Pattern of morbidity and mortality in Karbala hospitals during Ashura mass gathering at Karbala, Iraq, 2010

Religious mass gatherings are increasingly common in Iraq and can harbour considerable public health risks. This study was aimed at determining morbidity and mortality patterns in hospitals in Karbala city, Iraq during the mass gathering for Ashura in 2010. We conducted a cross-sectional study on attendees at the 3 public hospitals in the city. The study period was divided into pre-event, event, and post-event phases. Morbidity and mortality data were obtained from hospital registry books and the coroner's office. About 80% of the 18 415 consultations were at emergency rooms. Average daily emergency room attendance was higher during the event compared with pre- and post-event phases, while average daily admissions decreased. Compared with the pre-event phase, a 7-fold increase in febrile disorders and a 2-fold increase in chronic diseases and injuries were noted during the event phase. There was no difference between the 3 phases for average daily death rate,nor for cause of death

Acute severe asthma: a case presentation

Acute asthma is an episode of progressive increase in shortness of breath, cough, wheezing, or chest tightness, or some combination of these symptoms. If not treated immediately there will occur increase in flow resistance causing increased work of breathing, gas exchange inefficiency, respiratory muscle exhaustion and finally hypercapnic and hypoxemic respiratory failure. Acute severe asthma carries a high morbidity and mortality. Globally over 180,000 people die from asthma each year. A quarter of the adults is reported missing work because of asthma. This presentation discusses a patient, a smoker, with known history of bronchial asthma who suddenly developed an acute attack of severe asthma following an injection of Augmentin. She was initially managed as a case of anaphylaxis and subsequently shifted to the ICU and managed for severe asthma. Due to the severity of the attack she rapidly desaturated and was intubated and provided mechanical ventilatory support. Over three days on the ventilator her condition gradually improved and she was extubated on the 4[th] day. She was also prescribed bronchodilators, steroids and other supportive medications. Laboratory investigations included complete blood count, C reactive protein, and serial arterial blood gases. Post-extubation, she was stable and was advised to continue Tab. Augmentin, Prednisolone, and nebulisation with beta[2] agonist [Albuterol], anticholinergic [Iparatropium bromide] and steroid [Budesonide]. She was also advised to quit smoking. She has since been doing well

Massive blood transfusion in a post cesarean patient with placenta praevia

Massive blood transfusion is replacement of a patient's total blood volume in less than 24 hours, or acute administration of more than half the patient's estimated blood volume per hour. This case report describes the clinical profile, laboratory parameters and management of a post operative patient who lost nearly double her blood volume in 36 hours. She was operated and managed post operatively at GMCH. A 27 yr old Indian woman with no history of any medical illness, or co-morbidities underwent elective cesarean section for placenta praevia totalis. The maximal allowable blood loss calculated for her weight with target haemoglobin of 10g% was 450 ml. Though adequate hemostasis was achieved before closure, she had significantly increased bleeding PV 1 hour post operatively. Over the next 24 hrs she underwent a subtotal and then a total hysterectomy. Blood loss within this period amounted to 6500ml. The following day the lost 1900ml blood through the drains. As is the approach to a surgical patients with massive blood loss, it was ensured that the surgical cause of bleeding is controlled with simultaneous blood component therapy so as to maintain hemostasis, blood oxygen carrying capacity, oncotic pressure and plasma biochemistry. The patient received a total of 18 units Packed Red Blood Cells, 20 units Fresh Frozen Plasma and 6 platelets over 36 hours. The patient showed good recovery, and after another 3 days in the ICU and 2 days in the ward, she was discharged. A methodological approach to a patient with massive blood loss is essential for proper management. Key points in therapy include control and management of underlying cause, supportive treatment with appropriate blood components for maintaining tissue perfusion and oxygenation

Present status of understanding on the genetic etiology of polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women of reproductive age with a prevalence of approximately 7-10% worldwide. PCOS reflects multiple potential aetiologies and variable clinical manifestations. This syndrome is characterized by serious health implications such as diabetes, coronary heart diseases and cancer and also leads to infertility. PCOS can be viewed as a heterogeneous androgen excess disorder with varying degrees of reproductive and metabolic abnormalities determined by the interaction of multiple genetic and environmental factors. In this paper, we have attempted a comprehensive review of primarily molecular genetic studies done so far on PCOS. We have also covered the studies focusing on the environmental factors and impact of ethnicity on the presentation of this syndrome. A large number of studies have been attempted to understand the aetiological mechanisms behind PCOS both at the clinical and molecular genetic levels. In the Indian context, majority of the PCOS studies have been confined to the clinical dimensions. However, a concrete genetic mechanism behind the manifestation of PCOS is yet to be ascertained. Understanding of this complex disorder requires comprehensive studies incorporating relatively larger homogenous samples for genetic analysis and taking into account the ethnicity and the environmental conditions of the population/cohort under study. Research focused on these aspects may provide better understanding on the genetic etiology and the interaction between genes and environment, which may help develop new treatment methods and possible prevention of the syndrome.

Status of Austro-Asiatic groups in the peopling of India: An exploratory study based on the available prehistoric, linguistic and biological evidences.

Among the most contentious currently debated issues is about the people who had settled first in the Indian subcontinent. It has been suggested that the communities affiliated to the Austro-Asiatic linguistic family are perhaps the first to settle in India and the palaeoanthropological evidences suggest the earliest settlement probably around 60,000 years BP. Recent speculations, based on both traditional genetic markers and DNA markers, seem to corroborate the aforesaid view. However, these studies are inadequate both in terms of the representation of the constituent groups within this broad linguistic category as well as the number of samples that represent each of them. We strongly feel that, before making any formidable conclusions on the peopling of India and/or the history of settlement, it is necessary to ascertain that the Austro-Asiatic speakers, represented by over 30 different tribal groups, either genetically constitute a homogenous single entity or are a heterogeneous conglomeration, derived from different sources. As a first step towards this we tried to collate and analyse the existing information geographic, ethno-historic, cultural and biological. The results of the analyses of anthropometric and genetic marker data indicate that the Austro-Asiatic groups, particularly the Mundari speakers, with certain exceptions, show greater homogeneity among them when compared to the other linguistic groups, although certain groups show as outliers. However, traditional genetic markers show lower within population heterozygosity compared to Dravidian and other Indian populations. This is contrary to what has been claimed in case of certain DNA markers. Given that relatively greater heterozygosity among the Austro-Asiatic populations has been taken as one of the important evidences supporting greater antiquity of these populations one should await results of detailed DNA studies being currently undertaken by us, involving a number of Austro-Asiatic and other ethnic populations of India to resolve the issue unequivocally.