A thirty-eight-year-old uncontrolled diabetic with a recent COVID-19 infection presented with extensive bowel ischemia and gangrene with a microscopic diagnosis of intestinal and mesenteric mucormycosis. Although there are a few reported cases of primary gastrointestinal mucormycosis, our case showing involvement of the intestine and/or mesentery, that too in a post-COVID patient, is quite uncommon. The immunosuppressive effect of the COVID-19 disease, uncontrolled diabetes, and the use of corticosteroids for the treatment of severe COVID are the most probable reasons for the emergence of severe opportunistic infections, both as a coinfection and as a sequalae to COVID.
The ongoing coronavirus disease 2019 (COVID-19) pandemic has presented major challenges to health care workers including laboratory professionals. Clinical laboratories play a critical role in this challenging environment by providing information to clinicians regarding prognosis, disease severity, and response to therapy apart from the diagnosis of COVID-19. Clinical chemistry laboratories inhabit central role in the management of COVID-19 through assessing the biochemical and inflammatory profile. It has been emphasised by many health organisations that health care workers are at high risk with COVID-19 outbreak. Sharing and updating of personal experiences regarding the laboratory safety is essential to minimise the risk of laboratory personal working in this crisis. Hence, in this review article, we documented our experiences in setting up a dedicated COVID-19 clinical chemistry laboratory and the biosafety aspects followed in our setup. This review article will provide information to clinical biochemists and laboratory professionals to establish a safety laboratory environment during this COVID-19 pandemic.
IntroductionAnimal attacks cause a considerable number of injuries and lead to morbidity and mortality among children and adults. Bull gore injuries following bullfighting and other provoked attacks have been frequently described in literature. Our study describes the pattern of injuries and the unique mechanisms and management of blunt and penetrating trauma associated with unprovoked bull attacks. MethodsIn this retrospective study, we collected the data of 36 patients presenting to our emergency department with a history of bullhorn injury. The data comprised age, sex, location of injury, type and description of the injury, surgical procedure performed if any, requirement of postoperative intensive care unit (ICU) admission, and mortality. The data were then compiled and analyzed with MS Excel. ResultsAmong the 36 patients, blunt injuries constituted 58.3% of cases, whereas penetrating injuries were seen in 41.7%. Men were commonly injured with a mean age of 39.1 years. Thorax (36%) and abdomen (33%) were the common sites of injury followed by perineum (17%), head (5%), spine (6%), and extremity (2%). Fall following the impact of bull led to indirect injuries, such as intracranial hemorrhage, parietal bone fracture, cervical spine injuries, and tibial fracture. More than half of the patients (n=19, 52.8%) required some form of surgery under local or general anesthesia. Among the operated patients, seven required postoperative ICU care and two expired. ConclusionAnimal attack injuries represent a less explored niche of surgical conditions. Management in the emergency department includes prompt resuscitation to achieve hemodynamic stability, thorough wound wash to remove the contaminants, and appropriate imaging, if indicated. Wound exploration is recommended for penetrating injuries and on a case-to-case basis for blunt injuries. The complications of these wounds are due to multiple wound paths, muscle tearing, evisceration of internal organs, and high risk of wound infection.
Background: Minimally invasive surgeries for inguinal hernia repair have been reduced post-operative morbidity. However, certain complications such as seroma formation are unavoidable. In this study, we introduce a newer technique of reducing seroma formation by fenestration of the pseudo-sac (thickened transversalis fascia) in patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Patients and Methods: A randomised, controlled pilot study was conducted from January 2019 to December 2020 for the patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Study participants were randomised into interventional group and control groups. Demographics, operative duration and complications including post-operative pain and seroma on days 1, 10 and 30 were analysed between both the groups. Results: A total of 20 cases with 30 hernias were included in the study. Demographic data were comparable between the two groups. The intervention group showed a statistically significant decrease in the incidence of seroma formation on the post-operative day 10 (13.3% vs. 46.6%, P = 0.046). The mean volume of seroma on day 10 was also less compared to the non-fenestration group (2.5 vs. 6.58 ml, P = 0.048). After the 30 th day, no patient had a presence of seroma. There were no statistically significant differences in terms of mean operative duration, post-operative pain and other complications. Conclusion: Fenestration of pseudo-sac in laparoscopic hernia repair for uncomplicated direct inguinal hernia is a simple and effective technique. It has reduced the incidence and volume of seroma formation without any increased risk of infection, acute or chronic pain and recurrence.
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