Clots in COVID: A Case Series.

As the novel coronavirus-2019 (COVID-19) pandemic spreads across the world, early recognition of the spectrum of symptoms and patterns of clinical presentation is crucial for optimal management. Emerging evidence shows that COVID-19 leads to a prothrombotic state and its association with pulmonary thromboembolism is well established. However, clinicians and the vascular community, in particular, should watch out for the nonpulmonary targets of this lethal virus as the failure to do so could give rise to disastrous consequences. The significance of raised D-dimer levels, whether it translates into thrombotic events for all patients and the need for universal oral anticoagulation postdischarge are issues that need urgent answers. We report a case series of five patients with thrombosis involving nonpulmonary sites. How to cite this article: Kaneria MV, Nadaf S, Desai U. Clots in COVID: A Case Series. Indian J Crit Care Med 2021;25(7):817-821.

Incidence of Clostridium difficile associated diarrhoea in a tertiary care hospital.

BACKGROUND AND OBJECTIVES: Rampant and injudicious use of broad spectrum antibiotics in hospitalized patients has increased the incidence of Clostridium difficile associated diarrhoea (CDAD). Though antibiotic use is the best known risk factor for CDAD, the occurrence of community acquired C. difficile suggests the presence of other risk factors too. However CDAD is still under-recognized in India and Asia. Therefore we undertook a prospective study to determine the incidence of Clostridium difficile associated diarrhoea in our hospital. METHODS: 50 patients of antibiotic associated diarrhoea (AAD) and 50 age and sex matched controls were studied prospectively over a period of 1 year. Controls were patients on antibiotics who did not have diarrhoea. All other causes of diarrhoea were ruled out. Fresh stool samples were examined for the presence of C. difficile toxin A and B by the enzyme-linked immunofluorescence assay. RESULTS: 5 patients in the AAD group (10%) and 3 patients in the control group (6%) were positive for C. difficile toxin A and B. 5 (10%) patients in the control group showed equivocal results. Out of the 5 CDAD patients, 4 (80%) were males and 1 was a female (p = 2, not significant). 3 patients were from the MICU and 2 were from the medical wards. The median age of the patients was 39 years. Only 1 male patient was > 60 years old (p = 0.781, not significant). All 5 CDAD patients were on proton pump inhibitors (PPIs) and 2 had Ryle's tube inserted (p = 0.22, not significant). Only 2 patients had leucocytosis (p = 1.67, not significant) and none showed faecal leucocytosis. So out of 100 patients on antibiotics, 8 (8%) tested positive for C. difficile toxins in their stools. However, only 5 (5%) had diarrhoea (CDAD) whereas 3 (3%) were asymptomatic carriers. INTERPRETATION AND CONCLUSIONS: The incidence of CDAD in our hospital was 10% of the 50 patients with AAD. The asymptomatic carriage rate was 6%. All the cases had mild to moderate diarrhoea and were responsive to metronidazole unlike the west where the incidence is higher and the disease more severe.

Subarachnoid haemorrhage: possibly caused by the illegitimate use of sildenafil citrate.

Sildenafil (Viagra) has been developed as a drug to treat male impotence. It has also been used to reduce symptoms (e.g. improved exercise capacity) in patients with pulmonary arterial hypertension. A case of subarachnoid haemorrhage (SAH) following the illicit use of sildenafil is reported.