Total Antioxidant Status and Oxidative Stress in Patients with COVID-19 Infection.

INTRODUCTION: Oxidative stress (OS) may have a role in the pathogenesis and severity of the coronavirus disease 2019 (COVID-19) disease. The present study was conducted to estimate the association of inflammatory markers, total antioxidant status (TAS), and malondialdehyde (MDA) levels with the severity of the disease and to identify their trends after recovery. MATERIALS AND METHODS: Adult patients admitted with moderate or severe COVID-19 were included after obtaining written informed consent from patient or next of kin. Patients who were critically ill, on ventilator, or in sepsis/septic shock were excluded. Levels of inflammatory markers, TAS, and OS as measured by MDA were estimated within 24 hours of admission and reevaluated at 12 weeks following discharge. RESULTS: The mean age of the 40 patients (42.5% females) was 55 ± 15 years. TAS values (in trolox equivalents/L) were significantly reduced in severe compared to moderate COVID-19 patients at admission (7.2 ± 4.19 vs 12.3 ± 5.21). These increased at 12 weeks after discharge. The MDA levels (in nmol/mL) were significantly higher in severe in comparison to moderate disease (7.1 ± 2.68 vs 4.1 ± 1.81). These values showed a downward trend 12 weeks after discharge in severe disease group. Admission levels of interleukin-6 (IL-6), D-dimer, and lactate dehydrogenase (LDH) were statistically higher in severe COVID-19 patients in contrast to moderate disease. CONCLUSION: Moderate and severe COVID-19 are associated with a state of high OS and a low total antioxidant levels which tend to recover at 3 months following discharge.

Radiation protection and standardization.

X - Rays has become integral and indispensable part of health care diagnosis and intervention. Intervention procedures in Orthopedics surgery now mostly performed under image intensifiers (C-Arm) which involve the risks of occupational overexposure of radiation to the patients and health care personnel. The principles of radiation protection are helpful in keeping radiation exposure just adequate for diagnostic and intervention procedures. Regular surveillance of protective apparel is necessary for longevity of safety. It is responsibility of all OT personnel to know and implement radiation safety. Each situation involving X-ray radiation should include justification of the procedure, minimum radiation exposure just adequate for diagnostic and interventional procedures.

Adult Intraosseous Access by Advanced EMTs: A Statewide Non-Inferiority Study.

OBJECTIVE: Intraosseous (IO) access is increasingly being used as an alternative to peripheral intravenous access, which is often difficult or impossible to establish in critically ill patients in the prehospital setting. Until recently, only Paramedics performed adult IO access. In 2014, Vermont Emergency Medical Services (EMS) expanded the Advanced Emergency Medical Technicians (AEMTs) scope of practice to include IO access in adult patients. This study compares successful IO access in adults performed by AEMTs compared to Paramedics in the prehospital setting. METHODS: All Vermont EMS patient encounters between January 1, 2013 and November 30, 2015 were examined, and 543 adult patients with a documented IO access insertion attempt were identified. The proportion of successful IO insertions was compared between AEMTs and Paramedics using a Chi-Squared statistic and a non-inferiority test. RESULTS: There was no significant difference in the percentage of successful IO access between AEMTs and Paramedics [95.2% and 95.6%, respectively; P = 0.84]. The confidence interval around this 0.4% difference (95% confidence interval = -4.2, 3.2) was within a pre-specified delta of ±10% indicating non-inferiority of AEMTs compared to Paramedics. CONCLUSIONS: This study's finding that successful IO access was not different among AEMTs and Paramedics lends evidence in support of expanding the scope of practice of AEMTs to include establishing IO access in adults.

Delayed Presentation of Osteochondroma at Superior Angle of Scapula-A Case Report.

INTRODUCTION: Osteochondroma or exostosis is most common primary benign bony tumor comprising of more than one third of the total occurrences. Osteochondromas are considered as an aberration in the normal physial growth plate and originate from the metaphysis of long bone with more than third (35-46%) of cases affecting the bone around the knee (lower end femur> upper end tibia), 10% cases involve the small bones of the hand and 5% involve the pelvis and flat bones like scapula (4-6%) are least involved. These tumors usually affect the growing skeleton and cease to increase in size after skeletal maturity. These are usually painless but may become painful due to neurovascular entrapment/compression, fracture at the stalk, bursal inflammation or malignant transformation. CASE PRESENTATION: This article presents a case of osteochondroma on superior angle of scapula in a 23-year-old male presented with pseudo winging and snapping of scapula, crepitus on scapulothoracic motion and occasional pain since 5 years. However, there was no increase in size of the swelling or local and systemic signs of malignant transformation. X-ray demonstrated a pedunculated exophytic mass on supero medial aspect of the right scapula. The findings were confirmed on CT and excision of the lesion was done. The patient demonstrated full painless range of motion after 1 month and no recurrence was demonstrated during 1 year follow up. CONCLUSION: Scapular osteochondroma is a relatively rare condition. Usually a patient presents in early to late childhood, however, in some cases it may be presented in adults. Growth after maturity is indicative of a metastatic transformation. So an excision of the same should be accompanied with histopathological examinations.

Remitting seronegative symmetrical synovitis with pitting oedema.

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE) is a rare clinical entity often mimicking more common diseases like rheumatoid arthritis (RA) and polymyalgia rheumatica (PMR). Although the exact aetiology is not clear, yet it responds dramatically to low doses of steroids with excellent prognosis unlike RA and PMR. We report a case of 72 year old male agriculturist by profession presenting with acute polyarthritis and pitting oedema of both hands and feet as well as pretibial areas, diagnosed to be a case of RS3 PE.

Seroprevalence of hepatitis C virus (HCV) in health care workers of a tertiary care centre in New Delhi.

Hepatitis C virus (HCV) is a parenterally transmitted virus that poses an occupational hazard to the health care workers (HCWs). No significant data are available regarding the prevalence of HCV in health care workers in India. The present study was designed to determine the seroprevalence of HCV infection in health care workers in a tertiary care centre in New Delhi. The subjects (n=100) were divided according to the duration of employment and the unit where they were working. Blood samples were collected from all the subjects and sera were tested for anti-HCV antibodies. The seroprevalence of anti-HCV was found to be 4 per cent. The duration of occupational exposure was not a significant risk factor for HCV infection and prevalence of anti-HCV antibodies were highest in HCWs working in haemodialysis units. The seroprevalence of HCV in health care workers was considerably higher than that reported in the general population, and needs to be evaluated on a larger sample.