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Background: Phenylephrine (PE) is one of the vasopressor used to treat hypotension during anaesthesia. The primary aim of this study was to compare the effect of prophylactic infusion and rescue bolus of PE on the haemodynamic changes during spinal anaesthesia (SA) for Caesarean section (CS) in obese parturients. Methods: A total of 74 obese parturients scheduled for elective CS under SA were randomised into two groups; Group A (n = 37) received prophylactic PE infusion starting at 50 μg min-1 and adjusted according to the given algorithm and Group B (n = 37) received 100 μg PE bolus to treat hypotension. The measured parameters were systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), the total requirement of PE and neonatal Apgar score. Results: Six patients were excluded from the analysis due to missing data and only 68 were analysed. Group A showed significantly higher SBP, DBP and MAP than Group B (P < 0.05). The requirement of PE was higher in Group A than Group B [817.7 (265.7) µg versus 360.6 (156.0) µg; P = < 0.05]. Both groups had no difference in terms of the neonatal Apgar score. Conclusion: Prophylactic PE infusion provided better haemodynamic control than therapeutic boluses in obese parturients undergoing CS under SA. [ABSTRACT FROM AUTHOR]

Background & Objective: Addition of ketamine affects pain modulation through multiple mechanisms and may enhance the analgesic effect of local anesthetics in rectus sheath block (RSB). However, limited studies have evaluated the analgesic efficacy and safety of ketamine added to RSB for midline laparotomy. We aimed to evaluate the analgesic efficacy and safety of ketamine as an adjuvant to 0.25% bupivacaine in ultrasound-guided RSB following major abdominal or gynecological surgery with midline incision. Methodology: Fifty-four patients of American Society of Anesthesiologists class I−II, aged 18−65 y, who underwent midline laparotomy under general anesthesia were studied. The patients were randomly allocated to two groups: ultrasound-guided RSB was performed in the control group (n = 28) with 40 ml of 0.25% bupivacaine, while in the ketamine group (n = 28) it was performed with 40 ml of 0.25% bupivacaine plus ketamine 1 mg/kg. Postoperatively, both groups received IV morphine patient-controlled analgesia. The Numeric Rating Scale (NRS) pain scores at rest and on movement were assessed at 0, 1, 12 and 24 h postoperatively. The total 24-h postoperative morphine consumption and psychomimetic side effects were recorded. Results: The mean NRS pain score on movement was significantly lower in the ketamine group at most time points compared to the control group (P < 0.05). The ketamine group had a significantly reduced total 24 h postoperative morphine consumption (14.3 ± 6.55 mg) compared to the control group (21.86 ± 15.46 mg) (P < 0.05). No psychomimetic adverse effects were reported in both groups. Conclusion: The addition of ketamine to bupivacaine in RSB resulted in effective postoperative analgesia by reducing postoperative pain scores on movement in patients who underwent midline laparotomy. Such combination also reduced postoperative morphine requirement without serious side effects. [ABSTRACT FROM AUTHOR]

Abstract Present study was performed to determine the effects of physical and chemical agents on infective potential of highly pathogenic avian influenza (HPAI) H5N1 (local strain) virus recently isolated in Pakistan during 2006 outbreak. H5N1 virus having titer 108.3 ELD50/ml was mixed with sterilized peptone water to get final dilution of 4HA units and then exposed to physical (temperature, pH and ultraviolet light) and chemical (formalin, phenol crystals, iodine crystals, CID 20, virkon®-S, zeptin 10%, KEPCIDE 300, KEPCIDE 400, lifebuoy, surf excel and caustic soda) agents. Harvested amnio-allantoic fluid (AAF) from embryonated chicken eggs inoculated with H5N1 treated virus (0.2 ml/egg) was subjected to haemagglutination (HA) and haemagglutination inhibition (HI) tests. H5N1 virus lost infectivity after 30 min at 56°C, after 1 day at 28°C but remained viable for more than 100 days at 4°C. Acidic pH (1, 3) and basic pH (11, 13) were virucidal after 6 h contact time; however virus retained infectivity at pH 5 (18 h), 7 and 9 (more than 24 h). UV light was proved ineffectual in inactivating virus completely even after 60 min. Soap (lifebuoy®), detergent (surf excel®) and alkali (caustic soda) destroyed infectivity after 5 min at 0.1, 0.2 and 0.3% dilution. All commercially available disinfectants inactivated virus at recommended concentrations. Results of present study would be helpful in implementing bio-security measures at farms/hatcheries levels in the wake of avian influenza virus (AIV) outbreak.

This study aimed to compare the antinociceptive and antioxidative effects of Tualang honey and Vitamin C in formalininduced pain in the rat. About 24 Sprague Dawley male rats were randomized into three groups and each group (n=6) received either distilled water (C) or Tualang honey (1.2 g/kg body weight/day) (TH) or Vitamin C (20 mg/kg body weight/day) (VC) for 10 consecutive days. On the tenth day, intraplantar formalin 1% (0.1 mL) was given one hour after the treatment. Rat's pain behaviour was recorded using a digital camera for an hour. The rats were sacrificed two hours postformalin injection and blood was taken to measure the malondialdehyde (MDA) level, catalase (CAT) and superoxide dismutase (SOD) activities. TH not VC significantly reduced the pain behavior score and improved oxidative stress parameters compared to control. However, MDA level was not significantly different between groups. Interestingly, there was a good inverse correlation between CAT level and mean pain behavior score suggesting the important role of antioxidants in modulating the inflammatory pain responses. In conclusion, TH has better antinociceptive and antioxidative properties compared to VC. The antinociceptive property of TH might be partly contributed by increasing CAT level in this model of inflammatory pain. [ABSTRACT FROM AUTHOR]

Introduction: Procalcitonin (PCT) has attracted significant attention as a novel biomarker of sepsis. This study aimed to assess the agreement between blood results of PCT, obtained using the Finecare™ FIA Meter Plus (FS113), a pointof- care (POC) procalcitonin testing device, and the automated Elecsys® BRAHMS PCT assay on the Cobas e411, among critically ill septic patients. Methodology: This observational study was conducted in the intensive care unit of Hospital Universiti Sains Malaysia, in 2021. Whole blood samples were collected and tested with the Finecare™ FIA Meter Plus (FS113) (Wondfo, China) for PCT measurement. Additionally, the same whole blood samples were centrifuged to produce plasma samples, which were then analyzed using the automated Elecsys® BRAHMS PCT assay on the Cobas e411 (Roche Diagnostics, Germany). Results: A total of 40 samples were analyzed in this study. Both PCT measurement techniques demonstrated a significant correlation, with a correlation coefficient of 0.96. Regression analysis revealed the following results: an Ordinary Least Square (OLS) slope of 0.91 (95% CI 0.83, 1.00) with an intercept of 1.27 (95% CI -0.75, 3.29); a Deming slope of 0.95 (95% CI 0.80, 1.10) with an intercept of 0.77 (95% CI -0.44, 1.85); and a Passing-Bablok slope of 1.16 (95% CI 0.99, 1.36) with an intercept of 0.22 (95% CI 0.08, 0.58). Conclusion: The point-of-care procalcitonin measurement provided by the Finecare™ FIA Meter Plus presents a viable alternative for assessing procalcitonin levels among septic patients in the intensive care unit (ICU). [ABSTRACT FROM AUTHOR]

The usage of epidural infusion for intraoperative and postoperative pain relief is widely used in certain pediatric anesthetic practice because of the effectiveness and advantages. However, there is drawback for these techniques due to its potential complications such as inadvertent intrathecal placement, local anesthetic toxicity, catheter migration, infection, and breakage of epidural catheter. Though occur infrequently, epidural catheters have been known to snap during insertion or removal. The retained catheter tip may lead to multiple complications, including nerve injury, infection, and even catheter migration. Although there are literatures recommend options for management of removal of retained catheter, there are limited reports of these occurrences, especially among children. We report a case of sequestrated sheared epidural catheter segment in a child, aiming to share this experience for the future management of patients under similar condition. [ABSTRACT FROM AUTHOR]

Molecular epidemiology of Mycoplasma gallisepticum in commercial and backyard poultry was conducted in different parts of Pakistan and Azad Jammu and Kashmir. Molecular identification of the isolates was made with the application of polymerase chain reaction (PCR). A total of 142 isolates of M. gallisepticum from 573 flocks were identified. The isolates were further characterized on the basis of SDS-PAGE. The cumulative prevalence of M. gallisepticum noted in broilers, broiler breeders, commercial layers and layer breeders including backyard/rural poultry was 14.62, 29.33, 23.16 and 42.85%, respectively indicating significant prevalence in all type of birds with Chi-square value of X²=7.81. Significant seasonal variation (X²=3.84) indicated the higher prevalence 56.34% in winter as compared to 43.66% in summer. The findings of SDS-PAGE indicated that 71.43% of the tested isolates proved pathogenic with the presence of 74 kDa adhesive protein bands representing M. gallisepticum F strain. The remaining isolates represented less virulent or variant stains. The high prevalence of M. gallisepticum in respiratory infection of poultry in Pakistan demands for framing national policy through surveillance and control of the disease. [ABSTRACT FROM AUTHOR]

The study was initiated to compare the performance of economic traits of four internationally reputed broiler strains, imported in Pakistan, under the local environmental and management conditions. A total of 360 day old chicks of four broiler strains (90 from each strain) were procured from the local hatcheries and designated as four treatments i.e., A (Hubbard), B (Arbor Acres), C (Ross 308) and D (Hybro PN). The chicks were raised under recommended rearing requirements for 7 weeks and the economic traits measured were body weight, feed intake, feed conversion ratio (FCR), mortality, antibody titres, dressing percentage and economic evaluation as cost of broiler per kilogram live weight produced. The average body weights gained by the birds were 2264g, 2277g, 2256g and 1942g for A, B, C and D strains, respectively at 49 days of age. The birds in treatments A, B and C gained significantly (P <0.05) more weight than the birds in treatment D. On the contrary, the birds in treatment D (4371g) consumed significantly (P <0.05) less feed than birds in treatments A (4896g), B (4934g) and C (4905g) at 7 weeks of age. The FCR's in order of merit were 2.16(A), 2.17(B), 2.18(C) and 2.25(D) and differences were non-significant. The dressing percentage of birds in treatment A (71.4%) was significantly (P<0.05) higher than treatment C (68.1) and were non significant among the remaining treatments. The mortality in Hubbard strain (A) was significantly (P<0.05) low (4.4%) than Hybro PN, Ross 308 and Arbor Acres-strains. The overall performance of Hubbard strain seems better as the birds gained more body weight, gave better FCR, least mortality and least cost per kg live broiler produced as compared to other strains. The performance of strain D was poor as the birds gained less body weight, showed higher mortality rate, poor feed conversion ratio and incurred more cost to produce per kilogram live broiler as compared to other strains. The evaluation of different imported broiler strains must continue to remain abreast with the genetic improvement of broiler strains. [ABSTRACT FROM AUTHOR]

Present study was performed to determine the effects of physical and chemical agents on infective potential of highly pathogenic avian influenza (HPAI) H5N1 (local strain) virus recently isolated in Pakistan during 2006 outbreak. H5N1 virus having titer 108.3 ELD50/ml was mixed with sterilized peptone water to get final dilution of 4HA units and then exposed to physical (temperature, pH and ultraviolet light) and chemical (formalin, phenol crystals, iodine crystals, CID 20, virkon®-S, zeptin 10%, KEPCIDE 300, KEPCIDE 400, lifebuoy, surf excel and caustic soda) agents. Harvested amnio-allantoic fluid (AAF) from embryonated chicken eggs inoculated with H5N1 treated virus (0.2 ml/egg) was subjected to haemagglutination (HA) and haemagglutination inhibition (HI) tests. H5N1 virus lost infectivity after 30 min at 56°C, after 1 day at 28°C but remained viable for more than 100 days at 4°C. Acidic pH (1, 3) and basic pH (11, 13) were virucidal after 6 h contact time; however virus retained infectivity at pH 5 (18 h), 7 and 9 (more than 24 h). UV light was proved ineffectual in inactivating virus completely even after 60 min. Soap (lifebuoy®), detergent (surf excel®) and alkali (caustic soda) destroyed infectivity after 5 min at 0.1, 0.2 and 0.3% dilution. All commercially available disinfectants inactivated virus at recommended concentrations. Results of present study would be helpful in implementing bio-security measures at farms/hatcheries levels in the wake of avian influenza virus (AIV) outbreak. [ABSTRACT FROM AUTHOR]

Objectives: The question as to whether epidural analgesia during labor can cause subsequent chronic low backpain has become a concern of late but this association has not been tested locally and remains controversial. The objective of this retrospective cohort study was to determine whether epidural analgesia during labor was associated with low backpain six months after delivery. Methods: We contacted 200 nulliparous women who had delivered their first baby by normal vaginal delivery via telephone at six months after delivery. Onehundred women had received epidural analgesia for labor and 100 had not. The women were asked to quantify their backpain (yes/no, numeric rating score, and impairment of daily function). Differences between the epidural and the nonepidural groups were tested by using independent t-test and Chi-squared test, and logistic regression was used to control for confounding factors. Results: The baseline demographic and obstetric characteristics between the two groups were similar except in terms of body mass index, employment status and duration of labor. The prevalence of new onset low backpain at six months after delivery was significantly higher in women who had received epidural analgesia during labor than those who had not (28% versus 9%, P = 0.001). However, there was no different between the two groups on numeric rating score or level of impairment of daily function, with the pain being moderate in severity and the functional impairment being minimal in both groups. The adjusted odds ratio of low back pain at six months (epidural versus non-epidural) was 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: This retrospective cohort study demonstrated an association between epidural analgesia during labor and chronic low backpain which may not be causal but suggested that a randomized controlled study is warranted. [ABSTRACT FROM AUTHOR]

Introduction: The question as to whether epidural analgesia during labour can cause chronic low backpain has become a concern lately but this association has not been tested locally and remains controversial. This retrospective study aimed to ascertain the relationship between labour epidural analgesia and development of subsequent chronic low backpain. Methods: We contacted 200 primiparous women who had delivered by normal vaginal delivery via telephone at six months after delivery. While 100 of them had previously received epidural analgesia for labour, the other 100 had not. The women had to quantify their backpain by yes/no responses, numeric rating score, and impairment of daily function. Both the epidural and the non-epidural groups were compared using independent t-test and Chi-squared test while logistic regression was used to control for confounding factors. Results: The two groups had similar baseline characteristics except for body mass index, employment status and labour duration. The women who received epidural analgesia had significantly higher prevalence of low backpain at six months after delivery than those who had not (28% versus 9%, P = 0.001). However, the two groups did not show any difference in terms of numeric rating score or level of impairment of daily function. The low back pain at six months (epidural versus non-epidural) had an adjusted odds ratio of 8.1 (95% confidence interval 2.7 to 24.0, P <0.001). Conclusion: While epidural analgesia during labour was shown to be associated with chronic low back pain, this association may not be causal, suggesting the need for a randomized-controlled study in this area. [ABSTRACT FROM AUTHOR]

Giant haemangioma of the tongue is a disease which can obstruct the oropharyngeal airway and is presented with obstructive symptoms. Due to its vascularity, inserting laryngoscope for intubation can cause high risks, such as inducing bleeding. Hypoxia and excessive bleeding must be anticipated while securing the airway. We present a case of novel usage of dexmedetomidine as a conscious sedation agent for awake fibre optic intubation in a 9-year-old child with obstructive symptoms secondary to a huge tongue haemangioma, who was presented for interventional sclerotherapy of the lesion. [ABSTRACT FROM AUTHOR]

Background: The role of dedicated Trauma ICU (TICU) in Emergency Department is vital in the chain of trauma care to ensure rehabilitation and sustainable critical care for a better survival outcome. This study is conducted to find out demographic patterns and predictors that can affect the outcomes of trauma patients. Methods: A retrospective review of all patients admitted to TICU, Hospital Universiti Sains Malaysia (HUSM) was carried out from January 1st, 2016 till December 31st, 2018. Data were collected from TICU admission and discharge registers and were analyse using SPSS version 23.0. Results: A total of 108 trauma patients were included in this study. All cases were exclusively blunt trauma (99.1%) and mainly attributed by road traffic injuries (92.6%). In terms of trauma clinical scoring, 25%(p= 0.001) presented with GCS score < 4, 46.9% (p=0.001) with RTS score <5.5 and 15.6% (p=0.012) with APACHE II score > 28had demonstrated prolonged ICU stay (> 7 days). Meanwhile 62.5% (p= 0.000) with GCS < 4, 75% (p= 0.000) with RTS < 5.5 and 75% (p= 0.000) with APACHE II > 28 were died in TICU. Besides that, those who had prolonged ICU stay (> 7 days) were 8.5 times higher odds to get sepsis (adj OR= 8.532; 95% CI: 2.710, 26.863; p= 0.000) and 7 times higher odds to get acute kidney injury (AKI) (adj OR= 7.131; 95% CI: 1.464, 34.733; p= 0.015). Meanwhile, patient who received blood transfusion led to 5 folds higher odds of association with rhabdomyolysis (adj OR= 4.968; 95% CI: 1.821, 13.549; p= 0.002). Conclusion: In the midst of pandemic COVID-19 it is important for ED physician to early identify and prioritise high risk trauma patient based on predictors and allows for targeted monitoring and intervention that may improve their outcome and also optimise resources accordingly. [ABSTRACT FROM AUTHOR]

Background: Existing techniques of predicting difficult laryngoscopy are inadequate requiring evaluation of Maxillopharyngeal Angle (MP-A) on lateral cervical radiograph described. Objectives: This study aimed to compare MP-A test with Modified Mallapati Test (MMT) in predicting their diagnostic values and Area Under Curve of Receiver Operating Characteristic Curve (AUCROCC) of both test. Methods: This is a double blinded interventional study of 93 patients. Each patient's MMT score was assessed during preoperative assessment and subsequent MP-A test done by obtaining lateral cervical radiograph with the head in neutral position. Laryngeal view was assessed using Cormack-Lehane grade after induction of anesthesia, was used as reference standard to determine the diagnostic values of MMT and MP-A respectively. Results: The MP-A compared to MMT in predicting difficult larngoscopy had higher sensitivity (77.78 vs 44.44) specificity (88.10 vs 67.86) and accuracy (87.10 vs 65.59) with higher Odd Ratio(26.12 vs 1.68). The AUCROCC was significantly higher in MP-A test 0.83(95%CI: 0.67, 0.99) (P = 0.001) vs MMT 0.56(95%CI: 0.36, 0.76) (P = 0.546) with LR+ of 6.53 vs 1.38. Conclusion: The Maxillopharyngeal Angle test was superior in predicting difficult laryngoscopy as compared to Modified Mallampati Test. [ABSTRACT FROM AUTHOR]