{"title":"Frugal Surgical Innovations are the Need of the Hour","authors":"D. Sharma","doi":"10.38192/1.8.2.8","DOIUrl":"https://doi.org/10.38192/1.8.2.8","url":null,"abstract":"Innovation is defined by the dictionaries as “a new idea, device, or method; or the act or process of introducing new ideas, devices, or methods.” However, Surgical Innovation (SI) is more difficult to define. Common narratives include why-where-how-what-who as well as novelty, degree of change, safety, ethical standards, level of impact and peer acceptance. [1, 2] We have proposed a simpler, more egalitarian and ‘inclusive’ definition: “a SI is ‘any’ new surgical idea which improves patient welfare by solving an existing problem; and which like a three-legged stool is balanced by the three legs which represent surgical-precision, surgical-wisdom and patient-safety”. [3] \u0000Frugal Surgical Innovations (FSIs) are low-cost surgical innovations which are designed for economic reasons. These are all about ‘doing more and better with less for more people’. [4] FSIs make up for their lack in sophistication or complexity in affordability, without scrimping on safety or effectiveness. The three constructs of FSIs are: affordability, adaptability and accessibility. [5] The philosophy of FSIs originates from grassroots, resource-constrained settings (RCS), where most abundant of all-natural resources — human ingenuity — is used to optimize limited resources to solve problems. [6] Clinically meaningful inclusive research can be performed ‘only’ by surgeons working in RCS; as ‘only’ they understand the difficulties and nuances of various problems and can provide simple affordable solutions for their patients. [7]","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"248 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-07-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89174172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"An Audit of Hypophosphatemia after Intravenous Iron Therapy","authors":"M. Shahani, P. Thiagarajah, I. Chakravorty","doi":"10.38192/1.8.1.13","DOIUrl":"https://doi.org/10.38192/1.8.1.13","url":null,"abstract":"Background\u0000Due to the gastrointestinal side-effects of oral iron supplementation in patients with iron deficiency anaemia, which impairs tolerance - many acute medical and haematology day units provide intravenous iron replacement therapy as day cases. Hypophosphatemia is a frequent side effect following intravenous iron administration, which can persist for weeks or months, is under-recognised in clinical practice and can lead to patients presenting with typical features to the emergency departments.\u0000Aim\u0000We designed an audit to measure the incidence of symptomatic hypophosphatemia after intravenous iron therapy to develop monitoring, prevention, and treatment strategy in a secondary care hospital setting.\u0000Methods\u0000We audited a convenience sample of consecutive patients who attended an acute day-care assessment unit for intravenous (IV) iron infusion (ferric carboxymaltose). All patients had serum phosphate levels checked after IV iron infusion at different intervals, from 1- 6 weeks. The cohort was divided into two groups based on the occurrence of hypophosphataemia - early (1-3 weeks) and late (>3-6 weeks).\u0000Results\u0000We included 35 patients referred from primary care, gastroenterology, gynaecology, and acute internal medicine. 19 (55%) developed hypophosphatemia after receiving a single IV iron infusion and almost 100% after more than one dose. Hypophosphatemia in some patients lasted up to 12 weeks.\u0000Conclusion\u0000Hypophosphatemia was frequent after a single dose and almost universal after multiple doses of IV Iron, which can persist for many weeks. Clinicians prescribing ferric carboxymaltose (Ferinject®) should be aware of hypophosphataemia, which could be mild, moderate, or severe and can last for months.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"119 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74234179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A Hitchhikers Guide to Anxiety Disorders","authors":"J. Bamrah, Freya Dow, R. Ramkisson, S. Dave","doi":"10.38192/1.8.1.12","DOIUrl":"https://doi.org/10.38192/1.8.1.12","url":null,"abstract":"AD is the commonest mental disorder with a lifetime prevalence rate of 21.1% in Europe, 31.0% in the United States2,3, a point prevalence of 5%, and a greater preponderance amongst women4. \u0000Living with ADs can be a long-term challenge. In many cases, it occurs along with other mood disorders5,6. In most cases, AD improves with psychological therapies and medication. Making lifestyle changes, learning coping skills and using relaxation techniques also can help. However, failure to treat AD and its consequences can be economically and socially costly.\u0000Therefore, early recognition of the disorder is imperative as that improves the scope for treatment and the prognosis. This guide describes critical aspects of the various subtypes of AD and how to manage them.\u0000 ","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89487140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Aspergillus Endocarditis in a prosthetic Valve following COVID-19 Infection","authors":"Sai Manogna Vegiraju","doi":"10.38192/1.8.1.6","DOIUrl":"https://doi.org/10.38192/1.8.1.6","url":null,"abstract":"Endocarditis of a prosthetic valve is a known but rare occurrence. Fungal endocarditis is extremely rare. However, in the COVID-19 pandemic, there has been increasing recognition of fungal or yeast-related infections, often due to the combination of immune paresis, concurrent use of corticosteroids or underlying chronic conditions such as diabetes or neoplasms.\u0000We present a patient with fulminating, invasive aspergillosis of a prosthetic aortic valve who presented with catastrophic cardiovascular failure needing intensive care management. Early recognition and prompt therapy is the cornerstone of success in such presentations with high mortality.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77647519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Legacy of the Crown for the NHS?","authors":"I. Chakravorty","doi":"10.38192/1.8.1.4","DOIUrl":"https://doi.org/10.38192/1.8.1.4","url":null,"abstract":"The sixth of May 2023 marked the first Coronation in the United Kingdom after seventy years since Queen Elizabeth was coronated on 2 June 1953. King Charles III took oath for service and perfect justice. During his crowning ceremony, the Coronation Oath Act of 1688 required the King to declare that he would maintain the established Anglican Protestant Church, rule according to laws agreed upon in Parliament, and case law, with justice and mercy to be executed in his judgment. However, for the first time, a preface was added to the coronation oath in which the Archbishop said the Church of England “will seek to foster an environment where people of all faiths and beliefs may live freely”. King Charles III has enormous responsibilities as Head of State for the United Kingdom of 19 countries and the Commonwealth of Nations. What does his legacy mean for the diversity of people of the UK and the Commonwealth? What can the National Health Service expect from his legacy and vision?","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83366134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Betsy Francis, V. Goel, Pramod D Gandhi, S. Gathe, Harshwardhan S Bora, R. Atara, Sweta S. Lohiya, Ashish P Kamble, Rajan Barokar, Ashwini Tayade, V. Dehane, D. Raje
{"title":"COVID-19 Associated Mucormycosis","authors":"Betsy Francis, V. Goel, Pramod D Gandhi, S. Gathe, Harshwardhan S Bora, R. Atara, Sweta S. Lohiya, Ashish P Kamble, Rajan Barokar, Ashwini Tayade, V. Dehane, D. Raje","doi":"10.38192/1.8.1.3","DOIUrl":"https://doi.org/10.38192/1.8.1.3","url":null,"abstract":"Abstract\u0000This case series explores Covid-19 associated Mucormycosis (CAM), its risk factors, clinical features and outcomes from a tertiary centre in Maharashtra, India, during the second wave of COVID-19.\u0000Methods: A retrospective, observational case series of 104 consecutive patients admitted to the hospital at various stages of complications of CAM, during the second wave of the COVID-19 pandemic (Jan’21-Apr’21). The diagnosis was confirmed using Potassium hydroxide wet mount (KOH), histopathology, fungal culture, and Cone-Beam Computed Tomography(CBCT).\u0000Results: There were 81% men, mean age of 49 ± 12.4 years, and all patients had a history of corticosteroids usage, 82% had a prior diagnosis of diabetes mellitus (DM) and the rest were newly diagnosed. Diagnosis of mucormycosis was confirmed on 2 modalities in 71%; KOH and histopathology in 31 (30%), and fungal culture with KOH and histopathology together detected 25 (24%). 9% were diagnosed exclusively with CBCT. Patients with prior DM had higher morbidity OR 8.30 [95% CI: 2.12, 32.5; p=0.002] and mortality OR 13.23 [95% CI: 1.67, 104.7; p=0.014] than non-DM patients. Mortality was higher in patients with rhino + orbital involvement than patients with rhino + maxillary involvement [OR 8.37 [95% CI: 1.52, 46.09; p=0.014].\u0000Conclusion: Diabetes remained the highest risk factor for the development of CAM in patients with COVID-19 on corticosteroids, with high mortality and morbidity. Timely medical and surgical interventions and multi-disciplinary approaches could potentially reduce mucormycosis-associated mortality. Among the diagnostic modalities, detection using CBCT may increase the diagnostic yield in patients not detected in other modalities.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89939524","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Shafiah Abdul Gafoor, Russel Tilney, Pablo Garcia Reitboeck
{"title":"Sequential bilateral facial nerve palsy and gait ataxia – a rare presentation of neurosyphilis","authors":"Shafiah Abdul Gafoor, Russel Tilney, Pablo Garcia Reitboeck","doi":"10.38192/1.8.1.2","DOIUrl":"https://doi.org/10.38192/1.8.1.2","url":null,"abstract":"A middle-aged gentleman presented with sequential bilateral facial nerve palsy and ataxia. A diagnostic workup revealed positive blood serology for active syphilis infection. Interestingly, his cerebrospinal fluid was negative for syphilis. The patient responded to treatment with benzylpenicillin and made a complete recovery. Unfortunately, the diagnosis of neurosyphilis ‘still’ poses a challenge to clinicians due to insufficient ‘sensitive’ testing modalities and diagnostic criteria. \u0000We highlight the need for a low threshold to test for syphilis in patients presenting with neurological sequelae whose diagnosis is not precise.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89787857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Pituitary Apoplexy causing Panhypopituitarism","authors":"Mahesh Mutuerulan","doi":"10.38192/1.8.1.5","DOIUrl":"https://doi.org/10.38192/1.8.1.5","url":null,"abstract":"We present an atypical presentation of pituitary apoplexy as a pontine mimic with drowsiness and pin-point pupils. The patient had a known pituitary macroadenoma with suprasellar extension with hypogonadism and hypothyroidism.\u0000Initial investigations revealed hyponatraemia and imaging suggested a localised cerebral ischaemia in the basal ganglia and no change in the pituitary adenoma. Only further assessment with MRI showed the extent of the haemorrhage. Management was conservative, although close involvement of neurosurgery and ophthalmology teams is essential.\u0000We believe, that awareness of such unusual association is important for clinicians to consider apoplexy in the differential, even if the initial CT imaging is not suspicious.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78975516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Jose, T. Mathew, A. Oguntade, Rajinder Tripathy, Awais Iqbal
{"title":"Aneurysmal Bone Cyst presenting Incidentally as a Traumatic Foot Injury","authors":"T. Jose, T. Mathew, A. Oguntade, Rajinder Tripathy, Awais Iqbal","doi":"10.38192/1.8.1.7","DOIUrl":"https://doi.org/10.38192/1.8.1.7","url":null,"abstract":"Introduction: Aneurysmal bone cyst is a rare, non-neoplastic lesion affecting the metaphysis of long bones and vertebrae, characterized by blood-filled spaces separated by fibrous septae.\u0000Aims and objectives: In this study, we present a case of an aneurysmal bone cyst in a 7-year-old child with characteristic X-ray findings to increase awareness as early diagnosis and treatment can limit disability.\u0000An aneurysmal bone cyst is a rare, benign neoplastic lesion affecting the metaphysis of long bones and vertebrae, characterized by blood-filled spaces separated by fibrous septae.[1] Diagnosis depends on typical features of magnetic resonance imaging, and confirmation by biopsy is essential before surgery is considered. \u0000We present an aneurysmal bone cyst in a 7-year-old child with characteristic X-ray findings. Diagnosis of ABC should be suspected in young patients presenting with limb pain or swelling, and pain disproportionate to the mechanism of injury could indicate pathologic fracture. Early detection of ABC is possible as an incidental finding by closely examining routine X-rays so that appropriate treatment can be instituted early and complications like pathologic fractures can be avoided. This case will help to increase awareness as early diagnosis and treatment can limit disability.","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89595375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The First National Conference for Locally Employed Doctors in the UK NHS","authors":"Shubhangi Barnwal, Biju Simon","doi":"10.38192/1.8.1.1","DOIUrl":"https://doi.org/10.38192/1.8.1.1","url":null,"abstract":"Abstracts selected for presentation at the Conference in the Research and QI session by BAPIO Institute for Health Research, Leicester, UK","PeriodicalId":75015,"journal":{"name":"The Homoeopathic physician","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75361604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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