Anesthesiology Commons^™

Transfusion Intensity In The Icu: Reasons And Triggers, Merijn Reuland, Senta Raasveld, Jimmy Schenk, Claudia Oord, Sanne Bruin, Caroline Schaap, Andrew Flint, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background The reasons and physiological triggers for blood transfusion in critically ill patients are not well characterized. Beyond hemoglobin levels, hemodynamic instability is frequently cited, but its role across clinical contexts remains unclear.

Aims (1) To determine whether reasons and triggers for RBC transfusion differ across intensive care unit (ICU) days with varying transfusion intensity. (2) To describe reasons for non-RBC transfusions across these intensity groups.

Methods This sub-study of the prospective International Point Prevalence Study of Intensive Care Unit Transfusion Practices (InPUT) classified ICU days by transfusion intensity: nonmajor (1 RBC unit), major (≥2 units), and massive (≥6 units …

Characteristics Of Intensive Care Unit Registries - Findings From The Global Registry Icu Datasets (Grid) Survey, Luigi Pisani, Paola Lecce, Cornelius Sendagire, Vrindha Pari, Carlo Olivieri, Rabiul Uddin, Diptesh Aryal, Priyantha Athapattu, Sean Bagshaw, Wangari Siika

Anaesthesiology, East Africa

Background: Intensive care unit registries, which aim to improve the quality of intensive care unit care through benchmarking and quality improvement initiatives, are active worldwide, with considerable dishomogeneity. We aimed to map core datasets, additional variables, and research activities of these registries.

Methods: A cross-sectional survey was disseminated to registry leads between October 2023 and June 2024. The survey was structured into four main topics: registry characteristics and coverage, core dataset features, additional modules, and registry-enabled research.

Results: Leads of 34/42 national registries responded (response rate 81%), covering 3,337 intensive care units, with a larger representation from …

Exploration Of The Vein To Vein Blood Transfusion System In Three Kenyan Counties: A Qualitative Study, Linda Barnes, Jennifer Makin, Jose Paiz, Jana Macleod, Cindy Makanga, Tecla Chelagat, Alejandro Munoz-Valencia, Ejemai Eboreime, Robert Kaburu, Carolyne Njoki

Anaesthesiology, East Africa

Background Severe shortages of blood for transfusion are a persistent global health crisis, with the burden disproportionately concentrated in low-income countries. Diverse stakeholder perspectives on blood availability might inform improvements. We aimed to use a comprehensive approach to identify the challenges, facilitators, and innovations within the blood transfusion continuum (BTC) in three different Kenyan settings.

Methods In this qualitative study, we interrogated the BTC in Siaya, Nakuru, and Turkana counties as part of the Pathways for Innovation in Blood Transfusion Systems in Kenya (PITS Kenya) mixed methods research study. We used purposive sampling, and through interviews and focus group discussions, …

Impact Of Intracranial Pressure Monitoring On 30-Day Mortality In Severe Traumatic Brain Injury: A Retrospective Cohort Study In Kenya, George Ongas, Idris Chikophe, Jacqueline Mavuti, David Olunya, Mubashir Qureshi, Beverly Cheserem, Edwin Mogere

General Surgery, East Africa

OBJECTIVE The objective of this study was to evaluate 15-year trends in epidemiology, baseline severity, management, and outcomes of severe traumatic brain injury (sTBI) at a Kenyan tertiary center, and to determine the impact of invasive intracranial pressure (ICP) monitoring on 30-day mortality in a low- and middle-income country (LMIC) context.

METHODS A retrospective quasi-experimental cohort analysis of consecutive sTBI admissions (postresuscitation Glasgow Coma Scale [GCS] score ≤ 8, age ≥ 13 years) from January 1, 2010, to December 31, 2024, was conducted. This time period was divided into two eras: era 1 (2010–2014), premonitoring, and era 2 (2015–2024), routine …

The Influence Of Older Age On Rbc Transfusion Decisions In Icu Patients, Caroline Schaap, Jorinde Raasveld, Florian Reizine, Boillot Corentin, Jimmy Schenk, Sanne De Bruin, Merijn Reuland, Claudia Van Den Oord,, Andrew Flint, Marcus Lance

Anaesthesiology, East Africa

Objectives: RBC transfusions are common in the ICU. Recent studies suggest that a restrictive transfusion policy is noninferior or superior to a liberal policy. However, few studies focus on the influence of age in transfusion. In elderly ICU patients, reduced physiologic reserves may shift the perceived risk-benefit balance of transfusion, potentially leading to different transfusion practices. This study examines whether transfusion practices in ICU patients differ across patient age.

Design: This is a substudy of the International Point Prevalence Study of ICU Transfusion Practices (InPUT), a global, multicenter, prospective observational cohort study.

Setting: ICUs from 233 centers …

Airway Management In Thoracic Anesthesia: Eactaic Consensus Document, Manuel Granell, Caroline Vanpeteghem, Jo Mourisse, Mert Senturk, Laszlo Szegedi, Mohamed El Tahan, Chirojit Mukherjee, Izumi Kawagoe, Waheed Karzai, Marcus Lance

Anaesthesiology, East Africa

This article is the third in a series of articles prepared as part of a comprehensive, international and professional society–approved consensus project to advise on thoracic anesthesia. It represents the views and structured opinions of experts delegated to the Airway Management Task Force of the Thoracic Subcommittee of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC). This review highlights the main concepts and expert opinion of international leaders on the task of lung isolation and separation, as well as the current recommendations on the benefits and disadvantages of different devices in both routine and difficult airway scenarios. The …

Monitoring In Thoracic Anesthesia: Eactaic Consensus Document, Mohamed El Tahan, Edda Tschernko, Tamás Végh, Jo Mourisse, Mert Sentürk, Katarina Lenartova, Maria Alberici, Thomas Wasserscheid, Nandor Marczin, Marcus Lance

Anaesthesiology, East Africa

This is the first part of a series of articles prepared for a comprehensive, international, and professional society–approved consensus project to advise on thoracic anesthesia. It represents the views and structured opinions of experts delegated to the General Management: Monitoring Task Force of the Thoracic Subcommittee of the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC). This review highlights international leaders’ main concepts and expert opinions on how monitoring is the core task of anesthesiologists involved in the care of thoracic patients, providing recommendations for assessing principal organ systems and using different devices in routine and specialized scenarios. The …

Patient, Family And Clinician Priorities For Critical Care Research In Asia And Africa: A James Lind Alliance Priority Setting Partnership Using Modified Delphi And Nominal Group Techniques, Ccaa Priority Setting Partnership Steering Group, Teddy Abonyo, Sumaiya Arfin, Diptesh Aryal, Abi Beane, Martina Borellini, Arjen Dondorp, Emma Donley, Punam Gautam, Tiffany Gooden

Anaesthesiology, East Africa

Background This James Lind Alliance (JLA) Priority Setting Partnership aimed to identify and prioritise unanswered questions important to adult patients, their families and health professionals with lived experience of critical care across Asia and Africa.

Methods Modified Delphi techniques were used to generate suggestions using an online survey. Following verification, literature review and content analysis, these suggestions were iteratively codified into emergent topics. Topics were presented in a second online survey for ranking, prior to an online workshop where nominal group technique was used to identify top priority questions across stakeholder groups. Surveys were disseminated using snowballing techniques.

Findings The …

Multinational Transfusion Practices And Outcomes In Haematology Patients Admitted To The Intensive Care Unit, Caroline Schaap, Laurens Oomen, Senta Raasveld, Jimmy Schenk, Sanne De Bruin, Merijn Reuland, Claudia Oord, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background and Objectives The number of critically ill patients with haematological conditions is increasing, yet transfusion practices in this population remain poorly defined. This study aimed to compare transfusion strategies in critically ill patients with versus without haematological conditions.

Study Design and Methods This international, prospective observational substudy of the International Point Prevalence Study of Intensive Care Unit [ICU] Transfusion Practices (InPUT) evaluated transfusion use in ICU patients with and without haematological conditions, including benign or malignant diseases or a history of stem cell transplantation. Outcomes included use of red blood cells (RBCs), platelets, plasma, haemostatic interventions, transfusion indications and …

Safety Of Spinal Anaesthesia In The East African Population: Assessment Of Spinal Cord Termination Level At And Above L2 Vertebra In Adults, David Nekyon, Sheila Waa, Samuel Gitau, David Odaba

Anaesthesiology, East Africa

Background While spinal anaesthesia is a widely used technique, failure to accurately identify the L3-L4 intervertebral space (IVS) during the procedure may expose a patient to a needlestick injury to the spinal cord.

Objectives This study aimed to determine the proportion of Conus Medullaris Terminations (CMT) at or above the L2 vertebra in a black East African population and identify any age or gender-based variations.

Methodology A prospective observational study of lumbar spine MRI was conducted on 331 patients who had no vertebral deformities or prior spine surgeries. Two radiologists assessed the CMT level by consensus, referencing the nearest vertebral …

Global Transfusion Practices In Septic Patients In The Intensive Care Unit: Insights From The Input-Study Sub-Analysis, Vincent Kurucz, Andrew Flint, Alexis Poole, Merijn Reuland, Claudia Oord, Caroline Schaap, Jan Bakker, Maurizio Cecconi, Aarne Feldheiser, Marcus Lance

Anaesthesiology, East Africa

Background Transfusion practices among intensive care unit (ICU) patients with sepsis vary widely. While restrictive hemoglobin thresholds for red blood cell (RBC) transfusion are well studied, the indications and thresholds for platelet and plasma transfusions remain uncertain.

Methods We performed a sepsis-specific sub-analysis of the International Point Prevalence Study of Intensive Care Unit Transfusion Practices, a prospective, multicenter, observational study capturing all adult ICU admissions during four pre-scheduled weeks between March 2019 and October 2022. Patients admitted with sepsis or septic shock, or who developed sepsis during their ICU stay, were included. We recorded demographics, daily laboratory values, and transfusion …

2024 Eacts/Eactaic Guidelines On Patient Blood Management In Adult Cardiac Surgery In Collaboration With Ebcp, Filip Casselman, Marcus Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Haumann, Anders Jeppsson

Anaesthesiology, East Africa

No abstract provided.

The Effect Of A M-Health Application Compared To Standard Of Care On Adherence To Preoperative Fasting Instructions Among Adult Patients Undergoing Elective Surgery: A Randomized Controlled Study, Ivy Njeri Wanyoike

Master of Medicine in Anaesthesiology

Background: Preoperative fasting has been a pillar of the practice of anaesthesiology with the main aim of enhancing patient safety by reducing the risk of aspiration. Current clinical guidelines on preoperative fasting guidelines encourage shorter durations of fasting in keeping with current evidence that shows better patient outcomes while maintaining patient safety. Despite this, adherence to preoperative fasting instructions remains universally poor, with patients enduring long fasting periods. Advances in mobile technology, improving internet access and the widespread availability of smartphones have made mobile health a useful tool in patient care. mHealth applications are being increasingly used in perioperative …

Evidence Based Quality Improvement For Prescribing Stewardship In Icu (Equips-Icu): Protocol For Type Iii Hybrid Implementation-Effectiveness Study, Duncan Wagstaff, John Amausi, Sumaiya Arfin, Diptesh Aryal, Mohd Basri Mat Nor, Joseph Bonney, Arjen Dondorp, David Dongelmans, Layoni Dullawe, Wangari Siika

Anaesthesiology, East Africa

Approximately half of all antimicrobial prescriptions in intensive care units (ICUs) may be inappropriate, including those prescribed when not needed, in unnecessary combinations or for longer durations than needed. Inappropriate prescribing is costly, exposes patients to unnecessary side-effects and drives population-level antimicrobial resistance, the prevalence and consequences of which are greatest in low- and middle-income countries. However, the implementation of interventions to improve the appropriateness of antimicrobial prescribing has been variable and requires further study..

Plasma Transfusion In The Intensive Care Unit, Maite M. T. Van Haeren, Senta Jorinde Raasveld, Sanne De Bruin, Merijn C. Reuland, Claudia Van Den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% …

Management Of Adult Sepsis In Resource-Limited Settings: Global Expert Consensus Statements Using A Delphi Method, Louise Thwaites, Prashant Nasa, Brett Abbenbroek, Vu Quoc Dat, Simon Finfer, Arthur Kwizera, Lowell Ling, Suzana M. Lobo, Robert Sinto, Wangari Siika

Anaesthesiology, East Africa

Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resourcelimited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacifc Sepsis Alliance (APSA). The committee selected an interna‑ tional panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the fnal consensus statements.

Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include …

2024 Eacts/Eactaic Guidelines On Patient Blood Management In Adult Cardiac Surgery In Collaboration With Ebcp, Filip Casselman, Marcus Lance, Aamer Ahmed, Alice Ascari, Juan Blanco-Morillo, Daniel Bolliger, Maroua Eid, Gabor Erdoes, Renard Gerhardus Haumann

Anaesthesiology, East Africa

Clinical practice guidelines consolidate and evaluate all pertinent evidence available at their time of formulation on a specific topic, the goal being to assist physicians in determining the most effective management strategies for patients with a particular condition. These guidelines assess the impact on patient outcomes and weigh the risk–benefit ratio of various diagnostic or therapeutic approaches. Although not a replacement for textbooks, they provide supplementary information on topics relevant to current clinical practice, becoming an essential tool to support physicians' decision making in daily practice. Nonetheless, it is crucial to understand that these recommendations are intended to guide but …

The Analgesic Efficacy Of Ultrasound-Guided Transversus Abdominis Plane Block Vs. Local Anesthetic Infiltration Technique In Major Gynecologic Surgery: A Randomized Controlled Trial, Samina Ismail, Akbar A. Mistry, Ali S. Siddiqui, Aliya Aziz, Nadeem Zuberi

Department of Anaesthesia

Background and aim: Transversus abdominis plane (TAP) block and local anesthetic infiltration (LAI) technique are used as part of the multimodal analgesic regimen after abdominal surgery. Postoperative opioid consumption and analgesic efficacy was compared using TAP and LAI techniques in patients undergoing gynecologic surgery in a randomized, controlled clinical trial.
Material and methods: Total of 135 patients scheduled for major gynecological surgeries were allocated into three groups: group T received bilateral TAP block with bupivacaine 0.25%; group I received LAI with 0.25% bupivacaine with epinephrine 5 μ/mL in the peritoneum and abdominal wall, and group C was control group. Anesthesia …

Inferior Vena Cava Collapsibility Index Versus Passive Leg Raise To Assess Fluid Responsiveness In Non-Intubated Septic Patients A Prospective Observational Study, Anne Githaiga, Wangari Siika, Jeilan Mohamed, Vitalis Mung’Ayi, Idris Chikophe

Anaesthesiology, East Africa

Background: Rapid fluid loading at diagnosis of sepsis is part of standard treatment. Predictive tools of fluid responsiveness are required to guide fluid resuscitation. The Passive Leg Raise [PLR] manoeuvre can predict fluid responsiveness in non-intubated patients with sepsis. The Inferior Vena Cava Collapsibility Index [IVCCI] can also be utilised but is not routinely performed.

Aim: To investigate the correlation between Inferior Vena Cava Collapsibility Index [IVCCI] and a Passive Leg Raise [PLR] manoeuvre for the assessment of fluid responsiveness in non-intubated septic patients in a tertiary referral hospital in Sub-Saharan Africa.

Methodology: A prospective observational study which recruited non-intubated …

Who O2cov2: Oxygen Requirements And Respiratory Support In Patients With Covid-19 In Low-And-Middle Income Countries—Protocol For A Multicountry, Prospective, Observational Cohort Study, Pryanka Relan, Srinivas Murthy, John Marshall, Djillali Annane, Sylvie Chevret, Yaseen Arabi, Wangari Siika, Sara Dominguez Rodriguez, Pauline Convocar, Janet Diaz

Anaesthesiology, East Africa

Introduction: SARS-CoV-2 has been identified as the cause of the disease officially named COVID-19, primarily a respiratory illness. COVID-19 was characterised as a pandemic on 11 March 2020. It has been estimated that approximately 20% of people with COVID-19 require oxygen therapy. Oxygen has been listed on the WHO Model List of Essential Medicines List and Essential Medicines List for Children for almost two decades. The COVID-19 pandemic has highlighted, more than ever, the acute need for scale-up of oxygen therapy. Detailed data on the use of oxygen therapy in low-and-middle income countries at the patient and facility level are …

Management And Outcomes Of Pregnant Icu Patients With Severe Covid-19 Pneumonia In Qatar: A Retrospective Cohort Study, Hayat Elfil, Mogahed Ismail Hassan Hussein, Layla J. M. Kily, Sohel M. G. Ahmed, Mohammed Janish, Salwa M. Abuyaqoub, Huda A. Saleh, Marcus Lance

Anaesthesiology, East Africa

Introduction: Pregnant women are considered a high-risk group for COVID-19 due to their increased vulnerability to viral infections. The impact of COVID-19 on pregnant women is not well understood, and there is a need for data on managing severe COVID-19 in pregnant patients. This retrospective descriptive cohort study described the characteristics, hospital stay, interventions, and outcomes of pregnant patients admitted to the intensive care units (ICUs) with severe COVID-19 pneumonia in Qatar.

Methods: Data were collected from medical records and chart reviews of pregnant women admitted to Hamad Medical Corporation (HMC) with COVID-19 pneumonia from March 01, 2020, to July …

Organisation, Staffing And Resources Of Critical Care Units In Kenya, Wambui Mwangi, Ronnie Kaddu, Carolyne Njoki Muiru, Nabukwangwa Simiyu, Vishal Patel, Demet Sulemanji, Dorothy Otieno, David Misango, Wangari Siika, Rashan Haniffa

Anaesthesiology, East Africa

Objective: To describe the organisation, staffing patterns and resources available in critical care units in Kenya. The secondary objective was to explore variations between units in the public and private sectors.

Materials and methods: An online cross-sectional survey was used to collect data on organisational characteristics (model of care, type of unit, quality- related activities, use of electronic medical records and participation in the national ICU registry), staffing and available resources for monitoring, ventilation and general critical care.

Results: The survey included 60 of 75 identified units (80% response rate), with 43% (n = 23) located in government facilities. A …

Evaluation Of Hydrocortisone, Vitamin C, And Thiamine For The Treatment Of Septic Shock: A Randomized Controlled Trial (The Hyvits Trial), Adham Mohamed, Mohamed Abdelaty, Mohamed O. Saad, Ahmed Shible, Hassan Mitwally, Abdel-Rauof Akkari, Abdurrahmaan Elbuzidi, Awadh Bintaher, Ahmed Hashim, Marcus Lance

Anaesthesiology, East Africa

Purpose: The aim of the study is to evaluate the effect of combined hydrocortisone, vitamin C, and thiamine (triple therapy) on the mortality of patients with septic shock.

Methods: This multicenter, open-label, two-arm parallel-group, randomized controlled trial was conducted in four intensive care units in Qatar. Adult patients diagnosed with septic shock requiring norepinephrine at a rate of ≥0.1 μg/kg/min for ≥6 h were randomized to a triple therapy group or a control group. The primary outcome was in-hospital mortality at 60 days or at discharge, whichever occurred first. Secondary outcomes included time to death, change in Sequential Organ …

Importance Of Clinical Practice Guidelines (Cpgs) In Anesthesia: Who Is Responsible For Implementing It?, Fazal Hameed Khan, Yamna Sohail

Department of Anaesthesia

Clinical practice guidelines (CPGs) incorporate and support clinical decisions. CPGs can improve clinicians’ and patients’ decision-making by explicitly describing and evaluating the scientific evidence, based on the potential benefits and risks underpinning clinical recommendations, making them relevant to the specific patient encounter. The number of clinical research publications have increased to the point that new medical knowledge is expected to be double every 72 days. Consequently, clinicians depend heavily on the available evidence that has been condensed into clinical CPGs by the representative institutions or societies. CPGs can have potential benefits and harms. Different groups have different opinions on whether …

Sensitivity Of A Preanaesthesia Screening And Triage Tool In Identifying High-Risk Patients Attending The Preanaesthesia Assessment Clinic In A Tertiary Referral Hospital In Sub-Saharan Africa: A Diagnostic Accuracy Study, Brian Misoi, Vitalis Mung’Ayi, Rajpreet Bal, Shamshudin Mohammedali

General Surgery, East Africa

Objectives: The use of preoperative triage questionnaires is an innovative way to mitigate the shortage of anaesthesiologists and to identify and refer high-risk patients early for evaluation. This study evaluates the diagnostic accuracy of one such questionnaire in identifying high-risk patients in a Sub-Saharan population.

Design: Diagnostic accuracy study

Setting: The study was conducted in a preanaesthesia assessment clinic in a tertiary referral hospital in SubSaharan Africa. Participants The study had a sample size of 128, including all patients above the age of 18 scheduled for elective surgery under any modality of anaesthesia other than local anaesthesia presenting to the …

Measuring The Patient Safety Culture At A Tertiary Care Hospital In Pakistan Using The Hospital Survey On Patient Safety Culture (Hsopsc), Fasih Ali Ahmed, Fozia Asif, Tahir Munir, Sohail Haleem, Zehra Feroze Ali, Asim Belgaumi, Hasnain Zafar, Asad Latif

Department of Anaesthesia

Background: Patient safety is a top priority for many healthcare organisations worldwide. However, most of the initiatives aimed at the measurement and improvement of patient safety culture have been undertaken in developed countries. The purpose of this study was to measure the patient safety culture at a tertiary care hospital in Pakistan using the Hospital Survey on Patient Safety Culture (HSOPSC).
Methods: The HSOPSC was used to measure the patient safety culture across 12 dimensions at Aga Khan University Hospital, Karachi. 2,959 individuals, who had been working at the hospital, were administered the HSOPSC in paper form between June and …

Metallic Implant-Related Osteosarcoma, Frawa Mohsin, Mustafa Bin Ali Zubairi, Kulsoom Fatima, Muhammad Asad Diwan

Department of Radiology

Orthopedic metallic prostheses are commonly used in the current practice of orthopedic surgery. Although, biomaterials used in these implants are generally considered to be biologically inert, there have been consequences of foreign body reactions and potential carcinogenesis. Majority of implant-related malignancies are high grade, and develop in bone or soft tissue around the implant site. No clear association has been identified between the biomaterial implanted and the type of sarcoma. We report the case of a 36-year-old male who underwent intramedullary nailing of femur for mid-shaft fracture secondary to trauma and presented with osteogenic sarcoma of femur 14 months later.

Caesarean Section For Placenta Previa: A Retrospective Cohort Study Of Anaesthesia Techniques, Samina Ismail, Saima Rashid

Department of Anaesthesia

Objective: Placenta previa is associated with maternal and neonatal morbidity and mortality. This study aims to add to the limited literature from the developing world on the association of different anaesthetic techniques with blood loss, the need for blood transfusion, and maternal/ neonatal outcomes among women undergoing caesarean section with placenta previa.
Methods: This retrospective study was conducted at Aga University Hospital, Karachi, Pakistan. The patient population included parturients undergoing caesarean section for placenta previa from January 1, 2006, through December 31, 2019.
Results: Out of 276 consecutive cases of placenta previa progressing to caesarean section during the study period, …

Relationship Of Abdominal Circumference And Trunk Length With Spinal Anesthesia Block Height In Geriatric Patients Undergoing Transurethral Resection Of Prostate, Muhammad Yahya, Aliya Ahmed, Iayla Fatima, Muhammad Nasir

Department of Anaesthesia

Introduction: Spinal anesthesia is commonly used for various surgical procedures. Prediction of spinal anesthesia block height is always a challenging task for anesthetists. Higher than desired levels of spinal anesthesia blocks are associated with serious side effects, while inadequate block height does not provide satisfactory surgical anesthesia. In this study, we observed the relationship between the ratio of trunk length (TL) and square of the abdominal circumference (AC²) and spinal anesthesia sensory block height in geriatric patients undergoing transurethral resection of the prostate (TURP).
Material & Methods: This is a cross-sectional study conducted at the Aga Khan University …

Diagnostic Accuracy Of Different Cut-Off Values Of Adenosine Deaminase Levels In Tuberculous Pleural Effusion, Kiran Iqbal Masood, Shayan Shahid, Kauser Jabeen, Joveria Farooqi, Sabeika Raza Kerawala, Muhammad Irfan

Department of Pathology and Laboratory Medicine

Objective: To assess the diagnostic accuracy of different cut-off values of pleural fluid adenosine deaminase levels as a diagnostic method for tuberculous pleural effusion.
Method: The prospective study was conducted from 2014 to 2016 at the Aga Khan University Hospital, Karachi, and comprised pleural fluid samples of adult patients with and without tuberculosis which were tested for adenosine deaminase levels, and divided into tuberculosis group A and non-tuberculosis group B. Sensitivity, specificity, negative predictive value and positive predictive value were calculated using different cut-offs. Data was analysed using IBM SPSS (Statistical Package for Social Sciences) version 21.0 (IBM Corp., Armonk, …