Coronavirus disease-19 (COVID-19) causes mild to moderate illness in most patients but in some cases a severe illness may manifest. Such patients usually present with hypoxaemic respiratory failure due to acute lung injury caused by a viral infection and host-mediated cytokine storm. The characteristic radiographic findings are ground-glass opacities with consolidation in posterior basal areas of bilateral lungs and rarely pneumothorax (PTX) and pneumomediastinum (PM). The incidence of these findings was notably higher in the second wave of the pandemic in India in 2021 as compared to the first wave in 2020. The etiopathogenesis of this life-threatening condition can be due to Macklin phenomenon post-cytokinemediated diffuse alveolar injury, patient self-inflicted lung injury (P-SILI), and barotrauma in mechanically ventilated patients. The presence of pneumomediastinum is associated with higher mortality rates, prolonged intensive care unit (ICU) stays making it a poor prognostic marker. There is no consensus regarding its management in COVID-19 patients although both aggressive and conservative strategies have been tried.

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Background and objective: Bleeding from the upper gastrointestinal (GI) tract is one of the common medical emergencies. In this study, we assessed patients' socio-demographic and clinical characteristics and the association of clinical characteristics with treatment outcomes among patients with upper gastrointestinal bleed (UGIB) presenting to the emergency department (ED). At present, there is a scarcity of data on UGIB in Northern part of India. Material and method: The study was a single-center,prospective observational study conducted at an urban tertiary care center. Consecutive patients with UGIB were enrolled in the study from August 2020 to February 2022. A detailed history was obtained, including demographic data such as age and sex, presenting complaints, history of presenting illness, history related to co-morbidities, addiction, and drug history. Pre-endoscopic Rockall and Glasgow-Blatchford Score were calculated for each patient. The patients were subsequently followed up till discharge from the hospital. The final outcomes with regard to mortality, need for blood transfusion, length of ED, and hospital stay and discharge were noted. Result: 141 patients were included in the study. The mean age of the patients with UGIB was 48 ± 14 years. 115 (81.6%) patients were male. The most common co-morbidity was chronic liver disease (40;28.4%). The most frequent presenting complaint in this study was hematemesis (96; 68.1%), followed by melena (76;53.9%). The mean (SD) of the Rockall Score was 2.46 ± 1.75. The mean (SD) of the Glasgow Blatchford Score was 12.46 ± 3.15 in patients with UGIB. Conclusion: In our study, hematemesis was the most prevalent symptom of an UGIB, followed by melena. Portal hypertension was the more common cause of UGIB. Alcohol intake, NSAIDs abuse, and co-morbidities such as underlying chronic liver disease, hypertension, and diabetes are statistically significantly associated with UGIB. By doing early endoscopy we can find and treat the cause of bleeding, thereby we can prevent morbidity, mortality and decrease the length of hospital stay.

Background and objective Bleeding from the upper gastrointestinal tract is one of the common medical emergencies. In this study, we assessed patients' socio-demographic and clinical characteristics and the association of clinical characteristics with treatment outcomes among patients with upper gastrointestinal bleed (UGIB) presenting to the emergency medicine department. At present, there is a scarcity of data on upper GI bleed in Northern part of India. Material and method The study was a single-center, prospective observational study conducted at an urban tertiary care center. Consecutive patients with UGIB were enrolled in the study from August 2020 to February 2022. A detailed history was obtained, including demographic data such as age and sex, presenting complaints, history of presenting illness, history related to co-morbidities, addiction, and drug history. Pre-endoscopic Rockall and Glasgow-Blatchford Score were calculated for each patient. The patients were subsequently followed up till discharge from the hospital. The final outcomes with regard to mortality, need for blood transfusion, length of emergency department (ED), and hospital stay and discharge were noted. Result 141 patients were included in the study. The mean age of the patients with UGIB was 48.62 ± 14.63 years. 115(81.6%) patients were male compared to 26(18.4%) Females. The most common co-morbidity was chronic liver disease (40;28.4%). The most frequent presenting complaint in this study was hematemesis (96; 68.1%), followed by melena (76;53.9%). The mean (SD) of the Rockall Score was 2.46 ± 1.75. The mean (SD) of the Glasgow Blatchford Score was 12.46 ± 3.15 in patients with upper gastrointestinal bleed. Conclusion In our study, hematemesis was the most prevalent symptom of an upper GI bleed, followed by melena. Portal hypertension was the more common cause of upper GI bleed. Alcohol intake, NSAIDs abuse, and co-morbidities such as underlying chronic liver disease, hypertension, and diabetes are independent risk factors in patients with upper GI bleed. Early upper GI endoscopy can lower the morbidity, mortality, and length of hospital stay in patients with upper GI bleed.

Background: Atrial fibrillation with accessory pathway can present with confounding ECG findings leading to inaccurate diagnosis sometimes leading to fatal outcomes. Treatment with AV nodal blockers is contra-indicated in pre-excited atrial fibrillation as it can lead to fatal ventricular arrythmia. Case Presentation: A 72-year-old female presenting with acute onset palpitations, chest discomfort, shortness of breath and light-headedness with similar past episodes was initially diagnosed to have atrial fibrillation. An ECG after metoprolol administration revealed the features of pre-excitation and Wolff-Parkinson-White syndrome. A repeat episode of tachyarrhythmia was terminated with electrical cardioversion and patient was followed-up in cardiology for radiofrequency ablation. Conclusion: A bizarre ECG with irregular wide complex tachycardia with QRS of varied shape and amplitude and sustained rates surpassing 200 beats per minute, suspicion of WPW syndrome with pre-excited AF should be considered. It is difficult to distinguish from polymorphic ventricular tachycardia, although electrical cardioversion is the primary therapy when hemodynamically unstable.