ABSTRACT
Objective: To study the epidemiological characteristics of the pandemic by describing the clinical profile of the COVID-19 patients presenting to a super specialty hospital. Methods: This was a descriptive study using medical records of patients who tested positive for SARS-CoV-2 RNA using reverse transcription-polymerase chain reaction between 17th March and 15th January 2021 while maintaining confidentiality. The clinical and demographic data of all the patients were entered in a Microsoft Excel and statistical analysis was done using SPSS 21 software. Regression analysis was performed and a P value < 0.05 was considered to be statistically significant. Results: A total of 3534 patients were enrolled in this study aged 9-96 years. Among patients with symptoms, fever and cough were the most common presenting symptoms, while 5.6% of the patients were asymptomatic. Hypertension was the most common comorbidity (37%), while no comorbidities were present in 43.0% of the participants and this was statistically significant for age (P = 0.000). Among patient outcomes, >50% of patients were in home isolation, while 11% of patients had a fatal outcome. Elder age group had a higher proportion of expiry among outcomes (P <= 0.001). Most patients had a hospital stay of 9-11 days. A total of 63 health workers were included with male: female ratio being 3.5:1. Conclusion: Our study reflects that majority of the positive cases that presented to the hospital had mild/moderate symptoms. We believe that appropriate triaging of patients followed by early institution of medicine and good critical care services may help to control this epidemic.
ABSTRACT
Medical oxygen is an essential medicine as is aptly stated by the World Health Organization. With the advent of coronavirus disease 2019 (COVID-19) pandemic and with increased lung involvement, oxygen has become a precious life-saving drug. With more than 200 million cases worldwide, this pandemic has put tremendous pressure on scarce healthcare resources. In a step toward our readiness for further COVID-19 waves, we would like to bring forth the information regarding oxygen supply in the hospitals. We searched various published literature in journals and books, as well as scientific databases, including PubMed Central, Google Scholar, National Medical Library, and Medline, using search terms as "oxygen sources," "oxygen supply," and "hospitals." The relevant articles published during the period of 1990-2021 and in the English language were selected. This article is an attempt to enrich the readers in further strengthening the oxygen supplies in hospitals during such pandemics and other natural disasters.
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BACKGROUND: The coronavirus disease (COVID-19) presents across a spectrum of signs and symptoms and shows clinico-epidemiological predilections (elderly, those with comorbidities). Delhi is among the highest burden states in India. OBJECTIVES: To report the case detection trends and clinico-epidemiological profile of patients tested positive at a designated COVID-19 hospital in Delhi in Northern India. METHODS: Using an observational (descriptive design) we analyzed data from the electronic medical records of the hospital. All individuals testing positive for SARS-CoV-2 RNA using reverse transcription polymerase chain reaction (RT-PCR) between 17th March and 07th May 2020 (both dates inclusive) were included. Case detection trend (7-day moving averages) was plotted. Clinico-epidemiological profile of patients was summarized statistically. RESULTS: Total 308 positive cases were enrolled in this study. The median age of participants was 48 years (09-95 years) men (47.9 ± 16.4 years) and women (43.5 ± 14.0 years). Men to women ratio was 3.4:1 with a statistically significant difference (P < 0.001). During the study timeframe, 166 (54.0%) patients had an outcome: 11 (6.6%; 95% CI: 3.4-11.6) expired and 155 recovered (recovery rate: 93.4%; 95% CI: 88.5-96.7). Chance of death was significantly associated with the higher age group (P = 0.005). The commonest clinical symptoms noted were fever (38.9%) and cough (38.6%). Majority (56.6%) had mild to moderate symptoms, 12.6% had severe symptoms and the remaining were asymptomatic (30.8%). 31 patients (26.05%) needed ICU care. Total 119 patients (38.6%) had various preexisting comorbidities, most commonly diabetes mellitus (35.0%) and hypertension (34.0%). However, the comorbidities were not associated with age (P = 1.000). CONCLUSION: Triangulation of data and careful analysis of trends in designated COVID-19 hospitals and other institutional settings may help inform surge preparedness and care provisioning. Stringent containment strategies must continue as the pandemic is intensifying.
ABSTRACT
BACKGROUND: Preemptive analgesia is a part of multimodal regime for effective postoperative analgesia. Ketamine is said to possess preemptive effects, which has been simultaneously refuted by other studies. Hence, we designed this randomized, double-blinded trial to establish the influence of timing of perioperative ketamine administration for superior postoperative analgesia. METHODS: Ninety patients undergoing infraumbilical surgeries under spinal anesthesia were randomized to receive ketamine either preincision (Group KI), preincision and during skin closure (Group KII), or only during skin closure (Group KIII). Outcomes studied were postoperative pain, sedation, and incidence of side effects. RESULTS: Analysis of variance statistics for postoperative visual analog scales (VAS) for pain showed no significant difference in three groups. However, there was a significant difference between Groups KII and KIII in the immediate postoperative period (95% confidence interval [CI] of mean VAS for Group KI = 0.9249-1.4889; 95% CI for Group KII = 1.4406-1.8260; P = 0.043). Sedation scores in the immediate, 4 h and 8 h postoperative showed a significant difference between Group KI and Group KII (P = 0.007, 0.008, 0.001, respectively) and between Group KI and KIII (KI: KIII - P = 0.0008, 0.0006, 0.02, respectively). Although the incidence of psychotomimetic effect was more in Groups KIII, it was not statistically significant. CONCLUSION: Ketamine possesses postoperative analgesic effects in the immediate postoperative period only when its preemptive administration is supplemented with repeat administration during closure. Incidences of side effects were comparable in all groups.
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BACKGROUND AND AIM: Nausea and vomiting causes distress to patients and increases surgical complications. Though various antiemetics are available, their effectiveness and fetal safety profile when used in parturient remains debatable. This randomized, double-blind, comparative study was designed with an aim to compare the antiemetic effects of ondansetron and glycopyrrolate during cesarean section. METHODS: Sixty-six parturients (American Society of Anesthesiologist physical status I-II) scheduled for elective cesarean section were randomized to receive intravenous ondansetron 4 mg (Group O, n = 32) or glycopyrrolate 0.2 mg (Group G, n = 31) before spinal anesthesia. Outcome measures studied were emesis, episodes of hypotension and bradycardia and pain, till 10 h postoperative. Statistical software used was Epi Info 7 and Microsoft Excel. RESULTS: There was no significant difference in nausea and vomiting at all the study intervals between the two groups statistically. There was no difference in episodes of hypotension, but episodes of bradycardia were significantly less in glycopyrrolate group (26%) than in ondansetron group (56%) (P = 0.027). There was no difference in additional analgesic requirements. However, the incidence of dry mouth was significantly greater in glycopyrrolate group (21 [68%]) as compared to ondansetron group (5 [16%]) (P = 0.00). CONCLUSION: Effect of glycopyrrolate on nausea and vomiting during cesarean section are comparable to ondansetron, but with an increased incidence of dry mouth. Glycopyrrolate has no effect on hypotension or additional analgesic requirements, but the incidence of bradycardia is significantly less.
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Pyrexic patients are usually attended with some scepticism by anaesthesiologists. Main reasons are the absence of comprehensible guidelines pertaining to anaesthesia in such patients and the presence of innumerable aetiologies of pyrexia. This article has tried to fill the existing void in the medical literature regarding anaesthesia in a patient with pyrexia. The article aims to discuss common and relevant causes of pyrexia, their pathophysiology in anaesthetic perspective, and the subsequent anaesthetic management, though a detailed discourse on all the entities causing pyrexia is beyond the scope of this article. This article will also touch upon the thermoregulatory alterations during anaesthesia. The literature search was performed manually using text and reference books, peer-reviewed journals, online and offline and through internet search engines Google, PubMed and Medline databases, using search terms 'perioperative pyrexia or fever, anaesthesia and thermoregulation'. Articles from 1980 to 2013 in English language were selected.
ABSTRACT
BACKGROUND: Postoperative pain is a common complaint and despite the availability of various drugs, is still not managed well. Analgesic effects of glucocorticoids are still to be substantially established. Hence, we designed randomized, double-blind, placebo-controlled trial to compare the effect of two different doses of dexamethasone on postoperative pain in patients undergoing infra-umbilical surgeries under spinal anesthesia. METHODS: Ninety American Society of Anesthesiologists Grade I and II patients were randomized to receive injection dexamethasone 8 mg (Group DI), dexamethasone 16 mg (Group DII) or placebo (Group C) prior to performance of intrathecal block. Outcome studied was postoperative pain on the rest and motion and nausea and vomiting. RESULT: There was no difference in Visual Analog Scale (VAS) scores during rest in all the three groups. However, VAS scores on motion showed a significant decrease in Group DII at 24 and 36 h when compared to Group C (95% confidence interval [CI] of mean at 24 h for Group C = 5.6093-7.1049 and Group DII = 4.8709-5.9567, P = 0.04; 95% CI of mean at 36 h for Group C = 4.5868-5.8418 and Group DII = 3.5388-4.7378, P = 0.01). There was no significant difference in the incidence of postoperative nausea and vomiting or additional analgesic requirements. CONCLUSION: Dexamethasone 16 mg reduces postoperative pain on motion at 24 and 36 h. It has no effect on postoperative pain at rest or on nausea and vomiting.
