Wasim Rashid

High altitude pulmonary edema among "Amarnath Yatris"

Background: Annual pilgrimage (Yatra) to the cave shrine of Shri Amarnath Ji’ is a holy ritual among the Hindu devotees of Lord Shiva. Located in the Himalayan Mountain Range (altitude 13,000 ft) in south Kashmir, the shrine is visited by thousands of devotees and altitude sickness is reportedly common. Materials and Methods: More than 600,000 pilgrims visited the cave shrine in 2011 and 2012 with 239 recorded deaths. Thirty one patients with suspected altitude sickness were referred from medical centers en-route the cave to Sher-i-Kashmir Institute of Medical Sciences, a tertiary-care center in capital Srinagar (5,000 ft). The clinical features and the response to treatment were recorded. Results: Thirty-one patients (all lowlanders, 19 male; age 18-60 years, median 41) had presented with acute onset breathlessness of 1-4 days (median 1.9 d) starting within 12-24 h of a rapid ascent; accompanied by cough (68%), headache (8%), dizziness and nausea (65%). Sixteen patients had associated encephalopathy. Clinical features on admission included tachypnea (n = 31), tachycardia (n = 23), bilateral chest rales (n = 29), cyanosis (n = 22) and grade 2-4 encephalopathy. Hypoxemia was demonstrable in 24 cases and bilateral infiltrates on radiologic imaging in 29. Ten patients had evidence of high-altitude cerebral edema. All patients were managed with oxygen, steroids, nifedipine, sildenafil and other supportive measures including invasive ventilation (n = 3). Three patients died due to multiorgan dysfunction. Conclusions: Altitude sickness is common among Amaranath Yatris from the plains and appropriate educational strategies should be invoked for prevention and prompt treatment.

Pattern of gun pellet ocular injuries in Kashmir, India

Objective: The objective was to study the type and severity of ocular injuries in gun pellet victims. Materials and Methods: The study is a retrospective case series conducted in the Department of Ophthalmology, SKIMS Medical College, Bemina, Srinagar. The study included gun pellet victims admitted in our department between January 2010 and September 2013. Results: The study included 20 patients with 19 males and 1 female. Mean age of the subjects was 21.45 years. Ocular injury was unilateral in 17 cases and bilateral in 3 cases. The most common type of injuries encountered were hyphema in 82.60% of eyes, followed by corneo-scleral tear in 78.26% and vitreous hemorrhage in 47.82% of eyes. Of the 23 eyes, 18 eyes (78.26%) had an open globe injury, while only 3 eyes (13.04%) had closed globe injury at presentation in our hospital. The most commonly performed surgery was corneo-scleral repair in 18 eyes. Final corrected visual acuity (VA) remained unchanged in 34.78% and improved in 65.22% of eyes. About 47.83% of eyes had final VA < 6/60. Conclusion: Gun pellet related ocular injuries are becoming increasingly common in Kashmir Valley. In severely injured eyes, the visual prognosis remained poor despite adequate treatment. Measures toward reducing violence in our society so as to reduce avoidable visual impairment are strongly advocated.