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Introduction COVID-19 is primarily a pulmonary disease, but with significant and frequent systemic manifestations. Our study aims to assess, which scoring system on admission—Confusion, Uraemia, Respiratory Rate > 30/min, Blood Pressure low, Age > 65 years (CURB-65) or SOFA, better correlates with COVID-19-positive patient mortality. Methodology This prospective observational study was conducted in COVID-positive adult patients. Upon admission, patient demographics, clinical condition and laboratory investigations were noted. SOFA and CURB-65 scores were calculated for each patient and the patient was followed up till the final outcome—transfer or expiry. Results Out of the 100 patients included in our study, the majority belonged to the age group of 41–60 years, with a mean age of 51 years. A significant proportion of patients (83%) had at least 1 pre-existing co-morbidity. The absence of co-morbidity showed an association with improved survival. The overall mortality rate was 46%. Baseline SOFA and CURB-65 scores showed a correlation with patient outcome, but SOFA showed a greater strength of association. It was found that at a cut-off of a total SOFA score of ≥4, it predicts patient expiry with a sensitivity of 89% and a specificity of 72%. Discussion CURB-65 is a scoring system used for severity assessment, guide therapy and prognostication of patients with lower respiratory tract infection or pneumonia. SOFA, on the other hand, is an ICU score used in multi-system diseases used for evaluating disease progression and prognostication. Many authors have found that SOFA score correlates well with patient outcome, and a high SOFA on admission usually indicates poor prognosis.

Background Nutritional risk in patients with coronavirus disease (COVID-19) admitted in intensive care units (ICU) is less researched. We planned a prospective trial to determine the utility of Nutritional risk in the Critically ill (NUTRIC) and modified NUTRIC (mNUTRIC) scores in such cases. Materials and Methods Patient characteristics and data at admission of all 199 COVID-19 cases admitted to ICU were collected. Patients were divided into high- and low-risk nutrition groups using NUTRIC and mNUTRIC scores. These groups were compared in terms of 28-day ICU mortality, length of stay, calorie and protein intake, duration of ventilation, oxygen therapy, and problems of nutrition. Results When compared to low nutritional risk group, the high nutritional risk group (NUTRIC score ≥6) had higher mortality at 28 and 90 days (P < 0.001). High nutritional risk of mNUTRIC score (≥5) also had greater mortality at 28 and 90 days (P < 0.001) than the low-risk group. The high nutritional risk group had shorter hospital and ICU stays and needed more days of mechanical ventilation, according to both scores (P < 0.001). Patients in the high nutrition risk category also had more incidence of myocardial infarction, adult respiratory distress syndrome, renal replacement requirement, and vasopressor use. The sensitivity and specificity of NUTRIC score were 75 and 86.5%, respectively, as compared to 82.5 and 79% of mNUTRIC. Conclusion The mortality at 28 and 90 days was greater in COVID-19 patients with high nutritional risk as measured by NUTRIC and mNUTRIC scores with both the scores performing equally well.

Background Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine, and 1.5% lignocaine for FNB in fracture femur patients. Methods Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction. Results Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P

Background: Globally critically ill COVID-19 (Coronavirus disease-19) patients have stretched critical care services. This study was undertaken to find factors implicated in mortality amongst COVID positive and negative patients presenting with severe acute respiratory illness (SARI) and factors having the probability of indicating COVID positivity. Methods: The demographic parameters, comorbid illness, clinical parameters and laboratory values of 327 patients were retrospectively analyzed to find the risk factors for mortality in COVID positive and negative patients and factors predicting COVID positivity amongst SARI patients. Results: 58% of SARI patients tested positive by RTPCR. Most common comorbidities were diabetes and hypertension, 35.2% and 33% respectively. Duration of swelling and low haemoglobin were significantly associated with mortality in COVID positive group (p=0.01, 0.005). Acidosis and tachycardia (p=0.003, 0.034) were associated with mortality amongst COVID negative. Creatinine, Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) were higher in non-survivors of both groups (p

Background: Conduct of stable inhalational anesthetic induction in children with congenital heart disease (CHD) presents special challenges. It requires in-depth understanding of the effect of congenital shunt lesions on the uptake, delivery, and equilibration of anesthetic drugs. Intracardiac shunts can alter the induction time and if delivery of anesthetic agent is not carefully titrated, can lead to overdosing and undesirable myocardial depression. Aims: To study the effect of congenital shunt lesions on the speed of inhalational induction and also the impact of inhalational induction on hemodynamics in the presence of congenital shunt lesions. Setting: Tertiary care hospital. Design: A prospective, single-center clinical study. Materials and Methods: Ninety-three pediatric patients undergoing elective surgery were segregated into three equal groups, namely, Group 1: no CHD, Group 2: acyanotic CHD, and Group 3: cyanotic CHD. General anesthesia was induced with 8% sevoflurane in 6 L/min air-oxygen. The time to induction was noted at loss of eyelash reflex and decrease in bispectral index (BIS) value below 60. End-tidal sevoflurane concentration, minimum alveolar concentration, and BIS were recorded at 15 s intervals for the 1 st min followed by 30 s interval for another 1 min during induction. Hemodynamic data were recorded before and after induction. Results: Patients in Group 3 had significantly prolonged induction time (99 ± 12.3 s; P < 0.001), almost twice that of the patients in other two groups (51 ± 11.3 s in Group 1 and 53 ± 12.0 s in Group 2). Hypotension occurred after induction in Group 1. No other adverse hemodynamic perturbations were observed. Conclusion: The time to inhalational induction of anesthesia is significantly prolonged in patients with right-to-left shunt, compared to patients without CHD or those with left-to-right shunt, in whom it is similar. Sevoflurane is safe and maintains stable hemodynamics in the presence of CHD.

Background: Nosocomial infections (NIs) in the postoperative period not only increase morbidity and mortality, but also impose a significant economic burden on the health care infrastructure. This retrospective study was undertaken to (a) evaluate the incidence, characteristics, risk factors and outcomes of NIs and (b) identify common microorganisms responsible for infection and their antibiotic resistance profile in our Cardiac Surgical Intensive Care Unit (CSICU). Patients and Methods: After ethics committee approval, the CSICU records of all patients who underwent cardiovascular surgery between January 2013 and December 2014 were reviewed retrospectively. The incidence of NI, distribution of NI sites, types of microorganisms and their antibiotic resistance, length of CSICU stay, and patient-outcome were determined. Results: Three hundred and nineteen of 6864 patients (4.6%) developed NI after cardiac surgery. Lower respiratory tract infections (LRTIs) accounted for most of the infections (44.2%) followed by surgical-site infection (SSI, 11.6%), bloodstream infection (BSI, 7.5%), urinary tract infection (UTI, 6.9%) and infections from combined sources (29.8%). Acinetobacter, Klebsiella, Escherichia coli, and Staphylococcus were the most frequent pathogens isolated in patients with LRTI, BSI, UTI, and SSI, respectively. The Gram-negative bacteria isolated from different sources were found to be highly resistant to commonly used antibiotics. Conclusion: The incidence of NI and sepsis-related mortality, in our CSICU, was 4.6% and 1.9%, respectively. Lower respiratory tract was the most common site of infection and Gram-negative bacilli, the most common pathogens after cardiac surgery. Antibiotic resistance was maximum with Acinetobacter spp.

Infective endocarditis is a rare occurrence in the main pulmonary artery trunk and even rarer in tetralogy of Fallot.

Background: Clonidine diminishes stress response by reducing circulating catecholamines and hence increases perioperative circulatory stability in patients undergoing laparoscopic surgeries. The aim of this study was to compare intravenous (IV) clonidine (2 μg/kg) with intramuscular (IM) clonidine (2 μg/kg) for attenuation of stress response in laproscopic surgeries. Methods: Eighty adult patients classified as ASA physical status I or II, aged between 20 and 60 years undergoing elective cholecystectomy under general anesthesia were enrolled for a prospective, randomized, and double-blind controlled trial. They received either IV clonidine (2 μg/kg) 15 min prior to the scheduled surgery (Group I) or IM clonidine (2 μg/kg) 60-90 min prior to the scheduled surgery (Group II). Hemodynamic variables (Heart rate, systolic (SBP), diastolic (DBP), mean arterial pressure (MAP)), SpO 2 and EtCO 2 were recorded at specific times - baseline, prior to induction, 1 min after intubation, before CO 2 , insufflation, after CO 2 insufflation at 1,5,10,20,30,45,60 min, after release of CO 2 , at 1 and 10 minutes after extubation. Secondary outcomes included evaluation of adverse effect profile of the two groups. Results: No significant difference was observed in the HR throughout the intraoperative period in between the two groups (P>0.05). There was statistically significant difference in SBP between the two groups starting from 1 minute after induction till 1 min after extubation (P