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Objective: to record the frequency of isolating organisms causing early-onset neonatal sepsis resistant to common antibiotics, Methodology: This research was a cross-sectional study that was conducted in 2017 and 2018 at the Neonatal Intensive Care Unit of the Benazir Bhutto Hospital in Rawalpindi on 180 children who satisfied the following criteria and were delivered between 34 and 40 weeks of gestation either Spontaneous Vertex Delivery or Cesarean Section. The study was conducted on infants who were born between 34 and 40 weeks of gestation. Those newborns who had congenital defects, had had surgical intervention, had hypoxic ischemic encephalopathy, or had been treated with antibiotics were not included in the research. Every infant had three millilitres of its blood collected and stored in a sterile environment. The blood was placed into the Bactec 9240 blood culture bottles in a direct inoculation. After being transported to the BBH children's hospital pathology lab, the injection bottles were placed in a Bactee 9240 continuous monitoring blood culture system. The temperature inside the incubator was 37 degrees Celsius. The use of catalase, coagulase, and Dnase in the examination of Gram-positive bacteria was carried out. Using the Kirby-Bauer method, the isolated organism was put through a battery of tests to determine whether or not it was resistant to ampicillin, amikacin, tobramycin, cefotaxime, ceftazidime, ceftriaxone, meropenem, sulbactam, and vancomycin. Meuller Hinton Agar was the medium that was employed. Results: In our study, out of 140 cases, 65.71%(n=92) were between 1-48 hours and 34.29%(n=48) were between 49-72 hours, mean+sd was calculated as 35.96+16.65 hours, 47.86%(n=67) were male and 52.14%(n=73) were females. Frequency of isolated organisms shows that 27.86%(n=39) had S.Aureus, 22.14%(n=31) had E.Coli, 15%(n=21) had Staphylococcus epidermidis, 12.86%(n=18) had Klebseila and 22.14%(n=31) had others. Practical Implication: determination of the isolated bacterial resistance to antibiotics and common pathogens that cause neonatal sepsis would help in the appropriate and effective management of neonatal sepsis in our population Conclusion: Our results reveal that S.Aureus and E.Coli were the common showing 27.86% S.Aureus, 22.14% E.Coli, 15%, Staphylococcus epidermidis, 12.86% Klebseila and 22.14% had others isolates. organisms in EOS cases followed by Staphylococcus epidermidis and Klebseila whereas Ampicillin, Cefotaxime, Ceftriaxon, and Ceftazidime are also resistant in these cases. Keywords: Early onset neonatal sepsis, common pathogens, antimicrobial resistance of isolated organism

Ultra-low-dose contrast percutaneous coronary intervention (PCI) is a valuable approach in selected complex high-risk patients with renal failure. One of the objectives of ultra-low contrast PCI is to decrease the probability of developing postprocedural contrast-induced nephropathy (CIN), which predominately affects patients with baseline renal dysfunction. CIN is associated with poor clinical outcomes and increased healthcare-related costs. Another two clinical scenarios in which reduced dependence on contrast administration by the operator may contribute to improved safety are PCI in complex, high-risk indicated patients and in shock. In this review, we discuss the procedural techniques and recent technological innovations that enable ultra-low-dose contrast PCI to be performed in the cardiac cath lab.

Objective: To see graft uptake success rate in platelet rich fibrin aided underlay myringoplasties using temporalis fascia graft compared to conventional underlay myringoplasties. Study Design: Double blind randomized controlled trial study. Place and Duration of Study: ENT department, Pakistan Naval Ship Shifa Hospital, from Jan to Jun 2019. Methodology: Sixty cases with dry central tympanic membrane perforations were recruited. The patients suffering from sensori-neural hearing loss and co-morbidities like diabetes were excluded. The sampling technique was probability simple random. Patients were divided into two groups by lottery method. Statistical analysis was performed by using SPSS. The chi square test was applied to calculate p-value. Results: Out of total 60 patients 38 were males and 22 were females. Study group’s (Fibrin) mean age was 31.77 ± 12.43 years and Control group’s mean age was 27.53 ± 11.41 years. All the patients in platelet rich fibrin group had successful graft uptake at 2 months follow-up. In control group with conventional technique 23 out of 30 patients had successful graft uptake and rest 7 patients had different issues leading to graft rejection. Conclusion: In under lay myringoplasty procedure, application of platelet rich fibrin on temporalis fascia graft edge and perforation edges has significantly improved the successful uptake rate of graft.

Objective: To train young doctors and paramedical staff on needle cricothyroidotomy and surgical cricothyroidotomy and provision of kits in trauma centers, main operation theatres and medical reception centers of the hospitals. Study Design: Quasi experimental study. Place and Duration of Study: Combined Military Hospital Peshawar and Pakistan Naval Ship Shifa, Karachi Pakistan, from Nov 2017 to Oct 2020. Methodology: Doctors and paramedical staff were selected on volunteer basis. Small groups were trained in 2-3hours. The participants were shown two videos of two procedures in Urdu language first and then were trained on mannequin. Results: A total of 345 participants including 205 males and 140 females were trained with mean age was 28.2667 ± 6.24 (SD) years. Out of 61 residents, 54 medical officers, 143 house officers, 35 nurses and 52 paramedical staff were participants. Conclusion: ENT surgeons must arrange mannequins and conduct training sessions of small groups after every 1 to 2 months.

Objective: To determine the frequency of common complications of thyroid surgery by two types of surgeons. Study Design: Comparative cross sectional. Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Peshawar, from Jan 2013 to Dec 2017. Methodology: This study was conducted to assess the role of surgical skills in complications of thyroid surgery. Surgeons performing surgery for more than 5 years were considered expert and less than 5 years of experience were considered trainee for this specific surgery. Complications by both were analyzed by SPSS-21 and descriptive statistics were applied. Results: A total of 482 surgeries were performed. Out of 407 were female and 75 were males. Mean age was 43.55 ± 10.9 years. Expert surgeons performed 300 cases and 16 (5.3%) experienced some complication in 6 months of follow up.182 cases were performed by surgeons with lesser experience and 14 (7.5%) cases developed complications over the period of follow up. Recurrent laryngeal nerve paralysis occurred in 2 (0.67%) of experienced surgeons cases while 6 cases (3.2%) of less experienced surgeons had the similar complication. Conclusion: While the overall complication rates are not much different between experienced and lesser experienced surgeons, the rate of recurrent laryngeal nerve paralysis is significantly more, though still within the acceptable international complication rate for this particular surgery.

Objective: To comparison was made between standard (control group) nasopharyngeal sample collection technique for RTPCR and modified technique and the outcome was compared in terms of the proportion of positive results of Rt-PCR tests. Study Design: Double blinded randomized clinical trial. Place and Duration of Study: Pakistan Naval Ship Shifa Hospital Karachi Pakistan, from June and July 2020. Methodology: This study was a newly developed modified technique for nasopharyngeal sampling for RT-PCR tests of COVID-19 suspects. Target population included all patients who developed COVID-19 related symptoms and/or also had history of recent travel or closed contact with Covid-19 patients. Total 1500 nasopharyngeal PCR tests were done by a team of trained technicians. Systemetic probability sampling technique was utilized. Subjects were divided into two groups by using even and odd serial numbers. Proportion of positive test results were compared between two groups by using chi square test. Results: Results were collected for 3000 nasopharyngeal swab sample for RT-PCR testing. Mean age was 31.68 ± 11.89 years. In study group with modified technique, 470 tests were found positive for a total of 1500 samples while only 297 out of 1500 samples were detected positive in control group with standard technique. Chi square test applied to assess the difference between this proportion and it proved that the difference was highly statistically significant (p-value

Objective: To compare the recovery of patients in both groups having acute otitis externa induced by cotton buds/various objects. One group by old method and second group by unique method. Study Design: Quasi-experimental study. Place and Duration of Study: Pakistan Naval Ship Shifa Karachi, from Jan to Dec 2020. Methodology: Non-probability convenience sampling technique was applied. Out of 50 cases were selected for group 1 management. Fifty cases were selected for group 2 management. A chi-square test was applied to compare the recovery of two groups of patients on the 14th day and 42nd day of follow-up. p-value was kept 0.05 as significant. Results: A total of 100 cases were treated in 2 groups. The gender distribution of the study was 54 females and 46 males. The mean age of the study population was 33.09 ± 12.93 years. p-value was calculated on the 14th day and 42nd days. A 2x2 table of 14th follow up day showed recovery by both groups with a p-value of 0.041 which is

Objective: To determine frequency of our complications of endoscopic sinus surgery without pre-operative CT-Scan and to compare this frequency with other similar studies done with the help of pre-operative CT-Scans. Study Design: Cross sectional study. Place and Duration of Study: ENT Department, Combined Military Hospital Skardu Pakistan, from Jun 2017 to Jun 2019. Methodology: Total 69 patients (116 Sides) were operated under general anesthesia by using 0 and 30 degree endoscopes to address the Maxillary sinusitis. Frequency of complications was compared to other studies by applying chi-square test for goodness of fit. The complications were also correlated to ages of patients by applying Spearman correlation analysis. Results: Mean age was 29.75 ± 10.9 years (range 15-75). Overall complications rate was 4.3% (5 out of 116 sides, 95% confidence interval 4.23-4.4). Peri-orbital ecchymosis and peri-orbital emphysema were most commonly occurring complications (4.3%). This complication rate was compared to few other studies, which proved that difference was not statistically significant. Correlation of occurrences of orbital complications with the age proved that there was no statistically significant correlation (Correlation coefficient r=-0.085, p-value 0.276). Conclusion: Isolated chronic maxillary sinusitis refractory to medical treatment can be treated by endoscopic sinus surgery without pre-operative CT-Scan.

We measured the effect of wheat density on weed biomass and seed production, wheat biomass, and grain yield in five wheat cultivars in Pakistan in the presence and absence of individuals of the weed Medicago polymorpha L. The presence of M. polymorpha decreased wheat biomass and grain yield by up to 25%, even though the density of the weed was low (5 plants m−2). When wheat density was increased from 130 to 390 plants m−2, weed biomass and seed production were reduced by 68 and 85%, respectively, across all five cultivars. The average wheat yield increased by up to 7% with increasing density for all wheat cultivars. The cultivars varied in their responses to the weed and to their own density. While most effects were additive, there was a highly significant interaction between wheat density and cultivar on weed seed production, in which the cultivar that completely suppressed weed seed production at high wheat density was among the least suppressive at low density. The cultivar that produced the highest yield across all treatments was not among the best at suppressing the weed or producing biomass, suggesting that tolerance of weed biomass is also important at low but still damaging levels of weed infestation. Our results confirm that even a relatively low density of M. polymorpha can incur significant yield losses, but also show that it can be managed effectively with cultural practices like increasing seed rate and by selecting weed suppressive and tolerant cultivars suited to the local environment.

The use of coronary physiology allows for rational decision making at the time of PCI, contributing to better patient outcomes. Yet, coronary physiology is only one aspect of optimal revascularization. State-of-the-art PCI must also consider other important aspects such as intracoronary imaging guidance and specific procedural expertise, as tested in the SYNTAX II study. In this review, we highlight the technical aspects pertaining to the use of physiology as used in that trial and offer a glimpse into the future with emerging physiologic metrics, including functional coronary angiography, which have already established themselves as useful indices to guide decision making.

Background: Epinephrine, an alpha receptor agonist, has been suggested to be a supreme bronchodilator. A biologically active drug name Ipratropium bromide is helpful for the treatment of bronchiolitis among infants and improves on the signs and symptoms of bronchiolitis. Objective: To compare effectiveness of combined nebulized salbutamol with nebulized adrenaline and ipratropium bromide in bronchiolitis affected children in terms of mean improvement in RDAI score. Methodology: After approval from ethical committee this randomized control trial of 6 month duration is carried out by Randomization of patients in 2 groups. Group A received salbutamol (0.15mg/kg) combined with ipratropium bromide (250 micrograms per dose) with isotonic sodium chloride solution 0.9% (2 mL) and Group B received a dose of epinephrine (0.5mg/kg in concentration of 1:1000(max 5 mg), distributed by nebulizer with the help of a face mask with continuous oxygen flow at 6L/min Prior to each drug administration and at 30 mints, the researcher evaluated the condition of infant’s and records the respiratory rate, RDAI score9, heart rate and SaO2. RESULTS: Comparison of effectiveness of combined nebulized salbutamol with nebulized adrenaline and ipratropium bromide in bronchiolitis affected children in terms of mean improvement in RDAI score shows that at baseline in Group-A it was 10.73+1.59 and 10.98+1.42, p value was 0.27, it was reduced after 30 minutes of treatment in Group-A 3.23+0.52 and 2.67+0.47 in Group-B, p value was 0.001. Conclusion: We concluded that Epinephrine is better than salbutamol and ipratropium combined in terms of mean improvement in RDAI score Keywords: Bronchiolitis, children, salbutamol and ipratropium Bromide, Epinephrine.

Reproductive biology, abundance and control potential of Paramecops farinosus Wiedemann, (Aak weevil) a prospective biological control agent for Calotropis procera (Aiton) W.T. Aiton, (Calotrope) were studied under field conditions in Lahore, Pakistan, from spring to winter season. Newly emerged adult pairs were introduced inside insect-proof pouches with calotrope fruits, and the life cycle and reproductive biology of P. farinosus were studied. Pre-oviposition period was 4.8 ± 0.17 days and there were 6.1 ± 0.09 eggs per clutch. A female, laid eggs about 5.4 ± 0.32 times, producing 24 offspring during its lifespan. The mortality from egg to adult was 27% and the progeny sex ratio was 3:2 (female to male ratio). The developmental period of P. farinosus (egg to adult) was 59.9 ± 0.82 days and at least two generations were produced per year. The longevity of males and females recorded was 97 ± 1.98 and 69 ± 1.41 days, respectively and the pupae overwinter inside the infested fruits. The number of eggs and larvae inside fruits increased from March to July and declined in subsequent months. The highest number of eggs and larvae per fruit were recorded in July i.e. 8.27 ± 0.65 and 6.31 ± 1.77, respectively. The developing larvae destroyed 100% seeds and internal tissue of infested fruit pods of C. procera, resulting in significant reductions in fruit size (?12%) and biomass (?26%) compared to un-infested (healthy) fruits. The high reproductive capacity and control potential of P. farinosus indicate that this insect holds promise as a biological control agent of C. procera in its invaded ranges, including Australia, the Pacific, and South America.

Objective: To look for the complications of tracheostomy and factors correlated with presence of these complications at a tertiary care teaching hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: ENT department, Operation Theater, Emergency department and Critical Care Unit of Pakistan Naval Ship Shifa Hospital, Karachi Pakistan, from Apr to Oct 2019. Methodology: Sixty nine patients who underwent tracheostomy were included in the analysis. Final decision regarding offering the procedure of tracheostomy to the patient was made by consultant ENT specialist in liaison with the primary treating physician. Patients were assessed for the complications during the procedure, immediately after the procedure, 48 hours after the procedure and one week after the procedure. Results: Out of sixty nine patients included in the study, 8 (11.6%) patients underwent emergency tracheostomy while 61 (88.4%) underwent elective tracheostomy. Ten (14.5%) had undergone percutaneous procedure while 59 (85.5%) had undergone open surgical procedure. Hemorrhage was the commonest complication reported followed by dislodgement. With Pearson chi-square test, we found that increasing age (45 years) and emergency tracheostomy had strong association with the presence of complications among the patients undergoing tracheostomy. Conclusion: Tracheostomy emerged as a safe procedure with mostly minor self-limiting complications. Surgeon performing this procedure should be aware of these common complications and should give information care to the patients prior to the procedure. Patients who are elderly or undergoing emergency tracheostomy should be dealt with special care while doing this life saving procedure.

Objective: To compare the effect of using the tablet Alprazolam 0.25mg in the treatment outcome of vertigo related anxiety by beck anxiety inventory. Study Design: Comparative study. Place and Duration of Study: Combined Military Hospital Okara Cantt, Sep 2018 to Jun 2020. Methodology: A total of 384 patients were included in the study. They were randomly assigned to group A and B by randomized clinical trial. Group A was given tablet alprazolam 0.25 mg along with the conventional treatment of vertigo and group B was given the treatment of vertigo only and no anxiolytic was added. Their pre & post treatment (after 2 weeks) anxiety level using Beck anxiety inventory was scored. Results: There was a significant improvement in group A patient’s vertigo effects after treatment with alprazolam. Also, it was observed that group A patients responded significant improvement in anxiety score as compared to Group B patients 02 weeks post treatment. Conclusion: Antianxiety treatment should be added in all cases with the conventional treatment of vertigo to reduce the vertigo associated anxiety of the patients.

Objective: To find out the association of multiple diseases of external ear with the use of various objects and cotton buds. Study Design: Case control study. Place and Duration of Study: Ear Nose Throat Department, Pakistan Naval Ship Shifa Karachi, from Jan to Oct 2020. Methodology: All the patients having multiple diseases of external ear were included as cases. Controls were selected from the healthy volunteers from general populations. Results: Total number of subjects in this study was 140 with the mean age 25.11 ± 11.21 years (2-55 years of age range). Out of them, 82 were male and 58 were female. Odds ratio was 16.07. Conclusion: There is a solid relationship of illnesses of external ear with the utilization of cotton buds. This detrimental practice should be incapacitated by featuring the notice by brands owners of cotton bud and safety instructions at different instructive levels.

Coordinated molecular responses are key to effective initiation and resolution of both acute and chronic inflammation. Vascular inflammation plays an important role in initiating and perpetuating atherosclerotic disease, specifically at the site of plaque and subsequent fibrous cap rupture. Both men and women succumb to this disease process, and although management strategies have focused on revascularization and pharmacological therapies in the acute situation to reverse vessel closure and prevent thrombogenesis, data now suggest that regulation of host inflammation may improve both morbidity and mortality, thus supporting the notion that prevention is better than cure. There is a clear sex difference in the incidence of vascular disease, and data confirm biological differences in inflammatory initiation and resolution between men and women. This article reviews contemporary opinions describing the sex difference in the initiation and resolution of inflammatory responses, with a view to explore potential targets for pharmacological intervention.

OBJECTIVE To compare the possibility of Post-operative hemorrhage in septoplasty with and without nasal packing among the patients operated at PNS SHIFA hospital Karachi STUDY DESIGN: Comparative Study SETTING: PNS SHIFA hospital Karachi DURATION OF STUDY: Six months, 21-04-2019 to 20-10-2019 PATIENTS AND METHODS: Ninety two patients who underwent septoplasty due to deviation of nasal septum at ENT department of PNS SHIFA were included in the analysis. Patients were randomly divided into two groups. Group one did not undergo nasal packing after the surgery and group two underwent nasal packing after the surgical procedure. Chi-square was used to see the difference in post-operative hemorrhage, headache, discomfort and septal perforation between the two groups. RESULTS Out of 92 patients included in the final analysis 61 were male and 31 were female. Pot operative bleeding was found in three patients in group one while thirteen patients in group two had bleeding after the procedure. With Pearson chi-square test, we found that post-operative bleeding, headache and discomfort was significantly more in the patients with nasal packing after the procedure of septoplasty due to deviated nasal septum. CONCLUSION Nasal packing emerged as a procedure linked with more complications rather than benefits among the patients undergoing septoplasty in our study. Not only post-operative hemorrhage but also headache and discomfort were more common among the patients with nasal packing as compared to those without nasal packing. Nasal packing after septoplasty should be discouraged without any obvious indication in the patients undergoing septoplasty.

Coronary microvascular dysfunction (CMD) is a prevalent cause of ischemic heart disease and is associated with poorer quality of life and worse patient outcomes. Both functional and structural abnormalities of the microcirculation can generate ischemia in the absence of epicardial stenosis or worsen concomitant obstructive coronary artery disease (CAD). The invasive assessment of CMD allows for the evaluation of the entirety of the coronary vascular tree, from the large epicardial vessels to the microcirculation, and enables the study of vasomotor function through vasoreactivity testing. The standard evaluation of CMD includes vasomotor assessment with acetylcholine, as well as flow- and resistance-derived indices calculated with either thermodilution or Doppler guidewires. Tailored treatment based upon the information gathered from the invasive evaluation of CMD has been demonstrated to reduce the burden of angina; therefore, a thorough understanding of these procedures is warranted with the aim of improving the quality of life of the patient. This review summarizes the most widespread approaches for the invasive evaluation of CMD, with a focus on patients with ischemia and non-obstructive CAD.

Objective: To investigate the symptoms of COVID-19 disease cases which according to published scientific literature mainly includes upper respiratory track symptoms. Study Design: Case series study. Place and Duration of Study: It was carried out at ENT department, Pakistan Naval Ship Shifa, Karachi, from Mar 2020 to Jun 2020. Methodology: It was from March, 2020 to June, 2020. Patients included in study were above the age of 10 years who were able to give us the details about their symptoms, contact and recent travel history and cooperated for their nasopharyngeal swabs for COVID-19 RT PCR tests. Probability, convenient, sampling technique was used for our study. Frequencies of age, gender, clinical symptoms of patients were analyzed by using descriptive statistics of SPSS. Results: This study included 231 patients with COVID -19 positive nasopharyngeal swabs for RT-PC, out of which 200 were males and 31 were females. Mean age is 38.23 ± 14.77 years. Among the airway symptoms, multiple symptoms like fever, cough, myalgia were seen in 84 cases (36.4%) and cough was found in 22 (9.5%) of patients. Fever with cough was seen in 21 (9.2%) of patients. 58 (25.1%) cases were asymptomatic and were carriers. History of contact was positive in 122 (52.8%) of cases. Conclusion: COVID patients have fever, cough and myalgia as the most common symptoms and such patients should be assessed with care and as per the standard guidelines of institutions.

Life history and damage potential of the fruit fly, Dacus persicus Hendel, a prospective biological control agent for calotrope, Calotropis procera (Aiton) W.T. Aiton, are described. The duration o...

Aim: To compare the frequency of epigastric pain and uterotonic effect of an equivalent dose of oxytocin administered as an intravenous bolus versus intravenous infusion during elective LSCS under spinal anesthesia. Methodology: We recruited 98 parturients undergoing elective LSCS under spinal anesthesia for this prospective quasi experimental study and divided them into two groups. Group-A received 5 IU of oxytocin as bolus intravenous (IV) injection in 5 sec (bolus group, n= 48), and Group-B (infusion group, n= 50) received 5 IU of oxytocin as an infusion over 5 min. Any complaint of epigastric pain by the patients was noted and its frequency was compared between the two groups. The uterine tone was assessed as adequate or inadequate by an obstetrician. The data were entered into SPSS version 22. Patient demographic data were analyzed with independent samples T-test and the study data were analyzed with Chi‑square test and presented as n (%). p < 0.05 was considered statistically significant. Results: Epigastric pain was noted in 25 (52.03%) out of 48 parturients in Group-A and 15 (30%) out of 50 in Group-B (p = 0.026). There was no significant difference in the uterotonic effect of oxytocin between the two groups (p = 0.736). Conclusion: We conclude that oxytocin infusion is associated with lower frequency of epigastric pain in elective LSCS when compared to intravenous bolus of an equivalent dose of oxytocin, However, the effect on uterine contractions was adequate with both methods. Citation: Kashif A, Kiani RB, Shabbir SMA, Mahmood T, Sabir G, Fatima NE, Khan WA. Epigastric pain after intravenous administration of oxytocin in patients undergoing lower segment cesarean section: A quasi experimental study comparing intravenous bolus with infusion technique. Anaesth pain intensive care 2020;24(1):_ DOI: https://doi.org/10.35975/apic.v2i1. Received – 20 February 2019; Reviewed – 4, 16 March, 25 June, 9 September, 2, 25 November, 10 December 2019, 7 January 2020; Revised – 19 June, 10 August, 29 September, 1 November 2019, 6 January 2020; Accepted – 10 January 2020