bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of Ultrasound Guided Bilateral Erector Spinae Block in Attenuating Pneumoperitoneal Stretch Response in Patients Undergoing Laparoscopic Abdominal Surg
Authors:   Assistant Professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560004, Karnataka, India., N. Saraswathi , Chandra Namratha ,   Postgraduate, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560004, Karnataka, India., Sabreen Sumaiya ,   Assistant professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560004, Karnataka, India., Yasmeen Mohsina ,   Assistant Professor, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560004, Karnataka, India., Lonimath Ashwini ,   Senior Resident, Department of Anesthesiology, Bangalore Medical College and Research Institute, Bangalore 560004, Karnataka, India.
Published: January 2024

Background: Increase in heart rate and blood pressure in response to pneumoperitoneum produced during laparoscopic abdominal surgeries is a challenging situation to anesthesiologists. Without adequate control of sympathetic response there is a chance of increase in morbidity of the patient during perioperative period. Aim of the study is to evaluate the efficacy of bilateral erector spinae plane block in attenuating pneumoperitoneal stretch response in patients undergoing laparoscopic abdominal surgeries under general anesthesia. Methodology: A randomised control trial was conducted among 70 patients, who underwent laparoscopic abdominal surgeries. Under general anesthesia, 35 patients received ESP block with 20 ml of 0.25 levobupivacaine bilaterally (Group B) and 35 patients without block (Group R). This study compared requirement of opioids and response of hemodynamic parameters (Heart Rate, Mean Arterial Pressure) during pneumoperitoneal stretch. Statistical tests were applied. Results: The intra-operative fentanyl requirement in Group B was 100.85+ and in Group R 119.375 + P value <0.001, statistically significant. The intra-operative heart rate at the time of port insertion, at 5 min, 10 min of pneumoperitoneum and at the end of surgery in Group B (91.97 ±12.09, 90.82±10.7, 92.08±10.9 and 90.857±12.5) were significant when compared to Group R (R 99.9±10.5, 94.48±13.08, 96.68±14.14 and 95.35±14.14 and same is proven statistically. (p < 0.05). Conclusion: Ultrasound guided bilateral Erector spinae block with Levobupivacaine results in intra-operative hemodynamic stability during port insertion and pneumoperitoneum.
Ludwig’s Angina in a Parturient: A Case Report
Authors:   Junior resident, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., Ashok Revathi , Sunand Ankitha ,   Assistant professor, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India., Madhusudana Ravi ,   Professor, Department of Anesthesiology, Sri Devaraj Urs Medical College, SDUAHER, Kolar 563101, Karnataka, India.
Published: January 2024

Introduction: Ludwig’s angina is a rare but life threatening cellulitis of the soft tissue involving the floor of the mouth. Although Ludwig’s angina is a rare condition, it must be kept as a differential in the clinical setup when a patient presents with a neck swelling. Case Report: A 28 year old multigravida with 31 weeks 4 days gestational age presented with a swelling over the right side of the neck since 8 days. Patient also complains of toothache since past 5 days. The swelling was sudden in onset and progressed to attain the present size. It was associated with breathing difficulty since past 1 day. It was also associated with pain over the region. She had difficulty in eating solid food due the restriction in mouth opening due to the swelling. She was on liquid diet since past 7 days. She was diagnosed with hypothyroidism and was on Tab. Thyroxine 50 mcg. On physical examination, she is a moderately built and nourished female, vitals were stable. Examination of the head and neck revealed a diffuse swelling of size 10x10 cm over the right side of face extending from the right mastoid till the right oral commissure. Superiorly it extended up to 1 cm below right eye and inferiorly till the sternocleidomastoid origin. Total leucocyte count of 5.59 thousand/mm3. After admission, antibiotics were started. Incision and drainage was planned for the patient. Intraoperatively, patient was tracheostomized due to restricted mouth opening and difficult intubation. After induction, vertical incision was made and about 100 ml of pus was drained from the swelling on the right side. Post-operative period was uneventful. The patient was discharged on antibiotics and tracheostomy care. Conclusion: Ludwig’s angina should be kept in mind with this type of presentation. It can be life threatening if the treatment is improper, but intervention and subsequent correction can clear the symptoms completely.
Thinking Beyond ATLS Protocol: Clearing the C-Spine
Authors:   DNB resident,  Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Dhand Nitish , Datta Kishalay ,   Associate Director & HOD, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Govil Priya ,   MEM resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Singh Aakansha ,   Attending Consultant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

ATLS guidelines are considered standard for clearing the C-spine all over the world in any trauma patient. As per the guidelines, in patients with dangerous mechanism of injury, CT C-spine is considered as gold standard to clear C-spine in patients with absent initial permanent or transient neurological abnormalities. We are presenting a case of a 62 years old male who suffered from a RTA with dangerous mechanism of injury. Despite clearance of C-spine as per ATLS protocol , patient eventually landed up in quadriplegia; thus raising the question in mind that whether ATLS protocol is enough or we need to think beyond it for decreasing morbidity in such cases.
Neurogenic Heart Syndrome: A Rare Complication in A Syncopal Attack Patient
Authors:   Associate consultant, Department of Emergency Medicine, Peerless Hospital and B.K Roy Research Centre. Kolkata, West Bengal 700094, India., Chakraborty Sudip , Shylla Prince Stone ,   MEM Second Year PG Student, Department of Emergency Medicine, Peerless Hospital and B.K Roy Research Centre. Kolkata, West Bengal 700094, India., Dasgupta Indraneel ,   Clinical Director and Head, Department of Emergency Medicine, Peerless Hospital and B.K Roy Research Centre. Kolkata, West Bengal 700094, India.
Published: January 2024

This 50 year old lady presented to the emergency with history of one episode of syncopal attack followed by fall on the floor and involuntary movement of body parts. No history of vomiting and ENT bleeding. On presentation she was conscious, oriented to time, place and person and her vital status were heamodynamically stable. This case highlights the occurrence of Takotsubo Cardiomyopathy (TCM) in a middle age female patient perimenopausal women.
Spiked Helmet Sign: A Dreadful Pattern in ECG
Authors:   Resident, Accident & Emergency Department, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra 400053, India., Tambe Nikhil , Mehta Sanjay ,   Director, Accident & Emergency Department, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra 400053, India.
Published: January 2024

Electrocardiogram has been one of the oldest diagnostic modality for myocardial infarction. In last five years, pseudo ST elevation in critically ill patients in the form of “spiked helmet sign” has been studied [1-6]. Spiked helmet sign has been associated with noncardiac illnesswith raised intra-thoracic pressure or raised intraabdominal pressure [1-6]. We report one such case, encountered in our accident and emergency department, with ECG showing spiked helmet sign.
To Study the Level, Pattern and the Risk Factors of Polypharmacy among Elderly Admitted in a Tertiary Care Centre
Authors:   Lecturer, Department of Medicine, Department of Medicine, Government Medical College, Jammu, Jammu and Kashmir 180001, India., Gupta Rajesh , Sharma Sanjay ,   Lecturer, Department of Medicine, Department of Medicine, Government Medical College, Jammu, Jammu and Kashmir 180001, India., Gupta Puneeta ,   Professor, Department of Medicine, Acharya Shri Chander College of Medical Sciences Sidhra, Jammu, Jammu and Kashmir 180017, India., Yousuf Shoiab ,   PG Student, Department of Medicine, Acharya Shri Chander College of Medical Sciences Sidhra, Jammu, Jammu and Kashmir 180017, India.
Published: January 2024

The proportion of older adults exposed to polypharmacy defined as use of multiple medications, is rapidly increasing in the last two decades. There are many negative medical consequences associated with polypharmacy apart from greater health care costs. Studies in developed world have revealed that people aged 65-69 years fill an average of 14 prescriptions per year and adults aged 80-84 years, and average of 18 prescriptions per year. The reduced homeostatic ability as people age, given changes in pharmacokinetics, pharmacodynamics and physiological reserve affects different regulatory systems in elderly subjects. Aim and Objective: The aim of the present study was to explore level and pattern and; the risk factors of polypharmacy among elderly admitted and discharged in Department of Medicine, Government Medical College, Jammu. Materials and Methods: The prospective study was carried out in the departments of general medicine, in government medical college hospital Jammu. A total of 650 patients who were admitted in the medicine ward of the hospital during this period were studied, out of which 100 patients aged 65 or more were included in the study. Conclusion: Our study suggests that current practice in our hospital is associated with greater polypharmacy and inappropriate medication use. A regular medication chart review particularly in the elderly, by the clinical pharmacist to discontinue unnecessary medication will reduce the polypharmacy and inappropriate medication use.
Awareness & Knowledge Regarding Research Skills among Post Graduate Emergency Medicine Doctors in Teaching Hospitals of Kolkata
Authors:   Senior Registrar, Peerless Hospitex Hospital and Research Centre Limited, Peerless Hospitex Hospital, and Research Centre Limited, Kolkata, West Bengal 700094, India., Kumar Rudraneel , Mitra Indranil ,   Associate cunsoltant, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Peerless Hospitex Hospital, and Research Centre Limited, Kolkata, West Bengal 700094, India., Dasgupta Indraneel ,   Clinical Director and Head, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Peerless Hospitex Hospital, and Research Centre Limited, Kolkata, West Bengal 700094, India.
Published: January 2024

In today’s world, all doctors are required to keep their medical knowledge and training up-to-date. Doctors should provide effective treatments based on the ‘best available evidence’. It is widely accepted that evidence-based medicine has contributed significantly to the practice of medicine and advancement of medical science. Every doctor should strive to contribute to the generation of evidence by conducting research. Objectives of the Study: To assess the awareness and knowledge of research skills among post graduate emergency medicine doctors in teaching hospitals of Kolkata and identify any further scope inculcating research skills of emergency medicine residents leading to contribution in health research. Methodology: It is a multicentre, prospective questionnaire survey among post graduate emergency medicine residents of teaching hospitals in Kolkata. The sample size was 100 done during period of 1 year. Discussion: 60.6% were more than 29 years of age and 32% among 26-28. 60% had prior experience of writing research paper and even then 96% wanted to participate in research methodology workshop. 99% knew that research improves outcomes in patient management and that they require continue guidance and supervision during their thesis projects. Only few were able to complete their research work on time. The major reasons cited for poor research activity in our study were inadequate facilities for research and lack of time. In institutional reasons, we found 54% had found inadequate support from mentors or assistants and 20% cited lack of research curriculum. 51% believe that active participation can be done by MCI/DNB and universities by allocating time for research and making it mandatory. Conclusion: The study population was male predominant and young with majority having the background of research knowledge. Most of the participants however agreed that research methodology workshop was needed to improve their knowledge and in fact should be made compulsory in post graduation courses. 97% felt that specific time should be allotted separately during curriculum planning for research. In conclusion research is the realized need among our study population. Steps should be taken for promotion of research among emergency medicine post graduate residents.
Effect of Endotracheal Tube with Subglottic Suction Port vs Standard Endotracheal Tube on Incidence of Ventilator Associated Pneumonia in Patients of Organo-Phosphate Poisoning
Authors:   Professor and head, Department of Emergency Medicine, JJM Medical College, Davanagere, Karnataka 577004, India., S. Chandrashekar , V. Ashok Kumar ,   Associate professor, Department of Emergency Medicine, JJM Medical College, Davanagere, Karnataka 577004, India., Koushik N. Varun ,   Post Graduate Resident, Department of Emergency Medicine, JJM Medical College, Davanagere, Karnataka 577004, India.
Published: January 2024

Ventilator associated pneumonia is a hospital acquired infection that develops after 48 hours or more after a patient is intubated with an endotracheal or tracheostomy tube and is put on mechanical ventilation [1]. Ventilator associated pneumonia is most common nosocomial infection in ICU and associated with prolonged hospitalization, increased health care costs, and high attributable mortality. Intubation independently increases the risk of developing nosocomial pneumonia atleast seven fold with a peak incidence occurring around day five of ventilation [2]. Tracheal intubation thwarts cough reflex, compromises mucociliary clearance, injures tracheal epithelial surface, provides a direct conduct for rapid access of bacteria from upper into lower respiratory tract and allows formation of biofilm on Endotracheal tube surface. The combination of these factors puts mechanically ventilated patient at great risk of developing VAP. Aims and Objectives: To study incidence of VAP in ET tube with subglottic suction port versus standard ET tube in cases of O.P poisoning in J.J.M Medical college, Davangere from December 2015-June 2017. Material and Methods: A prospective observational case control study of 80 patients admitted to Red Zone/ICU of J.J.M. Medical College, Davangere. Results: Patients who have presented with Organophosphorous poisoning between the age group of 18 to 60 years who require ventilator support, intubated with standard ET tube and another sub set of patients intubated with ET tube with subglottic suction port were analysed. In this study we found that distribution of various organisms with regards to sputum culture in both groups were pseudomonas being maximum and proteus was found in minimum percentage. When subglottic suction port is used we observed improved patients were 70% and deaths were 30%. When subglottic suction port is not used we observed improved were 55% and death were 45%. Conclusion: VAP is common in patients who are intubated in ICU, which has higher morbidity and mortality among these patients. In our study we observed that atropine usually decreases secretions, but here in this study patient population who were admitted developed secretions instead of adequate atropine dosage and also developed VAP. Use of ET tube with Subglottic suction drainage may prevent VAP in cases of Organo Phosphorous poisoning and also improves patient outcomes.
Chronic Ulcerative Eyelid Lesion: A Rare Manifestation of Tuberculosis
Authors:   DNB Senior Resident, Dept. of Emergency Medicine, Max Superspeciality Hospital, Saket, Delhi 110017, India., Taneja Anuj
Published: January 2024

Any organ system in the body can be affected by tuberculosis. While pulmonary tuberculosis is the most common presentation, extrapulmonary tuberculosis including ocular tuberculosis is also an important clinical problem. Most commonly, ocular tuberculosis presents as anterior uveitis or choroiditis which is caused either by hematogenous infection or hypersensitivity after another organ infection. Eyelid involvement by tuberculosis is mostly secondary to orbital tuberculosis and often presents as a draining sinus. Isolated eyelid tuberculosis is however uncommon. We present the case of a 6 year old female with eyelid tuberculosis presenting as chronic non healing skin ulcer.
Atypical Diabetic Ketoacidosis in a Young Female
Authors:   MEM Final Year PG Student, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India., Mattoo Arif Ishtiq , Dasgupta Indraneel ,   Clinical Director and Head, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India., Das Subhendu ,   Associate cunsoltant, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India., Anjum Farhat ,   MEM Final Year PG Student, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India., Saha Saptrashi ,   Senior Associate Consultant, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India., Gull Tareq ,   MEM Second Year PG Student, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India., Kuila Siddhartha ,   MEM Final Year PG Student, Department of Emergency Medicine, Peerless Hospitex Hospital and Research Centre Limited, Kolkata, West Bengal 700094, India.
Published: January 2024

Diabetic ketoacidosis is a life threatning complication of Diabetes Milletus and can be catastrophic if left untreated.Being one of the most common complications but sometime with no clear history and symptoms the diagnosis become difficult. Hence emergency physicians should keep a broad vision while dealing with young patients with high glucose level. Diabetic ketoacidosis may be the first symptom of previously undiagnosed Diabetes. It is diagnosed with combination of Hyperglycemia, Acidosis and Ketonuria. Patients with prolonged acidosis and tendency to hypokalemia should be investigated for consumption of synthetic cannabinoids. No literature till date have showen Metabolic acidosis with PCO2 4.7 mmHg and HCO 3 1.3 mmol/L.
Prevalence of Sepsis and Role of Prophylactic Antibiotics in Acute Liver Failure
Authors:   Cunsoltant, Dept. of Gastroenterology, Academics, Quality and Research, Peerless Hospital and B K Roy Research Centre, Kolkata., Bose Partha Pratim , Haldar Mitali ,   Registrar A, Dept. of Gastroenterology, Apollo Gleneagles Hospital, Kolkata, West Bengal 700054, India., Konar Ashokananda ,   Clinical Director, Dept. of Gastroenterology, Peerless Hospital and B K Roy Research Centre, Kolkata., Bhowmick Subhrojyoti ,   Clinical Director, Academics, Quality and Research, Peerless Hospital and B K Roy Research Centre, Kolkata.
Published: January 2024

Sepsis is a major cause of death in ALF accounting for 24- 49% of death in Indian patients which is in fact more common than renal failure or GI bleed. We aimed to study the prevalence of sepsis in ALF and the role of prophylactic antibiotics in limiting the incidence of infections in ALF and improving related mortality. 46 patients of ALF were stratified into 2 main groups with SIRS>=2 and SIRS<2 on admission based on the number of SIRS components. Patients with SIRS>=2 were studied for the prevalence of sepsis in ALF. Patients with SIRS<2 were studied for the incidence of sepsis and the role of prophylactic antibiotics in ALF dividing them further into control group who received prophylactic antibiotics and the Test group who were given antibiotics only on worsening due to sepsis or there were evidence of infection. SIRS was documented regularly and on every episode of worsening. Prevalence of sepsis was studied by observing day1 infections. Role of prophylactic antibiotics was studied by documenting subsequent infections and related mortality in control group and comparing with the test group without prophylactic antibiotics. 70% of infected patients expressed more than 2 SIRS components whereas 27.3% infected patients never expressed more than 1 SIRS component. 50% infection rate was noted with expression of more than 2 SIRS components as compared to 14.3% who remained SIRS<2 without deterioration. Prevalence of sepsis was 64%. Mortality in the infected was 69% compared to 30% in the non infected. 71.4% infections with 40% related mortality was observed in the control group on prophylactic antibiotics whereas in the test group without antibiotic prophylaxis 75% infection were observed with 66.7% related mortality. This prospective evaluation points to SIRS being closely associated with infections. Use of prophylactic antibiotics may limit the incidence of infection and reduce sepsis related mortality in ALF.
Clinical Profile of Diabetic Patients with Liver Dysfunction
Authors:   Assistant professor, Department of General Medicine, Basaveshwara Medical College, Chitradurga, Karnataka 577502, India., Pasha Ghouse , G. Prashanth ,   Professor, Department of General Medicine, Basaveshwara Medical College, Chitradurga, Karnataka 577502, India.
Published: January 2024

The spectrum of clinical disease in fatty liver with steatohepatitis varies from the asymptomatic elevation of liver enzymes to severe liver disease with fibrosis and nodular regeneration. Patients with nonalcoholic steatohepatitis can develop progressive liver disease and complications to the point that they may need liver transplantation.Nonalcoholic steatohepatitis should be considered as a cause for chronically elevated liver enzymes in asymptomatic diabetic patients particularly if they are obese and have hyperlipidemia.This study was carried out among 100 diabetic patients diagnosed to be with hepatic dysfunction attending tertiary care hospital during the study period. Maximum number of patients had diabetic nephropathy (17%), followed by diabetic retinopathy (15%), peripheral neuropathy (11%) and peripheral vascular disease (4%). Neuropathy, Nephropathy, PVD and Retinopathy were present in patients who had diabetes for more than 10 years.
Relevance of Pseudo Cholinesterase Level to Clinical Profile as Prognostic Marker on Organophosphorus Compound Poisoning
Authors:   Senior resident, Dept. of Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka 577201, India., F.V. Manjunatha , C.L. Aravinda ,   Associate professor, Dept. of Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka 577201, India., S. Nagabhushana ,   Associate professor, Dept. of Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka 577201, India., V. Virupakshappa ,   Professor and Head, Dept. of Medicine, Shimoga Institute of Medical Sciences, Shivamogga, Karnataka 577201, India.
Published: January 2024

Background: Organophosphorus poisoning has a high mortality rate. Various factors decide prognosis of organophosphate poisoning. This study is carried out to analyze the significance of estimation of serum pseudo cholinesterase in assessment of severity as well as prognosis in OP poisoning. Materials and Methods: This prospective study was conducted at department of Medicine in McGann teaching hospital attached to Shimoga institute of medical sciences from June 2017 to December 2017. Total of 123 documented OP patients were analyzed. Noting of symptoms, signs, need of oxygen, ventilator support and their assessment with PChE levels carried out. Informed consent was taken from each study participant. Ethical committee approval was obtained to carry out the study. Suitable statistical methods applied to assess correlation and variables. Results: Among 123 patients, majority were male (64.2%), belonged to 21-30 age group (34.1%), were from rural areas (91%) and commonest compound ingested is chlorpyrifos (60.9%).Patients needing ventilator support were 3, 13 and 43 in patients of moderate poisoning, severe poisoning and very severe poisoning respectively, where as it was none in patients with mild poisoning and normal PChE levels. There were 21 deaths in very severe poisoning patients where as it was 4 and 1 in severe and moderate poisoning patients respectively and none in mild poisoning patients and in patients with normal PChE levels. Conclusions: Significant correlation (p value <0.001) was observed between PChE levels with clinical manifestations, need of mechanical ventilation and in hospital outcome. These findings can enforce the evaluation of patient’s prognosis, complications and treatment plan.
A Case of Reiters Syndrome in a Young Patient Presenting to the ED
Authors:   PGY1, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Shandilya Mayaskar , Das Indranil ,   Attending Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Jhaldiyal Pankaj ,   HOD & Senior Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India.
Published: January 2024

Introduction: In 1916, Hans Reiter described the classic triad of arthritis, nongonococcal urethritis, and conjunctivitis (Reiters syndrome) in a Prussian soldier with diarrhea, during the first world war. Reiter’s syndrome is defined as a complication of non gonococcal urethritis in which there is arthritis (mainly knees, ankles and feet), conjunctivitis, rashes, cardiac and neurological problems. Other features include; iritis, keratoderma blenorrhagicum, circinate balanitis, plantar fasciitis, Achilles tendonitis, aortic incompetence. RS is triggered by bacterial infection that enters via mucosal surfaces usually, (but not always) associated with human leukocyte antigen (HLA)- B27. Nongonococcal venereal disease (most often Chlamydia) and infectious diarrhea usually precede reiter’s syndrome. These include infections with: Shigella flexneri, Shigella dysenteriae, Salmonella typhimurium, Salmonella enteritidis, Streptococcus viridans, Mycoplasma pneumonia, Cyclospora, Chlamydia trachomatis, Yersinia enterocolitica, and Yersinia pseudotuberculosis. Campylobacter jejuni . Others include Chlamydia pneumoniæ and Ureaplasma urealiticum.
Naphthalene Toxicity-Winter Poison in Teenager
Authors:   PGY1, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Sharma Kratika , Das Indranil ,   Attending Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Jhaldiyal Pankaj ,   HOD & Senior Consultant, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India., Kumar Akshat ,   PGY2, Department of Emergency Medicine, Max Hospital, Dehradun, Uttarakhand 248001, India.
Published: January 2024

Introduction: Naphthalene is bicyclic aromatic hydrocarbon most commonly used as insect and moth repellent household product for storing clothes. The toxic manifestations have been proposedly due to increased free radical formation leading to lipid peroxidation and formation of epoxide and further ultimate DNA damage. Naphthalene toxicity manifests at doses ranging 5 to 15 gms to incidences as low as 2 gm have been reported in children.
A Rare Entity of Bottle Gourd Toxicity with Multiorgan Dysfunction Syndrome
Authors:   Resident, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Devi Kangjam Lakshmi , Naidu Sarat Kumar ,   Attending Consultant, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India., Nair Dheeraj Bhaskaran ,   Associate Consultant and Coordinator, Department of Emergency Medicine, Max Super Speciality Hospital, Vaishali, Ghaziabad, Uttar Pradesh 201012, India.
Published: January 2024

A 59 years old male was presented to our Emergency Department with complaints of multiple episode of vomiting and fresh blood in vomitus, loose stools and reddish coloured urine after consuming some home made bottle gourd juice. Later he was diagnosed as bottle gourd toxicity with a shock which led to MODS. He was aggressively managed with IV fluids, pantoprazole infusion, antibiotics and other supportive medications. He improved and was discharged in a stable condition after 7 days of hospitalization.
Prevalence of Metabolic Syndrome in the Cases of Acute Myocardial Infarction and the Impact of its Components on in-Hospital Prognosis
Authors:   Assistant professor, Department of General Medicine, Government Medical College, Kota, Rajasthan 324010, India., Chandel Rahul , Sagar Rajesh ,   Medical Officer, Department of General Medicine, Government Medical College, Kota, Rajasthan 324010, India.
Published: January 2024

Introduction: All over the world, with the increasing risk factors like obesity and sedentary lifestyle, it is expected that incidence of Metabolic syndrome (MetS) will be increasing dramatically. It is well established that the five components of MetS also individually increase the risk of cardiovascular disease. Aims and Objectives: The aim of our study was to determine the incidence of MetS in the cases of acute myocardial ischemia; and to study the detrimental impact of syndrome and its components over the in-hospital outcome in these patients. Methods: A total of one hundred and fifty patients of acute myocardial infarction (AMI) were included in this study. Results: Among these 150 AMI patients (113 males, 37 females) one hundred and two (68%) met with ATP III criteria of MetS. The mean age for the entire cohort was 54.99±13.18 years. In our study high prevalence of MetS (68%) was observed in the patients of AMI and at least one risk factor of Mets was present in 98.67% of patients. Most common combination of MetS observed was a four combination of obesity+ hyperglycemia+elevated triglycerides+ low-HDl (OB+DM+HTG+low-HDL) in 16.67%. most common three components combination observed was OB+DM+HDL (8.82%). HT, DM and HDL showed significant correlation with adverse in-hospital outcome among AMI patients (p<0.05). Conclusion: The present study concludes that there is noticeable high occurrence of metabolic syndrome and its components in the cases of AMI. In our findings hypertension showed strong association with adverse outcome in these patients.
A Study of Fever with Thrombocytopenia and Its Complications
Authors:   Professor, Department of Emergency Medicine, JJM medical College, Davanagere, Karnataka 577004, India., EM Surendra. , V. Ashok Kumar ,   Associate professor,Department of Emergency Medicine, JJM medical College, Davanagere, Karnataka 577004, India., Shamanur Kallash ,   Senior resident, Department of Emergency Medicine, JJM medical College, Davanagere, Karnataka 577004, India., Ramaiah Sree ,   Post Graduate Resident, Department of Emergency Medicine, JJM medical College, Davanagere, Karnataka 577004, India.
Published: January 2024

Background: Fever with thrombocytopenia is one of the commonest medical problem encountered in India. Management of complications associated with it is the most challenging task for emergency physician which includes bleeding manifestations, ARDS, hepatitis, acute kidney injury, shock syndrome. Aims and Objective: This study was conducted to analyse the cause and outcome of fever associated with thrombocytopenia. Materials and Methods: 100 patients of fever associated with thrombocytopenia who were admitted in the department of emergency medicine, JJM Medical College, Davangere were included in prospective clinical study. Results: 100 patients of fever with thrombocytopenia were analysed out of which male patients were 56 (56%) and female patients were 44 (44%). Among them those who were dengue positive were 64 (64%), Malaria cases were 12 (12%), typhus were 4 (4%), Negative fever profile were 20 (20%). Out of these 100 patients who developed ARDS were 25 (25%), Acute kidney injury were 8 (8%), hepatitis were 7 (7%), patients who developed rash/ petechiae and platelet count less than 20,000 were 60 (60%). Discussion: Infections particularly dengue was the commonest cause of fever with thrombocytopenia, with majority of patients developing bleeding manifestations and ARDS as a complication. The commonest bleeding manifestation were petechiae and purpura. In some patients diagnosed with malaria also developed complication like ARDS, while patients diagnosed with typhus fever had no complications like ARDS. In majority of patients thrombocytopenia was transient and by treating the specific cause improvement in platelet count was noticed during the course of illness.
Health Related Quality of Life among the Patients with Tuberculosis in Chitradurga District
Authors:   Assistant professor, Department of General Medicine, Basaveshwara Medical College, Chitradurga, Karnataka 577502, India., Pasha Ghouse , G. Prashanth ,   Professor, Department of General Medicine, Basaveshwara Medical College, Chitradurga, Karnataka 577502, India.
Published: January 2024

Introduction: The Revised National Tuberculosis Control Programme (RNTCP) uses sputum negativity as prognostic indicator but does not consider any other dimension of health. Apart from physical symptoms, TB patients face social and economic problems. Therefore, the overall impact of TB on health and patients’ perception of well being should be considered. This can be performed by measuring the Quality of Life (QoL). Methodology: A cross sectional study was undertaken in the Chalalkere Tuberculosis Unit of Chitradurga district for a period of two months between February and March, 2017. About 60 patients who are treatment for tuberculosis attending the tuberculosis unit were included as the study samples. The patients thus selected were obtained an informed, bilingual and written consent. Results: The mean score of the physical component summary (PCS) was 54.1, mental component summary (MCS) was 48.6, physical functioning (PH) was 62.1, role limitation due to physical health (RP) was 52.2, body pain was 60.2, general health was 41.7, role limitation due to emotional problem was 54, energy/fatigue was 44.4, mental health was 46.7 and social functioning was 49.2. Conclusion: The mean value of physical component summary, mental component summary, physical health and mental health were higher for class III of SES, RP, MH and VT were higher for Class V of SES and BP was higher for class I of SES.
Clinical Presentation of COVID 19 Patients Attending A Tertiary Care Hospital
Authors:   Postgraduate, Department of Emergency Medicine, Kempegowda Institute of Medical Sciences, KR Road, VV Puram, Bangalore, Karnataka 560004, India., Khan Abeer , K Bharath ,   Assistant professor, Department of Emergency Medicine, Kempegowda Institute of Medical Sciences, KR Road, VV Puram, Bangalore, Karnataka 560004, India., Basavaraju Brinda ,   Professor, Department of Emergency Medicine, Kempegowda Institute of Medical Sciences, KR Road, VV Puram, Bangalore, Karnataka 560004, India.
Published: January 2024

The coronavirus disease (COVID 19) pandemic, which originated in the city of Wuhan, China, has quickly spread to various countries including India. It has a range of clinical manifestations. There is still insufficient data on symptoms that easily help to identify mild and moderate cases which is necessary to contain the spread. Aims: In this study, we aim to identify the presenting symptoms of Category A (mild) and Category B (moderate) patients diagnosed to have COVID 19. Settings and Design: A prospective study was conducted in 56 adult patients with laboratory confirmed COVID 19 infection over a period of two months in a tertiary care centre in Bangalore, India. Methods and Material: Clinical data was collected from these patients and then they were classified into two categories: Category A which included the mild cases and Category B which included the moderate cases. Those with severe and critical illnesses were excluded from the study. Statistical Package for Social Sciences (SPSS) for Windows Version 22.0 Released 2013 was used to perform statistical analyses. Results: A total of 56 patients were included in the study of which of which 30 were males and 26 were females. Diabetes mellitus was the most common co morbidity. The most common clinical presentation among both the categories of patients were fever (85.7%) and cough (82.1%) followed by fatigue (78.6%), sore throat (58.9%), ageusia (33.9%) and anosmia (25%), headache (23.2%), vomiting (19.6%). Shortness of breath (88%) and chest pain (32%) were present mainly in the category B patients. Gastrointestinal symptoms (10.7%) were also reported in a few category A patients. Conclusion: Fever and cough were the most common findings among both the groups. Shortness of breath and chest pain were identified as symptoms of concern among the moderate cases of COVID 19 and hence these can help clinicians to predict the disease severity. Gastrointestinal symptoms present in those with mild disease even without respiratory symptoms was an important finding.
A Study on Left Ventricular Dysfunction in Diabetes Mellitus with No Overt Cardiac Symptoms or Signs
Authors:   Senior Resident, Department of General Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India., ... Bhaskara , G Ramakrishna Reddy ,   Senior Resident, Department of General Medicine, Vijayanagar Institute of Medical Sciences, Ballari, Karnataka 583104, India., K Abhilash ,   Senior Resident, Department of General Medicine, Raichur Institute of Medical Sciences, Raichur, Karnataka 584102, India.
Published: January 2024

The association of coronary heart disease and DM is well known, but epidemiologic and clinical data from the last 2 decades reveal heart failure also to be a major contributor to cardiovascular morbidity and mortality in patients with DM and also develop congestive heart failure even in the absence of coronary heart diseases, hypertension or any known structural heart disease. Methodology: Written informed consent was taken from all the patients who were recruited in the study. Data was collected in the case proforma which included clinical examination. Relevant investigations were carried out and recorded. Results: The chest X-ray of patients, 4(4.4%) showed COPD, 7(7.8%) showed pneumonia and rest all patients had normal chest X-ray. ECG was reported as normal in all the patients 90(100%). Urine routine was reported as normal in 73(81.1%) of patients. Conclusion: Out of all the diastolic parameters statistically significant difference was observed in ‘A’ velocity, E/A ratio and DT parameters.
Clinical Profile and Outcome of Patients Presenting to ER with Acute Rodenticide Poisoning
Authors:   Postgraduate resident, Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India., V R Kathyayini , K P Gireesh Kumar ,   Head of department,Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India., T P Sreekrishnan ,   Assistant Professor, Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India., Theresa Manna Maria ,   Postgraduate resident, Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India., U Vivek ,   Postgraduate resident, Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India., Ahamed D Riaz ,   Postgraduate resident, Department of Emergency Medicine, Amrita Institute of Medical Sciences, Kochi, Kerala 682041, India.
Published: January 2024

Background: Rodenticide consumption is one of the most common suicidal poisoning. The compounds vary in their chemical composition, mechanism of action, lethal dose and effects. Absence of a specific antidote along with rapid deterioration to multi organ failure has escalated the mortality. This study is intended to predict the clinical profile and the outcome of patients presenting to the ER of a tertiary care center in South India with acute rodenticide poisoning. Methods: A retrospective cross sectional analysis of all acute rodenticide poisoning cases presented to the ER of a tertiary care centre in south India during the period between 1st January 2018 to 1st December 2019 after fulfilling both inclusion and exclusion criteria was done. The clinical profile and outcome of patients presenting with acute rodenticide poisoning were assessed. Results: A total of 39 patients were included in the study population, of which 18(46.2%) were females and 21 (53.8%) were males. The mortality associated with rodenticide poisoning is 33.3%. Out of the 39 patients, 21 patients had acute liver failure , 16 had met the Kings college criteria for liver transplant, but liver transplant was done in only 2 patients and out of which 1 survived. On detailed analysis,two parameters SGOT, SGPT and the presence of hepatic encephalopathy correlate with mortality. Conclusion: The study revealed that, the mortality associated with rodenticide poisoning is high (33.3% ) and certain factors like SGOT, SGPT and the presence of hepatic encephalopathy are strong predictors of mortality in acute rodenticide poisoning.
A Study on Risk Factors Associated with Stroke
Authors:   Assistant Professor, Department of General Medicine, The Oxford Medical College, Hospital and Research Centre, Bangalore, Karnataka 562107, India., Kumar Prasanna , Gunaranjan Jeedigunta Sai ,   Senior Resident, Department of General Medicine, Siddhartha Medical College and Government General Hospital, Vijayawada, Andhra Pradesh 520008, India.
Published: January 2024

Introduction: The majority (about 75%) of cases of stroke occur in people over the age of 65 years and about one-third of patients die of stroke within a year of onset. Over half of survivors remain dependent on others for everyday activities, often with significant adverse effects on caregivers. Medical complications after acute stroke may adversely impact outcome and in some cases may be preventable. Limited data exist regarding the frequency of such complications occurring in the first days after the ictus and the relationship of these complications to outcome. Methodology: All selected patients were studied for post stroke pulmonary complications mainly pneumonia, mechanical ventilation, respiratory depression, it sincidence, age, gender distribution and its association with the site of lesion (i.e Anterior vs Posterior),type of lesion(infarct vs bleed), Severity of the stroke if measured by NIHSS scoring system. Results: Among smokers 9 out of 29 patients have developed pneumonia that is 47%. But this finding did not show statistical significance. Among 24 Alcholics 13 patients developed pneumonia with 54% association. but no statistical significance. Diabetic and hypertensives, did not show any significant association with pneumonia and statistical significance. Conclusion: With other risk factors, there was more incidence of developing pneumonia. but there was no statistical significance and so these are no independent risk factors for pneumonia.
A Rare Case of Acute B/L Optic Neuritis with B/L Papilloedema with Anti Mog Antibodies Positive
Authors:   Emergency Medicine Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Srivastava Ritul , Govil Priya ,   Senior cunsoltant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Datta Kishalay ,   Associate Director and HOD, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

A 46 years old ladycame to ED with c/o B/L progressive loss of vision since 6 days associated with intermittent headache. With Left eye perception of hand movements at 10 inches. With Right eye she can see objects about 5 meters but unable to identify color and face MRI orbit contrast/MRI brain contrast s/o B/L optic neuritis with subtle T2/flair hyperintense signal is seen in the periaqueductal region, ? artefactual, ? changes of NMO/NMOSD Hematology report revealed anti MOG antibodies:Positive Visual Evoked Potential(VEP) suggestive ofB/L demyelinating anterior visual pathway defect ANA and vasculitic panel negative. Ophthalmo opinion revealed B/ Lpapilloedema.
Decreased Platelet Count Due to Heparin in Covid-19
Authors:   Emergency Medicine Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Khan Ashar , Datta Kishalay ,   Associate Director and HOD, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Verma Siddharth ,   Senior Consultant, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India., Kaushik Arun ,   Emergency Medicine Resident, Department of Emergency Medicine, Max Hospital, Shalimar Bagh, New Delhi 110088, India.
Published: January 2024

COVID-19 (coronavirus disease-2019) infection may be a extremely prothrombotic state, ensuing from a dysregulation of the coagulation cascade. Therefore, thromboprophylaxis is powerfully suggested in these patients, with some consultants even advocating for therapeutic dosing to forestall thromboembolic events. Heparin-induced blood disorder (HIT) may be a well-known complication of heparin therapy. during this article, we tend to report a case of HIT in a patient with COVID-19. A 52-year-old male with history of one week of dry cough and loose stools. He had a positive COVID-19 reverse-transcriptase–polymerase chain reaction. On admission, the platelet count and liver function test were within normal limits. Throughout his hospitalization, he developed a right femoral deep venous thrombosis and was started on therapeutic anticoagulations. Due to worsening respiratory failure, he was intubated and mechanically ventilated. Between days eight and nine of hospitalization, platelet count decreased from 294000 to 89000 cells/μL. He had a high pretest likelihood for HIT with a 4T score of 6 and a positive anti-PF4/ heparin antibody. Heparin drip was interrupted and was switched to Argatroban. The serotinin assay eventually came back positive, that confirmed the diagnosis of HIT.