Tranexamic acid (TXA) lessens surgical bleeding and reduces mortality in patients with traumatic hemorrhage. Hemorrhage is common in combat zones and is one of the most common causes of mortality in a war scenario. The management of hemorrhage involves early arrest/temporization of ongoing bleed and restoration of blood volume to restore physiological stability as soon as possible. TXA by its antifibrinolytic action decreases blood loss, thus circumventing the requirement of massive crystalloid resuscitation, in turn an important causative factor for acute traumatic coagulopathy. Currently, TXA is recommended in acute hemorrhage worldwide; thus, its use in the combat scenario needs to be conceptualized by the primary caregivers. This conceptualization will be discussed in detail in this review article.

Background: Self-care activities related to diet, physical activity, foot care, and blood sugar monitoring in Type 2 diabetes mellitus (T2DM), besides traditional doctor-centered care is essential. Hence, the study was undertaken to find the prevalence of nonadherence to dietary practices among patients with T2DM, its associated factors and to study the association of nonadherence with body mass index (BMI). Methods: The community-based cross-sectional study was carried out among 400 participants with T2DM aged ≥ 18 years in urban Bangalore. Dietary adherence was assessed using The Summary of Diabetes Self-care Activities Questionnaire and anthropometric measurements were made to calculate BMI. Results: Of the total, 207 (51.8%) were ≥ 60 years, 211 (52.8%) were females and 377 (94.3%) were on oral hypoglycemic agents. Calories were unrestricted in 62.7%, fruits and vegetables were not consumed by 68.8%, and overall, 83.5% were nonadherent to diet. Conclusion: Education and marital status can affect a diabetic individual's diet adherence and hence it is necessary to focus on individuals who are likely to be nonadherent by giving them simple understandable instructions to follow and enabling them with wider variety of food and recipe options. Dislike to food in the diet plan contributed majorly to diet nonadherence and having individualized dietary options with the help of food exchange lists and involving nutritionists in diet planning may help overcome food aversions ensuring better adherence to diet. Creating awareness about self-care among people with T2DM, ensuring strict adherence to diet at every follow-up visit to the health-care professional is required to prevent complications of diabetes.

Aims: The inertial measurement unit (IMU), as a sensor-based assessment tool, could provide objective and quantitative data for evaluating a patient with adhesive capsulitis (AC). The IMUs have advantages in simplification of implementation, cost, and computation complexity. We aimed to propose an IMU-based approach to extract statistical features for the assessment of AC in daily activity. Methods: Nine healthy subjects and nine AC patients participate in this experiment. The accelerometers are placed on the wrist and arm to measure the movement performance. Each subject is asked to perform three basic shoulder motions, including flexion, extension, and abduction. Eight types of features are extracted from the norm of accelerometer signals, including mean, standard deviation (SD), variation, maximum, minimum, range, kurtosis, and skewness. These features are explored to distinguish the differences in the movement performance between healthy subjects and AC patients. Statistical Analysis Used: Student's t-test and effect size (Cohen's d) are calculated to assess the reliability of the proposed evaluation approach. Results: The results show that the feature of SD extracted from the wrist can achieve significant differences and large effect sizes between healthy subjects and AC patients. Conclusion: We demonstrate the feasibility of the proposed IMU-based functional evaluation for the AC assessment using statistical features.

Background: The incidence rate of extracorporeal membrane oxygenation (ECMO) use in Taiwan has increased significantly and is now higher than the worldwide incidence since 2000. Several studies have investigated hospital mortality and the risk factors of patients receiving ECMO. Comorbidities and age were not evaluated in these studies. Aim: To investigate the impact of age and comorbidities on hospital mortality of ECMO patients. Methods: A retrospective study of ECMO patients was performed using the claims data from the Taiwan National Health Insurance Research Database. Results: A total of 5834 adult patients were included in the study, and 2270 patients (38.9%) were discharged from the hospital between 2004 and 2012. The most common comorbidities were coronary artery disease (35.7%), hypertension (32.0%), and acute myocardial infarction (28.4%). Age, interstitial lung disease, rheumatologic disease, and lymphoma were the major predictors for hospital mortality in ECMO patients. On the contrary, acute myocarditis was found to be a favorable factor. Conclusion: Our results indicated that age and comorbidities were strongly associated with hospital mortality among ECMO patients. These findings can assist ECMO specialists to improve evaluations of mortality risk, especially among elderly patients with specific comorbidities.

Background: Acute kidney injury (AKI) is one of the most common complications associated with mortality. Aim: This study aims to find the correlation between renal dysfunction and inflammatory markers and their outcome in COVID-19 patients. Methods: The study was carried out in 100 patients whose inflammatory markers were available on the day of admission among the 814 patients with COVID-19. Results: Fifty-six percent of patients had moderate, and 36% of patients had severe disease outcomes including mortality in nine patients. Out of all the factors studied, advanced age, presence of chronic liver disease, increased levels of blood urea, serum creatinine and lactate dehydrogenase (LDH), decreased creatinine clearance were found to be significantly associated with risk of mortality (P < 0.05). Out of all the factors studied, advanced age increased interleukin (IL)-6 values, increased serum ferritin values, and known cases of hypertension (HTN) were found to be significantly associated with the occurrence of AKI (P < 0.05). The death rate among those with AKI was more than double, i.e., 13.3% compared to only 5.5% without AKI. It was found that only IL-6 was significantly more in those who died having AKI compared to those who recovered with AKI (P < 0.05) but other inflammatory markers were not significantly associated with this (P > 0.05). Conclusion: Significant risk factors of AKI were advanced age, increased IL-6 values, increased serum ferritin values, and known cases of HTN. Significant risk factors for mortality were advanced age, presence of chronic liver disease, increased levels of blood urea, serum creatinine and LDH, decreased creatinine clearance.

Lung cancer has the highest number of deaths globally. About 75% of nonsmall cell lung cancer (NSCLC) cases are diagnosed at an advanced stage. Despite significant therapeutic progress, the prognosis remains poor. For patients who have undergone conventional treatment followed by disease progression, palliative care generally remains the only option. As reported in recent years, cellular immunotherapies play an important role in treating lung cancer and may be an option for terminal-stage disease. We applied a novel management approach with immune killer cells therapy to treat a patient with NSCLC with liver metastases. The carcinoembryonic antigen returned to normal level during the treatment period, and the follow-up abdominal computed tomography at 3 months after completion of the therapy displayed no residual metastatic liver tumors.

Argon plasma coagulation (APC), a nontouch thermoablative therapy, is increasingly recommended as the treatment of choice for radiation proctitis. This paper described a case of recurrent hemorrhagic radiation proctitis after hyperbaric oxygen therapy that deteriorated after a course of acute urine retention successfully treated with APC.

Cerebral venous sinus thrombosis (CVT) is an uncommon subtype of stroke. In general, patients with CVT have one or more risk factors for venous thrombosis. Malignancy is an established risk factor for venous thromboembolism, and is seen in 8.9% of the patients. However, the occurrence of CVT in the case of solid organ malignancy is a rare phenomenon. Cervical cancer is a malignancy that has rarely been associated with CVT, with only one case reported in the literature, and in that also diagnosis of CVT was incidental. We present a case of a young lady with recently diagnosed locally advanced cervical cancer who presented with headache, monoparesis, and focal onset motor seizures with preserved awareness. The initial neuroimaging showed intracerebral hemorrhage. However, subsequently, she was diagnosed with CVT with hemorrhagic infarction, which was initially masqueraded as a tumor bleed.

Neuroendocrine tumor (NET) of gallbladder (GB) is very rare, accounting for 0.5% of all neuroendocrine malignancies and 2% of all GB cancers. It is very difficult to differentiate between carcinoma GB and NET GB. Here, we present a case of NET GB diagnosed in a 40-year-old female. The clinical features were nonspecific and the diagnosis was confirmed only on histopathological examination. The management of carcinoma GB and NET GB is discussed in detail.