Objective: To evaluate the effect of serum ionized calcium levels on the prognosis of severe sepsis patients. Methods: This retrospective cross-sectional study included sepsis patients who were hospitalized in an intensive care unit between January 2011 and December 2014. The demographic and baseline data of the patients who died and survived were compared. The cutoff value of ionized calcium for in-hospital mortality was determined by the receiver operating characteristics curve (ROC). In-hospital mortalities and the survival rates were compared between patients with different ionized calcium levels. Besides, the risk factor of in-hospital mortality was determined. Results: This study included 145 patients with 113 patients who died in the hospital. The patients who died had significantly lower ionized calcium levels (U=2.25, P=0.034). A cut-off value of 0.93 mmol/L of ionized calcium was determined by the ROC curve. The patients with ionized calcium>0.93 mmol/L showed a significantly lower morality (χ²=9.90, P=0.002) and higher survival rate than with ≤0.93 mmol/L (log rank=6.20, P=0.010). Multivariate Cox regression revealed that ionized calcium ≤0.93 mmol/L was a risk factor of in-hospital mortality. Conclusions: Ionized calcium level≤0.93 mmol/L was an independent predictor of in-hospital mortality of severe sepsis.

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Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 has become a pandemic disease. It also increases the risk of co-infections. Mucormycosis is a severe fungal infectious disease and its causative agent, mucormycetes, belongs to an opportunist fungus Mucoraceae family. Mucormycosis in COVID-19 patients with mucormycosis presents an additional challenge worldwide. Mucormycosis shares certain risk factors and signs and symptoms with COVID-19. In this review, we summarize manifestations and risk factors of mucormycosis and COVID-19.

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Objectives: To present our experience in delivering endovascular therapies for emergent vascular traumas with various vascular structures. Methods: Between September 2013 and February 2018, patients who underwent endovascular intervention due to penetrating, blunt and iatrogenic arterial traumas were analyzed, retrospectively. Demographic data, trauma site, mechanism of injury, angiographic findings or arterial injury patterns, treatment methods, and outcomes were recorded. Results: A total of 30 patients were included. The mean age of patients was 39 years (range: 15-87 years). Arterial trauma locations were in the compressible area with a rate of 43% (n=13) and in the noncompressed area with a rate of 57% (n=17). Mechanisms of injuries were blunt [53% (n=16)], penetrating [17% (n=5)], and iatrogenic [30% (n=9)]. The most common indication for endovascular treatment was blunt noncompressible injury (n=12). Methods used for treatment were stent-graft (46%, n=14) and coil embolization (54%, n=16). Immediate success was obtained in all procedures. The mean follow-up duration was 5 months (range: 1-12 months). Conclusions: Endovascular treatments performed in traumatic arterial emergencies are effective and minimally invasive with very low complication rates even in hemodynamically unstable patients.

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Objective: To report demographic and injury characteristics of tendo-Achilles (TA) injury, and determine its association with the use of Indian style commode seat (ISCS), the clinical and functional outcomes. Methods: This observational study was conducted between 1 January 2016 and 31 December 2019, and a total of 44 patients with TA injury were included in the study. Their demographic profile, etiology, operative details, and functional outcomes were studied. All patients underwent primary repair followed by standard postoperative management and follow-up for 6 months. Results: Out of 44 patients, 7 (15.9%) sustained closed injuries while 37 (84.1%) sustained open injuries. In open injury cases, 30 (81%) patients suffered an injury due to slipping in ISCS, 4 (11%) from road traffic accidents, and 3 (8%) due to falling of a heavy object. Besides, 20.45% of cases of ISCS injury had associated neurovascular injury. Twenty (45%) patients took more than 90 days to start independent ambulation. At 6 months follow-up, no one could reach pre-injury fitness status. Conclusions: Open TA injury by ISCS is an important, under-reported, and preventable cause of loss of physically active manpower in institutional setups.

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Objective: To investigate the effect of the use of color codes for patient triage on physicians’ clinical decision. Methods: This prospective study was conducted among female patients aged 18-65 years who visited the emergency department (ED) with complaints of acute abdominal pain. A 3-level of triage system [red (very urgent), yellow (urgent) and green (less urgent)] was used in our ED. All patients were green level. Half of these patients remained at the green level (the green group), and the remaining patients were re-labeled as false yellow (the false yellow group) in the order of ED visits. Ordering tests, consultation requests, intravenous treatment, length of hospital stay, and cost were compared between the two groups of patients. Results: In total 393 patients were included with 198 patients in the green group and 195 in the false yellow group. There was no statistically significant difference between the two groups in age, temperature, systolic blood pressure, diastolic blood pressure, pulse and oxygen saturation (P>0.05). It was observed that more tests (P=0.001), consultations (P<0.001), and intravenous treatment were requested (P<0.001), and the duration of stay in the ED was longer (P<0.001) and cost (P<0.001) was higher in the false yellow group. Conclusions: Triage do affect the decisions of physicians on female patients with acute abdominal pain.

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Rationale: Dengue fever is a prevalent tropical infectious disease that has a broad panorama of presentations from mild febrile illness to life-threatening manifestations in the form of dengue hemorrhagic fever and dengue shock syndrome. Patient’s concerns: A 20-year-old male presented with a 2-day history of fever, multiple episodes of vomiting, and altered sensorium. Diagnosis: Dengue fever leading to acute hemorrhagic leukoencephalitis. Interventions: Multiple transfusions of single donor platelets, intravenous methylprednisolone, intravenous immunoglobulin, anti-seizure prophylaxis, and broad-spectrum antibiotics. Outcomes: Repeat brain magnetic resonance imaging showed resolution of lesions. The patient was subsequently discharged from the hospital in a healthy state. Lessons: This report helps us to gain a better understanding of the patient’s presentation, which will help to improve the timely recognition and prevention of this rare devastating presentation.

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Objectives: To determine COVID-19 mortality and its risk factors in hospitalized patients at of a tertiary care center in north India. Methods: A retrospective observational study was conducted of patients who were hospitalized from May 2020 to January 2021. The in-hospital mortality was assessed, and demographic variables and comorbidities between COVID-19 deaths and survivors were compared. Results: A total of 24 000 patients were admitted during the study period, among which 17 000 had shown positive results of the RT-PCR test for COVID-19. The total mortality was 329 patients (1.37%), among which 232 (70.52%) succumbed due to COVID-19, and 97 (29.48%) died due to other illnesses. The mean age of the patients was (64.09±16.99) years. The mean age was significantly higher in COVID-19 related deaths [(67.63±13.78) years] as compared to that of the survivors [(60.52±19.5) years] (P<0.001). Compared to COVID-19 survivors, there were more males (72.41% v.s. 61.5%) and less females (27.59% v.s. 38.5%) in COVID-19 related deaths (P=0.001). Comorbidities such as hypertension, diabetes mellitus, and chronic kidney disease showed a significant correlation with COVID-19 mortality with an adjusted odds ratio of 2.389 (95% CI: 1.465-2.982), 3.891 (95% CI: 2.059-5.392), and 6.358 (95% CI: 5.675-10.564), respectively. Conclusions: Elderly males with comorbidities have higher risk for mortality related to COVID-19. Ongoing vaccination drive is rightfully prioritised to serve the high-risk category first.

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Rationale: COVID-19 has a wide range of clinical presentations requiring a high index of suspicion for diagnosing patients presenting with extrapulmonary manifestations. Among them, patients with cardiovascular involvement have a high mortality. Patient’s concerns: A 50-year-old male patient with COVID-19 infection presented with multiple syncopal episodes, myalgia, and mild respiratory symptoms. Diagnosis: Mild COVID-19 infection with complete heart block. Interventions: Temporary pacing followed by permanent pacemaker insertion 10 days after the onset. Outcomes: The patient was managed as per COVID-19 protocol in an isolation ward, and his condition improved but remained pacemaker dependent until a repeat RT-PCR for COVID-19 tested negative, after which he was shifted back to the cardiac care unit for permanent pacemaker insertion. The patient was discharged after inflammatory markers were normal and clinical condition was completely stable. Lessons: COVID-19 has a wide range of clinical presentations, and extrapulmonary manifestations, especially, cardiovascular involvement can not be ignored.

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