Assessment of anaesthesia workforce capacity in district and tehsil (taluka) hospitals in Sindh province of Pakistan: a survey.

OBJECTIVES: Our objective was to determine the current availability of human resource at secondary care hospitals in Sindh province and to identify gaps in term of appropriate number of anaesthesiologists available for delivery of safe anaesthesia care. DESIGN: A cross-sectional survey of anaesthesia workforce. SETTING: All district and taluka hospitals in the Sindh province of Pakistan. PARTICIPANTS: Administrative anaesthesia leaders in the hospitals. OUTCOME MEASURES: Standard descriptive statistics (percentages and numbers) of anaesthesia workforce in these hospitals including both full-time and part-time physician anaesthesiologists, and non-specialist physicians providing anaesthesia services as well as technician support. RESULTS: Only 54 (75%) hospitals had a full-time anaesthesia physician, and 32 of these had only one. Two hundred and one operating rooms were present in 72 (80%) hospitals with an average of three operating rooms/hospital. CONCLUSIONS: This study has identified a deficit of anaesthesiology personnel in district-level and tehsil-level hospitals of Sindh province of Pakistan.

Coronary Artery Anomalies in Tetralogy of Fallot Patients Undergoing CT Angiography at a Tertiary Care Hospital.

Background The aim of this study was to determine the frequency of coronary artery anomalies (CAAs) in Tetralogy of Fallot (TOF) patients undergoing computed tomography (CT)-angiography in a tertiary care hospital. Methodology In this observational study, we included consecutive TOF patients undergoing CT-angiography without prior history of cardiac surgery or congenital heart disease. CAAs were defined based on either origin or course of the artery. Results Out of 441 TOF patients, the prevalence of CCAs was 3.6% (16), of which 13 were below 18 years of age. Anomalous left main artery was observed in six (1.4%) patients, followed by left anterior descending artery and right coronary artery, observed in four (0.9%) patients each, and two (0.5%) patients had a single coronary artery originating from the left coronary cusp with an interarterial course. Conclusions CAAs were observed in a significant number (3.6%) of TOF patients. A CT-angiographic assessment before surgical correction would help identify the exact anatomy for better surgical planning to minimize complications.

Left ventricular aneurysmectomy in a young female with pseudoaneurysm of unknown etiology.

A left ventricular pseudoaneurysm is formed when there is free wall rupture of the myocardial wall with discontinuity and roof covered by pericardium mural thrombus or fibrous tissue without any myocardium. A left ventricular pseudoaneurysm is a rare and life-threatening event. We report a young 22-year-old female with unknown etiology of a pseudoaneurysm, who was previously managed as a psychiatric case and for musculoskeletal pain. On subsequent investigation and confirmation with cardiac magnetic resonance imaging, aneurysmectomy was done. This is a rare case in a young 22-year-old woman with a ventricular pseudoaneurysm of unknown etiology. Considering the high risk for rupture of a ventricular pseudoaneurysm, surgical resection was mandatory with no complications intra- and post-procedure.

Knowledge practice gaps about needle stick injuries among healthcare workers at tertiary care hospitals of Pakistan.

BACKGROUND: The aim of our study were to assess the knowledge and practice gaps about Needle Stick Injuries (NSIs) and their associated factors among Health Care Workers' (HCWs) at tertiary care hospitals of Pakistan. METHODS: A cross-sectional study was conducted in two tertiary care teaching hospitals in Karachi, Pakistan, representing both private and public health sector. During the months of January to May 2008, trained medical graduates interviewed 497 HCWs (Doctors and Nurses) who were working in those particular hospitals for more than a year and were willing to participate in the study. RESULTS: Overall the knowledge about transmission of HBV HCV and HIV was good. However, 19.1 and 12.3% HCWs had misconception about the transmission of malaria and tuberculosis by NSIs; more female and working as a nurse. Furthermore, a large number of participants had lack of knowledge for the transmission of infectious mononucleosis. Over two third of study subjects were not vaccinated for hepatitis B infection, again more females (p = 0.002) and nurses (p < 0.001). Large numbers of study participants were not wearing protective cloths, and do not us sharp containers. Similarly, preponderance of study subjects does not avoid breaking needle by hands and leave syringes open; these poor practices are significantly more prevalent among those working for more than five years and doctors (p = 0.003). CONCLUSION: In addition to lack of knowledge, poor practices were reported in this study. Proper curriculum reform and training are required to protect the health Care workers and patients. Further research and interventions are suggested in this regards.