Among freshwater fishes, the Indian Carp (Labeo rohita, \"ROHU\") is one of the most chosen species for Indian diets, but reports of toxicity are rare. This report is of a middle-aged healthy female who developed pain in the abdomen, vomiting, and diarrhea within hours of ingestion of a cooked portion of Indian carp\'s intestines and gallbladder. There was an inadvertent delay in diagnosis over 1 week due to the rarity of incidence and non-availability of a definite diagnostic indicator coupled with the lack of awareness and high index of suspicion. However, the patient could finally be diagnosed and treated appropriately after roving around many hospitals and then had life-threatening complications such as acute renal failure and hepatopathy, requiring repeated hemodialysis and supportive treatment before being fit for discharge. In this report, a detailed discussion of the clinical course and toxicological aspects are enumerated with a cautious note to spread awareness to facilitate prompt diagnosis.

Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation.
Case series.
High dependency unit of San Carlo University Hospital (Potenza, Italy).
Eleven consecutive patients with COVID-19 ARDS.
Helmet CPAP in prone position after failing a CPAP trial in the supine position.
Data collection at baseline and then after 24, 48 and 72h of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up.
Patients were treated with helmet CPAP for a mean±SD of 7±2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72h (p<.001). We also observed a significantly increase in Sp02 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU.
Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.

OBJECTIVE: Continuous positive airway pressure (CPAP) is an important therapeutic tool in COVID-19 acute respiratory distress syndrome (ARDS) since it improves oxygenation, reduces respiratory rate and can prevent intubation and intensive care unit (ICU) admission. CPAP during pronation has seldom been described and never during sedation.
METHODS: Case series.
METHODS: High dependency unit of San Carlo University Hospital (Potenza, Italy).
METHODS: Eleven consecutive patients with COVID-19 ARDS.
METHODS: Helmet CPAP in prone position after failing a CPAP trial in the supine position.
UNASSIGNED: Data collection at baseline and then after 24, 48 and 72h of pronation. We measured PaO2/FIO2, pH, lactate, PaCO2, SpO2, respiratory rate and the status of the patients at 28-day follow up.
RESULTS: Patients were treated with helmet CPAP for a mean±SD of 7±2.7 days. Prone positioning was feasible in all patients, but in 7 of them dexmedetomidine improved comfort. PaO2/FIO2 improved from 107.5±20.8 before starting pronation to 244.4±106.2 after 72h (p<.001). We also observed a significantly increase in Sp02 from 90.6±2.3 to 96±3.1 (p<.001) and a decrease in respiratory rate from 27.6±4.3 to 20.1±4.7 (p=.004). No difference was observed in PaCO2 or pH. At 28 days two patients died after ICU admission, one was discharged in the main ward after ICU admission and eight were discharged home after being successfully managed outside the ICU.
CONCLUSIONS: Helmet CPAP during pronation was feasible and safe in COVID-19 ARDS managed outside the ICU and sedation with dexmedetomidine safely improved comfort. We recorded an increase in PaO2/FIO2, SpO2 and a reduction in respiratory rate.