SummaryThis prospective study determined the level of radiation exposure of anaesthetists during interventional radiological procedures performed in the endoscopic retrograde cholangiopancreatography suite and cardiac catheterisation laboratory and compared it with the current safety guidelines. Anaesthetists wore area-specific lithium fluoride thermo-luminescent dosimeter badges at standardised positions. A total of 1344 procedures were performed over a 6-month period. Anaesthetists were involved in 39 ⁄ 645 (6.0%) procedures associated with ionisation radiation in the endoscopic retrograde cholangiopancreatography suite and 86 ⁄ 699 (12.3%) in the cardiac catheterisation laboratory. The mean (SD) duration of endoscopic retrograde cholangiopancreatography was 54.8 (29.1) min compared with 67.9 (42.8) min for cardiac catheterisation suite procedures (p = 0.058). The mean (SD) fluoroscopy time per procedure for endoscopic retrograde cholangiopancreatography was 5.5 (4.1) min compared with 12 (10.9) min in the cardiac catheterisation suite (p < 0.001). The combined net radiation exposure over 6 months was 0.28 mSv for endoscopic retrograde cholangiopancreatography procedures and 2.32 mSv in the cardiac catheterisation suite. The combined exposure was less than the maximum recommended exposure of 20 mSv per year.

SummaryThis prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.

We conducted a retrospective observational study to describe the clinical profile and outcomes of patients admitted with a diagnosis of dengue fever in a tertiary hospital in South India. A total of 159 patients admitted from April 2014 to October 2018 were included in the study. Vomiting (70.4%), myalgia (60.4%), headache (42.1%), abdominal pain (38.4%), bleeding (38%), and rash (37.1%) were the most common symptoms at presentation. The mean duration of hospital stay was 4.9 days (SD ± 2.4), and the median cost was INR 19,708 ($285) (IQR INR 12,968–32,056 ($188–$305)). Major bleeding was associated with elevated SGOT and SGPT, severe dengue, and secondary dengue. Mortality was associated with elderly age; elevated total leukocyte count, serum bilirubin, serum creatinine, SGOT, and SGPT; and high SOFA score. In view of these observations, we recommend stratifying patients according to the WHO classification of dengue and avoiding the use of thrombocytopenia as a single marker of the severity of the illness.

Introduction: Considerable interest has been shown in the field of sleep medicine in recent decades. Obstructive sleep apnoea (OSA) is a common condition that remains neglected in most parts of the world. Data are scarce, if any, when it comes to developing countries. We sought to describe the patient population in a single private tertiary care center from such a country. Materials and Methods: A cross-sectional study that included a total of 203 patients over a fiveyear period was conducted. Polysomnographic studies were conducted in a dedicated sleep laboratory, under the supervision of sleep physicians. Data were described and analyzed based on clinical and self-reported outcomes, as well as polysomnographic characteristics, and compared them between genders and severity. Results: With the participants having an average age of 50.84 years and a BMI of 34.7 kg/m 2 , the study found that the increase in age and BMI was significantly correlated with an increase in the severity of obstructive sleep apnea in the Pakistani population. There was a significant difference in sleep latency (20.6 min in women vs. 10.8 min in men; p-value = 0.001) and efficiency (63.7% in women vs. 69.8 in men; p-value = 0.02) between the two genders. Decreases in nadir saturation, total sleep time, and sleep latency were also associated with an increase in the level of severity. Conclusion: There is a dire need for Pakistani, and in extension Asian, medical professionals to ramp up their pace to meet the needs of their population with regard to sleep medicine.

Granulomatosis with polyangiitis (GPA) is a rare systemic disorder of unknown aetiology. The histological findings comprise necrotising granulomatous inflammation of small arteries, arterioles, and the capillaries mainly of upper and lower respiratory tract and the kidneys. However, the disease rarely involves the cardiovascular system but may manifest as pericarditis, myocarditis, coronary arteritis, valvular lesions, and severe conduction disorders. We present an interesting, unusual, and complex case of a middle-aged man who initially presented with symptoms suggestive of Wagener’s granulomatosis but two years later developed malignant ventricular arrhythmias. A diagnosis of exclusive involvement of the cardiac conduction system, without overt myocarditis, was made only after ruling it out by cardiac MRI, cardiac enzymes, echo, and normal serological markers. Evidence was paired with the cessation of monomorphic ventricular tachycardia due to induction therapy with Rituximab. In this case report, we highlight one of the rarest manifestations of GPA, i.e. Ventricular tachycardia Continuous...