Hyponatremia-induced worsening of trigeminal neuralgia- When the sodium plays the game.

A 78-year-old elderly male who was on treatment for trigeminal neuralgia and hypertension was brought to the emergency with altered sensorium. His vital parameters were within normal limits; however, the arterial blood gas analysis showed severe hyponatremia. He was admitted to the ward, where further workup was carried out and hyponatremia correction started. He had a sudden worsening in his facial pain before he landed in encephalopathy. His medications (oxcarbazepine and chlorthalidone) that could cause hyponatremia were stopped, and judicious correction of hyponatremia was done. His baseline investigations, including a chest roentgenogram and electrocardiogram, were normal. After he regained consciousness, it was noted that the facial pain had regressed significantly despite stopping his first-line drugs. This case of worsening trigeminal neuralgic pain due to hyponatremia responded well to judicious sodium correction.

Immune Thrombocytopenia Secondary to COVID-19 in a Vitamin B12-Deficient Patient: A Diagnostic Dilemma and Therapeutic Challenge.

Immune thrombocytopenia (ITP) caused by infectious and non-infectious conditions has been reported in coronavirus disease 2019 (COVID-19) patients too. Here we present a 64-year-old male patient with post-COVID-19 pneumonia who presented with a gastrointestinal bleed and was found to have severe isolated thrombocytopenia (22,000/cumm) diagnosed as ITP with extensive investigations. He was treated with pulse steroid therapy and later was also given intravenous immunoglobin in view of poor response. The addition of eltrombopag also resulted in a sub-optimal response. He was also having low vitamin B12, and his bone marrow also supported the megaloblastic picture. Hence, injectable cobalamin was added to the regimen, which resulted in a sustained rise in platelet count that reached 78,000/cumm, and the patient got discharged. This shows the possible hindrance to treatment response by concomitant B12 deficiency. Vitamin B12 deficiency is not an uncommon entity and should be tested in those who show no or slow response to thrombocytopenia.

Acute respiratory distress syndrome in Scrub typhus - An under recognized complication!

Scrub typhus is an acute febrile illness caused by the bacterium Orientia tsutsugamushi. It usually presents with high-grade fever, body aches, and skin rash. We report the case of a woman who presented with acute febrile illness, bilateral pneumonia, and severe hypoxemia. The presence of a typical eschar on the abdomen, made us suspect scrub typhus. Anti-O. tsutsugamushi Immunoglobulin M (IgM) antibody in the serum was detected in significant titers. She was treated with intravenous doxycycline and supplemental oxygen. Thus, scrub typhus should be considered in the differential diagnosis of febrile illness with acute respiratory distress syndrome.

Unusual Causes of Jaundice: A Diagnostic Challenge.

This case report discusses a complex medical scenario involving a 25-year-old female patient initially diagnosed with acute hepatitis A virus (HAV) who later developed symptoms indicative of autoimmune hepatitis (AIH). The transition from uncomplicated HAV to impending subacute hepatic failure and autoimmune overlap syndrome highlights the importance of vigilant monitoring and a comprehensive diagnostic approach. The patient's medical evaluation revealed autoantibodies, elevated IgG levels, and liver biopsy findings consistent with steatohepatitis. Management included immunosuppressive therapy, resulting in a positive treatment response. The phenomenon of AIH following acute HAV infection, though rare, remains a subject of medical interest and presents diagnostic and therapeutic challenges. Further research and clinical experience are needed to develop effective strategies for these infrequent cases.

Multiple endocrine neoplasia type 2 - solving the puzzle.

Multiple endocrine neoplasia (MEN) are tumors that involve two or more endocrine glands. It can also involve other organs and tissues as well. Out of the four types of MEN type 2 is the most common. In MEN type 2 or type 3, paraganglioma is rare, but in our case, medullary thyroid carcinoma (MTC), hyperparathyroidism, and pheochromocytoma were associated with the paraganglioma.

Picking up an insulinoma - The challenges ahead.

Insulinoma is a rare pancreatic neuroendocrine tumour (PNET) with an incidence rate of 4 per million population, and the most common cause of hypoglycaemia due to endogenous hyperinsulinism. We present the story of a 61-year-old male, who was extensively evaluated at many hospitals for his symptoms of giddiness, uneasiness and recurrent black outs for the last 3 months, his symptoms disappearing with a carbohydrate rich meal or sweets. Random sugar and fasting sugar values noted were low, with elevated insulin and C-peptide levels. Diagnosis of insulinoma was confirmed by a DOTA PET scan involving the tail of the pancreas and then surgically removed. Early detection is crucial for early surgery to allay symptoms. We describe our diagnostic and treatment plan with reference to previously published reports.

A Study of the Profile of Scrub Typhus in a Tertiary Care Hospital in Jharkhand: An Underestimated Problem.

Background and objective Scrub typhus (ST) is a rickettsial infection caused by Orientia tsutsugamushi, which is transmitted by the bite of the larval stage (chiggers) of trombiculid mites. Although it presents as an acute undifferentiated febrile illness (AUFI), its course can be complicated with acute respiratory distress syndrome, acute kidney injury (AKI), myocarditis, meningoencephalitis, hepatitis, multi-organ dysfunction syndrome (MODS), and ultimately death. This study aimed to evaluate the epidemiological features, clinical profile, laboratory features, and clinical outcomes of cases of scrub typhus and identify the predictors of disease severity. Methods and materials This study is a retrospective observational study that included confirmed cases of scrub typhus admitted in the medical wards and critical care unit (CCU) of Tata Main Hospital (TMH) from January 1, 2019, to December 31, 2021. The case records of patients were analyzed for demographic characteristics, clinical features, treatment, and outcomes, which included length of stay (LOS), complications, and mortality. The required odds ratio (OR) was calculated, univariate and binary regression analyses were done, and a p-value of <0.05 was considered statistically significant. Results Of the 42 confirmed cases, 38.1% were males and 61.9% were females. The average age of male patients was 12.6 ± 11.2 years, while that of females was 22 ± 19.3 years. Of the patients, 64.3% were in the age group of 1-20 years. The clinical manifestations in descending order were fever (71.2%), skin rash (19.1%), cough (16.7%), vomiting (28.6%), altered sensorium (23.8%), abdominal pain (23.8%), loose stools (14.3%), seizures (14.3%), anasarca (9.7%), breathlessness (9.7%), and melena (7.1%). Eschar was noted in 38.1% of patients. Swelling of the body (6.7%) and lymphadenopathy (10%) were seen exclusively in children. The common laboratory abnormalities observed were leukocytosis in 34.3% of cases; thrombocytopenia in 68.8% of cases, of which 25% of patients had platelets < 50,000/mm3; and transaminitis in 87.5% of cases. The ratio of AST/ALT of more than one was seen in 89.3% of patients, while it was less than one in 10.7% of patients. The average C-reactive protein (CRP) level was 10.9 ± 6.3 mg/dL. The complications noted were acute respiratory distress syndrome (ARDS) (16.7%), meningoencephalitis (21.4%), septic shock (14.3%), capillary leak syndrome (26.2%), thrombocytopenia (68.8%), transaminitis (87.5%), myocarditis (4.8%), disseminated intravascular coagulation (2.4%), and hypocalcemia (11.9%). The average length of stay (LOS) was 8.1 ± 4.2 days. Twenty-four (57.2%) patients required transfer to the critical care unit (CCU) for managing various complications. There was no mortality in this series, giving rise to the case fatality ratio (CFR) of 0. Conclusion Scrub typhus is a reemerging cause of acute febrile illness. The highest number of cases were found during the post-monsoon period and in those with rural backgrounds. It presents with varying clinical manifestations with or without eschar. Hence, a high degree of suspicion along with a thorough clinical examination is needed to diagnose this condition. The disease responds dramatically to doxycycline. One must be aware of its complications and atypical presentations, as a timely diagnosis can reduce the morbidity and mortality associated with this disease.

Vaccine-induced thrombosis and thrombocytopenia (VITT); Exploring the unknown.

Vaccination is supposed to be the most reliable means to end the COVID 19 pandemic, but recently there have been reports of thrombosis and thrombocytopenia in patients receiving the vaccine especially ChAdOx1 nCoV-19 (AstraZeneca University of Oxford and Serum Institute of India). This has been termed as vaccine-induced immune thrombotic thrombocytopenia (VITT), thrombosis with thrombocytopenia syndrome (TTS) and vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). This is a challenging situation and patients are treated with Fondaparinaux and Rivaroxaban after thrombocytopenia is corrected. Herewith, we report a case of VITT who presented to our hospital and was successfully treated over a weeks' time.

A Case of Pigmented Villonodular Synovitis.

Tenosynovial giant cell tumors (TGCT) are a rare group of generally non-malignant tumors that involves the synovium and tendon sheath. A young female patient presented to the outpatient department with a complaint of unilateral knee swelling and pain. She was evaluated as such and based on a provisional diagnosis of benign synovial proliferation, she was treated with an arthroscopic resection. We discuss our case and discuss the possible medical therapies to prevent recurrence.

An unusual association between anti-histone antibody seropositive SLE, autoimmune hemolytic anemia, and herpetic rash: A case report.

Systemic lupus erythematosus (SLE) is an autoimmune disease associated with several autoantibodies targeted to nuclear and cytoplasmic antigens. Positivity of the serum antinuclear antibody (ANA), double stranded (ds) DNA, anti-smith (sm) antibody are essential for the diagnosis of SLE. Anti-histone antibody is usually present in drug-induced SLE. Autoimmune hemolytic anemia (AIHA) in SLE is usually mediated by warm IgG anti-erythrocyte antibodies. Our case evaluation revealed negative anti-ds antibody and anti-smith antibody, low C3 and C4 complement level, strong anti-histone antibody-positive status, and AIHA. She responded with intravenous methyl prednisolone and showed significant clinical improvement. Anti-histone antibody-positive SLE presenting with AIHA is rare, probably we are reporting the first case.

Study of Profile of Mucormycosis During the Second Wave of COVID-19 in a Tertiary Care Hospital.

Introduction and aim Mucormycosis is a lethal opportunistic infection caused by filamentous fungi of the family Mucoraceae (black fungus). There has been a sudden increase in the incidence of these cases during the second wave of the COVID-19 pandemic due to the immunocompromised state caused by the disease and its treatment. Early diagnosis and appropriate medical management are essential to reduce disease morbidity and mortality. Through this study, we aim to study the clinical features, risk factors, laboratory investigations, and radiological findings of patients with mucormycosis as well as evaluate the clinical outcomes in each case. Methods and materials This was a prospective study that included only confirmed mucormycosis cases admitted in Tata Main Hospital (TMH) from April 2021 to July 2021. A case of mucormycosis was defined as the one in which clinical and radiological features were consistent with mucormycosis and fungus was demonstrated in the tissue by potassium hydroxide (KOH) mount/culture/histopathological examination (HPE). Data relating to epidemiology, risk factors, clinico-radiological features, and outcomes were analyzed and expressed as a percentage of total cases. Results Of the total 15 cases, three patients (33.3%) had active COVID-19 infection, eight (53.3%) were in the post-COVID-19 state, two (13.4%) had COVID-19 like illness and two (13.4%) patients did not have COVID-19 in the recent past. There was male predominance with the male to female ratio being 2.75:1. The commonest associated co-morbid condition was diabetes mellitus (13 patients, 86.7%). Amongst the myriad manifestations, periorbital swelling was the commonest symptom (11 patients, 73.3%). Among neurological manifestations, involvement of cranial nerves was found in nine (60%) patients with the third cranial nerve being the most commonly affected nerve (eight patients, 53.3%). Cavernous sinus thrombosis (CST) was found in one (6.7%) patient. Diagnostic nasal endoscopy (DNE) revealed eschar at various sites in 13 patients (86.7%). Central retinal artery occlusion (CRAO) was found bilaterally in one patient (6.7%) while two patients (13.3%) had CRAO on the left. Radiologically, the most commonly involved sinuses were maxillary and ethmoidal (eight patients, 53.3%). Bilateral sinus involvement was more common (46.7%) than unilateral sinus involvement. The average length of stay (LOS) was 17.5±7.8 days. The overall mortality was 40%. Five (33.3%) patients developed secondary bacterial infections. All patients received medical therapy with intravenous amphotericin B. In addition, seven (46.7%) patients underwent functional endoscopic sinus surgery (FESS) with debridement of which, five (71.4%) patients survived and made a good recovery. One patient (6.7%) with pulmonary mucormycosis underwent lobectomy. Conclusion New-onset headache, black nasal discharge, periorbital swelling, retro-orbital pain, visual diminution, restriction of eye movements should prompt an immediate search for mucormycosis especially in the background of history of diabetes mellitus in patient with recent or current COVID-19 disease. Radio-imaging with computerized tomography and magnetic resonance imaging are complementary to clinical evaluation in assessing the disease extent and diagnosis of complications. Prompt diagnosis is essential due to the angio-invasive nature of the mucor and requires aggressive anti-fungal therapy and debridement of the devitalized tissue.

Clinical and epidemiological profile of snakebite cases - A study from an industrial teaching hospital at Jamshedpur, Jharkhand, India.

Introduction: India accounts for approximately half of the worldwide snakebite deaths. It is often a neglected public health problem and particularly in Jharkhand region where medical facilities are limited. Epidemiological and clinical profile-related studies are scarce. The present study aims to assess the epidemiological profile and clinical features of snakebites encountered in a tertiary-care teaching hospital at Jamshedpur, Jharkhand, India. Aims and Objective: The aim of this study was to assess the clinical profile, outcome and epidemiological factors of snakebite cases, admitted to a tertiary care hospital in Jamshedpur. Material and Methods: This was a retrospective study from 2014 to 2021 wherein a total of 427 snakebite patients were admitted and had received treatment for snakebite at a tertiary-care teaching hospital at Jamshedpur, Jharkhand. All patients who reported with a history of snakebite were included in this study. The demographic and clinical details of each case were obtained and analysed. Result: A total of 427 snakebite cases were admitted to the hospital during the study period. The victims were predominantly males. Majority of the bite cases encountered were from rural areas and were in the second quarter of the year. The site of the bite was largely on the lower limb and the upper limb had fewer bites. The Glasgow Coma Scale was normal in those who presented early. Acute kidney injury, neutrophilic leucocytosis and deranged liver enzymes were associated with bad prognosis. Timely intervention with anti-snake venom offered good result. Conclusion: We had more male patients (69.55%), belonging to rural areas (67.91%), more bites in lower limbs and more cases in the second quarter of the year. Mortality rate was 0.7%.

Late onset crohns ileitis-A diagnostic dilemma.

Crohn's disease may affect individuals across all age groups. Usually, it tends to start at a young age, hence late onset Crohn's disease may be difficult to diagnose. The incidence of late-onset inflammatory bowel disease in the United States is 4 to 8 per 100,000 per year. The incidence of Crohn's disease is more in the United States and Europe and less in Asia and Africa. This makes it more challenging to suspect Crohn's disease in an elderly individual of Indian origin. It may be confused with Irritable bowel syndrome or Intestinal tuberculosis.

Salmonella Paratyphi and multiorgan dysfunction: A rare case report.

Salmonella typhi (S. typhi) and Salmonella paratyphi A (S. paratyphi A), together known as typhoidal Salmonella, are causal agents for an invasive, serious, and sometimes fatal disease of humans called typhoid fever or paratyphoid fever (also known as enteric fever). S. Typhi, the lineage causing typhoid fever, is the main group; whereas S. Paratyphi A, the lineage causing paratyphoid fever, belongs to the second group, which comprises a set of three paratyphoid types (the other two being S. Paratyphi C and d-tartrate-negative S. Paratyphi B). All these lineages are adapted to humans, with S. Typhi and S. Paratyphi A being strictly restricted to growth in humans, and S. Paratyphi C being able to establish infections in experimental animals quite easily (at moderate infection doses); the host-restriction status of d-tartrate-negative S. Paratyphi B is so far unclear. The potential source of infection is the use of sewage-contaminated water in plants and vegetable irrigation and clinical presentation is varied, mainly presenting with fever, malaise, abdominal discomfort, and nonspecific symptoms often confused with other causes of the febrile syndrome. S. Paratyphi is usually a mild form of disease without any complication, but we report a complicated case of Paratyphi, who presented with fever and gastrointestinal symptoms complicated by multiorgan dysfunction needing mechanical ventilatory support, multiple hemodialysis, and blood transfusion. Fortunately, he recovered from all the insults and was discharged home in stable condition on the 26th day of hospitalization.

Insulinoma: Presenting as hypoglycemia in a non-diabetic patient: A rare case report.

PNETs (pancreatic neuroendocrine tumors) are a rare sub-type of pancreatic tumors, with the majority of them being insulinomas. The vast majority of insulinomas (90%) are benign and solitary, with only 10% being malignant. It has a wide range of clinical manifestations and requires a high level of suspicion to diagnose. Surgical excision has long been the gold standard for treating localized PNET and is still the therapy of choice. Recurrent hypoglycemia is usual in diabetic patients, but this is a rare finding in non-diabetic individuals. Here, we are presenting a rare case of insulinoma who was non-diabetic and presented with recurrent hypoglycemic episodes. A 61-year-old non-diabetic male presented with multiple episodes of hypoglycemia in the past. On thorough workup, there was an increased fasting insulin level with the fasting blood glucose level ranging from 60 to 90 mg/dl. His C-peptide and proinsulin were markedly elevated. His abdominal ultrasound failed to pick up any abnormality. His DOTANOC scan revealed a 2 × 2 cm sized lesion in the distal pancreas suggestive of neuroendocrine pathology. He subsequently underwent spleen preserving distal pancreatectomy, following which his blood sugar levels remained normal, and continued to be free of symptoms on follow-up. Our instance emphasizes the need for evaluating insulinoma as a cause of recurrent hypoglycemia in people who are not diabetic. A high index of suspicion in hypoglycemic individuals who do not respond to standard treatment or whose symptom pattern changes will lower the likelihood of insulinoma diagnosis being delayed.

Getting paralysed after COVID: Guillain-Barre syndrome.

Neurological involvement after coronavirus disease (COVID-19) pneumonias is common and occurs in almost one-third of the patients. The commonest neurological symptoms are ageusia, anosmia, headache, nausea, vomiting, dizziness, and myalgia. Guillain-Barre syndrome (GBS) is a rare manifestation of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection; whereas the common neurological manifestations of the SARS-CoV-2 infection occur with the onset of the respiratory symptoms and may be due to the direct invasion of the nervous system by the virus, GBS in COVID-19 follows a time lag of 1-4 weeks and may be attributable to the immune mechanism of molecular mimicry. Here we report a case of GBS in a patient of COVID-19 which occurred on the 22nd day after the onset of the disease. The patient recovered completely and went home walking.

Hepatic Hydrothorax in the Absence of Ascites: A Diagnostic Challenge.

Hepatic hydrothorax is a rare complication of chronic liver disease. It usually occurs in patients with advanced liver disease, portal hypertension, and ascites. On a rare instance, it may be the index presentation of chronic liver disease. Hepatic hydrothorax occurs in approximately 5-6% of patients with cirrhosis. The exact mechanism has not been well defined, but it is frequently thought to be due to the direct passage of ascitic fluid from the peritoneal cavity through the diaphragmatic defects. Treatment involves salt and water restriction and diuretics. Therapeutic thoracocentesis is required in case of respiratory distress. In resistant cases, indwelling pleural catheter (IPC) like PleurX catheter system (Franklin Lakes, NJ: BD) is placed and patients manage their symptoms through intermittent drainage of the pleural fluid. Here we describe an unusual case of hepatic hydrothorax in a patient with rheumatoid arthritis and liver cirrhosis without any ascites, a scenario that has rarely been reported in the literature. The patient underwent thoracentesis thrice but in view of re-accumulating pleural effusion, a pig-tail catheter with underwater seal was inserted. She was then referred to a hepatology center for transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant.

Case Report of a Saga of Post-COVID-19 Complications.

Coronavirus disease 2019 (COVID--19), caused by severe acute respiratory syndrome coronavirus 2, is characterized by symptoms such as fever, sore throat, cough, fatigue, myalgias, headache, diarrhea, and dysgeusia. In a majority of the cases, it causes mild illness. However, in severe cases, the virus activates the immune system causing systemic inflammation, immune dysregulation, and pro-thrombotic state leading to various complications. Among hospitalized patients with COVID-19, pneumonia, sepsis, and respiratory failure are frequent complications. However, even in the second year of the COVID-19 pandemic, our knowledge of its myriad clinical features and complications is still incomplete and continues to evolve. Here, we present the case of a patient who developed several complications post-COVID-19 one after the other. He was admitted with severe COVID-19 for which he received standard COVID-19 treatment and mechanical ventilation. In the post-COVID-19 state extending up to six months, he serially developed deep vein thrombosis, endogenous endophthalmitis, empyema, and post-inflammatory arthritis of the hip joints. To our knowledge, such a case has not been reported earlier in the literature.

Prolonged Oxygen Therapy Post COVID-19 Infection: Factors Leading to the Risk of Poor Outcome.

BACKGROUND: Coronavirus disease 2019 (COVID-19) infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a single-stranded ribonucleic acid (RNA) ß-coronavirus. Prolonged duration of symptoms, ill health, disability, and need for hospitalisation are all well-known features of severe COVID-19 disease. OBJECTIVE: To describe the epidemiological, clinical and imaging characteristics of hospitalised patients of COVID-19 who required prolonged oxygen therapy after testing negative for SARS-CoV-2 and attempt to determine the associated factors leading to delayed recovery, failure to wean, and mortality. MATERIAL AND METHOD: Prospective observational study from 9th September to 6th November 2020 in a tertiary care COVID hospital of Jharkhand. Included COVID-19-infected patients requiring oxygen to maintain a saturation of ≥95% after testing reverse transcription polymerase chain reaction (RT-PCR) negative. Patients were classified as Group I, those who could be weaned off oxygen, and Group II, those who could not be weaned off oxygen during their stay in the isolation ward. A detailed assessment for outcome in these two groups related to age, gender, presence or absence of co-morbidities, nature of co-morbidities and findings of high-resolution CT (HRCT) thorax was done to ascertain risk factors for failure to wean and adverse outcomes. RESULTS: During the study period, 93 patients suffering from moderate to severe COVID-19 infection, could not be discharged from the hospital and were admitted to the post-COVID isolation ward after testing RT-PCR negative, due to breathlessness and need for oxygen therapy, with a male predominance, M:F ratio of 2.2:1. Of these 93 patients, 51 could be weaned off oxygen in the isolation ward. The mean and median age of patients who could be successfully weaned was 58.5±14.3 years and 60 years respectively, compared to a mean age of 64±12.4 years and a median age of 67 years for patients who could not be weaned off oxygen during the isolation period. Patients aged ≥60 years were at risk for prolonged requirement of oxygen compared to those <50 years of age, relative risk (RR) 1.43 (95%CI 0.9-2, p=0.051). Failure to wean in <50 years was noted in presence of co-morbidities, RR 4 (95%CI 1.5-10.6, p=0.005). Multivariable logistic regression analysis calculated an odds ratio (OR) of 12.22 (95%CI 2.4-61.5, p<0.002) in patients of coronary artery disease (CAD), and 3.34 (95%CI 1.01-10.9, p<0.046) in patients of diabetes, for failure to wean with delayed recovery in patients aged 50 years and more, having multiple co-morbidities. Presence of ≥three co-morbid conditions was associated with increased risk of critical care unit (CCU) admissions (RR 2.1, p=0.02), failure to wean (RR 1.79, p<0.006), and death (p=0.02). Elderly male patients (mean age of 81.3±7.2years) with CAD and multiple comorbidities were at a high risk of mortality (p=0.01). CONCLUSION:  Patients ≥50 years of age having ≥three co-morbidities are at increased risk of prolonged hospitalisation and oxygen therapy in moderate to severe COVID-19 infection, precluding their discharge even after they test negative for SARS-CoV-2. Elderly male patients of COVID-19 with CAD and multiple comorbidities are at a high risk of mortality.

Success rate of Remdesivir, Convalescent Plasma, and Tocilizumab in moderate to severe Covid-19 pneumonia: our experience in a tertiary care center.

INTRODUCTION: After the first case of Covid-19 was identified in Wuhan City, China, the numbers increased rapidly all over the world putting a huge burden on the entire healthcare system. Managing these cases posed a great challenge to the treating clinicians in the absence of targeted therapy. At this juncture, few modalities got approved as EUA (Emergency use under authorization) drugs namely Remdesivir, Convalescent Plasma (CP), and Tocilizumab (TCZ) to treat this deadly disease. AIM: To analyze the success rates of EUA therapies for Covid-19 pneumonia in our hospital. MATERIALS AND METHODS: This was a prospective observational study conducted from April 2020 to October 2020 in the department of Medicine at Tata Main Hospital, Jamshedpur, Jharkhand. All adults with moderate to severe Covid-19 as per the WHO criteria were enrolled in the study with their informed consent. Patients with estimated glomerular filtration rate <30 mL/min, deranged liver function tests, electrocardiographic abnormalities, and deranged hematological parameters were excluded from the study. Thorough clinical evaluation was done in all cases. Routine investigations together with CRP, LDH, serum Ferritin, D Dimer and IL6, Chest X-Ray, and HRCT thorax were done in all cases. ECG was done in all cases and 2D-ECHO in selected ones. Depending on their clinical and radiological criteria, patients were treated with various modalities approved under EUA with close monitoring of clinical, biochemical, and radiological parameters. Presenting symptoms, clinical findings, co-morbidities, laboratory parameters, and radiological assessment were analyzed, and statistical analysis was done. The survival rate and in-hospital mortality was analyzed. OBSERVATIONS AND RESULTS: We had a total of 448 patients who were included in our study, out of which 326 were males and 122 were females with a male to female ratio of 2.7:1. Their age varied between 16 and 91 years with an average age of 51.4 years with a standard deviation (SD) of +/- 6.4 years. About 255 patients (57%) received only Remdesivir (176 males, 79 females), 139 (105 males, 35 females) patients (31%) received Remdesivir along with two units of CP, and 38 (32 males, 6 females) patients received a combination of Remdesivir, CP, and TCZ. All patients in our study tolerated the drugs well. About 5% of cases who received CP had minor transfusion reactions. One patient had TRALI and three patients had TACO, which was managed aggressively. Asymptomatic transaminitis was seen in 36% patients. The survival rate in patients treated with Remdesivir was 78%, those with Remdesivir and CP was 44%, and those with all three was 13%. The mean length of stay was 14.23 days with a SD of 9.06 days in patients treated with TCZ in comparison to other two modalities, which was 13.88 days with a standard variation of +/- 8.71 days in Remdesivir and 13.88 days with a SD of 8.73 days in patients treated with CP that was stastically significant. CONCLUSIONS: Though the success rate of various drugs under EUA varies in different studies from all over the world, the data to support their use are encouraging. We also observed satisfying results in our study specially with the use of Remdesivir. Therefore, EUA agents should be used early to fight against COVID-19 along with the other measures as per the protocol laid by ICMR and MoHFW.