Background: The objective of the study was to identify the factors that alter the length of hospital stay of COVID-19 patients so we have an estimate of the duration of hospitalization of patients. To achieve this, we used a time to event analysis to arrive at factors that could alter the length of hospital stay, aiding in planning additional beds for any future rise in cases. Methods: Information about COVID-19 patients was collected between June and August 2020. The response variable was the time from admission to discharge of patients. Cox proportional hazard model was used to identify the factors that were associated with the length of hospital stay. Results: A total of 730 COVID-19 patients were included, of which 675 (92.5%) recovered and 55 (7.5%) were considered to be right-censored, that is, the patient died or was discharged against medical advice. The median length of hospital stay of COVID-19 patients who were hospitalized was found to be 7 days by the Kaplan Meier curve. The covariates that prolonged the length of hospital stay were found to be abnormalities in oxygen saturation (HR = 0.446, P < .001), neutrophil-lymphocyte ratio (HR = 0.742, P = .003), levels of D-dimer (HR = 0.60, P = .002), lactate dehydrogenase (HR = 0.717, P = .002), and ferritin (HR = 0.763, P = .037). Also, patients who had more than 2 chronic diseases had a significantly longer length of stay (HR = 0.586, P = .008) compared to those with no comorbidities. Conclusion: Factors that are associated with prolonged length of hospital stay of patients need to be considered in planning bed strength on a contingency basis.

Objective To identify factors associated with recovery time from coronavirus disease 2019 (COVID-19). Methods In this retrospective study, data for patients with COVID-19 were obtained between 21 June and 30 August 2020. An accelerated failure time (AFT) model was used to identify covariates associated with recovery time (days from hospital admission to discharge). AFT models with different distributions (exponential, log-normal, Weibull, generalized gamma, and log-logistic) were generated. Akaike’s information criterion (AIC) was used to identify the most suitable model. Results A total of 730 patients with COVID-19 were included (92.5% recovered and 7.5% censored). Based on its low AIC value, the log-logistic AFT model was the best fit for the data. The covariates affecting length of hospital stay were oxygen saturation, lactate dehydrogenase, neutrophil-lymphocyte ratio, D-dimer, ferritin, creatinine, total leucocyte count, age > 80 years, and coronary artery disease. Conclusions The log-logistic AFT model accurately described the recovery time of patients with COVID-19.

Background: Arterial and venous thrombosis is one of the major complications of coronavirus disease 2019 (COVID-19) infection. Studies have not assessed the difference in D-dimer levels between patients who develop thrombosis and those who do not. Methods:Our study retrospectively assessed D-dimer levels in all virus confirmed hospitalized patients between May to September, 2020. Patients were divided into three groups: group 1 with normal D-dimer of < 0.5 µg/mL, group 2 with elevation up to six folds, and group 3 with more than six-fold elevation. Statistical analysis was done using SPSS software 23.0.Results: Seven hundred twenty patients (group1 (n = 414), group 2 (n = 284) and group 3 (n = 22)) were studied. Eight thrombotic events were observed. Events were two with stroke, two non-ST elevation myocardial infarction and one each of ST elevation myocardial infarction, superior mesenteric artery thrombosis with bowel gangrene, arteriovenous fistula thrombus and unstable angina. No significant difference (P = 0.11) was observed between median D-dimer levels among patients who developed thrombosis (1.34) and those who did not develop thrombosis (0.91). Twenty-nine patients died. The adjusted odds of death among those with a six-fold or higher elevation in D-dimer was 128.4 (95% confidence interval (CI): 14.2 -446.3, P < 0.001), while adjusted odds of developing clinical thrombosis was 1.96 (95% CI: 0.82 -18.2, P = 0.18). Conclusions:Our study observed a 1.1% in-hospital incidence of clinical thrombosis. While, a six-fold elevation in D-dimer was significantly associated with death; the same was not a strong predictor of thrombosis; an observation which implies that dose of anticoagulation should not be based on absolute D-dimer level.

Objectives: This study aimed to assess the outcome and mortality predictors of SARS-CoV-2 infection requiring hospitalization among elderly population. Methods: In this retrospective study, hospitalized elderly people with virologically confirmed SARS-CoV-2 infection were evaluated. Participants were divided into three groups of mild, moderate, and severe based on oxygenation. The primary outcome was death or discharge to home. Results: A total of 169 patients were studied (mean age: 68 years). Apart from respiratory symptoms, other reported symptoms included gastrointestinal complaints in 11% (n = 19), acute stroke in 1.1% (n = 2), delirium in 1.7% (n = 3), and anosmia or ageusia in 8.88% (n = 15). Also, 65 (38.5%) patients required oxygen support, 25 (14.7%) were admitted to the intensive care unit (ICU), 7 (4.1%) required non-invasive ventilation (Fio2 0.6 to 1.0), 14 (8.28%) were mechanically ventilated. 72 (42%) received steroid, and 100 (59%) received prophylactic heparin. Overall mortality was 12.4% (n = 21). Gender had no effect on mortality (P = 0.83). Presence of ≥ 3 risk factors, elevated neutrophil lymphocyte ratio, D-dimer, and lactate dehydrogenase, were associated with mortality (P = 0.001, P = 0.0005, P = 0.05, and P = 0.0005, respectively). Sepsis and cardiovascular events were higher among those who died. Conclusions: We observed a low mortality among the elderly treated with steroids compared to studies done in the pre-steroid period. Elevated NLR, LDH, and D-dimer were associated with mortality.

We report a case of Kimura’s disease in a 65-year-old woman who presented with generalised itching, abdominal pain, facial puffiness, difficulty in swallowing and loss of appetite. She was found to have generalised lymphadenopathy and a fine-needle aspiration cytology initially done revealed ‘reactive lymphadenitis’ which was inconclusive. PET-CT done showed features suggestive of lymphoma. Hence, lymph node biopsy was done for confirmation and incidentally after immunohistochemistry staining it turned out to be Kimura’s disease. High-dose steroid therapy was started and patient showed dramatic clinical and symptomatic improvement. Kimura’s disease almost always presents as cervical lymphadenopathy and usually never causes compressive symptoms. Our patient presented with compressive symptoms and generalised lymphadenopathy which is a rarity.

Background: Hyperinsulinemia and insulin resistance occurs in obese patients with primary hypertension independent of diabetes and obesity. This study was aimed at assessing serum fasting insulin levels, the homeostatic model assessment for insulin resistance (HOMA-IR), and serum lipid levels in non-obese patients with primary hypertension when compared to normotensive subjects. Methods: This observational study comprised 100 patients over 18 years of age, divided into two groups. The hypertensive group comprised non-obese patients with primary hypertension (n=50); the normotensive group comprised normotensive age- and sex-matched individuals (n=50). Patients with diabetes, impaired fasting glucose, obesity, and other causative factors of insulin resistance were excluded from the study. Serum fasting insulin levels and fasting lipid profiles were measured, and insulin resistance was calculated using HOMA-IR. These data were compared between the two groups. Pearson’s correlation coefficient was used to assess the extent of a linear relationship between HOMA-IR and to evaluate the association between HOMA-IR and systolic and diastolic blood pressures. Results: Mean serum fasting insulin levels (mIU/L), mean HOMA-IR values, and fasting triglyceride levels (mg/dL) were significantly higher in the hypertensive versus normotensive patients (10.32 versus 6.46, P<0.001; 1.35 versus 0.84, P<0.001; 113.70 versus 97.04, P=0.005, respectively). The HOMA-IR levels were associated with systolic blood pressure (r value 0.764, P=0.0005). Conclusion: We observed significantly higher fasting insulin levels, serum triglyceride levels, and HOMA-IR reflecting hyperinsulinemia and possibly an insulin-resistant state among primary hypertension patients with no other causally linked factors for insulin resistance. We observed a significant correlation between systolic blood pressure and HOMA-IR.

Diabetics who develop severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) are more likely to have severe disease, higher odds of intensive care requirement and mortality. Fifteen percent of patients have new onset hyperglycemia. We studied the comparative outcomes between prior DM, newly detected hyperglycemia and assessed role of secondary sepsis on mortality. RWe performed a r etrospective study of confirmed SARS-CoV-2 patients at a tertiary care hospital in Chennai, India. Patients were divided as 2 groups (Group 1: With preexisting diabetes mellitus, Group 2: With newly diagnosed hyperglycemia due to newly detected diabetes mellitus or non-diabetic hyperglycemia. Clinical and laboratory data was analysed. Two hundred and thirty eight patients had prior-diabetes mellitus (Group 1) and 40 had newly diagnosed hyperglycemia (Group 2). Thirty four of group 1 and 7 of group 2 patients required intensive care. Mean capillary blood glucose (MCBG) during hospital stay was 207 mg/dl (Group 1) and 192 mg/dl (Group 2). Twentysix patients (9.3%) had secondary sepsis of which sixteen died. Logistic regression identified secondary sepsis(p<0.0001), elevated D-dimer >6 fold (p= 0.0001), elderly p=0.0045), male (p=0.0006), NLR >5 (p=0.01),serum creatinine ≥2 mg/dl (p=0.0004), FiO2 requirement >0.6 in first 48 hours (p=0.001) as mortality predictors.Our study observed a 14.38 % prevalence of newly diagnosed DM or non-diabetic hyperglycemia. Secondary sepsis and >6 fold elevation in D-dimer were strong predictors of mortality. Steroid use possibly contributed to secondary sepsis. Early identification and aggressive management of secondary sepsis are necessary for diabetics.

Background: The profile of acute poisoning cases is fast changing in last few years, due to advancements in agriculture, construction, sanitation, cosmetic industry and not the least in pharmacology. The advancements and invention of new chemical agents in these industries have increased the access to wide range of materials with quite varied chemical nature, which is reflected in the profile of acute poisonings.Methods: The study is a prospective observational study for a period of 18 months .The study population included all the patients presenting to the emergency department with history of acute poisoning excluding accidental non-self- poisoning.Conclusion: In the current study, highest proportion of subjects in the overall study group was between 26 to 40 years. The proportion of males and females were almost equal whereas in OPC poisoning group the proportion of males was much higher than females. Majority of the affected population were married, living in urban areas, educated ,belonged to lower class. Highest proportion was constituted by housewives and students .Organophosphorous poisoning was the most common poisoning reported followed by benzodiazepines and rat killer in thestudy.The overall mortality rate in the study was 10.53%.Mortality was highest when the subjects were presented beyond 6 hours. Among the type of poisons OPC poisoning had highest mortality.