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Snake bite envenomation is one of the most toxicology-related cause that can mimic brain death. This is a case report of 73-year-old elderly female, a hypertensive on treatment, who presented with chief complaints of cobra snake bite on the dorsum of right hand. On admission, patient had dyspnea, bilateral ptosis and ophthalmoplegia. In the next 10-15 min, her symptoms got worsened for which she was administered intravenous doses of atropine (2 mg), neostigmine (0.5 mg) and anti-snake venom. She developed respiratory arrest, hence was intubated and was started on mechanical ventilation. On assessment following 12 h post admission, the patient had Glasgow Coma Scale (GCS)-E1V1M1, with pupils bilateral 2.5 mm sluggishly reacting to light. After 36 h post admission, patient began to show signs of recovery. She began to blink her eyes, follow objects and attempted to move her limbs on command. On day 3, Patient was weaned off from the ventilator, extubated two days later and discharged home on Day 7. This case report highlights a unique presentation of cobra bite induced neuroparalytic syndrome mimicking brain death in an elderly patient. Furthermore, the life-threatening presentation of cobra envenomation mandates the use of higher doses of Polyvalent snake antivenom (PSA) to reverse the neuroparalytic toxicity. We should consider the role of anticholinesterase as an adjunctive therapy to PSA in severe cobra envenomation.While tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease among children, its first presentation in the third decade of life just after successful pregnancy outcome is extremely rare. In fact, survival of both child and mother having uncorrected TOF after noninstitutional delivery is unheard of. Herein, authors report a case of previously undiagnosed TOF associated with other midline congenital abnormalities, that is, nasal dermoid cyst and cleft palate, who presented for the first time with postpartum hemorrhage after an unsupervised home birth. To the best of our knowledge, this unique association has never been described before.

Deliberate self-poisoning and harm (DSPH) is an unabating problem with a wide variation in the methods used across the world. Hence, this study was conducted to understand the current spectrum of methods used for DSPH by patients in our geographic locality and catchment area with special emphasis on newer compounds and drugs used.

This retrospective study included patients presenting with DSPH to the emergency department (ED) between January 2017 and December 2018.

This study included 1802 patients, with a mean age of 32 ± 12.7 years. Of the patients, 85% were in the young to middle age group (16-45 years). Agrochemicals (n = 604, 33.5%), drugs (n = 498, 27.6%), plant toxins (n = 150, 8.3%) and rodenticides (n = 145, 8%) were the predominantly used compounds. The major emergency resuscitation procedures required in the ED were intubation (n = 321, 18%), vasopressor support (n = 73, 4%) and cardiopulmonary resuscitation (n = 27, 1.4%). A quarter (23.2%) was discharged stable from the ED, whereas a further 56.5% were discharged stable after hospital admission. The in-hospital mortality rate was 3% (n = 47). Multivariate logistic regression analysis showed rodenticides (odds ratio (OR) 22.32; 95% confidence interval (CI) 8.05-61.88;

= 0.005) and plant poisons (OR 23.92; 95% CI 8.95-63.94;

= 0.005) to be the independent predictors of mortality.

DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality.

DSPH is prevalent in the highly productive young age group. Agrochemical ingestion and drug overdose are the most common methods used, whereas rodenticide and plant poisoning are associated with significant mortality.

The ongoing corona pandemic has created medical crises all over the world. An increased surge in the number of COVID-19 cases was observed in the month of August, September and October 2020. Punjab has around 10 Lakh migrant workers. Intensive rapid antigen testing was done during this surge among factory workers. With this background, the study aims to find out the positivity rate of rapid antigen testing and to find out the final outcome of the COVID positive cases in terms of morbidity.

Screening of factory workers working in various factories was done for COVID-19 by rapid antigen testing from 26

august to 31

October 2020. Those who tested positive were clinically examined, counseled, and followed up telephonically to get information regarding their course of illness. The collected information was entered in Microsoft excel sheet and analyzed using SPSS.

A total of 11045 factory workers were screened using the rapid antigen test. The mean age of subjects was 33.37 ± 10.97 years. The majority of them were males (88.3%) and migrants (who did not belong to Punjab) (97.3%). ISX-9 The majority of the subjects (97.3%) had no symptoms at the time of screening. COVID-19 positivity rate increased with age, was found to be higher in males (2.3%) as compared to females.

The positivity rate was higher in asymptomatic males and local resident workers. Rapid antigen testing is an important public health measure to prevent the further spread of the disease during a pandemic due to its quick results and detection of asymptomatic patients.

The positivity rate was higher in asymptomatic males and local resident workers. Rapid antigen testing is an important public health measure to prevent the further spread of the disease during a pandemic due to its quick results and detection of asymptomatic patients.Neurotoxic snakebites are a common emergency in tropical countries and account for significant morbidity and mortality worldwide. Manifestations vary from mild ptosis and ophthalmoplegia to severe flaccid paralysis with ventilatory failure. At times, the neuromuscular paralysis may be severe enough for patients to be misdiagnosed as a locked-in syndrome or brain dead. Occult snakebites, wherein patients are unaware of the bite and fang marks are absent, have been reported in kraits, an endemic neurotoxic snake belonging to the Elapidae family. We report a series of three cases in which young males presented with dramatic neuromuscular paralysis and were likely suffering from elapid snake bites. Each of these patients presented an intriguing clinical challenge and had different in-hospital outcomes. Primary care physicians in the emergency department are usually the first respondents to such patients. Owing to a lack of snake bite history and unavailability of specific diagnostic tests, severe envenomation presents a challenge for physicians, unless they are aware of it and a high level of suspicion is maintained.Data show that antibody-related immunity against SARS-CoV-2 may not be long-lasting. We report two cases regarded as cured from COVID-19, which presented again with symptoms and a positive SARS-CoV-2 RT-PCR test. Case one, a 60-year-old male, had a biphasic presentation of symptoms compatible with COVID-19 infection, associated with a positive RT-PCR test. Case two, a 25-year-old female, had a first positive RT-PCR test during hospital screening, and months later a symptomatic presentation of COVID-19, associated with a positive RT-PCR test. All cases were immunocompetent. Anti-IgG-SARS-CoV-2 blood samples were negative in both. Elevation of analytical inflammatory markers suggested new infection in both cases. COVID-19 reinfection may be a differential diagnosis and primary care physicians should acknowledge it. Previously cured patients should be encouraged to comply with health public preventive measures.

To assess the pattern, prevalence and outcome of poisoning cases reporting to hospital in North India during COVID-19 pandemic.

An observational, prospective study was conducted for 100 patients reporting to medical emergency with history of poisoning intake from April 2020 to January 2021. Age range was 14-85 years. Obtained data were analysed using descriptive statistics and results were expressed as percentage and mean.

Out of 100 patients (77M, 33F), mean age of 32.6 years, most cases belong to age group of 20-30 years and 50% were matriculates and majority of the patients belonged to Punjab and Himachal Pradesh. The most common poisoning agents consumed were corrosives (34%) followed by Aluminium Phosphide (24%). Respiratory distress (53%), loss of consciousness (43%), acute kidney injury (36%) were the common clinical presentations. PSS (Poisoning Severity Score) was moderate in 52% of patients, severe in 14%, fatal in 16% and minor PSS in 18% of patients. 16 patients with fatal PSS and 16 patients with moderate to severe PSS got expired. High mortality of 33% was seen in our study.

The most vulnerable group in our study was of young males in age group of 21-30 years and less educated, who had lost their jobs due to COVID-19 pandemic lockdown. Corrosives were the most commonly consumed poison during lockdown. Our study found that scoring systems PSS and GCS were good assessment tools for degree of severity of poisoning at an early stage.

The most vulnerable group in our study was of young males in age group of 21-30 years and less educated, who had lost their jobs due to COVID-19 pandemic lockdown. Corrosives were the most commonly consumed poison during lockdown. Our study found that scoring systems PSS and GCS were good assessment tools for degree of severity of poisoning at an early stage.Caregivers, or persons who provide unpaid support to a loved one who could not manage to live independently or whose health or well-being would deteriorate without this help, are increasingly common. These rates have only increased with the COVID-19 pandemic forcing many to care for sick family members in the short or long term. Unfortunately, caregiving is associated with significant burden and health risks, not only for caregivers themselves but also for the care recipients of overwhelmed caregivers. These risks have also been exacerbated by the social isolation of the COVID-19 pandemic. Although interventions exist which have been proven to reduce caregiver burden, education on these interventions is lacking, partly because there has not been a memorable framework on how to care for caregivers. In this paper, an innovative framework to teach clinicians about caring for caregivers is introduced, the C.A.R.E. framework Caregiver well-being, Advanced care planning, Respite, and Education. This simple framework will help providers become aware of caregiver needs, comfortable in addressing their needs, and able to suggest interventions proven to reduce caregiver burden. Knowledge of this framework should start with medical students so that they can incorporate this critical aspect of primary care into their clinical practice early on in their careers. If providers can simply remember to perform these four interventions, to C.A.R.E. for our caregivers, then they will make a significant impact on the lives of both our patients and their loved ones, during the present COVID-19 pandemic and thereafter.

COVID-19 was declared a public health emergency of global concern by the World Health Organization (WHO) on January 30, 2020. Vaccination is one of the most effective methods for halting the pandemic and preventing complications. Vaccine hesitancy is a possible threat to global public health. Understanding the key determinants that influence the community's preferences and demands for a future vaccine may aid in the development of strategies to improve the global vaccination program. The aim of this study was to assess the beliefs, barriers, and acceptance of COVID-19 vaccination among Taif University students in Saudi Arabia.

This was a descriptive cross-sectional study, based study in Taif University, Saudi Arabia. Data was collected using a designed self-administered questionnaire that was shared as a link through social media. 332 students were considered eligible to participate voluntarily. Data were analyzed using the (SPSS) program version 25.

Out of 332 participants, 278 (83.7%) were accepting to take the covid vaccine, while 54 (16.