Risk of acquiring cutaneous leishmaniasis in tribal areas of Pakistan

Objective: To assess the risk of acquiring cutaneous leishmaniasis [CL] in tribal areas of Pakistan. Study Design: A cross sectional observational study. Place and duration of study: Combined Military Hospital, Okara, from Oct 2014 to Mar 2015

Material and Methods: A total of 4500 persons between the ages of 22 to 50 years, who were moved from central areas of Punjab to Waziristan on duty, were studied for the occurrence of CL. All cases was developed cutaneous lesions and were confirmed as having CL were included in the study. During the same period, 4300 persons living at Okara, who did not have any exposure to the Federally Administered Tribal Area in same age group, were also observed and studied as control group

Results: A total of 36 patients suffered from CL in the study population, while one case from the control group developed the disease [p<0.05]. This patient was resident of Sindh and had repeated visits to his home station. The risk of developing CL was greater in Waziristan as compared to central Punjab as odds ratio [OR] was calculated as 30.79

Conclusion: There is substantial risk of developing CL in persons exposed to tribal areas of Pakistan

Evaluating the effect of intravenous lignocaine on improving the condition for laryngeal mask air way placement under thiopentone anaesthesia

To find out whether intravenous lignocaine improves the condition for Laryngeal Mask Airway [LMA] placement under thiopentone anaesthesia. A prospective study. Combined Military Hospital, Peshawar. 100 ASA I and II patients were selected and were randomly divided into two groups. Group-I patients received saline while group-II pts received 1.5 mg /kg of lignocaine prior to induction with thiopentone sodium. Three variables, [Jaw opening, Coughing and ease of placement of LMA] were evaluated. Study showed that lignocaine facilitated first attempt LMA placement in 60% of the patients, accompanied by ease of jaw opening in 58% and devoid of coughing in 62% of the patients. This shows that lignocaine significantly reduces the laryngospasm which occurs during LMA placement under thiopentone anaesthesia, due to its ability to suppress the upper airway reflexes. Therefore, it is concluded that intravenous lignocaine gives better results than normal saline

Anesthesia crisis resource management

The critical scenario in which rapid response is needed, for example. Malignant Hyperthermia, occurs rarely. Hence conducting training about such clinical events leaves no alternative but to use simulation. The aims of anesthesia crisis resources management [ACRM] training are to learn principles of complex problem solving, decision making, resource management and team work behavior to improve medical and technical skills. In medical training, simulator can substitute for actual patients and recreate actual clinical environment for anesthesiologists, surgeons, radiologists, cardiologists, gynecologists, etc. for their training. Simulators range from simple mannequin to high fidelity simulators. Mannequin represents the patient, and the participants act as surgeons, anesthetists and operating room assistants in a replica of operation theatre. The high fidelity simulators are programmed to create a special situation which the trainees are required to diagnose and manage the situation and resources accordingly. A panel consisting of consultants and instructors trained in this field are observing and recording all the details on the video tape which is used later on for the debriefing sessions. Simulators have high face validity because they ease trainees' transition to actual patient. Simulators can effectively identify errors and appropriateness of decision making. There is a risk that clinician might acquire inappropriate behavior or develop a false sense of security in their skills that could theoretically lead to harm the patient. The trainees develop an underst and ing that how stresses contribute to the occurrence of error. The ACRM training is an effort to improve our underst and ing about the crisis management aiming at reducing error and ultimately improve patient safety