Safety and effectiveness of ultrasound guided peripheral nerve blocks: Audit at tertiary care hospital

Objective: To assess the safety and effectiveness of peripheral nerve blocks using ultrasound.Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients who received peripheral nerve blocks as part of anaesthesia care between January 2015 and January 2017. The data included outcomes of peripheral nerve block effectiveness, complications and limb conditions after the block. Peripheral nerve block effectiveness was assessed by monitoring pain scores at rest and on movement, and the requirement of co-analgesia. Complications, like numbness, motor block, metallic taste, hypotension and respiratory depression, were also assessed. Data was analysed using SPSS 19.Results: There were 299 patients who received ultrasound-guided peripheral nerve blocks. The overall mean age was 44.57±16.64 years. Of the total, 140 (47%) received transversus abdominis plane block, followed by supraclavicular block 49(16.7%). The most common complication in the recovery room was numbness 19 (6.2%). Overall, 70% patients remained pain-free, while 16% had moderate pain on movement 12 hours postoperatively.Conclusions: Ultrasound-guided regional anaesthesia was found to provide effective analgesia during and after surgery. Nerve blocks proved to be safe when used with ultrasound

First detailed taxonomic report of Coscinodiscus jonesianus from North Arabian Sea after Tasman Spirit Oil Spill

This study concerns first detailed taxonomic record and distribution of Coscinodiscus jonesianus from North Arabian Sea bordering Pakistan after an incident of Tasman Spirit Oil Spill. The study comprised of 5 phytoplankton samples collected immediate after Tasman Spirit Oil Spill (TSOS) and 16 samples after 1.5 year of spill in Bioremedial Project (BP). Scanning Electron Microscopic illustrations along with morphometric comparisons have also been presented

Scanning electron microscopic evidence of Cocconeis convexa Giffen from North Arabian Sea, Pakistan

Marine epiphytic diatom Cocconeis convexa Giffen was observed from a sample collected just after an incidence of Tasman Spirit Oil Spill in 2003. This species was isolated from only one sample collected from station # 2 along the sandy beach of Clifton, Karachi. Morphological characters described in this study were observed from Scanning Electron Microscopic (SEM) image, this is the first report from North Arabian Sea Pakistan

Bellerochea malleus (Brightwell) Van Heurk: a new record from North Arabian Sea after Tasman Spirit Oil Spill

Present report is a first record from the area of North Arabian Sea which describes morphological features of marine centric diatom Bellarochea malleus isolated after 1.5 year of Tasman Spirit Oil Spill during Bioremedial Project (BP). Hydrographic parameters, cell count along with comparison of morphometric data with other reports has also been documented

Coscinodiscus wailesii: centric diatom reported from the oil affected area of North Arabian Sea after Tasman Spirit Oil Spill

In this study presence of large centric diatom Coscinodiscus wailesii was observed in phytoplankton samples collected just after Tasman Spirit Oil Spill (TSOS) and after 1.5 year of spill in Bio-remedial project (BP).Occurrence of Coscinodiscus wailesii in both the study periods showed resistance against spilled oil after an incident of Tasman Spirit Oil Spill which might be due to mucilage secretion on its surface. Moreover Light and Scanning Electron Microscopic illustrations are described in this report

Post-operative pain management modalities employed in clinical trials for adult patients in LMIC; a systematic review

Background: Unrelieved postoperative pain afflicts millions each year in low and middle income countries (LMIC). Despite substantial advances in the study of pain, this area remains neglected. Current systematic review was designed to ascertain the types of clinical trials conducted in LMIC on postoperative pain management modalities over the last decade.Methods: A comprehensive search was performed in June 2019 on PubMed, Cochrane Library, CINAHL Plus, and Web of Science databases to identify relevant trials on the management of postoperative pain in LMIC. Out of 1450 RCTs, 108 studies were reviewed for quality evidence using structured form of critical appraisal skill program. Total of 51 clinical trials were included after applying inclusion/exclusion criteria.Results: Results are charted according to the type of surgery. Eleven trials on laparoscopic cholecystectomy used multimodal analgesia including some form of regional analgesia. Different analgesic modalities were studied in 4 trials on thoracotomy, but none used multimodal approach. In 11 trials on laparotomy, multimodal analgesia was employed along with the studied modalities. In 2 trials on hysterectomy, preemptive pregabalin or gabapentin were used for reduction in rescue analgesia. In 13 trials on breast surgical procedures and 10 on orthopaedic surgery, multimodal analgesia was used with some form of regional analgesia.Conclusion: We found that over the past 10 years, clinical trials for postoperative pain modalities have evolved in LMIC according to the current postoperative pain management guidelines i.e. multi-modal approach with some form of regional analgesia. The current review shows that clinical trials were conducted using multimodal analgesia including but not limited to some form of regional analgesia for postoperative pain in LMIC however this research snapshot (of only three countries) may not exactly reflect the clinical practices in all 47 countries. Post Operative Pain Management Modalities Employed in Clinical Trials for Adult Patients in LMIC; A Systematic Review

Open vessel and steam boiler methods for acid based agar extraction by Gracilaria corticata

Agar is a commercially important biopolymer by marine algae and used up in various industries like microbiological, food, medicine, cosmetics. Acid based pretreatment is explored in this study for open vessel and steam boiler methods in terms of agar production at wet conditions. For the selection of acids the very strong (H2SO4), strong (HCl) and weak acid (CH3COOH) were used and CH3COOH was selected. Furthermore, the strength of CH3COOH was optimized at 1%. The steam boiler treatment with 1h soaking in 1% CH3COOH produced 10g agar which was better than open vessel treatment

Alkali based agar extraction by Gracilaria corticata from the Pakistani coast

Gracillaria corticata is abundantly found upon coast line of Pakistan during the months of July to September and it is naturally available rich source of polysaccharides which have commercial importance. In this study different alkalies were sorted out in a combination with physiochemical based agar extraction. The open vessel and steam boiler were studied in a comparison for suitability of NaOH, KOH and NH4OH, duration of heat treatment and NaOH concentration were also optimized. Maximum agar production, 12gm at wet condition was achieved through 1.5 hours heat treatment through steam boiler by the use of 5% NaOH

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: Multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P \u3c 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (β coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely