Relationship of anemia with COVID-19 deaths: A retrospective cross-sectional study.

Background and Aims: With the second wave of COVID-19, India lost close to three lakh people within the span of a few months. In this study, we aimed to investigate the impact of anemia on the severity of COVID-19 based on the hemoglobin (Hb) concentration of the patients noted at the time of admission to the intensive care unit (ICU), to mark Hb as a prognostic marker of disease severity for the future. Material and Methods: Retrospective data was collected from 784 patients admitted to the COVID adult ICU between March and June 2021. Patients were identified as anemic and non-anemic based on the World Health Organization (WHO) guidelines. Chi-squared test was applied to see the relationship of anemia with the patient deaths. Results: Among the 784 patients, 507 succumbed to COVID-19. Of these, 49.3% had varying degrees of anemia. Significant correlation of anemia with death due to COVID-19 was found in males and females (P = 0.002106 and P = 0.033071, respectively) and in patients without any other comorbidities except anemia (P = 0.002020). This suggests that anemia is independently an important parameter that plays a role in severity of COVID-19. Conclusion: Upon observing a significant correlation between anemia and COVID-19 severity, it can be stated that anemia should be considered as an independent prognostic risk factor for COVID-19 and that hemoglobin can be used for risk stratification in patients under home or hospital care.

Bi-Spectral Index-Guided Comparison of Propofol versus Etomidate for Induction in Electroconvulsive Therapy.

BACKGROUND: Previous studies have compared varying doses of propofol and etomidate for electroconvulsive therapy (ECT) without monitoring the depth of anesthesia. Seizure duration may vary with the depth of anesthesia. AIM: This study aimed to compare the effects of bi-spectral index (BIS)-guided induction with propofol and etomidate on various parameters of ECT. SETTINGS AND DESIGN: This was a prospective, randomized, double-blind study. MATERIALS AND METHODS: Sixty patients undergoing ECT were randomly allocated to two groups. Group P received intravenous propofol 1-2 mg.kg -1 and Group E received etomidate 0.1-0.3 mg.kg -1 to attain a BIS of 40-60. Heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), and BIS were recorded at various time points intraoperatively till 30 min following ECT. Seizure duration, recovery time, and adverse effects were also recorded. STATISTICAL ANALYSIS: Quantitative data were compared using unpaired t-test. Chi-square test or Fisher's exact test was used to compare categorical data. P < 0.05 was considered statistically significant. RESULTS: The mean induction time and seizure duration were shorter (P < 0.001), and recovery time to obey commands was longer in Group P as compared to that of Group E (P = 0.031). HR, SBP, and DBP for 10 min after ECT had elevated more in Group E than that in Group P (P < 0.05). The incidence of myoclonus was higher in Group P compared to that of Group E (P = 0.012). CONCLUSION: During ECT, BIS-guided induction with propofol provides more stable hemodynamics than etomidate, but reduces induction time, seizure duration, and recovery time more as compared to that of etomidate.

Metatarsal Fracture Leading to Massive Pulmonary Embolism.

Immobilization and bed rest after fracture and orthopedic surgery are routinely advised protocol. Period of bed rest usually depends on the type of injury and orthopedic procedure, ranging from few days to weeks. The trauma, surgery, and immobilization with other contributing factors can lead to deep vein thrombosis and pulmonary embolism (PE) in these patients. Although there is high incidence of PE in such patients, it is difficult to diagnose, primarily because of the variety of nonspecific signs and symptoms. Here, we discuss a case of a 30-year-old female, who had suffered a trivial roadside accident leading to metatarsal bone fracture and later on presented in emergency with seizures, pulmonary edema, and cardiac arrest, after immobilization of just 5 days which was diagnosed to be result of massive PE. Here, we will discuss the pathophysiology, risk factors, and management of massive PE.

Prehospital care training in a rapidly developing economy: a multi-institutional study.

BACKGROUND: The trauma pandemic is one of the leading causes of death worldwide but especially in rapidly developing economies. Perhaps, a common cause of trauma-related mortality in these settings comes from the rapid expansion of motor vehicle ownership without the corresponding expansion of national prehospital training in developed countries. The resulting road traffic injuries often never make it to the hospital in time for effective treatment, resulting in preventable disability and death. The current article examines the development of a medical first responder training program that has the potential to reduce this unnecessary morbidity and mortality. METHODS: An intensive training workshop has been differentiated into two progressive tiers: acute trauma training (ATT) and broad trauma training (BTT) protocols. These four-hour and two-day protocols, respectively, allow for the mass education of laypersons-such as police officials, fire brigade, and taxi and/or ambulance drivers-who are most likely to interact first with prehospital victims. Over 750 ATT participants and 168 BTT participants were trained across three Indian educational institutions at Jodhpur and Jaipur. Trainees were given didactic and hands-on education in a series of critical trauma topics, in addition to pretraining and post-training self-assessments to rate clinical confidence across curricular topics. Two-sample t-test statistical analyses were performed to compare pretraining and post-training confidence levels. RESULTS: Program development resulted in recruitment of a variety of career backgrounds for enrollment in both our ATT and BTT workshops. The workshops were run by local physicians from a wide spectrum of medical specialties and previously ATT-trained police officials. Statistically significant improvements in clinical confidence across all curricular topics for ATT and BTT protocols were identified (P < 0.0001). In addition, improvement in confidence after BTT training was similar in Jodhpur compared with Jaipur. CONCLUSIONS: These results suggest a promising level of reliability and reproducibility across different geographic areas in rapidly developing settings. Program expansion can offer an exponential growth in the training rate of medical first responders, which can help curb the trauma-related mortality in rapidly developing economies. Future directions will include clinical competency assessments and further progressive differentiation into higher tiers of trauma expertise.

Clinical profile and mortality among novel influenza A (H1N1) infected patients: 2009-2010 Jodhpur, Rajasthan pandemic.

OBJECTIVES: Influenza causes annual seasonal epidemics around the world. Periodically, a genetically novel strain of influenza circulates worldwide, causing an influenza pandemic. The present study aims to assess the clinical profile, factors determining the response, prognosis of the disease and outcome in H1N1 positive patients during 2009-2010 H1N1 pandemic, so that epidemiology of the disease could be known and high risk groups can be identified. METHODS: Medical records of the H1N1 positive patients, confirmed by RT-PCR method, admitted in ICU/Isolation ward in M.D.M. Hospital, Jodhpur during pandemic of H1N1 influenza (2009-2010) were retrieved and retrospectively studied, the data collected was analysed. RESULTS: During the study period there were 221 H1N1 positive admissions. The age group most affected was 21-40 years in both males (52%) and females (67%). There were 80 deaths; mortality was high in rural population (64%) and pregnant women particularly in third trimester (80%). Common presenting symptoms were Cough, Fever, Breathlessness, Sore throat, Nasal Discharge, Expectoration and Body aches, other less common symptoms were Headache, Vomiting, Diarrhoea and Fatigue. CONCLUSION: Swine flu influenza infection took its heaviest toll in terms of human lives and economy because the young and productive population was mostly affected. Pregnant women and the patients with co-morbid conditions were the susceptible population and thus preventive and therapeutic interventions should be directed to them. Early vaccination of high risk groups and high index of suspicion in the symptomatic patients and chemoprophylaxis accordingly can save many human lives.