Fatal sickling-associated microvascular occlusive crisis in a young with sickle cell trait.

Sickle cell trait (SCT), a heterozygous state characterized by hemoglobin AS, occurs commonly in sub-Saharan Africa, South America, Central America, India, and the Mediterranean countries. SCT is compatible with a normal lifespan and is not commonly regarded as a cause of morbid illness or death compared to its homozygous counterpart. We describe a case of fatal sickling-associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 21-year-old military recruit with sickle cell trait. The individual presented with repeated syncope episodes during his training and was autopsied in the pursuit of cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organized run during routine training activities. To our knowledge, this is the first report of fatal sickling-associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all armed forces and sports physicians of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.

A novel 5E training model and other methods implemented for rapid readiness at an ad-hoc COVID-19 facility in India

BackgroundA ad-hoc dedicated COVID-19 hospital was setup in New Delhi, India over a span of 12 days. At this time, new teaching modalities were employed to train the staff. This study aims to identify and quantify the effectiveness of these teaching models in terms of learning which was evaluated using case scenarios before and after the teaching session. ObjectivesTo assess education methods and models for training of healthcare workers during rapid deployment at an ad-hoc dedicated COVID-19 hospital. MethodsThe 5E (Engage, Explore, Explain, Elaborate and Evaluate) teaching modality through peer group teaching methods was utilised in the situation. Statistical analysis was done using Mann Whitney U test. ResultsA total of 86 participants (43 doctors and 43 nurses) answered the pre and post test questionnaires. The number of correct responses per question in the pre test (Mean + SD;49.0+ 18.53) vs post test (Mean + SD;54.40+ 15.95) with stratification by the domain of learning was analysed. No significant difference was found in the pre and post test responses. ConclusionFurther studies of this nature will contribute towards assessing efficacy of teaching modalities employed in rapid readiness for future pandemic scenarios.

Chemotherapy-Associated Pulmonary Toxicity-Case Series from a Single Center.

Background Pulmonary toxicity due to chemotherapeutic agents can occur with many established and new drugs. Strong clinical suspicion is important as the clinical presentation is usually with nonspecific symptoms like cough, dyspnea, fever, and pulmonary infiltrates. Timely discontinuation of the offending agent alone can improve the condition. Methods A prospective observational study on patients receiving chemotherapy at an 800-bedded tertiary care hospital was performed from 2014 to 2016. Consecutive patients on chemotherapy, presenting with nonresolving respiratory symptoms were evaluated with contrast-enhanced computerized tomography of chest, diffusion lung capacity for carbon monoxide (DLCO), fiberoptic bronchoscopy with lavage, and biopsy, after excluding all causes for pulmonary infections. Descriptive data has been depicted. Results A total of 18 patients were evaluated for persistent symptoms of dry cough, dyspnea, and fever among 624 who received chemotherapy during the study period. Ground-glass opacities on high-resolution CT was the most common imaging finding, others being patchy subpleural consolidation and pleural effusion. Lymphocyte-predominant bronchoalveolar lavage was detected in nine. Eight of the 15 patients who underwent DLCO, had abnormal results. Seven had significant histopathological findings on bronchoscopic lung biopsy, which revealed organizing pneumonia as the most common pattern. Paclitaxel, fluorouracil, gemcitabine, and tyrosine kinase inhibitors were the common culprit drugs. Discontinuation alone of the culprit drug was effective in 15 and 3 needed oral corticosteroids for relief of symptoms. None of the patients died due to the toxicity. Conclusion An incidence of 2.8% for chemotherapy-induced lung injury was seen in our observational study of 3 years, with parenchymal, interstitial, and pleural involvement due to various chemotherapeutic agents. Oral steroids maybe required in a subset of patients not responding to discontinuation of the culprit agent.

Fatal sickling-associated microvascular occlusive crisis in a young with sickle cell trait

Sickle cell trait (SCT), a heterozygous state characterized by hemoglobin AS, occurs commonly in sub-Saharan Africa, South America, Central America, India, and the Mediterranean countries. SCT is compatible with a normal lifespan and is not commonly regarded as a cause of morbid illness or death compared to its homozygous counterpart. We describe a case of fatal sickling-associated microvascular crisis, identified on post mortem evaluation in a previously undiagnosed 21-year-old military recruit with sickle cell trait. The individual presented with repeated syncope episodes during his training and was autopsied in the pursuit of cardiac anomalies and heat syncope. During the terminal episode, he collapsed and died of severe metabolic complications as he struggled to complete an organized run during routine training activities. To our knowledge, this is the first report of fatal sickling-associated crisis in a military recruit with sickle cell trait from India. This case serves to remind all armed forces and sports physicians of the importance of screening a recruit who is unable to complete exertional physical training for the presence of sickle cell trait.

Self-learning on COVID-19 among medical students and their preparedness to participate in government's COVID-19 response in Bhutan: a cross-sectional study

BackgroundBhutan lacks a medical school and all their medical students are trained outside in Sri Lanka, Bangladesh and India. When the COVID-19 pandemic let to closure of medical schools in these countries, the Bhutanese medical students were repatriated in March-April 2020. Upon return, they were kept in government-sponsored facility quarantine for 21 days. This study assessed their knowledge on COVID-19 as a part of self-learning and attitude as part of preparedness towards participation in governments health response to COVID-19. MethodThis was a cross-sectional study among medical students who had returned to the country. This survey was conducted through an online questionnaire while the students were in 21-day facility quarantine. The sample size calculated was 129 and a convenient sampling was used. Knowledge was assessed using 20 questions, each scored 1/20. Cumulative score of score of [≥]80% was categorized as "good knowledge", score of [≥]60 - 79% was considered "satisfactory knowledge", and score < 60% was considered "poor knowledge." Correlation between knowledge score and duration of clinical clerkship was tested using Pearsons correlation coefficient. Attitude of students towards their willingness to participate in the national COVID-19 response were tested using rating scales. Data were analysed using Stata 13.1. Results120 medical students responded to this survey (response rate = 93%). Eighty-eight (74%) had good knowledge, 28 (23%) had satisfactory knowledge and only four (3%) had poor knowledge on COVID-19. The students scored high on the symptomatology, mode of transmission, prevention and treatment options and on local epidemiology; and scored low on the forms of mechanical ventilations and on the home-management of non-critical cases. The knowledge score correlated with duration of clinical clerkship (r = 0.326, p = 0.001). The primary source of information were social media sites (102, 85%), television (94, 78%) and newspapers (76, 63%). The majority (78, 65%) were willing to participate in the governments COVID-19 response but could not identify what roles they could play. The fear of contracting COVID-19 was reported in only in 8.7%. ConclusionsThe medical students had good knowledge on COVID-19 and were self-learned through social media, television and newspapers. The students held positive attitude towards participation in the governments COVID-19 response.