ABSTRACT
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.
ABSTRACT
In the past 20 years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and 2003, H1N1 influenza in 2009, and Middle East Respiratory Coronavirus in 2012 have been recorded. The COVID-19 pandemic caused by SARS-CoV-2 has infected millions across the globe and has been a unique public health challenge with its increased rates of contagion and transmission. This outbreak was likely to have started from a zoonotic transmission event associated with a large sea-food market that also traded live wild animals. An exponential increase in the number of nonzoonotic cases in late December 2019, pointed toward the risk of human-to-human transmission. This led to a faster spread of infection and made the outbreak difficult to contain. The situation was unique in the busy Emergency Department (ED) of our institution, where regular emergency care could not be halted but had to be modified to accommodate COVID-19 confirmed and suspect patients. The ED needed to develop standard operating protocols to isolate and manage these patients, without putting other patients and health-care workers at risk of infection. This is a story of evolving practices in the ED of a leading tertiary care center of South India. © 2022 Medical Journal of Dr. D.Y. Patil Vidyapeeth ;Published by Wolters Kluwer - Medknow
ABSTRACT
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.
ABSTRACT
Introduction: The dominant respiratory feature of Coronavirus Disease 2019 (COVID-19) is arterial hypoxaemia, greatly exceeding abnormalities in pulmonary mechanics. Arterial Blood Gas (ABG) analysis helps to find out respiratory, metabolic acidosis and alkalosis. Aim: To evaluate the blood gas levels among critically ill COVID-19 positive patients admitted in Intensive Care Unit (ICU). Materials and Methods: A retrospective, observational study was conducted. Data of ABG analysis {pH, PaO2 (partial pressure of oxygen in arterial blood), PaCO2 (partial pressure of carbon dioxide in arterial blood) and bicarbonate (HCO3)} in 314 adult COVID-19 positive cases were obtained from ICU records. All critically ill COVID-19 patients those who were admitted in ICU and age more than 15 years of age were included in this study. Data were analysed and Pearson correlation test was applied for statistical significance. Results: Among the study subjects, 234 (74.5%) were male. Most affected age group was 51-60 years among males and above 60 years among females. Most common ABG finding was high pH indicating alkalosis, found among 183 (58.3%) patients. Acidosis was rare and seen in only 19 (6.0%) patients. A total of 174 (55.4%) patients developed respiratory alkalosis with low PaCo2. Hypoxaemia was found in 144 (45.9%) patients. High HCO3, indicating metabolic alkalosis, was seen in 144 (45.9%) patients. Statistically significant correlation was found between PaCO2 and pH (person correlation coefficient (r) =-0.153, p=0.007) and PaCO2 and HCO3 standard (r=0.185, p=0.001). Conclusion: ABG should be done in all COVID-19 patients during admission. A regular interval monitoring of ABG can help in early identification of respiratory damage, silent hypoxia and cytokine storm and with early detection many lives can be saved with early initiation of management.
ABSTRACT
COVID-19 outbreak is likely to have started from a zoonotic transmission event associated with a large seafood market that also traded in live wild animals. Initial epidemiological studies suggested a predilection for older adult males with comorbidities due to their immunocompromised status and very rarely, coinfection with bacteria and fungi. An exponential increase in the number of nonlinked cases in the late December 2019 pointed toward the risk of human-To-human transmission. Similar to its predecessor, severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) also acts on the angiotensin-converting enzyme-2 (ACE2) present on the type 1 and type 2 alveolar epithelial cells. ACE2 expression has been found to be higher in males than females and in Asian populations compared to White and African-American populations. This led to an agreement that the Asian males were more susceptible to SARS-CoV-2 infection. The ability of SARS-CoV-2 to bind to ACE2 receptor was found to be 10-20 times more than that of the SARS-CoV, thus making the new pathogen much more aggressive. At the time of writing this article, the global burden of confirmed cases of COVID-19 has risen to half a million with death toll touching 25,000 people. For the first time, we may be looking at a pandemic which could be controlled on a short-Term basis and prevented on a long term with adequate research and clinical trials for newer therapeutic agents.