Appraisal of Critically Ill COVID-19 Patients at a Dedicated COVID Hospital.

PURPOSE: To study the pattern of severe COVID-19 to reduce morbidity and mortality. METHODS: It was an observational cohort study for comprehensive clinical analysis of critically ill COVID-19 patients at a dedicated COVID public hospital. RESULTS: Total 373(13.6%) patients were critically ill with 254(68.1%) males and 119(31.9%) females (including 25 pregnant) and death occurred in 69(18.5%) patients. Mean of parameters associated with critical COVID illness and having significant difference among dead and recovered were; age (47.08,p= 5.67E- 09), SpO2 (86.08), blood sugar(168.47,p= 1.86E-08), IL-6(210.5,p=0.0058) D-dimer(0.753,p= 0.00178). All the patients were given oxygen by non invasive technique, in 46(12.3%) intubation and invasive ventilation required. Use of hydroxychloroquin in 284(76.1%) (p=0.041,OR0.555,95%CI 0.314-0.981), lopinavir/ ritonavir in 283(75.9%) (p=4.222E-009,OR0.198, 95%CI0.114-0.345), tocilizumab in 124(33.2%) patients, (p=3.27E006, OR0.150, 95%CI0.063-0.358) were associated with recovery. Factors that influenced mortality were presence of co-morbidities (p=0.088,OR1.784,95%CI0.911-3.492), hypertension(p=0.0031,OR2.432,95% CI1.370 -4.318), low SpO2 (p=3.91E-010,OR0.017,95%CI0.002-0.137), high blood sugar(p=7.75E-009,OR8.514,95%CI 3.776-19.201), high LDH(p=0.00064,OR2.7 22,95%CI1.545-4.798) high ferritin(p=0.00014,OR4.606,95%CI 2.035-10.422), high D-dimer(p=2.85E-007,OR4.090,95%CI 2.371-7.056), low PFR(p=4.84E-008), and endotracheal intubation(p=3.14E-043,OR165.936,95%CI48.160-571.731). Using binary logistic regression, elevated IL-6(0.02441), low PFR(0.00082), and endotracheal intubation(2.04E-10) were statistically significant predictors of death. CONCLUSION: "Happy Hypoxia", hyperglycemia, high inflammatory markers (IL-6, ferritin), and ARDS were hallmark of critical COVID-19, early detection of factors associated with severity and mortality and starting the multipronged management with oxygen in prone position, hydroxychloroquin, antiviral, methylprednisolone, anticoagulants, tocilizumab early may help in halting the worsening of COVID and reduce morbidity and mortality.

Analysis of Poisoning in Urban Setting: A Single Centre Study.

BACKGROUND: Poisoning are common emergencies associated with high mortality and morbidity in India. This study aims to analyse the pattern of poisoning, clinico-epidemiological features, course and outcome of patients and factors affecting the outcome. METHODOLOGY: This was an observational, prospective study conducted at a tertiary care, teaching, public, urban hospital. We noted demographic profile, nature and class of poison, clinical manifestations, duration of stay in ICU and hospital, investigations, management and outcome. Association between qualitative variables was assessed by Chi-Square test, Fisher's exact test and Binary Logistic Regression. RESULTS: Among 250 patients mortality was 24%. Common agents of poisoning used were chemicals seen in 102 patients (41%), followed by pesticides (52 patients, 21%) and rodenticides (33 patients, 13%). Ventilator support was needed in 63 patients (25%) and mean hospital stay of patients was 3.7 days with range being 5-15 days. Deranged liver function test was present in 22 (41.51%) cases of rodenticides poisoning, Deranged renal function test was present in 44 (59.46%) cases of Chemicals. CONCLUSIONS: Poisoning was predominant in unmarried young males from lower economic class. The most common type of poisoning was suicidal, route was oral and agent was chemicals. Vomiting and pain in abdomen were the most common clinical features. Chemical poisoning was highly associated with renal failure and aspiration chemical pneumonitis requiring ventilator support and high mortality. Chemical agent of poisoning, Intravenous route of poisoning, requirement of mechanical ventilation, duration of hospital stay were significantly associated with mortality.

Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis.

BACKGROUND AND AIM: Thrombocytopenia in pregnancy varies from benign to severe with fetomaternal complications. We aimed to evaluate thrombocytopenia in pregnant Indian females in third trimester mainly during labor and delivery. MATERIALS AND METHODS: It was a prospective observational study done in a tertiary care teaching public hospital over 1 year. Consecutive 150 pregnant patients admitted to labor ward with thrombocytopenia were analyzed for etiology of thrombocytopenia, severity, mode of delivery, type of anesthesia, and fetomaternal complications. SPSS version 17 was used for the analysis. RESULTS: Most common cause of thrombocytopenia was preeclampsia 50 (33.3%) and preeclampsia with hemolysis, elevated liver enzyme, and low platelet count syndrome (HELLP syndrome) 31 (20.7%) together followed by gestational 42 (28%). Infectious causes such as malaria, dengue, and leptospirosis were found in 19 patients (12.7%). Moderate to severe thrombocytopenia was seen in preeclampsia, preeclampsia with HELLP syndrome, and infectious etiology. Eleven patients (7.3%) developed antepartum hemorrhage (APH), 24 (16%) postpartum hemorrhage (PPH), 12 (8%) required ICU admission, and 3 (2%) mortalities were noted. Fifteen neonates (10%) needed ICU admission. Complications were observed in preeclampsia with HELLP syndrome (82%) and infectious causes (18%) and none in gestational. Sixty-eight patients underwent lower segment cesarean section (LSCS), among them 41 (27.3%) were given spinal anesthesia (SA) and none of them developed any neurological complications. CONCLUSION: Study widened the spectrum of causes for thrombocytopenia in pregnant patients. Preeclampsia with or without HELLP syndrome and vector-borne infections such as malaria, dengue, and leptospirosis were found to be very important causes of moderate to severe thrombocytopenia and were associated with complications. Spinal anesthesia is safe in parturients with mild thrombocytopenia. Awareness and vigilance about thrombocytopenia is vital to reduce maternal morbidity and mortality. HOW TO CITE THIS ARTICLE: Harde M, Bhadade R, deSouza R, Jhingan M. Thrombocytopenia in Pregnancy Nearing Term: A Clinical Analysis. IJCCM 2019;23(11):503-508.

Emerging trends of nosocomial pneumonia in intensive care unit of a tertiary care public teaching hospital in Western India.

BACKGROUND: Nosocomial pneumonia poses great challenge to an intensivist. Detailed information about hospital-acquired pneumonia (HAP) and ventilator-acquired pneumonia (VAP) is crucial for prevention and optimal management, thus improving quality Intensive Care Unit (ICU) care. Hence, we aimed to study the current trend of nosocomial pneumonia in ICU. MATERIALS AND METHODS: It was a prospective observational cohort study, conducted in the ICU of a tertiary care teaching public hospital over a period of 18 months. We studied clinical profile and outcome of 120 adult patients who developed VAP/HAP during the study period. We also analyzed the causative organisms, antibiotic sensitivity, and resistance pattern in these patients. RESULTS: Out of 120 patients, 29 patients were HAP and 91 patients were VAP. Mortality was 60% (72), and development of VAP and requirement of mechanical ventilation showed significant association with mortality (P < 0.00001). Most common organism causing HAP was Staphylococcus aureus (43.4%) and VAP was Klebsiella pneumoniae (49%). Maximum antibiotic sensitivity was found to piperacillin + tazobactam (58.8%), followed by imipenem (49.5%) and meropenem (41.8%), whereas maximum antibiotic resistance was found to cefepime (95.1%), followed by ceftazidime and amoxicillin (91.2%). CONCLUSION: Nosocomial pneumonia showed high incidence (17.44%) and mortality (60%). Common organisms identified were S. aureus and K. pneumoniae. Resistance was high for commonly used antibiotics and high antibiotic sensitivity for piperacillin + tazobactam and carbapenem. Contexte: La pneumonie nosocomiale pose un grand défi à un intensiviste. Des informations détaillées sur la pneumonie acquise dans les hôpitaux (HAP) et la pneumonie acquise par le ventilateur (VAP) sont essentielles pour la prévention et la gestion optimale, améliorant ainsi les soins de soins intensifs de qualité (UTI). Par conséquent, nous avons cherché à étudier la tendance actuelle de la pneumonie nosocomiale en UTI. Matériaux et méthodes: il s'agissait d'une étude de cohorte observationnelle prospective menée dans l'UCI d'un hôpital public d'enseignement tertiaire sur une période de 18 mois. Nous avons étudié le profil clinique et le résultat de 120 patients adultes qui ont développé le VAP / HAP pendant la période d'étude. Nous avons également analysé les organismes responsables, la sensibilité aux antibiotiques et le modèle de résistance chez ces patients. Résultats: Sur 120 patients, 29 patients étaient HAP et 91 patients étaient VAP. La mortalité était de 60% (72), et le développement du VAP et l'exigence de ventilation mécanique ont montré une association significative avec la mortalité (P < 0,00001). L'organisme le plus fréquent causant HAP était Staphylococcus aureus (43,4%) et VAP était Klebsiella pneumoniae (49%). Une sensibilité antibiotique maximale a été observée chez la pipéracilline + tazobactam (58,8%), suivie de l'imipénème (49,5%) et du méropénem (41,8%), alors que la résistance antibiotique maximale a été observée à cefépime (95,1%), suivie de ceftazidime et de l'amoxicilline (91,2%) . CONCLUSION: la pneumonie nosocomiale a montré une incidence élevée (17,44%) et la mortalité (60%). Les organismes communs identifiés étaient S. aureus et K. pneumoniae. La résistance était élevée pour les antibiotiques couramment utilisés et une forte sensibilité aux antibiotiques pour la pipéracilline + le tazobactam et le carbapénème.