Background:Stroke, characterized by sudden loss of cerebral function, is among one of the leading cause of death and disability world over. The newer treatment modalities have changed the landscape of stroke treatment but are very much time bound.Aim:To characterize pre-hospital and in-hospital factors affecting acute stroke management thus defining lacunae in stroke management.Subjects and Methods:A prospective observational study, conducted at the emergency department of a tertiary care center in southern India from August 2015 to July 2016. All stroke patients presenting within first 24 hours of onset were included. A pre -defined Knowledge-Attitude-Practice (KAP) questionnaire was used.Results:Total of 133 patients were eligible out of which 28 were excluded for various reasons. Majority were >60 years age and male (61%). About 60% arrived within window. Distance from the hospital was one of the major factors for arrival within the window period. When compared by KAP questionnaire, bystanders of those arriving within window period had better awareness of stroke symptoms.Conclusions:Improving awareness of stroke symptoms and increasing availability of EMS is likely increase chances of stroke patients receiving appropriate acute management.

Background: Acute pancreatitis (AP) is associated with high mortality in its severe form. Conventional laboratory tests used in its diagnosis are fraught with multiple shortcomings. Early institution of intravenous fluid resuscitation can reduce morbidity and mortality. Measurement of urinary trypsinogen-2 using a bedside urine dipstick test may prove useful in early identification of AP.Methods: Patients with symptoms consistent with AP, attending the emergency department, at a tertiary care hospital in southern India, between November 2014 and November 2016, were included in a prospective observational study. The patients underwent routine investigations and additionally were tested with a urinary trypsinogen-2 dipstick test (UTT). The diagnostic performance and the time to reporting of the different investigations were compared with those of UTT. Final diagnosis of AP, made by clinicians, served as the standard.Results: The sensitivities of serum amylase, serum lipase, UTT, ultrasonography (USG) and contrast-enhanced computed tomography (CECT) were 97.1%, 94.1%, 92.7%, 98.3% and 100%, respectively. The respective specificities were 92.4%, 98.5%, 98.5%, 100% and 100%. The average time required to obtain the test report was about half hour from admission in case of UTT, compared to about 3 hours for serum amylase/lipase, 4 hours for USG and 6 hours for CECT.Conclusions: The results indicate that UTT test, due to its high performance indices, simplicity and faster availability of reports, can serve as an ideal screening test for AP and help in early institution of treatment.

The coronavirus pandemic has become a challenge to all the healthcare systems in the world. Urgent creation of an intensive care unit (ICU) for the same is the need of the hour. The ideal ICU for COVID -19 should be isolated, fully equipped with invasive and noninvasive monitoring, with 24/7 trained medical personnel, nursing staff and laboratory support. As the coronavirus infection is transmitted by droplets and is highly contagious, protection of healthcare workers is crucial. Personnel working inside the ICU should get personal protective equipment (PPE). Strict guidelines for donning and doffing of PPE should be followed to prevent cross-contamination. Respiratory failure being the commonest complication of COVID-19, knowing the ventilator management for the same is essential. It is of great importance to meticulously manage all the resources to combat this contagion.

Introduction: The Mortality Prediction Model (MPM0) was developed to estimate the probability of hospital mortality among patients in general and surgical intensive care units (ICUs). Although this score is widely accepted, its applicability in patients with primary cardiac conditions has not been thoroughly evaluated. The aim of this study is to assess the performance of the MPM0 score in a cardiac intensive care unit (CICU). Methods: From 2007 to 2012, data related to variables from the MPM0 (Table 1) were prospectively collected on all consecutive patients admitted due to a primary cardiac condition to the CICU of a tertiary referral center. MPM0 was applied to all patients. Two variables of the original risk score were not included in the analysis: intracranial mass effect and cirrhosis. The incidence of each variable within the score was determined. Test performance was assessed using the area under the receiver operating characteristic curve (c-statistic). Results: A total of 6,433 patients were admitted to the CICU, of whom 5,710 (89%) had a primary cardiac diagnosis. Complete data were available for 4,641 patients, who comprise the study population. Primary cardiac diagnoses were: acute coronary syndrome (54%), arrhythmia (13%), valvular (12%), cardiomyopathy (8%), cardiac arrest (4%) and other (9%). Overall hospital mortality was 10.4%. The c-statistic for application of MPM0 to this population was 0.82 (95% CI 0.81-0.84), indicating excellent discriminatory capacity. Conclusions: The MPM0 risk score, described originally to aid in prediction of mortality for patients admitted to medical and surgical ICUs, performed extremely well when applied to cardiac patients admitted to a large contemporary CICU.

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