RESUMO
Objectives: To assess clinical presentation and outcome of patients with thrombotic thrombocytopenic purpura [TTP] in our setup
Study Design: Descriptive study
Place and Duration of Study: Combined Military Hospital [CMH] Peshawar, from Feb 2016 to Aug 2017
Patients and Methods: In a prospective design, patients diagnosed to be suffering from TTP, were included in this study. Detailed history along with physical examination and thorough investigation of all cases was carried out and collected on proformas. The diagnosis of TTP in our study was done by demonstration of significant schistocytes [more than 1 percent] on peripheral blood film. The patients were treated with steroids and plasma pheresis and in some cases with weekly Rituximab for 4 weeks. The patients were followed up in outdoor clinic on monthly basis
Results: Being a very rare disease, only 11 patients suffering from TTP reported during the study period. They were followed prospectively with a mean duration of follow-up of 11.23 months [ +/- SD 5.57]. All patients [100 percent] had anaemia, thrombocytopenia and acute kidney injury. Fever was seen in 54.4 percent patients and 63.6 percent patients had neurological involvement. A likely secondary cause of precipitation of TTP was found in 54.5 percent cases. The mortality rate was 18.2 percent
Conclusion: TTP is a challenging disease for intensive care specialists and can be fatal without effective treatment. A high index of suspicion followed by early diagnosis and prompt treatment can save life. Documentation of deficiency of plasma ADAMTS13 activity is not essential for the diagnosis of TTP and plasmapheresis is the treatment of choice
RESUMO
Objective: To determine the frequency of acute complications of hemodialysis in adult age group at a tertiary care centre
Study Design: Descriptive study
Place and Duration of Study: Department of Medicine, Combined Military Hospital Lahore, from Apr 2012 to Oct 2012
Patients and Methods: We included 100 consecutive patients of chronic kidney disease on hemodialysis with age more than 12 years. Personal profile, comorbidities, intravenous access type and duration, hemodialysis parameters were recorded for each patient. Monitoring of blood pressure, temperature, pulse and history of palpitations, headache, nausea, vomiting, muscle cramps, fever, shivering, chest-pain, bleeding, fits, itching was recorded before and up till one hour post hemodialysis session
Results: In our study population fever was the commonest complication with frequency of 37 percent, followed by nausea and vomiting in 36 percent, muscle cramps in 28 percent, hypotension in 24 percent, headache in 23 percent, shivering in 22 percent, chest Pain in 15 percent, itching in 14 percent, hypertension in 10 percent, cardiac arrhythmias in 8 percent, hemorrhage in 7 percent and Seizures in 7 percent of patients
Conclusion: Infection related complications were more common in our set up as compared to international statistics which depicts that we should improve our antiseptic techniques