Background:Organophosphorus poisoning (OPP) is a major global public health problem. Pralidoxime has been used in a complimentary role to atropine for the management of OPP. World Health Organization (WHO) recommends use of pralidoxime but studies regarding its role have been inconclusive, ranging from being ineffective to harmful or beneficial.Materials and Methods:The present study was undertaken to evaluate the effectiveness of pralidoxime. Eddleston's study was the most compelling factor for our study, as he showed worst outcomes using pralidoxime. Our practice of continuous use of pralidoxime was based on the WHO guidelines and the study by Pawar (2006), which showed better outcome with higher doses of pralidoxime. These conflicting results suggested that a re-evaluation of its use in our clinical practice was indicated.Results:There was no difference in mortality rates, hemodynamic parameters and atropine requirements between the AP and A groups. Mean duration of ventilation (3.6 ± 4.6 in AP group vs. 3.6 ± 4.4 in A group) and Intensive Care Unit stay (7.1 ± 5.4 in AP group vs. 6.8 ± 4.7 in A group) was comparable. Serum sodium concentrations showed a correlation with mortality, with lower concentrations associated with better outcomes.Conclusion:The study suggests that add-on WHO-recommended pralidoxime therapy does not provide any benefit over atropine monotherapy. Adding pralidoxime does not seem to be beneficial and at the same time does not result in increased mortality rates. Our practice changed after completion of this study, and it has proven to be of significant benefit to patients who had to bear the expense of treatment.
Background: The use of neuraxial anesthesia for caesarean section has dramatically increased in last 2 decades because it is easier to perform, safe to the mother and the fetus, and has a high degree of success rate. However, post-dural puncture headache is a well-known complication of spinal anesthesia. It is a common and incapacitating compliation following dura-arachnoid puncture and results in increased morbidity, prolonged hospital stay, increased cost, and patient dissatisfaction.Methods: It was a double-blinded comparative study conducted on 75 consecutive pregnant patients meeting the inclusion criteria of the study. Patient and anesthesiologist involved in collection of data were blinded to the gauge of the needle used. Standard anesthesia protocol was followed in all the patients and spinal anesthesia performed using 25G Quincke needle in 38 patients and 27G Quincke needle in 37 patients.Results: we included 75 consecutive patients in the age group 20-35 years in the study. Overall incidence of PDPH was 14.67% (11/75) in present study. 23.68% (9/38) and 5.4% (2/37) patients who received spinal anesthesia with 25G and 27G needles respectively developed PDPH. Difference was statistically insignificant.Conclusions: The incidence of PDPH was less in patients who underwent caesarean section under spinal anesthesia with 27G needle compared to that of patients in whom block was performed using 25G needles. However, there was no definite advantage of 27G Quincke needle over 25G Quincke needle as far as the incidence of PDPH is concerned.
Neuroanaesthesia practice is associated with risk of significant blood loss resulting in anaemia in the intraoperative and postoperative period. The transfusion triggers in a neurologically injured brain are not clearly defined. Both a low haematocrit and a high haematocrit have not shown any improvement in the outcome. Transfusion of red blood cells may improve the cerebral oxygenation on neurophysiological monitors. However, these benefits have not been translated into clinical practice. Transfusion in subarachnoid haemorrhage leads to increased incidence of vasospasm and a poor outcome. Restrictive transfusion strategy is seen to have a lower incidence of pneumonia, urinary tract infection, bacteremia and septic shock in severe head injury. Current evidence suggests that a haemoglobin (Hb) level of <7 g/dl may be deleterious to the neurosurgical population. Target Hb of 8-9 g/dl may be desirable intraoperatively. Different transfusion triggers may hold true for different neurosurgical pathologies.
Individuals in changing generations are different; aiding in explanation of the same, citations of 18-interviews of white-collar personnel working in discrete organizations in Pakistan helped the researchers explore and endorse individual level generational differences for encoded factors of Psychological Contract (PC). The study entails extensive discussion in PC development with a meticulous focus on three generational clusters: Baby Boomers, Generation-X and Generation-Y. It is endorsed throughout the generated themes that the development of psychological contract varies in different generations. In the case of Pakistan, the career stages of the job play an intersecting role during employment timeline depending upon the organization's nature as public or private. The association has shown meaningful and extremely influencing role in PC development. The findings show that the organizations in Pakistan display poor conditions of nationwide employment theory and practice, which are worsening the context of PC development, and the recruitment houses would soon be realizing the significance for PC as per their growing 3600 survival needs to become multinationals. Thus, the study postulates that it is indispensable for organizations to execute its implementation in the organizational context.
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