BACKGROUND Globally, there is significant variation in the Out of Hospital Cardiac Arrest (OHCA) survival rate. Early links in the chain of survival, including bystander Cardiopulmonary Resuscitation (CPR) and the use of an Automated External Defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East is limited and reports variable rates of bystander cardiopulmonary resuscitation (CPR) and survival. It is crucial to get prospective reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. OBJECTIVE This international collaborative study is aimed at 1) To describe the characteristics, including bystander interventions and outcomes in out-of-hospital cardiac arrests brought to the hospitals enrolled in the study from Abu Dhabi (UAE), Doha (Qatar), and Muscat (Oman). 2) To describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rate. METHODS This multicenter, prospective, noninterventional observational study will be conducted at the Emergency Departments of four participating tertiary care hospitals in three countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, co-morbidities), peri cardiac arrest variables (location, witnessed or not, bystander CPR, use of AED, time of EMS arrival, initial rhythm, number of shocks, time of prehospital CPR) and outcome variables (Return of Spontaneous Circulation (ROSC), survival to discharge and neurological outcome at discharge and at three months). RESULTS The trial is expected to record reliable prospective data about bystander response and OHCA outcomes. Descriptive statistics using means with standard deviation and modes with interquartile ranges will be presented in tables and graphs. Univariate and multivariate analysis with logistic regression models will be used to measure the strength of association of bystander interventions with outcomes using SPSS Version 22. CONCLUSIONS Bystander response to an OHCA is key to a favorable outcome. The reliable baseline bystander CPR data will be a cornerstone in the team's next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. CLINICALTRIAL Nil.
Aim: To compare the outcomes in term of complication of Veress Needle Insertion (VNI) to Direct Trocar Insertion (DTI) for creation of pneumoperitoneum in laparoscopic cholecystectomy.
Design: Randomized controlled trial
Place and Duration of Study: The current analysis was conducted at Khawaja Muhammad Safdar Medical College Surgical Department, Allama Iqbal Memorial Hospital and Govt. Sardar Begum Teaching Hospital, Sialkot from September 27, 2017, to September 26, 2020.
Methodology: A total of six hundred and eight (n=608) patients, having age 30 to 75 years planned for laparoscopic cholecystectomy were included in this study. Patients were randomly divided into two groups, Group A (Direct Trocar Insertion), Group B (Veress Needle Insertion). Both groups had age and sex matched males and female. All trocars and veress needle used were disposable, with a safety shield. The primary outcome of our study was to compare the complications to assess the safety levels, while total time taken by the procedure and mean time for laparoscopic entry were the secondary end points. The collected data was analyzed by using software SPSS version 22. Chi-square test was used to check the significance of variance. P-value less than 0.05 remained the statistically significant.
Results: The complication rate in VNI group were significantly greater than the DTI group (p < 0.01), the duration of surgery between the two groups was not significantly different (p > 0.05), but we found statistically significant difference in mean laparoscope insertion time (DTI 3.4+ 1.4 versus VNI 4.8+ 0.7 minutes, p < 0.001).
Conclusion: From the results of our study, it can be concluded that the direct trocar insertion is a safe alternative to veress needle insertion in laparoscopic cholecystectomy as it is associated with fewer complications.
Background: Hepatitis B and C is a global health issue in developing countries because of multiple factors like lack of community health education, illiteracy and poverty. Aim: To find the frequency of Hepatitis B and C virus infection among patients who present in Surgical Emergency and to correlate risk factors for these infections. Study design: Cross sectional study. Methodology: Patients (n=200) were included in present study through non-probability, convenient sampling technique. It was conducted in Accident and Emergency Department, Jinnah Hospital Lahore, following approval from Hospital Ethical Committee from Jan 2018 to Jun 2018. Both male and female patients (12-65 yrs) who underwent emergency surgical procedures, were included while unwilling subjects as well as patients having other medical issues were excluded. Data analyzed by SPSS 21.0v. Results: Thirty four patients were found sero-positive for Anti-HCV Antibodies with prevalence rate of 17.0% and 9 patients (4.5%) were HBsAg positive. Among the sero-positive patients risk factors were IV injections, dental extraction, sharing of shaving razors, jaundice, history of previous surgical operations. Conclusion: This study concluded that there was a declining attitude of HBV infection as compared to HCV. However, educational status of the patients was unsatisfactory. Hence, there is a need to educate the people regarding safety measures. Keywords: Viral infections, HBsAg, Risk Factors and Emergency Surgeries.
Background: Infantile hypertrophic pyloric stenosis (IHPS) is an exceedingly rare cause of postoperative emesis in a case of hiatal hernia. Occasionally it may simulate other etiology of gastric outlet obstruction. Case Presentation: A 32-day-old male baby presented with respiratory distress and vomiting since birth. Diagnosis of eventration of left hemi diaphragm was made on CT Chest. At surgery, hiatal hernia with an intrathoracic stomach was found, which was repaired. On 5th postoperative day, the baby developed vomiting after feeding which gradually turned to be projectile in nature over a week. Contrast meal performed showed malpositioned stomach with delayed emptying. At re-operation, a well-formed olive of pylorus was encountered; Ramstedt pyloromyotomy was done. Postoperative course remained uneventful. Conclusion: IHPS is a rarely described association with hiatal hernia. Pyloric stenosis should be considered in differential diagnoses of postoperative emesis in infants with hiatal hernia.
Complete heart block (CHB) is defined as the complete absence of atrioventricular conduction. Electrical pacing is the treatment of choice. We present a case of CHB which is interesting not only due to being a diagnostic dilemma in the emergency department but also for its management and the final diagnosis.
The study was aimed at assessing the carcass quality and physicochemical parameters of dual purpose Vanaraja chicken. Five female and five male Vanaraja birds of over 80 weeks of age were slaughtered by ritual halal method. The birds were bled, plucked and later weighed to determine blood and feather losses, carcasses were then eviscerated and weight of dressed carcass were precisely recorded. The different cut up parts viz. back, breast and leg were further analyzed for physico-chemical studies. The means of various carcass cuts viz. neck, wings, legs, back and breast were 173 g, 241.2g, 797g, 356g and 572.6g for males and 131g, 187g, 517.8g, 317.8g and 530.2g for female birds, respectively.
Background : Globally, there is significant variation in the out-of-hospital cardiac arrest (OHCA) survival rate. Early links in the chain of survival, including bystander cardiopulmonary resuscitation (CPR) and the use of an automated external defibrillator at the scene, are known to be of crucial importance, with strong evidence of increased survival rate with good neurological outcomes. The data from the Middle East are limited and report variable rates of bystander CPR and survival. It is crucial to get prospective, reliable data on bystander response in these regions to help plan interventions to improve bystander response and outcomes. Objective This international collaborative study aims to describe the characteristics, including bystander interventions and outcomes, of OHCAs brought to hospitals enrolled in the study from Abu Dhabi, United Arab Emirates; Doha, Qatar; and Muscat, Oman. It also aims to describe the strength of the association between bystander response and OHCA outcomes, including the return of spontaneous circulation, survival to hospital admission, survival to discharge, and good neurological outcome at discharge in the local context of low bystander CPR rates. Methods This multicenter, prospective, noninterventional observational study (Bro. Study) will be conducted at the emergency departments of 4 participating tertiary care hospitals in 3 countries. The data will be collected prospectively according to the Utstein style (a set of internationally accepted guidelines for uniform reporting of cardiac arrests) on demographic variables (age, sex, nationality, country, participating center, and comorbidities), peri–cardiac arrest variables (location, witnessed or not, bystander CPR, use of automated external defibrillator, time of emergency medical services arrival, initial rhythm, number of shocks, and time of prehospital CPR), and outcome variables (return of spontaneous circulation, survival to discharge, and neurological outcome at discharge and 3 months). Univariate and multivariate analysis with logistic regression models will be used to measure the strength of the association of bystander interventions with outcomes using SPSS (version 22). Results Data collection began in November 2023 and will continue for 2 years, with publication expected by early 2026. Conclusions Bystander response to an OHCA is critical to a favorable outcome. The reliable, baseline bystander CPR data will be a cornerstone in the team’s next planned projects, which are to qualitatively identify the barriers to bystander CPR, conduct a scoping review of community interventions in the Gulf and other Asian countries, and design and implement strategies to help improve the bystander CPR rate in the community. International Registered Report Identifier (IRRID) DERR1-10.2196/58780
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