Safety and effectiveness of ultrasound guided peripheral nerve blocks: Audit at tertiary care hospital

Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients who received peripheral nerve blocks as part of anaesthesia care between January 2015 and January 2017. The data included outcomes of peripheral nerve block effectiveness, complications and limb conditions after the block. Peripheral nerve block effectiveness was assessed by monitoring pain scores at rest and on movement, and the requirement of co-analgesia. Complications, like numbness, motor block, metallic taste, hypotension and respiratory depression, were also assessed. Data was analysed using SPSS 19.Results: There were 299 patients who received ultrasound-guided peripheral nerve blocks. The overall mean age was 44.57±16.64 years. Of the total, 140 (47%) received transversus abdominis plane block, followed by supraclavicular block 49(16.7%). The most common complication in the recovery room was numbness 19 (6.2%). Overall, 70% patients remained pain-free, while 16% had moderate pain on movement 12 hours postoperatively.Conclusions: Ultrasound-guided regional anaesthesia was found to provide effective analgesia during and after surgery. Nerve blocks proved to be safe when used with ultrasound

Psychological Assessment of Health Care Workers in Intensive Care Units During the COVID-19 Pandemic

ABSTRACT Background Fear and depression are common to any pandemic particularly in healthcare workers as they are in the front line to treat the diseased. Such a state directly affects the performance of the health system and the patients who are seeking care. This study aimed at assessing the psychological effect of COVID-19 among the healthcare workers in the intensive care units of two tertiary care hospitals of Rawalpindi & Islamabad.   Methods It was a descriptive cross-sectional study, conducted over five months i.e., 1st July 2020 to 1st November 2020. Non-probability consecutive sampling technique was used for recruiting health care workers. PHQ-9 tool was used including 9 questions (items) related to the depression due to COVID-19. Other tool Fear of COVID-19 scale was based on 5 points Likert scale as ‘strongly disagree’, ‘disagree’, ‘neutral’, ‘agree’ and ‘strongly agree’. Besides descriptive frequencies, mean and standard deviation, Spearman correlation (r) was applied to check the correlation between fear of COVID-19 with age (years) and professional experience (years).   Results Out of 382 healthcare workers (doctors, nurses & other staff) recruited in the study, around 50% were found to be suffering from severe depression and have developed a fear of the disease. A significant positive correlation was observed between the age of the healthcare worker and the degree of fear of COVID-19 (p<0.05). Similarly, a significant positive correlation was observed between the number of professional experience and the fear of COVID-19 (p<0.05).   Conclusion It is concluded that healthcare workers in ICU are at risk of depression because of fear of COVID-19. The current situation highlights the areas that need attention. Special training or orientation must be arranged for a situation of an outbreak or a pandemic and skills for keeping one’s psychological wellbeing and mental health must be imparted. KEYWORDS: Fear; Depression; Psychological impact; COVID-19, Healthcare workers, Pakista

Comparative efficacy of phosphate solubilizing bacteria and synthetic phosphate fertilizers on the growth of wheat

Wheat is recognized as one of the most important dietary elements due to its high nutritious content and thus, has become greatest food option all over the world. Phosphorus (P) being major plant food nutrient plays a vital role multiple functions of plant growth and development. The current study was carried out to compare the performance of phosphate solubilizing bacteria (PSB) as bio-fertilizer with commercially available phosphate fertilizers on wheat crop. The trial was designed in randomized complete block (RCB) replicated thrice. 6 different sources of phosphate fertilizers (Di-ammonium phosphate as DAP, Nitrophos as NP, Single super phosphate as SSP, Restore as PSB, Marathon as PSB, Nitrogen (N2) fixing bacteria as PSB) followed by control were evaluated for agronomic, physiological and quality attributes of wheat. The results showed that most of the qualitative traits were significantly influenced by different treatments. However, application of N2 fixing bacteria was more significant in all treatments. Highest total viable count of colony-forming units (14.63×106 at 3-WAS & 17.70×106 after harvest CFU g-1), maximum tillers’ count (337 m-2), grains’ count (45.57 spike-1), grain yield (2714.3 kg ha-1), LAI (0.67 & 1.16 at 56 & 112 DAS), CGR (13.59 g day-1 m-2), photosynthesis rate (26.13 µ mol m-2 sec-1) and flag leaf sugar content (0.24%) were recorded on account of using N2-fixing bacteria applied as PSB. Moreover, NPK content in shoot, grain as well as uptake of NPK by grain were also received as highest in the same treatment. Based on research findings, it is concluded that application of N2-fixing bacteria as PSB (7.5 kg ha-1) might be increasing wheat production in Dera Ismail Khan and other areas of similar environment in Pakistan

A nationwide virtual research education program for medical students in Pakistan: Methodological framework, feasibility testing, and outcomes

Introduction: Equipping young medical trainees with fundamental research skills can be a promising strategy to address the need for professionals who can understand and responsibly communicate evolving scientific evidence during a pandemic. Despite an ardent interest to partake in research, most educational institutions in Pakistan and other low-middle income countries have not yet adopted a comprehensive strategy for research skills education. The authors aimed to design and assess the feasibility of implementing the first nation-wide virtual research workshop for medical students in Pakistan. Methods: The course Beginners Guide to Research, designed as a nation-wide virtual research workshop series, was conducted for medical students across Pakistan in June 2020. Four interactive live workshops took place online on alternate days from June 22nd, 2020, to June 27th, 2020, each lasting 1-2 h. Outcomes included: (i) reach, (ii) efficacy as indexed by pre-post change in score pertaining to knowledge and application of research and (iii) self-rated perceptions about understanding of research on a Likert scale. Results: 3,862 participants enrolled from 41 cities and 123 institutions. Enrolled participants belonged to the following provinces: Sindh (n = 1,852, 48.0%), Punjab (n = 1,767, 45.8%), Khyber Pakhtunkhwa (n = 109, 2.8%), Azad Jammu and Kashmir (n = 84, 2.2%) Balochistan (n = 42, 1.1%). We also saw a few registrations from international students (n = 8, 0.2%). Mean (SD) age of enrolled medical students was 21.1 (2.1) years, 2,453 (63.5%) participants were female and 2,394 (62.0%) were from private-sector medical colleges. Two thousand ninety-three participants participants filled out all four pre-test and post-test forms. The total median knowledge score improved from 39.7 to 60.3% with the highest improvements in concepts of research bioethics and literature search (p \u3c 0.001) with greater change for females compared to males (+20.6 vs. +16.2%, p \u3c 0.001) and private institutions compared to public ones (+16.2 vs. +22.1%, p \u3c 0.001). Conclusion: The overwhelming enrollment and significant improvement in learning outcomes (\u3e50% of baseline) indicate feasibility of a medical student-led research course during a pandemic, highlighting its role in catering to the research needs in the LMICs

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Hermite–Hadamard–Mercer Inequalities Associated with Twice-Differentiable Functions with Applications

In this work, we initially derive an integral identity that incorporates a twice-differentiable function. After establishing the recently created identity, we proceed to demonstrate some new Hermite–Hadamard–Mercer-type inequalities for twice-differentiable convex functions. Additionally, it demonstrates that the recently introduced inequalities have extended certain pre-existing inequalities found in the literature. Finally, we provide applications to the newly established inequalities to verify their usefulness

COVID-19 vaccine hesitancy among health service providers: a single centre experience from Karachi, Pakistan

Objective: To assess the views of health service providers towards coronavirus disease 2019 vaccination with Cansino, Sinovac and Sinopharm vaccines. Method: The analytical cross-sectional study was conducted at the Sindh Institute of Urology and Transplantation, Karachi, in May and June 2021, and comprised doctors, nurses, technical staff, and medical social officers. Data was collected using a questionnaire, in Urdu and English languages, assessing determinants of hesitancy. Data was analysed using SPSS 19. Results: Of the 331 subjects, 156(47%) were males and 175(53%) were females. Overall, 183(55%) subjects were aged 60 years. Among the responders, 274(83%) were vaccinated, 49(15%) wanted to delay, and 8(2.4%) were outright refusers. Among the hesitant, 43(80%) were women, and 56(98%) were aged <40 years. Age, gender, occupational group and personal experience with the disease had significant correlations with vaccination status (p<0.05). Personal safety 202(74%) followed by the perception of official requirement 162(59%) were the prime reasons for getting vaccinated. No respondent cited religious inhibitions or social media as the reason behind vaccine refusal. Conclusion: A lack of trust in the safety and efficacy data of the available Chinese vaccines appeared as a factor inducing hesitancy. The resistance of younger respondents, especially trainee physicians, was a finding of concern since they form the backbone of the health system in the country. Key Words: COVID-19, Vaccine hesitancy, Health service providers

Antibacterial Effect of Silver Nanoparticles (AgNPs) Synthesized from Trichoderma Harzianum Against Clavibacter Michiganensis

In nanotechnology, fungal mediated green synthesis of silver nanoparticles (AgNPs) has tremendous application in the development of antimicrobial systems but the mechanism behind the synthesis is yet to be understood. This study aims to synthesize the silver nanoparticles via a green chemistry route using mycellial aqueous extract of agriculturally beneficial fungi Trichoderma harzianum. Two different concentrations (1 mM and 2.5 Mm) of aqueous silver salt (AgNO3) were used and mixed as 1:1 ratio with aqueous extract of T. harzianum at room temperature and the pH of the reaction mixture was monitored until it stabilized. Formation of AgNPs was confirmed by using UV-Vis spectroscopic analysis. For further insight, AgNPs were characterized by using HR-TEM and XRD, which clearly showed appearance of crystalline, monodispersed round-shaped particles of 3-20 nm in size. The synthesised NPs were subjected to antimicrobial assay against gram +ve and gram –ve bacteria using the disk diffusion method. The focused species was Clavibacter michiganensis subsp michiganensis, which is the causitive pathogen of Tomato canker disease and we hypothesised that the synthesised AgNPs might be useful to control this pathogen. Appreciable antibiotic activity was monitored even at a low concentration of 1mM level, while the zone of inhibition was positively increased at 2.5 mM. Our results clearly indicate that the present process is an excellent candidate for industrial scale production of AgNPs, and has the potential to control the bacterial pathogen cmm