Comparison of COVID-19 Infection in Operating Room Staff During Two COVID-19 Waves Using Different Preventive Strategies in a Tertiary Care Hospital in Pakistan.

OBJECTIVE: To assess if limiting elective surgeries during specific pandemic phases significantly affected COVID-19 incidence among operating room (OR) staff. STUDY DESIGN: Retrospective cohort study. Place and Duration of the Study: Operation Theatre (OT), The Aga Khan University Hospital, Karachi, Pakistan, from May 2020 to 2021. METHODOLOGY: This retrospective study compared two pandemic waves: Wave 1, during which elective surgeries were restricted (REL), and Wave 2, during which elective surgeries were continued routinely (EL). Exposure levels were measured based on OR activity. Incidence rates were calculated per 100 OR staff, per 100 ORs, and per 100 surgeries for both Groups. RESULTS: No statistically significant difference emerged in COVID-19 incidence among OR staff between REL (13.8 per 100 staff) and EL (14.4 per 100 staff) Groups (p = 0.825). However, the EL Group exhibited a significantly lower incidence risk per running OR (5.6 per 100 ORs vs. REL's 12 per 100 ORs, p <0.001). Additionally, the EL Group showed a lower incidence per 100 surgeries (1.5 vs. REL's 2.9, p <0.002). CONCLUSION: Restricting elective surgeries during the early pandemic phase did not significantly reduce COVID-19 incidence among OR staff. Infections were primarily linked to interactions with colleagues and the community, emphasising the need for a balanced pandemic response considering patient care and the consequences of surgery restrictions. KEY WORDS: COVID-19 infection, Operating room staff, COVID-19 waves, COVID-19 transmission, Hospital epidemiology, Pandemic response.

Frequency of Prescribing and Administering Premedication in Paediatric Surgical Patients at a Tertiary Care Hospital: An Observational Study.

INTRODUCTION:  Preoperative period is a stressful event, especially for paediatric patients undergoing surgery. Stress may lead to the development of perioperative maladaptive behaviour, activation of stress responses, and susceptibility to postoperative infections. To alleviate preoperative stress, the use of a multimodal approach including preoperative pharmacological premedication in the ward is recommended. We conducted an observational study to determine the frequency of prescribing and administering premedication in paediatric surgical patients. METHODS: This three-month retrospective observational study was conducted in the main operating room of the Aga Khan University Hospital, Karachi, from October to December 2014. It included all paediatric patients (aged 1-16 years) coming for elective surgery. Patients' preoperative forms and medical records were reviewed, and data recorded for written orders of premedication and the timing of administration of the premedication drug in the inpatient ward/surgical day care ward. A p-value <0.05 was considered statistically significant. RESULTS: This study included 125 paediatric patients. Premedication was not prescribed to 40% (50/125) patients. In these patients, drug and dose were properly mentioned in 98.7% (74/75) of cases while the route and time of administration were not mentioned in 26.6% and 12% prescription orders, respectively. The premedication drug was administered in 67 out of 75 patients (89.3%) by ward nurses as per prescription. The administration of premedication was documented in 95.5% patients, but the time was missing in 46.3% of cases. CONCLUSION: A significant number of patients were not prescribed preoperative premedication by the anaesthetist. Moreover, the route and timing of administration of drug were not mentioned especially in cases when premedication was prescribed in the wards.

Trend of anaesthesia research from SAARC countries. A decade's bibliographic analysis of indexed journals of Pakistan.

OBJECTIVE: To evaluate the contribution of member countries of the South Asian Association for Regional Cooperation towards anaesthesia research. METHODS: The retrospective study was conducted at Department of Anaesthesia, Aga Khan University, Karachi from January 2018 to June 2018 and comprised literature search to identify published articles related to anaesthesia, critical care and pain research contributed by authors from member countries of the South Asian Association for Regional Cooperation region and published in Pakistani indexed journals between January 2007 and December 2016. Data was analysed using SPSS 19. RESULTS: Of the 183 articles extracted, 179(97.8%) were contributed from Pakistan and 4(2.2%) from India. Overall, there were 50(27%) randomised controlled trials, 38((20%) case reports and 36(19.5%) observational studies. There was 1(0.5%) collaborative study involving researchers from two member countries. CONCLUSIONS: The contribution to anaesthesia, critical care and pain research was not ideal from the member countries of the South Asian Association for Regional Cooperation.

Frequency of Immediate Neonatal Complications (Hypoglycemia and Neonatal Jaundice) in Late Preterm and Term Neonates.

Background Evidence suggests that neonates born at 34-36 weeks should not be considered full-term neonates, given the magnitude of morbidities they experience compared with term infants. Neonates born at 34 to 36 weeks are at increased risk for early illness such as hypoglycemia and hyperbilirubinemia compared to term infants. Objective This study's objective was to determine the frequency of immediate neonatal complications (hypoglycemia and neonatal jaundice) in late preterm and term neonates. Subjects and methods A serial descriptive case study was conducted at the private tertiary care hospital. Random samplings were taken, and the sample size was calculated on Epi Info software (Centers for Disease Control and Prevention, Atlanta, GA). All the eligible samples were taken into confidence following approval by the College of Physicians and Surgeons Pakistan's institutional review board. A structured questionnaire was used in which demographic information of the patient was collected, and all neonates were closely observed for early targeted morbidities (hypoglycemia, hyperbilirubinemia) Results A total of 215 neonates were born during the study period, of whom 108 (50.2%) were term babies and 107 (49.8%) late preterm babies. There were 122 (56.7%) male infants and 93 (43.3%) female infants. Jaundice was observed in 6.5% (n=7) of term neonates and 22.4% (n=24) of late preterm neonates (p<0.0). Similarly, hypoglycemia was observed in only 4.6% (n=5) of term neonates and 15.9% (n=17) of late preterm neonates (p<0.01). Conclusion There is a significant association between gestational age and immediate neonatal complications of jaundice and hypoglycemia. Compared with term neonates, late preterm neonates are at a higher risk of neonatal jaundice and hypoglycemia. Gender and mode of delivery did not correlate to complications rate.

First-Pass Success of Tracheal Intubation With Videolaryngoscopy in Head and Neck Cancer Patients: A Registry-Based Retrospective Cohort Study.

Background The incidence of difficult airway is higher in head and neck oncological surgery than in other surgeries. Limited evidence is available on the use of videolaryngoscopes in this cohort. A registry database on perioperative management of these patients was set up in our department in 2017. Methods Data from 2018 to 2019 were retrieved from this database. In 128 patients, videolaryngoscopy was used as the initial airway management of choice. Ease of intubation by first-pass success, its association with accessory manoeuvres, and complications were noted. Results Of the patients, 87% (n = 111) were successfully intubated with a videolaryngoscope in the first attempts. There was a strong association between the use of external laryngeal manipulation and successful first-pass intubation with videolaryngoscope. In patients with reduced inter-incisor distance, videolaryngoscope has shown greater benefit. There were very few complications including bleeding from the tumour site and a transient decrease in oxygen saturation to 88% in two patients. Conclusion Videolaryngoscopy was associated with high first-attempt intubation success and we recommend its use as the initial choice for airway management in head and neck cancer patients.

Relationship between labour force satisfaction, wages and retention within the UK National Health Service: a systematic review of the literature.

OBJECTIVES: A systematic review was undertaken to understand the nature of the relationship between the UK National Health Service (NHS) labour force and satisfaction, retention and wages. DESIGN: Narrative systematic review. DATA SOURCES: The literature was searched using seven databases in January 2020: MEDLINE (1996-present), the Cumulative Index to Nursing and Allied Health Literature (CINAHL via EBSCO) (1984-present), Embase (1996-present), PsycINFO (1987-present), ProQuest (1996-present), Scopus (all years) and Cochrane library (all years). We used medical subject headings and key words relating to 'retention', 'satisfaction' and 'wages'. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Primary research studies or reviews that focused on the following relationships within the NHS workforce: wages and job satisfaction, job satisfaction and retention or wages and retention. DATA EXTRACTION AND SYNTHESIS: Two independent reviewers screened all titles, abstracts and full texts, with arbitration by a third reviewer. RESULTS: 27 803 articles were identified and after removing duplicates (n=17 156), articles were removed at the title (n=10 421), abstract (n=150) and full-text (n=45) stages. A total of 31 full-text articles were included. They identified three broad themes, low job satisfaction impacting negatively on job retention, poor pay impacting negatively on staff satisfaction and the limitations of increasing pay as a means of improving staff retention. Several factors affected these relationships, including the environment, discrimination, flexibility, autonomy, training and staffing levels. CONCLUSIONS: This review highlighted how multiple factors influence NHS labour force retention. Pay was found to influence satisfaction, which in turn affected retention. An increase in wages alone is unlikely to be sufficient to ameliorate the concerns of NHS workers. More research is needed to identify the role of autonomy on retention. A system leadership approach underpinned by data is required to implement bespoke job satisfaction improvement strategies to improve retention and achieve the goals of the NHS Long Term Plan.

Urinary Retention in Unilateral Total Knee Arthroplasty: Comparison between Continuous Epidural Analgesia and Single-Shot Femoral Nerve Block.

OBJECTIVE: To compare the frequency of urinary retention and requirement of bladder catheterization in patients undergoing total knee arthroplasty while receiving either continuous epidural analgesia or single-shot femoral nerve block. STUDY DESIGN: Randomized controlled study. PLACE AND DURATION OF STUDY: Operating Rooms of Aga Khan University Hospital, Karachi, from January 2014 to January 2015. METHODOLOGY: Patients were randomized in two groups of 30 each, i.e. epidural group (group E) or femoral nerve block group (group F). Baseline parameters were recorded. Postoperatively, patients were followed for upto 24 hours to collect the data regarding urinary retention. Final outcome was taken at 24 hours postoperatively. Data was analyzed to compare the frequency of urinary retention between the two groups. RESULTS: The average age of the patients was 59.58 ±5.85 years. There were 28 (46.7%) male and 32 (53.3%) female patients. Frequency of urinary retention was significantly high in Group E than Group F (46.7% vs. 6.7%; p=0.0005). CONCLUSION: Single-shot femoral nerve block offers a more favorable profile in terms of postoperative urinary retention when compared to continuous epidural analgesia.

Anaesthetic Management in a Child with Goldenhar Syndrome.

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and neck, which suggested possibility of difficult laryngoscopy and intubation. He had no vertebral anomalies or cardiac disease. A difficult airway continues to be a major cause of anaesthesia-related morbidity and mortality; and maintaining spontaneous breathing remains a vital technique in its management. Lack of anaesthesia-related complications with supraglottic devices encouraged us to present the advantage of utilising a laryngeal mask airway (LMA) under anaesthesia for successful management of predicted difficult airway.

Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia.

BACKGROUND: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature. METHODS: This was a prospective, observational study. A total of two hundred and fifteen (215) patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0. RESULTS: Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening) hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed) was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities CONCLUSION: This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.