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Coronavirus disease 2019 (COVID-19) virus usually spreads through aerosol and close contact. Frontline health-care workers handle aerosol-generating procedures like endotracheal intubation. To reduce this risk, COVID-19 barrier box came into the picture. However, the COVID-19 barrier box may compromise easy and successful intubation, and their limitation must be studied.The objective of this study was to assess the time to successful intubation with or without the COVID-19 barrier box using the Macintosh laryngoscope and King Vision video laryngoscope (KVVL). We also assessed the first-pass success rate, ease of intubation, Cormack-Lehane (CL) grade, and requirement of external laryngeal manipulation.We conducted this manikin-based randomized crossover study to assess the time to successful intubation by anesthesiologists (22) and emergency physicians (11) having 1 year or more experience with or without COVID-19 barrier box by using the Macintosh laryngoscope and KVVL. Our study randomized the sequence of the four different intubation scenarios.The comparison of mean duration of intubation between KVVL (13.21 ± 4.05 s) and Macintosh laryngoscope (12.89 ± 4.28 s) with COVID-19 barrier box was not statistically significant (95% confidence interval: 1.21-0.97). The ease of intubation, number of attempts, and requirement of external laryngeal manipulation were not statistically significant. Intubations were statistically significant more difficult with barrier box in view of higher CL grade.Time to intubation was longer with COVID-19 barrier box using KVVL as compared to Macintosh laryngoscope which was statistically not significant.

A blood gas analyzer is a point-of-care (POC) testing device used in the Emergency Department (ED) to manage critically ill patients. However, there were differences in results found from blood gas analyzers for hemoglobin (Hgb) and electrolytes parameters. We conducted a comparative validity study in ED in patients who had requirements of venous gas analysis, complete blood count, and electrolytes. The objective was to find the correlation of Hgb, sodium (NaA total of 206 paired samples were tested for Hgb, NaThe mean difference between POC and laboratory method was 0.608 ± 1.41 (95% confidence interval [CI], 0.41-0.80;Although there was a statistical difference found between the two methods, it was under the United States Clinical Laboratory Improvement Amendment range. Hence, starting the therapy according to the blood gas analyzer results may be beneficial to the patient and improve the outcome.

In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India.This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases.Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.

Aluminum phosphide is a common suicidal agent in an agrarian country like India. Toxicity is mostly due to the liberation of phosphine gas, which non-competitively inhibits cytochrome oxidase in the mitochondria causing cell hypoxia. It can involve almost any organ in the body, but the most common is cardiovascular system. Various cardiovascular manifestations are hypotension, myocarditis, pericarditis, congestive heart failure, various ECG changes like myocardial infarction, conduction abnormalities, various arrhythmias, and very rarely unmasking of the Brugada pattern. Here we are presenting a case in which the patient developed unmasking of the Brugada pattern in ECG, and gradually he improved symptomatically and ECG wise with conservative treatment. As unmasking of the Brugada pattern in ECG can lead to life-threatening arrhythmias, one has to be cautious and keep this in mind while dealing with a case of aluminum phosphide poisoning.

Intravenous immunoglobulin (IVIG) is used in the treatment of a variety of autoimmune neurological disorders and is generally regarded as safe. We present a case series where IVIG causes transaminitis. The adverse effects are mostly due to the stabilizing agent used to prepare the IVIG (e.g., maltose in this series). While the adverse effects are usually self-limiting, physicians should be cautious in administering an IVIG preparation to these patients.

Multicentric reticulohistiocytosis (MRH) is a rare multisystem macrophage disorder of unknown etiology characterized by papulonodular skin and mucosal lesions, rapidly progressive erosive symmetric polyarthritis, and inflammation of internal organs. Most often, it is misdiagnosed as rheumatoid arthritis (RA). Here, we report the case of a 60-year-old woman found to have features of both MRH and RA with positive rheumatoid factor and high titer of anti-cyclic citrullinated peptide antibody in serum. It was confirmed by a histopathology of skin lesions, which showed diffuse histiocytic infiltrate with multinucleated giant cells. She was treated with methotrexate, hydroxychloroquine, corticosteroids, and nonsteroidal anti-inflammatory drugs and bisphosphonate.

Macrophage Activation Syndrome (MAS), a potentially life threatening condition belongs to acquired cause of Hemophagocytic lymphohistiocytosis (HLH) group of diseases more often found in children than adults. It presents as familial forms or acquired forms that include infectious aetiologies notably viral, malignancies, drugs and autoimmune diseases. Its association with several systemic autoimmune disease includes commonly systemic Juvenile Idiopathic Arthritis (sJIA), adult-onset Still's disease and rarely with Systemic Lupus Erythematosus (SLE), rheumatoid arthritis and dermatomyositis. It is a heterogeneous presentation of systemic and laboratory findings characterised by abnormal immune activation and inflammation warrants early diagnosis and prompt treatment. Herein we report a rare case of 15-year-old female who presented with fever of two months duration, who was later diagnosed to be having MAS with SLE. Despite the rarity MAS can be initial presenter in SLE and should be searched in the background of fever and features of SLE. Initiation of treatment with pulse methylprednisolone and follow up with oral hydroxychloroquine, cyclosporine and steroids had a favourable outcome.

An anomalous origin for the coronary artery is a rare congenital condition with an incidence of about 0.17%based on autopsy cases. A 23 year old male presented to the Cardiology OPD of AIIMS, Bhubaneswar with effort dyspnea NYHA class II and exertional ang ina CCS class II with evidence of lateral ischaemia in ECG. He was advised coronary CT angiography and was found to have left circumflex coronary artery ( LCX) originating from the right sinus of Valsalva . CT coronary angiography also revealed that LCX coursed posterior to the aorta and followed a normal course after it entered the left anterior atrioventricular groove

Introduction: Complete heart block is a rare disorder of conduction system which can be congenital oracquired.Anesthesia in patients with complete heart block can be challenging to anesthetist. Case Report: We report a 25-year-old female presented for emergency cesarean section with fetal distress found to have complete heart block. We discuss the management of patient with complete block posted for surgery according to advanced cardiac support guidelines with review of literature. Conclusion: Anesthesia in patients with complete heart block can be challenging due to uncontrolled hemodynamics unresponsive to conventional drugs. Anesthetic management in such patients should be according advanced cardiac life support guidelines. General anesthesia is preferred over spinal anesthesia for better control of hemodynamics. Keywords: Transcutaneous pacemaker, complete heart block, emergency cesarean section.

BACKGROUND Sickle cell trait is usually asymptomatic. Anaemia and painful crises are rare. An uncommon, but highly distinctive symptom is painless haematuria probably due to papillary necrosis. Few isolated cases of massive sickling or sudden death due to exposure to high altitudes or extremes of exercise and dehydration are also reported. Though pulmonary infarction is a wellknown complication of sickle cell disease, it is very uncommon in sickle cell trait. Our case is an unique presentation of a 34- year-old female who is a known sickle cell trait patient who presented as pneumonia and subsequently found to have pulmonary infarction. Patient was successfully treated with antibiotics, low molecular weight heparin (LMWH) and anticoagulants (Acitrom).