Sepsis management: An evidence-based approach.

The Surviving Sepsis Campaign (SSC) guidelines have outlined an early goal directed therapy (EGDT) which demonstrates a standardized approach to ensure prompt and effective management of sepsis. Having said that, there are barriers associated with the application of evidence-based practice, which often lead to an overall poorer adherence to guidelines. Considering the global burden of disease, data from low- to middle-income countries is scarce. Asia is the largest continent but most Asian countries do not have a well-developed healthcare system and compliance rates to resuscitation and management bundles are as low as 7.6% and 3.5%, respectively. Intensive care units are not adequately equipped and financial concerns limit implementation of expensive treatment strategies. Healthcare policy-makers should be notified in order to alleviate financial restrictions and ensure delivery of standard care to septic patients

Overcrowding in the emergency departments: challenges and opportunities for improvement

With the advent of Emergency Medicine, one can observe an increase in the number of Emergency Departments (ED) across the country. However, most EDs struggle due to an overwhelming number of patients. Overcrowding can lead to delays in patient care. For a city like Karachi which is an active disaster zone, preemptive preparedness is required in the face of terror threats and such overcrowding needs to be decreased to a bare minimum. The most frequent causes of prolonged length of stay (LOS) in the ED include non-availability of in-hospital beds, delays in response to subspecialty consultations and escalating medical expenses. All of these can negatively impact patient care by putting patient safety at risk and patient care in jeopardy. There is an increased risk of unintentional medical errors and a concomitant increase in unwanted lawsuits. A few simple interventions which may help alleviate this situation to some extent have been discussed

Role of preoperative embolization in management of central nervous system tumours

Preoperative embolization plays a significant role as an adjunct to surgical intervention in the cases of certain vascular tumours of the brain. While the procedure has resulted in facilitated resection of the tumour, and has reduced morbidity and mortality, its application remains debatable within the neurosurgical community, owing to rare, but major post-procedural complications. Herein, we have reviewed the literature to assess the safety and efficacy of preoperative angiographic embolization for brain tumours

Neurological disorder burden in Faisalabad, Punjab-Pakistan:data from the major tertiary carecenters of the city

The burden of neurological disorders (NDs) in developing countries is 4-5%, compared to 10-11% in developed countries. This burden is rising in developing countries due to prolonged life expectancy, improved health facilities, easy access to diagnostic facilities, and a trend in urbanization. There is inadequate data about the epidemiology of major NDs in Pakistan and most available information are hospital-based estimations or physicians’ collected data

Biosorption studies on arsenic (III) removal from industrial wastewater by using fixed and fluidized bed operation

Previously, activated carbon was used as adsorbent for the removal of heavy metals at batch scale and the reported removal efficiency was up to 25 % (while in our technique the efficiency is up to 75%). The large industries operate with continuous processes and discharge large amount of wastewater containing heavy metals. No research was published for continuous operation using fluidized bed adsorption column till now. The novelty of this study is on the mode of operation (continuous operation at large scale under fixed and fluidized bed conditions), Biosorbent activated carbon (AC), and maximum efficiency of arsenic removal (i.e. 75 %). The Biosorbent activated carbon prepared from waste agriculture material. Industrial wastewater consists of many inorganic and organic pollutants which are discharged into water bodies resulting the serious health problems. Now a days, concentration of arsenic has much increased as compared to the permissive concentration level (25mg/L). Therefore, there is need to reduce this concentration up to threshold value (10μg/L). The use of biosorbents for arsenic removal from wastewater has global significance due to its widespread availability and low cost. Biosorption of Arsenic strongly depends on the initial metal concentration, contact time, speed of stirring, pH and temperature. The maximum arsenic as (III) removed at pH-7.5 is 70%, it was improved to 83% by agitation in batch experiments. While in continuous mode experiments (Fixed bed) the bed height and flow rates were varied. At the Fluidized bed experiments, the maximum As (III) removed was 75%. The effects of several factors such as pH, initial solute concentration, biosorbents dose, has been revaluated in this paper. The low cost, easily available biosorbent AC is recommended for removal of arsenic from contaminated wastewaters to bring them in compliance

Persistence of Primary and Secondary Pollutants in Delhi : Concentrations and Composition from 2017 through the COVID Pandemic

We assess impacts of the 2020 COVID-19 lockdown on ambient air quality in Delhi, building on over three years of real-time measurements of black carbon (BC) and nonrefractory submicrometer aerosol (NR-PM1) composition from the Delhi Aerosol Supersite and public data from the regulatory monitoring network. We performed source apportionment of organic aerosol (OA) and robust statistical analyses to differentiate lockdown-related impacts from baseline seasonal and interannual variability. The primary pollutants NOx, CO, and BC were most reduced, primarily due to lower transportation emissions. Local and regional emissions such as agricultural burning decreased during the lockdown. PM2.5 declined but remained well above WHO guidelines. Despite the lockdown, NR-PM1 changed only moderately compared to prior years. Differences in the trends of hydrocarbon-like OA and BC suggest that some sources of primary aerosol may have increased. Despite notable reductions in some primary pollutants, the lockdown restrictions led to rather small perturbations in the primary fraction of NR-PM1, with secondary aerosol continuing to dominate. Overall, our results demonstrate the impact of secondary and primary pollution on Delhi's air quality and show that large changes in emissions within Delhi alone are insufficient to bring about needed improvements in air quality.Peer reviewe

Persistence of Primary and Secondary Pollutants in Delhi : Concentrations and Composition from 2017 through the COVID Pandemic

We assess impacts of the 2020 COVID-19 lockdown on ambient air quality in Delhi, building on over three years of real-time measurements of black carbon (BC) and nonrefractory submicrometer aerosol (NR-PM1) composition from the Delhi Aerosol Supersite and public data from the regulatory monitoring network. We performed source apportionment of organic aerosol (OA) and robust statistical analyses to differentiate lockdown-related impacts from baseline seasonal and interannual variability. The primary pollutants NOx, CO, and BC were most reduced, primarily due to lower transportation emissions. Local and regional emissions such as agricultural burning decreased during the lockdown. PM2.5 declined but remained well above WHO guidelines. Despite the lockdown, NR-PM1 changed only moderately compared to prior years. Differences in the trends of hydrocarbon-like OA and BC suggest that some sources of primary aerosol may have increased. Despite notable reductions in some primary pollutants, the lockdown restrictions led to rather small perturbations in the primary fraction of NR-PM1, with secondary aerosol continuing to dominate. Overall, our results demonstrate the impact of secondary and primary pollution on Delhi's air quality and show that large changes in emissions within Delhi alone are insufficient to bring about needed improvements in air quality.Peer reviewe

Adverse clinical sequelae after skin branding: a case series

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