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Vig S, Meena JK, Kumar A, Rathore P, Bhan S, Sirohiya P, Goswami G, Elavarasi A, Sagiraju HKR, Gupta N, Ratre B, Pandit A, Singh R, Kumar B, Garg R, Meena VP, Paul SS, Mohan A, Guleria R, Bhatnagar S. Mortality in Two Waves of COVID-19: A Comparative Analysis of a Tertiary Care Hospital in India. Cureus 2023; 15:e45025. [PMID: 37829991 PMCID: PMC10566229 DOI: 10.7759/cureus.45025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Background COVID-19 has spread as two distinct surges of cases in many countries. Several countries have reported differences in disease severity and mortality in the two waves. Objective Compare the in-hospital mortality in the two COVID-19 waves at a tertiary care hospital in India. Methods We conducted a retrospective data collection. Distinct periods of surges in cases and admissions were defined as the first wave spanning from March 2020 to December 2020 and the second wave from April 2021 to June 21, 2021. The primary outcome of this study was to compare mortality rates in terms of total hospital mortality rate (TMR) and case fatality rate (CFR). Results Mortality rates of wave 2 were approximately 10 times that of wave 1 (TMR of 20.3% in wave 2 versus 2.4% in wave 1 and CFR of 1.5% versus 17.7% in wave 1 and 2, respectively). Mortalities in wave 2 had a larger proportion of severe disease at presentation, faster progression of symptoms to death, and more patients without any chronic comorbid condition dying due to the direct effect of COVID-19 acute respiratory distress syndrome (ARDS). Conclusion Our data matches the worldwide reported pooled hospital mortality figures and shows the comparative difference in disease severity between the two waves.
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Affiliation(s)
- Saurabh Vig
- Onco-Anesthesiology and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Jitendra K Meena
- Preventive Oncology, National Cancer Institute, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Abhishek Kumar
- Anesthesiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS), Lucknow, IND
| | - Puneet Rathore
- Onco-Anesthesiology and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Swati Bhan
- Anesthesiology, Vardhaman Mahavir Medical College (VMMC) and Safdarjung Hospital, New Delhi, IND
| | - Prashant Sirohiya
- Onco-Anesthesiology and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Gitartha Goswami
- Onco-Anesthesiology and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | | | - Hari Krishna Raju Sagiraju
- Preventive Oncology, National Cancer Institute, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Nishkarsh Gupta
- Onco-Anesthesiology and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), Delhi, IND
| | - Brajesh Ratre
- Onco-Anesthesiology and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Anuja Pandit
- Onco-Anesthesiology and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Ram Singh
- Anesthesiology and Critical Care, All India Institute of Medical Sciences (AIIMS) New Delhi, New Delhi, IND
| | - Balbir Kumar
- Onco-Anesthesiology and Palliative Medicine, National Cancer Institute, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Rakesh Garg
- Onco-Anesthesiology and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
| | - Ved P Meena
- Internal Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, New Delhi, IND
| | - Saurav S Paul
- Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, New Delhi, IND
| | - Anant Mohan
- Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, New Delhi, IND
| | - Randeep Guleria
- Pulmonary Medicine, All India Institute of Medical Sciences (AIIMS) New Delhi, New Delhi, IND
| | - Sushma Bhatnagar
- Onco-Anesthesiology and Palliative Medicine, Dr. B. R. Ambedkar Institute Rotary Cancer Hospital, All India Institute of Medical Sciences (AIIMS), New Delhi, IND
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2
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Dwivedi T, Raj A, Das N, Gupta R, Gupta N, Tiwari P, Sahoo B, Sagiraju HKR, Sirohiya P, Ratre B, Elavarasi A, Mohan A, Bhatnagar S. The Evaluation of Laboratory Parameters as Predictors of Disease Severity and Mortality in COVID-19 Patients: A Retrospective Study From a Tertiary Care Hospital in India. Cureus 2023; 15:e40273. [PMID: 37448393 PMCID: PMC10336329 DOI: 10.7759/cureus.40273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/15/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection affects and alters various laboratory parameters that are predictors of disease severity and mortality, and hence, their prompt identification can aid in patient triaging and resource allocation. Objectives A retrospective study was conducted on 7416 admitted coronavirus disease 2019 (COVID-19) patients from 20 March 2020 to 9 August 2021 to identify crucial laboratory biomarkers as predictors of disease severity and outcome; also, their optimal cutoffs were also calculated. A comparison of laboratory markers between both COVID-19 waves was also performed. Results The majority of patients had mild disease (4295/7416, 57.92%), whereas 1262/7416 (17.02%) had severe disease. The overall fatal outcome was reported in 461 (6.22%) patients. Predictors for mortality were age (>52 years), albumin/globulin (A/G) ratio (≤1.47), chloride (≤101 mmol/L), ferritin (>483.89 ng/mL), lactate dehydrogenase (LDH) (>393 U/L), procalcitonin (>0.10 ng/mL), interleukin-6 (IL-6) (>8.8 pg/mL), fibrinogen (>403 mg/dL), international normalized ratio (INR) (>1.18), and D-dimer (>268 ng/mL). Disease severity predictors were neutrophils (>81%), lymphocyte (≤25.4%), absolute lymphocyte count (ALC) (≤1.38×103/µL), absolute eosinophil count (AEC) (≤0.03×103/µL), total bilirubin (TBIL) (≥0.51 mg/dL), A/G ratio (≤1.49), albumin (≤4.2 g/dL), ferritin (≥445.4 mg/dL), LDH (≥479 U/L), IL-6 (≥28.6 pg/mL), C-reactive protein/albumin (CRP/ALB) ratio (≥1.78), D-dimer (≥237 ng/mL), and fibrinogen (≥425 mg/dL). The majority of patients admitted in the second wave were older and had severe disease, increased fatality, and significantly deranged laboratory parameters than first wave patients. Conclusion Our findings suggested that several biomarkers are crucial for both severe disease and mortality in COVID-19 patients. Ferritin, LDH, IL-6, A/G ratio, fibrinogen, and D-dimer are important biomarkers for both severity and mortality, and when combined, they provide valuable information for patient monitoring and triaging. In addition to these, older age, INR, chloride, and procalcitonin are also significant risk factors for mortality. For severe COVID-19, TBIL, CRP/ALB, albumin, neutrophil percentage, lymphocyte percentage, ALC, and AEC are also important biomarkers. According to the study, the majority of the baseline laboratory parameters associated with COVID-19 mortality and severe disease were significantly higher during the second wave, which could be one of the possible causes for the high mortality rate in India during the second wave. So, the combination of all these parameters can be a powerful tool in emergency settings to improve the efficacy of treatment and prevent mortality, and the planning of subsequent waves should be done accordingly.
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Affiliation(s)
- Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | - Apurva Raj
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | - Nupur Das
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | - Nishkarsh Gupta
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Biswajeet Sahoo
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Prashant Sirohiya
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Brajesh Ratre
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | | | - Anant Mohan
- Department of Pulmonary, Critical Care, and Sleep Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Sushma Bhatnagar
- Department of Onco-Anesthesiology and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, IND
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Bhan S, Gupta R, Vig S, Garg R, Gupta N, Kumar V, Bharati SJ, Mishra S, Ratre B, Pandit A, Sirohiya P, Singh R, Kumar B, Bhopale S, Bhatnagar S. Marching Ahead through the Pandemic: Continuing Anesthesia Services in COVID Era—Our Experience from a Tertiary Care Cancer Centre. South Asian J Cancer 2023. [DOI: 10.1055/s-0042-1757557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023] Open
Abstract
Introduction This paper aims to provide an overview of the administrative and clinical preparations done in a tertiary care cancer hospital in continuing operation theatre (OT) services through the COVID pandemic.
Methods Retrospective data collection, data for the past 1.5 years (COVID period) March 2020 to August 2021 were compared to surgical output for a similar duration of time before the COVID era (September 2018–February 2020).
Results A total of 1,022 surgeries were done under anesthesia in the COVID period as against 1,710 surgeries done in a similar time frame in the pre-COVID era. Overall, we saw a 40%drop in the total number of cases. Thorax, abdominal, and miscellaneous surgeries (soft tissue sarcomas, urology, and gyneconcology) saw a maximum fall in numbers; however, head and neck cases saw an increase in numbers during the pandemic. Surgical morbidity and mortality were similar in the COVID and pre-COVID era. No cases of severe COVID infection were reported among the healthcare staff working in OT.
Discussion We could successfully continue our anesthesia services with minimal risk to healthcare staff throughout the pandemic by adopting major guidelines in a pragmatic and practical approach with minor changes to suit our setup.
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Affiliation(s)
- Swati Bhan
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Raghav Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
| | - Vinod Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
| | | | - Seema Mishra
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
| | - Brajesh Ratre
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
| | - Anuja Pandit
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Prashant Sirohiya
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Ram Singh
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Balbir Kumar
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Shweta Bhopale
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute, AIIMS, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia and Palliative Medicine, BRAIRCH, AIIMS, New Delhi, India
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Sagiraju HKR, Elavarasi A, Gupta N, Garg RK, Paul SS, Vig S, Sirohiya P, Ratre B, Garg R, Pandit A, Singh R, Kumar B, Meena VP, Wig N, Mittal S, Pahuja S, Madan K, Das N, Dwivedi T, Gupta R, Wundavalli L, Singh AR, Singh S, Mishra A, Pandey M, Matharoo KS, Kumar S, Mohan A, Guleria R, Bhatnagar S. The Effectiveness of SARS-CoV-2 Vaccination in Preventing Severe Illness and Death - Real-world Data from a Cohort of Patients Hospitalized with COVID-19. Indian J Community Med 2022; 47:510-516. [PMID: 36742977 PMCID: PMC9891054 DOI: 10.4103/ijcm.ijcm_1388_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 12/24/2021] [Indexed: 02/07/2023] Open
Abstract
Background While long-term studies on the correlates of protection, vaccine effectiveness, and enhanced surveillance are awaited for SARS-CoV-2 vaccine, studies on breakthrough infections help understand the nature and course of this illness among vaccinated individuals and guide in public health preparedness. This study aims to compare the differences in the hospitalization outcomes SARS-CoV-2 infection of fully vaccinated individuals with with those of unvaccinated and partially vaccinated individuals. Materials and Methods Single institution observational cohort study. This study compared the differences in clinical, biochemical parameters and the hospitalization outcomes of 53 fully vaccinated individuals with those of unvaccinated (1464) and partially vaccinated (231) individuals, among a cohort of 2,080 individuals hospitalized with SARS-CoV-2 infection. Descriptive statistics and propensity-score weighted multivariate logistic regression analysis adjusting for clinical and laboratory parameters were used to compare the differences and to identify factors associated with outcomes. Results Completing the course of vaccination protected individuals from developing severe COVID-19 as evidenced by lower proportions of those with hypoxia, abnormal levels of inflammatory markers, requiring ventilatory support, and death compared to unvaccinated and partially vaccinated individuals. There were no differences in these outcomes among patients who received either vaccine type approved in India. Conclusions Efforts should be made to improve the vaccination rates as a timely measure to prepare for the upcoming waves of this highly transmissible pandemic. Vaccination rates of the communities may also guide in the planning of the health needs and appropriate use of medical resources.
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Affiliation(s)
- Hari Krishna Raju Sagiraju
- Department of Preventive Oncology, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Arunmozhimaran Elavarasi
- Department of Neurology, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Kumar Garg
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Saurav Sekhar Paul
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Sirohiya
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Brajesh Ratre
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anuja Pandit
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ram Singh
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Balbir Kumar
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Pahuja
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Nupur Das
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - LaxmiTej Wundavalli
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Mishra
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Pandey
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karanvir Singh Matharoo
- Department of Onco-Anesthesia and Palliative Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
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5
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Elavarasi A, Raju Sagiraju HK, Garg RK, Ratre B, Sirohiya P, Gupta N, Garg R, Pandit A, Vig S, Singh R, Kumar B, Meena VP, Wig N, Mittal S, Pahuja S, Madan K, Guleria R, Mohan A, Dwivedi T, Gupta R, Vidyarthi AJ, Chaudhry R, Das A, Wundavalli L, Singh AR, Singh S, Kumar S, Pandey M, Mishra A, Matharoo KS, Bhatnagar S. Clinical features, demography, and predictors of outcomes of SARS-CoV-2 infection at a tertiary care hospital in India: A cohort study. Lung India 2022; 39:16-26. [PMID: 34975048 PMCID: PMC8926224 DOI: 10.4103/lungindia.lungindia_493_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: The “second wave” of the COVID-19 pandemic hit India from early April 2021 to June 2021. We describe the clinical features, treatment trends, and baseline laboratory parameters of a cohort of patients with SARS-CoV-2 infection and their association with the outcome. Methods: This was a retrospective cohort study. Multivariate logistic regression models were fitted to identify clinical and biochemical predictors of developing hypoxia, deterioration during the hospital stay, and death. Results: A total of 2080 patients were included. The case fatality rate was 19.5%. Among the survivors, the median duration of hospital stay was 8 (5–11) days. Out of 853 (42.3%%) of patients who had COVID-19 acute respiratory distress syndrome at presentation, 340 (39.9%) died. Patients aged >45 years had higher odds of death as compared to the 18–44 years age group. Vaccination reduced the odds of death by 40% (odds ratio [OR] [95% confidence interval [CI]]: 0.6 [0.4–0.9], P = 0.032). Patients with hyper inflammation at baseline as suggested by leukocytosis (OR [95% CI]: 2.1 [1.5–3.1], P < 0.001), raised d-dimer >500 mg/dL (OR [95% CI]: 3.2 [2.2–4.7], P < 0.001), and raised C-reactive peptide >0.5 mg/L (OR [95% CI]: 3.7 [2.2–13], P = 0.037) had higher odds of death. Patients who were admitted in the 2nd week had lower odds and those admitted in the 3rd week had higher odds of death. Conclusion: This study shows that vaccination status and early admission during the inflammatory phase can change the course of illness of these patients. Improving vaccination rates and early admission of patients with moderate and severe COVID-19 can improve the outcomes.
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Affiliation(s)
| | | | - Rohit Kumar Garg
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Brajesh Ratre
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Prashant Sirohiya
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anuja Pandit
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Vig
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ram Singh
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balbir Kumar
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Naveet Wig
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Pahuja
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Anant Mohan
- Department of Pulmonary Medicine, Critical Care and Sleep Disorders, All India Institute of Medical Sciences, New Delhi, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ritu Gupta
- Department of Laboratory Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashima Jain Vidyarthi
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rama Chaudhry
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Arghya Das
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - LaxmiTej Wundavalli
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sunil Kumar
- Department of Surgical Oncology, All India Institute of Medical Sciences, New Delhi, India
| | - Manisha Pandey
- Department of Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhinav Mishra
- Department of Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karanvir Singh Matharoo
- Department of Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-anesthesia and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
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More S, Sarma R, Ratre B, Bharati SJ. Carotid Blood Flow-Guided Fluid Therapy in Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: A Case Report. A A Pract 2021; 15:e01391. [PMID: 33560643 DOI: 10.1213/xaa.0000000000001391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is associated with significant volume shifts and requires meticulous hemodynamic management. The conventional and arbitrary "liberal" and "restrictive" fluid regimens are now being challenged. With increasing recognition of the need to individualize perioperative fluid therapy, dynamic assessment of fluid status and hemodynamic response to administration of fluids have become vital. Herein, we describe a case in which point of care ultrasound of the carotid artery and derived parameters were used to guide intraoperative fluid management. We discuss the reliability of this technique and the potential advantages it could offer.
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Affiliation(s)
- Shikhar More
- From the Department of Onco-Anaesthesia and Palliative Medicine, Dr Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital (BRAIRCH)
| | - Riniki Sarma
- From the Department of Onco-Anaesthesia and Palliative Medicine, Dr Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital (BRAIRCH)
| | - Brajesh Ratre
- Department of Onco-Anaesthesia and Palliative Medicine, National Cancer Institute (NCI), All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sachidanand Jee Bharati
- From the Department of Onco-Anaesthesia and Palliative Medicine, Dr Bhimrao Ramji Ambedkar Institute Rotary Cancer Hospital (BRAIRCH)
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7
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Mohan A, Tiwari P, Bhatnagar S, Patel A, Maurya A, Dar L, Pahuja S, Garg R, Gupta N, Sahoo B, Gupta R, Meena VP, Vig S, Pandit A, Mittal S, Madan K, Hadda V, Dwivedi T, Choudhary A, Brijwal M, Soneja M, Guleria R, Ratre B, Kumar B, Bhopale S, Panda S, Singh AR, Singh S, Wundavalli L. Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India. Indian J Med Res 2020; 152:61-69. [PMID: 32773414 PMCID: PMC7853260 DOI: 10.4103/ijmr.ijmr_1788_20] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND & OBJECTIVES In December 2019, a novel coronavirus (SARS-CoV-2) emerged in China and rapidly spread globally including India. The characteristic clinical observations and outcomes of this disease (COVID-19) have been reported from different countries. The present study was aimed to describe the clinico-demographic characteristics and in-hospital outcomes of a group of COVID-19 patients in north India. METHODS This was a prospective, single-centre collection of data regarding epidemiological, demographic, clinical and laboratory parameters, management and outcome of COVID-19 patients admitted in a tertiary care facility in north India. Patient outcomes were recorded as death, discharge and still admitted. RESULTS Data of 144 patients with COVID-19 were recorded and analyzed. The mean age of the patients was 40.1±13.1 yr, with 93.1 per cent males, and included 10 (6.9%) foreign nationals. Domestic travel to or from affected States (77.1%) and close contact with COVID-19 patients in congregations (82.6%) constituted the most commonly documented exposure. Nine (6.3%) patients were smokers, with a median smoking index of 200. Comorbidities were present in 23 (15.9%) patients, of which diabetes mellitus (n=16; 11.1%) was the most common. A significant proportion of patients had no symptoms (n=64; 44.4%); among the symptomatic, cough (34.7%) was the most common symptom followed by fever (17.4%) and nasal symptoms (2.15%). Majority of the patients were managed with supportive treatment with hydroxychloroquine and azithromycin given on a case-to-case basis. Only five (3.5%) patients required oxygen supplementation, four (2.8%) patients had severe disease requiring intensive care, one required mechanical ventilation and mortality occurred in two (1.4%) patients. The time to reverse transcription-polymerase chain reaction (RT-PCR) negativity was 16-18 days. INTERPRETATION & CONCLUSIONS In this single-centre study of 144 hospitalized patients with confirmed COVID-19 in north India, the characteristic findings included younger age, high proportion of asymptomatic patients, long time to PCR negativity and low need for intensive care unit care.
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Affiliation(s)
- Anant Mohan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
- For correspondence: Dr Anant Mohan, Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi 110 029, India e-mail:
| | - Pawan Tiwari
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Sushma Bhatnagar
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Ankit Patel
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Maurya
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Lalit Dar
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sourabh Pahuja
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Rakesh Garg
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Nishkarsh Gupta
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Biswajeet Sahoo
- Department of Laboratory Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Ritu Gupta
- Department of Hospital Administration, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Ved Prakash Meena
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Vig
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Anuja Pandit
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Saurabh Mittal
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Karan Madan
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Vijay Hadda
- Department of Pulmonary, Critical Care & Sleep Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Tanima Dwivedi
- Department of Laboratory Oncology, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Aashish Choudhary
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Megha Brijwal
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Soneja
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Randeep Guleria
- Department of Hospital Administration, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Brajesh Ratre
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Balbir Kumar
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Shweta Bhopale
- Department of Onco-Anaesthesia & Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Smriti Panda
- Department of Otolaryngology & Head-Neck Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Angel Rajan Singh
- Department of Hospital Administration, All India Institute of Medical Sciences, New Delhi, India
| | - Sheetal Singh
- Department of Hospital Administration, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
| | - Laxmitej Wundavalli
- Department of Hospital Administration, National Cancer Institute, All India Institute of Medical Sciences, Jhajjar, Haryana, India
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Pandey K, Vig S, Ratre B, Gupta N. Use of Sterillium on Protective Goggles for Anti-Fogging during Donning for Care of COVID-19 Patients: A Novel Technique. Turk J Anaesthesiol Reanim 2020; 48:344-345. [PMID: 32864655 PMCID: PMC7434339 DOI: 10.5152/tjar.2020.682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 05/26/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Khushboo Pandey
- Dr BRAIRCH, All India Institute of Medical Sciences, Onco-Anaesthesia and Palliative Medicine, New Delhi, India
| | - Saurabh Vig
- National Cancer Institute, All India Institute of Medical Sciences, Onco-Anaesthesia and Palliative Medicine, New Delhi, India
| | - Brajesh Ratre
- Dr BRAIRCH, All India Institute of Medical Sciences, Onco-Anaesthesia and Palliative Medicine, New Delhi, India
| | - Nishkarsh Gupta
- Dr BRAIRCH, All India Institute of Medical Sciences, Onco-Anaesthesia and Palliative Medicine, New Delhi, India
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Choudhary S, Dogra N, Dogra J, Jain P, Ola SK, Ratre B. Evaluation of caudal dexamethasone with ropivacaine for post-operative analgesia in paediatric herniotomies: A randomised controlled study. Indian J Anaesth 2016; 60:30-3. [PMID: 26962252 PMCID: PMC4782420 DOI: 10.4103/0019-5049.174804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background and Aims: Caudal analgesia is one of the most popular regional blocks in paediatric patients undergoing infra-umbilical surgeries but with the drawback of short duration of action after single shot local anaesthetic injection. We evaluated whether caudal dexamethasone 0.1 mg/kg as an adjuvant to the ropivacaine improved analgesic efficacy after paediatric herniotomies. Methods: Totally 128 patients of 1–5 years age group, American Society of Anaesthesiologists physical status I and II undergoing elective inguinal herniotomy were randomly allocated to two groups in double-blind manner. Group A received 1 ml/kg of 0.2% ropivacaine caudally and Group B received 1 ml/kg of 0.2% ropivacaine, in which 0.1 mg/kg dexamethasone was added for caudal analgesia. Post operative pain by faces, legs, activity, cry and consolability tool score, rescue analgesic requirement and adverse effects were noted for 24 h. Results: Results were statistically analysed using Student's t-test. Pain scores measured at 1, 2, 4, and 6 h post-operative, were lower in Group B as compared to Group A. Mean duration of analgesia in Group A was 248.4 ± 54.1 min and in Group B was 478.046 ± 104.57 min with P = 0.001. Rescue analgesic requirement was more in Group A as compared to Group B. Adverse effects after surgery were comparable between the two groups. Conclusion: Caudal dexamethasone added to ropivacaine is a good alternative to prolong post-operative analgesia with less pain score compared to caudal ropivacaine alone.
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Affiliation(s)
- Santosh Choudhary
- Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Neelam Dogra
- Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | - Jaideep Dogra
- Medicine Consultant in Private Hospital, Jaipur, Rajasthan, India
| | - Priyanka Jain
- Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
| | | | - Brajesh Ratre
- Department of Anaesthesia and Critical Care, Sawai Man Singh Medical College and Hospital, Jaipur, Rajasthan, India
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