Clinical profile and epidemiological characteristics of COVID-19 patients admitted in the district hospital of North India- a retrospective study

Background: During COVID-19 all the tertiary institutes were overburdened so all the peripheral institutes, mostly district hospitals were made functional to provide management to COVID-19 patients in moderate and severe cases. The study attempts to find out the clinical profile of admitted patients in one of the district hospital. Methods: Retrospective data was studied from records of district hospital Samba when it was chosen as COVID-19 dedicated hospital. Results: Record of 77 patients was studied and data was analyzed with the help of descriptive statistics. Chi square test was done to find out the association. Mean age was 56.8±16.19 years with male female ratio of 1.33:1. 50% males and 42.4% of females did not have any associated co-morbidities. Half of the studied participants were anemic. Conclusions: Study showed that patients admitted in hospital presented with variable presentation and associated co morbidities were significantly associated with mortality. Peripheral institutions should be equipped with all the facilities to cope with such public health emergencies

Enhancing Safety Through strengthening Human Barrier

PresentationIt is a well-known fact that up to 80 % of industrial incidents are caused wholly or partly by human actions. “Machines on its own does not cause any Incidents but human intervention does” is the well know based on incident investigations. To reduce the Incidents and its consequence, it is imperative to have knowledge, know-how, authority & controls be given to all front line personnel making them a reliable and competent barrier. Based on the learnings from events, it was observed that for every incident there are several factors which had contributed to the event. Outcome of the findings suggest enhancing the robustness of preventive measures and this was the top priority within KOC – It includes workforce involvement through Competency Enhancement, further enabling them to identify the underlying hazards and follow the company procedures and standards. The process is chalked on a routine basis as a Plan Do Check Act (PDCA) activity to improve the inherent human reflexes. This plan/campaign was audited periodically to ensure that workforce can be included as a barrier. It was observed that PDCA where planning was based on the inspection & Audit gaps identified. The gaps suggested the diversity of training and awareness session required and competency enhancement at various levels to ensure that personnel act as a critical barrier reducing the human error. It is imperative to suggest that unfamiliarity/skill & knowledge, planning (time shortage or hasting up) and understanding the hazards present along with supervision and feedback stood out as the top human factors which weakens the Human Barrier. The various sessions had motivated the frontline workforce to voice upon the concerns to their superiors for ensuring a safer operation prevail in the oil field. Further the Human factors play a significant role and this is to be given priority at all levels to include safety behavior and safety culture. The Human factor along with the feedback forms the base of the safety pyramid. It was also observed from the quarterly trends which focused on developing a significant improvement in the safety integrated policy concept for enhancing safety through strengthening human barrier. Page | 2 The concept of Human and Human factors being a reliable barrier in the past has not been given significant weightage in design and operation. The idea of this paper is to showcase the approach where the reliability has increased and can consider personnel as a barrier and ensure a reliability operation/ activity. Workforce with a significant support can transform into efficient preventive and mitigative barrier

A multi-wavelength polarimetric study of the blazar CTA 102 during a Gamma-ray flare in 2012

We perform a multi-wavelength polarimetric study of the quasar CTA 102 during an extraordinarily bright $\gamma$-ray outburst detected by the {\it Fermi} Large Area Telescope in September-October 2012 when the source reached a flux of F$_{>100~\mathrm{MeV}} =5.2\pm0.4\times10^{-6}$ photons cm$^{-2}$ s$^{-1}$. At the same time the source displayed an unprecedented optical and NIR outburst. We study the evolution of the parsec scale jet with ultra-high angular resolution through a sequence of 80 total and polarized intensity Very Long Baseline Array images at 43 GHz, covering the observing period from June 2007 to June 2014. We find that the $\gamma$-ray outburst is coincident with flares at all the other frequencies and is related to the passage of a new superluminal knot through the radio core. The powerful $\gamma$-ray emission is associated with a change in direction of the jet, which became oriented more closely to our line of sight ($\theta\sim$1.2$^{\circ}$) during the ejection of the knot and the $\gamma$-ray outburst. During the flare, the optical polarized emission displays intra-day variability and a clear clockwise rotation of EVPAs, which we associate with the path followed by the knot as it moves along helical magnetic field lines, although a random walk of the EVPA caused by a turbulent magnetic field cannot be ruled out. We locate the $\gamma$-ray outburst a short distance downstream of the radio core, parsecs from the black hole. This suggests that synchrotron self-Compton scattering of near-infrared to ultraviolet photons is the probable mechanism for the $\gamma$-ray production.Comment: Accepted for publication in The Astrophysical Journa

Operative management of acute abdomen after bariatric surgery in the emergency setting: the OBA guidelines

Background: Patients presenting with acute abdominal pain that occurs after months or years following bariatric surgery may present for assessment and management in the local emergency units. Due to the large variety of surgical bariatric techniques, emergency surgeons have to be aware of the main functional outcomes and long-term surgical complications following the most performed bariatric surgical procedures. The purpose of these evidence-based guidelines is to present a consensus position from members of the WSES in collaboration with IFSO bariatric experienced surgeons, on the management of acute abdomen after bariatric surgery focusing on long-term complications in patients who have undergone laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Method: A working group of experienced general, acute care, and bariatric surgeons was created to carry out a systematic review of the literature following the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and to answer the PICO questions formulated after the Operative management in bariatric acute abdomen survey. The literature search was limited to late/long-term complications following laparoscopic sleeve gastrectomy and laparoscopic Roux-en-Y gastric bypass. Conclusions: The acute abdomen after bariatric surgery is a common cause of admission in emergency departments. Knowledge of the most common late/long-term complications (> 4 weeks after surgical procedure) following sleeve gastrectomy and Roux-en-Y gastric bypass and their anatomy leads to a focused management in the emergency setting with good outcomes and decreased morbidity and mortality rates. A close collaboration between emergency surgeons, radiologists, endoscopists, and anesthesiologists is mandatory in the management of this group of patients in the emergency setting

Acute mesenteric ischemia : updated guidelines of the World Society of Emergency Surgery

Acute mesenteric ischemia (AMI) is a group of diseases characterized by an interruption of the blood supply to varying portions of the intestine, leading to ischemia and secondary inflammatory changes. If untreated, this process may progress to life-threatening intestinal necrosis. The incidence is low, estimated at 0.09-0.2% of all acute surgical admissions, but increases with age. Although the entity is an uncommon cause of abdominal pain, diligence is required because if untreated, mortality remains in the range of 50%. Early diagnosis and timely surgical intervention are the cornerstones of modern treatment to reduce the high mortality associated with this entity. The advent of endovascular approaches in parallel with modern imaging techniques is evolving and provides new treatment options. Lastly, a focused multidisciplinary approach based on early diagnosis and individualized treatment is essential. Thus, we believe that updated guidelines from World Society of Emergency Surgery are warranted, in order to provide the most recent and practical recommendations for diagnosis and treatment of AMI.Peer reviewe

The management of intra-abdominal infections from a global perspective : 2017 WSES guidelines for management of intra-abdominal infections

Intra-abdominal infections (IAIs) are common surgical emergencies and have been reported as major contributors to non-trauma deaths in the emergency departments worldwide. The cornerstones of effective treatment of IAIs are early recognition, adequate source control, and appropriate antimicrobial therapy. Prompt resuscitation of patients with ongoing sepsis is of utmost important. In hospitals worldwide, non-acceptance of, or lack of access to, accessible evidence-based practices and guidelines result in overall poorer outcome of patients suffering IAIs. The aim of this paper is to promote global standards of care in IAIs and update the 2013 WSES guidelines for management of intra-abdominal infections.Peer reviewe

Science with the Daksha High Energy Transients Mission

We present the science case for the proposed Daksha high energy transients mission. Daksha will comprise of two satellites covering the entire sky from 1~keV to $>1$~MeV. The primary objectives of the mission are to discover and characterize electromagnetic counterparts to gravitational wave source; and to study Gamma Ray Bursts (GRBs). Daksha is a versatile all-sky monitor that can address a wide variety of science cases. With its broadband spectral response, high sensitivity, and continuous all-sky coverage, it will discover fainter and rarer sources than any other existing or proposed mission. Daksha can make key strides in GRB research with polarization studies, prompt soft spectroscopy, and fine time-resolved spectral studies. Daksha will provide continuous monitoring of X-ray pulsars. It will detect magnetar outbursts and high energy counterparts to Fast Radio Bursts. Using Earth occultation to measure source fluxes, the two satellites together will obtain daily flux measurements of bright hard X-ray sources including active galactic nuclei, X-ray binaries, and slow transients like Novae. Correlation studies between the two satellites can be used to probe primordial black holes through lensing. Daksha will have a set of detectors continuously pointing towards the Sun, providing excellent hard X-ray monitoring data. Closer to home, the high sensitivity and time resolution of Daksha can be leveraged for the characterization of Terrestrial Gamma-ray Flashes.Comment: 19 pages, 7 figures. Submitted to ApJ. More details about the mission at https://www.dakshasat.in

2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients

In the last three decades, Clostridium difficile infection (CDI) has increased in incidence and severity in many countries worldwide. The increase in CDI incidence has been particularly apparent among surgical patients. Therefore, prevention of CDI and optimization of management in the surgical patient are paramount. An international multidisciplinary panel of experts from the World Society of Emergency Surgery (WSES) updated its guidelines for management of CDI in surgical patients according to the most recent available literature. The update includes recent changes introduced in the management of this infection.Peer reviewe