Effects of extreme dry climate of Sudan on Pakistani peacekeepers

Objective: To determine the frequencies of nasal itching, epistaxis, dry/chapped lips and xerosis of skin among Pakistani peacekeepers exposed to the dry climate of Nyala, Sudan

Study Design: Prospective cohort study

Place and Duration of Study: Pakistan Field Hospital 6 Nyala, Sudan, from February 2014 to May 2012

Material and Methods: Total 144 United Nations Pakistani Peacekeepers of Pakistan Field Hospital 6[all ranks] were selected by non-probability convenient sampling. The data consists of frequency of four symptoms was collected after three months of exposure to dry climate

Results: The most common symptom was dryness of skin [36.1%] followed by chapping of lips [29.9%] while nasal bleeding [epistaxis] was least common [9%]. Significantly higher number of subjects of ages more than 40 years had nasal bleeding compared to the younger group [p value 0.002]

Conclusion: Exposure to extreme dry climate affects skin and nasal mucosa. Frequency of epistaxis found to be significantly more in subjects older than 40 years as compared to younger ones

Management of combat casualties received during war on terrorism in Federally Administered Tribal Area [FATA] and Swat Valley of Pakistan

The aim of this study was to highlight the excessive workload on the under staffed surgical teams, handling the combat mass casualties of 'war on terrorism'. Triage, nature of injuries sustained, operative management, post operative care and the outcome in terms of morbidity and mortality are discussed. This study was carried out at Combined Military Hospital [CMH] Peshawar Pakistan, from July 2008 to June 2009. A total of 1309 evacuated combat casualties were received at this hospital from the combat zone during this period and 1847 surgical procedures [1128 minor and 719 major] were performed. The major surgical procedures were performed for 80 abdominal, 204 orthopedic, 12 chest, 31 neurological, 17 vascular and 375 multiple injuries [including burns, amputations, foreign bodies, deep lacerated wounds, ENT, eye and orodental injuries]. Two surgical teams, each comprising of 2 anesthesiologists, 6 surgeons and 18 operating room assistants [ORA], worked alternatively, round the clock in 6 operating rooms. It was a race against the time as almost all the patients requiring major surgery, were in shock state. Resuscitation and surgical procedures had to start simultaneously. Only two trained nurses were looking after 11 critically ill patients in 1CU and just one nurse was available for 20-30 patients in the general ward at any given time. Out of a total of 1309 patients, 1298 survived, 29 required ventilatory support. Out of 10 patients of penetrating head injury 6 developed brain death and were removed from the ventilator, 4 were successfully weaned off. Five patients died due to septicemia, DIG [disseminated intravascular coagulation] and multiple organ dysfunction syndrome [MODS]. Combat casualties comprise of a spectrum of trauma; head injury, hemorrhage and septicemia are the main killers. Apart from optimal use of resources available, it is the shear dedication and commitment to the service that drives the men to work continuously for long hours to manage mass combat casualties efficiently and yield good result

Long term home ventilatory support in a patient of motor neuron disease [MND]- a case report

A 45 years old male patient was diagnosed as a case of motor neuron disease. Within four years he became paralyzed and bed ridden. Due to severe respiratory tract infection, the patient developed respiratory failure and was put on ventilator. Later on the infection was successfully treated but the patient could not be weaned from the ventilator because of the paralysis of respiratory muscles. It was obvious that the patient would require life long ventilatory support so the same was arranged at the patient's home and he was discharged from the hospital after nine months. Now, for the past six years the patient is on ventilatory support

Analysis of outcome of general versus spinal anaesthesia for caesarean delivery in severe pre-eclampsia with foetal compromise

The aim of this study was to evaluate and compare the outcome of general versus spinal anaesthesia for caesarean delivery in mothers with pre eclampsia and foetal compromise. Retrospective comparative analysis of peri-operative morbidity and mortality in severe pre eclampsia, conducted at Pakistan Naval Hospital Shifa Karachi, Pakistan, from Jan 2002 to Dec 2003. Sixty patients who had diastolic blood pressure >110 mmHg and proteinuria >3+, were selected for study. Thirty patients were given general anaesthesia [GA group] and 30 were delivered under spinal anaesthesia [SA group]. Incidence of morbidity, mortality and admission in intensive care unit, were noticed. Statistically, incidence of hypotension and bradycardia was significantly [p<0.05] high in SA group but hypertension and tachycardia were more [P<0.05] in GA group. Clinically haemodynamic changes in both the groups, were in acceptable and manageable limits during the procedure. One-minute Apgar scores were lower in GA group [6 us. 8] but there was no difference in 5 min scores. Postoperative complications were significantly [p<0.05] more common in GA group [66.7% vs. 16.6%] as compared to SA group. Admission ratio in ICU and total hospital stay, GA vs. SA group was 4:1 and 2:1 respectively. Mortality was more in GA group [6.6% vs. 0%] as compared to SA group. As a conclusion, we advocate that spinal anaesthesia should be used as first choice for severe pre eclamptic patients, which is safer than general anaesthesia, with less postoperative morbidity and mortality