Case Report in the Brazilian Context: Cognitive and Behavioral Changes Following an Electric Injury

Electrical injury (EI) is the sequel of an electrical shock. Physical sequelae are most common, but also other symptoms can happen, such as neurological symptoms, psychiatric alteration, and cognitive decline. The repercussion of EI can happen whether or not the head is a point of contact with the electrical current. There are no official diagnostic criteria for cognitive repercussions of EI, which may lead to incorrect diagnostics and confusion with other most frequent causes of dementia, such as frontotemporal dementia, pseudodementia, or dementias for reversible causes. In this case report, we described a right-handed man, aged 56 years old, referred to our service due to behavioral changes and cognitive alterations related to electric shock. The psychiatric team has monitored him, but cognitive deficits have raised doubts about the presence of dementia syndrome. The neuropsychological evaluation revealed severe deficits and loss of functionality, which filled the criteria for major neurocognitive disorder according to the Diagnostic and Statistical Manual of Mental Disorders fifth edition (DSM-5). Adding these findings to the patient's history and after a detailed investigation of other causes of dementia, we concluded that this is a possible case of EI with strong neuropsychological symptoms. This case report should help clinicians to recognize this condition and its features. We aimed to share the importance of recognizing the neuropsychological and psychiatric features of EI, mainly in the Brazilian context.

Application and Experience of Various Reconstructive Procedures in Scalp Defects

Aim: To evaluate the outcome of various reconstructive procedures in scalp defects. Study Design: Cross sectional descriptive study. Place and Duration of Study: Department of Plastic/Reconstructive Surgery & Burns, LUMHS Jamshoro from 1st January 2018 to 31st December 2020. Methodology: Thirty patients of scalp wounds were admitted through outpatient and casualty departments. The patients were diagnosed by pre-operative workup and on clinical parameters were included. The patients unfit for general anaesthesia, patients having associated skin pathology, patients with history of allergic reactions and patients having any poorly controlled systemic co-morbidity like diabetes and hypertension were excluded. Results: Twenty two (73.33%) were males and 8 (26.66%) were females with mean age of 38.98±8.25 years. Scalp defect was due to trauma in46.66%, electric injury 23.33%, benign lesions 16.66%, malignant tumour 3.33%, Infection 3.33%, haemangioma and pigmented nevus 3.33%. Follow up duration was 42.34±7.83 weeks. Conclusion: Primary closure remained the mainstay of our treatments hence proved that simplest reconstruction should be used whenever possible to provide the most functional and aesthetic scalp reconstruction, with the least amount of complexity. Key Words: Scalp, Reconstructive surgical procedure, Graft, Flap

Rehabilitation Challenge of Motor Neuron Disease Following Occupational Exposure to Magnetic Fields and Electric Shocks: Case Series

Amyotrophic lateral sclerosis (ALS) is a progressive neurodegenerative disorder of motor neurons and their axons characterized by signs of upper and lower motor neuron dysfunction. ALS has been associated with exposures in so called electrical occupation. We have found two young patient who developed features of MND following electrocution within 1 year. Due to this great diversity of possible causing agents for ALS, new researches are necessary to elucidate possible etiologies for a better approach to the patients, promoting preventive programs for the disease, optimizing functions and improving the life quality of the patients. A number of studies have demonstrated cognitive performance deficits following electric injury observed cognitive symptoms and neurobehavioral defecit. As treatment approach rehabilitation is important part of treatment as pharmacological part didn't prove strong recovery. As MND causes high level of disability and dependency on caregiver causes gap in rehabilitation due to psychological issue. Neuropalliative rehabilitation is more important in these patient which is unavailable in our country. KYAMC Journal Vol. 11, No.-4, January 2021, Page 218-221

Case Report: Risk of Electric Injury on Delayed Initial Treatment

Electric Injury is a very aggressive burn injury with severe functional and aesthetic consequences caused by progressive and prolonged tissue necrosis. Necrosis that attacks the skeletal muscle can lead to rhabdomyolysis which results in complications if not treated properly. A complicated case of electric injury in Dr. Soebandi Jember General Hospital, a 26 years old man came to the emergency room with complaints of severe shortness of breath and urinary disorders. The patient had a history of having an electric shock in his right hand when turning on the fan a week prior of admission. The examination showed that the patient had bilateral pulmonary effusion, generalized edema and acute tubular necrosis (ATN) which was characterized by oliguria and even anuria accompanied by hematuria. Other symptoms experienced by patients are anterior uveitis, subconjunctival hemorrhage, and hematemesis.

Clipless laparoscopic cholecystectomy: 3 Port access.

Objectives: Use to ultrasound vibrations instead of electric current makes Harmonic Scalpel a safer and more efficient instrument for dissection during laparoscopic surgeries. The property of both coagulation and cutting using single Harmonic Scalpel instruments saves time of surgery reducing anesthesia load. Cystic artery and liver bed dissection has been widely used and established but a contemporary approach is the coagulation and cutting of cystic duct with Harmonic Scalpel eliminating the need for clips and reducing the epigastric port size from 10mm to 5mm thus reducing post-operative pain. Study Design: Prospective Study. Setting: This study was conducted in Department of surgery Quaid e Azam Medical College Bahawalpur. Period: Dec, 2015 to Dec, 2017. Material & Methods: 60 patients undergoing laparoscopic cholecystectomy 3 ports were introduced one 10mm and two 5mm. the dissection and division of both cystic artery and duct was done by a single instrument, Harmonic Scalpel after tying the cystic duct with 2/0 extracorporeal knot. Results: None of the patients developed Major or Minor bile leaks or hemorrhage. Conclusion: Harmonic scalpel provides a safe alternative for dissecting and division of cystic duct and may replace the more widely used clip technique. The number of ports can be reduced to 3 and size reduced from 10mm to 5 mm. Harmonic scalpel technique eliminates the time wasted during changing of instruments per-operatively and also reduces the risk of remote electric injury.

Bilateral Post-electrocution Cataract

Trauma from electric injury can be of multiple forms, ranging from mild damage to life-threatening conditions like cardiac arrest. Ophthalmic injuries are not uncommon following electrocution. We report a case of post electrocution cataract in a 24 year old male who presented to us three years after the injury. On examination his best corrected visual acuity was 1/60 in the right eye and hand movement in the left eye. Slit lamp examination revealed a white, mature cataract in the left eye and a developing anterior capsular cataract in the right eye. B-scan of left eye was normal. Fundoscopic examination of right eye was normal. Left cataract surgery was done. Per-operatively, the capsulorhexis was surgically challenging due to the adherence of the cataract with the anterior capsule. The BCVA in the left eye was 6/6 postoperatively. MeSh Words : Electric Injury Cataract, Phacoemulsification, Capsulorhexis

Indian Subcontinent’s First Proximal Forearm Level Double Upper Extremity Transplantation

Introduction Vascularized composite allotransplantation (VCA) has added another step to the reconstructive ladder, leading to a paradigm shift in the approach toward management of cases of upper limb amputations. In this article, we discuss in detail the technical aspects of proximal forearm level transplantation, as well as the immediate posttransplant monitoring and immunosuppression protocols. Materials and Methods A 24-year-old male victim of an electric injury presented with a bilateral proximal forearm level amputation. After the mandatory preoperative psychiatric and immunological evaluation, the patient underwent a proximal forearm level double upper extremity transplantation. He was then put on a stringent immunosuppression and physical rehabilitative regime. Discussion Conceptually, the proximal forearm level transplantation is significantly different from distal forearm level transplant. This transplant “reestablishes” the “donor extremity length,” maintains the normal functional length of the donor muscles, and the functional return happens only after the newly transplanted donor muscles are reinnervated over a period of time. Conclusion As the sequence of surgical repair and associated decision making could be quite confusing for this level of transplantation, it is highly advisable to do mock cadaver surgical dissections in order to standardize the procedure and make the team familiar with it.