Slipped capital femoral epiphysis as primary presentation in an adolescent with primary hyperparathyroidism due to ectopic mediastinal parathyroid adenoma.

Key Clinical Message: Ectopic mediastinal parathyroid adenoma causes primary hyperparathyroidism presenting as hypercalcemia. When children with hypercalcemia present with slipped capital femoral epiphysis, a detailed evaluation for hypercalcemia must be done before surgery. Abstract: The association between slipped capital femoral epiphysis (SCFE) and hyperparathyroidism has been reported and is rare. Each is known to affect different age groups. We report a case of a 13-year-old boy with SCFE and primary HPT leading to hypercalcemia and skeletal deformities.

Dermoscopic Findings in Clinically Diagnosed Cases of Plantar Warts, Corns, and Calluses: A Cross-Sectional Study.

INTRODUCTION:  With the naked eye, it can frequently be challenging to tell a plantar wart from a corn or callus. A non-invasive diagnostic method called dermoscopy allows for the inspection of morphological features that are not apparent to the unaided eye. This study aimed to examine the dermoscopic findings in pared and unpared cases of palmoplantar warts, corns, and calluses. METHODS: Seventy patients who had palmoplantar warts, corns, and calluses were included in this study. A predesigned structured format was used to document the dermoscopic findings. RESULT: The majority of patients (51.4%) had warts followed by callus (28.6%) and corn (20%). On dermoscopic examination, all unpared and pared cases of warts had homogenous black/red dots. Translucent central core was present in 92.85% unpared and 100% pared lesions of corns. Homogenous opacity was present in 75% unpared and 100% pared cases of callus. There was no association between unpared and pared lesions (p>0.05). CONCLUSION: The accuracy of identifying various clinical types of cutaneous warts, calluses, and corns can be improved by dermoscopy without paring.

Age Estimation Based on CT Chest Analysis of Ossification of the Xiphisternal Joint in a Living Population Aged 35-50 in a Tertiary Setup.

Introduction Age estimation has been an area of special interest in the medicolegal context because of its necessity in various criminal and civil cases like assaults, murders, rapes, inheritance, insurance claims, etc. While legal documents are useful in daily activities that require age identity, they cannot be relied on for criminal and civil proceedings because of being falsifiable and inaccessible to some people. Scientific methods of age determination like physical, dental, and radiological examinations are used for reliable age estimation due to their universal and non-falsifiable nature. The skeletal examination is of great importance here because the human skeleton provides many sites for age estimation in different age groups. The xiphisternal joint between the xiphoid process and the body of the sternum provides one such opportunity in participants of 35-50 years of age. The ossification in this joint proceeds gradually in approximately the third to fifth decade of life; this natural variation in the morphology of the joint can be leveraged for age estimation. Previous studies showed that the mean age of fusion varied with the ethnicity of individuals and environmental factors. Thus, it is critical to have statistical information for the concerned population to avoid errors. Also, the relation of gender with the mean age of complete fusion remained ambiguous with the previous studies. The xiphisternal joint can be studied by radiological techniques like computed tomography (CT) and plain radiographs. Radiological methods have the benefit that they can be used on both living and dead participants and are non-invasive. The present study aims at gathering data relevant for use in India (Maharashtra) and to find out the reference age group in which there is complete ossification of the xiphisternal joint in males and females.  Methods and materials This was a cross-sectional observational study in a tertiary care setup over a period of one year. High-resolution computed tomography (HRCT) was used for assessing joint fusion due to its high spatial resolution. The participants were included in the study if they were referred for HRCT chest by a physician for some pathology, did not have any trauma or lesion of the sternum and consented to the use of their information for the purpose of this study. Results The study included a total of 384 participants, out of whom 195 (50.8%) were males and 189 (49.2%) were females. The mean age of participants was 42.87 years. The mean age of complete xiphisternal joint fusion was observed to be 46.31 years (95% CI: 45.61 to 47.00) in males and 45.57 years (95% CI: 44.73 to 46.42) in females. Similarly, the mean age of participants with an unfused xiphisternal joint was observed to be 38.42 years (95% CI: 37.47 to 39.39) in males and 37.85 years (95% CI: 37.14 to 38.57) in females. There was no statistically significant difference in the age above which males and females show complete ossification of the xiphisternal joint. Conclusion The xiphisternal joint fusion can be used to determine the chronological age of an individual. It can be estimated as lesser than or equal to 45 years if the xiphisternal joint is unossified and greater than or equal to 37 years if the joint is ossified, with a 95% level of confidence.

Patient Safety in Intensive Care Unit: What can We Do Better?

Patient safety is an important step in providing high-quality health care. Every intensive care unit (ICU) is unique and its needs would be different; it is thus necessary to build a safety culture based on local and cultural characteristics. Various measures such as regular training, the use of bundles of care, and a blame-free environment can promote patient safety in ICUs. These measures are simple to implement even in resource-limiting settings and can go a long way in improving patient outcomes in our country. How to cite this article: Patil SJ, Ambulkar R, Kulkarni AP. Patient Safety in Intensive Care Unit: What can We Do Better? Indian J Crit Care Med 2023;27(3):163-165.

Use of the McGRATH™ MAC videolaryngoscope to evaluate the ability of anesthetists to give effective cricoid pressure: An interventional study.

Background and Aims: The application of cricoid pressure (CP) for rapid sequence induction is questioned on two grounds: its effectiveness in clinical settings and its impact on the laryngeal view. The main reason cited for its ineffectiveness is the lack of knowledge and training in its correct application. This study assessed, the performance of anesthetists in applying effective CP in a clinical setting. Material and Methods: Eighty-five ASA I/II adult patients posted for elective surgery requiring oral endotracheal intubation with nasogastric tube (NGT) placement participated in the study. Eighty-five anesthetists divided into five groups based on their level of experience were randomly chosen to apply CP after induction of anesthesia. An experienced anesthetist performed videolaryngoscopy and attempted NGT insertion. The primary outcome was effectiveness of CP defined as the inability to pass the NGT into the esophageal opening. We also noted that the glottic view with and without CP and the effectiveness of CP across different levels of experience of anesthetists. Results: Of the 85 anesthetists, 61 (71.8%) applied effective CP. The effectiveness improved with experience (first-year residents-11/17 [64.7%], second-year residents-11/17 [64.7%], third-year residents-10/17 [58.8%], senior residents-13/17 [76.5%], and consultants-16/17 [94.1%]) (P = 0.157). Post hoc analysis showed higher effectiveness among anesthetists with >3 years of experience (85.3%) compared with <3 years of experience (62.7%) (P = 0.024). CP did not always impede the laryngeal view, rather it has no effect or actually improves the glottic view in many instances (81%). Conclusion: CP is effective in occluding the esophageal lumen without hampering glottic view in the majority of the cases, and its effectiveness improves with experience.

Patient satisfaction with anaesthesia services in a tertiary care cancer centre. (SAY study).

Background and Aims: Patient satisfaction is an important measure of quality of health care. Its assessment leads to a balanced evaluation of the structure, process and outcome of service at an institution. The aim of our study was to assess patient satisfaction with perioperative anaesthesia services provided in our institution and identify factors leading to dissatisfaction which could be preventable or addressed to improve patient care and experience. Material and Methods: A convenient sample size of 200 patients was accrued after written informed consent. A questionnaire to suit local needs of institute was developed, validated and a language appropriate questionnaire was administered by a trained research nurse 24-48 hours post anaesthesia to accrued patients. Data was summarised in percentages and satisfaction scores were compared across demographic variables using Chi square test. Results: A total of 96% (192/200) patients were satisfied with the overall interaction with the anaesthetists in the perioperative period; with 99% (198/200) patients being satisfied with acute pain services provided, postoperatively. As regards to recovery room, 96.5% (193/200) patients were satisfied with the services provided. Satisfaction scores of the pre-anaesthetic clinic (PAC), pain team and anaesthesia services compared across demographic variables - age, gender and education qualifications were found to be statistically non-significant. Conclusion: High rate of patients were satisfied with perioperative anaesthesia care services at our institute. Good and effective preoperative communication with the patient, effective management of postoperative pain and complications significantly contributed towards overall high patient satisfaction.