respiratory Infections ◽

Clinical Manifestations ◽

Fetal Distress ◽

Medical Subject Headings ◽

Substantial Evidence ◽

The Subject

Abstract Objective Coronavirus disease 2019 (COVID-19) is a disease caused by a newly discovered coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which usually leads to non-specific respiratory symptoms. Although pregnant women are considered at risk for respiratory infections by other viruses, such as SARS and Middle East respiratory syndrome (MERS), little is known about their vulnerability to SARS-CoV-2. Therefore, this study aims to identify and present the main studies on the topic, including the postpartum period. Methods In this narrative review, articles were searched in various databases, organizations, and health entities using keywords compatible with medical subject headings (MeSH), such as: COVID-19, pregnancy, vertical transmission, coronavirus 2019, and SARS-CoV-2. Results The review of the scientific literature on the subject revealed that pregnant women with COVID-19 did not present clinical manifestations significantly different from those of non-pregnant women; however, there are contraindicated therapies. Regarding fetuses, studies were identified that reported that infection by SARS-CoV-2 in pregnant women can cause fetal distress, breathing difficulties and premature birth, but there is no substantial evidence of vertical transmission. Conclusion Due to the lack of adequate information and the limitations of the analyzed studies, it is necessary to provide detailed clinical data on pregnant women infected with SARS-CoV-2 and on the maternal-fetal repercussions caused by this infection. Thus, this review may contribute to expand the knowledge of professionals working in the area as well as to guide more advanced studies on the risk related to pregnant women and their newborns. Meanwhile, monitoring of confirmed or suspected pregnant women with COVID-19 is essential, including in the postpartum period.

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Assessing the Respiratory Effects of Air Pollution from Biomass Cookstoves on Pregnant Women in Rural India

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18010183 ◽

2020 ◽

Vol 18 (1) ◽

pp. 183

Author(s):

Raj Parikh ◽

Sowmya R. Rao ◽

Rakesh Kukde ◽

George T. O'Connor ◽

Archana Patel ◽

...

Keyword(s):

Air Pollution ◽

Pregnant Women ◽

Central India ◽

Respiratory Illness ◽

Biomass Fuel ◽

Second Hand Smoke ◽

Rural India ◽

P Value ◽

Liquefied Petroleum Gas ◽

Respiratory Effects

Background: In India, biomass fuel is burned in many homes under inefficient conditions, leading to a complex milieu of particulate matter and environmental toxins known as household air pollution (HAP). Pregnant women are particularly vulnerable as they and their fetus may suffer from adverse consequences of HAP. Fractional exhaled nitric oxide (FeNO) is a noninvasive, underutilized tool that can serve as a surrogate for airway inflammation. We evaluated the prevalence of respiratory illness, using pulmonary questionnaires and FeNO measurements, among pregnant women in rural India who utilize biomass fuel as a source of energy within their home. Methods: We prospectively studied 60 pregnant women in their 1st and 2nd trimester residing in villages near Nagpur, Central India. We measured FeNO levels in parts per billion (ppb), St. George’s Respiratory Questionnaire (SGRQ-C) scores, and the Modified Medical Research Council (mMRC) Dyspnea Scale. We evaluated the difference in the outcome distributions between women using biomass fuels and those using liquefied petroleum gas (LPG) using two-tailed t-tests. Results: Sixty-five subjects (32 in Biomass households; 28 in LPG households; 5 unable to complete) were enrolled in the study. Age, education level, and second-hand smoke exposure were comparable between both groups. FeNO levels were higher in the Biomass vs. LPG group (25.4 ppb vs. 8.6 ppb; p-value = 0.001). There was a difference in mean composite SGRQ-C score (27.1 Biomass vs. 10.8 LPG; p-value < 0.001) including three subtotal scores for Symptoms (47.0 Biomass vs. 20.2 LPG; p-value< 0.001), Activity (36.4 Biomass vs. 16.5 LPG; p-value < 0.001) and Impact (15.9 Biomass vs. 5.2 LPG; p-value < 0.001). The mMRC Dyspnea Scale was higher in the Biomass vs. LPG group as well (2.9 vs. 0.5; p < 0.001). Conclusion: Increased FeNO levels and higher dyspnea scores in biomass-fuel-exposed subjects confirm the adverse respiratory effects of this exposure during pregnancy. More so, FeNO may be a useful, noninvasive biomarker of inflammation that can help better understand the physiologic effects of biomass smoke on pregnant women. In the future, larger studies are needed to characterize the utility of FeNO in a population exposed to HAP.

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