Temporary epicardial pacing wires in isolated coronary artery bypass graft: Necessity or force of habit?

Objective: To determine the frequency of Temporary epicardial pacing wires usage and its predictors in the immediate postoperative period in isolated coronary artery bypass graft surgery. Methods: The longitudinal study was conducted at the Aga Khan University Hospital, Karachi, from September 2019 to August 2020, and comprised adult patients of either gender who underwent isolated coronary artery bypass graft in the Department of Cardiothoracic Surgery. Demographic, peri-operative and post-operative Temporary Epicardial Pacing Wires use data was extracted from patient\u27s files and the institutional electronic database. Logistic regression models were built to explore predictors of Temporary epicardial pacing wires usage. Data was analysed using SPSS 22. Results: Of the 322 cases evaluated, 27(8.4%) required the use of Temporary Epicardial Pacing Wires. Mean age of the patients requiring temporary epicardial pacing wires was 66.3±8.9 years compared to 58.7±8.9 years in those who did not require it (p\u3c0.001), while the left ventricular ejection fraction percentage was 44.1±12.8 and 48.9±12.8 respectively (p=0.032). After adjusting for clinically plausible demographics and peri-operative variables, increasing age and low left ventricular ejection fraction were significantly associated with the use of temporary epicardial pacing wires in post-operative period of isolated coronary artery bypass graft patients (p\u3c0.05). Conclusions: The frequency of temporary epicardial pacing wires usage in the post-operative period of coronary artery bypass graft was found to be low

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\ub74% vs 44\ub72%; absolute difference \u20131\ub769 [\u20139\ub758 to 6\ub711] p=0\ub767; 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\u20138] vs 6 [5\u20138] cm H2O; p=0\ub70011). ICU mortality was higher in MICs than in HICs (30\ub75% vs 19\ub79%; p=0\ub70004; adjusted effect 16\ub741% [95% CI 9\ub752\u201323\ub752]; p<0\ub70001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0\ub780 [95% CI 0\ub775\u20130\ub786]; p<0\ub70001). 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. Funding: No funding

Introduction to research ethics and integrity

Ethics deals with moral principles. The ethical principles of autonomy, beneficence, non-maleficence and justice applies to biomedical research as much as it applies to other human activities. This chapter gives an overview of the ethics of planning, conducting, and reporting of research. It discusses the basic principles of collection, use and interpretation of research data. It touches upon areas pertaining to the protection of research subjects and ethical principles governing the use of human and animal in research. The concept of research misconduct and importance of responsible conduct in research is also discussed. Education in research ethics is essential for all scientists and researchers as it equips them to assess, interpret and apply ethical principles in different situations

Waste Auditing in Pesticide Sector: Towards Cleaner Production

The need for cleaner production emerges in pesticide industry due to various environmental problems associated with pesticide formulation, refilling and packaging processes. Variety of active pesticides ingredients, solvents, and other chemicals are generated as wastes during the pesticides production. Developing countries, due to their economic, social and cultural limitations are slow to adapt to new ideas. Three pesticide industrial units were audited. The study focuses on the environmental problems caused by pesticide industries and recommends measure to abate them. The major objectives of the study undertaken are summarized as; (i)to conduct an waste audit of the pesticide industries to find out the extent of pollution problems (ii)to investigate the possibilities for stream segregation to conserve water and to minimize pollution load generation (iii)to set up an demonstration case study on the “Cleaner Production” in a medium scale pesticide industry to visualize the possibilities of pollution reduction and waste minimization. While investing little on the process, it is possible to save a lot of money in the disposal of waste and operation of the process. As a result of waste auditing, methods were proposed to save water and to segregate the waste, and to modify the existing wastewater treatment system. It is hoped that the present audit would serve as a step ahead in the implementation of the concept of cleaner production in a small, medium and large sized industries to visualize the possibilities of pollution reduction and waste minimization. Based on the three environmental surveys undertaken, following cleaner production / end-of-pipe recommendations have been developed. As mentioned earlier some of the pesticide industries have already implemented some of these recommendations. Therefore these recommendations are for those units only who have yet to implement them. The costs calculated in this report are very preliminary, based on limited survey and mainly on foreign technologies. Civil works’ cost would be far less than those quoted in different sections. The purpose of preliminary costing is to work out a broader range of possible environmental investment in future. The above problems do not exist in all pesticide industries simultaneously. However, this summary is valid for the entire pesticide sector of Pakistan

Problems and Prospects of Neglected Renal Calculi in Pakistan Can This Tragedy be Averted?

Materials and Methods: From January 2010 to December 2010, a total of 2838 new patients withstone disease were treated at a tertiary care center. The medical files of 278 patients presenting withstone disease and renal failure were reviewed and compared with a cohort of 878 patients withnormal renal functions. Their demographic and clinicopathological parameters were noted andanalyzed.Results: Of 2838 patients, 278 presented with acute and chronic renal failure, 40 (1.4%) withunilateral non-functioning kidneys, and 25 (0.8%) with pyonephrosis and perinephric abscess.Management in 278 (9.7%) subjects was divided into initial relief of obstruction by percutaneousnephrolithotomy and double-J stents followed by definitive management in the form of open surgery,percutaneous nephrolithotomy, extracorporeal shockwave lithotripsy, and ureterorenoscopyto make these patients stone-free. Results of treatment showed that 72% of patients either recoveredtheir renal functions or became dialysis-free at the end of the follow-up period.Conclusion: Complications of renal calculi in the era of modern treatment can be prevented bypublic education and organizing courses for family physicians as well as opening new stone clinicsin the rural areas of the country equipped with modern treatment facilities and strategies forprevention of renal calculi

Print And Electronic Media: Cause Of Depression

Objective: To assess depression in normal people and associate it with print and electronic media of Pakistan. Methodology: The study was descriptive, cross-sectional and conducted from July to November 2011. Three hundred and twenty men and women, with age range of 20-70 years were included in study following informed consent. A structured questionnaire with five items of Yes and No category relating media to depression was used. To assess the severity of depression Zung self –rating depression scale was used. Subjects with score of 80-90 were excluded as this score is of clinical depression. Data analysis was done by SPSS version 13.0. Pearson Chi-square was applied with p<0.01 considered statistically significant. Results: Depression was seen in 55 % of subjects on reading newspaper. Watching television caused depression in 59.7% (p<0001). In 68% subjects daily routine life was disturbed (p<0.01). The highest rate of depression 32.6% was due to watching political news, while 28.3 % were by photographs and visuals of dead bodies and 24.6% by news of terrorism. Prevalence of mildly and moderately depressed individuals was 56.3 % and 15.8% respectively. Conclusion: Reading newspaper and watching television causes depression. The content of news on media in particular leads to depression

Incidental prostate cancer: a 23-year review of a tertiary care hospital

Prostate cancer is the second most commonly diagnosed malignancy in men worldwide. The prevalence has been increasing with significant differences between regions. This study assesses the prevalence of incidental prostate cancer detected in specimens removed during bladder outlet obstruction operation. A retrospective analysis of the records of patients who had either endoscopic or open prostatectomy from January 1998 to December 2021 was conducted. The variables analysed were age, procedure, date of surgery, and Gleason score. A total of 2,842 patients underwent surgery on the prostate gland during the study period. Most of the patients, i.e. 2,733 (96.2%), were pathologically diagnosed with benign prostatic hyperplasia, while only 110 (3.9%) had prostate cancer. The frequency of incidental prostate cancer following surgery for bladder outlet obstruction has decreased over the last two decades at our centre, possibly because of an increase in PSA testing

Inflammatory myofibroblastic tumour of genitourinary system

We describe two cases of inflammatory myofibroblastic tumor (IMT) involving genitourinary system. One patient with mass of urinary bladder presented with lower abdominal pain. Other presented with a mass involving right kidney presented with right flank pain. At time there are no specific guidelines exist for the management of inflammatory myofibroblastic tumors. In this case series we will discuss the work-up and management approaches done for each case. Continuous..