Role of fibreoptic bronchoscopy in haemoptysis: an analysis of 157 patients.

Background: Objectives of this study were to define the role of fibreoptic bronchoscopy (FOB) in determining the etiology of haemoptysis, to determine whether bronchoscopy is useful in haemoptysis with normal chest x-ray, to determine whether early bronchoscopy is better than delayed bronchoscopy. Methods: This prospective study was conducted on 157 patients who presented with hemoptysis to the Department of Tuberculosis and Chest diseases. All these patients underwent FOB after taking proper history and examination and ruling out any contraindication to the procedure. Results: In patients with haemoptysis with normal CXR, a diagnosis was established in 54.5% by FOB while 38.6% had a normal bronchoscopy. An endoscopic diagnosis of bronchitis was made in 22.7% patients. In only 9.1% patients an endobronchial mass was seen on bronchoscopy, and all of them were more than 40 years of age. Active bleeding/bleeding site was localized in 18.1% patients. In patients with abnormal chest roentgenogram who underwent FOB, a definitive diagnosis was established in 75.4% cases with active bleeding/ bleeding site localized in 59.6%. Thirty five percent were having an endobronchial mass. Of all the patients who underwent FOB for recurrent haemoptysis, active bleeding/bleeding site was localized in 48.4% patients. Bleeding site was localized in 62.9% patients who underwent early FOB, while the yield was lower (29.4%) in patients who underwent delayed FOB. Conclusions: Fibreoptic bronchoscopy (FOB) is an important and useful investigation in patients of haemoptysis in determining the bleeding site and etiology of haemoptysis. Early FOB has higher yield in localizing the bleeding site than delayed FOB.

Pulmonary aplasia with unusual associations in a woman

Failure of development of the primitive lung bud leads to an extremely rare congenital anomaly with a prevalence of 34 per 10 lac live births termed pulmonary aplasia. In half of such cases, associated congenital malformations of the cardiovascular, skeletal, gastrointestinal, or genitourinary systems are present. The Mayer-Rokitansky-Küster-Hauser [MRKH] syndrome is defined as the congenital aplasia of the uterus and the upper two thirds of the vagina with normal secondary sexual characteristics, ovaries, and a normal karyotype [46, XX]. We report an extremely rare association of right lung aplasia, MRKH syndrome, and right renal agenesis with left pelvic kidney, which to the best of our knowledge is the first such association reported

cost of unsafe injections in Pakistan and challenges for prevention program

The burden of disease associated with unsafe therapeutic injection practices in Pakistan is very high. The number of injection per person per year has been estimated to be in the range of 8.2 to 13.6, one of the highest in developing world. Extrapolating this number to the whole country would result in 1.5 billion injections per year. Approximately 4% [75 million] of these are administered for immunization while the remainders are used for therapeutic use. Of these, 94.2% are unnecessary. Average price of an injection [not the complete prescription] is Rs. 20.6 [US$ 0.34]. Under conservative estimate, over three billion rupees or 500 million dollars outof- pocket healthcare resources may be wasted each year. Appropriate use of injections would be highly cost effective. According to adjusted analysis, safe and appropriate use of injection in Pakistan would cost US$ 92 million each year with a high proportion that would be injection devices paid through out-of-pocket expenses. Behaviour change for reduction in number of injections require long-term multidimentional efforts. Interventions in the form of phasing out of convention disposable injection equipment and switching to reuse prevention devices for all injections could prevent the common practice of reuse, hence reducing the transmission of infections

Determinants of therapeutic injection overuse among communities in Sindh, Pakistan

Unsafe injections including reuse of disposable syringe is very common in developing countries including Pakistan. Healthcare providers unnecessarily prescribe injections to patients suggesting that patients ask for injections. We conducted this qualitative study to determine the reasons of overuse of therapeutic injections by the communities in Sindh province of Pakistan. Using field-tested focus group guides of World Health Organization, eighteen focus group discussions [FGDs] were conducted with community members of rural Sindh, peri-urban and urban Karachi during January-February 2001. Injections are overused in Sindh, Pakistan, because patients prefer them, believing that they provide quick relief, and perceive them as a therapeutic norm and standard practice. According to community members initiative of prescription of injections are taken by doctors. Overuse of injections is of particular concern as patients are not aware of the risks associated with reuse of injection equipment. Doctors and television are considered as the most credible source of providing healthcare information. There is a need to educate communities regarding rationale use of therapeutic injections. Open discussion and frequent communication between doctors and patient should be encouraged. Mass media could play a vital role in educating communities about risks of unsafe injections

Crimean congo haemorrhagic fever [CCHF] outbreak in Karachi

A retrospective investigation was conducted in Karachi during November 2000 to determine the cause of death of a butcher and his contacts who were exposed to the body fluids and vomitus of the butcher while he was being treated at the Aga Khan Hospital, Karachi. The Laboratory analysis of blood samples of HCWs at CDC proved the secondary cases as CCHF infection. This is another example of the risk of nosocomial spread of CCHF in a hospital when health care workers are exposed to the body fluids of a CCHF patient. Case Report: A butcher from Sliah Faisal Colonv Karachi was brought to Aga Khan University Hospital [AKUH]. Karachi with complaints of fever, body aches and bleeding from gums who was admitted on 12th October 2000. He also had severe hematemesis and vomited fresh blood. He was transfused large number of blood bags [approx. 40] 40]. These could possibly be blood products such as whole blood, plasma and platelets. Despite all efforts lie could not survive and died on 16th October 2000. Blood sample of the deceased Nvas not tested for Viral Haemorrhagic Fever [VHF]. Two health care workers [HCW] of AKUH contracted CCHF from index case when they were dealing and clearing tire blood and vomitus from mouth of the index case. One HCW died on November 3. 2000 and another recovered. A team from National Institute of Health [NIH] Islamabad conducted a retrospective investigation to determine the cause of the disease; transmission risks among close contacts; and advised preventive measures to the provincial health authorities and community. The blood samples of both health care workers were confirmed as CCHF positive by CDC Atlanta and the blood samples of mother and wife of the deceased were confirmed as Polymerase Chain Reaction [PCR] negative for CCHF and none of them had IgG or IgM antibodies to CCHF when lab confirmed at National Institute of Virology [NIV], South Africa