COVIDTrach is a UK multidisciplinary collaborative project that aims to evaluate the outcomes of tracheostomy in COVID-19 patients. It also examines the implementation of national guidance in COVID-19 tracheostomies and the incidence of COVID-19 infections amongst those health care workers involved in the procedure. An invitation to participate in an online survey tool (REDCap) was disseminated to all UK NHS departments involved in tracheostomy in mechanically ventilated COVID-19 patients via the Federation of Surgical Specialty Associations, it's subsidiary organisations and the Intensive Care Society. To date 78 hospitals have submitted 564 COVID-19 tracheostomy cases. Fifty-two percent (n=219/465) of patients who had undergone tracheostomy and were still alive, had been successfully weaned from mechanical ventilation at the point of completing the survey. The all cause in-hospital mortality following tracheostomy was 12% (n=62/530), with 3% of these (n=2/62) due to tracheostomy related complications and the remaining deaths due to COVID-19 related complications. Amongst 400 cases submitting data two weeks after the tracheostomy, no instance of COVID-19 infection amongst operators was recorded. FFP3 masks or Powered Air Purifying Respirators were used by operators in 100% of tracheostomies and a face visor or hood with face shield was available in 99% of cases. This interim report highlights early outcomes following tracheostomy in mechanically ventilated COVID-19 patients. Future reporting from COVIDTrach will include more detailed analysis at later timepoints using comparator groups in order to provide a more comprehensive assessment of tracheostomy in COVID-19.

Background: COVIDTrach is a UK multi-centre prospective cohort study project evaluating the outcomes of tracheostomy in patients with COVID-19 receiving mechanical ventilation. It also examines the incidence of SARS-CoV-2 infection among healthcare workers involved in the procedure. Method: An invitation to participate was sent to all UK NHS departments involved in tracheostomy in mechanically ventilated patients with COVID-19. Data was entered prospectively and clinical outcomes updated over time via an online database (REDCap). Clinical variables were compared with clinical outcomes using multivariable regression analysis, with logistic regression used to develop a prediction model for mortality. Participants recorded whether any of the operators tested positive for SARS-CoV-2 within two weeks of the procedure. Findings: The cohort comprised 1605 tracheostomy cases from 126 UK hospitals. The median time from intubation to tracheostomy was 15 days (IQR 11, 21). 285 (18%) patients died following the procedure. 1229 (93%) of the survivors had been successfully weaned from mechanical ventilation at censoring and 1049 (81%) had been discharged from hospital. Age, inspired oxygen concentration requirement on the day of tracheostomy, PEEP setting, pyrexia, number of days of ventilation before tracheostomy, C-reactive protein and the use of anticoagulation and inotropic support independently predicticted mortality. Six reports were received of operators testing positive for SARS-CoV-2 within two weeks following the procedure. Interpretation: Tracheostomy appears to be safe in mechanically ventilated patients with COVID-19 and to operators performing the procedure and we identified clinical indicators that are predictive of mortality. Optimal timing of the procedure remains to be determined. Funding: The COVIDTrach project is supported by the Wellcome Trust UCL COVID-19 Rapid Response Award and the National Institute for Health Research.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the novel coronavirus (CoV) that emerged from China causing diseases known as COVID-19, mainly involves the respiratory system. It has ravaged through most of the world causing death in huge numbers. CoVs are zoonotic as they are transferred from animals to humans. Several animals have been suggested to be the host for SARS-CoV-2 ranging from bats, camels and pigs. The presence of a type 1 transmembrane glycoprotein called spike protein is responsible for CoVs’ ability to penetrate the host’s tissues. The immune response elicited during the proliferation of SARS-CoV-2 is most largely dependent on the macrophages, dendritic cells, T-cells and the human epithelial cells which determine the aftermath and lodging of chemokines and cytokines. The RT-qPCR is the preferred test for the confirmation of the disease although several Rapid Diagnostic Tests are also in use. Remdesivir, favilavir, niclosamide and ciclesonide are promising drugs under clinical trial or research to manage COVID-19. Several vaccines are also under clinical trial phase to mitigate the effect of COVID-19. Malaysia had its index case on the January 24th, 2020 and since then, Malaysia handling of the pandemic have been superb, well planned out and worthy of emulation from other countries. They have carried out an unprecedented number of tests surpassing any other country in the region. Keywords: diagnosis, Malaysia, pathogenesis, Sars-CoV-2, COVID-19, treatment.

This study was conducted to determine the level of contamination of domestic water sources in Pindiga, Akko Local Government, Gombe State, to observe the trend of quality change of these water sources, if any. Water samples were collected and analyzed for the presence of coliforms and physicochemical quality using standard methods. The results show that the mean value recorded for the physicochemical parameters and the total coliform count among the domestic water sources were within stipulated limits of WHO and NSDWQ except for the chloride mean value of 444.9±437.3 mg/L recorded in borehole water, Biochemical Oxygen Demand means value of 154±8.58 mg/L (hand dug well) and 166.83±32.67 mg/L (borehole) and total hardness mean value of 626.5±510.26 mg/L recorded in hand dug well. Although most of the Physicochemical parameters and the total number of coliforms in domestic water sources were within acceptable limits, continuous monitoring and quality assessment of these domestic water sources in relation to their purification process is needed to maximize safety and healthy life for everyone.

Senna alata (Linn) Roxb. plant is widely used to manage various infections in folkloric medicine. Methicillin-resistant Staphylococcus aureus (MRSA) infection continues to be a major global public health problem. This study aims to investigate the bioactive components of S. alata leaves active against MRSA. The leaves of S. alata were sequentially extracted and fractionated using standard methods and screened for activities against MRSA. The diethyl ether active thin layer chromatography (TLC) spot was subjected to infrared (IR) and gas chromatography-mass spectroscopic (GC-MS) studies. The aqueous extract and diethyl ether fraction of S. alata leaves elicited the highest activity against the MRSA. The GC-MS analysis of the fraction produced 15 eluates; only the sub-fraction 13 was effective. The TLC analysis of the sub-fraction 13 revealed three spots; only the second spot produced activity. The GC-MS result of the spot showed six peaks. The spectral results for peak 3 match the data from the IR study suggestive of 9-octadecenoic acid methyl ester. Senna alata leaves possess bioactive compounds closely related to 9-octadecenoic acid methyl ester with potent antibacterial activity against MRSA.