A BSTRACT Background: During the COVID-19 pandemic, many patients presented to the emergency department (ED) with features of Influenza-like illnesses (ILI) and with other atypical presentations. This study was done to determine the etiology, co-infections, and clinical profile of patients with ILI. Methods: This prospective observational study included all patients presenting to the ED with fever and/or cough, breathing difficulty, sore throat, myalgia, gastrointestinal complaints (abdominal pain/vomiting/diarrhea), loss of taste and altered sensorium or asymptomatic patients who resided in or travelled from containment zones, or those who had contact with COVID-19 positive patients during the first wave of the pandemic between April and August 2020. Respiratory virus screening was done on a subset of COVID-19 patients to determine co-infection. Results: During the study period, we recruited 1462 patients with ILI and 857 patients with the non-ILI presentation of confirmed COVID-19 infection. The mean age group of our patient population was 51.4 (SD: 14.9) years with a male predominance (n-1593; 68.7%). The average duration of symptoms was 4.1 (SD: 2.9) days. A sub-analysis to determine an alternate viral etiology was done in 293 (16.4%) ILI patients, where 54 (19.4%) patients had COVID 19 and co-infection with other viruses, of which Adenovirus (n-39; 14.0%) was the most common. The most common symptoms in the ILI-COVID-19 positive group (other than fever and/or cough and/or breathing difficulty) were loss of taste (n-385; 26.3%) and diarrhea (n- 123; 8.4%). Respiratory rate (27.5 (SD: 8.1)/minute: p-value < 0.001) and oxygen saturation (92.1% (SD: 11.2) on room air; p-value < 0.001) in the ILI group were statistically significant. Age more than 60 years (adjusted odds ratio (OR): 4.826 (3.348-6.956); p-value: <0.001), sequential organ function assessment score more than or equal to four (adjusted OR: 5.619 (3.526-8.957); p-value: <0.001), and WHO critical severity score (Adjusted OR: 13.812 (9.656-19.756); p-value: <0.001) were independent predictors of mortality. Conclusion: COVID-19 patients were more likely to present with ILI than atypical features. Co-infection with Adenovirus was most common. Age more than 60 years, SOFA score more than or equal to four and WHO critical severity score were independent predictors of mortality.

Background: Uncontrolled diabetes leads to acute and chronic complications, both of which present to the emergency department (ED). Glycated hemoglobin (HbA1c) reflects glycemic history. This study was done to determine the correlation between acute diabetic complications and implications of HbA1c levels in ED. Materials and Methods: We conducted a prospective observational study between May 2019 and April 2020. Data was collected in a standard datasheet and analysed using Statistical Package for Social Sciences for Windows. Results: Our study included a total of 382 (0.5%) patients, among which 56% were male patients. Mean age was 57.9 (standard deviation ± 14.9) years. Based on their hemodynamic stability, majority (n = 291) were triaged as priority one. Acute diabetic complications included hypoglycemia-62% (238/382), diabetic ketoacidosis (DKA) - 26% (98/382) and hyperglycemic hyperosmolar state - 12% (46/382). Most common presenting complaints were unresponsiveness (49.7%) followed by breathing difficulty (31.6%) and fever (24.6%). Random blood sugar level at presentation was <70 mg/Dl in majority (62.3%) of them. Common precipitating factors were poor food intake (51%), infection (30%) and drug noncompliance (29.5%). Three-fourth of the study population was previously diagnosed to have diabetes mellitus and HbA1c >7 was seen in 227 (59%) patients. Bivariate and multivariate logistic regression analysis showed DKA (adjusted odds ratio [OR]: 5.2;95% confidence interval [CI]: 1.39–19.41; P = 0.014), noncompliance to medications (adjusted OR: 3.9; 95% CI: 1.4–10.76; P = 0.009) and poor oral intake (adjusted OR: 0.3; 95% CI: 0.14–0.59; P = 0.001) as independent predictors to have a HbA1c level >7. Approximately half (51.2%) the study population required admission while one patient died in the ED during resuscitation. Conclusion: Elderly male population were most commonly involved. Unresponsiveness was the most common presenting complain and hypoglycemia was the most common presenting clinical feature. Majority of the acute diabetic complications were precipitated by poor food intake, infection and noncompliance to medications. Hospital admission was warranted in majority of the study population. HbA1c in the ED is a useful parameter that would help plan further medication at discharge.

In the past 20 years, several viral epidemics such as the severe acute respiratory syndrome coronavirus (SARS-CoV) in 2002 and 2003, H1N1 influenza in 2009, and Middle East Respiratory Coronavirus in 2012 have been recorded. The COVID-19 pandemic caused by SARS-CoV-2 has infected millions across the globe and has been a unique public health challenge with its increased rates of contagion and transmission. This outbreak was likely to have started from a zoonotic transmission event associated with a large sea-food market that also traded live wild animals. An exponential increase in the number of nonzoonotic cases in late December 2019, pointed toward the risk of human-to-human transmission. This led to a faster spread of infection and made the outbreak difficult to contain. The situation was unique in the busy Emergency Department (ED) of our institution, where regular emergency care could not be halted but had to be modified to accommodate COVID-19 confirmed and suspect patients. The ED needed to develop standard operating protocols to isolate and manage these patients, without putting other patients and health-care workers at risk of infection. This is a story of evolving practices in the ED of a leading tertiary care center of South India.