Anaesthetic management of two patients with beta-thalassaemia intermedia

There is paucity of literature regarding the anaesthetic management of patients with thalassaemia intermedia. In this case study, the anaesthetic management and concerns in two children with thalassaemia intermedia aged eleven and nine years undergoing herniotomy and splenectomy respectively is reported. Both children had unanticipated difficulty in airway management and high intraoperative blood pressure trends. These cases are representative of the range of problems seen in children with thalassaemia intermedia

Biochemical Assessment of Bilirubin Level in Pancreatic Adenocarcinoma Patients in Khartoum State

اﻟﺨﻠﻔﯿﺔ :اﻛﺜﺮ اﻻﻧﻮاع اﻟﻤﻨﺘﺸﺮه ﻟﻤﺮض اﻟﺒﻨﻜﺮﯾﺎس ھﻮ)ﻣﺮض ﺧﺒﯿﺚ ﯾﻨﺸﺄ ﻓﻲ اﻟﻐﺪه( 95% ﻣﻨﮫ ﻋﺒﺎر ه ﻋﻦ ﺳﺮﻃﺎن اﻟﺒﻨﻜﺮﯾﺎس ﯾﻮﺟﺪ ﻓﻲ رأس اﻟﺒﻨﻜﺮﯾﺎس وھﻮ اﻟﻤﺴﺒﺐ اﻟﺮاﺑﻊ ﻣﻦ أﺳﺒﺎب اﻟﻮﻓﺎة ﻓﻲ اﻟﻌﺎﻟﻢ. اﻟﮭﺪف ﻣﻦ اﻟﺪراﺳﮫ ﻗﯿﺎس ﻣﻌﺪل اﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ ﻟﻤﺮﯾﺾ ﺳﺮﻃﺎن اﻟﺒﻨﻜﺮﯾﺎس ﻗﺒﻞ وﺑﻌﺪ اﻟﻌﻼج وﻓﻘﺎ ﻟﻠﻌﻤﺮ واﻟﺠﻨﺲ. اﺟﺮﯾﺖ اﻟﺪراﺳﮫ ﻓﻲ ﻣﺮﻛﺰ اﻟﺨﺮﻃﻮم ﻟﻠﻌﻼج ﺑﺎﻷﺷﻌﮫ واﻟﻄﺐ اﻟﻨﻮوي ﻓﻲ اﻟﻔﺘﺮه دﯾﺴﻤﺒﺮ 2017 اﻟﻰ ﺳﺒﺘﻤﺒﺮ 2018. ﺗﻀﻤﻦت اﻟﺪراﺳﮫ ارﺑﻌﮫ وﺛﻤﺎﻧﻮن ﻣﺮﯾﻀﺎ )50رﺟﻼ و34 اﻣﺮاه( ﺗﺘﺮاوح اﻋﻤﺎرھﻢ ﺑﯿﻦ ال20 ﺳﻨﮫ اﻟﻲ70 ﺳﻨﮫ . اﻟﻤﻌﺪل اﻟﻄﺒﯿﻌﻲ ﻟﻠﻤﺎده اﻟﺼﻔﺮاوﯾﮫ اﻟﻜﻠﯿﮫ )اﻟﻰ 1.2 ﻣﻞ/دﺳﻢ( ,اﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ اﻟﻤﺒﺎﺷﺮه)اﻟﻰ 0.25ﻣﻞ/دﺳﻢ( واﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ اﻟﻐﯿﺮ ﻣﺒﺎﺷﺮه)اﻟﻰ0.95ﻣﻞ/دﺳﻢ(. اﺟﺮﯾﺖ اﻟﺪراﺳﮫ ﻟﺜﻼث ﺳﻨﻮات ﺳﺎﺑﻘﮫ. أﻇﮭﺮت اﻟﺪراسه أن ﻣﻌﺪل اﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ اﻟﻜﻠﻲه ﻓﻲ اﻟﻤﺮﺣﻠﮫ اﻷوﻟﻰ ﻗﺒﻞ اﻟﻌﻼج وﺑﻌﺪ اﻟﺠﺮاﺣﮫ وﺑﻌﺪ اﻟﻌﻼج اﻟﻜﯿﻤﺎوي اﻻﺷﻌﺎﻋﻲ ﻛﺎن)1.48±0.49 (9.56±1.48, 2.01±0.77, andﻣﻞﻏﻢ/دﺳﻢ ﻋﻠﻰ اﻟﺘﻮاﻟﻲ. وﻣﻌﺪل اﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ اﻟﻤﺒﺎﺷﺮه ﻗﺒﻞ اﻟﻌﻼج وﺑﻌﺪ اﻟﺠﺮاﺣﮫ وﺑﻌﺪ اﻟﻌﻼج اﻟﻜﯿﻤﺎوي اﻻﺷﻌﺎﻋﻲ ﻛﺎن)(5.56±1.40,0.80±0.60, 0.45±,0.38 ﻣﻞﻏﻢ/دﺳﻢ ﻋﻠﻰ اﻟﺘﻮاﻟﻲ. ﻣﻌﺪل اﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ اﻟﻐﯿﺮ ﻣﺒﺎﺷﺮه ﻗﺒﻞ اﻟﻌﻼج وﺑﻌﺪ اﻟﺠﺮاﺣﮫ وﺑﻌﺪ اﻟﻌﻼج اﻟﻜﯿﻤﺎوي اﻻﺷﻌﺎﻋﻲ ﻛﺎن)1.02±0.37 ,3.96±1.26,,1.19±0,46(ﻣﻠﻐﻢ /دﺳﻢ ﻋﻠﻰ اﻟﺘﻮاﻟﻲ. أﻇﮭﺮت اﻟﺪراسه ان اﻟﻌﻼج اﻷﻓﻀﻞ ﻟﺨﻔﺾ ﻧﺴﺒﺔ اﻟﻤﺎده اﻟﺼﻔﺮاوﯾﮫ ﻛﺎن اﻟﻌﻼج اﻟﻜﯿﻤﺎوي اﻻﺷﻌﺎﻋﻲ ﻓﻲ اﻟﻤﺮﺣﻠﮫ اﻷوﻟﯿﮫ ﻓﻲ ﻛﻞ اﻟﺜﻼث ﺳﻨﻮات ﻟﻠﻤﺼﺎﺑﯿﻦ

ANALISIS PERSPEKTIF MAHASISWA SISTEM INFORMASI ITS TERHADAP KURIKULUM MERDEKA BELAJAR KAMPUS MERDEKA

Universities are required to be able to adapt the existing education system to the current state of the Indonesian industry. Merdeka Belajar Kampus Merdeka (MBKM) is a policy of the Minister of Education and Culture that encourages students to master various sciences as a subject before entering the world of business and industry. The purpose of the study was to find out the perspectives of the ITS Information Systems Department students regarding the implementation of the MBKM policy. This research uses a case study method with a qualitative approach. The results showed that 42.1% of students contributed to discussions/meetings/workshops related to the preparation for the implementation of MBKM, 44.7% of students stated that there was a fairly good increase in capacity, and 50% of students stated that there was an improvement in the quality of the learning process well. The main obstacle that affect the implementation of MBKM is curriculum adjustments.Perguruan tinggi dituntut untuk dapat menyesuaikan sistem pendidikan yang ada dengan keadaan industri Indonesia saat ini. Merdeka Belajar Kampus Merdeka (MBKM) adalah kebijakan Menteri Pendidikan dan Kebudayaan yang mendorong mahasiswa untuk menguasai berbagai ilmu sebagai mata pelajaran sebelum memasuki dunia usaha dan industri. Tujuan penelitian adalah untuk mengetahui pandangan mahasiswa Departemen Sistem Informasi ITS terkait implementasi kebijakan MBKM. Penelitian ini menggunakan metode studi kasus dengan pendekatan kualitatif. Hasil penelitian menunjukkan bahwa 42,1% siswa berkontribusi dalam diskusi/rapat/lokakarya terkait persiapan pelaksanaan MBKM, 44,7% siswa menyatakan terjadi peningkatan kapasitas yang cukup baik, dan 50% siswa menyatakan terjadi peningkatan. peningkatan kualitas proses pembelajaran dengan baik. Kendala utama yang mempengaruhi implementasi MBKM adalah penyesuaian kurikulum

Using participatory research methods to explore residents’ perception of workplace stressors during residency training

Introduction: The culture of the learning environment is a major determinant of behaviours developed by residency trainees. This study explores anaesthesia residents perceptions of workplace stressors which affect behaviour and work performance adversely during the training period. Methods: We used two complementary qualitative participatory research methods based on focus group discussions and semi-structured interviews, with volunteers from each year of residency. The discussions were held in complete privacy and recorded on a digital voice recorder. Report of each discussion was shared with all participants to ensure credibility through member checking. Results: The stressors identified by anaesthesia residents which impaired work performance and generated stress were related to multiple supervisors, conflicting attitudes of different supervisors, workload and unsupportive organizational culture outside the parent department. Conclusion: Tensions due to lack of tolerance for divergent practices, diverse faculty, lack of constructive feedback and respect are the major stressors identified by residents which affect behaviour adversely. This information is a valuable resource for evaluation of workplace culture as perceived by the trainees, and planning self-development programs for faculty members and medicals resident

Haemodynamic response to induction, laryngoscopy and tracheal intubation in diabetic and non-diabetic patients

OBJECTIVE: Presence of autonomic neuropathy in diabetic patients can alter the haemodynamic response to induction and tracheal intubation. This trial was conducted to compare this response in 30 non-diabetic (control group) and 30 diabetic patients including both insulin and non-insulin dependent. METHODS: A prospective, age matched case controlled study was conducted at the Aga Khan University Hospital, for one year. After pre-medication with tablet midazolam 7.5 mgs orally, patients received pethidine 0.8 mg kg(-1), thiopentone sodium 4 to 5 mg kg(-1) for induction and vecuronium 0.1 mg kg(-1) to facilitate tracheal intubation. Following manual ventilation with isoflurane 0.8% in oxygen 33% and nitrous oxide 66%, laryngoscopy and tracheal intubation was performed. Blood pressure (systolic, diastolic and mean) and heart rate responses were measured for 10 minutes. RESULTS: The systolic arterial pressure dropped by 9% after induction and rose by 16% after intubation in nondiabetics compared to 12% drop after induction and a rise of 10% after intubation in diabetics. No difference was seen in diastolic blood pressure which increased by 27% in ND compared to 22% in DB groups. The heart rate rose by 27% in non-diabetics compared to 17% in diabetics after intubation. CONCLUSION: The systolic, diastolic and mean blood pressure response was similar in the two groups. A greater fall in SAP was observed post intubation in the DB group. A significant difference was observed in the heart rate response which was less in the diabetic group

Violence against Children: A Challenge for Public Health in Pakistan

World Health Organization has identified violence against children as a growing public-health issue with a global magnitude. This paper explored violence against children as a challenge in the developing world using Pakistan as a case study. A systematic review of existing research and literature on violence against children was followed by assessing the magnitude of this challenge and its impact on policy. Most research done in Pakistan is observational, descriptive, and anecdotal with data collected through survey methods and interviews with small sample sizes. The findings suggest that the confluence of macro risk factors, such as poverty, poor legal protections, illiteracy, large family size, and unemployment, create an enabling environment for violence against children. Lack of empirical data makes it difficult to assess the magnitude of this issue. The health problems reported and the extent of human potential destroyed are unknown. Conclusion calls for focused research to examine the prevalence, potential interventions, and policies in Pakistan

Major causes of negative and positive impacts on mental health during lock-down due to COVID-19 pandemic.

Introduction: Soon after pandemic of Covid-19; Lockdown across Pakistan led to wide spectrum of problems that includes unemployment, closure of schools & Colleges, shattered economy. Least in focused remained the mental health of the people affected due to different reasons. Objective: To determine the major causes of negative and positive impact on mental health during Covid-19 pandemic. of lock-down on mental health. Methodology: This cross-sectional study was conducted at Dow University of Health Sciences during April-May 2020. Using structured online questionnaire, 362 participants took part in the study. The selection criteria were age above 14 years and resident of Karachi in an area under lock down due to pandemic of COVID-19. Results: Overall, 95.3% participants agreed that lock down is most appropriate strategy to counter the spread of Covid-19. Stress consequent to lock down was attributed as concern for their loved ones and relative by 47% of the participants, social distancing and restrictions by 44.2% and fall in economic situation by 43.4%. When asked for the probable solutions to these problems; provision of grocery items at door steps was stated by 53%, ease on taxes and/or bills by 52.5%; while 51.7% were of the opinion that people should be keep informed about development regarding Covid-19.  The positive impacts on mental health were due to having more time for family (63.5%) and break from busy life (47.5%). Conclusion: Different causes of negative and positive impacts of lock-down were acknowledged with people experiencing almost similar causes of stress and anxiety. Almost all of the problems are solvable if people’s recommendations are taken into account.   Keywords: COVID-19 19, pandemic, Mental health

Pre-anaesthetic assessment of intracranial pressure using optic nerve sheath diameter in patients scheduled for elective tumour craniotomy

Background: The objective of study was to determine the pre-anaesthetic status of intracranial pressure (ICP), using ultrasonographic measurement of optic nerve sheath diameter (ONSD) inpatient scheduled for elective tumour craniotomy. The secondary objective was to compare the diagnostic accuracy of ONSD guided rise in ICP with clinical and radiographic parameters. This is prospective observational study, conducted at single neurosurgical theatre of The Aga Khan University over a period of one year.Methods: After getting ethical approval and informed consent patient fulfilling inclusion criteria and planned for elective tumour craniotomy were enrolled in study. The clinical and radiographic signs predicting the status of ICP were recorded. The ultrasonographic measurement of ONSD was done using liner array probe. Value more than 5 mm was considered as abnormal.Results: Total 26 cases were enrolled. Seventy percent patients showed rise in ICP based on clinical parameters, while 65% diagnosed to have raised ICP on the basis of radiographic findings. The ultrasonographic measurement of ONSD predicted this rise in 61% of cases. The diagnostic accuracy of ONSD in detecting raised ICP in comparison to clinical and radiographic evidence was 87.5% respectively.Conclusions: The ultrasonographic-guided ONSD was used successfully for predicting the status of ICP in pre-induction phase of anaesthesia. It also showed good correlation in diagnosing rise in ICP as compared to clinical and radiographic parameters, which indicates that test can be used reliably in preoperative period for patients planned for tumour craniotomy

Application of Trustworthy IoT Technology in Fast Communities: Smart Access Control

As a response to the current development status and existing problems in the ubiquitous and trustworthy aspect of the Internet of Things (IoT) in the construction of smart community systems in Bangladesh, this paper presents the trustworthy technology strategy of the ubiquitous and trustworthy IoT intelligent system. Additionally, it provides a list of the demonstration application practice of trustworthy IoT technology at the level of smart communities through three different application scenario project construction cases. These cases include smart access control, smart buildings' construction, and smart parks' construction.&nbsp

A Qualitative Study: Why Prolonged Stay in the Recovery Room?

There are a number of factors that prolong patients’ stay in the recovery room (RR), which are related to system or clinical issues. However, less has been discovered from the RR nurses about reasons for prolonged patient stay and recommendations to solve this issue. Prolonged patient stay of more than 2 hours in the RR interferes with the primary role of the RR nurse, which is to provide care to immediate postanaesthesia patients. Consequently, this could affect the operating room schedule, normal flow of patients to the RR and discharge to the nursing units