Chandka Medical College

About: Chandka Medical College is a education organization based out in Larkana, Pakistan. It is known for research contribution in the topics: Population & Outpatient clinic. The organization has 106 authors who have published 108 publications receiving 1170 citations.

Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study

Abstract: Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID-19 Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan Result: A total of 302 surgeons were included from 53 cities all over Pakistan Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery This trend was higher in younger consultants of less than 45 years of age (p<0 001) Almost two-third of the surgeons, mostly senior (p=0 03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0 01) Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients

Clinical Presentation, Complication and Outcome of Black Stone (Paraphenylene Diamine) Poisoning.

Abstract: Introduction In recent time, developing countries of South Asia and Africa have seen significant increase in ingestion of Para-Phenylene Diamine (PPD), locally known as Kala Pathar, either accidental or for suicide. Through this study, we aim to study the clinical presentations and outcomes among patients who have ingested PPD. Method This retrospective case series study was conducted in a tertiary care hospital of Pakistan, from April 2013 to August 2017. Data of patients of PPD poisoning was archived from the hospital’s medical records. Around 174 consecutive cases were included in the study. Patients were evaluated based on self-administrated proforma. Result Out of 174 cases of PPD poisoning that were identified, 57(32.8%) were males and 117(67.2%) were females. The mean age ± SD (range) of the patients was 24.16±9 (10 to 70) years. Approximately 170 (97.8%) patients used PPD for suicidal intention. The most common presentation was facial swelling which was present in 144(82.8%) patients followed by dysphagia in 143(82.2%) patients. Complications include metabolic acidosis in 50 (28.7%) patients and aspiration pneumonia in 36 (20.7%) patients. A total of 101 (58%) improved, while others were either referred or left against medical advice (LAMA). Conclusion Increasing incidence of ingestion of PPD for suicide warrants the regulatory authorities to restrict the use of PPD in hair dyes and implement strict measures to educate masses and curtail the easy access of such poisonous substances among common people.

Furosemide-Associated Drug Reaction With Eosinophilia and Systemic Symptoms.

Abstract: To the Editor: Drug reaction with eosinophilia and systemic symptoms (DRESSs), also called drug-induced hypersensitivity syndrome, is a life-threatening adverse drug reaction with mortality rates of up to 10%–20%.1 The clinical presentation includes mucocutaneous rash, fever, lymphadenopathy, hematologic abnormalities such as eosinophilia and atypical lymphocytes, and multiple organ dysfunction, including liver, kidneys, heart, and lungs.1 Although fever and rash are the most common presentations, the defining characteristic of the syndrome is organ dysfunction. It usually presents 2–8 weeks after the introduction of the causative agent and symptoms may persist for a longer period of time, despite discontinuing the offending drug. Most commonly associated medications are aromatic antiepileptics.2,3 Others include sulfonamides/sulfones, nonsteroidal anti-inflammatory agents, angiotensinogen-converting enzyme inhibitors, and antidepressants. The precise incidence of DRESS is yet to be determined; an estimate is 1/1000 to 1/10,000 new users of antiepileptic therapy may present with this hypersensitivity reaction.4,5 The patient is a 29-year-old woman with a history of chronic pancreatitis and gastric bypass surgery, who initially presented with lower extremity swelling in the setting of hypoalbuminemia and protein-calorie malnutrition. She was started on a high calorie/protein diet and was discharged on furosemide andmultivitamin tablets. Three weeks after discharge, she noticed peri-oral rash, which extended to lower extremities, groin, and trunk. On presentation she had multiple areas of erythema and crusting over body, with small tense vesicles of legs and bilateral lower extremity edema. Blood work showed elevated liver enzymes, elevated International normalized ratio, low vitamin D, macrocytic anemia, and elevated eosinophils. She underwent skin biopsy of the left forearm, which showed spongiotic epidermis with paucicellular intraepidermal vesicle/bullae with scattered eosinophils and neutrophils. Rare necrotic keratinocytes sites were identified within the epidermis. The Naranjo algorithm score was 5 that indicated probable adverse dug reaction to furosemide, and no other offending agents were identified. She was diagnosed with DRESS syndrome secondary to furosemide and was started on oral prednisone therapy in view of liver dysfunction. The rash and liver function improved with oral steroid therapy. Hospital course was complicated by sudden drop in hemoglobin. No source of bleeding was identified. Hemolysis workup came back positive with elevated Lactate Dehydrogenase, low haptoglobin, elevated reticulocyte count, and positive C3 and poly antibody Coombs tests (negative Immunoglobulin G Coombs test). She was diagnosed with autoimmune hemolytic anemia refractory to oral prednisone therapy and received 1 dose of intravenous immunoglobulin therapy. She also received 1 unit of packed red blood cells. Her hemoglobin remained stable, without any further drop. She was discharged on oral prednisone therapy and completed prednisone taper over the next 12 weeks as an outpatient. No recurrence of hemolytic episodes is seen in 6 months outpatient follow-up. DRESS syndrome is a severe delayed type hypersensitivity (type IV hypersensitivity) reaction with a prolonged latency period of 3–8 weeks. The clinical course of the syndrome varies widely. Early in the course it may present with prodromal symptoms (fever, pruritus, dysphagia, or lymphadenopathy) and a mucocutaneous rash.1 Internal organ involvement is the characteristic feature of DRESS syndrome, and the most commonly involved organs are the liver, kidneys, heart, and lungs. Although fever and rash are the most common presenting features, liver damage may develop before the onset of a rash in up to 10% of patients.6 Hematologic abnormalities, including eosinophilia and atypical lymphocytosis may be seen on initial presentation. The most commonly associated drugs are aromatic anticonvulsants (carbamazepine, phenytoin, and phenobarbital). Although cross-sensitivity as high as 75% has been reported among the aromatic anticonvulsants, carbamazepine remains the most widely reported agent.7 There are only a few case reports of DRESS syndrome in association with loop diuretics (furosemide and torsemide). American Journal of Therapeutics 0, 1–3 (2020)