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Simultaneous bilateral spontaneous pneumothorax is a situation that rarely occurs. The patient can have various presentations, from dyspnoea and chest pain to significant respiratory failure. Although it causes lung collapse in nearly two thirds of cases, early diagnosis and treatment are of the utmost importance. Here, we present the case of an 18-year-old boy who presented with complaints of sudden onset respiratory distress. He was immediately put on mechanical ventilation. He was diagnosed with simultaneous bilateral spontaneous pneumothorax on chest X-ray. He needed bilateral intra-thoracic drainage, following which a video-assisted thoracoscopy was done on the left side.
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Introduction Anion gap (AG) metabolic acidosis is common in critically ill patients. The relationship between initial AG at the time of admission to the medical intensive care unit (MICU) and mortality or length of stay is unclear. This study was undertaken to evaluate this relationship. Materials and Method We prospectively examined the acid-base status of 500 consecutive patients at the time of MICU admission and outcome was measured in terms of mortality, length of ICU stay, need of ventilator, and laboratory parameters. The patients were divided into four stages based on the severity of AG. Outcome based on the severity of AG was measured, and comparisons that adjusted for baseline characteristics were performed. Results This study showed that increased AG was associated with the higher mortality. Patients with the highest AG also had the longest length of stay in the MICU, and patients with normal acid-base status had the shortest ICU length of stays ( p < 0.05). Conclusion A high AG at the time of admission to the MICU was associated with higher mortality and length of stays. Initial risk stratification based on AG and metabolic acidosis may help guide appropriate patient disposition (especially in patients without other definitive criteria for MICU admission) and assist with prognosis.
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OBJECTIVE: Euthanasia is a controversial issue that puts doctors into a dilemma and can have the capacity to end the patients' sufferings. However, it is never an easy decision; hence, this study was planned to find the attitude of practicing doctors of medical colleges in a South Indian city of Mangalore towards euthanasia. METHODS: A cross sectional study was conducted in March-April 2010 among the doctors practicing in the four medical colleges of Mangalore city. A pretested semi-structured questionnaire was used to collect data from 220 doctors after their informed consent. Data was analyzed using SPSS version 11.5. RESULTS: Mean age of the doctors was 37.9 years (SD=9. 4), most of them were males and belonging to the Hindu religion. Euthanasia was justified according to 46.8% of the doctors in order to curtail the sufferings of the patients or to ameliorate the emotional and financial burden. Another 41% said it should be legalized and 39% said that they would use it if it was legalized. Nevertheless 84.5% of them were concerned that it may be misused if legalized. More than half of them felt it was not justified in the face of moral obligations and legal complications. Religion and department were independently associated with the doctors feeling that euthanasia was justified with 69.4% of Muslim doctors saying it was justified as compared to 59.2% of Hindu doctors (OR=2.82; p=.001) and 59.3% of doctors from medical specialities said it was justified as opposed to 39.8% of doctors from surgical specialities (OR=2.3; p=.008). Despite the illegality of it, 25% of the doctors had received requests from patients and 22.3% from relatives for euthanasia. CONCLUSIONS: Though euthanasia is illegal in the country, there are doctors who feel it is justified in some situations, yet not without reservations. The fact that they had been requested for euthanasia by the patients and relatives show that even the public are being aware and accepting the practice. Yet, the law in our country has not changed and it would be worthwhile to garner opinions and attitudes of all stakeholders to aid the legislators in framing policy guidelines in the future.
