Background: Welders in the unorganized occupational sector in the economically developing world are exposed to respiratory, skin, eye, ear, and neurological problems exacerbated by non-usage of personal protective equipment (PPE). Objective: To study the frequency of health problems and the usage of PPE among welders in unorganized welding units in Vellore, India. Methods: A cross-sectional survey was conducted among 150 welders to determine the frequency of skin, ear, eye, and respiratory morbidity and the usage of PPE. A group of 150 non-welders were chosen for comparison. Results: Significant differences in the frequency of skin burns, redness, hyper pigmentation, itching, eye injuries, and sensorineural deafness were observed among the welders and non-welders (P < 0.001). Hypertension was noted in 12.6% of the welders as compared to 0.7% among the non-welders. None of the welders used appropriate PPE. For welders, low educational attainment was associated with an increased risk of eye injury (P < 0.05, OR = 0.29). There was also a significant difference between sensorineural deafness and a welder having less than 10 years of welding work experience (P < 0.001, OR = 18.18) which could probably be accounted for by the healthy worker effect. Conclusion: Welders in this sample experienced a significant skin, eye, and ear morbidity accentuated by the non-usage of PPE. All worked without formal training and were unaware of the safe working guidelines that exist, but are not implemented for the welders in India.
Background: Characterization of reticulo-endothelial activation in COVID-19 may guide treatment. Objectives: To assess reticulo-endothelial activation and its correlation with disease severity and death in patients across the entire spectrum of COVID-19 severity. Methods: Consecutive hospitalized COVID-19 patients were studied, with similar number of patients in each disease severity category. Baseline serum ferritin, sCD163 (macrophage activation markers) and plasma von Willebrand factor (VWF) antigen (endothelial activation marker) levels were studied. Clinical parameters and plasma D-dimer levels were also studied. The study parameters were correlated with COVID-19 severity and survival. Results: The 143 patients (104 males [80%], age 54 [42 – 65] years, median [inter-quartile range]) presented 4 (3—7) days after symptom onset. Thirty-four patients had mild disease, 36 had moderate disease, 36 had severe disease and 37 had critical disease at baseline. With increasing COVID-19 severity, ferritin, sCD163, VWF and D-dimer levels significantly increased at baseline, however, 139 patients had normal sCD163 levels. Of the reticulo-endothelial markers, VWF level independently correlated with COVID-19 severity and with survival. VWF level > 332.6 units/dl correlated with COVID-19 severity (odds ratio [OR]: 2.77 [95% confidence interval (C.I): 1.1 – 6.99], p value: 0.031) and in-hospital death (OR [95% CI]: 29.28 [5.2 – 165], p value < 0.001). Conclusions: Reticulo-endothelial activation markers increased incrementally with worsening COVID-19 severity. Baseline endothelial activation marker (VWF), and not macrophage activation markers, independently correlated with COVID-19 severity and death.
Simple telephone call a feasible, useful and acceptable method of following up patients with cerebrovascular accidents: Prospective Cohort study in South India Dear editor, Eighty-five percent of the strokes occur in low-and middle-income countries, where mortality has not decreased over time. Hospital-based follow-up is difficult, while community-based 3 resource is intensive. The role of telephonic follow-up for stroke patients has been studied in the west. Our prospective cohort studies evaluated the feasibility, acceptability and usefulness of telephonic follow-up of stroke patients. Patients 18 years or older with acute stroke presenting at our centre between December 2011 and 2012 were recruited. Telephonic follow-up was done at the end of 1, 6 and 12 months after discharge. Data on modified Rankin scores (MRS), dysphagia, urinary incontinence and mortality were collected. Patient/ caregiver responses to the calls were rated as friendly, neutral or unhappy by the investigator.Of 439 stroke subjects, 275 (63%) were men and 302 (70%) had ischemic strokes. Telephonic follow-up was successful in 78% (278/356), 74% (220/298) and 71% (103/145) at 1, 6 and 12 months, respectively (Figure 1). The patients/caregiver responses were happy (73%), neutral (22%) and unhappy (5%) to the calls. The mean (sd) call durations were 3.99 (1-11), 1.69 (1-6) and 1.7 (1-4) min at 1, 6 and 12 months, respectively. AE: accident and emergency department; Pt: patient; X: consent-refused consent.
Objectives To investigate factors affecting the haemostatic success of non‐dissolvable intranasal packs in the management of acute epistaxis presenting to the emergency department (ED). Design Prospective cohort study. Setting A nationwide prospective audit examining epistaxis management at 113 sites in the UK over a 30‐day period. Participants Patients 16 years or older, presenting to the ED with acute epistaxis managed with non‐dissolvable intranasal packs. Main outcome measures The primary outcome was pack success, defined as successful haemostasis following nasal pack removal, not requiring further packing or surgical intervention or interventional radiology. Results A cohort of 969 patients presented with epistaxis to the ED, with nasal packs being inserted in 54.4% by ED staff and by ENT in a further 18.9%. Overall, nasal packs were successful in 87.5%. Longer duration packs (≥21 hours) were more successful than shorter‐duration packs (89.9% vs. 84.3%, χ2 P = .028). A patient survey supported longer packing duration. The most significant predictors of treatment failure were shorter packing duration (Odds Ratio (OR) = 2.3; 95% Confidence Interval (CI) = 1.4‐3.8), alongside ischaemic heart disease (OR = 1.9; 95% CI = 1.1‐3.3), normal admission haemoglobin (OR = 2.0; 95% CI = 1.2‐3.4) and no attempt at cautery following pack removal (OR = 2.5; 95% CI = 1.4‐4.2). Conclusions The majority of epistaxis patients are packed by the ED prior to referral to ENT. Once inserted, nasal packs are highly successful, with data supporting the British Rhinological Society guidance of maintaining nasal packs for around 24 hours. Further work is needed to explore alternatives to non‐dissolvable intranasal packs to improve patient experience in epistaxis.
Acute parvovirus B19 infection can cause acute symmetric polyarthritis indistinguishable from polyarticular rheumatoid arthritis. Most cases of acute arthritis due to parvovirus B19 are self-limiting and resolve with symptomatic treatment. We present a 65-year-old lady from Southern India who presented with history of fever and joint pain for 10 days. Clinical examination revealed symmetric inflammatory arthritis involving the appendicular skeleton with predominant involvement of bilateral metacarpophalageal joints. Laboratory investigations revealed elevated inflammatory markers with negative serology for rheumatoid arthritis. Parvovirus B19 IgM antibody tested positive. She was initiated on nonsteroidal anti-inflammatory drugs with which her symptoms resolved completely.
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