Multispeciality Team Research Articles

Resurgence of orbital mucormycosis during COVID-19 pandemic: Study from a tertiary care center in Eastern India.

A sudden surge of Mucormycosis cases during the second wave of Covid 19 was observed in certain parts of India. The reasons for this upsurge remain unknown. However its impact on the overall healthcare system was quite overwhelming. In this context this study was decided to estimate and assess the spectrum of orbital involvement in patients with Mucormycosis, to find its association with coexisting disease entities if any, and at the same time evaluate the therapeutic response to established treatment regimens. This descriptive longitudinal study was conducted over a period of six months. Patients presenting with symptoms of Mucormycosis were jointly evaluated by a multi speciality team. After confirmation of diagnosis, patients were treated with intravenous Amphotericin B, surgical debridement of affected sinuses and orbital exenteration when indicated. They were followed up for three months after discharge. Forty-three patients were enrolled in this study. Thirty-seven (86.04%) were COVID positive. All of them had history of steroid exposure during COVID treatment. Ninety five percent of study participants had diabetes mellitus. Twenty-seven (62.79%) patients had orbital involvement. Most common clinical presentation was peri-orbital or facial pain and edema. Besides medical treatment, thirty-nine patients (90.69%) required sinus debridement and nine patients (20.9%) required orbital exenteration. Thirteen patients (30.23%) expired during the follow up period. With treatment disease regressed in twenty patients (46.51%). Diabetes and use of steroids to prevent anticipated cytokine storm may be the inciting factors for Orbital Mucormycosis in COVID patients. Early diagnosis, treatment and control of risk factors are keys for recovery and survival..

An Emergency and Challenging Life-Saving Surgery in a Newborn with Imperforate Anus in a Remote Village in South Sudan – A Case Report

Anorectal malformation, a congenital defect is usually detected at birth and managed by a multispeciality team in a tertiary care hospital. We present a case of a five day old neonate, born in a remote village in South Sudan, who presented in a critical condition to our field hospital and was managed with basic resources. A 5 day old neonate was detected with imperforate anus and presented to our hospital on day 5 with abdominal distension, severe dehydration, tachycardia and tachypnoea. Radiographic investigations revealed findings suggestive of a high ano-rectal malformation. The neonate underwent an emergency exploratory Laparotomy with diversion double barrel Colostomy in a set up catering for adult combatants. The neonate gradually improved before developing burst abdomen managed with emergency wound closure. The neonate gradually accepted breast feeds and was discharged for subsequent need for definitive surgery. This was a challenging surgery with respect to the resources available at a field hospital catering to adult combatants.

Prevalence of long COVID-19 syndrome among health care workers of Patan Academy of Health Sciences

Introduction: Any symptoms acquired after COVID-19 infection that persists beyond 12 weeks period and not explained by any other disease either already present or acquired after COVID-19 infection is termed as long COVID 19 by World Health Organisation. We tried to find out the prevalence of long COVID 19 in healthcare workers.
 Method: Questionnaire was made in google form based on COVID-19 Yorkshire Rehabilitation Screening Tool (COVID YRS Tool). Ethical approval was taken from IRC-PAHS. Data collected from all health care workers of PAHS from 2022/05/20 to 2022/07/20. Difference in Precovid and Postcovid status in different domains were compared by statistical tests.
 Result: The median age of our participants was 29 years. Prevalence of Long COVID 19 was 68.1%. 19 55.3% ha mild, 10.4% had moderate, 2.4% had severe symptoms. The most common symptom was fatigue (44%), anxiety (41%) and shortness of breath (36%). The COVID YRS Tool overall score was statically significant with p value <0.001. Pre COVID 19 and Post COVID 19, patients had statically significant in breathlessness, fatigue, nutrition, anxiety, usual activity, pain, anxiety and depression. Only 6% of our patients had severe COVID 19.
 Conclusion: People are still experiencing various symptoms after COVID 19 infection. Long COVID 19 has now been a health care problem. Long COVID 19 patients have multisystem involvement and multi-speciality team is needed for their management and rehabilitation.

Ведение пациенток с забрюшинными гематомами в позднем послеродовом периоде

Postpartum retroperitoneal hematomas can occur both after surgical and normal vaginal delivery. Etiology includes mechanical and spontaneous causes. If a retroperitoneal hematoma is suspected, it is necessary to carry out urgent diagnostic measures with the participation of a multi-speciality team to develop a plan for the patient management and treatment. Surgical intervention or conservative treatment is performed depending on the clinical situation. The continuing instability of hemodynamics is an indication for surgical intervention (revision of the abdominal cavity, intra-arterial embolization, puncture, etc.). This article presents two clinical cases of combined conservative treatment and uterine artery embolization of patients with this pathology. In both cases the treatment was effective.

O03 Continuation of golimumab (anti-TNF) in a patient with SpA and low-risk prostate cancer, what is the right decision?

Case report - IntroductionGolimumab is an anti-TNF alpha drug used in the treatment of inflammatory arthritis including spondyloarthritis (SpA). The introduction of this drug class has revolutionised the treatment of SpA over the last 20 years with significantly improved patient outcomes.Despite their treatment benefits multiple adverse effects of TNF-alpha inhibition have been reported through clinical trials including a possible increased risk of malignancy.We describe a case of a patient with known ankylosing spondylitis (AS) on golimumab who was diagnosed with low-grade prostate carcinoma and discuss the factors taken into consideration in guiding our decision-making process regarding ongoing treatment. Case report - Case descriptionA 57-year-old gentleman with known AS presented to the rheumatology clinic for routine review. His AS was well controlled, and he had been taking golimumab for the past 3 years. Upon review he was in clinical remission with a CRP <1 and ESR 5. Prior to the initiation of anti-TNF therapy his disease had been poorly controlled. However, following commencement his symptoms had significantly improved and he was able to work as a professional sports coach whilst bringing up a young family.On review he had recently been diagnosed with low-risk cancer of the prostate by his urologist. A prostate biopsy found Gleason 3 + 3 adenocarcinoma involving 2 out of 22 cores on each side, with a prostate specific antigen (PSA) of 3.95ng/ml. An MRI had shown chronic prostatitis. He was in the lowest risk category of grade group 1 prostate cancer and no treatment for his prostate cancer was indicated. The plan from his urology team was active surveillance with PSA monitoring.Whilst being investigated for possible malignancy his golimumab had been held for six months and during this period he had a significant flare in symptoms. He experienced severe back pain that forced him to stop working. Following his prostate cancer diagnosis, golimumab was restarted by his urologist with a subsequent improvement in his AS symptoms.To guide ongoing treatment his case was reviewed in the local biologics multi-disciplinary team meeting, alongside close communication with his urologist. The patient was informed of the risks of continuing golimumab in relation to his malignancy. Despite this he was reluctant to stop anti-TNF therapy or switch to another treatment, citing concerns about the impact it might have on his symptoms and ability to work.Case report - Discussion This case highlights the complexities involved in the management of a patient on anti-TNF therapy, who receives a diagnosis of malignancy, particularly when the diagnosis is classed as low risk. Traditionally anti-TNF therapy was contraindicated for patients with a history of a solid organ tumour within the previous five years. The British Society of Rheumatology (BSR) guidelines recommends that patients should be advised that there is no conclusive evidence for an increased risk of solid organ tumours but that on-going vigilance is required.A holistic patient-centred approach needs to be taken in these contexts, and consideration of cases on an individual basis is needed. Inter-disciplinary and multi-speciality team input, with the effective use of a biologics MDT, is crucial. The patient was understandably reluctant to stop his treatment due to the significant impact this may have on his quality of life.On liaison with his urologist his prostate cancer was in the lowest risk category with 99% 5-year survival rates with low risk of disease progression or spread.Evidence in this field to date has been conflicting and studies have predominantly focused on the safety of anti-TNFs in rheumatoid arthritis patients. Recent large national registry data has been reassuring. Few studies have looked at the AS and psoriatic arthritis anti-TNF treated population; however, a meta-analysis of RCTs found no evidence of increased incidence of malignancy.Taking into account his low-risk cancer, the patient’s wishes and clinical evidence in this field we have made to decision to continue anti-TNF treatment for now but with ongoing surveillance for any tumour progression. The patient will undergo urology follow up alongside regular PSA monitoring, and there will be a low threshold to stop or switch treatment in the futureCase report - Key learning pointsTreatment with anti-TNF therapy in patients with concomitant inflammatory arthritis and malignancy pose a specific challenge that require close co-ordination of care between rheumatologists, oncologists, other relevant teams and may benefit from the use of local biologics MDT to guide ongoing drug therapy.It is important to take a patient centred approach and consider cases on an individual basis taking into account their cancer diagnosis, extent of disease, histology findings and their response to TNF treatment.Patients must always be counselled on the risk of continuing anti-TNF and be involved in the decision-making process.Further research is required to look at the safety of anti-TNF particularly in SpA and if there is an increased risk of malignancy.

Ect in Two Elderly Patients with Covid-19: Weighing Up Unknown Risks in Unprecedented Times.

The COVID-19 pandemic has created an unprecedented situation demanding a rapid response to a barrage of unknown risks. Issues around infection control, resource allocation and treatment delivery have threatened the viability and accessibility of Electroconvulsive Therapy (ECT) services. Additionally, there are unquantified risks around the delivery and effect of ECT in patients who have had COVID-19. We discuss two cases where ECT was restarted in older-adults who had had symptomatic COVID-19. We consider the importance of clinical assessment, multi-speciality team involvement, and comprehensive risk assessment in making high stakes treatment decisions around ECT in patients with COVID-19. Although more research and international multi-speciality collaboration is required to develop evidence-based guidance, it is vital that we maintain equitable access to safe, effective and potentially life-saving ECT during this pandemic.

Glomus tumor: an atypical presentation

&lt;div class="WordSection1"&gt;&lt;p class="abstract"&gt;Glomus tumors are rare soft-tissue neoplasms of the neuromyoarterial glomus body, typically present in adults as small, blue-red papules or nodules of the distal extremities, with most cases involving subungual sites. The majority of glomus tumors are benign, malignant cases have been rarely reported, with such cases typically being locally invasive. 27 years old patient presented with four years history of intermittent swelling, pain in left lower leg. Biopsy of the lesion revealed lobulated vascular tumour composed of endothelial cells showing intracytoplasmic lumina and solid aggregates of tumour cells, divided by intervening fibrocollagenous septae. Glomus tumour of uncertain malignant potential was diagnosed after excision biopsy. Multispeciality team approach was done for complete cure of the condition.&lt;/p&gt;&lt;/div&gt;

United Kingdom CSF Disorders Day 2017

ABSTRACTThe management of patients with cerebrospinal fluid disorders requires a multi-specialty approach involving specialists in neurosurgery, neurology, neuroradiology and neuro-ophthalmology. A symposium on CSF disorders was organised by the clinical and academic teams at University Hospitals Birmingham, United Kingdom. The meeting featured a synopsis of the latest scientific research on CSF disorders. Some of the more challenging and controversial issues facing the multi-speciality team were presented and discussed. A summary of the event is provided.

Traumatic eye ball luxation: A stepwise approach to globe salvage

Craniofacial trauma is often associated with orbital and ocular injuries. We report a case of a 21-year-old male with motor vehicular accident, orbital roof blow-in fracture, cerebrospinal fluid (CSF) leak, and left sided globe luxation with corneal abrasion and complete conjunctival denuding. The patient was managed by a multispeciality team and the eyeball was protected by amniotic membrane graft (AMG) biological dressing with novel use of inverted sterile metallic bowl as mechanical protection till the patient stabilized. During surgery, eyeball was reposited and ocular surface was reconstructed using amniotic membrane and symblepharon ring. Surgical correction and plating of the facial fractures and dural repair with autologus tensor fascia lata was done. Post surgery ocular surface was intact, ocular motility was well preserved and the globe was prephthisical. Traumatic eyeball luxation is a rare, but dramatic presentation which may occur in a blow in fracture when the intra orbital volume reduces and expels the eye ball out of the socket. This may be associated with extra ocular muscle rupture or optic nerve avulsion. The visual prognosis is nil in majority cases. However, the management is targeted towards globe preservation in view of psychological benefit and ease of cosmetic or prosthetic rehabilitation. Knowing the mechanism of luxation helps to plan the management. A stepwise approach for globe salvage is recommended. Team efforts to take care of various morbidities with special steps to safeguard the eye help to optimize outcomes.

Mouth Cancer for Clinicians. Part 9: The Patient and Care Team.

A MEDLINE search early in 2015 revealed more than 250,000 papers on head and neck cancer; over 100,000 on oral cancer; and over 60,000 on mouth cancer. Not all publications contain robust evidence. We endeavour to encapsulate the most important of the latest information and advances now employed in practice, in a form comprehensible to healthcare workers, patients and their carers. This series offers the primary care dental team in particular, an overview of the aetiopathogenesis, prevention, diagnosis and multidisciplinary care of mouth cancer, the functional and psychosocial implications, and minimization of the impact on the quality of life of patient and family. Clinical Relevance: This article offers the dental team an overview of the multidisciplinary team (MDT; or multi-speciality team) and its roles, and an overview of the implications of therapies that are discussed more fully in future articles in the series.

Bringing up Preterm Babies—A Guide for Parents: Krisha Krishnani and Umesh Vaidya (eds)

Preterm babies contribute a huge burden of sick newborns in the world. Many of them require prolonged stay in level II and III care newborn units for treatment and later, for a long term follow-up by a multispeciality team of doctors, developmental specialists and lactational management experts. During hospital stay, the parents and familymembers of the preterm babies undergo tremendous psychological and financial stress resulting in feeling of guilt and helplessness. Most often, the treating neonatologists and nurses are too preoccupied by their busy work schedule and always may not be in a position to explain and counsel the family in the right manner which leads to a sense of dissatisfaction among the family members. The book “Bringing up preterm babies—A guide for parents” written by Ms Krisha Krishnani and Dr Umesh Vaidya clarifies most of the problems and queries of the parents and families who are faced with a situation of having a preterm baby admitted in one of the neonatal units. The book highlights, in very simple language, the terminologies used in newborn care including different levels of care, how to cope up with stress, the follow up care, special feeding technique, including importance of breast milk and lactational management. The chapter on parenting your neonatal intensive care unit (NICU) baby at home, parental participation in NICU care and financial aspects of neonatal care are excellently written and are of great use for the parents and family. The book covers a wide spectrum of the medical complications including problems in growth and development and assessment depicting various charts for monitoring. The chapters are very well written in a simple language for the parents. However, many of these topics appear to be difficult to understand by ordinary parents without any background knowledge of medical sciences unless they are explained by the doctors. It shall be heartening for all the parents of preterm babies to know about famous preemies of the world. I congratulate the authors of all the chapters who have done excellent work by simplifying the subject in simple and understandable language. The book shall be a useful knowledge bank for not only parents but also for all nurses and doctors caring for the newborn babies.

Maternal and neonatal outcomes of placenta previa and placenta accreta: three years of experience with a two-consultant approach.

ObjectiveThe aim of this retrospective cohort study was to evaluate maternal and neonatal outcomes in patients with placenta previa (PP) and placenta accreta (PA).MethodsThe study population comprised all patients who had a cesarean section for PP and PA at a tertiary referral hospital in Taif, Kingdom of Saudi Arabia, from December 2009 to December 2012. Maternal and neonatal data were obtained from medical records and the hospital database system. PA cases were managed by a multispeciality team, including two obstetric consultants.ResultsIn total, 122 patients with PP were identified, with PA found in 25 cases. The median intraoperative blood loss in cases of PA was 2,000 (mean 3,000) mL, with a loss of ≥2,000 mL occurring in 72%, and ≥5,000 mL in 20%. The median packed red blood cell transfusion requirement was 6 (mean 7.7) units, and 28% received ≥10 units. Fetal growth restriction was diagnosed in two cases with known maternal medical disorders. Four cases (3.3%) were diagnosed as small for gestational age. The mean birth weight of the neonates was at the 10th–50th percentile according to Hadlock fetal growth charts.ConclusionThe presence of a second obstetric consultant among the multispeciality team during surgery for PA was associated with a reduction in blood loss and a decreased need for large-volume blood transfusion. The rate of fetal growth restriction/small for gestational age in PP was average, but the babies were relatively small (level 2 evidence).

Replantation of an Amputated Hand: A Rare Case Report and Acknowledgement of a Multidisciplinary Team Input

An amputation of the hand is a devastating injury. It adversely affects the victim's ability to earn a livelihood, support a family, and carry out daily activities. It has a great psychological impact. We report a middle aged male with an amputation at the level of the distal forearm who underwent replantation. The operative details of this case are described. Awareness of the possibility of salvage should be spread among healthcare personnel and the need for immediate attention by a multispeciality team is advocated. This report reviews the literature related to the operative technique, contraindications and long term results.

Erythrodermic Juvenile Dermatomyositis

Juvenile dermatomyositis (JDMS) is an inflammatory myopathy with various cutaneous manifestations, usually affecting children between 2 and 15 years of age. We describe a 9-year-old female diagnosed with Juvenile dermatomyositis presenting with generalized erythroderma, Gottron papules, inflammatory myopathy associated with systemic hypertension confirmed on histopathogical examination of skin and muscle biopsy. Since erythroderma, though rare, is an early manifestation of dermatomyositis (adult onset), presence in a pediatric case should prompt early investigations and effective management by a multispeciality team.

Successful revascularization of near total amputation of the upper limb at the sultan qaboos hospital, salalah.

Severe crush injuries to the upper limb may require a formal amputation with devastating consequences to the patient. We report a patient with a near total amputation at the level of mid-forearm who underwent revascularization and salvage of his hand. The operative details of this case are described. It is the first time that such a patient has been treated successfully by plastic surgeons and orthopedic surgeons at the Sultan Qaboos Hospital, Salalah. Awareness of the possibility of salvage should be spread among health care personnel as well as the need for immediate attention by a multispeciality team. Literature related to the operative technique, contraindications and long term results is reviewed.

Ethmoidal osteoid osteoma with orbital and intracranial extension – a case report

BackgroundOsteoid osteoma is a benign bone neoplasm which is seen in the long bones of appendicular skeleton. It is rarely seen in the cranium. Skull base osteoid osteoma is extremely rare and has been anecdotally reported.Case presentationThe authors report a case of a large osteoid osteoma of the ethmoid with intraorbital and intracranial extension in a 33 year old male patient. He presented with loss of vision in the left eye. The intra-cranial extension was excised through a single burr-hole fronto-orbitotomy. The ethmoid and orbital portions were approached and excised through a Weber-Ferguson incision and inferior orbitotomy. Radical excision of the tumor could thus be achieved through a craniofacial approach.ConclusionAlthough benign and rare, skull base osteoid osteoma can present with neurological deficit due to its mass effect and involvement of vital structures. A multispeciality team approach is advisable in such cases if radical excision is to be achieved. A craniofacial approach made radical single stage excision of this multicompartmental osteoid osteoma possible with an uneventful postoperative period.

Quality of Life and Comprehensive Care

EpilepsiaVolume 44, Issue s6 p. 59-59 Free Access Quality of Life and Comprehensive Care First published: 18 August 2003 https://doi.org/10.1046/j.1528-1157.44.s6.23.xAboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Improvement in the medical course of a disease does not automatically improve quality of life (QOL), since the psychological, social, and occupational consequences of the illness often remain. Epilepsy may result in early retirement, unemployment or employment for which the individual is overqualified, and social limitations due to fear of seizures. Such people need a comprehensive approach to diagnosis, treatment and counselling. Furthermore, a considerable number of people who remain seizure-free and without side effects nevertheless report restrictions in activities of daily life. Other people have refractory seizures, with and without additional disabilities, or neuro-psychological deficits, which impair their daily activities. All these individuals need additional help to overcome the negative consequences of epilepsy. Comprehensive care programmes are a possible way forward. COMPREHENSIVE CARE IN THE UNITED STATES In the United States, a comprehensive epilepsy programme has been described as one “in which a multispeciality team (physicians, psychologists, nurses, social workers, and specialised technical help) is brought together to provide an organised approach to the management of people with complex problems related to epilepsy”1. An example is the Minnesota Comprehensive Epilepsy Program (MINCEP). COMPREHENSIVE CARE IN EUROPE Comprehensive care was introduced in Europe in the 1990s, and although such programmes so far are generally limited to major medical centres, the concept includes assessment, therapy and networking to all other levels. Comprehensive care requires QOL-oriented, planned, individual therapy and the development of regional services. The first step in such a programme is a comprehensive assessment (preferably by a multidisciplinary team) of the person's performance, including his or her abilities as well as disabilities. The goal of planned individual therapy is to improve QOL, including personal beliefs (Fig. 1). Figure 1Open in figure viewerPowerPoint Comprehensive care. Comprehensive care is generally limited to major medical centres 2. Thus, good communication between those centres and local services is crucial. Examples include detailed and specific reports and videos for the person with epilepsy, their relatives, physician-in-charge and sometimes (with the individual's consent) employers and local social workers. Within each region, there should be expert individuals responsible for people with epilepsy in the community with a remit to coordinate medical treatment, counseling, and psychosocial support. Such experts may be social workers who spend some time in major epilepsy centres to learn more about the illness or epileptologists who regularly visit residential homes for people with disabilities to improve medical treatment and to teach staff. Other tasks include visiting employers to educate them about the risks—real and imagined—associated with epilepsy. In the larger regions, efforts are under way to link services in comprehensive networks. Ultimately, comprehensive care must be tailored to the different levels of the health service, including primary care, and should become the accepted standard of care. “HRQOL [health-related quality of life] takes time to evolve and to become fully evident in patient reports”3. The establishment of good comprehensive care programmes therefore calls for a considerable amount of perseverance, research support, and creativity. RECOMMENDATIONS Multidisciplinary teams are needed for the management of epilepsy. Research projects are needed to study the long-term effects of comprehensive care. REFERENCES 1 Gumnit RJ. Comprehensive epilepsy programs: United States. In: Engel J Jr, Pedley TA, eds. Epilepsy: a comprehensive textbook. Philadelphia: Lippincott-Raven, 1997:2865–7. Google Scholar 2 Pfäfflin M, Thorbecke R. Organization of healthcare in different countries: Germany. In: Engel J Jr, Pedley TA, eds. Epilepsy: a comprehensive textbook Philadelphia: Lippincott-Raven, 1997:2829–33. Google Scholar 3 McLachlan RS, Rose KJ, Derry PA, et al. Health related quality of life and seizure control in temporal lobe epilepsy. Ann Neurol 1997; 41: 482– 9.Wiley Online LibraryPubMedWeb of Science®Google Scholar Volume44, Issues6September 2003Pages 59-59 FiguresReferencesRelatedInformation

Treatment of Colleagues

To the Editor.— Dr Robert Iacono, in his letter to the editor published in the Nov 19, 1982, issue ofThe Journal(1982;248:2448), addresses what can be a real problem—treating colleagues. He strikes to the heart of the matter when he comments that it has been noted that the greatest tragedies in medicine occur when routine is broken. Unfortunately, he then suggests as a possible solution that these routines be broken with multispeciality team[s]. The answer to this is simple and was among many other things taught to me by one of my mentors, Dr Dwight E. Harken. The routine followed during all my years of clinical practice has been to explain to the colleague that he will be admitted to the hospital in a routine manner and will be treated as any other patient by the usual routine measures. In addition, I advise him that he will not be