Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Objective To assess the effect of tranexamic acid on blood transfusion, thromboembolic events, and mortality in surgical patients. Design Systematic review and meta-analysis. Data sources Cochrane central register of controlled trials, Medline, and Embase, from inception to September 2011, the World Health Organization International Clinical Trials Registry Platform, and the reference lists of relevant articles. Study selection Randomised controlled trials comparing tranexamic acid with no tranexamic acid or placebo in surgical patients. Outcome measures of interest were the number of patients receiving a blood transfusion; the number of patients with a thromboembolic event (myocardial infarction, stroke, deep vein thrombosis, and pulmonary embolism); and the number of deaths. Trials were included irrespective of language or publication status. Results 129 trials, totalling 10 488 patients, carried out between 1972 and 2011 were included. Tranexamic acid reduced the probability of receiving a blood transfusion by a third (risk ratio 0.62, 95% confidence interval 0.58 to 0.65; P Conclusions Strong evidence that tranexamic acid reduces blood transfusion in surgery has been available for many years. Further trials on the effect of tranexamic acid on blood transfusion are unlikely to add useful new information. However, the effect of tranexamic acid on thromboembolic events and mortality remains uncertain. Surgical patients should be made aware of this evidence so that they can make an informed choice.

https://www.bmj.com/content/bmj/344/bmj.e3054.full.pdf

Effect of tranexamic acid on surgical bleeding: systematic review and cumulative meta-analysis

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(11)61171-9.pdf

Rheumatic Heart Disease

Background: Extensive blood loss is common in pediatric craniosynostosis reconstruction surgery. Tranexamic acid (TXA) is increasingly used to reduce perioperative blood loss in various settings, but data on its efficacy are limited in children. The purpose of this randomized, double-blind, placebo-controlled, parallel trial was to evaluate the efficacy of TXA in pediatric craniosynostosis correction surgery. The primary and secondary outcome variables were reduction in perioperative blood loss and reduction in blood transfusion, respectively. Methods: Forty-three children, ages 2 months to 6 yr, received either placebo or TXA in a loading dose of 50 mg·kg ―1 , followed by an infusion of 5 mg·kg ―1 ·h ―1 during surgery. TXA plasma concentrations were measured. Results: The TXA group had significantly lower perioperative mean blood loss (65 vs. 119 ml·kg ―1 , P < 0.001) and lower perioperative mean blood transfusion (33 vs. 56 ml· kg ―1 , P = 0.006) compared to the placebo group. The mean difference between the TXA and placebo groups for total blood loss was 54 ml·kg ―1 (95% CI for the difference, 23-84 ml·kg ―1 ) and for packed erythrocytes transfused was 23 ml·kg ―1 (95% CI for the difference, 7-39 ml·kg ―1 ). TXA administration also significantly diminished (by two thirds) the perioperative exposure of patients to transfused blood (median, 1 unit vs. 3 units; P < 0.001). TXA plasma concentrations were maintained above the in vitro thresholds reported for inhibition of fibrinolysis (10 μg·ml ―1 ) and plasmin-induced platelet activation (16 μg·ml ―1 ) throughout the infusion. Conclusions: TXA is effective in reducing perioperative blood loss and transfusion requirement in children undergoing craniosynostosis reconstruction surgery.

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Efficacy of tranexamic acid in pediatric craniosynostosis surgery: a double-blind, placebo-controlled trial.

Thrombosis has long been recognized as a potentially life-threatening complication in children with congenital heart disease (CHD), children with acquired heart disease, and in adults with CHD. High-risk groups include patients with shunt- dependent single ventricles (shunt thrombosis, 8%–12%; 4%

Prevention and Treatment of Thrombosis in Pediatric and Congenital Heart Disease A Scientific Statement From the American Heart Association

Mitral valve repair in children with rheumatic heart disease.

Background & objectives: Antifibrinolytic agents are used commonly in adult cardiac surgery to reduce postoperative blood loss. Paucity of literature on the use of a newer antifibrinolytic agent tranexamic acid (TA) in children undergoing cardiac surgery promoted us to conduct this study in children with cyanotic heart disease. Methods: One hundred and twenty consecutive children with cyanotic heart disease were randomised into two groups. Control (group A) (n=24) given no drug while the study (group B, n=96) group was given tranexamic acid 10 mg/kg each after anaesthetic induction, on bypass and after protamine at the end of bypass. Postoperatively, total mediastinal chest tube drainage and blood and blood product usage at 24 h were recorded. Tests of coagulation including activated clotting time, fibrinogen, fibrin degradation products and platelet count were performed at 6 h postoperatively. Results: The two groups were comparable in terms of demographic characteristics such as age, sex, weight, operations performed, and preoperative haematocrit. Postoperatively, group B, had a significantly (P<0.05) lower blood loss, blood and blood product usage, re-exploration rate compared to the control group. There was preservation of fibrinogen and lower levels of fibrin degradation products in group B. Interpretation & conclusion: Tranexamine acid was highly effective in reducing post-operative blood loss, blood and blood product usage in children with congenital cyanotic heart disease undergoing corrective surgery.

Tranexamic acid in paediatric cardiac surgery.

Purpose - Corona Virus Disease 2019 (COVID-19) is a deadly virus named after severe acute respiratory syndrome coronavirus 2;it affects the respiratory system of the human and sometimes leads to death The COVID-19 mainly attacks the person with previous lung diseases;the major cause of lung diseases is the exposure to nitrogen dioxide (NO2) for a longer duration NO2 is a gaseous air pollutant caused as an outcome of the vehicles, industrial smoke and other combustion processes Exposure of NO2 for long-term leads to the risk of respiratory and cardiovascular diseases and sometimes leads to fatality This paper aims to analyze the NO2 level impact in India during pre- and post-COVID-19 lockdown The study also examines the relationship between the fatality rate of humans because of exposure to NO2 and COVID-19 Design/methodology/approach - Spatial analysis has been conducted in India based on the mortality rate caused by the COVID-19 using the data obtained through Internet of Medical things Meanwhile, the mortality rate because of the exposure of NO2 has been conducted in India to analyze the relationship Further, NO2 level assessment is carried out using Copernicus Sentinel-5P satellite data Moreover, aerosol optical depth analysis has been carried out based on NASA's Earth Observing System data Findings - The results indicate that NO2 level has dropped 20-year low because of the COVID-19 lockdown The results also determine that the mortality rate because of long-time exposure to NO2 is higher than COVID-19 and the mortality rate because of COVID-19 may be a circumlocutory effect owing to the inhalation of NO2 Originality/value - Using the proposed approach, the COVID-19 spread can be identified by knowing the air pollution in major cities The research also identifies that COVID-19 may have an effect because of the inhalation of NO2, which can severe the COVID-19 in the human body

Assessing nitrogen dioxide (NO2) impact on health pre- and post-COVID-19 pandemic using IoT in India

We report two cases of mitral stenosis after Duran ring annuloplasty for myxomatous mitral regurgitation. Simple explantation of the ring provided relief of mitral stenosis.

Mitral stenosis after Duran ring annuloplasty for non-rheumatic mitral regurgitation--a foreign body response?

Methods: From January 1988 through December 2003, 278 children (153 male children) underwent mitral valve repair. Mean age was 11.7 2.9 years (range, 2-15 years). One hundred seventy-three children (62%) were in the New York Heart Association functional class III or IV. Congestive heart failure was present in 24 (8.6%). Reparative procedures included posterior collar annuloplasty (n 242), commissurotomy (n 187), cusp-level chordal shortening (n 94), cusp thinning (n 71), cleft suture (n 65), and cusp excision or plication (n 10). Associated procedures included atrial septal defect closure (n 22), aortic valve repair/ replacement (n 13), and tricuspid valve repair (n 3).

M. Rajesh

Papers

Mitral valve repair in children with rheumatic heart disease.

Tranexamic acid in paediatric cardiac surgery.

Assessing nitrogen dioxide (NO2) impact on health pre- and post-COVID-19 pandemic using IoT in India

Mitral stenosis after Duran ring annuloplasty for non-rheumatic mitral regurgitation--a foreign body response?

Mitral Valve Repair in Children With Rheumatic Heart Disease