Compassionate use of convalescent plasma for the management of severe pneumonia in critically ill COVID-19 patients-a single center experience, Kerala, India

We assessed treatment effectiveness with convalescent plasma in critically ill COVID-19 pneumonia patients and their association with reduction in C reactive protein level as a sensitive inflammatory marker to the ongoing cytokine storm. Retrospective cohort study based on the detailed electronic medical chart review. The primary outcome was a clinical improvement on day 14, defined as the reduction in cytokine storm as demonstrated by a drop in acute phase reactant C reactive protein; de-escalation from the prior mode of oxygen delivery or not on mechanical ventilation in critically ill COVID-19 patients. C reactive protein was measured by using immunoturbidimetry. IgG antibody against spike protein S1 was measured by chemiluminescent immunoassay. Of 14 patients, all had severe COVID-19 pneumonia [category C], and 9 (64%) were mechanically ventilated soon after the admission into the medical intensive care unit. De-escalation of the oxygenation strategy mode was noted in 11 (79%) patients after convalescent plasma infusion. All patients showed a significant drop in C reactive protein when compared to pre-infusion and post-infusion day 5.  Early compassionate use of convalescent plasma with higher titters of IgG antibodies against S1may positively benefit the overall outcome in critically ill COVID-19 patients with severe pneumonia

FASE-family and social engagement model for prevention and management of self harm behavior–a study protocol for cluster randomized control trial in India

BackgroundSuicide is a substantial public health concern for countries worldwide. Effective preventive and curative interventions for self-harm behavior (SHB) are imperative for nations with an alarmingly high rate of suicide and self-harm behaviors. The intervention protocol named FASE (Family and Social Engagement) consists of comprehensive assessment, Attachment-Based Family Therapy (ABFT), and community linkages for people presenting with suicide or self-harm in emergency departments of tertiary hospitals.MethodsThis article reports the design and protocol for a cluster randomized control trial for suicide prevention and management. After the developed intervention is pilot tested in a tertiary hospital in Kerala, the intervention will be scaled up to be implemented in various tertiary hospitals in Kerala. Each hospital emergency department will be considered a cluster, and these clusters will be randomized to the intervention group and control group in a 1:1 ratio. The eligible people from the intervention clusters will undergo a baseline assessment, a structured moderate intense intervention with twelve sessions spread across 6 months by the trained social workers supervised by the Mental health team, and a follow-up assessment at the end. Participants will be recruited after obtaining consent and explaining the study. The primary outcome includes suicidality measured by the Depressive Symptom Inventory–Suicidality Subscale (DSI-SS), Depression, Anxiety and Stress Scale (DASS), MOS Social Support Survey, and Brief resilience scale (BRS).DiscussionKnowledge generated from this trial can significantly affect new programmatic policy and clinical guidelines that will improve the reduction of suicide rates in the country.Trial registrationProspectively registered in Clinical Trial Registry India (ICMR-NIMS) on 18/10/2021 (ref number- REF/2021/10/048264)

Acute Presentation of Amiodarone Toxicity with Pleural Involvement

Amiodarone is a frequently prescribed anti-arrhythmic drug which is used to treat ventricular and supraventricular tachyarrhythmia. Although it has excellent efficacy in controlling or preventing common arrhythmias, it is potentially associated with a variety of adverse effects, the most serious of these being pulmonary toxicity. Amiodarone-associated toxicities are usually seen in solid organs like lung, spleen and thyroid due to extension of its pharmacokinetic properties. The presentation is often subacute. Acute presentation with pleural involvement is distinctly uncommon in amiodarone toxicity and can pose diagnostic challenges. Here the case presented is of a 67 year old female with multiple co-morbidities on amiodarone therapy, who presented with massive pleural effusion and respiratory failure. Typical radiological findings along with exclusion of alternate causes with appropriate tests led to a diagnosis of amiodarone toxicity involving lung parenchyma, pleura, liver and other organs. She responded to withdrawal of drug, steroid therapy and supportive care