The effect of COVID-19 on intrapartum care: a case review from early in the pandemic

The COVID-19 pandemic has had a marked impact on maternity services in the UK. Those who are pregnant are identified as a higher risk population and there have been significant changes in the structure of antenatal, intrapartum and postnatal care. This case of interest explores a moderate case of SARS-CoV-2 during the intrapartum period in the early stages of the pandemic which was managed by a multidisciplinary approach. The family are well and are now fully recovered. Midwifery accounts recall uncertainties regarding personal protective equipment. Obstetricians recall minimalising patient contact where appropriate and anticipating for obstetric emergencies to reduce delays. Despite challenges, staff recall excellent multidisciplinary team work and the use of technology to facilitate communication between service user and birth partner.

A 10-year-old Child with Severe Subglottic Stenosis Following Intubation: A Case Report

Background: Subglottic stenosis is among the most common airway problems in children, i.e., acquired or congenital. More than 90% of acquired cases are secondary to endotracheal intubation and occur iatrogenically. Subglottic stenosis is an unexpected problem that requires timely diagnosis and intervention. Most cases of subglottic stenosis in children are mild to moderate. Case Presentation: The presented patient was a 10-year-old child who, after long intubation due to head trauma following early discharge from the surgical center, was referred to the Children’s Hospital on the same day with a complaint of high fever and shortness of breath. With the development of respiratory distress and cyanosis, the patient was transferred to the intensive care unit. Due to the impossibility of passing the tracheal tube with the appropriate age for the patient, the initial diagnosis of subglottic stenosis was established and a tracheostomy was performed. Diagnostic bronchoscopy confirmed severe subglottic stenosis, and the child was referred to a specialized Ear, Nose, Throat (ENT) center for the repair of the tracheal stenosis. Conclusion: One of the most common causes of stridor in children is subglottic stenosis following prolonged intubation. Recognizing the predisposing factors, prevention, strong clinical suspicion, timely diagnosis, and treatment can prevent further adverse complications or consequences in children.

Recurrent coronary thrombotic events in a moderate case of COVID-19

We describe the case of a healthy patient with moderate COVID-19 infection without thrombophilia nor coronary disease background who presented with a relapsing thrombotic occlusion of the right coronary artery despite normal oxygenation, adequate antiaggregation and prophylactic anticoagulation. Prophylactic anticoagulation recommendations in COVID-19 were inadequate for this patient. Further data are needed to propose full-dose therapeutic anticoagulation for patients with coronary thrombosis and COVID-19 infection. This could nevertheless be considered even in mild forms of COVID-19.

Analisis Spasial Kasus Malaria di Kabupaten Banyumas Tahun 2009-2018

Malaria is still a public health problem in the Banyumas district. Spatial information can be used as a strategy to control malaria. This study aimed to describe malaria cases using spatial analysis in the Banyumas District from 2009 to 2018 based on environmental conditions. This research was quantitative method conducted by a descriptive spatial approach. Data collected by secondary data which was obtained from various sources such as Health Agency, Statistics Indonesia, Indonesian Ministry of National Development, National Institute of Research and Development, and Office of Public Works of Banyumas. The data analysis implemented was descriptive and processed with ArcGis software. The findings illustrated that the number of malaria cases during the 2009-2018 period in Banyumas district was 1624 cases. The most dominant malaria cases distribution were in Sumpiuh and Tambak Subdistrict. The Trend of API from 2009 to 2018 was getting better, 2009 to 2012 found that there were subdistricts with Moderate Case Incidence (MCI) and High Case Incidence (HCI), however, Low Case Incidence (LCI) was present in 2013 to 2018 in Sumpiuh and Kebasen subdistricts and the rests were free from malaria. The results of spatial analysis discovered that most of the malaria cases were in the medium population density area. The distribution of malaria cases has decreased significantly, even though the environmental conditions still potentially transmit malaria.

Development and External Evaluation of Predictions Models for Mortality of COVID-19 Patients using Machine Learning Method

Background To develop and evaluate the prognostic machine-learning model for mortality in patients with coronavirus disease 2019 (COVID-19).Methods Clinical data of confirmed COVID-19 were retrospectively collected from Wuhan between 18th January and 29th March 2020. Gradient Boosting Decision Tree (GBDT), logistic regression (LR) model, and simplified LR with selected 5 features (LR-5) model were built to predict the mortality of COVID-19. 5-fold area under curve (AUC), accuracy, positive predictive value (PPV), and negative predictive value (NPV) were calculated and compared between models.Results A total of 2,924 patients were included in the final analysis, 257(8.8%) of whom died during hospitalization and 2,667 (91.2%) survived. There were 21(0.7%) mild cases, 2,051(70.1%) moderate case, 779(26.6%) severe cases, and 73(2.5%) critically severe cases of COVID-19 on admission. The overall 5-fold AUC was observed highest in GBDT model (0.941), followed by LR (0.928) and LR-5 (0.913). The diagnostic accuracy were 0.889 in GBDT, 0.868 in LR and 0.887 in LR-5. GBDT model also showed the highest sensitivity (0.899) and speciality (0.889). The NPV of all three models exceeded 97%, while the PPV were relatively low in all models, 0.381 for LR, 0.402 for LR-5 and 0.432 for GBDT. In subgroups analysis with severe cases only, GBDT model also performed the best with a accuracy of 0.799 and 5-fold AUC (0.918).Conclusion The finding revealed that mortality prediction performance of the GBDT was superior to the LR models in confirmed cases of COVID-19, regardless of disease severity.

Hand and foot syndrome secondary to capecitabine

<p class="abstract">Hand and foot syndrome are an adverse effect often seen with chemotherapy or with the use of biologics. It is characterised by painful erythema and edema, dry or moist desquamation of palms and soles in mild to moderate case. Severe cases usually present with cracking, peeling, blister, ulcer and severe pain. Here we report a 65-year-old woman with breast carcinoma who was on treatment with capecitabine and presented with fissuring and bleeding over palms and soles, with progressive burning sensation. On examination, hyperpigmentation and scaling were also noted over both palms and soles. She was diagnosed with hand and foot syndrome and was treated with emollients, antibiotics and topical steroids.</p>

AN OBSERVATIONAL STUDY OF 11 CASES OF CARTAP POISONING - A RARE POISONING

Objective: Cartap hydrochloride poisoning is an uncommon poisoning encountered in India. The aim of this study was to assess the characteristics, severity, management, and outcome of patients with Cartap poisoning, treated with N-acetylcysteine (NAC) in intensive care unit (ICU) of a tertiary referral hospital.Methods: This is a retrospective study where 11 cases of Cartap poisoning admitted to hospital ICU between 2011 and 2016 were identified from the case records. The demographic data, mode of ingestion, time to treat, ingested dose and severity of poisoning, presenting features, duration of mechanical ventilation (MV), dose of NAC used, complications, and outcome were noted.Results: Patients were scored as moderate or severe cases of poisoning. Severe cases consumed >10 g, underwent gastric lavage > 4 hrs, and took Cartap concomitantly with alcohol or in empty stomach. Duration of MV varied from 68-94 hrs in severe cases and 12-48 hrs in moderate cases. Average dose of NAC in severe case was 11.19 g and moderate case was 8.89 g. The most common presenting symptoms were vomiting, altered sensorium, and breathlessness. Severe cases had more complications, and the most common complication was hypotension followed by seizures. Survival was 100%.Conclusion: 50% of Cartap poisoning cases had good survival outcome. Severity of poisoning depends on amount of Cartap ingested, time taken for gastric lavage, and concomitant administration of alcohol. Duration of MV and dose of NAC and complications encountered correlates with the severity of poisoning.

STUDY ON THE APPLICATION OF ISS AND RTS FOR THE EVALUATION OF SEVERITY OF TRAUMATIC PATIENTS TREATED IN BACH MAI HOSPITAL

Background: Injury is a common surgical emergency causing serious burden for patients and the society. Accurate diagnosis and prognosis of trauma patients are helpful in the treatment of these patients. Objectives: To apply ISS and RTS for the evaluation of the severity of trauma patients admitted Emergency room of Surgery Department, Bach Mai Hospital. Subjects and methods: A retrospective study on 194 trauma patients treated at the Emergency room of the Surgery Department, Bach Mai Hospital from 8/2015 to 12/2016. Results: There were total 194 patients, 131 males (67.5%), 63 females (32.5%). The average age was 41.7±18.7. Median RTS score was 7.84 in 96.6% of the patients with corresponding survival probability was 0.988. There was 114 minor case (59.7%), 59 moderate case (30.9%), 16 severe case (8.4%), 2 critical case (1.1%) and 0 unsurvivable case based on the ISS classification. There was no significant difference in ISS between preservation and surgical group. Conclusion: Most of our patients was mild and moderate. Severity scores such as RTS and ISS were useful in these patients. Key words: Injury, ISS, RTS, preservation, surgery

Radiation pneumonitis and pulmonary function with lung dose–volume constraints in breast cancer irradiation

PurposeWe studied symptomatic radiation pneumonitis (RP) and changes in pulmonary function tests (PFTs) after loco-regional radiotherapy (LRRT) with V20 lung constraints in breast cancer (BC).Patients and methodsSixty-four women underwent PFTs before and 5 months after 3D planned LRRT for BC. The incidentally irradiated ipsilateral lung V20 was minimised to <30%. Patients were monitored for symptoms of RP 1, 4 and 7 months after radiotherapy (RT) and data on covariates were collected prospectively. The outcome was compared with previous treatment series.ResultsPneumonitis was less frequent with the applied constraint, that is, four mild and one moderate case, than in our previous report (p < 0·001). In multivariate analyses, neither dosimetric data nor covariates appeared to influence mean changes in vital capacity [−0·11L, standard error of the mean (SEM) 0·03] or diffusing capacity of the lung for carbon monoxide (DLCO) (−0·20 mmol/kPa/min, SEM 0·01), except for pre-RT chemotherapy, which diminished the change in DLCO 5 months post-RT.ConclusionsThe used constraint and 3D planning lowered the rate of RP and short-term changes in PFTs compared with our previous treatment series. Pre-RT chemotherapy affects DLCO baseline levels. Rates of side effects should be continuously studied when new target definitions or therapies are introduced in LRRT of BC.