A complicated case of delayed onset intermediate syndrome post organophosphorus poisoning: A rare case report

Herein, we present a case of 44-year-old male who landed in our emergency department with altered mental status with difficulty in breathing after 14 days of consumption of chlorpyrifos. Organophosphorus (OP) poisoning is one of the most common causes of poisoning encountered in rural India. There are reported cases of its acute and sub-acute atypical presentation but very few of delayed onset intermediate syndrome. By means of this case report, we want to emphasize on the delayed complications post OP poisoning and importance of treating physician’s awareness to recognize and treat such complications.

A rare cause of recurrent gastrointestinal bleed: Blue rubber bleb nevus syndrome

Congenital venous malformations (VMs) are rare cause of gastrointestinal (GI) bleed in children. Blue rubber bleb nevus syndrome characterized by VMs in GI tract and skin affect at early age in life. Diagnosis is based on typical skin lesion and history of recurrent GI bleed. In this article, we presented a similar case of young girl with typical skin lesion and recurrent GI bleed requiring multiple blood transfusions presenting our department. She was subjected to surgical treatment and endoscopy therapy due to failure of conservative therapy. This case report depicts importance of typical clinical features of rare diseases.

Kikuchi disease: An unusual cause of cervical lymphadenopathy in a young female

Kikuchi-Fujimoto disease (KD), also known as histiocytic necrotizing lymphadenitis, is a rare cause of unilateral cervical lymphadenopathy usually described in adolescents and young adults with female preponderance. Clinically patients present with palpable lymphadenopathy, fever, and loss of weight. Hence, it should be differentiated from other causes of lymphadenopathy such as tuberculosis, lymphoma, or malignancy. Although the majority resolve spontaneously without treatment some may require non-steroidal anti-inflammatory drug or steroids. It may also be associated with systemic lupus erythematosus. Hence early detection, prompt diagnosis, and follow-up of the patient are essential in all cases of unilateral cervical lymphadenopathy in young adults. Here, we describe a 22-year old female who presented with unilateral neck swelling and was clinically diagnosed initially as a case of tuberculous lymphadenitis which on biopsy turned out to be KD.

Fat graft myringoplasty: A clinical study and review of literature

Objectives: There are numerous surgical techniques that have been demonstrated and utilized to repair small perforations in the tympanic membrane (TM) with various graft materials such as veins, perichondrium, periosteum, and others. In our study, fat was taken as the graft material and the main aim of the study was to evaluate the success rate of graft uptake, assessment of hearing improvement, and complications of the operative procedure. Material and Methods: In this single-center study, 46 patients underwent fat myringoplasty, 52 ears were operated from October 2016 to September 2017 for a period of 1 year. A detailed history, general physical, and a through ear, nose, and throat examination were done. Audiometric assessment was done using pure tone audiometry. Patients between the age group of 15 and 50 years were included in the study. Results: A total of 46 patients were included in the study who met the inclusion criteria. Six patients had bilateral perforations and 40 patients had unilateral perforation, a total of 52 perforations were operated. Forty-three (82.69%) patients had successful graft uptake and graft failure was seen in 9 (17.30%) patients. Maximum gain in hearing was seen in in patients with hearing loss between 20 and 30 dB, that is, 24 patients (46.1%). Conclusion: Fat myringoplasty is a methodized, precise, inexpensive, mini-invasive, and cosmetic outpatient procedure for small perforations of TM. It can be done under local anesthesia and has a good success rate if the patient selection is done appropriately.

Efficacy of screening cancer patients at hospital entrance for COVID-19 with a questionnaire and thermal scanning: An audit

Objectives: Although commonly practiced, the accuracy, effectiveness, and safety of screening patients for COVID-19 at hospital entrances is not well documented. Material and Methods: We performed a retrospective analysis of single institution data involving screening patients for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection at hospital entrances by trained health personnel, with thermal scanning and administration of a standard questionnaire eliciting risk factors and symptoms of COVID-19. SARS-CoV-2 positivity among patients screened positive and negative and among personnel involved in screening were estimated. Results: Between May 22, 2020, and July 4, 2020, a total of 20152 patients involving 54955 hospital visits were screened at hospital entrances of whom 668 (3.31%, 95% CI 3.07–3.57) were screened positive for suspected COVID-19 and 19484 (96.69%, 95% CI 96.44–96.93) were screened negative. Among patients screened positive, of the 638 patients with available records, 109 (17.08%, 95% CI 14.24–20.23) were confirmed to be SARS-CoV-2 positive by polymerase chain reaction test, 288 (45.14%, 95% CI 41.23–49.10) were negative, 71 (11.13%, 95% CI 8.79–13.83) were not tested after secondary assessment, and 170 (26.65%, 95% CI 23.25–30.26) patients declined the test. Among screen negative patients, 162 (0.83%, 95% CI 0.71–0.97) were SARS-CoV-2 positive. Of the 104 personnel involved in screening, 03 (2.88%, 95% CI 0.60–8.20) were confirmed to be SARS-CoV-2 positive during study period. Conclusion: Screening patients with a combination of thermal scanning and a standard questionnaire for COVID-19 has a high positive predictive value for detecting this infection with low risk of SARS-COV-2 transmission to the involved health personnel.

Assessment of quality of life among head-and-neck cancer patients

Objectives: To assess QOL of different head and neck cancer patients. Material and Methods: A cross sectional study of 35 subjects with HNC was selected based on the type of cancer. After a background study, 35 subjects were chosen classifying on the type of cancer and were assessed using an interview schedule. Results: Physical as well as emotional score was poor among the group (312.5 and 349.5). The results had a high degree of variation. Conclusion: QOL among HNC patients were concluded to be poor.

Determinants of quality of life among COVID-19 patients in Southwestern region of Bangladesh

Objectives: The outbreak of COVID-19 has caused an unprecedented health crisis and dramatically changed human lives. This study aims to identify risk factors related to health-related quality of life (HRQoL) among COVID-19 patients who were discharged from the hospital. Material and Methods: A total of 557 COVID-19 patients of Jhenaidah district of Bangladesh who had tested positive before February 1 of 2021 were selected for this cross-sectional study. The EuroQol 5-dimensional-5 level questionnaire was used to measure the HRQoL. Thai value set was used to assess the full health status. Chi-square test was used to find out the association of HRQoL with sociodemographic and clinical factors. Finally, logistic regression was used to find out the predictors of the dimensions of HRQoL. Results: Using the Thai value set, it is observed that 57.27% of participants had reported that they had experienced moderate or severe health problems. About 40.57% of the respondent reported anxiety or depression, whereas 39.14% of the participants had experienced moderate or severe pain or discomfort. The result of the logistic regression showed that age, gender, occupation, place of care, heart problems, and diabetes significantly affect various dimensions of the HRQoL. Conclusion: The COVID-19 significantly depletes the health condition of the patients in both mental and physical aspects. Therefore, the policy-makers and government should need to come with comprehensive strategies to reduce the psychological and physical health woe of COVID-19 patients.

Alcohol-based hand sanitizer-induced burns: A harsh reality in current times

Due to the recent coronavirus pandemic, there is a steep rise in the use of alcohol-based hand sanitizers (ABHSs) over the past few months. For them to be effective against microorganisms, the minimum recommended concentration of alcohol is 60%. This high alcohol content makes the sanitizers easily flammable. Although, they are extremely convenient to use, they can also prove to be a hazard if used in an improper manner. Guidelines have been published for safe manufacturing and distribution of these sanitizers. There are recommendations for storage and use, which should be adhered to in a strict manner. Their use by children should always be supervised. We report four cases of burn injuries caused by injudicious use of alcohol-based sanitizers. The flammable nature of ABHSs can also be exploited as witnessed in one of our cases. With this report, we wish to emphasize that judicious and correct use of these seemingly benign products is essential.