Comparison of Outcomes of Topical Anesthesia with Peribulbar Anesthesia in Vitrectomy for Unresolving Vitreous Hemorrhage

OBJECTIVES: To compare the Surgeon's ease level and duration of surgery in topical anesthesia with peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months. METHODOLOGY: A randomized controlled trial was carried out at the Department of Ophthalmology, Lahore General Hospital, Postgraduate Medical Institute, Lahore from October 2017 to September 2018. A total of 110 patients were equally divided (n=55) in group A (topical anesthesia) and group B (peribulbar anesthesia) by lottery method. In group A, 0.5% proparacaine hydrochloride eye drops were instilled into the conjunctival sac every 3 minutes preoperatively 5 times before surgery. For group B patients, 5cc injection consisting of 2.5ml of 0.5% bupivacaine and 2.5ml of 1% lidocaine was injected thirty minutes before surgery. Surgical time was noted from first incision to enter the eye for vitrectomy till application of last closing suture. Surgeon ease was recorded with a 4 Grade scale. All data was recorded, entered, and analyzed by SPSS version 25.0. Continuous variables were presented as mean, standard deviation and independent t-test was applied. RESULTS:  The mean age of the patient was 43.83±9.76 years. Male cases were 78 (70.9%) and female cases were 32 (29.1%). Mean duration of surgery was 30.32±7.07 minutes and the surgeon’s ease was 2.30±0.98. There was a significant difference (P<0.05) with respect to mean duration of surgery and surgeon’s ease level in patients who were given topical anesthesia (28.12±6.57 minutes and 3.11±0.90) versus peribulbar anesthesia (32.52±6.92 minutes and 2.67±0.90). CONCLUSION: Topical anesthesia without sedation is better than peribulbar anesthesia for vitrectomy without sedation in patients with unresolving vitreous hemorrhage of duration greater than 3 months

How COVID-19 is Changing Behaviors of Population: A Study from Punjab?

Background and Objectives: Coronavirus disease 2019 (COVID-19) is a respiratory disease caused by a novel Coronavirus. The World Health Organization (WHO) officially declared it a health emergency on January 30, 2020. WHO also called for collaborative efforts from all countries to prevent its further spread. The success of the world&rsquo;s battle against COVID-19 depends upon people&rsquo;s adherence to the control measures which is affected by their Knowledge, Attitudes and Practices (KAP) towards the disease as suggested by KAP theory. In this study, the KAP of population from Punjab towards COVID-19 during the rapid rise period of the COVID-19 outbreak is investigated. Methods: This was a cross-sectional study based on Google forms-based survey regarding the Knowledge, Attitudes and Practices of participants towards COVID-19. A total of n = 500 participants completing their questionnaires were included. Online data was extracted and cross-checked for any discrepancy. Statistical analysis was done by using SPSS ver.22. Results: Participants with &ge; 22 years of age significantly practicing more social distancing (P&lt;0.05). Knowledge of hand hygiene and proper discarding of mask were significantly more associated with the practices of social distancing. Knowledge of cough and sneezing etiquettes was significantly related to practice social distancing (P &lt; 0.01). Attitude of hand hygiene protocols was significantly related to practicing hand washing, minimizing touching environment (P &lt; 0.01) and disinfecting house and workplace (P &lt; 0.05). Conclusion: The present study showed a good knowledge, positive attitudes and suitable practices in population of Punjab. The health awareness programs designed after pandemic declaration by WHO, played a vital role in improving all these things.</p

Geoeconomic variations in epidemiology, ventilation management, and outcomes in invasively ventilated intensive care unit patients without acute respiratory distress syndrome: a pooled analysis of four observational studies

Background: Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods: In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings: Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference -1·69 [-9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5-8] vs 6 [5-8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52-23·52]; p&lt;0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75-0·86]; p&lt;0·0001). Interpretation: Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status