Donning Sterile Surgical Gloves - A Prospective Clinical Audit of Young Surgeons at a Tertiary Care Hospital of Lahore, Pakistan.

Background Sterilization and aseptic surgical techniques are the most important keys to successful postoperative outcomes. The standard surgical gloving technique causes early wound healing and reduces morbidity and mortality. Objective To assess the standard technique of donning sterile surgical gloves while scrubbing among young surgeons. Material and Methods This two-week prospective audit involved 60 young residents and house officers after ensuring ethical implications. Participants were observed unannounced for donning sterile surgical gloves in the surgical operation theatre (OT) according to the standard criteria set by World Health Organization (WHO) before and after the relevant intervention. The intervention was made through a clinical lecture, live demonstration, and hands-on sessions. After a detailed literature study, a pro forma was generated to record participants' compliance with 14 steps of donning sterile surgical gloves. Data was sent to a statistician for descriptive analysis. Results About 72.14% of the participants followed the standard criteria of donning sterile surgical gloves before intervention. This percentage raised to 90.71% after the intervention, showing marked improvement. Conclusion Pre-intervention and post-intervention observations showed apparent differences in compliance rates for the standard criteria of donning sterile surgical gloves. This scientific study signifies the need for such clinical audits to boost standard surgical practices, especially among newcomers.

Congenital Cytomegalovirus Infection and Tetralogy of Fallot: An Unusual Association in a Three-month-old Baby.

Congenital cytomegalovirus (cCMV) infection is the leading cause of infant morbidity and mortality worldwide. Despite being associated with significant neurological sequelae in infected infants, it remains an under-recognized public health entity. Symptomatic newborns most frequently display hepatosplenomegaly, petechiae, jaundice, microcephaly, intrauterine growth restriction, chorioretinitis, purpura, and seizures. Progressive sensorineural hearing loss is the most prominent adverse outcome of both symptomatic and asymptomatic CMV infections in infants. We report the case of a three-month-old baby who presented with complaints of progressive jaundice for three months and a two days history of fever associated with one episode of fits. The baby was diagnosed with congenital CMV infection on the basis of positive CMV IgM and IgG and positive maternal serum CMV IgG. Finding a murmur on physical examination prompted echocardiography which revealed Tetralogy of Fallot (TOF). The child was managed with a 6-week course of ganciclovir after which his symptoms improved and he was referred to cardiology for the evaluation of his heart defect. Follow-ups at the clinic have shown normal growth and development. This is the first reported association of cCMV infection with TOF. This case highlights the need to consider the possibility of the presence of heart defects in all infants with cCMV infection in addition to neurodevelopmental abnormalities. Clinicians should maintain a high degree of suspicion for cCMV infection in all neonates to ensure timely intervention and to prevent long-term neurological sequelae.

Congenital Adrenal Hyperplasia Presenting as Pulseless Ventricular Tachycardia in a Neonate.

Congenital adrenal hyperplasia (CAH) comprises a group of autosomal recessive inherited disorders that arise due to defects in one of the enzymes of steroidogenesis pathway in the adrenal glands. Ninety-five percent of the cases occur due to deficiency in 21-hydroxylase (21-OH). Clinically, CAH due to 21-OH deficiency presents in two distinct forms, classic CAH and non-classic CAH. Females with classical forms present with genial ambiguity while the presentation in males is more subtle with severe electrolyte disturbances being the initial manifestation in many cases. Arrhythmias are a rare manifestation of CAH. We report the case of an 18-day-old male child who presented with pulseless ventricular tachycardia and was later diagnosed with congenital adrenal hyperplasia based on the laboratory findings of elevated 17-hydroxyprogesterone (17-OHP) levels. Our case reveals that fatal arrhythmias such as a pulseless ventricular tachycardia can be the primary manifestation of the adrenal insufficiency of CAH even in the absence of any physical findings and hence clinicians should always maintain a strong suspicion for CAH in any child presenting with unexplained arrhythmia. Furthermore, this case also highlights the need for CAH screening in neonates so that the appropriate hormone replacement can be initiated before the development of life-threatening adrenal crisis.