Kavita M. Jaiswal

Abstract

Background and Objectives: The peak of second wave of corona virus disease in India was from mid March to mid May 2021 which was lethal. The present study was carried out with the objectives to find the characteristics, clinical presentation of patients and to co-relate these features with treatment outcomes - mortality and adverse effects. Materials and Methods: This is an observational study carried out in patients admitted in a Dedicated COVID Hospital (DCH) with severe symptoms of COVID-19 with or without undergoing lab test for diagnosis. The patients were prospectively evaluated for demographics, clinical course, treatment offered and outcomes during a period from 15 April to 19 May 2021. Results: Patients in age group of 45-61 years were most affected. Men were affected more as compared to women. All patients were offered treatment protocol as per updated National guidelines. Primary outcomes in terms of In- hospital mortality was 24.13% The In- hospital mortality was significantly more in patents above the age of 45 years as compared to patients below 45 years and also in patients with co-morbidity than in patients without it. The biomarkers of patients who died were found to be on higher side. Secondary outcomes –death post discharge was 8.04% and 2.29% of patients developed mucormycosis. Conclusions: All the admitted patients had severe symptoms irrespective of confirmatory diagnosis and High –resolution computed tomography (HRCT) scores. All of them required mechanical ventilation, injection Remdisivir, injectable antibiotics, anti-coagulants, injection Methyl Prednisolone. Inspite of this management the In-hospital mortality was 24.13%. Keywords: C-Reactive Protein, corona virus disease, inj Remdesivir, mechanical ventilation, mucormycosis, RT-PCR

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Abstract

Introduction: Chloroquine (CQ) and Hydroxychloroquine (HCQ) has received huge momentum as possible treatment for COVID-19. In India the drug is approved for prophylaxis of asymptomatic health workers treating suspected or confirmed COVID-19 cases, and asymptomatic household contacts of confirmed patients. The U.S. Food and Drug Administration (FDA) has issued Emergency Use Authorization (EUA) of HCQ to treat COVID-19. Materials and Methods: Here we present the database of trials with these compounds in COVID-19. Discussion: Early 15 registered clinical trials of CQ and HCQ in COVID -19 positive patients in China, showed that the drugs were superior to the control treatment in inhibiting the exacerbation of pneumonia, improving lung imaging findings, promoting a virus-negative conversion, and shortening the disease course. Some studies had no positive results including a multinational registry analysis of HCQ with or without a macrolide for treatment of COVID-19 published online in Lancet on 22nd May 2020.The study showed that there was decreased in-hospital survival and an increased frequency of ventricular arrhythmias when HCQ was used for treatment of COVID-19.In the light of this publication the WHO temporarily paused the HCQ arm of its ‘Solidarity’ global clinical trial on 26th May 2020 and trials with HCQ /CQ for COVID were also suspended. The Lancet paper was in controversy until finally on June 4th 2020 the article was retracted by authors. Conclusions: Until we get results of WHO fast track ‘Solidarity’ clinical trial and other randomized clinical trials repurposing these drugs remains questionable. Keywords: CQVID-19 pandemic, Corona ‘Solidarity’ trial, Severe acute respiratory syndrome

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Abstract

Introduction: Surgical Antimicrobial Prophylaxis (SAP) lowers post-operative surgical site infection (SSI) if used with American Society of Health-System Pharmacists (ASHP) guidelines. Objective: The present study was carried out with the aim to assess the rational use of antibiotics for prevention of SSI and to look for adherence to ASHP guidelines. Materials and Method: This was a prospective study done in 228 patients in surgical ward/ICU who received antibiotics for surgical prophylaxis. Results: There was unnecessary SAP pre-operatively in 22.80 % respondents. Post-operatively 10.08 % patients received single antibiotic, 79.39% received two, 14.91% received three, one received four antimicrobials. Antibiotics were used for procedures where antibiotic prophylaxis is not indicated There was appropriate antimicrobial selection in 31.58% surgeries .Appropriate initial time of SAP was in 87.72% surgeries .Route, dose, dose interval were appropriate in all surgeries. The duration of prophylaxis was consistent with the guideline recommendation in 47.37% patients. SSI developed in 3.5% cases. Patients were discharged without complications. Conclusion: Utilization of antimicrobials for surgical prophylaxis are not in accordance with standard treatment guidelines. There was overuse of antimicrobials .Costly and branded drugs were used. Effective educational intervention, development of local guidelines / protocols can help to overcome this. Keywords: Antimicrobial, surgical prophylaxis, ASHP guidelines, surgical site infection

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