COVID-19 pandemic: Hospital preparedness in a tertiary care hospital in North East India.

Background: The first case of Coronavirus was reported by World Health Organisation (WHO) on 31 December 2019. Due to its high infectivity and increasing mortality, WHO on 30 January 2020 declared the infection as public health emergency of international concern. Various measures were initiated and carried out by health care facilities to tackle the pandemic. Our experiences of hospital preparedness may help future health policies to tackle the pandemics. Method: Various guidelines given by Ministry of Health and Family Welfare, Centre for Disease Control, Indian Council of Medical Research were studied and analysed. The hospital lay out plan was studied, modifications in the physical structure of the hospital as planned by the hospital authorities were observed and recorded. The impact of the new planning on patient management was recorded by the investigators. Results: It was observed that proper planning on the basis of laid down guidelines and the modifiable initial layout is very effective in the prevention and management of the pandemic. A total of 130 beds of the hospital under study could be separated from the main building with little modifications. Another important observation was dedicated leadership and coordination among different specialities ensuring successful planning. The investigators concluded that the new hospitals should be planned and constructed in such a way so that a major part of the hospital building can be converted to an isolation area with little modifications in the physical structure of the hospital at the time of pandemics.

Abdominal Epilepsy and Foreign Body in the Abdomen - Dilemma in Diagnosis of Abdominal Pain

There are many medical causes of abdominal pain; abdominal epilepsy is one of the rarer causes. It is a form of temporal lobe epilepsy presenting with abdominal aura. Temporal lobe epilepsy is often idiopathic, however it may be associated with mesial temporal lobe sclerosis, dysembryoplastic neuroepithelial tumors and other benign tumors, arterio-venous malformations, gliomas, neuronal migration defects or gliotic damage as a result of encephalitis. When associated with anatomical abnormality, abdominal epilepsy is difficult to control with medication alone. In such cases, appropriate neurosurgery can provide a cure or, at least, make this condition easier to treat with medication. Once all known intra-abdominal causes have been ruled out, many cases of abdominal pain are dubbed as functional. If clinicians are not aware of abdominal epilepsy, this diagnosis is easily missed, resulting in inappropriate treatment. We present a case report of a middle aged woman presenting with abdominal pain and episodes of unconsciousness. On evaluation she was found to have an intra-abdominal foreign body (needle). Nevertheless, the presence of this entity was insufficient to explain her episodes of unconsciousness. On detailed analysis of her medical history and after appropriate investigations, she was diagnosed with temporal lobe epilepsy which was treated with appropriate medications, and which resulted in her pain being relieved.