Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 ... more Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 clinical data collection based on ISARIC/WHO Clinical Characterization Protocol. The near real-time data platform includes epidemiology, severity of illness, microbiology, treatment and outcomes of patients admitted with suspected or laboratory confirmed COVID19 infection to 67 intensive care and high dependency units across the country. Data has been extracted and analysed at regular intervals to inform stakeholders and improve care practices. This is our 28th report including all patients with suspected or confirmed COVID-19 from 26th March 2020 to 26th December 2021. Key findings from 8624 patients who met eligibility criteria, are as follows: [bullet] Median age of 60 years (IQR 50-70). [bullet] The most common symptoms were shortness of breath (n = 6428, 77.8%), fever (n = 6091, 73.8%), and Cough (n = 3354, 38.9%) [bullet] The most common comorbidity was hypertension followed by dia...
Objective: To compare the mean duration of atracurium induced neuromuscular blockade in minutes w... more Objective: To compare the mean duration of atracurium induced neuromuscular blockade in minutes when dosed according to real body weight (RBW) or ideal body weight (IBW) to obese patients undergoing abdominal surgeries under general anesthesia. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesiology, National hospital defense Lahore, From March 2015 to March 2016. Material and Methods: One hundred and fifty (150) patients were selected for this study and divided in to two equal groups (75 patients in each group), group-I (experimental group) and group-II (control group). Sample size was calculated with 80% power of test, 95% confidence interval taking mean and standard deviation of duration of atracurium induced neuromuscular blockade in minutes in both groups i.e. 74.6 ± 37.56 in real body weight group versus 40.02 ± 22.5 in ideal body weight group. Non probability consecutive sampling technique was used. SPSS version 16 was used for dat...
Background: General anesthesia and selective ventilation has long been the traditional anesthetic... more Background: General anesthesia and selective ventilation has long been the traditional anesthetic approach for video-assisted thoracoscopic surgery (VATS). However it may not always be necessary or feasible in a certain variety of patients. VATS under locoregional anesthesia and sedation has proved to be a safer and more efficacious alternative to general anesthesia, especially in cases deemed unfit for the latter.
Background: I-gel is a new supraglottic device, which is comparable with classical LMA for its se... more Background: I-gel is a new supraglottic device, which is comparable with classical LMA for its seal and ease of insertion. It has an additional port for insertion of gastric tube. We studied whether insertion of a gastric tube has any effect on the seal pressure of I-gel. The present study was conducted in 30 ASA I and II patients undergoing general anesthesia. The aim was to study the difference in the seal pressure of I-gel before and after insertion of gastric tube. Methods: Water lubricated I-gel was inserted in 30 patients 1 minute after induction of general anaesthesia with Propofol 2.5 mg/kg and rocuronium 0.6mg/kg I/V for muscle relaxation, according to the technique described in the manual. Seal pressure was measured using manometer before and after gastric tube insertion. Results: The subjects were 86.7% females and 13.3% males. 43.3% weighed <65kg. 83.3% belonged to ASA class I, and 16.7% belonged to ASA class II. Mean seal pressure was 23.3±8.0 millibar before gastric tube insertion through I-gel and 24.4±8.4 millibar after gastric tube. Paired sample t-test showed a P value = 0.2, which was not significant. Conclusion: Insertion of gastric tube did not influence the seal pressure of the I-gel device.
Recognized by Higher Education Commission (HEC) Permission granted by District Magistrate Islamab... more Recognized by Higher Education Commission (HEC) Permission granted by District Magistrate Islamabad for publication. General Information: The journal is published thrice a year in the months of April, August and December. Please direct inquiries regarding subscriptions, single copies and back issues, changes of addresses, and other correspondence to the Publications Office. Advertising inquiries should also be sent to the same address. See us at FACE BOOK, Twitter, Linked in and Medpedia All articles represent the opinions of the authors and do not reflect official policy of the journal. All rights are reserved to the publisher. No part of the journal may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, regarding, or via any retrieval system, without written permission from the publisher.
Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outco... more Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
Objective: To determine the frequency of epidural catheter migration and its relation with durati... more Objective: To determine the frequency of epidural catheter migration and its relation with duration in situ in patients receiving epidural analgesia during labor. Study Design: Descriptive case series. Place and Duration of Study: Hameed Latif Hospital Lahore from Jun 2014 to Dec 2014. Material and Methods: Extent of catheter migration was studied in 240 patients receiving epidural analgesia for labor analgesia. Epidural catheters were removed immediately after delivery and Duration of catheter in place and migration either inwards or outwards was noted for each. Data was stratified for duration of catheter placement into two groups. Group 1 with catheter placed for 330min. Results: 240 patients in labor were included in this study. Mean age was 26.60 ± 3.856. Mean distance of catheter migration was 2.92 ± 4.756 mm. 86 of the 240(35.8%) patients had catheter migration, inwards 25/86 (29.06%) while outwards in 61/86 (70.93%).Data was stratified for duration of catheter placement into...
'Euthanasia' or 'mercy killing' is a deliberate intervention undertaken with the express intentio... more 'Euthanasia' or 'mercy killing' is a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. The debate in favor of or against it is nothing new, but emanates from the days of Socrates, Plato and Hippocrates. Medical advances in the vital organ function support and treatments during later part of the twentieth century, and organ harvesting for transplantation have added newer dimension to this subject; whereas, religious teachings may not favor individual wishes. Financial and social cost of sustaining life of a incurable patient may force us to take unpopular decisions. The debate about euthanasia continues and is likely to continue for the times to come.
Objective: To determine the frequency of stroke associated pneumonia in Intensive Care Unit patie... more Objective: To determine the frequency of stroke associated pneumonia in Intensive Care Unit patients, and its impact on economical cost and length of hospital stay. Study Design: Descriptive case series study. Place and Duration of Study: Intensive Care Unit-National Hospital and Medical Centre Lahore, during Aug 2017 to Sep 2018. Methodology: The cases of acute stroke were selected on the basis of clinical symptoms and computed tomography (CT) scan findings irrespective of the gender with age >30 years. Stroke associated pneumonia was labelled on the basis of consensus definition of stroke group. Results: In this study out of total 80 cases 60% were males, mean age of the participants was 62.01 ± 9.79 years Ischemic stroke was seen in 75%. Stroke associated pneumonia was observed in 10 (12.5%) cases. Stroke associated pneumonia was significantly high in cases with haemorrhagic stroke where this was seen in 30% of the cases (p=0.006). This difference was also statistically signif...
Objective: The objective of the study was to determine if injecting 10 ml saline before threading... more Objective: The objective of the study was to determine if injecting 10 ml saline before threading epidural catheter can decrease the accidental intravascular placement in epidural space. Study Design: Interventional: experimental study.
Purpose: To describe the extent and variation of critical care services in Pakistan Materials and... more Purpose: To describe the extent and variation of critical care services in Pakistan Materials and methods: A cross-sectional survey was conducted in all CCUs recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results: There were 220 CCUs registered for training, providing 2166 CCU beds and 1473 ventilators. Regional distribution of CCU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units, giving a ratio of one trained intensivist for every 82 CCU beds and 0.009 trained intensivists per 100,000 population. One to one nurse to bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. All CCUs had basic infrastructure (electricity, running ...
Objective: To compare the mean consumption of equipotent doses of tramadol and nalbuphine for fir... more Objective: To compare the mean consumption of equipotent doses of tramadol and nalbuphine for first 12 hours of post-operative analgesia, in patients undergoing gynaecological laparotomies. Study Design: Randomized clinical trial. Place and Durration of Study: Hameed Latif Hospital Lahore from 6 months. Materials and Methods: One hundred American society of anaesthesiologists (ASA) I & II, consenting females, ages between 20 and 50 years were divided randomly into two equal groups. All patients were given a loading dose of either tramadol (1.5mg/kg) or nalbuphine (0.15mg/kg) after the induction of anesthesia. Same drug was continued as baseline infusion; tramadol 0.5mg/kg or nalbuphine 0.05mg/kg respectively was given as a bolus whenever the visual analogue scale (VAS) score was ≥3. Total dose given in bolus was calculated and compared. Time at the instant of first demand of analgesia in postop was also noted in both groups. Results: Mean SD dose of rescue boluses in Tramadol group ...
Introduction: Post-operative nausea and vomiting (PONV) is one of the important complications aft... more Introduction: Post-operative nausea and vomiting (PONV) is one of the important complications after laparoscopic surgery resulting in patient dissatisfaction and consumption of healthcare resources. Objectives: We compared the efficacy of dexamethasone and ondansetron in preventing post operative nausea and vomiting in gynaecological laparoscopic surgeries. Methods: After approval from ethical committee and informed consent, the patients were randomly assigned to receive dexamethasone 8 mg or ondansetron 4 mg i.v. at induction. Postoperative PONV scores, pain scores, morphine consumption and Richmond Agitation sedation scores were compared one hourly for 6 hours and at 12 and 24 hours. Results: Both patient groups were similar in age, weight, height, duration of surgery and ASA distribution. No difference was observed in PONV scores at 1 hour (p=0.33), 2-3 hours (p=0.27), 4-6 hours (p=0.13) and 7-12 hours (test p=0.48); first episode of vomiting (4.87 sd ±2.29 vs. 4.29 sd ±1.32 hour...
neglect-to-attain-the-SDGs-NTD-Roadmap.pdf (accessed Nov 12, 2020). 4 Anderson RM, May RM. Popula... more neglect-to-attain-the-SDGs-NTD-Roadmap.pdf (accessed Nov 12, 2020). 4 Anderson RM, May RM. Population dynamics of human helminth infections: control by chemotherapy. Nature 1982; 297: 557-63. 5 Werkman M, Wright JE, Truscott JE, et al. The impact of community-wide, mass drug administration on aggregation of soil-transmitted helminth infection in human host populations.
Objective: To determine the outcomes of patients discharged from a general intensive care unit on... more Objective: To determine the outcomes of patients discharged from a general intensive care unit one month after discharge. Study Design: Descriptive case series. Place and Duration of Study: Intensive Care Unit - National Hospital and Medical Centre Lahore, from Jan 2018to Dec 2018. Methodology: All patients of both genders and age more than 12 years were included. Follow up was donethrough a phone call to the contact number provided, one-month post intensive care unit discharge. Information regarding outcome i.e. survival, bed bound state, degree of dependence for day to day activities and return to routine life. Results: A total of 106 cases were recruited, out of which 55.7% were male and 44.3% female; mean age was56.86 ± 23.16 years. At 1-month intensive care unit discharge 8.49% of the patients were dead; 73.58% cases hadreturned to pre intensive care unit admission routines, 11.32% were partially dependent on someone, 6.6% were bed bound. Death and bed bounding was highest in 6...
Purpose: To describe the extent and variation of critical care services in Pakistan. Materials an... more Purpose: To describe the extent and variation of critical care services in Pakistan. Materials and methods: A cross-sectional survey was conducted in all intensive care units (ICUs) recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results: There were 151 hospitals recognised for training, providing 2166 ICU beds and 1473 ventilators. Regional distribution of ICU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units. One-to-one nurse-to-bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. Similarly, there was disparity in the availability of ventilators between provinces. All ICUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (electronic monitoring and infusion pumps). Conclusion: Pakistan, a lower middle-income country, has an established network of critical care facilities with access to basic equipment, but inequalities in its distribution. Investment in critical care training for doctors and nurses is needed.
Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 ... more Pakistan Registry of Intensive Care (PRICE) is a platform that has enabled standardized COVID-19 clinical data collection based on ISARIC/WHO Clinical Characterization Protocol. The near real-time data platform includes epidemiology, severity of illness, microbiology, treatment and outcomes of patients admitted with suspected or laboratory confirmed COVID19 infection to 67 intensive care and high dependency units across the country. Data has been extracted and analysed at regular intervals to inform stakeholders and improve care practices. This is our 28th report including all patients with suspected or confirmed COVID-19 from 26th March 2020 to 26th December 2021. Key findings from 8624 patients who met eligibility criteria, are as follows: [bullet] Median age of 60 years (IQR 50-70). [bullet] The most common symptoms were shortness of breath (n = 6428, 77.8%), fever (n = 6091, 73.8%), and Cough (n = 3354, 38.9%) [bullet] The most common comorbidity was hypertension followed by dia...
Objective: To compare the mean duration of atracurium induced neuromuscular blockade in minutes w... more Objective: To compare the mean duration of atracurium induced neuromuscular blockade in minutes when dosed according to real body weight (RBW) or ideal body weight (IBW) to obese patients undergoing abdominal surgeries under general anesthesia. Study Design: Randomized controlled trial. Place and Duration of Study: Department of Anesthesiology, National hospital defense Lahore, From March 2015 to March 2016. Material and Methods: One hundred and fifty (150) patients were selected for this study and divided in to two equal groups (75 patients in each group), group-I (experimental group) and group-II (control group). Sample size was calculated with 80% power of test, 95% confidence interval taking mean and standard deviation of duration of atracurium induced neuromuscular blockade in minutes in both groups i.e. 74.6 ± 37.56 in real body weight group versus 40.02 ± 22.5 in ideal body weight group. Non probability consecutive sampling technique was used. SPSS version 16 was used for dat...
Background: General anesthesia and selective ventilation has long been the traditional anesthetic... more Background: General anesthesia and selective ventilation has long been the traditional anesthetic approach for video-assisted thoracoscopic surgery (VATS). However it may not always be necessary or feasible in a certain variety of patients. VATS under locoregional anesthesia and sedation has proved to be a safer and more efficacious alternative to general anesthesia, especially in cases deemed unfit for the latter.
Background: I-gel is a new supraglottic device, which is comparable with classical LMA for its se... more Background: I-gel is a new supraglottic device, which is comparable with classical LMA for its seal and ease of insertion. It has an additional port for insertion of gastric tube. We studied whether insertion of a gastric tube has any effect on the seal pressure of I-gel. The present study was conducted in 30 ASA I and II patients undergoing general anesthesia. The aim was to study the difference in the seal pressure of I-gel before and after insertion of gastric tube. Methods: Water lubricated I-gel was inserted in 30 patients 1 minute after induction of general anaesthesia with Propofol 2.5 mg/kg and rocuronium 0.6mg/kg I/V for muscle relaxation, according to the technique described in the manual. Seal pressure was measured using manometer before and after gastric tube insertion. Results: The subjects were 86.7% females and 13.3% males. 43.3% weighed <65kg. 83.3% belonged to ASA class I, and 16.7% belonged to ASA class II. Mean seal pressure was 23.3±8.0 millibar before gastric tube insertion through I-gel and 24.4±8.4 millibar after gastric tube. Paired sample t-test showed a P value = 0.2, which was not significant. Conclusion: Insertion of gastric tube did not influence the seal pressure of the I-gel device.
Recognized by Higher Education Commission (HEC) Permission granted by District Magistrate Islamab... more Recognized by Higher Education Commission (HEC) Permission granted by District Magistrate Islamabad for publication. General Information: The journal is published thrice a year in the months of April, August and December. Please direct inquiries regarding subscriptions, single copies and back issues, changes of addresses, and other correspondence to the Publications Office. Advertising inquiries should also be sent to the same address. See us at FACE BOOK, Twitter, Linked in and Medpedia All articles represent the opinions of the authors and do not reflect official policy of the journal. All rights are reserved to the publisher. No part of the journal may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, regarding, or via any retrieval system, without written permission from the publisher.
Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outco... more Summary Background Geoeconomic variations in epidemiology, the practice of ventilation, and outcome in invasively ventilated intensive care unit (ICU) patients without acute respiratory distress syndrome (ARDS) remain unexplored. In this analysis we aim to address these gaps using individual patient data of four large observational studies. Methods In this pooled analysis we harmonised individual patient data from the ERICC, LUNG SAFE, PRoVENT, and PRoVENT-iMiC prospective observational studies, which were conducted from June, 2011, to December, 2018, in 534 ICUs in 54 countries. We used the 2016 World Bank classification to define two geoeconomic regions: middle-income countries (MICs) and high-income countries (HICs). ARDS was defined according to the Berlin criteria. Descriptive statistics were used to compare patients in MICs versus HICs. The primary outcome was the use of low tidal volume ventilation (LTVV) for the first 3 days of mechanical ventilation. Secondary outcomes were key ventilation parameters (tidal volume size, positive end-expiratory pressure, fraction of inspired oxygen, peak pressure, plateau pressure, driving pressure, and respiratory rate), patient characteristics, the risk for and actual development of acute respiratory distress syndrome after the first day of ventilation, duration of ventilation, ICU length of stay, and ICU mortality. Findings Of the 7608 patients included in the original studies, this analysis included 3852 patients without ARDS, of whom 2345 were from MICs and 1507 were from HICs. Patients in MICs were younger, shorter and with a slightly lower body-mass index, more often had diabetes and active cancer, but less often chronic obstructive pulmonary disease and heart failure than patients from HICs. Sequential organ failure assessment scores were similar in MICs and HICs. Use of LTVV in MICs and HICs was comparable (42·4% vs 44·2%; absolute difference –1·69 [–9·58 to 6·11] p=0·67; data available in 3174 [82%] of 3852 patients). The median applied positive end expiratory pressure was lower in MICs than in HICs (5 [IQR 5–8] vs 6 [5–8] cm H2O; p=0·0011). ICU mortality was higher in MICs than in HICs (30·5% vs 19·9%; p=0·0004; adjusted effect 16·41% [95% CI 9·52–23·52]; p<0·0001) and was inversely associated with gross domestic product (adjusted odds ratio for a US$10 000 increase per capita 0·80 [95% CI 0·75–0·86]; p<0·0001). Interpretation Despite similar disease severity and ventilation management, ICU mortality in patients without ARDS is higher in MICs than in HICs, with a strong association with country-level economic status. Funding No funding.
Objective: To determine the frequency of epidural catheter migration and its relation with durati... more Objective: To determine the frequency of epidural catheter migration and its relation with duration in situ in patients receiving epidural analgesia during labor. Study Design: Descriptive case series. Place and Duration of Study: Hameed Latif Hospital Lahore from Jun 2014 to Dec 2014. Material and Methods: Extent of catheter migration was studied in 240 patients receiving epidural analgesia for labor analgesia. Epidural catheters were removed immediately after delivery and Duration of catheter in place and migration either inwards or outwards was noted for each. Data was stratified for duration of catheter placement into two groups. Group 1 with catheter placed for 330min. Results: 240 patients in labor were included in this study. Mean age was 26.60 ± 3.856. Mean distance of catheter migration was 2.92 ± 4.756 mm. 86 of the 240(35.8%) patients had catheter migration, inwards 25/86 (29.06%) while outwards in 61/86 (70.93%).Data was stratified for duration of catheter placement into...
'Euthanasia' or 'mercy killing' is a deliberate intervention undertaken with the express intentio... more 'Euthanasia' or 'mercy killing' is a deliberate intervention undertaken with the express intention of ending a life, to relieve intractable suffering. The debate in favor of or against it is nothing new, but emanates from the days of Socrates, Plato and Hippocrates. Medical advances in the vital organ function support and treatments during later part of the twentieth century, and organ harvesting for transplantation have added newer dimension to this subject; whereas, religious teachings may not favor individual wishes. Financial and social cost of sustaining life of a incurable patient may force us to take unpopular decisions. The debate about euthanasia continues and is likely to continue for the times to come.
Objective: To determine the frequency of stroke associated pneumonia in Intensive Care Unit patie... more Objective: To determine the frequency of stroke associated pneumonia in Intensive Care Unit patients, and its impact on economical cost and length of hospital stay. Study Design: Descriptive case series study. Place and Duration of Study: Intensive Care Unit-National Hospital and Medical Centre Lahore, during Aug 2017 to Sep 2018. Methodology: The cases of acute stroke were selected on the basis of clinical symptoms and computed tomography (CT) scan findings irrespective of the gender with age >30 years. Stroke associated pneumonia was labelled on the basis of consensus definition of stroke group. Results: In this study out of total 80 cases 60% were males, mean age of the participants was 62.01 ± 9.79 years Ischemic stroke was seen in 75%. Stroke associated pneumonia was observed in 10 (12.5%) cases. Stroke associated pneumonia was significantly high in cases with haemorrhagic stroke where this was seen in 30% of the cases (p=0.006). This difference was also statistically signif...
Objective: The objective of the study was to determine if injecting 10 ml saline before threading... more Objective: The objective of the study was to determine if injecting 10 ml saline before threading epidural catheter can decrease the accidental intravascular placement in epidural space. Study Design: Interventional: experimental study.
Purpose: To describe the extent and variation of critical care services in Pakistan Materials and... more Purpose: To describe the extent and variation of critical care services in Pakistan Materials and methods: A cross-sectional survey was conducted in all CCUs recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results: There were 220 CCUs registered for training, providing 2166 CCU beds and 1473 ventilators. Regional distribution of CCU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units, giving a ratio of one trained intensivist for every 82 CCU beds and 0.009 trained intensivists per 100,000 population. One to one nurse to bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. All CCUs had basic infrastructure (electricity, running ...
Objective: To compare the mean consumption of equipotent doses of tramadol and nalbuphine for fir... more Objective: To compare the mean consumption of equipotent doses of tramadol and nalbuphine for first 12 hours of post-operative analgesia, in patients undergoing gynaecological laparotomies. Study Design: Randomized clinical trial. Place and Durration of Study: Hameed Latif Hospital Lahore from 6 months. Materials and Methods: One hundred American society of anaesthesiologists (ASA) I & II, consenting females, ages between 20 and 50 years were divided randomly into two equal groups. All patients were given a loading dose of either tramadol (1.5mg/kg) or nalbuphine (0.15mg/kg) after the induction of anesthesia. Same drug was continued as baseline infusion; tramadol 0.5mg/kg or nalbuphine 0.05mg/kg respectively was given as a bolus whenever the visual analogue scale (VAS) score was ≥3. Total dose given in bolus was calculated and compared. Time at the instant of first demand of analgesia in postop was also noted in both groups. Results: Mean SD dose of rescue boluses in Tramadol group ...
Introduction: Post-operative nausea and vomiting (PONV) is one of the important complications aft... more Introduction: Post-operative nausea and vomiting (PONV) is one of the important complications after laparoscopic surgery resulting in patient dissatisfaction and consumption of healthcare resources. Objectives: We compared the efficacy of dexamethasone and ondansetron in preventing post operative nausea and vomiting in gynaecological laparoscopic surgeries. Methods: After approval from ethical committee and informed consent, the patients were randomly assigned to receive dexamethasone 8 mg or ondansetron 4 mg i.v. at induction. Postoperative PONV scores, pain scores, morphine consumption and Richmond Agitation sedation scores were compared one hourly for 6 hours and at 12 and 24 hours. Results: Both patient groups were similar in age, weight, height, duration of surgery and ASA distribution. No difference was observed in PONV scores at 1 hour (p=0.33), 2-3 hours (p=0.27), 4-6 hours (p=0.13) and 7-12 hours (test p=0.48); first episode of vomiting (4.87 sd ±2.29 vs. 4.29 sd ±1.32 hour...
neglect-to-attain-the-SDGs-NTD-Roadmap.pdf (accessed Nov 12, 2020). 4 Anderson RM, May RM. Popula... more neglect-to-attain-the-SDGs-NTD-Roadmap.pdf (accessed Nov 12, 2020). 4 Anderson RM, May RM. Population dynamics of human helminth infections: control by chemotherapy. Nature 1982; 297: 557-63. 5 Werkman M, Wright JE, Truscott JE, et al. The impact of community-wide, mass drug administration on aggregation of soil-transmitted helminth infection in human host populations.
Objective: To determine the outcomes of patients discharged from a general intensive care unit on... more Objective: To determine the outcomes of patients discharged from a general intensive care unit one month after discharge. Study Design: Descriptive case series. Place and Duration of Study: Intensive Care Unit - National Hospital and Medical Centre Lahore, from Jan 2018to Dec 2018. Methodology: All patients of both genders and age more than 12 years were included. Follow up was donethrough a phone call to the contact number provided, one-month post intensive care unit discharge. Information regarding outcome i.e. survival, bed bound state, degree of dependence for day to day activities and return to routine life. Results: A total of 106 cases were recruited, out of which 55.7% were male and 44.3% female; mean age was56.86 ± 23.16 years. At 1-month intensive care unit discharge 8.49% of the patients were dead; 73.58% cases hadreturned to pre intensive care unit admission routines, 11.32% were partially dependent on someone, 6.6% were bed bound. Death and bed bounding was highest in 6...
Purpose: To describe the extent and variation of critical care services in Pakistan. Materials an... more Purpose: To describe the extent and variation of critical care services in Pakistan. Materials and methods: A cross-sectional survey was conducted in all intensive care units (ICUs) recognised for postgraduate training to determine administration, infrastructure, equipment, staffing, and training. Results: There were 151 hospitals recognised for training, providing 2166 ICU beds and 1473 ventilators. Regional distribution of ICU beds per 100,000 population ranged from 1.0 in Sindh to none in Gilgit Baltistan (median 0.7). A senior clinician trained in critical care was available in 19 (12.1%) of units. One-to-one nurse-to-bed ratio during the day was available in 84 (53.5%) of units, dropping to 75 (47.8%) at night. Availability of 1:1 nursing also varied between provinces, ranging from 56.5% in Punjab compared to 0% in Azad Jamu Kashmir. Similarly, there was disparity in the availability of ventilators between provinces. All ICUs had basic infrastructure (electricity, running water, piped oxygen) and basic equipment (electronic monitoring and infusion pumps). Conclusion: Pakistan, a lower middle-income country, has an established network of critical care facilities with access to basic equipment, but inequalities in its distribution. Investment in critical care training for doctors and nurses is needed.
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