Comprehensive Analysis of Perioperative Anaesthesia Concerns in Covid Associated Mucormycosis: A Retrospective Study of Surgical Patients

Background: Data regarding sudden surge of mucormycosis cases with COVID-19 outbreak and its impact on anaesthesia management are lacking. This retrospective study was designed to analyze the number and characteristics of patients posted for mucormycosis surgery in COVID19 pandemic while emphasizing upon the anaesthesia concerns. Methods: Data was collected from all patients who were admitted with mucormycosis in our institute from the year 2020 onwards. Further analysis of patients who were surgically treated was carried out in terms of demographic characteristics, association with COVID19 and perioperative course of mucormycosis and anaesthetic management. All statistical analyses were performed with the Statistical package for social sciences (SPSS) version 25·0 software. Results: We report an incidence of 30 operated patients of the average age 52.60 years with mucormycosis from August 2020 to May 2021. Diabetes as a comorbidity was common (86.90%). Previous infection with COVID-19 was observed in 29 (96.60%) out of which 80% patients had residual pulmonary involvement. Concomitant medical therapy with Amphotericin B was received by 90% patients and subsequently 70% had deranged renal profile. While 20 % patients had compromised airway, 60 % required blood transfusion and 76.6% patients were electively ventilated while 1 patient (3.3%) succumbed amounting to a survival rate of 96.6%. Conclusion: To conclude elderly male diabetic patients with history of COVID19 infection is the most vulnerable population for developing mucormycosis. Airway management, glycemic control, concomitant Amphotericin B therapy and intraoperative bleeding are the major challenges for anaesthesiologist along with an element of post Covid respiratory compromise.

Postoperative Respiratory Compromise following Cesarean Birth: The Impact of Obesity and Systemic Opioids

Objective The aim of this study was to measure the effect of obesity and systemic opioids on respiratory events within the first 24 hours following cesarean. Methods Opioid-naive women undergoing cesarean between January 2016 and December 2017 were included in this retrospective cohort study. The primary outcome was the proportion of women experiencing at least one composite respiratory outcome (oxygen saturation less than 95% lasting 30+ seconds or need for respiratory support) within 24 hours of cesarean. The impact of obesity and total systemic opioid dose in 24 hours (measured in morphine milligram equivalents [MMEs]) on the composite respiratory compromise outcome were evaluated. Results Of 2,230 cesarean births, 790 women had at least one composite respiratory event. Predictors of the composite respiratory outcome included body mass index (BMI) as a continuous variable (odds ratio = 1.063 for every one unit increase in BMI [95% confidence interval (CI): 1.021–1.108], p = 0.003), and MME (odds ratio = 1.005 [95% CI: 1.002–1.008], p = 0.003), adjusting for magnesium sulfate use. The interaction between obesity and opioid dose demonstrated an odds ratio of 1.000 (95% CI: 0.999–1.000, p = 0.030). Conclusion The proportion of women experiencing respiratory events following cesarean birth increases with the degree of obesity and opioid dose. Key Points

A Review of Burn Patients Requiring Extracorporeal Membrane Oxygenation at a Burns Facility

Respiratory compromise is a recognised sequelae of major burn injuries, and in rare instances requires extracorporeal membrane oxygenation (ECMO). Over a ten-year period, our hospital trust, an ECMO centre and burns facility, had five major burn patients requiring ECMO, whose burn injuries would normally be managed at trusts with higher levels of burn care. Three patients (60%) survived to hospital discharge, one (20%) died at our trust, and one patient died after repatriation. All patients required regular, time-intensive dressing changes from our specialist nursing team, beyond their regular duties. This review presents these patients, as well as a review of the literature on the use of ECMO in burn injury patients. A formal review of the overlap between the networks that cater to ECMO and burn patients is recommended.

Importance of Imaging in Congenital Unilateral Vocal Fold Paralysis: A Case of Neck Neuroblastoma Presenting with Unilateral Vocal Fold Paralysis

Congenital vocal fold paralysis (VFP) is an important cause of respiratory compromise in infants. It can either be unilateral or bilateral, while imaging is routinely performed for bilateral VFP to evaluate for potential neurological causes, and such a practice may not be routine for unilateral VFP. While many of the unilateral VFP cases are idiopathic, the cause may occasionally be more sinister in nature, such as tumors. Therefore, unless an obvious cause of unilateral VFP is present (such as cardiac surgery or birth trauma), routine imaging of the brain, neck, and mediastinum should be performed for congenital unilateral VFP. We describe a rare case of a cervical neuroblastoma presenting with unilateral VFP that was detected only on imaging, thus highlighting its value and importance.

The opto-respiratory compromise: Balancing oxygen supply and light transmittance in the retina

The light-absorbing retina has an exceptionally high oxygen demand, which imposes two conflicting needs: high rates of blood perfusion and an unobstructed light path devoid of blood vessels. This review discusses mechanisms and physiological tradeoffs underlying retinal oxygen supply in vertebrates and examines how these physiological systems supported the evolution of vision.

PHYSIOTHERAPY REHABILITATION IN YOUNG PATIENT WITH IDIOPATHIC SCOLIOSIS

The cause of scoliosis is unknown. Males and females have almost the same rate of scoliosis; however, females have a 10-fold higher chance of curve progression. While many with scoliosis may not experience serious complications, it can lead to rib deformity and respiratory compromise, as well as cosmetic issues and emotional discomfort in some patients. However, it is the most common spinal deformity in adolescents. Physiotherapy Rehabilitation helps in correcting the deformity if functional deformity. A 20 year old female presented with dorso-lumbar scoliosis, L 4 – L5 disc bulge, Sacralization of L5 S1 diagnosed as adolescent idiopathic scoliosis. She had decreased muscular strength of back muscles, abdominals and pelvic floor muscles. She also complaint of radiating pain with tingling numbness in both lower limbs with restricted range of motion. Multiple tender points were present throughout her spinal musculature with muscle tightness. The Adam's forward bent test and a scoliometer calculation will help direct the use of radiologic tests for Cobb angle measurement and orthopaedic referrals. Proper conservative management with Prompt physical therapy which leads to achieve functional goals .The case report suggests that prompt structured physical rehabilitation led to improving functional goals progressively and significantly which is a major aspect leading to a successful recovery and better living.

Conservative management of Occult Hemothorax in trauma patients requiring assisted ventilation: An observational descriptive study

Background: Traumatic hemothorax is a common consequence of blunt chest trauma. A hemothorax that is missed by initial chest X-ray, but diagnosed by computed tomography (CT), is known as an occult hemothorax. The present study aims at investigating the clinical outcomes of conservative management of occult hemothorax in mechanically ventilated trauma patients. Methods: A retrospective study of all adult blunt chest trauma patients with occult hemothorax requiring mechanical ventilation in a level 1 trauma center was conducted (2010- 2017). Data were obtained from the trauma registry and electronic medical records. Patients were categorized into (a) successful conservative treatment group, and (b) tube thoracostomy group. Results: During the study period, 78 blunt chest trauma patients who had occult hemothorax required mechanical ventilation. Occult hemothorax was managed conservatively in 69% of the patients, while 31% underwent tube thoracostomy. The main indication for tube thoracostomy was the progression of hemothorax on follow-up chest radiographs. Comparison between groups showed that pulmonary contusions (59% vs. 83%), bilateral hemothorax (26% vs. 58%) and chest infections (9% vs. 29%) were lower in conservatively treated group (p < 0.05). Length of stays in ICU and hospital were also lower (p < 0.05). Longer duration of mechanical ventilation and maximum PEEP were significantly associated with tube thoracostomy. Overall mortality was 12% and was comparable between groups. Conclusion: Mechanically ventilated patients with occult hemothorax following blunt chest trauma can be managed conservatively without tube thoracostomy. Tube thoracostomy can be restricted to patients who had evidence of progression of hemothorax on follow-up or developed respiratory compromise.

COVID-19 Associated Multisystem Inflammatory Syndrome in Children (MIS-C): A New Pediatric Alert

Multisystem inflammatory syndrome in children (MIS-C), also termed pediatric multisystem inflammatory syndrome (PMIS) temporally associated with coronavirus disease-2019 (COVID-19) is rare but an emerging alarming condition. Though the exact pathogenesis is unknown, COVID-19 can trigger the condition directly or indirectly via immune complex mediated or antibody-dependent enhancement. Patients with MIS-C can present with persistent fever and a constellation of symptoms including hypotension, multiorgan involvement and elevated inflammatory markers. Presentations of MIS-C have overlapping features of Kawasaki disease (KD), toxic shock syndrome (TSS) and Kawasaki disease shock syndrome. Age of presentation, features of shock and more predilections for myocardial dysfunction can distinguish MIS-C from Kawasaki disease. Early recognition is essential, followed by prompt admission to the hospital for specialist attention. Admission to a pediatric intensive unit is mandatory for children with hemodynamic instability (shock, arrhythmia), significant respiratory compromise, or other potentially life-threatening complications. It is also necessary to maintain an appropriate follow-up schedule to observe the long-term outcome. The prognosis of PMIS/ MIS-C is uncertain, given that it is a new clinical entity and understanding of the disease is still evolving. J Bangladesh Coll Phys Surg 2021; 39: 249-260

Evaluation of pulmonary function and quality of life among smokers and non-smokers

Smoking is a major concern in modern society, as it is the main risk factor for COPD. In Brazil, one third of the adult population smokes, 16.7 million men and 11.2 million women. According to INCA statistics, there are an estimated 200 thousand annual deaths related to smoking in Brazil. To assess lung function and quality of life between smokers and non-smokers. A cross-sectional observational study will be carried out with 40 volunteers, 20 smokers and 20 non-smokers, male, aged between 50 and 70 years. Volunteers diagnosed with COPD, restrictive diseases, lung cancer, trachea and bronchi will be excluded. Volunteers will undergo an assessment of lung function through the following assessment methods: respiratory muscle strength by manovacuometry, peak expiratory flow and forced expiratory volume in one second through spirometry and quality of life will be performed using the Short Form Health Survey questionnaire 36 (SF-36). It is expected with the results obtained, to identify if there are changes in respiratory muscle strength, ventilatory function and quality of life of smokers. If there is respiratory compromise, the physical therapy approach can be directed towards preventive aspects of possible diseases related to smoking.

Complete agenesis of the right hemi-diaphragm in an adult: case report and literature review.

Congenital agenesis of the hemi-diaphragm (AHD) in adults is rare and exceedingly so on the right side. Since its first recognition in 1959, no more than 9 cases have been published in the English literature by the year 2016. “Partial diaphragm agenesis” is actually large congenital diaphragmatic hernia (CDH) rather than true AHD. Respiratory compromise is the likely presentation, however, patients may survive for years without symptoms. Despite a straightforward clinical and radiographic diagnosis of AHD, the best method of repair is controversial. Herein, we present a case of complete right-sided AHD in a man of 54 diagnosed on surgical exploration 16 years earlier. Despite trans-thoracic mesh repair, the patient experienced just a modest improvement of his shortness of breath (SOB). Though the liver persisted high in the chest as shown by serial CT scans of the chest, polypropylene mesh was effective in preventing further visceral herniation. Adult patients with right-sided AHD always deserve operative intervention to avoid the potential complications.