Emaduddin Siddiqui

Burn injury characteristics: findings from Pakistan National Emergency Department Surveillance Study

BackgroundBurn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.MethodsPakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.ResultsThere were 403 burn injury patients in Pak-NEDS, with a male to female ratio 2:1. About 48.9% of the burn injury patients (n = 199) were between 10 - 29 years of age. There was no statistically significant difference between unintentional and intentional burn injury patients except for body part injured (p-value 0.004) and ED disposition (p-value 0.025). Among 21 patients who died, most were between 40 - 49 years of age (61.9%) and suffered from fire burns (81%).ConclusionBurn injuries are a burden on emergency rooms in Pakistan. We were able to demonstrate the significant burden of burn injuries that is not addressed by specialized burn centers.

The pediatric disease spectrum in emergency departments across Pakistan: data from a pilot surveillance system

BackgroundThere is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.MethodsThrough the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of over one million ED encounters.ResultsOf 25,052 children registered in Pak-NEDS (10% of all patients seen): 61% were male, 13% under 5 years, while almost 65% were between 10 to < 16 years. The majority (90%) were seen in public hospital EDs. About half the patients were discharged from the EDs, 9% admitted to hospitals and only 1.3% died in the EDs. Injury (39%) was the most common presenting complaint, followed by fever/malaise (19%) and gastrointestinal symptoms (18%). Injury was more likely in males vs. females (43% vs. 33%; p < 0.001), with a peak presentation in the 5-12 year age group (45%).ConclusionsPediatric patients constitute a smaller proportion among general ED users in Pakistan. Injury is the most common presenting complaint for children seen in the ED. These data will help in resource allocation for cost effective pediatric ED service delivery systems. Prospective longer duration surveillance is needed in more representative pediatric EDs across Pakistan.

Unusually high serum lactate in patient presenting with septic shock

Sepsis and septic shock may have atypical presentation and multiple differential diagnoses can be track down in the emergency room settings and the physicians must be aware of the confusing and overlapping presentation of sepsis. ED physician’s effort must be geared towards a structured and early diagnosis and treatment, similarly understanding the pathophysiological process of sepsis and septic shock is an integral part of improving clinical outcomes. The initial evaluation, early recognition and management of patients with sepsis and septic shock may reduce mortality and morbidity, hence prompt institution of empiric therapy is of utmost importance in this regard. Aggressive fluid expansion, early broad-spectrum antibiotics as well as inotropic and vasopressors support are the main stay of sepsis bundle management all over the world.

Phosphine inhalation, case series of domestic unintentional poisoning commonly used as anti-bed bug chemical from a low income country

Acute poisoning is a public health issue worldwide especially in low income countries. Almost 300,000 people die due to pesticide poisoning every year globally. Phosphine (Aluminum phosphide) is a commonly used fumigant in Pakistan. The fumigant applicators themselves reported chronic illness when in contact with the fumigant. Evidence from previous literature suggests phosphine gas (fumigant), which possesses a smell similar to that of garlic, is extremely hazardous to human health. It is commonly known as “suicide poison” which can be easily accessed and to date, has no particular effective antidote. There are very few reports of phosphine poisoning cases which clearly concludes congestion, pulmonary edema, and focal myocardial infiltration, to small-vessel injury as lethal effects of phosphine inhalation however all of the cases showed presence of phosphine in blood and liver specimens.