Awareness of the Standard of Care for Snakebite Management Among Physicians in Kerala: A Cross-sectional Study.

Snakebite remains a largely neglected yet important cause of morbidity as well as mortality in Kerala. This study aimed to assess the knowledge about the standard of care for snakebite management among physicians in Kerala. This was a cross-sectional study using a questionnaire-based survey among 110 physicians from Kerala. The overall knowledge levels were assessed using a questionnaire with answers being scored as 0 for wrong answers and as 1 for correct answers. The total knowledge scores for all respondents were calculated, with a maximum possible score of 14 and a minimum possible score of 0. Comparisons were made between subsets of respondents. The questionnaire was administered to 110 physicians who fulfilled the predetermined criteria. The overall mean knowledge score during the study was 10.7 (standard deviation ± 2.9). However, there were certain pitfalls associated with the management of snakebite. In particular, questions about tourniquet use, bringing a dead snake to the physician, and the anti-snake venom test dose had high proportions of incorrect answers. Significantly higher knowledge levels were also observed in certain subgroups. There seems to be varying knowledge gaps associated with various aspects of snakebite management for certain subsets of respondents who are likely to benefit from specific training.

A quality improvement project on adherence to antibiotic policy in acute admissions from a tertiary care hospital in south India.

The indiscriminate use of antibiotics in clinical practice may be an independent risk factor for the development of antimicrobial resistance. To combat this, our hospital implemented a hospital antibiotic policy which outlines the appropriate antibiotic to be used in an acute admission, based on a continuously updated local antibiogram. However, we felt that compliance with the policy was poor and hence carried out a quality improvement project (QIP) to assess and increase compliance. We show that a simple QIP model combined with the use of a mobile application can serve to improve compliance even in a low-resource setting with minimum infrastructure. This model could be easily extrapolated into similar settings.

Aspergillus fumigatus meningitis in an immunocompetent young woman.

Aspergillus meningitis is a rare clinical entity that is much more frequently observed among immunocompetent patients. Here we present the case of a 28 year old immunocompetent lady with Aspergillus fumigatus meningitis possibly following spinal anaesthesia for her caesarean section. The diagnosis of Aspergillus meningitis is very difficult and challenging. Even after diagnosis, clinical outcomes remain poor with treatment. We wish to highlight the need for high index of suspicion for Fungal meningitis in patients presenting with meningism after Neurosurgeries and procedures involving invasion into the CSF compartment.

Cardiovascular and stroke disease risk among doctors: a cross-sectional study.

The leading causes of death in the world are cardiovascular disease (CVD) and stroke according to the World Health Organization, as is also the case in India. There is also a high prevalence of major conventional risk factors in India, where 18.3%, 9.0% and 14.1% of adults are diagnosed with hypertension, diabetes and smoking, respectively. The aim of the present study was to look at the risk of CVD among doctors in our country using a validated tool developed by the National Health Service (NHS) in the UK, the QRISK3 calculator.

Little Known Dangers of an Exotic Poisonous Fruit: Lessons From Two Cases of Konjac Ingestion.

Amorphophallus konjac, often abbreviated to Konjac, is a perennial plant that is not uncommon in parts of Asia where it is cultivated as a food source. However, consumption of the raw plant has been known to be toxic to animals. We report the first human cases of Konjac poisoning in two children after accidental ingestion of its seeds.

A Bundled Approach to Pulmonary Tuberculosis Testing: Experience from a Tertiary Care Centre in South India.

The diagnosis of pulmonary tuberculosis (PTB) is based on a stepwise approach consisting of sputum microscopy and molecular testing (GeneXpert), with the use of Mycobacterium culture in select cases. We analysed a bundled approach of PTB testing, consisting of all three of these tests during the patient's first visit, for all patients fitting into the clinical criteria of PTB. We retrospectively analysed the medical records of all patients who underwent the TB diagnosis bundle during a period of 29 months. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of sputum microscopy and GeneXpert were compared against the gold standard of Mycobacterium culture. The incremental yield of diagnosing PTB by addition of Mycobacterium culture in the diagnostic bundle during the initial testing was also calculated. The bundled approach conferred an advantage in terms of faster clinical decision and increased diagnosis rates, by virtue of the speed of smear microscopy and GeneXpert, combined with the higher sensitivity of culture. The bundle also had the additional benefit of detecting non-tuberculous Mycobacterium (NTM) by the culture method. Hence we feel that the bundled approach ensures fewer number of hospital visits and reduces the potential delays in a clinical decision making.