ABSTRACT
Background: The patient partnership is desirable for the optimal management of comorbidities. This became significant more so during the coronavirus disease 2019 (COVID-19) crisis wherein health infrastructure was overburdened. Objectives?The aim of this study was to estimate the clinicoepidemiological profile, health literacy regarding predisposing risk factors, and disease management in patients with COVID-19-associated mucormycosis (CAMCR). Materials and Methods?A structured questionnaire-based study on randomly chosen 100 microbiologically proven patients of CAMCR, consisting of 38 multiple choice questions, was designed with each answer having a patient and assessor response to it. Results?A male predilection was seen (68%) with rhino-orbital (73%) being the commonest anatomic site. Forty-nine percent of the study participants had pre-existing diabetes of which 62% did not carry out regular blood sugar monitoring and in 18%, blood sugars were controlled prior to COVID-19. Thirty-five percent of patients with mild COVID-19 illness were treated with unwarranted steroids and 56% of patients had fluctuating blood sugar levels, during COVID-19 illness. Seventy-nine percent of patients were not vaccinated against COVID-19, 16% only partially vaccinated. Seventy-one percent of patients were not aware of red flag signs and of mucormycosis with 8% presenting early, on noticing nasal symptoms. Conclusion?This study observed diabetes as the most common comorbidity in patients with CAMCR. A lacuna in the health literacy of diabetics presenting with CAMCR was found. Additionally, knowledge regarding glycemic control during COVID-19 illness with or without the use of steroids and awareness of the “red flag” signs of CAMCR were mostly lacking. Interventions to improve awareness amongst patients with diabetes should help in optimal glycemic control, and avoid potential complications like severe COVID-19 illness, and mucormycosis
ABSTRACT
Transient ischemic attack (TIA) is a diagnostic challenge for all physicians due to the temporariness of symptoms and the absence of any definitive diagnostic test. There is a very high risk of TIA being followed by an ischemic stroke, hence require urgent investigation and preventive strategies. At the same time, it is also important to distinguish TIA from other close differentials, to avoid wrong diagnoses leading to harmful, misdirected medical management. In this report, we will discuss the case of a middle-aged male patient with stable pre-operative vitals who was posted for total parotidectomy and suddenly developed jerky movement of the upper limb and transient aphasia on the operation theater table along with raised blood pressure. This is a very rare presentation of TIA that needs to be differentiated from other close differentials as this form is mostly associated with severe carotid occlusive disease and, hence, carries a high risk of stroke.
ABSTRACT
Pain is a distressing symptom having biological, psychological, and social consequences. A large number of cancer patients are in advanced stages of the disease and for these patients the only positive and realistic option is pain management and palliative care. These patients have complex needs that have to be taken care of in order to improve the quality of life of such patients and their family members. Surgical treatment along with chemotherapy and radiotherapy is the mainstay for the treatment of cancer, but these modalities also have limitations. The main aim behind palliative care is to allay the sufferings of a terminally ill patient by responding to pain using multimodal analgesia including opioids. According to WHO step ladder, other symptoms like breathlessness, fatigue, delirium etc., are also needed to be managed adequately along with psychosocial and spiritual support. Along with it patients and his family members should be well explained that palliative care is a multidimensional approach directed to the best possible care for that stage of their illness, which may not be curative in nature. There are multiple obstacles in the growth of palliative care in India. Nonetheless we have overcome many such hurdles and there has been a noticeable change regarding palliative care in the mindset of health care providers in the last 2 decades.
ABSTRACT
Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups – Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure’s ANOVA with Tukey’s test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/ additive treatment modality in these cases.