Singap Med J
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Disseminated intravascular coagulation (DIC) and thrombocytopenia are well-known complications of sepsis, but the relationship between these coagulation abnormalities and outcome have not been well documented. We studied the incidence of thrombocytopenia and DIC in our Medical Intensive Care Unit, and evaluated their usefulness as prognostic risk factors for mortality. Platelet count was not found to be an independent risk factor associated with overall mortality in the 107 patients studied. ⋯ We conclude that DIC and thrombocytopenia are common in our adult Medical Intensive Care patients with sepsis, but only the latter is a prognostic factor in addition to the APACHE II score. The incidence of DIC in our patients (mainly Chinese) seems to be more than that of 10 to 20% reported in other series of Caucasian patients. We would, therefore, like to emphasise the importance of platelet count as an prognostic risk factor in sepsis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Topical nasal anaesthesia for fibreoptic bronchoscopy: lignocaine spray or gel?
Lignocaine spray for anaesthetising the nasal mucosa for fibreoptic bronchoscopy often causes discomfort to the patient. We compared two techniques of applying nasal topical anaesthesia using either lignocaine spray (group A: 25 patients) or gel (group B: 30 patients) to assess patients' tolerance to the procedure. Both groups received 100 mg of lignocaine in the nostril, 40-50 mg to oropharynx, 120 mg to vocal cords and 40-100 mg to trachea and bronchi. ⋯ Significantly more patients in group A experienced discomfort or pain during nasal anaesthesia as compared to group B (p < 0.001). Patients' tolerance to the bronchoscopy was similar in both groups and the examination was performed satisfactorily in all patients. Thus, lignocaine gel is a simple technique, effective and less irritating as compared to lignocaine spray for topical nasal anaesthesia.
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Snake bites in Hong Kong are most commonly due to Tr. albolabris (White-lipped pit viper, bamboo snake). We studied 21 cases of envenoming by Tr. albolabris prospectively in order to document the incidence and severity of associated coagulation abnormalities. Eighteen patients (86%) had increased blood concentrations of fibrin degradation products (FDP) ranging from 10-40 micrograms/l to greater than 200 micrograms/l (normal: less than 10 micrograms/l), the majority of whom also had detectable soluble fibrin monomers. ⋯ Only one patient developed systemic bleeding but no fatality was observed. The coagulation abnormalities are usually correctable by replacement therapy. Further studies are required to study the mechanisms of this coagulopathy and its relationship with venom antigenaemia.
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We studied the presence of Hepatitis C Virus (HCV) antibodies in a defined Malaysian population and examined the association, if any, between HCV and the Hepatitis B Virus (HBV), using sensitive recombinant DNA second generation Enzyme Immunoassay (EIA) test kits. This sero-prevalence study comprised 1,434 sera from eleven distinct groups comprising intravenous drug users (IVDU), haemophiliacs, male homosexuals, female prostitutes, healthy blood donors, staff of dialysis unit and laboratory personnel, chronic renal failure patients undergoing dialysis (CRFD), patients with liver cirrhosis, chronic active hepatitis, chronic persistent hepatitis and primary liver cancer. ⋯ The HBV was found to be the major viral etiological agent in 75% of chronic liver disease (CLD); while in 10% of cases both HCV and HBV were detected. HCV was implicated as the sole viral agent in only a small proportion (1.5%) of patients with chronic liver disease.