Continuous hemoglobin monitoring during massive blood transfusion in a multivisceral pediatric transplant patient

A 10 year old, 25 kg girl, who was formerly a conjoined twin at the heart, diaphragm, liver, duodenum, bile ducts, and intestine, was admitted for a repeat liver, small bowel, pancreas, and kidney multivisceral transplant after having intestinal and liver failure. Intraoperatively, the patient had excessive bleeding, coagulopathy, and acidosis. Pulse co-oximetry was used for continuous monitoring of hemoglobin (Hb) during the procedure. Although noninvasive Hb appeared to follow a trend that correlated with arterial Hb concentration, it did not show accurate agreement with measured values from intermittent blood gas analysis. It may not be reliable during cases with abnormal physiology, rapid blood loss, and massive transfusion.     

Blood conservation strategies in orthopedic surgeries: A review

In orthopedics management of surgical blood loss is an important aspect which has evolved along with modern surgeries. Replacement of lost blood by transfusion alone is not the answer as was considered earlier. Complications like infection and immune reaction due to blood transfusion are a major concern. Today numerous techniques are available in place of allogenic blood transfusion which can be employed safely and effectively. In this article we have reviewed these techniques, their merits and demerits.     

Assessing the efficacy of video versus direct laryngoscopy through retrospective comparison of 436 emergency intubation cases

Video laryngoscopy has become a common practice for tracheal intubations. However, information on its efficacy in emergency intubations is minimal. The external video monitor may act as a means for assistance by present staff, heighten teaching ability, and improve intubation outcomes. We conducted a retrospective review consisting of 436 patients requiring emergency intubation outside the operating room to evaluate the application of a C-MAC video laryngoscope for emergency intubation(s). Nine cases were removed, 315 underwent direct laryngoscopy, 73 underwent video laryngoscopy, and 39 underwent both methods. The C-MAC laryngoscope provided a significantly better visualization of the glottis (p = 0.02). The C-MAC also provided successful intubation on the first attempt in 82 % of the 39 direct laryngoscopy cases subsequently intubated with the C-MAC. The presence of the attending anesthesiologist (while the resident intubates) had no effect on complication rates; the number of attempts required and the grade view obtained were nonsignificant (p = 0.91 and p = 0.34, respectively). Overall, use of the C-MAC video laryngoscope provided a better view of the airway structures during an emergency intubation. The success of the C-MAC laryngoscope in intubation after failed direct laryngoscopy suggests the importance of the video laryngoscope as the primary intubation approach during an emergency intubation.     

Penile Incarceration with Metallic Foreign Bodies: Management and Review of Literature

Introduction

Penile strangulation from constricting metallic objects disorders is an uncommon urological emergency which requires prompt intervention to prevent complications. The treatment modalities are diverse and characterized by lack of consensus.

Material and Methods

Three cases with penile incarceration due to constricting metallic objects who presented to our department were included in this study. All 3 patients required different management options highlighting the diversity of clinical presentation and need for customization of treatment as per the clinical scenario.

Results

The 3 patients required different approach for treatment. First patient could be managed by degloving of penile skin while second patient required mechanical removal of the foreign body and debridement of local necrotic tissues. The third patient had to undergo excision of gangrenous penile skin and skin grafting.

Conclusion

The study emphasizes the diversity of clinical presentations and the need for employing different surgical techniques to achieve the desired results.Key Words: Penile strangulation, Constricting objects, Penile amputation     

Current biomedical waste management practices and cross-infection control procedures of dentists in India

Objectives: To investigate the knowledge, attitudes and behaviour of dentists working in dental clinics and dental hospitals regarding biomedical waste management and cross‐infection control. Methods: A national survey was conducted. Self‐administered questionnaires were sent to 800 dentists across India. Results: A total of 494 dentists responded, giving a response rate of 61.8%. Of these, 228 of 323 (70.6%) general dentists reported using boiling water as a sterilising medium and 339 (68.6%) dentists reported disposing of hazardous waste such as syringes, blades and ampoules in dustbins and emptying these into municipal corporation bins. Conclusions: Dentists should undergo continuing education programmes on biomedical waste management and infection control guidelines. Greater cooperation between dental clinics and hospitals and pollution control boards is needed to ensure the proper handling and disposal of biomedical waste.     

Voluntariness in clinical research at the end of life

Voluntariness is a requirement that is frequently voiced in research ethics but is poorly understood. This article seeks to clarify voluntariness and assess its significance in clinical research at the end of life. First, what voluntariness is and why we consider it important is considered. Next, where voluntariness fits in the overall context of making clinical research ethical is clarified. Finally, the murky terms "vulnerability," "exploitation," and "coercion" are clarified and their relationship to voluntariness examined. The danger of using some of these terms is that they carry a lot of moral weight and labeling patients as "vulnerable" or "coerced" can close off conversation because they are reflexively associated with unethical research. Finally, correctly characterized threats to voluntariness are examined and ways to ameliorate them are presented.