Summary: Coronavirus disease 2019 (COVID-19) is a novel virus with continuously evolving transmission trends. Contact tracing and quarantining of positive cases are chief strategies of disease control that has been accepted globally, though scientific knowledge regarding household transmission of the COVID-19 through contact of positive case is sparse. Current systematic review was planned to assess global statistics and characteristics of household secondary attack rate (SAR) of COVID-19. Eligible articles were retrieved through search of—MEDLINE, SCOPUS and EMBASE for the period December 2019 to 15 June 2020. Search terms were developed to identify articles reporting household SARs in various countries. After initial screening of 326 articles, 13 eligible studies were included in the final evidence synthesis. We found that SAR varies widely across countries with lowest reported rate as 4.6% and highest as 49.56%. The rates were unaffected by confounders such as population of the country, lockdown status and geographic location. Review suggested greater vulnerability of spouse and elderly population for secondary transmission than other household members. It was also observed that quarantining and isolation are most effective strategies for prevention of the secondary transmission of the disease. Symptomatic status of the index case emerged to be a critical factor, with very low transmission probability during asymptomatic phase. Present review findings recommend that adequate measures should be provided to protect the vulnerable population as only case tracing and quarantining might be insufficient. It should be combined with advisory for limiting household contacts and active surveillance for symptom onset.

Objective: Current meta-analysis aims to understand the effect of oral supplementation of vitamin D on intensive care unit (ICU) requirement and mortality in hospitalized COVID-19 patients. Methods: Databases PubMed, preprint servers, and google scholar were searched from December 2019 to December 2020. Authors searched for the articles assessing role of vitamin D supplementation on COVID-19. Cochrane RevMan tool was used for quantitative assessment of the data, where heterogeneity was assessed using I2 and Q statistics and data was expressed using odds ratio with 95% confidence interval. Results: Final meta-analysis involved pooled data of 532 hospitalized patients (189 on vitamin D supplementation and 343 on usual care/placebo) of COVID-19 from three studies (Two randomized controlled trials, one retrospective case-control study). Statistically (p<0.0001) lower ICU requirement was observed in patients with vitamin D supplementation as compared to patients without supplementations (odds ratio: 0.36; 95% CI: 0.210-0.626). However, it suffered from significant heterogeneity, which reduced after sensitivity analysis. In case of mortality, vitamin D supplements has comparable findings with placebo treatment/usual care (odds ratio: 0.93; 95% CI: 0.413-2.113; p=0.87). The studies did not show any publication bias and had fair quality score. Subgroup analysis could not be performed due to limited number of studies and hence dose and duration dependent effect of vitamin D could not be evaluated. Conclusions: Although the current meta-analysis findings indicate potential role of vitamin D in improving COVID-19 severity in hospitalized patients, more robust data from randomized controlled trials are needed to substantiate its effects on mortality.

Purpose. To assess combined data from seventeen randomized controlled trials studying effect of anthocyanin consumption on levels of various lipids and inflammatory markers with meta-analysis approach. Methods. Various databases, namely, PubMed, MEDLINE, EMBASE, and Cochrane Trial Register were used to identify randomized controlled trials (RCTs) investigating an association between anthocyanins and lipid profile and inflammatory markers. Heterogeneity was assessed using Q and I2 statistics and data was expressed using mean difference with 95% confidence interval. Results. Statistically significant reduction in triglyceride [mean difference (MD) = −9.16, 95% CI: −14.02 to −4.31 mg/dL, I2=33.54%, P=0.149], low density lipoprotein [MD = −8.86, 95% CI: −11.17 to −20.02 mg/dL, I2 = 37.75%, P=0.098], and apolipoprotein B [MD = −7.13, 95% CI: −8.66 to −5.59 mg/dL, I2=20.42%, P=0.287] levels and increase in high-density lipoprotein [MD = 1.67, 95% CI: 0.8 to 2.54 mg/dL, I2=44.88%, P=0.053] and apolipoprotein A-1 [MD = 6.1, 95% CI: 4.51 to 7.69 mg/dL, I2=6.95%, P=0.358] levels were observed with anthocyanin supplementation. Levels of inflammatory markers were found to reduce [TNF-∞ - MD = −1.98, 95% CI: −2.40 to −1.55 pg/mL, I2=0%, P=0.975; IL-6 - MD = 1.17, 95% CI: 0.8 to 1.53 pg/mL, I2=0%, P=0.825; hs-CRP - MD = 0.164, 95% CI: −0.06 to 0.39 mg/dL, I2=0%, P=0.569]. Though the effect on TC, IL-6, and hs-CRP was positive, it was nonsignificant in nature. Conclusion. Anthocyanin supplementation significantly improves lipid profile and inflammatory status. However, future trials with sufficient sample size are recommended to substantiate the findings especially for the parameters showing nonsignificant improvement.

Background: We aimed to assess the incidence and perioperative risk factors for hyperbilirubinemia after cardiac surgery, and determine its influence on early operative outcome. Methods: This prospective observational study was conducted on 476 patients who underwent cardiac surgical procedures from January 2014 to March 2014. Postoperative hyperbilirubinemia was defined as serum total bilirubin >2.0 mg dL ⁻¹ . Results: The overall incidence of postoperative hyperbilirubinemia was 25% (119 patients). Patients undergoing valve repair or replacement had the highest incidence of hyperbilirubinemia (36.2%), followed by coronary artery bypass grafting with concomitant valve surgery (34.1%), congenital heart surgery (23.1%), and coronary artery bypass alone (12.7%). Postoperative hyperbilirubinemia was associated with increased duration of inotropic support ( p = 0.0001), mechanical ventilation ( p = 0.0001), intensive care unit stay ( p = 0.001), hospital stay ( p = 0.006), and mortality ( p = 0.014). The perioperative factors associated with postoperative hyperbilirubinemia were increased preoperative bilirubin level ( p < 0.0001), preoperative prothrombin time ( p < 0.0001), cardiopulmonary bypass time ( p = 0.028), aortic crossclamp time ( p = 0.004), and blood transfusion units ( p = 0.0001). Conclusions: Postoperative hyperbilirubinemia is common in patients undergoing cardiopulmonary bypass and is associated with high hospital mortality. The factors associated with its occurrence are increased preoperative bilirubin level, preoperative prothrombin time, cardiopulmonary bypass time, aortic crossclamp time, and blood transfusion units. Persistent hyperbilirubinemia is associated with a worse outcome than early transient hyperbilirubinemia.

Role of pediatric cases in secondary transmission of COVID-19 is not well understood. We aim to study secondary attack rate (SAR) of COVID-19 in household contacts of pediatric index cases from Gujarat, Western Indian state. For this cross-sectional study, details of 2412 paediatric patients were collected from Government records. Through stratified random sampling 10% (n = 242) of the patients were selected for the study and were telephonically contacted for obtaining the details of household secondary infection; 72 pediatric index cases having 287 household contacts were included in the study. The SAR in household contacts of pediatric index cases was 1.7% (95% CI: 0.74–4%). Majority of the index cases were males (94.4%) with 66% of the patients being admitted at various hospitals and isolation facilities (45%); 37% were home quarantine. Of 72, 50 (74%) cases were aged between 12 and 18 years. The family size of the index cases causing secondary infection was comparatively larger than index cases without secondary household infection (6.75 ± 2.3 versus 4.9 ± 1.9; P = 0.034). The household SAR from pediatric patients is low and is closely associated with the family size of the index cases. Hence, home quarantine should be advocated in smaller families with appropriate isolation facilities.

Introduction. COVID-19, a multisystem disease, has implications for various immunity and infection biomarkers. Yoga (Y), meditation (M), and pranayama (P), and their combinations have shown positive changes on those biomarkers among other than COVID-19 patients and healthy people. So, we aimed to document the evidence of possible implication in a systematic way. Materials and Methods. We screened 84 full texts, published in the last ten years, from three databases, from which only 44 met the eligibility criteria, and then extracted the data related to demographic characteristics, intervention, results, and strengths and limitations in two MS-Excel grids, and then presented them in tables and figures. Furthermore, we carried out meta-analysis including subgroup and sensitivity analysis using a random effects model of 11 RCTs and reported the mean difference, heterogeneity, and value with 95% CI and presented them with forest and funnel plots and the tables. Results. Twenty-five biomarkers of 4023 participants (range, 15–413) from 13 countries, healthy and clinical, from both sexes above 18 years, and from mainly clinical settings, were reported. YMP intervention, in solitary or in different possible combinations with varied durations among clinical and pregnant (range, 960–4800 minutes) and healthy (960–8400 minutes, excluding two studies of 20 minutes only) participants, was reported. It was revealed that 25 biomarkers, nine among the apparently healthy, 14 among the patients, and two among the pregnant, changed favourably ( ). Furthermore, either in meta- or subgroup-analysis, mean differences of IL-6 (−1.44 pg/ml) (95% CI) (−2.33, −0.55), ( , I² = 82%), Cortisol (−40.75 pg/ml) (95% CI) (−64.13, −17.38), ( , I² = 87%), and TNF-α (−3.40 pg/ml) (95% CI) (−4.83, −1.98), ( , I² = 79%) showed statistically significant changes. Nonetheless, considerable heterogeneity and publication bias were observed among the studies. Conclusion. Although more than two dozens of biomarkers in individual studies showed favourable changes, only IL-6, Cortisol, and TNF-α produced significant combined results, even then with much less certainty. Further meta-analysis of biomarkers of COVID-19 patients is highly recommended. Registration: CRD42021283894.