Ulinastatin Add-on to Standard of Care in Critically Ill COVID-19 Patients: A Multicenter, Retrospective Study

Aim: To assess the impact on 30-day mortality with ulinastatin (ULI) used as add-on to standard of care (SOC) compared to SOC alone in coronavirus disease (COVID-19) patients requiring admission to the intensive care unit (ICU). Materials and methods: In this multicentric, retrospective study, we collected data on clinical, laboratory, and outcome parameters in patients with COVID-19. Thirty-day mortality outcome was compared among patients treated with SOC alone and ULI used as add-on to SOC. Odds ratio (OR) and 95% confidence intervals (CI) were determined to identify the predictors of 30-day mortality. Results: Ninety-four patients were identified and enrolled in both groups with comparable baseline parameters. On univariate analysis, 30-day mortality was significantly lower in ULI plus SOC group than SOC alone group (36.2 vs 51.1%, OR 0.54, 95% CI 0.30–0.97, p = 0.040). The effect on mortality was more pronounced in patients who did not require intubation (10.9 vs 34.0%, OR 0.24, 95% CI 0.09–0.66, p = 0.006) and with early administration (within 72 hours of admission) of ULI (30.7 vs 57.9%, OR 0.32, 95% CI 0.11–0.91, p = 0.032). On multivariate analysis, only intubation predicted mortality (adjusted OR 10.13, 95% CI 3.77–27.25, p<0.0001) and the effect of ULI on survival was not significant (adjusted OR 0.58, 95% CI 0.22–1.52, p = 0.270). Conclusion: Given the limited options for COVID-19 patients treated in ICU, early administration of ULI may be helpful, especially in patients not requiring intubation to improve the outcomes. Further, a large, randomized study is warranted to confirm these findings.

Clinical efficacy of medicinal leech therapy in treating third- and fourth-degree hemorrhoids / Eficácia clínica da hirudoterapia no tratamento de hemorroidas de terceiro e quarto graus

Abstract Objectives Hemorrhoids are characterized by bleeding, mucous discharge, itching, pain, and prolapse. This condition is known as bawaseer in Unani medicine, and Hirudinaria granulosa has been used for its treatment in Irsal-e Alaq, or medicinal leech therapy (MLT), for centuries. Hirudinaria granulosa with antithrombotic and antiinflammatory action is used in the treatment of chronic venous disease and hemorrhoids. The present study was aimed to investigate the efficacy of MLT in third and fourth-degree hemorrhoids. Methods A single-centre prospective, clinical trial with a pre and postanalysis design was conducted at the hospital of the National Institute of UnaniMedicine. Twenty male and female patients, with a mean age of 38 years, presenting moderate symptoms assessed with the colorectal evaluation of clinical therapeutics scale (CORECTS) questionnaire were included in the study. Hirudinaria granulosa were applied around the pile mass for 15 minutes weekly, for 4 weeks. The efficacy of the treatment was measured by an objective and subjective assessment using the CORECTS. Results When analyzed by the clinician, MLT reduced the symptoms' severity score in the following domains: pain (55% improvement; p < 0.001); anorectal itching (30% improvement; p < 0.10); and bleeding (10% improvement; p < 0.7963). Significant improvement (p < 0.001) was reported in the CORECTS score in relation to pain (44.09% improvement; p < 0.001), itching (38.55% improvement; p < 0.001), swelling (44% improvement; p < 0.001), bleeding (17.28% improvement; p < 0.007), discomfort (34.01% improvement; p < 0.001), and wellbeing (32.35 % improvement; p < 0.001), giving an average overall opinion on the therapy of 4/10. Conclusion The results of the study albeit smaller in sample size show that MLT is an effective and safe therapeutic option in reducing the symptoms of 3rd and 4th degree haemorrhoids.

Resumo Objetivos As hemorroidas são caracterizadas por sangramento, secreção mucosa, prurido, dor e prolapso. Esta condição é conhecida como bawaseer namedicina Unani, e a Hirudinaria granulosa tem sido usada para seu tratamento na Irsal-e Alaq, ou hirudoterapia, há séculos. A H. granulosa, devido à sua ação antitrombótica e antiinflamatória, é utilizada no tratamento de doenças venosas crônicas e hemorroidas. O presente estudo teve como objetivo investigar a eficácia da hirudoterapia em hemorroidas de terceiro e quarto graus. Métodos Este ensaio clínico prospectivo e unicêntrico com delineamento pré e pósanálise foi conduzido no hospital do National Institute of Unani Medicine. Foram incluídos no estudo 20 pacientes de ambos os sexos, com média de idade de 38 anos, que apresentavam sintomas moderados avaliados pelo questionário colorectal evaluation of clinical therapeutics scale (CORECTS). Espécimes de H. granulosa foram aplicadas em volta da área afetada por um período de 15 minutos semanais, durante 4 semanas. A eficácia do tratamento foi medida por uma avaliação objetiva e subjetiva usando o questionário CORECTS. Resultados Quando analisada pelo clínico, a hirudoterapia reduziu o escore de gravidade dos sintomas nos seguintes domínios: dor (55% de melhora; p < 0,001); prurido anorretal (melhora de 30%; p < 0,10); e sangramento (melhora de 10%; p < 0,7963). Melhora significativa (p < 0,001) foi relatada no escore CORECTS em relação à dor (44,09% de melhora; p < 0,001), prurido (38,55% de melhora; p < 0,001), inchaço (44% de melhora; p < 0,001), sangramento (17,28 % de melhora; p < 0,007), desconforto (34,01% de melhora; p < 0,001) e bem-estar (32,35% de melhora; p < 0,001), o que resultou em uma opinião geral média sobre a terapia de 4/10. Conclusão Os resultados do estudo, embora com tamanho de amostra pequeno, mostram que a hirudoterapia é uma opção terapêutica eficaz e segura na redução dos sintomas de hemorroidas de terceiro e quarto graus.

Utility of the Epworth sleepiness scale: Hindi version in identifying obstructive sleep apnoea in adult patients with symptoms of sleep disordered breathing in a tertiary care centre

Background: Excessive daytime sleepiness is a key symptom in patients with sleep- breathing disorders (SBD) and represents a new major public health issue due to its repercussions. The ESS is a simple and validated method, which measures the probability of falling asleep in a variety of situations. Aims and objectives is to study the accuracy of the Epworth Sleepiness Scale (ESS) questionnaire in the identification of Obstructive Sleep Apnoea (OSA) in patients with symptoms of sleep disordered breathing in a tertiary care centre.Methods: This present study was conducted in the Department of Respiratory medicine, New Medical College, Kota on 70 adult patients who presented with symptoms of Sleep Disordered Breathing and underwent Type 2 Polysomnography after answering Epworth sleepiness score in Hindi Language.Results: Epworth sleepiness scale has predicted excessive day time sleepiness in 60% of study subjects with ESS score more than 10 taken as cut off. Mean value for ESS in the study was 10.78. 35.71% of the patients had severe OSA diagnosed by polysomnography and 30% patients had moderate OSA. Mild OSA was detected in 7.14% patients. Sensitivity of the ESS score >10 in diagnosing OSA was found to be 72.5%. Specificity of the scale was 73.6%.There was significant correlation between ESS score and diagnosis of OSA (p value <0.001).Conclusions: The study concludes that ESS has got good relevance in predicting OSA in patients with sleep disordered breathing.

Role of medical thoracoscopy in the management of parapneumonic effusion and empyema thoracic

Background: The treatment modality use in early pleural empyema mainly depends on the antimicrobial therapy along with thoracocentesis. In case of complicated empyema this modality does not work and lung not fully expand, until removal of adhesions. The main purpose of the current study is to analyze the experience of management of complicated parapneumonic effusion and empyema thoracic through rigid medical thoracoscopy under local anaesthesia. Aim and objective is to study the role of medical thoracoscopy in the management of empyema thoracic and parapneumonic effusion at tertiary health centre.Methods: This is a descriptive case series study in which 49 patients were recruited, who have clinically and radiologically show empyema thoracic, from department of Respiratory medicine, GMC, Kota, Rajasthan. All patients underwent medical thoracoscopy under local anesthesia. Written Informed consent was taken from the study participants. Ethical approval was obtained from Ethical Review Committee of the hospital. Patients who have HIV and Hbsag positive, those with multiple organ failure and bleeding disorders were excluded.Results: Total 49 patients, out of them 41(84%) were male and 8(16%) were female with mean age 45 years (range 18 to 70 years). Final evolution through chest x-ray revealed complete resolution or successful thoracoscopy done in 37 case of fibrinopurulent (92.50%) and 5 cases of organizing empyema (55.56%). overall success rate 85.71%. Total 7 cases (3 case of fibrinopurulent and 4 cases of organizing empyema) refer to higher center for decortications.Conclusions: Medical Thoracoscopy under local anaesthesia is a safe procedure, efficient and cost-effective intervention for early management of complicated empyema, particularly in early stage of empyema (fibro purulent).

A study of radiological presentation in bronchogenic carcinoma along with prevelance of pulmonary TB in a tertiary center

Background: Lung cancer is most common cause of cancer related death in men and women world wise responsible for over 1 million death annually. Lung cancer is leading cause of cancer death in united states and worldwide. Lung cancer is the most common neoplasm contributing more frequent among males causing cancer related mortality in both sexes. Objective of this study was to radiological presentation in bronchogenic carcinoma along with   prevalence of pulmonary TB in a tertiary center.Methods: Total of 100 patients with histologically proven lung cancer, from July 2018 to June 2019 at a tertiary center Kota Rajasthan. Data of participants regarding demographics, history of smoking habit, clinical presentation, histopathological type, radiographic findings on chest radiograph, ultrasonography, computed tomography (CT) scan, Statistical analysis was performed using descriptive statistics of the collected data.Results: Most common age group of bronchogenic carcinomas was seen between 60-69 years of age (37%) with male predominance (82%).  smoking history present in about (80%) patients.  Most common radiological presentation was a mass lesion present in 91% patients (n=91) followed by unilateral hilar prominence present in 44% of patients (n=44). Other common finding includes mediastinal widening (38%), collapse (26%). pleural effusion (22%), metastasis (22%), cavitation (13%), consolidation (12%), bony erosion (11%), pneumothorax (5%), and pancost tumor (4%).  prevalence of pulmonary TB in bronchogenic carcinoma is 9% and this is due to high burden of pulmonary TB in India.Conclusions: In this study adenocarcinoma was found to be most common type of lung cancer. Smoking is most common risk factor. Pulmonary TB coexistence with bronchogenic carcinoma was more common. The local immunity is deteriorated in cancer cases.

Consensus statement on the management of invasive candidiasis in Indian scenario

Invasive fungal infections in critically ill patients are associated with increased morbidity and mortality. Candida species are among the most common causes of nosocomial bloodstream infections and of invasive infections in intensive care units (ICUs). The high mortality mandates early identification of invasive candidiasis which is vital to initiate appropriate and timely treatment and improve outcomes. Delaying the initiation of treatment could result in an increase in mortality which can be avoided by usage of more rapid diagnostic techniques. There are multiple diagnostic tests including culture and non-culture tests like 1,3-β-D-glucan and newer techniques like MALDI-TOF which are available to diagnose candidemia but each with their drawbacks. Additionally, there are various guidelines like IDSA and ESCMID on treatment which aim to minimize death, late complications from deep-seated candidiasis and rise of drug- resistant Candida strains. Through this consensus statement prepared by a panel of experts, all of whom are senior intensivists, infectious disease specialists and microbiologists, we aim to address the major aspects of management of invasive candidiasis in the Indian population as per the authors opinions, backed by published evidence and supported by the latest clinical guidelines.

Tobacco abuse and dental problems among sanitation workers of Allahabad city: a cross sectional study

Background: ‘Sanitary labourers’ are known by different names such as ‘Health Labourers’, ‘Manual Scavengers’ garbage man, trash man etc. They are mainly involved in street cleaning, waste carrying, drainage and toilet cleaning in the cities. Intake of alcohol and tobacco products is prevalent to cope with the inhuman task of cleaning filthy sewage, and as a modality to forget their health problems. The aim of the present cross-sectional study was to find out the association of dental problems with tobacco abuse among the study population.Methods: The study population included 610, 122 from each zone of Allahabad city through “Proportionate stratified random sampling”. The study subjects was interviewed and examined, Dental problems were assessed by taking history, doing a clinical examination, reviewing past medical records.Results: Dental problems were found to be higher in prevalence among “exclusive smokers”, “combined abuser” and “exclusive tobacco” chewers as compared to “non abuser”. Dental caries were found to be higher in prevalence among the entire three abusers group as compared to “non abusers”. Missed teeth were found to higher in prevalence among “combined abuser” and “exclusive tobacco chewers” group as compared to “non abusers”. Enamel erosion was found to be higher among “exclusive tobacco chewers” group as compared to “non abusers”. All these finding were found to be statistically significant.Conclusions: Dental problems were found to be more prevalent among tobacco abusers than non abusers.

Analysis of enamel and material wear by digital microscope: an in-vitro study

Abstract: The objective of the study was to analyze the surface area (SA) of the wear caused by simulated chewing on human enamel and opposing restorative material, namely: composite resin (CR), porcelain fused to metal (PFM), lithium disilicate (LD), or monolithic zirconia (MZr). Forty-eight premolars were selected as enamel specimens and divided randomly into 4 groups (n = 48; n =12) used as antagonists in chewing simulation (250,000 loading cycles) against one of the four selected test materials. Enamel and material specimens were scanned and evaluated under digital microscope, and wear SA (mm2) were recorded. Descriptive statistics, paired t-test, one-way ANOVA, and post-hoc Tukey-HSD tests were used for statistics (p < 0.05). The smallest and largest SA were exhibited by enamel against LD (0.80 mm2) and PFM (1.74 mm2), respectively. PFM (3.48 mm2) showed the largest SA and CR (2.28 mm2) showed the smallest SA. Paired t-test for SA values showed significant difference (p < 0.05) in all wear comparisons between materials and enamel antagonists. The wear of materials were greater than that of their respective enamel antagonists (p < 0.05). One-way ANOVA of the logarithmic means of wear SA revealed significant differences (P<0.05). Post-hoc Tukey test revealed significance for PFM (p < 0.05) with other materials. Wear of all test materials was greater compared to the wear of enamel antagonists. PFM and LD caused the largest and the smallest enamel wear, respectively. CR, LD, and MZr are more resistant than PFM to wear after simulated chewing against enamel.

DRESS Syndrome; Just a Rash or Much More?? Time to Rethink

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome is a severe multiorgan drug induced idiosyncratic reaction. As the name suggests it is characterized by peripheral eosinophilia and systemic symptoms like fever, rash, lymphadenopathy, liver failure. Incidence is around 1:1000 to 1:10,000 drug exposures and has a high mortality if not diagnosed and treated timely. Diagnosis is difficult and challenging due to the diversity of symptoms this syndrome has, hence scoring systems like the RegiSCAR and Japanese criteria may be used. Mortality rate is around 10-20% and mostly due to liver failure. Most important step in treatment is withdrawal of the offending drug and supportive line of therapy with corticosteroids forming the mainstay of therapy. This paper reports two such cases which were a diagnostic dilemma and timely withdrawal of the offending drug and corticosteroids changed the course of the condition completely.