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Background: Indo-US Masters in Emergency Medicine (MEM) certification courses are rigorous three-year emergency medicine (EM) training courses that operate as a partnership between affiliate hospitals or universities in the United States with established EM training programs and local partner sites in India. Throughout their 15 years of operation, these global training partnerships have contributed to the EM workforce in India. Our objective in this study was to describe Indo-US MEM program graduates, their work environments, and their contribution to the growth of academic EM and to the coronavirus disease 2019 (COVID-19) response. Methods: An electronic survey was created by US and Indian MEM course stakeholders and distributed to 714 US-affiliated MEM program graduates. The survey questions investigated where graduates were working, their work environments and involvement in teaching and research, and their involvement in the COVID-19 response. We consolidated the results into three domains: work environment and clinical contribution; academic contribution; and contribution to the COVID-19 response. Results: The survey response rate was 46.9% (335 responses). Most graduates reported working within India (210, 62.7%) and in an emergency department (ED) setting (304, 91.0%). The most common reason for practicing outside of India was difficulty with formal MEM certificate recognition within India (97, 79.5%). Over half of graduates reported dedicating over 25% of their work hours to teaching others about EM (223, 66.6%), about half reported presenting research projects at conferences on the regional, national, or international level (168, 50.5%), and almost all graduates were engaged in treating COVID-19 patients during the pandemic (333, 99.4%). Most graduates agreed or strongly agreed that they were satisfied with their overall MEM training (296, 88.4%) and confident in their ability to practice EM (306, 91.6%). Conclusion: Indo-US MEM graduates have made a notable contribution to EM in India through clinical service delivery, teaching, and research, even more essential in the context of the COVID-19 pandemic. The roles of these graduates should be acknowledged and can contribute further to expandEM specialty and systems development across India. [ABSTRACT FROM AUTHOR]

Background: High in-hospital mortality in sepsis patients remains challenging for clinicians worldwide. Early recognition, prognostication, and aggressive management are essential for treating septic patients. Many scores have been formulated to guide clinicians to predict the early deterioration of such patients. Our objective was to compare predictive values of quick Sequential Organ Failure Assessment (qSOFA) and National Early Warning Score 2 (NEWS2) with respect to in-hospital mortality. Methods: This prospective observational study was conducted in a tertiary care center in India. Adults with suspected infection with at least two Systemic Inflammatory Response Syndrome criteria presenting to the emergency department (ED) were enrolled. NEWS2 and qSOFA scores were calculated, and patients were followed until their primary outcome of mortality or hospital discharge. The diagnostic accuracy of qSOFA and NEWS2 for predicting mortality was analyzed. Results: Three hundred and seventy-three patients were enrolled. Overall mortality was 35.12%. A majority of patients had LOS between 2 and 6 days (43.70%). NEWS2 had higher area under curve at 0.781 (95% confidence interval [CI] (0.59, 0.97)) than qSOFA at 0.729 (95% CI [0.51, 0.94]), with P < 0.001. Sensitivity, specificity, and diagnostic efficiency to predict mortality by NEWS2 were 83.21% (95% CI [83.17%, 83.24%]); 57.44% (95% CI [57.39%, 57.49%]); and 66.48% (95% CI [66.43%, 66.53%]), respectively. qSOFA score had sensitivity, specificity, and diagnostic efficiency to predict mortality of 77.10% (95% CI [77.06%, 77.14%]); 42.98% (95% CI [42.92%, 43.03%]); and 54.95% (95% CI [54.90%, 55.00%]), respectively. Conclusion: NEWS2 is superior to qSOFA in predicting in-hospital mortality for sepsis patients presenting to the ED in India. [ABSTRACT FROM AUTHOR]

The study on age specific life table of Bombyx mori Linn. race NB4D2 x SH6 reared on leaves of mulberry (Morus alba) plant variety S-1 at two different temperatures viz. control temperature (25 ± 1 °C) with 75 ± 5% relative humidity and room temperature in the laboratory of Sericulture Research, Demonstration and Training Unit, Department of Entomology, College of Agriculture, Sardar Vallabhbhai Patel University of Agriculture & Technology, Meerut-250110 (Uttar Pradesh), India. Data revealed that Bombyx mori Linn. race NB4D2 x SH6 required 37 and 40 days to complete its life cycle at control temperature (25 ± 1 °C) with 75 ± 5% relative humidity and room temperature, respectively. At control temperature, the highest mortality 85.19 per cent was exhibited at 36th day followed by 49.06 per cent at 35th day and the lowest mortality 1.12 per cent was recorded on 5th day followed by 1.14 per cent on 6th day. In case of room temperature, the highest mortality 88.89 per cent was recorded at 39th day followed by 66.67 per cent at 38th day and lowest mortality 1.20 per cent was recorded at 8th day followed by 1.35 per cent at 15th day. There an initial drop in survivorship (lx) was seen followed by an intermittent steady decline with long pauses till the formation of adult and sharp decline was observed at adult stage in both the conditions viz., control temperature (25 ± 1 °C) with 75 ± 5% relative humidity as well as at room temperature till the end of generation. [ABSTRACT FROM AUTHOR]

Objectives: Emergency department (ED) length of stay (LOS) is defined as the time a patient is registered to the time the patient is shifted to a hospital bed or discharged. Increasing demand for quality emergency care has resulted in increased wait times due to demand and supply mismatch. It is perceived that longer LOS in the ED of critical patients leads to poor outcomes. Our goal was to study the impact of LOS in the ED on the patients who required critical care admissions. Methods: This was a retrospective study conducted in the ED of a tertiary center. Data were collected using electronic health records (EHR) for patients admitted to the intensive care units (ICUs). Patient's LOS in ED was divided into 0--4, 4--8, 8--12, 12--24, and >24 hours. ED LOS was calculated from the registration time to the time patient was handed over in the ICU. Patients were divided into four categories (1--4) based on their criticality. LOS in ED, mortality, and total hospital LOS were analyzed in the study. Results: Three thousand four hundred and twenty-nine patients were enrolled in the study. Mean age was 62.69 years (95% CI 62.11--63.26). A total of 42.09% (95% CI 40.5--43.8) were Category 1 patients. Overall mortality rate was 52.46% (95% CI 50.79--54.13). LOS of 48.15% (95% CI 46.54--49.88) patients in the ED was between 0 and 4 hours, 19.90% (95% CI 18.62--21.29) between 4 and 8 hours, 8.21% (95% CI 7.35--9.19) between 8 and 12 hours, 15.50% (95% CI 14.34--16.77) between 12 and 24 hours, and 8.13% (95% CI 7.27--9.10) >24 hours. Mortality for LOS of 0--4 hours was 51.30% (95% CI 48.89--53.70), 54.03% (95% CI 50.28--57.73) for 4--8 hours, 48.94% (95% CI 43.16--54.75) for 8--12 hours, 51.50% (95% CI 47.26--55.72) for 12--24 hours, and 60.57% (95% CI 54.73--66.13) for >24 hours. Conclusion: We concluded that the longer the critically ill patients are boarded in the ED, the higher is the chance for mortality. Processes should be implemented to ease the throughput from the ED. [ABSTRACT FROM AUTHOR]

The present investigations entitled "Development of IPM module for sustainable management of Diamondback moth (Plutella xylostella Linn.) and insecticide residues analysis in cabbage (Brassica oleracea Linn.)" was carried out during Rabi, 2018-19 and 2019-20 at White grub laboratory, Department of Entomology, Sardar Vallabhbhai Patel University of Agriculture and Technology, Meerut (U.P.), India. Maximum residue of Spinosad was 1.25 and 1.17 (ppm) found in module-6 fallowed by 1.23 and 1.19 (ppm) in module-4 during both Rabi, 2018-19 and 2019-20. Maximum residue of indoxacarb was 1.12 and 0.95 (ppm) found in module -2 fallowed by 1.14 and 1.02 (ppm) in module-4 during both Rabi, 2018 and 2019. Maximum residue of Lambda-cyhalothrin was 0.13 and 0.11 (ppm) found in module-5 fallowed by 1.14 to 0.13 (ppm) in module-4 during both Rabi, 2018-19 and 2019-20. [ABSTRACT FROM AUTHOR]

The present investigations entitled "Efficacy of certain IPM modules on the population of spider (predatory spider) in cabbage" was carried out during Rabi, 2018-19 and 2019-20 at Horticulture Research Center, Sardar Vallabhbhai Patel University of Agriculture and Technology, Meerut (U.P.), India. The all module reduces the natural enemy's population as compared to control. Among the entire module, module-1 was found most safe with maximum mean number of Spider (1.83 adult/five plant) followed by module-3, module-5, module-2 and module-6 with 2.50, 2.17, 1.67, and 1.00 per five plants, respectively. When the data of both the year were pooled and found all the module was found again effective and significantly superior over untreated control. The most unsafe module for spider was module-4, which recorded with minimum average adult's population of 0.00 per five plants during Rabi, 2018-19 and 2019-20. [ABSTRACT FROM AUTHOR]

The present investigation was carried out during the Kharif season, 2017-18 at Student’s Instructional Farm, N. D. University of Agriculture and Technology, Kumarganj, Faizabad (U.P.), India. The incidence of three major insect viz., Jassid (Amsacta biguttula biguttula), White fly (Bemacia tabaci) and Epilachna beetle (Henosepilachna vigintioctopunctata) were recorded. The incidence of whitefly and jassid were noticed for the first time from 36th SW onwards while Epilachna beetle were seen from 41st SW. The incidence of brinjal shoot and fruit borer was noticed for the first time from 39th SW onwards. Maximum and minimum whitefly population was observed in 42nd SW and 36th SW i.e. 4.40 and 0.53 whiteflies/cage, respectively. Maximum and minimum jassid population was observed in 42nd SW and 36th SW i.e. 2.33 and 0.13 jassids/cage, respectively. Maximum and minimum epilachna beetle population was observed in 46th SW and 5th SW i.e. 2.33 and 0.07 beetles/3 leaves, respectively. Correlation coefficient was worked out between the incidence of insect pests and abiotic factors. In case of whitefly and jassid, the correlation was positive with minimum and maximum temperature while it was negative with RH and rainfall. In case of epilachna beetle, the correlation was negative with minimum and maximum temperature as well as with RH and rainfall. [ABSTRACT FROM AUTHOR]

The article focuses on the Emergency medicine in India. Topics discussed include the COVID-19 pandemic continues to rage across the U.S. and Europe, attention has been diverted from the toll the virus is taking in India; and India is currently home to the second largest COVID-19 outbreak in the world, with more than 10 million confirmed cases and over 150,000 confirmed death.

Background: Altered mental status (AMS) comprises a group of clinical symptoms rather than a specific diagnosis. A variety of neurological scales have been used to monitor these patients, including the Glasgow coma scale (GCS), AVPU (alert, responds to verbal stimuli, responds to painful stimuli, unresponsive) scale, and ACDU (alert, confused, drowsy, unresponsive) scale. The simplified motor scale (SMS) has been found to be a potential replacement for the GCS. In this study, we compare the interrater reliability of the GCS (individual components), AVPU, ACDU, and SMS to patients presenting to the ED with AMS. Materials and methods: This was a prospective observational study conducted in the emergency department of an urban tertiary-care hospital in New Delhi, India. Patients with AMS (traumatic and nontraumatic) presenting to the ED were assessed by two emergency physicians within 10 minutes of each other using the four neurological scales. Percentage agreement and kappa coefficient score were used to determine interrater reliability for SMS, individual components of GCS, AVPU, and ACDU. Results: The SMS had the best inter-rater percent agreement with 83.91% (95% CI 77.7-88.6%), followed by ACDU which was 76.44% (95% CI 69.0-81.6%), AVPU 75.29% (95% CI 67.8-80.6%), GCS Eye 74.14% (95% CI 66.6-79.6%), GCS Verbal 67.82% (95% CI 60.6-74.3%), and GCS Motor was 64.94% (95% CI 57.6-71.6%).The kappa coefficient for SMS was 0.75 (95% CI 0.67-0.83), followed by GCS Eye which was 0.63 (95% CI 0.540.72), AVPU 0.62 (95% CI 0.52-0.72), ACDU 0.60 (95% CI 0.49-0.71), and GCS Verbal 0.58 (0.49-0.66) and GCS Motor was 0.53 (95% CI 0.44-0.63). Conclusion: It can be said that SMS has the best interrater reliability in the ED and can be recommended for clinical use in the emergency departments for patients presenting with AMS. [ABSTRACT FROM AUTHOR]

BACKGROUND: Bottle gourd (Lagenaria siceraria) is popularly known as lauki, ghia or dudhi in India. Its consumption is advocated by traditional medicine healers for controlling diabetes mellitus, hypertension, liver diseases, weight loss and other diseases. However, in last few years there have been reports of suspected toxicity due to consumption of its juice leading to severe vomiting and upper gastrointestinal bleeding. As emergency physicians we need to be aware of this very rare poisoning specially in India. METHODS: We present a case of a 52-year-old woman who presented with multiple episodes of hematemesis and shock to the emergency department (ED) after consuming bottle gourd juice. The patient was resuscitated and stabilized with fluids, proton pump inhibitors and antiemetics and shifted to the intensive care unit (ICU) under the care of a gastroenterology team for urgent endoscopy and further management. RESULTS: The patient received intravenous fluids, antibiotics, antiemetics, and antacids and underwent upper gastroenterologic endoscopy during the hospitalization. She was discharged in a stable condition 4 days later. CONCLUSIONS: As a member of the Cucurbitaceae family, bottle gourd contains toxic tetracyclic triterpenoid compounds called cucurbitacins which are responsible for the bitter taste and toxicity. There is no known antidote for this toxicity, and clinicians treat such patients symptomatically only. It is important to educate the public about the harmful effects of this potentially life-threatening toxicity. [ABSTRACT FROM AUTHOR]