Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: A case series.

Fast‑track extubation is an established safe practice in pediatric congenital heart disease (CHD) surgical patients. On table extubation (OTE) in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF) cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post‑TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2–3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.

prospective study on parasites among expatriate workers in Al-Baha from 2009-2011, Saudi Arabia

AI-Baha is an area with large influx of expatriate workers in Saudi Arabia. This study was carried out from October 2009 to January 2011 on expatriate workers [2000] to determine the prevalence of parasitosis. Urine and stool samples were collected and specifically examined. The results showed that 1079 [53.95%] were infected with one or up to ten parasitic species. Trichuris trichiura had the highest prevalence 190 [17.6%]. Other helminthes were Ascaris lumbricoides 179 [16.58%], Ancylostoma duodenal 163 [15.10%], Hymenolepis nana 120 [11.12%], Taenia saginata 119 [11.02%], Strongyloides stercoralis 28 [2.59], Enterobius vermicularis 16[1.48%], and Schistosoma mansoni 4 [0.37%]. Protozoan parasites were Giardia lamblia 152 [14.09%] and Enta-moeba histolytica 108[10.0%] Besides, Fasciola species was detected in an Egyptian worker and Dicrocelium den-driticum in one Syrian worker. Parasitic infections were higher among Indonesian people 447 [41.42%] followed by Indian 247 [22.89%], Bangladeshis 118 [10.93%], Philippines 96 [8.89%], Pakistani 94 [9.71%], Seri-Lankan 55 [5.09%] and lastly Egyptian and Syrian 22 [2.03%] workers. The occupational imperatives, beliefs and general life style were contributing factors to the prevalence of parasites among the workers in AI-Baha