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Indian Journal of Critical Care Medicine ; 26:S117, 2022.
Article in English | EMBASE | ID: covidwho-2006408


Aim and background: Delirium is the disturbance of consciousness characterised by acute onset, rapid fluctuations in mental status, and impaired cognitive functioning. The patient's ability to receive, process, store, and recall information is impaired in delirium. Objective: To study the incidence of delirium in patients in COVID and non-COVID ICU. To also study various risk factors associated with delirium. Materials and methods: After ethical committee approval and written informed consent, this study was carried out over a period of 1 year (August 2020 to July 2021). Each patient meeting the inclusion criteria was evaluated on the RAAS score within 24 hours of admission, then screened for delirium according to CAM-ICU worksheet every 6th hourly after admission in MICU. 50 patients were studied each in COVID and non-COVID ICU. Patients found to have delirium after the first assessment were classified as new cases. Various risk factors were evaluated prospectively. Results: Incidence of delirium in non-COVID ICU was 29%, while in COVID ICU was 37%. Delirium is present in a patient who has risk factors including smoking, higher severity of illness, oversedation, and mechanical ventilation. Antipsychotics can be used for patients who develop delirium. Conclusion: Delirium is a preventable issue in ICU patients that can be managed by preventing the risk factors that will decrease overall length of stay in ICU.

Indian Journal of Critical Care Medicine ; 26:S116, 2022.
Article in English | EMBASE | ID: covidwho-2006404


Background: Hospitalised COVID-19 patients are known to exhibit varying degrees of immune dysfunction, few modifiable risk factors have been identified to improve this state of which one is the immune modulator effects of vitamin D. Vitamin D is being prescribed as a treatment of COVID-19 in a few guidelines as there is generalised assumption that vitamin D enhances immunity during this illness. So this is an attempt to find out whether a deficiency of vitamin D is associated with the severity of COVID-19. Aim: To study the relationship of serum 25 hydroxy vitamin D [25(OH)D] deficiency with disease severity in hospitalised COVID-19 patients. Materials and methods: The present case-control study compared serum 25(OH)D levels among Mild to moderate and severe COVID- 19 patients. Around 39 diagnosed and Hospitalised Severe COVID- 19 disease are compared with 39 Hospitalised Mild and Moderate COVID-19 disease in Care Hospital, Bhubaneswar, Odisha, India between April 1, 2021, ad August 31, 2021. Patients were divided into 2 groups. The Group 1-Mild to Moderate infection with CT Severity index < 10/25 and Group 2-Severe Infection with HRCT Chest of CTSI >10/25. As per hospital policy, severe infection patients were kept in Critical Care Area and Mild infection patients were kept in Ward/Cabin areas. Any patients becoming sick and being transferred to critical areas are shifted from Group 1 to Group 2 after HRCT chest. Vitamin D levels (25 D Cholecalciferol) are done on the day of admission by chemiluminescence immunoassay test after taking due consent from the patients/attenders. The level of cut-off used in our study is 20 ng/mL. The association was analysed using regression analysis and other statistical methods. Results: The status of 25(OH)D deficiency (present/absent with cut-off being 20 ng/mL) showed no significant difference among cases and control at p < 0.05. Chi-square statistics with Yates correction is 1.8909. The p value is 0.169099. So there were no significant differences in vitamin D3 levels between Mild to moderate and Severe COVID- 19 patients. Conclusion: 25(OH)D levels appear to have no strong association with disease severity amongst hospitalised COVID-19 patients. Hence, its prescription for COVID-19 treatment as well as prevention needs to be reconsidered.

Indian Journal of Critical Care Medicine ; 26:S108, 2022.
Article in English | EMBASE | ID: covidwho-2006399


Aim and background: Due to the resurgence of COVID cases many doctors, medical students, and nurses from varied backgrounds, many a time novice to COVID management are deployed in turn from time to time at different COVID care centers and hospitals across India, before they are properly trained and skilled for effective management of COVID and post COVID syndromes, as the disease is relatively new, leading to non-uniform management and documentation. COVID being a contagious disease with newer symptomatology and ongoing research outputs suggesting new guidelines from time to time, which sometimes are conflicting in nature for novice healthcare workers. For uniform and appropriate management to reduce morbidity and mortality, it mandates a unique and effective solution towards guided and error-free disease management, authentic high volume data capture for future research and to trace patient to post COVID condition in the community outside the hospital, virtual patient counselling cum relative visit, generation of the daily patient bulletin, simultaneous teleround of multiple units, and sharing patient's data across multiple specialities and investigation areas. Objective: To have all these above-mentioned facilities over one platform, we aim to test run a cloud-based dynamic mobile application based dedicated device, the C O V I D Device (Covid Operation Vital Information Delivery device) across many hospitals in India simultaneously for COVID and post COVID syndrome management and data retrieval for research. Materials and methods: Two institutes, namely IMS and SUM Hospital and ITER have collaborated to design a cloud-based device having recent COVID guidelines on the management of adult COVID patients. The software has been incorporated into a dedicated handheld device (tablet or android mobile phone), the COVID Device in a dynamic way (when new symptomatology surfaces and new research outcomes on management are published). The important modules pertaining to this COVID Device are Web-based application for Registration Desk and Device-based application for Doctor's Module/Care-givers Module and Patient's/Patient's relative's module. Results: In a pilot, we have successfully test run the COVID device on virtual patients and 2 actual patients in a secondary level COVID ICU and HDU to examine the different functionality of the cloud-based application, namely error-free and guided patient management without missing any point, daily patient relative's counselling and virtual patient visiting by relatives, generating daily patient bulletin, simultaneous tele round of multiple units, and sharing patient's data across multiple specialities and investigation areas and tracing patient to the community after discharge to enquire about post COVID condition and retrieval of data across all module and incorporation of new guideline in a dynamic way and checking the facilities for incorporating other modules namely pediatric module. Conclusion: COVID Device (Adult module) is a very effective tool for COVID and post COVID condition management and research. It has the potential to incorporate other modules namely obstetric, pediatric, and neonatal modules. If used across all hospital of India, it will be a real boost to digital health mission and centralized COVID data management and research in India.