Background and Aim: In the wave of COVID-19 pandemic, the whole world has come to a standstill. This led to a major setback for cancer patients jeopardizing their treatment plans. This study analyzes the coping mechanisms of running outpatient and inpatient palliative care services in these COVID-19 times – the New Normal. Materials and Methods: An observational study was conducted in the pain and palliative care unit at a tertiary care hospital, India. The data were collected from March 23, 2020, to May 22, 2020, of all patients coming to the clinic and inpatient referrals. Using manual and electronic records, demographic data was collected along with clinical data. Additional data were compiled with special attention to the patient's pain and its management. Results: Despite complete lockdown and initial low patient load, we saw a progressive increase in the number of patients coming to the clinic. A total of 108 patients visited our clinic (65 male and 43 female), of which 78% of the patients were from Delhi. The median age was 43.94 years (range 6 years to 76 years). We had 33 new and 75 old registered cases coming. The main reason was new-onset pain because of noncompliance of drugs; the opioid stock finished with the patient. We saw a very high number of patients requiring strong and weak opioids. Proper personal protection and social distancing helped in preventing crossinfection. None of our staff or patients fell ill during this time. Communication skills were modified to convey feelings and empathize patients. Telemedicine using phone and video calls was used and found to be useful. Conclusion: We share our experience and challenges of providing palliative care in our clinic which can be modified as per the individual requirements in other setups.

Type-III tracheoesophageal fistula is the commonest type of fistula where upper pouch is blind and distal oesophageal pouch communicates with trachea. In this condition, gastric distension is a common manifestation which can be worsened by positive pressure ventilation. Pulmonary pathology may necessitate ventilation with high peak airway pressures which may rarely lead to gastric perforation with serious consequences. We are reporting such a case of gastric perforation during ventilatory management for fistula repair which needed surgical repair. Keywords: Airway management; esophageal atresia; gastric perforation; tracheo-oesophageal fistula.

Background and Aim: Coronavirus disease 2019 (COVID-19) has become a global pandemic with the spectrum of disease from asymptomatic or mild disease to severe cases requiring intensive care unit (ICU) admission. In India, it started with milder presentation affecting younger population. Later on, an increase in disease severity was observed involving older age group as well. However, there is a paucity of published data regarding patients requiring ICU care in India. This case series describes the initial experience of an ICU in India regarding epidemiological profile, clinical course, and outcome of critically ill COVID-19 patients. Methods: This case series included 27 consecutive laboratory-confirmed COVID-19 patients who were admitted in a tertiary care ICU over 14 days period, followed up till their discharge from ICU. Demographic and clinical data, including laboratory and radiological findings, were compiled with special attention to co-morbidities of the patients. The management of these patients was done as per the institutional protocol for critically ill COVID-19 patients. Results: The median age of the patients was 50 years with no difference in gender. Comorbid conditions were seen in 85% of the patients with diabetes (43.7%) and hypertension (37.5%) as the most common conditions. The median duration of symptoms before admission was 6 days with fever as the most common clinical symptom at presentation. Chest roentogram showed bilateral lung infiltrates in 88.8% of the patients. Mild, moderate, and severe hypoxia were observed in 3, 8, and 16 patients, respectively. Ten patients were managed with oxygen therapy. Seventeen patients (62.9%) required ventilatory support. Mortality rate among patients admitted to our ICU was 59.2%. Conclusions: This case series shows middle-aged patients with comorbid diseases present with severe COVID-19 disease and have poor outcome.

No abstract

Shigruguggulu is anubhoota yoga of Banaras Hindu University using as analgesic and anti-inflammatory since long time in the Shalya Ward and OPD of the Sir Sunderlal Hospital, Banaras Hindu University. Present research work was done on 150 healthy patients. The patients were divided into three Groups. Each Group included 50 patients with age (16-60 years), height and weight distribution. The patients were posted for primary threading, herniotomy with herniorrhaphy and hemorrhoidectomy, skin grafting, sentinel tag, tubectomy and abdominal hysterectomy. Group I was pre medicated with two capsules of Shigruguggulu 500 mg (2/3 part of Shigru root bark decoction and 1/3 Shigru root bark choorna with guggulu) orally at 10 pm and 90 minute before anesthesia and inj. Glycopyrrolate 0.2 mg IM, 60 minute before anesthesia. Group II was pre medicated with two capsules of Shigruguggulu 500 mg (Shigru root bark decoction with guggulu) orally at 10 pm and 90 minute before anesthesia and inj. Glycopyrrolate 0.2 mg IM, 60 minute before anesthesia. Group III was pre medicated with tab. Diclofenac sodium 50 mg orally 10 pm and 90 minute before anesthesia and inj. Glycopyrrolate 0.2 mg IM 60 minute before anesthesia. It was observed that no alteration in Mean Blood Pressure, respiratory rate, pulse rate, temperature and liver function test etc. Post anesthetic sequel, like nausea, vomiting, headache, backache, CNS irritability was observed insignificant in all the three Groups. It means that drug has no any side effect.