The International Journal of Frontier Sciences

Background: This study was conducted to evaluate the feasibility of local anesthesia (LA) instead of general anesthesia (GA) in upper gastrointestinal abdominal procedures including open gastrostomy, gastrojejunostomy, gastroduodenal disjunction, jejunostomy and traction esophageal stenting. Materials and Methods: This study was conducted at Thoracic surgery department, Nishtar Hospital Multan, Pakistan from September,1st-December,31st,2020. Out of 147 patients 80 and 67 patients were operated under LA and GA respectively. Age, BMI, gender, procedure performed, etiology, mean time, stay in recovery, PONV, postoperative pain at 4, 8, 12 hours, postoperative sedation and discomfort, within 3-and 7-days postoperative mortality were documented and compared between the two groups. Results: Mean age of the patients in group LA was significantly higher as compared to group GA(p<0.001). Procedure time was 30.06±12.01minutes and 34.42±11.76minutes (p=0.029), mean duration of stay in recovery was 2.31±5.68minutes and 18.80±6.40minutes(p<0.001) in group LA and GA, respectively(p=0.029). Postoperative discomfort was also higher in group GA as compared to group LA(p=0.001). The incidence of PONV was 12.5% and 35.8% in group LA and GA, respectively(p=0.001). Complaint of postoperative pain was 16.2% and 37.3% at 4 hours(p=0.004); 18.8% and 35.8% at 8 hours(p=0.020); and 21.2% and 26.9% at 12 hours(p=0.426) in group LA and GA, respectively. Conclusion: For performing various upper abdominal procedures, LA is safe for the patients who are medically unfit for GA. Moreover, LA is associated with lesser adverse effects as compared to GA. Patient is more comfortable and there is better pain relief in early postoperative period. Full article

Integrated health care has the ability to provide adequate care system in different modalities of medical care. Saudi Arabia is going through major transformation in its health care services in order to provide sufficient resources. A 12-dimension SCIROCCO online self-assessment tool, was extracted from the B3-MM, was used for the scaling up of health intervention and for assessing the maturity level of integrated care within different regions. SCIROCCO tool assess a step wise scaling up technique to evaluate how to scale up integrated care during heath transformation. By having knowledge of the factors which make this strategy difficult to implement this study evaluates to what extent SCIROCCO technique was applied. The SCIROCCO tool was used to assess the maturity of systems of Jazan, Saudi Arabia for integrated care system and for the evaluation of factors affecting scaling up. Data was collected from Stakeholders from multiple disciplines including decision-maker, healthcare professional, IT specialist by self-assessment method. The outcomes of the self-assessment process were visually captured in the form of spider diagrams. All three fundamental steps of the scaling up procedure were executed with satisfactory devotion. Integrated heath transformation in Jazan yielded 18 points out of 60 on spider diagram according to SCIROCCO tool. Majority of the dimensions have no more than 3 score. Digital Health care transformation in Jazan needs to be improved in most of the aspects. This study assesses maturity level of integrated care in Jazan and concludes that An ICT infrastructure to support integrated care has been agreed together with a recommended set of technical standards but there are Still local variations or some systems in place are not yet standardized. Learning about integrated care and change management was in place but not widely implemented. Full article

Dear Editor, Temporary cardiac pacing is an artificial method of electrical cardiac stimulation to treat a bradyarrhythmia (BA) or tachyarrhythmia until resolution or initiation of long-term treatment. The goal of this temporary stimulation is to restore circulation and normal hemodynamics that has been significantly compromised by abnormal heart rate (1). Temporary artificial pacing is recommended in a variety of circumstances, most notably in individuals with severe BA such as second- or third-degree atrioventricular block (AVB), or severe symptomatic bradycardia irrespective of the cause. Furthermore, temporary pacing can be used as an overpass while awaiting placement of permanent pacemaker (PPM) in patients (2). Temporary pacemakers (TPM) are used to treat emergencies in individuals with severe symptomatic BA and for elderly patients who are hemodynamically unstable and refractory to medical treatment. TPM is a critical emergency tool for saving lives in such situations, which is why it is highly concerning that the people of Khyber Pakhtunkhwa (KPK) can avail this vital therapy only at the province's four tertiary care hospitals (TCH). For people residing in peripheral areas, it takes more than 4-5 hours on average to reach TCH, which is dreadful in face of an emergency. This discrepancy in availability of TPM often causes thromboembolism, stroke and in many cases culminating in the patient's death before reaching the hospital. According to the American Heart Association (AHA), if left untreated, severe or prolonged bradycardia can lead to a variety of problems, including heart failure, hypotension, and hypertension. For certain situations, bradycardia can be followed by a rapid heartbeat, known as tachycardia. When these two conditions occur simultaneously, they are referred to as Bradycardia-Tachycardia or Tachy-Brady syndrome. This is a form of sick sinus syndrome that can be linked with the heart rhythm disease atrial fibrillation, increasing the risk of consequences such as stroke and sudden death, or cardiac arrest (3). As of 2019, almost 15 million Pakistanis were over the age of 60 years, accounting for 7% of the country's total population (4). This is concerning since research shows that conduction abnormalities increased with age. According to a study done in Pakistan, the incidence of conduction defects rose with age, with the highest frequency (28%) seen between the ages of 61 to 70. Third-degree heart block was common (75%) among conduction abnormalities in the investigated group. It was also determined that the rate of pacemaker placement increased with age (5). Therefore, the need for an unprecedented demand for TPM is crucial. It is high time to take steps towards widespread availability of TPM all over KPK at the District Head Quarters (DHQs) level. It is also critical to appoint appropriate allied health professionals for TPM placement, who could deal with the situation without immediate supervision by the cardiologist. With this letter, we call for action to the concerned health care sector authorities in KPK and in Pakistan to supply the requisite quantity of TPM in all KPK health care institutions including smaller set-ups such as DHQs. This would safeguard the preservation of valuable lives while also help reduce mortality and morbidity owing to the scarcity of TPM. To conclude, there is an urgent need for TPM to be made available in all the province's hospitals to prevent the vulnerable population from the life-threatening consequences of BA. Full article

Since the outbreak of coronavirus (COVID-19) in December 2019, understanding regarding coronavirus symptoms has been evolving. Medical issues in pregnancy usually resolve after delivery. Similarly, pregnant ladies with COVID-19 pneumonia had improvement in their condition after giving birth. However, in this case, the patient tested positive for "SARS-Cov-19 antigen PCR" and intended for vaginal birth, which was unsuccessful and resulted in a caesarean surgery. After the healthy baby was delivered, she experienced a life-threatening cytokine storm that necessitated elective intubation and mechanical breathing, as well as anti-viral medication. She was extubated after two weeks and then discharged on recovery. Previously, the Middle Eastern Respiratory Syndrome Coronavirus (MERS-SARS) and the Influenza virus (H1N1) were the most well-known viruses for generating potentially fatal results in pregnancy. This is first reported instance in Pakistan of a pregnant lady developing severe COVID-19 pneumonia. This research fills a vacuum in the medical literature and alerts obstetricians and clinicians to the likelihood of life-threatening postpartum, COVID-19 pneumonia complications. Full article

Background: Microorganisms are turning out to be greatly resistant to existing antibiotics, specifically gram-negative rods which shows resistance to currently accessible antibiotics. Beta-lactam antibiotics are the main therapeutic option to treat infections of gram-negative microorganisms i.e., ESBL and Carbapenemase producers. Saussurea lappa herb is a medicinal herb use since many times. Basically, the roots of S. lappa herb were used as medicines. Current study was conducted to find out activity of various fractions of S. lappa herb against multidrug resistant gram-negative rods. Methods: Crude extracts of ethanol, methanol and water and fractions of n-hexane, chloroform, and methanol from S. lappa herb were used. Total of sixty multidrug resistant organisms were included in which thirty were ESBL and thirty were carbapenemase producing organisms. Mean MIC and comparative analysis of various extracts and fractions have been evaluated. Results: The mean MIC value of crude extracts of ethanol, methanol, n-hexane, chloroform and methanol fractions and water extract from S. lappa against ESBL producing organisms were 109.33± 6.915 mg/ml, 154.67± 5.164 mg/ml, 150.00± 5.345 mg/ml, 55.33±5.164 mg/ml, 178.00±6.103 mg/ml, 64.00± 7.701 mg/ml respectively. Similarly, the mean MIC value against carbapenemase producing organisms were 100.67± 8.683 mg/ml, 158.67± 3.519 mg/ml, 150.67± 5.936 mg/ml, 54.67±5.164 mg/ml, 176.67±14.223 mg/ml, 64.33± 9.353 mg/ml respectively. Conclusion: This study suggests that extracts and fractions of S. lappa herb can form the basis to develop novel broad-spectrum formulation for antimicrobial drugs as it contains compounds that has novelty to perform its action against multi-resistant mechanisms. Full article

Background: In light of the COVID-19 pandemic, the Government of Pakistan issued safety measures in an effort to mitigate the rising number of cases, the effectiveness of which depends on people’s response and behavior. This study investigates the knowledge, attitude and practices towards COVID-19 pandemic among residents of Karachi, Pakistan. Methods: An online survey of 764 residents of Karachi was conducted between 15 September and 20 November 2020. Popular social media and authors’ networks with the residents were utilized for the successful recruitment of these responses. A self-developed online KAP questionnaire was developed with 9 questions on knowledge, 7 on attitude, and 5 on practices. Results: Out of 764 participants, 60.6% were female, 37.2% had university degrees and 20.8% were white collar workers. Social media was the most popular information source (52.9%) and a trend to update daily on the news was observed (69.6%). Preventative measures were well known; washing hands with soap and water (97.4%), wearing facemasks (91.5%) and using hand sanitizer (89.4%). Majority (86.7%) were aware of social distancing. Favorable practices were observed; with 83% using masks, 71.6% limiting social interaction, 74% staying at home, 95% ensuring extra hygiene and 73% authenticating information from trusted sources. Conclusion: Most residents of Karachi were knowledgeable regarding mitigation measures and had optimistic attitude and appropriate practices during the initial period of the COVID-19 outbreak. Future interventions in low and middle-income countries ought to prioritize interventions to develop a community-centered approach, targeting vulnerable subgroups in rural areas. Full article

By the beginning of the twenty-first century, the trend of digitalization has been widely appreciated. At first, digitalization became famous for social networks (e.g., Facebook, Twitter etc.), professional networks (e.g., LinkedIn, ResearchGate etc.), online banking, cryptocurrencies (e.g., Bitcoin etc.), education (e.g., Coursera etc.), and dating (e.g., Tinder etc.). Digitalization has been widely accepted by governments for state businesses. International chambers of commerce and multinational companies are utilizing digital means to access new markets and to operate and expand their businesses. A revolutionary shift in digitalization occurred in famous start-ups, such as Uber and Airbnb etc. The current COVID-19 pandemic has promoted digitalization on a mass scale, when social distancing has become a primary infection prevention measure (Qian and Jiang, 2020). Europe and the United States (US) have been points of origin for digital products, later extending to China, India, and the rest of the world. Digitalization has been a good management practice for developed economies but a challenge for developing countries. Usually, developing countries develop digitalization from foreign aid because of a lack of local funding and economic instability. Dependence on foreign aid usually limits independent policymaking because of the funding agency’s interests. In this editorial, we present digitalization in Pakistan as an example of sustainability challenges faced by developing countries. Full article