Uma Sharma - Academia.edu (original) (raw)

Papers by Uma Sharma

Research paper thumbnail of Aesthetic practice in covid times-evolving guidelines at the cosmetic clinic, indraprastha apollo hospital, New Delhi

Apollo Medicine, 2020

Background: The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial ... more Background: The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial halt of all elective surgical and medical procedures, more so in the practice of esthetic surgery and medicine, globally. As practices are trying to open up, the when, how, and what services can be scheduled again are the questions which arise in front of all service providers. Stringent infection control measures are the need of the hour in response to the current continuing COVID-19 pandemic. In esthetic clinics, guidelines for infection control measures as well as protocols for performing procedures are of particular importance for their safe and smooth functioning. Methods: A Medline/PubMed search was conducted for any and all possible publications on esthetic guidelines for safe functioning during the COVID pandemic. Advisories by the governments of the day, the World Health Organization, as well as those issued by various national and international esthetic societies were also taken into consideration. A set of protocols and preferred practice guidelines were drafted to allow functioning of the esthetic clinics as well as protect the doctors, clinic staff, and patients from the SARS-CoV-2 infection. Results: “Standard operating procedure (SOP)” guidelines for esthetic clinics were drafted and put into place in our Aesthetic Clinic at Indraprastha Apollo Hospital after going through all possible recommendations for scheduling patients, screening at entry, declaration and esthetic consultations, and for safety precautions about the different procedures and later categorized into low risk, moderate risk, and high risk based on the possibility of the transmission of SARS-CoV-2 virus from a possible infected patient to the treating physician or therapist, and the other way around. Conclusions: The SOP provides sound infection control measures for esthetic practices. There are guidelines regarding safety measures and use of personal protective equipment during scheduling, distancing, and risk-wise categorization, and also what procedures are permitted. These may vary from country to country, but local and national guidelines should be incorporated and followed to prevent the COVID-19 infection in esthetic clinics.

Research paper thumbnail of An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis

Indian Journal of Critical Care Medicine, 2009

Free full text available from www.ijccm.org cascade of events initiated by the traumatic impact, ... more Free full text available from www.ijccm.org cascade of events initiated by the traumatic impact, the Systemic Infl ammatory Response Syndrome (SIRS), is also ongoing in a patient of sepsis. This continuum of clinical and pathophysiological events triggered in the body is manifested as shock. If undeterred, it extends to the ominous Multi Organ Dysfunction Syndrome (MODS). Serial blood lactate evaluation can be useful in predicting shock in patients in the compensated stage with normal hemodynamic parameters. Elevated blood lactate levels provide an insight into the presence of global tissue hypoxia-a forerunner to the development of shock and MODS. Timely identifi cation of ongoing events before they take an ominous turn is essential in the management of the patient in shock. [1-3] Context: Attainment of hemodynamic parameters to within a normal range may leave patients in compensatory shock. In such patients, serial blood lactate evaluation can be useful in predicting shock. Aims: To ascertain the role of serum lactate as a predictor of shock and its outcome in patients of trauma and sepsis. Settings and Design: A prospective, non-interventional study. Materials and Methods: The study included 50 patients (5 to 60 years old) of trauma admitted within 12 hours of injury and patients of suspected or proven sepsis. Those with chronic medical illnesses, alcohol intoxication, or poisoning were excluded. Blood lactate levels were analyzed at admission and 12, 24, and 36 hours of inclusion with records of corresponding hemodynamic variables, investigations, and interventions. The outcome was recorded as survival or non-survival. Statistical Analysis Used: Statistical analysis was done with a student's t test and repeated measure ANOVA (Analysis of Variance). Results: An analysis revealed higher mean lactate levels in non-survivors as compared with survivors. Mean lactate levels in non-survivors did not attain normal levels, while that of survivors reached normal levels by 24 hrs in trauma patients and 36 hrs in sepsis patients. The predicted mortality rates by a lactate level >40 mg/dl at admission, 12, 24, and 36 hours were 52.6%, 61.5%, 83.3%, and 100%, respectively for both the subgroups combined. Non-survivors had a higher incidence of MODS (Multi Organ Dysfunction Syndrome). Conclusions: Serial lactate values followed over a period of time can be used to predict impending complications or grave outcome in patients of trauma or sepsis. Interventions that decrease lactate values to normal early may improve chances of survival and can be considered effective therapy. Lactate values need to be followed for a longer period of time in critical patients.

Research paper thumbnail of Aesthetic practice in covid times-evolving guidelines at the cosmetic clinic, indraprastha apollo hospital, New Delhi

Apollo Medicine, 2020

Background: The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial ... more Background: The coronavirus disease 19 (COVID-19) pandemic has led to an almost complete initial halt of all elective surgical and medical procedures, more so in the practice of esthetic surgery and medicine, globally. As practices are trying to open up, the when, how, and what services can be scheduled again are the questions which arise in front of all service providers. Stringent infection control measures are the need of the hour in response to the current continuing COVID-19 pandemic. In esthetic clinics, guidelines for infection control measures as well as protocols for performing procedures are of particular importance for their safe and smooth functioning. Methods: A Medline/PubMed search was conducted for any and all possible publications on esthetic guidelines for safe functioning during the COVID pandemic. Advisories by the governments of the day, the World Health Organization, as well as those issued by various national and international esthetic societies were also taken into consideration. A set of protocols and preferred practice guidelines were drafted to allow functioning of the esthetic clinics as well as protect the doctors, clinic staff, and patients from the SARS-CoV-2 infection. Results: “Standard operating procedure (SOP)” guidelines for esthetic clinics were drafted and put into place in our Aesthetic Clinic at Indraprastha Apollo Hospital after going through all possible recommendations for scheduling patients, screening at entry, declaration and esthetic consultations, and for safety precautions about the different procedures and later categorized into low risk, moderate risk, and high risk based on the possibility of the transmission of SARS-CoV-2 virus from a possible infected patient to the treating physician or therapist, and the other way around. Conclusions: The SOP provides sound infection control measures for esthetic practices. There are guidelines regarding safety measures and use of personal protective equipment during scheduling, distancing, and risk-wise categorization, and also what procedures are permitted. These may vary from country to country, but local and national guidelines should be incorporated and followed to prevent the COVID-19 infection in esthetic clinics.

Research paper thumbnail of An evaluation of serial blood lactate measurement as an early predictor of shock and its outcome in patients of trauma or sepsis

Indian Journal of Critical Care Medicine, 2009

Free full text available from www.ijccm.org cascade of events initiated by the traumatic impact, ... more Free full text available from www.ijccm.org cascade of events initiated by the traumatic impact, the Systemic Infl ammatory Response Syndrome (SIRS), is also ongoing in a patient of sepsis. This continuum of clinical and pathophysiological events triggered in the body is manifested as shock. If undeterred, it extends to the ominous Multi Organ Dysfunction Syndrome (MODS). Serial blood lactate evaluation can be useful in predicting shock in patients in the compensated stage with normal hemodynamic parameters. Elevated blood lactate levels provide an insight into the presence of global tissue hypoxia-a forerunner to the development of shock and MODS. Timely identifi cation of ongoing events before they take an ominous turn is essential in the management of the patient in shock. [1-3] Context: Attainment of hemodynamic parameters to within a normal range may leave patients in compensatory shock. In such patients, serial blood lactate evaluation can be useful in predicting shock. Aims: To ascertain the role of serum lactate as a predictor of shock and its outcome in patients of trauma and sepsis. Settings and Design: A prospective, non-interventional study. Materials and Methods: The study included 50 patients (5 to 60 years old) of trauma admitted within 12 hours of injury and patients of suspected or proven sepsis. Those with chronic medical illnesses, alcohol intoxication, or poisoning were excluded. Blood lactate levels were analyzed at admission and 12, 24, and 36 hours of inclusion with records of corresponding hemodynamic variables, investigations, and interventions. The outcome was recorded as survival or non-survival. Statistical Analysis Used: Statistical analysis was done with a student's t test and repeated measure ANOVA (Analysis of Variance). Results: An analysis revealed higher mean lactate levels in non-survivors as compared with survivors. Mean lactate levels in non-survivors did not attain normal levels, while that of survivors reached normal levels by 24 hrs in trauma patients and 36 hrs in sepsis patients. The predicted mortality rates by a lactate level >40 mg/dl at admission, 12, 24, and 36 hours were 52.6%, 61.5%, 83.3%, and 100%, respectively for both the subgroups combined. Non-survivors had a higher incidence of MODS (Multi Organ Dysfunction Syndrome). Conclusions: Serial lactate values followed over a period of time can be used to predict impending complications or grave outcome in patients of trauma or sepsis. Interventions that decrease lactate values to normal early may improve chances of survival and can be considered effective therapy. Lactate values need to be followed for a longer period of time in critical patients.