Mortality in Two Waves of COVID-19: A Comparative Analysis of a Tertiary Care Hospital in India

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.

Airway management, procedural data, and in-hospital mortality records of patients undergoing surgery for mucormycosis associated with coronavirus disease (COVID-19)

Purpose

Although unexpected airway difficulties are reported in patients with mucormycosis, the literature on airway management in patients with mucormycosis associated with Coronavirus disease is sparse.

Methods

In this retrospective case record review of 57 patients who underwent surgery for mucormycosis associated with coronavirus disease, we aimed to evaluate the demographics, airway management, procedural data, and in-hospital mortality records.

Results

Forty-one (71.9%) patients had a diagnosis of sino-nasal mucormycosis, fourteen (24.6%) patients had a diagnosis of rhino-orbital mucormycosis, and 2 (3.5%) patients had a diagnosis of palatal mucormycosis. A total of 44 (77.2%) patients had co-morbidities. The most common co-morbidities were diabetes mellitus in 42 (73.6%) patients, followed by hypertension in 21 (36.8%) patients, and acute kidney injury in 14 (28.1%) patients. We used the intubation difficulty scale score to assess intubating conditions. Intubation was easy to slightly difficult in 53 (92.9%) patients. In our study, mortality occurred in 7 (12.3%) patients. The median (range) mortality time was 60 (27–74) days. The median (range) time to hospital discharge was 53.5 (10–85) days. The median [interquartile range] age of discharged versus expired patients was 47.5 [41,57.5] versus 64 [47,70] years (P = 0.04), and median (interquartile range) D-dimer levels in discharged versus expired patients was 364 [213, 638] versus 2448 [408,3301] ng/mL (P = 0.03).

Conclusion

In patients undergoing surgery for mucormycosis associated with the coronavirus disease, airway management was easy to slightly difficult in most patients. Perioperative complications can be minimized by taking timely and precautionary measures.

Prospective correlation of the radiological, surgical and pathological findings in patients undergoing cytoreductive surgery for colorectal peritoneal metastases: implications for the preoperative estimation of the peritoneal cancer index

AIM

The peritoneal cancer index (PCI) is one of the strongest prognostic factors in patients undergoing cytoreductive surgery (CRS) for colorectal peritoneal metastases. Using pathological evaluation, however, the disease extent differs in a large proportion of patients. Our aim was to study the correlation between the radiological (rPCI), surgical (sPCI) and pathological (pPCI) PCI in order to determine factors affecting the discordance between these indices and their potential therapeutic implications.

METHOD

From July 2018 to December 2019, 128 patients were included in this study. The radiological, pathological and surgical findings were compared. A protocol for pathological evaluation was followed at all centres.

RESULTS

All patients underwent a CT scan and 102 (79.6%) had a peritoneal MRI. The rPCI was the same as the sPCI in 81 (63.2%) patients and the pPCI in 93 (72.6%). Concordance was significantly lower for moderate-volume (sPCI 13-20) and high-volume (sPCI > 20) disease than for low-volume disease (sPCI 0-12) (P < 0.001 for sPCI; P = 0.001 for pPCI). The accuracy of imaging in predicting presence/absence of disease upon pathological evaluation ranged from 63% to 97% in the different regions of the PCI. The pPCI concurred with the sPCI in 86 (68.8%) patients. Of the nine patients with sPCI > 20, the pPCI was less than 20 in six.

CONCLUSION

The rPCI and sPCI both concurred with pPCI in approximately two thirds of patients. Preoperative evaluation should focus on the range in which the sPCI lies and not its absolute value. Radiological evaluation did not overestimate sPCI in any patient with high/moderate-volume disease. The benefit of CRS in patients with a high r/sPCI (> 20) who respond to systemic therapies should be prospectively evaluated.

PA01.72. Evaluation of DB14201 on prevention of development of streptozotocin induced diabetes mellitus in wistar rats

Purpose:

Study is part of an ongoing reverse pharmacology approach in new drug development for diabetes. It was designed to determine the potential of DB14201 to prevent the development of Streptozotocin induced Diabetes Mellitus in Wistar rats.

Method:

35 female Wistar rats were randomized and allocated to different groups on the basis of body weight. G1 served as non diabetic control (Negative Control) and G2 served as Diabetic control (Vehicle Control) and received 10 ml/kg of Milli Q water. G3 and G4 were treated with 500mg/kg and 250mg/kg of DB14201 respectively. All the groups were treated orally for 21 days using disposable syringes tipped with an oral gavage needle. At the end of dosing period, hyperglycemia was induced in G2,G3 and G4 rats by intra peritoneal injection of streptozotocin (STZ) 55 mg/kg in citrate buffer (pH 4.5). Fasting blood glucose level was estimated before induction of diabetes and on 2nd & 7th days post induction. All animals were observed daily for mortality and clinical signs of toxicity throughout the experimental period. Body weight of each animal was recorded daily throughout the experimental period. On the 8th day post STZ injection, animals were killed by cervical dislocation. Their pancreatic tissues were quickly removed. Tissues were washed in normal saline and visible clots were removed to minimize blood contamination. Part of the pancreatic tissue was sent for histological evaluation. With second part of tissue, homogenates was prepared and stored at 70 A°C until the determination of biochemical parameters and enzyme activity.

Result:

Findings of this study strongly demonstrate that DB14201 treatment have prominent role in the prevention of STZ induced diabetes mellitus.

Conclusion:

Result clearly indicates the prophylactic as well as therapeutic potential of DB14201 in this experimental model. DB14201 at the dose of 500mg/kg was found to be more promising.

Tc-99m MAG3 scintigraphy in unusually dilated bilateral extrarenal pelves

The authors report the findings of a radionuclide diuretic renogram in a patient with markedly dilated pelves bilaterally that filled most of the abdominal cavity. With the patient in the sitting position, at the end of the furosemide injection, there was good delineation and filling of the dilated calyces. These findings are unusual because of the extensive pelvicaliceal dilatation, and they emphasize the importance of the sitting position.

Effects of the status of women on the first-birth interval in Indian urban society

The status of women, which is relative and multidimensional, has an important bearing on any long-term reduction in fertility. In Indian society, where cohabitation and childbearing are socially sanctioned only after marriage, the length of the first-birth interval affects the completed family size by influencing the spacing and childbearing pattern of a family. This study examines the influence of certain aspects of the status of married women--education, employment, role in family decision making, and age at marriage--along with three socioeconomic variables--per capita income of the family, social position of the household, and the caste system--on the duration of the first-birth interval in an urban Hindu society of the north-east Indian state of Assam. The data were analysed by applying life table and hazard regression techniques. The results indicate that a female's age at marriage, education, current age, role in decision making, and the per capita income of the household are the main covariates that strongly influence the length of the first-birth interval of Hindu females of urban Assam. Of all the covariates studied, a female's education appears to be a key mediating factor, through its influence on her probability of employment outside the home and thereby an earned income and on her role in family decision making. Unlike other Indian communities, the effect of the caste system does not have a significant effect on first-birth timing in this urban Hindu society.

Determinants of breast-feeding patterns in an urban society of India

Breast feeding is the focus of rapidly growing interest in many areas of demographic research. However, relatively few rigorous studies on breast-feeding patterns and correlates in contemporary India have been published. This study uses data from a retrospective survey conducted in 1991-1992 to investigate current breast-feeding patterns and to identify the key factors that influence the duration of exclusive breast feeding and infant's age at the time of weaning in an urban Hindu society of the northeast Indian state of Assam. Applying life table procedures and a hazards regression model, we found evidence that the median duration of exclusive breast feeding and infant's age at the time of weaning were negatively associated with mother's education, per capita income, and social status of the household. Those infants who were breast-fed longer at night than in the daytime were also at greater risk of earlier introduction of non-breast-milk foods and of earlier termination of breast feeding than infants who were breast-fed longer during the day. Gender bias toward males in rearing infants prevails in this urban society, and male infants were found to have a significantly lower risk of early weaning than female infants.

Scattered radiation from linear accelerator and cobalt-60 collimator jaws

PURPOSE

Solid state diodes and/or thermoluminescent dosimeters (TLDs) are often used to measure scattered radiation doses to critical organs immediately adjacent to radiation field sites. The energy-dependent response of these commonly used in vivo dosimeters sometimes makes the interpretation of measured values uncertain. This study investigates scattered radiation arising from the collimator jaws of linear accelerators and the treatment head of a cobalt-60 teletherapy unit.

METHODS AND MATERIALS

A thin window Markus-type parallel-plate ionization chamber placed in a polystyrene phantom was employed to document the magnitude, energy composition, and sources of scattered radiation at surfaces near radiation fields. Measurements were taken both with and without additional phantom material covering the ionization chamber, as well as with various distances between the ionization chamber and edges of the radiation fields tested.

RESULTS

Data was collected, analyzed and compared for treatment units produced by different manufacturers. It was found that the magnitude of scattered radiation to surfaces immediately adjacent to radiation fields ranged from 1% to 15% of the maximum dose along the beam central axis. These values showed a strong dependence upon distance from the edge of the radiation field, beam energy, collimator setting (field size), and the presence of externally mounted accessories. Teletherapy unit differences due to manufacturing firm origins were found to only slightly affect scattered radiation magnitude, while the orientation of upper and lower collimator jaws had absolutely no effect.

CONCLUSIONS

Percent depth dose curves of scattered radiation were obtained and analyzed. The shapes of these depth dose curves suggest the presence of complex energy spectra from secondary electrons and scattered x-rays. Because of the presence of these complex energy spectra in areas immediately adjacent to radiation fields, caution should be observed when interpreting patient doses near radiation fields, if dose values have been measured in vivo using thermoluminescent dosimeters (TLDs) or solid state diodes. Many of these on-patient dosimetry devices are strongly energy dependent and may demonstrate large over- or under-responses in areas dominated by scattered radiation. The results of this study, thus, suggest that ionization chambers are preferred for determination of scattered radiation doses in such regions.