Indian Journal of Emergency Medicine

The Coronavirus Pandemic began in China in December 2019. In a short time, this pandemic spread globally. This virus has been called the 2019 new coronavirus (2019-nCoV) by the World Health Organization. The characteristic features/symptoms of Covid-19 are fever, cough, shortness of breath, abdominal pain, myalgia, sore throat, loss of smell and taste, diarrhoea, chest pain other possible symptoms. The characteristics features on Chest xray/CT chest are subpleural localized ground glass opacities and numerous irregular areas of consolidation in both lungs and especially in the lower lobes. Pneumothorax and Subcutaneous emphysemaremains a relatively rare sequelae indicating a rate of 1%. In this case report, we aim to present a case of Covid-19 positive patient with cough, high fever and breathlessness who later developed pneumothorax in the left hemithorax and subcutaneous emphysema. It should be kept in mind that in patients with Covid-19 pneumonia, pneumothorax secondary to lungparenchymal damage may occur. Mortality rates can be reduced in patients with early diagnosis and treatment.
Keywords: Covid 19 Patients; Sequele of Events in 2019.

Eosinophilic gastroenteritis (EGE) is a rare disease characterized by eosinophilic infiltration and peripheral eosinophilia. It can be seen anywhere in the gastrointestinal tract. It is diagnosed in the biopsies taken during endoscopic examination of the patients with abdominal pain and chronic diarrhoea. A 22 years old Female patient is having Gastroesophageal reflux disease (GERD) presented with complaints of painin abdomen,centrally located,diffuse in nature,pain exacerbate with food and norelieving factor associated with nausea,vomiting and constipation.On examination abdomen was soft with diffuse tenderness. In this article we present a case of Pain abdomen associated with vomiting and constipation diagnosed as EGE.
Keywords: Gastroenteritis; Eosinophilic.

Introduction: Characteristics of patients presenting to Emergency Department (ED) are important in order to plan future strategies and improve quality assurance. However, very few tertiary hospitals routinely utilize the patient data to improve the quality of health care services. In this study we aim to analyse the characteristics of patients presenting to ED in a tertiary care hospital in India.

Methods: This retrospective observational study included 1124 adult patients presenting to the Emergency department from May, 2018 to August, 2019 at a tertiary care hospital in Mumbai. Patient demographic details, laboratory investigations and clinical outcomes were assessed.

Results: Out of 1124 patients, 899 were taken up for analysis wherein 61% were males and 39% were females. Fever (13.9%) was the most common complaint noted which was followed by abdominal pain (12.6%) and chest pain (11.1%). Of the total number of patients, 58%were managed successfully in the emergency room while 30.6%patients were admitted to wards and 10%patients were shifted to the ICU. The most common investigations conducted were blood glucose (31.6%), complete blood count (31.5%) and electrocardiography (31.4%). 42.05% patients were admitted to the hospital, 18% patients left against medical advice, while more than a quarter of patients (37.05%) were discharged and 1.45% patients succumbed to death.

Conclusion: Demographic and characteristic data obtained through the hospital’s information management system, provided a holistic snapshot of patients visiting the emergency department which will help us in carving out strategies in regulating the ED training programmes, planning adequate infrastructure and developing faculty resources.

Introduction: In Diabetes mellitus, it is observed that there will be an increase in plasma glucose levels because of the failure in inhibition of hepatic glucose production in combination with reduction in uptake by tissues especially muscles. These occur due to combination of insulin resistance and inadequate insulin secretion by both liver and muscle failure to suppress plasma glucose. Methodology: Data was entered using MS Excel (2010) and statistical analysis was done using SPSS software version 16. Statistical analysis was done by using percentages, mean values and standard deviation. All statistical analysis was carried out at 5% level of significance and p value <0.05 was considered as significant. Results: The mean haemoglobin value was 11.11±1.94 g%. The fasting blood sugar and the post prandial blood sugar mean values were 157.52 ± 47.52 mg/dl and 226.34±56.93 mg/dl respectively. The HbA1c mean value was 7.94±0.54%. The serum creatinine and blood urea levels were 0.98 ±0.26 mg/dl and 31.28±12.56 mg/dl respectively. Conclusion: Out of 90 patients, 47(52.2%) of patients were on OHA treatment and 43(47.8%) patients were on insulin.
Keywords: Diabetes mellitus; HbA1c; OHA.

Background: Corona Virus disease 2019 (COVID-19) related lockdown has affected the health sector in many ways. In this study we have analysed the impact of lockdown on emergency admissions. Aim: To compare the trend and number of claims for medical and surgical emergencies during the lockdown period 1.0 and 2.0 from 25th March to 3rd May 2020 with the same period in 2019. Methods: All the claims for medical and surgical emergencies from 25th March 2020 to 3rd May 2020 were compared with the similar data for the same period in 2019. This study was performed sourcing the data from the database of Star Health Insurance medical claims platform. ICD-10 codes (59 medical and 57 surgical) were chosen for common medical and surgical emergencies. The results were expressed as percentage of total claims and statistical analysis was performed with Chi square test (Graphpad Prism version 7). Results: Number of medical emergency claims dropped significantly by 61% during lockdown period 2020 (1899) compared to the same period in 2019 (4900). Cardiac emergencies dropped by 58%; strokes by 58% and gastrointestinal emergencies by 50%. Surgical emergencies dropped significantly by 78% (Non-traumatic emergencies by 67%; Traumatic emergencies by 89%). In 2019 proportion of (medical+surgical) emergencies/ total claims was 10413/68480 (15.2 %) and this dropped significantly to 3138/28767 (10.9%) in 2020 (p=0.0001). Conclusions: Both non traumatic surgical and medical emergencies dropped significantly during lockdown. The reasons for such drop in emergencies are worth analysing further.
Keywords: Covid-19; Emergency; Admissions; Insurance.

Introduction: The association of coronary heart disease and DM is well known, but epidemiologic and clinical data from the last 2 decades reveal heart failure also to be a major contributor to cardiovascular morbidity and mortality in patients with DM and also develop congestive heart failure even in the absence of coronary heart diseases, hypertension or any known structural heart disease. Methodology: Written informed consent was taken from all the patients who were recruited in the study. Data was collected in the case proforma which included clinical examination. Relevant investigations were carried out and recorded. Results: The chest X-ray of patients, 4(4.4%) showed COPD, 7(7.8%) showed pneumonia and rest all patients had normal chest X-ray. ECG was reported as normal in all the patients 90(100%). Urine routine was reported as normal in 73(81.1%) of patients. Conclusion: Out of all the diastolic parameters statistically significant difference was observed in ‘A’ velocity, E/A ratio and DT parameters.
Keywords: Left Ventricular Diastolic Dysfunction; Diabetes Mellitus; DM.

Background: Platelets play a pivotal role in both hemostasis and thrombosis. Mean platelet volume (MPV) is a measure of the average size of your platelets. Mean platelet volume (MPV) has been found to be an independent risk factor in western populations and also from Indian Data. Aims: To investigate whether there is association between Mean Platelet Volume (MPV) and Cardiac Troponins (C Tn I ) in patients admitted with suspected case of Myocardial infarction. To Assess the potential efficiency of MPV in the diagnostic workup of Myocardial infarction. Methodology: 100 patients admitted in SDM Medical College and Hospital casualty and CCU of Narayana Hrudayala were included in this study after taking informed consent. Results: In our study, we found that only 5 % of patients has MPV Value more than 11.5 out of 100 patients, 20 % of patients has MPV value more than 10. It is observed that it MPV is higher in males with mean value of 9.27 compared to females which is 8.946.where as Troponin-I is higher in females with mean value 5.089 in comparison with females which is 5.303. Conclusion: Mean platelet volume (MPV) has been found to be an independent risk factor in western populations and also from Indian Data. Hence we thought it appropriate to look at this parameter in Indian patients with history of MI or CAD.
Keywords: Myocardial Infarction; Mean Platelet Volume; Troponin.

Introduction: Elevated serum Uric Acid levels have been observed in clinical conditions associated with hypoxia. Cell death can cause accumulation of purine bodies and hence hyperuricemia. Increased activation of Xanthine Oxidase can be caused by tissue hypoxia, which itself is a consequence of vascular (and cardiac) dysfunction. Methodology: A detailed history was taken including past or current morbidities. A structured clinical examination and the laboratory investigation profile of the subjects was recorded on a predesigned proforma. Height was measured by a Stadiometer, weight was recorded using a spring based weighting scale. BMI was calculated using formula of BMI = Weight (in kg)/ Height (in metre2). Results: Serum Uric Acid level (SUA) estimation done in our study group of 85 patients diagnosed as congestive heart failure showed the following results – Patients with SUA <5 mg/dl consisted of 8.2% of the study group (n=7); patients with SUA 5.1–7 mg/dl consisted of 28.2% of the study group (n=24); the maximum number of patients had their SUA 7.1–9 mg/dl contributing 44.7% of the study group (n=38); whereas those with SUA >9 mg/dl contributed 18.8% of the group (n=16). Conclusion: Thus, a total of 49 patients (65.33%) had hyperuricemia. The mean SUA was 7.68 ± 2.26 mg/dl.
Keywords: Serum Uric Acid; Heart failure; Hyperuricemia.

Introduction: Heart failure is third most common cardiovascular disease in the US affecting 2 per cent of the U.S. population, or almost 5 million people. The prevalence of heart failure increases with the age from less than 1 per cent in the 20 - 39-year-old age group to over 20 per cent in the people age 80 year or older. The life time risk of developing heart failure is estimated at about 20 per cent both in men and women. Methodology: The target population consisted of patients of either sex diagnosed as Congestive Heart Failure according to the Framingham Criteria for Congestive Heart Failure, either admitted to the In-Patient Department (IPD) or visiting the out-patient department. They were contacted, explained about the purpose of study and requested for enrolment. They were provided with a patient information sheet either in Kannada, Hindi or English. Results: The mean arterial blood pressure was subsequently measured and patients were divided into two categories – Normal (70-105 mg/dl) and Hypertensives(>105 mg/dl). Conclusion: The mean value of MABP in the study group was 96.43 ± 12.38 mmHg with a median value of 95 mmHg. In the study group, 78.67% patients had normal MABP (70-105 mg/dl) while 21.33% patients had high MABP (> 105 mmHg).
Keywords: Heart failure; MABP; Hypertensive.

Trauma is a major problem in India with severe and wide-ranging consequences for individuals and society as a whole, particularly in light of rapid development and increasing motorization. Emergency management of trauma in rural India is at a primitive stage of development. Emergency medical services are yet to be legally regulated. There is lack of trauma care related infrastructure, self-motivation, standard training, education and operating protocols. Results: Males were 155 (77.5%), females 45(22.5%). M: F ratio of (3.4:1). There was significant preponderance of male victims in our study. Patients were of the age group between 3 to 80 years with means age of 36.65 and median 31 years. Youngest patient studied was 3 and eldest 80 years old. 152(76%) were married and 48(24 %) unmarried. Married to un-married ratio was (3.16:1 Educational status of the victims showed that 64(34%) of injured belonged to formally un-educated class Commonest mode of injuries, 93(46.5%) were due to fall from height, 2nd being 62(31%) road traffic accidents (RTAs). Mode of injury had no statistical significance to injury severity or severity of neuro-trauma in our study. Family members accompanied 119 out of 200 (59.5%). 183(91.5%) were transported by common means of local non-ambulance transportation. Time interval from pack and go of the victim from its place near the incident to arrival in our emergency room was considered care delay. Care delay of the study patients showed that only 65(32.5%) patients reported to our hospital within one (Golden) hour and about two third, 135(62.50%) reported after one (Golden) hour. Study of the pre-hospital life support-stabilization showed that only 53(26.5%) out of 200 patients received some elementary first aid before arriving to our hospital. Incidence of accidents was slightly more in country side 77(38.5%). Country side was mostly near to home. Road was second 62(31%) and home third 61(30.5%) location of injury. Poly-trauma and the Injury Severity Score (ISS) showed that 140(70%) out of 200 had 2 and 3 body regions injured, 36(18%) had more than 3 body regions injured and 24(12%) had only one body region injured. Higher scores were associated with worse outcome. Brain injury and neuro-trauma severity scaled by (3–15 point) Glasgow coma scale with severity score (0–4) showed that only 3(1.5%) study patients had severe brain trauma while 30(15%) had moderate brain trauma and 167(83.5%) had only mild to no neuro-trauma. Conclusion: The civilian population in northern rural Indian Kashmir is exposed to high levels of trauma and the principal cause of life-threatening injuries is blunt trauma and fractures. Our study shows that skids and falls from height, mostly falls from trees, buildings and hillocks and RTAs are the predominant causes of acute traumatic injuries. Increasing awareness and proper training of the field staff about pre-hospital management of trauma are the urgent need of the time.
Keywords: Northern rural frontier India; Demography and trauma epidemiology; Modes of injury; Injury
severity scoring; Emergency medical service.

Background: The coronavirus disease (COVID 19) pandemic, which originated in the city of Wuhan, China, has quickly spread to various countries including India. It has a range of clinical manifestations. There is still insufficient data on symptoms that easily help to identify mild and moderate cases which is necessary to contain the spread. Aims: In this study, we aim to identify the presenting symptoms of Category A (mild) and Category B (moderate) patients diagnosed to have COVID 19. Settings and Design: A prospective study was conducted in 56 adult patients with laboratory confirmed COVID 19 infection over a period of two months in a tertiary care centre in Bangalore, India. Methods and Material: Clinical data was collected from these patients and then they were classified into two categories: Category A which included the mild cases and Category B which included the moderate cases. Those with severe and critical illnesses were excluded from the study. Statistical Package for Social Sciences (SPSS) for Windows Version 22.0 Released 2013 was used to perform statistical analyses. Results: A total of 56 patients were included in the study of which of which 30 were males and 26 were females. Diabetes mellitus was the most common co morbidity. The most common clinical presentation among both the categories of patients were fever (85.7%) and cough (82.1%) followed by fatigue (78.6%), sore throat (58.9%), ageusia (33.9%) and anosmia (25%), headache (23.2%), vomiting (19.6%). Shortness of breath (88%) and chest pain (32%) were present mainly in the category B patients. Gastrointestinal symptoms (10.7%) were also reported in a few category A patients. Conclusion: Fever and cough were the most common findings among both the groups. Shortness of breath and chest pain were identified as symptoms of concern among the moderate cases of COVID 19 and hence these can help clinicians to predict the disease severity. Gastrointestinal symptoms present in those with mild disease even without respiratory symptoms was an important finding.
Keywords: COVID 19; Category; Mild; Moderate; Fever.