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Background & objective: The anesthesiologists have been trying various strategies to lessen the adverse effects of endotracheal intubation on hemodynamic parameters. The aim of this study was to explore a better and safer drug to attenuate the pressor response to laryngoscopy and intubation by comparing dexmedetomidine (Precedex; Brookes Pharma), fentanyl (Fentra; Brookes Pharma), and lidocaine (Xylocaine; Barret Hodgson). Methodology: In this double-blind, randomized controlled trial, a total of 90 patients of ASA physical status I and II, undergoing laparoscopic cholecystectomy under general anesthesia were included. Sample size was calculated using OPEN EPI sample size calculator. Patients were randomized into three groups by sealed envelope method. Patients in Group D received intravenous dexmedetomidine 0.6 μg/kg, Group F received intravenous fentanyl 2 μg/kg and Group L received intravenous lidocaine 1.5 mg/kg over 10 min before induction. Hemodynamic variables were recorded at baseline, at laryngoscopy, 1, 3, 5 and 10 min after intubation. Perioperative complications and postoperative sedation and recovery were also noted at 0 and 10 min in Post Anesthesia Care Unit (PACU). Results: As compared to dexmedetomidine, there was no significant impact of lidocaine (P = 0.774) and fentanyl (P = 0.992) in managing the heart rate (HR) of patients, while time had a significant impact on the HR. There was no substantial effect of fentanyl (P = 0.123) or lidocaine (P = 0.616) in managing SBP and no effect of fentanyl (P = 0.580) or lidocaine (P = 0.752) in managing DBP, in contrast to dexmedetomidine. Although statistically significant reduction in HR, SBP and DBP was observed in Group D, soon after study drug infusion, but overall long-term stability was noticed. Ramsey sedation scores were significantly higher in the Group D at arrival in PACU, but after 10 min all three study groups showed almost similar results. Aldrete score was statistically significant in the fentanyl group compared to Group D and L in PACU, both at arrival and after 10 min (P = 0.001 and 0.010 respectively). Conclusion: We conclude that intravenous dexmedetomidine demonstrated better attenuation of hemodynamic response to laryngoscopy and intubation in patients undergoing laparoscopic cholecystectomy by controlling rise in heart rate and by providing long-term stability in systolic and diastolic blood pressure. Fentanyl and lidocaine showed inconsistencies in heart rate, systolic and diastolic blood pressure over time. Fentanyl showed better hemodynamic profile compared to lidocaine. Patients included in fentanyl group exhibited early recovery than dexmedetomidine and lidocaine. [ABSTRACT FROM AUTHOR]

Background & objectives: Spinal anesthesia is the preferred technique for obstetric patients as it is economical, simple to perform, has a rapid onset and provides complete muscle relaxation. A variety of adjuvants have been used to enhance or prolong its effects. We compared the effects of dexmedetomidine and fentanyl on the onset and recovery times of sensory and motor blockade as well as on hemodynamics, postoperative complications and duration of postoperative analgesia in parturients undergoing lower segment cesarean section (LSCS). Methodology: It was a prospective, double blind, randomized controlled trial. Sixty healthy parturients having cesarean delivery under spinal anesthesia were randomly divided into two equal groups. Group BD was given 10 mg bupivacaine plus 5 μg of dexmedetomidine and Group BF was given 10 mg bupivacaine plus 10 μg of fentanyl. Parturients was then observed for the onset and recovery times of sensorimotor blockade, hemodynamics, postoperative complications and postoperative analgesia. Results: There was no statistically significant difference in the onset of sensorimotor block between the groups. The time to complete sensory and motor recovery was significantly prolonged in Group BD (P = 0.01 and P = 0.0001 respectively) as compared to Group BF. Both groups did not show significant differences in hemodynamic changes, but there was a reduction in systolic and diastolic blood pressures ≥ 20% from baseline intraoperative. The VAS at 3 and 4 h postoperatively in the Group BD was significantly lower (P = 0.02 and P = 0.01 respectively). The incidence of complications was found comparable in two groups, except incidence of hypotension and nausea was more in the Group BD compared to Group BF (P = 0.006 and 0.002 respectively). Conclusion: Although intrathecal dexmedetomidine prolongs the duration of sensory block, with comparable hemodynamic changes and good postoperative analgesia, prolonged motor block due to it, compared to intrathecal fentanyl, is not a desirable outcome particularly in short duration surgeries like LSCS, which can increase discharge time from post anesthesia care unit (PACU) to the ward. [ABSTRACT FROM AUTHOR]

The present study was designed to determine physic-chemical characteristics and best extender for refrigerated preservation of Labeo rohita milt. In experiment I, milt was collected from mature and healthy brooders (n = 5) of L. rohita reared at fish seed hatchery, Rawal Town, Islamabad, Pakistan. After collection, milt was maintained at 4°C and physico-chemical characteristics were studied. The mean volume of Labeo rohita milt was 8.02 ± 0.12 ml, pH 7.60 ± 0.17, sperm count 2.77 ± 0.19 1010/ml, osmolality 267.6 ± 7.4 mOsmol/kg, sodium 95.43 ± 6.7 (mM/L), potassium 34.41 ± 1.2 (mM/L), total lipids 178.94 ± 5.0 mg/dl and motility 83.5 ± 5.0%. In experiment II, nine male brooders (3 brooders/replicate) maintained in three different ponds were used. In each replicate, milt from three brooders was pooled, kept at 4°C and divided into 4 aliquots. An aliquot was kept undiluted (control), while other aliquots were diluted in Alsever's solution, sugar-based extender and modified Kurokura extender (KE) in 1:9 ratio at 4°C and stored up to 7 days. Sperm motility and viability were assessed for up to 7 days. Total antioxidant capacity was measured on Day 4. Sperm motility was higher (p < 0.05) in milt diluted with KE compared with control and other diluents from Day 5 to Day 7. However, highest sperm viability was observed on Day 6 and Day 7 in sperm diluted with KE. Total antioxidant capacity of milt diluted with KE and control was higher than other diluents on Day 4. In conclusion, viability of Labeo rohita sperm can be increased by diluting it in KE. [ABSTRACT FROM AUTHOR]

Objective: Encephalitis is a disease that has a major impact on health systems worldwide in terms of mortality, morbidity and costs. Furthermore, it is a challenging disease for the treating physician, as the patient presentation varies, and not all patients present with typical complaints. In addition, if left untreated or if there is a delay in the treatment, the mortality rate due to encephalitis can increase. The incidence of encephalitis in Pakistan is scarce in the literature because, in most of cases, the specific cause is not evaluated due to lack of resources and also because the majority of cases are not reported. The aim of this study was to determine the incidence and outcomes of encephalitis in patients admitted to a tertiary care hospital intensive care unit in Pakistan. Methods: This retrospective study was conducted in the intensive care unit of the Aziz Fatimah Medical College and Hospital, Faisalabad. After obtaining the ethical approval, a total of 75 patients were found in the medical records with a confirmed diagnosis of encephalitis out of total 3,921 patients admitted to the intensive care unit in the 5-year period from 1st January 2013 to 31st December 2018. Results: The most common clinical presentation were seizures (64%) followed by headache (53%), irritability (29.3%) and hemiparesis (26.7%). Among all patients, 44 needed invasive ventilation, and 7 required non-invasive ventilation. In addition, the outcomes were variable. Conclusion: The incidence of encephalitis was 1.9% in the 5-year period, and the mortality rate was 37.3%. Also, 6.7% patients improved without any complications. [ABSTRACT FROM AUTHOR]

Back ground & Objective: Tetanus is a preventable disease that is still prevalent in the developing countries due to inadequate vaccination practices. It has a prolonged disease course and requires an extended intensive care unit (ICU) stay, as supportive care is the mainstay for a better outcome. This study examines the clinical profile of adult tetanus patients and the impact of early tracheostomy on the final outcome in patients admitted to our ICU. Methodology: In this retrospective observational study, patients with age of 18 y or above, diagnosed as a case of tetanus on the basis of the presence of at least two of the clinical features; trismus with or without risus sardonicus, and the rigidity of the abdominal wall and reflex spasm, were included. Neonates, pregnant and epileptic patients were excluded. The study was conducted at the ICU of our institute after approval from the Ethical Review Committee (ERC No.000003/SMBBIT/Approval/2019-2020). Medical records from August 2017 to February 2021 were collected in a pre-defined questionnaire. The primary outcome was the impact of early tracheostomy on survival and secondary outcomes were the risk factors of mortality. Results: 48 patients were included in the study with 44 (91.7%) males and 4 (8.3%) females. The median age of patients was 25.5 (22-35) y. Lower limb was the primary site in 32 (66.7%) of the patients. Neck rigidity (39.6%) and trismus (35.4%) were the main presenting symptoms. The median incubation period was 14 (10-16) days. The median length of stay in the ICU was 28 (25-30) days. The most common complication was ventilator-associated pneumonia (VAP) acquired by 16 (33.3%) patients. Almost all patients showed a significantly higher level of creatine phosphokinase (CPK) 3908.85 ± 2974.91 IU/L, which gradually decreased on discharge to 430.48 ± 360.7 IU/L. 43 patients underwent tracheostomy. Early tracheostomy (within 7 days) was associated with a lower incidence of VAP (p = 0.000) and lesser need of mechanical ventilation (MV) (p = 0.000) with better survival rate (p = 0.000). The overall survival rate was 81.3%. Conclusion: We conclude that the patients who underwent early tracheostomy, had better survival and lower risk of being mechanically ventilated and development of ventilator associated pneumonia. Periodic estimation of CPK level can be used as a valuable prognostic tool and predictor of mortality in tetanus patients. Age, any comorbid, mechanical ventilation and complications were the probable risk factors. Over all we had a good rate of survival. [ABSTRACT FROM AUTHOR]

Objective: To assess the practice of ordering unnecessary laboratory investigations by primary surgical teams., Methods: The clinical audit was conducted from December 17, 2022, to January 15, 2023, at the Civil Hospital, Karachi, and comprised primary surgeons working in different surgical units who ordered laboratory investigations for patients as a part of preoperative assessment. Data was collected using a self-administered questionnaire. Data was analysed using SPSS 20., Results: Of the 280 surgeons approached, 249(89%) responded. The units covered were General surgery 96(38.5%), Gynaecology 74(29.7%), Neurosurgery 5(2.0%), Ear, Nose and Throat 19(7.6%), Plastic surgery 15(6.02%), Paediatric surgery 13(5.2%), Vascular surgery 8(3.21%), Oromaxilofacial 9(3.61%), Opthalmology 6(2.4%), and Orthopaedics 4(1.60%).As part of baseline investigations, 244(98%) surgeons ordered complete blood count, 173(69.5%) ordered urea and creatinine, 229(92%) ordered viral markers, 197(78.7%) ordered fasting and random blood glucose, and 178(71.5%) focussed on cardiac fitness., Conclusion: A need was found to establish standard protocols for pre-surgery evaluation so that unnecessary investigations may be avoided.