Clinical characteristics & severity profile of children with COVID-19 during the second wave pandemic: An experience from tertiary care hospital in Mumbai.

This retrospective observational study was aimed at defining the demographic and clinical characteristics as well as severity profile of COVID-19 disease in children admitted to dedicated COVID-19 tertiary care hospital in Mumbai, India, during the second wave. COVID-19 infection detected in children (1 month-12 years) by the rapid antigen test or reverse transcriptase polymerase chain reaction or TRUENAT from March 1 to July 31, 2021 on throat/nasopharyngeal samples were enrolled and their clinical features and outcomes were studied. During the study period, 77 children with COVID-19 infection were admitted, of whom two-third (59.7%) were <5 yr old. The common presenting symptom was fever (77%), followed by respiratory distress. Comorbidities were noted in 34 (44.2%) children. Most of the patients belonged to the mild severity category (41.55%). While 25.97 per cent of patients presented in severe category and 19.48 per cent were asymptomatic. Admission to intensive care was needed in 20 (25.9%) patients, with 13 patients needing invasive ventilation. Nine patients succumbed while 68 were discharged. The results might help understand the course, severity profile and outcomes of the second wave of the COVID-19 pandemic in the paediatric population.

A case of Ehlers-Danlos syndrome presenting as short stature: a novel mutation in SLC39A13 causing spondylodysplastic Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome (EDS) is a heritable connective tissue disorder characterized by a varying degree of skin hyperextensibility and joint hypermobility. EDS is classified into 13 subtypes according to the most recent classification. These subtypes are clinically and genetically heterogenous. The spondylodysplastic subvariety of EDS (spEDS) is caused by homozygous mutations in B4GALT7, B3GALT6 and SLC39A13. To date, 13 individuals with molecularly diagnosed SLC39A13-related spEDS have been reported. The spEDS caused by biallelic pathogenic SLC39A13 variants are characterized by short stature, protuberant eyes with bluish sclera, finely wrinkled palms, hypermobile joints, hyperextensible skin and characteristic radiological findings. Herein, we report a case of 7-year-old-female child with spEDS associated with novel homozygous (pathogenic/likely pathogenic) missense variation of the SLC39A13 gene.

Spectrum of viral hepatitis in hospitalized children in western India.

Viral hepatitis is a major public health problem affecting children globally. Clinical presentation varies from asymptomatic illness to hepatitis, and liver failure. Data on clinical features and laboratory parameters were collected and analysed on 300 children, aged 1-12 years, admitted with confirmed viral hepatitis. A small majority (52%) were boys. The mean age of presentation was 6.9 ± 2.8 years with the commonest symptoms being anorexia or vomiting (in 98%), fever (in 89%) and jaundice (in 71.3%). Tender hepatomegaly was seen in 31.7%. Almost all (97.6%) had hepatitis A, though mixed infection (A & E) was seen in 1.7%. Only 8% had serum bilirubin levels >200 µmol/L. Significantly elevated (>20 µkat/L) levels of aspartate transaminase and alanine transaminase were seen in 19% and 25.3% of cases respectively. Coagulopathy (PT >15 s) was present in 11.0% cases. HAV remains the most common cause of viral hepatitis in children in our environment. Public awareness and universal vaccination should be the focus to prevent morbidity and mortality due to these pathogens.

Apps on Google Play Store to assist in self-management of hypertension in Indian context: features analysis study.

Background: A large number of individuals with hypertension are turning to the Internet and m-health technologies for assistance. There is a need to study the content of smartphone applications on hypertension. The study aimed to review and investigate the functional and analytical characteristics of apps related to the self-management of hypertension available on Google Play Store. Methods: Search was conducted in February 2021 in India using the Google Play Store database to identify currently available Android-based apps related to self-management of hypertension/high blood pressure (BP). Keywords used were: 'Hypertension', 'High blood pressure', 'DASH diet', 'Hypertension diet', and 'Blood pressure diet'. A total of 822 apps were screened based on the duplicates, inclusion, and exclusion criteria. A total of 210 were included for further analysis. Results: Eighteen percent (n=37) of the apps had an overall rating of 4.5 or above. About 41% of the apps belonged to the medical category and 41% of the apps were characterized in the health and fitness category. Feature of logging/recording the BP measurement was seen in 73% of the apps. In-app graphing to analyze BP trends was reported in 64 % of the included apps. A few apps focused on tracking medication (n=19), sodium intake (n=2), and calorie intake (n=4). Conclusions: The features were common across all the included apps and were focusing only on recording the BP, providing statistics and trends of BP, and providing educational information. App developers should now aim to provide other components of self-management techniques to help individuals tackle hypertension.

Clinical Presentation of Cases with SARS-CoV-2 Reinfection/ Reactivation.

BACKGROUND: Reinfection/reactivation of SARS-CoV-2 has been a matter of great interest from the immunological and vaccine perspective. However, little is known about the clinical presentation of such reinfection/reactivation. We report a case series of 9 COVID-19 patients having experienced two clinically- and/or virologically-confirmed episodes of COVID-19. METHODS: Epidemiological and clinical characteristics of 9 healthcare workers (HCWs) with two episodes of SARS-CoV-2 are described. RESULTS: The incidence of reinfection/reactivation amongst the HCWs was 2% (9 out of 491) with an average remission period of 66 days (range 43-78 days). Amongst the cases of reinfection 4/9 were asymptomatic in first episode were symptomatic in second episode. There is negative correlation between numbers of days the patients took to become SARS-CoV-2 negative by RT-CPR and/or clinically recover in the first episode and the second episode irrespective for the time spent in remission. CONCLUSION: Shorter durations of SARS-COV-2 infection in the first episode are associated with longer time to recovery in the second episode in patients with re-infection/reactivation.

Co-infection of malaria and early clearance of SARS-CoV-2 in healthcare workers.

Healthcare workers (HCWs) are at higher risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Information regarding co-infection of SARS-CoV-2 with vector-borne diseases (malaria and dengue) is crucial especially for the countries wherein malaria and dengue are endemic. The objective was to study the prevalence, demographic, clinical presentations among HCWs with coronavirus disease 2019 (COVID-19) and to compare the viral clearance in HCWs with COVID-19 and co-infection of malaria and dengue. This retrospective study was conducted at a dedicated COVID-19 hospital, BYL Nair Charitable Hospital (NH), Mumbai, India April 6th-October 31st 2020. The SARS-CoV-2 infection in HCWs was confirmed by reverse transcription-plymerase chain reaction. Out of 491 HCWs infected with SARS-CoV-2, analysis of viral clearance was carried out in 467 HCWs over seven month periods, The prevalence of SARS-CoV-2 infection in HCWs was 13% (491 out of 3711). Out of the HCWs with COVID-19, prevalence of SARS-CoV-2 infection was higher among security guards (25%) with 1% mortality. The co-infection of malaria or dengue was reported in 31 HCWs (6.3%). The mean duration of virus clearance was longer (12 days) in symptomatic HCWs as compared to asymptomatic (8 days, p < .005). The recovery of SARS-CoV-2 infection in HCWs was faster (mean 8 days) with co-infection of malaria than without malaria (p < .005). We recommend universal testing of HCWs, to optimize staffing levels during the current pandemic as HCWs are the most precious resource. There is a need to effectively implement standard protocols for prevention of vector-borne diseases, especially in the hospital settings.

Prevalence and Clinical Presentation of COVID-19 among Healthcare Workers at a Dedicated Hospital in India

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rapidly spreading in India and across the world. Healthcare workers (HCWs) are at increased risk of contracting COVID-19 due to direct or indirect exposure to COVID-19 patients, and require special attention. Limited information is available about its effect in HCWs. Secondary transmission from HCWs is a possibility among patients, family members, and the community. Therefore, it is important to investigate the infection risk of HCWs and the clinical characteristics of affected cases and possible source of infection with exposure details. Methods: The aim of this study is to analyze the medical records of HCWs with COVID-19 retrospectively and carry out the analysis of the data of HCWs with COVID-19 at TNMC and BYL Nair Charitable Hospital (NH, COVID-19 Hospital) in Mumbai. Results: Interim analysis was carried out for the data collected from 6th April to 20th August 2020. Total 3711 HCWs (frontline, 74.32%, non-frontline, 25.68%) are working at NH Mumbai. We observed 11% prevalence of SARS-CoV-2 infection among HCWs, 4% co-infection and 1% mortality. Majority (85%) of the HCWs with COVID-19 were symptomatic and 15% were asymptomatic. Comorbidities were reported in 19% of HCWs with COVID-19. Hypertension and Diabetes Mellitus were the most common co-morbidities reported. More than 4% percent of HCWs with COVID-19 were also positive for plasmodium vivax Malaria. Conclusion: The results of the study will be useful for determining the impact of COVID-19 and adverse outcomes in HCWs, identifying probable mode of acquiring SARS-CoV-2 infection in HCWs. This is required for planning the strategies to handle the epidemic of COVID-19 among HCWs in Mumbai region, and at Maharashtra state level.

Preparedness, administrative challenges for establishing obstetric services, and experience of delivering over 400 women at a tertiary care COVID-19 hospital in India.

OBJECTIVE: To provide a descriptive account of the challenges and administrative preparedness for establishing and sustaining safe obstetric services during the COVID-19 pandemic at Topiwala National Medical College & BYL Nair Charitable Hospital (NH), Mumbai, India. METHODS: The management of pregnant women with COVID-19 was implemented as per international (WHO, RCOG, ACOG) and national (Indian Council of Medical Research) recommendations and guidelines at an academic, tertiary care, COVID-19 hospital in India. RESULTS: Using a multidisciplinary approach and active engagement of a multispecialty team, obstetric services were provided to over 400 women with laboratory-confirmed COVID-19. A sustainable model is established for providing services to pregnant women with COVID-19 in Mumbai Metropolitan Region, India. CONCLUSION: With limited resources, it is possible to set up dedicated maternity services, aligned to international guidelines, for safe pregnancy outcomes in COVID-19 settings. This COVID-19 hospital addressed the challenges and implemented several known and novel methods to establish and sustain obstetric services for women with COVID-19. The model established in the present study can be replicated in other low- and middle-income countries.

Eosinophilia in an Acutely Limping Child: An Easy Guess of Rare Systemic Aetiology!

Painful limping child is often considered due to septic arthritis. Iliopsoas abscess (IPA) is rare in adults and children. The aetiology is often related to tuberculosis of spine. Hereby we report a case of staphylococcal IPA where incidental evaluations led to obvious diagnosis of a rare primary immunodeficiency syndrome called Job syndrome or hyperimmunoglobulin E and Eosinophilia Syndrome (HIES). This was the first case of IPA in a case of immunodeficiency syndrome including HIES.

Hospital Based Prospective Observational Study to Audit the Prescription Practices and Outcomes of Paediatric Patients (6 months to 5 years age group) Presenting with Acute Diarrhea.

INTRODUCTION: Diarrhea is a leading killer of children, accounting for 9% of all deaths among under-five children worldwide. WHO protocol deviation in management of diarrheas in children is likely due to various reasons. AIM: To study the prescription practices, regarding adherence to WHO protocol and deviations, in the management of acute diarrhea in children presenting at a tertiary care hospital and its impact on the outcome. MATERIALS AND METHODS: This was a prospective observational hospital based study at a tertiary care carried out over a 12-month period including all cases of acute diarrhea (defined as 3 or more loose stools in last 24 hours) in children belonging to the age group of 6 months to 5 years. Patients were followed up on day 3,7,14 and 28 from the day of presentation. Software SPSS Version 17.0 was used for analysis. Correlation regression analysis was used to study predictiveness of different variables affecting outcome. RESULTS: In this study, 447 children aged between 6 months and 5 years were enrolled, of which 45 cases were lost in follow-up and excluded. The median age was 14 months. Some deviation from WHO protocol was noted in 78.4% of the cases. Most common deviations from WHO protocol were addition of probiotics (78.1% of cases) and addition of race cadotril (15.9% of cases). Inadvertent use of antibiotics in diarrhea was noted in 12.2% of cases. Presence of fever was strong predictor for use of antibiotics. Cases of early recovery within 3 days of presentation were higher in WHO protocol deviation group. Use of probiotics had statistically significant association with early recovery. CONCLUSION: In diarrhea management, WHO protocol deviation is common. Probiotics are likely to help in early recovery.