Anaesthetic considerations for whole lung lavage for pulmonary alveolar pro-teinosis

Pulmonary alveolar proteinosis (PAP) is an uncommon lung disease characterized by excessive accumulation of pulmonary surfactant that usually requires treatment with whole-lung lavage. A 47-year-old female presented with history of dry cough and breathlessness for past 6months. Chest radiograph demonstrated bilateral alveolar shadows and highresolution computerized tomography thorax showed crazy paving pattern. Broncho-alveolar lavage (BAL) and transbronchial lung biopsy confirmed a diagnosis of PAP. Due to worsening hypoxemia and respiratory failure, wholelung lavage was planned and performed. Anaesthetic management involved integrated use of pre-oxygenation, complete lung isolation, one-lung ventilation with optimal positive end-expiratory pressure, vigilant use of positional manoeuvres,and use of recruitment manoeuvres for the lavaged lung. We have discussed valuable strategies for the anaesthetic management of patients undergoing this multifaceted procedure in a case of severe PAP.Keywords: PAP, Whole lung lavage, anaesthesia, managementFunding: None declare

Quality of life of palliative care cancer patients during COVID-19 lockdown phase

Introduction: Corona virus pandemic in 2019 led India to implement complete lockdown except for essential services. Cancer patients faced hindrances seeking medical help. This caused stress and worry, leading to reduced quality of life (QoL). This study evaluated QoL and pain management in palliative care cancer patients during lockdown. Patients and methods: This was a cross-sectional observational study at a tertiary cancer hospital, over one month period with convenience sampling. Participants included all who were unable to visit the palliative outpatient department during the lockdown during COVID-19 pandemic. They were contacted telephonically and a valid QoL questionnaire filled. Disease, demographic details and pain were assessed. Results: A total 51 were interviewed, 45% (n = 23) patients reported difficult access to medication during the lockdown; 18 (35.3%) required morphine to alleviate pain and 6 (33.33%) faced difficulty in acquiring morphine tablets. QoL scores did not differ based on access to morphine (p = 0.648). Mean QoL scores were 12.7 ± 3.76 and 15.0 ± 3.60 amongst patients who did not have access to other medications and who did have access, respectively (p = 0.03). Overall QoL FACT G7 mean score was 14 ± 3.8. The variables NRS (pain intensity) and QoL scores were found to be negatively correlated (Pearson's Correlation Coefficient: r (49) = −0.69, p < 0.00001). Conclusions: Evaluation of QoL of palliative care cancer patients during global crises plays an important role in the assessment of patients overall condition as well as to maintain continuum of care

Safe practices for legitimate medical use of opioids: a study of trends in opioids prescription over a decade

Background: An unwavering availability of opioids is crucial for effective pain and palliative care and for managing opioid dependence. This study aims to study the pattern of morphine consumption and the use of safety protocols for prescribing opioids in a tertiary cancer hospital in India. Patients and methods: We studied the medical and pharmacy records retrospectively, to investigate the pattern of oral Morphine consumption and distribution from 2008 to 2020. Results: The number of new cancer patients visiting the hospital, the number of re-visits of these patients, and inpatient admissions to palliative care service increased unswervingly from 2008 to 2019 with a sharp fall in 2020 owing to the COVID pandemic. Annual oral morphine consumption showed a steady increase from 4.89 kgs in 2008 to 11.53 kgs in 2019 with a fall to 5.68 kgs in 2020. However, the trend for oral morphine dispensed per patient per visit showed a mild increase from 1.1 gram in 2008 to 2.06 grams in 2012, followed by a gradual decline to 0.89 grams in 2020. Opioid diversion incidence was found to be zero. Conclusions: Comprehensive interventions alongside safety protocols for prescriptions of opioids and effective integration of palliative care can help prevent opioid use disorders

Prevalence of Metabolic Syndrome in Psychiatric Inpatients: A Naturalistic Study

The aim of this naturalistic survey was to measure the prevalence of metabolic syndrome by collating data on routine physical investigation in an acute psychiatric inpatient population. The size of this study is small, but the results offer some interesting and useful preliminary findings, pertinent to the provision of good physical health care to psychiatric inpatients and from which further research could develop. Metabolic syndrome was found in more than a third (38%) of the population studied and was equally prevalent across a variety of psychiatric disorders. A higher trend was found in females than in males, but this figure did not reach statistical significance. Although small, the naturalistic setting of this survey demonstrates the ease with which metabolic syndrome can be opportunely excluded or identified in this vulnerable population, where physical healthcare is often problematic. With the increasing involvement of non-medically qualified practitioners in psychiatric care, simple techniques such as this hold a valuable place in holistic patient management

Prevalence of Metabolic Syndrome in Psychiatric Inpatients: A Naturalistic Study

The aim of this naturalistic survey was to measure the prevalence of metabolic syndrome by collating data on routine physical investigation in an acute psychiatric inpatient population. The size of this study is small, but the results offer some interesting and useful preliminary findings, pertinent to the provision of good physical health care to psychiatric inpatients and from which further research could develop. Metabolic syndrome was found in more than a third (38%) of the population studied and was equally prevalent across a variety of psychiatric disorders. A higher trend was found in females than in males, but this figure did not reach statistical significance. Although small, the naturalistic setting of this survey demonstrates the ease with which metabolic syndrome can be opportunely excluded or identified in this vulnerable population, where physical healthcare is often problematic. With the increasing involvement of non-medically qualified practitioners in psychiatric care, simple techniques such as this hold a valuable place in holistic patient management

A glycotherapeutic approach to functionalize biomaterials-based systems

In addition to being one of the primary building block materials of living cells, glycans are also favorable candidates for therapeutic applications. In the mid-20th century, the progress of glycans in the drug discovery field became surpassed by protein and DNA-focused treatments. However, the emergence of new analytical tools and methods to synthesize structurally specific glycans has encouraged and motivated the scientific community toward the development of glycan-based therapeutics. This review discusses the reemergence of glycan-based agents in the last decade and the technical strategies that played a key role in bringing the glycan-based treatments into the limelight of modern medicine. The review also includes the application of native glycans as the therapeutic agents along with the chemically engineered cell surface glycans and proteins to meet the preclinical and clinical scenario. Glycan-based therapeutic materials hold a huge potential that can be harnessed to meet the clinical needs in medicine.Authors would like to acknowledge the Science Foundation Ireland (SFI) and the European Regional Development Fund (Grant Number 13/RC/2073) for financial assistance. A.G. is supported through a research grant (16/ENM-ERA/3456) received under SFI ERA-NET Horizon 2020 program. S.B is supported through Horizon 2020, Marie Skłodowska-Curie Individual Fellowship-2017 (H2020-MSCA-IF-2017; Grant Number 797855).2021-03-1

A glycotherapeutic approach to functionalize biomaterials-based systems

In addition to being one of the primary building block materials of living cells, glycans are also favorable candidates for therapeutic applications. In the mid-20th century, the progress of glycans in the drug discovery field became surpassed by protein and DNA-focused treatments. However, the emergence of new analytical tools and methods to synthesize structurally specific glycans has encouraged and motivated the scientific community toward the development of glycan-based therapeutics. This review discusses the reemergence of glycan-based agents in the last decade and the technical strategies that played a key role in bringing the glycan-based treatments into the limelight of modern medicine. The review also includes the application of native glycans as the therapeutic agents along with the chemically engineered cell surface glycans and proteins to meet the preclinical and clinical scenario. Glycan-based therapeutic materials hold a huge potential that can be harnessed to meet the clinical needs in medicine.Authors would like to acknowledge the Science Foundation Ireland (SFI) and the European Regional Development Fund (Grant Number 13/RC/2073) for financial assistance. A.G. is supported through a research grant (16/ENM-ERA/3456) received under SFI ERA-NET Horizon 2020 program. S.B is supported through Horizon 2020, Marie Skłodowska-Curie Individual Fellowship-2017 (H2020-MSCA-IF-2017; Grant Number 797855).peer-reviewed2021-03-1

Zidovudine-induced reversible pure red cell aplasia

Hematological abnormalities are frequent among human immunodeficiency virus (HIV)-infected patients and may be directly attributable to the virus or may be caused by opportunistic infections, neoplasms or drugs that cause bone marrow suppression or hemolysis. Pure red cell aplasia (PRCA) is an uncommon hematological disorder that causes anemia. We report a 37-year-old male with HIV infection who developed PRCA 6 weeks after commencing Zidovudine and recovered following cessation of the drug. This is the first case of Zidovudine-induced PRCA reported from the Indian subcontinent