Giant cell myocarditis masquerading as orbital myositis with a rapid, fulminant course necessitating mechanical support and heart transplantation.

Giant cell myocarditis (GCM), a rapidly progressive inflammation of the myocardium, is associated with fulminant heart failure, refractory ventricular arrhythmias, and conduction system abnormalities. Few case reports have noted orbital myositis as the initial clinical presentation. Our case demonstrates a unique presentation of GCM with only ocular symptoms, which unlike prior studies, rapidly progressed to heart failure, tachyarrhythmias, and conduction disease. Our case necessitated quick recognition and treatment with mechanical support making this the first known case of GCM with successful placement of biventricular assist devices and ultimately with heart transplantation

Appropriateness of antibiotic prescribing for upper respiratory tract infection in a tertiary care teaching hospital: a cross sectional study

Background: Overuse of antibiotics among the patients with upper respiratory tract infection (URTI) is a worldwide problem, leading to antimicrobial resistance. This study is aimed to evaluate the appropriateness of the antimicrobial prescribing for upper respiratory tract infections in a tertiary care teaching hospital. Methods: This was a cross-sectional, observational study. Data was collected from outdoor adult patients who were clinically diagnosed to have URTIs from General Medicine and Otorhinolaryngology Department of a tertiary care teaching hospital. The appropriateness of antibiotics used in URTI was assessed. The data was analyzed using descriptive statistics. Results: Total 100 cases, clinically diagnosed to have URTI were included in the study. Among these, common cold (46%) and acute otitis media (23%) were the most frequent encounters. 75% of the prescriptions contained at least one antibiotic. In fact, antibiotics were the most commonly prescribed agents (21.2%) followed by antihistaminic (19.8%) and NSAIDs. 57% of the antibiotics were prescribed inappropriately, either in terms of inappropriate choice (37%) or over use (20%) of antibiotic. Conclusions: Inappropriate prescription of antibiotics for otherwise self-limiting URTI cases is a common practice even in a tertiary care teaching hospital. Implementation of multifaceted approach is needed to curtail the same

Clinical profile of ocular trauma in a tertiary care hospital of Southern Rajasthan

Background: Ocular trauma is a major cause of preventable visual impairment and blindness leading to permanent loss of vision and deterioration of quality of life. 90% of the injuries are preventable. Aim of the current study was to study the clinical profile of patients with ocular trauma at a tertiary care hospital in Southern Rajasthan. Current study was a cross- sectional, observational study was conducted at Geetanjali medical college and hospital, Udaipur.Methods: After taking a well-informed consent a generalized detailed history of 108 cases (123 injured eyes) was obtained. Assessment of best corrected visual acuity, near vision, intraocular pressure, slit-lamp evaluation and dilated fundus examination was carried out. Then injury was classified as per BETTS classification. Patients with corneal foreign bodies and chemical injuries were recorded separately. Imaging modalities like ultrasound B-scan, CT-scan and MRI were employed wherever required. Results: Number of males (98) was much higher than females (9) in our study. Male: female ratio was found to be 10.8:1. The most commonly affected age group was 21-30 years, this highlights the alarmingly high incidence of ocular injuries in economically active young males. Farming is the primary occupation across India, hence it deserves a special mention. 22% of injury cases in our study were farm- work related injuries. Farmers need to be educated and provided eye protective equipment during high-risk activities. Laws regarding agricultural code of practice should be implemented and followed.Conclusions: In our study, not a single case out of 108 had used eye protection at the time of injury. Every effort should be made to create awareness regarding use of safety measures during driving and engaging in high-risk occupations. This will help prevent sight-threatening complications of ocular trauma and the deleterious impact on quality of life

A Scoping Review: Overview of Current Respectful Maternity Care Research by Research Approach and Study Location

Introduction: Disrespectful care during childbirth contributes to poor health outcomes, perpetuates disparities, and encourages childbirth outside of healthcare facilities. To measure disrespectful care, investigators use many research approaches. Most research has focused on low/low-middle income countries. This scoping review aims to 1) summarize current research and research approaches to analyze whether these approaches identify the same types of mistreatment and 2) identify gaps in current research analyzing disrespectful care during childbirth. Methods: Following PRISMA guidelines, this review utilized search terms to filter articles from the Pubmed database. Using specific criteria, articles were then excluded by title and abstract, then full article review. Included articles were organized by research approach and analyzed for study location and the presence of 9 types of mistreatment. Results: 102 included articles were organized by research approach, including direct labor observation, survey, interview, and focus groups, yielding 144 total studies to account for articles with more than one research approach. Each research approach identified all 9 types of mistreatment, with neglect/abandonment, verbal mistreatment, and physical mistreatment reported the most. Low-income countries represented 134/144 studies, with most research centered in East Africa and India. High-income countries represented only 7% of research. Discussion: This review is the first to organize current respectful maternity care research by research approach and study location. Analysis of study location shows gaps in research, particularly among high-income countries. Further research, particularly in high-income countries, is necessary to better this global health concern

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

A mixed toxidrome presenting with bilateral ptosis with normal pupils: The first case in the literature

Snakebite is an environmental hazard associated with a significant morbidity and mortality. Two main types of toxicity occur due to snakebite, namely vasculotoxicity and neurotoxicity. Neurotoxic snakebites present mainly with bilateral ptosis with dilated pupils and/or difficulty in breathing. Jatropha curcas belongs to the family Euphorbiaceae and is commonly referred to as " Ratanjyot" in Gujarati. It has got many medicinal uses such as anticancerous properties and bio-oil. There are very few cases of its toxicity in adults. Toxicity from it causes meiosis, vomiting, diarrhea, etc., We will hereby discuss one such patient who consumed J. curcas seeds intentionally, became drowsy and accidentally got bit by a snake, and then, the patient started having bilateral ptosis, but with normal-sized pupils. There is no case reported yet in the literature mentioning the combined toxicity of snakebite and J. curcas, so we thought to publish this first case report of its kind in the world, thus discussing its diagnosis, symptoms, and treatment modalities

Tailoring stability and thermophysical properties of CuO nanofluid through ultrasonication

International audienceThe objective of this research is to examine how ultrasonication time affects agglomeration, stability, thermal conductivity, and viscosity of CuO nanofluid. Using different reaction conditions, distinct shaped CuO nanoparticles are synthesised and dispersed in an EG: DW (70:30) ratio with 0.3 vol%. Microscopic and TEM images are used to analyze colloidal solutions with varying sizes and shapes of nanoparticles. After 30 days of preparation, the zeta potential is measured to ensure that the suspension is stable. The Bridgman equation is used to compute thermal conductivity using sound velocity values. Viscosity of colloidal suspension is measured by viscometer. All of the studies are performed at 30° ± 2 °C room temperature for ultrasonication times ranging from 30–120 min. At an optimal sonication time of 80 min, there is less agglomeration and more stable particle dispersion. In comparison to other morphological suspensions, CuO spherical shape suspended nanofluid has the lowest viscosity and maximum thermal conductivity, as well as the most stable fluid. At the optimal sonication period, measured results demonstrate thermal increase and decreased viscosity, which could have implications for heat transfer applications

Effectiveness of Induction Training on Newly Joined Employee Knowledge and Hospital Performance

Introduction Every organization needs well-trained employees to perform job activities effectively and efficiently. Training and development is a continuous process that helps to develop skills, knowledge, and abilities in its workers, which leads to better performance of employees. This study aims to assess the effectiveness of an induction training program for hospital employees as well as the impact on employee knowledge and performance in the clinical field according quality indicator benchmarks. Methods A sample of individuals (N = 775) who were newly hired, promoted, or re-categorized at our institution in 2021 were included in the program. The effectiveness of the induction training program was assessed with a pre- and post-test and feedback form. Topics covered in the training program will help employees know about the institute and increase knowledge and skills. Results The average pre-test score was 60%, which increased to 84% after the training (p = 0.0001). There was a significantly positive relationship between the quality indicators and the clinical audit results (p = 0.006). Conclusion The induction training program effectively improved the employees' knowledge regarding their rights and responsibilities as well as clinical knowledge (i.e., Infection control and prevention, quality, disaster management, biomedical waste management, and facility safety)