Unresolved chronic ulcerated nodules: Disseminated Cutaneous Sporotrichosis

We present a case of disseminated cutaneous sporotrichosis in a 72-year-old male patient who has multiple ulcerated painless nodules over the left side of his chest and on his upper and lower left limbs for three years. He was initially diagnosed to have nodular vasculitis based on early repeated biopsies. Despite the patient’s good compliance with his prednisolone medication, no significant clinical improvement was observed. Another biopsy, which was arranged after two years of treatment for nodular vasculitis, supported the diagnosis of sporotrichosis. Itraconazole was initiated, and all the lesions showed a remarkable response toward the treatment. The delay in finding the correct diagnosis unnecessarily exposed the patient to the side effects of steroid and caused the disease to worsen. Bangladesh Journal of Medical Science Vol. 21(1) 2022 Page : 191-195

Mindfulness-Based Interventions in Psychosis

Individuals suffering with psychotic disorders face lifelong emotional dysregulation and may have impairments in their thought processes and perceptual experiences despite the availability to pharmacological treatment and good compliance. They feel extreme distress with their psychotic experiences that may result in avoidance of these experiences which may further warrant for residual symptoms and frequent hospitalizations. For a few decades literature has focused on exploring the possibilities of acceptance-based interventions in psychosis. Mindfulness interventions employ the strategies of direct use of meditation practice or combined use of meditation with acceptance-based or compassion-based practices. This chapter tends to summarize the various mindfulness interventions used for psychosis and review their feasibility in terms of evidence base and therapeutic specificity. Furthermore, it recommends the guidelines for protocol to be used with psychotic individuals and advocates the need for more methodologically rigorous evidence.

Prospective study of maternal outcomes in primigravida with gestational diabetes mellitus in a tertiary care centre Venjaramood, Thiruvananthapuram

Background: The prevalence of Gestational diabetes mellitus (GDM) is on the rise. Understanding the various outcomes of it is essential to face this challenge. The aim of the study was to understand the maternal outcomes of GDM in primigravida and to compare the maternal outcomes in primigravida with GDM and without GDM.Methods: This prospective study was conducted in the department of obstetrics and gynaecology at Sree Gokulam Medical College and Research Foundation, Venjaramood, Thiruvananthapuram, on 180 primigravida mothers,90 with and 90 without gestational diabetes. GDM was diagnosed with IADPSG criteria using 75 g Oral glucose tolerance test (OGTT).Results: A total of 180 primigravida with singleton gestation, 90 with GDM and 90 without GDM were followed from pregnancy to delivery after fulfilling criteria during study period. 65.6% GDM mothers had good compliance with Medical nutrition therapy (MNT) and exercise. 88.8% of GDM mothers required induction of labour, 13.3% had pregnancy induced hypertension, 12.2% had vulvovaginal candidiasis and 10% had postpartum hemorrhage. Thus, women with GDM on MNT or MNT with insulin had a higher risk of adverse maternal outcomes but was comparable to normoglycemic mothers if they had good compliance to MNT or insulin.Conclusions: Women with GDM had a higher but comparable risk of adverse maternal outcomes as compared to normoglycemic pregnant mothers, if they strictly adhere to MNT with or without insulin reflecting the importance of good treatment compliance.

Prevention Practice of COVID-19 Using Personal Protective Equipment and Hand Hygiene Among Healthcare Workers in Public Hospitals of South Wollo Zone, Ethiopia

Objective: The use of personal protective equipment and hand hygiene are often the most recommended line of defense against coronavirus disease-19 (COVID-19). The purpose of this study is to determine the magnitude of compliance and associated factors of personal protective equipment (PPE) utilization and hand hygiene practice among healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia.Methods: A hospital-based cross-sectional study was conducted among 489 healthcare workers in public hospitals of South Wollo Zone, Northeastern Ethiopia from June 15 to July 30, 2021. Proportional sample size allocation to each selected hospital followed by simple random sampling techniques were used to select the study participants using human resource records from each hospital. A pre-tested and structured self-administered questionnaire with WHO's standardized hand hygiene and PPE utilization observational checklist were used to collect data. Bivariate and multivariable analyses with 95% CI and p-value < 0.05 were employed to identify the associated factors of personal protective equipment utilization.Results: About 32 and 22.3% of healthcare workers were compliant with personal protective equipment utilization and hand hygiene practice, respectively. Feedback for safety (AOR = 2.05; 95% CI: 1.26–3.35), training on COVID-19 prevention (AOR = 3.43; 95% CI: 2.01–5.86), and perception to infection risk (AOR = 1.98; 95% CI: 1.18–3.33) were significant factors of good compliance with personal protective equipment utilization.Conclusion: The magnitude of good compliance with personal protective equipment utilization and hand hygiene was low. Interventions to promote personal protective equipment utilization and hand hygiene should focus on feedback for safety, training on COVID-19 prevention, and perception of infection risk.

Pomalidomide-Dexamethasone in the Management of Heavily Pretreated Multiple Myeloma

Pomalidomide is a new generation IMID, with a very good compliance, thanks to oral administration, which can be used also in heavily pretreated patients, in a domestic setting. In this retrospective observational trial, It has been evaluated efficacy and tolerance of pomalidomide plus dexamethasone (PD) as salvage regimen in heavily pretreated patients with relapsed and refractory MM (rrMM), whose prognosis is particularly severe. 57 patients (31 M/26 F), with rrMM, median age at diagnosis 69 years (r. 52-86), and median age at start of treatment 76 years (r.56-90) treated with several lines of treatments (median 7, r. 2-11), every refractory to all the drugs previously received (also Bortezomib, Thalidomide and Lenalidomide), received Pomalidomide-Dexamethasone (Pomalidomide 4 mg for 21 days, Dexamethasone 40 mg days 1,8,15,22, pegfilgrastim day +8) every 28 days, until progression. ISS was equally distributed, and cytogenetic at relapse was evaluable in 14 patients. All the patients had previously been treated with schedule containing bortezomib and IMIDs. 63% (36/57) had undergone at least to a single ASCT. All patients were relapsed and refractory to last therapies received before PD. Pomalidomide was well tolerated, with grade 3-4 transfusion-dependent anemia in 58% (33/57) of patients, 44% (23/57) grade 3-4 neutropenia (pegfilgrastim in primary prophylaxis was given, no hospitalization was required, no septic shocks were observed), 40% (23/57) grade 3-4 thrombocytopenia without hemorrhagic events and transfusion-dependence. No severe extra-hematologic toxicity was observed. According to IMWG, ORR1 (≥PR) was 47.3% (27/57: 5 CR, 11 VGPR, 7 PR, 4 MR), but, considering that we are evaluating a cohort of heavily pretreated patients, with poor prognosis, another parameter should be considered, ORR2 (≥SD), considering stable disease as a successful result in progressive MM. ORR2 was 77.1% (17 SD). These can be considered as impressive result in this subset of patients. Oral treatment gives a really good compliance, in frail and unfit patients, and response, when present, is always really fast (median time to response: 2 months (r.1-6)), median OS from diagnosis was 94 months (range 21-234), median OS from start of pomalidomide was 9 months (range 1-25). Nine patients have surprisingly achieved a notable response (3 VGPR, 4 PR, 2 MR) after failure of novel agents (i.e. Carfilzomib, Daratumumab and Pomalidomide). Pomalidomide-dexamethasone has shown significant efficacy and a very good compliance, thanks to oral administration, in a particularly severe setting of heavily pretreated patients, relapsed and refractory to all available therapeutic resources, also after failure of novel agents. Disclosures Martinelli: Stemline Therapeutics: Consultancy; Incyte: Consultancy; Pfizer: Consultancy, Speakers Bureau; Roche: Consultancy; Celgene /BMS: Consultancy, Speakers Bureau; Daichii Sankyo: Consultancy; Jazz Pharmaceuticals: Consultancy; Abbvie: Consultancy; Astellas: Consultancy, Speakers Bureau.

BURN, EPILEPSY AND COVID-19

The COVID-19 pandemic is a major public health problem. It is not only a health crisis of planetary scope but also a socio-economic crisis with serious consequences. Among the dramatic repercussions in our country was the condemnation of several health structures, including ours. We report the case of a young epileptic woman who suffered a thermal burn by scalding, causing her to suffer from 3rd-degree lesions.Her treatment was delayed because of the sanitary conditions preventing an excision with a skin graft, which led us to follow this patient in directed healing. Therapeutic management in the context of an epilepsy-burn association must be multidisciplinary and adequate, hence the interest of prevention based on patient education, good compliance with treatment, and correct management of the environment.

The Feasibility and Efficiency of Remote Spirometry System on the Pulmonary Function for Multiple Ribs Fracture Patients

Background: Multiple rib fractures is a common chest trauma with a significant and sustained impact on pulmonary function and quality of life. Continuous monitoring of the pulmonary function parameter was necessary to adjust the therapeutic goals in these patients. We developed an internet-based remote system for lung function monitoring with a remote spirometry and smart device application to follow up these patients consecutively. Method: From Jan 2021 to April 2021, we conducted a prospective study that applied an intelligent spirometry system for patients with multiple rib fractures. With informed consent, we collected clinical data from them and introduced the remote spirometry system. We followed up with these patients for 12 weeks after trauma and compared the recovery of pulmonary function parameters and clinical outcomes. Result: A total of 21 patients were enrolled in our study. We divided them into two groups by the compliance to this remote spirometry system. The improvement of forced vital capacitywas better in the good compliance group than the poor compliance group (110% versus 21%, p value 0.049). Moreover, the complication rate was also lower in the good compliance group than the poor compliance group (10% versus 66.7% p value 0.017). Conclusion: Remote spirometry system is a novel system that can help in lung rehabilitation in patients with multiple rib fractures. Patients that cooperate well with this system presented superior lung function improvement and inferior complication rate.

Environmental Sensitivity of Large Stealth Longwave Antenna Systems

This article presents an analysis of measurements collected during a six-month-long experimental deployment of a surface-placed horizontal magnetic loop antenna. The changes in the measured parameters of the loop are investigated in relation to the surrounding environment’s composition, temperature and water content. Basic functions describing these changes are formulated. The results are confronted with outcomes from similar experiments from previous years and different locations, showing good compliance. The developed functions and antenna system can be used for environmental monitoring of soil composition and humidity over large areas and volumes, helpful in, for example, flood awareness.

862 A Retrospective Audit on Management of Ankle fracture In a District General Hospital in South east England

Aim Ankle fractures are common injuries encountered by orthopaedic surgeons on a daily basis. Primary aim of the audit is to compare management of ankle fracture in Ashford and St Peter’s Hospital under NHS trust with the BOAST guidelines. As a secondary objective, quality of life of patients less than 60 years of age is assessed in order to review the specificity of timing of surgery as mentioned in the guidelines. Method An audit was conducted among patients who have undergone open reduction and internal fixation for ankle fracture during a period of one year in Ashford and St. Peter’s hospital. BOAST guidelines was kept as a standard to compare the management practice in the trust. Quality of life is assessed with the help of COST (Chertsey Outcome Scoring for Trauma) scoring method. Results Trust showed good compliance with the guidelines regarding documentation and reviewing patients within 6 weeks’ time. Only 45% of the patients, less than 60 years old had surgery within 24 hours. The average COST score does not show any significant difference between those who had surgery within 24 hours and after that. Conclusions To conclude, trust showed good compliance in certain aspects like documentation and reviewing patients, but the surgery was delayed up to 19 days for patients less than 60 years of age. The average COST score showed that there are no functional benefits for patients who had surgery on an early date. So, the specificity of timing in the BOAST guideline is questionable.