Cognitive Task Analysis of Escharotomy.

INTRODUCTION: With the Army's emerging doctrine of prolonged field care, and with burns being a common injury among soldiers, non-expert providers must be trained to perform escharotomy when indicated. However, the existing physical simulators and training protocols are not sufficient for training non-experts for performing effective escharotomy. Hence, to provide guidance in developing realistic escharotomy simulators and effective training protocols suitable for prolonged field care, a cognitive task analysis (CTA) is needed. This work aims to obtain educative information from expert burn surgeons regarding escharotomy procedures via the CTA. MATERIALS AND METHODS: The CTA was done by interviewing five subject matter experts with experience in performing escharotomy ranging from 20 to over 100 procedures and analyzing their responses. Interview questions were developed to obtain educative information from expert burn surgeons regarding the escharotomy procedure. A "gold standard protocol" was developed based on the CTA of each of the subject matter experts. RESULTS: The CTA helped identify general themes, including objectives, conditions that mandate escharotomy, signs of successful escharotomy, precautions, challenges, decisions, and performance standards, and specific learning goals such as the use of equipment, vital signs, performing the procedure, and preoperative and postoperative care. A unique aspect of this CTA is that it identifies the background information and preparations that could be useful to the practitioners at various levels of expertise. CONCLUSIONS: The CTA enabled us to compile a "gold standard protocol" for escharotomy that may serve as a guide for practitioners at various levels of expertise. This information will provide a framework for escharotomy training systems and simulators.

Analysis of Risk Factors for Cholelithiasis: A Single-Center Retrospective Study.

Objectives Cholelithiasis poses a considerable medical burden worldwide. While its pathogenesis is multifactorial, identifying the key risk factors is essential for understanding the disease and improving patient care. This study aims to investigate the potential associations between demographic, clinical, and laboratory variables and the development of cholelithiasis. Methods This single-center retrospective study was conducted at Malla Reddy Institute of Medical Sciences, Hyderabad, India, over one month. A total of 200 patients diagnosed with cholelithiasis were included. Data were extracted from electronic health records and the patients using a questionnaire, including demographic information (age, gender), clinical data including body mass index (BMI), and comorbidities. Statistical analyses were conducted to determine the associations between risk factors and cholelithiasis. Results The frequency of cholelithiasis is found to be higher in the female gender and patients with obesity, sedentary lifestyle and hypertension as compared to male patients, and the risk of cholelithiasis also increases with age. Females demonstrated a higher prevalence of cholelithiasis, with an odds ratio (OR) and confidence interval (CI) of 1.4, 95% CI [1.1, 1.7], p < 0.05). Obese individuals (BMI ≥ 30) had 2.2 times higher odds of cholelithiasis compared to those with normal BMI (< 24.9) (OR = 2.2, 95% CI [1.7, 2.9], p < 0.001). The presence of diabetes significantly increased the odds of cholelithiasis by 1.6 times (OR = 1.6, 95% CI [1.2, 2.1], p < 0.01). Overweight individuals (BMI: 25-29.9) were associated with 1.4 times higher odds of cholelithiasis (OR = 1.4, 95% CI [1.1, 1.9], p < 0.05). Conclusion Our study identified age, gender, BMI, diabetes, and obesity as significant risk factors for cholelithiasis. These findings underscore the importance of targeted interventions and lifestyle modifications to mitigate cholelithiasis risk and improve patient outcomes. Further research, including prospective multicentric studies, must validate these findings and explore potential underlying mechanisms.

Long-Term Neurological Impact of COVID-19.

INTRODUCTION: Recent research has observed the ability of coronavirus disease 2019 (COVID-19) to spread in the brain from the respiratory system. The associated neurological disorder includes encephalopathies, inflammatory syndromes, stroke, peripheral neuropathies, and various other central nervous system disorders. This study aims to highlight the long-term neurological sequelae in patients with COVID-19 disease. METHODS: This long-term study was carried out in the COVID-19 unit of a tertiary care hospital in Pakistan from July 2020 to July 2021. After obtaining informed consent, we enrolled 1000 patients who recovered from COVID-19 and were discharged. The participants were followed up after 30 and 90 days. RESULTS: At the time of enrollment, there were 602 (60.2%) males and 398 (39.8%) females. The most common neurological symptom on 30-day follow-up was headache (8.8%), followed by insomnia. The most common neurological symptom on day 90 follow-up was insomnia (5.07%), followed by an altered sense of smell (3.3%). CONCLUSION: COVID-19 tends to produce a wide range of neurological symptoms, ranging from headache to anosmia to increased risk of stroke, that complicates clinical management. Potential neurologic effects and drug interactions have been reported secondary to the medications used to treat COVID-19. In light of the aforementioned facts, COVID-19 could potentially have a long-term effect on the brain. Therefore, it is important that the clinicians must be aware of the potential neurologic complications. Lastly, proper follow-up is recommended that would aid in timely recognition and management of the neurological disorder.

Frequency of Cutaneous Disorders in Patients With Celiac Disease.

Background and objective Celiac disease is an autoimmune multisystem disorder that is triggered by dietary gluten sensitivity in genetically susceptible individuals. It presents with extraintestinal cutaneous manifestations including dermatitis herpetiformis (DH), atopic dermatitis, psoriasis, urticaria, and alopecia areata. Due to the insufficient availability of data, this study aimed to estimate the frequency of cutaneous manifestation in a Pakistani population with celiac disease. Methods This cross-sectional study was conducted from January 2020 to July 2021, and 300 patients with a confirmed diagnosis of celiac disease were enrolled in the study from the internal medicine department of a tertiary care hospital in Pakistan. Celiac disease was confirmed by the presence of immunoglobulin A (IgA) endomysial antibody and IgA tissue transglutaminase antibody. The presence of cutaneous manifestations was assessed with the assistance of a qualified dermatologist and noted in a self-structured questionnaire. Results Overall, the most common cutaneous manifestation was DH (16.0%), whereas the second most common cutaneous manifestation was psoriasis (13.8%). DH was most commonly found among males (18.9%), while psoriasis was more common among females (14.12%). Conclusion Among the various cutaneous presentations in patients with celiac disease, the most common dermatological manifestation was DH. Therefore, patients with cutaneous manifestations should undergo screening for celiac disease.

Association Between Rheumatoid Arthritis and Serum Vitamin D Levels.

Introduction Vitamin D is responsible for regulating innate and adaptive immune responses and for boosting the immune system; hence, a decline in its levels results in autoimmunity. Current studies have linked the deficiency of vitamin D to different autoimmune diseases, including rheumatoid arthritis (RA). In this study, we will determine the association between vitamin D level and RA. Methods This is a case-control study, conducted in a tertiary care hospital in Pakistan from January 2021 to May 2021. Three hundred patients with a confirmed recent diagnosis of RA were enrolled as the study group. Another 300 participants without RA, matched for age and gender, were enrolled in the study as a control group. RA was diagnosed on the basis of clinical symptoms, radiological features on X-ray, and anti-citrullinated protein levels of more than 20 u/mL. Results The mean vitamin D level in participants with RA was significantly lower than in the placebo group (30.18 ± 6.27 vs. 38.29 ± 7.98; p-value: <0.0001). The mean vitamin D level in participants with positive RF patients was significantly lower compared to rheumatoid factor (RF)-negative RA patients (29.21 ± 5.16 vs. 32.26 ± 7.02; p-value: <0.0001). There were more participants with hypovitaminosis D in RF-positive participants as compared to RF negative (88.6% vs. 44.3%; p-value: 0.00001). Conclusion There is a high prevalence of vitamin D deficiency in patients with RA and there is a link with disease severity. Therefore, a high index of suspicion is required while evaluating the at-risk patients, especially women, with complaints of vitamin D deficiency. Vitamin D supplementation may be needed for the prevention or avoidance of the progression of the disease.