ABSTRACT
Coronaviridae family from which coronavirus descends is the recent major health concern that threats the humanity worldwide. The novel flu-like coronavirus disease COVID-19 is responsible for infecting 2,257,789 individual as of 18th of April. COVID-19 health consequences include acute respiratory distress syndrome ARDS, pneumonia, hypoxic lung, sepsis multi-organ failure, respiratory arrest and eventually causing death. Interestingly, pneumonia caused by novel coronavirus was associated with coagulopathy disorder, elevated D-dimer, fibrin degradation product, disseminated intravascular coagulation DIC all are part of the hyper coagulability status of COVID-19 patients. the most commonly drugs used now to treat COVID19 symptoms is causing serious cardiac adverse reaction such as QTc prolongation caused by the combination of HCQ and Azithromycin which is the most commonly used regimen for the treatment of COVID19, here comes the role of magnesium sulfate (MgSO4) which is an inorganic salt commonly known as Epsom salt as an adjunctive therapy as extended release infusion to the patients suffering from previous serious conditions and their complications that the patients may develop in late stage of the disease. Magnesium sulfate is a cheap, safe and readily available medication can be a drug of choice in supportive treatment of COVID-19 especially critically ill patients with promising crucial beneficial medical effects.

ABSTRACT
The coronavirus spread rapidly throughout the country and around the world, novel coronavirus was later identified as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The whole world is racing to find a vaccine or a drug or repurpose already existed drugs to stop the spread of it. Almost all the health care sectors are focusing on treating the symptoms and decrease mortality. Although many repurposed drugs have succeeded to alleviate symptoms and decrease the infection burden. Inhibition of excessive inflammatory response may be an adjunct for treating COVID-19, so in some countries, addition an adjuvant corticosteroid therapy to standard antiviral treatment. Literature does not currently provide convulsive evidence for or against the use of corticosteroids in the treatment of COVID-19 patients. Typically, Corticosteroids are used to treat severe acute respiratory infections of viral etiology because of their anti-inflammatory effect. Nevertheless, when use corticosteroid, the neutrophil count is increased, other lymphocyte/leucocytes subsets are decreased. So, the monocyte -to- lymphocyte ratio (MLR) take same direction in decreasing whereas neutrophil-to-lymphocyte ratio (NLR) abnormally increased which leads to predict a worse prognosis and wrong intervention. A need to monitor the prognosis of the disease using a specific marker is feasible economic wise and health wise, as seeing the prognosis of COVID-19 give us the ability to take an action in managing the upcoming issues and precede the virus one step ahead. So, in this review article, we will discuss all available evidences regarding the prognostication performances of MLR and NLR in discrimination bacterial from viral infections, clinical infectious from clinical non-infectious cases, and COVID-19 from other viral infections. Also, in this review article, we will focus on the Corticosteroid and Mal-Nutrition-Associated Overestimation impacts on the performance potentials of MLR vs NLR for prog

ABSTRACT
A case of 35 year old male who had sustained motor vehicle crash with a four wheeler while riding on his motorcycle on a national highway during the lockdown period. During his transit to hospital in the tractor, we had noticed the patient to be unresponsive with GCS of three (E1V1M1) and no carotid pulse. Immediately compression only CPR (CO CPR) given with cervical spine in line manual stabilization throughout the procedure with the help of another bystander. After approximately 4 cycles (30 compressions each) of CO CPR, ROSC attained. In spite of being alone in a resource limited setting we are able to comply with the IRC guideline of COLS and had successfully revived the patient.

ABSTRACT
Introduction:Scrub typhus is a zoonotic disease caused by rickettsea Orientia tsutsughamushi .It is characterised by acute febrile illness with multiorgan dysfunction.Crop fields are the main reservoir for transmission hence infected when accidentally exposed to mite infested areas.In the pre-antibiotic era scrub typhus was considered as a lethal disease and continues to be major health problem in south Asia and west Pacific regions.Mortality of Scrub typhus ranges from 7% to 30% next to malaria among infectious diseases. Methods: All patients had a full work up for fever that included three smears for malarial parasites, serology for dengue, leptospirosis, scrub typhus, enteric fever, blood, urine,sputum or endotracheal cultures and other tests as clinically indicated.A diagnosis of scrub typhus was made when a patient is tested positive for IgM ELISA and other causes of fever excluded. Results: total patients,the vasopressor requirements being Dopamine (7%) , Nor adrenaline(12.7%) and Vasopressin(2.8%).1.4% received packed red blood cell transfusions whereas 16.9% had platelet transfusions . 40.8% required non invasive ventilation whereas 8.5% required invasive mechanical ventilation and 1.4% required both non invasive and invasive mechanical ventilation . 1.4% of patients required haemodialysis.The mean duration of ICU and hospital stay were 4.56 and 6.98 days respectively. In hospital mortality was 1.4%. Conclusion: In our study we hereby conclude that the incidence of organ dysfunction is highly variable compared with other studies whereas the in hospital mortality was relatively low.

ABSTRACT
Introduction :World wide dengue has become the most common vector bone tropical fever spread by Aedes Egypti.This virus have four circulating serotypes worldwide .In urban and suburban areas of high endemicity this infection is responsible for high mortality and morbidity.WHO estimates incidence of dengue globally ranges between 50 million to 200 million every year.Dengue fever presentations can vary from fatigability and malaise to severe shock and multiorgan dysfunction syndrome Methods All patients had a full work up for fever that included three smears for malarial parasites, serology for dengue, leptospirosis, scrub typhus, enteric fever, blood, urine,sputum or endotracheal cultures and other tests as clinically indicated.A diagnosis of Dengue was made when a patient is tested positive for NS1-Antigen Strip® ELISA (BioRad), IgM and IgG- Capture ELISA Panbio® (AlereTM) and other causes of fever excluded. Patients were treated with Ceftriaxone along with enteral doxycycline and intravenous azithromycin as needed. Results Of total patients,the vasopressor requirements being Dopamine(12.9%) , Nor adrenaline(12.9%) & Vasopressin(3.2%).1.6% received packed red blood cell transfusions whereas 80.6% had platelet transfusions . 4.8% required Non invasive ventilation whereas 9.7% required Invasive mechanical ventilation and 3.2% required both non invasive and invasive mechanical ventilation . 6.5% of patients had received haemodialysis.The mean duration of ICU and hospital stay were 4.25 and 6.54 days respectively. In hospital mortality was 1.6%. Conclusion In our study we hereby conclude the incidence of clinical features is in agreement with other studies whereas the in hospital mortality was relatively low.

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: Background- Intra-arterial cannulation for invasive blood pressure monitoring is required in patients with shock. However in these patients it is difficult to pass the cannula because of difficulty in palpation of artery. Few tools like ultrasound guidance and Doppler auscultatory assistance are available to locate the artery in such difficult cases. However use of ultrasound requires practical as well as operator knowledge. Hand held fetal Doppler auscultatory assistance device is an easily available tool that can be effectively used for arterial cannulation in patients with shock. Method: This is a prospective study conducted in 100 patients who were admitted to Intensive care unit with shock. Here intra-arterial cannulation was done with the help of hand held Doppler ausculatory assistance device by an inexperienced operator. We observed the ease of cannulation indicated by number of attempts, number of cannulas used, failure to cannulate and post cannulation complications in difficult conditions like shock, by inexperienced operators. Result - In 72 patients cannula was placed in first attempt, 12 patients required 2-3 attempts. In 10 patients though artery was located cannulation was unsuccessful and different site was cannulated. These 10 patients required more than 2 cannula as they were damaged during the procedure. In 6 patients neither artery was located satisfactorily nor were we able to cannulate the artery. Conclusion - A simple hand held Doppler ascultatory assist device can be used to cannulate the artery in difficult cases even by inexperienced operator where palpation of artery is difficult.

ABSTRACT
Background: The amount of strain that cardiac surgery exerts on blood bank services is an example that emphasises the need for multimodal blood conservation strategy. The most common factor which is being attributable to increase bleeding after cardiac surgery is hyperfibrinolysis. Thererfore the use of antifibrinolytics during high risk cardiac surgery becomes inevitable. Commonly used antifibrinolytic include Tranexamic Acid(TA) and Epsilon-amino-caproic acid (EACA) .The aim of our study was to compare the effectiveness of both TA and EACA in reducing post-surgical bleeding in on-pump CABG surgeries and to assess the post-operative complications associated with its use.Material and Methods: After obtaining informed written consent, approval of ethics and research committee patients who were scheduled for on-pump CABG were included in the study. Patients were divided into two groups randomly by using a comupter generated randomized block design namely group TA(n=40) and group EACA (n=40). TA group received tranaxamic acid at a dose of 10mg/kg IV over 20 min at the time of induction then 1-2 mg/kg in CPB prime followed by 1 mg /kg/hr infusion during surgery. Group EACA received EACA in a dose of 100mg/kg/IV over 20 min at the time of induction then 5-10mg/kg in CPB prime followed by 10mg/kg/hr. infusion during surgery. Patients were assessed for blood loss and were monitored for fibrinogen level and D- dimer levels. Other parameters which were assessed included Re-exploration and post-operative complications. Result: Primary outcomes like bleeding at 4hrs, there was no significant difference between the groups but when total bleeding at 24hrs. was compared there was a significantly lesser bleed in group TA group compared to group EACA (P=0.0022).The requirement of PRBC in group TA was for 3 patients, where as in EACA group 4 patients required PRBC (P>0.05).There was no significant difference in the rate of post-operative complications between the groups.(P>0.05)

ABSTRACT
One of the primary aims of anaesthesia is to render adequate pain relief, thereby permitting the performance of surgical procedures without stress and discomfort. General anaesthesia does not abolish the stress response completely. The local anaesthetics when used intrathecal or epidural, abolishes the response to a great extent, particularly in lower abdominal operations. The present study designed to compare the clinical efficacy of hyperbaric solution of Ropivacaine (0.5%) with that of hyperbaric Bupivacaine (0.5%) in spinal anaesthesia.The aims and objectives of this study were to study the characteristics of spinal blockade in terms of sensory and motor blockade (onset, extent, regression and duration), hemodynamic stability, the recovery profile and side effects of both the drugs if any. In present randomized double blind prospective comparative study, after approval of ethical committee, 100 patients of either sex, ASA grade I and II, aged 20 – 60 years scheduled for different surgical procedures on abdomen, genitourinary region and lower extremity were included in this study. The sample size was determined by power analysis. The patients were randomly allocated into two groups. Pre-anaesthetic evaluation was done one day prior to surgery and all necessary investigations done. An informed consent was taken. Group R - Received inj. Ropivacaine 3 ml of 0.5% hyperbaric (in glucose 8.3%) solution. Group B - Received injection Bupivacaine 3 ml of 0.5% hyperbaric (glucose 8%) solution. Following observations were made - Time of onset of sensory block, maximum cephalic spread (dermatome), time to maximum cephalic spread, two segment regression time (min) and total duration of sensory block. Degree of motor block was assessed by Bromage scale. Intraoperatively, pulse rate, systolic and diastolic blood pressure, respiratory rate and SPO2 monitored at induction, 2, 5, 10, 15, 20, 25, 30, 45, 60 min with help of multipara monitor. In this study, for quantitative data o