Challenges Faced in Biomedical Waste Management by Waste Handlers amidstthe COVID-19 Pandemic in a Tertiary Care Hospital: A Qualitative Study

Introduction :Coronavirus disease 2019(COVID-19) saw an overhaul in the biomedical waste management (BMWM) practices. Waste handlers were at the brunt of these changes. If the challenges pertaining to BMWM at the ground level are better understood, more effective measures to overcome them can be formulated. 1. To identify myths and concerns regarding BMWM in the context of COVID-Objectives: 19 pandemic. 2. To explore the challenges faced in BMWM amidst the COVID-19 pandemic. 3.To explore opportunities and future perspectives of BMWM. In-depth interviews were conducted among 17Method: purposively selected Class IV health care workers during August to November 2021 in a tertiary care institute in Mumbai. Data was reported using thematic analysis. Three major themes - challengesResults: and concerns faced by BMW handlers, enablers/ motivators, opportunities and future practices were generated from the transcripts. Various challenges faced by waste handlers were- difficulties in segregation and transport of BMW, exhaustion from PPE usage and fear of acquiring and spreading COVID-19 from work, stigma faced from public, and handling COVID-19 deaths. Support from family and colleagues, incentives and a positive change in public perception enabled them to work. Forming redressal committees, addressing job security concerns and timely provision of good quality equipment can improve hospital waste management measures in the future. It is of utmost importance to address challenges faced byConclusion: waste handlers in BMWM. Onus should also be on periodic training in BMWM

The role of prophylactic central compartment lymph node dissection in differentiated thyroid carcinoma

Background: Differentiated thyroid carcinoma, arising from thyroid follicular epithelial cells, accounts for the vast majority of thyroid carcinomas. Of the differentiated cancers, papillary cancer comprises about 85% of cases compared to about 12% that have follicular histology, including conventional and oncocytic (Hurthle cell) carcinomas, and <3% that are poorly differentiated tumors. In general, stage for stage, the prognoses of PTC and follicular cancer are similar. The aim of this study is to evaluate the benefit of central compartment lymph node dissection in accurate staging of the disease and plan radioiodine treatment and dosing. And also to assess the morbidity associated with central neck dissection. Materials and methods: This was a prospective clinical study conducted at MNJIO and RCC, Hyderabad. 20 patients with carcinoma thyroid who underwent total thyroidectomy and prophylactic central compartment lymph node dissection from December 2015 to December 2017 were included. The protocol was submitted to the ethics committee at Osmania Medical College and was approved. Results: We analyzed the number of patients of that age in whom the disease stage changed due to the presence of central nodal dissection. Prophylactic CND resulted in upstaging of tumour in 2/20 (10%) patients from stage I to stage II. Also in 4/20 (20%) patients, the evidence of node metastases influenced also the therapeutic strategy because these patients would not have been treated with 131-I if the prophylactic central neck dissection had not been performed. Thus a prophylactic CLND may play an even larger role in determining RAI use. A prophylactic CLND that demonstrates a lack of lymph node metastasis would strengthen the case not to use RAI treatment in a low-risk patient. Nived Rao, M. Muralidhar, M. Srinivasulu. The role of prophylactic central compartment lymph node dissection in differentiated thyroid carcinoma. IAIM, 2018; 5(9): 91-98. Page 92 Conclusion: With the available evidence, we advocate a selective approach to performing prophylactic CND and to be done in high volume centres. Routine prophylactic central lymph node dissection should be avoided in the absence of involved lymph nodes, reserving the procedure to “high-risk” patients as defined by ATA and European Society of Endocrine Surgeons, which include extremes of ages, large primary tumor size, and male gender, which were similar to high risk cases seen in our study.

Clinical rabies: is cure possible.

Rabies is a fatal disease in humans and till date survivors of the disease after the clinical onset of the illness are rare. The approach to management of rabies is usually palliative. In rare cases of paralytic rabies a trial for cure has been tried. No single therapeutic agent is likely to be effective, but a combination of specific therapies could be considered, including rabies vaccine, rabies immunoglobulin, monoclonal antibodies, ribavirin, interferon alpha, ketamine etc. the only reported cases in literature were with rare success of the Milwaukee protocol. This is the case report of a 45 year old male who presented with clinical rabies and was started on the trial. Has the treatment had any benefit is to be debated and further options discussed.

Randomized double blind trial of intraperitoneal instillation of bupivacaine and morphine for pain relief after laparoscopic gynecological surgeries

Intraperitoneal injection of anesthetic has been proposed to minimize postoperative pain after laparoscopic surgery. So a randomized, placebo-controlled study was conducted to compare the effectiveness of intraperitoneal bupivacaine with or without morphine for postoperative analgesia after laparoscopic gynecological surgeries. A total of 90 ASA I and II female patients scheduled for laparoscopic gynecological procedures were enrolled in the randomized double blind prospective study. The drug was injected intraperitoneally before the removal of trocar at the end of surgery. In group BM [n=30]: 0.25% bupivacaine 30 ml + 2 mg morphine, in group BO [n=30] 30 ml 0.25% bupivacaine and in group C [n=30] 30 ml of saline was injected intraperitoneally. Postoperative quality of analgesia was assessed by VAS [0-100], for 24 hours and when VAS >40, rescue analgesic was administered. Total dose of rescue analgesia and side effects were noted. Intraperitoneal instillation of bupivacaine and morphine significantly reduces immediate postoperative pain [VAS: 23.33 +/- 6.04 vs. 45.5 +/- 8.57]. It also reduces pain at 4 hours after surgery in the BM group [VAS 24 +/- 12.13 vs. 41.17 +/- 7.27 in the BO group]. The time of administration of first rescue analgesic was significantly higher in the BM group [6.15 hours] compared to the BO group [4.51 hours]. The total dosage of rescue analgesic was more in the BO and C groups compared to the BM group. Addition of morphine to local anesthetic significantly prolonged the time to first rescue analgesic requirement and the total consumption of rescue analgesic in 24 hours without any significant increase in adverse events