How safe is blood sampling? Anterior interosseus nerve injury by venepuncture

All invasive procedures carry some degree of risk of damage to the normal structures in the proximity of the region where the procedure is performed. The risk is, however, minimal for venous cannulation. A case is reported of an injury to the anterior interosseus nerve sustained during venepunture for routine blood sampling at the cubital fossa.     

Disseminated cryptococcosis with extensive subcutaneous nodules in a renal transplant recipient

patients with disseminated cryptococcosis infrequently present with cutaneous involvement.A 34-year-old woman who had a reual transplant developed disseminated cryptococcosis with an unusal cutaneous presentation.Extensive subcutaneous nodules are rare in disseminated cryptococcosis.but the patient belonged to a high-risk group.Fluconazole 200 mg/d was administered intravenously.After a total dose of 1800 mg of flucouazole was given,the patient‘s situation improved.     

Hymenolepis nana in a renal transplant recipient: to treat or not to treat?

A case of hymenolepiasis in a renal transplant recipient. Issues discussed include the benefit of anti-parasitic agents as well as the preventive measures.     

A better long-term outcome in cardiac transplant recipient with a history of previous open heart operations.

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How reliable is a radiological report in osteoporosis in diagnosing low bone density?

Patients are often referred to osteoporosis clinics with a radiological diagnosis of osteoporosis. Previous studies attempting to ascertain risk of osteoporosis from radiographs have been conflicting. The aim of our study was to determine how reliable spinal radiographs were at detecting low bone density compared with Dual Energy X ray Absorptiometry (DXA). We retrospectively measured the Bone Mineral Density (BMD) at the spine in 130 patients with a radiological diagnosis of osteopenia or osteoporosis in the absence of vertebral fractures. They were compared with a group of 119 age and sex matched patients with one or more low trauma vertebral fractures. There was a statistically significant difference in the mean BMD between these two groups. 12.7%, of the x-ray group with osteopenia reported, had a normal bone density, 49.2% had osteopenia (T-score -1 to -2.5) and 38.1% had osteoporosis (T-score <-2.5). Of those with a radiological report of osteoporosis, 12.8% had a normal bone density, 44.7% had osteopenia and 42.6% had osteoporosis. We conclude that a radiological report of low bone density is a strong predictor of osteopenia or osteoporosis by BMD measurement.     

The Curse of HIV: How Well Prepared is our Paramedical Force?

Background

HIV patient-care is determined by the knowledge and attitudes of the health care workers (HCWs) towards the disease and towards HIV-positive individuals. With increasing incidence of HIV, a need was felt to assess the preparedness of the health care providers in the Armed Forces.

Methods

A population based, cross-sectional, questionnaire based analytical study was undertaken among para medical workers in the setting of a medical college and tertiary care service hospital to assess the knowledge and attitudes of HCWs towards HIV.

Results

The study indicated that contrary to the expectations and general belief, important knowledge gaps regarding modes of transmission, clinical course, diagnosis and management of HIV infection still exist among the paramedical workers of the Armed Forces.

Conclusions

The present study has highlighted the urgent need to review the training curriculum of our paramedical workers at all levels and undertake intensive on the job training. The study recommends that medical officers should take full responsibility for imparting correct knowledge and ensuring correct attitude among the paramedical workers.Key Words: Health care workers (HCWs), HIV/AIDS, Knowledge and attitude, Armed Forces     

Perioperative blood loss in open retropubic radical prostatectomy - is it safe to get operated at an educational hospital?

Introduction

Blood loss during radical prostatectomy has been a long term issue. The aim of this study was to investigate the influence of the training level of the first assistant regarding blood loss in open retropubic radical prostatectomy at an educational hospital.

Material and methods

364 patients underwent radical prostatectomy from 11/2006 to 10/2007 at one institution operated by one surgeon. In 319 patients all predefined parameters were obtained. Training level was determined by year of residency (1-5 yrs) or consultant status. Perioperative blood loss was calculated using three parameters: Hemoglobin level before and after surgery, postoperative sucker volume and weight of compresses. Furthermore the influence of prostatic size and BMI was analyzed.

Results

The Hb-decrease 24 h postoperatively was 2.4 g/dl median (-0.4-7.6 g/dl); sucker volume was 250 ml median (10-1500 ml); weight of compresses and swabs was 412 g median (0-972 g). One patient needed a transfusion with two erythrocyte concentrates one day after the surgery. There was no significant correlation regarding Hb-decrease (p = 0.86) or sucker volume plus weight of compresses (p = 0.59) in regard to the years of residency of the assisting physician. Also the number of assisted operations (n = < or > 20) had no significant influence on calculated blood loss (p = 0.38).

Conclusions

For an experienced surgeon the impact of the assistant regarding blood loss seems negligible. The training level of the assistant was not significantly correlated to a rise or decrease of perioperative blood loss. In our data radical prostatectomy could be safely performed at an educational hospital independent of the training level of the first assistant.     

Double-positive in triple-negative? How significant is basal cytokeratin expression in breast cancer?

BackgroundBasal-like breast cancer has an unfavorable prognosis. Immunohistochemically, they are predominantly estrogen receptor (ER), progesterone receptor (PR) and CerbB2 receptor (HER2)-negative, show expression of Cytokeratins (CKs) 5/6, CK14, CK 17 and P-cadherin and are associated with germline BRCA1 mutations. Immunohistochemistry (IHC) is an easily available and relatively inexpensive technique that can detect this cancer subtype, and patients can benefit from aggressive management protocols. The aim of this study was to evaluate the expression of CK 5/6 and CK14 in breast cancer and its correlation with age, tumor grade, tumor size, histomorphological pattern, nodal status, ER, PR, HER2/neu, and Ki-67 index.MethodsFifty treatment-naїve patients of breast carcinoma who underwent surgery constituted the study group. No core cut biopsy specimens were considered. Histopathological examination along with IHC was performed for CK5/6, CK14, ER, PR, HER2/neu, and Ki-67. Comparison between the expression of CK5/6 and CK14 with age, tumor size, tumor grade, histological subtype, nodal status, ER, PR, HER2/neu, and Ki-67 expression was performed using SPSS 20 version software.ResultsTwenty-six percent of cases showed expression of CK5/6 and CK14. CK5/6 and CK14 expression correlated strongly with ER/PR negativity, young age, and Ki-67 proliferative index greater than 15%. No significant association with HER2/neu negativity was demonstrated. Contrasting results were obtained between CK5/6 and CK14 expression with respect to tumor grade and lymph node status.ConclusionIHC can be used to identify patients with basal phenotype breast cancer with good sensitivity and specificity, and such patients can benefit from aggressive management.     

Subgrouping of A and AB blood groups in Indian blood centres: is it required?

Anti A1 antibody in the serum of A2 and A2B individuals is rare but when present can have laboratory and clinical significance. Routine subgrouping of all A and AB blood groups in blood centres in India is difficult due to economic constraints and has always been a point of debate. This study thus brings out the prevalence of anti A1 antibody and the clinical significance related to its presence. The results of the study showed a low prevalence of anti A1 antibody and when present, it had a low thermal amplitude and titre. Further, no blood group discrepancy or problems during compatibility testing were encountered with these (A1 antibody positive) blood units. Thus, it may be concluded that in India and other developing countries where resources are scarce, routine subgrouping of A and AB may not be really worthwhile unless there is a group discrepancy, problem during compatibility testing or history of a transfusion reaction.