Reducing blood sample hemolysis in the emergency department using S-Monovette® in aspiration mode

Background

Blood sample hemolysis continues to be a significant problem in clinical practice. In vitro hemolysis rates up to 77% have been reported in literature. The use of manual aspiration techniques for blood sampling has previously been shown to reduce the burden of erythrocyte injury in the pre-analytical phase compared to the vacuum collection technique. This study compares the hemolysis rates between two blood sampling methods: 5.0 ml BD Vacutainer® SST™ (BDV) and 4.9 ml S-Monovette® serum gel tubes in aspiration mode (SMA).

Methods

This was a prospective randomised controlled study conducted in an Emergency department (ED). A convenience sample of 191 adult patients, aged 18-90 years old, presenting at the ED and requiring blood samples for serum electrolyte was included in the study. Paired blood samples were obtained through an intravenous cannula from each patient with randomised order of blood draw using SMA or BDV. Patient data was obtained and hemolysis index (HI), serum lactate dehydrogenase (LDH), and serum potassium (K) levels measured.

Results

The adjusted mean HI (35.2 vs 21.5 mg/dL, p < 0.001), serum K (4.38 vs 4.16 mmol/L, p < 0.001) and LDH levels (259.6 vs 228.4 U/L, p < 0.001) were significantly higher in blood samples taken using BDV compared to SMA. The frequency of severely hemolyzed (>150 mg/dL) samples was also higher in blood collected using BDV (16.2%) compared to SMA (0%).

Conclusions

The burden of hemolysis in blood samples taken from IV cannulae can be effectively reduced with the use of manual aspiration using the S-Monovette® blood collection system as compared to BD-Vacutainer.

Ball-shaped right atrial mass in renal cell carcinoma: A case report

BACKGROUND

Renal cell carcinoma (RCC) is an aggressive tumor, with an incidental discovery in most patients. Classic presentation is rare, and it has a high frequency of local and distant metastasis at the time of detection.

CASE SUMMARY

We present a rare case of a 58-year-old man with a ball-shaped thrombus in the right atrium at the time of first incidental identification of RCC in the emergency department. Cardiac metastasis, especially thrombus in the right atrium, is rare. It could either be a bland thrombus or a tumor thrombus, and physicians should consider this potentially fatal complication of RCC early at the time of initial presentation.

CONCLUSION

Ball-shaped lesions in the right atrium are rare, and bland thrombus should be differentiated from tumor thrombus secondary to intracardiac metastasis.

Ethnobotanical study of wild edible fruits in eastern Bhutan

BACKGROUND

In the past, wild edible fruits (WEFs) were a significant source of food and nutrition in Bhutan. These nutrient-rich species can enhance food security and alleviate poverty in Bhutan. However, recent developments like the introduction of improved fruit varieties, changes in dietary choices, and infrastructure development are expected to influence indigenous knowledge and consumption of WEFs. We aimed to document the species diversity of WEFs and their uses in eastern Bhutan and examine how the knowledge and consumption of WEFs vary with socio-demographic factors.

METHODS

A total of 97 households in two districts were selected to participate in the survey. A semi-structured questionnaire was used to interview a selected adult from each household. Comparative analysis of indigenous knowledge and consumption of WEFs among the socio-demographic factors was performed using one-way ANOVA and a Chi-square test on R software.

RESULTS

The present study reported 52 species of WEFs belonging to 35 families. The prevalence of WEF consumption was found to be 42%. WEF consumption differed significantly between districts, age groups, and indigenous knowledge levels. Similarly, indigenous knowledge of WEFs was significantly associated with districts and age groups.

CONCLUSIONS

Eastern Bhutan has a rich diversity of WEFs, but their consumption has been decreasing. Recent agricultural and infrastructure developments may have impacted the consumption and indigenous knowledge of WEFs in this region. Thus, domestication and agro-processing of WEFs should become a major focus in Bhutan to utilize their nutritional value and potential economic benefits to enhance food security in the country. Additionally, incorporating WEF-related knowledge in the school curriculum is essential to educate younger generations on WEFs.

Clinical characteristics of spinning-induced rhabdomyolysis and other causes of rhabdomyolysis: a comparative study

INTRODUCTION

Spinning is an indoor stationary cycling programme that can cause severe rhabdomyolysis. We compared the clinical characteristics of spinning-induced exertional rhabdomyolysis (SER) with other exertional rhabdomyolysis (ER) and non-exertional rhabdomyolysis (NER).

METHODS

This was a retrospective observational study of adult patients presenting with rhabdomyolysis to an emergency department from August 2018 to August 2019. Patients were classified as SER, ER or NER based on chart review. We compared patient demographics, serum creatine kinase (CK), transaminase and creatinine levels, admission rates, duration of hospitalisation and treatment prescribed.

RESULTS

62 patients were analysed. SER patients were predominantly female (77% vs. 24% vs. 26%, p < 0.01), Chinese (100% vs. 47% vs. 79%, p < 0.01) and younger (mean age 27.7 vs. 34.6 vs. 59.4 years, p < 0.01) than those with ER and NER. The SER group had the highest CK level (20,000 vs. 10,465 vs. 6,007 U/L, p < 0.01) but the lowest mean serum creatinine level (53.5 vs. 80.9 vs. 143.5 μmol/L, p < 0.01) compared to the ER and NER groups. Admission rates were the highest in SER patients (100% vs. 57% vs. 90%, p < 0.01). SER mean inpatient length of stay was longer than ER but shorter than NER patients (4.3 vs. 1.9 vs. 6.0 days, p = 0.02).

CONCLUSION

SER is a unique form of rhabdomyolysis. Predominantly seen in young, healthy women, it often presents with extremely high CK levels. However, the prognosis is good and the rate of complication is low with fluid treatment.

Assessment of knowledge on sexually transmitted infections and sexual risk behaviour in two rural districts of Bhutan

Background

The incidence of STI is high and increasing in Bhutan. Poor understanding of risky sexual behavior could be a cause. Comprehensive community surveys have not been previously done. This study was conducted to assess local knowledge on STIs and sexual risk behaviour in two rural districts of Bhutan: Gasa and Zhemgang.

Methods

The study population included residents aged 15–49 years in the two districts. Health Assistants (HAs) visited all households to distribute questionnaires assessing understanding of knowledge on STIs and risk behaviour. Questionnaires were scored and analyzed.

Results

The average score was 61.6%. Respondents had highest knowledge about prevention and lowest about disease and complications. There was a positive correlation between level of education and knowledge on STI (P < 0.05). Almost 37% of students scored low. Nearly one-third of the study population was practicing risky sexual behavior with 31.2% having sexual relationships with non-regular partners and 10.9% had extramarital sexual contacts. Regular use of condoms with non-regular partners was 49.1%. The most common reason for not using condom was unavailability during the sexual encounter. The study showed that despite increasing knowledge there was no reduction in risky sexual behaviour (p > 0.05).

Conclusions

The study population had variable understanding of STIs and their complications. One in three persons practiced risky sexual behaviour, higher in men. Condom use was low. There was no reduction of risky sexual behaviour with increasing level of knowledge indicating that increasing level of knowledge does not necessarily reduce risky sexual behaviour.