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A bstract Introduction World Health Organization proposes severe acute respiratory infection (SARI) case definition for coronavirus disease 2019 (COVID-19) surveillance; however, early differentiation between SARI etiologies remains challenging. We aimed to investigate the spectrum and outcome of SARI and compare COVID-19 to non-COVID-19 causes. Patients and methods A prospective cohort study was conducted between March 15, 2020, to August 15, 2020, at an adult medical emergency in North India. SARI was diagnosed using a “modified” case definition—febrile respiratory symptoms or radiographic evidence of pneumonia or acute respiratory distress syndrome of ≤14 days duration, along with a need for hospitalization and in the absence of an alternative etiology that fully explains the illness. COVID-19 was diagnosed with reverse transcription-polymerase chain reaction testing. Results In total, 95/212 (44.8%) cases had COVID-19. Community-acquired pneumonia ( n = 57), exacerbation of chronic lung disease ( n = 11), heart failure ( n = 11), tropical febrile illnesses ( n = 10), and influenza A ( n = 5) were common non-COVID-19 causes. No between-group differences were apparent in age ≥60 years, comorbidities, oxygenation, leukocytosis, lymphopenia, acute physiology and chronic health evaluation (APACHE)-II score, CURB-65 score, and ventilator requirement at 24-hour. Bilateral lung distribution and middle-lower zones involvement in radiography predicted COVID-19. The median hospital stay was longer with COVID-19 (12 versus 5 days, p = 0.000); however, mortality was similar (31.6% versus 28.2%, p = 0.593). Independent mortality predictors were higher mean APACHE II in COVID-19 and early ventilator requirement in non-COVID-19 cases. Conclusions COVID-19 has similar severity and mortality as non-COVID-19 SARI but requires an extended hospital stay. Including radiography in the SARI definition might improve COVID-19 surveillance. How to cite this article Pannu AK, Kumar M, Singh P, Shaji A, Ghosh A, Behera A, et al . Severe Acute Respiratory Infection Surveillance during the Initial Phase of the COVID-19 Outbreak in North India: A Comparison of COVID-19 to Other SARI Causes. Indian J Crit Care Med 2021;25(7):761–767.

OBJECTIVES: Despite the acute and life-threatening repercussions that tuberculosis (TB) may have on the burgeoning older population in endemic countries like India, the spectrum of geriatric TB emergencies is not adequately understood. METHODS: We performed a prospective observational study at the emergency department of an academic hospital in north India between January 2019 and June 2020, investigating the clinical and laboratory features and outcomes of active TB in older patients aged 60 years and above. RESULTS: Out of 71 geriatric TB emergencies, central nervous system disease predominated ( n = 41, 57.7%), followed by pulmonary ( n = 16, 22.5%), pleural TB ( n = 8, 11.3%), and multisite involvement ( n = 6, 8.4%). Nearly 71.8% were male, and 77.4% belonged to low socioeconomic status (lower-middle or lower class). Usual predisposing factors were tobacco smoking (38.0%), chronic alcohol use (27.0%), and diabetes mellitus (23.9%). Atypical features were more frequent with extrapulmonary TB. Only 28.2% were microbiologically confirmed cases, and rifampicin resistance was seen in only one case. The mortality rate was considerably high (24.0%), highest with pulmonary TB (37.0%). CONCLUSION: Older patients with TB emergencies have atypical presentations, diagnostic difficulties, and high mortality.

Chronic pancreatitis is associated with an uncommon but important complication, the formation of the pseudoaneurysm with an incidence of 10%. The splenic artery is the most common artery affected by pseudoaneurysm. A 55-year-old male patient with pseudoaneurysm of the gastroduodenal artery, an unusual complication of chronic pancreatitis. He presented with haematemesisf and was managed with transfusion of blood and blood products and coil embolisation with the help of digital subtraction angiography. Pseudoaneurysms are one of the rare but important complications of chronic pancreatitis which requires treatment even if they are asymptomatic and incidentally diagnosed on imaging. A history suggestive of upper gastrointestinal bleeding in a case of pancreatitis requires adequate evaluation for source of the bleeding.

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has taken the world as a storm, has been indisputably found to be associated with mild to life-threatening pneumonia in the majority of patients. Mucormycosis emerged as a life-threatening complication of coronavirus disease 2019 in India during the second wave of the COVID-19 pandemic. There lies a large lacuna in the understanding of the disease progression and the association of mucormycosis with COVID-19 and the various predisposing factors.Aim: To assess the pattern, risk factors, and outcome of mucormycosis cases reported to hospitals in North India during the second wave of the COVID-19 pandemic.Material and methods: An observational, prospective study was conducted for 109 patients reporting to a medical emergency with a history of suspected or confirmed mucormycosis from May 2021 to July 2021. Obtained data were analysed using descriptive statistics and results were expressed as a percentage and mean.Results: Out of 109 patients, 75 were male and 34 were female with a mean age of 50.6 years, most cases belong to the rural background. The most common types of mucormycosis were rhino-orbital (34.8%), rhinoorbital cerebral (20.18%), and pulmonary (23.8%). The most common risk factors were uncontrolled diabetes (80 %), use of steroids (68.8%), diabetic ketoacidosis (42%), and COVID-19 positive status (66.9%). High mortality of 33.9% was seen in our study.Conclusions: The most vulnerable group in our study were patients with pulmonary manifestations (51.4%) and patients requiring oxygen therapy (94.6%). Our study found that scoring systems namely the quick sequential organ failure assessment (q SOFA) scoring system (p-value <0.001) along with the Glasgow Coma Scale (p-value <0.038) can be used as a prognostic indicator and good assessment tools for the degree of severity of disease at an early stage.