July 2021 Critical Care Case of the Month: When a Chronic Disease Becomes Acute

No abstract available. Article truncated after 150 words. History of Present Illness A 32-year-old woman with no known past medical history presented with progressive shortness of breath for 2 weeks. She denied having a cough, fever, or chills, but she did have a one-month history of fatigue, weakness, and painful rashes on her hands. PMH, SH, and FH • No known past medical history • Former tobacco user (quit 2 years prior to admission) • No drug use • Worked as an office assistant • Has two pet dogs and four pet macaws • No family history of lung disease • Not taking any prescription medications Physical Exam • BP: 116/65, Pulse: 105, T: 37°C, RR: 28, SpO2: 89% on HHFNC (60L; 100%) • Pulmonary: Tachypneic, in respiratory distress, crackles throughout • Cardiovascular: Tachycardic but regular, no murmurs • Extremities: No edema • Skin: Palms with purplish discoloration and erythematous papules Which of the following should be done next? 1. CT Chest 2. COVID-19 testing 3. Sputum gram stain and …

Acute Arterial Occlusions in Patients with COVID-19: Results and Outcomes

In this paper, we aimed to describe a case series report of four patients that were admitted in the emergency room of our vascular and endovascular surgery department with acute arterial occlusion after a diagnosis of Covid-19 infection. The first patient was a male, 50 years, tobacco user, with arterial systemic hypertension and COVID-19 positive that was admitted with an acute arterial occlusion Rutherford IIb in the left lower limb. He was submitted to an arterial thromboembolectomy with Fogarty catheter and had a satisfactory evolution. CASE 2 was a female, 63 years, with arterial systemic hypertension, diabetes, esquizophrenia, that was admitted with acute limb ischemia (ALI) Rutherford III in the upper left limb. Despite attempts do revascularize the upper limb, the patient evolved with a hand amputation. CASE 3 was a Male patient, 49 years, HIV positive, diabetic with previous debridement in both feet due to diabetic foot infection, tobacco user and Rutherford IIb ALI in the right lower limb..The patient was submitted to an arterial thromboembolectomy with Fogarty catheter, however presented with fasciotomy infection and another post-operative complications that led him to die. Finally, CASE 4 was a female patient, 49 years, diabetic, admitted with COVID-19 infection that presented ALI during hospitalization on the right lower limb. She was submitted to proper thromboembolectomy, with a satisfactory evolution and limb salvage. COVID-19 pandemic crisis is a challenging situation that has increased the number of acute arterial thrombosis and embolism urgencies and emergencies surgeries in the vascular world. The four patients related in this paper bring valuable information regarding the impact of COVID-19 on micro and macrovascular system.

Prevalence and determinants of tobacco use in a remote rural area of South India: a community based cross sectional study

Background: Tobacco use is a major public health problem in India. We intended to study the tobacco use and its risk factors from a rural area of South India.Methods: This study was conducted in 2018, among twenty villages located around a rural health training centre, in South India.Results: Total population surveyed was 14925. Among them 11995 individuals were in the age group of 15 years and above. In this group 739, 6% (5.7-6.6) of tobacco users, 423, 3.5% (3.2-3.9) of smokers and 369, 3% (2.8-3.4) of tobacco chewers were included in the study. Individuals belonging to lower caste were four to five times more likely to be a tobacco user. Tobacco use increases with age. Illiterates were 1.8 times more likely to be a tobacco user, married and Widows were two times more likely to be a tobacco user. Alcoholics were 13 times and hypertensive patients were 1.5 times, non-vegetarians were 1.4 times, individual preferring open defecation were 1.7 times more likely to be a tobacco user. Smoking was more associated with male gender, lower caste, increase in age, married individuals, alcoholics, hypertension and having semi-pucca house. Tobacco chewing was more associated with female, lower caste, increase in age illiteracy, married and widow, alcoholic, hypertension, non-vegetarian diet, open defecation, having kutcha or semi-pucca house.Conclusions: Tobacco use in a remote rural area is high among the socially deprived community who are illiterate, belonging to lower caste and those who prefer open defecation.

Impact of tobacco use on oxidative stress in cataract

Even today, the leading cause of visual impairment is age related cataract. Among the risk factors for cataract, tobacco is one of the modifiable risk factors. Association between smoking and increased oxidative stress among cataract patients has been shown by some studies. But studies related to smokeless tobacco use are not done. The aim of the study was to estimate oxidative stress by markers like enzymatic antioxidant Superoxide Dismutase (SOD) and lipid peroxiation product Malondialdehyde (MDA) in tobacco user age related cataract (ARC) subjects and compare them with tobacco nonuser age related cataract (ARC) subjects. This cross sectional study was performed in 120 subjects divided into 2 groups – 60 tobacco nonuser age related cataract subjects and 60 tobacco user age related cataract subjects. 60 tobacco user cataract subjects divided into 5 groups - tobacco smokers, tobacco chewers, tobacco mishri users, dual tobacco chewers with mishri users and dual smokers with smokeless tobacco users. Oxidative stress was assessed by estimation of erythrocytic SOD and serum MDA. The study showed that in tobacco user group age of cataract patients was significantly less than tobacco nonuser cataract patients (P<0.05). Serum MDA levels were significantly high and erythrocytic SOD levels were significantly low in tobacco user cataract patients than tobacco nonuser cataract patients (P<0.001). Nuclear cataract was significantly more in tobacco user group (P<0.05). On comparison of subtypes of cataract in tobacco user subgroup, no significant difference was found. These results suggested that age related Cataract occurs at an earlier age in tobacco users due to increased oxidative stress. Also nuclear cataract was significantly associated with tobacco use.

Influence of Family Environment and Tobacco Addiction: A Short Report from a Post-Graduate Teaching Hospital, India

Background: The initiation of tobacco addiction is complex, and several factors contribute to the onset of this behavior. It is presumed that the influence of family environment may pose a key factor in tobacco addiction. Tobacco-use has been highly observed in the Jamnagar district of Saurashtra region of Gujarat, India. No earlier study has focused on determining the pervasiveness of tobacco-use in families of tobacco users and non-users in this geographical area. Thus, this study aimed to assess the practice and pattern of tobacco-use (smoking and/or tobacco-chewing) in the families of tobacco-user patients. Methods: We studied the families of 65 tobacco-user patients (Group 1) who visited an outpatient clinic of an Ayurvedic post-graduate hospital with complaints of cough were studied and compared with age and gender-matched non-tobacco users (Group 2). The prevalence of tobacco use among the parents, siblings, and children of both groups was analyzed and compared. Results: The findings revealed that tobacco use among parents, siblings, and children in Group 1 was higher than Group 2 (p < 0.001). This meant that the problems of tobacco addiction are not always related to the individual, and therefore, tobacco-prevention strategies should focus on the entire family. Conclusions: These findings offer further insight into the promotion of smoking prevention interventions. Nevertheless, further research is warranted.

In Hospital outcome of Prediction of Peripheral Arterial disease In Diabetic Tobacco User Patients

Background: Peripheral artery disease (PAD) is a distinct atherosclerotic disorder marked by stenosis of the arteries common in tobacco users. Here we investigate prediction of unknown peripheral arterial disease (PAD) amongst patients with diabetic tobacco user and diabetic without tobacco user.Methodology: This prospective observational study was conducted in the Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh. A total of 60 patients were enrolled in this study who were presented with chest pain associated with lower limb claudication. They were diabetic population, constituted tobacco user in group-I and without tobacco user in group-II.Results: Hypertension was the leading risk factor in both groups (76.7% vs. 80%). 80% of patients of group I and 46.7% of patients of group II had mild form of ABI value. 3.3% of patient of group II had severe form of ABI value. There was no statistical significant difference between two group of patients (p=0.053). 93.3% patients of group I and 96.7% patients of group II had coronary artery disease. Twenty three patients of tobacco user group (n=30) had peripheral artery disease, whereas ten patients of without tobacco user group (n=30) had peripheral artery disease which was statistically significant (p=0.003). Three quarters (76.7%) of group I developed PVD as compared to 33.3% of group II. The risk of developing PVD in diabetic smokers was observed to be more than 6 fold (95% CI: 2.109-20.479) higher than that in non tobacco user were diabetics. 16.7% patients of group I atherosclerosis in femoral artery and the value is 10% in case of group-II, which is statistically in significant(p=0.433).Conclusion: The awareness and implementation of ABI in general clinical practice is poor. A simple, inexpensive test like ABI can improve the diagnosis of PAD in clinical practice and thus help in preventing CAD and consequent death by a range of medical therapies.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 102-109