Roshan Mathew - Academia.edu (original) (raw)
Papers by Roshan Mathew
Journal of Family Medicine and Primary Care
Emergency Care Journal, 2020
Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But ... more Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But presentation with atypical ECG changes constitute a diagnostic challenge. We here report a case of 23-year-old male who presented with chest pain having atypical ECG changes with hyper-acute T waves called de Winters T wave. This is a rare presentation of patient with acute Left Anterior Descending artery occlusion. Some authors propose that de Winters pattern should be considered as “STEMI Equivalent”.
The COVID-19 pandemic in a matter of few months has wreaked havoc across the globe. However as pe... more The COVID-19 pandemic in a matter of few months has wreaked havoc across the globe. However as per the WHO, the worst may not be over yet and COVID-19 is going to stay with us for a long time. The coronavirus is highly contagious, and in the current scenario containment measures in the form of lockdowns and curfew may only be useful in transiently flattening the curve and not disease elimination. The absence of an effective vaccine and/or treatment, means that morbidity and mortality associated with COVID-19 is going to increase in the foreseeable future. For the emergency physicians (EPs) working on the frontlines, the battle may have just begun. Any patient coming to emergency room (ER), with COVID-19 related symptoms or otherwise, could be a potential source for the spread of coronavirus infection in the hospital. With most of the ER’s being overcrowded, the place itself will act as amplifier which could lead to a catastrophe. Ever since the beginning of this pandemic, our focus ...
Turkish Journal of Emergency Medicine, 2021
Nerve blocks are frequently used in emergency department for pain management in patients with fra... more Nerve blocks are frequently used in emergency department for pain management in patients with fractures. Their utility in medical conditions with severe intactable pain is largely unknown. We report a series of seven patients with pancreatitis who presented with severe abdominal pain (defense and veteran pain rating scale > 7) and had no relief on regular analgesia. They were subjected to erector spinae plane block (ESPB), and reduction in pain score at different time intervals, side effects, and additional analgesic dose requirements were noted. The objective of this case series is to explore the utility of ESPB in patients with pancreatitis.
Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires earl... more Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.
Background India does not have a formal cardiac arrest registry or a centralized emergency medica... more Background India does not have a formal cardiac arrest registry or a centralized emergency medical system. In this study, we aimed to assess the prehospital care received by the patients with OHCA and predict the factors that could influence their outcome. Methods Out-of-hospital cardiac arrest patients presenting to the emergency department in a tertiary care centre were included in the study. Prehospital care was assessed in terms of bystander cardiopulmonary resuscitation (CPR), mode of transport, resuscitation in ambulance. OHCA outcomes like Return of spontaneous circulation (ROSC), survival to hospital discharge and favourable neurological outcome at discharge were assessed. Results Among 205 patients, the majority were male (71.2%) and were above 60 years of age (49.3%); Predominantly non-traumatic (82.4%). 30.7% of the patients had sustained cardiac arrest in transit to the hospital. 41.5% of patients reached hospital by means other than ambulance. Only 9.8% patients had rec...
BACKGROUND Various risk-stratification scores have been developed to identify low-risk febrile ne... more BACKGROUND Various risk-stratification scores have been developed to identify low-risk febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) score is a commonly used validated scoring system, although its performance varies due to its subjectivity. Biomarkers like procalcitonin (PCT) are being used in patients with FN to detect bacteremia and additional complications. OBJECTIVE Our objective was to compare the performance of MASCC score with PCT in predicting adverse outcomes in patients with FN. METHODS This was a prospective observational study that included chemotherapy-induced FN in hematologic or solid malignancy. The MASCC score, PCT levels, and blood cultures were taken at the first point of contact, and patient treatment was managed according to routine institutional protocol. The primary outcome was mortality at 30 days. RESULTS A total of 100 patients were recruited, of which 92 had hematologic malignancy and 8 had solid malignancy. F...
Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life... more Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs). The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3–13.5), moderate stroke was 13.8 (13.5–14.4) and with severe stroke was 15.4 (15.1–15.6) (p < 0.001). The median ...
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 2020
As per current guidelines, whenever an advanced airway is in place during cardiopulmonary resusci... more As per current guidelines, whenever an advanced airway is in place during cardiopulmonary resuscitation, positive pressure ventilation should be provided without pausing for chest compression. Positive pressure ventilation can be provided through bag-valve resuscitator (BV) or mechanical ventilator (MV), which was found to be equally efficacious. In a busy emergency department, with less trained personnel use of MV is advantageous over BV in terms of reducing human errors and relieving the airway manager to focus on other resuscitation tasks. Currently, there are no guidelines specific to MV settings in cardiac arrest. We present a concept of “six-dial ventilator strategy during CPR” that encompasses the evidence-based settings appropriate during chest compression. We suggest use of volume control ventilation with the following settings: (1) positive end-expiratory pressure of 0 cm of water (to allow venous return), (2) tidal volume of 8 mL/kg with fraction of inspired oxygen at 100...
Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life... more Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs). The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3-13.5), moderate stroke was 13.8 (13.5-14.4) and with severe stroke was 15.4 (15.115.6) (p < 0.001). The median (...
Introduction: Foreign body ingestion is a common presenting complaint in the emergency department... more Introduction: Foreign body ingestion is a common presenting complaint in the emergency department. While ingestion of small foreign bodies like coins and button batteries is not uncommon, ingestion of long and rigid foreign bodies like toothbrush is very rare. Case presentation: We describe a 36-year-old man who presented to us after accidental ingestion of a toothbrush. The patient underwent urgent endoscopic removal; Psychiatric evaluation revealed an acute and transient psychotic disorder in him. Conclusion: Ingestion of long and rigid foreign bodies like a toothbrush is an uncommon entity. Such foreign bodies when ingested find it difficult to maneuver through the GI tract, which makes their spontaneous passage almost impossible. Their ingestion is associated with increased risk of impaction, perforation and, bleeding. Therefore, early removal of the ingested toothbrush is recommended before complications develop.
QJM: An International Journal of Medicine
Summary Background Corticosteroids have become the mainstay treatment in severe COVID-19. However... more Summary Background Corticosteroids have become the mainstay treatment in severe COVID-19. However, its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis were conducted to assess effect of steroids in mild COVID-19 patients. Methods PubMed, EMBASE, Web of Science and medRxiv were searched from 31 December 2019 to 14 May 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay (LOHS). Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane's ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method. Results A total of 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (in...
Journal of Ultrasonography
The American Journal of Emergency Medicine
Postgraduate Medical Journal
The Journal of Emergency Medicine
Emergency Medicine Journal
Journal of Family Medicine and Primary Care
Indian Journal of Pediatrics
Indian Journal of Psychological Medicine
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused great financial and psych... more Background: The coronavirus disease 2019 (COVID-19) pandemic has caused great financial and psychological havoc. Healthcare professionals (HCPs) are among the many groups of people who are in the frontline and facing a risk of direct exposure to the virus. This study aimed to assess the prevalence and predictors of stress, depressive, and anxiety symptoms among HCPs of India. Methods: It was a cross-sectional, online survey conducted in April 2020 among HCPs who are directly involved in the triage, screening, diagnosing, and treatment of COVID-19 patients and suspects. Stress was estimated using Cohen’s perceived stress scale. Depression and anxiety were assessed using the tools Public Health Questionnaire—9 and Generalized Anxiety Disorder—7. Predictors were analyzed using univariate and multivariate binary logistic regression. Results: A total of 433 online responses were obtained, and N = 350 were finally included. The prevalence (95% CI) of HCPs with high-level stress was 3.7% (...
Journal of Family Medicine and Primary Care
Emergency Care Journal, 2020
Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But ... more Early recognition of ECG signs of acute coronary syndrome is essential for prompt treatment. But presentation with atypical ECG changes constitute a diagnostic challenge. We here report a case of 23-year-old male who presented with chest pain having atypical ECG changes with hyper-acute T waves called de Winters T wave. This is a rare presentation of patient with acute Left Anterior Descending artery occlusion. Some authors propose that de Winters pattern should be considered as “STEMI Equivalent”.
The COVID-19 pandemic in a matter of few months has wreaked havoc across the globe. However as pe... more The COVID-19 pandemic in a matter of few months has wreaked havoc across the globe. However as per the WHO, the worst may not be over yet and COVID-19 is going to stay with us for a long time. The coronavirus is highly contagious, and in the current scenario containment measures in the form of lockdowns and curfew may only be useful in transiently flattening the curve and not disease elimination. The absence of an effective vaccine and/or treatment, means that morbidity and mortality associated with COVID-19 is going to increase in the foreseeable future. For the emergency physicians (EPs) working on the frontlines, the battle may have just begun. Any patient coming to emergency room (ER), with COVID-19 related symptoms or otherwise, could be a potential source for the spread of coronavirus infection in the hospital. With most of the ER’s being overcrowded, the place itself will act as amplifier which could lead to a catastrophe. Ever since the beginning of this pandemic, our focus ...
Turkish Journal of Emergency Medicine, 2021
Nerve blocks are frequently used in emergency department for pain management in patients with fra... more Nerve blocks are frequently used in emergency department for pain management in patients with fractures. Their utility in medical conditions with severe intactable pain is largely unknown. We report a series of seven patients with pancreatitis who presented with severe abdominal pain (defense and veteran pain rating scale > 7) and had no relief on regular analgesia. They were subjected to erector spinae plane block (ESPB), and reduction in pain score at different time intervals, side effects, and additional analgesic dose requirements were noted. The objective of this case series is to explore the utility of ESPB in patients with pancreatitis.
Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires earl... more Sympathetic crash acute pulmonary edema (SCAPE) is a life-threatening injury, which requires early recognition and intervention to prevent mortality. We present a case of 18-year-old woman with no previous comorbidity, presenting with SCAPE who was successfully resuscitated and eventually diagnosed with renal artery stenosis. Pickering syndrome is a rare cause of hypertensive emergency and should be considered in a young patient presenting with SCAPE in emergency department.
Background India does not have a formal cardiac arrest registry or a centralized emergency medica... more Background India does not have a formal cardiac arrest registry or a centralized emergency medical system. In this study, we aimed to assess the prehospital care received by the patients with OHCA and predict the factors that could influence their outcome. Methods Out-of-hospital cardiac arrest patients presenting to the emergency department in a tertiary care centre were included in the study. Prehospital care was assessed in terms of bystander cardiopulmonary resuscitation (CPR), mode of transport, resuscitation in ambulance. OHCA outcomes like Return of spontaneous circulation (ROSC), survival to hospital discharge and favourable neurological outcome at discharge were assessed. Results Among 205 patients, the majority were male (71.2%) and were above 60 years of age (49.3%); Predominantly non-traumatic (82.4%). 30.7% of the patients had sustained cardiac arrest in transit to the hospital. 41.5% of patients reached hospital by means other than ambulance. Only 9.8% patients had rec...
BACKGROUND Various risk-stratification scores have been developed to identify low-risk febrile ne... more BACKGROUND Various risk-stratification scores have been developed to identify low-risk febrile neutropenia (FN). The Multinational Association of Supportive Care in Cancer (MASCC) score is a commonly used validated scoring system, although its performance varies due to its subjectivity. Biomarkers like procalcitonin (PCT) are being used in patients with FN to detect bacteremia and additional complications. OBJECTIVE Our objective was to compare the performance of MASCC score with PCT in predicting adverse outcomes in patients with FN. METHODS This was a prospective observational study that included chemotherapy-induced FN in hematologic or solid malignancy. The MASCC score, PCT levels, and blood cultures were taken at the first point of contact, and patient treatment was managed according to routine institutional protocol. The primary outcome was mortality at 30 days. RESULTS A total of 100 patients were recruited, of which 92 had hematologic malignancy and 8 had solid malignancy. F...
Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life... more Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs). The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3–13.5), moderate stroke was 13.8 (13.5–14.4) and with severe stroke was 15.4 (15.1–15.6) (p < 0.001). The median ...
Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 2020
As per current guidelines, whenever an advanced airway is in place during cardiopulmonary resusci... more As per current guidelines, whenever an advanced airway is in place during cardiopulmonary resuscitation, positive pressure ventilation should be provided without pausing for chest compression. Positive pressure ventilation can be provided through bag-valve resuscitator (BV) or mechanical ventilator (MV), which was found to be equally efficacious. In a busy emergency department, with less trained personnel use of MV is advantageous over BV in terms of reducing human errors and relieving the airway manager to focus on other resuscitation tasks. Currently, there are no guidelines specific to MV settings in cardiac arrest. We present a concept of “six-dial ventilator strategy during CPR” that encompasses the evidence-based settings appropriate during chest compression. We suggest use of volume control ventilation with the following settings: (1) positive end-expiratory pressure of 0 cm of water (to allow venous return), (2) tidal volume of 8 mL/kg with fraction of inspired oxygen at 100...
Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life... more Introduction: Globally, stroke is one of the leading causes of death and disability-adjusted life-years (DALYs). The red cell distribution width (RDW) is a readily available and inexpensive test which is done routinely as a part of complete blood count in these patients. Objective: In this study, we tried to correlate the RDW with severity of acute ischemic stroke (AIS). Methods: Patients presenting to emergency department (ED) within 24 hours of the onset of clinical signs and symptoms suggestive of AIS were assessed for Glasgow Coma Scale (GCS) and National Institutes of Health Stroke Scale (NIHSS) score followed by non-contrast computed tomography (NCCT) scan. RDW value for all the patients who were included in the study were co-related with the severity of the stroke. Results: The median (IQR) RDW in the patients with minor stroke on the basis of GCS was 13.5 (13.3-13.5), moderate stroke was 13.8 (13.5-14.4) and with severe stroke was 15.4 (15.115.6) (p < 0.001). The median (...
Introduction: Foreign body ingestion is a common presenting complaint in the emergency department... more Introduction: Foreign body ingestion is a common presenting complaint in the emergency department. While ingestion of small foreign bodies like coins and button batteries is not uncommon, ingestion of long and rigid foreign bodies like toothbrush is very rare. Case presentation: We describe a 36-year-old man who presented to us after accidental ingestion of a toothbrush. The patient underwent urgent endoscopic removal; Psychiatric evaluation revealed an acute and transient psychotic disorder in him. Conclusion: Ingestion of long and rigid foreign bodies like a toothbrush is an uncommon entity. Such foreign bodies when ingested find it difficult to maneuver through the GI tract, which makes their spontaneous passage almost impossible. Their ingestion is associated with increased risk of impaction, perforation and, bleeding. Therefore, early removal of the ingested toothbrush is recommended before complications develop.
QJM: An International Journal of Medicine
Summary Background Corticosteroids have become the mainstay treatment in severe COVID-19. However... more Summary Background Corticosteroids have become the mainstay treatment in severe COVID-19. However, its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis were conducted to assess effect of steroids in mild COVID-19 patients. Methods PubMed, EMBASE, Web of Science and medRxiv were searched from 31 December 2019 to 14 May 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay (LOHS). Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane's ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method. Results A total of 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (in...
Journal of Ultrasonography
The American Journal of Emergency Medicine
Postgraduate Medical Journal
The Journal of Emergency Medicine
Emergency Medicine Journal
Journal of Family Medicine and Primary Care
Indian Journal of Pediatrics
Indian Journal of Psychological Medicine
Background: The coronavirus disease 2019 (COVID-19) pandemic has caused great financial and psych... more Background: The coronavirus disease 2019 (COVID-19) pandemic has caused great financial and psychological havoc. Healthcare professionals (HCPs) are among the many groups of people who are in the frontline and facing a risk of direct exposure to the virus. This study aimed to assess the prevalence and predictors of stress, depressive, and anxiety symptoms among HCPs of India. Methods: It was a cross-sectional, online survey conducted in April 2020 among HCPs who are directly involved in the triage, screening, diagnosing, and treatment of COVID-19 patients and suspects. Stress was estimated using Cohen’s perceived stress scale. Depression and anxiety were assessed using the tools Public Health Questionnaire—9 and Generalized Anxiety Disorder—7. Predictors were analyzed using univariate and multivariate binary logistic regression. Results: A total of 433 online responses were obtained, and N = 350 were finally included. The prevalence (95% CI) of HCPs with high-level stress was 3.7% (...