The evaluation and management of neonatal brachial plexus palsy

Neonatal brachial plexus palsy presents at birth and can be a debilitating condition with long-term consequences. Presentation at birth depends on the extent of nerve injury, and can vary from transient weakness to global paresis, with active range of motion affected. Serial clinical examination after birth and during the neonatal period (first month of life) is crucial to assess recovery and predicts long-term outcomes. This position statement guides the evaluation of neonates for risk factors at birth, early referral to a multidisciplinary specialized team, and ongoing communication between community providers and specialists to optimize childhood outcomes.

Burn injury from filling balloons with nitrous oxide

We present the case of a female teenager who sustained nitrous oxide burns to the medial aspect of both thighs from contact with a nitrous oxide canister being used to fill balloons. There was a delay in presentation as the injury was not initially recognised. These burns were initially assessed as being superficial partial-thickness burns but took a prolonged time to heal despite regular wound care. This was complicated by a lack of adherence to recommended treatment for much of the patient care as well as the patient testing positive for COVID-19 during their management, which prevented surgery and significantly extended time to healing. While small numbers of similar cases have been previously described this is the first reported case outside of the Netherlands and in a child. Being aware of such cases ensures early referral to specialist burn care for appropriate management to give patients the best possible outcome.

Obstetric hysterectomy: a retrospective study

Background: Obstetric hysterectomy (OH) is last resort usually opted to save life of a mother in critical obstetric conditions compromising her reproductive potential. With increasing caesarean deliveries incidence of morbidly adhered placenta is increasing, thus increasing need of OH. We aimed to study socio-demographic factors, incidence, indications, complications and feto-maternal outcomes associated with obstetric hysterectomy. Also, we aimed to study factors which affect the maternal and fetal outcome in obstetric hysterectomy case so as to minimize maternal and neonatal mortality and morbidity.Methods: We conducted a retrospective analytical study of 2 years 6 months in Department of Obstetrics and Gynecology at a tertiary and teaching institute of western Maharashtra.Results: The incidence of obstetric hysterectomy was 0.4%. Majority of women were between 25-35 years age group and parity two or more. Most common indication was postpartum haemorrhage (PPH) (41.1%) followed by uterine rupture (29.4%) and adhered placenta (23.5%). Most common risk factor found was previous caesarean delivery. Most common complication was need of intensive care unit (ICU) and vasopressor support.Conclusions: Proper antenatal care, screening for high-risk obstetric cases and registration of those patients at a well-equipped hospital and early referral and delivery at tertiary hospital by expert surgeon with timely decision, timely and adequate transfusions can prevent maternal and fetal complications.

ANALYSIS OF FACTORS ASSOCIATED WITH LOSS OF FOLLOW UP AFTER INITIAL CONSULTATION AMONG THE PATIENTS ATTENDING THE PALLIATIVE CARE CLINIC IN A TERTIARY CARE HOSPITAL OF RURAL AREA OF THE WESTERN INDIA-AN OBSERVATIONAL STUDY.

Aim: To determine factors responsible for loss of follow up and thereby to improve compliance and adherence to treatment in a palliative care unit. Methods: Among the data of patients maintained in our department, we found 81 patients out of 1200 OPD visits who didn't turn up for follow up after the rst outpatient department (O.P.D) visit in the study period [July 2017-June 2018] . After taking the institutional ethical committee approval we did telephonic interview of those patients and/or their relatives, took their consent to participate after explaining the study in brief. We noted the reason of not coming for follow up in our questionnaire. Out of 81, 61 patients could be contacted on phone. Results: Major reason for loss of follow up was death after the rst visit (n=31). 7 patients had started alternate medicine. Factors like exhaustion due to prolong treatment and difculty in bringing patients were noted in 3 patients and 1 patient respectively. Other factors like lack of palliative care awareness, nancial incapability, or no benet from treatment were not found in any of the patient. Conclusion: Death after the rst visit was leading cause for loss of follow up. Majority of the deaths were within one month of the visit. Early referral and early palliative care interventions of those could have helped us to serve those patients better.

Analysing the reasons for rejection of neurosurgery intervention in patients with Parkinson’s disease referred to an extrapyramidal movement disorders clinic

We present findings of a 10-year retrospective study, analysing the reasons for rejection of neurosurgical intervention (deep brain stimulation or DBS) in patients with Parkinsons disease, who were referred to an extrapyramidal movement disorders clinic and then to a neurosurgery centre. It was found that after screening, 78.6% of patients referred as candidates for neurosurgical treatment to an extrapyramidal movement disorders clinic were rejected, while 21.4% of patients were referred to a neurosurgery centre, where 12% underwent surgery. The main reasons for rejecting potential DBS candidates were: early referral, inadequate pharmacotherapy, levodopa-resistant symptoms, atypical/secondary Parkinsonism, cognitive reasons, psychological reasons, comorbidity, abnormal MRI, poor response to levodopa medication and declined surgery. Furthermore, the number of self-referrals decreased, the number of patients referred by neurologists increased, the number of rejections of unsuitable DBS candidates decreased, and the number of suitable candidates referred to the extrapyramidal centre increased during the time period of 10 years. In addition, the number of patients who were referred to the neurosurgery centre and underwent surgery there increased, which suggests greater awareness of the selection criteria among doctors, as well increased knowledge and experience among neurologists in both primary healthcare and specialized centres.

Characteristics of new patient referrals to specialised diabetic foot units across Europe and factors influencing delays

Objective: Foot ulcers are a common complication of diabetes and are associated with an increase in lower limb amputation and death. Early referral to a specialised unit is recommended. The aim of this study was to assess the characteristics of new-patient referrals to specialised diabetes foot care units across Europe and to determine the factors involved in delayed referral. Method: In this prospective observational study, consecutive patients with a new foot ulcer presenting to nine diabetic foot centres in five European countries (France, Germany, Italy, Spain and the UK) were included. Results: Some 25% of the 332 patients included had presented with a foot ulcer >3 months before referral to the participating foot clinic. Compared with patients referred earlier, patients with a long time to referral (>3 months) were older (p=0.006) and had a less severe wound according to Infectious Diseases Society of America (IDSA) classification (p=0.003) and University of Texas classification (grade D=infection + peripheral artery disease, p=0.004). Conclusion: The proportion of patients with a diabetic foot ulcer (DFU) referred to a specialised unit >3 months after the beginning of the ulcer remained high throughout Europe. Patients with severe DFU were, however, referred more quickly by front line health professionals. Primary care professionals need to be made aware of the importance of early referral to a specialised unit in order to improve the management of foot disease in patients with diabetes. Declaration of interest: The authors have no conflicts of interest to declare.

Spectrum of Non-Traumatic Bleeding Complaints among women with Bleeding Disorders

Objective: To study the spectrum of bleeding complaints among women with bleeding disorders. Methodology: This observational study was done at Dept. of Pathology – Liaquat University Hospital, Hyderabad from January 2019 to July 2019 upon a sample of 121 women, selected via non-probability, consecutive sampling). Women presenting to study setting with complaints of non-traumatic bleeding were included in the study. After taking written informed consent, the data was obtained from patient interviews and laboratory investigations was. The data obtained was analyzed using SPSS v. 21.0. Results: The mean age of the women was 28.13 years (±5.21 SD). Among the 121 women studied, 73.55% hailed from urban areas, while 26.45% were from rural residential background. The most common presenting complaint was menorrhagia (30.58%), followed by bruising (17.36%) and epistaxis (15.7%). Among the underlying hemostatic pathologies, VWD was the most common (15.7%), followed by other platelet dysfunctions comprising the second most common finding (6.6%). Mean duration of presence of symptoms was 34 months (±17 SD). Conclusion: As per the findings of this study, menorrhagia, occasional bruising and epistaxis are reported to be the most common non-traumatic bleeding complaints among women with bleeding disorders. The presence of these symptoms may serve as potential indicators of the probable presence such as bleeding disorders and help in early referral, timely diagnosis and appropriate treatment. Keywords: menorrhagia, epistaxis, Hemostatic Dysfunction, Bleeding Disorder, Non traumatic bleeding complaints