Compliance rate of anti-rabies vaccination in patients presenting with an animal bite

Introduction: To prevent rabies in animal bite victims, complete postexposure prophylaxis (PEP) with an anti-rabies vaccination (ARV) is essential. This study was done to determine the compliance rate of ARV in patients with animal bites who presented to the emergency department (ED) during the COVID-19 pandemic. Materials and Methods: This was a prospective observational study done on patients presenting to the ED with a history of animal bites over 1 year (May 2020-June 2021). Categorical variables were presented as percentages, and quantitative variables were summarized using mean and standard deviation (SD). Results: A total of 122 animal bite (World Health Organization [WHO] Category II and III) victims presented to the ED during the study. The mean age of the cohort was 38.12 (SD: 16.4) years with a male (n = 67: 54.9%) preponderance. Based on the physiological stability, a majority were triaged as priority III (n = 119;97.5%). Most patients presented with dog bites (n = 88;72.1%), followed by cat (n = 14;11.5%) and rat bites (n = 13;10.7%). Two-thirds were unprovoked (n = 82;67.2%) and were caused by stray animals (n = 62;50.8%). More than half (n = 65;53.3%) of the bites were WHO Category III bites. All Category II and III patients had received the first dose of ARV at our center and category III patients received immunoglobulin local injection as well. Noncompliance to ARV was seen in almost a quarter (n = 32;26.2%) of patients of which forgotten dates (n = 11;34.4%) were the most common cause. There was no significant statistical variable to determine the cause of noncompliance. Conclusion: Unprovoked bites by stray dogs were the cause of a majority of the animal bites. Compliance with PEP remains low at two-thirds of the total. The most common cause of noncompliance to ARV was due to forgotten dates. The following core competencies are addressed in this article: Medical knowledge, Systems-based practice, Practice-based learning and improvement. © 2022 The authors.

Revised workflow practices in the management of acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic.

OBJECTIVE: To document changes in evaluation protocols for acute invasive fungal sinusitis during the coronavirus disease 2019 pandemic, and to analyse concordance between clinical and histopathological diagnoses based on new practice guidelines. METHODS: Protocols for the evaluation of patients with suspected acute invasive fungal sinusitis both prior and during the coronavirus disease 2019 period are described. A retrospective analysis of patients presenting with suspected acute invasive fungal sinusitis from 1 May to 30 June 2021 was conducted, with assessment of the concordance between clinical and final diagnoses. RESULTS: Among 171 patients with high clinical suspicion, 160 (93.6 per cent) had a final histopathological diagnosis of invasive fungal sinusitis, concordant with the clinical diagnosis, with sensitivity of 100 per cent, positive predictive value of 93.6 per cent and negative predictive value of 100 per cent. CONCLUSION: The study highlights a valuable screening tool with good accuracy, involving emphasis on 'red flag' signs in high-risk populations. This could be valuable in situations demanding the avoidance of aerosol-generating procedures and in resource-limited settings facilitating early referral to higher level care centres.

Risk of COVID-19 for frontline health care workers during the current pandemic

Background: Covid-19 pandemic has exhausted health systems across the world due to the sheer magnitude of patients presenting to the hospitals. Healthcare workers (HCW) are constantly in contact with a highly transmissible novel virus and hence at high risk. Methods: In this study, we studied the outcome of exposure to Covid-19 among HCWs in high-risk areas and low risk areas. Clinical data such as the duration of exposure to Covid patients, presence of comorbid illnesses, vaccination against COVID-19, need for admission and treatment received were collected. The study period is from May 2020 - August 2021, the data was collected using a crosssectional, interviewer administered questionnaire. Blood samples for measuring Immunoglobulin levels were collected in 5 different time periods. Results: 299 people were included in the study, 89% were high risk HCW and 11% low risk HCW. 39.7% of the high risk HCWs tested positive for Covid-19 as opposed to 9% of low risk HCWs. 46.2% and 50% of high and low risk HCWs received vaccination prior to testing positive for COVID-19. There was no significant difference in home isolation or hospital admission rates between the two groups. Only 1 High risk HCW required Oxygen with no mortality. High risk HCW had higher Nucleocapsid antibody positivity. Conclusion: Absolute risk reduction of confirmed Covid-19 between high and low risk HCWs was 84.2%. Factors such as age, gender, workplace exposure, seniority of staff and comorbidity did not affect seropositivity rates. Following strict infection prevention and control measures and vaccination helped decrease severe illness.

A review of triage practices and evolution of Christian Medical College, Vellore triage system (CMCTS) during the COVID-19 pandemic

Triage is practiced in hospitals around the world and has proved its worth in identifying and prioritizing sick patients for emergency resuscitation, especially in resource-limited settings. Both formal and informal systems are utilized in different health centers to differentiate between patients with varying severity of illness. The Christian Medical College, Vellore Triage System (CMCTS) developed at our emergency department (ED) in 1997 is a four-category system that makes this differentiation based on presenting symptoms, signs, and predefined physiological parameters. In our ED, triaging is performed by a triage team composed of both nursing personnel and emergency physicians. During the COVID-19 pandemic, our triaging system was modified to segregate potential COVID and non-COVID patients into different zones for containment and for safety of healthcare workers.

Plasma Von Willebrand Factor Levels Predict Survival in COVID-19 Patients Across the Entire Spectrum of Disease Severity.

BACKGROUND: Characterization of reticulo-endothelial activation in COVID-19 may guide treatment. OBJECTIVES: To assess reticulo-endothelial activation and its correlation with disease severity and death in patients across the entire spectrum of COVID-19 severity. METHODS: Consecutive hospitalized COVID-19 patients were studied, with similar number of patients in each disease severity category. Baseline serum ferritin, sCD163 (macrophage activation markers) and plasma von Willebrand factor (VWF) antigen (endothelial activation marker) levels were studied. Clinical parameters and plasma D-dimer levels were also studied. The study parameters were correlated with COVID-19 severity and survival. RESULTS: The 143 patients (104 males [80%], age 54 [42 - 65] years, median [inter-quartile range]) presented 4 (3-7) days after symptom onset. Thirty-four patients had mild disease, 36 had moderate disease, 36 had severe disease and 37 had critical disease at baseline. With increasing COVID-19 severity, ferritin, sCD163, VWF and D-dimer levels significantly increased at baseline, however, 139 patients had normal sCD163 levels. Of the reticulo-endothelial markers, VWF level independently correlated with COVID-19 severity and with survival. VWF level > 332.6 units/dl correlated with COVID-19 severity (odds ratio [OR]: 2.77 [95% confidence interval (C.I): 1.1 - 6.99], p value: 0.031) and in-hospital death (OR [95% CI]: 29.28 [5.2 - 165], p value < 0.001). CONCLUSIONS: Reticulo-endothelial activation markers increased incrementally with worsening COVID-19 severity. Baseline endothelial activation marker (VWF), and not macrophage activation markers, independently correlated with COVID-19 severity and death.

Impact of the lockdown due to COVID-19 pandemic on the spectrum and outcome of trauma in India

Background: As a pre-emptive measure against the rampaging severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), the Government of India ordered an unprecedented but imperative step of a nationwide lockdown on 22nd March, 2020. The entire month of April 2020 remained in a complete national lockdown. Methodology: We conducted this retrospective study to compare the spectrum and outcome of trauma victims who presented to our emergency department (ED) from April 2020 (lockdown period) to a similar season matched control arm of April 2018 (non-lockdown period).