Identification and management of atypical Hemolytic Uremic Syndrome immediately post heart transplantation

Atypical hemolytic uremic syndrome (aHUS) is a serious hematologic disorder with high mortality if left untreated. A comprehensive literature review revealed only two cases of aHUS post–heart transplantation. In both cases the disease developed after induction of calcineurin inhibitor therapy. We report a case of immediate post–heart transplantation aHUS, manifested before the induction of, and therefore not associated with, calcineurin inhibitor

Early experience of dynamic hip screw with spiral blade and locking side plate for the stabilization of trochanteric fractures.

Abstract OBJECTIVE: To evaluate early experience with helical hip system in osteoporotic elderly patients with per-trochanteric fractures. METHODS: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients having low-velocity pertrochanteric fractures who were fixed with spiral blade Dynamic Helical Hip Systemfrom July to December 2014 and were followed up for a minimum of 3 months. Demographic variables and clinical outcomes were noted from the medical records whereas operative details were recorded from the operative note. Radiological variables and outcomes were assessed by viewing appropriate pre-operative, post-operative and follow-up radiographs. RESULTS: Of the 32 patients in the study, 14(44%) were men and 18(56%) were women, with an overall mean age of 77.81±7.04 years and mean body mass index of 25.99±4.13 kg/m2. Of the total, 1(3.13%) patient had implant cut-out, 1(3.13%) had myocardial infarctionand 2(6.2) expired. CONCLUSIONS: The introduction of spiral blade dynamic hip screw manifested favourable results and good clinical and radiological outcomes with low cut-out rates

A retroperitoneal abscess caused by Haemophilus parainfluenza after endoscopic retrograde cholangiopancreatography and open cholecystectomy with a common bile duct exploration: a case report

<p>Abstract</p> <p>Introduction</p> <p>Abscesses after open cholecystectomies have been reported to occur in less than 1% of patients. The majority of these abscesses are colonized by gastrointestinal tract flora. It is clearly known that <it>Haemophilus parainfluenza </it>is a normal inhabitant of the human respiratory tract. However, its origin and route of transmission into the gastrointestinal tract is unknown.</p> <p>Case presentation</p> <p>We present the case of a 68-year-old Caucasian female who developed a retroperitoneal abscess caused by <it>H. parainfluenza </it>after open cholecystectomy and common bile duct exploration. This presented nearly five weeks post-operatively. She underwent a second operation to drain the abscess, and was subsequently placed on appropriate antibiotics.</p> <p>Conclusion</p> <p>A retroperitoneal abscess due to <it>H. parainfluenza </it>is extremely rare. It is a normal inhabitant of the human respiratory tract. To the best of our knowledge, there have been only a few reported cases of these abscesses, and they mainly involve the psoas muscle. The retroperitoneal abscess originated from the oropharynx, most likely after the endoscopic retrograde cholangiopancreatography was performed. With the advent of Natural Orifice Translumenal Endoscopic Surgery, oral decontamination will need to be considered to decrease the potential for such infections.</p

Intracellular Ca2+ Dysregulation in Coronary Smooth Muscle Is Similar in Coronary Disease of Humans and Ossabaw Miniature Swine

Intracellular free Ca2+ ([Ca2+]i) dysregulation occurs in coronary smooth muscle (CSM) in atherosclerotic coronary artery disease (CAD) of metabolic syndrome (MetS) swine. Our goal was to determine how CAD severity, arterial structure, and MetS risk factors associate with [Ca2+]i dysregulation in human CAD compared to changes in Ossabaw miniature swine. CSM cells were dispersed from coronary arteries of explanted hearts from transplant recipients and from lean and MetS swine with CAD. CSM [Ca2+]i elicited by Ca2+ influx and sarcoplasmic reticulum (SR) Ca2+ release and sequestration was measured with fura-2. Increased [Ca2+]i signaling was associated with advanced age and a greater media area in human CAD. Decreased [Ca2+]i signaling was associated with a greater number of risk factors and a higher plaque burden in human and swine CAD. Similar [Ca2+]i dysregulation exhibited in human and Ossabaw swine CSM provides strong evidence for the translational relevance of this large animal model

Are trauma surgery simulation courses beneficial in low‐ and middle‐income countries—a systematic review and meta‐analysis

Despite trauma-related injuries being a leading cause of death worldwide, low- and middle-income countries (LMICs) lack the infrastructure and resources required to offer immediate surgical care, further perpetuating the risk of morbidity and mortality. In high-income countries, trauma surgery simulation courses are routinely delivered to surgeons, teaching the fundamental skills of operative trauma. This study aimed to assess whether similar courses are beneficial in LMICs and how they can be improved. We performed a systematic review and meta-analysis using MEDLINE, Embase and Google Scholar, analysing studies evaluating trauma surgery simulation in LMICs. The outcomes measured included clinical knowledge improvement, participant confidence and general course-feedback. The review was carried out in-line with PRISMA guidelines. Five studies were included, summating a population of 172 participants. In three studies, meta-analysis showed an overall significant weighted mean improvement of knowledge post-course by 22.91% (95%CI 19.53, 26.29; p &lt; 0.00001; I2 = 0%). One study reported a significant increase in participant confidence for 20/22 of operative skills taught (p &lt; 0.04). We conclude that these courses are beneficial in LMICs; however, further research is necessary to establish the optimum course design, and whether patient outcomes are improved following their implementation. Collaboration between international trauma institutions is essential for closing the educational resource inequality gap between higher- and lower-income countries

The Efficacy of Honey Compared to Silver Sulfadiazine for Burn Wound Dressing in Superficial and Partial Thickness Burns—A Systematic Review and Meta-Analysis

Burn dressings play a vital role in protecting the patient from infection and aiding in the wound healing process. At present, the best burn wound dressing remains unknown. This study aimed to assess the efficacy of honey versus silver sulfadiazine dressing (SSD) for the treatment of superficial and partial thickness burns. We performed a systematic review and meta-analysis using the PubMed, MEDLINE and Embase databases to find relevant randomised control trials (RCTs) for inclusion. The outcomes measures included complete burn wound healing time, the proportion of wounds rendered sterile and subjective pain relief associated with the respective dressing type. This review was completed in line with PRISMA guidelines and has been registered with PROSPERO (Study ID: CRD42022337433). All studies in the English language that assessed honey versus SSD for patients with superficial or partial thickness burns were included. Quality and risk of bias assessments were performed using the Cochrane RoB2 tool. Seven studies were identified: totalling a population of 582 patients. From three studies, meta-analysis showed no significant difference in complete wound healing time (p = 0.06). Meta-analysis from five studies highlighted an overall significant difference favouring honey dressing in the proportion of wounds rendered sterile at day 7 post-injury (OR 10.80; 95% CI [5.76, 20.26]; p 2 = 88%). We conclude that honey dressings may be as or more effective than SSD in the treatment of superficial and partial thickness burn injuries. However, due to the low quality of available studies in this field, further research is necessary to establish the optimum burn dressing. Ideally, this should be conducted in the form of prospective three-arm RCTs in accordance with the CONSORT statement

Left ventricular thrombus associated with arteriovenous extra corporeal membrane oxygenation

Extra corporeal membrane oxygenation (ECMO) has remarkably progressed over the recent years. It has become an invaluable tool in the care of adults and pediatric patients with severe cardiogenic shock. At the initiation of ECMO support, the left ventricular contractility is profoundly impaired. Inadequate right ventricular drainage and bronchial circulation can lead to left ventricular distension, with potential deleterious consequences, ranging from inadequate myocardial rest, pulmonary edema, or intracardiac clot formation. Therefore, it is of extreme importance to ensure an adequate left ventricular drainage. Here we present a case of LV thrombus developed while the patient is on central venoarterial (VA) ECMO

Proteinuria in Asymptomatic Siblings of Children with Steroid Resistant Nephrotic Syndrome: A Screening Using Urinary Dipstick

Objective: To screen asymptomatic siblings of steroid-resistant nephrotic syndrome patients for proteinuria using the urinary dipstick method to determine the involvement of siblings in the familial and likely genetic cause of the steroid-resistant nephrotic syndrome. Methods: This cross-sectional study was performed at the outpatient department of Sindh Institute of Urology and Transplantation (SIUT) from May to July 2021. Results: Out of 104 patients with steroid-resistant nephrotic syndrome, siblings of 66 patients were enrolled. Mean age of primary patients with steroid resistant nephrotic syndrome was 8.7±4.3 years. Most common histopathological diagnosis was focal segmental glomerulosclerosis in 25 (37.9%) children followed by minimal change disease in 17(25.8%) of them. The majority, 48 (72.7%) patients were on immunosuppressive treatment, while 4 (6.1%) had progressed to chronic kidney disease (CKD). A total of 178 siblings were recruited in the study. There were 99(55.6%) boys and 79(44.4%) girls. Their mean age was 10.67±6.2 years. Consanguinity was high in our study population i.e. 56(84%) families. Positive proteinuria on dipstick was detected in only 5(7.5%) enrolled SRNS families. One family refused further testing. Two of the five affected siblings had nephrotic range proteinuria. Renal biopsy of one of them showed membranous nephropathy while the second showed mesangiocapillary glomerulonephritis. Both had normal renal functions. Conclusion: The frequency of proteinuria in asymptomatic siblings of children with steroid-resistant syndrome is low in our population despite a high prevalence of consanguineous marriages. Hence, familial involvement of nephrotic syndrome is low and further genetic testing for monogenic causes is required in steroid-resistant nephrotic syndrome cases. Keywords: steroid-resistant, nephrotic, syndrome, proteinuria