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Background: Globally, over a million people commit suicide every year. Although suicide rates are more in high-income countries, many countries do not report suicide cases regularly to the World Health Organization (WHO). Therefore, this study aimed to determine the factor associated with suicide and self-harm in Pakistan. Method: This cross-sectional study was conducted at Peoples Medical College Hospital (PMCH) in Shaheed Benazirabad, Sindh, Pakistan, from July to December 2019. A total of 131 cases of suicide/self-harm were included using a convenience sampling technique. Data were collected on a predesigned questionnaire consisting of 14 close-ended questions. A chi-square test was used to determine the association between different categorical variables. Results: The majority of the subjects were males (53.4%), young adults aged between 16 and 30 years (69.5%), single (51.9%), and uneducated (57.3%). More than half (51.9%) of the subjects who attempted suicide or self-harm were unemployed. There was a significant association between education level (Χ² =13.149, P = 0.001) and age groups (Χ² = 15.554, P = 0.001) with health outcomes (suicide or self-harm) only. Moreover, gender (Χ² = 20.776, P = 0.004), marital status (Χ² = 69.047, P < 0.001), level of education (Χ² = 63.144, P < 0.001), age groups (Χ² = 69.848, P < 0.001), and employment status (Χ² = 28.677, P = 0.012) were also associated with the reasons of suicide and self-harm. Conclusion: Our study concluded that mostly single, unemployed males with low literacy and with marital and family issues are determined as factors associated with a high risk of self-harm and suicide. [ABSTRACT FROM AUTHOR]

Spinal anesthesia still a very common method of anesthesia for surgery on the torso below the neck; but it is known to be associated with some setbacks / complications, e.g., failed spinal, spinal hypotension, patch effect with missed dermatomes, post-spinal headache etc. The author presents a rare occurrence of spinal needle being broken during the procedure, and the distal part being removed by surgical exploration. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the efficacy of pain for Ultrasound-Guided Transversus Abdmominis Plane Block versus landmark technique in lower abdominal surgery. METHODOLOGY: This Randomized Control trial study was conducted from July to December 2018 at the Department of Anesthesiology, Peoples Medical University & Hospital Shaheed Benazirabad. The sample techniques were used randomly through envelopes, and the sample size was 120. RESULTS: The study findings revealed that age distribution among L and U groups regarding gender was 70% females 66.7% females. Moreover, for ASA status in the L group, 58.3% of the participants stand in 2-4 ASA status, whereas in the U group, 50% of the participants were in ASA status 1 and 2-4 each. The bilateral block was performed among 85% of the participants in the L group and 96.7% of the participants in the U group. In the surgical procedure in the L group, 15% underwent appendectomy, whereas, in the U group, 28.3% underwent lower c-section. The overall rate of postoperative pain at 60 minutes was observed in 10 women among both groups. Statistically significant results among both groups with a p-value of 0.001. CONCLUSION: Our study results showed that surgeries performed using Ultrasound-Guided Transversus Abdominis Plane Block are more effective with less postoperative analgesia. [ABSTRACT FROM AUTHOR]

Anemia in pregnancy is a globally health-related issue, that affects both mothers and their newborn. Anemia during pregnancy across the world involves approximately 38% of the world population. To evaluate the effect of gestational anemia on perinatal outcome in the population. The aim of present study is to evaluate the effect of gestational anemia on perinatal outcome in the population of Hyderabad, Sindh, Pakistan. A cross-sectional comparative analysis was conducted among pregnant mothers who were listed to give birth at Liaquat University of medical and health sciences Jamshoro/Hyderabad during the period of September 2018 to September 2019. The study population 400 were selected by convenient random sampling, and grouped into 2 on the basis of their Hb levels, with Hb < 11 gm% they were classified as anemic mothers, Hb ≥ 11 gm% were termed as non-anemic mothers, data was collected on the preformed questionnaire, and was analyzed on SPSS 21. The prevalence of anemia was 51.5% in in total population out of which, the incidence of normocytic normochromic anemia was highest 52.4 %microcytic hypochromic anemia was found in 19.4%, Overall, extremely low Apgar was found in 53 anemics, and 8 non. anemic mother's infants, LBW incidence was 47.5 %; in anemic mothers, and 15.4 % in non-anemic group, the term, small for gestational age infants were 14.5% in anemic mothers, and 3.6% in non-anemic mothers, there were 36 preterm births to anemic mothers and 10 in non-anemic mothers. The incidence of caesarian section is 53.3% in anemic mothers compared to 30.9% in non-anemic mothers. Anemia in pregnancy significantly increases risks of low Apgar, LBW, term SGA, preterm birth, and an increase incidence of caesarian section. [ABSTRACT FROM AUTHOR]

COVID-19 is the current topic of discussion globally as people are getting affected by it on a huge scale. This study is focused to determine the concerns and perceptions of healthcare workers (HCWs) due to the COVID-19 pandemic and its effect on their mental health, routine work, family and social life. Study was conducted at various health care facilities of Sindh, Pakistan, from October to December 2020 (three months). An online survey questionnaire consisting of fourteen closed-ended questions was designed in Google Forms and circulcalted among the HCWs through email and social media. The data collected was analyzed using SPSS 24 and descriptive statistical tools were used to measure the frequencies and the Chi-square test was applied among correlated variables. Among 412 respondents, majority of the participants were male (54.6%) and young with 18-28 years of age (47.3%). Two-third of HCWs were highly concerned about their family's health versus own health (67.7% vs 44.7% respectively) and 157 (38.1%) were emotionally distressed. It was also found that HCWs with assigned duties in the isolation wards were more emotionally distressed (56.2% high to very high) compared to those not working in isolation units (45.3% high to very high). More than half of HCWs (51.9%) reported that their family life was also disturbed. Our findings indicate that COVID-19 pandemic has a significant psychological impact on frontline soldiers (HCWs) particularly they were worried about family's health. The HCWs who were assigned duties in isolation units were more emotionally distressed than those who were not assigned duties in isolation wards. [ABSTRACT FROM AUTHOR]

Objectives: To compare efficacy in term of intubating condition between rocuronium and succinylcholine for rapid sequence induction in cesarean section Methodology: This randomized controlled trial was conducted at anesthesia department of our hospital at Nawabshah from January to December 2016. A total of 124 full term patients with Mallampati I & II and American Society of Anesthesiologists (ASA) physical status class I and II were randomly allocated into two groups. Group A (62 patients), was treated with succinylcholine chloride and Group B (62 patients) received rocuronium bromide for intubation. Intubating conditions were assessed by jaw relaxation, movement of vocal cords and bucking. Efficacy was labeled as ‘Yes’ when score 8 and 9 (excellent) otherwise ‘No’ if score was less than 8 “good and poor”. Blood pressure, heart rate, and SpO2 were monitored. Results: - The average age of the patients was 32.37 ± 1.98 y. Overall rate of excellent intubating conditions at one min was observed in 103 (83.1%) patients, good in 17 (13.7%) and poor in 4 (3.2%). The frequency of clinically acceptable intubating conditions (i.e. excellent) was 87.1% in group A and 79.03% in group B which is not statistically significant. Conclusion: Rocuronium can be safely used for rapid sequence induction in caesarean sections and the intubating conditions are similar to those of succinylcholine. [ABSTRACT FROM AUTHOR]

Objective: Suicidal victims often reach Intensive Care Units (ICU), if they manage to reach a hospital, and the anesthesiologist get involved in their management. We aimed to evaluate the incidence of suicidal patterns, methods being used and seasonal variations in the frequency of suicide victims admission at Intensive Care Unit (ICU) of Peoples Medical College Hospital (PMCH), Nawabshah (Pakistan). Study design: Retrospective study Methodology: A cohort study was conducted over a four and a half years (January 2014 to August 2018), including suicidal cases of both sexes received at ICU, PMCH, Nawabshah, from six districts of interior Sindh. Cases were selected on the basis of information from hospital record files after the approval of hospital ethical review committee. Findings were tabulated and analysed. Results: This study revealed that out of a total of 685 cases, 391 (57.08%) were males and 294 (42.92%) were females. Eighty males (11.67%) and 68 (9.93%) females could not be survived while two cases (0.29%) were referred to Karachi during the study period. The highest incidence of suicidal attempts and suicidal deaths were 164 and 38 during 2017 and 2014 respectively. Males were the predominant victims of suicide with a male to female ratio of 2:1.7. The most common method used for suicide was poisoning 98.77% (n = 656) followed by hanging 3.21% (n = 22) and drug overdose 1.02% (n = 07). A seasonal surge in autumn (August 17.81%) was noted. Conclusion: Males were the predominant victims of suicide in rural areas of interior Sindh Province of Pakistan. The most common method used for suicide was poisoning. [ABSTRACT FROM AUTHOR]

Objectives: To compare the efficacy of bupivacaine 2.5 mg and fentanyl 25 µg with bupivacaine 1.25 mg and fentanyl 25µg for spinal-epidural analgesia in the first stage of labor. Study Design: Double-blind randomized controlled trial. Setting: Anesthesia Department, Surgical Intensive Care Unit, and Pain management clinic, Peoples Medical College Hospital Nawabshah. Period: August 2014 to July 2015. Methodology: All the participants meeting the eligibility criteria were randomly allocated into two groups i.e. intervention (I) and control (II), with the allocation ratio of 1:1. Patients in the Group I (intervention) received intrathecal Inj. Bupivacaine 1.25 mg (0.5% Bupivacaine 0.25ml) and Inj. Fentanyl 25 µg whereas the Group II (control) was given intrathecal Inj. Bupivacaine 2.5 mg (0.5% Bupivacaine 0.5ml) and Inj. Fentanyl 25 µg for combined spinal epidural analgesia, both made up of total volume of 2 ml of normal saline. Mean±SD (standard deviation) was computed for continuous data (age, weight, VAS). Frequency and percentages was calculated categorical data. Independent t test and Chi square test were used for the differences between the groups. Results: The age of all the cases was 27.64±4.07 years. Moreover, groups were homogenous at baseline (p<0.05) in terms of mean age, weight, cervical dilatation, gravida, and ASA classification. Mean pain score on VAS was not significant between groups at 0 min and 15 min however mean pain score was found significantly low (p<0.05) in group-I. Likewise, efficacy of Bupivacaine 1.25 mg and Fentanyl 25 µg (group-I) was significantly higher than the other group. Conclusion: Low-dose bupivacaine 1.25 mg was significantly more effective than high-dose (2.5 mg) bupivacaine when added to 25 µg of fentanyl for combined spinal-epidural analgesia in the first stage of labor, having fewer chances of sensory and motor block, and hypotension. [ABSTRACT FROM AUTHOR]

Background: Paraphenylenediamine (PPD) is a substance present in hair dyes which is metabolized in the body cytochrome P450 system, and is further oxidized to a toxic product that can lead to multi organ failure Objective: To determine the frequency of clinical features, complications and outcome in PPD intoxicated patients admitted to the ICU of Peoples Medical College Hospital Nawabshah S.B.A, Sindh, Pakistan. Methodology: This retrospective study was conducted at the Intensive Care Unit of Peoples Medical College Hospital, Nawabshah between January 2011 and December 2016. A detailed clinical history was recorded including demographic profile, symptoms signs and outcome. Diagnosis of PPD poisoning was based on history of ingestion and clinical manifestations Results: There were 1032 patients of hair dye (PPD) poisoning. There were 350 (33.91%) males and 682 (66.09%) females (mean age 22.08±8.42 years). Dysphagia was observed in 1032 (100%), cervicofacial swelling in 939 (90.99%), dyspnea in 927 (89.82%), generalized body ache with muscle weakness in 712 (68.99%), decreased urine output in 185 (17.93%) and chocolate brown color urine in 776 (75.19%) cases. Regarding the reason of ingestion of poison, suicidal intention was observed in 1021 (98.94%), accidental ingestion in 8 (0.77%), homicidal in 1 (0.097%) and in 2 (0.193%) patient's intention could not be determined. All patients consumed local stone (black stone) based hair dye by oral route. Thirty nine patients were lost to follow up. Mortality rate in rest 993 patients was 14.5% (n=139) in male and 17.52% (n=172) in females. Conclusion: PPD poisoning was more common in females (66%) for suicidal purpose due to easy availability, and is associated with an overall mortality rate of 31.6%. [ABSTRACT FROM AUTHOR]

Objective: To determine the effect of organophosphate poisoning (OPP) among patients at tertiary healthcare, Pakistan. Methods: This cohort study was conducted over a six-year period (January 2011 to December 2016) of OPP patients admitted to the intensive care unit of Peoples University of Medical & Health Sciences for Women SBA, Hospital Pakistan and their outcome was determined. Results: Total mortality was 17.39% (84 deaths in 483 patients, excluding those referred to Karachi). Out of these 84 deaths, 65 patients (13.46%) expired due to cardiorespiratory failure, 17 deaths (3.52%) followed due to complication of mechanical ventilation & ICU acquired infection and two deaths (0.41%) occurred due to renal failure. The major cause of poisoning was deliberate self-harm /suicidal intention (93.02%), with gender distribution of female (57.07%) and male (35.95%), followed by unintentional/accidental exposure (6.98%) in males. The intensive supportive treatment, precise and appropriate respiratory care, and adequate amount of atropine and pralidoxime doses are keys to reducing the OPP patient's mortality. Conclusion: Organophosphate poisoning (OPP) intoxication is common in female gender. The easy availability of these harmful compounds has resulted in increased mortality either by accidental exposure or most often by the deliberate suicidal attempt. [ABSTRACT FROM AUTHOR]

Objective: The recent interest in intravenous magnesium sulphate for using it in many other indications other than control of eclamptic fits lead the researchers to try it as a smooth muscle relaxant in cases of acute bronchial asthma. The results have largely been controversial, so we conducted this study to determine efficacy of intravenous magnesium sulphate in acute asthma based on its terminal outcome. Methodology: This retrospective study was conducted at Surgical Intensive Care Unit at Peoples University of Medical and Health Sciences for Women, Nawabshah from January 2014-December 2015. We retrospectively reviewed the medical data sheets of all cases of acute asthma admitted during the study period, and extracted the relevant information. All the patients were initially treated with standard therapy for asthma and then given 4ml of 50% MgSO4 (2g) diluted in 250 ml of normal saline intravenously. Outcomes were presented in percentages and frequencies while patient age is presented as mean ± SD. Results: The mean age of the population was 45.29 ± 20.1 y. We had a female predominance in our population (60.3%). Successfully cured patients were 32.3% whereas those expired were 57.4%. There was not a significant difference between the genders for the outcome (p > 0.05). Conclusions: We found that intravenous magnesium sulphate is ineffective in successfully management of patients with acute asthma in terms of enhanced survival rate. [ABSTRACT FROM AUTHOR]

Objective: The aim of this descriptive, case series study was to study demographics, clinical features and outcome of paraphenylene diamine (PPD) (commonly known by local people as 'kala pathar') poisoning admitted to our intensive care unit (ICU) from June 2009 and May 2012. Methodology: All cases of PPD poisoning admitted to ICU of the Peoples Medical College Hospital, Nawabshah, between June 2009 and May 2012 were included in this study. Demographic features, clinical features and outcome of patients were recorded. Results: A total of 16 poisoning cases were admitted to the ICU. The mean age was 25.87± 5.59 years; a majority of the patients were young females (21-30 years) and belonged to a low socioeconomic class. The main cause was intentional suicidal ingestion. Cervicofacial edema, throat pain, dysphagia, dysphonia, and stridor were the earliest clinical findings. Rhabdomyolysis, hepatitis and acute renal failure dominated the clinical picture during the later course of poisoning. Active pharmacological intervention, elective tracheostomy and assisted ventilation were the therapeutic measures required for survival. A high mortality rate (37.5%) was observed in the study. Conclusion: Paraphenylene diamine (PPD) poisoning is associated with high morbidity & mortality. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of general and spinal anesthesia in patients undergoing elective Cesarean section in terms of neonatal outcome. Study design: Randomized control trial. Setting: This study was conducted in the department of anesthesiology, surgical intensive care and pain management and department of Gynecology and Obstetrics, Peoples Medical College Hospital Nawabshah. Duration of study: June 2009 to December 2009. Subjects and methods: Patients in this study were admitted through obstetric OPD for lower segment Cesarean section. Patients were selected by simple random envelop draw method. Sample size were 160 patients, they divided in to two equal groups. Group A (N=80) patients underwent spinal anesthesia and Group B patients underwent general anesthesia. Immediately after delivery of the neonate, umbilical artery blood sample was taken for assessment of blood pH. Apgar score was assessed at 01 and 05 minutes and recorded on proforma. Anesthesia was labeled as effective i-e satisfactory if the Apgar score was 7 and above and blood pH 7.2 and above. Results: An Apgar score >7 was observed at 01 and 05 minutes in 78(97.5%) and 80 (100%) neonates respectively in group A while it was 60(75%) and 74 (92.5%) in group B neonates. Apgar score>7 was observed in significanty more neonates in group A as compare to group B (p =0.028). Average Apgar score at 01 and 05 minutes was also significantly higher in group A than group B; 8.04±0.82 vs 7.10±0.92 (p=0.0001) and 9.89±0.32 vs 9.34±1.07 respectively (p=0.0001).Umbilical artery blood pH>7.2 was observed significantly high in group A93.8% as compared to group B 83.8% (p=0.045). Also average pH was significantly high in group A than group B e.g. 7.38±0.15 vs 7.21±0.16 (p=0.017). Conclusion: Spinal anesthesia is associated with better neonatal out come as compared to general anesthesia in elective Cesarean sections. [ABSTRACT FROM AUTHOR]