Resuscitation Facilities Research Articles

Premature burial

The fear of being buried alive or taphophobia remains a significant concern for a number of individuals. In previous centuries however, reports of live burials were frequently promulgated in the media fostering an industry focused around the manufacturing and selling of security coffins which either facilitated egress or enabled the recently buried to alert those on the surface to their plight. Holding mortuaries with resuscitation facilities were also established mainly in Continental Europe to permit close observation of the recently deceased until definitive signs of putrefaction had developed. Underpinning much of this panic was the inability of medical practitioners to definitely diagnose death. Although still a rare possibility, mainly in situations where qualified medical personnel are not available, the likelihood of alive burial is nowadays fortunately rare.

Sleeve gastrectomy in the surgical management of obesity in Cameroon (a sub-Saharan country): A single-institute retrospective review of 30-day postoperative morbidity and mortality

BACKGROUNDObesity is a major public health concern even in sub-Saharan Africa. In this part of the world, characterized by limited technical platform and resuscitation facilities, sleeve gastrectomy in the surgical management of obesity is a quite new procedure. We aimed to assess intraoperative complications and 30-day postoperative morbidity and mortality of this procedure in our setting.METHODSThis study was conducted in the digestive and laparoscopic surgery unit of the National Insurance Fund Health Centre of Essos (Cameroon, Central Africa region). Retrospectively, we reviewed the medical reports of all patients who had undergone a bariatric surgery through a sleeve gastrectomy from January 2016 to December 2020. The 3 end points were intraoperative complications, postoperative 30-day morbidity, and postoperative 30-day mortality.RESULTSWe included 21 patients among whom 19 were female (90.5%). Their mean age and body mass index were 40.3 ± 10.8 years and 44.9 ± 7.4 kg/m2, respectively. All of them presented with at least 1 comorbidity. All procedures were totally completed laparoscopically with 3 cases of intraoperative complications (14.3%) consisting on bleeding in all of them. The mean operative time was 192.2 ± 52.8 minutes, and the mean hospital stay was 4.7 ± 1.1 days. Eight patients (38.1%) presented a total of twelve 30-day postoperative complications, all of them classified as minor according to the Clavien–Dindo method. The main postoperative morbidity was represented by nausea and vomiting (n = 3, 14.3%). No 30-day readmission was recorded, and the 30-day mortality was nil.CONCLUSIONSleeve gastrectomy in the management of obesity is a safe procedure even in a limited setting like our own.

Comparative study between bedside chest ultrasound and chest CT scan in the diagnosis of traumatic pneumothorax

BackgroundTraumatic pneumothorax (PTx) is common in chest trauma. Its incidence ranges between 10 and 28%. Chest X-ray (CXR) is the traditional imaging for the potential traumatic PTx, while CT chest is considered the gold standard diagnostic tool. However, it requires that the patient to be transferred from the Emergency Department (ED) with its resuscitative facilities. Chest US (E-FAST) has emerged as a sensitive tool that can be used on bedside basis with much higher sensitivity than CXR. The objective of this study was to compare between accuracy and usefulness of the bedside US chest and CT chest in the diagnosis of traumatic PTx, as well as its ability to quantify its size. This was a prospective clinical study that included two hundred patients who have been admitted to the ED. The inclusion criteria included any patient with chest trauma. Exclusion criteria included patients with clinical surgical emphysema, patients with life threatening PTx, and patients who did not undergo CT chest.ResultsForty-seven hemithoraces were proved positive for PTx by CT chest, while forty-five hemithoraces out of those 47 were confirmed by bedside chest US. The sensitivity for chest US is 95.74% in detection of traumatic PTx. No false-positive cases were diagnosed. All of the forty-five hemithoraces diagnosed by chest US have been confirmed by CT scan making a specificity of 100%.ConclusionsChest US is a useful rapid diagnostic tool in the diagnosis and quantification of the traumatic PTx at ED. It avoids the delay in transportation of the critically ill patients to perform CT chest.

A comparative study of side effects of intravenous etomidate (0.3mg/Kg) versus propofol (2mg/Kg) during induction of anaesthesia and endotracheal intubation

Patients given propofol should be constantly monitored and facilities for maintenance of a patient airway, artificial ventilation, oxygen enrichment and other resuscitative facilities should be readily available at all times. Apnoea often occurs during induction and may persist for more than 60 seconds. Group 1 patient following premedication receives injection Propofol 2mg/kg i.v. and group 2 patient following premedication receives inj. Etomidate 0.3mg/kg i.v. for induction of anaesthesia. Required parameters in haemodynamics and side effects were compared with the help of proforma data analysis. the mean value of Ramsey sedation scale for etomidate group was 2.1 ± 0.58 whereas it was 2.18 ± 0.75 for propofol group. There was no statistical significance between both groups on inter-group analysis.

Pre-hospital care: demography, current profile and future trends

Introduction. Traumatic brain injury (TBI) is a major public health problem throughout the world. It is one of the leading causes of mortality and disability as a consequence results in a great financial burden on societies. Damage to the brain following trauma does not occur only at the moment of injury but also develops over a period of hours to days with the further secondary insult of the brain. Methods. This was a prospective study done between April 2017 to March 2019. A total of 2134 patients were enrolled for this study with a collection of data in a formatted proforma. All the patients of trauma with clinical or radiological evidence of head injury coming to the trauma centre were included. Results. In our study patient, mortality was 6.79% in patients receiving pre-hospital care compared to 12.03% in patients not receiving adequate pre-hospital care. 29.42% were in the age group of 21–30 years. RTA (overall 64.45%) was the most common mode of injury in the age group 21–30 years with 81.36% cases. Mortality in first emergency care provider by ambulance paramedics was 5.69% and member of the public was 10.10%. Conclusion. It was observed that mortality was higher in patients not receiving adequate pre-hospital care. Early resuscitation facilities at the site of the accident have to be introduced and improved with the execution of rapid transportation to trauma care centres.

PGI22 Treatment Patterns and Burden of Treatment for Iron Deficiency Anaemia in Patients with Inflammatory Bowel Disease in FIVE European Countries

Iron deficiency anaemia (IDA) is a common complication of inflammatory bowel disease (IBD) and can impair quality of life. Guidelines recommend treatment to correct anaemia and replenish iron stores, either with oral iron products or with intravenous (IV) iron infusions where oral iron is ineffective, not tolerated or unsuitable. This study describes patterns of IDA treatment for IBD patients in five European countries. Responses were analysed from a structured online survey of 221 gastroenterologists from France, Germany, Italy, Spain and the UK who frequently treat IBD patients with IDA. Responses related to their three most recent such patients. Data were summarised descriptively. Data were collected on 654 patients (France 123, Germany 150, Italy 120, Spain 112, UK 149), of whom 55% were female. Mean age was 43 years (range 18-87), with 9% aged ≥65 years. Mean (SD) haemoglobin (Hb) level at baseline (i.e. at diagnosis of IDA) was 9.75(1.27)g/dL (range 4-14), mean serum ferritin was 113(98)μg/L, and mean iron need (Ganzoni formula) was 1,322(250)mg. After the most recent visit, in patients whose treatment was known (526/654 [80%]), 55% were treated with IV iron and 45% were on oral treatment. Ferric carboxymaltose (FCM) accounted for 78-91% of IV iron use depending on country. For the FCM course begun after the most recent visit (n=201), mean iron dose at first infusion was 748(362)mg; 132 patients (66%) had a second infusion, 33 (16%) had a third infusion and 17 (9%) a fourth. These data suggest that approximately half of gastroenterologist-treated IBD patients with IDA receive IV iron, with a majority receiving two or more infusions in a treatment course. As IV iron must be given at clinics with full resuscitation facilities, this will exert a burden in terms of healthcare resource use and patient inconvenience from travel and lost time.

Impact of COVID-19 lockdown on A&E performances in an NHS Foundation Trust

County Durham and Darlington Foundation Trust (CDDFT) is a National Health Service (NHS) Trust and is one of the largest integrated care providers in England. It serves a population of...

P1385BOLUS FERRIC CARBOXYMALTOSE ADMINISTRATION COULD BE A GOOD OPTION FOR IRON MAINTENANCE THERAPY IN HD FACILITIES WITHOUT REGULAR MEDICAL ASSISTANCE

Abstract Background and Aims In 2013, the European Medicines Agency (EMA) claimed that iron preparations should be exclusively given in an environment where resuscitation facilities are available and, therefore, the iron administration was highly discouraged without the presence of a doctor. What this means is that in dialysis centres without regular medical presence the dose of iron administered might be inadequate. Ferric carboxyimaltose (FCM) allows to administer high single doses of iron with an excellent safety profile. Method We compare the effect of a maintenance iron therapy in two groups of prevalent and clinical stable hemodialysis patients; the former (A; n=19pts) was treated with iron gluconate (FG) in low refracted doses (i.e. 60 mg one or two times a week) while the latter (B;n=20 pts) was treated with FCM in high doses (i.e. 200 mg once or twice a month). The groups have been followed up for one year. All treated patients in the two groups had similar and “adequate” basal iron parameters according to European Clinical Guideline (Serum Ferritin(SF) ≥200 mic/l and transferrin saturation(TS) ≥20%) (see Table 1). The therapy was administered in order to maintain SF between 200-500 mic/l and TS between 20-40%. Erythropoietin dose (Epo) was evaluated considering the erythropoietin resistance index (ERI =EPO/weight/Hb). Results Table 1 show the results at the start and end follow up. The mean monthly iron dose was similar between the two groups at the end of follow up (144±100 mg group A vs 157±81 mg group B). In group A there was a more significant increase in the TS with a non-significant trend to an increase in SF. Six pts of group A had an overshooting of SF (1164±360mc/L) vs 3 pts in group B (SF 830±30 mc/L). No significant differences in pre and post therapy ERI could be recorded. Conclusion A therapy with a high single doses of FCM could be a positive solution to treat patients in dialysis centres without regular medical presence.

Successful Desensitization with Ferric Carboxymaltose

Parenteral iron treatment is used especially in patients who need urgent treatment, have intolerance symptoms to oral iron therapy, and/ or where therapy with oral iron supplementation is insufficient. Allergic reactions can be observed with intravenous iron containing medicines and they should thus only be administered by trained staff with appropriate resuscitation facilities. The European Medicines Agency does not approve the use of intravenous iron-containing products in patients with previous hypersensitivity reactions to other parenteral iron products in its 2013 recommendations to manage the risk of allergic reactions to intravenous iron-containing medicines. However, it may be an option to administer intravenous iron therapy with desensitization in patients who need urgent treatment, who cannot be treated effectively with oral iron preparations, or display intolerance to these products. Here we present the first case of successful ferric carboxymaltose desensitization in a patient who had suffered a prior reaction with the same medicine.

Quality of neonatal resuscitation in Ethiopia: implications for the survival of neonates

BackgroundBirth asphyxia accounts for one-quarter newborn deaths. Providing quality care service of neonatal resuscitation reduces neonatal mortality. However, challenges to providing quality neonatal resuscitation are not well investigated in Ethiopia. Hence, this study is conducted to assess the quality provision of neonatal resuscitation in Ethiopia.MethodWe used data from the Ethiopian 2016 Emergency Obstetric Newborn Care survey, conducted in 3804 health facilities providing maternal and newborn health services. We described the quality of neonatal resuscitation services according to the structure, process and outcome triad of quality dimension. Data from registers and birth records for the last 12 months prior to the survey were extracted. In each facility, the three last eligible charts of resuscitated neonates were reviewed and the highest frequency of chart of resuscitated baby was considered to the analysis. Thus, a total of 555 charts were assessed. Logistic regression model was used to assess the relationship between the neonatal resuscitation processes, provider, facility and newborn characteristics with neonatal outcome at the time of discharge.ResultsThe finding suggested that, around two-third, 364(65.6%) of the asphyxiated babies resuscitated by bag and mask type of neonatal resuscitation. Of the babies who had got neonatal resuscitation 463 (83.4%) survived. Resuscitated neonates with a gestational age of greater than 37 weeks and above (Adjusted Odds Ratio (AOR) =1.82; 95% Confidence Interval (CI) (1.09–3.04)), availability of priority equipment in health facilities for neonatal resuscitation (AOR = 1.24, 95% CI (1.09, 1.54)) and women who had 12 h and less duration of labor (AOR = 1.76; 95% CI (1.23, 3.13)) were the independent factors of survival of the neonate.ConclusionOnly half of the health facilities were ready for neonatal resuscitation (NR) in terms of priority equipment’s. However, eight out of ten babies survived after NR in Ethiopia. Gestational age, priority equipment for NR and duration of labor were determinants of survival of resuscitated neonates in Ethiopia. Therefore, the availability of priority equipment and attentive care and follow-up for premature neonates and those face prolonged labor need to be improved in Ethiopia.

Reducing Gastroschisis Mortality: A Quality Improvement Initiative at a Ugandan Pediatric Surgery Unit

IntroductionWith modern treatment, survival of gastroschisis exceeds 90% in high-income countries. Survival in these countries has been largely attributed to prenatal diagnosis, delivery at tertiary facilities with timely resuscitation, timely intervention, parenteral nutrition and intensive care facilities. In sub-Saharan Africa, due to lack of these facilities, mortality rates are still alarmingly high ranging from 75 to 100%. In Uganda the mortality is 98%.AimThe aim of this study was to reduce gastroschisis mortality in a feasible, sustainable way using a locally derived gastroschisis care protocol at a referring hospital in Western Uganda.MethodsData collection was performed from January to October 2018. Nursing staff were interviewed regarding the survival and management of gastroschisis babies. A locally derived protocol was created with staff input and commitment from all the team members.ResultsFour mothers absconded and 17 babies were cared for using the newly designed protocol. Seven survived and were well at one month post discharge follow-up, reducing the mortality for this condition from 98 to 59%.ConclusionA dedicated team with minimal resources can significantly reduce the mortality in gastroschisis by almost 40% using a locally derived protocol.

1899 Bronchial Aspiration of Capsule Endoscopy: A Rare but Potentially Fatal Complication

INTRODUCTION: Video capsule endoscopy (VCE) is increasingly being used in the diagnosis of small bowel disorders and the evaluation of suspected small bowel bleeding in adults. VCE is considered a safe procedure with no attributable deaths. Clinically significant complications include symptomatic capsule retention and aspiration that occur in less than 2% of examinations. CASE DESCRIPTION/METHODS: A 67-year-old male with history of developmental delay and with no history of swallowing disorder or stroke was initially admitted to the hospital with severe symptomatic anemia. His hemoglobin was 7.1g/dl. Anemia work up revealed serum iron level of <10g/dl and a ferritin level of 4.30. He underwent upper GI endoscopy and colonoscopy with findings of a short segment Barrett’s esophagus and small non-bleeding hemorrhoids. He was then scheduled an outpatient VCE. He was given the capsule and asked to swallow it. He initially had some difficulty in swallowing it but then took a big gulp and apparently swallowed it. Immediately upon swallowing, he started experiencing difficulty breathing. Nursing staff present immediately checked his oxygen saturation and noted a transient drop which corrected with minimal oxygen supplementation. An X-ray was immediately ordered and the monitor activated. Images suggested ingestion into the bronchus and a chest X-ray confirmed presence of a pill camera overlying the right main stem bronchus. He underwent an emergent flexible bronchoscopy with successful extraction of the capsule. This was followed by endoscopy assisted capsule insertion into his duodenum.He tolerated the procedure well. DISCUSSION: VCE is increasingly being used to provide diagnostic imaging of the small intestines, an anatomic site that is peculiarly difficult to visualize. Suspected small bowel bleeding and tumors of the small bowel are some of the common indications of VCE.Capsule aspiration although a rare complication with VCE can be life threatening. Early detection with emergent timely retrieval of the capsule is recommended. In order to prevent such complications and to be able to intervene expeditiously, it is recommended that VCE should be administered in an office with oxygen and where other resuscitative facilities are available. In conclusion, though rare, capsule aspiration is a serious complication of VCE and physicians should pay attention to patients who have any delay in capsule ingestion and if possible confirm passage of the capsule endoscope into the stomach before the patient leaves the clinic.

Unmasking Brugada Syndrome with Oral Flecainide Provocation. A Case Series of Three Patients

The present case series discuss three patients who had brugada type 2/ type 3 like ECG pattern that was converted to type 1 pattern with oral flecanide challenge test. Brugada syndrome is associated with a high incidence of sudden cardiac death, typical ECG pattern being ST-segment elevation in the right precordial leads with T wave inversion. Pharmacological provocation should only be performed when the baseline ECG is not diagnostic of Brugada Syndrome. PR prolongation in the baseline ECG is also a contraindication because of the risk of inducing AV block. Drug challenge is performed under strict monitoring of BP and 12-lead ECG and facilities for cardio version and resuscitation are available. Atypical RBBB pattern/type 2/3 Brugada pattern on ECG in patients of syncope or family history of sudden cardiac arrest is commonly encountered by a cardiologist. This can be performed to provoke type 1 brugada pattern on ECG. Diagnosed cases of Brugada may be treated with ICD with proper indication if needed and thus prevent sudden cardiac death.

Infantile and adult mortality in precarious conditions

IntroductionMaxillofacial surgery plays an important role in humanitarian surgery because this specialty includes common procedures such as facial reconstruction after burns, facial clefts or Noma's sequelae, which do not require complex infrastructures and thus can be carried out in sub-optimal conditions. Nevertheless, there is a mortality rate during those missions and few studies evaluating their rate and circumstances have been published. The aim of our study was threefold: to study the deaths reported during humanitarian missions, to analyze the circumstances of those deaths, and to determine the risk factors in order to propose possible adaptations in operative indications and therapeutic attitudes so that those mortalities may be avoided in the future. Material and methodWe evaluated the early deaths (between day 0 and day 8) observed among 3,494 patients operated on during humanitarian missions conducted between 2007 and 2018 in Africa and Asia by the charity organization "Les Enfants du Noma" (EDN). Information (patient, type of surgery, circumstances of death) was collected from the medical files and by questioning the medical teams who took part in the missions. ResultsFive deaths were recorded from 2007 to 2018, representing a mortality rate of 0.14%. The deceased were between 1 and 20 years of age and the deaths occurred between the day of the surgical procedure and the third post-operative day. The causes of death were as follows: two cases of respiratory failure due to mucous plugs (one in the endotracheal tube and one in the tracheotomy canule), one cardio-respiratory failure, one bilateral tension pneumothorax and one peritonitis from several duodenal perforations. DiscussionIn order to minimize the risks of lethal complications, it is important to identify as early as possible certain high-risk situations, to ensure the adequacy of the means available, and to establish an indication for surgery by a concerted discussion among the surgeons and anesthetists involved. One of the general limitations of humanitarian missions is the lack of resuscitation facilities and the lack of availability of further exams. Rites, beliefs, superstitions, gri-gri and ancestral practices often hold a prominent place in these cultures. The absence of well-kept medical records (including personal and family histories), language barriers, large volumes of patients to manage, the inexperience of first-time teams, the lack of knowledge of the terrain and local health conditions, and an inability to empathize with patients, limit the quality of preoperative assessment and sometimes lead to poor decisions.

Hospitals’ extracorporeal cardiopulmonary resuscitation capabilities and outcomes in out-of-hospital cardiac arrest: A population-based study

AimExtracorporeal cardiopulmonary resuscitation (ECPR) is the emerging resuscitative strategy to save refractory ventricular fibrillation (VF) or pulseless ventricular tachycardia (VT) patients. We investigated whether the receiving hospitals’ ECPR capabilities are associated with outcomes in out-of-hospital cardiac arrest (OHCA) patients who have refractory VF or pulseless VT. MethodsIn a population-based cohort study performed in Kobe City, Japan, between 2010 and 2017, we identified all OHCA patients who had refractory VF or pulseless VT. Based on their ECPR capabilities, hospitals were categorised into ECPR facilities and conventional cardiopulmonary resuscitation (CCPR) facilities. We compared patient survivals between ECPR facilities and CCPR facilities by applying inverse probability weighting using a propensity score. ResultsOf all 10,971 OHCA patients, 518 had refractory VF or pulseless VT. The proportion of favourable neurologic outcomes was 43/188 (22.9%) in ECPR facilities and 28/330 (8.5%) in CCPR facilities. In the propensity analysis, hospitals’ ECPR capabilities were associated with favourable neurologic outcomes (adjusted risk difference [ARD], 9.7% [95% confidence interval [CI], 3.7%–15.7%]; adjusted risk ratio [ARR], 2.01 [95% CI, 1.31–3.09]), and overall survival (87/188 [46.3%] vs. 67/330 [20.3%]; ARD, 19.0% [95% CI, 11.1%–26.9%]; ARR, 1.88 [95% CI, 1.45–2.44]). ConclusionsHospitals’ ECPR capabilities were associated with favourable neurologic outcomes in OHCA patients who had refractory VF or pulseless VT. We should take each hospital’s ECPR capability into consideration when developing a regional system of care for OHCA.

The administration of blood components: a British Society for Haematology Guideline.

The administration of blood components: a British Society for Haematology Guideline.

English

INTRODUCTION: Regional anesthesia as the name implies is the blocking of peripheral nerve conduction in a reversible manner by using local anesthetic agents, thereby one region of the body is made insensitive to pain and is devoid of reflex response to surgical stimuli. The central nervous system is spared, so the patient is conscious during the surgical procedure. Regional anesthesia offers many advantages over general anesthesia for surgery on upper extremities, particularly in emergency operations. AIM OF THE STUDY: The aim of the present study is to evaluate the effect of addition of 50μg/kg of preservative free Midazolam to 0.5% Bupivacaine solution in supraclavicular brachial plexus block on the • Onset of blockade, • Duration of blockade, • Intensity of blockade, • Sedation, • Complications if any & • Quality of analgesia. MATERIALS AND METHODOLOGY: Forty adult patients of both sexes in the age group of 20 – 60 years belonging to ASA I / II category and their weight ranging between 50 – 70 kgs, posted for various types of upper limb surgeries at the Department of Plastic Surgery, Institute of Research and Rehabilitation of Hand, Government Stanley Hospital, formed the study group. This study was designed as a prospective, randomized comparative study. After receiving the institutional ethical committee approval and informed consent, the patients were randomly allocated into two groups. Supraclavicular brachial plexus was performed via subclavian perivascular technique. Groups: 1. BM - 20 patients received 30 ml of 0.5% Bupivacaine with preservative free Midazolam 50 μg/kg. 2. B - 20 patients received 30 ml of 0.5% Bupivacaine alone. Inclusion Criteria. 1. ASA I & II. 2. Age group 20 – 60 years. 3. Weight 50 – 70 kilograms. 4. Surgeries of forearm and hand. Exclusion Criteria: 1. Patient refusal. 2. Coagulopathy. 3. Infection at injection site. 4. Pneumothorax or previous pneumonectomy on the opposite side. Patients were all preoperatively evaluated, clinically examined and investigations done prior to assessment. Procedures were explained in detail and written consent obtained. The procedure was carried out in the preparation room or in the theatre were facilities for resuscitation were available. SUMMARY: 1. Onset time for both motor and sensory block was quicker in the Bupivacaine with midazolam group. 2. There was no significant difference between the groups in the time taken for completion of both motor and sensory blockade. 3. There was no difference between the groups in the intensity of blockade. 4. There was no difference between the groups in the mean duration of motor blockade. 5. The mean duration of sensory blockade was significantly prolonged in the Bupivacaine midazolam group. 6. Sedation was statistically significant with Bupivacaine midazolam group in the intraoperative period. 7. There was no complication due to the addition of 50μg/kg Midazolam to Bupivacaine. CONCLUSION: In conclusion, midazolam 50μg/kg when used as an additive to 0.5% Bupivacaine solution for supraclavicular brachial plexus block, quickens the onset of sensory and motor blockade, prolongs the duration of sensory blockade and improves the quality of post operative analgesia with mild intraoperative sedation. Hence, midazolam can be considered as a safe additive to local anaestetic solution for brachial plexus block.

NEONATAL RESUSCITATION;

Introduction: The need for neonatal resuscitation is usually unexpected andapproximately 10% infants require some assistance at birth to begin breathing. We conducteda study to know the facilities and practice of neonatal resuscitation among healthcareproviders at different healthcare centers of Multan. Study Design: A cross sectional descriptiveepidemiological study. Setting: Different Health Care Centers providing Gynecological andObstetrical Care in different areas of Urban Multan. Period: 15-08-2016 to 30-08-2016. Method:A questionnaire-type survey on neonatal resuscitation was performed at 69 different health carefacilities of Multan. Data were analyzed using SPSS version 17.0 for windows. The results arepresented using tables. Results: Out of 69 healthcare facilities, 50 (72.5%) were private hospitals.Majority of the center were run by doctors (52.2%). Ambu-bags were present in 83% centers,bulb sucker 68%, foot sucker 62% and electric sucker in 75% of healthcare centers. Routinedelivery room care like drying, warmth and wrap were given in 70%, 74% and 48% centersrespectively. Most common way of resuscitating the baby was suction 74%. Post resuscitationreferrals in cases needing special care to other facility were made by 88% centers. New bornresuscitation courses had been attended by only 36% of healthcare providers. Conclusion:Basic neonatal resuscitation facilities were available at most of the health facilities. There isincreased need of new born resuscitation courses attended by the healthcare providers.

Clinical practice guidelines on iron therapy: A critical evaluation.

Anemia is common among patients with chronic kidney disease (CKD) and it is managed primarily with erythropoiesis-stimulating agents (ESA) and iron therapy. Following concerns around ESA therapy and economic constraints, IV iron is more and more administered worldwide. Several guidelines or position papers, which give indications on iron therapy in CKD patients, have been issued in Nephrology. Unfortunately, the field is characterized by a lack of evidence. As a result, the recommendations/suggestions are not uniform. There is general consensus to prescribe iron therapy to patients who are clearly iron deficient. In addition, iron therapy may increase Hb values, delay the start of ESA therapy in ESA-naïve patients and reduce ESA dose in ESA-treated patients. However, there is debate on the safety and efficacy of IV iron therapy when given in the presence of already high serum ferritin levels. In addition, not all the guidelines/position papers differentiate between non-dialysis/dialysis patients and between the presence/absence of ESA therapy. Many international Bodies or Societies suggest caution when administering IV iron during infections. A trial of oral iron should be considered as a first step, especially in the ND-CKD population. Finally, recommendations on the prevention of anaphylactic reactions following IV iron therapy are given by several bodies. There is consensus that IV iron is to be administered in the presence of resuscitative facilities (including medications) and personnel trained for emergencies.

A survey of neonatal resuscitation facilities in the urban setting of Lahore

Objectives: To assess the status of basic facilities and equipment required for neonatal resuscitation and the level of training in neonatal resuscitation of personnel attending neonates at the time of delivery at different health care centers in Lahore. Study design: A cross sectional descriptive epidemiological study. Place and duration: The study was conducted at different health care centers providing obstetrical care in different areas of urban Lahore from February to May 1998. Subjects & Methods: A survey of about 51 different health care facilities like Private hospitals private clinics and MCH centers in different areas of Lahore was done. Based on a preset questionnaire the in charge of the relevant place was interviewed regarding availability of requisite equipment and level of training of their staff in neonatal resuscitation. Results: A total of 51 centers in Lahore were surveyed. Out of them 36 were private clinics, 11 private hospitals and 4 MCH Centers. These centers were run by doctors (65%), LHVs (23%) and nurses (6%), mid wife, dai, dispenser (2%) each. Most of these centers did not have all the required resuscitation equipment, for instance the space for resuscitation was available with 50%, warmers were present 24%, blankets 60%, bulb sucker 49%, electric suction machine 31%, oxygen 51 `%, bag &mask 20% and intubation equipment 16% were available. The referral transportation was not available in 75%. Regarding training level of the personnel present at the time of delivery 80% did not have any newborn resuscitation training and only Out of the rest only 8 personnel knew how to intubate the newborn. Conclusion: Most of the centers lack requisite equipment needed for neonatal resuscitation and there is a need for the staff to under go training in neonatal resuscitation.