A Rare Life-Threatening Presentation of Shoulder Pain: Cervical Epidural Hematoma.

Shoulder pain is a common complaint of patients presenting to emergency department. Various conditions, intrinsic and extrinsic to the shoulder, can result in shoulder pain. Some of these extrinsic conditions can pose a threat to life. We present a case of a young, previously healthy male who initially had bilateral shoulder pain, later developed quadriparesis, and was ultimately diagnosed with a spontaneous cervical epidural hematoma. He underwent an emergency C7-T1 laminectomy with hematoma evacuation and had a full recovery. Cervical epidural hematoma is a rare surgical emergency where timely diagnosis and treatment are crucial.

Correlation of Severity of Renal Colic With Clinical, Laboratory, and Radiological Parameters: An Emergency Department-Based Prospective Observational Study.

Introduction In this study, we investigated the correlation of severity of renal colic with clinical parameters like pain characteristics, haematuria and pyuria, laboratory parameters such as inflammatory markers, and radiological parameters including site and size of stone and hydronephrosis. Methods The Visual Analogue Scale (VAS) determined the pain severity. Detailed history and clinicodemographic profiling of the patient was done, laboratory investigations were done, ultrasound and non-contrast computed tomography of kidney-ureter-bladder were done and all the parameters were duly noted and correlated with the pain severity. Result The mean age of the 183 patients was 43.96 ± 15.16 years, and 62.8% were male. The patients' mean VAS score at presentation was 8.57 ± 1.08. The mean VAS score was found to be statistically higher in patients having a first episode of renal colic, solitary kidney, pyuria, raised creatinine, severe hydronephrosis, and stones located at the renal pelvis. In addition, higher VAS scores led to more surgical interventions. Conclusion The correlation of pain severity of renal colic with various parameters can aid in the development of quick diagnostic and therapeutic protocols for patients presenting to the emergency department with renal stone disease. This study shows that pain scores can correlate with various parameters and predict the outcome and complications in these patients.

An Evaluation of the Predictive Value of Sepsis Patient Evaluation in the Emergency Department (SPEED) Score in Estimating 28-Day Mortality Among Patients With Sepsis Presenting to the Emergency Department: A Prospective Observational Study.

Background and objective Sepsis is a life-threatening medical emergency and a significant cause of mortality. Risk stratification scores for sepsis can be unsuitable for use in the emergency department (ED) due to their complexity, and an appropriate solution has yet to be found. In this study, the predictive value of the Sepsis Patient Evaluation in the Emergency Department (SPEED) score in estimating 28-day mortality was assessed among patients with sepsis presenting to the ED, in order to determine its suitability as an efficient risk stratification system. Materials and methods This was a single-center, prospective observational study conducted at an urban tertiary care center. We included patients presenting to the ED with suspected or confirmed sepsis who met the inclusion and exclusion criteria of our study. The patients were evaluated with the following scoring systems on arrival: the SPEED score; Predisposition, Infection, Response, and Organ dysfunction (PIRO) score; and Mortality in Emergency Department Sepsis (MEDS) score; the patients were subsequently followed up on the 28th day to record the final outcomes with regard to mortality and discharge rates. Results This study included 127 patients in total. The median age of the study population was 49 years, and the 28-day mortality rate was 50.4%. The area under the receiver operating characteristic (AUROC) curve for the SPEED score for predicting mortality was 0.899 (95% CI: 0.847-0.951). In comparison, the AUROC for MEDS and PIRO scores was 0.857 (95% CI: 0.793-0.92) and 0.895 (95% CI: 0.838-0.951), respectively. Based on the DeLong test, no significant difference was found in the diagnostic performances with respect to these scores. Conclusion The SPEED score is a simple and handy parameter that can be used for the early and appropriate risk stratification of patients with sepsis in the ED.

Current scenario, future possibilities and applicability of telemedicine in hilly and remote areas in India: A review protocol.

In India telemedicine is ideal because of its diverse landmass, difficult terrain and huge population. India, a developing country is witnessing an increase in economic growth but growing health expenditure is still posing a challenge. Telemedicine offers a solution to bridge the gap between resources available and growing needs in the health care set up. It offers an opportunity for effective collaboration of primary and secondary health care setups and to reach population staying in underserved areas. The purpose of this article is to discuss current scenario, future possibilities and applicability of telemedicine in hilly and remote areas in India.

Single center experience of managing methanol poisoning in the hilly state of Uttarakhand: A cross sectional study.

BACKGROUND: In this article, we describe our experience in managing one of the worst tragedies of an outbreak of methanol poisoning in the state of Uttarakhand in February 2019. It was reported that more than 100 people of Uttarakhand and neighboring districts of Uttar Pradesh succumbed to death after consuming this toxic alcohol laced with methanol. MATERIALS AND METHODS: Demographic, clinical, and biochemical data were collected retrospectively from the hospital record section of the tertiary care hospital in the state of Uttarakhand. RESULTS: Ninety-three patients of methanol poisoning were attended by the emergency medicine department of our hospital. The mean age of the patients was 38.9 ± 10.3 years. Majority of the patients were males (92/93). The most common clinical symptoms were gastrointestinal (56; 60.2%) followed by neurological (21; 22.6%) and respiratory (18; 19.3%). Most of the patients presented within 12-24 h after consumption of methanol. The mean of latent time of presentation was 4.8 ± 2.6 h. The mean values of pH, bicarbonate levels, lactate, and base deficit were 7.13 ± 0.6, 12.3 ± 6.4, 2.6 ± 0.8, and 15.6 ± 3.8 mmol/l, respectively. Acute kidney injury (26; 27.9%), blurring of vision (9; 9.6%), and sepsis (6, 6.4%) were common complications. Seven patients (7.5%) succumbed to death. Intensive alkali therapy was the main modality of treatment. Ethanol therapy was useful in patients resistant to alkali therapy. Sixteen (17.2%) patients with acute methanol poisoning were dialyzed once. CONCLUSION: Patients with acute methanol poisoning have varied presentations. Gastrointestinal symptoms are the most common presentation. Such outbreaks account for the heavy toll of mortality and morbidity in the society. Prompt diagnosis and a protocol based treatment can have a significant impact on the outcome of these patients. Thus, public health warning should be immediately issued with initial presentation of the casualties.

Shigella flexneri associated reactive arthritis - GI transmitted or sexually transmitted?

The pathogenic association of reactive arthritis with human immunodeficiency virus (HIV) needs more attention. In this case report we described a case of 22 year old male patient suffering from severe HIV infection. He presented with the complaints of left knee joint pain associated with swelling and tenderness. He also developed keratotic papules on palms and soles and polycyclic erosions on the glans penis. He was diagnosed as a case of reactive arthritis with HIV infection. The patient was treated with sulfasalazine and anti retroviral therapy. We, hereby discuss the underlying pathogenesis and treatment modalities in patients of reactive arthritis with underlying HIV infection. The treatment of reactive arthritis with HIV is a challenge due to limited options of immunosupressive agents.