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Background Severe dengue causes more than 22,000 deaths annually worldwide. Complicated dengue has high mortality of 44–72%. Disordered immune system with capillary leak and thrombocytopenia are hallmark of complicated dengue. Intravenous immunoglobulin (IV Ig) therapy has shown to be effective in complicated dengue in pediatric age group with refractory shock, but studies in adults are lacking. Its immunoresuscitative role is not yet fully explored in critically ill patients with severe dengue. Methods This is retrospective observational study of patients with complicated dengue fever who were administered IV Ig therapy in a tertiary care hospital of southern India from 01 Jan 2018 to 31 Dec 2019. Results A total of 999 patients with dengue were admitted; 754 (75.47%) were males, and 245 (24.53%) were females. A total of 402 (40.24%) patients presented with warning signs. Bleeding was seen in 121 patients (12.11%); 102 (10.21%) had shock; 29 (2.90%) had acute kidney injury and 24 (2.40%) had adult respiratory distress syndrome. Overall, four people died (mortality rate: 0.40%). IV Ig in the dose of 0.4 g/kg for 5 days was used in 13 critically ill patients where standard therapy failed, 9 patients with refractory shock (which included three with myocarditis with refractory shock), 2 with encephalitis, 2 in hemophagocytic lymphohistiocytosis. Two patients died, one with myocarditis with refractory shock and another with refractory shock. Conclusion IV Ig therapy in critically ill patients with complicated dengue can be used as a rescue therapy.

A 59-year-old male patient presented with a history of dyspnea on exertion for the past 10 years, which was gradually progressive in nature. The patient had orthopnea and paroxysmal nocturnal dyspnea for the past few months. On evaluation, he was found to have cardiomegaly and a giant left atrium. Contrast-enhanced computed tomography of the heart showed the left atrium to be enlarged to a dimension of 20.7 cm which, as of the time of writing, is the largest ever reported.

Background: The COVID-19 pandemic, caused by the Severe Acute Respiratory Syndrome Corona Virus 2 (SARS CoV-2) has the potential to affect the mental health of health-care professionals in several adverse ways, owing to a multifactorial, unprecedented volley of evolving factors. It may contribute to the elevated levels of depression, anxiety, and worry among the personnel on the frontline, who are often affected by medical and psychosocial factors, including pre-existing illness, scarcity of resources, uncertainty of outcome, prolonged working hours, lack of consensus, prevalent societal misbeliefs, prevailing stigma, and a constant threat to safety. Aim: The aim of this study was to screen health-care professionals for symptoms of depression, anxiety, and worry during SARS CoV-2 pandemic. Methods: In this cross-sectional study, a questionnaire was designed based on Patient Health Questionnaire-9, generalized anxiety disorder-7. It was disseminated through web-based and mobile-based social networks, thereby keeping in line with the social distancing and lockdown protocols. Results: Two hundred and fifty-seven participants were included in the study. Anxiety and depression were present in 23% (n = 59) and 16.8% (n = 43) of participants, respectively, most cases being mild in intensity. Nearly 56.4% (n = 145) of the participants reported that they were worried about COVID 19 pandemic, major cause of worry being risk of family and friends to be infected by COVID 19. About 40.9% (n = 105) participants reported sleep disturbances. Nearly 33.5% (n = 86) of participants reported increase in their smoking/alcohol consumption during lockdown. Conclusions: A significant proportion of health-care professionals experienced worry, sleep disturbances, anxiety, and depressive symptoms. Having clear guidelines, policies and procedures, training on infection control measures, occasional drills and being able to maintain communication with family members while in quarantine can go a long way in reducing worry and psychological impact of pandemic on health-care professionals.

Background In late 2019, the world saw a viral outbreak of unprecedented scale that sent a significant fraction of humankind into either quarantine or lockdown. Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which was first recognized in Wuhan, China, in December 2019. Methods We created and administered a 17-item questionnaire for health care professionals (HCPs) to assess their level of knowledge towards this ongoing and evolving pandemic. It was disseminated through Web- and mobile-based social networks. The questions were sourced and created from various standard national and international guidelines available at the time of writing. Results A total of 827 medical personnel participated in the study. Among them, 65.5% scored between 60% and 79%, indicating a moderate level of knowledge. There was no statistically significant difference in the scores of doctors, nursing officers and dental surgeons (p = 0.200). Participants had good knowledge regarding clinical symptoms, mode of transmission and preventive measures. But the study identified some gaps in knowledge in the implementation of management protocols, handling of dead bodies and biomedical waste management of COVID-19 cases. Conclusion With this understanding, regular training, drills and knowledge dissemination along with skill development through learning correct practices focusing on HCP at all levels are the current needs.

Introduction: Chest pain is amongst the commonest causes of visits to the emergency department. A rapid assessment with a prompt evaluation with an electrocardiogram clinches the diagnosis in most cases. However, with ever increasing strain on our limited resources, patient reported symptoms are central to initial assessment and must decide the course of action. Although considered ominous signs requiring further, often emergent, assessment, data on correlation of symptoms of angina with ST segment elevation is limited in contemporary literature. Methodology: 230 patients with biomarker proven ST segment elevation myocardial infarction (STEMI) were studied and assessed for frequency of the four, patient reported, cardinal symptoms of angina, namely retrosternal chest discomfort, diaphoresis, palpitations and radiation. We assessed the relative presence or absence of these supposedly cardinal symptoms of angina and set out to classify the most important symptoms of angina. Results: Our study shows that presence of three or more above symptoms is associated with a much higher possibility of an actual STEMI as opposed to only one symptom. Furthermore, a measurable increase in the probability of MI exists, when the number of patient reported symptoms increases from none to all four, as mentioned above. Though the study also reaffirmed the association between hypertension and Type 2 Diabetes Mellitus with acute coronary syndromes, our study was neither powered, nor designed to study this association. Conclusions: Patient reported symptoms have a direct and additive correlation with STEMI. A quick but detailed history in the emergency department is of paramount importance to identify high risk patients.

A 42-year-old female was admitted to tertiary care teaching hospital with history of headache, vertigo, difficulty in swallowing both liquids and solids, vomiting, gait ataxia, drooping of left eyelid, inability to feel hot and cold on right side of body and diplopia of forty-fivedays’ duration. Clinical examination and neuroimaging were suggestive a posterior circulation stroke, with lateral medullary syndrome.The patient had selective thermoanaesthesia on the right side, including the face, which is an atypical finding, given the clinical setting.