Indian Journal of Emergency Medicine

A 10-year old child presented to ED with pain and swelling over the right ankle for 2 days H/O right ankle twist 3 days back and the patient had undergone traditional Indian medicine treatment (desi massage) No H/O Juvenile arthritis or vasculitis Outside X-ray suggestive of – no obvious bony abnormality MRI Right ankle joint done in ED which showed diffusely altered calcaneal signal, osteomyelitis large associated collections in the adjacent tissue Partial tear of the plantar fascia at its calcaneal attachment laterally.

COVID-19 (coronavirus disease-2019) infection may be a extremely prothrombotic state, ensuing from a dysregulation of the coagulation cascade. Therefore, thromboprophylaxis is powerfully suggested in these patients, with some consultants even advocating for therapeutic dosing to forestall thromboembolic events. Heparin-induced blood disorder (HIT) may be a well-known complication of heparin therapy. during this article, we tend to report a case of HIT in a patient with COVID-19. A 52-year-old male with history of one week of dry cough and loose stools. He had a positive COVID-19 reverse-transcriptase–polymerase chain reaction. On admission, the platelet count and liver function test were within normal limits. Throughout his hospitalization, he developed a right femoral deep venous thrombosis and was started on therapeutic anticoagulations. Due to worsening respiratory failure, he was intubated and mechanically ventilated. Between days eight and nine of hospitalization, platelet count decreased from 294000 to 89000 cells/μL. He had a high pretest likelihood for HIT with a 4T score of 6 and a positive anti-PF4/ heparin antibody. Heparin drip was interrupted and was switched to Argatroban. The serotinin assay eventually came back positive, that confirmed the diagnosis of HIT.

A 46 years old ladycame to ED with c/o B/L progressive loss of vision since 6 days associated with intermittent headache. With Left eye perception of hand movements at 10 inches. With Right eye she can see objects about 5 meters but unable to identify color and face MRI orbit contrast/MRI brain contrast s/o B/L optic neuritis with subtle T2/flair hyperintense signal is seen in the periaqueductal region, ? artefactual, ? changes of NMO/NMOSD Hematology report revealed anti MOG antibodies:Positive Visual Evoked Potential(VEP) suggestive ofB/L demyelinating anterior visual pathway defect ANA and vasculitic panel negative. Ophthalmo opinion revealed B/ Lpapilloedema.

The Coronavirus Pandemic began in China in December 2019. In a short time, this pandemic spread globally. World has been challenged by SARS COV-2, a new virus causing pneumonia and acute respiratory distress syndrome. There is lack of literature implicating COVID-19 in Pancreatitis, yet virus is generally understood to be a cause of pancreatitis in children. We present a case of previously well 12-year-old girl who presented to emergency department with a chief complain of abdominal pain, anorexia and bilious vomiting. She was diagnosed with acute pancreatitis with an abnormal lipase, ultrasound and computed tomography and was found to be COVID-19 positive by polymerase chain reaction. Our case suggest that in current pandemic, consideration for SARS COV2 testing in children with gastrointestinal symptoms and pancreatitis may be considered. Additionally, this case highlights the need for appropriate personal protective equipment for providers, even when COVID is not initially on the differential.

Introduction: The majority (about 75%) of cases of stroke occur in people over the age of 65 years and about one-third of patients die of stroke within a year of onset. Over half of survivors remain dependent on others for everyday activities, often with significant adverse effects on caregivers. Medical complications after acute stroke may adversely impact outcome and in some cases may be preventable. Limited data exist regarding the frequency of such complications occurring in the first days after the ictus and the relationship of these complications to outcome.

Methodology: All selected patients were studied for post stroke pulmonary complications mainly pneumonia, mechanical ventilation, respiratory depression, it sincidence, age, gender distribution and its association with the site of lesion (i.e Anterior vs Posterior),type of lesion(infarct vs bleed), Severity of the stroke if measured by NIHSS scoring system.

Results: Among smokers 9 out of 29 patients have developed pneumonia that is 47%. But this finding did not show statistical significance. Among 24 Alcholics 13 patients developed pneumonia with 54% association. but no statistical significance. Diabetic and hypertensives, did not show any significant association with pneumonia and statistical significance.

Conclusion: With other risk factors, there was more incidence of developing pneumonia. but there was no statistical significance and so these are no independent risk factors for pneumonia.

Introduction: When the air passes through the nasal cavity and pharynx, it gets warmed and takes up water
vapour. And it passes down the trachea and through bronchioles, respiratory bronchioles and alveolar ducts to the
alveoli. Between the trachea and the alveolar sacs, the airway divides 23 times forming 23 generations. The first 16
generations form the conducting zone of the airways made up of bronchi, bronchioles and terminal bronchioles.
The remaining 7 generations from the transitional and respiratory zones where gas exchange occur and are made
up of respiratory bronchioles, alveolar ducts and alveoli.
Methodology: Information will be collected through a pre tested and structured proforma for each patient Qualifying
patients will be undergoing detailed history, clinical examination, routine investigations like FBS, PPBS, HBA1c,
fundus evaluation and spirometric evaluation using a easy one flow spirometer Glycemic control is taken as HBA1C
below 7.5 and HBA1C more than 7.5 is considered as uncontrolled sugars.
Results: Group 1 had 15 patients with uncontrolled sugars i.e HbA1c of more than 7.5 Group 2 had 26 patients with
HbA1c of more than 7.5, out of 70 patients of type 2 DM, 41 (58.6%) patients had HBA1C of more than 7.5.
Conclusion: Diabetes mellitus leads to increased hepatic glucose output. First, liver glycogen stores are mobilised
then hepatic gluconeogenesis is used to produce glucose. Insulin deficiency also impairs non-hepatic tissue
utilization of glucose, particularly in adipose tissue and skeletal muscle, insulin stimulates glucose uptake.

Introduction: Stroke is the second most common cause of death worldwide and a frequent cause of adult disability in developed countries. Stroke burden on families and society is projected to rise from approximately 38 million disability-adjusted life years (DALYs) lost globally in 1990 to 61 million DALYs in 2020 due to population ageing.

Methodology: A total of 100 consecutive stroke patients who got admitted in Medical ICU, medical step down of our hospital and met inclusion criteria and exclusion criteria were studied prospectively over a period of 12 months.

Results: As per our study results, stroke associated pneumonia is found to be the most common pulmonary complication of the stroke next followed by mechanical ventilation. Stroke associated pneumonia is most commonly observed in posterior circulation strokes, Infarcts and in patients who required mechanical ventilation.

Conclusion: Stroke incidence is most commonly seen in the age group of 51-70yrs, male sex, anterior circulation stroke, infarctions are more common in our study.

Background: Rodenticide consumption is one of the most common suicidal poisoning. The compounds vary in their chemical composition, mechanism of action, lethal dose and effects. Absence of a specific antidote along with rapid deterioration to multi organ failure has escalated the mortality. This study is intended to predict the clinical profile and the outcome of patients presenting to the ER of a tertiary care center in South India with acute rodenticide poisoning.

Methods: A retrospective cross sectional analysis of all acute rodenticide poisoning cases presented to the ER of a tertiary care centre in south India during the period between 1st January 2018 to 1st December 2019 after fulfilling both inclusion and exclusion criteria was done. The clinical profile and outcome of patients presenting with acute rodenticide poisoning were assessed.

Results: A total of 39 patients were included in the study population, of which 18(46.2%) were females and 21 (53.8%) were males. The mortality associated with rodenticide poisoning is 33.3%. Out of the 39 patients, 21 patients had acute liver failure , 16 had met the Kings college criteria for liver transplant, but liver transplant was done in only 2 patients and out of which 1 survived. On detailed analysis,two parameters SGOT, SGPT and the presence of hepatic encephalopathy correlate with mortality.

Conclusion: The study revealed that, the mortality associated with rodenticide poisoning is high (33.3% ) and certain factors like SGOT, SGPT and the presence of hepatic encephalopathy are strong predictors of mortality in acute rodenticide poisoning.

Introduction: Pulmonary function tests (PFTs) is a generic term used to indicate a battery of studies or manoeuvres that may be performed using standardized equipment to measure lung function. PFTs can include simple screening spirometry, formal lung volume measurement, diffusing capacity for carbon monoxide, and arterial blood gases. These studies may collectively be referred to as a complete pulmonary function survey.

Methodology: Information was collected through a pre tested and structured proforma for each patient Qualifying patients will be undergoing detailed history, clinical examination, routine investigations like FBS, PPBS, HBA1c, fundus evaluation and spirometric evaluation using a easy one flow spirometer. Glycemic control is taken as HBA1C below 7.5 and HBA1C more than 7.5 is considered as uncontrolled sugars Diabetic patients of different durations are selected Using criteria laid down.

Results: In our study, 2(10%)patients with HBA1C <7.5 had restrictive pattern and out of 15 patients with HBA1C of more than 7.5, 10(20%) patients had restrictive pattern in group 1 where as in group 2, 6 patients with HBA1C >< 7.5 had restrictive pattern and out of 26 patients with HBA1C >7.5, restrictive pattern was seen in 21 patients in group 2.

Conclusion: Spirometry is the most commonly used lung function screening study. It generally should be the clinicians first option.