Primary vesical varices: a cause of gross haematuria.

We report a case of isolated bladder varices that manifested with sudden onset, gross hematuria, in a 44-year-old male with no co-morbid conditions. Varicosities were discovered on cystoscopy. Conditions to look out for in such a situation are discussed.

Educating and informing patients receiving psychopharmacological medications: are family physicians in Pakistan up to the task?

INTRODUCTION: Studies have shown a high prevalence of psychiatric illnesses among patients in primary health care settings. Family physicians have a fundamental role in managing psychiatric illness with psychopharmacological medications. Providing information about the disease, its management and the potential adverse effects of the medications is an important part of the management of mental illnesses. Our objective was to determine if patients who were prescribed psychopharmacological drugs by family physicians at a community health center in Karachi, Pakistan were provided adequate education about their disease and its management. METHODS: A cross-sectional study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital Karachi, Pakistan. Details about the prescriptions and patient education were acquired from the patients after their consultations. RESULTS: A total of 354 adult patients were interviewed during 3 days. Among them, 73 (20.6%) were prescribed psychopharmacological medications. Among patients receiving psychopharmacological medicines, 37 (50.7%) did not know their diagnosis; 50 (68.5%) were unaware of the disease process; 52 (71.2%) were unaware of alternative treatments; 63 (86.3%) were not cautioned about the potential adverse effects of the drugs; 24 (32.9%) were unaware of the duration of treatment and in 60 (82.2%) of the participants an appropriate referral had not been discussed. For all aspects of education, patients prescribed psychopharmacological medications knew less as compared to those patients that were prescribed other medications. DISCUSSION: The practice of imparting information to patients who receive psychopharmacological medications seems to be inadequate in Pakistan. We have hypothesized about the possible reasons for our findings, and identified a need for further research to determine the cause for such findings and to address them accordingly. At the same time there is a need to educate family physicians in Pakistan about the special importance of providing adequate information to such patients.

Transfusion related acute lung injury--TRALI: an under diagnosed entity.

Transfusion related acute lung injury (TRALI) is a life-threatening complication of transfusion of blood and its components resembling acute respiratory distress syndrome (ARDS) or acute lung injury (ALI). TRALI is a particular form of ARDS that follows blood transfusion and is caused by donor-derived antibodies present in the transfused products, reacting with the recipients' blood cells, inducing release of inflammatory mediators thus compromising lung functions. Anti-HLA antibodies are the most frequently indicted inducers in this category. Literature search has not revealed any documented case of TRALI from Pakistan. This in no way implies that TRALI is non existent in this part of the world but rather indicates that many clinicians may be unaware of the condition or may not recognize transfusion as the cause and like in other parts of the world, is almost certainly under-diagnosed. The lack of agreement on the definite cellular and molecular mechanisms underlying the development of TRALI renders the task of improving the safety of blood transfusion far more complex and potentially quite expensive. This review discusses the modern concepts of pathogenesis of TRALI along with its clinicopathological manifestations and management with the aim to improve awareness of our clinicians towards this dreadful and potentially fatal condition.

Fatal transfusion related acute lung injury following coronary artery by-pass surgery: a case report.

BACKGROUND: Transfusion related acute lung injury (TRALI) is a potentially fatal Acute Lung Injury following transfusion of blood components. Hypotheses implicate donor-derived anti-human leukocyte antigen or granulocyte antibodies reacting with recipients' leukocytes, releasing inflammatory mediators. Lack of agreement on underlying cellular and molecular mechanisms renders improving transfusion safety difficult and expensive. CASE PRESENTATION: Literature search has not revealed any case of TRALI from Pakistan. We report the case of fatal TRALI in a 68 year old male who received blood products after coronary artery by-pass surgery. CONCLUSION: This article aims to create awareness about this complication and suggests that post transfusion cardiopulmonary instability should alert to the possibility of TRALI.