Paediatric blunt torso trauma: injury mechanisms, patterns and outcomes among children requiring hospitalisation at the sultan Qaboos university hospital, Oman

Objectives: Trauma is the greatest cause of morbidity and mortality in paediatric/adolescent populations worldwide. This study aimed to describe trauma mechanisms, patterns and outcomes among children with blunt torso trauma admitted to the Sultan Qaboos University Hospital [SQUH] in Muscat, Oman

Methods: This retrospective single-centre study involved all children

Results: A total of 70 children were admitted with blunt torso trauma during the study period, including 39 [55.7%] male patients. The mean age was 5.19 +/- 2.66 years. Of the cohort, 35 children [50.0%] received their injuries after having been hit by cars as pedestrians, while 19 [27.1%] were injured by falls, 12 [17.1%] during car accidents as passengers and four [5.7%] by falling heavy objects. According to computed tomography scans, thoracic injuries were most common [65.7%], followed by abdominal injuries [42.9%]. The most commonly involved solid organs were the liver [15.7%] and spleen [11.4%]. The majority of the patients were managed conservatively [92.9%] with a good outcome [74.3%]. The mortality rate was 7.1%. Most deaths were due to multisystem involvement

Conclusion: Among children with blunt torso trauma admitted to SQUH, the main mechanism of injury was motor vehicle accidents. As a result, parental education and enforcement of infant car seat/child seat belt laws are recommended. Conservative management was the most successful approach

Interferon lambda-3 rs12979860 variants and response to pegylated interferon in chronic hepatitis-c genotype-3

Objective: To assess the role of single nucleotide polymorphisms [SNPs] near the interferon lambda-3 [IFNX3] [formal IL-28B] gene rs12979860 in predicting sustained virologic response [SVR] in hepatitis-C virus genotype-3 [HCV-3]

Study Design: Descriptive, analytical study

Place and Duration of Study: Department of Medicine, The Aga Khan University Hospital, Karachi, from July 2012 to June 2014

Methodology: Patients with HCV-3 were classified as sustained virologic response [SVR], relapsers and non-responders. SNP rs12979860 was determined by PCR-RFLP protocol. Differences between categorical variables were assessed by chi-square or Fisher's exact test, while those between continuous variables were evaluated using the Mann-Whitney U-test. Binary logistic regression analysis by forward conditional method was performed by using significant variables with p-values less than 0.05 as the criteria for model inclusion

Results: Out of 115 patients, rs12979860 genotype-CC, CT, TT was found in 37 [32.2%], 70 [60.9%], and 8 [7%] patients. 72 patients were male with median age of 45 years. Cirrhosis was present in 32 patients. Patients with response failures [no response and relapse, n=36 and 29, respectively] had higher baseline gamma glutamyl transferase [GOT] level [p < 0.001], higher alanine aminotransferase [p=0.027] and cirrhosis [p=0.001] than patients with SVR. Genotype-CC was present in 16/65 in response failures compared to 21/50 who achieved SVR [p=0.048]. Rapid virologic response [RVR] [p < 0.001], low GGT [p=0.001] and absence of cirrhosis [p=0.039] were the independent predictive factors for SVR. In patients who could not achieve RVR and in patients with cirrhosis, SVR was seen more in with genotype-CC [p=0.007 and 0.038]

Conclusion: In patients infected with HCV-3, IFNA3 rs12979860, SNP has less impact on SVR

[Safety and complications of Double-Lumen Tunnelled Cuffed Central Venous Dialysis Catheters; clinical and radiological perspective from a tertiary centre in Oman]

Objectives: This study aimed to assess the technical success, safety and immediate and delayed complications of double-lumen tunnelled cuffed central venous catheters [TVCs] at the Sultan Qaboos University Hospital [SQUH], Muscat, Oman

Methods: This retrospective study took place between January 2012 and October 2013. The clinical records and radiological data of all patients who underwent ultrasound- and fluoroscopy-guided TVC placement at SQUH during the study period were reviewed. Demographic data and information regarding catheter placement, technical success and peri- and post-procedure complications [such as catheter-related infections or thrombosis] were collected

Results: A total of 204 TVCs were placed in 161 patients. Of these, 68 were female [42.2%] and 93 were male [57.8%]. The mean age of the patients was 54.4 +/- 17.3 years. The most common reason for catheter placement was the initiation of dialysis [63.4%]. A total of 203 procedures were technically successful [99.5%]. The right internal jugular vein was the most common site of catheter placement [74.9%]. Mild haemorrhage which resolved spontaneously occurred in 11 cases [5.4%]. No other complications were observed. Subsequent follow-up data was available for 132 catheters [65.0%]; of these, thrombosis-related catheter malfunction was observed in 22 cases [16.7%] and catheter-related infection in 29 cases [22.0%]. Conclusion: Radiological-guided placement of tunnelled haemodialysis catheters can be performed safely with excellent technical success. The success rate of catheter insertion at SQUH was favourable in comparison with other studies reported in the literature

[Comparing the effect of continuous and intermittent feeding on the ventilator-associated pneumonia in intensive care unit patients]

Ventilator-Associated pneumonia [VAP] is the second common infections with high mortality [24-40%].In this study designed to determined effect of continuous[infusion] and intermittent[bolus] feeding on the Ventilator-associated Pneumonia in ICU Patient. This randomized controlled trial was performed on 76 patients admitted in ICU. They were randomly allocated to equal two groups [n=38]. In case group, continuous feeding and in controlled group intermittent feeding was performed during the first five days. The incidences of early pneumonia [the first 3 to 5 days] and increase WBC [White Blood Cell] and PMN [Poly Morph Nuclear] in both groups were compared during the first 5 days. The rate of increase in WBC [>11000/ml] and PMN [band cell>50%] in continuous group was 8 patients [10.5%] and in intermittent group were 7 patients [9.2%] [pv=0.32]. The incidences of early pneumonia [CPIS >or=6] in case group were 4 patients [5.3%] and in control group were 7 patients [9.2%] [pv=0.77]. The results of this study showed that incidence of early VAP in case group was lesser, but this difference was not significant. Also, there was no significant difference in increase of WBC and PMN in both groups

Nutritional status in patients with hepatitis C

To assess the nutritional status via the SGA [subjective global assessment] screening tool of patients at all stages of hepatitis C virus [HCV] liver disease. Descriptive study. Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011. Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls [HC], those with chronic hepatitis C infection [CHC], compensated cirrhotics [CC] and decompensated cirrhotics [DC]. The validated subjective global assessment [SGA] tool was used to assess nutritional status. A total of 400 patients were enrolled. Most of the patients in the HC group were class A [best nutritional status]. In contrast, the majority [64%] in the DC group were in the class C [worst status]. The compensated cirrhosis [CC] group showed that 90% of patients were malnourished, while 98% of all patients were malnourished in the DC group, predominantly class C. Most importantly, 14% of patients with chronic hepatitis C [CHC] also scored a B on the SGA; which when compared to HC was statistically significant [p=0.005]. As the groups progressed in their disease from CHC to DC, the transition in nutritional status from A to C between groups was statistically significant. Malnutrition occurs early in the course of HCV, and progresses relentlessly throughout the spectrum of HCV disease

Rapid assessment of trachoma in 9 governorates and Socotra Island in Yemen

This study described the pattern of trichiasis, active trachoma and trachoma risk factors in 9 governorates of Yemen plus Socotra Island, using a rapid assessment during October and February 2004. A total of 3169 children aged 1- 9 years were examined in a central meeting point or at home. Active trachoma was found in a high percentage of children in Al-Jawf, Mareb and Shabwah governorates and the SAFE strategy [Surgery, Antibiotic treatment, Facial cleanliness, Environmental improvement] should be directed toward these governorates. Trichiasis cases were also found in Hadramout and Taiz, suggesting that eyelid surgery should be provided in these governorates

Incidence of traumatic injection neuropathy among children in Pakistan

We used acute flaccid paralysis surveillance data collected between 1 January 2001 and 31 December 2003 from the Pakistan Polio Eradication Initiative to describe the epidemiological characteristics and disease burden of traumatic injection neuropathy among children aged under 15 years. Of the 5627 acute flaccid paralysis cases reported, 456 were identified as traumatic injection neuropathy by case review. The condition was more common in younger children who were also more likely to have persistent paralysis. We estimate that the annual incidence of traumatic injection neuropathy rate in Pakistan is 7.1 per 1 000 000 in children under 3 years old

Pressure measurements during cardiac surgery-internal jugular vs central venous

Although central venous pressure [CVP] is a valuable guide and measurement during cardiac surgery anesthesia, there are many occasions however, when the time consumed in inserting a peripheral catheter, defeats the actual purpose. The purpose of this study was to compare central venous pressure and internal jugular veins pressure, and to see whether the jugular veins pressures were a reliable guide to central venous pressure monitoring. Simultaneous measurements of the internal jugular [both left and right side] and right atrial venous pressures were made in 70 patients undergoing cardiac surgery both at times when the chests were closed and when they were opened. After induction of anesthesia, a 16 gauge catheter was inserted into the internal jugular vein on each side of the neck, and another catheter was passed into the right atrium. Then the CVP and internal jugular veins were measured six times during anesthesia and postoperatively. A good correlation was found between pressures of right and left internal jugular veins with that of CVP both at times when the chests were closed and when they were opened. It is concluded that left and right internal jugular vein pressures are reliable guides to central venous pressures during anesthesia in cardiac surgery

TIVA and conventional general anaesthesia in elective C-section: comparative effects on the neonate

A comparative study was carried out on 70 patients, admitted at MH Rawalpindi from January 2003 to April 2003. The object of the study was to compare the effects on the new born of TIVA [total intravenous anaesthesia] using IV Propofol and conventional general anaesthesia. The selection criteria included, pregnant patients of ASA class I aged between 20 and 30 years, undergoing elective caesarean section, having no fetal abnormalities on antenatal ultra sound and incision to delivery time less than 5 minutes. The apgar score of the new born delivered was measured at first minute and fifth minute after birth and it was seen that the average apgar score of the group delivered by TIVA using IV Propofol was 9.63 the other group delivered by using conventional general anesthesia was 7.94. However as the Apgar score is highly subjective, so it was supplemented by observing various neurobehavioral reflexes. This also proved that the newborn babies delivered by TIVA using IV Propofol had higher Neurobehavioral scores as compared to newborns delivered using conventional general anaesthesia