Challenges in the Endotracheal Intubation of a Patient With Severe Spine Curvature Abnormality.

Severe spine curvature disorders are commonly associated with multiple pathophysiological challenges during airway management, secondary to physiological and anatomical factors. These factors are mostly related to the reduced vital capacity and chest wall compliance, along with the misalignment of axes and limitation in neck movement. Careful assessment and planning of alternative strategies by experienced anesthesiologists, appropriate positioning, and proper use of rescue devices can significantly improve the chances of successful intubation. In this report, we present a case of a 26-year-old man with severe spine curvature abnormality, unstable vitals, low Glasgow Coma Scale (GCS) score, and low oxygen saturation necessitating emergency intubation. We shed light on the importance of proper airway assessment and good team communication and also highlight the technique used for emergency intubation in case of an anticipated difficult airway.

Prevalence and Predictors of the Burnout Syndrome in Medical Students of Karachi, Pakistan.

Objectives Burnout is a psychophysiological syndrome, consisting of a triad of emotional and physical exhaustion, exhibition of impersonal attitude and loss of a sense of achievement for oneself. This study aimed to pinpoint its risk factors, measure its current prevalence in medical students of Karachi, Pakistan and accentuate the areas of focus to benefit the primary care-oriented community as a whole. Methods This cross-sectional study included responses from 600 medical students in Karachi (third to final year). A self-administered questionnaire using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS), multi-dimensional mood state questionnaire and perceived stress scale was used, along with a section about burnout prevention assessment. Data were analyzed using SPSS version 24.0 (IBM Corp., Armonk, NY) and chi-square tests used to find significant associations. Results One-fifth (n=109, 18.2%) of our subjects were burned out. The syndrome was significantly observed in those who operated on insufficient sleep (p-value 0.028) and in those having anger management issues and non-dominating temperaments (p-value 0.05). Furthermore, it was statistically significant in those who gave up easily, in those who had no hobbies and had no time to exercise and pray (p-value <0.05). It was more prevalent in pupils of private medical colleges whereas two of its three constitutive factors, Emotional Exhaustion (p-value 0.03) and Personal Achievement (p-value <0.001) were significantly higher in pupils of public sector universities.  Conclusion The deleterious repercussions of burnout syndrome warrant the need for extensive efforts towards the propagation of its awareness.

The Role of Glycated Hemoglobin A1c in Determining the Severity of Coronary Artery Disease in Diabetic and Non-Diabetic Subjects in Karachi.

Introduction Coronary artery disease is the leading cause of death worldwide by incidence. Over the years, many studies have been conducted to find predictors of coronary artery disease; however, in the last few decades, the level of HbA1c in diabetics has been investigated as a potential predictor. Our study offers additional insight by investigating similar relationships in non-diabetic patients and by investigating potential predictors more comprehensively, making it the first of its kind study. The aim of our study is to indicate that rising HbA1c levels suggest that there's a greater risk of coronary artery disease, which can further be confirmed by the SYNTAX score, degree of stenosis, and numbers of vessels involved. Methods Data from 177 diabetic and 378 non-diabetic patients, all of whom were above 18 years of age, were included in the research. HbA1c levels (>5.6%), SYNTAX score, hypertension, number of vessels involved, and other demographic elements, such as age, smoking, and body measurements, were calculated and compared for diabetics and non-diabetics. Results HbA1c was higher in comparison to non-diabetic subjects (p <0.001). Age >53 was found to be a predictor for SYNTAX score ≥23 in diabetic patients (p <0.05). Male gender and smoking were found to be independent predictors for three-vessel disease in the non-diabetic population (p-value<0.05). There was no significant relationship between the SYNTAX score and HbA1c levels in non-diabetics (p=0.885) and diabetics. In conclusion, there is no correlation between elevated HbA1c levels and SYNTAX score ≥23.

Prevalence of Rheumatic Diseases in a Tertiary Care Hospital of Karachi.

BACKGROUND: Rheumatic diseases are referred to as conditions affecting joints, muscles, ligaments, tendons, and bones. According to a report by World Health Organization, rheumatic and musculoskeletal diseases were labeled as the second most reported cause of disability around the globe. The purpose of this study was to estimate the prevalence of rheumatic diseases in a tertiary care hospital of Karachi; additionally, associations with age groups, gender and comorbidities were obtained as well. METHODS: A cross-sectional study was conducted at the Orthopedic Out Patient Department (OPD) of Dr. Ruth KM Pfau Civil Hospital, Karachi over a span of three months in 2018 (February till May). All 346 patients were follow-up diagnosed cases in the age range of 11-90 years, divided into groups of adolescents, young adults, adults, and older adults. The subjects were questioned about their symptoms, duration of illness, presence of comorbidities, genetic background and the therapy they are undergoing along with compliance. Simple statistical analysis of frequency was done, whereas chi-square test was applied to study associations with gender, age groups, and comorbidities. RESULTS: During the study period, a total of 2000 patients visited the orthopedic OPD, 346 of which were diagnosed cases of rheumatic diseases, yielding a prevalence of 17.3%. The mean age of rheumatic patients who partook in the study was 46.15 ± 15.49 (Range: 12 - 84). Osteoarthritis was recorded as the most prevalent condition, followed by non-specific low back pain and rheumatoid arthritis. Osteoarthritis was statistically significant in young adults, adults, and older adults, while non-specific low back pain had significant associations with gender, young adults, and adults. Diabetes was significantly associated with osteoarthritis, non-specific low back pain, shoulder pain syndrome and psoriatic arthritis, while hypertension significantly co-existed with systemic lupus erthematosus. CONCLUSION: Rheumatic diseases constitute a major disease burden in almost all of the age groups, especially in young patients (18-40 years) within our setup.