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MIRACLE IN AFRICA

MIRACLE IN AFRICA A fine afternoon with well equipped vehicles and personal equipments, a platoon of soldier were moving towards their destination. Suddenly, a firefight begins and the troops were trapped into an ambush. The peace and calmness around turned into chaos within a fraction of second. 14-JUNE-2025, A platoon of troops was moving towards the destination in a threat environment around. However, in the present time, the threat level was low as compared to earlier phases.Around 14:30, unfortunately the vehicles were entrapped in an ambush that led to bilateral firefight. Suddenly, the peace and calm environment turned into a chaotic space.However, due to the courage and determination, brilliant tactics and brave troops; the troops were successfully able to retaliate from the enemy fire. The vehicles moved away from the killing zone to a secured place. All of a sudden, the commander of the vehicle noticed that 2 people inside the vehicle were heavily bleeding. After quick examination it was confirmed that there was bullet injury among 2 troops members. Combat Application Torniquet was applied in the incident site and pressure compression through dressing gauge and bandage was done. Even Chest seal was applied on the mid-anterior part of the left chest as soon as the bleeding was noticed.Unfortunately, A 5.56mm caliber bullet fired from the enemy weapon injured 2 members of the troops. A single bullet piercing the Right arm with visible entry and exit wound and the same bullet piercing the left side of the chest of another member of the troops. Hence, 2 members of the troops were severely injured by the single bullet fired from the enemy.After the basic first aid given at the incident site, the casualties were referred to the nearest hospital about 8 km away from the incident site.The CASEVAC (Casualty Evacuation) team has already been informed till the time and the chopper along with AMET (Aero Medical Evacuation Team) were ready to rescue the patient. At Hospital, IV medication along with IV fluids were given to stabilize the patient in order to maintain the normal vitals and prevent further complication till the patient receives care and treatment at secondary level hospital. General examination of the patient was done by the doctor at the primary level hospital. After 2 hrs., the helicopter reached the site and the both patients were rescued to the secondary level hospital. PATIENT NO 1The bullet had injured the right arm of patient with visible entry and exit wound on right arm. Due to proper technique of compression bandage and quick reaction, the bleeding stopped till the time. After the x-ray of hand, it was confirmed that there was no any bony involvement. The bullet luckily escaped from the edge of humerus without even touching it. Hence, there was entry and exit wound of the patient on right arm region. Wound cleaning and dressing were further performed under aseptic condition. The patient was admitted under injectable medication and for further observation and evaluation. After few days, suturing of wound was done and patient was discharged from the hospital. PATIENT NO 2The patient was hit by bullet fired from enemy with entry wound on left side, midaxillary region of the chest. Chest seal was already applied on the incident site and IV fluids along with injectable medication were given in the nearby hospital in order to prevent further complication and bleeding. After the successful attempt of CASEVAC, the patient was taken to secondary level hospital via helicopter.On Xray of chest, the report confirmed there were no any bony injury of the chest and no involvement of heart and lung parenchyma. The reports were not less than a miracle in the 21st century.On Amazing note, the bullet was still inside the chest and stuck into the 1st intercoastal space on the right side of the chest.The bullet piercing from the mid axillary region of the left side of the chest and sparing heart, left lung, trachea, esophagus, aorta, major vessels, right lung and bony prominence left everyone there turned into a huge sight of relief. That was a miracle I have ever seen. After few days of admission, the patient was successfully discharged from the hospital.But, sadly the bullet still remained with him till the date.

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MILIARIA- SKIN DISORDER

INTRODUCTION“Miliaria” is the general term used to describe conditions caused by blockage within the sweat duct. Eccrine miliaria is a common, transient cutaneous disorder caused by blockage within the eccrine sweat duct. It is also known as “sweat rash,” “prickly heat,” or “heat rash.”CAUSES:Anything that causes sweating can lead to eccrine miliaria in infants, children, and adults. Common causes include:●Hot and humid environments●Strenuous physical activity●Febrile illness [6]●Occlusion of the skinCLINICAL MANIFESTATIONSThe clinical features of miliaria crystallina, miliaria rubra, and miliaria profunda are reviewed below:●Miliaria crystallina – Results from superficial blockage of the sweat duct (within the stratum corneum) and is characterized by superficial, clear 1 to 2 mm vesicles that resemble water droplets. The vesicles may coalesce. Due to their superficial location, the vesicles rupture easily and do not cause a significant inflammatory response. ●Miliaria rubra – Results from blockage of the duct, usually within the epidermis, although it can occur in the dermis. Leakage of sweat causes inflammation in the periductal tissue. Miliaria rubra is characterized by erythematous 2 to 4 mm papules. They may be papulovesicular or pustular. ●Miliaria profunda – Caused by blockage deeper within the sweat duct (at the dermal-epidermal junction or below). It usually occurs after repeated episodes of miliaria rubra. Escape of sweat into the surrounding tissues results in erythematous to skin-colored, firm papules 1 to 4 mm in diameter. The papules are non-follicular. It is most common in adult males, especially military personnel stationed in tropical climatesSeen most in adults, miliaria profunda usually occurs on the trunk but can be seen on the extremities as well. Because sweat is obstructed deeply within the skin, affected areas show little or no sweating. The eruption is typically asymptomatic. It may also be subtle and become more visible when the patient sweats. ●Management•General measures – Treatment of miliaria revolves around minimizing exposure to factors that stimulate sweating and occlusion of eccrine sweat glands. This approach includes the following measures:-Move patient to a cooler environment if possible-Wear breathable clothing (such as cotton) that does not occlude the skin-Remove occlusive bandages or medication patches in the affected area and use more porous alternatives if needed-Treat fever with antipyretics  

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Treatment of Malaria

For Uncomplicated Falciparum malaria (Adult >35 kg) The first line treatment for falciparum malaria is artemether + lumefantrine (AL) given over three days and a single dose primaquine.  (6 doses) STAT-8Hrs- then BD for 2 more days. NOTE: Take after a full meal or whole milk. If a patient vomits within 30 minutes of taking a dose, he or she should repeat the dose. Ideally, the first two doses should be taken 8 hours apart. For Complicated Falciparum Malaria (Severe): Intravenous or intramuscular artesunate for at least 24 h and until the patient can tolerate oral medication. Once a patient has received at least 24h of parenteral therapy and can tolerate oral therapy, complete treatment with full course artemether + lumefantrine (AL). Inj. Artesunate 2.4 mg/kg STAT, 12 hours and 24hours and then OD until oral medication is tolerated. If Artemisinin combination therapy is not available and chloroquine sensitive species. Dosage Distribution: Chloroquine- Day 1: chloroquine is given at an initial dose of 10 mg base/kg body weight, Day 2: followed by 10 mg/kg body weight, Day 3: 5 mg/kg body weight. Primaquine- 0.25 mg/kg body weight per day. Artemether and Lumefantrine- Total dose of 5-24 mg/kg of artemether and 29-144 mg /kg of lumefantrine.

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