Pub Date : 2022-09-01DOI: 10.5005/jp-journals-10071-23712A.174
S. Saseedharan, Sharangouda J. Patil, Gauri Kene, A. 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.
{"title":"Effect of Lateral Positioning on Oxygen Levels in an Obese, Critically Hypoxic COVID-19 Patient","authors":"S. Saseedharan, Sharangouda J. Patil, Gauri Kene, A. Yadav, Rujuta Bagade","doi":"10.5005/jp-journals-10071-23712A.174","DOIUrl":"https://doi.org/10.5005/jp-journals-10071-23712A.174","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45872540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_15_22
Muthu Singaram, V. Muraleedhran, M. 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.
{"title":"Translational Research in Health Care: A Paradigm Shift from Traditional Research","authors":"Muthu Singaram, V. Muraleedhran, M. Sivaprakasam","doi":"10.4103/mamcjms.mamcjms_15_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_15_22","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43026548","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_114_21
Sahil Verma, Rajeev Sarpal, Shikha 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.
{"title":"Effect of Chronic Urinary Retention over Serum Prostate-Specific Antigen and Its Role in Histopathological Diagnosis","authors":"Sahil Verma, Rajeev Sarpal, Shikha Agarwal, Jacob Kim Mammen","doi":"10.4103/mamcjms.mamcjms_114_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_114_21","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45630123","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_46_22
L. Gupta, G. Dwivedi, K. 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.
{"title":"Post-Suxamethonium Muscle Pains after Vitamin C Pretreatment: An Observational Study","authors":"L. Gupta, G. Dwivedi, K. Choudhary","doi":"10.4103/mamcjms.mamcjms_46_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_46_22","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45822671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_49_22
B. Wadhwa, K. Saxena, M. 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.
{"title":"Paraplegic Patient for Lower Limb Surgery: Monitored Anesthesia Care (MAC) as an Alternative Approach","authors":"B. Wadhwa, K. Saxena, M. Saha","doi":"10.4103/mamcjms.mamcjms_49_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_49_22","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43844031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_26_22
Abhishek Kashyap, Akash Yadav, Vineet Bajaj, Yasim Khan, S. Arora, L. 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.
{"title":"Blockchain Technology in Healthcare: The Idea and What Lies Beyond","authors":"Abhishek Kashyap, Akash Yadav, Vineet Bajaj, Yasim Khan, S. Arora, L. Maini","doi":"10.4103/mamcjms.mamcjms_26_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_26_22","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43177027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_18_22
Ranvijay Singh, S. Garg, S. Aggarwal, H. 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.
{"title":"Oxygen Delivery Devices in Hypoxemic Respiratory Failure","authors":"Ranvijay Singh, S. Garg, S. Aggarwal, H. Hira, Ranvir Singh","doi":"10.4103/mamcjms.mamcjms_18_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_18_22","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45513926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-09-01DOI: 10.4103/mamcjms.mamcjms_55_22
S. Singhal, S. Bansal, Ankita Negi, B. Kalra, L. Gupta, S. Garg, S. Sural, S. Kapoor, S. 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.
{"title":"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","authors":"S. Singhal, S. Bansal, Ankita Negi, B. Kalra, L. Gupta, S. Garg, S. Sural, S. Kapoor, S. Chawla","doi":"10.4103/mamcjms.mamcjms_55_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_55_22","url":null,"abstract":"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.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43977478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.4103/mamcjms.mamcjms_41_22
S. Chadha, S. Prasad, D. Tyagi, Aaliya Ansari, Govind Kahar
Objective: This study was done to determine the prevalence and predictors of depression, anxiety, and stress among doctors in COVID MCH unit in Delhi. Method: A cross-sectional study was conducted in India among 356 doctors to evaluate the mental health of doctors working in COVID-infected maternity wards over a period of 6 months using a predesigned, semistructured Depression, Anxiety, and Stress Scale (DASS-21) questionnaire which was developed on Google Forms. The predictors to stress, anxiety, and depression were subject to univariate logistic regression. Result: Out of the total 356 participants, 38.76% felt stressed, 56.46% were anxious, while 43.25% felt depressed. The mean DASS-21 score for stress, anxiety, and depression was 7.46, 4.12, and 4.29, respectively. Female gender was found to be a significant predictor of stress, anxiety, and depression. Staying with parents/children was a significant predictor for stress and living alone was found to be a significant predictor of depression. Fear of infecting their family members was the main concern among those tested positive. Conclusion: The present study has shown a significant psychological impact arising from this pandemic. Early screening targeting the medical workforce and the implementation of psychological interventions is essential for maintaining the functionality of the healthcare system.
{"title":"Psychological Impact of COVID-19 Pandemic on Healthcare Workers Posted in the Obstetric Unit","authors":"S. Chadha, S. Prasad, D. Tyagi, Aaliya Ansari, Govind Kahar","doi":"10.4103/mamcjms.mamcjms_41_22","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_41_22","url":null,"abstract":"Objective: This study was done to determine the prevalence and predictors of depression, anxiety, and stress among doctors in COVID MCH unit in Delhi. Method: A cross-sectional study was conducted in India among 356 doctors to evaluate the mental health of doctors working in COVID-infected maternity wards over a period of 6 months using a predesigned, semistructured Depression, Anxiety, and Stress Scale (DASS-21) questionnaire which was developed on Google Forms. The predictors to stress, anxiety, and depression were subject to univariate logistic regression. Result: Out of the total 356 participants, 38.76% felt stressed, 56.46% were anxious, while 43.25% felt depressed. The mean DASS-21 score for stress, anxiety, and depression was 7.46, 4.12, and 4.29, respectively. Female gender was found to be a significant predictor of stress, anxiety, and depression. Staying with parents/children was a significant predictor for stress and living alone was found to be a significant predictor of depression. Fear of infecting their family members was the main concern among those tested positive. Conclusion: The present study has shown a significant psychological impact arising from this pandemic. Early screening targeting the medical workforce and the implementation of psychological interventions is essential for maintaining the functionality of the healthcare system.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44975300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-05-01DOI: 10.4103/mamcjms.mamcjms_105_21
Vaibhav Aggarwal, Suneha Kumari, K. Kataria, A. Goyal
Angiolipomas are uncommon benign vascular adipocytic mesenchymal tumors and generally present as painful subcutaneous nodules in the extremities and trunk. Chest wall is a rare site for angiolipoma. We describe a case of a giant retromammary angiolipoma that presented clinically as an apparent large breast lump. This tumor was surgically excised after preoperative angioembolization. Latter was carried out to reduce intraoperative bleeding and facilitate the excision. We recommend keeping benign tumors such as angiolipomas in differential when dealing with apparent breast/chest wall lumps. We also advocate preoperative angioembolization in select cases while excising large angiolipomas to decrease perioperative blood loss.
{"title":"A Giant Angiolipoma: A Case Report","authors":"Vaibhav Aggarwal, Suneha Kumari, K. Kataria, A. Goyal","doi":"10.4103/mamcjms.mamcjms_105_21","DOIUrl":"https://doi.org/10.4103/mamcjms.mamcjms_105_21","url":null,"abstract":"Angiolipomas are uncommon benign vascular adipocytic mesenchymal tumors and generally present as painful subcutaneous nodules in the extremities and trunk. Chest wall is a rare site for angiolipoma. We describe a case of a giant retromammary angiolipoma that presented clinically as an apparent large breast lump. This tumor was surgically excised after preoperative angioembolization. Latter was carried out to reduce intraoperative bleeding and facilitate the excision. We recommend keeping benign tumors such as angiolipomas in differential when dealing with apparent breast/chest wall lumps. We also advocate preoperative angioembolization in select cases while excising large angiolipomas to decrease perioperative blood loss.","PeriodicalId":32900,"journal":{"name":"MAMC Journal of Medical Sciences","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41990012","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：