Comparison between intravenous boluses versus infusion of tranexamic acid [TXA] to reduce bleeding in paediatric cyanotic congenital heart disease [CHD] surgeries

Objective: To compare the intravenous boluses and intravenous continuous infusion of tranexamic acid [TXA] to reduce postoperative bleeding in cyanotic congenital heart disease surgeries

Study Design: Single-blinded randomised clinical trial

Place and Duration of Study: Anaesthesia Department, The Aga Khan University Hospital, Karachi, from July 2016 to April 2017

Methodology: Sixty patients of cyanotic congenital heart disease, undergoing either palliative or corrective surgery involving cardiopulmonary bypass [CPB], were recruited. These 60 patients were divided randomly into two groups. The infusion group received intravenous infusion of TXA at 5 mg/kg/hour while the bolus group received three intravenous boluses of 10 mg/kg after induction, after going to bypass and after protamine reversal. Data was collected through predesigned proforma. There were two primary outcomes: postoperative bleeding in the first 24 hours, and chest closure time

Results: Postoperative bleeding was 13.94 [10.27-20.18] ml/kg in the first 24 hours in infusion group and 15.05 [9.04-23.50] ml/kg in the bolus group. Chest closure time was 38.5 [25-45] in infusion group and 30 [20-46.25] minutes in the bolus group. There was no statistically significant and clinical difference between both groups regarding postoperative bleeding in the first 24 hours and chest closure time

Conclusion: These infusion and bolus groups had comparable postoperative bleeding and chest closure time

Urgent aortic valve replacement in severe aortic stenosis with severe left ventricular dysfunction and severe pulmonary hypertension: a perioperative multidisciplinary management approach

Severe aortic stenosis [AS] with reduced left ventricular systolic function and pulmonary artery hypertension [PH] is associated with poor outcome if remained untreated We report a case report of a 62 years old male patient weighing 69 kg had progressive dyspnea for 5 years and was diagnosed cardiac patient, and was scheduled for an urgent aortic valve replacement. He had severely reduced left ventricular [LV] function and severe pulmonary hypertension. The patient was put on bypass with special emphasis on myocardial protection. Tissue valve was placed and patient was successfully put off cardiopulmonary bypass on high inotrope score, which was tapered after some time. The patient was shifted to CICU after chest closure and was extubated on fast track mode. The patient was followed up for three months showing improvement in symptoms and LV function The objective of reporting the case is to highlight the role of multidisciplinary integrated approach in the perioperative period for best patient outcome

Veterinary public health capacitybuilding in India: a grim reflection of the developing world’s underpreparedness to address zoonotic risks.

Veterinary public health (VPH) is ideally suited to promote convergence between human, animal and environmental sectors. Recent zoonotic and emerging infectious disease events have given rise to increasing calls for efforts to build global VPH capacities. However, even with their greater vulnerability to such events, including their economic and livelihood impacts, the response from lowand middle-income countries such as India has been suboptimal, thereby elevating global health risks. Addressing risks effectively at the human–animal interface in these countries will require a clear vision, consistent policies, strategic approach and sustained political commitment to reform and refine the current VPH capacitybuilding efforts. Only then can the discipline serve its goal of disease prevention, poverty alleviation and support for sustainable livelihoods through improvements in human and animal health.

Public health engineering education in India: Current scenario, opportunities and challenges.

Public health engineering can play an important and significant role in solving environmental health issues. In order to confront public health challenges emerging out of environmental problems we need adequately trained public health engineers / environmental engineers. Considering the current burden of disease attributable to environmental factors and expansion in scope of applications of public health / environmental engineering science, it is essential to understand the present scenario of teaching, training and capacity building programs in these areas. Against this background the present research was carried out to know the current teaching and training programs in public health engineering and related disciplines in India and to understand the potential opportunities and challenges availables. A systematic, predefined approach was used to collect and assemble the data related to various teaching and training programs in public health engineering / environmental engineering in India. Public health engineering / environmental engineering education and training in the country is mainly offered through engineering institutions, as pre-service and in-service training. Pre-service programs include diploma, degree (graduate) and post-graduate courses affiliated to various state technical boards, institutes and universities, whereas in-service training is mainly provided by Government of India recognized engineering and public health training institutes. Though trainees of these programs acquire skills related to engineering sciences, they significantly lack in public health skills. The teaching and training of public health engineering / environmental engineering is limited as a part of public health programs (MD Community Medicine, MPH, DPH) in India. There is need for developing teaching and training of public health engineering or environmental engineering as an interdisciplinary subject. Public health institutes can play an important and significant role in this regard by engaging themselves in initiating specialized programs in this domain.

Frequency of glucose-6-phosphate dehydrogenase [G6PD] deficiency in asymptomatic Pakistani population

To determine the frequency of G6PD deficiency in asymptomatic Pakistan population. Cross sectional study. This was carried out at Pakistan Air Force [PAF] Hospital at PAF Base Masroor Karachi between June 2004 - September 2007. Healthy young males and females between the ages of 13 to 28 years were tested for G6PD deficiency. None of the individuals had the findings of chronic hemolytic anemia. Their test was carried out on Trinity Biotech visual, qualitative, colorimetric procedure for determining G6PD deficiency using dichlorophenol indophenols as an indicator. During the study period 888 individuals, 804 males and 84 females were tested for G6PD deficiency. Forty [4.5%] individual had G6PD deficiency. All were otherwise healthy with normal general physical examination, complete blood count, blood glucose level, liver function tests, renal function tests, lipid profile, urine analysis, electrocardiogram and X- Ray chest .Out of 804 males 40[5.0%] had G6PD deficiency. None of the 84 females had the enzyme deficiency. G6PD deficiency is observed to be 4.5%. Our findings are in conformity with W.H.O data for geographic distribution of G6PD deficiency in Pakistan .It should be considered in the differential diagnosis of hemolytic anemia, especially following drug administration

Effect of thioperamide on nitric oxide in middle cerebral artery occlusion model of focal cerebral ischemia in rats

The present study evaluated the effect of Thioperamide [THP], a selective histamine H[3]-receptor antagonist, on middle cerebral artery occlusion [MCAO]-induced focal cerebral ischemia in rats. The rats were subjected to 2 hrs of MCAO followed by 22 hrs reperfusion followed by nitrate and nitrite levels estimations in the whole brain of rats. A decrease in the level of nitrate and nitrite was observed following MCAO. THP pre-treatment could not reverse such a reduction in nitrite but slightly reversed reduced nitrate levels. The opposite effect of THP on nitrate and nitrite levels requires further investigation and raises doubts on its possible use in cerebral ischemia