Predictors of prolonged hospitalisation and mortality among children admitted with blackwater fever in eastern Uganda

Our study aimed at determining clinical factors associated with prolonged hospitalisation and death among children admitted with blackwater fever (BWF). We analysed 920 eligible records for the period January – December 2018 from Mbale and Soroti Regional Referral Hospitals in Eastern Uganda. The median hospitalisation was 3 (IQR: 2–5 days) days. Prolonged hospitalisation was in 251/920 (27.3%). Clinical features independently associated with prolonged hospitalisation included abdominal tenderness, body pain and mild fever. 29/920 (3.2%) died, of these 20 (69.0%) within 48 h of admission. Features of severity associated with mortality were noisy or interrupted breathing, tachypnoea, chest pain, convulsions, delayed capillary refill time (≥3 s), severe pallor, high fever (>38.5°C), altered level of consciousness, prostration and acidotic breathing.

Extensive subcutaneous emphysema from scalp to lower limbs in a 44-year old

A 44-year-old man was admitted after being found suspended by his ankles from a bridge for 5 days. The events leading to it was not clearly known initially. On examination, the patient was hypotensive and hypothermic, airway was oedematous and both lower limbs were mottled with dusky feet. Both foot pulses were impalpable, with prolonged capillary refill time and sensation barely present. Doppler signals were not heard in the feet, but groin pulses and popliteal signals were present. On CT, the patient had bilateral pneumothoraxes, extensive subcutaneous emphysema throughout the body from the subcutaneous tissue of the scalp to both lower limbs and pneumomediastinum and pneumoperitoneum. CT angiogram showed opacification up to proximal crural vessels and absence beyond. After multispeciality input and optimisation of his physiology, he underwent bilateral below knee amputations as they were non-salvageable.

Optical Fibre Sensor for Capillary Refill Time and Contact Pressure Measurements under the Foot

Capillary refill time (CRT) refers to the time taken for body tissue to regain its colour after an applied blanching pressure is released. Usually, pressure is manually applied and not measured. Upon release of pressure, simple mental counting is typically used to estimate how long it takes for the skin to regain its colour. However, this method is subjective and can provide inaccurate readings due to human error. CRT is often used to assess shock and hydration but also has the potential to assess peripheral arterial disease which can result in tissue breakdown, foot ulcers and ultimately amputation, especially in people with diabetes. The aim of this study was to design an optical fibre sensor to simultaneously detect blood volume changes and the contact pressure applied to the foot. The CRT probe combines two sensors: a plastic optical fibre (POF) based on photoplethysmography (PPG) to measure blood volume changes and a fibre Bragg grating to measure skin contact pressure. The results from 10 healthy volunteers demonstrate that the blanching pressure on the subject’s first metatarsal head of the foot was 100.8 ± 4.8 kPa (mean and standard deviation), the average CRT was 1.37 ± 0.46 s and the time to achieve a stable blood volume was 4.77 ± 1.57 s. For individual volunteers, the fastest CRT measured was 0.82 ± 0.11 and the slowest 1.94 ± 0.49 s. The combined sensor and curve fitting process has the potential to provide increased reliability and accuracy for CRT measurement of the foot in diabetic foot ulcer clinics and in the community.

600 Bilateral Upper Limb Compartment Syndrome After Massive Postpartum Haemorrhage

Case Summary Upper limb compartment syndrome (ULCS) is an uncommon limb-threatening emergency occurring as a result of increased interstitial pressure within osteofascial compartments. The overwhelming majority of causes occur in one limb, with frequent causes including fractures, reperfusion injury and burns. We report the unusual case of bilateral upper limb CS in a previously well 35-year-old female secondary to massive resuscitation following postpartum haemorrhage. The patient received 7 litres of blood products and 4 litres of crystalloid over a period of 8 hours. One hour postoperatively both hands became painful and swollen. Symptoms worsened over the following hour: both forearms were tense to palpate with demonstrable pain on passive extension of bilateral wrists and digits of the left hand, and capillary refill to all digits was brisk. Creatinine kinase was measured at 4,600U/L and bilateral forearm and left-hand fasciotomies were performed. The presence of bulging muscles in both forearms and the left hand confirmed the diagnosis of compartment syndrome, and perfusion was restored to all digits after release of the compartments. The patient later underwent split thickness skin grafting to both forearms and left-hand fasciotomy wounds. After 5 weeks of hand therapy, she regained good function of both hands. Bilateral ULCS is extremely uncommon but has been reported secondary to massive resuscitation, particularly in trauma patients, and we suspect that this was the cause in our patient.

↵​Clinical and Haemato-biochemical Studies on Gastro-intestinal Colic in Horses

Background: Colic is an important disease of horses. It is a multifactorial and complex disorder. Colic remains one of the common causes of death in horses therefore in present investigation, clinical and haemato-biochemical changes associated with GI colic in horses were studied. Methods: Total 105 horses were examined to study the clinical and haemato-biochemical parameters in colicky horses in southern part of Rajasthan. Result: Mean respiration rate, pulse rate and capillary refill time was found to be significantly increased in horses affected with colic than healthy control animals (P less than 0.05). In haematological indices, mean packed cell volume was significantly increased in colic affected horses (P less than 0.05) whereas mean total platelet count and mean lymphocyte count was found to be significantly decreased (P less than 0.05). In serum biochemical indices, serum aspartate amino transferase, serum alanine amino transferase, blood urea nitrogen, serum creatinine, serum glucose, serum albumin, serum total protein, serum alkaline phosphate and blood lactate were found to be significantly increased in horses affected with colic than healthy control group (P less than 0.05).

Laporan Kasus: Babesiosis pada Anjing Pomeranian

Babesiosis atau piroplasmosis merupakan penyakit parasit didalam sel darah merah akibat infeksi protozoa dari genus Babesia. Kejadian babesiosis pada anjing umumnya disebabkan oleh Babesia canis dan B. gibsoni. Caplak merupakan vektor penting dalam penyebaran penyakit protozoa darah. Jenis caplak daerah tropis dan subtropis yang mejadi vektor penyakit adalah Rhipicephalus sanguineus. Hasil pegamatan ditemukan kasus babesiosis pada anjing pomeranian, berjenis kelamin jantan, usia satu tahun dengan gejala klinis penurunan nafsu makan dan ditemukan infeksi caplak di seluruh tubuhnya. Hasil pemeriksaan fisik menunjukkan Capillary Refill Time >2 detik, mukosa mulut pucat, peningkatan suhu tubuh dan dehidrasi. Hasil pemeriksaan Complete Blood Count (CBC) diinterpretasikan bahwa anjing mengalami anemia mikrositik hiperkromik, leukositosis, eritrositopenia dan trombositopenia. Hasil pemeriksaan mikroskopik ulas darah menunjukkan adanya infeksi protozoa Babesia sp. yang ditandai dengan stadium merozoit dengan bentuk piriform secara khas berpasangan membentuk buah pir (the pear shaped form) dan tropozoit berbentuk lingkaran pada eritrosit. Terapi yang diberikan yaitu ivermectin (0,2-0,5 mg/kg BB, q: 7-14 hari, SC) setiap seminggu selama empat kali, diphenhydramine (1 mg/kg BB, q: 8-12 jam, SC), Clindamycin (25 mg/kg BB, q: 12 jam, PO) diberikan selama 14 hari dan hematopoetik sekali sehari 1 tablet yang diberikan selama 7 hari. Kondisi anjing membaik setelah 14 hari.

An unusual presentation to the burn’ unit – a cautionary tale

We report a case of a 34-year old female with systemic lupus erythematosus (SLE) and lupus nephritis who was referred to the regional burns service with a suspected contact burn to the left flank and hypogastrium from a hot water bottle. The patient had been applying a hot-water bottle to the area at night for pain relief and after 3-days she noticed a localised area of erythema which became larger and began to blister over a period of 5-days. The blistered areas were erythematous and wet, however the capillary refill time was sluggish. The lesion was initially diagnosed and treated as a superficial partial thickness burn that had developed secondary to prolonged contact with a hot water bottle. However, due to the history of immunosuppression as well as elements of the lesion being unusual for a burn, we consequently diagnosed this as herpes zoster infection. This case highlights the importance of always thinking of alternative diagnoses. There are several cases in the literature where shingles has been dangerously misdiagnosed, furthermore leading to patients being mistakenly treated and even operated on. In the early stages, abdominal shingles may present very similarly to superficial partial thickness burns, both with neuropathic pain, erythema and blistering. It is important for the burns surgeon to be aware of this diagnosis as a differential in atypical presentations, and to pay particular attention to the timeline of events is the key to diagnosis.