No abstract

A method to achieve distal fistula occlusion by inflating the balloon of a catheter placed at the gastroesophageal junction via a transgastric route was tried in seven consecutive neonates with esophageal atresia and wide distal fistula. Due to associated moderate or severe pneumonia, these infants were at poor anesthetic risk for the definitive repair. The procedure was done under local anesthesia with mild sedation and took an average of half an hour for completion. Another feeding tube was negotiated through another gastrotomy across the pylorus to allow early enteral feeds. Temporary transgastric fistula occlusion (TTFO) allowed better ventilation of the hypocompliant lungs (by increasing resistance at the fistulous end), prevented lung injury due to aspiration of the refluxing gastric juices, and facilitated optimal ventilation by preventing epigastric distension. All study subjects survived this procedure except for one of our earlier study subjects who died of massive pneumothorax that was a procedure-related complication. None of the remaining subjects required mechanical ventilation either after TTFO or after the definitive esophageal repair that was carried out 5-7 days subsequent to TTFO, except for one other neonate with right lung aplasia who began deteriorating 48 h after thoracotomy and died of cardiac failure. There were no anastomosis-related problems among the survivors over a 12-month follow-up. The gratifying results of our study prompt us to suggest that this procedure deserves attention, and its role should be explored for salvaging neonates with type C esophageal atresia with wide fistula and pneumonia in developing countries with few neonatal intensive care services.

BackgroundCorona virus has literally travelled “around the world in 80 days” akin to Fogg and Passepartoute of Jules Verne fame. Manning of corona virus disease 2019 (COVID-19) wards and ICUs, also surgery on COVID-positive patients is increasingly being relegated to that subset of health care workers (HCW) who themselves have resumed duties after surviving COVID-19 infection. Convalescent plasma therapy has been widely endorsed. Several vaccines are in the pipeline as potential preventive measures against the virus keeping HCW on the priority-list of recipients. Immunity passports are being validated for foreign travel. These events share a common presumption that exposure to COVID-19 virus (natural infection/inoculation) produces protective adaptive immunity. It is unknown whether all (COVID-19) infected patients mount a protective immune response and for how long any protective effect will last.MethodsThis single institutional prospective longitudinal panel survey questions were deployed to the respondents online via email/WhatsApp groups to ascertain the symptomology and immunity status of HCW in the months following COVID-19 infection. The survey was administered to the same set/cohort of health care workers over 6 months.Results165 responses from 151 respondents (70 at 1-2months; 95 at 3-4 months including 14 at both time points) were analysed. 7.14% of infected HCW failed to develop IgG antibodies at 4-6 weeks. 91.7% HCW with IgG titres in the highest bracket had experienced anosmia. Mean antibody titres were 12.08 ± 9.56 and 9.72 ± 9.34 at 1-2 months and 3-4 months post-development of first symptom, respectively.ConclusionUnderstanding of COVID-19 patterns of variation in HCW may guide their deployment in the COVID ward and COVID-OTs. Revelation of this enigma (by quantification of serial IgG antibody levels) is critical for predicting response to vaccines under trial, fostering effective stratagems and tactics for pandemic control, ascertaining validity of immunity passports and understanding longevity/durability of protection by forecasting immunological memory against SARS-CoV-2.