Do Not Huff, Puff, or Vape That Stuff: Interstitial Airspace Disease in a Teenager.

A 17-year-old previously healthy male was admitted to the hospital for intractable and persistent vomiting, fever, cough, abdominal pain, and intermittent diarrhea and dehydration. He presented with severe chest pain and O2 desaturations up to 80% on room air. An infectious (including a nasopharyngeal swab), GI, and cardiac workup was completed and was negative except for elevated inflammatory markers with a C-reactive protein (CRP) level of 261 mg/L, erythrocyte sedimentation rate (ESR) of 53 mm/hr, and a D-dimer level of 0.93 mcg/ml. Chest X-ray showed diffuse multifocal infiltrates. The patient was treated with ceftriaxone and azithromycin initially for a suspected pneumonia. He was also started on 4L of nasal cannula O2 supplementation. Due to persistent hypoxic respiratory failure, worsening respiratory distress clinically, with tachypnea and retractions, and lab findings of elevated D-dimer, a chest CT was performed to rule out a pulmonary embolism (PE). Computed tomography (CT) findings were negative for PE but notable for diffuse airspace opacities, primarily within the lower lobes, with a ground-glass appearance concerning for ARDS. Upon further investigation of the social history, the patient admitted to vaping nicotine products for the past 4 years and tetrahydrocannabinol (THC) products within the last several months. He was immediately started on prednisone 30 mg BID for a diagnosis of e-cigarette or vaping product use-associated lung injury (EVALI) and started showing clinical improvement. The patient was able to be weaned off of supplemental oxygen to room air, and clinical symptoms of respiratory distress began to improve over the next 24 hours.

Burden Faced by Caregivers of Stroke Patients Who Attend Rural-based Medical Teaching Hospital in Western India.

BACKGROUND: Stroke results in significant caregiver burden and strain. OBJECTIVE: The main objectives of this study is to assess the burden and its consequences in caregivers of stroke patients and to determine the associated factors to caregivers' burden. METHODS: A cross-sectional study was conducted over 1 year on 70 consecutive patients who attended the Shree Krishna Hospital, Karamsad stroke clinic. Demographic and clinical characteristics of all patients were recorded after obtaining the consent. The modified rankin scale and Barthel index were administered to the patient, whereas Caregiver strain index, Caregiver burden scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and Kuppuswami scale were administered to the patient's caregiver. Descriptive statistics were used to portray demographic and clinical profiles. Correlation coefficients were used to assess the association between different scales, and t-test was applied to assess association of caregivers' burden with different categorical variables. RESULTS: The mean age was 60 years for patients and 47 years for caregivers. Nearly 72.8% of patients were male, whereas 57% of caregivers were female. The mean caregiver burden scale score was 28.26. Caregivers' burden decreased with increase in stroke duration (P = 0.01), increase in education level (P = 0.054), and upper socioeconomic status (P = 0.02). Caregivers' burden increased with caring for male gender (P = 0.18), being a female caregiver (P = 0.31), longer caregiver hours (r = 0.51), and increased patient disability (P < 0.01). A strong correlation existed between caregivers' burden and depression (0.72); anxiety and depression (0.84); caregivers' burden and caregiver strain index (0.72). CONCLUSIONS: A structured and targeted caregiver intervention is urgently needed to relieve caregivers' burden and related psychological comorbidities in an Indian setup.

Knowledge of umbilical cord blood banking among obstetricians and mothers in Anand and Kheda District, India.

BACKGROUND: To assess the knowledge of obstetricians and expectant mothers towards UCB banking and their awareness regarding pros and cons of the process. METHODS: Questionnaires from a previously published study were modified contextually and translated into vernacular language (Gujarati). The questionnaires were distributed among 200 obstetricians, of which 100 responded and 100 mothers were in Anand and Kheda districts of India. Informed consent was taken for both. RESULTS: Mean (SD) age of obstetricians was 47.5 years (11.14) with mean (SD) work experience of 19.72 years (9.94). Almost all were aware of collection procedure for UCB and felt that UCB banking is useful. Thirty obstetricians thought that stored blood can be used in conditions of Autism, Duchenne Muscular Dystrophy and all genetic conditions. Sixty-three were aware of the procedure technique. Majority felt that the process was feasible and would do it for their own child. All the 100 mothers approached consented for the study with average age (SD) of 26.88 (4.17). Many were not aware of such a procedure and were not certain about the usefulness of the procedure. Seventy-six did not know the conditions in which the stored blood can be used. Only 4 mothers/family members had opted for UCB banking, whereas 27 expressed their willingness to recommend UCB to another mother. Five Muslim women wanted UCB but could not pursue it due to religious norms. CONCLUSION: The level of understanding among obstetricians was not commensurate with the amount of faith with which they promoted UCB banking.

Training Village Health Workers in Detection and Monitoring of Noncommunicable Diseases: A Low Cost Option for Rural Areas Facing the Emerging Health Epidemic.

Noncommunicable diseases account for 53% of deaths and 44% of disability-adjusted life years lost in India. Village health workers (VHWs) were trained in blood pressure (BP) and blood sugar (BS) measurement and assessed using a checklist. A total of 38 VHWs with a mean age of 44.8 years, schooling of 9.9 years, scored 10.0 (76.9%) for BP and 9.74 (69.6%) for BS. There was no difference in scores for education and age. It is possible to train VHWs in BP and BS measurement and utilize them for screening and monitoring of hypertension and diabetes in a noncommunicable disease care program.

Perceived Stress and Professional Quality of Life in Neonatal Intensive Care Unit Nurses in Gujarat, India.

OBJECTIVE: To study the levels of perceived stress in Neonatal Intensive Care Unit (NICU) nurses and its association with professional quality of life domains viz. compassion satisfaction, burnout and secondary trauma. METHODS: In this multicenter, cross sectional study, data was collected by surveying 129 nurses from nine NICUs across six cities of Gujarat, India using demographic questionnaire, Perceived Stress Scale (PSS14) and Professional Quality of Life Scale (ProQOL5) during July to September 2013. Descriptive statistics, correlation coefficient and multiple regression were used for analysis. RESULTS: The mean (SD) age of participants was 28.37 (8.20) y. Most were single, satisfied with salary benefits and reported 'good' to 'excellent' relationships at work. The mean (SD) duration of duty hours was 8.12 (0.76) h and 43.6% were attending to more than 4 patients/shift. The mean (SD) perceived stress level was 22.19 (7.17) [Range: 3 to 39]. High compassion satisfaction, high burnout, and high secondary traumatic stress were reported by 25 (19.4%), 30 (23.3%) and 30 (23.3%) nurses respectively. PSS14 was negatively correlated with compassion satisfaction (r = -0.28) and positively correlated with burnout (r = 0.43) and secondary traumatic stress (r = 0.24). CONCLUSIONS: Most of the nurses (91, 70.5%) were identified as perceiving moderate to high stress. Professional quality of life domains correlated with perceived stress. There is further need to study domains influencing NICU nurses' professional QOL. Identifying stress and QOL issues in NICU nurses can help formulate relevant policies.