Nasal itching and bleeding due to excessive exposure to air conditioners

Introduction: Nasal mucosa is very sensitive when it is exposed to extreme dry and cold weather conditions. Persistent or recurrent nasal itching due to such exposure is usually followed by the epistaxis. Objective of the study was to analyze effects of excessive exposure to dry and cold air of air conditioners on nose in terms of nasal itching and epistaxis

Methods: This prospective cohort study carried out on 144 healthy Pakistani individuals working in United Nations Hospital in Nyala, Sudan from February 2014 to May 2014. Individuals spending less than 8 hours daily inside air conditioners were compared to those spending more than 15 hours daily. Chi square tests were applied to compare the proportions of incidence of nasal itching and epistaxis between these two groups as well as between two age groups

Results: Mean age of all 144 subjects was 35.01 years [+/- 6.4]. Chi square test results confirmed that there was statistically significant difference of both the symptoms [nasal itching p-value 0.021 and nasal bleeding p-value 0.044] between two groups. Those spending more time in air conditioners were significantly more affected by dry and cold air. As for as the age group is concerned significantly higher number of subjects of ages more than 40 years had nasal bleeding compared to the younger age group [equal or less than 40 years]

Conclusion: Effects of exposure of dry air of air conditioners on nasal mucosa in terms of nasal itching and nasal bleeding were found to be significantly higher when subjects were exposed 15 hours or more per day. Furthermore nasal bleeding was more commonly seen in elderly subjects [more than 40 years] due to such exposure

Hematologic adverse effects and efficacy monitoring in chronic Hepatitis C patients treated with interferon and ribavirin combination therapy

180 million people are affected by chronic Hepatitis C Virus infection globally and more than 50 million in South East Asia. Combination of Interferon and Ribavirin is the current anti-HCV therapy in practice and is associated with certain hematologic adverse effects. In this concurrent observational study the incidence rate of major hematologic adverse effects and efficacy outcomes of Interferon and Ribavirin combination therapy was evaluated in 288 chronic hepatitis C patients at Lahore General Hospital. Levels of Hb, TLC, and Platelets counts were monitored for hematologic adverse effects monitoring, whereas, ALT, AST and bilirubin levels were monitored for efficacy. PCR was done at week 4, 12 and 36 for therapeutic success evaluation. A significant reduction in Hb levels [p<0.05] was observed after week 4, 8 and 12 of therapy. Frequency of anemia increased in both genders with body weight <65kg and platelet count <150,000/mm3. End Treatment Response [ETR] was achieved in 64.5%. Anemia was the major side effect of the combination therapy particularly in the males. Higher ETR was observed in patients who achieved RVR and were <50 years of age

Right main bronchial disruption due to blunt trauma

A young soldier was crushed between two vehicles sustaining severe injury to right side of chest leading to multiple rib fractures, tension pneumothorax, bronchopleural fistula, and later on gross surgical emphysema. Rigid bronchoscopy confirmed injury to right upper bronchus. Surgical repair and postoperative care of such a major, although rare, injury was successfully achieved in this small hospital by a team augmented by a specialist from thoracic surgery centre. The risks of transport of a major thoracic injury should be assessed against a possible definitive treatment locally. Fibreoptic or rigid bronchoscopy should be employed as early as possible in all suspected cases of major airways injury. An outreach service by a thoracic surgery centre can be life-saving

Anaesthestic management in disasters an anaesthetist's experience in "LAMNO" banda ache, Indonesia

The purpose of this study is to highlight the problems faced by the anaesthesiologist in the field and to mention some of the anaesthetic techniques which have proved useful in such adverse circumstances. Responding to the call for help to the victims of Tsunami on December 26 2004, the Pakistan Field hospital [Level II] arrived in Sumatra [Indonesia] and was deployed in a remote island, Lamno, Banda Ache. A total of 11,299 patients were treated including 1164 surgeries, from 12[th] January 2005 to 26[th] February 2005. The main problems were non availability of pressurized oxygen source, hostile and adverse circumstances, language barrier and massive number of tsunami victims requiring immediate medical attention. The Boyle's apparatus could not be used as it requires high pressure gases at 40 to 50 psi. The Oxygen concentrator was the only source of Oxygen. Descriptive. The surgical patients mostly had wounds of extremities which were infected. Majority of the surgical procedures included debridements of the wounds, skin grafting and amputation of the extremities. Most of the surgeries were performed under local and regional anaesthetic techniques. A modified general anaesthetic technique using an oxygen concentrator was devised for those few patients where regional anaesthetics alone were inappropriate. Local anaesthesia was administered to 1055 [90.64%] patients with minor injuries; peripheral regional blocks were administered to 35 [3.0%] patients, spinal anaesthesia to 31 [2.66%] patients and extradural anaesthesia to 17 [1.46%] patients. Eighteen [1.546%] patients were operated under dissociative anaesthesia with Ketamine and 08 [0.687%] patients were administered total intravenous anaesthesia, muscle relaxants, endotracheal intubation, bag valve mask [Ambu's] ventilation, oxygen supplementation from the oxygen concentrator and local anaesthetic infilteration. The incidence of complications was very low and none of the surgical patients had anaesthesia related morbidity or mortality. Most of the Tsunami affected patients could be managed safely under local anaesthesia, regional blocks or dissociative anaesthesia with Ketamine. The oxygen concentrator proved to be highly useful source of oxygen for a modified general anaesthetic technique without using a proper anaesthesia machine

Treatment of sciatica at high altitude

Sciatic nerve block is one of the various diagnostic and therapeutic modalities for acute or chronic pain in the leg and foot. A randomized, retrospective, clinical study of 103 patients with symptoms of sciatic nerve root pain, was carried out at a remote place in the Northern areas at altitudes ranging from 9500-12000 feet. The inclusion criteria were; compromised morbidity, pain not responding to NSAIDs and a history of over one year. Age groups were 40-60 years and male to female ratio was 12:1. Ninety patients were given 0.125% bupivacain and 13 were given 0.5% lignocaine with 1:800,000 adrenaline. Patients were put on aspirin 300 and ibuprofen 200 mg thrice a day for three days. A follow up of 4-6 months revealed a complete relief in 80% of the cases. Of the rest 20% most were those treated with lignocaine. An unexpected finding was that 80% of patients in bupivacain group had motor blockade and 20% had dense sensory block even at this lower concentration. In lignocaine group 100% of the patients had dense sensory blockade. We conclude that both lignocaine and bupivacain are effective in treating sciatica by sciatic nerve block at high altitude, bupivacain being a better choice; the population at this altitude is hyperreactive to both the drugs