Pattern of fall injuries in Pakistan: the Pakistan National Emergency Department Surveillance (Pak-NEDS) study

Background

We aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan.

Methods

Pakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with outcomes.

Results

There were 3335 fall-related injuries. In cases where intent was available, two-thirds (n = 1186, 65.3%) of fall injuries were unintentional. Among unintentional fall patients presenting to EDs, the majority (76.9%) were males and between 15-44 years of age (69%). The majority of the unintentional falls (n = 671, 56.6%) were due to slipping, followed by fall from height (n = 338, 28.5%). About two-thirds (n = 675, 66.6%) of fall injuries involved extremities, followed by head/neck (n = 257, 25.4%) and face (n = 99, 9.8%). Most of the patients were discharged from the hospital (n = 1059, 89.3%). There were 17 (1.3%) deaths among unintentional fall cases.

Conclusion

Falls are an important cause of injury-related visits to EDs in Pakistan. Most of the fall injury patients were men and in a productive age group. Fall injuries pose a burden on the healthcare system, especially emergency services, and future studies should therefore focus on safety measures at home and in workplaces to reduce this burden.

     

Clinicopathological profile of cervicofacial masses in pediatric patients

Four hundred pediatric patients (0-12 years of age) who presented with cervicofacial masses were evaluated clinically and pathologically. Infl ammatory lesions were the commonest (48%) followed by congenital and developmental malformations (26%). In infl ammatory lesions, reactive lymphadenopathy was the commonest (16%) followed by tubercular lymphadenitis (11.5%). In congenital and developmental malformations hemangiomas were the commonest (12%) followed by TG cyst (6.5%). Cystic lesions (non-developmental) constituted 19%, benign neoplastic lesions 7% and malignant neoplastic lesions 2% of the cases. Males predominated the series (53.5%) and commonest age group involved was 10–12 years (20.5%). FNAB was performed in 93% of cases and HPE was available in 51.5% of cases. Sensitivity of FNAB in our series was 87.4%.     

Acute limb ischemia due to ergotism

Acute ischemia of an extremity potentially threatens limb loss and occasionally the life of the patient. We are reporting two cases of extremity ischemia secondary to ergot poisoning. The first patient was a 60 years old woman, who presented with a 15 days history of ischemia of the left arm with gangrene of the fingers and pain in the resting right hand for one day. Right brachial artery catheterization showed severe spasm of the artery which was resolved by passage of the inflated balloon catheter. She underwent amputation for gangrene of the left hand. The second patient presented with bilateral symmetrical ischemia of the lower extremities which improved upon withdrawal of the ergot containing medicine. She responded to nifedipine.     

Superficial angiomyxoma of the breast in a 16-year-old girl without carney’s complex: A case report

Superficial angiomyxoma (SA) is a rare benign soft-tissue tumor, arising sporadically or as the earliest manifestation of Carney's complex. When it arises sporadically, the breast is infrequently involved with only few cases reported in the literature. Key imaging findings include T2 signal hyperintensity on MRI and hypervascularity. In this study, we report the clinical, radiological, surgical, and histopathologic findings of a case of sporadic SA of the breast in a 16-year-old girl.     

Lipid peroxidation vs. antioxidant modulation in the bivalve Scrobicularia plana in response to environmental mercury--organ specificities and age effect

This study aimed at the assessment of mercury burden and its association to damage vs. antioxidant protection in the bivalve Scrobicularia plana environmentally exposed to mercury. Inter-age and organ-specific approaches were applied by using different annual size classes (2+, 3+, 4+ and 5+ year old) and assessing specific organs (gills, digestive gland), respectively. Bivalves were collected from moderately and highly contaminated sites at Laranjo basin - Ria de Aveiro (Portugal), where a mercury gradient was identified, and compared with those from a reference site. Besides total and organic mercury accumulation, endpoints combining lipid peroxidation (LPO), as a damage sign, and antioxidant protection (catalase, CAT; glutathione peroxidase, GPX; glutathione S-transferase, GST, activities) were determined. The whole-body accumulation as total mercury changed according to the environmental gradient for all age classes, while in terms of organic mercury, only 5+-year-old animals showed increased accumulation with increased environmental mercury level. Mercury induced peroxidative damage, showing that antioxidative mechanisms were insufficient. The adaptive capacity to pro-oxidant challenge, expressed as antioxidant induction and lesser vulnerability to enzyme inhibition, increased with age. The specific analyses of gills and digestive gland revealed that both organs were able to mirror external levels of exposure in the accumulation of total and organic mercury. Nevertheless, gills displayed higher potential to accumulate organic forms. The organ specificity was evident for antioxidant response with a clear pattern of overall increase in gills and decrease in digestive gland. In addition, only gills displayed statistical correlations between oxidative stress responses and mercury accumulation. Besides the contribution to understand mercury toxicodynamics, specific organs approach is strongly recommended in order to avoid misinterpretations. The use of whole-body analyses can be particularly compromising when oxidative stress responses (rather than mercury accumulation) are addressed.     

Successful treatment of watermelon stomach / GAVE syndrome by using argon plasma coagulation

This case report describes a 50-year-old female patient with liver cirrhosis presented with anemia. She was found to be suffering from gastric antral vascular ectasia (watermelon stomach) on upper gastrointestinal endoscopy. She underwent multiple sessions with Argon plasma coagulation, a non-contact thermal method of hemostasis for the management of watermelon stomach. After 3 sessions, the lesions disappeared and the hemoglobin increased by 2.4 gm/dl without any need of transfusion.     

Presence of Virulent Newcastle Disease Virus in Vaccinated Chickens in Farms in Pakistan

One year after a virulent Newcastle disease virus (vNDV) outbreak in Pakistan, the causative strain was present in vaccinated chickens of multiple farms despite the existence of high-average NDV-specific antibody titers (>4.75 log₂). The data suggest a possible role of vaccinated birds as reservoirs of vNDV.