ABSTRACT
Background and Aims: ACLF is a condition in which 2 insults to liver operate simultaneously, 1 being chronic, and other acute. Complementary & alternative medicine (CAM) are important causes for ACLF. India is the birth place of Ayurveda & CAM is considered safe by the common population with around 80% of the population relying on it. CAM consumption has increased in recent years. Due to the pandemic and the focus on improved immunity, the consumption of CAM has gone up. India has reported 4.8 lakh COVID 19 related deaths till December 2021. However, WHO has estimated 4.7 million deaths directly or indirectly related to COVID-19. We documented a case series of CAM related DILI-ACLF, with CAM being consumed for COVID prevention Methods: ACLF established with APASL defining criteria. USG was done to assess for features of CLD. Liver biopsy was done where feasible. Results: Case 1-39-year-old diabetic taking Giloy Kwath for 2 months for COVID prevention. Presenting with jaundice & ascites having MELD score 18 and CTP class B, he had NASH related cirrhosis on biopsy and is still on follow up. Case 2- f/u/c of CTP A alcoholic cirrhosis who consumed a crushed herb for protection against COVID given by a quack for 3 months, with no alcohol intake in 2 years. He presented with jaundice and encephelopathy, had MELD score 38 & CTP C & succumbed to illness. Case 3 49-year-old lady consuming Giloy Kwath for 4 months for COVID prevention. She was diagnosed with AIH type 1 with MELD score 39. She succumbed to illness with post-mortem liver biopsy showed features of AIH cirrhosis Conclusion: CAM is the most common cause of drug induced ACLF. CAM consumption increased during the pandemic and may have lead to increase in indirect COVID related deaths
ABSTRACT
The COVID-19 pandemic has led to the imminent collapse of medical supply chains across global economies at an unprecedented scale. Essential supplies such as personnel protective equipment (PPE), ventilator components, and face shields have witnessed a continuous rise in demand and eventually boost the role of 3D printing. Over the months following the spread of the pandemic, 3D printed alternatives of many medical devices were made more accessible to hospitals, mostly by community-sourced design and fabrication. However, with the high volume usage of additive methodologies, several challenges associated with the design, manufacturing, and deployment of medical products have now been brought to further attention. In this work, a systematic evaluation of such challenges along with few possible solutions are presented. The pandemic and its effects on the industry are introduced in the context of disruptions caused across the supply chains. The role of additive manufacturing to counter these effects is presented with an introduction of the technology itself. Employing 3D printed products to address the shortages of healthcare equipment are mentioned and visualized. Thereafter, a central discussion is followed on the issues arising from the shift in production methodology of such medical devices—from conventional manufacturing to additive one. The problems are highlighted by discussing two important types of COVID-19 related 3D printed medical equipments—mechanical ventilators and PPEs. Thereafter, few possible solution methodologies are discussed as case studies of two particular instances of having such problems. Finally, a conclusion is drawn to solve the issues raised using similar solutions followed by future opportunities. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.