COVID-19: Clinical Course and Outcome of hospitalized Hemodialysis Patients: Single-center Experience

Background: There is a paucity of data regarding the consequences of coronavirus disease 2019 (COVID-19) infection in patients with maintenance hemodialysis (MHD). Our objective was to identify the clinical manifestations and prognostic factors and to assess the impact of treatment schemes on the outcome. Materials and methods: Here we present retrospectively collected data from medical records of patients on MHD hospitalized with COVID-19 infection from 1st June to 30th November 2020. Result: Around 69 patients were admitted with a median age of 51 years. About 81% had hypertension, 41% had diabetes, and 24% had body mass index (BMI) ? 23 kg/m2 . Of all who died, 73.33% had dialysis vintage of <12 months (p = 0.06). Common presenting symptoms were fatigue (67%), fever (58%), cough (42%), and dyspnea (35%). Milder, severe, and critical disease was found in 35, 45, and 20% of patients, respectively. About 54 patients were living 4 weeks after discharge. Around 15 patients died, that includes all who received invasive ventilatory support. Nonsurvivors were older and had lower oxygen saturation on admission, lower hemoglobin (Hb), and worst lactate dehydrogenase (LDH), interleukin (IL)—6, and D-dimer values than survivors, which were statistically significant. Use of remdesivir and anticoagulant improves chances of survival (p-value 0.035 and 0.034, respectively) Conclusion: About one-third of patients had mild disease. Those with critical disease displayed high mortality. Older age, male gender, short dialysis vintage, lower oxygen saturation on admission, anemia, leucocytosis, higher inflammatory markers [except C-reactive protein (CRP)], bilateral lung opacity, and requirement of the mechanical ventilator are poor prognostic factors. CRP, ferritin, and lymphopenia are not good prognostic markers unlike in the general population. These findings need to be verified in larger cohorts.

Deep vein thrombosis risk stratification in intensive care unit patients: a pressing need

Background: Risk stratification of deep vein thrombosis in patients admitted to ICU and incorporating DVT risk assessment score as a regular practice were the aim of the present study.Methods: This study was carried out in 67 patients admitted in ICU >18 years of age, over one year. Patients with confirmed DVT, <48 hours of stay, thrombocytopenia, diagnosed coagulation disorders, those who have received DVT prophylaxis in last 1 month and those with active bleeding were excluded. It was a cross sectional observational study. A SMART assessment score and pretest probability scoring card was used. Mechanical or pharmacological prophylaxis was given to those with moderate and high risk for DVT.Results: As per SMART assessment score 4.5%, 41.8%, 6% and 23.9% had no, moderate, high and highest risk of developing DVT. As per the pretest probability scores 76%, 20.9% and 3% were in low, moderate and high-risk group. Both scoring systems are comparable (p=0.001). There was significant association between paralysis (p value was 0.003), central venous access (p value was 0.006), patient bed ridden for >72 hours (p value was 0.009) and risk group.Conclusions: Prolonged bed rest, paralysis and central venous access are the most important contributing conditions for high risk of DVT. Risk stratification should be routinely performed in ICU.  SMART assessment tool and pre-test probability scores are both equally efficacious in identifying high risk patients for DVT. Both mechanical and pharmacological means of DVT prophylaxis are equally effective in preventing DVT.

Critically ill obstetric patients requiring mechanical ventilation in rural western India: A retrospective analysis.

Background. There is a dearth of studies on the clinical profile and therapeutic aspects of critically ill obstetric patients from rural areas, especially those requiring tertiary care support and ventilator therapy. Methods. We retrospectively analysed the aetiological, clinical, interventional and outcome-related factors of obstetric patients requiring mechanical ventilation in western India. We analysed factors that influence seeking of antenatal care, pregnancy and its complications, severity assessment score, indications and initiation of mechanical ventilation, multiorgan failure and their correlation with maternal mortality. Results. Of the 6708 obstetric admissions studied, 1112 were of critically ill (16.5%) patients and 200 (17%) of these required mechanical ventilation. Over three-fourths (77%) of patients were from rural areas, 83.5% were referred and 97% had inadequate antenatal care. Severe pregnancy-induced hypertension/eclampsia, massive haemorrhage and sepsis were the common obstetric complications. Pulmonary oedema (32.5%), acute respiratory distress syndrome (ARDS, 14%) and acute lung injury (22.5%) were the three most common indications for mechanical ventilation. In 26% of patients, mechanical ventilation was initiated early based on a worsening cardiorespiratory profile. A sequential organ failure assessment score of >5 on admission and delay in treatment resulted in multi-organ failure and worsening outcome. The maternal mortality ratio was 32.5%, incidence of multi-organ dysfunction syndrome was 71%, and pregnancy loss was 43.5%. The odds ratio for maternal mortality in patients ventilated early was 0.39 as against 5 in those with ARDS. Conclusions. Inadequate antenatal care, delayed referral practices, pregnancy-induced hypertension, obstetric haemorrhage and sepsis remain the major causes of complications in obstetric patients from rural areas. The common indications for mechanical ventilation were pulmonary oedema, ARDS and acute lung injury. Early initiation of mechanical ventilation upon detection of imminent

Recurrent Hypoglycaemia in Organophosphorus Compound Poisoning - An Unusual Complication.

Organophosphorus compound poisoning commonly presents with muscarinic, nicotinic and central nervous system manifestations. Endocrinal complications of various organophosphorus compounds are rare and cannot be explained by commonly known mechanisms. We report a clinically proven case of organophosphorus compound poisoning in a young male, in whom at least 22 episodes of hypoglycaemia (blood sugar levels in the range of 47–80 mg %) were observed over 2 weeks during his hospi-talization. Hypoglycaemic episodes completely disappeared upon recovery from poisoning. The exact mechanism for such recurrent hypoglycaemia requires detailed evaluation. This report emphasizes the need to observe blood sugar levels in patients with organophosphorus compound poisoning, so as to detect and promptly treat this rare yet important and correctable complication.