Clearing the air around spontaneous pneumorrhachis

We present a case of spontaneous pneumorrhachis associated with minimal pneumomediastinum from a tertiary care cancer hospital in Mumbai. A 16-year-old boy who was a case of Hodgkin lymphoma undergoing chemotherapy presented to the physician with complaints of cough associated with white-colored sputum and chest pain. Computed tomography of the chest done to rule out infection revealed pneumorrhachis, that is, air lurking in the spinal canal. Radiological and laboratory investigations were done to rule out crucial and life-threatening differentials. The patient was kept on observation, and finally, we figuratively cleared the air around the finding of “air in the spinal cord.” This is the first reported case in the literature of pneumorrachis in a patient with Hodgkin’s lymphoma

Comparison Of In-Hospital Mortality Of COVID-19 Patients Between Those Who Were Vaccinated And Who Were Not

Background:We compared the mortality rate of patients with moderate to severe COVID-19 who were vaccinated and who were not. Material And Methods:In this retrospective observational study, we collected data of patients who were admitted with moderate to severe COVID-19.The vaccination status and co morbidities of the patients were documented. The incidence and in-hospital mortality of COVID-19 patients was assessed.Univariate analysis was performed to determine the risk factors of in-hospital mortality.Result:Of 294 patients, 5.1% (n=15) received Covaxin™and 26.5% (n=78) received Covishield™;68.4%(n=201) patientswere unvaccinated.Of patientswho were vaccinated and contracted COVID-19, 24.8%(n=73) had taken the first dose and 6.8%(n=20) had taken the second dose of either vaccine.The in-hospital mortality rate was 13.6% (n=40). No significant association was found with the type of vaccine and the in-hospital mortality (p=0.23). Significant associations with in-hospital mortality were found with the interval before COVID-19 disease andvaccination (OR, 3.02; p=0.01); and the presence ofdiabetes mellitus (OR, 2.13; p=0.02), cardiovascular diseases (OR, 2.11; p<0.001), and malignancy (OR: 2.33; p=0.0325).Conclusion:The mortality rate of unvaccinated patients with moderate to severe COVID-19 was high. There was no significant difference in the effectiveness of Covaxin™ and Covishield™ in terms of the incidence of COVID-19 and in-hospital mortality. Diabetes mellitus, cardiovascular diseases, and malignancies had a significant association with in-hospital mortality in patients with moderate to severe COVID-19.

A new technique of fixation of radial head fractures using a modified tubular plate.

Radial head fractures are fairly common, occurring in 17-44% of all elbow injuries. Mason Type 2 fractures may be fixed using mini fragment screws, this fixation often needing augmentation with a plate to make the construct rotationally stable. However, the drill holes needed to fix the plate to the radial head, carry the risk of inflicting more injury to the fractured fragments. In our case, the radial head fracture was fixed with a modified one-third tubular plate. The plate was cut through the distal hole and the two cut ends were bent into hooks. These two hooks were engaged into two breaches made on the margin of the radial head and this provided rotational stability to the head without causing further damage. The fracture healed well and the patient regained full movement in the elbow. We conclude that this method may be used to fix fractures of the radial head, which require additional support with a plate.

Fast track thrombolysis in acute myocardial infarction: a quality improvement project.

Thrombolytic therapy for acute myocardial infarction has been proved to be most effective if given very early in the course of evolving infarction. This study was undertaken to optimise such treatment by overcoming the in-hospital delay in the existing set-up of an industrial hospital. A quality improvement project was undertaken to analyse the existing system of thrombolysing 46 consecutive patients of acute myocardial infarction treated in six months. By following the breakthrough sequence and proceeding in steps, the causes for delay in door to needle time were identified and rectified over two months. Impact of such measures in 32 patients of acute myocardial infarction thrombolysed consecutively in the next five months was studied. Door to needle time in the baseline group (n = 46) was in the range of 15-145 minutes and the average was 48.9 minutes. Only 32.6 percent of the patients in this group were thrombolysed within 30 minutes of arrival in the hospital. After the corrective measures were implemented in a study group of 32 patients, 27 with clear indication on admission were thrombolysed on the fast track i.e. with minimum delay. Five patients with doubtful need were put on the slow track and subsequently thrombolysed. Patients with no indication or a contra-indication for thrombolysis were excluded from this study. In the fast group, door to needle time reduced to an average of 22.56 minutes with a range of 7 to 67 minutes and 75 percent of the thrombolysed patients received the infusion within 30 minutes of arrival in the hospital. Differences in door to needle time between the two groups were statistically significant. Streamlining the hospital systems and procedures can help reduce the door to needle time in thrombolysing patients of acute myocardial infarction. This could be achieved within the existing resources by applying the principles of total quality improvement.

Inhibition of bacterial respiration by a low-molecular weight lectin, scyllin, from Scylla serrata crab hemolymph.

Interaction of plant and/or invertebrate lectins with mammalian cells and different microorganisms is well known. In the present study, we have demonstrated that scyllin, a low molecular weight (MW 4000) lectin from the edible crab Scylla serrata hemolymph, purified by GalNAc-Sepharon affinity column followed by Mono-Q ion exchanger in FPLC exhibits antimicrobial activity against Bacillus cereus and Escherichia coli by inhibiting endogenous respiration as well as exogenous glucose oxidation. In both the cases oxygen consumption has been measured in an oxygraph. Scyllin has produced 50% inhibition of endogenous respiration at a concentration of 110 micrograms/ml and 125 micrograms/ml in B. cereus and E. coli respectively. It also reduced the exogenous glucose oxidation by 50% at a concentration of 12 micrograms/ml and 80 micrograms/ml respectively in B. cereus and E. coli. From the above study the mechanism of bacterial growth inhibitory property of scyllin is suggested though the other studies such as inhibition of nucleic acid biosynthesis, cell wall biosynthesis etc. to evaluate its total mode of inhibitory action are not yet obtained.

Variation of serum potassium and creatinine phosphokinase levels in suxamethonium-induced muscle relaxation.

Popular depolarising muscle relaxant, suxamethonium (succinylcholine chloride), produces fasciculation in group of muscles and 'after pain'. Mode of its action is neuromuscular blockage. It also may be associated with muscle fibre injury and altered membrane permeability. These may cause rise of serum K+ and creatinine phosphokinase (CPK) levels. But use of diazepam either during or as pretreatment may reduce the fasciculation, 'after pain' and rise of K+ and CPK levels. Present study was undertaken to show whether any correlation of the degree of fasciculation and postsuxamethonium myalgia is present or not and whether diazepam has any role in reducing muscle injury and in turn reducing the levels of serum K+ and CPK.