Introduction The COVID pandemic, which started on 11th March as per the World Health Organization, has resulted in a drastic change in health care delivery, including emergency services. Most health workers have deviated towards COVID care delivery; only a few were available for non-COVID conditions. All elective and non-essential services were postponed resulting in the increased burden of the emergency department. The emergency department had to provide essential emergency care with available staff without exposing them to the virus. Triaging of the patients was modified according to the needs. Methods The statistics of the emergency department of this period (April and May 2020) are compared with the same period of previous years (2018–2019) with the number of patients, indications, and complications. The methods of triaging and preparation were discussed. Discussion The number of patients admitted to the emergency department (ED) was low during the COVID pandemic. Nevertheless, they got admitted with complications due to delay in accessing the health care facility. Patients with diabetic foot ulcers were also presenting late, leading to an increased number of the forefoot and below knee amputations. In trauma, the emergency department has maintained the same death rate as previous years by giving great care. The indications for tracheostomy were worrisome because it would have been prevented if the patients presented early. Pediatric patients were also presented late, resulting in increased mortality. Some cancer patients also presented with a complication in the emergency department because of the postponement of elective surgeries. Conclusion There is a delay in accessing the health care delivery for non-COVID conditions resulting in more amputations of limbs and resections of the bowel. So the type of care in the emergency department was changed due to atypical presentation and complicated cases. It is necessary to ensure the provision of high quality health care delivery to non-COVID patients also.

Introduction. Hashimoto’s thyroiditis (HT) is a common autoimmune thyroid disorder, which predominantly presents as a diffuse goiter, with few studies which report HT presenting as multinodular goiter, with variable frequencies ranging from 59% to 78.6% especially from south Indian populations. This variant clinical presentation may have diagnostic challenges which require further analysis. Anti-TPO antibodies are more common (90-95%) in Hashimoto’s thyroiditis than anti-TG antibodies in Hashimoto’s thyroiditis. This study analyzes the clinical features and the correlation of anti-TPO levels with diffuse and multinodular forms of HT. Material and Methods. This study was conducted in the Department of General Surgery in a tertiary care hospital in south Tamil Nadu. Patients presenting with clinical features of a thyroid disorder were interviewed and given a detailed clinical, radiological examination and guided FNAC. Those patients diagnosed by FNAC as HT were registered and a sample of 3cc of blood was drawn for T3, T4, TSH, and anti-TPO analysis. All the data were tabulated. Results and Discussion. Of the 212 patients who presented with goiters, 96 were diagnosed by FNAC as having a cytological picture suggestive of Hashimoto’s thyroiditis. Of these 96 patients with HT, 46 (47.9%) were multinodular (HT-MNG), 14 (14.58%) were solitary nodules (HT-SNT), and the remaining 36 (37.5%) were diffuse goiters (HT-D). Of the 46 patients who are HT-MNG, 36.9% had elevated anti-TPO-Ab (more than 35.0U/l) and 63.1% had normal/lower values (less than 35.0U/l). But of 36 patients with HT-D, 77.7% had elevated anti-TPO-Ab levels (>35U/l). Chi square statistics was 15.8346 and the p value is 0.0005 (<.05). Eight cases of HT-D and 3 cases of HT-MNG had hyperthyroidism and 3 cases of HT-D had hypothyroidism and all other cases were in euthyroid state. Conclusion. Patients presenting as multinodular Hashimoto’s thyroiditis have low prevalence of elevated anti-TPO-Ab than diffuse HT which suggests that multinodular form of Hashimoto’s thyroiditis is a unique clinical entity with etiopathogenesis that is at variance with the diffuse form.

Background: Surgical Site Infections (SSIs) are the third most frequently reported nosocomial infection, accounting for 14 to 16 percent of all nosocomial infections among hospitalized patients according to National Nosocomial Infections Surveillance. SSIs are responsible for the increased morbidity and mortality related to surgery. Surgical wounds are classified as clean, clean contaminated, contaminated and dirty wounds as per CDC criteria. Better understanding of the causal factors of SSIs and prevention will reduce the cost of the surgery. Materials and methods: 1570 patients who underwent surgery in the dept. of General surgery in a tertiary care hospital were taken for the study. Out of which 990 patients underwent elective surgical procedures and 580 underwent emergency procedures. An elaborate study of these cases with regard to date of admission, history, clinical features, type of surgery, emergency or elective, preoperative preparation, type of incision, contamination, procedure done, peroperative findings, drain used and its type and duration of operation and postoperative management and signs of wound infection were done and the findings are tabulated. Results: 115 cases out of 1570 surgeries had surgical site infections. The overall post-operative SSI rate in elective clean and clean contaminated cases is 4.34% and emergency cases is 12.41%. The study showed that the superficial surgical site infections are the commonest type and accounted for about 72.09% in elective and 61.11% in emergency of all the SSI's and deep surgical site infection accounted for about 23% in elective and 30.55% in emergency cases. E. Coli is the commonest organism isolated from the surgical wounds that is 30.23% in elective cases. In emergency cases Proteus mirabilis is the most common organism involved in SSI followed by E. Coli. Conclusion: E. coli is the commonest organism isolated from elective surgical wounds and Proteus mirabilis is the commonest organism isolated from emergency surgical wounds. A change in the pre operative antibiotics may reduce the incidence even lower. A preexisting medical illness like diabetes mellitus and duration of operating time, class of the wound, emergency surgeries and wound contamination had strong effect on the development of surgical site infection. Highlights:

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Road traffic accidents are one of the leading causes of mortality. Blunt injury abdomen contributes to the mortality in road traffic accidents second to head injury. The mechanism of injury in road traffic accidents are due to blunt force created by collision between the patient and the external forces, acceleration and deceleration forces acting on the person’s internal forces. The common solid organs involved in blunt abdominal trauma are Spleen, Liver, and Kidney. Mesenteric tear and isolated small bowel injuries can also occur. Blunt abdominal trauma is one of the very common emergencies in the emergency department. High degree of suspicion and watchfulness, regular examination, imaging and investigations are needed to diagnose blunt injury abdomen. E-FAST is the emergency screening tool used to diagnose intra-abdominal injuries in emergency department even in hemodynamically unstable patient. The treatment will depend on the hemodynamical status, whether stable or unstable. Hemodynamically unstable patient with positive E-FAST will be taken up for emergency exploration while stable patient will undergo further imaging and investigation to plan the management. The chapter will discuss about the grades of injuries in spleen, Liver, mesentery and retroperitoneum. It will also discuss about the various diagnostic and treatment modalities available and when and where to use them to improve the quality of management. This chapter will be useful for the surgical postgraduates and young budding surgeons and trauma surgeons.