Simulation-based ventilatory training for the caregivers at primary and rural health care workers in Central India for dealing with COVID-19 pandemic: recommendations.

In 2020 COVID-19 made a major burden on health care system. The capacity of the healthcare system particularly emergency departments, ICU, hospital beds are insufficient to manage the increasing number of patients in cities and rural areas too. The primary health care centers and rural hospitals need preparedness for such disasters conditions. Novel and future oriented solutions are needed to effectively address the unprecedented pressure on the healthcare systems created by the COVID-19 pandemic. Considering the lacunae in healthcare system at primary level, various challenges encountered during pandemic has been identified and training session in consortia with simulation based training program for the training of the doctors, nurses, attendants and other related healthcare staff of Primary Health Center and Rural Hospitals intending to prepare them for future challenges in ventilatory care of COVID-19 has been carried out. After these training session certain conclusions and recommendations were drawn which could be able our health care system to be prepared for more critical situations and we can take our primary health care system at new horizon.

Postoperative clinicoradiological outcome of pott's spine.

Introduction: Tuberculosis (TB) is one of the main diseases impacting humanity. Fifty percent of all the cases of skeletal TB belong to spinal TB (STB), and it is also the most common form of TB. In India, patients usually present late after the onset of neurological symptoms, for which surgical management is essential for recovery. In our study, we have evaluated the outcome of forty patients of STB who underwent posterior decompression and instrumentation. Methods: Forty patients with STB who underwent posterior decompression and instrumentation were reviewed. All cases were followed up for 18 months. The groups were compared by parameters such as improvement in pain, improvement in kyphosis, and neurological recovery. Visual Analog Scale (VAS) score and american spinal cord injury assosciation (ASIA) score are used for the assessment. Results: VAS score was significantly decreased postoperatively (mean: 1.28) as compared to preoperative values (mean: 7.25). Erythrocyte sedimentation rate (ESR) was significantly decreased postoperatively (mean: 30.95) as compared to preoperative values (76.15). Cobb's angle was significantly decreased immediate postoperatively (mean: 7.8) as compared to preoperative values (mean: 24.8). There was no deterioration of neurological symptoms in any of the patients. Conclusion: Surgical intervention in Pott's spine with posterior decompression and stabilization, whenever indicated, gives good improvement in pain, decreases kyphotic deformity, and in most cases, also improves neurology.

RésuméIntroduction: La tuberculose (TB) est l'une des principales maladies affectant l'humanité. Cinquante pour cent de tous les cas de tuberculose squelettique appartiennent à la colonne vertébrale TB (STB), et c'est aussi la forme la plus courante de TB. En Inde, les patients se présentent généralement tardivement après l'apparition des symptômes neurologiques, pour lesquels la prise en charge chirurgicale est essentielle à la guérison. Dans notre étude, nous avons évalué les résultats de quarante patients de STB qui ont subi une décompression et instrumentation. Méthodes: Quarante patients atteints de STB qui ont subi une décompression postérieure et une instrumentation ont été revu. Tous les cas ont été suivis pendant 18 mois. Les groupes ont été comparés par des paramètres tels que l'amélioration de la douleur, l'amélioration de la la cyphose et la récupération neurologique. Le score de l'échelle visuelle analogique (EVA) et le score de l'association américaine des lésions de la moelle épinière (ASIA) sont utilisés pour l'évaluation. Résultats: Le score EVA était significativement diminué en postopératoire (moyenne : 1,28) par rapport aux valeurs préopératoires (moyenne : 7,25). La vitesse de sédimentation des érythrocytes (VS) était significativement diminuée en postopératoire (moyenne : 30,95) par rapport aux valeurs préopératoires (76,15). L'angle de Cobb était significativement diminué en postopératoire immédiat (moyenne : 7,8) par rapport aux valeurs préopératoires (moyenne : 24,8). Il n'y avait pas détérioration des symptômes neurologiques chez l'un des patients. Conclusion: Intervention chirurgicale dans le rachis de Pott avec décompression postérieure et la stabilisation, chaque fois qu'elle est indiquée, améliore la douleur, diminue la déformation cyphotique et, dans la plupart des cas, améliore également la neurologie.

The Effectiveness and Safety of Ultrasonic Bone Scalpel Versus Conventional Method in Cervical Laminectomy: A Retrospective Study of 311 Patients.

STUDY DESIGN: Retrospective cohort study. OBJECTIVES: The aim of this study was to compare the results of cervical laminectomy (CL) performed with ultrasonic bone scalpel (UBS) or conventional method (CM). METHOD: This study comprised 311 CL performed by a single surgeon between January 2004 and December 2017. Group A (GpA) comprised 124 cases of CL performed using UBS, while Group B (GpB) comprised 187 cases of CL performed using CM. These 2 groups were compared in terms of demographic characteristics of patients, duration of surgery, estimated blood loss, and surgical complications. RESULTS: GpA included 112 males and 12 females, mean age being 61.18 years. GpB comprised 166 males and 21 females, mean age being 62.04 years. Mean duration of surgery, estimated blood loss, and length of hospital stay was 65.52/70.87 minutes, 90.24/98.40 mL, and 4.80/4.87 days in GpA and GpB, respectively. Six patients were reported to have dural injuries in each group. In GpA, 2 cases of C5 palsy and 1 nerve root injury was observed, while in GpB, 3 cases of C5 palsy and no nerve root injury was reported. One patient had developed transient neurological deterioration postsurgery in GpA as against 11 patients in GpB. CONCLUSION: Neurological complications observed in CM leads to intensive care unit admission, additional morbidity, and additional expenditure, whereas UBS provides a safe, rapid, and effective means of performing CL, thereby decreasing the rate of surgical complications and postoperative morbidity.