Bleeding is a common occurrence during any dermatologic surgery that disrupts blood vessels. The complications of excess bleeding can include delayed wound healing, hematoma formation, infection, dehiscence, and necrosis. In part one of this review, we discussed the pre-operative, intra-operative, and post-operative management of patients undergoing dermatologic surgery. In Part two, we discuss traditional and new topical hemostatic agents used to achieve hemostasis in dermatological procedures and surgery. We will evaluate the caustic and non-caustic hemostatic agents as well as hemostatic dressings. The mechanisms of action, side effect profile, and advantages and disadvantages of the topical hemostatic agents are provided. Sources for this article were found searching the English literature in PubMed for the time period 1940 to March 2012. A thorough bibliography search was also performed and key references examined.
Dermatologic surgery; hemostasis; topical hemostatic agents
As dermatological procedures continue to become increasingly complex, improved methods and tools to achieve appropriate hemostasis become necessary. The methods for achieving adequate hemostasis are variable and depend greatly on the type of procedure performed and the unique characteristics of the individual patient. In Part 1 of this review, we discuss the preoperative, intraoperative, and postoperative management of patients undergoing dermatologic surgery. We address oral medications and supplements that affect hemostasis, hemostatic anesthesia, and intraoperative interventions such as suture ligation and heat-generating cautery devices. In Part 2 of this review, we will discuss topical hemostats. The authors conducted an extensive literature review using the following keywords: “hemostasis,” “dermatology,” “dermatological surgery,” “dermatologic sutures,” “electrosurgery,” “hemostatic anesthesia,” and “laser surgery.” Sources for this article were identified by searching the English literature in the Pubmed database for the time period from 1940 to March 2012. A thorough bibliography search was also conducted and key references were examined.
Dermatological surgery; dermatologic sutures; electrosurgery; hemostasis; hemostatic anesthesia and laser surgery
There have been few studies focusing on occupational/organizational causes of stress in police. Hardly any studies exist on personality traits and coping methods in this group of individuals.
To study the association of personality traits and coping methods to psychological stress in police personnel.
Settings and Design:
This cross-sectional study was conducted among the constables and head constables working in the Police Department, Vizianagram town, Andhra Pradesh.
Materials and Methods:
The study sample consisted of 150 police persons. The socio-demographic data was individually collected from them. General Health Questionnaire-28 (GHQ-28) was used for assessing psychological stress, Eysenck's Personality Questionnaire (EPQ) for personality traits, and Coping Checklist-1 (CCL-1) for eliciting coping methods. The statistical analysis was done using SPSS v 10 software.
On screening by GHQ-28, 35.33% of the police were found to be having psychological distress. The socio-demographic variables showed no significant association to psychological stress. Personality traits such as neuroticism, psychoticism, and extroversion and coping methods like negative distraction and denial/blame showed statistically significant association (P<0.05) with psychological stress. The most commonly used coping methods across the sample were social support (72.55%), acceptance/redefinition (64.72%), and problem solving (60.46%). As measured by Pearson's correlation coefficient (r), there was evidence of linear association between certain personality traits and coping methods as well.
The personality traits and coping methods have significant independent and interactive role in the development of high psychological stress in police persons, thus placing them at a high risk of developing psychiatric disorders.
Coping methods; personality traits; police personnel; psychological distress
The recent studies on cataract formation focus on the primary role of the systemic oxidative stress which is generated outside the lens. Our research was directed to assess the oxidative stress by measuring the lipid peroxidation products in the form of the Thiobarbituric Acid Reactive Substances (TBARS) and the antioxidant enzyme levels in the blood. The antioxidant therapy may have a role to play in delaying the onset and the progression of age related cataracts.
Material and Method
This was a case control study. It comprised of 100 age matched subjects (50 with cataracts and 50 controls) with their ages ranging from 45- 75 years. Oxidative stresses such as the Thiobarbituric Acid Reactive Substances (TBARS) and the antioxidant enzymes, Superoxide Dismutase (SOD) and Glutathione Peroxidase( GPX ) were investigated in all the patients and the controls.
Significantly increased levels of serum lipid peroxide in the form of Malondialdehyde (MDA) (p<0.001) were observed in the cataract patients as compared to the controls. Significantly decreased blood levels of SOD and GPX were observed in all the patients.
In the present study, it was concluded that oxidative stress plays an important role in the onset and the progression of cataracts. The pro-oxidant i.e. serum malondialdehyde (MDA) levels were increased in the cataract patients. The blood levels of the enzymatic anti-oxidants, SOD and GPX were decreased. The plasma TBARS can be used as biomarkers of the degeneration in the lens.
Cataract age related; Plasma TBARS; Oxidative stress; Superoxide dismutase; Glutathione peroxidase; Lipid peroxidation(LPO)
Melioidosis is endemic in the South Asian regions, like Thailand, Singapore Malaysia and Australia. The disease is more pronounced in the southern part of the country. It is caused by Burkholderia pseudomallei which causes systemic involvement, morbidity and mortality associated with the disease is high. Due to highly varied clinical presentation, and low general awareness this infection is largely underdiagnosed and under reported in our country. Most laboratories in the country still rely on conventional culturing methods with their low sensitivity, adding to the under reporting. To enhance physician awareness we describe here two cases who presented to our institute after months of misdiagnosis.
Burkholderia pseudomallei; melioidosis; systemic involvement
There have been rapid technological advances in blood banking in South Asian region over the past decade with an increasing emphasis on quality and safety of blood products. The conventional test tube technique has given way to newer techniques such as column agglutination technique, solid phase red cell adherence assay, and erythrocyte-magnetized technique. These new technologies are adaptable to automation and major manufacturers in this field have come up with semi and fully automated equipments for immunohematology tests in the blood bank. Automation improves the objectivity and reproducibility of tests. It reduces human errors in patient identification and transcription errors. Documentation and traceability of tests, reagents and processes and archiving of results is another major advantage of automation. Shifting from manual methods to automation is a major undertaking for any transfusion service to provide quality patient care with lesser turnaround time for their ever increasing workload. This article discusses the various issues involved in the process.
Automation; immunohematology; serology
The spectrum of hemolytic disease of the newborn has changed over the last few decades. With the implementation of Rhesus D immunoprophylaxis, hemolytic disease due to ABO incompatibility and other alloantibodies has now emerged as major causes of this condition. Though in developing countries, anti D is still a common antibody in pregnant women, many Asian countries have identified alloantibodies other than anti D as a cause of moderate-severe hemolytic disease. The most concerned fact is that, some of these have been described in Rh D positive women. It appears that universal antenatal screening in all pregnant women needs to be initiated, since Rh D positive women are just as likely as D negative women to form alloantibodies. Many developed nations have national screening programs for pregnant women. This is necessary to ensure timely availability of antigen negative blood and reduce effects on the newborn. Although universal screening seems justified, the cost and infrastructure required would be immense. Developing countries and under resourced nations need to consider universal antenatal screening and frame guidelines accordingly.
Newborn hemolytic disease; red cell alloimmunisation; antenatal antibody screening
Blood and blood components are considered drugs because they are used in the treatment of diseases. As with any drug, adverse effects may occur, necessitating careful consideration of therapy. Like any other therapeutic decision, the need for transfusion should be considered on the basis of risks and benefits and alternative treatments available to avoid over- and under-transfusion. This review is focused on the blood transfusion protocol in trauma patients with hemorrhagic shock. Besides, issues related to emergency and massive transfusion have also been elaborated. We conducted a comprehensive MEDLINE search and reviewed the relevant literature, with particular reference to emergency medical care in trauma.
Blood transfusion; massive transfusion; resuscitation; trauma
Widely considered the gold standard treatment option for tattoo removal, the use of Q-switched lasers may very rarely result in the formation of large bulla. While very disconcerting to patients, these lesions are easily managed and, with proper care, heal quickly with no long-term consequences. The authors present three cases of patients who had bullous reactions shortly after receiving Q-switched laser treatment of tattoo ink. Bullous formation in all three patients was treated successfully.
The transfusion-medicine specialists and physicians are often in a difficult situation when the patient has severe worsening anemia and all the blood is mismatched. This situation can arise in patients with red cell autoantibodies or alloantibodies due to previous transfusions. We report two cases of immune hemolysis – one due to warm auto antibodies and the second due to alloimmunization from multiple transfusions.
Auto antibodies; hemolysis; alloimmunization; blood transfusion