Trends of Safety Performance in Construction and Civil Engineering Projects in Pakistan

The major construction and  civil engineering projects are sponsored by public sector in Pakistan. The users contracting and bidding procedures do not offer a significant space to the aspect of safety performance in construction and engineering projects. The prevalent measures of safety are after- the- fact measures - that means safety is given importance once casualties have actually been occurred. Such practices or measures are termed as inductive, reactive, trailing, down stream or lagging indicators. This is so because they are based upon retrospective data. As the country has undergone through massive development in engineering, construction and infrastructure sectors, safety aspect has been transformed from lagging indicators to leading indicator. Companies and organizations have started focusing on good safety performance under safety climate and culture. In this paper, a sincere research effort has been made to assess and analyze the health and safety performance of various constructions firms as well as overall construction engineering industry of Pakistan. In order to achieve this objective, various structured interviews and survey questionnaire were designed. The data collected from industry specific respondents has been analyzed using statpro   software. The salient findings of this study are as follows; the majority of the casualties are Fall of Individuals from Heights, Electric Shocks, Caught in between the Plants, Machinery and Confined Spaces and Struck by an Object or Machinery. Similarly there is no positive mindset from top down, non application of safety laws, lack of safety management plan, lack of safety and health of workplace, inadequate arrangement of first aid, lack of personnel’s protective equipment and absence of accident reporting mechanism. The major recommendations of the study are as follows; At industry level, safety rules should be  as regulated and re-defined, documented and enforced. Moreover  provision of personnel protective equipment, training of entire organization, safety management plan under safety officer, adequate first aid at sites, efficient reporting mechanism and safety awareness of employees and workforce will also improve the existing situation. It is also recommended that more research should be carried out in order to evolve a comprehensive safety management policies. Keywords: Construction, civil engineering, Pakistan, safet

Role of Oxidative Stress in various stages of Psoriasis

Background: Psoriasis is a chronic inflammatory, immune mediated, provocative and challenging skin condition. It is a non-contagious but debilitating disease and a leading cause of socioeconomic burden on the health system. Objective: To evaluate the role of antioxidant levels, lipid peroxidation status and lipid profile in the etiology and degree of severity of psoriatic illness among psoriasis patients presenting in Dermatology department. Study Design: This study was carried out as a retrospective case control study. Place and duration of Study: It was carried out by the Department of Biochemistry, Basic Medical Sciences Institute (BMSI) in collaboration with Departmnt of Biochemistry, Khyber Medical College, Peshawar and Department of Skin and Venereal disease, Jinnah Post Graduate Medical Centre (JPMC) Karachi. Material and Methods: One hundred and twenty cases (n=130) of already diagnosed psoriasis patients were randommely and fifty healthy matched controls (n=50) of the same age and gender were included from the general population for comparison. Lipid profile including serum total cholesterol, TG, HDL-c and LDL-c levels were measured by enzyme colorimetric analysis on Micro Lab 300 (Merck & Germany). Antioxidant status SOD and lipid peroxidation status MDA were measured by ELISA technique. Statistical analysis was performed using SPSS software Version 16. In this analysis, a “p” value of less than 0.05 was considered to be significant. Results: The study showed significantly elevated levels of MDA, serum TG, total cholesterol and LDL-c levels in psoriatic patients in comparison with controls, whereas SOD levels and HDL-c levels were found to be significantly lower in psoriatic patients as compared to normal healthy matched controls. Conclusion: The findings of this study support the hypothesis that an imbalance in oxidant-antioxidant system may play a role in the etiology of psoriasis and the degree of severity of its presentation. The study also concluded that dyslipidemia was an observed risk factor for the development of cardiovascular diseases in psoriatic patients.

An evaluation of prescribing trends of antibiotics used in neonatal sepsis in a tertiary care hospital of Lahore, Pakistan

To find out commonly used antibiotic combinations in the management of neonatal sepsis, prevalence of early onset sepsis (EOS) and late onset sepsis (LOS) in a public sector tertiary care hospital of Lahore. Neonatal sepsis is a clinical syndrome of bacteremia with systemic signs and symptoms of infection in the first 4 weeks of life. Neonatal sepsis is an important and common cause of morbidity and mortality in full term as well as preterm neonates. A retrospective observational study was conducted at the Neonatal Intensive Care Unit of a tertiary care hospital of Lahore from September 2013 to November 2013. 50 cases of neonatal sepsis suspected on clinical grounds were included in this study. LOS was more prevalent (60%) as compared to EOS (40%). Three combinations of antibiotics were frequently being used. Combination of Amikacin, Ampicillin & Ceftazidime was the most frequently used (48%) followed by combination of Amikacin, Ampicillin and Cefotaxime (30%), and combination of Vancomycin with Meropenam (22%). High potency antibiotics were being used frequently with less reliance on performance of culture tests for definitive therapy selection

Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Infarct

Objective: To know outcome of Decompressive hemicraniectomy in patients presented with malignant middle cerebral artery (MCA) infarct.Materials and Methods: This prospective study was conducted in Neurosurgery department of Lady Reading Hospital, from December 2011 toNovember 2014. A total number of 10 patients were included in the study. All patients were admitted in neurosurgery ward through emergency, were subjected to detail history and exami-nation. After preoperative workup patients were operated in emergency. We analyzed gender, age, Glasgow Coma Scale (GCS) on admission, pre-surgical evaluation, clinical status on pre-surgical exam, and Glasgow Outcome Scale (GOS), immediate postoperatively, at 3 months and 6 months after discharge. We assessed out-come by Glasgow outcome score and modified Rankin scale (mRS). Data was analyzed by SPSS version 17.Results: Of the total 10 patients, 8 (80%) were male and 2 (20%) were female. Age ranged from 40 to 75 years (mean 62.7 ± 11.19 years). On admission, the mean GCS was 10 (Ranged from 8 to 12). Time between onset of symptoms and decompressive craniectomy was less than 24 hours in 2 (20%), 24-48 hours in 3 (30%), 48 – 72 hours in 1 (10%) and 72-96 hours in 4 cases (40%). Early surgery (≤ 48 hours) was carried out in 5 (50%) cases and late surgery (≥ 48 hours) in other 5 (50%) patients. Length of stay in the hospital was 7 to 16 (mean 11.5) days. Surgery improved significantly the GCS of patients comparing the immediate preoperative scores (6 to 10) and immediate post-operative GCS 5 to 15 (mean 10).Conclusion: Decompressive hemicraniectomy increases the probability of survival without increasing the number of very severely disabled survivors. Still, the decision to perform surgery should be made on an individual basis in every patient

Frequency of Post-Operative Cerebrospinal Fluid Leak after Infratentorial Surgery

Introduction: The infratentorial space (posterior fossa) is the region of the brain below the tentorium cerebelli and contains structures like of the midbrain, pons, medulla oblongata and the cerebellum. Cerebellopontine angle (CPA); an extra-axial region between the cerebellar hemisphere and the pons and is the site of exit for the cranial nerves 5th to 12th is also located infratentorialy. Primary brain tumors are commonly located in the posterior cranial fossa in children and approximately 54 – 70% of all intracranial tumors in children are infratentorial. Eighty-eight percent of all tumors fall into one of the 4 categories, astrocytoma, medulloblastoma, ependymoma and craniopharyngioma.Objective: The objective of the study is to determine the frequency of post-operative Cerebro spinal fluid (CSF) leak after infratentorial surgery.Material and Methods: This study was conducted at Department of Neurosurgery, PGMI Lady Reading Hospital, Peshawar. Duration of the study was six months and the study design was descriptive case series in which a total of 132 patients were observed by using 21.4% CSF leak11, 95% confidence level and 7% margin of error with the help of WHO software for sample size determination. More over consecutive non probability sampling technique was used for sample collection.Results: In this study 67% patients were in age range < 20 years, 20% patients were in age range 21 – 35 years, 10% patients were in age range 36 – 50 years while 3% patients were 51 – 60`years. Mean age was 22 years with a standard deviation of ±5.71. Fifty three patients were male and 47% patients were female. More over 7% patients had CSF leak.Conclusion: Our study concludes that the incidence of CSF leak after infratentorial surgery was 7% which give us an insight into our complication rate so that we should modify our surgical technique such as we can use fibrin glue or artificial dura in case our rate is hig

Risks of Surgery for Myelomeningocele in Children

Objective: To know about complications in Myelomeningocele (MMC) surgery.Material and Methods: Fifty five children underwent surgical repair of MMCs and represent our experience about complication in surgery for MMC. Retrospective observational study carried out in Neurosurgery ward, Lady reading hospital Peshawar, from 2013 to 2015. Patients suffering from MMC were admitted. The clinical, radiological and laboratory finding of patients were documented on a designed proforma. Moreover ventri-culoperitonial shunting (V/P) was performed for children who had or developed hydrocephalus. Eliptical incision in vertical plane was given in 45 cases and horizontal incision in 6 cases. Plastic surgery unit consulted for very large MMC in rest of 4 cases and transposition of gluteus maximus musculocutaneous unit performed. All patients with MMC of both gender and age range from 1 month to 10 years who were willing and fit for surgery were included in this study and all those who were not willing and fit for surgery were excluded. The study was approved by Institute of Research in Ethics and Biomedicine (IREB).This study will help to make recommen-dations.Results: Patients in this study were in the age range of 1 month to 10 years. Mean age was 1.8 years. Thirty seven patients (67%) were Paraparetic (MRC grade from 1 to 4) and 18 patients (32.72%) were completely paraplegic. Seventeen patients (30.9%) had ruptured MMC at presentation and underwent surgery in emergency. Fifteen patients (27.27%) had V/P shunting before surgery for MMC and 11 patients (20%) developed hydro-cephalus after excision and repair of MMC and V/P shunting carried out. Seven patients (12.72%) developed wound dehiscence and CSF leak and subjected to redo surgery. Three patients (5.45%) had wound infection followed by meningitis and two patients (3.63%) died after surgery.Conclusion: From this study we concluded that wound dehiscence and CSF leak are the most common complication after surgery for MMC and can be prevented by tensionless closure of the wound. In MMC patients with overt hydrocephalus prior to repair and excision of MMC V/P shunting should be performed. If patient develop hydrocephalus after surgery then immediate diversion of CSF should be carried out

Epidemiology and outcomes of out-of-hospital cardiac arrest in a developing country-a multicenter cohort study.

Background Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country. Methods We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a structured questionnaire. All patients ≥18 years of age, presenting with OHCA of cardiac origin, were included. Patients with do-not-resuscitate status or referred from other hospitals were excluded. Our primary outcome was survival of OHCA patients at the end of ED stay. Results During the three month period, data was obtained from 310 OHCA patients. The overall survival to ED discharge was 1.6 % which decreased to 0 % at 2-months after discharge. More than half (58.3 %) of these OHCA patients were brought to the hospital in a non-EMS (emergency medical service) vehicle i.e. public or private transportation. Patients utilizing non-EMS transportation reached the hospital earlier with a median time of 23 min compared to patients utilizing any type of ambulances which had a delay of 7 min hospital reaching time (median time 30 min). However, patients utilizing ambulances with life-support facilities, as compared to all other types of pre-hospital transportation, had the shortest time to first life-support intervention (15 min). Most of the patients (92.9 %) had a witnessed cardiac arrest out of which only a small percentage (2.3 %) received bystander CPR (cardio pulmonary resuscitation). Median time from arrest to receiving first CPR was 20 min. Only 1 % of patients were found to have a shockable rhythm on first assessment. Conclusion This study showed that the overall survival of OHCA is null in this population. Lack of bystander CPR and weaker emergency medical services (EMS) leading to a delay in receiving life-support interventions were some of the important observations. Poor survival emphasizes the need to standardize EMS systems, initiate public awareness programs and strengthen links in the chain of survival. Electronic supplementary material The online version of this article (doi:10.1186/s12873-016-0093-2) contains supplementary material, which is available to authorized users. Keywords: Out-of-hospital cardiac arrest, Survival, Chain-of-surviva

Role of Emergency Decompressive Craniectomy in Patients of Traumatic Brain Injury

Objective: To study the role of emergency decompressive craniectomy in patients of traumatic brain injury. Methodology: This observational study was performed in the department of Neurosurgery, MTI, LRH, Peshawar, from 1st February, 2016 to 31st January, 2017. A total of 28 patients of traumatic brain injury, who underwent emergency decompressive craniectomy within 24 hours of their admission were included in the study after applying the inclusion and exclusion criteria. A questionnaire was used to document the data. Data analysis was performed with the help of SPSS version 20. Results: The total no. of patients were 28, out of which 21 (75%) were male and 7 (25%) were female. The mean age of all the patients was 31 ± 19.84, with a range of 10 – 80 years. The preoperative diagnosis was acute subdural hematoma (ASDH) in 15 (53.6%), large contusion in 6 (21.4%), post-traumatic intracerebral bleed in 3 (10.7%), and ASDH plus small multiple contusions in 4 (14.3%) patients. Dura was left open in all the cases. The preoperative mean GCS was 8.39 ± 3.01. A total of 8 (28.6%) patients expired during the first postoperative week. The mean GCS of the remaining 20 patients at discharge was 10.55 ± 4.05. At 3 months follow-up, 7 (25%) patients were in vegetative state (GOS2), 3 (10.7%) were having major disability (GOS3) and 10 (35.7%) had good (GOS 4 and 5) clinical outcome. Conclusion: The decompressive craniectomy can be very helpful in patients of traumatic brain injury because it can lower the ICP and improve the survival rate in TBI patients. Abbreviations: GCS (Glasgow Coma Scale), GOS (Glasgow Outcome Scale), ICP (Intracranial Pressure)

Prognostic model to predict postoperative acute kidney injury in patients undergoing major gastrointestinal surgery based on a national prospective observational cohort study.

Background: Acute illness, existing co-morbidities and surgical stress response can all contribute to postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery. The aim of this study was prospectively to develop a pragmatic prognostic model to stratify patients according to risk of developing AKI after major gastrointestinal surgery. Methods: This prospective multicentre cohort study included consecutive adults undergoing elective or emergency gastrointestinal resection, liver resection or stoma reversal in 2-week blocks over a continuous 3-month period. The primary outcome was the rate of AKI within 7 days of surgery. Bootstrap stability was used to select clinically plausible risk factors into the model. Internal model validation was carried out by bootstrap validation. Results: A total of 4544 patients were included across 173 centres in the UK and Ireland. The overall rate of AKI was 14·2 per cent (646 of 4544) and the 30-day mortality rate was 1·8 per cent (84 of 4544). Stage 1 AKI was significantly associated with 30-day mortality (unadjusted odds ratio 7·61, 95 per cent c.i. 4·49 to 12·90; P < 0·001), with increasing odds of death with each AKI stage. Six variables were selected for inclusion in the prognostic model: age, sex, ASA grade, preoperative estimated glomerular filtration rate, planned open surgery and preoperative use of either an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. Internal validation demonstrated good model discrimination (c-statistic 0·65). Discussion: Following major gastrointestinal surgery, AKI occurred in one in seven patients. This preoperative prognostic model identified patients at high risk of postoperative AKI. Validation in an independent data set is required to ensure generalizability