Smear Layer Removal Efficacy of EDTA and Citric Acid in Endodontics

Introduction: Smear layer is formed by organic and inorganic components generated during endodontic instrumentation. Smear layer has many deleterious effects on the success of root canal treatment. So removal of smear layer is advocated. Sodium Hypochlorite (NaOCl) and a chelating agent like Ethylene Diamine Tetra Acetic Acid (EDTA) or Citric Acid is commonly used alternatively to remove smear layer. But the alternate use increase dentine erosion in root canal surface. This in vitro study attempts to compare the smear layer removal efficacy of 15% EDTA & 10% Citric Acid as a final rinsing solution. Materials and Methods: Forty extracted, single rooted and single canal human anterior tooth were used. Endodontic preparation of the root canal was done after grouping and access cavity preparation. Final irrigation was given with 15% EDTA & 10% Citric Acid to the test groups and distilled water control groups and kept for one minute. Photomicrograph of the root canal surface at 3000X magnification at coronal, middle and apical regions were taken with the help of SEM and scoring for smear layer removal was done. Data was analyzed using SPSS version 16 and were compared with the control samples and subjected to statistical analysis by one way ANOVA and Bonferroni multiple comparison tests at 5% level of significance. Result: The test solutions removed smear layer but none could be removed completely from all of the three root canal regions. 10% Citric Acid removed smear layer better from the coronal and middle region but in apical region 15% EDTA produced a better result. The difference of smear layer removal efficacy of 15% EDTA & 10% Citric Acid with the Control solution was found statistically significant (p<0.001) but in between 15% EDTA & 10% Citric Acid it was not significant in all three root canal regions. Conclusion: Regarding the smear layer removal efficacy of 10% Citric Acid was found better as a final rinse solution

Culture-Based Identification of Causative Organisms in Ascitic Fluids of Patients with Spontaneous Bacterial Peritonitis Secondary to Decompensated Liver Disease and their Sensitivities to Ceftriaxone as an Empiric Therapy

OBJECTIVES To identify the pathogens in the ascitic fluids of patients with spontaneous bacterial peritonitis and then to determine their sensitivity pattern to ceftriaxone. METHODOLOGY The cross-sectional study was conducted at the Medical Unit-A, Department of Medicine, Hayatabad Medical Complex, Peshawar, from November 2021 to April 2022. Before ceftriaxone treatment was started, a minimum of 10 ml of ascitic fluid was introduced into a blood culture vial. Only patients with a positive culture were registered, and their information was gathered using a proforma. For statistical analysis, SPSS version 23 was used. RESULTSA total of 96 patients were enrolled in our study. There were 62 (59.52%) male and 34 (40.48%) female patients. Based on the isolation and identification of bacteria, the most prevalent bacteria isolated was Escherichia coli in 36 (37.5%) patients, followed by Acinetobacter Spp in 13 (13.54%) patients, Streptococcus spp in 14 (14.58%), Enterococcus spp in 11 (11.45%), Staphylococcus aureus in 9 (9.39%), MRSA in 8(8.33%) and K. Pneumonia in  5(5.21%) patients. The overall sensitivity of ceftriaxone to gram-positive bacteria was observed in 12 (42.85%) isolates, whereas the overall sensitivity of ceftriaxone to gram-negative bacteria was observed in 25 (36.76%) isolates. (p=0.091) (Figure 6). CONCLUSION Our study concludes that gram-negative bacteria were more prevalent than gram-positive bacteria in ascitic fluids of patients with spontaneous bacterial peritonitis. The most common isolated pathogen was E.coli. Gram-negative was more resistant to ceftriaxone as compared to gram-positive bacteria

Managing acute pain in HIV+/AIDS patients: Knowledge and practice trends among emergency physicians of major tertiary care centers of a developing country

Objective: To assess knowledge and practice trends in managing acute pain in patients infected with human immunodeficiency virus (HIV+) or having acquired immunodeficiency syndrome (AIDS) among emergency physicians of four tertiary care hospitals. Acute pain management in such patients is complex because of multiple concomitant painful conditions related to their disease. After obtaining ethical approval and written informed consent, emergency physicians were requested to fill out a questionnaire.Results: Out of 84 physicians who participated, 49 had managed HIV+/AIDS patients during the preceding year. Out of the 49, 30 (61.2%) physicians stated that they used a combination of analgesics for acute pain in these patients. Forty-two (50%) out of the 84 participants believed that routine doses of opioids were adequate for pain relief, while 42 (50%) agreed that pain management was more complex in these patients mainly due to presence of multiple coexisting problems and psychological issues. Only 26 (31%) respondents considered that pain was under-reported and under-treated in these patients, mainly because physicians were more focused on patients\u27 other disease related complications and issues. Formulation of guidelines are recommended for effective acute pain management in these patients encompassing associated issues, including concomitant painful conditions, opioid dependence, psychiatric problems, etc

Heat emergencies: Perceptions and practices of community members and emergency department healthcare providers in Karachi, Pakistan: A qualitative study

Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies

Teaching children road safety through storybooks: an approach to child health literacy in Pakistan

Background: Road traffic injuries (RTIs) commonly affect the younger population in low- and-middle-income countries. School children may be educated about road safety using storybooks with colorful pictures, which tends to increase the child’s interest in the text. Therefore, this study assessed the use of bilingual pictorial storybooks to improve RTI prevention knowledge among school children.Methods: This pretest-posttest study was conducted in eight public and nine private schools of Karachi, Pakistan, between February to May 2015. Children in grades four and five were enrolled at baseline (n = 410). The intervention was an interactive discussion about RTI prevention using a bilingual (Urdu and English) pictorial storybook. A baseline test was conducted to assess children’s pre-existing knowledge about RTI prevention followed by administration of the intervention. Two posttests were conducted: first immediately after the intervention, and second after 2 months. Test scores were analyzed using McNemar test and paired sample t-test. Results: There were 57% girls and 55% public school students; age range 8–16 years. Compared to the overall baseline score (5.1 ± 1.4), the number of correct answers increased in both subsequent tests (5.9 ± 1.2 and 6.1 ± 1.1 respectively, p-value \u3c 0.001). Statistically significant improvement in mean scores was observed based on gender, grades and school type over time (p-value \u3c 0.001).Conclusion: Discussions using bilingual pictorial storybooks helped primary school children in Pakistan grasp knowledge of RTI prevention. RTI education sessions may be incorporated into school curricula using storybooks as teaching tools. Potential exists to create similar models for other developing countries by translating the storybooks into local languages

Randomised controlled trial to assess the effectiveness of apnoeic oxygenation in adults using low-flow or high-flow nasal cannula with head side elevation versus usual care to prevent desaturation during endotracheal intubation in the emergency department (ApOxED): Study protocol

Introduction: Apnoeic oxygenation is a process of delivering continuous oxygen through nasal cannula during direct laryngoscopy. The oxygen that is delivered through these nasal cannulas is either low flow or high flow. Although the effectiveness of apnoeic oxygenation has been shown through systematic reviews and randomised controlled trials, a comparison of high-flow versus low-flow oxygen delivery has not been tested through a superiority study design. In this study we propose to assess the effectiveness of giving low-flow oxygen with head side elevation versus high-flow oxygen with head side elevation against the usual practice of care in which no oxygen is provided during direct laryngoscopy.Methods and analysis: This will be a three-arm study instituting a block randomisation technique with a sample size of 46 in each arm (see table 1). Due to the nature of the intervention, no blinding will be introduced. The primary outcomes will be lowest non-invasive oxygen saturation measurement during direct laryngoscopy and during the 2 min after the placement of the tube and the first pass success rate. The intervention constitutes head side elevation up to 30° for improving glottis visualisation together with low-flow or high-flow oxygen delivery through nasal cannula to increase safe apnoea time for participants undergoing endotracheal intubation. Primary analysis will be intention to treat.Ethics and dissemination: The study is approved by the Ethical Review Committee of Aga Khan University Hospital (2019-0726-2463). The project is an institution University Research Committee grant recipient 192 002ER-PK. The results of the study will be disseminated among participants, patient communities and healthcare professionals in the institution through seminars, presentations and emails. Further, the findings will be published in a highly accessed peer-reviewed medical journal and will be presented at both national and international conferences

Perception of students and teachers regarding the attributes of an effective clinical teacher in dentistry: a cross-sectional analytical study

Objectives: To compare the perception of dental students and faculty members regarding the attributes of effective clinical teachers. Method: The cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, from August 2021 to November 2021, and comprised third and final year dental students and associated clinical faculty members from in three dental colleges in the city. Data was collected using the modified version of a pre-validated questionnaire. Data was analysed using SPSS 25. Results: Of the 200 students approached, 169(84.5%) responded; 135(79.9%) females and 34(20.1%) males with mean age 21.78±1.099 years (range: 19-26 years). Of the 59 teachers approached, 49(83%) responded; 33(67.3%) females and 16(32.7%) males with mean age 31.59±5.041 years (range: 23-49 years). The students found record-keeping a tiresome task (42%), while teachers regarded it essential for clinical development. Unlike teachers, the students were unable to identify the relevance of clinical objectives and they also did not appreciate teachers’ involvement in clinical procedures. For other domains regarding personal traits, teaching methods and clinical skills, both groups had similar responses. Conclusion: There was generally a similarity of opinions among students and teachers regarding the essential qualities of effective dental clinical teaching. Key Words: Dental education, Clinical teaching, Competent clinical teacher

Bomb blast injuries: an exploration of patient characteristics and outcome using Pakistan National Emergency Departments Surveillance (Pak-NEDS) data.

BACKGROUND: Bomb blast injuries result in premature deaths and burdening of healthcare systems. The objective of this study was to explore the characteristics and outcome of patients presenting to the emergency departments in Pakistan with bomb blast injuries. METHODS: Active surveillance was conducted in seven major emergency departments of Pakistan from November 2010-March 2011. All the sites are tertiary care urban centers. All the patients who presented to the hospital\u27s emergency department (ED) following a bomb blast injury as per self-report or the ambulance personnel were included in the study. Frequency of demographics, injury pattern, and outcomes were calculated. RESULTS: A total of 103 patients with bomb blast injuries presented to the selected emergency departments. The median age of patients was 30 years. Around three-fourth of the patients were males (n = 74, 74.7%). Most of the bomb blast patients were seen in Peshawar (n = 41, 39.8%) and Karachi city (n = 31, 30.1%) and the most common mode of arrival was non-ambulance transport (n = 71, 76.3%). Upper limb injuries (n = 12, 40%) were common in the under 18 age group and lower limb injuries (n = 31, 39.2%) in the 18 years and above group. There were a total of 8 (7.7%) deaths reported out of these 103 patients. CONCLUSION: Bomb blast injuries in Pakistan generally affect young males. Non-ambulance transport is the most common way to access emergency departments (ED). Overall ED mortality is high and capturing data during a disaster in an emergency department is challenging

PW 0211 Impact of child-friendly activities on patient satisfaction in the pediatric emergency department of a low to middle income country

Child- and family-centered care in the Pediatric Emergency Department (PED) is imperative for patient quality and safety, as well as for allaying anxiety in both parents and their children. To assess satisfaction of children before and after introduction of child-friendly activities in PED of a low-resource country. This was an interventional trial conducted at Aga Khan University PED, Karachi, Pakistan, between October 2014 and February 2015. Children (6 months – 16 years) presenting to PED and categorized as priority levels 3–5 per Emergency Severity Index were enrolled in two phases. No intervention was provided in first phase (control group). In second phase, after a month, age-appropriate, low cost child-friendly activities were introduced (intervention group). Satisfaction was gauged using the modified Wong-Baker scale administered to patients (over 6 years) or parents (with children under 6 years), by pre-trained data collectors before and after introduction of child-friendly activities in PED. There were 303 patients enrolled in each group. Mean age was around 5 years, with over half male, for both groups. No significant difference was observed in mean satisfaction levels for overall treatment between the two groups (2.2 in control vs 2.3 in intervention). Although patients most commonly presented with pain to the PED, no significant difference was observed between the groups for degree of pain/fear. Child-friendly activities in the PED did not improve patient satisfaction. Additional strategies are needed to help the pediatric population deal with emotional turmoil during their visits to the low-resource PED

Tip-over injuries among children: Data from an urban emergency department of Karachi, Pakistan

Introduction: Most unintentional injuries among children occur in the home environment. Tip-overs, defined as incidents where heavy objects fall on children due to some type of interaction, are one of the reasons for injuries inside the home. This study aims to determine injury patterns and outcomes for child injuries resulting from tip-overs in the home environment as reported in the emergency department.Methods: We performed a retrospective chart review of pediatric (under 18 years) tip-overs injuries occurred in years 2010 to 2015 at the Aga Khan University Hospital. Furthermore, parents of injured children participated in phone interviews to provide information about the injury scene. File review and telephonic interviews were conducted in the year 2015 and 2016.Results: A total of 75 children visited the emergency department with tip-over injuries, out of which 55 (73%) were boys. The majority of incidents (75.5%) happened inside the home, and the most common places were the living room and bedroom (32% and 21% respectively). More than half (53%) of the children were not under adult supervision at the time of the incident and less than half (47%) of the household took safety measures after the incident. Tip-over injuries were common among 3-year-old children with decreasing frequency as children grew older. The most common causes of tip-overs were TV/TV trolley (32%), followed by furniture (28%), and wall and roof (23%). The most common sites of injuries were head (n = 33, 44%) and extremities (n = 33, 44%). A majority of the cases (n = 66, 88%) were admitted to the hospital from the emergency department, under care of both general (n = 51, 68%) and critical care units (n = 15, 20%). More than a quarter (n = 27, 36%) required at least one surgical procedure during their hospital stay. The median length of hospital stay was one days (interquartile range, IQR 1-5 days). There were two cases of mortality (3%).Conclusion: Most tip-over injuries among children were caused by TV, furniture, and TV trolleys. These injuries can be prevented with public education around home safety measures, such as mounting them on the wall