Evaluation of laryngoscopes decontamination practices in different hospitals

To find disinfection and sterilization practices of laryngoscope in different hospitals. Descriptive study. Combined Military Hospital Gujranwala, from Jan 2010 to Jan 2011. laryngoscope decontamination practices in different hospitals were evaluated in this study which was based on a telephonic structured questionnaires. Preset questions were asked on phone from operation room technicians of 50 different hospitals. For clarification and confirmation of procedure anesthesiologist of the hospital was contacted. Laryngoscope decontamination practices were asked as per questionnaire and data collected was recorded and analyzed. Results were documented and compared with studies regarding laryngoscope decontamination practices of different countries. Most exercised methods were manual decontamination with simple gauze [50%], alcohol gauze [11%] or tap water [27%]. The use of disposable blades and sheathing of blades was not practiced by any of the hospitals. Similarly chemical disinfectants were used rarely [2%]. Rinsing laryngoscopes with water [always 27%, sometime 23%] was very common while, autoclaving or sheathing of blades was not done in any of the hospital. The rate of different postoperative infections is on the increase in our hospitals and one likely contributing source in contaminated laryngoscopes. Lack of awareness and poor practices among health care professionals, over work and economic constraints are the major contributing factors which need to be controlled by adhering to international standards

Bilateral miliary shadowing on chest x-ray

A patient presented with recent onset of increasing shortness of breath, weight loss and low-grade fever. His chest X-ray revealed bilateral miliary shadowing. He was investigated with CT-scanning of thorax. Later, a biopsy from supra-clavicular node and its immunocytochemistry studies confirmed metastasis from primary lung cancer. Primary lung cancer with miliary pulmonary metastases is a rare happening and is mostly associated with lung adenocarcinoma.

Assessment of metered dose inhaler technique in patients with chronic lung disease at government hospitals of Rawalpindi

Metered dose inhalers [MDIs] are an affective modality of treatment for fast relief from asthma flare-ups and other symptoms, and are often used by asthmatic athletes. It has got lots of benefits and some drawbacks depending on usage technique. With proper technique and training drawbacks can be minimised. The objective of this study was to assess the metered dose inhaler technique in patients with chronic lung disease at government hospitals of Rawalpindi. A cross-sectional study was conducted in three government hospitals of Rawalpindi. The inhalation technique was assessed in six steps. Clear evidence showed that only 24% patient could perform all the steps correctly. Percentages of people that followed individual steps properly were: preparation [87.5%], exhalation [53.85%], lip closure [68.27%], inhalation [56.73%], breath-holding [27.88%] and puff interval [36.54%]. This study showed that a number of patients in government hospitals of Rawalpindi were unable to use metered-dose-inhaler properly and therefore indicates the need to make people aware of this technique either by counselling or arranging seminars

Cervicofacial emphysema

The case describes a young girl developing cervicofacial emphysema after fall. She presented in emergency with gradually worsening upper body swelling without any sign of distress. Swelling was found on the right side of the face, all around the neck and right arm with crepitus in all these areas. CT scanning of head, neck and chest were performed and a small area of communication between nasopharynx and the trapped air of subcutaneous emphysema was seen. Video-endoscopy of the pharynx showed a tear in the nasopharyngeal mucosa acting as a one way valve leading to the development of cervicofacial emphysema

Pulmonary alveolar microlithiasis

This is a case report of 32 years old male, who presented in outdoor clinic of Pulmonology Department, Jinnah Hospital, Lahore, with progressively increasing shortness of breath over 2 years, multiple episodes of dry cough over 9 months, history of low-grade fever for 15 days and haemoptysis for the last one day. He was diagnosed as a case of miliary tuberculosis on the basis of his chest X-ray findings and was on anti-tuberculosis treatment by the GP of the locality. Diagnosis of pulmonary alveolar microlithiasis was made on the basis of clinical features and laboratory findings

Precipitating factors of hepatic encephalopathy: experience at Pakistan Institute of Medical Sciences Islamabad

Hepatic encephalopathy is an extra hepatic complication of impaired liver function and is manifested as neuropsychiatric signs and symptoms associated with acute or chronic liver disease in the absence of other neurological disorders. There are numerous factors of hepatic encephalopathy. The main objective of this study was to analyse the precipitating factors of hepatic encephalopathy in cases seen in Pakistan Institute of Medical Sciences Islamabad. Fifty admitted patients with acute or chronic liver diseases complicating to hepatic encephalopathy were probed into for precipitating factors, based on history, clinical examination and laboratory methods from September 2005 to December 2005. The associated biochemical laboratory data analysis and prognostic stratification through Child's Pugh classification was also done. Infection [44%], gastrointestinal bleeding [38%] and constipation [38%], stood out as the most common factors. Usage of drugs with ammonium salts, tranquilizers and large volume paracentesis were least common factors. Most patients were in grade III [52%], and grade IV [22%], of hepatic encephalopathy. Other common associations were ascites [64%], Child's class C [62%], hyponatremia [50%], low haemoglobin [70%], hepatitis C [62%], and high mortality rate [30%]. Infection, gastrointestinal bleeding and constipation being the most important precipitating factors must be prevented and hospital funds, medicines and human efforts should lay emphasis, on these factors to decrease the incidence of hepatic encephalopathy. This also includes effective control measures against rising cases of hepatitis C, as it is the leading cause of liver cirrhosis in Pakistan