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Objectives: To analyze the adverse effects of HMG CoA reductase inhibitor (statin) and garlic (Allium sativum) on renal function in diabetic dyslipidemic patients. Methods: This clinical trial was conducted at Surgeon Munawar Memorial Hospital, Karachi from 1st March 2019 to 30th August 2019. Total of 60 patients of 30-70 years of age with abnormal lipid profile were enrolled for this study after a written consent. The study was conducted to assess the side effects of statin (20 mg/day) and garlic (300 mg/day) in diabetic dyslipidemia patients. The study period consisted of six months. Blood pressure, body weight and height of subjects were assessed. The patient answered the questionnaire on health complaints, smoking, social role, drug usage, family history and dietary pattern. The initial inclusion criteria of the patient were 1) Age between 30-70 years old of either sex, 2) Patients with diabetic dyslipidemia. The exclusion criteria were 1) Pregnancy or lactation, 2) Patients with liver diseases, 3) Patients with renal diseases. Detailed medical history and physical examination of all patients were carried out. Results: This study included 60 patients with an abnormal lipid profile of age 30-70 years. International statin product (20 mg/day) and local garlic product (300 mg/day) for 08 weeks were used for oral administration in patients. Urea and creatinine levels in the serum of diabetic dyslipidemic patients were measured before and after treatment with an international statin (20 mg/day) and a local garlic product (300 mg/day). Conclusion: According to the findings of this study, statins increase the serum level of urea and creatinine while garlic has no effect on urea and creatinine serum level. [ABSTRACT FROM AUTHOR]

Objectives: To observe the variations in lipid profile in patients with secondary hyperlipidemia using HMG-CoA reductase inhibitor. Methods: This study was done at private hospital in patients predominantly suffering from secondary hyperlipidemia. The duration of study was about 4 months. Body weight, height and blood pressure of subjects were assessed. The subjects were asked to answer the related question on cigarette smoking, health related complaints, detailed history of family, drug usage, and nutritional habits. Subjects were requested to make up a permission form before starting the research study. This case control study was performed at local private Hospital, located at Karachi from 1st April 2017 to 30th July 2017. The aim of research was to analyze the effects of HMG-CoA reductase inhibitor on lipid profile in patients of secondary hyperlipidemia. Age between 35 to 65 years and secondary hyperlipidemic patients were included in the inclusion criteria. Lactating/pregnant women, renal, liver and established coronary artery diseases were included in exclusion criteria. Results: Sixty patients having deteriorated lipid profile were included in this research (age 30-60 years). Subjects were prescribed simvastatin orally 20 mg/day (international product) for 04 months. The total cholesterol, triacylglycerol, LDL and HDL were analysed using simvastatin (20mg/day) of international standard in the serum of secondary hyperlipidemic patients. Conclusion: During this study it is observed that Simvastatin raises the HDL level and reduces LDL level and cholesterol level. [ABSTRACT FROM AUTHOR]

Objective: To study the depression among medical and engineering students of different medical and engineering colleges in Karachi, Pakistan. Methods: A comparative cross-sectional study was conducted at different medical and engineering colleges of Karachi from 1st March 2018 till 30th August 2018. Sample size of 362 was calculated by using software SPSS version 22. A close ended, self-administered, modified form of standardized questionnaire was used which comprised of two parts. First part included collection of socio-demographic data, second part had questions for the assessment of depression. Hamilton Depression Scale (HAM-D) was utilized in scoring the depression level in the study subjects. Results: In engineering and medical colleges 82.87% and 56.9% students were found depressed repeatedly. The result was highly statistically significant. Overall, 109 (30.1%) students were normal, 114 (31.5%) were suffering from mild, 67 (18.5%) moderate, 32 (8.8%) severe and 40 (11.0%) had very severe depression. Conclusion: In the present study, rate of depression was higher in engineering students as compared to medical students. It is recommended in future that qualitative studies of the causes of depression reducing interventions need to be encouraged in professional program, especially in engineering students. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the changes in lipid profile in patients with diabetic dyslipidemia using lipid lowering drug, simvastatin and herbal product allium sativum. Study Design: Clinical trial. Setting: Surgeon Munawar Memorial Hospital, Karachi. Period: 1st January 2017 to 30th April 2017. Material & Methods: The study was designed to assess the effects of HMG Co-A reductase inhibitor (simvastatin) and allium sativum on lipid profile in patients with diabetic dysplipidemia. The exclusion criteria included lactating/pregnant women’s, renal, liver and established coronary artery disease. Results: Sixty patients with abnormal lipid profile were included in the study (age 30-60 years). Patients were divided into two groups (30 patients each). Group a was orally administered with product of simvastatin (20 mg)/day for 04 months and in group b, patients were orally administered with herbal product of allium sativum (300mg)/day for 04 months. Conclusion: On the basis of this study it is observed that allium sativum as well as simvastatin tablets both reduce total cholesterol, low density lipoprotein cholesterol (ldl-c) and increase high density lipoprotein cholesterol (hdl-c). [ABSTRACT FROM AUTHOR]

What We Already Know About This Topic: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Success of a cricothyrotomy is dependent on accurate identification of the cricothyroid membrane. The objective of this study was to compare the accuracy of ultrasonography versus external palpation in localizing the cricothyroid membrane.Methods: In total, 223 subjects with abnormal neck anatomy who were scheduled for neck computed-tomography scan at University Health Network hospitals in Toronto, Canada, were randomized into two groups: external palpation and ultrasound. The localization points of the cricothyroid membrane determined by ultrasonography or external palpation were compared to the reference midpoint (computed-tomography point) of the cricothyroid membrane by a radiologist who was blinded to group allocation. Primary outcome was the accuracy in identification of the cricothyroid membrane, which was measured by digital ruler in millimeters from the computed-tomography point to the ultrasound point or external-palpation point. Success was defined as the proportion of accurate attempts within a 5-mm distance from the computed-tomography point to the ultrasound point or external-palpation point.Results: The percentage of accurate attempts was 10-fold greater in the ultrasound than external-palpation group (81% vs. 8%; 95% CI, 63.6 to 81.3%; P < 0.0001). The mean (SD) distance measured from the external-palpation to computed-tomography point was five-fold greater than the ultrasound to the computed-tomography point (16.6 ± 7.5 vs. 3.4 ± 3.3 mm; 95% CI, 11.67 to 14.70; P < 0.0001). Analysis demonstrated that the risk ratio of inaccurate localization of the cricothyroid membrane was 9.14-fold greater with the external palpation than with the ultrasound (P < 0.0001). There were no adverse events observed.Conclusions: In subjects with poorly defined neck landmarks, ultrasonography is more accurate than external palpation in localizing the cricothyroid membrane. [ABSTRACT FROM AUTHOR]

Background Enhanced recovery after surgery programs has incorporated gabapentin as part of a multimodal analgesia protocol. The preemptive use of gabapentin was found to be beneficial due to its opioid-sparing effect. However, excessive sedation and delayed discharge from postanesthesia recovery units are of concern. The aim of this study was to investigate whether preoperative gabapentin increased the length of stay in the recovery unit. Methods This retrospective cross-sectional study was carried out over a period of 2 months in the postanesthesia care unit ( PACU) of a tertiary care hospital in Canada. Two hundred and twenty-eight consecutive patients who underwent elective surgical procedures and who required a longer than 2-hour stay in the PACU were included. Prolonged stays caused by respiratory inadequacy, hemodynamic instability, nausea, vomiting, pain, and loss of consciousness were recorded. The data were collected from patients' charts and nursing flow sheets. Results All patients were grouped into those who received 300 mg gabapentin ( n = 108), 600 mg gabapentin ( n = 41), and no gabapentin ( n = 139). No significant difference was observed between the groups in terms of opioid consumption, respiratory inadequacy, nausea, vomiting, and hemodynamic parameters. Gabapentin administration groups had significantly lower postoperative pain scores ( P < 0.001). Decreased level of consciousness occurred significantly more often in a dose-dependent fashion in the gabapentin groups and led to a longer stay in the PACU ( P < 0.001). Conclusion In the setting of enhanced recovery after surgery, gabapentin did reduce pain scores, but at the cost of delayed discharge from the recovery room. Future studies are needed to evaluate the efficacy of gabapentin in this setting. [ABSTRACT FROM AUTHOR]

B Methods: b Nurse led morning huddles were started in PICU of Aga Khan University Hospital, after taking all stakeholders on board and making a consensus list of things to be discussed at these huddles. B Introduction: b We aimed to evaluate the perception, knowledge, empowerment & the comfort level of critical care staff (including physician, nurses, and paramedics) in relation to implementation of safety huddles in paediatric intensive care unit (PICU) of a tertiary care hospital of Pakistan. [Extracted from the article]

Objective: To evaluate the role and side effects of garlic on lipid profile in diabetic dyslipidemic patients along with their lipid lowering efficacy. Methodology: This cross sectional study was carried out at Surgeon Munawar Memorial Hospital Bahadurabad Karachi. The study period consisted of 8 weeks st st from 1 February 2015 to 31 March 2015. Patients with age between 30 and 60 years of either gender with diabetic dyslipidemia were included. The exclusion criteria included pregnant/lactating females, liver, renal and established coronary artery disease or ischemic heart disease. Results: Total of 30 diabetic dyslipidemic patients with abnormal lipid profile were included. Patients were orally administered with local herbal product of garlic (300 mg/day) for 8 weeks. Serum levels of cholesterol, high density lipoprotein (HDL), triglyceride (TG), and low density lipoprotein (LDL) were estimated in patients before and after treatment with local herbal product of garlic (300 mg/day). After the treatment of garlic, serum cholesterol and low density lipoprotein were significantly decreased but there was no effect on triglyceride levels (p >0.05). Conclusion: On the basis of this study we concluded that herbal products like garlic significantly decreases cholesterol, low density lipoprotein (LDL) and increases high density lipoprotein (HDL). [ABSTRACT FROM AUTHOR]

The ratio of cardiovascular disease (CVD) in Pakistan is high as compare to western world and is one of the chief reasons of disability around the world. When CVD is diagnosed, following preventive measures should be taken which include regular exercise, proper diet, weight control and lipid reducing drugs to overcome the risk of morbidity or mortality. Primary hyperlipidemia is common factors for the progression and development of atherosclerosis and coronary heart disease. This study was designed to evaluate the effects of simvastatin and allium sativum (garlic) on lipid profile and to compare the lipid decreasing efficacy of simvastatin and herbal product of allium sativum in primary hyperlipidemic patients. Objectives: To evaluate the changes in lipid profile in patients with primary hyperlipidemia using original product of simvastatin and herbal product of the allium sativum (garlic). Study design: Cross-sectional study. Setting: The study was conducted at Surgeon Munawar Memorial Hospital, Karachi in year 2013 -2014. Material and Methods: Total of 60 patients of 30-70 years of age with abnormal lipid profile was enrolled for this study after a written consent. The patients were divided into group I and II with primary hyperlipidemia. Patients of group 1 and II were orally treated with simvastatin (20 mg)/day and allium sativum (garlic) (300 mg/day) for 8 weeks. All patients were evaluated before and after treatment with product of simvastatin and herbal product of allium sativum. Results: In this study the cholesterol, triglyceride (TG), high density lipoprotein (HDL) and low density lipoprotein (LDL) were estimated in the serum of patients before and after treatment with Simvastatin (20 mg)/day and herbal product of allium sativum (garlic) (300 mg/day). It is observed in the present study that treatment with simvastatin significantly reduced the level of serum total cholesterol, triglycerides, LDL and increase serum HDL level. Allium sativum significantly reduces serum total cholesterol, serum LDL and increase serum HDL level in primary hyperlipidemic patients but there was no effect on triglyceride levels. Conclusion: We concluded that simvastatin significantly reduced the level of serum total cholesterol, triglycerides, LDL and increase serum HDL level and allium sativum significantly reduces serum total cholesterol, serum LDL and increase serum HDL level in primary hyperlipidemic patients but there was no effect on triglyceride levels. [ABSTRACT FROM AUTHOR]

Background: Misidentification of the cricothyroid membrane in a "cannot intubate-cannot oxygenate" situation can lead to failures and serious complications. The authors hypothesized that preprocedure ultrasound-guided identification of the cricothyroid membrane would reduce complications associated with cricothyrotomy.Methods: A group of 47 trainees were randomized to digital palpation (n = 23) and ultrasound (n = 24) groups. Cricothyrotomy was performed on human cadavers by using the Portex device (Smiths Medical, USA). Anatomical landmarks of cadavers were graded as follows: grade 1-easy = visual landmarks; 2-moderate = requires light palpation of landmarks; 3-difficult = requires deep palpation of landmarks; and 4-impossible = landmarks not palpable. Primary outcome was the complication rate as measured by the severity of injuries. Secondary outcomes were correct device placement, failure to cannulate, and insertion time.Results: Ultrasound guidance significantly decreased the incidence of injuries to the larynx and trachea (digital palpation: 17 of 23 = 74% vs. ultrasound: 6 of 24 = 25%; relative risk, 2.88; 95% CI, 1.39 to 5.94; P = 0.001) and increased the probability of correct insertion by 5.6 times (P = 0.043) in cadavers with difficult and impossible landmark palpation (digital palpation 8.3% vs. ultrasound 46.7%). Injuries were found in 100% of the grades 3 to 4 (difficult-impossible landmark palpation) cadavers by digital palpation compared with only 33% by ultrasound (P < 0.001). The mean (SD) insertion time was significantly longer with ultrasound than with digital palpation (196.1 s [60.6 s] vs. 110.5 s [46.9 s]; P < 0.001).Conclusion: Preprocedure ultrasound guidance in cadavers with poorly defined neck anatomy significantly reduces complications and improves correct insertion of the airway device in the cricothyroid membrane. [ABSTRACT FROM AUTHOR]

Background and Aim: Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries. Materials and Methods: Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month - 16 years of age who died in PICU, from January 2007 to December 2012. Results: A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period. Conclusion: We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making. [ABSTRACT FROM AUTHOR]

Background: Patients in pediatric intensive care Units (PICU) are susceptible to infections with antibiotic resistant organisms which increase the morbidity, mortality and cost of care. To describe the clinical characteristics and mortality in patients with Multi-Drug Resistant (MDR) gram negative organisms. We also report safety of Polymyxin B use in these patients. Methods: Files of patients admitted in PICU of Aga Khan University Hospital, from January 2010 to December 2011, one month to 15 years of age were reviewed. Demographic and clinical features of patients with MDR gram negative infections, antibiotic susceptibility pattern of isolates, discharge disposition and adverse effects of Polymyxin B were recorded. Results: A total of 44.8/1000(36/803) admitted patients developed MDR gram negative infections, of which 47.2% (17/36) were male, with mean age of 3.4 yrs(+/−4.16). Acinetobacter Species (25.5%) was the most frequently isolated MDR organisms followed by Klebsiella Pneumoniae (17%). Sensitivity of isolates was 100% to Polymyxin B, followed by Imipenem (50%), and piperacillin/tazobactem (45%). The crude mortality rate of patients with MDR gram negative infections was 44.4% (16/36). Fourteen of 36 patients received Polymyxin B and 57.1%; (8/14) of them were cured. Nephrotoxicity was observed in 21.4% (3/14) cases, none of the patients showed signs of neuropathy. Conclusion: Our study highlights high rates of Carbapenem resistant gram negative isolates, leading to increasing use of Polymyxin B as the only drug to combat against these critically ill children. Therefore, we emphasizeon Stewardship of Antibiotics and continuous surveillance system as strategies in overall management of these critically ill children. [ABSTRACT FROM AUTHOR]

Introduction: Non-steroidal anti-inflammatory drugs (NSAIDs) decrease postoperative pain and opioid consumption. The objective of the study was to determine if postoperative NSAIDs were associated with anastomotic leaks following elective colorectal surgery. Materials and Methods: We used a matched nested case-control study design. Using a prospectively collected database, we identified all patients having elective colorectal surgery between January 2001 and June 2012. Cases and matched controls were identified based on the occurrence of a postoperative anastomotic leak. The primary and secondary exposure variables were, respectively, use of any NSAID and use of ketorolac specifically. Conditional logistic regression was used to determine the unadjusted and adjusted odds ratio. Results: A total of 262 patients were included (65.6 % inflammatory bowel disease, 34.4 % cancer). Use of any NSAID was associated with a non-significant increase in anastomotic leaks (odds ratio (OR) 1.81, 95 % confidence interval (CI) 0.98-3.37, p = 0.06). Use of ketorolac was associated with a significant increase in anastomotic leaks (OR 2.09, 95 % CI 1.12-3.89, p = 0.021). There was no significant association between anastomotic leaks and cumulative NSAID dose. Conclusion: These data suggest that there may be an association between NSAIDs and risk of anastomotic leaks after colorectal surgery. Further research is needed to better elucidate this relationship to clarify the implications for patients. [ABSTRACT FROM AUTHOR]

• Continuous adductor canal block has been proven superior for total knee arthroplasty analgesia. • Safety concerns such as intravascular injection, nerve injury or catheter displacement must always be considered. • I nter-fascial space between the SA rtorius muscle and FE moral artery (ISAFE) approach is effective and potentially safer. [ABSTRACT FROM AUTHOR]

Background Postoperative pain management for patients with inflammatory bowel disease ( IBD) can be challenging. These patients have a high tolerance to pain medication, and relative contraindications to the use of epidural analgesia, limiting the pain management options. We evaluated the effect of a single preoperative gabapentin dose on opioid consumption for patients with IBD undergoing abdominal surgery. Secondary outcomes were postoperative pain scores, opioid-related side effects, and patient's length of hospital stay. Methods Following Research Ethics Board approval and informed written consent, patients were randomly allocated into 2 groups receiving either 600 mg of oral gabapentin or placebo 1 hour before the surgery. A blinded anesthesiologist recorded pain scores at rest and movement twice daily for 2 postoperative days. Also recorded were opioid consumption, time of return of bowel function, time to discharge, and opioid-related side effects on the opioid-related symptom distress scale ( ORSDS). Results Seventy-two patients completed the study. The difference in opioid consumption ( P = 0.4169) and pain scores measured at rest and movement on all 4 postoperative visits was not statistically significant. There was no significant difference between gabapentin and placebo on all the 11 symptoms reported on the ORSDS. There was a slight increase in length of hospital stay in the placebo group, but the return of bowel function was similar between the groups. Conclusions This study examined the effect of a single preoperative administration of gabapentin in patients with IBD undergoing major bowel surgery. Our results suggest a single preoperative oral dose of gabapentin 600 mg does not reduce postoperative pain scores, opioid consumption, or opioid-related side effects. [ABSTRACT FROM AUTHOR]

Study Objective: To evaluate predictors of desaturation and to identify practice for patient transport following general anesthesia. Design: Observational quality assurance study. Setting: Postanesthesia Care Unit (PACU) of a university-affiliated, tertiary-care hospital. Patients: All adult postsurgical patients who received general anesthesia and who were admitted to the PACU. Measurements: Patients were observed over a three-month study period during transfer to the PACU with or without oxygen supplementation. Sixteen variables related to patient, surgery, and anesthesia were recorded. Results: The study recorded a total of 502 PACU admissions. The practice pattern showed that 57% of patients were transferred without oxygen and 19% of the entire sample had an initial oxygen desaturation of less than 90% on arrival to the PACU. Only 0.8% of patients experienced oxygen desaturation when they were transferred with oxygen supplementation. After logistic regression analysis, the most significant predictor of desaturation was transport without oxygen. Conclusions: The majority of anesthesiologists did not use supplemental oxygen for patient transfer. As a result, a higher incidence of postoperative desaturation was noted in their patients. Significant predictors of desaturation after general anesthesia included patients' sedation score, low respiratory rate, and transport without oxygen. The use of oxygen almost completely prevented desaturation during transport. [ABSTRACT FROM AUTHOR]

Abstract: The in-plane and torsional shear properties directly relevant to specific applications of carbon fiber-reinforced composites (CFRPs), such as sporting goods and wind turbine blades, are studied. Multiscale composites are fabricated using carbon fiber prepregs containing carbon nanotube (CNT) modified epoxy matrix. The interlaminar shear strength (ILSS) of the composites with 0.5wt.% CNTs increases by 12% compared to the neat CFRP composites, whereas the torsional shear modulus and strength determined using tubular specimens present corresponding improvements of 17% and 19.5%, respectively. The enhanced interfacial adhesion between the modified matrix and carbon fibers, and the increases in matrix modulus/strength arising from the well-dispersed functionalized CNTs are mainly responsible for the above observations. An increase in CNT content beyond 0.5wt.% has moderately negative effects on these properties, indicating potential agglomeration at a high CNT content. [Copyright &y& Elsevier]

After securing airway with tracheostomy 6.0, throat examination revealed purulent yellow grey membrane in the throat and tonsils for which throat swabs culture was sent which later came positive for I Corynebacterium diphtheria i and child was shifted to PICU for further management. There is an emergent need esp in the LMIC for highlighting the importance of primary immunization in children at government level esp for the preventable diseases like diphtheria and other preventable communicable diseases. B Introduction: b SARS-CoV-2 (COVID 19) is responsible for more than 176 million infections and over 3.8 million deaths worldwide, with a wide range of clinical spectrum, including mild, moderate, and severe which vary from patient to patient. [Extracted from the article]

Introduction: Pediatric oncology patients are at increased risk of contracting healthcare-associated infections (HAIs), which are responsible for increased morbidity and mortality rates as well as treatment costs. This study aimed to identify the frequency of HAIs among pediatric oncology patients and their outcome. Methodology: Pediatric oncology patients admitted between January 2009 and June 2010 in a pediatric ward at Aga Khan University Hospital, Karachi, Pakistan, who developed HAIs, were analyzed. Results: A total of 90 HAIs were identified in 32 patients in 70 admissions. The HAI rate among pediatric oncology patients was 3.1/100 admission episodes. Bloodstream infections (63 episodes, 90.0%) were the most common, followed by urinary tract infection (two episodes, 2.9%). Gram-positive infections were seen in 54 (60%) patients, followed by Gram-negative infection in 34 (37.8%), and fungi in 2 (2.8%) cases. Coagulase negative staphylococci was the most common Gram-positive and Escherichia coli and Pseudomonas aeruginosa were most common Gram-negative infections. Mortality rate among pediatric oncology patients who developed HAIs was 12.5% (4/32). Total parental nutrition use and length of stay longer than 30 days were the identified risk factors associated with increased mortality among pediatric oncology patients who developed HAIs. Conclusion: We report an HAI rate among pediatric oncology patients of 3.1/100 admission episodes with a mortality rate of 12.5% in Pakistan. Further studies should be done, especially in the developing world, to identify the risk factors associated with increased mortality among pediatric oncology patients so that adequate measures can be taken to reduce the mortality among these patients. [ABSTRACT FROM AUTHOR]

Abstract: This paper proposes the correlation between the electrokinetic potential, dispersibility in solvents, surface energy and oxygen content of carbon nanotubes (CNTs) affected by functionalization. Colloidal systems consisting of CNTs with varying degrees of dispersion are prepared and characterized to evaluate CNT dispersibility and suspension stability in solvents with different polarities. The results show that an absolute value of zeta potential at about 25mV is closely related to the micro- and macroscopic dispersion of CNTs, whereas a high absolute value of 40mV is regarded as an indication of high quality CNT dispersion with much enhanced suspension stability in solvents. The absolute zeta potential value increases consistently with increasing degree of CNT functionality, the increase being most pronounced in a hydrophilic liquid such as water. A linear correlation is established between the surface energy of a CNT film and the oxygen to carbon ratio of CNT surface. The CNT dispersibility in a liquid is determined not only by their physical states, but also by the hydrophilicity and surface functionality of CNTs, all of which are reflected by zeta potential. [Copyright &y& Elsevier]

Congenital vallecular cyst is one of the rare etiologies of upper airway obstruction. Due to the scarcity of literature review, the exact incidence is not known. We report the case of a 10-month-old infant, who came to to Aga Khan University Hospital (AKUH) for the first time with signs of upper airway obstruction; was initially misdiagnosed as foreign body aspiration for which an emergency bronchoscopy was performed that did not reveal any foreign body. The patient was then managed in the pediatric intensive care unit, where he was diagnosed as a congenital vallecular cyst on a subsequent laryngoscopy after extubation failure. The cyst was aspirated and cauterized by the ENT team. The patient was successfully extubated without any signs of upper airway obstruction. In evaluating a child with signs and symptoms of upper airway obstruction, it is crucial to consider not only common causes like foreign body, acute epiglottitis, and croup, but also rare factors such as laryngeal cysts. [ABSTRACT FROM AUTHOR]

Background: Deep neck space infections are uncommon in infants. Retropharyngeal abscess (RPA) is a deep space neck infection that can present with subtle signs and symptoms. Delay in diagnosis can lead to life-threatening complications. Here we describe life-threatening complication of retropharyngeal abscess. Case presentation: We report a life-threatening complication of retropharyngeal abscess in 10-month old Asian infant weighing 8.2 kg. The patient presented with fever, right-sided neck swelling, hoarseness of voice, and respiratory distress. The clinical and radiological findings were suggestive of airway obstruction complicated by retropharyngeal abscess. The patient was urgently taken to the operating room and underwent (grade 3) intubation. After stabilization, the patient underwent endoscopic trans-oral incision and drainage, during which 5 cc pus was aspirated. Antibiotics were prescribed for 2 weeks following the procedure based on the sensitivity result of the pus culture. Conclusion: In retropharyngeal abscess, a delay in diagnosis can result in life-threatening complications. This report highlights the importance of prompt recognition of a threatened airway and the management of retropharyngeal abscess by emergency physicians. If an emergency physician suspects RPA with airway obstructions, the airway should be immediately secured in a secure environment by otolaryngologist and an anesthesiologist. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: Pre-emptive gabapentin has been shown to decrease postoperative pain in abdominal and vaginal hysterectomy. However, the effect of pre-emptive low-dose gabapentin has not been studied in vaginal hysterectomy combined with concomitant pelvic reconstruction.Methods: A randomized double-blind placebo-controlled trial assessed all women seen for symptomatic prolapse requiring vaginal hysterectomy with concomitant pelvic reconstruction with or without midurethral sling. Gabapentin dosing was 600 mg (<65 years) or 300 mg (>65 years). The primary outcome was reduction in opioid consumption in the first 24 h after surgery. Secondary outcomes included sedation and prolongation of recovery room stay. Sample-size calculations indicated a need for 22 participants/group. Student's t test was used to compare differences in oral administration of morphine equivalents in the first 24 h postoperatively, time from end of surgery to leaving the recovery room, and length of recovery room stay. Mann-Whitney U test was used to compare visual analog scale (VAS) scores for anxiety, drowsiness/sedation, pain, and nausea.Results: Twenty-one patients received gabapentin and 26 a placebo capsule. Groups were similar with respect to age, menopause status, parity, American Society of Anesthesiologist (ASA) class, and concomitant procedures. There were also no significant differences between groups in opioid requirements within the first 24 h after surgery, time from end of surgery to leaving the recovery room, length of time in recovery room, or VAS scores.Conclusions: Pre-emptive gabapentin at our institutional low doses did not significantly affect postoperative pain and opioid requirements in women undergoing vaginal hysterectomy with concomitant reconstruction.Trial registration: www.clinicaltrials.gov, #NCT02999724. [ABSTRACT FROM AUTHOR]

The article presents case studies of an eight-months-old male infant with bulging anterior fontanelle and a three-months-old male with two days history of episodic seizures. It states that the eight-months-old male infant, who was diagnosed with meningitis, was discharged after five days with an initial management involving supportive and symptomatic management. It adds that the initial management for the three-months-old infant diagnosed with meningitis are antibiotics and anticonvulsant.

BACKGROUND: Raised intracranial pressure (ICP) is a common life threatening syndrome and early recognition and treatment is associated with better outcome. OBJECTIVES: To determine the utility of ultrasound guided Optic nerve sheath diameter (ONSD) measurement as compared to CT scan. METHODS: A Prospective case series done in Emergency and Paediatric critical care unit of Aga Khan University Hospital. Measurement of ONSD in millimetres was done by placing the linear probe of ultrasound on the eye ball and average of three readings were taken from each side. RESULTS: 48 patients who had clinical suspicion of raised ICP were included in study with mean age of 7.5 yrs (+/- 5.0) with 21/48 (43.8%) between 1-8 yrs and 19/48(39.6%) > 8 yrs with 32/48(66.7%) were male. Non traumatic coma was the most common diagnosis 41/48(85.4%) with infectious cause being most common while Traumatic brain injury constitutes 7/48(14.6%). Ct scan and MRI brain were done in 39/48(81.3%) and 9/48(18.7%) of patients. 33/48(68.8%) patients shown raised ICP with ultrasound guided ONSD measurement as compared to CT scan/MRI which showed only 14/48(29.2%) to have raised ICP. We found mean value of 4.36mm (+/-0.62) and 4.51mm (+/-0.64) on on right and left side of ONSD in patients < 1 yrs, 5.57mm(+/- 0.86) and 5.65mm(+/-0.98) on right and left side of ONSD in patients 1-8 yrs, and 6.0mm(+/-0.75) and 6.0mm(+/-0.88) on right and left side of ONSD in patients > 8 yrs respectively. Overall sensitivity and specificity of ultrasound guided ONSD measurement of 86.7% and 39.4% respectively as compared to CT scan/MRI of 60% and 84.8% respectively. CONCLUSION: We found ultrasound guided ONSD measurement as a better, inexpensive, non-invasive and reproducible screening tool for the diagnosis of raised ICP. [ABSTRACT FROM AUTHOR]

Background: Obstructive sleep apnea (OSA) is associated with neurocognitive impairment – a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty. Methods: We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were ≥ 6 0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea–hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery. Results: Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups. Conclusions: We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty. Trial registration: This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016. [ABSTRACT FROM AUTHOR]

Abstract: Exposure to surgery and general anesthesia (GA) has been hypothesized to be a potential risk factor for the development of Alzheimer's disease (AD). Some basic science research studies have demonstrated AD pathology in animals following exposure to inhalational anesthetics. However, controversy exists as to whether GA is associated with an elevated risk of developing AD in human populations. While randomized controlled clinical trials would provide the strongest evidence for a causal relationship between exposure to surgery under GA and the subsequent development of AD, to date there have not been any trials to address this important question. Therefore, a potential relationship between GA and AD must currently be examined using observational methods. A recent meta-analysis of case–control studies (N=15) did not find that AD was associated with prior exposure to GA (OR=1.05, 95% CI: 0.93–1.19, p=0.4). A limited number of retrospective cohort studies have likewise not provided definitive information supporting an association. Therefore, at the present time there is limited information to support the hypothesis of AD developing as a consequence of GA, although there are few high quality studies in this area. Given the high prevalence and impact of AD, and the relatively frequent exposure of large populations to surgical procedures, the association between AD and GA requires further study. [Copyright &y& Elsevier]

Abstract: Vibration damping characteristic of nanocomposites and carbon fiber reinforced polymer composites (CFRPs) containing multiwall carbon nanotubes (CNTs) have been studied using the free and forced vibration tests. Several vibration parameters are varied to characterize the damping behavior in different amplitudes, natural frequencies and vibration modes. The damping ratio of the hybrid composites is enhanced with the addition of CNTs, which is attributed to sliding at the CNT–matrix interfaces. The damping ratio is dependent on the amplitude as a result of the random orientation of CNTs in the epoxy matrix. The natural frequency shows negligible influence on the damping properties. The forced vibration test indicates that the damping ratios of the CFRP composites increase with increasing CNT content in both the 1st and 2nd vibration modes. The CNT–epoxy nanocomposites also show similar increasing trends of damping ratio with CNT content, indicating the enhanced damping property of CFRPs arising mainly from the improved damping property of the modified matrix. The dynamic mechanical analysis further confirms that the CNTs have a strong influence on the composites damping properties. Both the dynamic loss modulus and loss factor of the nanocomposites and the corresponding CFRPs show consistent increases with the addition of CNTs, an indication of enhanced damping performance. [Copyright &y& Elsevier]

Background: To determine the rate of conversion of abstracts presented at conferences into full-text articles published in peer-reviewed journals in the field of pediatric critical care medicine (PCCM) in a developing country. Methods: We retrospectively reviewed PCCM abstracts from Pakistan presented at national and international pediatric and critical care conferences over 10 years (January 2010 to March 2020). Data included abstract characteristics, such as presentation (poster/oral), presenter (fellow/resident), time of meeting (month and year), type of meeting, study design and topic; and publication characteristics, such as journal name, time (month and year) and first author. The primary outcome was publication rate of PCCM abstracts presented in meetings and time (months) from presentation to publication. Results: A total of 79 PCCM abstracts were presented in 20 meetings during the study period. There were 65 poster presentations (82.28%), of which 63 (79.74%) were presented at international critical care conferences and all presenters were PCCM fellows. In total, 64 (81%) abstracts were descriptive observational studies (retrospective: 50, 63.29%) and prospective (14, 17.72%). Only one was an interventional randomized controlled trial. The publication rate of PCCM abstracts was 63.3% (50/79) and the mean time to publication was 12.39±13.61 months. The publication rate was significantly correlated to the year of publication (P<0.001). Conclusions: The PCCM abstract publication rate and mean time from presentation to publication was 63.3% and 12.39±13.61 months, respectively, in a developing country. [ABSTRACT FROM AUTHOR]

Aim: To assess the effects of intravenously administered meperidine, fentanyl and tramadol in reducing the incidence, onset time and severity of the shivering response in parturients during cesarean delivery under spinal anesthesia. Secondary outcomes included patient satisfaction and sedation scores. Methods: After Ethics board approval and informed written consent, 350 parturients (ASA physical status I or II), between 20 and 40 years of age, undergoing emergency or elective cesarean delivery under spinal anesthesia were recruited. Parturients were then randomly allocated to seven study groups: normal saline (control), low‐dose meperidine (0.5 mg/kg), high‐dose meperidine (0.75 mg/kg), low‐dose fentanyl (0.5 mcg/kg), high‐dose fentanyl (0.75 mcg/kg), low‐dose tramadol (0.5 mg/kg) and high‐dose tramadol (0.75 mg/kg). The incidence, onset time and severity of shivering, along with patient satisfaction and sedation scores were measured. Results: All study drugs showed significant reduction in incidence, onset time and severity of shivering and greater satisfaction scores compared to the control group (P < 0.01). Within each drug class, no significant differences in shivering were found between the high‐dose and low‐dose groups. Among study drugs, low‐dose tramadol was superior due to shivering prevention and significantly reduced sedation. Conclusion: Intravenously administered meperidine, fentanyl and tramadol reduce shivering incidence, onset time and severity in parturients undergoing cesarean delivery following spinal anesthesia. Importantly, low‐dose intravenous tramadol (0.5 mg/kg) allowed shivering prevention and low sedation scores, thereby offering greater parturient satisfaction and better maternal–newborn bonding. [ABSTRACT FROM AUTHOR]

Background: Although antiemetics are commonly used to prevent postoperative nausea or vomiting, the failure rate is appreciable and there is currently no generally accepted standard for rescue treatment of postoperative nausea or vomiting after failed prophylaxis. This prospective, randomized, double-blind, parallel-group, placebo-controlled, multicenter study was designed to test the hypothesis that intravenous amisulpride, a dopamine D2/D3-antagonist, is superior to placebo at treating established postoperative nausea or vomiting after failed prophylaxis.Methods: A total of 2,285 adult patients undergoing surgery under general inhalational anesthesia and receiving standard antiemetic prophylaxis were enrolled at 23 sites in Canada, France, Germany, and the United States. Of these, 702 patients experienced postoperative nausea or vomiting in the 24-h period after surgery and were randomized to receive a single dose of 5 or 10 mg intravenous amisulpride or matching placebo. The primary endpoint was complete response, defined as no emesis or rescue antiemetic use for 24 h after study drug administration, excluding emesis in the first 30 min. Secondary endpoints included incidence of emesis and rescue medication use, nausea burden, time to treatment failure, and length of stay in postanesthesia care unit and hospital.Results: Complete response occurred in significantly more patients receiving 10 mg amisulpride (96 of 230, 41.7%) than placebo (67 of 235, 28.5%), a 13.2% difference (95% CI, 4.6 to 21.8; odds ratio, 1.80; P = 0.006). A 5-mg dose of amisulpride did not show a significant benefit (80 of 237, 33.8%); the difference from placebo was 5.2% (95% CI, 3.1 to 13.6; odds ratio, 1.24; P = 0.109). The total number of adverse events recorded and proportion of patients with at least one adverse event were comparable between the placebo and amisulpride groups. No clinically relevant toxicities were observed.Conclusions: A single 10-mg dose of intravenous amisulpride was safe and more effective than placebo at treating established postoperative nausea or vomiting in patients failing postoperative nausea or vomiting prophylaxis. [ABSTRACT FROM AUTHOR]

Background: Delirium is a common problem that occurs in 5-50% of elderly individuals following surgery. Patients who develop delirium after surgery are at increased risk for serious complications. Recent studies suggest that patients with obstructive sleep apnea (OSA), a sleep disorder characterized by repeated episodes of complete or partial blockage of the upper airway - are at greater risk to develop delirium. OSA is more common in elderly individuals but is often undiagnosed. Identification and treatment of unrecognized OSA may reduce the incidence of postoperative delirium. However, few studies have investigated the effect of perioperative treatment of OSA to prevent postoperative delirium. Methods: This multi-centre randomized controlled trial will enrol 634 elderly patients undergoing elective hip/knee replacement surgery. The study has been approved by the Research Ethics Boards of the three participating institutions. Patients will be screened with the STOP-Bang questionnaire. Those with a score of 3 or greater will have a portable home sleep study using the ApneaLink™ Air device. Patients identified to have OSA will be randomized to 1) Auto-titrating continuous positive airway pressure (APAP) applied during sleep for 72 h after surgery or until discharge if they are discharged before 72 h or 2) Control group - routine care, no APAP. All patients will be evaluated for delirium for 72 h after surgery or until discharge if they are discharged before 72 h. The primary outcome is the occurrence of delirium - assessed twice daily using the Confusion Assessment Method for 72 h or until discharge if the hospital stay is <72 h. Discussion: Delirium is associated with increased morbidity and mortality, and higher healthcare costs. With the aging population, the incidence of postoperative delirium will likely increase as the number of elderly individuals undergoing surgery rises. The results of our study will be published in a peer-reviewed journal and presented at local and international medical conferences. Our study findings may lead to improved surgical outcomes, enhanced patient safety and reduced healthcare costs. Trial registration: This study was retrospectively registered at clinicaltrials.gov NCT02954224 on November 3, 2016. [ABSTRACT FROM AUTHOR]

Background: Airway guidelines recommend the use of ultrasound to localize the cricothyroid membrane prior to airway manipulation in difficult airways. In this study, we aimed to determine the amount of training anesthesia trainees would need to achieve competence in bedside ultrasound to identify the cricothyroid membrane. Methods: This is a prospective non-randomized cohort study in the Department of Anesthesia at Mount Sinai Hospital (Toronto, Ontario, Canada). Following institutional ethics approval, six anesthesia trainees consisting of four residents and two fellows underwent a 2-h training session on neck ultrasound to identify neck landmarks and the cricothyroid membrane. The trainees had no previous airway ultrasound experience. One-two weeks later, each trainee performed consecutive neck ultrasound scans on 20 healthy volunteers to identify the cricothyroid membrane. Cumulative sum (CUSUM) learning curves were constructed for each trainee. Primary outcome was the number of ultrasound examinations required to achieve competence, defined as 90% success rate in a series of 20 ultrasound scans. Secondary outcomes were the overall success rate, the time (sec.) required to perform the task, and 3-month skills assessment. Results: CUSUM analysis showed four trainees achieved competence with a mean [range] success rate of 94.0% [90-100%] and a median [range] number of attempts of 14 [9-18]. Two trainees did not achieve competence, but obtained a success rate of 75.0 and 80.0% each. Overall (number of attempts) success rate was 88.3% (106/120) with a mean (SD) time of 36.9 (9.0) sec. Three months after training, ultrasound of five consecutive neck scans showed a mean success rate of 86.7% (26/30) and mean (SD) time of 47.7 (16.0) sec. Conclusions: After a short 2-h training session, most anesthesia trainees (n = 4/6) achieved competence in ultrasound-identification of the cricothyroid membrane with less than 20 scans in a mean time less than 60 s., and that they remain reasonably competent 3 months later. The learning curve for ultrasound identification of the cricothyroid membrane seems to be short even without prior airway ultrasound experience. [ABSTRACT FROM AUTHOR]

Purpose Following discharge, patients requiring high opioid doses may be at risk for both under- and overdosing, posing a major challenge to community physicians. The aim of this study was to examine the effectiveness and degree of satisfaction with a personalized taper schedule and physician letter through interviews of patients and physicians. Methods This was a 1-year prospective study. Following ethics approval and informed written consent, patients admitted for elective surgery, 18 to 60 years of age, receiving opioid analgesics, were recruited. Prior to discharge, the acute pain service team provided patients with a taper schedule explained in detail. Individualized physician letters were faxed to treating family physicians. Patients were contacted by phone 2, 4, and 6 weeks after discharge. Physicians were contacted once, a month after discharge. Patients and physicians were asked to grade the taper schedule on a 1- to 5-point Likert scale. Questions pertained to clarity, usefulness, ability to follow the instructions, and general satisfaction. Results Twenty-six patients and 21 physicians completed the study. Physicians were generally satisfied with both the taper schedule and letter and rated all aspects between 3.76 and 4.38 of 5. Similarly, patients were satisfied with the taper schedule and rated all aspects between 4.08 and 4.5. Conclusions Both physicians and patients generally found the taper schedule and letter helpful in assisting them to taper off their opioid use. This is one way of bridging the gap in continuity of care between the acute and primary care providers while reducing the risk to patients during the transition period. [ABSTRACT FROM AUTHOR]

B Conclusions: b Our study shows that PICU is progressing is Pakistan but highlighted the deficiencies in the pediatric critical care infrastructure in Pakistan. This study aims to evaluate the current landscape of pediatric critical care facilities in Pakistan. B Introduction: b With persistent population growth and the need to rapidly provide healthcare coverage in Pakistan, the need to enhance the critical care capacity may also have increased. [Extracted from the article]

B Introduction: b Most biomarker studies of sepsis and acute respiratory distress syndrome (ARDS) originate from high-income countries per World Bank classification, whereas mortality risk is higher in low- and middle-income countries. Non-survivors had higher plasma angiopoietin-2 (ANG2), soluble thrombomodulin (sTM), and plasminogen activator inhibitor 1 (PAI1; all rank-sum p < 0.05), with increasing ANG2 across worsening PERSEVERE-II risk strata. Additional biomarkers were compared between PERSEVERE-II risk strata (low, medium, and high mortality risk), between survivors and non-survivors, and between those with and without ARDS. [Extracted from the article]

Study Objective: There exists no commonly accepted regimen for an intravenous lidocaine infusion (IVLI). This study aims to determine an appropriate end time for an IVLI during bowel surgery.Design: A systematic search for randomized controlled trials assessing IVLI for bowel surgery was conducted using Ovid MEDLINE, EMBASE, CINAHL, Cochrane CENTRAL, Google Scholar, hand-searching references, and grey literature. Data were pooled for studies that stopped IVLI ≤60 minutes (intraoperative IVLI) after skin closure and where IVLI continued >60 minutes after surgery (postoperative continued IVLI). Quantitative analysis was done using the random-effects model.Main Results: Seven studies (n = 362) were identified after the systematic search. Three studies (n = 160) and 4 studies (n = 202) used an intraoperative and postoperative continued IVLI, respectively. An intraoperative IVLI significantly reduced pain scores at rest for 48 hours (standardized mean difference on a 0-10 scale, -1.24; 95% confidence interval, -1.93 to -0.56) and 72 hours (standardized mean difference, -1.12; 95% confidence interval, -1.79 to -0.44) compared with postoperative IVLI (test for interaction: P < .001 and P = .003, respectively). Although intraoperative IVLI reduced 24-hour pain scores on movement, this was not statistically different than pain scores in the postoperative IVLI group (test of interaction: P = 0.68). There were no differences between intraoperative IVLI and postoperative IVLI for postoperative in-hospital nausea, vomiting, time to bowel movement, and length of hospital stay.Conclusion: Continuing an IVLI beyond 60 minutes after surgery has no added analgesic or gastrointestinal benefit. Further research is needed to clarify an optimal IVLI regimen and end time. [ABSTRACT FROM AUTHOR]

B Objective: b To determine the performance of a commercially available predictive analytic tool (IDO2) to predict SVO2< 40% in patients admitted in cardiac intensive care unit (CICU) of Aga Khan University Pakistan. Compared to all other IDO2 ranges, average IDO2 above 75 had the highest absolute risk (42.11, confidence interval: 20.25-66.50) and highest relative risk (4.63, confidence interval: 2.31-9.28, p-value < 0.0001) of SvO2 < 40%. B Conclusions: b iDO2 performed well in predicting low SvO2 (< 40%) in pediatric patients presenting to a CICU in a low resource setting. [Extracted from the article]

▪ Abstract: An ideal patient-controlled analgesia (PCA) opioid would have both a rapid onset and a long duration of action, attributes, which are not available in currently existing opioids including morphine, the most widely used agent. A mixture of rapid onset and long-acting opioids may potentially achieve both these qualities. In a randomized, double-blind study, we compared a fentanyl–morphine combination with morphine alone for PCA, in 54 patients undergoing bowel surgery. The combination solution was prepared according to a 1:75 fentanyl to morphine potency ratio. The mixture contained fentanyl 13.33 μg/mL and morphine 1 mg/mL. The morphine alone solution contained 2 mg/mL. Patients were randomly allocated to one of the regimens and were then evaluated 4 times during the first 48 hours following surgery. Time to effect, visual analog pain scores, opioid consumption, demands, deliveries, and side effects on an opioid-related symptom distress scale were recorded. Groups were well matched for age, weight, and sex. There were no significant differences between groups in time to effect, PCA usage, pain scores or side effects other than the occurrence of nausea, which was lower for the combination group in 1 visit. Further studies are needed to explore the potential of different potency ratios and opioid combinations to achieve rapid and long-lasting pain control. ▪ [ABSTRACT FROM AUTHOR]

Background: Airway guidelines recommend an emergency surgical airway as a potential life-saving treatment in a "Can't Intubate, Can't Oxygenate" (CICO) situation. Surgical airways can be achieved either through a cricothyroidotomy or tracheostomy. The current literature has limited data regarding complications of cricothyroidotomy and tracheostomy in an emergency situation. The objective of this systematic review is to analyze complications following cricothyroidotomy and tracheostomy in airway emergencies. Methods: This synthesis of literature was exempt from ethics approval. Eight databases were searched from inception to October 2018, using a comprehensive search strategy. Studies were included if they were randomized controlled trials or observational studies reporting complications following emergency surgical airway. Complications were classified as minor (evolving to spontaneous remission or not requiring intervention or not persisting chronically), major (requiring intervention or persisting chronically), early (from the start of the procedure up to 7 days) and late (beyond 7 days of the procedure). Results: We retrieved 2659 references from our search criteria. Following the removal of duplicates, title and abstract review, 33 articles were selected for full-text reading. Twenty-one articles were finally included in the systematic review. We found no differences in minor, major or early complications between the two techniques. However, late complications were significantly more frequent in the tracheostomy group [OR (95% CI) 0.21 (0.20–0.22), p < 0.0001]. Conclusions: Our results demonstrate that cricothyroidotomies performed in emergent situations resulted in fewer late complications than tracheostomies. This finding supports the recommendations from the latest Difficult Airway Society (DAS) guidelines regarding using cricothyroidotomy as the technique of choice for emergency surgical airway. However, emergency cricothyroidotomies should be converted to tracheostomies in a timely fashion as there is insufficient evidence to suggest that emergency cricothyrotomies are long term airways. [ABSTRACT FROM AUTHOR]

Summary Ca 2+ dynamics and oxidative signaling are fundamental mechanisms for mitochondrial bioenergetics and cell function. The MCU complex is the major pathway by which these signals are integrated in mitochondria. Whether and how these coactive elements interact with MCU have not been established. As an approach toward understanding the regulation of MCU channel by oxidative milieu, we adapted inflammatory and hypoxia models. We identified the conserved cysteine 97 (Cys-97) to be the only reactive thiol in human MCU that undergoes S-glutathionylation. Furthermore, biochemical, structural, and superresolution imaging analysis revealed that MCU oxidation promotes MCU higher order oligomer formation. Both oxidation and mutation of MCU Cys-97 exhibited persistent MCU channel activity with higher [Ca 2+ ] m uptake rate, elevated mROS, and enhanced [Ca 2+ ] m overload-induced cell death. In contrast, these effects were largely independent of MCU interaction with its regulators. These findings reveal a distinct functional role for Cys-97 in ROS sensing and regulation of MCU activity. [ABSTRACT FROM AUTHOR]