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Objective: To evaluate functional outcomes and complications in gunshot femur shaft fractures treated with intramedullary nailing primarily. Study Design: Prospective longitudinal study Place and Duration of Study: Department of Orthopaedic Combined Military Hospital, Nowshera, Combined Military Hospital Sialkot, Combined Military Hospital, Rawalpindi Pakistan, from Jan 2016 to Dec 2021. Methodology: A total number of 53 cases of open fracture of the femur shaft due to gunshot were included in the study. After initial wound debridement, an X-ray was taken, and fractures were classified according to the Gustilo–Anderson classification. All fractures were fixed with titanium I/M I/L Nail in static mode by the same orthopaedic surgeon. Rehabilitation was instituted immediately after the operation, and the outcome was assessed in regards to infection, range of motion at the knee, full weight bearing and radiological union achieved. Results: Thirty-four (64.15%) patients had Type-1 fractures of the femur shaft, and 19(35.8%) patients had Type-2 fractures. Fracture union was observed in 47(88.67%) patients after three months and 6(11.32%) over the next five months. Complications were wound infections 5(9.44%), leg length discrepancy 4(7.53%), and non-union 2(3.77%) at six months. In these two cases, bone grafting was done, and union was achieved. Conclusion: Primary intramedullary (IM) is the preferred mode of treatment of Type 1 and 2 shafts of femur fractures if early good debridement is done. It avoids secondary procedures, has fewer complications and helps in early mobilization.

Objective: To assess the role of early triage and emergency obstetric care for high-risk pregnancies and their outcome. Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Bahawalpur Pakistan, from Jan 2021 to Jun 2022. Methodology: Women with high-risk pregnancies, aged 18-40 years, gestational age >28 weeks, were included. Emergency obstetric care was provided to participants of the study. Maternal outcome was assessed regarding their hospital stay duration, morbidity, mortality and mode of delivery. The fetal outcome was in terms of intra-uterine death (IUD), Early neonatal death (ENND), and live births. Results: The mean age of patients was 28.1±3.49 years. Most of the patients belonged to high-order cesarean section and hypertensive disorders of pregnancy. 94.3% were delivered by cesarean section due to obstetric reasons, and hospital stay was an average of> 72 hours in 57.7 %. Maternal mortality and morbidity were not observed. 99.9% of babies were live births, 0.7% ended into ENND, and one received an IUD. Conclusion: Early triage followed by the provision of emergency obstetric emergency care is recommended in high-risk pregnancies for optimum feto-maternal outcome.

Objective: To determine whether the blood lost in total knee arthroplasty surgery can be salvaged and reused using the autotransfusion technique without adverse effects and need more blood requirement. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Orthopaedic Surgery, Combined Military Hospital Rawalpindi from Aug 2020 to Dec 2021. Methodology: The study included all the candidates undergoing total knee replacement surgery. Fifty-five patients underwent autologous transfusion using blood bags attached to drains and reusing them within 4-6 hours. All the transfusions were recorded. Results: Out of 55 patients, 49(89%) underwent unilateral knee replacement, and 6(11%) underwent bilateral knee replacement. All 49 patients (89%) received a single blood transfusion, and all 6(11%) bilateral knee replacements received two blood transfusions each. Out of 61 transfusions, no adverse reaction was noted. One patient needed additional blood transfusion while undergoing bilateral knee replacement. Conclusion: Blood autologous transfusion during knee replacement surgeries is a practical and cost-effective measure, especially in rare blood groups. Autotransfusion is a simple and hassle-free approach that can be used routinely while avoiding adverse blood reactions.

Objective: To compare the institutional practices among patients undergoing living-related renal transplants in different hospitals throughout Pakistan. Study Design: Cross-sectional survey. Place and Duration of Study: Armed Forces of Institute of Urology, Rawalpindi Pakistan, from Jun 2020 to Jan 2021. Methodology: Pakistan's leading kidney transplant centres were sent data electronically to ask about their anaesthetic practices. The methodology adopted was a simple questionnaire model that included 26 questions encompassing all the steps the anaesthesia team took for renal transplant. Uniformity in anaesthetic practices was expected in large centres through rigorous training and workload management. The teams responded according to their standard operating procedures and compared their answers using statistical formulas. Results: Nine out of 11(81.8%) institutes responded. Marked heterogeneity in Anaesthesia practices was found among different institutes. Only 2(18.2%) institutes had Anaesthesia guidelines for a kidney transplant. Conclusion: There is a need for centralized country-specific homogeneous guidelines for Anaesthesia for the kidney transplant to improve outcomes.

Objective: To assess live donor nephrectomy for development of hypertension. Study Design: Retrospective observational study. Place and Duration of Study: The study was conducted at Armed Forces Institute of Urology (AFIU) Rawalpindi, from May 2016 to May 2020. Methodology: All consenting kidney donors for live renal transplant were introduced with the process. Baseline blood pressure at time of workup of donation and annually afterwards after transplant on follow up examinations using retrospective data analysis of donor’s workup and follow up was used. Comparison of 1,2,3 and 4-year occurrence of hypertension among (normotensive) donors with 1,2,3 and 4-year of donation using estimates from Framingham Hypertension Risk Score. Results: A total of 79 donors with a completed annual follow-up rate of up to100 % during a 4-year period. The average age at donation was 33.96 ± 10.23 SD years; 50 donors (63.4%) were women. Overall 27% (22 out of 79) of all live donors developed post donation hypertension who were normotensive at the time of donation. Almost 2/3rd of the patients developing hypertension were females. There was a significant increase in blood pressure measurements each year after donation. Increased BMI of the patient was a risk factor for post donation development of hypertension. The donors who continue being normotensive 1-year post donation yielded an analogous risk to that fit Framingham populace. Conclusion: Live organ kidney givers are at augmented risk of development of hypertension post kidney donation. The study ascertains the potential significance of following donors and handling risk factors aggressively................

Objective: To describe the experience of educational activities in the prevention and management of COVID-19 with a staff of AFIU. Materials and Methods: Experience report of lectures and hands-on approach to COVID-19 Pandemic. Results: It was carried out as two hand sanitizing, donning, and doffing workshops preceded by lectures on the prevention of COVID-19 with 323 participants attending from AFIU. Conclusion: the hybrid approach of lectures with hands-on training was effective in building up and refreshing the knowledge of staff in the wake of the COVID-19 pandemic.

Objective: To determine the efficacy of high dose carboxymaltose vs iron sucrose for anemia among pregnant women managed at our hospital. Study Design: Comparative cross-sectional study. Place and Duration of Study: Gynecology and Obstetrics department, Pak Emirates Military Hospital Rawalpindi, from Jan 2019 to Jan 2020. Methodology: The study was done on 150 patients receiving carboxymaltose preparation and 150 patients receiving iron sucrose preparation in second or third trimester of pregnancy due to either not responding to or not tolerating the oral preparation. Mean change in hemoglobin was assessed after 12 weeks of standard therapy with both the agents. Complete recovery from anemia (hemoglobin levels), mean corpuscular volume and ferritin levels were also compared in both the groups. Results: Mean age of participants was 32.89±7.191 years. Mean rise in hemoglobin in carboxymaltose was 3.96 ± 4.19 mg/dl while in iron sucrose group was 2.11±1.72 mg/dl (p-value

Objective: To compare effectiveness of infusion with phenylephrine plus rescue boluses and rescue boluses in preventing frequency of maternal hypotension in patients undergoing cesarean section under spinal anesthesia. Study Design: Quasi experimental study. Place and Duration of Study: Anesthesia Department, Holy Family Hospital Rawalpindi, from Nov 2015 to May 2016. Methodology: A total of 80 patients were randomly divided using lottery method in group A and B. Spinal anesthesia was given with co-loading as 15 ml/kg of ringer lactate, with 12mg of hyperbaric bupivacaine (0.75%). No pre-medication was used. Patients received variable amount phenylephrine infusion starting at 0.75μg/kg/ min (group A) or variable rate prophylactic saline infusion at 0.0075ml/kg/min (group B) (control group). Maternal hypotension was treated with rescue boluses of phenylephrine (50-100μg). Results: Mean age was 30 ± 2.23years’ vs. 31± 2.81 years (group A Vs group B) (p=0.0818). The two groups did not differ in American society of Anaesthesiologists ASA status. Mean BMI in group A and group B was 24 ± 2.813 vs. 25 ± 3.114 (p=0.1358). Mean NIBP in group A and group B was 110/70mm Hg ± 8.62 vs. 111/80mm Hg ± 10.224 (p=0.6376). Phenylephrine infusion with rescue boluses was operational in 32 (80%) subjects (there was less incidence of maternal hypotension) compared to boluses only was efficacious in 14 (35%) of all patients p

ABSTRACT: INTRODUCTION: Spinal Anaesthesia is a major component of Anaesthetist's tool set and is widely used in Anaesthesia practices. A frequent problem encountered after spinal Anaesthesia is shivering caused by hypothermia. Incidence is 10-40%, if no prophylactic measures are taken, in different studies conducted on this topic. Hypothermia during intraoperative period is caused by different causes like cold ambient OR temperature, cold IV fluids, unhumidified cold inspired gases, body cavity exposure, extremes of age and prolonged procedures. Shivering occurs because of vasodilation caused by inhibition of vasoconstriction by spinal Anaesthesia and altered perception from anaesthetized dermatomes. Shivering has an array of adverse effects including increased workload for cardiopulmonary system , poorly tolerated by patients at extremes of age. A number of drugs have been studied for shivering. Objective: To compare efficacy of Dexmedetomidine and ondansetron for prevention of shivering under spinal Anaesthesia Setting: AFIU Study design: Randomized quasi experimental study Study duration: 03 months Materials and Methods: The selected patients were randomly allocated to any of the two groups with 50 patients each, according to computer generated random numbers. Both groups recieved study drugs after spinal Anaesthesia. Ondansetron group, 0.1mg/kg (groupO) and Dexmedetomidine group 0.1mcg/kg (group D). Patients were scored for shivering at scheduled intervals and rescue doses of Pethidine were given for severe shivering not responding to study drugs. Results: Our study in group O had high mean shivering scores at scheduled intervals as compared to group D Conclusion: Dexmedetomidine provides better control of shivering than Ondansetron

Objective: This study was carried out to determine whether the rate of abnormal placentation is increasing in concurrence with the cesarean section and to assess risk factors and outcomes with multidisciplinary team interventions and anesthetic practices. Study design: Prospective cohort study. Material & Methods: A study was conducted in the department of anaesthesia from January 2014 to December 2017. All candidates under the spectrum of placenta accreta were observed for maternal age, parity, mode of anesthesia, blood loss, and outcome. Results: Out of 109 patients, the preoperative diagnosis of PAS was made up of 100 (91.74%) and intraoperative diagnosis of 9 (08. 26%) patients. According to the mode of anesthesia, 100 (91.74%) patients received GA, and 09 (08.26%) patients received spinal anesthesia. In 06 (05.49%) patients, spinal was converted to GA. Perioperative CPR was done in 05 (04.58%) cases. Out of 109 cases, 83 survived uneventfully, and 21 developed complications. 05 patients expired in the following days. (01 immediately postoperative period, 02 in 1st 24 hours and 02 in 1st 48 hours. Conclusion The rate of placenta accreta increased in conjunction with cesarean deliveries; the most important risk factors were previous cesarean delivery, placenta previa, and advanced maternal age and outcomes improved in a multidisciplinary team intervention.

Background: To compare the ephedrine with lidocaine for reducing frequency of pain on propofol injection during elective surgeries. Methods: In this randomized controlled trial 80 patients were observed by taking 40 patients in each group, i.e. group A: ephedrine group and group B:lidocaine group. Patients with ASA–I (normal healthy patient), II (mild systemic disease with no functional limitation) aging between 20 and 40 years and opting for elective surgical procedures were included. The pain intensity was classified in four levels from no pain to severe pain. The frequencies of pain intensity were recorded during the injection period before the loss of consciousness according to the verbal rating scale (VRS) explained to patients at the preoperative visit. Chi square test was used to compare the frequency of pain in two groups, where p-value