Catastrophe Disguised as a Complication After Epiduroscopy-A Case Study

Background: Epiduroscopy is a minimally invasive technique that enables diagnosis and treatment within the epidural space with direct vision. Previously reported complications of this technique have been mostly mild neurological complications of a transitory nature. In the present case, we describe a serious complication following an epiduroscopy, resulting in death. Case Report: The patient was a 39-year-old woman with lower back and lower limb pain who had undergone 3 surgical interventions previously on the lumbar spine. Only limited results from conservative and interventional treatment had been observed. She underwent an epiduroscopy in the Pain Management Unit. Immediately after the procedure, which was completed without incident, the patient presented neurological symptoms with areflexic paraplegia and a loss of sensation in the lower limbs and the upper left limb. Imaging tests identified signs of craniospinal hypotension that progressed slowly despite medical intervention. Ventricular dilation and cerebral edema without remission occurred, which ultimately caused the patient’s death 2 months after admission to the intensive care unit. Conclusion: Epiduroscopy has the potential to present adverse effects and complications. A thorough evaluation of the clinical history and the imaging tests are advisable Key words: Complications, epiduroscopy, low back pain, spinal cord, spinal endoscopy

Comparing Effectiveness of Standard vs HF10 Spinal Cord Stimulator Implants for Chronic Intractable Pain

Background: There is limited real-world evidence regarding the long-term effectiveness and safety outcomes related to spinal cord stimulation (SCS) for patients with chronic refractory pain. Case Report: This study included a total of 132 patients (73 had HF10); 53% was female. Mean Pretrial Numeric Pain Score for all patients was 8.4 ± 1.1 which decreased to 4.4 ± 2.0 at the end of one year (P < 0.0001). A 6% decrease in the percent of responders, between one month and one-year post-implant, was noted in the HF10 SCS compared to the 15% in standard SCS. A statistically significant decrease in pain relief in the male population (P = 0.02) and obese patients (P = 0.002) was observed. Most common complications: “IPG malfunction” (17%) for standard SCS and “IPG site pain” (12%) for HF10 SCS. Conclusion: HF10 SCS is a viable alternative to standard SCS for chronic intractable pain conditions. Key words: Complications, HF10, high-frequency stimulation, neuromodulation, patient outcomes, spinal cord stimulation

Assessment of knowledge, attitude and practice of Pakistani population about the risk factors, causes, complications and management of diabetes mellitus

Objective: To compare the knowledge, attitude and practice regarding diabetes mellitus among diabetics and non-diabetics. Methods: The cross-sectional study was conducted at the Government College University, Faisalabad, Pakistan, from December 2017 to April 2018, and comprised subjects recruited randomly from different cities of Punjab, Pakistan. Data was collected using a predesigned structured questionnaire regarding socio-demographic characteristics, general knowledge about diabetes, perception regarding indication, risk factors, diagnosis, and complications, and practices followed for treatment and management of diabetes. Results: Of the 2,000 subjects, 972(48.6%) had family history of diabetes, 1338(66.9%) were living in urban areas, 1068(53.4%) were university graduates, 804(40.2%) were employed and 1152(57.6%) belonged to socio-economically balanced families. Composite knowledge score was significantly associated with age and socio-economic status (p<0.05). A highly significant association was observed regarding family history (p<0.001), level of education (p<0.0001) and occupation (p<0.001) with composite knowledge score. Conclusion: The knowledge level about diabetes was seen to be average. Key Words: Complications of diabetes mellitus, Diabetes knowledge, Management of diabetes mellitus, Pakistani population, Questionnaire. Continuous...

Outcome of Trans-obturator Tape Procedure in the treatment of Stress Urinary Incontinence at Kathmandu Model Hospital

Aims: To evaluate the improvement in the quality of life of women with stress urinary incontinence who were treated with trans-obturator tape procedure. Methods: This is a cross-sectional study of treatment of stress urinary incontinence using trans-obturator tape at Kathmandu Model Hospital from February 2018 to December 2019. The outcome of the procedure in terms of improvement in quality of life and surgical complications were assessed. Results: Out of 16 cases of stress urinary incontinence half of them were post-menopausal. One each had intra-operative bladder injury, urinary retention and urinary tract infection; 14 cases improved completely by a week, one had some improvement and one didn’t improve. At six months follow-up one case had no improvement and one developed urge incontinence. Conclusions: Trans-obturator tape has been found a good procedure for the treatment of stress urinary incontinence in our setting and hence led to high rate of improvement in quality of life with minimal and minor complications. Key words: Complications; quality of life; stress urinary incontinence; trans-obturator tape

Comparison of Outcome of Teenage Pregnancy with Non- teenage pregnancy

Aims: To analyze the maternal and fetal outcome in teenage pregnancy (≤ 19years) with that of pregnancy at optimal childbearing age group (20- 34 years). Methodology: This was a hospital based observational analytical study conducted at Paropakar Maternity and Women’s Hospital in Kathmandu from August 2016 to February 2017.Results were analyzed using SPSS 21 taking p-value≤ 0.05 as statistically significant. Results: There were 200 cases in each group (≤19 and 20-34 years). Anemia (p=0.001), hypertensive disorder of pregnancy (p=0.001), preterm delivery (p=0.001), Cesarean Section rate (p=0.006), 5-minute Apgar score (p=0.035), low birth weight (p=0.017) and neonatal admission rates (p=0.018) were significantly high in teenage pregnancy. Conclusions: Both maternal and neonatal complications are increased in teenage pregnancy in comparison to the optimal reproductive age group. Key words: complications, pregnancy, teenage

Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is the practice of using circulatory assist devices and a gas exchange system to maintain sufficient tissue oxygen delivery, supplementing pulmonary and/or cardiac function in patients whose native physiology is too severely altered to be successfully supported solely by conventional life support techniques (eg, mechanical ventilation and inotropic and vasopressor drugs). ECMO should be considered in patients who are at a high risk of death due to a potentially reversible etiology of cardiopulmonary collapse. Indications for ECMO can be broadly divided into profound respiratory failure and/or cardiogenic shock. The indications include acute respiratory distress syndrome, heart failure, postoperative cardiogenic shock, and as an adjunct to cardiopulmonary resuscitation in patients with cardiac arrest. ECMO is currently experiencing a renaissance, and familiarity with its concepts is important for all critical care practitioners. This review contains 8 figures, 8 tables and 34 references Key Words: complications, equipment, indications, management basics, outcomes

Posttransplant Complications: Renal, Cardiovascular, Diabetes, and Obesity

With improving surgical technique and perioperative care, liver transplant recipients will continue to survive longer and longer. After the first year of transplantation, the risk of mortality is largely based on the development of renal disease and metabolic syndrome, including hypertension, hyperlipidemia, diabetes, and obesity. Mechanistically, these complications can be a result of immunosuppressive medications as well as a return to poor dietary and exercise regimens posttransplant. Renal injury is almost exclusively a result of calcineurin toxicity over time, and new strategies are in place, utilizing mammalian target of rapamycin inhibitors to minimize this risk. Cardiovascular complications can also be spurred on by immunosuppressive medications, and close monitoring and treatment with standard agents are required in the recipient. Diabetes is perhaps the most feared medical complication posttransplant, as it carries a higher risk of mortality. It is also impacted by many of the different immunosuppressive regimens. Finally, novel strategies are being researched to appropriately treat the obese patient pre- and post liver transplant. This review contains 1 figure, 2 tables, and 52 references. Key Words: complications, diabetes, everolimus, immunosuppression, liver transplant, medical, metabolic syndrome, obesity, posttransplant, renal disease, tacrolimus.

Extracorporeal Membrane Oxygenation

Extracorporeal membrane oxygenation (ECMO), also known as extracorporeal life support, is the practice of using circulatory assist devices and a gas exchange system to maintain sufficient tissue oxygen delivery, supplementing pulmonary and/or cardiac function in patients whose native physiology is too severely altered to be successfully supported solely by conventional life support techniques (eg, mechanical ventilation and inotropic and vasopressor drugs). ECMO should be considered in patients who are at a high risk of death due to a potentially reversible etiology of cardiopulmonary collapse. Indications for ECMO can be broadly divided into profound respiratory failure and/or cardiogenic shock. The indications include acute respiratory distress syndrome, heart failure, postoperative cardiogenic shock, and as an adjunct to cardiopulmonary resuscitation in patients with cardiac arrest. ECMO is currently experiencing a renaissance, and familiarity with its concepts is important for all critical care practitioners. This review contains 8 figures, 8 tables and 34 references Key Words: complications, equipment, indications, management basics, outcomes

Immediate and Late Complications of Temporary and Permanent Hemodialysis Catheters

This study aimed to identify the immediate and late complications of temporary and permanent catheters for hemodialysis in a nephrology service. This is an exploratory-descriptive study with quantitative approach, performed in a Nephrology center that is reference in the State and located in Recife/Pernambuco. The sutdy was conducted in the period from April to September 2015 using an instrument developed by the authors, consisting of socio-demographic and clinical data. The study included 40 patients who had a total of 57 complications. The most frequent immediate complication was hematoma (33.4%) and the most common late complication was decreased blood flow (46.1%). Results led to conclude that the nursing staff, in particular, should be alert to the occurrence of complications. For this, it is suggested that training and continuing education be developed as a way to improve the performance of the nursing staff before any sort of problem related to catheters for hemodialysis. Key words: Complications; Catheters; Renal dialysis; Nephrology.

Pediatric Pain and Postoperative Management

Both assessment and management of pain in children present challenges for perioperative physicians, including surgeons, anesthesiologists, intensivists, and pediatricians, among others. Several reports have indicated that pediatric pain is undertreated postoperatively compared with pain in adults, resulting in both severe physical consequences, such as the development of chronic pain and complex regional pain syndromes, and significant psychological distress, such as nightmares and reversal of learned behavior. Moreover, chronic pain in childhood has been shown to heighten the risk for mental health problems in adulthood. Children with chronic pain (n = 14,790) reported higher rates of lifetime anxiety disorders (21.1% versus 12.4%) and depressive disorders (24.5% vs 14.1%) as adults. Although many evidence-based practice guidelines for pain management in younger people have been developed, adherence is often less than complete. The perioperative physician should be aware of barriers in pediatric pain management and be able to address them, thus improving pain management and patient outcome. Some of the problems in dealing with pediatric pain management include a realization of the controversies as to the age at which children feel pain, how pain can be assessed from the newborn to the adolescent, how the level of education and involvement of parents impact the situation, and a general knowledge of available pain treatments for the pediatric population. Key words: complications, opioids, pediatrics, postoperative pain, regional techniques