Transfusion knowledge of medical and surgical specialty board residents: a cohort study.

OBJECTIVES: This study was conducted to assess transfusion knowledge between different specialty board residents and to identify areas of need for further education. BACKGROUND: Physicians' knowledge of transfusion medicine (TM) is critical for patients' safety. Many clinicians who are involved in day-to-day transfusion practice have little or no formal training in TM. There are no studies to assess physician's TM knowledge locally. METHODS: A comprehensive anonymous survey was developed to assess baseline TM knowledge of all the residents. The survey is composed of different sections, including a questionnaire on resident's demographics, resident's self-reflection on their TM knowledge and 30 multiple choice questions addressing basic and clinical TM knowledge in two major domains: component selection and transfusion practice and transfusion safety and transfusion reactions. Finally, the residents' opinion on educational needs was assessed. RESULTS: A total of 130 residents were surveyed. The lowest score obtained among the two major domains assessed was in the transfusion safety and transfusion reaction domain, with a mean score of 4·34 of 15 (SD ± 3·27). The mean score obtained on component selection and transfusion practice was 7·1 of 15 (SD ± 3·74). A substantial proportion of the residents (74·7%) admitted minimal baseline knowledge in the field of TM. Finally, 94·5% of the residents admitted the need for more education during residency, whereas 49·5% thought additional education is required during the first year of practice. CONCLUSION: This survey shows serious TM knowledge deficiency and indicates the need for additional education among all physicians during training.

Recombinant factor XIII A-subunit in a patient with factor XIII deficiency and recurrent pregnancy loss.

Essentials Inherited factor XIII deficiency is a very rare bleeding disorder. We used recombinant factor XIII-A in a pregnant patient with factor XIII-A subunit deficiency. The patient had a successful pregnancy outcome with no pregnancy related complications. The dose of recombinant factor XIII-A was minimized by using frequent trough level monitoring. SUMMARY: Inherited factor XIII deficiency is a very rare bleeding disorder, and is one of the causes of recurrent pregnancy loss. The use of plasma-derived FXIII to improve pregnancy outcomes has been reported. We report a 26-year-old woman with FXIII A-subunit (FXIII-A) deficiency who was treated with recombinant FXIII-A and had a successful pregnancy outcome with no pregnancy-related complications. Our case illustrates that the dose of recombinant FXIII-A can be minimized and adjusted on the basis of frequent trough level monitoring.

Intra-operative cell salvage in cardiac surgery may increase platelet transfusion requirements: a cohort study.

BACKGROUND AND OBJECTIVES: The cell saver (CS) has been widely utilized in cardiac surgery to reduce red blood cell (RBC) transfusion. We aim at examining its effect on the rate of allogeneic transfusion, morbidity and mortality in our population. MATERIALS AND METHODS: Retrospective review of all patients operated at the Sultan Qaboos University Hospital between 2008 and 2013 was performed. Patients' demographics, comorbidities and surgical details were retrieved. Study end-points included blood transfusion, infection, renal failure and mortality. Baseline characteristics of both groups were compared and differences were adjusted for in the multivariable logistic regression. RESULTS: A total of 673 patients were included (CS = 395, non-CS = 278). Baseline characteristics were similar except for systemic hypertension, congestive heart failure and use of cardiopulmonary bypass. The CS group had higher transfusion rates of platelets (CS 36% vs. non-CS 18%; P < 0·001) and plasma (CS 31% vs. non-CS 19%; P < 0·001). After adjusting for baseline differences, CS use increased the odds of receiving platelet transfusion (odds ratio (OR) 3·2; P < 0·001) but not of plasma transfusion (OR 1·6; P = 0·087). There was no difference in the rate of RBC transfusion (CS 45% vs. non-CS 40%; P = 0·212), renal failure (CS 11% vs. non-CS 6%; P = 0·139), infection (CS 16% vs. non-CS 13%; P = 0·434) and mortality (CS 5% vs. non-CS 2%; P = 0·146). CONCLUSION: The CS use increases platelet requirements and has no impact on the rate of RBC transfusion in our population. These findings warrant caution with generalized use and require larger studies to confirm its results.

Transfusion indication predictive score: a proposed risk stratification score for perioperative red blood cell transfusion in cardiac surgery.

BACKGROUND AND OBJECTIVES: Red blood cell transfusion is known to be associated with increased morbidity and mortality in cardiac surgery. This study was performed to derive a score to predict that risk in our patients. MATERIALS AND METHODS: Clinical details of patients who underwent cardiac surgery at the Sultan Qaboos University Hospital over 5 years were reviewed. We used univariable and multivariable logistic regression to develop the score, the Hosmer-Lemeshow test for calibration, the receiver operator curve for discrimination and the bootstrap procedure for internal validation. RESULTS: The sample included 413 patients. The following were found to be statistically significant transfusion predictors (score given): cerebrovascular disease (4), use of aspirin or clopidogril within 7 days of surgery (3), non-elective surgery (2), haematocrit <35% (2), glucose-6-phosphate dehydrogenase (G6PD) deficiency (2), use of cardiopulmonary bypass (2), age > 60 years (1), diabetes mellitus (1) and male gender (-2). We classified the observations into three groups: group 1 with total score of <2, group 2 with total score of 2-5 and group 3 with total score of >5. The calculated probabilities of receiving transfusion were 42%, 63% and 91% for groups 1, 2 and 3 respectively. CONCLUSION: We derived a simple score that can be utilized to assess the need of blood transfusion in patients undergoing cardiac surgery. We are the first to report G6PD deficiency and history of cerebrovascular disease as predictors. We recommend prospective external validation of the proposed score on a larger cohort of patients.

The pneumatic tube system does not affect complete blood count results; a validation study at a tertiary care hospital.

INTRODUCTION: Effect of the pneumatic tube system (PTS) on sample quality is controversial. Herein we aim at evaluating the impact of sample transportation via the PTS on complete blood count (CBC) results. METHODS: Duplicate CBC samples from normal donors and anemic patients were sent in parallel to the laboratory for testing through the PTS and the courier (CO). We used scatter plots, Bland-Altman plots, correlation coefficient (r), and coefficient of determination for the validation. RESULTS: A total of 115 samples (donors: 59, patients: 56) were tested. There was excellent correlation between both methods for red blood cell parameters (r range = 0.9213-0.9958) and platelet count. White blood cell (WBC) count and differential count showed similar results (r range = 0.8605-0.9821) for all, with exception of basophils which showed modest correlation (r = 0.4827 for patients and 0.5758 for normal donors). Most of the differences in measurement of all CBC parameters were within the 95% confidence interval of the mean difference on Bland-Altman plots. CONCLUSION: Modern PTS can be safely used for transporting CBC samples.

Congenital cholesteatoma in identical twins.

OBJECTIVE: We present an extremely rare case of congenital cholesteatoma in identical twins. METHOD: Case report of congenital cholesteatoma in identical twins, and a literature review, are presented. RESULTS: Both cases presented to the ENT out-patient clinic, but with different clinical pictures. Both were managed surgically. CONCLUSION: Congenital cholesteatoma presents as a whitish mass in the middle ear, with an intact tympanic membrane. It is a rare entity comprising between 3.7 and 24 per cent of total cholesteatoma cases. The key to its diagnosis is the absence of previous ear infection, ear surgery and local trauma. To our best knowledge, this paper represents the first report in the world literature of congenital cholesteatoma in identical twins.

Acute fulminant fungal sinusitis: clinical presentation, radiological findings and treatment.

Acute fulminant fungal sinusitis is characterized by acute symptoms and rapid progress with a mortality rate of 60-80%. A large number of survivors have permanent neurological, visual and cosmetic disabilities. This clearly underscores the need of early recognition of this disease in at risk population in order to start urgent treatment. The at-risk population of diabetics, AIDS and other immunosuppressed is likely to increase, as will the incidence of acute fulminant fungal sinusitis. In the present study we have reviewed nine cases of acute fulminant fungal sinusitis to determine clinical presentation, related radiological picture and optimum treatment. Most common presenting features were fever, headache, facial swelling and proptosis. Many patients presented with blindness, facial paralysis and meningitis. Predisposing causes were uncontrolled diabetes with ketoacidosis in four out of six cases, post renal transplant immunosuppression and leukemia. All patients were treated with amphotericin B or liposomal amphotericin B (AmBisome). Diagnosis was confirmed by biopsy and culture of sinus mucosa, soft tissues of cheek, or orbit. Mucor (Zygomycetes) was identified on culture or histopathology in all cases. Surgical debridement was performed in seven cases. Six out of nine patients survived but morbidity was high: only two patients survived without any permanent disability.

Nasopharyngeal cyst of branchiogenic origin: report of a case and review of the literature.

To date, only 22 cases of nasopharyngeal cyst of branchiogenic origin have been reported in the literature. In this article, we report a new case in a 35-year-old woman. We also present a review of the literature and a discussion of the sites of origin, histopathology, and treatment modalities.

Treacher Collins syndrome with acute airway obstruction.

Treacher Collins syndrome presents with cranio-facial deformities of variable expressions and severity, but rarely is it associated with acute airway obstruction of such severity that it necessitates surgical intervention. The authors describe their experience with such a neonate, who presented with acute airway obstruction successfully managed with a tracheostomy. The relevant English literature is reviewed.

Naso-labial flap in the reconstruction of floor of the mouth defects.

Defects caused by tumour excision in the floor of the mouth can be closed by different methods. We present thirteen cases treated in our department over the last seven years in whom naso-labial flaps were used. Twelve patients had squamous cell carcinoma of the floor of the mouth and one had fibro-sarcoma of the right lower mandible. Five received post-operative radiotherapy, one was resected following radiotherapy and seven were treated with surgery alone. Patient selection is important to give good functional results without compromising tumour clearance.

Simple method of insertion of Xomed one piece septal button.

Silicone septal buttons have been available to obturate septal perforations since the 1970s. Various methods of insertion have been suggested but the procedure is not always easy. We have devised an alternative method which has proved quick and simple to perform.

A randomized prospective comparison of two methods of administering topical treatment in otitis externa.

Ten patients with bilateral moderate or severe otitis externa were studied. Following aural toilet each patient was subjected to two different treatments: one ear had alternate day dressings containing a topical antibiotic/steroid mixture, while the external canal of the other was filled with the same topical preparation (sump filling). Improvement in the severity of the otitis externa was assessed after 1 week. 9 out of 10 ear canals improved in each group. An estimate of the relative cost of each treatment was made and sump filling was found to be less expensive. The results suggest that sump filling is a low cost alternative to standard treatment in moderate and severe otitis externa.