Negative pressure pulmonary oedema: a rare complication following general anaesthesia

An important cause of pulmonary oedema is Negative Pressure Pulmonary Oedema (NPPE) which characteristically develops soon after extubation from an endo-tracheal intubation. In this case report we identified a case of previously healthy man who was intubated for General Anaesthesia for extraction of impacted molar tooth. Soon after extubation he developed severe respiratory distress. Immediate diagnosis of NPPE secondary to post extubation laryngospasm was made. He was promptly treated with 100 percent oxygen via CPAP (continuous positive airway pressure) mask and within an hour he markedly improved and subsequently became asymptomatic. NPPE is an important cause of morbidity and need for ICU admission in a healthy individual

Pulmonary hyalinising granuloma: a rare pulmonary disorder

Pulmonary hyalinising granulomas are rare, noninfectious fibrosclerosing lesions of the lung which can mimic metastatic disease. It was first described in literature by Engleman et al in the year 1977. Its etiology is unknown but they may be caused by an exaggerated immune response. The patient typically presents with cough, chest pain. dyspnoea or haemoptysis in association with multiple bilateral parenchymal nodules. We report the case of a 20 years old male who presented with a 12-month history of worsening dry cough. His plain chest radiograph and subsequent CT scan revealed bilateral pulmonary nodules. A CT guided biopsy of the pulmonary lesions was consistent with Pulmonary Hyalinising Granuloma [PHG]

Assessing two spirometric criteria of pre-bronchodilator and post-bronchodilator FEV1/FVC ratio in detecting air flow obstruction

OBJECTIVES: To assess the Pre-bronchodilator criteria and the Post-bronchodilator criteria of FEV1/FVC ratio in diagnosing Airflow obstruction. METHODS: An observational study was conducted from 1988 to 2006 at the Aga Khan University Hospital Patients referred to the pulmonary function test laboratory for spirometry with bronchodilator reversibility at the hospital during the above said period were enrolled. Forced spirometry was performed according to ATS guidelines. All patients who had pre-bronchodilator criteria of airflow obstruction were analyzed and compared with the post bronchodilator criteria. RESULTS: A total of 4222 individuals underwent spirometry out of which 4072 individuals were studied. Using the pre bronchodilator criteria, 1375 (34%) patients had airflow obstruction. Applying the post bronchodilator criteria on the same patients, 1098 (27%) had evidence of airway obstruction. Out of these 1375 patients who had airflow obstruction by using pre-bronchodilator criteria, 277 (20%) patients had no airflow obstruction by using the post bronchodilator criteria. Out of these 277 patients, 52% had significant airways reversibility as evidenced by \u3e12% increase in their FEV1 pre and post bronchodilator. CONCLUSION: Pre bronchodilator criteria for detection of airflow obstruction overestimate the diagnosis of airflow obstruction and by using post bronchodilator criteria for airway obstruction on spirometry, decreases this over diagnosis of the conditio

Assessment of Knowledge of Cardiopulmonary Resuscitation among Pharmacy Students of Mirpur, Azad Jammu & Kashmir

Introduction: Cardiopulmonary resuscitation (CPR) is the most important lifesaving technique in several emergency situations such as cardiac arrest. In future, being part of health care professionals, pharmacy students are deemed to possess basic skills and expertise which are required to perform CPR. Objective: To access the knowledge of cardiopulmonary among pharmacy students of Mirpur Azad Jammu & Kashmir. Methods: It was a questionnaire-based, descriptive cross-sectional study, conducted among 4th and 5th year students of two Pharmacy institutes of Mirpur AJ&K from November 2018 to January 2019. A pre-tested questionnaire from previous study was used to collect data. It comprised of 13 dichotomous questions with “Yes/No” options, regarding knowledge of CPR. Descriptive statistics was used to unfold the demographic characteristics. Inferential statistics (Kruskal Wallis and Man Whitney) tests were used for evaluating difference between dependent continuous variables and independent variables and Chi-square was applied to determine difference between grouped variables. P-value of less than 0.05 is considered significant. The data was analyzed using SPSS version 20. Result: Overall, 131 out of 150(response rate= 92%) students participated in current study. Gender distribution among the participants was almost equal with 66 males (50.4%) males and 65 (49.6%) females took part in current study. Participants of the age group 21-23 years (n=88, 67.2%) were dominant. Only few students (n=23, 17.6%) reported to have taken training in CPR previously. Eighty-eight (66.7%) had average knowledge of CPR. No significant differences among male and female, 4th and 5th year students of both the institutes were found. Conclusion: The study revealed that knowledge level of CPR is adequate in most of the students of pharmacy. However, further improvements are required to perform CPR in an efficient manner. Thus, training in CPR should be mandatory in the pharmacy curriculum

Tobacco Cessation Treatment: Knowledge, Attitude and Practices of Physician in Karachi, Pakistan: A Cross Sectional Study

Introduction: Tobacco smoking is a public health problem leading to substantial morbidity and mortality with around 80% of the deaths occurring in developing countries. Physician intervention has been shown to increase cessation rates. The study aims to assess knowledge, attitudes and practices of physicians in tobacco cessation treatment in Karachi Pakistan. Methods: A descriptive cross sectional study was carried out between June to December 2013. All practicing physicians from Karachi were recruited. Survey questionnaire was distributed among randomly selected physicians after obtaining their consent. The study was approved by ethics review committee of The Aga Khan University Hospital. Results: A total of 189 physicians were approached and 163 consented to take part. Around 58.3% of the physicians reported high levels of confidence for discussing tobacco cessation, 40.5% of them developing tobacco cessation plan and only 26.4% were confident in recommending pharmacological treatment. Regarding knowledge of pharmacotherapy on a five-point scale majority (45.4%) rated themselves four or five. However, very Low rates of correct answers were noted for objective knowledge assessment (5.5%). Most physicians (78.5%) reported that they identify every patient’s tobacco use status. Most physicians (61.4%) reported always or almost always advising tobacco users to quit. Conclusion: Majority of the physicians believed in the importance of tobacco cessation treatment and understand their primary role. Most feel they have adequate knowledge regarding smoking cessation but lacked the skills required to implement tobacco cessation treatment strategies. Effective training is required to enhance physicians’ capacity to intervene in the field of tobacco cessation