The outcomes measure of wide awake hand surgery

Objective: To measure the effects of WAHS intra-operatively with respect to subject’s well-being, pain and choice for wide awake surgery. Methodology: A cross sectional study of seventy patients with age range from 15-65 years, who underwent hand surgery in Jinnah Burn and Reconstructive Surgery Center, Lahore, between January 2019 to August 2019. The effectiveness of anesthesia was measured by pain, well-being and patient preferences. Pain was rated using the visual analogue scale (VAS). Patient well-being was tested depending on how they felt with respect to options on the Likert scale depicting in terms of extremely well, well, less well and extremely less well on VAS scoring. The preference of the subject was assessed by his experience in the surgery and the anesthesia they chose. Results: The total number of patients was 70, whose age was 33.63±6.94 in the range of 15 to 65 years. The average pain score on the VAS was 0.51±1.38 and the duration of surgery was 1.43±0.35 hours. Pain was a variation in the outcome observed in operation during surgery. There were 84.3% of patients who did not experience any pain during their surgery. The remaining patients showed various levels of pain on VAS. Conclusion: The benefits of WAHS are that short duration hand surgery procedures can be done using local anesthesia containing epinephrine. It is cost effective, avoids the side effects of general anesthesia, avoids the use of a tourniquet and reduces the burden of surgical patients requiring general or regional anesthesia procedure. It also avoids patient admission in to the hospital thus sparing hospital beds

Bone graft donor site infection with a rare organism, aeromonas hydrophila: A typical location, presentation and organism with 2 years follow-up: Case report

Introduction: Aeromonas are Gram-negative bacilli often causing necrotizing fasciitis or sepsis in immunocompromised patients. Aeromonas Hydrophila is most often found in immunocompromised patients or those with burns or aquatic trauma. When patients present with a discharge and infection on bone graft donor site and progressive sepsis, an Aeromonas hydrophila infection should be considered in the differential diagnosis. Presentation of Case: We report here a rare case of Aeromonas hydrophila with surgical site sep- sis/infection in an immunocompromised 69 years old female, with several comorbids. Here we are reporting infection on donor surgical graft site, sparing major surgical site with the implant. After getting culture report of exudates from the wound that grew A. hydrophila, immediate wound debridement and antibiotic beads insertion was performed with appropriate antimicrobial therapy and regular wound dressing. She was followed for around 2 years. Discussion: This is the first report to our knowledge of A. Hydrophila infection in bone graft donor site. Aeromonas most often cause gastrointestinal and soft tissue infections, and bacteremia in immuno- compromised patients. Early surgical intervention is essential to reducing mortality in deep soft tissue infections caused by this organism. Aeromonas have shown resistance to penicillin but are sensitive to other broad-spectrum antibiotics. Conclusion: Early suspicion, diagnosis, and treatment with potent antibiotics are needed to prevent any further complications resulting from infection by this emerging aggressive pathogen

Medical Students’ Perception and preferences on Methods of Anatomy Teaching- A survey between public and private institutes of Karachi, Pakistan

Anatomy is an essential and basic subject in the field of human sciences. The reforms and new teaching methodologies has been revolutionizing the world and helping the student in better understanding the anatomical landmarks and specific details in an interactive way. The present study evaluated the mode of anatomy teaching in public and private medical institutes of Karachi along with the opinion of students on the best teaching tool of anatomy. A total of 347 participants from private and public medical colleges of Karachi participated in the study. The data was collected by rotating questionnaires in the classrooms. Data was analyzed using Statistical Package for Social Sciences (SPSS) version 20. The mean age ± SD of our sample was 19.10 ± 0.77 years. In this study, majority of students from private sector institute were satisfied (58%) with the teaching methodology implemented for teaching Anatomy whereas, about (74%) participants from public sector institutes were not satisfied with the teaching methodology of teaching Anatomy. Students recommended that the use of Anatomy models may help in their better understanding of Anatomy. The present study indicates that public and private medical institutes were still using old multimedia based teaching methods of anatomy and the students were not very satisfied with the mode of teaching in their institutes. Amendments and reforms shall be implemented and efficacious teaching techniques should be applied taking into consideration the opinion of the students to bring out the best understaning in the field of Anatomy

The Workload Pressures Experienced by Nurses at Public Sector Hospitals, Peshawar

OBJECTIVE The study's objective was to assess that nurses working in in-patient wards were under workload stress. METHODOLOGY Descriptive observational research on nurses working in the in-patient ward of a public sector hospital in Peshawar was undertaken in November 2020. Workload Indicators of Staffing Need (WISN), a tool established by the World Health Organization (WHO) to anticipate the number of health staff needed to cope with workload pressure, was used to determine nurses' workload. To ensure the successful implementation of the WISN methodology, three tiers of committees were developed, including steering, technical, and expert committees. Data were also analyzed using the tool. RESULTS Nurses in the hospital's in-patient unit work 1966 hours per year. Health service activities, support, and other activities account for 47.92%, 33.33%, and 18.75% of all nurses' time, respectively, during this time. Four nurses were working in the hospital during the research study; however, WISN estimated that three nurses were needed to cope with the ward's workload pressure, and one nurse was overstaffed at the time. The WISN ratio calculated was 1.33. CONCLUSIONS The study concluded that there was no workload pressure on nurses (negative), and the ward had an extra nurse who could be accommodated in any other department with greater demand

Phylogenetic study of 46 Ancient Mitochondrial Human Genomes

Background: In the third era of ancient DNA field, it has endured the mesmerising modifications, which should be revealed. From side to side period, analysis of mitochondrial DNA permits to determine the evolutionary relationship among the species, to expose the terrestrial roots of the entities, to standardise the molecular clocks and to study the demographic pasts. Methods: In the current study we used bioinformatics tools for prediction of mitochondrial haplogroups and phylogenetic analysis. The ancient complete mitochondrial genomes were retrieved from online resources and were further used for phylogenetic analysis to know the evolutionary position of the ancient populations lived thousands of years ago. Results: We aligned 46 ancient genomes, collected online and estimated trees by using neighbour-joining, maximum parsimony and maximum-likelihood. Support for nodes was assessed with bootstrap replicates. During our analysis a strong bond between genomes of Altai Neanderthal, Motala 12, Motala 1, Loschbour, Ust'-Ishim, LBK, Mezmaiskaya Neanderthal, Denisova, RISE391(ERR844272), Clovis Anzick-1, RISE395(ERR844275) and RISE210(ERR844262) were found. In this context these ancient samples recommended the presence of a mutual earliest genomic signature. Conclusion: A significant population immigrations and alternates, accountable for influencing main parts of current demographic structure together in Europe and Asia is supported by the Bot15 (ERR668415) and RISE family. In the initial bronze period, ancestral similarity among these populations also share the theorised blow-out of Indo-European languages. Mechanisms of pathogen development and alteration for evolving and reappearing toxicities is also explained by this study. We aim that this study will help researchers in understanding the evolutionary position of ancient populations resided around the world.