The youngest surviving COVID-19 patient: A case report.

Introduction and importance: Vertical transmission of the novel coronavirus, known as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), has not yet been proven. However, several case reports and case series worldwide, including ours, support this certain type of transmission. Although COVID-19 has been mostly treated supportively, in some cases, including ours, medical treatment seems to be essential. Case presentation: Herein, we present a case of a neonate born to an asymptomatic mother with no known history of COVID-19 during pregnancy who was diagnosed as an asymptomatic silent carrier following the confirmation of COVID-19 in her newborn. Although bacterial pneumonia, early-onset sepsis, and meconium aspiration syndrome were the possible differential diagnosis, positive COVID-19 real-time reverse transcriptase-polymerase chain reaction (RT-PCR) confirmed the diagnosis. Due to the neonate's critical lung involvement leading to a critical condition, remdesivir, intravenous immune globulin (IVIG) and corticosteroid were administered. The patient fully recovered and was discharged after around 20 days. Clinical discussion: Although treatment in most cases of neonatal COVID-19 has been mainly supportive, in a few case reports remdesivir, corticosteroids and IVIG have been successfully used. Since a satisfying clinical improvement was not noticed following sepsis workup, all the three aforementioned medications were administered. Conclusion: Immunomodulatory medications as well as antiviral therapy should be considered in severe neonatal COVID-19 cases, as were shown to be lifesaving in our patient. Interestingly, to date, this case seems to be the youngest survived patient who has received medicines other than supportive care.

Spatial analysis and probabilistic risk assessment of exposure to fluoride in drinking water using GIS and Monte Carlo simulation.

Prevalence of fluorosis is a worldwide public health problem especially in many states of India. It is necessary to find out the fluoride endemic areas to adopt remedial measures to the people on the risk of fluorosis. The target goals of this research were to assess (a) the exposure of fluoride concentration; (b) probabilistic risk assessment, sensitivity analysis, and uncertainty through intake of groundwater among population of Agra City (infants, children and adults) by Crystal Ball software; and (c) spatial distribution of HQ and fluoride concentration. A total of sixty samples from standing tube wells/hand pumps were gathered from selected and identified fluoride prevalent areas in Agra City. The concentration of fluoride scrutinized was obtained to be ranging from 1.32 to 4.60 mg/L with mean value of 2.36 in Agra City, and more than 91% of samples investigated surpassed the allowable level set for fluoride concentration in potable water 1.5 mg/L, although 9% of the samples were well within the drinking water guidelines (0.5-1.5 mg/L). The hazard quotient (HQ) was obtained to an enormous difference in the exposure dose in infants (1.66-3.91), children (1.87-4.4), and adults (0.92-2.16), correspondingly. The non-carcinogenic HQ values in the group of infants, children, and more than 90% of adults were higher than those of the safety level (i.e., HQ >1). Consequently, the non-carcinogenic risks (HQ level) of fluoride vary from the most to the least: children, infant, and adults, respectively. With 87.41% certainty, the results indicated that the HQ values are between 1 and 3.42. So, infant is the most vulnerable group to fluoride consumption in study area. Uncertainty analysis results indicated that the children group's HQ level was between 1 and 1.90 with 38.48% certainty. To avoid further worsening of the situation as far as health is concerned, remedial actions like alternate sources of water supply and appropriate treatment of water need to be adopted besides required medical attention to affected people.

Neonates with Covid-19 infection: Is there any different treatment process?

This study was designed to investigate the neonates with COVID-19 admitted to two hospitals in Neyshabur and Mashhad, Iran. In this study, 17 neonates are introduced with positive nasopharyngeal COVID-19 polymerase chain reaction (PCR) test who admitted to two hospitals in Iran. Perinatal information, contacts with a person with COVID-19 infection, clinical signs at the time of admission, laboratory tests, radiological evaluations, pulmonary and extra pulmonary complications, and short-term outcome have been reported. 8 neonates had positive COVID-19 PCR test of mothers at the time of delivery in the first 24 hours and subjected to invasive or non-invasive mechanical ventilation due to respiratory distress. 9 neonates on 9-18 days of birth were admitted with pulmonary and extra pulmonary symptoms by fever as a main clinical sign. All of cases except one had a history of contact with the infected person. The treatments were mostly supportive, by the way 6 neonates receiving surfactant treatment and 2 of them receiving systemic steroid therapy. Only one neonate died and the others were discharged without any complications. The results showed that the symptoms and severity of the disease in neonates are milder than adults. The possibility of vertical transmission due to the onset of symptoms immediately after birth is still present in some neonates of affected mothers.