Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India

How to cite this article: Anand A, Panghal R, Kaler P, Saigal S, Panda R, Kodamanchili S, et al. Reanalyzing the Mortality Analysis of COVID-19 Deaths in a Tertiary Care Center in India. Indian J Crit Care Med 2021; 25(10):1211.

Sir,Recently, one of the most awaited publications by the premier government medical institute of our country, titled “Clinicoepidemiological Features and Mortality Analysis of Deceased Patients with COVID-19 in a Tertiary Care Center”, was a very delightful read.¹ All the intensivists of India look up to this institute for regular guidelines of management of COVID-19. It is a very informative and learning piece analyzing mortality among the patients admitted to one of the (intensive care units) ICU of this center.When compared with other similar studies across the globe, this paper does not provide supplementary data that could have answered questions like how many of the admitted patients were intubated in total and what was the mortality rate among the subgroup who were intubated.^2,3 Rather a retrospective approach of data representation has been employed, which tells that among the total 247 deceased patients, 24.2% were intubated and 30.3% of total deceased were intubated within 24 hours. Even this representation does not throw light on how many patients of total 654 patients were intubated during their ICU stay. The policy guiding intubation of patients should also be specified as if it was decided by the intensivist on duty or by any fixed institutional criteria.The incidence of pulmonary embolism (PE) among the deceased in the original paper is 2.8%, which is quite less than reported by Mahmoud et al. in a meta-analysis who reported the overall PE rate in ICU to be 19%, and on autopsy, 22% of deceased patients were found to have PE in COVID-19.⁴ The question that remains unanswered is how were those patients, who died in this published paper, diagnosed with PE. The diagnosis of PE was a clinical diagnosis or radiological diagnosis or by autopsy should have been specified. If the incidence of PE is so less than what was the antithrombotic practice of the institute as this piece of information can help to save many lives.     

Pathways of Translation: Deep Brain Stimulation

Electrical stimulation of the brain has a 2000 year history. Deep brain stimulation (DBS), one form of neurostimulation, is a functional neurosurgical approach in which a high‐frequency electrical current stimulates targeted brain structures for therapeutic benefit. It is an effective treatment for certain neuropathologic movement disorders and an emerging therapy for psychiatric conditions and epilepsy. Its translational journey did not follow the typical bench‐to‐bedside path, but rather reversed the process. The shift from ancient and medieval folkloric remedy to accepted medical practice began with independent discoveries about electricity during the 19th century and was fostered by technological advances of the 20th. In this paper, we review that journey and discuss how the quest to expand its applications and improve outcomes is taking DBS from the bedside back to the bench.     

A lowered salt intake does not compromise iodine status in Cape Town,South Africa,where salt iodization is mandatory

ObjectiveUniversal salt iodization is an effective strategy to optimize population-level iodine. At the same time as salt-lowering initiatives are encouraged globally, there is concern about compromised iodine intakes. This study investigated whether salt intakes at recommended levels resulted in a suboptimal iodine status in a country where salt is the vehicle for iodine fortification.MethodsThree 24-h urine samples were collected for the assessment of urinary sodium and one sample was taken for urinary iodine concentrations (UICs) in a convenience sample of 262 adult men and women in Cape Town, South Africa. Median UIC was compared across categories of sodium excretion equivalent to salt intakes lower than 5, 5 to 9, and greater than or equal to 9 g/d.ResultsThe median UIC was 120 μg/L (interquartile range 75.3–196.3), indicating iodine sufficiency. Less one-fourth (23.2%) of subjects had urinary sodium excretion values within the desirable range (salt <5 g/d), 50.7% had high values (5–9 g/d), and 22.8% had very high values (≥9 g/d). No association between urinary iodine and mean 3 × 24-h urinary sodium concentration was found (r = 0.087, P = 0.198) and UIC status did not differ according to urinary sodium categories (P = 0.804).ConclusionIn a country with mandatory universal salt iodization, consumers with salt intakes within the recommended range (<5 g/d) are iodine replete, and median UIC does not differ across categories of salt intake. This indicates that much of the dietary salt is provided from non-iodinated sources, presumably added to processed foods.     

Assessing rheumatologists’ attitudes and utilization of classification criteria for ankylosing spondylitis and axial spondyloarthritis: a global effort

Clinical Rheumatology - This study aims to assess rheumatologists’ perceptions, utilization patterns, and attitudes towards the modified New York (mNY) criteria for ankylosing spondylitis...     

Intramuscular schwannoma: clinical and magnetic resonance imaging features

INTRODUCTION

Schwannomas that arise within the muscle plane are called intramuscular schwannomas. The low incidence of these tumours and the lack of specific clinical features make preoperative diagnosis difficult. Herein, we report our experience with intramuscular schwannomas. We present details of the clinical presentation, radiological diagnosis and management of these tumours.

METHODS

Between January 2011 and December 2013, 29 patients were diagnosed and treated for histologically proven schwannoma at the National University Hospital, Singapore. Among these 29 patients, eight (five male, three female) had intramuscular schwannomas.

RESULTS

The mean age of the eight patients was 40 (range 27–57) years. The most common presenting feature was a palpable mass. The mean interval between surgical treatment and the onset of clinical symptoms was 17.1 (range 4–72) months. Six of the eight tumours (75.0%) were located in the lower limb, while 2 (25.0%) were located in the upper limb. None of the patients had any preoperative neurological deficits. Tinel’s sign was present in one patient. Magnetic resonance (MR) imaging showed that the findings of split-fat sign, low signal margin and fascicular sign were present in all patients. The entry and exit sign was observed in 4 (50.0%) patients, a hyperintense rim was observed in 7 (87.5%) patients and the target sign was observed in 5 (62.5%) patients. All patients underwent microsurgical excision of the tumour and none developed any postoperative neurological deficits.

CONCLUSION

Intramuscular schwannomas demonstrate the findings of split-fat sign, low signal margin and fascicular sign on MR imaging. These findings are useful for the radiological diagnosis of intramuscular schwannoma.