A case of neglected hepatorenal dysfunction during the COVID pandemic.

As the world fights with the Coronavirus, most of the hospitals are gearing up for the care of these patients. As most of the attention these days is being given on Coronavirus, the patients suffering from other clinical infections are being neglected. SARS-CoV-2 is being kept as the top differential in patients presenting with fever and respiratory distress. We hereby present a case of patient returning from Indonesia during the pandemic presenting with a history of hepatic, renal dysfunction with fever and cough. Due to the pandemic, the patient's fever and cough outweighed the hepatic and renal dysfunction, and the patient had to undergo dialysis before the final diagnosis of leptospirosis could be made.

Comparison of ultrasound-guided versus conventional palpatory method of dorsalis pedis artery cannulation: A randomized controlled trial.

BACKGROUND: Whether use of ultrasound (USG) to cannulate dorsalis pedis artery (DPA) increases first pass successful cannulation, decreases the number of attempts and complications as compared to palpation technique was assessed in this study. DESIGN: Randomized controlled trial. SETTING: Operating room. PATIENTS: About 60 adult patients undergoing any head-neck or faciomaxillary surgery requiring arterial cannulation were enrolled. INTERVENTION: DPA was cannulated either by USG-guided technique (USG group) or by palpation technique (palpation group) with 30 patients in each group. MEASUREMENT: Data were assessed for "first-attempt success" of cannulation, number of attempts, assessment time, cannulation time, cannulation failure, and incidence of complications. MAIN RESULTS: Successful first pass DPA cannulation was similar between the groups (ultrasound group vs. palpation group, 76.7% vs. 60%, respectively) [relative risk (95% confidence interval (CI) = 0.69 (0.43, 1.13), P = 0.267)] as was the number of attempts required for successful cannulation [median (interquartile range (IQR) number of attempts 1 (1-2) in palpation group P and USG group U 1 (1-1); P = 0.376]. Median (IQR) assessment time was significantly less (P < 0.0004) in palpation group [palpation group 12 (9-17) vs. USG group U 19 (15-21)]. However, cannulation time was significantly higher (P = 0.0093) in Group P [median (IQR) 17.5 (12-36 s) and 11.5 (9-15)]. Although the total procedure time (sum of both assessment time and cannulation time) remain statistically similar between two groups (P = 0.8882). CONCLUSIONS: Use of USG for the cannulation of DPA is feasible, but it is not associated with significant increase in first-attempt success rate, decrease in total number of cannulation attempts or total procedure time.