Pregnancy related acute kidney injury takes substantial share of acute kidney injury (AKI) in India, with obstetrical haemorrhage having high morbidity and mortality. A young female had neglected obstetric haemorrhage (unrecognized intrauterine and massive intraperitoneal bleeding post caesarean, due to uterine trauma and atony) and dangerous intra-abdominal hypertension with exsanguination eventually leading to shock, multifactorial AKI, metabolic acidosis, and hyperkalemia. Intensive and aggressive management with subtotal hysterectomy, inotropes, fluid management, mechanical ventilation, tracheostomy, and hemodialysis changed the outcome. Despite odds against, neglected obstetric haemorrhage with complicated AKI, was managed successfully by emergency hysterectomy, aggressive intervention for AKI with intensive fluid, ventilatory management and daily hemodialysis. Timely identification and aggressive management of this condition and complications is pivotal in preventing complications, morbidity, and maternal mortality.
BACKGROUND:Musculoskeletal pain is one of the leading causes of years lived with disability, which constitutes a substantial burden on society This study was done in a global transcontinental population dependent on a single physiotherapy centre of a UN level II Hospital in Naquora, Lebanon (catering predominantly to the military population of >39 countries serving in UNIFIL Lebanon) between Jan 2014 to Dec 2019. The patients were of various musculoskeletal injuries (including sports injuries- both acute and chronic) requiring conservative treatment, predominantly physiotherapy – using physiotherapy-based equipments followed by different rehabilitation exercises. Literature lacks any study involving the predominantly adult military population cohort of various parts of the globe with similar lifestyles and duties treated in a single centre. METHODS:Patients from more than 39 countries spread across various continents are included in this study. It is a retrospective observational study comprising hospital-based cohorts of patients who did not need any operative intervention for the treatmentand were essentially managed onservatively using physiotherapy equipments and rehabilitation exercises on OPD/inhospital admission basis. They underwent necessary diagnostic tests and then multiple sittings of physiotherapy as part of the individual treatment protocol. Data was collected from the UNIFIL Hospital registers. SWD, IFT ,TENS and other physiotherapy equipments and rehabilitation aids were used in the treatment.RESULTS:The study shows back complaints more common in all populations and more disabling than other injuries each year throughout the study. Foot and ankle complaints were the least reported symptoms in the centre. Regionwise, the local population was the largest clientele followed by Asians & thereafter equally by the found in the March to September months because of more outdoor sports activities during these months due to the congenial weather conditions.CONCLUSION:Back complaints are the most common complaints compared to the peripheral limbs and extremities complaints. All continents are equally affected irrespective of their original race, culture and climate. Dedicated hospital staff and good physiotherapy equipments are essential to treat such patients. Timely consultation to specialist doctors help to mitigate such ailments early by conservative means. SWD and IFT effectively treats both acute and chronic musculoskeletal complaints than single isolated SWD or IFT therapy. TRIAL REGISTRATION:Since this study is a retrospective observational non-interventional study not involving any new drug/ implant /equipment. Hence, trial registration is not applicable in this study. The study is purely of academic and research interest and the security classification of this research study is unclassified category.
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