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ObjectiveLarge data on the clinical characteristics and outcome of COVID-19 in the Indian population are scarce. We analysed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma.DesignSecondary analysis of data from a Phase II, Open Label, Randomized Controlled Trial to Assess the Safety and Efficacy of Convalescent Plasma to Limit COVID-19 Associated Complications in Moderate Disease.Setting39 public and private hospitals across India during the study period from 22 April to 14 July 2020.ParticipantsOf the 464 patients recruited, two were lost to follow-up, nine withdrew consent and two patients did not receive the intervention after randomisation. The cohort of 451 participants with known outcome at 28 days was analysed.Primary outcome measureFactors associated with all-cause mortality at 28 days after enrolment.ResultsThe mean (SD) age was 51±12.4 years; 76.7% were males. Admission Sequential Organ Failure Assessment score was 2.4±1.1. Non-invasive ventilation, invasive ventilation and vasopressor therapy were required in 98.9%, 8.4% and 4.0%, respectively. The 28-day mortality was 14.4%. Median time from symptom onset to hospital admission was similar in survivors (4 days; IQR 3–7) and non-survivors (4 days; IQR 3–6). Patients with two or more comorbidities had 2.25 (95% CI 1.18 to 4.29, p=0.014) times risk of death. When compared with survivors, admission interleukin-6 levels were higher (p2/FiO2 ratio 10 (9.97, 3.65–27.13, p1.0 mg/L (2.50, 1.14–5.48, p=0.022), ferritin ≥500 ng/mL (2.67, 1.44–4.96, p=0.002) and lactate dehydrogenase ≥450 IU/L (2.96, 1.60–5.45, p=0.001) were significantly associated with death.ConclusionIn this cohort of moderately and severely ill patients with COVID-19, severity of illness, underlying comorbidities and elevated levels of inflammatory markers were significantly associated with death.Trial registration numberCTRI/2020/04/024775.

Background Psychogenic nonepileptic seizures (PNES), the commonest nonepileptic event, represent 20–30% of drug-resistant epilepsy. Correct identification of PNES avoids unnecessary hospitalization and exposure of antiepileptic drugs (AEDs), and helps implement appropriate psychological treatment. Long-term video-electroencephalography (LTVEEG) is the gold standard test to diagnose PNES. However, in a poor-resource country like India, hypothetically, short-term video-electroencephalography (STVEEG) may substitute it, as its usefulness is established in attack disorders. Objective The objective of this study was to evaluate effectiveness of STVEEG in PNES and to look into their clinical profile and outcome. Design/Methods Consecutive cases of PNES diagnosed with STVEEG or LTVEEG during 2015–16 (two years) were enrolled. All cases were followed for 12 months or more. Detailed clinical evaluation was done including demography, semiology, coexisting anxiety/depressive disorders, and seizure frequency at time of first diagnosis and follow-up. The PNES were classified as Type I hypermotor, type II hypomotor, and type III unclassified/mixed. Favorable outcome was defined as seizure freedom or > 50% reduction in seizure frequency while unfavorable outcome was defined as Results Among 57 patients with PNES [median age of onset 24 years (10–69 years), F:M ratio = 7:3)], STVEEG ± induction could record event(s) in 80.7% while the rest required LTVEEG to confirm diagnosis. Among 82 events analyzed, the mean ± 2 standard deviation (SD) duration of events was 5′14″ ± 13′4″. Sixty-two (75.6%) and 10 (12.1%) events were hypermotor and hypomotor respectively, while 10 (12.1%) were unclassified/mixed. Forty-five (79%) patients had pure PNES, while 12 (21%) had coexistent epilepsy. Forty-nine (86%) and 54 (94.7%) patients had statistically significant reduction of seizure frequency (favorable outcome), at 6 and 12 months of follow-up respectively, while the rest had an unfavorable outcome. Conclusions The STVEEG has a remarkably good yield in diagnosing PNES, and it may be used when LTVEEG is not feasible. However, further studies are needed to show if it can substitute LTVEEG in PNES.

Pulmonary involvement due to leptospirosis carries high case fatality rate and is the commonest cause of death due to leptospirosis. Immune mechanisms play a key role in the pathogenesis of leptospiral pulmonary haemorrhage. As other immune pulmonary haemorrhages due to non leptospiral causes are treated with plasma exchange and cyclophosphamide we evaluated their efficacy in patient with leptospiral pulmonary haemorrhage.Of the 602 confirmed patients of leptospirosis, 236 (39.2%) had pulmonary haemorrhage. Of these,144 had mild haemorrhage (acute lung injury score2.5) and were included in the study. One hundred and fourteen patients were given two cycles of plasma exchange, 24 h apart, 25 ml/kg body weight of plasma was removed in each cycle. Cyclophosphamide (20 mg/kg body weight) was given after the first plasma exchange cycle. The remaining 30 patients were not given this treatment, and used as control.In the control group only 5 (16.6%) patients survived while in the treatment group 70 (61.40%) patients survived. Thrombocytopenia was observed in 111 (77.08%) patients. Renal and hepatic involvement was seen but did not account for mortality. Minor complications were seen in group I patients after plasma exchange and cyclophosphamide treatment, but none were serious.Our findings showed that plasma exchange with immunosuppression improved survival in patients of pulmonary alveolar haemorrhage due to leptospirosis, suggesting that immune mechanisms play a key role in the pathogenesis of the disease.