Perioperative and acute care transesophageal echocardiography (TOE)

In Pakistan perioperative transoesophageal echocardiography (TOE) during cardiac surgery is available in a few centers with reliance on cardiologists and cardiac technicians and its use in noncardiac surgery and intensive care units is very limited. In view of the increasing popularity of TOE based on obvious benefits this review is presented with an aim to evaluate the current indications and potential benefits of using TOE during anesthesia for cardiac and non-cardiac surgery and the intensive care units and compare TOE with pulmonary artery catheter (PAC) and transthoracic echocardiography (TTE) as an hemodynamic monitor in the acute care setting

World Sepsis Day in Pakistan

Celebration of World Sepsis Day at a global level started just three years back, and the immense importance of this celebration was not lost to Pakistan Society of Anaesthesiologists (PSA) and Pakistan Society of Critical Care Medicine (PSCCM). Both these organizations were quick to grasp the opportunity to use it to achieve the common goal of enhancing the level of awareness about sepsis and prevention of sepsis among the healthcare professionals as well as higher authorities. The result was multiple international academic events being organized regularly across the country as well as the adoption of National Sepsis Guidelines. The struggle to create more awareness about sepsis continues

Predicting interethnic bridging social capital in youth ethnic-diversity engagement: the role of interethnic interaction and intercultural sensitivity

In this study, the authors examined the relationships between interethnic interaction, intercultural sensitivity and interethnic bridging social capital among students of different ethnicities at a Malaysian public university. Results of the regression analysis on data from 447 self-administered questionnaires revealed that while interethnic interaction and intercultural sensitivity are significantly correlated with interethnic bridging social capital at the bivariate level, only intercultural sensitivity has a direct relationship and significantly predicts interethnic bridging social capital. The finding underscores the role of intercultural sensitivity on interethnic bridging social capital development through ethnic diversity engagement

794 Evaluating disability in adult burn injury patients treated at a tertiary-care burn unit in Karachi, Pakistan: a longitudinal study using who disability assessment schedule II

Abstract Background Disability after burn injury is not assessed in the context of Pakistan. This study assesses disability among adult burn injury patients presenting to a burn unit in Karachi, Pakistan. Methods This longitudinal study was conducted at a burn centre is Karachi, Pakistan. Adult patients(\u3e18 years) who were discharge after 24-hour admission were enrolled from August 2014–March 2015. Baseline assessment before discharge and follow-up at 2,6 and 12 weeks after discharge via telephone was done using 12-item WHODAS 2.0 (5 -point likert-scale; 1 = none; 2 = mild; 3 = moderate; 4 = severe; and 5 = extreme) related to cognition, mobility, self-care, getting along, life activities and participation. The score range was 12–60 with higher score being worse. Ethical approval was taken from collaborating and participating sites. Results Of the 59 eligible patients, 53 completed all follow-ups. There were 69.8% males. Mean age of all patients was 36.8 ± 14.0 years, 71.7% were married and 17.0% had no/informal education. About half the patients were breadwinners. More than half of burn incidents occurred at home. Flame burns (50.9%) and scalds (17%) were the most common type of burns. The average surface area burnt was 43.0 ± 14.2%. The mean-scores for all patients at baseline, 2-week, 6-week and 12-week were 13.9 ± 4.9, 35.3 ± 13.8, 26.8 ± 11.9 and 20.1 ± 9.1, respectively. The mean-scores for males were lower than that of females for the four assessments (Males: 13.5 ± 1.8, 34.2 ± 14.1, 25.3 ± 10.7, 19.2 ± 8.4 and females: 16.1 ± 8.5, 37.3 ± 13.3, 30.5 ± 14.4, 22.1 ± 10.6). The two-week score was higher for those with \u3e15% burn(36.7 ± 13.9) compared to those with ≤15% burn(34.6 ± 14.2) while the score were similar at 12-week follow-up. Conclusions This analysis shows that the burn injury patients tend to recover from their injury over a period of 12 weeks after discharge. Future work should focus on larger group of patients and long term follow-up at one and two years after burn injury

A review of critical care management of maternal sepsis

Sepsis is a leading cause of preventable maternal mortality in developing countries due to poverty, home deliveries by untrained persons in unhygienic conditions, limited access to healthcare facilities and lack of availability of antibiotics. Recent confidential enquiries into maternal deaths from the developed nations have revealed an increase in maternal mortality secondary to genital tract sepsis and provision of suboptimal critical care. Early recognition of critical illness in obstetric patients, involvement of intensive care teams earlier and provision of same standard of critical care to pregnant women as non-pregnant patients while being mindful of the altered maternal physiology and fetal wellbeing is necessary to improve outcome of this vulnerable population. This article reviews the definitions and risk factors of maternal sepsis and describes the standards recommended for efficient delivery of maternal critical care and sepsis management

Anticipated and unanticipated complications of severe dengue in a primigravida

As the incidence of dengue is rising among adults more cases of dengue fever are being reported during pregnancy. Physiological changes of pregnancy mask the pathognomonic features of severe dengue such as increased hematocrit, thrombocytopenia, and leukopenia and a high index of suspicion are required in endemic areas. Massive hemorrhage may complicate operative deliveries in unsuspected patients. World Health Organization recommends that all patients with severe dengue should be admitted to a hospital with access to intensive care facilities and blood transfusion. We present the successful management of hemorrhage and unanticipated complications of severe dengue in a young primigravida admitted to the Intensive Care Unit after an emergency cesarean section

Optic nerve sheath diameter evaluated by transorbital sonography in healthy volunteers from Pakistan

Objective: Raised intracranial pressure (ICP) is a common manifestation of severe brain injury. Rapid diagnosis and timely intervention is required to prevent secondary brain damage and death. Measurement of optic nerve sheath diameter (ONSD) by ultrasound is increasingly used as a marker to detect raised ICP. Knowledge of normal ONSD in a healthy population is essential to interpret this measurement. We aimed to evaluate normal optic nerve sheath diameter in healthy volunteers in Pakistan. Methodology: It was a prospective, observational study in which one hundred healthy volunteers of Pakistani origin, aged more than 18 years were recruited in the study. The ultrasound probe was placed on the superior and lateral aspect of the orbit against the upper eyelid with the eye closed. For each subject, the primary investigator performed three measurements on each eye. The measurements of each eye were then averaged to yield a mean ONSD. Results: The median ONSD of right eye was 4.84 mm and 95% of individuals had mean ONSD in the range 4.84–4.97 mm while the median ONSD of left eye was 4.86 mm and 95% of individuals had mean ONSD in the range 4.85–4.96 mm. There was no difference among the 3 repeated measures of ONSD in each eye. There was no relationship between ONSD with age, gender and measurement taken between left and right eyes. Conclusion: 95% of study sample have an ONSD less than 4.82 mm. ONSD more than 4.82 mm in this population should be considered abnormal and may reflect raised intracranial pressure

A six-month retrospective study of resources burden by trauma victims in the surgical intensive care unit of a university hospital in Pakistan

Introduction: Trauma is the fourth leading cause of death globally and constitutes a huge burden on limited critical care resources. Aim This study aimed to identify the trauma patient burden in terms of resources used in the surgical intensive care unit (SICU) of Aga Khan University Hospital in Pakistan which also included characteristics and outcomes of trauma and non-trauma patients.Methods: We retrospectively reviewed all patient data for adult patients (\u3e16 years old) admitted to the SICU from July through December 2014.Results: Of 141 SICU cases included in our study period, 32 (22.7%) trauma patients were identified. On further stratification of trauma patients, road traffic injuries (43.8%), gunshot injuries (43.8%), and blast injuries (6.3%) were the most common, and about 73% of all trauma patients underwent emergency surgical interventions, comprising a huge burden on all resources. The average age of the trauma patients was significantly lower than non-trauma patients (36 years ± 13 vs. 49 years ± 19; p \u3c 0.01). The male-to-female ratio was 7:1 in trauma cases and 2:1 in non-trauma cases (p = 0.019). There was no statistically significant difference in mortality (31.3% vs. 42.2% p \u3e 0.05) and median length of stay [Median (interquartile range), 5(8) vs. 4(7); p \u3e 0.05] between trauma and non-trauma patients.Conclusions: Trauma constitutes a significant burden in terms of resources used for the SICU of the Aga Khan University, Pakistan. Trauma victims are predominantly young men in whom gunshot injuries are as common as road traffic injuries. Emergency surgical interventions comprise the largest draw on resources, followed by use of blood products, radiological, and laboratory investigations

Rare presentation of posterior reversible encephalopathy syndrome (PRES) and neurogenic stunned myocardium in a patient after emergency cesarean section

Posterior Reversible Encephalopathy Syndrome (PRES) is clinically characterized by seizures, lethargy, nausea and visual impairment. These findings are thought to be due to vasogenic edema, predominantly in the posterior cerebral hemispheres and are reversible with appropriate management. Neurogenicstunned myocardium is a syndrome of reversible left ventricular dysfunction, associated with excessive sympathetic discharge states like pheochromocytoma, high-grade subarachnoid hemorrhage (SAH), status epilepticus and significant emotional stress. Here, we report a case of PRES and Neurogenic-stunned myocardium occurring simultaneously in a 25 year old primigravida at 34 weeks of gestation with twin pregnancy who presented to the emergency department with eclampsia and fetal distress. A careful review of literature did not return any report where these two conditions co-existed in an obstetric patient