Urinary retention in unilateral total knee arthroplasty: Comparison between continuous epidural analgesia and single-shot femoral nerve block

Objective: To compare the frequency of urinary retention and requirement of bladder catheterization in patients undergoing total knee arthroplasty while receiving either continuous epidural analgesia or single-shot femoral nerve block.Study design: Randomized controlled study.Place and duration of study: Operating Rooms of Aga Khan University Hospital, Karachi, from January 2014 to January 2015.Methodology: Patients were randomized in two groups of 30 each, i.e. epidural group (group E) or femoral nerve block group (group F). Baseline parameters were recorded. Postoperatively, patients were followed for upto 24 hours to collect the data regarding urinary retention. Final outcome was taken at 24 hours postoperatively. Data was analyzed to compare the frequency of urinary retention between the two groups.Results: The average age of the patients was 59.58 ±5.85 years. There were 28 (46.7%) male and 32 (53.3%) female patients. Frequency of urinary retention was significantly high in Group E than Group F (46.7% vs. 6.7%; p=0.0005).Conclusion: Single-shot femoral nerve block offers a more favorable profile in terms of postoperative urinary retention when compared to continuous epidural analgesia

Anaesthetic Management in a Child with Goldenhar Syndrome

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and neck, which suggested possibility of difficult laryngoscopy and intubation. He had no vertebral anomalies or cardiac disease. A difficult airway continues to be a major cause of anaesthesia-related morbidity and mortality; and maintaining spontaneous breathing remains a vital technique in its management. Lack of anaesthesia-related complications with supraglottic devices encouraged us to present the advantage of utilising a laryngeal mask airway (LMA) under anaesthesia for successful management of predicted difficult airway

Rare presentation of posterior reversible encephalopathy syndrome (PRES) and neurogenic stunned myocardium in a patient after emergency cesarean section

Posterior Reversible Encephalopathy Syndrome (PRES) is clinically characterized by seizures, lethargy, nausea and visual impairment. These findings are thought to be due to vasogenic edema, predominantly in the posterior cerebral hemispheres and are reversible with appropriate management. Neurogenicstunned myocardium is a syndrome of reversible left ventricular dysfunction, associated with excessive sympathetic discharge states like pheochromocytoma, high-grade subarachnoid hemorrhage (SAH), status epilepticus and significant emotional stress. Here, we report a case of PRES and Neurogenic-stunned myocardium occurring simultaneously in a 25 year old primigravida at 34 weeks of gestation with twin pregnancy who presented to the emergency department with eclampsia and fetal distress. A careful review of literature did not return any report where these two conditions co-existed in an obstetric patient

Artificial neural network (ANN) enabled internet of things (IoT) architecture for music therapy

Alternative medicine techniques such as music therapy have been a recent interest of medical practitioners and researchers. Significant clinical evidence suggests that music has a positive influence over pain, stress and anxiety for the patients of cancer, pre and post surgery, insomnia, child birth, end of life care, etc. Similarly, the technologies of Internet of Things (IoT), Body Area Networks (BAN) and Artificial Neural Networks (ANN) have been playing a vital role to improve the health and safety of the population through offering continuous remote monitoring facilities and immediate medical response. In this article, we propose a novel ANN enabled IoT architecture to integrate music therapy with BAN and ANN for providing immediate assistance to patients by automating the process of music therapy. The proposed architecture comprises of monitoring the body parameters of patients using BAN, categorizing the disease using ANN and playing music of the most appropriate type over the patient’s handheld device, when required. In addition, the ANN will also exploit Music Analytics such as the type and duration of music played and its impact over patient’s body parameters to iteratively improve the process of automated music therapy. We detail development of a prototype Android app which builds a playlist and plays music according to the emotional state of the user, in real time. Data for pulse rate, blood pressure and breath rate has been generated using Node-Red, and ANN has been created using Google Colaboratory (Colab). MQTT broker has been used to send generated data to Android device. The ANN uses binary and categorical cross-entropy loss functions, Adam optimiser and ReLU activation function to predict the mood of patient and suggest the most appropriate type of music

Frequency of immediate neonatal complications (hypoglycemia and neonatal jaundice) in late preterm and term neonates

Background: Evidence suggests that neonates born at 34-36 weeks should not be considered full-term neonates, given the magnitude of morbidities they experience compared with term infants. Neonates born at 34 to 36 weeks are at increased risk for early illness such as hypoglycemia and hyperbilirubinemia compared to term infants.Objective: This study\u27s objective was to determine the frequency of immediate neonatal complications (hypoglycemia and neonatal jaundice) in late preterm and term neonates.Subjects and methods: A serial descriptive case study was conducted at the private tertiary care hospital. Random samplings were taken, and the sample size was calculated on Epi Info software (Centers for Disease Control and Prevention, Atlanta, GA). All the eligible samples were taken into confidence following approval by the College of Physicians and Surgeons Pakistan\u27s institutional review board. A structured questionnaire was used in which demographic information of the patient was collected, and all neonates were closely observed for early targeted morbidities (hypoglycemia, hyperbilirubinemia).Results: A total of 215 neonates were born during the study period, of whom 108 (50.2%) were term babies and 107 (49.8%) late preterm babies. There were 122 (56.7%) male infants and 93 (43.3%) female infants. Jaundice was observed in 6.5% (n=7) of term neonates and 22.4% (n=24) of late preterm neonates (p\u3c0.0). Similarly, hypoglycemia was observed in only 4.6% (n=5) of term neonates and 15.9% (n=17) of late preterm neonates (p\u3c0.01).Conclusion: There is a significant association between gestational age and immediate neonatal complications of jaundice and hypoglycemia. Compared with term neonates, late preterm neonates are at a higher risk of neonatal jaundice and hypoglycemia. Gender and mode of delivery did not correlate to complications rate

Incidence and Impact of Baseline Electrolyte Abnormalities in Patients Admitted with Chemotherapy Induced Febrile Neutropenia

BACKGROUND: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature

Trend of anaesthesia research from SAARC countries. A decade’s bibliographic analysis of indexed journals of Pakistan

Objective: To evaluate the contribution of member countries of the South Asian Association for Regional Cooperation towards anaesthesia research. Method: The retrospective study was conducted at Department of Anaesthesia, Aga Khan University from January 2018 to June 2018 and comprised literature search to identify published articles related to anaesthesia, critical care and pain research contributed by authors from member countries of the South Asian Association for Regional Cooperation region and published in Pakistani indexed journals between January 2007 and December 2016. Data was analysed using SPSS 19. Results: Of the 183 articles extracted, 179(97.8%) were contributed from Pakistan and 4(2.2%) from India. Overall, there were 50(27%) randomised controlled trials, 38((20%) case reports and 36(19.5%) observational studies. There was 1(0.5%) collaborative study involving researchers from two member countries. Conclusions: The contribution to anaesthesia, critical care and pain research was not ideal from the member countries of the South Asian Association for Regional Cooperation. Key Words: South Asia, Research, Anaesthesiology, Pakistan

Comparison of COVID-19 infection in operating room staff during two COVID-19 waves using different preventive strategies in a tertiary care hospital in Pakistan

Objective: To assess if limiting elective surgeries during specific pandemic phases significantly affected COVID-19 incidence among operating room (OR) staff.Study design: Retrospective cohort study. Place and Duration of the Study: Operation Theatre (OT), The Aga Khan University Hospital, Karachi, Pakistan, from May 2020 to 2021.Methodology: This retrospective study compared two pandemic waves: Wave 1, during which elective surgeries were restricted (REL), and Wave 2, during which elective surgeries were continued routinely (EL). Exposure levels were measured based on OR activity. Incidence rates were calculated per 100 OR staff, per 100 ORs, and per 100 surgeries for both Groups.Results: No statistically significant difference emerged in COVID-19 incidence among OR staff between REL (13.8 per 100 staff) and EL (14.4 per 100 staff) Groups (p = 0.825). However, the EL Group exhibited a significantly lower incidence risk per running OR (5.6 per 100 ORs vs. REL\u27s 12 per 100 ORs, p \u3c0.001). Additionally, the EL Group showed a lower incidence per 100 surgeries (1.5 vs. REL\u27s 2.9, p \u3c0.002).Conclusion: Restricting elective surgeries during the early pandemic phase did not significantly reduce COVID-19 incidence among OR staff. Infections were primarily linked to interactions with colleagues and the community, emphasising the need for a balanced pandemic response considering patient care and the consequences of surgery restrictions

Utility of Opportunistic Infections, Joints’ Involvement and Accuracy of Various Screening Tests to Diagnose Rheumatoid Arthritis Patients

Background and Objectives: Rheumatoid Arthritis (RA) is an auto-immune disease in which the body mistakenly considers some parts of its own system as pathogens and attacks them. Prevalence is approximately 0.75% in India. About 40% of the diseased become work disabled within 5 years from the onset of symptoms. The objective of this paper is to assess the sign/symptoms, joints’ involvement, difficulties in daily activities and screening accuracy of serology tests of clinically suspected RA patients. Material and Methods: A cross-sectional cohort study design was conducted on two hundred ninety clinically suspected subjects who were referred by different OPDs of hospitals for screening. The profiles of study subjects were carried through a semi-structured, pre-tested schedule method. About 2 mL of blood samples were collected in a plain vial from each patient and tested for diagnostic tests RF, CRP and AntiCCP by using RF-Latex, CRP Latex and ELISA method, respectively, by the laboratory persons. Results: Joint pain shows to be a leading problem in RA as compared to other signs and symptoms. The majority of the study subjects suffer from knee problems (62%). Approximately equal numbers of RA-positive cases were screened by RF and AntiCCP tests. The CRP test screened about one-third of cases. CRP+ AntiCCP, RF+ AntiCCP and RF + CRP all have good sensitivity, and RF+ AntiCCP + CRP has a very high sensitivity for diagnosing RA. Conclusions: This study found that a substantiation of a major proportion of clinically suspected RA patients were suffering from knee pain. Predication of AntiCCP increased the possibility for the diagnosis of RA. However, RF was also moderately related to the diagnosis of RA, and the combination of both tests was more valuable