Emphysematous pyelonephritis (EPN) is a severe, necrotizing renal parenchymal infection characterized by production of intraparenchymal gas. EPN predominantly affects female diabetics and immunocompromised patients. In a three-year period 2008–2011, a total of 8 patients were admitted to our hospital. All of them were diabetics, and both males and females were equally affected. These patients showed vague symptoms at admission and frequently presented with fever, loin pain, dysuria, and pyuria necessitating urgent medical attention. EPN required radiological diagnosis. CT scan revealed bilateral EPN with urinary obstruction and hydronephrosis in 50% of patients. Escherichia coli was found to be the causative organism in all the patients. Treatment comprised of resuscitation, normalization of serum electrolytes and blood sugars, administration of parenteral antibiotics, and relieving ureteric obstruction if present. All the patients improved with conservative management without any mortality.

Background: To validate the clinical scoring system TOPRSS for the severity of the illness to prioritize care and predict outcomes in the emergency department.Methods: This prospective hospital-based observational study in 100 children for three months carried out. Cases<1-month age or>14 years excluded. Demographics data, provisional diagnosis, hemodynamics, seizures, and other clinical parameters were recorded on predesigned proforma at the time of admission. Final outcome of the patient, either discharge or death, was considered as the primary variable.Results: Out of 100 children, 92 were discharged and 8 deaths were recorded. Of the six variables, oxygen saturation and sensorium were found to be significantly associated with mortality. Logistic regression found that variables such as oxygen saturation and sensorium were strongly associated with mortality with a highly significant p value of 1% and variables such as pulse rate and seizures were also associated with mortality with a significant P value of 5%.Conclusions: For triage in pediatric emergency, a patient with two or more abnormal variables should be evaluated to facilitate admission as they have a potential risk of death. TOPRSS score being a simple clinical scoring system which does not require any expertise can applied at all levels of health care to identify critically ill patient referral to higher centre especially in regions of resource poor environment.

Background: COVID-19 has swiftly spread to emerge as a global pandemic with no visible signs of decline. It is imperative to identify the parameters contributing toward COVID-19 mortality to facilitate prompt evaluation and control measures. Materials and Methods: A total of 1754 patients with confirmed COVID-19 infection were admitted at MVJMC and RH, Bangalore, from July 1, 2020 to December 12, 2020. Various parameters such as demographical profile, symptomatology, risk factors, laboratory profile, and complications of 75 patients (4.27%) who succumbed were studied. Results: About 45.33% of the patients who died were older than 65 years. 77% of patients who died were males. About 61.33% had severe illness at the time of presentation. 84% of the patients who died had comorbid illnesses. Respiratory failure secondary to acute respiratory distress syndrome and bilateral pneumonia was the leading cause of mortality followed by sepsis/multiple organ dysfunction syndrome, myocarditis, coagulopathy, and acute cardiovascular event. The presence of lymphopenia elevated inflammatory markers, and comorbid conditions were identified as risk factors for the requirement of oxygen, mechanical ventilation, and death. Conclusion: Elderly patients (>65 years of age) and middle-age patients (45–65 years of age) comprised the highest and second-highest proportion of mortality respectively. The increasing proportion of deaths among the middle-aged patients and the narrowing gap of the same between these two groups are alarming. Old age, male gender, underlying chronic illnesses, and elevated inflammatory markers are some of the factors attributed to these trends. Hence, stringent preventive measures, early detection, and initiation of treatment pose a greater impact on reducing the burden of morbidity and mortality.

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