Two forgotten induction agents; etomidate versus thiopental sodium with rocuronium for rapid sequence induction

To assess the effect on intubating conditions and haemodynamic response on intubation of two different induction agents etomidate and thiopental sodium with rocuronium during rapid sequence induction. This prospective quasi experimentalstudy was conducted in Department Of Anaesthesia, SICU and Pain Management, Dow Medical College, Civil Hospital Karachi and Abbasi Shaheed Hospital Karachi Medical and Dental College over a period of one year. Total 120 American Society of Anaesthesiologists [ASA] physical class I and II, adult patients of either gender, aged between 18 to 60 years, undergoing elective surgery were allocated randomly into two equal groups to receive either intravenous thiopental sodium [Group NTR] or etomidate[Group NER] for rapid sequence induction. Group NER was given nalbuphine 0.1 mg/kg, induction agent etomidate 3 mg/kg with muscle relaxant rocuronium 1.0 mg/kg while in group NTR induction agent thiopental sodium was given in the dose of 4 mg/kg with nalbuphine and rocuronium in the same doses. After sixty seconds, laryngoscopy was done. Intubating condition was assessed using the criteria of Cooper and colleagues: ease of intubation, condition of vocal cords and response to intubation. Cardiovascular response on intubation in terms of systolic and diastolic blood pressure and heart rate was evaluated at 0,1, 3 and 5 minutes. Demographic data were comparable between the groups. Intubating conditions which were assessed in terms of ease of laryngoscopy, condition of vocal cords at intubation and intubation response coughing, bucking and diaphragmatic movement were significantly better in the group NER [p<0.05]. Similarly, arterial blood pressure remained close to base line in NER group but there was significant fall in both systolic and diastolic blood pressure in group NTR. However, there was no significant difference in change in the heart rate in the groups. Etomidate-rocuronium is better than thiopental-rocuronium in terms of intubating conditions and haemodynamic stability during rapid sequence induction in non-septic surgical patients in emergency department

Directly observed treatment short course [DOTS] program for treatment of tuberculosis in Balochistan-role of lady health workers

The main objective of the study was to reduce problem of tuberculosis by increasing the success rate by implementing DOTS through LHWs. The study was an observational descriptive one. The patients for this study were recruited from the four districts of Balochistan; Mastung, Dera Allah Yar, Dera Bugti and Nasirabad, Balochistan. The study was done during January 2004 to September 2004. All those who were sputum smear positive and presented for the first time were included as 'new' patients and those on re-treatment as "relapses". The study population consisted of all pulmonary tuberculosis patients over 15 years old in the four districts of Balochistan, who started a new course of tuberculosis treatment after sputum examination at any of the diagnostic clinics. Patients were excluded from the study if they had multiple-drug resistance [MDR] or severe illness where facility based management was indicated. The results of study showed that the majority [47%] of affected persons belonged to younger age group [15-35], and out of the 111 persons who were enrolled in the study, 65% wore males. Fifty percent of affected persons were daily wagers and farmers [49%] and earning less than 2500 rupees per month. Majority [75%] were illiterate. Regarding sputum conversion, there was significant impact of DOTS to sputum conversion within adequate time period, majority [74%] of DOTS cases converted to negative within two months and 14% within 3 months of starting the treatment. It is concluded that DOTS is an effective strategy to treat tuberculosis in Pakistan. However, if we have to replicate it on a wider scale, we need to strengthen the LHW program