Élaboration et implantation du Guide d'Ottawa de médecine d'urgence

Implication Statement Medical students face multiple academic challenges during their transition to clerkship, including the ability to navigate various educational resources and translate acquired knowledge clinically. The Ottawa Handbook of Emergency Medicine (EM) was created by referencing EM textbooks and relevant literature, followed by a local peer-review process. A website metrics assessment was performed to assess student uptake. Implementation of the Ottawa Handbook of EM across Canadian clerkship curriculums is anticipated to bridge the EM knowledge gap for junior learners.  Énoncé des implications de la recherche Les étudiants en médecine sont confrontés à de multiples défis académiques au moment de leur transition vers l’externat, notamment à celui de se servir de diverses ressources éducatives et d'appliquer leurs connaissances dans un contexte clinique. Le Guide d’Ottawa de médecine d'urgence (MU) a été élaboré à partir de manuels de MU et de la littérature pertinente, et il a fait l'objet d'un processus local d'examen par les pairs. Une évaluation bibliométrique a été effectuée pour évaluer son utilisation par les étudiants. L’application du Guide d'Ottawa de médecine d'urgence dans le cadre des cursus canadiens d’externat devrait permettre de combler les lacunes qu’auraient les étudiants débutants en matière de médecine d'urgence

Un estudio observacional sobre infecciones bacterianas en pacientes con coronavirus hospitalizados en un centro de tercer nivel de atención

Introduction: The latest global pandemic is caused by SARS-CoV-2 coronavirus. 6% of patients are admitted to the hospital, with 20% of those admitted to the intensive care unit (ICU) due to acute respiratory distress syndrome (ARDS).Aim: to characterise the bacterial infections in patients with coronavirus at an ICU of North Indian Hospital.Method: After receiving ethical approval from the institutional review board, a retrospective study was done on coronavirus subjects admitted to GMC Srinagar's ICUs between January and June 2021. Data on demographics, comorbidities, and microbiology were obtained retrospectively.Results: Overall, “394 COVID-19 patients were admitted to ICU. Median age was 58 years (IQR 51–69) and sex ratio (M/F) was 3. At admission the median SAPS II was 33 (IQR 24–49). Among patients, 232 had at least one co-morbidity and 162 were overweight (body mass index (BMI) = 27.8 kg/m2). In all, 358 patients received antibiotics (244/358 introduced before ICU and 114/358 during ICU stay)”.Conclusion: The current study is the first of its kind in our hospital setting to describe the bacterial persistence in the lungs despite adequate therapy, as well as frequent bloodstream infections possibly associated with bacterial translocations originating from the digestive or oropharyngeal microbiota, in COVID-19 ICU patients.Introducción: La última pandemia mundial está provocada por el coronavirus SARS-CoV-2. El 6 % de los pacientes ingresan en el hospital, con un 20% de los ingresados en la unidad de cuidados intensivos (UCI) debido al síndrome de dificultad respiratoria aguda (SDRA).Objetivo: caracterizar las infecciones bacterianas en pacientes con coronavirus en una UCI del North Indian Hospital.Método: Después de recibir la aprobación ética de la junta de revisión institucional, se realizó un estudio retrospectivo en sujetos con coronavirus admitidos en las UCI de GMC Srinagar entre enero y junio de 2021. Los datos sobre demografía, comorbilidades y microbiología se obtuvieron retrospectivamente.Resultados: en general, “394 pacientes con COVID-19 fueron admitidos en la UCI. La mediana de edad fue de 58 años (RIC 51-69) y la proporción de sexos (M/F) de 3. Al ingreso, la mediana de SAPS II fue de 33 (RIC 24-49). Entre los pacientes, 232 tenían al menos una comorbilidad y 162 tenían sobrepeso (índice de masa corporal (IMC) = 27,8 kg/m2). En total, 358 pacientes recibieron antibióticos (244/358 introducidos antes de la UCI y 114/358 durante la estancia en la UCI)”.Conclusión: El presente estudio es el primero de su tipo en nuestro medio hospitalario en describir la persistencia bacteriana en los pulmones a pesar de una terapia adecuada, así como infecciones frecuentes del torrente sanguíneo posiblemente asociadas con translocaciones bacterianas originadas en la microbiota digestiva u orofaríngea, en COVID-19 pacientes de la UCI

Un estudio observacional sobre infecciones bacterianas en pacientes con coronavirus hospitalizados en un centro de tercer nivel de atención

Introduction: The latest global pandemic is caused by SARS-CoV-2 coronavirus. 6% of patients are admitted to the hospital, with 20% of those admitted to the intensive care unit (ICU) due to acute respiratory distress syndrome (ARDS).Aim: to characterise the bacterial infections in patients with coronavirus at an ICU of North Indian Hospital.Method: After receiving ethical approval from the institutional review board, a retrospective study was done on coronavirus subjects admitted to GMC Srinagar's ICUs between January and June 2021. Data on demographics, comorbidities, and microbiology were obtained retrospectively.Results: Overall, “394 COVID-19 patients were admitted to ICU. Median age was 58 years (IQR 51–69) and sex ratio (M/F) was 3. At admission the median SAPS II was 33 (IQR 24–49). Among patients, 232 had at least one co-morbidity and 162 were overweight (body mass index (BMI) = 27.8 kg/m2). In all, 358 patients received antibiotics (244/358 introduced before ICU and 114/358 during ICU stay)”.Conclusion: The current study is the first of its kind in our hospital setting to describe the bacterial persistence in the lungs despite adequate therapy, as well as frequent bloodstream infections possibly associated with bacterial translocations originating from the digestive or oropharyngeal microbiota, in COVID-19 ICU patients.Introducción: La última pandemia mundial está provocada por el coronavirus SARS-CoV-2. El 6 % de los pacientes ingresan en el hospital, con un 20% de los ingresados en la unidad de cuidados intensivos (UCI) debido al síndrome de dificultad respiratoria aguda (SDRA).Objetivo: caracterizar las infecciones bacterianas en pacientes con coronavirus en una UCI del North Indian Hospital.Método: Después de recibir la aprobación ética de la junta de revisión institucional, se realizó un estudio retrospectivo en sujetos con coronavirus admitidos en las UCI de GMC Srinagar entre enero y junio de 2021. Los datos sobre demografía, comorbilidades y microbiología se obtuvieron retrospectivamente.Resultados: en general, “394 pacientes con COVID-19 fueron admitidos en la UCI. La mediana de edad fue de 58 años (RIC 51-69) y la proporción de sexos (M/F) de 3. Al ingreso, la mediana de SAPS II fue de 33 (RIC 24-49). Entre los pacientes, 232 tenían al menos una comorbilidad y 162 tenían sobrepeso (índice de masa corporal (IMC) = 27,8 kg/m2). En total, 358 pacientes recibieron antibióticos (244/358 introducidos antes de la UCI y 114/358 durante la estancia en la UCI)”.Conclusión: El presente estudio es el primero de su tipo en nuestro medio hospitalario en describir la persistencia bacteriana en los pulmones a pesar de una terapia adecuada, así como infecciones frecuentes del torrente sanguíneo posiblemente asociadas con translocaciones bacterianas originadas en la microbiota digestiva u orofaríngea, en COVID-19 pacientes de la UCI

Un estudio observacional sobre infecciones bacterianas en pacientes con coronavirus hospitalizados en un centro de tercer nivel de atención

Introduction: The latest global pandemic is caused by SARS-CoV-2 coronavirus. 6% of patients are admitted to the hospital, with 20% of those admitted to the intensive care unit (ICU) due to acute respiratory distress syndrome (ARDS).Aim: to characterise the bacterial infections in patients with coronavirus at an ICU of North Indian Hospital.Method: After receiving ethical approval from the institutional review board, a retrospective study was done on coronavirus subjects admitted to GMC Srinagar's ICUs between January and June 2021. Data on demographics, comorbidities, and microbiology were obtained retrospectively.Results: Overall, “394 COVID-19 patients were admitted to ICU. Median age was 58 years (IQR 51–69) and sex ratio (M/F) was 3. At admission the median SAPS II was 33 (IQR 24–49). Among patients, 232 had at least one co-morbidity and 162 were overweight (body mass index (BMI) = 27.8 kg/m2). In all, 358 patients received antibiotics (244/358 introduced before ICU and 114/358 during ICU stay)”.Conclusion: The current study is the first of its kind in our hospital setting to describe the bacterial persistence in the lungs despite adequate therapy, as well as frequent bloodstream infections possibly associated with bacterial translocations originating from the digestive or oropharyngeal microbiota, in COVID-19 ICU patients.Introducción: La última pandemia mundial está provocada por el coronavirus SARS-CoV-2. El 6 % de los pacientes ingresan en el hospital, con un 20% de los ingresados en la unidad de cuidados intensivos (UCI) debido al síndrome de dificultad respiratoria aguda (SDRA).Objetivo: caracterizar las infecciones bacterianas en pacientes con coronavirus en una UCI del North Indian Hospital.Método: Después de recibir la aprobación ética de la junta de revisión institucional, se realizó un estudio retrospectivo en sujetos con coronavirus admitidos en las UCI de GMC Srinagar entre enero y junio de 2021. Los datos sobre demografía, comorbilidades y microbiología se obtuvieron retrospectivamente.Resultados: en general, “394 pacientes con COVID-19 fueron admitidos en la UCI. La mediana de edad fue de 58 años (RIC 51-69) y la proporción de sexos (M/F) de 3. Al ingreso, la mediana de SAPS II fue de 33 (RIC 24-49). Entre los pacientes, 232 tenían al menos una comorbilidad y 162 tenían sobrepeso (índice de masa corporal (IMC) = 27,8 kg/m2). En total, 358 pacientes recibieron antibióticos (244/358 introducidos antes de la UCI y 114/358 durante la estancia en la UCI)”.Conclusión: El presente estudio es el primero de su tipo en nuestro medio hospitalario en describir la persistencia bacteriana en los pulmones a pesar de una terapia adecuada, así como infecciones frecuentes del torrente sanguíneo posiblemente asociadas con translocaciones bacterianas originadas en la microbiota digestiva u orofaríngea, en COVID-19 pacientes de la UCI

A comparative study of supraclavicular versus infraclavicular approach for central venous catheterization in neurosurgical patients

Background: Central venous cannulation is a commonly performed procedure in neurosurgical patients to maintain the hemodynamic stability in the intraoperative period. It is used for infusion of intravenous fluids, vasopressors central venous pressure monitoring and detection of air embolism. Subclavian vein is commonly performed as there are minimal effects of positioning on it. Supraclavicular approach to subclavian vein cannulation is not as frequently employed as the infraclavicular approach. The purpose of this study was to compare the supraclavicular approach versus the infraclavicular approach in terms of number of attempts, success rate of catheterization and complications associated with the procedure.Methods: About 150 patients undergoing various neurosurgical procedures were enrolled in the study. They were divided into two groups. 75 patients underwent right supraclavicular catheterization of subclavian vein while as 75 patients underwent right infraclavicular catheterisation of the subclavian vein. The number of attempts for cannulation, success or failure of catheterization and any complications associated with the procedure or in the postoperative period were noted in each group. The data was compared between the two groups by using Chi-square test and Student’s Independent Samples T-test.Results: The right supraclavicular vein was successfully cannulated in 90.66% while as the right infraclaviclar vein was successfully cannulated in 96% of the patients (p >0.05). Malpositioning of catheter (threaded in contralateral subclavian) was noted in 4 patients in Group S and ipsilateral internal jugular vein in 2 patients. Pneumothorax was encountered in 1 patient in the group S undergoing supraclavicular subclavian vein cannulations while as subclavian arterial puncture was seen in 4 patients who underwent infraclavicular arterial puncture.Conclusions: There was no difference in successive cannulations between right the supraclavicular and right infraclaviclar veins. The rate of complications between the two approaches was comparable

AN EFFECTIVE APPROACH OF FOUR-STEP METHOD FOR OPTIMAL SOLUTION OF TRANSPORTATION PROBLEM

Transportation problem (TP) in operation research is one of the most in use optimization technique to deal the problems that are related with transportation of goods from sources to destinations. Initial Basic Feasible Solution (IBFS) plays a vital role in TP which offers a way to obtain the optimal solution. The objective is to prevail the total transportation cost equivalent or nearer to optimal solution. In this paper, an effective approach of Four Step Method (FSM) for optimal solution of TP has been brought up in order to get optimal solution of TPs. In this method we construct the Maximum Column Table (MCT) and Maximum Row Table (MRT). Several problems has been solved using this method to get the optimal solution. The outcomes of proposed method are contrasted with results of North West Corner Method (NWCM), Least Cost Method (LCM) and Vogal’s Approximation Method (VAM). It is observed that the proposed method is not only achieving better results but also overcoming the limitation of VAM. Key Words: Transportation problem, Initial Basic Feasible Solution, Optimal solution, Linear programming proble

Indications of enucleations and eviscerations performed at a tertiary eye care unit: a case series.

Abstract The retrospective study was planned to look at the indications of eye enucleations and eviscerations, and comprised all such procedures done at the Aga Khan University Hospital, Karachi, from January 2006 to December 2015. Data was collected regarding age at the time of procedure, gender, procedure type, indication for enucleation or evisceration, type of implant if used and complications. Of the 66 eyes of 65 individuals, 47 (71.2%) underwent evisceration and 19 (28.8%) enucleation. The mean age at the time of the procedures was 37.86±23.09 years. The indication for enucleation or evisceration were keratitis 14(21.2%), introcular tumours 13(19.7%), trauma 10(15.2%), endophthalmitis 10(15.2%), cosmesis 10(15.2%) and painful blind eye 9(13.6%). Only 5(7.5%) procedures had postoperative complications such as wound dehiscence, infected socket, loose suture, or stich abscess. Most of causes of enucleation and evisceration in this case series could have prevented through the application of evidence-based safety practices

Modelling of heat integrated reactive distillation column (r-HIDiC): Simulation studies of MTBE synthesis

In the present study, heat integrated distillation column is modelled and simulated for the production of Methyl tert-Butyl Ether (MTBE) from methanol and isobutylene using ASPEN Plus®. Also, the objective of this study is to have comparative analysis between the reactive distillation process and an alternative intensified process (r-HIDiC) to produce MTBE. Rigorous simulation study has been conducted to compare the optimal flow sheet of the above two designs. Temperature and composition profiles are studied and compared for both the models and found that the temperature at the last stage of the stripping section in r-HIDiC is 406 K while that of the stripping section in RDC is 427.24 K. This reduced temperature decreases the composition of methanol in bottom product in stripping column in case of r-HIDiC as methanol forms a homogenous azeotrope with MTBE at 408.53 K. Also, it is found that, although with nominal increase in TAC i.e. 16.56%, in r-HIDiC design as compared to the reactive distillation column design which is caused due to the high cost of the additional compressor needed in the vapour compression, however, the r-HIDiC design can save reboiler and condenser heat duties to a considerable amount i.e. by 35.06% and 36.65% respectively