Family Satisfaction of Polytrauma Patients in Intensive Care Unit at a Tertiary Care Center.

BACKGROUND: Family members play a crucial role in ICU patients' treatment and decision-making, despite the stress and uncertainty they may experience, ensuring high-quality medical care. Providing comfortable spaces with noise-reducing techniques can boost family satisfaction. Further research is needed to support families in intensive care units (ICU). This study aims to evaluate family satisfaction and decision-making in polytrauma patients in the ICU, identify improvement opportunities, and analyze demographic and socioeconomic factors influencing satisfaction. METHODS: This cross-sectional study was conducted at King George's Medical University, Lucknow, over a period of one year. A total of 66 patients, aged between 20 and 70, their family members, and those who gave written informed consent were included. Exclusion criteria included those who died within 48 hours of ICU admission or did not give consent. Patient characteristics, such as age, sex, Acute Physiology and Chronic Health Evaluation (APACHE) II score, and hospital stay length, were also collected. The family satisfaction in the intensive care unit (FS-ICU) questionnaire, consisting of 24 items with five Likert response options, was used to assess satisfaction levels in ICU care and decision-making. RESULTS:  A study of 66 patients which included 78.79% male and 21.21% female. The majority of the patients (66.67%) lived with their family members. The mean ICU stay was 13.03 days, with an APACHE score of 17.39. The results showed that families were very satisfied with a considerable portion of the ICU stay. The overall satisfaction score was 57.00. Families were less satisfied with the atmosphere in the ICU and involvement in the decision-making process. The satisfaction scores were comparable for both genders, except for the time taken to respond to questions, which was significantly higher for women. CONCLUSION: Although families were very satisfied with the ICU stay, several areas were identified as having potential for improvement. The present study shows that the quality of treatment and communication during hospitalization is a major factor in the need for follow-up care. This underlines the need for a constant focus on communication skills in the training of nurses and doctors and in their practical training in the ICU. Participation in decision-making, especially by family members of survivors, was identified as an area for improvement. We recommend more research to be conducted in India focusing on family satisfaction with involvement in the decision-making in ICU considering the unique racial, cultural, ethnic, and linguistic differences in India.

Isolated Pyomyositis of the Thigh With a Sinus Tract: A Rare Presentation of Tuberculosis.

Muscular tuberculosis as a primary focal lesion in an immunocompetent individual without any underlying bone involvement is a rare finding. The authors present a case of a young female in her 30s who presented with complaints of recurrent discharging sinus in the posteromedial aspect of the proximal right thigh for eight months. The patient was treated by surgical debridement followed by antitubercular therapy (ATT) and has shown full recovery during the post-eight-month treatment period. Such a presentation of primary tubercular pyomyositis imposes a diagnostic as well as a therapeutic challenge.

Insulin and early debridement keys to survival in-COVID 19 associated mucormycosis patients(CAM)- An experience from tertiary care hospital In India.

Introduction: Amid the second wave of COVID 19 India witnessed a surge of mucormycosis cases. This worsened the already existing health emergency. India a diabetic capital had all the favourable factors to support the growth of black fungus. This study was conducted with objectives of ascertaining patient characteristics, clinical type of mucormycosis, predisposing factors, predictors of survival and long term outcome of survivors. Materials and methods: An ambispective study of COVID 19 associated mucormycosis patients admitted in mucor ward of tertiary care hospital between May 2021- August 2021 was done. Study was approved by Institute Ethical Committee. Demographic characteristics, presence of risk factors, clinical sign and symptoms, mode of diagnosis, treatment given, final outcome and long term follow up for a period of 1 year from discharge was done. Results: 367 CAM patients were included in the study. 72.5%(n = 266) were men and 27.5% (n = 101) were females. Mean age group was 51.3 years (SD 12.4 years). Most important comorbidity was diabetes( n = 320,87.2%), followed by cardiovascular disease (n = 68, 18.5%) and hypertension (n = 58,15.8%). Other predisposing factors were use of oxygen (n = 367,100%), antibiotics( n = 213,58%) and steroids (n = 272, 74.1%). Dexamethasone was the most commonly used steroid (n = 218,59.4%). Rhino orbital cerebral mucormycosis was the most common type. 83.7% patients (n = 307) survived and 16.3% (n = 60) succumbed to illness. Kaplan Meir survival analysis curve showed use of insulin (p = 0.025), early debridement ( p < 0.05) significantly increased survival rate. Similarly patients with lesions involving, face (p < 0.05) and nose (p = 0.014) had much better outcome as compared to disseminated forms. Only 96 patients remained in follow up. Of these patients no significant alteration in metabolic profile was noted and they remained euglycemic on oral hypoglycaemics. Conclusion: Early debridement and insulin use are keys to improved survival. Oxygen, Steroids and antibiotics are the risk factors for mucormycosis. Diabetes is the most important comorbidity.

Revisiting extracranial cysticercosis: A rare case series of mycoparasitism affecting the cervicofacial region from an endemic zone.

A systemic parasitic infestation caused by the larval stages of the pork tapeworm, Taenia solium is known as Cysticercosis. While encysted form of the larval stage is attributed to rare variant of Cysticercosis of soft tissues. Muscle infestation by this parasite can lead to vague clinical presentation. We are presenting a series of 4 rare cases of extracranial, cervicofacial cysticercosis their clinical attributes and imaging characteristics leading to diagnosis of cysticercosis and approach to successful outcome with pharmacotherapy alone that spared the need of surgical management.

Mussel-Inspired Adhesive Hydrogels Based on Laponite-Confined Dopamine Polymerization as a Transdermal Patch.

Transdermal patch for local drug delivery has attained huge attention as an attractive alternative to existing drug delivery techniques as it is painless and user-friendly. However, most adhesive hydrogels either do not have adequate adhesion with the skin or cause discomfort while being removed from the skin surface due to excessive adhesion. To address this challenge, we developed an adhesive hydrogel based on laponite-confined dopamine polymerization as a transdermal patch. Laponite RDS nanoclay was used to control the hydrogel's viscous behavior and dopamine polymerization. The laponite polymerized polydopamine (l-PDA) was incorporated into poly(vinyl alcohol) (PVA) to make the PVA-l-PDA hydrogel. The laponite-confined polymerization improved the hydrogels' water contact angle and adhesion strength. The adhesion strength of the PVA-l-PDA hydrogel was adequate to adhere to the evaluated goat skin, glass, and polypropylene surfaces. Notably, the PVA-l-PDA hydrogel was easy to peel off from the skin. Further, we evaluated the drug release profile in goat skin using lidocaine as a model drug. We observed the controlled release of lidocaine from the PVA-l-PDA hydrogel compared to the PVA-PDA hydrogel. In addition, the nanoclay-confined adhesive hydrogel did not show any cytotoxic effect in fibroblasts. Altogether, PVA-l-PDA hydrogels offer appropriate adhesive strength, toughness, and biocompatibility. Thus, the PVA-l-PDA hydrogel has the potential to be an efficient transdermal patch.

Varicosity of a single breast: a rare entity.

Varicosity of the breasts is a rare clinical entity that may lead to symptoms such as prominent vascular markings over the breasts and may be painless; in long-standing cases it can lead to recurrent bleeding episodes. Bilateral venous affection in the breasts has been described in the literature; however, unilateral affection is a rarely documented phenomenon. Since vascular affliction of a single breast is rare and there is inherent difficulty in obtaining a histopathological diagnosis against a background of suspicion of malignancy, it is always challenging to provide optimal management to the patient. We are reporting a rare case of a 42-year-old, postmenopausal Indian woman with a long-standing history of unilateral varicosity of the left breast, who was treated successfully with a simple mastectomy; postoperative histopathology was consistent with benign vascular lesion, that is, angiomatosis.

Myoparasitism mimicking parotid swelling: a rare presentation of cysticercosis.

Muscular infestation with larval stage of Taenia solium is a well-recognised entity but cysticercosis of the head and neck region is a rarity. We present a case of 35-year-old young man with diffuse swelling of 3.5×4 cm in the parotid region on the right side of the face with signs of inflammation. Diagnosis was established on high-resolution ultrasonography which revealed it to be of parasitic origin. The patient was managed with antihelminthic pharmacotherapy and improved within a month. Thus cysticercosis should be considered in the differential diagnosis of subcutaneous swellings of the head and neck region, especially in endemic zones and it must be investigated well with appropriate imaging modalities so that inadvertent surgery can be avoided.