Blood transfusion support in mass disaster and trauma situations an experience at a tertiary care center

Objectives: To assess the blood transfusion support requirements in mass disaster and trauma situations

Study Design: Cross-sectional observational study

Place and Duration of Study: This study was conducted at Combined Military Hospital Quetta from, Jan 2013 to Dec 2015

Material and Methods: Nature of injuries, triage details, details of surgical procedures and duration of hospital stay were noted. Data was analyzed with respect to cross match to transfusion ratio and the number of units of each component transfused. Patients requiring massive transfusion and any associated complications were also studied

Results: A total of 2228 casualties were received during the study period, of these, males were 18 [75 percent] and 6 [25 percent] were females. Mean age was29.7 years. 1636 [73.4 percent] casualties had sustained major injuries. Mean hospital stay was 6.31 days. Only 199 [12.2 percent] patients required blood transfusion with a mean of 2.9 units of RCC, 8.7 bags of FFP and 4.6 bags of platelets. Fifteen [7.5 percent] patients received massive transfusion. Following massive transfusion, one case of metabolic acidosis and two cases of coagulopathy were reported

Conclusion: Mass disasters and trauma casualties pose a serious challenge to any healthcare facility in general and the blood transfusion services in particular. Only a well-organized blood transfusion center and blood transfusion emergency preparedness can result in better patient care and outcome. Not all patients need transfusion and a delicate balance between demand and supply has to be maintained

Varicocele: prevalence, incidence and its related testicular atrophy

Varicocele is characterized by abnormal tortuosity and dilatation of the pampiniform plexus veins within the spermatic cord and it is one of the causes related to male infertility. The aim of our study was to determine the prevalence of varicocele, its site incidence of secondary infertility due to varicocele and related testicular atrophy in adults. The study was conducted on 175 patients presenting with infertility and other problems. Of 175 patients, 75 were diagnosed with varicocele with prevalence of varicocele to be 22.85% and the incidence of 45.0% in adults. The complaint of infertility in the population with varicocele was 72.7%, atrophy of testis was 22.5% and it was associated with severity of varicocele. We conclude that early diagnosis of varicocele is important to prevent future infertility

Clinical indications and adverse reactions of platelet apheresis

To determine the clinical indications and adverse reactions of platelet apheresis procedure. Cross-sectional, observational study. Blood Bank of Pakistan Atomic Energy Commission General Hospital, Islamabad, from January 2010 to December 2014. Indications and adverse reaction verified for 200 consecutive platelet apheresis donations performed for 125 patients was included in this study. Data was analysed for descriptive variables using SPSS version 16. Donor deferral rate in the study was 63.83%. All the donors were males [100%] and replacement donors. Most prevalent blood type was B-positive [n=63, 31.5%], followed by O-positive [n=59, 29.5%]. Rh negative groups constituted 13.5% [n=27] of all the donors. Average age of platelet apheresis donors was 28.56 +/- 5.77 years. Maximum numbers of donors were in age range 20 - 30 years. Average weight of the donors was 73.96 +/- 11.96 kg. Mean pre-procedure platelet count of donors was 268,000/microL. The postprocedure average platelet count was approximately 200,000/microL. The mean duration of a platelet apheresis session was 78.27 +/- 26.07 minutes. Average volume of the final product was 412.53 +/- 45.33 ml. Average volume of anti-coagulant acid citrate dextrose used per procedure was 300 +/- 40 ml, 245 ml returned to donor along with returned blood while 55 ml used as anticoagulant in final concentrate. Of total 200, two [1%] final products were contaminated with red cells. Three [1.5%] products were not issued and finally expired. Of the 125 patients for which plateletpheresis procedures were performed, 54 [43.2%] patients were males and 71 [56.8%] were females [M: F=0.76:1]. Six donors [3%] had adverse events: three donors [1.5%] had mild reactions, two [1%] moderate reaction, and one donor [0.5%] developing hematoma. None had severe or life-threatening reactions. Plateletpheresis procedure is relatively safe and forms an important adjuvant to blood bank inventory

Comparison of risk factors profile in patients below and above forty years of age presenting with acute myocardial infarction

To compare the frequency of conventional risk factors in patients below and above forty years of age presenting with acute myocardial infarction. It was a three years retrospective comparative descriptive study conducted in Cardiology Department, PGMI, Lady Reading Hospital, Peshawar. Computerized data of patients admitted with acute myocardial infarction [AMI] from 1st September 2006 to 31st August 2009 was reviewed. Patients with age <40 years were assigned Group-I while those with >/= 40 years as Group-II. Conventional risk factors were age, sex, pertinent family history, smoking, hypercholesterolemia, hypertriglyceridemia, hypertension and diabetes mellitus. Using SPSS version 16, data was analyzed. A total of 4935 patients were admitted with AMI over the study period. Mean age was 58.4 +/- 12.37 [20 to 99] years. Group-I had 252 patients [79.4% males], while Group-II had 4683[65.9% males].Positive family history in Group-I vs. Group-II was 43[17.1%] vs. 426[9.1%], [p<0.001], respectively. Hypertension in Group-I vs. Group-II was 57[22.6%] vs. 1666[35.6%], [p<0.001], respectively. Diabetes mellitus in Group-I vs. Group-II was 29/252[1.5%] vs. 1059[22.6%], [p<0.001], respectively. Hypercholesterolemia in Group-I vs. Group-II was 63[25%] and 583[12.4%], [p<0.001], respectively. Hypertriglyceridemia in Group-I vs. Group-II was 68[27%] vs.1188 [25.4%], [p<0.001], respectively. Smokers in Group-I vs. Group-II were reported in 24[9.5%] vs. 76[1.6%], [p<0.001], respectively. Positive family history, hypercholesterolemia, hypertriglyceridemia and smoking were more frequent in younger age group while hypertension and diabetes mellitus were the predominant risk factors in older age group

Role of [Kabdeen] [Unani compound drug] on liver function test in post choledocholithotomy patients

This study was conducted in Ajmal Khan Tibbia College Hospital on 23 patients presenting with biliary lithiasis [cholelithiasis with choledocholithiasis]. The duration of study was three years. We found that 65.21% patients were jaundiced or they had history of jaundice. In our study we have seen the result of Unani compound drug Kabdeen as it has been reported to be effective in the treatment of hepatitis. We observed that it is a hepatoprotective, possibly an immunomodulator drug and is helpful in early normalization of post operative deranged liver function and helps in speedy recovery of operated patients

Comparative predictive value of three prognostic markers, s-phase fraction, PCNA and mitotic count on axillary lymph node metastasis in carcinoma breast

Axillary lymph node metastasis is the single most important prognostic factor in carcinoma of the breast. Therefore, prognostic markers that may reliably predict probability of lymph node [LN] metastases are of great value. This study was conducted to compare the predictive value of two novel prognostic/ proliferative markers i.e. S-phase fraction [SPF] and proliferating cell nuclear antigen [PCNA] in parallel with mitotic index. Data of consecutive cases of infiltrating ductal carcinoma [IDC] breast diagnosed from July 2003 to July 2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, were reviewed. A total of 112 cases of infiltrating ductal carcinoma [IDC] of the breast with axillary LN sampling were selected. SPF was calculated by flow cytometry while PCNA staining was done by immunohistochemistry. Mitotic count was calculated according to modified Bloom and Richardson's grading guidelines. It was observed that the number of axillary LN was found between the results of various categories of PCNA on axillary LN metastases [p value: 0.182] and mitotic count with axillary lymph node metastases [p value: 0.324]. It was concluded that mitotic count and /PCNA alone cannot be used in predicting axillary LN metastases. SPF was found to be a more reliable marker compared to PCNA reactivity and conventional mitotic count in predicting axillary LN metastases

Evaluation of post challenge Glucose Estimation For Diagnosis of Gestational Diabetes Mellitus [W.H.O. - Criteria 1999]

To compare sensitivity, specificity and Positive Predictive Value [PPV] and Negative Predictive Value [NPV] of 75g Oral Glucose Tolerance Test [OGTT] i.e. WHO criteria 1999 with 100g OGTT of National Diabetes Data Group [NDDG criteria]. Study Design: Comparative cross sectional. Material and Methods:The study was conducted at Department of Chemical Pathology and Endocrinology, Armed Forces Institute of Pathology [AFIP], Rawalpindi. Duration of study: 1st January 2004 to 31st August 2004. Sample size: Approx one hundred pregnant ladies between 24 to 28 gestational weeks. Sampling technique: Non-probability convenience. Data collection procedure: Patients consent for participation in the study was taken with explanation of test procedure. Patient's characteristics such as age, obesity, family history of diabetes, pregnancy induced hypertension, previous bad obstetric history [of still birth, macrosomia, recurrence abortion] was recorded on a predesigned proforma. Patients were first called for 75g OGTT and then after a gap of 1-2 days for OGTT 100g. Both tests were performed according to standard protocols. OGTT 75g was found to have 87.5% sensitivity, 97.8% specificity, and 77.7% positive predictive value and 98.8% negative predictive value, when compared with 100g OGTT