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   Table of Contents - Current issue
September-December 2022
Volume 8 | Issue 3
Page Nos. 187-284

Online since Wednesday, December 7, 2022

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Blockchain Technology in Healthcare: The Idea and What Lies Beyond p. 187
Abhishek Kashyap, Akash Yadav, Vineet Bajaj, Yasim Khan, Sumit Arora, Lalit Maini
Blockchain technology has recently been at the center stage of academic discussions. This is owing to its use in the financial sector and the rise of cryptocurrencies like Bitcoin. In essence, digital ledger technology (DLT) is shared digital data spread across multiple sites. A blockchain is a type of DLT consisting of a growing list of records, called blocks, securely linked with a time stamp. Maintaining data privacy and security is one of the core benefits of using the blockchain network. In healthcare, efficient data sharing is desirable with secure long-term access to data. In recent years, numerous applications built on blockchain infrastructure have been introduced in the healthcare sector. In this narrative review, we intend to introduce the science of blockchain technology, its core concepts, and its application to healthcare. We also describe current instances of its application in the healthcare sector, its application from the Indian perspective, and its limitations and future possibilities.
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Oxygen Delivery Devices in Hypoxemic Respiratory Failure Highly accessed article p. 193
Ranvijay Singh, Sandeep Garg, Sunita Aggarwal, HS Hira, Ranvir Singh
Abstract Oxygen therapy by appropriate oxygen delivery device (ODD) at different stages is an essential part of hypoxemic respiratory failure management. The choice of ODDs depends on the degree of hypoxemia, precision of delivery, patient comfort, risk of transmission of infection to Health Care Worker (HCW), and the cost. Management of hypoxemic respiratory failure depends on underlying etiology and pathophysiology of the disease process. Study from the current global pandemic of novel coronavirus disease 2019 (COVID-19) showed that the severity of hypoxemia is independently associated with in-hospital mortality and can be an important predictor risk of admission to intensive care unit. In this review, we will discuss the different ODDs, their indication for use along with the advantages and disadvantages.
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Acceptance of COVID-19 Vaccine and Its Related Determinants Among the Residents of Western Uttar Pradesh p. 201
Aprajita Panwar, P.K. Tyagi, Apoorva Bhargava, Rakesh K Gupta
Background and Objectives: Amidst multiple waves of the coronavirus disease 2019 (COVID-19) pandemic, numerous vaccines are being used worldwide to provide immunity against the coronavirus. Knowledge, attitudes, and perceptions of the community toward COVID-19 vaccination could influence vaccine acceptance. This study aimed to evaluate the knowledge, attitudes, and perceptions toward COVID-19 vaccination and assess its determinants. Material and Methods: A web-based cross-sectional study was conducted as a structured 27-item questionnaire through Google Forms. Qualitative data were processed by categorizing responses for an item according to intended objectives, and data were coded numerically. The associations between variables were explored by using a modified Poisson regression to determine adjusted prevalence ratios and their 95% confidence intervals. Results: The vaccine acceptance rate among the respondents was 72% and was more among those involved in the health care sector. The participants feared vaccine-related side effects and were less willing to accept the vaccination. The participants who believed adults also require vaccination against diseases accepted the COVID-19 vaccine. We found that the subjects with comorbid conditions, urban areas, and those who had contacted COVID-19 infection or family members were more willing to get vaccinated (P < 0.001). Conclusions: We concluded that a considerable majority (72%) of residents exhibit good vaccine acceptability. Health care providers, social media, and community influencers can design awareness campaigns to address perceived safety concerns and achieve a 100% acceptance rate in the community.
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COVID-19 Biomedical Waste Management Practices among Medical Professionals in a Tertiary Hospital: Need for Safe and Sustainable Methods p. 207
Aiman Perween Afsar, Lovenish Bains, Anurag Mishra, Akshit Mittal, Sulakshna Aggarwal, Daljit Kaur
Context: The Coronavirus Disease 2019 (COVID-19) pandemic that began in 2019 has affected more than 232 million people around the world with over 4.7 million deaths as on September 30, 2021. Amidst the crisis, there has been increased generation of biomedical-waste (BMW). In April 2021, a 62% rise was observed compared to 123 metric tonnes of waste generated in February 2021. The hospital waste mismanagement has diverse ramifications as it affects the patients, healthcare workers (HCWs), public, environment, and economy. Proper BMW management aims to reduce generation, ensures efficient collection, handling and safe disposal so that it controls infection and improves safety. Aims: The present study was conducted to assess the knowledge among medical professionals regarding BMW segregation, transport, and treatment. Settings, Design, Methods, and Materials: A google formed based survey was done to assess the knowledge regarding management of COVID-19 BMW among HCWs (MBBS students, residents, and consultants) associated with tertiary care hospitals of North India. Results: The knowledge score was : for segregation − 27.4%, 59.6%, and 49.8%; transport from site of generation to site of disposal − 63.6%, 89.1%, and 95.2%; disposal − 29%, 71.9%, and 68.2%; overall score − 41.4%, 67.9%, and 61.3% among the students, residents, and consultants respectively. We found that participants with greater years of experience (residents and consultants) had better knowledge as compared to that of the students (P = 0.032). Conclusion: We found a mean score of 56.9% which is more than that of few low- and middle-income countries but less than that of European countries. The chances of infection directly correlate with lower knowledge score. Appropriate evidence-based, judicious use of PPE as per the settings and guidelines should be followed. Training aspects, periodic evaluation, and assessment should be strengthened, both for practising medical professionals and for students, to ensure a safe and sustainable healthcare system.
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Correlation between Levels of Vitamin D and Disease Severity and Outcome in COVID 19 Patients at a Tertiary Hospital in North India p. 214
Tamoghna Ghosh, Rahul Krishnan, Souradeep Chowdhury, Arvind Kumar, Upendra Baitha, Shweta Sharma, Naveet Wig
Introduction: COVID-19 disease is more prevalent and severe in people who are more likely to be deficient in vitamin D, people with obesity and diabetes mellitus, and people who live in higher latitudes. Materials and methods: The study was an ambispective, analytical, observational study conducted at a tertiary care teaching hospital in New Delhi, India. The study population consisted of adults with a confirmed diagnosis of COVID-19. Results and conclusion: Eighty eight patients diagnosed with COVID-19 between February and July 2021 were enrolled, with mean (SD) age being 40(2) years and there were 55 (62.5%) males. The most common co-morbidities were hypertension, diabetes mellitus, and chronic obstructive pulmonary disease (COPD) and the most common symptoms were fever, cough, and myalgia. Twelve (13.6%) patients had severe disease. Seven (7.9%) patients died. Sixty one (69.3%) patients had vitamin D levels <30 ng/mL and had severe disease, more symptoms, and increased oxygen requirement, but did not affect laboratory parameters and mortality.
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Drug Utilization Pattern in the Treatment of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV 2) Patients at Dedicated COVID Tertiary Care Teaching Hospital: An Observational Study p. 218
Shubha Singhal, Sumit Bansal, Ankita Negi, Bhupinder S Kalra, Lalit Gupta, Sandeep Garg, Sumit Sural, Seema Kapoor, Shalini Chawla
Background and aims: Coronavirus disease of 2019 (COVID-19) has emerged as a pandemic and increasing numbers of patients are being admitted to dedicated COVID hospitals in a city. Since patients were being prescribed investigational, off label, and some approved drugs, it is important to understand and document prescription and drug utilization patterns. Material and methods: A prospective observational study was conducted on 1164 RT-PCR positive COVID-19 patients admitted to a dedicated COVID-19 tertiary care hospital. Treatment given to patients with COVID-19 was recorded and evaluated with respect to the place of admission, that is, wards or Intensive Care Unit (ICU). Descriptive statistics were used for the evaluation of data. Results: Among the 1164 patients, 670 (57.5%) patients were admitted to the wards while 494 (42.4%) patients were admitted to the ICU. The mortality rate of study participants was 4.1%. Ceftriaxone (39.27%) was the most commonly prescribed antibiotic in the ICU patients while azithromycin (79.10%) was the most prescribed antibiotic in wards patients. 242 (48.98%) patients received dexamethasone whereas methylprednisolone was administered to 88 (17.81%) patients. Remdesivir was administered to 48% of the patients in our study. Conclusion: We observed high rates of mortality in patients with one or more comorbidities having SpO2 less than 65. Concordance and adherence to the line of treatment as recommended by Ministry of Health and Family Welfare/ICMR guidelines were discerned. Rational use of antimicrobials is warranted to curb antibiotic resistance and opportunistic infections since most of the patients received empirical therapy.
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Patient-reported Outcomes of SARS-CoV-2 Positive Adult Orthopedic Trauma Patients Treated During the Ongoing Pandemic: An Experience from Single Center p. 224
Vineet Bajaj, Yasim Khan, Abhishek Kashyap, Bharat Ram Devajee, Saurabh Arora, Sumit Arora, Vinod Kumar, Lalit Maini
Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic has become a matter of concern all over the world. It has resulted in delay in surgery or, at times, preference for nonoperative treatment for SARS-CoV-2 positive orthopedically injured adult patients which may adversely affect the clinical outcomes. In this study, we report the outcomes of orthopedic adult trauma patients who tested positive for SARS-CoV-2 at admission. Methods: We retrospectively reviewed the prospectively collected data from the period between April 1, 2020 and December 31, 2020. We reviewed 521 out of total 2435 patients presenting in the casualty that required orthopedic trauma surgery. Thirty-eight out of total 521 patients, that tested positive for SARS-CoV-2, were followed-up using telecommunication for final outcome of fracture treatment. A telecommunication patient satisfaction score after injury (TPSSI) was used to evaluate the patient satisfaction. Results: The mean age was 37.94 years (range: 18–72 years). They were followed-up for mean duration of 8.18 months (range: 6–13 months). Out of total 38, 23 underwent orthopedic trauma surgeries and rest 15 were managed nonoperatively. There was a mean delay in surgery of 5 weeks (range: 3–12 weeks). Five patients lost their lives and seven others had nonunion. The median TPSSI score was three. Conclusions: Nonoperative and delayed surgical management of adult orthopedic trauma patients, who tested positive for SARS-CoV-2 at admission, result adversely in activities of daily living and return to original occupation and, thus, have poor patient satisfaction.
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Tuberculous and Nontuberculous Lesion of Lymphnodes − Histopathological and Cytological Correlation p. 234
Deep Patel, Jignasa Bhalodia, Shraddha J Patel
Background: The lymph node is one of the major anatomic components of the immune system. Lymph nodes are the most widely distributed and easily accessible component of lymphoid tissue and hence they are frequently examined for diagnosis of lymphoreticular disorders. Lymph node swellings are one of the commonest clinical presentation of patients and it encompasses a wide spectrum ranging from inflammation to a malignant lymphoma or a more obnoxious metastatic malignancy. Aims and objectives: The aim of this study is to evaluate the diagnostic accuracy of Fine Needle Aspiration Cytology (FNAC) in correlation with histopathology in cases of cervical lymphadenopathies. Material and methods: Patients referred to the Department of Pathology, GMERS Medical College and Hospital, Sola Ahmedabad for period of 12 months from June 2021 to May 2022 for palpable lymph node swelling on whom FNAC procedure was performed were included in the study. FNAC diagnosis of patients was compared with histopathology in cases which underwent surgical excision and its diagnostic accuracy was studied. Results: Out of 100 cases which were included in the study, lymph node biopsy was carried out in all 100 cases. Most were in age group of 21 to 30 years. Gender wise, there was male preponderance. Benign lymphadenopathies were diagnosed in 93% of cases. Metastatic deposits were diagnosed in 7% of cases. On correlation of FNAC findings with histopathology, overall correlation rate was 85.2%. Conclusions: FNAC is especially helpful as lymphnode biopsy is a difficult and invasive procedure. Although excision biopsy is the gold standard, FNAC is preferred as first-line investigation.
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Post-Suxamethonium Muscle Pains after Vitamin C Pretreatment: An Observational Study p. 240
Lalit Gupta, Gaurav Dwivedi, Kapil Choudhary
Background: Succinylcholine has been extensively used for endotracheal intubation because of its ultrashort duration of action, quick onset with complete and predictable paralysis. However, the occurrence of some side effects like post injection fasciculations, postoperative myalgia, and increase in serum potassium levels limits its use in some situations like burns, myopathies, and myoglobinuria. For attenuation of these effects, many drugs have been studied but with limited success. Aims and objectives: To evaluate the role of vitamin C on attenuation of post-suxamethonium myalgia and increase in serum potassium levels. Materials and methods: Seventy-five females of American Society of Anaesthesiologists grade I and II and aged 20 to 50 years undergoing general anesthesia for various short surgical procedures were randomly allocated into three groups. Induction of anesthesia was performed with injection thiopentone 5 mg/kg body weight and suxamethonium 50 mg in all three groups. In group I, no drug was administered before induction of anesthesia. In group II, 500 mg tablet of vitamin C was administered twice orally a day before and on the day of surgery half an hour before induction of anesthesia. In group III, vitamin C 500 mg was administered intravenously in 50 ml saline half an hour before induction of anesthesia. The absence or presence of muscle pains and fasciculations were noted and if present, then their severity was also estimated. Serum potassium levels were measured in the venous samples collected just before induction and at 5-minute interval after the administration of suxamethonium. Patients were observed for myalgia on postoperative days 1, 2, and 3. Results: The patients receiving vitamin C had a little reduction in the incidents but marked reduction in severity of muscle pains and fasciculation. Furthermore, the administration of vitamin C markedly delayed the onset of muscle pains. There was no effect of vitamin C pretreatment on serum potassium levels. Conclusion: Pretreatment with vitamin C 500 mg may be useful in reduction of severity of post- suxamethonium myalgia.
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Translational Research in Health Care: A Paradigm Shift from Traditional Research p. 245
Muthu Singaram, VR Muraleedhran, Mohanasankar Sivaprakasam
Abstract Background and Objective: The translational research objective is to produce meaningful and applicable results that directly benefit the community. The objective of translational research is to move from traditional research discoveries rapidly and efficiently into practice. Translational research encourages and promotes multidisciplinary collaboration among clinicians, researchers, industry, policy makers, and other related stakeholders. It further incorporates the needs of the general public with communities being engaged to determine their requirements for health invention. It identifies and supports medical and health practices. Translational research is frequently classified by which stage of restatement (from beginning exploration to societal operation and impact) it falls into. Translational research is the process of turning compliances in the laboratory, clinic, and community into interventions that apply to the health of individualities, public from diagnostics, and to medical procedures as well as behavioral changes. Methods: This study adopted a qualitative research methodology based on Hill et al. consensual qualitative research (CQR) to build multiple case studies to acquire the information. We ion.opted to apply a modified method of CQR[9] based on multiple case studies. This is an emerging methodological approach in research. Results: Based on the 24 semi-structured interviews, these interviews were directly with researchers who carry out the research. Twenty-four voluntary researchers participated in the research and these semi-structured interviews were made into 24 case studies to be analyzed. Each case study was built based on the questions on methods of research. These were used to identify and build the tools for practicing translational research. Conclusion: There is a huge untapped potential for India in the area of translational research.
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Effect of Chronic Urinary Retention over Serum Prostate-Specific Antigen and Its Role in Histopathological Diagnosis p. 252
Sahil Verma, Rajeev Sarpal, Shikhar Agarwal, Jacob Kim Mammen
Background: Prostate-specific antigen (PSA) rises in all types of retentions and also in carcinoma prostate. The raised levels of PSA levels due to urinary retention may raise a false suspicion of carcinoma prostate in these patients. Unlike chronic urinary retention (CUR), the effect of acute urinary retention (AUR) on serum PSA levels had been studied in detail as evident from the past literature. Objectives: The objectives of the study were first to estimate and interpret serum PSA levels in adult males with CUR due to prostatic pathology, second to assess the need of taking prostatic biopsy based on the studied PSA trends, and finally to assess the prostatic histopathology in cases of persistently high PSA levels after 6 weeks. Materials and Methods: This was an observational follow-up study including 41 patients diagnosed with CUR due to prostatic etiology, matching the inclusion and exclusion criteria. On presentation, serum PSA levels were recorded. Retention was relieved by either per urethral catheterization or suprapubic catheterization. PSA levels were recorded after 24 hours, 1 week, 3 weeks, and 6 weeks and PSA trends were noted. Prostatic biopsy was advised for only those subjects in whom PSA did not attain the baseline value of 4 ng/mL within 6 weeks. The histopathological report of the biopsy was followed in each patient for studying its association with PSA trends. Results: Mean PSA at the time of presentation was 17.92 ng/mL. PSA trends showed that in the majority of the patients “Suspected benign group” (80.49%, n = 33), PSA returned to <4 ng/mL within 6 weeks of catheterization. Six patients, the “Borderline group” (14.63%), showed a downtrend in their PSA trends but could not attain baseline value. PSA trends in only two patients, the “Suspected malignant group” (4.87%), showed a comparative constant or an uptrend. All patients in the “Suspected benign group” and a majority of the “Borderline group” patients (83.33%) had a histopathologically confirmed benign prostatic pathology. Out of the two highly suspected malignant cases, only one patient (50%) had carcinoma prostate on final histopathology. Conclusion: PSA rises mainly in carcinoma prostate, but it falsely rises in all urinary retentions. The relationship between AUR and PSA had been studied in detail as evident from the past literature but needs to be established in patients with CUR. A period of 4 to 6 weeks can be safely employed for waiting for PSA to fall back to normal in CUR. A biopsy is required only for patients in which PSA is constantly high to rule out carcinoma prostate.
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Assessment of Periodontal Status in the Patients with Chronic Obstructive Pulmonary Disease (COPD) p. 257
Shanta Shree, Rehbar Khan, Vivek Pathak, Anuj Kumar Pandey, Ajay Kumar Verma, Devendra Kumar Singh
Background: Oral infections, especially periodontal diseases, may affect the course and pathogenesis of a number of systemic diseases including respiratory diseases. The current study aimed to determine the periodontal status in the patients with chronic obstructive pulmonary disease (COPD). Materials and Methods: The study consisted of 65 COPD patients (case) and 65 healthy individuals (non-COPD). Individuals in the case group were well-functioning, ambulatory patients having COPD as determined by their history, clinical examination, and spirometry. Periodontal status was evaluated by the indices, namely, simplified oral hygiene index (OHI-S), plaque index (PI), gingival index (GI), pocket probing depth (PPD), and clinical attachment level (CAL) in both the groups. Results: In the studied population, the mean (± standard deviation, SD) age was higher in COPD group (50.3 ± 11.4) compared to the control group (41.9±8.1; P < 0.0001). In the COPD group, average smoking index was 369.3 ± 167.2, while in control group, it was 323.88 ± 132.8 (P = 0.889). Our data show that individuals in the COPD group had significantly higher OHI-S, PI, GI, PPD, and CAL (P < 0.0001) compared with the control group. The mean score of OHI-S, PI, GI, PPD, and CAL was higher in moderate and severe COPD patients compared to mild COPD patients; however, this difference was not statistically significant. Conclusion: The patients with COPD showed poor oral hygiene and a higher prevalence of periodontal disease. Prevention and treatment of periodontal disease could be included in the planned intervention campaigns designed to help patients with COPD.
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Use of Mobile Phones in Patients with Stroke p. 262
Alvina , Adithya Philip Paul, Atiya R Faruqui
Objectives: There is a paucity of systematic studies conducted to get information on the impact of mobile phone radiation on health. This pilot study was done to explore the use of mobile phones in patients with stroke. Methods: This cross-sectional study used a structured questionnaire among stroke patients in a tertiary hospital in India. We collected demographic details, history, and information on their mobile phone type, usage, and specific absorption rate (SAR) value. We used descriptive statistics to report our findings. Results: This group of 50 stroke patients was predominantly an urban population (78%) with a higher number of male subjects (56%); a higher prevalence of ischemic stroke (76%); 30% were smokers; with comorbidities of hypertension (75%) and diabetes (46%), a significant proportion of whom were not on regular treatment 64% and 74%, respectively. More number of patients used feature phones (82%). The median (SAR) value of all phones was 0.81 W/kg. Hypertension was present in patients who had contact with the phone for >5 hours (78%), subjects who kept their phone closer to the pillow while sleeping (71%), and those carrying a phone in their pockets or on self for >5 hours (80%). Conclusion: This group of patients had predominantly ischemic stroke; a significant proportion having hypertension and diabetes were not on regular treatment and were smokers. Cases of hypertension were noted to be higher in patients with increased exposure to mobile phone radiation. As a pilot study with limitations of a small number of patients, these findings could be only incidental. Further research is required to make any conclusions.
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Tubercular osteomyelitis as scalp swelling and alopecia areata p. 269
Anjali Bhatia, Pushpendra Verma, Ashok Kumar Singh
Tuberculosis (TB) is a well-known endemic disease in developing countries. It continues to be one of the major causes of death and disability in such countries. However, extrapulmonary TB is less common than pulmonary TB. Skeletal TB constitutes about 1% of all tubercular cases. Tubercular osteomyelitis of skull is a rare entity. The most common sites affected are the frontal and parietal bones with destruction of both the inner and outer table. We hereby report a young male presenting to us with scalp swelling in the left frontal region with loss of hair in surrounding areas and in left temporal region. NCCT head was suggestive of osteolytic lesion in frontal bone on left side with accompanying periosteal reaction, consistent with osteomyelitis. In Gene Xpert of pus drained from the swelling, Mycobacterium tuberculosis was detected. Patient was started on Antituberculous treatment, and subsequently improved.
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Effect of Lateral Positioning on Oxygen Levels in an Obese, Critically Hypoxic COVID-19 Patient p. 272
Sanjith Saseedharan, Shalaka Patil, Gauri Kene, Ashish Yadav, Rujuta Bagade
Abstract COVID-19 is an infectious disease caused by SARS-CoV-2 virus. COVID-19 patients can develop a severe disease that can lead to hypoxic respiratory failure and acute respiratory distress syndrome (ARDS), which requires mechanical ventilation, prone ventilation, and salvage therapy like extracorporeal membrane oxygenation. The COVID lung is a hypoxic lung with myriad of reasons of hypoxia including poor ventilation perfusion mismatch and atelectasis. We present a case report of a morbidly obese individual managed with lateral positioning as a salvage for deteriorating PaO2/FiO2 ratio. We also demonstrated that the improvement of oxygenation was due to the recruitment of previously nonventilated lung areas as demonstrated by electrical impedance tomography (EIT). Our patient was morbidly obese and there was a dearth of man power to perform the prone position on this patient. Moreover, the sheer weight of this patient prevented us from trying the prone position. Hence, this patient was placed in a cycle of left lateral, right lateral, and supine position for 120 minutes each for the subsequent 24 hours. Significant improvement in oxygenation and ventilation was noticed in the EIT and SpO2 measurements. The EIT reading indicated ventilation redistribution to previously collapsed areas of the lung and this change persisted even when the patient was turned supine due the application of positive end expiratory pressure (PEEP) to maintain positive expiratory transpulmonary pressure. These results provide evidence of effectiveness of a lateral positioning in the improvement of oxygenation in COVID-19 ARDS.
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Pitfalls of Sanitizer Use in the COVID-19 Era: A Case Report of Hand Sanitizer-Induced Blindness due to Contamination by Methanol p. 278
Sunita Aggarwal, Sricharan Vijayakumar, Ranvijay Singh, Bidhan Chandra Koner, Rajni Saijpaul, Naresh Kumar, Ankitesh Kumar, Tushar Mittal
The COVID-19 pandemic has boosted the availability of hand sanitizers worldwide, which have become ubiquitous. Their widespread utility has also contributed to increased accidental or intentional sanitizer ingestion. We describe the case of a young male who presented with an unintentional ingestion of hand sanitizer. On examination, he had a depressed sensorium, and further evaluation revealed severe metabolic acidosis. The patient was suspected of ethanol toxicity and underwent hemodialysis with concurrent bicarbonate replacement. However, the presence of bilateral visual loss, characteristic Computed Tomography (CT) brain finding of hemorrhagic putaminal necrosis, and normal serum ethanol levels prompted a search for methanol in the sanitizer. Specific biochemical tests confirmed this for methanol, and a diagnosis of sanitizer-induced methanol poisoning was made.
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Paraplegic Patient for Lower Limb Surgery: Monitored Anesthesia Care (MAC) as an Alternative Approach p. 281
Bharti Wadhwa, Kirti N Saxena, Mousumi Saha
Patients with spinal cord injury 4–8 weeks back presenting for non-spinal elective surgery, present a unique challenge to the anesthesiologist. The perioperative concerns include potential for perioperative autonomic hypereflexia, muscle spasms, respiratory inadequacy, controversies regarding the use of muscle relaxants and opioids as well as medico-legal and technical issues associated with administration of regional anesthesia. Both general as well as regional anesthesia has been used for surgery on the insensate part below the level of injury with variable success but no standard definitive anesthetic management is recommended. We present our case series of monitored anesthesia care administration in paraplegic patients who presented for lower limb surgeries.
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