Needle stick injuries among dental health care providers: a survey done at Hyderabad and Karachi

The objective of this study was to assess the frequency of needle stick injury [NSI] among dental health care providers including dental technicians. A cross sectional survey was conducted among dental health care providers running independent dental clinics at Hyderabad and Karachi during the month of April 2013 and a total of 166 qualified dentists and 88 dental technicians were interviewed. Ninety [54.2%] out of 166 qualified dentists and 45 [51.1%] out of 88 dental technicians had been the victims of NSI at least once in preceding 12 months. 104 [62.6%] dentists knew about universal guidelines for prevention of needle stick injury, whereas only 7 [8%] technicians knew about safety guidelines. Only 67 [40.4%] dentists out of 166 and 7 [8.0%] technicians out of 88 reported about the needle stick injury to health authorities [or seniors]. Common reasons for non-reporting among qualified dentists were: 55 [33.1%] believed that there was no benefit to report, 45 [27.1%] did not know where to report and 32 [19.3%] assumed that needle was new. In the category of technicians, 52[59.1%] did not want to report. 03[3.4%] believed needles were used for first time and 5 [5.7%] believed nothing will happen. The risk of blood borne viral infections due to needle stick injury among dental health care providers, especially dental technicians is very high. Based on local studies and international guidelines, national guidelines for Pakistan should be developed by experts to minimize the chances of needle stick injury

Acid aspiration prophylaxis during anaesthesia for caesarean section: a survey among anaesthetists at Hyderabad

Pulmonary aspiration of gastric contents leading to acid aspiration syndrome [AAS] is a well recognized risk factor during general anaesthesia [GA] for Caesarean section [CS]. The cross sectional observational study was conducted during July 2008 to October 2008 at Department of Anaesthesiology and Intensive Care, Liaquat University of Medical and Health Sciences Jamshoro, Sindh, Pakistan. The objective was to assess anaesthetic practice patterns and measures to prevent aspiration of acid gastric contents in full term pregnant women undergoing anaesthesia for Caesarean section. A structured questionnaire regarding practice of anaesthesia for Caesarean section was distributed among anaesthetists working and practicing at Hyderabad. Results from the completed questionnaires were transferred to a Microsoft Excel spreadsheet and the responses represented as percentages. General anaesthesia was preferred by 75.4% anaesthetists for caesarean section, 83.6% anaesthetists used rapid sequence induction with cricoid pressure during general anaesthesia, 29.5% respondents restricted clear fluids for 2-3 hours. Antacids were used by 90% of the anaesthetists, while about 50% anaesthetists performed extubation when patients were fully awake. Recommended practice patterns and measures to prevent aspiration of acid gastric contents during anaesthesia for caesarean section are not observed by most of the anaesthetists working at Hyderabad

investigation of mechanism of vasodilator activity of 17 beta-estradiol as being geriomic or non-genomic

To determine the vasodilator activity of 17 beta-estradiol as being genomic or non-genomic. The experimental protocol was divided into three groups, In group I aorta of rat was subjected to serial dilutions of norepinephrine and a standard concentration was selected, which produced optimal vasoconstriction. In group II, tissue was challenged with serial dilutions of 17 beta-estradiol in the presence of vascconstriction induced by the standard concentration of norepinephrine. Meanwhile in group III tissue was challenged with serial dilutions of 17 beta-estradiol in presence of standard concentration of norepinephrine after pretreatment with dactinomycin, which was used to inhibit protein synthesis so that genomic mode of action could be blocked. In our study 17 beta-estradiol, after pretreatment with dactinomycin, produced vasodilator activity in the same pattern as obtained without administration of protein synthesis inhibitor in the tissue preconstricted with norepinephrine [P<0.001]. The observations demonstrate the vasodilator activity of the 17 beta-stradiol to be its non-genomic action

Frequency, pattern and etiology of nosocomial infection in intensive care unit: an experience at a tertiary care hospital

Nosocomial infection is defined as an infection which develops 48 hours after hospital admission or within 48 hours after being discharged. The objectives were to assess the frequency of nosocomial infection in patients admitted to intensive care unit [ICU] and to determine the etiological factors in such patients. It was an Observational Study and conducted in Intensive Care Unit, Liaquat University Hospital Hyderabad Sindh Pakistan from January 2008 to November 2008. All patients above 16 years of age admitted in the ICU for more than 48 hours and developed clinical evidence of infection that did not originate from patients' original diagnosis at the time of admission, were included in the study. Data was entered in a proforma and analyzed using SPSS version 10.0. During the study period, 97 out of 333 patients acquired nosocomial infection. The frequency of nosocomial infection was 29.13%. Respiratory tract infection was seen in 29 [30.1%], urinary tract infection in 38 [39.1%] and blood stream infection in 23 [23.7%] patients. Other infections we identified were skin, soft tissue, wound and gastrointestinal tract infections. Patients admitted in intensive care unit are at more risk of acquiring nosocomial infection from different sources. It is suggested that proper nursing care, sterilization and disinfection of instruments and equipment and careful handling of invasive procedures are the best tool to control these life threatening infections

Post dural puncture headache after spinal anaesthesia for caesarean section: a comparison of 25G Quincke, 27G Quincke and 27G whitacre spinal needles

To compare the frequency and severity of post dural puncture headache in obstetric patients using 25G Quincke, 27G Quincke and 27G Whitacre spinal needles. Comparative, randomized, double-blind, interventional study. Liaquat University Hospital Hyderabad from October 2005 to December 2006. 480 ASA I-II full term pregnant women, 18 to 45 years of age, scheduled for elective Caesarean section, under spinal anaesthesia, were randomized into three groups: Group I [25G Quincke spinal needle: n=168], Group II [27G Quincke spinal needle: n=160] and Group III [27G Whitacre spinal needle: n=152]. Spinal anaesthesia was performed with 1.5-2.0 ml 0.75% hyperbaric bupivacaine using 25G Quincke spinal needle [Group I], 27G Quincke spinal needle [Group II] and 27G Whitacre spinal needle [Group III] at L3-4 inter-vertebral space. Each patient was assessed daily for four consecutive days following Caesarean section. Frequency and severity and of postdural puncture headache [PDPH] were recorded. Data were analyzed using SPSS-11. Frequency of PDPH following the use of 25G Quincke [Group I], 27G Quincke [Group II] and 27G Whitacre [Group III] spinal needles was 8.3% [14/168], 3.8% [6/160] and 2.0% [3/152] respectively. In Group I, PDPH was mild in 5 patients, moderate in 7 patients and severe in 2 patients. In Group II, it was mild in 2, moderate in 3 and severe in 1 patient. In group III, it was mild in 2 and moderate in 1 patient. Severe PDPH did not occur in Group III. Most of the patients with PDPH developed it on first and second postoperative day. When using a 27G Whitacre spinal needle, the frequency and severity of PDPH was significantly lower than when a 25G Quincke or 27G Quincke needle was used

Vesico-vaginal fistula experience of surgical repair at Larkana

To assess the causes of Vesico-vaginal fistula and evaluate the results of surgical repair ot'Vesico-vaginal fistula A retrospective study was conducted in Ch and ka Medical College Hospital and Larkan Medical Centre from March 1999 to February 2005. Forty patients of Vesico-vaginal fistula resulting from causes other than malignancies and radiations were included in the study. Majority of the patients had fistula secondary to an obstetrical cause. Of the total 32 patients were repaired trans-vaginally. Prolonged labour was the major cause of Vesico-vaginal fistula [80%]. Thirty two [80%] patients were operated trans vaginally and 8 trans-abdominally. Success rate was 85.8% for the transvaginal approach in the first instance. Stress urinary incontinence was noted in 2 patients while 1 patient with transabdominal approach developed recurrence. In developing countries the major cause of Vesico-vaginal fistula is obstructed labour which can be repaired trans. vaginally in majority of cases under skilled surgeon

Double phallus

A 2.8 kg newborn was brought to the hospital soon after birth because of absence of anal opening and duplication of penis. Examination of cardiovascular, central nervous system and respiratory system was normal. His abdomen was distended. Examination of perineum revealed absence of anal opening. His genital examination showed two penises with normal scrotum. One penis was larger, looking apparently abnormal. The other penis was smaller, normal in appearance and present to the right of large penis. Both penises had patent urethral meatuses. The scrotum contained both testes. X-ray invertogram showed an intermediate type of anorectal malformation. His Micturiting cystourethrogram [MCUG] showed pooling of contrast in accessory urethra. Initially a sigmoid colostomy was performed for anorectal malformation to relieve the intestinal obstruction and stabilize the clinical condition. After few days the accessory penis was also excised. Postoperative recovery was uneventful. Biopsy showed fibromuscular tissue surrounded by skin with a central cystic space lined by urethral mucosa. Vascular spaces and neural tissue also seen. Patient has been visiting our outpatient department every month for follow-up and for the management of his colostomy