Background & Objective: Diabetes mellitus is widely prevalent and significantly impacts the perio... more Background & Objective: Diabetes mellitus is widely prevalent and significantly impacts the perioperative outcome. We aimed to assess the perioperative practice for managing diabetes mellitus patients and variation across different establishments. Methodology: A questionnaire-based online survey was conducted for the present cross-sectional, multinational study; data collection followed a snowball method and was conducted from November 2020 to January 2021. Responses were presented in absolute number and percentage scale, and response rates among the subgroups were analyzed using Fisher’s exact test; p < 0.05 was considered significant. Results: Responses from 556 out of 637 from six South Asian Association for Regional Cooperation countries were analyzed. A considerable amount of practice variation was noted; variation increased as the invasiveness of surgery increased. Perioperative insulin administration strategy and case postponement based on blood sugar level differed betwee...
This is a century of corona virus. The world is still coping up with the third wave of COVID-19, ... more This is a century of corona virus. The world is still coping up with the third wave of COVID-19, while the scientists have already warned that a fourth wave is imminent. This wave is expected to be more lethal due to multiple mutated variety of the corona virus, including one of the most lethal one known as Indian variant or delta variant. Meanwhile, the health staff has to deal with those patients who survived COVID-19, but continued to have a variety of new complaints, including respiratory distress, dysautonomia, intravascular thrombosis and endocardial myocarditis etc. Anti-corona therapy, in itself lead to multiple syndromes including acute kidney injury, bone marrow depression and deranged blood sugar levels. One of the more lethal complication is mucormycosis-a fungal disease. It has effected thousands of recovering or recovered corona patients in India. This editorial highlights the salient features of post-corona syndrome or long covid. Key words: COVID-19; Genome; Mutation...
Cardiopulmonary resuscitation (CPR) is a part of physiology curriculum, which is taught in the fi... more Cardiopulmonary resuscitation (CPR) is a part of physiology curriculum, which is taught in the first two years of medical education. In the next three years medical undergraduates study the diseases and their treatment, which also includes cardiac and/or pulmonary arrest due to any cause, and its management.
The number of cancer patients has been steadily increasing and with it the number of cancer relat... more The number of cancer patients has been steadily increasing and with it the number of cancer related pain patients is also increasing. Cancer pain (CP) is the most unique and versatile pain, regarding type, intensity, site, variations and the needed management modalities. No one pain specialist or the pain center can be capable of adequately manage every cancer patient. In this background, an idea to confront this menace at a national level with a combined effort is presented. If implemented it is hoped that the CP patients will get rid of at least the worry about their excruciating pain. The idea of the ‘Cancer Pain Initiative’ has been in circulation for quite some time, but needs to be discussed at various levels. Key words: Cancer; Cancer pain; Pain management Citation: Khan TH. Cancer, cancer pain and the ‘Cancer Pain Initiative’. Anaesth. pain intensive care 2021;25(2):126–12. DOI: 10.35975/apic.v25i2.1482
The anaesthetists are probably the only specialists in healthcare facilities in this country. The... more The anaesthetists are probably the only specialists in healthcare facilities in this country. The drug might the practice of medicine who administer drugs well have to be used only a few times in the life time of (almost always intravenously) and observe its effects a professional anaesthetist, but its presence in his on different physiological or pathological phenomena armamentarium will ensure that no patient will ever in a patient. The art of administering anaesthesia is die just because of its non-availability. really an induction of an unnatural state to facilitate Almost all textbooks of anaesthesia advocate surgical procedures and in itself involves many ephedrine as the drug of choice to counter the systemic changes in the body of the recipient. Hence, postspinal hypotension. Yet only select centres induction of general anaesthesia as well as spinal manage to procure this important vasoconstrictor; analgesia is usually associated with hypotension and the drug is not availabl...
The incidence of transfusion has increased day by day due to many factors, including increasing p... more The incidence of transfusion has increased day by day due to many factors, including increasing population, enhanced expertise and facilities to operate once inoperable conditions and the willingness of the public to pay high cost of advanced surgical procedures. Trauma services have been well-organized now and victims may have massive transfusion. Many authors have pointed out the need of protocols and guidelines to be followed to avoid transfusion associated risks and complications. Under-transfusion has been preferred to over-transfusion and a need to have a ‘Maximum Surgical Blood Order Schedule’ has been stressed. Citation: Khan TH. Transfusion, under-transfusion and over-transfusion. Anaesth Pain & Intensive Care 2013;17(1):1-3
Pain is usually regarded as of two types, pain caused by tissue damage, also called nociceptive p... more Pain is usually regarded as of two types, pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A less known third category is psychogenic pain, which becomes an integral part, in due course of time, of the first two types. It is pain that is affected by psychological factors. Pain physicians tens to focus usually on the first, less commonly on the second and very rarely on the last type of pain. This ignorance may be the prime factor in failure of otherwise more rational pain management regimen. It needs to be adequately addressed, and expert help from qualified psychologist and/or a psychiatrist may be required in selected patients to incorporate body-mind techniques in the pain management.Citation: Khan TH.Another dimension of pain. Anaesth Pain & Intensive Care 2015;19(1):1-2
Professor Dr. Mehdi Hassan Mumtaz is a name that stands out amongst others as the most significan... more Professor Dr. Mehdi Hassan Mumtaz is a name that stands out amongst others as the most significant anesthesiologist and intensivist of the country. He was the first to commission an intensive care unit (ICU), at Nishtar Hospital Multan (Pakistan) in 1981. It was first such unit in the country He was the founder president of Pakistan Society of Intensive Care. He innovated the technique of combined spinal epidural (CSE-SST), also called Epispinal, in 1982. This technique has been used all over the world now. Dr. Mehdi is one of the finest teachers in anesthesiology today. He trained a lot many anesthesiologists who are holding key positions in anesthesiology departments in the country as well as abroad, and continuing his hard work.
We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/i... more We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/internal fixationof humerus fracture under general anesthesia. Isoflurane has been reported as a potent triggering agent of malignanthyperthermia. Dantrolene remains the gold standard for treating this life threatening syndrome but it is not availablein many countries including Pakistan. However, we successfully managed our patient by timely recognition of thissyndrome and administering prompt and effective symptomatic treatment.
Background: The efficacy of carotid endarterectomy (CEA) has been validated by several multicentr... more Background: The efficacy of carotid endarterectomy (CEA) has been validated by several multicentre, randomized trials. At present, comparative studies are mounting insight into the role of carotid angioplasty and stenting (CAS), also optimizing patient selection based on factors identification.CAS has been proposed as an alternative to CEA for the treatment of carotid endarterectomy. Aim: To equate the safety and efficacy of endovascular techniques i.e. CAS and CEA with surgery for carotid stenosis, we implemented a systematic review and meta-analysis of randomized controlled trials. Methods: We recognized 8 trials randomizing a total of 2250 patients; 1123 to CEA and 1127 to CAS. Search was made through various databases i.e., PubMed, MEDLINE etc, to identify randomized controlled trials comparing CAS with CEA. To calculate the pooled odds ratios (OR) and their confidence intervals, both fixed and random effects models were used. A lower value to one indicates benefit from endovasc...
It is with great sadness that we learn of Henk’s untimely death. Henk Haisma was a Dutch anesth... more It is with great sadness that we learn of Henk’s untimely death. Henk Haisma was a Dutch anesthesiologist of the highest order. During the late 1990s and early 2000s he was pivotal in the early growth and development of Primary Trauma Care (PTC). PTC was, in fact, his second love after anesthesiology.
Lisa Stearns, MD, Founder & Medical Director at Center for Pain and Supportive Care, Phoenix, USA... more Lisa Stearns, MD, Founder & Medical Director at Center for Pain and Supportive Care, Phoenix, USA, breathed her last on 31 May 2020 at her home in Mexico.As a physician, she was a valiant warrior. Her pursuit of novel methods, innovation, and creative approaches contributed widely to the practice of pain medicine globally. Courageous, stubbornly committed, and always compassionate, she was one of the heroes in the epidemic of pain and suffering.
Following the publication of the article entitled, ‘Lignocaine’s substantial role in COVID-19 man... more Following the publication of the article entitled, ‘Lignocaine’s substantial role in COVID-19 management: potential remedial and therapeutic implications’, authored by Nasser Ali Malik, Amjid Hammodi and Dayanidhi Jaiswara, published in the Anaesthesia, Pain and Intensive Care; 21(1);59-63, 2020, I would like to suggest a revolutionary idea that could help control the spread of respiratory viruses from person to person, achieve potential prophylaxis against them and even could be used as a treatment for mild to moderately infected cases.
The Covid-19 pandemic is the most severe global health crisis of our time and greatest challenge ... more The Covid-19 pandemic is the most severe global health crisis of our time and greatest challenge to mankind after World War II. A combination of therapies including vitamins, hydroxychloroquine, steroids, plasma therapy and immunomodulators have proved to be effective in symptomatic cases but no specific drug or vaccine has been developed to fight covid-19 till date. Till the time new vaccine rolls out, trials are evaluating the efficacy of BCG in fighting against Covid-19. The Covid-19 with its high propensity of transmission, especially through asymptomatic carriers has been spreading rapidly since the outbreak of the disease. With the existing lacunas in ongoing preventive and management strategies and increasing risk of community transmission, the role of development of herd immunity in control of covid-19 can play a major role.
Rheo Probe is a minimally invasive device, implanted in the brain matter for patients in a coma f... more Rheo Probe is a minimally invasive device, implanted in the brain matter for patients in a coma following brain haemorrage or traumatic brain injuries to measure cerebral blood flow, intracranial pressure, temperature and oxygenation parameters. Nearinfrared sensors assess levels of tissue oxygenation as well as cerebral blood flow by measuring oxygenated and deoxygenated hemoglobin based on spectrometry.
Alleviation of pain is a basic human right. And patients who experience the greatest pain and su... more Alleviation of pain is a basic human right. And patients who experience the greatest pain and suffering are the ones in the intensive care unit (ICU). Sedation allows to prevent the patients’ awareness and reduction of their response to various external stimuli. However, sedation is like a double-edged sword for ICU patients. Over-sedation can cause long-term ventilatory support and increase duration of ICU stay, whereas under-sedation can cause hyper-catabolism, immunosuppression, hypercoagulability and increased sympathetic activity. Pain is widely regarded as the fifth vital sign, and it induces a myriad of deleterious physiological changes in most organ systems. Pain can cause agitation, delirium, and inadequate pain management can have psychological sequelae like post-traumatic stress disorder, depression and anxiety or it can progress to chronic pain. In this review, we will focus on the role of sedation & analgesia in ICU, current practice trends and a holistic approach for ...
The term artificial intelligence (AI) was introduced in 1950. There have been many attempts to de... more The term artificial intelligence (AI) was introduced in 1950. There have been many attempts to develop machines capable of performing cognitive and skill based tasks of anesthesiologist based on the principles of AI. These attempts have not been successful because of the complexities of anesthesia practice. Recent innovations in AI, especially machine learning, will continue to grow in importance in the years to come and will greatly revolutionize the face of anesthesia along with surgical practice, perioperative medicine practiced in clinics, and imaging interpretation. Anesthesiologists should continue to embrace this technology, stay up to date with the advances in AI, and also make genuine efforts to smoothly assimilate it in their routine practice now so that they can be the revolutionaries of their own future. We hope to see an ever-widening spectrum of the uses of AI in all fields of medical practice, and anesthesiology is not an exception. Its time our friends start visualiz...
Background & Objective: Diabetes mellitus is widely prevalent and significantly impacts the perio... more Background & Objective: Diabetes mellitus is widely prevalent and significantly impacts the perioperative outcome. We aimed to assess the perioperative practice for managing diabetes mellitus patients and variation across different establishments. Methodology: A questionnaire-based online survey was conducted for the present cross-sectional, multinational study; data collection followed a snowball method and was conducted from November 2020 to January 2021. Responses were presented in absolute number and percentage scale, and response rates among the subgroups were analyzed using Fisher’s exact test; p < 0.05 was considered significant. Results: Responses from 556 out of 637 from six South Asian Association for Regional Cooperation countries were analyzed. A considerable amount of practice variation was noted; variation increased as the invasiveness of surgery increased. Perioperative insulin administration strategy and case postponement based on blood sugar level differed betwee...
This is a century of corona virus. The world is still coping up with the third wave of COVID-19, ... more This is a century of corona virus. The world is still coping up with the third wave of COVID-19, while the scientists have already warned that a fourth wave is imminent. This wave is expected to be more lethal due to multiple mutated variety of the corona virus, including one of the most lethal one known as Indian variant or delta variant. Meanwhile, the health staff has to deal with those patients who survived COVID-19, but continued to have a variety of new complaints, including respiratory distress, dysautonomia, intravascular thrombosis and endocardial myocarditis etc. Anti-corona therapy, in itself lead to multiple syndromes including acute kidney injury, bone marrow depression and deranged blood sugar levels. One of the more lethal complication is mucormycosis-a fungal disease. It has effected thousands of recovering or recovered corona patients in India. This editorial highlights the salient features of post-corona syndrome or long covid. Key words: COVID-19; Genome; Mutation...
Cardiopulmonary resuscitation (CPR) is a part of physiology curriculum, which is taught in the fi... more Cardiopulmonary resuscitation (CPR) is a part of physiology curriculum, which is taught in the first two years of medical education. In the next three years medical undergraduates study the diseases and their treatment, which also includes cardiac and/or pulmonary arrest due to any cause, and its management.
The number of cancer patients has been steadily increasing and with it the number of cancer relat... more The number of cancer patients has been steadily increasing and with it the number of cancer related pain patients is also increasing. Cancer pain (CP) is the most unique and versatile pain, regarding type, intensity, site, variations and the needed management modalities. No one pain specialist or the pain center can be capable of adequately manage every cancer patient. In this background, an idea to confront this menace at a national level with a combined effort is presented. If implemented it is hoped that the CP patients will get rid of at least the worry about their excruciating pain. The idea of the ‘Cancer Pain Initiative’ has been in circulation for quite some time, but needs to be discussed at various levels. Key words: Cancer; Cancer pain; Pain management Citation: Khan TH. Cancer, cancer pain and the ‘Cancer Pain Initiative’. Anaesth. pain intensive care 2021;25(2):126–12. DOI: 10.35975/apic.v25i2.1482
The anaesthetists are probably the only specialists in healthcare facilities in this country. The... more The anaesthetists are probably the only specialists in healthcare facilities in this country. The drug might the practice of medicine who administer drugs well have to be used only a few times in the life time of (almost always intravenously) and observe its effects a professional anaesthetist, but its presence in his on different physiological or pathological phenomena armamentarium will ensure that no patient will ever in a patient. The art of administering anaesthesia is die just because of its non-availability. really an induction of an unnatural state to facilitate Almost all textbooks of anaesthesia advocate surgical procedures and in itself involves many ephedrine as the drug of choice to counter the systemic changes in the body of the recipient. Hence, postspinal hypotension. Yet only select centres induction of general anaesthesia as well as spinal manage to procure this important vasoconstrictor; analgesia is usually associated with hypotension and the drug is not availabl...
The incidence of transfusion has increased day by day due to many factors, including increasing p... more The incidence of transfusion has increased day by day due to many factors, including increasing population, enhanced expertise and facilities to operate once inoperable conditions and the willingness of the public to pay high cost of advanced surgical procedures. Trauma services have been well-organized now and victims may have massive transfusion. Many authors have pointed out the need of protocols and guidelines to be followed to avoid transfusion associated risks and complications. Under-transfusion has been preferred to over-transfusion and a need to have a ‘Maximum Surgical Blood Order Schedule’ has been stressed. Citation: Khan TH. Transfusion, under-transfusion and over-transfusion. Anaesth Pain & Intensive Care 2013;17(1):1-3
Pain is usually regarded as of two types, pain caused by tissue damage, also called nociceptive p... more Pain is usually regarded as of two types, pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A less known third category is psychogenic pain, which becomes an integral part, in due course of time, of the first two types. It is pain that is affected by psychological factors. Pain physicians tens to focus usually on the first, less commonly on the second and very rarely on the last type of pain. This ignorance may be the prime factor in failure of otherwise more rational pain management regimen. It needs to be adequately addressed, and expert help from qualified psychologist and/or a psychiatrist may be required in selected patients to incorporate body-mind techniques in the pain management.Citation: Khan TH.Another dimension of pain. Anaesth Pain & Intensive Care 2015;19(1):1-2
Professor Dr. Mehdi Hassan Mumtaz is a name that stands out amongst others as the most significan... more Professor Dr. Mehdi Hassan Mumtaz is a name that stands out amongst others as the most significant anesthesiologist and intensivist of the country. He was the first to commission an intensive care unit (ICU), at Nishtar Hospital Multan (Pakistan) in 1981. It was first such unit in the country He was the founder president of Pakistan Society of Intensive Care. He innovated the technique of combined spinal epidural (CSE-SST), also called Epispinal, in 1982. This technique has been used all over the world now. Dr. Mehdi is one of the finest teachers in anesthesiology today. He trained a lot many anesthesiologists who are holding key positions in anesthesiology departments in the country as well as abroad, and continuing his hard work.
We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/i... more We encountered a case of malignant hyperthermia in a 52 year old male undergoing open reduction/internal fixationof humerus fracture under general anesthesia. Isoflurane has been reported as a potent triggering agent of malignanthyperthermia. Dantrolene remains the gold standard for treating this life threatening syndrome but it is not availablein many countries including Pakistan. However, we successfully managed our patient by timely recognition of thissyndrome and administering prompt and effective symptomatic treatment.
Background: The efficacy of carotid endarterectomy (CEA) has been validated by several multicentr... more Background: The efficacy of carotid endarterectomy (CEA) has been validated by several multicentre, randomized trials. At present, comparative studies are mounting insight into the role of carotid angioplasty and stenting (CAS), also optimizing patient selection based on factors identification.CAS has been proposed as an alternative to CEA for the treatment of carotid endarterectomy. Aim: To equate the safety and efficacy of endovascular techniques i.e. CAS and CEA with surgery for carotid stenosis, we implemented a systematic review and meta-analysis of randomized controlled trials. Methods: We recognized 8 trials randomizing a total of 2250 patients; 1123 to CEA and 1127 to CAS. Search was made through various databases i.e., PubMed, MEDLINE etc, to identify randomized controlled trials comparing CAS with CEA. To calculate the pooled odds ratios (OR) and their confidence intervals, both fixed and random effects models were used. A lower value to one indicates benefit from endovasc...
It is with great sadness that we learn of Henk’s untimely death. Henk Haisma was a Dutch anesth... more It is with great sadness that we learn of Henk’s untimely death. Henk Haisma was a Dutch anesthesiologist of the highest order. During the late 1990s and early 2000s he was pivotal in the early growth and development of Primary Trauma Care (PTC). PTC was, in fact, his second love after anesthesiology.
Lisa Stearns, MD, Founder & Medical Director at Center for Pain and Supportive Care, Phoenix, USA... more Lisa Stearns, MD, Founder & Medical Director at Center for Pain and Supportive Care, Phoenix, USA, breathed her last on 31 May 2020 at her home in Mexico.As a physician, she was a valiant warrior. Her pursuit of novel methods, innovation, and creative approaches contributed widely to the practice of pain medicine globally. Courageous, stubbornly committed, and always compassionate, she was one of the heroes in the epidemic of pain and suffering.
Following the publication of the article entitled, ‘Lignocaine’s substantial role in COVID-19 man... more Following the publication of the article entitled, ‘Lignocaine’s substantial role in COVID-19 management: potential remedial and therapeutic implications’, authored by Nasser Ali Malik, Amjid Hammodi and Dayanidhi Jaiswara, published in the Anaesthesia, Pain and Intensive Care; 21(1);59-63, 2020, I would like to suggest a revolutionary idea that could help control the spread of respiratory viruses from person to person, achieve potential prophylaxis against them and even could be used as a treatment for mild to moderately infected cases.
The Covid-19 pandemic is the most severe global health crisis of our time and greatest challenge ... more The Covid-19 pandemic is the most severe global health crisis of our time and greatest challenge to mankind after World War II. A combination of therapies including vitamins, hydroxychloroquine, steroids, plasma therapy and immunomodulators have proved to be effective in symptomatic cases but no specific drug or vaccine has been developed to fight covid-19 till date. Till the time new vaccine rolls out, trials are evaluating the efficacy of BCG in fighting against Covid-19. The Covid-19 with its high propensity of transmission, especially through asymptomatic carriers has been spreading rapidly since the outbreak of the disease. With the existing lacunas in ongoing preventive and management strategies and increasing risk of community transmission, the role of development of herd immunity in control of covid-19 can play a major role.
Rheo Probe is a minimally invasive device, implanted in the brain matter for patients in a coma f... more Rheo Probe is a minimally invasive device, implanted in the brain matter for patients in a coma following brain haemorrage or traumatic brain injuries to measure cerebral blood flow, intracranial pressure, temperature and oxygenation parameters. Nearinfrared sensors assess levels of tissue oxygenation as well as cerebral blood flow by measuring oxygenated and deoxygenated hemoglobin based on spectrometry.
Alleviation of pain is a basic human right. And patients who experience the greatest pain and su... more Alleviation of pain is a basic human right. And patients who experience the greatest pain and suffering are the ones in the intensive care unit (ICU). Sedation allows to prevent the patients’ awareness and reduction of their response to various external stimuli. However, sedation is like a double-edged sword for ICU patients. Over-sedation can cause long-term ventilatory support and increase duration of ICU stay, whereas under-sedation can cause hyper-catabolism, immunosuppression, hypercoagulability and increased sympathetic activity. Pain is widely regarded as the fifth vital sign, and it induces a myriad of deleterious physiological changes in most organ systems. Pain can cause agitation, delirium, and inadequate pain management can have psychological sequelae like post-traumatic stress disorder, depression and anxiety or it can progress to chronic pain. In this review, we will focus on the role of sedation & analgesia in ICU, current practice trends and a holistic approach for ...
The term artificial intelligence (AI) was introduced in 1950. There have been many attempts to de... more The term artificial intelligence (AI) was introduced in 1950. There have been many attempts to develop machines capable of performing cognitive and skill based tasks of anesthesiologist based on the principles of AI. These attempts have not been successful because of the complexities of anesthesia practice. Recent innovations in AI, especially machine learning, will continue to grow in importance in the years to come and will greatly revolutionize the face of anesthesia along with surgical practice, perioperative medicine practiced in clinics, and imaging interpretation. Anesthesiologists should continue to embrace this technology, stay up to date with the advances in AI, and also make genuine efforts to smoothly assimilate it in their routine practice now so that they can be the revolutionaries of their own future. We hope to see an ever-widening spectrum of the uses of AI in all fields of medical practice, and anesthesiology is not an exception. Its time our friends start visualiz...
Roy Hodgson has used the forum of Academia.edu to send messages to help him with consuming huge a... more Roy Hodgson has used the forum of Academia.edu to send messages to help him with consuming huge amounts of illegal money. The administrators are requested to take note of this.
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