A 38-year-old male was diagnosed with aortoiliac aneurysm while evaluating for new-onset hypertension. On further workup, the cause was identified as tubercular aortoiliac aneurysm. His aneurysm had stormy course and disseminated further while ongoing antitubercular therapy with multiple episodes of aneurysmal rupture and endovascular interventions. Management of this case was complicated with several other rarer entities, such as haemophagocytosis and thrombotic microangiopathy with disseminated intravascular coagulation resistant to steroids and plasmapheresis, within a span of few weeks. Moreover, first-line antitubercular therapy had to be regularly modified in view of emerging complications. While case reports for each individual entity exists in literature, this is the first case to the best of our knowledge where such varied complications were present in a patient of tubercular mycotic aneurysm.
{"title":"Tubercular aortoiliac aneurysm with challenging management","authors":"M. Shah, A. Kakar, A. Gogia, A. Satwik","doi":"10.4103/cmrp.cmrp_39_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_39_23","url":null,"abstract":"A 38-year-old male was diagnosed with aortoiliac aneurysm while evaluating for new-onset hypertension. On further workup, the cause was identified as tubercular aortoiliac aneurysm. His aneurysm had stormy course and disseminated further while ongoing antitubercular therapy with multiple episodes of aneurysmal rupture and endovascular interventions. Management of this case was complicated with several other rarer entities, such as haemophagocytosis and thrombotic microangiopathy with disseminated intravascular coagulation resistant to steroids and plasmapheresis, within a span of few weeks. Moreover, first-line antitubercular therapy had to be regularly modified in view of emerging complications. While case reports for each individual entity exists in literature, this is the first case to the best of our knowledge where such varied complications were present in a patient of tubercular mycotic aneurysm.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"36 1","pages":"89 - 92"},"PeriodicalIF":0.0,"publicationDate":"2023-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88296335","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 : 2023-01-01DOI: 10.4103/cmrp.cmrp_198_23
Samiran Nundy, Atul Kakar
After the advent and ubiquitous presence of the Internet, many medical journals began to publish their content online and most readers preferred to access their information on research via the Web. This was generally free and the phenomenon of Open Access journals was born. Advertisements and subscriptions to print journals declined[1] and to generate revenue the new online publications began to demand that, to be included in their publication, contributors needed to pay an article processing fee which was usually fairly substantial. This was affordable by western researchers who either paid themselves or were supported by funding agencies but those in the poorer developing countries who did not have such access became even further excluded from publishing their work to a wide international audience. This became a fertile ground for the beginning of the so-called ‘Predatory’ medical journals. The term was coined in 2008 by Jeffrey Beall, a librarian at the University of Colorado, USA.[2] He published a list of journals whose common characteristics were that they were much cheaper to enter than the mainstream publications but to attract contributors who were mainly from the third world they promised quick publication which meant that the articles were not sent for peer review, their editing was cursory with little attention paid to language as well as scientific content. The listed publishers were mostly non-existent and the journals were not included in most indexing services like PubMed or the Directory of Open Access Journals. Thus, the articles carried are ignored by most of the scientific community being cited very rarely.[3] Most of them originate and receive and publish papers from developing countries where the ‘publish or perish’ phenomenon previously confined to the West has spread. The reputation of a researcher no longer depends on the quality, but now, the quantity of articles he or she publishes.[4] There has been a veritable explosion in the number of these predatory journals which has now reached more than 8000 worldwide and they collectively publish 420,000 articles every year, nearly a fifth of the scientific community’s annual output of 2.5 million papers.[5] They carry dubious titles like ‘International Journal of …’ and most of them are located in the developing world, usually Asia (25% in India) or Africa, although to enhance their credibility they claim that they are based in the USA or UK. Scholars in the developing world feel that reputable Western journals might be prejudiced against them not only because the unfamiliar English language is poor, the science is weak and their content is not relevant to their largely western readers. Thus, they feel their chances of acceptance are greater by submitting their articles to ‘predatory’ whose author fees are lower and publication is rapid. Other scholars may be unaware of the reputation of these journals and would not have selected them had they known. However, some scholars hav
{"title":"Predatory medical journals","authors":"Samiran Nundy, Atul Kakar","doi":"10.4103/cmrp.cmrp_198_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_198_23","url":null,"abstract":"After the advent and ubiquitous presence of the Internet, many medical journals began to publish their content online and most readers preferred to access their information on research via the Web. This was generally free and the phenomenon of Open Access journals was born. Advertisements and subscriptions to print journals declined[1] and to generate revenue the new online publications began to demand that, to be included in their publication, contributors needed to pay an article processing fee which was usually fairly substantial. This was affordable by western researchers who either paid themselves or were supported by funding agencies but those in the poorer developing countries who did not have such access became even further excluded from publishing their work to a wide international audience. This became a fertile ground for the beginning of the so-called ‘Predatory’ medical journals. The term was coined in 2008 by Jeffrey Beall, a librarian at the University of Colorado, USA.[2] He published a list of journals whose common characteristics were that they were much cheaper to enter than the mainstream publications but to attract contributors who were mainly from the third world they promised quick publication which meant that the articles were not sent for peer review, their editing was cursory with little attention paid to language as well as scientific content. The listed publishers were mostly non-existent and the journals were not included in most indexing services like PubMed or the Directory of Open Access Journals. Thus, the articles carried are ignored by most of the scientific community being cited very rarely.[3] Most of them originate and receive and publish papers from developing countries where the ‘publish or perish’ phenomenon previously confined to the West has spread. The reputation of a researcher no longer depends on the quality, but now, the quantity of articles he or she publishes.[4] There has been a veritable explosion in the number of these predatory journals which has now reached more than 8000 worldwide and they collectively publish 420,000 articles every year, nearly a fifth of the scientific community’s annual output of 2.5 million papers.[5] They carry dubious titles like ‘International Journal of …’ and most of them are located in the developing world, usually Asia (25% in India) or Africa, although to enhance their credibility they claim that they are based in the USA or UK. Scholars in the developing world feel that reputable Western journals might be prejudiced against them not only because the unfamiliar English language is poor, the science is weak and their content is not relevant to their largely western readers. Thus, they feel their chances of acceptance are greater by submitting their articles to ‘predatory’ whose author fees are lower and publication is rapid. Other scholars may be unaware of the reputation of these journals and would not have selected them had they known. However, some scholars hav","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445270","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}
Cold agglutinin disease is a type of autoimmune haemolytic anaemia caused by autoantibodies that bind to red blood cell antigens at a cold temperature and causes extravascular haemolysis and sometimes thrombosis also. Due to exposure to a lower temperature during open-heart surgery, the activation of haemolysis may occur in the presence of cold agglutinin antibodies. We present the management of a cyanotic child who has undergone open-heart surgery after the detection of high cold agglutinin titres during routine pre-transfusion screening.
{"title":"Congenital cardiac surgery in a patient with cold agglutinins","authors":"M. Agarwal, R. Joshi, Neeraj Aggarwal, R. Joshi","doi":"10.4103/cmrp.cmrp_73_21","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_73_21","url":null,"abstract":"Cold agglutinin disease is a type of autoimmune haemolytic anaemia caused by autoantibodies that bind to red blood cell antigens at a cold temperature and causes extravascular haemolysis and sometimes thrombosis also. Due to exposure to a lower temperature during open-heart surgery, the activation of haemolysis may occur in the presence of cold agglutinin antibodies. We present the management of a cyanotic child who has undergone open-heart surgery after the detection of high cold agglutinin titres during routine pre-transfusion screening.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"31 1","pages":"40 - 42"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87657415","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}
Background: The current model of procedure training involves lectures, seminars, observations and personalised education in small groups or by watching videos on digital platforms. Central venous catheterisation (CVC) is an important skill; however, its training largely remains unstructured. There is a need of protocol-based uniform training policy. Aims: The aims and objectives of the study are to prepare and implement simulation-based CVC training module for the 1st year post-graduate students. Materials and Methods: After approval from the institutional ethical committee, 1st year post-graduate students of anaesthesia, medicine and surgery were enroled. Training modules and questionnaires were prepared with discussions amongst faculty. Students’ baseline knowledge regarding the CVC was noted on mannequins along with self-reported confidence. After that, they were subjected to training module. Students repeat knowledge and confidence regarding CVC were noted. In the next few months, procedures performed by post-graduate students were directly observed and rated. Students as well as faculty feedback regarding this teaching module was also collected. Results: Training module was associated with a statistically significant increase in knowledge and self-reported confidence regarding the knowledge and skill of CVC (P < 0.05). Most of the students and faculty agreed regarding the training module utility. Conclusions: A structured simulation module for CVC helped to improve students’ knowledge and confidence about the CVC skill. The module was well accepted by both faculty and students.
{"title":"Simulation-based training in central venous catheterization for first-year postgraduate students: A prospective study","authors":"Amandeep Singh, Haramritpal Kaur, Sarabjot Kaur, Urvashi Grover, Chandni Maheshwari, SumitpalSingh Chawla","doi":"10.4103/cmrp.cmrp_15_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_15_23","url":null,"abstract":"Background: The current model of procedure training involves lectures, seminars, observations and personalised education in small groups or by watching videos on digital platforms. Central venous catheterisation (CVC) is an important skill; however, its training largely remains unstructured. There is a need of protocol-based uniform training policy. Aims: The aims and objectives of the study are to prepare and implement simulation-based CVC training module for the 1st year post-graduate students. Materials and Methods: After approval from the institutional ethical committee, 1st year post-graduate students of anaesthesia, medicine and surgery were enroled. Training modules and questionnaires were prepared with discussions amongst faculty. Students’ baseline knowledge regarding the CVC was noted on mannequins along with self-reported confidence. After that, they were subjected to training module. Students repeat knowledge and confidence regarding CVC were noted. In the next few months, procedures performed by post-graduate students were directly observed and rated. Students as well as faculty feedback regarding this teaching module was also collected. Results: Training module was associated with a statistically significant increase in knowledge and self-reported confidence regarding the knowledge and skill of CVC (P < 0.05). Most of the students and faculty agreed regarding the training module utility. Conclusions: A structured simulation module for CVC helped to improve students’ knowledge and confidence about the CVC skill. The module was well accepted by both faculty and students.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445266","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}
Background: Perioperative anxiety may adversely influence anaesthetic induction and patient’s recovery. Pharmacological interventions include the use of narcotics, sedatives and anxiolytics. However, such drug interventions are typically accompanied by adverse reactions. Perioperative anxiety experienced by patients can be significantly diminished through the provision of comprehensive information regarding the anaesthesia procedure, surgical procedure and perioperative events during the pre-anaesthetic assessment conducted in an outpatient consultation clinic. Aims: This prospective study was conducted to assess the impact of providing comprehensive information on alleviating patient anxiety throughout the perioperative period. Materials and Methods: This prospective observational study was conducted on 60 patients to assess patient’s perioperative anxiety for anaesthesia and surgery. All study participants were asked to mark their pre-operative anxiety on the Visual Analogue Scale-Anxiety (VAS-A) and asked to fill the questionnaire of Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Results: During the pre-information evaluation, patient’s mean VAS-A score was 4.73 ± 2.75 which decreased to 3.65 ± 2.53 in post-information evaluation (P = 0.027). The overall APAIS score during pre-information and post-information evaluation was 17.4 ± 8.06 and 13.18 ± 7.06 (P = 0.002). The mean APAIS score for anaesthesia and surgery during the pre-information evaluation was 2.67 ± 1.46 and 3.13 ± 1.54, respectively, which decreased to 2.04 ± 1.18 and 2.35 ± 1.30, respectively, in post-information evaluation. This difference in APAIS score evaluation during pre-information and post-information evaluation for anaesthesia (P = 0.0105) and surgery (P = 0.003) was statistically significant. Conclusion: Perioperative anxiety experienced by patients can be effectively mitigated by providing comprehensive information pertaining to anaesthesia procedures, surgical procedures and perioperative events during the pre-anaesthetic assessment conducted within an outpatient consultation clinic.
{"title":"Role of detailed information about anaesthesia during PAC to reduce patient's anxiety during the perioperative period","authors":"Harsha Patel, Krishna Padsala, Rajesh Nakum, NalinP Sojitra","doi":"10.4103/cmrp.cmrp_148_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_148_23","url":null,"abstract":"Background: Perioperative anxiety may adversely influence anaesthetic induction and patient’s recovery. Pharmacological interventions include the use of narcotics, sedatives and anxiolytics. However, such drug interventions are typically accompanied by adverse reactions. Perioperative anxiety experienced by patients can be significantly diminished through the provision of comprehensive information regarding the anaesthesia procedure, surgical procedure and perioperative events during the pre-anaesthetic assessment conducted in an outpatient consultation clinic. Aims: This prospective study was conducted to assess the impact of providing comprehensive information on alleviating patient anxiety throughout the perioperative period. Materials and Methods: This prospective observational study was conducted on 60 patients to assess patient’s perioperative anxiety for anaesthesia and surgery. All study participants were asked to mark their pre-operative anxiety on the Visual Analogue Scale-Anxiety (VAS-A) and asked to fill the questionnaire of Amsterdam Pre-operative Anxiety and Information Scale (APAIS). Results: During the pre-information evaluation, patient’s mean VAS-A score was 4.73 ± 2.75 which decreased to 3.65 ± 2.53 in post-information evaluation (P = 0.027). The overall APAIS score during pre-information and post-information evaluation was 17.4 ± 8.06 and 13.18 ± 7.06 (P = 0.002). The mean APAIS score for anaesthesia and surgery during the pre-information evaluation was 2.67 ± 1.46 and 3.13 ± 1.54, respectively, which decreased to 2.04 ± 1.18 and 2.35 ± 1.30, respectively, in post-information evaluation. This difference in APAIS score evaluation during pre-information and post-information evaluation for anaesthesia (P = 0.0105) and surgery (P = 0.003) was statistically significant. Conclusion: Perioperative anxiety experienced by patients can be effectively mitigated by providing comprehensive information pertaining to anaesthesia procedures, surgical procedures and perioperative events during the pre-anaesthetic assessment conducted within an outpatient consultation clinic.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445281","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}
Immune checkpoint (IC) therapy has brought a huge revolution in the field of lung cancer treatment over the past decade. It has also revolutionised treatment paradigm and has tremendously improved patient prognosis. IC inhibitors (ICIs) targeting Programmed Cell Death Protein 1/Programmed cell death Ligand 1 (PD1/PD-L1) have shown remarkable success and are now being used as first-line therapies in metastatic disease, adjuvant therapy following surgical resection and chemotherapy in resectable disease. Despite this remarkable success, only a subset of patients obtains complete benefit and most patients do not respond or develop progressive disease during treatment. ICIs are relatively expensive and some patients suffer from significant immune-related adverse toxicities. Hence, the identification and discovery of new predictive and prognostic immunotherapy biomarkers remains the present crucial need for patient selection, stratification and also for guiding therapeutic decisions. Currently established biomarkers such as PD-L1 determined by immunohistochemistry and tumour mutation burden determined by next-generation sequencing are non-specific and possess limitations. At present, several other biomarkers using peripheral blood, liquid biopsies along with gene expression signatures, and tumour infiltrating lymphocytes are being researched globally which have demonstrated predictive potential to characterise ICIs responders. In this review, we provide a comprehensive overview of the current biomarkers, highlighting the main clinical challenges and possible novel potential biomarkers to better predict responders to ICIs.
{"title":"Comprehensive overview of biomarkers to predict response to immune checkpoint therapy in lung cancer","authors":"Kriti Jain, Deepa Mehra, NirmalKumar Ganguly, Rashmi Rana, Surajit Ganguly, Shyam Aggarwal","doi":"10.4103/cmrp.cmrp_78_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_78_23","url":null,"abstract":"Immune checkpoint (IC) therapy has brought a huge revolution in the field of lung cancer treatment over the past decade. It has also revolutionised treatment paradigm and has tremendously improved patient prognosis. IC inhibitors (ICIs) targeting Programmed Cell Death Protein 1/Programmed cell death Ligand 1 (PD1/PD-L1) have shown remarkable success and are now being used as first-line therapies in metastatic disease, adjuvant therapy following surgical resection and chemotherapy in resectable disease. Despite this remarkable success, only a subset of patients obtains complete benefit and most patients do not respond or develop progressive disease during treatment. ICIs are relatively expensive and some patients suffer from significant immune-related adverse toxicities. Hence, the identification and discovery of new predictive and prognostic immunotherapy biomarkers remains the present crucial need for patient selection, stratification and also for guiding therapeutic decisions. Currently established biomarkers such as PD-L1 determined by immunohistochemistry and tumour mutation burden determined by next-generation sequencing are non-specific and possess limitations. At present, several other biomarkers using peripheral blood, liquid biopsies along with gene expression signatures, and tumour infiltrating lymphocytes are being researched globally which have demonstrated predictive potential to characterise ICIs responders. In this review, we provide a comprehensive overview of the current biomarkers, highlighting the main clinical challenges and possible novel potential biomarkers to better predict responders to ICIs.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"28 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445282","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}
Intraventricular metastasis is very often carries a poor outcome. Here may be the case of a 55-year-old farmer presented to us with headache, vomiting and gradual deterioration in vision. Imaging studies revealed a heterogeneously enhancing lesion within the ventricle. Intraoperatively, highly vascular intraventricular lesion arising from Plexus Choroideus was found. Histopathology revealed metastatic lesion from epithelial metastasis. High-resolution computed tomography of the lung revealed a little lesion within the left apex of the lung. The patient recovered well and was referred for radiotherapy.
{"title":"A clinical case report on intraventricular metastatic from a lung primary","authors":"A. Sarma, M. Devi, Jibon Sharma","doi":"10.4103/cmrp.cmrp_89_21","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_89_21","url":null,"abstract":"Intraventricular metastasis is very often carries a poor outcome. Here may be the case of a 55-year-old farmer presented to us with headache, vomiting and gradual deterioration in vision. Imaging studies revealed a heterogeneously enhancing lesion within the ventricle. Intraoperatively, highly vascular intraventricular lesion arising from Plexus Choroideus was found. Histopathology revealed metastatic lesion from epithelial metastasis. High-resolution computed tomography of the lung revealed a little lesion within the left apex of the lung. The patient recovered well and was referred for radiotherapy.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"107 1","pages":"43 - 44"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77417616","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 : 2023-01-01DOI: 10.4103/cmrp.cmrp_108_22
Anjali Gera, B. Sharma, J. Sood
End-of-life (EOL) care is a multidisciplinary approach to provide 'whole person care' to individuals with advanced, progressive, incurable or life-limiting illnesses to prevent or relieve suffering with a goal to reduce suffering as much as possible while respecting the patient's wishes. The focus is on comfort, symptom control and quality of death (QOD) rather than actual treatment or prolonging life. It includes withholding or withdrawing life support treatments and initiating palliative care in terminally ill patients. However, lack of awareness amongst people and healthcare workers and inadequate legal framework are barriers to ensuring good QOD. All these issues result in a prolonged stay of terminally ill patients in intensive care units, high financial costs and emotional stress to the family, resulting in an excessive burden on the healthcare system. EOL care poses numerous legal and ethical problems for physicians. It is critical in therapeutic decision-making to protect the rights, dignity and vigour of all individuals concerned, including the patient's family members and the society. Physicians must comprehend the concepts of relevant legal and biomedical ethics to solve EOL care issues.
{"title":"Legal issues in end-of-life care: Current status in India and the road ahead","authors":"Anjali Gera, B. Sharma, J. Sood","doi":"10.4103/cmrp.cmrp_108_22","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_108_22","url":null,"abstract":"End-of-life (EOL) care is a multidisciplinary approach to provide 'whole person care' to individuals with advanced, progressive, incurable or life-limiting illnesses to prevent or relieve suffering with a goal to reduce suffering as much as possible while respecting the patient's wishes. The focus is on comfort, symptom control and quality of death (QOD) rather than actual treatment or prolonging life. It includes withholding or withdrawing life support treatments and initiating palliative care in terminally ill patients. However, lack of awareness amongst people and healthcare workers and inadequate legal framework are barriers to ensuring good QOD. All these issues result in a prolonged stay of terminally ill patients in intensive care units, high financial costs and emotional stress to the family, resulting in an excessive burden on the healthcare system. EOL care poses numerous legal and ethical problems for physicians. It is critical in therapeutic decision-making to protect the rights, dignity and vigour of all individuals concerned, including the patient's family members and the society. Physicians must comprehend the concepts of relevant legal and biomedical ethics to solve EOL care issues.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"56 1","pages":"32 - 39"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90701182","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}
Noisy breathing is a common symptom in infancy and childhood. It can sometimes be intimidating to the parents and a diagnostic challenge to the treating physician. Causes for a noisy airway include congenital and acquired conditions. They can vary in etiology from self-resolving conditions like laryngomalacia to more sinister entities like malignant tumors. We present a 3-year-old girl who presented with noisy breathing since the age of 6months associated with poor weight gain and chest deformity. Due to persistence of her symptoms, she underwent upper airway evaluation at different time points and was found to have varied causes for her noisy respiration that included airway malacia, pharyngeal wall inspiratory collapse and later adenoidal hypertrophy which was complicated by symptoms suggestive of obstructive sleep apnea. The above three conditions are known to co-exist and can manifest at varied points of time. Since it is unusual to encounter varied causes of upper airway obstruction in the same patient, this case is being presented for its rarity and to highlight the importance of evaluating the upper airway repeatedly if symptoms are persistent, variable or progressive.
{"title":"A noisy airway: Varying causes for upper airway obstruction in a child","authors":"Sushma Krishna, Ranjini Srinivasan, Chitra Dinakar, CB Pratibha","doi":"10.4103/cmrp.cmrp_49_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_49_23","url":null,"abstract":"Noisy breathing is a common symptom in infancy and childhood. It can sometimes be intimidating to the parents and a diagnostic challenge to the treating physician. Causes for a noisy airway include congenital and acquired conditions. They can vary in etiology from self-resolving conditions like laryngomalacia to more sinister entities like malignant tumors. We present a 3-year-old girl who presented with noisy breathing since the age of 6months associated with poor weight gain and chest deformity. Due to persistence of her symptoms, she underwent upper airway evaluation at different time points and was found to have varied causes for her noisy respiration that included airway malacia, pharyngeal wall inspiratory collapse and later adenoidal hypertrophy which was complicated by symptoms suggestive of obstructive sleep apnea. The above three conditions are known to co-exist and can manifest at varied points of time. Since it is unusual to encounter varied causes of upper airway obstruction in the same patient, this case is being presented for its rarity and to highlight the importance of evaluating the upper airway repeatedly if symptoms are persistent, variable or progressive.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"25 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445279","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}
Background: Respiratory viral infection covers a significant admission in our Neonatal Intensive care unit. However due to limited diagnostic it is often underdiagnosed. Due to this, neonates are treated like bacterial infection, with unnecessary antibiotics and increased hospital stay. This also exposes other admitted neonates to the viral infection. Aim: The aim of our study is to determine the yield of respiratory BioFire in neonates presenting with respiratory symptoms. Materials and Methods: A retrospective observational study was conducted from January 2021 to March 2023 on neonates with respiratory symptoms. Respiratory BioFire panel was performed on nasopharyngeal specimens amongst infants with clinical suspicion of respiratory viral infection Result: During the 16-month study, amongst the 54 neonates for which respiratory BioFire was sent, 55% had positive results. 90% was community-acquired infection, whereas 10% was hospital-acquired infection. Cough and tachypnoea were the common presenting symptoms. Respiratory syncytial virus (RSV) (60%) was the predominant virus detected. 88% of infants with RSV required respiratory support; out of which 2 out of 18(11%) required high-frequency oscillatory ventilation. Amongst term and pre-term neonates, invasive ventilation was required in 7.7% and 41.2%, respectively, amongst the tested positive, only 13% had blood culture positive, due to which antibiotics were never started in 50% and amongst those in which antibiotics were started stopped before 72 h in 40% neonates. It was seen in our study that most (88.6%) of the virus detected were in the winter months (August–January). Conclusion: Acute viral infections are common amongst neonates admitted with respiratory symptoms. Early recognition can rationalise management and reduce unnecessary use of antibiotics.
{"title":"Acute respiratory tract viral infections in a neonatal intensive care unit: An observational study","authors":"Astha Singh, Satish Saluja, Arun Soni, Manoj Modi, Neelam Kler, Pankaj Garg, Anup Thakur","doi":"10.4103/cmrp.cmrp_160_23","DOIUrl":"https://doi.org/10.4103/cmrp.cmrp_160_23","url":null,"abstract":"Background: Respiratory viral infection covers a significant admission in our Neonatal Intensive care unit. However due to limited diagnostic it is often underdiagnosed. Due to this, neonates are treated like bacterial infection, with unnecessary antibiotics and increased hospital stay. This also exposes other admitted neonates to the viral infection. Aim: The aim of our study is to determine the yield of respiratory BioFire in neonates presenting with respiratory symptoms. Materials and Methods: A retrospective observational study was conducted from January 2021 to March 2023 on neonates with respiratory symptoms. Respiratory BioFire panel was performed on nasopharyngeal specimens amongst infants with clinical suspicion of respiratory viral infection Result: During the 16-month study, amongst the 54 neonates for which respiratory BioFire was sent, 55% had positive results. 90% was community-acquired infection, whereas 10% was hospital-acquired infection. Cough and tachypnoea were the common presenting symptoms. Respiratory syncytial virus (RSV) (60%) was the predominant virus detected. 88% of infants with RSV required respiratory support; out of which 2 out of 18(11%) required high-frequency oscillatory ventilation. Amongst term and pre-term neonates, invasive ventilation was required in 7.7% and 41.2%, respectively, amongst the tested positive, only 13% had blood culture positive, due to which antibiotics were never started in 50% and amongst those in which antibiotics were started stopped before 72 h in 40% neonates. It was seen in our study that most (88.6%) of the virus detected were in the winter months (August–January). Conclusion: Acute viral infections are common amongst neonates admitted with respiratory symptoms. Early recognition can rationalise management and reduce unnecessary use of antibiotics.","PeriodicalId":72736,"journal":{"name":"Current medicine research and practice","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135445595","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}
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