Smell and Taste Disturbance in COVID-19 Patients: A Prospective Multicenteric Review.

To study the incidence of the smell and taste disturbance in the COVID-19 patients and a follow up at 4 months to observe for the duration of resolution of these symptoms. This is a multicentric prospective study carried out in 3 different countries, from April, 2020 to January, 2021. The COVID-19 positive patients, aged between 15 and 60 years, were inquired about the presence of any smell or taste related symptoms. The same patients were followed up with the telephonic interview after 2 months and then after 4 months, respectively. The duration of resolution of the smell and taste disturbance symptoms was noted. Total of 188 COVID-19 positive patients, average age 33.1 ± 1.7 years, 54.2% males and 45.8% female were included in the study. The smell disturbance was present in 60.6% (hyposmia 36.1%, anosmia 20.2%, and parosmia 4.2%) and taste disturbance in 28.7% of patients (hypogeusia 20.2%, ageusia 6.9%, and parageusia 1.6%). There was improvement of anosmia by 97.4, hyposmia by 95.6%, parosmia by 100%, ageusia by 100%, hypogeusia 94.8%, and parageusia by 66.7%, at 4 months follow up. The present study concludes that the smell and taste disturbances are one of the main early presenting features of the COVID-19 infection. The temporary effect of the COVID-19 infection on the olfactory and gustatory pathway was also highlighted with more than 95% patients improving at 4 months of follow up.

Massive Hemoptysis Through Endotracheal Tube During Emergency Cesarean Delivery: A Case Report and Literature Review.

Severe pulmonary hemorrhage occurred through the endotracheal tube during an emergency cesarean delivery. Intubation trauma was excluded with fiberoptic bronchoscopy. Episodes of hemoptysis continued for 48 hours. The patient was subsequently diagnosed with diffuse alveolar hemorrhage because of systemic lupus erythematosus. The diagnostic workup, successful management, and literature review are presented.

Intracerebral Hemorrhage Score and Volume as an Independent Predictor of Mortality in Primary Intracerebral Hemorrhage Patients.

We studied how well the original intracerebral hemorrhage (ICH) score would predict mortality. All nine patients with an ICH score of 0 survived, whereas those having scores of 1, 2, 3, and 4 had 10, 53, 71, and 100 % mortality, respectively. Thirty-nine patients were found to have hematoma of <30 mL (56 % survived), whereas 11 patients were found to have volume of >30 mL (only 10 % survived). The ICH score and volume is a simple clinical grading scale that allows risk stratification on presentation with ICH. The use of a scale such as the ICH score could improve standardization of clinical treatment protocols.

Use of indigenously made negative-pressure wound therapy system for patients with diabetic foot.

OBJECTIVE: Negative-pressure wound therapy (NPWT) is a well-known treatment modality for chronic, difficult, nonhealing wounds. Unfortunately, many commercially available negative-pressure therapy systems for wounds are expensive, require hospitalization, and may not be available throughout the world. The authors have designed a less expensive and effective NPWT system from components readily available in the hospital. DESIGN: The system is assembled from ethylene oxide sterilized polyurethane foam, transparent adhesive dressing, and a simple negative suction drain system, which is being routinely used in surgical cases. The multiple holes suction tube is inserted between 2 layers of polyurethane foam and is put on the wound, which is sealed by adhesive dressing. The negative pressure is created using a closed wound suction set. The dressing is changed every third day or as needed. MAIN RESULTS: The authors have used this system in 11 patients with diabetic foot. The mean time for preparation of wound for surgery with this system was 7 days (5-9 days). The raw areas were either secondarily closed or were covered with split-thickness skin graft. The mean hospital stay for debridement and definitive surgical procedure was 11 days (8-15 days). CONCLUSION: In the authors' experience, the NPWT system developed from off-the-shelf components reduces the length of hospital stays and therefore cost, without any compromise on quality. It leads to a quicker wound closure and reduces the need for multiple surgeries or flaps. This modification presents a simple, cheap, and effective alternative to commercially available NPWT machines.

Splenic infarct with polysplenia syndrome and situs inversus.

A rare case of spontaneous splenic infarction with polysplenia and situs inversus is presented. The diagnosis was made by ultrasound and confirmed by CT which showed multiple aberrant right-sided spleens with situs inversus and one of the spleen showing low attenuation areas representing infarct. Polysplenia syndrome is a rare entity associated with heterotaxy syndromes, congenital cyanotic heart diseases, billiary atresia, intestinal malrotation, immotile cilia syndrome, annular or short pancreas, preduodenal portal vein and vena caval anomalies.

A randomised trial of the analgesic efficacy of ultrasound-guided transversus abdominis plane block after caesarean delivery under general anaesthesia.

CONTEXT: Previous studies examining the efficacy of transversus abdominis plane block after caesarean section have mostly been in parturients under spinal anaesthesia. OBJECTIVES: We postulated that the advantage of performing transversus abdominis plane block after caesarean section might be even more obvious after general anaesthesia, resulting in reduced 24-h consumption of morphine. DESIGN, SETTING, PATIENTS AND INTERVENTIONS: In this single centre, randomised double-blind controlled trial, 40 women who underwent caesarean delivery under general anaesthesia were allocated randomly to receive a transversus abdominis plane block or no block. In those who received the block, 20 ml of levobupivacaine 2.5 mg ml was deposited bilaterally into the transversus abdominis plane under ultrasound guidance using a Sonosite Titan (SonoSite, Bothell, Washington, USA) 7-13 MHz linear transducer at the end of surgery when the patient was still anaesthetised. MAIN OUTCOME MEASURES: We recorded patient-controlled intravenous morphine use for 24 h, pain scores at rest and activity, sedation, nausea and vomiting, use of antiemetic medication and overall maternal satisfaction. The primary outcome was 24-h morphine consumption. RESULTS: Patients who received the transversus abdominis plane block used significantly less morphine in 24 h than those in the control group [12.3 (2.6) vs. 31.4 mg (3.1), P<0.001) and had higher satisfaction scores [16 (80%) vs. 5 (25%), P = 0.012). There were no differences between groups in the visual analogue pain scores, sedation level, nausea and vomiting or the use of antiemetic medication. CONCLUSION: Ultrasound-guided transversus abdominis plane block reduced morphine consumption following caesarean section under general anaesthesia, with increased maternal satisfaction.

Case series: Congenital left ventricular diverticulum.

Congenital left ventricular diverticulum is a rare cardiac malformation characterized by a localized outpouching from the cardiac chamber. The patient is usually asymptomatic. However, complications like embolism, infective endocarditis, arrhythmia and, rarely, rupture can be the initial presentation. Diagnosis can be established by USG, echocardiography, CT angiography, and MRI. We report here two neonates with congenital left ventricular apical diverticulum associated with epigastric hernia.

Antimicrobial beta-peptoids by a block synthesis approach.

Antimicrobial peptides and their mimetics offer a potential new disinfective tool. beta-Peptoids (oligo-N-substituted beta-alanines) were synthesized and investigated for antimicrobial activity. A block approach whereby di- and tri-beta-peptoids were first prepared and then ligated via amide bond formation to synthesize larger beta-peptoids was developed. The beta-peptoids were found to possess moderate activity in an Escheridchia coli assay.