High-Fidelity, Indigenously Prepared, Low-Cost Moulage as a Valid Simulation Tool to Improve Trauma Education.

Background Simulation-based trauma education facilitates repeated practice in a controlled and safer environment for the learner without any risk to the patient's well-being. Moulage contributes to the perception of reality during training using standardized patients. However, the high cost of commercial moulage items is often prohibitive for regular use. This study aimed to assess the effectiveness of indigenously prepared, low-cost moulage as a valid simulation tool to improve trauma education, explore possible replacements of commercial moulage products, and determine their merits and demerits. Methodology Readily available economic items were used to make low-cost moulage on the simulated patients to replicate trauma victims. A cross-sectional design used a pre-validated Modified Moulage Authenticity Rating Scale to collect data from 61 participants of Advanced Trauma Life Support and Advanced Trauma Care for Nurses courses to analyze the effectiveness and fidelity of moulage. Results In total, 54 (89%) participants scored the low-cost moulage to provide high fidelity effectively. The majority of respondents graded the authenticity of moulage as good. Overall, 46 (75%) participants felt moulage injuries were quite realistic. All agreed that the moulage-based simulation offered a good teaching-learning alternative to assess and manage trauma victims. Further, 45 (73%) participants felt they were in an actual clinical situation, and 58 (95%) stated it could help them in their clinical practice. Conclusions Indigenously prepared, low-cost moulage is a feasible and cost-effective means to enhance fidelity in simulation-based trauma education. It can also be a possible replacement for commercial moulage. Further research is needed to rigorously evaluate the effectiveness of indigenously prepared, cost-effective moulage in trauma education to enhance patient care outcomes. This technique can also be easily translated into other simulation-based medical education domains.

Prevalence of blindness and visual impairment in a coastal region of Southern India: A cross-sectional survey in Prakasam district, Andhra Pradesh.

PURPOSE: To estimate the magnitude, determinants, and causes of visual impairment (VI) and blindness among people >40 years. METHODS: In this cross-sectional survey, 2,968 people >40 years from 34 clusters were examined. A cluster random sampling method with a compact segment sampling technique was used to select the study participants. Prevalence of any VI (presenting visual acuity (PVA) <6/12 in better eye), severe VI (PVA <6/60 - 3/60), and blindness (PVA <3/60 in better eye) were expressed as percentage with 95% confidence interval. Logistic regression was performed to determine the risk factors associated with blindness. A P value of less than 0.05 was considered statistically significant. RESULTS: The mean age of the participants was 54.6 years (Standard deviation ± 11.2 years). The prevalence of mild, moderate, and severe visual impairment was 14.2% (12.95-15.49), 13.7% (12.46-14.97), and 0.7% (0.47-1.12), respectively. The prevalence of blindness was 1.3% (0.94-1.79, n = 39). The overall prevalence of VI (presenting Visual Acuity <6/12) was 12.0% (95% CI: 10.8-13.2%). The major causes of VI were cataract (78.08%), refractive error (12.07%), and optic atrophy (2.22%), and corneal opacity (2.22%) and the major cause of blindness was cataract (77.27%). Blindness was strongly associated with increasing age- OR 17.1 (95% CI: 4.9-59.8) for people >70 years, and OR 7.6 (95% CI: 2.2-26.5) for people aged between 60 and 69 years compared to those aged 41-50 years and people living near coastal regions (Within 50 km of coast) (OR: 3.9, 95% CI: 1.6-7.3). CONCLUSION: Blindness and vision impairment are of public health concern in this geographic region. Eye care services need to be augmented to address this challenge.

Pneumoperitoneum, pneumothorax, pneumomediastinum with massive subcutaneous emphysema: A rare presentation following transanal colonic barotrauma.

Iatrogenic colonic barotrauma is a well-documented entity, mostly due to endoscopic procedures. Compressed air pressure colorectal injury is less frequent, and the exact mechanism is not defined clearly to date. We present our experience of managing high transanal barotrauma to the colorectum in two similar cases presented with massive pneumoperitoneum, pneumothorax, and pneumomediastinum, a rare presentation in emergency departments, with an accident being the common etiology, where both the patients presented with massive abdominal distension and respiratory distress with diffuse subcutaneous emphysema. A huge amount of gas was noted in the peritoneal cavity on radiographs; the FAST examination was inconclusive and attributed to emphysema impeding the diagnosis. A big gush of air was noted during temporary pneumoperitoneum decompression and laparotomy. Multiple seromuscular tears with perforation in the transverse colon were identified and primarily repaired in the first patient, and the second one had perforation at the rectosigmoid junction, which was brought out as a stoma. The restoration of the stoma was done after ensuring adequate anal tone, with both patients doing well in the follow-up period.

Role of Interleukin-6 in Prediction of Early Complications After Minimally Invasive Oesophagectomy-a Pilot Study.

Infectious complications following oesophagectomy are associated with significant morbidity. Early prediction of these complications may mitigate significant morbidity and mortality. Patients undergoing minimally invasive oesophagectomy for carcinoma oesophagus between January 2019 and June 2020 were included in the study. All patients underwent standard preoperative investigations and preparation. Post-operative complications including infectious complications were recorded. Association of post-operative serum interleukin-6 (IL-6) levels with post-operative complications were analysed. A total of twenty-two participants were included in the study (median age; 51 years, 13 (%) male). The tumour site was middle 1/3rd of oesophagus in 13 (59.1%), lower 1/3rd of oesophagus in 9 (40.9%). The tumour histology was squamous cell carcinoma in all patients. Eight (36.4 %) patients developed major complications and five of them developed anastomotic leak. IL-6 levels were significantly higher on POD 3 in patients who developed major complications (p = 0.009) and anastomotic leak (p = 0.031). At receiver operating characteristic curve (ROC curve) analysis, an IL-6 cut-off level of 36.4 pg/ml on POD 3 yielded a sensitivity of 87% and a specificity of 79% for the prediction of major complication and cut-off level of 44.3 pg/ml on POD 3 yielded a sensitivity of 80% and a specificity of 82% for the prediction of anastomotic leak. A high post-operative IL-6 level helps in the prediction of major complications and cervical oesophagogastric anastomotic leak.

Effectiveness of Removal of Hard Tissue Debris from the Mesial Root Canal System of Mandibular Molars using Different Supplementary Irrigation Protocols: An Original Study.

Introduction: An instrumented and endodontically treated tooth may sometimes impede disinfection by trapping hard tissue as well as the other canal contents at the isthmus level of the canal. Thus, the current in vitro study was piloted to assess the competence of two irrigating systems. Methods: Twenty mandibular with two mesial canals convergent into a single foramen and joined by an isthmus of the human permanent teeth were compared for the two irrigation systems of continuous and intermittent ultrasonic (US) motions of the irrigation. The teeth were prepared by a single rotary system and were imaged using the "Scanning electronic microscopy-SCM". The parameters were compared before and after the irrigation of the canal with the intended US systems for the removal of hard tissue debris. The appropriate statistical tools were used to find the significance, the value of which was kept at P < 0.05. Results: Significant percentage reduction of the hard tissue debris was achieved after the application of the supplemental irrigation protocols (P < 0.05). However between the groups, there was no significant difference. Conclusions: Comparable removal of the hard tissue debris was obtained in both the irrigation systems. Though not significant, the GentleWave performed better than the Irrisafe.

Correlation Between Tumor Volume and Hemoglobin Level in Gastrointestinal Stromal Tumor.

INTRODUCTION: Gastrointestinal stromal tumors (GIST) are the most common mesenchymal tumors. Anemia is a common finding in GIST, but the relationship between tumor volume and anemia severity is not well established. METHODS: This study aimed to investigate the correlation between the severity of anemia and various factors, mainly tumor volume, in GIST patients who underwent surgical resection. The study included 20 patients with GIST who underwent surgical resection at a tertiary care center. Demographic data, clinical presentation, hemoglobin level, radiological findings, surgical procedure, tumor characteristics, pathological findings, and immunohistochemical analysis were recorded. The tumor volume was calculated from the final resected tumor dimensions. RESULTS: The mean age of the patients was 53.8 ± 12 years. Eleven were males, and nine were females. The most common presentation was upper gastrointestinal bleeding (50%), followed by pain in the abdomen (35%). The most common tumor location was the stomach (75%). The mean hemoglobin level was 10.29 ± 1.9 g/dL. The mean tumor volume was 470.8 ± 1269.07 cc. R0 resection was achieved in 18 (90%) patients. There was no significant correlation between tumor volume and hemoglobin level (r=0.227, p=0.358). CONCLUSION: This study found no significant correlation between tumor volume and the severity of anemia in patients with GIST. Further studies with larger sample sizes are needed to validate these findings.

Diagnostic and Therapeutic Challenges in the Management of Acute Massive Overt Bleeding of Jejunal Gastrointestinal Stromal Tumours: Case Series.

INTRODUCTION: Jejunal gastrointestinal stromal tumours (GIST) are rare mesenchymal tumours. Acute massive overt bleeding from jejunal GIST is very rare and poses both diagnostic and therapeutic challenges in emergent conditions. METHODS: A case series with retrospective analysis of prospectively maintained database of patients presenting with acute massive overt bleeding secondary to histologically proven jejunal GIST was done. Clinical characteristics, endoscopic and imaging diagnostic features, histological findings, surgical procedures and outcomes in these patients were studied. RESULTS: Three patients were included in this case series. Mean age of presentation was 49.0 years with two male and one female patient. All three patients presented with melena and hemodynamic instability, resuscitated with adequate blood transfusions. Routine endoscopic assessment were inconclusive. Multiphasic Computed Tomographic Angiography (CTA) revealed hypodense hypervascular mass in jejunum in all three patients. One patient was unresponsive to blood transfusion and underwent emergency exploratory laparotomy. One patient underwent laparoscopic resection and reconstruction. Mean length of hospital stay was 5.3 days. Histopathological examination confirmed jejunal GIST in all three patients with microscopically negative resection margins. Two patients were disease free till 18-month follow-up and the one patient lost to follow-up after 1 year. CONCLUSION: Multiphasic CTA is a single-step diagnostic tool for localisation of bleed and assessment of tumour characteristics in emergent conditions. Surgical resection is the mainstay of treatment for both control of bleed and to provide oncologically clear resection margins.

Field evaluation of biosurfactants, surfactin and di-rhamnolipid produced by Bacillus subtilis subsp. subtilis (VCRC B471) and Pseudomonas fluorescens (VCRC B426) against immature stages of the urban malaria vector Anopheles stephensi.

BACKGROUND & OBJECTIVES: Bacillus subtilis subsp. subtilis (VCRC B471) and Pseudomonas fluorescens (B426) produce mosquitocidal biosurfactant, surfactin and di-rhamnolipid. The objective of the study was to carry out a small-scale field evaluation of the two biosurfactants to determine the efficacy, application dosage, residual activity and frequency of application against Anopheles stephensi immatures in selected sites in Goa, India. METHODS: Surfactin (VCRC B471) and di-rhamnolipid (VCRC B426) were formulated as aqueous suspensions (5% AS), and were applied at the dosages of 34, 51 and 68 mL/m2 and 27, 41 and 54 mL/m2 respectively. Two experiments were carried out with the two formulations. RESULTS: Surfactin (VCRC B471) formulation was effective at all the dosages and there was sustained reduction (>80%) in immature density in the treated sites up to 18 days in experiment 1 and up to 15 days in experiment 2. No pupae were found in the treated sites throughout the study. Di-rhamnolipid (VCRC B426) formulation was also found to reduce the immature density in the treated sites up to 14 days in experiment 1 and up to 15 days in experiment 2. INTERPRETATION & CONCLUSION: For VCRC B471, the optimum application dosage determined was 51 mL/m2 and for VCRC B426, 27mL/m2. The formulations are to be applied fortnightly for effective control of Anopheles. The application dosage determined in the present study can be used for large scale field evaluation to assess their suitability for use in public health programmes for the control of Anopheles mosquitoes vectoring malaria.

Two-drug versus three-drug induction chemotherapy in pediatric acute myeloid leukemia: a randomized controlled trial.

The benefit of three-drug induction chemotherapy over a two-drug induction has not been evaluated in pediatric acute myeloid leukemia (AML). We, therefore, conducted a randomized controlled trial to ascertain the benefit of a three-drug induction regimen. Patients aged 1-18 years with newly diagnosed AML were randomized to two cycles of induction chemotherapy with daunorubicin and ara-C (DA) or two cycles of ara-C, daunorubicin, and etoposide (ADE). After induction, patients in both arms received consolidation with two cycles of high-dose ara-C. The study's primary objective was to compare the event-free survival (EFS) between the two arms. The secondary objectives included comparing the composite complete remission (cCR) rates, overall survival (OS), and toxicities. The study randomized 149 patients, 77 in the DA and 72 in the ADE arm. The median age was 8.7 years, and 92 (62%) patients were males. The median follow-up was 50.9 months. The cCR rate in the DA and ADE arm were 82% and 79% (p = 0.68) after the second induction. There were 13 (17%) induction deaths in the DA arm and 12 (17%) in the ADE arm (p = 0.97). The 5-year EFS in the DA and ADE arm was 34.4% and 34.5%, respectively (p = 0.66). The 5-year OS in the DA and ADE arms was 41.4% and 42.09%, respectively (p = 0.74). There were no significant differences in toxicities between the regimens. There was no statistically significant difference in EFS, OS, CR, or toxicity between ADE and DA regimens in pediatric AML. The trial was registered with the Clinical Trial Registry of India (Reference number: CTRI/2014/11/005202).

A prospective, non-randomized study to determine the role of intraperitoneal drain placement in perforation peritonitis.

BACKGROUND: Surgical site infection continues to be a major problem after laparotomy for perforation peritonitis, as it increases morbidity and hospital stay and decreases the quality of life. Intra-abdominal drain placement is a routine practice in perforation peri-tonitis. The aim of our study is to compare the incidence of surgical site infection in two groups of patients who were operated for perforation peritonitis: The first group received the intraperitoneal drain, while no drain was placed in the second group. METHODS: The present single-center, prospective, non-randomized study was conducted in the Department of General Surgery at the Postgraduate Institute of Medical Education and Research, India. A total of 122 patients underwent exploratory laparotomy for gastroduodenal and small bowel perforation peritonitis, of which 100 participants were included in this study, based on specified cri-teria for inclusion and exclusion. A total of 50 participants each were included in the drain group and the no drain group, respectively. A drain was placed in every alternate patient with perforation peritonitis who received primary closure or resection anastomosis. Patients with diabetes, renal failure, and hemodynamic instability and those who presented more than 72 h since symptom onset were excluded from the study. Peritoneal fluids were cultured. The primary endpoint was to identify the incidence of surgical site infections (SSIs) in the two groups. We also compared the time taken for the return of bowel movements, duration for which a nasogastric tube was inserted, whether any intervention was performed under local or general anesthesia within 30 days of surgery, the duration of hospital stay, and the ease of diagnosing repair leak in the post-operative period in both the groups. RESULTS: Demographics of participants in both the groups were matched. No significant difference was observed between the drain and no-drain groups with respect to the incidence of surgical site infection (p=0.779). The duration of surgery and length of hospital stay were significantly lower in the no drain group. A significant difference was observed between the two groups concerning the peritoneal culture growth, and increased bacterial growth was seen in the drain group. No significant difference in morbidity was noted between the two groups, which was classified according to the Clavien-Dindo classification. CONCLUSION: Routine use of intra-abdominal drains was not found to be effective in preventing SSIs, but a selection bias cannot be ruled out. Patients with no drains had a significantly shorter duration of hospital stay.

ASCITIC AND SERUM LEVELS OF TUMOR BIOMARKERS (CA 72-4, CA 19-9, CEA AND CA 125) IN DISCRIMINATION OF CAUSE OF ASCITES: A PROSPECTIVE STUDY.

BACKGROUND: The role of ascitic and serum levels of various tumour biomarkers in the discrimination of cause of ascites is not well established. OBJECTIVE: To evaluate the role of serum and ascitic levels of tumor biomarkers (CA 72-4, CA 19-9, CEA and CA 125) in discrimination of cause of ascites. METHODS: A prospective study was conducted in consecutive patients presenting with ascites. Serum and ascitic levels of CA 19-9, CA 125, CA 72-4 and carcinoembryonic antigen (CEA) were determined at the presentation. The patients with cirrhotic ascites, tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC) were eventually included in analysis. RESULTS: Of the 93 patients (58 males, mean age 47 years) included, the underlying cause was cirrhosis in 31, PC in 42 and peritoneal tuberculosis in 20. The best cutoff for discriminating benign and malignant ascites for serum CEA, CA 19-9 and CA 72-4 were 6.7 ng/mL, 108 IU/mL and 8.9 IU/mL, respectively. The best cutoff for discriminating benign and malignant ascites for ascitic CA 125, CEA, CA 19-9 and CA 72-4 were 623 IU/mL, 8.7 ng/mL, 33.2 IU/mL and 7 IU/mL, respectively. CONCLUSION: The performance of single biomarker for the prediction of underlying PC is low but a combination of serum CA 19-9 and CA 72-4 best predicted the presence of peritoneal carcinomatosis.

Bedaquiline, Delamanid, Linezolid and Clofazimine for Treatment of Pre-extensively Drug-Resistant Tuberculosis.

BACKGROUND: Treatment success rates for multidrug-resistant tuberculosis (MDR-TB) remain low globally. Availability of newer drugs has given scope to develop regimens that can be patient-friendly, less toxic, with improved outcomes. We proposed to determine the effectiveness of an entirely oral, short-course regimen with Bedaquiline and Delamanid in treating MDR-TB with additional resistance to fluoroquinolones (MDR-TBFQ+) or second-line injectable (MDR-TBSLI+). METHODS: We prospectively determined the effectiveness and safety of combining two new drugs with two repurposed drugs - Bedaquiline, Delamanid, Linezolid, and Clofazimine for 24-36 weeks in adults with pulmonary MDR-TBFQ+ or/and MDR-TBSLI+. The primary outcome was a favorable response at end of treatment, defined as two consecutive negative cultures taken four weeks apart. The unfavorable outcomes included bacteriologic or clinical failure during treatment period. RESULTS: Of the 165 participants enrolled, 158 had MDR-TBFQ+. At the end of treatment, after excluding 12 patients due to baseline drug susceptibility and culture negatives, 139 of 153 patients (91%) had a favorable outcome. Fourteen patients (9%) had unfavorable outcomes: four deaths, seven treatment changes, two bacteriological failures, and one withdrawal. During treatment, 85 patients (52%) developed myelosuppression, 69 (42%) reported peripheral neuropathy, and none had QTc(F) prolongation >500msec. At 48 weeks of follow-up, 131 patients showed sustained treatment success with the resolution of adverse events in the majority. CONCLUSION: After 24-36 weeks of treatment, this regimen resulted in a satisfactory favorable outcome in pulmonary MDR-TB patients with additional drug resistance. Cardiotoxicity was minimal, and myelosuppression, while common, was detected early and treated successfully.

Airway management training program for nurses via online course in COVID-19 preparedness.

BACKGROUND: Nursing officers are an integral component of any medical team. They participate in taking care of basic airway management and assist in advanced airway management, specifically amidst the current coronavirus disease 2019 (COVID-19) pandemic. AIM: To assess the efficacy of a standardized web-based training module for nurses in preparedness to fight against COVID-19. METHODS: The training was held in three sessions of 1 h each, consisting of live audio-visual lectures, case scenarios, and skill demonstrations. The sequence of airway equipment, drug preparation, airway examination, and plans of airway management was demonstrated through mannequin-based video-clips. RESULTS: Pre- and post-test scores as well as objective structured clinical examination scores were analyzed using Student's t-test and the Likert scale was used for feedback assessment. It was found that the mean score out of the total score of 20 was 8.47 ± 4.2 in the pre-test, while in the post-test it was 17.4 ± 1.8 (P value < 0.001). The participants also felt self-reliant in executing the roles of airway assistant (63.3%) and drug assistant (74.3%). Fear of self-infection with COVID-19 was also high, as 66% of participants feared working with the patient's airway. CONCLUSION: Amidst this COVID-19 emergency, when the health care systems are being persistently challenged, training of nursing staff in the safe conduct of airway management can ensure delivery of life-saving treatment.

Níveis ascíticos e soros de biomarcadores tumorais (CA 72-4, CA 19-9, CEA e CA 125) em discriminação de causa de ascites: um estudo prospectivo / Ascitic and serum levels of tumor biomarkers (ca 72-4, ca 19-9, cea and ca 125) in discrimination of cause of ascites: a prospective study

ABSTRACT Background: The role of ascitic and serum levels of various tumour biomarkers in the discrimination of cause of ascites is not well established. Objective: To evaluate the role of serum and ascitic levels of tumor biomarkers (CA 72-4, CA 19-9, CEA and CA 125) in discrimination of cause of ascites. Methods: A prospective study was conducted in consecutive patients presenting with ascites. Serum and ascitic levels of CA 19-9, CA 125, CA 72-4 and carcinoembryonic antigen (CEA) were determined at the presentation. The patients with cirrhotic ascites, tuberculous peritonitis (TBP) and peritoneal carcinomatosis (PC) were eventually included in analysis. Results: Of the 93 patients (58 males, mean age 47 years) included, the underlying cause was cirrhosis in 31, PC in 42 and peritoneal tuberculosis in 20. The best cutoff for discriminating benign and malignant ascites for serum CEA, CA 19-9 and CA 72-4 were 6.7 ng/mL, 108 IU/mL and 8.9 IU/mL, respectively. The best cutoff for discriminating benign and malignant ascites for ascitic CA 125, CEA, CA 19-9 and CA 72-4 were 623 IU/mL, 8.7 ng/mL, 33.2 IU/mL and 7 IU/mL, respectively. Conclusion: The performance of single biomarker for the prediction of underlying PC is low but a combination of serum CA 19-9 and CA 72-4 best predicted the presence of peritoneal carcinomatosis.

RESUMO Contexto: O papel dos níveis ascíticos e séricos de vários biomarcadores de tumores na discriminação da causa das ascites não está bem estabelecido. Objetivo: Avaliar o papel dos níveis séricos e ascíticos de biomarcadores tumorais (CA 72-4, CA 19-9, CEA e CA 125) na discriminação da causa das ascites. Métodos: Estudo prospectivo foi realizado em pacientes consecutivos que apresentaram ascite. Foram determinados níveis do soro e ascítico de CA 19-9, CA 125, CA 72-4 e antígeno carcinoembrínico (CEA). Os pacientes com ascites cirróticas, peritonite tuberculosa e carcinomatose peritoneal (CP) foram eventualmente incluídos na análise. Resultados: Dos 93 pacientes (58 homens, média de idade 47 anos) incluídos, a causa básica foi cirrose em 31, CP em 42 e tuberculose peritoneal em 20. O melhor corte para discriminação de ascites benignas e malignas para soro CEA, CA 19-9 e CA 72-4 foram 6,7 ng/mL, 108 UI/mL e 8,9 UI/mL, respectivamente. O melhor corte para discriminação de ascites benignas e malignas para CA 125 ascitico, CEA, CA 19-9 e CA 72-4 foram 623 UI/mL, 8,7 ng/mL, 33,2 UI/mL e 7 UI/mL, respectivamente. Conclusão: O desempenho do biomarcador único para a previsão do CP subjacente é baixo, mas uma combinação de soro CA 19-9 e CA 72-4 melhor previu a presença de carcinomatose peritoneal.

Frequency and Predictors of Acute Kidney Injury in Patients With Acute Coronary Syndrome in a Tertiary Care Hospital: A Retrospective Study.

Introduction Acute kidney injury (AKI) is a complex condition marked by rapid deterioration of renal function (within hours or days), with clinical symptoms ranging from a minor rise in serum creatinine to anuric renal failure needing renal replacement therapy. AKI is one of the complications of acute coronary syndrome (ACS). This study aims to determine the frequency of AKI among patients with ACS and identify its predictors. Method This study is a retrospective observational study conducted at the Dow University of Health Sciences, a tertiary care hospital located in Karachi, Pakistan. This study was conducted from January 2020 to June 2021. All patients aged 18-75 years admitted with ACS and admitted for more than 48 hours were included in the study. A pre-set questionnaire was used to collect data from the hospital management information system (HMIS). Results The frequency of AKI among patients with ACS was 24.18%. The factors associated with AKI among patients with ACS on multivariable logistic regression included the age of patients (odds ratio (OR) = 1.04, p-value = 0.018), having diabetes mellitus (OR = 2.33, p-value = 0.031), admission Killip ≥ II (OR = 2.12, p-value = 0.041), previous history of myocardial infarction (MI) (OR = 3.64, p-value = 0.001), baseline glomerular filtration rate (GFR) (OR = 0.94, p-value = 0.001), in-hospital ejection fraction (EF) (OR = 0.93, p-value = 0.001), and serum creatinine at admission (OR = 1.02, p-value = 0.001). Conclusion Age, comorbidities including diabetes mellitus and previous history of MI, admission Killip ≥ II, baseline GFR, in-hospital EF, and serum creatinine level at admission are significant independent predictors of AKI in patients with ACS.

Retraction: Frequency and Predictors of Acute Kidney Injury in Patients With Acute Coronary Syndrome in a Tertiary Care Hospital: A Retrospective Study.

[This retracts the article DOI: 10.7759/cureus.21869.].

Deep Vein Thrombosis in Lepromatous Leprosy: A Case Report of Secondary Pediatric Antiphospholipid Syndrome.

Antiphospholipid syndrome (APS) is a rare autoimmune disorder characterized by thromboembolic events, fetal loss during pregnancy, and evidence of antiphospholipid (aPL) antibodies such as beta-2-glycoprotein I (B2-GPI) and anticardiolipin (aCL). The diagnosis and treatment of this condition in the pediatric population have limited literature evidence due to the rarity of the condition in this age group. Guidelines have been adopted from the adult counterpart of the affected population, thereby giving rise to diagnostic and therapeutic challenges. In this report, we describe a rare case of a 15-year-old male who presented with lepromatous leprosy and developed deep vein thrombosis in his right leg. The laboratory evidence of positive aPL antibodies guided our diagnosis of APS and treatment with oral anticoagulants. This report highlights the importance of screening and timely diagnosis of APS in the pediatric population presenting with venous thrombosis in the backdrop of infection.