Independent Predictors of Mortality in COVID-19 Myocardial Injury: The Role of Troponin Levels, GRACE Score, SOFA Score, and TIMI Score.

Background Coronavirus disease 2019 (COVID-19) infection is associated with troponin elevation, which is associated with increased mortality. However, it is not clear if troponin elevation is independently linked to increased mortality in COVID-19 patients. Although there is considerable literature on risk factors for mortality in COVID-19-associated myocardial injury, the Global Registry of Acute Coronary Events (GRACE), Thrombolysis in Myocardial Infarction (TIMI), and Sequential Organ Failure Assessment (SOFA) scores have not been studied in COVID-19-related myocardial injury. This data is important in risk-stratifying COVID-19 myocardial injury patients. Methodology Of the 1,500 COVID-19 patients admitted to our hospitals, 217 patients who had troponin levels measured were included. Key variables were collected manually, and univariate and multivariate cox regression analysis was done to determine the predictors of mortality in COVID-19-associated myocardial injury. The differences in clinical profiles and outcomes of COVID-19 patients with and without troponin elevation were compared. Results Mortality was 26.5% in the normal troponin group and 54.6% in the elevated troponin group. Patients with elevated troponins had increased frequency of hypotension (p = 0.01), oxygen support (p \u3c 0.01), low absolute lymphocyte (p \u3c 0.01), elevated blood urea nitrogen (p \u3c 0.01), higher C-reactive protein (p \u3c 0.01), higher D-dimer (p \u3c 0.01), higher lactic acid (p \u3c 0.01), and higher Quick SOFA (qSOFA), SOFA, TIMI, and GRACE (all scores p \u3c 0.01). On univariate cox regression, troponin elevation (hazard ratio (HR) = 1.85, 95% confidence interval (CI) = 1.18-2.88, p \u3c 0.01), TIMI score \u3e3 (HRv = 1.79, 95% CI = 1.11-2.75, p = 0.01), and GRACE score \u3e140 (HR = 2.27, 95% CI = 1.45-3.55, p \u3c 0.01) were highly associated with mortality, whereas cardiovascular disease (HR = 1.40, 95% CI = 0.89-2.21, p = 0.129) and cardiovascular risk factors (HR = 1.15, 95% CI = 0.73-1.81, p = 0.52) were not. After adjusting for age, use of a non-rebreather or high-flow nasal cannula, hemoglobi

Contamination of Household Open Wells in an Urban Area of Trivandrum, Kerala State, India: A Spatial Analysis of Health Risk Using Geographic Information System

Objective: To assess the sanitary condition and water quality of household wells and to depict it spatially using Geographic Information System (GIS) in an urban area of Trivandrum, Kerala state, India. Study design: A community-based cross-sectional census-type study. Methods: Study was conducted in an urban area of Trivandrum. All households (n = 449) residing in a 1.05 km 2 area were enrolled in the study. Structured questionnaire and Differential Global Positioning System (DGPS) device were used for data collection. Water samples taken were analyzed in an accredited laboratory. Results: Most of the wells were in an intermediate-high contamination risk state, with more than 77% of wells having a septic tank within 7.5 m radius. Coliform contamination was prevalent in 73% of wells, and the groundwater was predominantly acidic with a mean of 5.4, rendering it unfit for drinking. The well chlorination and cleaning practices were inadequate, which were significantly associated with coliform contamination apart from a closely located septic tank. However, water purification practices like boiling were practiced widely in the area. Conclusion: Despite the presence of wells with high risk of contamination and inadequate chlorination practices, the apparent rarity of Water-borne diseases in the area may be attributed to the widespread boiling and water purification practices at the consumption level by the households. GIS technology proves useful in picking environmental determinants like polluting sources near the well and to plan control activities