The efficacy of preemptive analgesia for prevention of phantom limb pain has been controversial although pain management before amputation is empirically important. The aim of this study was to determine the associated factors with perioperative phantom limb pain.
Methods
Following approval by the Medical Ethics Committee in our university, medical records of patients receiving limb amputation surgery in our hospital between April 1, 2013 and October 31, 2017 were retrospectively reviewed. To determine which pre-operative factors could affect the development of phantom limb pain, we performed univariate analysis to find candidate factors (p < 0.05), and then did multivariate regression analysis.
Results
Incidence of phantom limb pain was 50% (22/44). There was no difference between the groups in types of anesthesia and post-operative pain levels. The multivariate logistic regression including possible confounders suggested that diabetes mellitus and uncontrollable preoperative pain with non-steroidal anti-inflammatory drugs (NSAIDs) were independently associated with the development of phantom limb pain (Adjusted odds ratio (OR) 0.238 [95% confidential interval (CI) 0.0643–0.883], p = 0.032, Adjusted OR 6.360 [95% CI 1.280–31.50], p = 0.024, respectively).
Conclusion
The types of anesthesia and the degree of postoperative pain were not related to the development of phantom limb pain. The present data suggest that insufficient preoperative pain with NSAIDs and diabetes mellitus would give an impact on the development of phantom limb pain.
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Tracheal intubation for general anesthesia causes postoperative sore throat. The purpose of this study was to evaluate the effect of sevoflurane and desflurane on prevalence of postoperative sore throat in patients after general anesthesia.
Methods
Ninety-six patients scheduled for orthopedic lower extremity surgery under general anesthesia were assigned to sevoflurane group or desflurane group. In the sevoflurane group (n = 48), sevoflurane was used as a maintenance anesthetic agent. In the desflurane group (n = 48), desflurane was used. Prevalence of sore throat, number of patients with rescue analgesics, and analgesics requirements were evaluated.
Results
The overall prevalence of postoperative sore throat in the sevoflurane group was lower than that in the desflurane group [21 (44%) vs. 32 (67%), p = 0.024]. The prevalence of sore throat at postoperative 4 h in the sevoflurane group was lower than that in the desflurane group [6 (13%) vs. 18 (38%), p = 0.005]. The number of patients requiring rescue analgesics was lower in the sevoflurane group [25 (52%) vs. 36 (75%), p = 0.020]. The requirement of diclofenac was also lower in the sevoflurane group (30 ± 37 mg vs. 47 ± 40 mg, p = 0.031).
Conclusions
We have shown that sevoflurane was associated with less frequent sore throat than desflurane in patients undergoing orthopedic lower extremity surgery.
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To evaluate risk factors associated with improper postoperative nasal Ring–Adair–Elwyn (RAE) tube depth.
Methods
We retrospectively enrolled 133 adult patients who were admitted to the intensive care unit (ICU) with the nasal RAE tube after head and neck surgery. Postoperative chest radiography was performed to confirm nasal RAE tube depth immediately after the patient was admitted to the ICU. Proper tube depth was defined as the tube tip between 2 and 7 cm above the carina. The patients were divided into the proper-depth group (78 patients) and the improper-depth group (55 patients). Patients' characteristics were collected. The risk factors for improper postoperative tube depth were assessed using logistic regression analysis.
Main results
All patients who showed improper tube depth had a shallow tube depth (the tube tip > 7 cm above the carina). Multivariable analysis revealed that tall stature [odds ratio (OR) 1.16; 95% confidence interval (CI) 1.08–1.25; P < 0.001], prolonged anesthesia duration (OR 1.16; 95% CI 1.02–1.32; P = 0.026), and right-sided surgical field as compared to the left (OR 0.36; 95% CI 0.14–0.93; P = 0.034) or median field (OR 0.25; 95% CI 0.07–0.85; P = 0.027) were risk factors associated with postoperative shallow tube depth.
Conclusions
Tall stature, prolonged anesthesia duration, and right-sided surgical field were independent risk factors for postoperative shallow nasal RAE tube depth.
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Jamir Pitton Rissardo Department of Medicine, Federal University of Santa Maria, Santa Maria, RS
DOI: 10.4103/IJAMR.IJAMR_35_18
Abstract
Pasteurella multocida (PM) is part of the normal nasopharyngeal flora of many animals. The most common PM infections occur in soft tissue, secondary to animal contact. Meningitis is rarely associated. An adult female developed chronic right-sided otorrhea and tympanic membrane perforation. Elective mastoidectomy was performed. On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures. Cerebrospinal fluid (CSF) analysis revealed low glucose, high protein, and high cellularity. Blood tests were within normal limits, except for high leukocyte count. Two days after the neurological manifestations, bacteria, identified as PM, grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillins. She was started on intravenous penicillin G. The patient had a full recovery. On further questioning, she admitted having a dog, which licks on her face frequently.
Pasteurella multocida (PM) is a Gram-negative coccobacillus and facultative anaerobe. It is present in the nasopharyngeal flora of domestic pets.[1] Frequently, PM infections in humans are located in the soft tissue and are associated with animal bites. In rare cases, severe infection, like meningitis, can occur. In this context, it is known that surgical procedures such as mastoidectomy may contribute to meningitis, particularly in a predisposed individual.[1],[2] To the authors' knowledge, only two cases of mastoidectomy followed by PM meningitis have been reported.[3],[4] Herein, we report a case of an adult woman who had PM meningitis after mastoidectomy.
Case Report
A 51-year-old female patient presented with chronic right-sided otorrhea and ipsilateral tympanic membrane perforation within 2 months of onset. She was admitted for elective mastoidectomy with tympanoplasty. Her medical history included recurrent ear infections with otorrhea through a tympanic perforation. On neurological examination, conductive hearing loss was observed. The left otoscopy was normal, and right otoscopy showed perforated tympanic membrane with tympanosclerosis. There was no evidence of otorrhea, soft-tissue mass, crusting, or desquamated debris. Her comorbid conditions were dyslipidemia, hypertension, and major depressive disorder. She was in use of sertraline, hydrochlorothiazide, enalapril, and simvastatin.
On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures presenting with bilateral tonic-clonic movements and impaired awareness. There was no fever or focal neurological signs. Cranial computed tomography scan showed the mastoidectomy and the absence of mass or hematoma [Figure 1]. Cerebrospinal fluid (CSF) analysis revealed low glucose (5 mg/dL), high protein (114 mg/dL), and high cellularity (158/mm3) with 85% of neutrophils. Blood tests, including glucose level (90 mg/dL), were within normal limits, except for the presence of leukocytosis (20,010/mm3). Initial gram stain of the CSF showed abundant neutrophils and the absence of microorganisms. She was treated empirically for bacterial meningitis with intravenous (IV) ceftriaxone and vancomycin.
Figure 1: Images of computed tomography scan showing the right mastoidectomy, the communication between the right ear and right middle cranial fossa (indicated by the arrow). Coronal (a) and axial (b) views of head computed tomography scan. Axial with brain window (c) and coronal with bone window (d) views of computed tomography scan of the temporal bone
Two days after the neurological manifestations, PM grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillin. She was started on IV penicillin G 2 million units, every 4 h, for 14 days. After 10 days, the patient had a full recovery.
On further questioning, she admitted having a dog which lives inside her house and licks on her face frequently. In the follow-up, investigation for immunosuppression was negative.
Discussion
PM meningitis was first documented in 1925 by Claudius.[5] Since 1950, about 39 cases have been reported in the English literature. In these cases, the infection was generally associated with cranial surgery or trauma, chronic otitis media, and soft-tissue infection with secondary spread.[1],[2],[6] History of recent animal contact was reported in 89% of cases.[2]
There are only a few case reports of PM meningitis following mastoidectomy. We identified two cases after a review of the English literature, and we compared them with the present case [Table 1].[3],[4] Literature search was performed in Embase, Google Scholar, Lilacs, Medline, Scielo, and ScienceDirect, using a set of terms that included mastoidectomy, meningitis, and PM.
Table 1: Reported cases of Pasteurella multocida meningitis following mastoidectomy
In the case reported by Dammeijer and McCombe, PM meningitis occurred after a modified radical mastoidectomy due to recurrent cholesteatoma.[4] On the other hand, in the study from Pond et al., PM meningitis was associated with a typanomastoidectomy and removal of the incus and malleus with tympanoplasty performed for chronic otorrhea related to tympanic membrane perforation.[3]
The pathogenesis in PM meningitis following mastoidectomy is probably related with the contiguous spread of the bacteria from a colonized external acoustic meatus, which has contaminated the CSF during the surgery. This hypothesis is based on the preoperative growth of PM in the ear swab, the absence of clinical meningitis signs, and the development of the infection 24 h after the mastoidectomy.[3],[4]
We agree with the statement of Pond et al.[3] and Dammeijer and McCombe,[4] that any patient requiring mastoidectomy should be asked about contact with animals, and in the case of a positive answer, a preoperative ear swab is mandatory since it allows early intervention and prevents possible complications.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore) 1984;63:133-54.
International Journal of Advanced Medical and Health Research 2018 5(2):43-51
Suicide is a complex human behavior with multiple interacting determinants. Clinicians and practitioners often face difficulties in assimilating the evidence base for suicide prevention interventions, evaluating their effectiveness and decoding the best practice elements of each approach. In this article, we do not aim to provide an exhaustive coverage of every approach. Instead, we provide an overview of the following eight major suicide prevention interventions: awareness programs, screening, gatekeeper training, access to means restriction, follow-up care, hotlines, media strategies, pharmacotherapeutic and psychotherapeutic approaches. The evidence base and components of each approach are described to facilitate replication. The best practice elements are synthesized from each approach and presented to aid program development and practice. Although a number of approaches hold promise, there are difficulties in ascertaining the effective elements under each of them. Innovative research designs are needed to address this knowledge gap as it will facilitate optimal allocation of resources for suicide prevention.
International Journal of Advanced Medical and Health Research 2018 5(2):52-56
Background: Healthcare-seeking behavior is associated with the severity of infectious diseases, particularly in low-income countries. We need better understanding about the current healthcare-seeking behavior of rural people in low-resource settings. This study aimed to describe the healthcare-seeking behavior of rural people for infectious diseases and identify the associated factors. Methods: We conducted a cross-sectional survey in a rural community in Bangladesh. We interviewed a total of 450 persons to collect data on demographics, household income, household expenditure, and healthcare-seeking behavior. We performed a descriptive analysis to summarize the demographic characteristics and multivariate logistic regression analysis to identify the association between healthcare-seeking behavior and variables of interest. Results: Among the study participants, 42% went to the health facilities, 30% went to the pharmacy, 14% went to the nonregistered doctors, 1% went to the traditional healers, 1% went to the spiritual healer, and 2% took self-treatment. Proximity of the health-care facilities (prevalence ratio [PR] 1.97, 95% confidence interval [CI]: 1.55–2.49) and number of clinical symptoms (PR 1.23, 95% CI: 1–1.52) were significantly associated with the care-seeking behavior. Conclusions: Healthcare-seeking behavior for infectious diseases among rural people in Bangladesh was poor. Information obtained from this study could be useful to develop, design, and improve health-care systems in low-resource settings.
International Journal of Advanced Medical and Health Research 2018 5(2):57-65
Introduction: Lassa fever (LF) is an endemic West African viral hemorrhagic fever which presents acutely and is often fatal. This study assessed the level of knowledge about LF among the health workers in Sokoto State and also examined their cross-infection control practices against LF during ongoing outbreaks in health facilities in Nigeria. Methods: Data obtained from a total of 298 health workers in five hospitals in Sokoto metropolis, Nigeria, were used for this study. The study tool was a 25-item questionnaire. Data obtained were analyzed using the SPSS version 20 Software. Results: Three-tenth of the participants were within the age bracket of 26–30 years. About 54% were men, 54.4% were nursing officers, and 75.2% of the participants had practice ≤10 years. All of the surveyed medical doctors and dentists were aware of the ongoing LF outbreak in Nigeria. All of the dentists and medical laboratory scientists surveyed accurately identified the virus as the cause of LF. Only the dentists accurately identified Mastomys natalensis rodents as the vector for LF, and its transmission from person-person. Less than 20% of the participants in each occupational category did not know the universal precaution measures against infections, and about 12% of the respondents wore their personal protective equipment outside the surroundings of their duty posts. It was observed that more than 50% of the participants were below 60% on a scale of 1%–100% regarding their cross-infection and control practices. Conclusion: The findings obtained from this study revealed a very low level of knowledge about LF and very poor universal cross-infection control practices against LF among the health workers in Sokoto City, Nigeria.
International Journal of Advanced Medical and Health Research 2018 5(2):66-70
Introduction: Information on incidence of various transfusion reactions could help in early recognition as well as management and could also help to institute adequate measures to make blood transfusion as safe as possible. The primary objective of the present study was to determine the frequency and types of adverse transfusion reactions in patients who required blood component transfusion. Methodology: This was a cross-sectional, observational study conducted over a period of 22 months from September 2014 to June 2016 in the Department of Transfusion Medicine, JIPMER. All patients admitted to the wards of various specialty departments who were transfused with blood components and reported to have transfusion reaction during or after transfusion of blood components were included in the study. Results: A total of 90,758 components were issued during the study period, and 137 transfusion reactions were reported which accounted for 0.15% of total transfusions. Febrile nonhemolytic transfusion reaction (46.7%) was the most common reaction followed by allergic reaction (31.3%). Among different blood components, packed red blood cells (82%) were most commonly associated with transfusion reactions. Conclusion: Transfusion reactions unless serious are grossly underreported either due to lack of attributing the adverse event to transfusion or because the milder reactions are usually managed and unreported as the staff are too often used to having them, especially in chronically transfused patients.
International Journal of Advanced Medical and Health Research 2018 5(2):71-74
Human immunodeficiency virus-1 (HIV-1)/acquired immunodeficiency syndrome (AIDS) has been shown to be associated with a constellation of neuropsychiatric disorders. The presence of depressive symptoms may obscure the evaluation of cognitive manifestation of a neurodegenerative disorder like dementia associated with AIDS. Further, it is uncommon to see catatonia in association with HIV/AIDS. In this report, we present a case who had an array of psychiatric syndromes as the initial manifestation of AIDS. The subsequent management issues are also dealt with.
International Journal of Advanced Medical and Health Research 2018 5(2):75-77
Dyskeratosis congenita (DC) is a rare heritable skin disorder with progressive bone marrow failure. Psychiatric manifestations could also be a presentation of this rare skin condition. Although it has been associated with psychiatric manifestations, there is a dearth of information regarding mood symptoms in this condition. We report a 41-year-old male who had presented with predominant psychotic followed by affective symptoms and was diagnosed with DC and comorbid organic delusional and mood disorder. He was also worked up for other physical manifestations of DC.
International Journal of Advanced Medical and Health Research 2018 5(2):78-80
Pasteurella multocida (PM) is part of the normal nasopharyngeal flora of many animals. The most common PM infections occur in soft tissue, secondary to animal contact. Meningitis is rarely associated. An adult female developed chronic right-sided otorrhea and tympanic membrane perforation. Elective mastoidectomy was performed. On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures. Cerebrospinal fluid (CSF) analysis revealed low glucose, high protein, and high cellularity. Blood tests were within normal limits, except for high leukocyte count. Two days after the neurological manifestations, bacteria, identified as PM, grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillins. She was started on intravenous penicillin G. The patient had a full recovery. On further questioning, she admitted having a dog, which licks on her face frequently.
EDITORIAL
Cutting to cure to cutting down the incision: From kindest cut to virtually no cut
p. 41
Vikram Kate, Raja Kalayarasan DOI:10.4103/IJAMR.IJAMR_81_18
Suicide is a complex human behavior with multiple interacting determinants. Clinicians and practitioners often face difficulties in assimilating the evidence base for suicide prevention interventions, evaluating their effectiveness and decoding the best practice elements of each approach. In this article, we do not aim to provide an exhaustive coverage of every approach. Instead, we provide an overview of the following eight major suicide prevention interventions: awareness programs, screening, gatekeeper training, access to means restriction, follow-up care, hotlines, media strategies, pharmacotherapeutic and psychotherapeutic approaches. The evidence base and components of each approach are described to facilitate replication. The best practice elements are synthesized from each approach and presented to aid program development and practice. Although a number of approaches hold promise, there are difficulties in ascertaining the effective elements under each of them. Innovative research designs are needed to address this knowledge gap as it will facilitate optimal allocation of resources for suicide prevention.
Healthcare-seeking behavior for infectious diseases in a community in Bangladesh
p. 52
Md Shafiqul Islam Khan, Jannatul Ferdous Ani, Bithika Rani, Shafaet Jamil Apon, Fahmida Rashid, Tanjil Islam Yead, Musammet Rasheda Begum, Sukanta Chowdhury DOI:10.4103/IJAMR.IJAMR_38_18
Background: Healthcare-seeking behavior is associated with the severity of infectious diseases, particularly in low-income countries. We need better understanding about the current healthcare-seeking behavior of rural people in low-resource settings. This study aimed to describe the healthcare-seeking behavior of rural people for infectious diseases and identify the associated factors. Methods: We conducted a cross-sectional survey in a rural community in Bangladesh. We interviewed a total of 450 persons to collect data on demographics, household income, household expenditure, and healthcare-seeking behavior. We performed a descriptive analysis to summarize the demographic characteristics and multivariate logistic regression analysis to identify the association between healthcare-seeking behavior and variables of interest. Results: Among the study participants, 42% went to the health facilities, 30% went to the pharmacy, 14% went to the nonregistered doctors, 1% went to the traditional healers, 1% went to the spiritual healer, and 2% took self-treatment. Proximity of the health-care facilities (prevalence ratio [PR] 1.97, 95% confidence interval [CI]: 1.55–2.49) and number of clinical symptoms (PR 1.23, 95% CI: 1–1.52) were significantly associated with the care-seeking behavior. Conclusions:Healthcare-seeking behavior for infectious diseases among rural people in Bangladesh was poor. Information obtained from this study could be useful to develop, design, and improve health-care systems in low-resource settings.
Assessment of the level of knowledge and universal cross-infection control practices against lassa fever among health workers in Sokoto, Nigeria: A hospital survey during lassa fever outbreak in Nigeria
p. 57
Catherine Fidelis, Johnson Olajolumo DOI:10.4103/IJAMR.IJAMR_11_18
Introduction: Lassa fever (LF) is an endemic West African viral hemorrhagic fever which presents acutely and is often fatal. This study assessed the level of knowledge about LF among the health workers in Sokoto State and also examined their cross-infection control practices against LF during ongoing outbreaks in health facilities in Nigeria. Methods: Data obtained from a total of 298 health workers in five hospitals in Sokoto metropolis, Nigeria, were used for this study. The study tool was a 25-item questionnaire. Data obtained were analyzed using the SPSS version 20 Software. Results: Three-tenth of the participants were within the age bracket of 26–30 years. About 54% were men, 54.4% were nursing officers, and 75.2% of the participants had practice ≤10 years. All of the surveyed medical doctors and dentists were aware of the ongoing LF outbreak in Nigeria. All of the dentists and medical laboratory scientists surveyed accurately identified the virus as the cause of LF. Only the dentists accurately identified Mastomys natalensis rodents as the vector for LF, and its transmission from person-person. Less than 20% of the participants in each occupational category did not know the universal precaution measures against infections, and about 12% of the respondents wore their personal protective equipment outside the surroundings of their duty posts. It was observed that more than 50% of the participants were below 60% on a scale of 1%–100% regarding their cross-infection and control practices. Conclusion: The findings obtained from this study revealed a very low level of knowledge about LF and very poor universal cross-infection control practices against LF among the health workers in Sokoto City, Nigeria.
Introduction: Information on incidence of various transfusion reactions could help in early recognition as well as management and could also help to institute adequate measures to make blood transfusion as safe as possible. The primary objective of the present study was to determine the frequency and types of adverse transfusion reactions in patients who required blood component transfusion. Methodology: This was a cross-sectional, observational study conducted over a period of 22 months from September 2014 to June 2016 in the Department of Transfusion Medicine, JIPMER. All patients admitted to the wards of various specialty departments who were transfused with blood components and reported to have transfusion reaction during or after transfusion of blood components were included in the study. Results:A total of 90,758 components were issued during the study period, and 137 transfusion reactions were reported which accounted for 0.15% of total transfusions. Febrile nonhemolytic transfusion reaction (46.7%) was the most common reaction followed by allergic reaction (31.3%). Among different blood components, packed red blood cells (82%) were most commonly associated with transfusion reactions. Conclusion: Transfusion reactions unless serious are grossly underreported either due to lack of attributing the adverse event to transfusion or because the milder reactions are usually managed and unreported as the staff are too often used to having them, especially in chronically transfused patients.
Human immunodeficiency virus-associated neurocognitive disorder masquerading as psychiatric illness
p. 71
Jitender Aneja, Navratan Suthar, Gopal K Bohra, Pawan Garg DOI:10.4103/IJAMR.IJAMR_31_18
Human immunodeficiency virus-1 (HIV-1)/acquired immunodeficiency syndrome (AIDS) has been shown to be associated with a constellation of neuropsychiatric disorders. The presence of depressive symptoms may obscure the evaluation of cognitive manifestation of a neurodegenerative disorder like dementia associated with AIDS. Further, it is uncommon to see catatonia in association with HIV/AIDS. In this report, we present a case who had an array of psychiatric syndromes as the initial manifestation of AIDS. The subsequent management issues are also dealt with.
Dyskeratosis congenita (DC) is a rare heritable skin disorder with progressive bone marrow failure. Psychiatric manifestations could also be a presentation of this rare skin condition. Although it has been associated with psychiatric manifestations, there is a dearth of information regarding mood symptoms in this condition. We report a 41-year-old male who had presented with predominant psychotic followed by affective symptoms and was diagnosed with DC and comorbid organic delusional and mood disorder. He was also worked up for other physical manifestations of DC.
Pasteurella multocida meningitis following mastoidectomy: A case report and literature review
p. 78
Jamir Pitton Rissardo, Ana Letícia Fornari Caprara DOI:10.4103/IJAMR.IJAMR_35_18
Pasteurella multocida (PM) is part of the normal nasopharyngeal flora of many animals. The most common PM infections occur in soft tissue, secondary to animal contact. Meningitis is rarely associated. An adult female developed chronic right-sided otorrhea and tympanic membrane perforation. Elective mastoidectomy was performed. On the postoperative day 2, the patient experienced a decreased level of consciousness, headache, nausea, and seizures. Cerebrospinal fluid (CSF) analysis revealed low glucose, high protein, and high cellularity. Blood tests were within normal limits, except for high leukocyte count. Two days after the neurological manifestations, bacteria, identified as PM, grew in the aerobic cultures of CSF and preoperative ear swab. The isolate was sensitive to penicillins. She was started on intravenous penicillin G. The patient had a full recovery. On further questioning, she admitted having a dog, which licks on her face frequently.
