Introduction Mishandled endotracheal cuff pressure may either make ventilation difficult or cause damage to the airway. Therefore, the aim of this audit was to assess the knowledge about endotracheal cuff pressure monitoring with a manometer and manual palpation of pilot balloon among critical care providers. Methods This audit includes 150 critical care providers having experience of handling endotracheal tube (ETT) cuff at critical care area of National Institute of Cardiovascular Diseases (NICVD), Karachi from April 2017 to June 2017. Knowledge about endotracheal cuff pressure monitoring with the manometer and deleterious effects of mishandled ETT cuff was assessed using a self-reported questionnaire. Enrolled healthcare providers were asked to palpate the patient and cuff pressure was recorded and categorized. Results Out of 150 participants, 66 (44.0%) were doctors. Only 46 (30.67%) participants had prior knowledge about ETT cuff manometer and 110 (73.33%) had never used a manometer. Similarly only 42 (28.0%) had knowledge of hazardous effects of mishandled ETT cuff. Kappa coefficient of 0.155 with p=0.015 showed significant yet low agreement between participant prediction and the actual amount of air in cuff balloon. Agreement level was comparatively higher for staff as compared to doctors with a Kappa coefficient of 0.210 (p=0.018) vs. 0.133 (p=0.099). Conclusion In this study of knowledge and practice of ETT tube cuff pressure monitoring, we observed low levels of knowledge (30.67%), poor adherence to standard practice (73.33%) and were able to demonstrate poor agreement (Kappa coefficient 0.155; p=0.015) between the palpation method and cuff manometer measurements for assessing cuff pressure.

Objective This article systematically reviews current literature on the efficacy and efficiency of selective serotonin reuptake inhibitors (SSRIs) in the treatment of patients with frontotemporal lobar degeneration (FTLD), with a particular focus on behavior and cognitive functions. Methods A search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using CENTRAL, MEDLINE, and Cochrane Library databases. Eleven randomized controlled trials and open-label studies looking at the effects of SSRIs on FTLD patients were included. A random-effects meta-analysis was performed, consisting of 3 randomized and controlled studies that used the neuropsychiatric inventory to assess SSRI intervention. Results The meta-analysis shows a combined mean reduction of 10.17 points (95% confidence interval, 18.14–2.19; P = 0.01) on the neuropsychiatric inventory with SSRI treatment in FTLD patients. The I 2 calculated for this study was 62% (P = 0.07), which represents moderate heterogeneity among the studies. The Egger regression test (P = 0.526) did not show a publication bias. Sensitivity analysis showed no significant change. Conclusions The current meta-analysis supports SSRIs as an intervention for management of behavioral symptoms of FTLD. Marked improvements were seen in disinhibition, irritability, aggression, and aberrant motor activity across studies. However, apathy/loss of empathy did not show similarly promising results. A deteriorative effect on cognition was seen associated with SSRI use.

Background: Gallbladder surgeries are among the commonest major abdominal operations and to continuously improve the procedure many variants have developed that need evidence-based comparison in terms of frequency common bile duct (CBD) clearance, the mean operative time and hospital stay, and rate of adverse outcomes (post-operative pancreatitis). Through this study, we aimed to compare the surgical outcome of single-stage Endoscopic Retrograde Cholangio-Pancreatography (ERCP) with LC in comparison to two-stage ERCP. Methodology: This prospective study was conducted on a sample of 190 diagnosed patients (chosen via nonprobability consecutive sampling) of cholelithiasis with choledocholithiasis, aged between 20 to 70 years who were scheduled to undergo surgery at the Ziauddin University Hospital, Karachi. The patients were divided into two equal groups (Group A: Single-stage ERCP & LC, and Group B: Two-stage ERCP followed by interval LC). After taking written informed consent, data pertaining to surgical outcome were recorded onto a pre-structured questionnaire and analyzed using SPSS Version 23.0. Results: The demographic and clinical characteristics of both the groups were similar and so were the success rates. Adverse events free and positive outcomes were reported in 95.79% and 90.53% of the patients in groups A and B respectively. Post-operative pancreatitis was reported more often among the patients of group B. The length of hospital stay and costs were lower among Group A patients despite the longer operative times in this group. Conclusion: Patients in group A yield better surgical outcomes, giving single-stage ERCP & LC the edge over two-stage ERCP followed by interval LC. Thus, single-stage ERCP & LC is recommended as the method of choice.

Background: Percutaneous Endoscopic Gastrostomy (PEG) is the primary modality for patients requiring long-term enteric feeding and stomach decompression, it has the potential for complications. Therefore, an open surgical gastrostomy presents as an appropriate alternative for patients not viable for an endoscopic approach. The purpose of the study was to assess the complications associated with Open Modified Janeway Gastrostomy (OMJG) in patients with head & neck tumors and determine their post-operative pain and satisfaction scores. Methodology: A cross-sectional study was conducted at Ziauddin Hospital, North Nazimabad Campus, Karachi, from May 2015 and November 2019. Patients undergoing Open Modified Janeway Gastrostomy were included in this study. Patients with over 18 years of age and who had feeding needs extending beyond 30 days were included in this study. Outcomes measured included length of stay, operating time, complications, surgical satisfaction and post-operative pain. Chi-square test, with a 95% confidence interval, was used to evaluate any association of complications with patient demography and post-treatment parameters. Results: A cross-sectional study was conducted at Ziauddin Hospital, North Nazimabad Campus, Karachi, from May 2015 and November 2019. Patients undergoing Open Modified Janeway Gastrostomy were included in this study. Patients with over 18 years of age and who had feeding needs extending beyond 30 days were included in this study. Outcomes measured included length of stay, operating time, complications, surgical satisfaction and post-operative pain. Chi-square test, with a 95% confidence interval, was used to evaluate any association of complications with patient demography and post-treatment parameters. Conclusion: OMJG was found an effective procedure for the insertion of a feeding tube when endoscopic procedures are not feasible, with minimal complications and post-operative pain. It provides more cumulative benefits than other available methods.