Success and failure of fast track extubation in cardiac surgery patients of tertiary care hospital: one year audit

OBJECTIVE: To identify the causes of delayed extubation in patients planned for fast tract extubation during cardiac surgery. METHODS: A prospective observational study was conducted at cardiothoracic unit of Aga Khan University Hospital for the period of one year. All elective coronary artery bypass graft (CABG) surgery patients, between the ages of 35-75 years with LVEF \u3e or = 40 percent were included. Patients with Intra aortic balloon pump, chronic renal failure, respiratory compromise and requiring high ionotropic support were excluded from this audit. A performa was designed and later filled by the primary investigator. Patient demographics and various reasons for delayed extubation were noted in this proforma. RESULTS: Total 614 patients underwent CABG surgery and 388 (63.19%) patients were planned for fast track extubation. A total of 196 (49.5%) patients could be extubated within six hours of arrival in the cardiac ICU. Common reasons for delayed extubation included deep sedation in 80 (46.5%), confusion 44 (25%), excessive bleeding in 20 (11.3%) and high inotropic support in 10 (5.68%). CONCLUSION: Major contributing factors for delayed extubation were identified by this audit. These factors need to be targeted accordingly by modifications in intra operative management

EKSPRESI KEAGAMAAN MASYARAKAT PINGGIR KOTA (Studi Kasus di Cimenyan Bandung)

This study departs from the assumption that a society that is transitioning from a technological perspective will affect its religious attitude. The research was conducted at the Parukuyan Community in the Ciburial Village, Cimenyan District, Bandung Regency. This research uses qualitative methods with sociological and anthropological approaches. The theory used is Emile Durkheim's theory about the nature of religious experience. The results showed that: 1. The parukuyan community followers belong to religious groups, this is evidenced by the parukuyan followers in the divine aspect who believe in God as the ruler of the universe, however, in this divinity parukuyan followers practice religious syncretism in their beliefs. ; 2. In the aspect of message bearers and propagators of religion, parukuyan followers believe in prophethood as an intermediary from God to convey religious teachings to mankind, and also parukuyan followers respect guardians as the successors of prophets and spreaders of religious teachings; and 3. In the socio-cultural aspects such as radicalism and tolerance, followers of the Parukuyan association appreciate the diversity of humans in various aspects and are believed that this diversity is a necessity that everyone should respect

Investigation of the laxative, spasmolytic and prokinetic properties of aqueous methanol extract of Buxus sempervirens Linn (Buxaceae)

Purpose: To investigate the spasmolytic and laxative properties of Buxus sempervirens Linn (Buxaceae) in rabbits and mice.Methods: Aqueous methanol extract (AqMeBS) as well as the dichloromethane (DCMF) and aqueous (AqF) fractions of Buxus sempervirens were investigated on isolated rabbit jejunum to explore its antispasmodic effect, relative to the standard drug, verapamil. Laxative and prokinetic potentials of 250 and 500 mg/kg doses of AqMeBS extract were evaluated in mice and compared to that of negative (normal saline) and positive (carbachol) control groups. The effects of AqMeBS and carbachol were also tested in mice pretreated with atropine (10 mg/kg). Single dose, acute oral toxicity study on AqMeBS was also executed in mice at 4000, 8000 and 12000 mg/kg doses.Results: AqMeBS, DCMF and AqF significantly inhibited the rhythmic contractility of jejunum with 0.961, 0.0327 and 0.242 mg/mL, respectively, as median effective concentrations (EC50). In addition, AqMeBS, DCMF and AqF significantly relaxed the contractions due to K+, with EC50 of 1.85, 0.05 and 1.07 mg/mL, respectively. Ca2+ concentration response curves (CCRCs) were shifted to the right by AqMeBS and DCMF, in the same manner as verapamil. In the in vivo experiments, AqMeBS produced significant (p < 0.0001) laxative and prokinetic effects at 250 and 500 mg/kg doses and was comparable to that of carbachol. The acute toxicity study showed that AqMeBS was associated with one mortality at the highest tested dose (12000 mg/kg).Conclusion: These results provide the pharmacological basis for the traditional use of B. sempervirens Linn as a laxative and prokinetic remedy in the management of constipation.Keywords: Buxus sempervirens, Calcium channel blocker, Prokinetic, Laxative, Spasmolyti

Manual trans-tracheal high frequency positive pressure ventilation for left main bronchus and carinal mass surgical resection in a child

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was used for ventilation and oxygenation during surgery. Total Intravenous anaesthesia with propofol infusion and increments of fentanyl was used during HFPPV. After the completion of the surgery, conventional positive pressure ventilation (PPV) was continued through the endotracheal tube (ETT) to check any bronchial stump leak. After the surgery, patient was weaned and extubated in the operating room. Hospital course remained uneventful and the patient was discharged after 6 days. HFPPV with manually improvised technique is applicable in carinal surgery for optimization of oxygenation, ventilation, and uninterrupted surgical resection

Incidence and pattern of thrombocytopenia in cardiac surgery patients

Objective: To observe the incidence and pattern of thrombocytopenia in cardiac surgery patients.Methods: This prospective, cohort study was conducted at the Aga Khan University Hospital, Karachi, from November 2014 to April 2015, and comprised adult cardiac patients. Patients with platelet count less than 150,000 x 109/L, history of malignancy, immune thrombocytopenic purpura and on chemo or radiotherapy were excluded. All information including demographics, platelet count, heparin doses, total cardiopulmonary bypass time, cross-clamp time, blood products transfused, any thromboembolic complication and the presence of infection were recorded on a pre-designed proforma. SPSS 19 was used for data analysis..Results: Of the 177 patients, 130(73.4%) were males and 47(26.6%) were females. The overall mean age was 59.21±10.99 years. Thrombocytopenia was observed in 167(94.4%) patients. Of them, platelet count dropped below 50% in 71(42.5%) patients, 30-50% in 68(40.7%) patients and 20-30% in 28(16.8%) from the baseline value. Regarding pattern of thrombocytopenia, maximum drop in platelet count was noticed on 2nd and 3rd day of surgery. Furthermore, 9(5.3%) patients developed severe thrombocytopenia (\u3c50,000 x 109/l).Conclusions: The incidence of thrombocytopeni

Magnesium, a drug of diverse use

Magnesium has evolved as a drug with diverse clinical applications. Mg++ is an important caution and its homeostasis is very important for normal body functioning. The physiological role of Mg is due to its calcium channel blocking properties at smooth muscle, skeletal muscle and conduction system levels. The analgesic properties are due to NMDA receptor blocking action. Mg++ is beneficial in acute Myocardial Infarction, protection during open heart surgery and treatment and prevention of heart rhythm disturbances. Mg has an established role in the management of preeclampsia and eclampsia. Magnesium prevents or controls convulsions by blocking neuromuscular transmission and decreasing the release of acetylcholine at the motor nerve terminals. The use of MgSO4 in treating tetanus and acute asthma is established. In conclusion, Mg is a cost effective, widely used drug with multidisciplinary applications. Its majority of physiological effects are attributed to calcium channel blocking properties

Islamic Bathroom: A Recommendation of Bathroom Layout Design with Islamic Values

A bathroom is a room that cannot be separated from humans’ daily lives and there are activities performed inside of it. Today’s bathroom usually is designed in the universal style, even though there is no human with the same background nor the same religion. Every religion has its own rules and should be applied by its followers in every aspect of their lives, especially in Islam. There are two guidelines which have the explanation of the bathroom etiquette, Al Quran and Hadits. For the Muslim users, the synchronization between bathroom etiquette and the design of the bathroom is an effort of the observance to Allah SWT. Therefore, this writing is an attempt to give a reminder and also a recommendation of bathroom design layouts based on the rules of Islamic bathroom etiquette. The methodology of this research is to describe all of the bathroom etiquettes in Al-Quran and Hadits and make the concept of the bathroom design layouts based on what is permitted and forbidden

Sleeping pattern before thoracic surgery: A comparison of baseline and night before surgery

Background: Sleep deprivation is considered a stress factor in the perioperative period. There are several studies on sleep disturbance after surgery but very limited literature available on preoperative sleep patterns, predictors of sleep disturbance and its effect on surgical outcome.Methodology: Patients scheduled for thoracic surgery were asked to fill out a written Pittsburgh Sleep Quality Index (PSQI) questionnaire. The primary investigator explained this form to all the patients. This was filled out before premedication for subjective assessment of sleeping pattern at two different time point. Only those patients included who spent the previous night at home. Participants were asked to respond to the questions regarding their baseline sleeping pattern and compare it with last night.Results: Total eighty-three patients with a mean age of 47.83 ± 17.88 were included in the study. Overall mean PSQI scores were significantly higher (p-value \u3c 0.01) during the night before surgery (6.94 ± 2.115) when compared with baseline (3.88 ± 1.877). Sleep latency was also significantly affected when last night-1 (the night before admission) was compared with usual sleep latency. Twenty patients were unable to sleep more than 5 hrs at night before admission which was significant when compared with their last month status (20 vs 3). Logistic regression model demonstrated the age and Timing of surgery as a strong predictors of poor sleep (defined as PSQI ≥ 5).Conclusion: Quality of sleep was profoundly affected at night before thoracic surgery, mainly due to a significant change in sleep latency and sleep duration. Although age and Timing of surgery were strong predictors of poor sleep we were unable to find any association between quality of sleep and type of surgery