09/12/2024


The COVID-19 pandemic originated in China in December 2019 and has since then, swept across the world. The last Influenza pandemic of 1918 happened before the advent of modern medicine. We have come a long way since then. But the pandemic has still caught us unprepared in many quarters. The review focuses on the management of critically ill COVID-19 patients and the various challenges faced by intensivists.The COVID-19 epidemic has put an enormous burden on the health-care system and the economy. The virus has very high infectivity and is crippling in patients developing severe disease. The disease caused by this infective agent, a novel RNA coronavirus (SARS-CoV-2), was named by the World Health Organization as COVID-19. SARS-CoV-2 usually enters the human body from the respiratory tract and gradually causes systemic disease. The disease is mild in 81% and severe in the balance. The virus causes multiorgan damage and primarily damages airway epithelium, small intestine epithelium, and vascular endothelium, which are organs with high angiotensin-converting enzyme (angiotensin-converting enzyme-2 [ACE2] expression). The most affected organ is the lungs, and the cardiovascular system follows it closely. Symptomatic hypoxic patients are initially treated with oxygen supplementation, but those with severe hypoxia need mechanical ventilation support. Patients with COVID-19 infection present as two phenotypes. The ventilation strategy should be based on the phenotype. The disease causes major hemodynamic disturbances in its invasion of the cardiovascular system. Strict personal protection protocols are needed to ensure the safety of health-care workers and nosocomial spread.Indians stranded in countries reporting widespread transmission of COVID-19 in Jan to Mar 2020 were evacuated at short notice. Unclear and evolving evidence on COVID-19, risk of transmission of the disease from pre-symptomatic, asymptomatic and known cases of COVID-19 has put the spotlight back on the practice of quarantine. The article describes the processes, inter-sectoral coordination and methodology adopted for putting in place all measures for a successful evacuation and subsequent quarantine of the evacuees at the first Quarantine camp set up in India at Manesar, Gurugram near New Delhi by the Armed Forces. No health care worker or support staff contracted any infection with SARS-Cov-2 during the period of care and contact with those quarantined. The archaic practice of quarantine has yet again proven to be a robust and effective Public Health tool with great relevance in the ongoing Pandemic of COVID-19.The ongoing pandemic of COVID-19 has affected more than 43 million people all over the world with about 280000 deaths worldwide at the time of writing this article The outcome of this pandemic is impossible to predict at the present time as the numbers of both, infected patients and those dying of the disease are increasing on a daily basis. China, Italy, France, Spain, Germany, United Kingdom, and USA are the worst affected countries. All these countries have robust health care systems but despite this there has been a huge shortage of health care facilities especially intensive care beds in these countries. A country like India has different challenges as far as medical care during this pandemic is concerned. The need of the hour is to improve the health care system as a whole. In the present pandemic this involves setting up of patients screening facilities for the disease, enhancing the number of hospital beds, setting up of dedicated high dependency units, intensive care units and operation theatres for COVID positive patients. The present article describes in brief the way this can be done in a short time.The recently published ISCHEMIA trial which is a prospective randomized multi-centre trial has concluded that there was no evidence that an initial invasive strategy of revascularisation in patients with stable angina reduced the risk of ischaemic cardiovascular events or death from any cause. The trial has confirmed that patients with stable angina do not greatly benefit from revascularisation and optimal medical treatment (OMT) is an acceptable alternative. The trial has also confirmed that in patients with stable angina and end-stage renal impairment, OMT is once again an equally effective initial strategy. While the ISCHEMIA trial is one of the most rigorously and meticulously conducted trial, exclusion of symptomatic patients, recruitment of patients who are not known to derive significant benefit from revascularisation and those who were at low risk of clinical events, along with a short follow-up period, may all have contributed to the lack of difference seen between the groups. The fact that the ISCHEMIA trial does not represent the entire cohort of real-life patients requiring revascularisation should be borne in mind, and care should be taken in extrapolating these results to the wider group of patients requiring revascularisation for coronary artery disease.We report a case of giant left ventricular outflow tract pseudoaneurysm diagnosed by multidetector computed tomography cardiac angiography. This report highlights the importance of preoperative computed tomography in the evaluation of left ventricular outflow tract pseudoaneurysm which can be kept as a differential diagnosis for anterior mediastinal masses.Myositis ossificans (MO) is the abnormal formation of benign heterotopic bone tissue in soft tissues or muscles, mostly in sites of trauma. Though it has been described in most parts of the body, less than a dozen cases involving the chest wall have been reported. https://www.selleckchem.com/products/GSK429286A.html It is known to resolve spontaneously and various medical treatments have been suggested to hasten its resolution. Large tumors, suspicion of malignancy, and presence of symptoms are indications for surgical intervention. The differential diagnoses include sarcomas, infections, callous, calcified hematomas, and cysts. We present the clinical, radiological, and pathological images of a post traumatic MO of the chest wall, arising from under the medial third of the clavicle and growing into the deeper surface of the pectoralis major muscle. The patient is doing well eight months after the excision of the same.