Vergis Paul

Bioethics in a Plural World: Contemporary Challenges in Medical and Technological Ethics (ed. Ioannis N. Ladas) offers a wide-ranging, intercultural exploration of contemporary bioethical dilemmas as they unfold within medically and technologically accelerated, yet irreducibly plural, moral worlds. It is worth noting that the volume’s twenty-three chapters deliberately stage a dialogue among religious and theological traditions and secular bioethical frameworks, moving from questions of reproductive genetics, virtue ethics, and the “image of God” to the more unsettled terrain of artificial intelligence, personhood, and digital mortality. The thought naturally leads to the book’s second, equally decisive emphasis: bioethics as lived clinical reality. Here, issues such as research ethics and clinical trials oversight, resource allocation, medical education, mental health and stigma, domestic violence, gender dysphoria in youth, living organ donation, and systemic ethical conflicts in hospital practice (with particular attention to the Indian healthcare context) are examined in concrete, case-sensitive terms. Blending normative argument with contextual awareness, the volume invites scholars, students, clinicians, and policy-oriented readers to rethink autonomy, dignity, justice, and responsibility at the intersection of medicine, technology, and cultural–religious diversity.

Background: Coronavirus disease 2019 (COVID-19) patients with acute respiratory failure who experience delayed initiation of invasive mechanical ventilation have poor outcomes. The lack of objective measures to define the timing of intubation is an area of concern. We investigated the effect of timing of intubation based on respiratory rate-oxygenation (ROX) index on the outcomes of COVID-19 pneumonia. Methods: This was a retrospective cross-sectional study performed in a tertiary care teaching hospital in Kerala, India. Patients with COVID-19 pneumonia who were intubated were grouped into early intubation (within 12 hours of ROX index <4.88) or delayed intubation (12 hours or more hours after ROX <4.88). Results: A total of 58 patients was included in the study after exclusions. Among them, 20 patients were intubated early, and 38 patients were intubated 12 hours after ROX index <4.88. The mean age of the study population was 57±14 years, and 55.0% of the patients were male; diabetes mellitus (48.3%) and hypertension (50.0%) were the most common comorbidities. The early intubation group had 88.2% successful extubation, while only 11.8% of the delayed group had successful extubation (P<0.001). Survival was also significantly more frequent in the early intubation group. Conclusions: Early intubation within 12 hours of ROX index <4.88 was associated with improved extubation and survival in patients with COVID-19 pneumonia.

Background: Our aim was to determine the usefulness of hepatic transaminases as hematological markers to predict the presence and severity of liver injury in adult patients with abdominal trauma.Methods: This is a retrospective study of patients admitted with abdominal trauma (blunt and penetrating) over a three-year period. Grading of liver injury was based on CT-scan or surgical findings. Patients in whom liver enzymes were estimated in the first 48 hours were included.Results: Out of the 66 patients in the study, 23 (63.89%) patients had minor liver injuries, while 13 (36.11%) had major liver injuries. Injury was blunt in 63 (95.45%) and penetrating in 3 (4.54%) patients. The mortality rate was 7.57% (n=5). The median SGOT and SGPT levels in the liver injury group were higher than those in the non-liver injury group SGOT (209LI vs. 43.5) U/L and SGPT (283.22 vs. 72.97) U/L, respectively, (p=0.001). Receiver operating characteristic (ROC) curve assessment, showed the optimum SGOT and SGPT thresholds to be >112.5 and >120.5U/L respectively, which were strongly associated with the presence of liver injuries. There was significant correlation between liver transaminases with grade of liver injury, SGOT (p=0.013) and SGPT (p=0.004).Conclusions: SGOT and SGPT values >112.5 and >120.5U/L respectively, are strongly suggestive of liver injury. Hepatic transaminases are useful screening hematological markers for liver injuries and should be included in the initial trauma blood test panel and may guide in the decision making especially in medical centers with limited facilities.