Natl Med J India
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Background Although there are many studies on violence against physicians in the literature, there are few studies on violence against physicians working in intensive care units (ICUs). We aimed to investigate the frequency, type and underlying factors of violence against physicians working in ICUs in Turkey in the past 1 year. Methods We collected data by sending a questionnaire about violence against physicians working in ICUs via e-mail and WhatsApp between 1 and 15 May 2022. ⋯ Conclusion Physicians working in ICUs encounter violence against them. The frequency of violence increased after the Covid-19 pandemic. A significant relationship was found between the frequency of violence and female gender, age group, title, subspecialization status, working style and duration of working in ICUs.
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Observational Study
Clinical profile of patients and sensitivity of troponin I in patients with and without acute coronary syndrome: An observational study.
Background Various clinical conditions can cause troponin elevation in the absence of myocardial ischaemia. Elevated troponin represents the likely occurrence of myocardial necrosis and does not itself provide any indication of the aetiology. Identifying the cause for troponin elevation and its sensitivity and specificity in predicting acute coronary syndrome (ACS) and cardiac mortality is an important step in determining the optimal management for these patients. ⋯ Conclusion A variety of conditions apart from myocardial infarction can lead to elevated TnI. Hence, caution should be exercised while diagnosing a patient with ACS based on TnI value in the absence of other supporting evidence given its low specificity. Elevated TnI portends a worse prognosis regardless of the aetiology and has a role in predicting all-cause and cardiac mortality.
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Case Reports
Haemophagocytic lymphohistiocytosis associated with liver injury in systemic sarcoidosis.
Hepatic involvement in sarcoidosis, though common, is usually asymptomatic. Hepatomegaly and deranged liver function tests are the usual manifestations. However, unexplained hepatomegaly in sarcoidosis not responding to immunosuppressive therapy could indicate an alternative pathology. ⋯ We report a patient of systemic sarcoidosis who presented with fever, hepatosplenomegaly and jaundice despite being on steroid therapy. He was subsequently diagnosed with HLH. The clinical response to treatment with pulse steroid and oral cyclosporine was dramatic.
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A lobar re-expansion pulmonary oedema (REPO) after pleural drainage procedure is rare and usually asymptomatic. We report a 56-year-old man with severe left lower lobar REPO after tube thoracostomy drainage of a loculated hydro-pneumothorax of 2 days' duration with underlying chronic obstructive pulmonary disease. ⋯ The severity of lobar REPO was probably related to the pre-existing emphysematous changes and airway obstruction. Supplemental oxygen and intermittent pleural drainage led to clinical recovery within 24 hours, followed by radiological clearance of alveolar opacities within 3 days.