Post-traumatic thrombotic microangiopathy: What trauma surgeons need to know? / 中华创伤杂志(英文版)

Thrombotic microangiopathy (TMA) is characterized by systemic microvascular thrombosis, target organ injury, anemia and thrombocytopenia. Thrombotic thrombocytopenic purpura, atypical hemolytic uremic syndrome and Shiga toxin E-coli-related hemolytic uremic syndrome are the three common forms of TMAs. Traditionally, TMA is encountered during pregnancy/postpartum period, malignant hypertension, systemic infections, malignancies, autoimmune disorders, etc. Recently, the patients presenting with trauma have been reported to suffer from TMA. TMA carries a high morbidity and mortality, and demands a prompt recognition and early intervention to limit the target organ injury. Because trauma surgeons are the first line of defense for patients presenting with trauma, the prompt recognition of TMA for these experts is critically important. Early treatment of post-traumatic TMA can help improve the patient outcomes, if the diagnosis is made early. The treatment of TMA is also different from acute blood loss anemia namely in that plasmapheresis is recommended rather than platelet transfusion. This article familiarizes trauma surgeons with TMA encountered in the context of trauma. Besides, it provides a simplified approach to establishing the diagnosis of TMA. Because trauma patients can require multiple transfusions, the development of disseminated intravascular coagulation must be considered. Therefore, the article also provides different features of disseminated intravascular coagulation and TMA. Finally, the article suggests practical points that can be readily applied to the management of these patients.

Two years' study of Tetanus cases in a paediatric intensive care unit

Objective: To study the demographic and clinical features, outcome, complications and treatment cost of tetanus patients admitted in Paediatirc Intensive Care Unit [PICU] of Civil Hospital Karachi [CHK]

Methods: It is a descriptive observational study conducted at Civil Hospital Karachi from July 2013 to June 2015. Patients of tetanus admitted in PICU during the study period were enrolled. Data was collected from the file records of patients and included the demographic profile, clinical presentation, grade of severity, length of stay, complications and outcome. It also included the cost of treatment. Descriptive statistics were applied to describe the results

Results: During the study period, 23 cases of tetanus were admitted in P.I.C.U. twelve were male and 11 female. Majority of cases [13] belonged to age group 2-6 years. Seventeen cases were unvaccinated and 6 had received only BCG and OPV. None was appropriately vaccinated for age.There were 9 cases of post injury tetanus, 6 of them were males, 5 cases of otogenic tetanus and 9 cases had no clinically identifiable portal of entry. Eleven cases belonged to grade III severity of Ablett classification and 6 had grade IV severity. Mortality in our case series was 26%. Autonomic instability was seen in 17 patients and all of them needed ionotropic support. The estimated cost of per day treatment of a tetanus patient with mechanical ventilation was approximatly 31, 979/Pak Rs and without mechanical ventilation was 20,000/Pak Rs

Conclusion: Tetanus is an entirely preventable disease with a high mortality. Treatment is very costly as compared to vaccination which is free of cost. Complete vaccination and proper wound care is the only option to reduce the ongoing burden of tetanus

Miscellaneous liver diseases in infancy and childhood in several hospitals

Most of the liver diseases are different in pediatric age group, as compared to those in adult in many respects. Beside inflammatory, neoplastic and metabolic liver diseases; pediatric liver diseases also exhibit specific features of genetic predisposition, as well as environmental or other acquired diseases. In congenital diseases choledochal cyst, biliary atresia and cholestasis are included. While in environmental or acquired/nutritional diseases, fatty change liver and Kawashiorkor are found. A study is done to overview the miscellaneous congenital and acquired liver diseases in infancy and childhood which are important but less common as compare to inflammatory, metabolic and other liver diseases. Retrospective Study. This study was conducted at Department of Pathology, Basic Medical Science Institute [BMSI], Jinnah Postgraduate Medical Center, Karachi from 1995 to 2004. Slides / paraffin blocks of liver biopsies were taken from patients under 15 years of age. The cases were retrospective. The distribution of 100 cases of miscellaneous liver diseases in infancy and childhood were according to age and sex. Total 48 [48%] cases were encountered in the youngest of 0-5 year's age group, 36 [36%] cases in 6-10 years and only 16 [16%] cases in 11-15 years age group. It is observed that the tendency of miscellaneous liver diseases are higher up till 5 years of age and sexual differentiation showing male predominance with male to female ratio of 3:2. The miscellaneous liver diseases in younger children, may be congenital like biliary atresia, intra hepatic biliary hypoplasia and cholestasis or acquired; like tuberculosis and the Kawashiorkor [malnutrition].These are well known in third world countries and in Pakistan

Biosafety intervention and follow up assessment in laboratory workers of Karachi, Pakistan

Regular trainings and capacity building are required for all health care workers to ensure that they follow the laid down standard operating procedures and thus avoid any mishap. Delays in such trainings and improper supervision results in their reverting back to their old habits. Post intervention assessment of laboratory workers of public and private sector hospitals of Karachi on adherence to biosafety practices. Quantitative-qualitative cross-sectional survey done from August-November, 2012 using simple random sampling. Study population comprised of 253 laboratory workers of public and private sector hospital laboratories of Karachi. An initial KAP survey on biosafety practices in the laboratories and their workers followed by training and a post intervention evaluation was done in 2008. Four years later these workers were re-evaluated using an anonymous closed ended questionnaire to assess how many are following the training and the standard guidelines. Data was entered and analyzed using SPSS 13.0. Mean and percentages were calculated for quantitative variables and x[2] - test was applied for significance. A total of 253 participants [168 males and 85 females] returned the filled questionnaire Almost all [98.8%] laboratory workers had correct concept on use of personal protective equipment, 85% were neither practicing mouth pipetting for chemical and biological samples, nor using laboratories for eating and drinking purposes while importance of SOP/BOP and laboratory accident record maintenance was acknowledged by over 95%. Knowledge about discarding the used syringe was present in only 68%. A comparison between public and private sector laboratory workers revealed that 37% public sector workers were still discarding syringes in the dustbin as opposed to 3% from private sector. Educational interventions performed almost 4 years ago were still followed by laboratory workers indicating the importance of at least one training every 2-3 years to sensitize them on biosafety