Carbon monoxide-related fatalities: A fifteen-year single institution experience.

Introduction: The winter climate in Delhi is severe, with temperatures dropping below 10°C. As a result, individuals often resort to utilizing diverse heat sources such as electrical heating appliances, coal and gas geysers. Unfortunately, these sources are commonly associated with the emission of carbon monoxide (CO) which can accumulate in inadequately ventilated spaces. Exposure to this noxious gas can lead to acute lethargy and debilitation, leaving individuals in a state of helpless distress. Materials and Methods: The present study utilized a retrospective descriptive analysis to examine cases of fatal carbon monoxide exposure retrieved from the Department of Forensic Medicine archives at the esteemed All India Institute of Medical Sciences, New Delhi. Autopsy records were thoroughly examined with respect to various parameters including age, gender, seasonality of the incident, circumstances surrounding the death, source of carbon monoxide generation, post mortem observations, as well as toxicological analysis reports. Results and Discussion: This study entailed an analysis of 56 individuals who fell victim to carbon monoxide poisoning, with a staggering 95% of fatalities occurring during the winter season. The majority of the individuals affected belonged to the age bracket of 21-30 years. The most common sources of carbon monoxide exposure were linked to the use of coal-burning earthen or iron vessels for room heating, as well as structural fires. With the exception of one case, all incidents were accidental in nature. Additionally, nearly all of the victims were discovered in enclosed spaces with heating equipment in close proximity, and evidence of a struggle was noted on the crime scene or with the deceased. Conclusion: The findings of this study indicate that the principal contributor to the inadvertent build-up of lethal concentrations of carbon monoxide gas is the utilization of heating appliances within inadequately ventilated, enclosed spaces. Due to the scentless and non-irritating properties of this gas, individuals who are asleep may be unable to detect its presence in their surroundings, thereby leading to a silent death. To mitigate such risks, the installation of carbon monoxide detectors is crucial. Additionally, it is of utmost importance to raise public awareness regarding the perils associated with using fire pots, coal burning and electrical heating appliances in areas with insufficient ventilation.

Monitored Anesthesia Care (MAC) as an Alternative to General Anesthesia (GA): Prospective Double-Blinded Randomized Controlled Study Comparing Efficacy and Safety of Dexmedetomidine and Ketamine Infusions with Ultrasonography (USG) Guided Pectoral Nerve Block (PECs) for Postoperative Analgesia in Breast Surgery.

BACKGROUND AND PURPOSE: PECs blocks are usually combined for breast surgery under general anesthesia (GA) to provide postoperative analgesia rather than primary anesthesia technique. MATERIAL AND METHODS: A prospective, interventional, single-center, double-blind, randomized, parallel-group, active-controlled, Helsinki protocol-compliant clinical study was conducted in a tertiary care teaching center after obtaining the Ethics Committee's approval and patients' written informed consent. Forty-eight American Society of Anesthesiologists physical status I/II patients aged 18-60 years, undergoing elective unilateral breast surgery were enrolled. Patients were block-randomized (computer-generated) to two equal groups (24 patients each), with one of them receiving Dexmedetomidine and the other one Ketamine. For concealment, sequentially numbered, sealed, opaque envelopes were used. The study was double-blinded for both the anesthesiologist and outcome assessor anesthesiologist. Obese patients (body mass index > 30), those with infection at block site, coagulopathy and known hypersensitivity to local anesthetics or study medications as well as individuals who refused participation in research were all excluded. The Dexmedetomidine group received a bolus of 0.5 mcg/kg over ten minutes, followed by an infusion of 0.3 mcg/kg/hour, while the Ketamine group received a bolus of 0.5 mg/kg over ten minutes, followed by an infusion of 0.3 mg/kg/hour. Postoperative analgesia was compared using a visual analogue scale (VAS) at regular intervals. When VAS exceeded four, 1 mg/kg intravenous Pethidine was administered as a rescue analgesic. RESULTS: Sub-anesthetic low-dose Ketamine was more effective than low-dose Dexmedetomidine in prolonging PECs block analgesia, which was statistically significant (p value < 0.001). The Ketamine group had lower rescue analgesic Pethidine consumption and longer first-rescue analgesia demand time. There was no significant hemodynamic difference between the study groups. CONCLUSION: Ketamine was more efficient than Dexmedetomidine for postoperative analgesia.

Impaired Vibratory and Reciprocal Inhibition in Soleus H-Reflex Testing in Children With Spastic Cerebral Palsy.

Introduction Cerebral palsy (CP) is a neurodevelopmental condition that results from an injury to a developing brain. Children with CP fail to execute precise, well-coordinated movements, and excessive muscular co-contraction or co-activation is a prominent attribute of CP. The normal reciprocal relationship between agonists and antagonists during voluntary movements is altered in patients with CP. H-reflex, which is often regarded as the electrical equivalent of the spinal stretch reflex, can be used to examine the overall reflex arc, including the Ia sensory afferent strength and the spinal motoneuron excitability state. Furthermore, neuromodulatory influence of vibration on H-reflex has been found, which has been increasingly investigated to ascertain its potential use as an intervention in patients with increased spinal reflex excitability. Our goal was to identify the brain mechanism underlying the motor deficits by studying Soleus H-reflex changes during voluntary movement (dorsiflexion) and also to determine the role of vibration in H-reflex modulation in children with spastic CP. Methods Soleus H-reflex was recorded in 12 children with spastic CP (10-16 years) and 15 age-matched controls. Recordings were obtained at rest, during dorsiflexion, and during vibratory stimulation for each subject. H-responses (Hmax amplitudes and Hmax-to-Mmax ratio) were compared among the controls and the cases (CP), for the experiments performed, by the Wilcoxon signed-rank test. The recruitment curves depicting the distribution of mean H-response amplitudes with stimulus intensity increment, for dorsiflexion and vibration were compared among controls and cases by the two-sample Kolmogorov-Smirnov (KS) test. p-value <0.05 was considered as statistically significant. Results Hmax amplitudes and the Hmax-to-Mmax ratio increased (15 % and 12.2 % increment, respectively) from the resting values in the children with CP (p<0.05), while controls exhibited a decrease (reduction of 62% and 57 %, respectively) during dorsiflexion (p<0.05). Vibratory stimulation produced a decreasing trend in H-response measures in both the groups. There was about 15 % and 16 % reduction respectively among children with CP while that of 24 % and 21 % respectively among the controls. The differences in the recruitment curves (distribution of average H-response amplitudes with stimulation intensity) recorded during dorsiflexion and vibration experiments among controls compared with those with CP were found to be statistically significant by the two-sample KS test (p<0.0001). Conclusion The failure of H-reflex suppression during voluntary antagonist muscle activation suggests the presence of impaired reciprocal inhibition in spastic CP. The relatively modest H-response reduction caused by vibratory stimulation in children with CP provides limited evidence of vibratory regulation of the H-reflex in CP. More research into the mechanisms driving motor abnormalities in children with CP is needed, which could aid in therapy planning.

Pregabalin Dependence and Management in a 55-Year-Old Female with Chronic Low Back Pain.

This case report explores the complexities of managing chronic pain and the subsequent development of pregabalin dependence in a 55-year-old female patient with a prior history of vertebral fracture. Over a period of 10 years, the patient relied on a combination of Aceclofenac and pregabalin to alleviate her pain. An alternative treatment approach was implemented, involving adjustments to medication dosages and gradual tapering. Throughout the treatment process, interdisciplinary collaboration played a pivotal role in addressing unexpected symptoms such as facial movements and neck swelling. This case report highlights the significance of recognizing and addressing pregabalin dependence in patients with chronic pain.

Epidemio-toxicological profile of fatal poisoning cases autopsied at a tertiary care centre of North India.

Background: Poisoning is an important health hazard and one of the leading causes of morbidity and mortality worldwide including in India. The study was conducted to understand the magnitude, pattern, and gender differentials of all poisoning fatalities in relation to the manner of death autopsied at a tertiary care center. Methods: A retrospective study of all fatal poisoning cases autopsied at the department of Forensic Medicine & Toxicology of a tertiary care institute in Northern India for the period 1st January 1998 to 31st December 2017 was conducted, and a profile of the victims of fatal poisoning was prepared. Data were analyzed with descriptive and inferential statistics. Results: The study included a total of 1099 cases of fatal poisoning autopsied at the department of Forensic medicine & Toxicology. Suicidal poisoning was reported in 90.2% of cases and accidental poisoning was seen in 8.9% of cases. Males were predominantly affected (63.8%). The majority of the victims were in the 3rd decade (40.0%) of life. The age of the victims ranged from 2 to 82 years with a mean age of 38.4 years. Agrochemical compounds were implicated in 44.4% of the total fatalities. Conclusion: Males in the 2nd to 4th decades of life were more prone to self-poisoning with Agrochemical compounds in the region of North India. Accidental poisoning deaths were uncommon and poisoning was not a preferred method of homicide in this region. Our approach to the study reveals that quantitative chemical (toxicological) analysis is required to further strengthen and improve the databases of the epidemiology of poisoning in this region.

COVID-Related suicide during the second wave of COVID-19 pandemic in India: A tip of the iceberg of mental health problems.

The coronavirus disease (COVID-19) pandemic has influenced the entire world. There has been great surge of mental health problems after the pandemic has started. The second wave has almost exhausted the Indian Health care system. There has also been cases of suicide due to COVID-19 infection. The objective of study was to highlight various factors involved in COVID-19 related suicide (CRS) during second wave of COVID-19 pandemic in India. CRS reports on the websites of 10 popular newspapers and television news channels in North India and official government websites such as the Ministry of Health and Family Welfare were searched between February 1, 2020, and May 31, 2021. We also searched the Medline and Google Scholar databases for CRS reports from India using the terms "corona", "COVID-19", "SARS CoV 2", "India", and "suicide" in various combinations. A total of 62 articles were included for the study. Most common mode of suicide was hanging and most common site was the deceased's home. Fear of infecting family members was the most common cause of CRS during second wave of the ongoing pandemic in India. Many individuals lost their lives to suicide due to COVID-19 pandemic. The media report does not provide the exact picture of community suicide. Proper physician counselling at the time of providing treatment can help in reducing few CRS.

Sleep Patterns, Issues, Reasons for Sleep Problems, and Their Impact on Academic Performance among First-Year Medical Students in Central India.

Introduction:Sleep is an essential part of the human daily routine. Studies have shown that sleep deprivation causes and worsens a wide range of psychological problems in people of all ages. Undergraduate students' sleep disorders are likely to persist and worsen over time. Medical students who work with sick patients on a daily basis and perform skilled activities find that sleep is very important for them. Aims and objectives: The main objective of the present study was to determine undergraduate medical students' sleeping habits as well as the numerous causes of sleep disorders. The secondary aim of our research was to determine the influence of sleep-related problems on students' academic performance. Methods:Following approval from the Ethics Committee, a cross-sectional study of 171 first-year medical students was conducted using a semi-structured self-administered questionnaire. Data was collected using Google Forms on the internet. Microsoft Excel 2019 was used to enter and analyze data. Prevalence was expressed as percentage with a 95% confidence interval. The mean and standard deviation of continuous variables was reported. Results:Of all included students, 39.2% reported they had six to seven hours of sleep each day. Study-related reasons were indicated by 32.6% of students, followed by those who utilized social media (21.7%). Laziness, exhaustion, annoyance, and restlessness were the top reasons for sleeping less (27.5%). Prior academic success was significantly connected to sleep length, while current sleep duration was not.

Understanding health care seeking behavior in a tribal setting in West Bengal.

Background: The health-related problems of the tribal population depend on their ecology and culture. Often the tribal people do not utilize the medical and preventive health services available to them. Health problems in tribal groups need special attention because many tribal communities are backward. The current study was planned to determine the healthcare-seeking behavior of the tribal population in India. Method: A descriptive, cross-sectional study, conducted by interviewing key respondents of each participating family. Result: Two-thirds of the key respondents were literate and half (53.8%) of the total households in the three villages had a per capita monthly income between Rupees 500-1499. More than half (57%) of all respondents preferred government institutions for moderate illness, and the rest equally opted for private practitioners and quacks. However, for emergencies, dog bites, and snake bites, all key respondents in the three study villages unanimously preferred government institutions. A significant population (38.5%) got their children delivered at home. The majority of illiterate respondents (86.1%) preferred government institutions for health care of under-five children, while 60% of literates expressed a similar view. The choice of government institutions as a source of health care was increasingly favored with decreasing per capita monthly household income. Conclusion: Traditional healers are no longer preferred among the tribal population but they are reluctant to avail them because of the loss of valuable time. Home delivery is still prevalent. With improving socioeconomic status, people are going further away from government services as private practitioners, and quacks take less time.

The need for physical medicine and rehabilitation as an integral component in the medical education curriculum in India.

Enhanced quality of health care and increased life expectancy come with issues about the quality of life. This challenge is especially relevant to physical medicine and rehabilitation (PM and R)-a specialty focused on enhancing the quality of life. With the increasing burden of chronic diseases and disabling conditions, requirement for PM and R specialists will increase. This narrative review discusses the changing demographics, the disability trends, and the unmet needs both at present and anticipated in future. We also discussed problems faced by the present training system in PM and R, identified the lacunae, and attempted to provide suggestions to fill those.

International Classification of Functioning, Disability, and Health augmented by telemedicine and artificial intelligence for assessment of functional disability.

The concept of functional disability is aligned with the biopsycho-social model of disability. However, there are reasons why the antiquated measurement of medical impairment continues to be in use. We propose solutions for a fairer process using the International Classification of Functioning, Disability, and Health (ICF) at the level of the medical boards augmented by telemedicine and artificial intelligence (AI). The proposed technologies (Level 1 and Level 2 AI) need to be tried in pilot projects. It will accomplish two goals, the first being the measurement of disability and not merely the impairment. Second, and perhaps more importantly, making the process more transparent in creating a "just" society.

Comparing Effectiveness of Combination of Collagen Peptide Type-1, Low Molecular Weight Chondroitin Sulphate, Sodium Hyaluronate, and Vitamin-C Versus Oral Diclofenac Sodium in Achilles Tendinopathy: A Prospective Randomized Control Trial.

Background Achilles tendinopathy, a common cause of heel pain, is primarily considered mechanical in origin, but its pathogenesis and treatment lack consensus. Molecules such as collagen peptide type-1, low molecular weight chondroitin sulphate, sodium hyaluronate and vitamin C have been shown to act as building blocks of tendon structure, and oral supplementation of these have promising results in Achilles tendinopathy. Methods This study was a prospective randomized control trial to compare the effectiveness of oral diclofenac sodium versus a nutraceutical combination of collagen peptide type-1, chondroitin sulphate, sodium hyaluronate, and vitamin C in the treatment of Achilles tendinopathy on pain and ultrasonographic structures. A total of 40 patients satisfying inclusion and exclusion criteria were randomly allocated into two groups and were given the nutraceutical combination in group A and diclofenac sodium in group B. The patient evaluation was done at baseline, six-week, and 12-week intervals in terms of VAS (Visual Analogue Scale) and tendo-Achilles thickness by ultrasound. Results Both nutraceutical combination and diclofenac reduced pain in persons with Achilles tendinopathy. The nutraceutical combination had a statistically significant better outcome in reducing pain at the end of 12 weeks. On ultrasound, both the interventions reduced Achilles tendon anteroposterior and mediolateral thickness by the end of 12 weeks. Although there was no absolute significant intergroup difference, the percentage change was more in the nutraceutical group in the case of anteroposterior thickness. Conclusion Combining collagen peptide type-1, low molecular weight chondroitin sulphate, sodium hyaluronate, and vitamin C is more effective than oral diclofenac in controlling pain in Achilles tendinopathy.

Digitization of disability certification using technology to curtail infringement of dignity.

Privacy and dignity are the rights of every human being. The disability certificate issued has the medical diagnosis mentioned explicitly as well as the patients' photograph. A person with disability needs to produce a certificate to avail the benefits, which the law of the land accords. This article discusses the dignity and privacy issues, which may be felt while producing such a certificate before competent authorities and proposes a blinded disability certificate. Besides, the proposed certificate uses advanced technologies to link a functioning profile to a cloud-based central database.

Efficacy of a local corticosteroid injection on pain, disability and radial nerve thickness in patients with lateral epicondylitis.

Introduction: The aim of this study was to compare the effect of a steroid injection with conservative therapy (CT) versus CT alone on pain, functional limitations and the cross-sectional area (CSA) of the radial nerve (RN) in patients with lateral epicondylitis (LE). Methods: In this clinical trial, seventy subjects in the age group of 30-60 years with a clinical diagnosis of LE were recruited. Patients received an ultrasound-guided steroid injection and CT (Group A, n = 35) or CT alone (Group B, n = 35). Pain intensity (numeric pain rating scale), functional limitations (Quick Disabilities of the Arm, Shoulder, and Hand questionnaire) and the CSA of RN (mm2) using ultrasound were assessed at baseline, 4 and 12 weeks. Results: There was a significant difference in pain intensity (P < 0.05) at 4 weeks in favour of Group A but not at 12 weeks. A statistically significant difference was not present favouring either group concerning disability at both the follow-ups. The difference in CSA of the RN at the affected side in both groups A and B was not statistically significant at either the spiral groove or the antecubital fossa at baseline or the subsequent follow-ups. Conclusions: The CT with a steroid injection proved to be more efficacious in the short term concerning pain intensity and functional limitations. The RN thickness is not increased in patients with LE, thereby refuting its role to some extent in the pathogenesis of LE.