We herein report a witnessed cardiopulmonary collapse of a patient with difficult mask ventilation and near-impossible laryngoscopy-cum-intubation in the critical care unit. The airway was successfully rescued with a laryngeal mask airway Supreme™, followed by an open, crash tracheostomy by the otolaryngologist.
Airway Management ; methods ; Critical Care ; Heart Arrest ; therapy ; Humans ; Laryngeal Masks ; Larynx ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Oropharyngeal Neoplasms ; diagnosis ; Trachea ; surgery ; Tracheostomy ; Treatment Outcome

BACKGROUND: Motor vehicle crash (MVC) related injury has been identified as a major public health concern. Child restrain (CR) seat belts can minimize the mortality and morbidity from MVC. The use for seat belts is substantially low in developing countries like Pakistan even though its use has been shown to decrease morbidity and mortality by a significant extent. METHODS: This was a case control study with cases from the general population (GP) and controls from the Aga Khan University (AKU) employees in a 3:1 ratio. The study questionnaire was based on parameters like gender, education level, awareness and presence of CR and also assessed the frequency of usage, reasons for not using CR and the source of knowledge regarding CR use. RESULTS: Out of 848 respondents, 212 were from AKU and 636 were from the GP. 96.7% from AKU had at least a bachelor's degree while less than half (42.6%) of those from the GP were graduate or above (P<0.001). A statistically significant difference was found between the two groups with drivers from AKU being generally more aware about CR and its use. 81.1% of the group from AKU compared to 59.7% from the general population were found to be aware of child restraint use (P<0.001). Media (40.6%) was found to be the most common source of information amongst the AKU employees. CONCLUSION: Most motor vehicle related injuries in children can be prevented or their severity may be reduced by the use of appropriate child restraint seat belts.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that affects the overall cognitive, emotional, social, and physical health of the affected individual. It is characterised by challenges in social communication and interaction, repetitive and stereotyped behaviours, and narrow interests. The pathogenesis of ASD is thought to involve a combination of genetic and environmental factors. Increasing evidence suggests that vitamin D deficiency during pregnancy and early childhood may contribute to the development of ASD. While studies have indicated that vitamin D supplementation can significantly improve symptoms of ASD, the underlying mechanism remains elusive. This review summarises the association between vitamin D levels and ASD, explores potential mechanisms underlying vitamin D's role in ASD, and examines the effect of vitamin D supplementation on ASD symptoms.

Humans ; Palliative Care ; Surgeons ; Terminal Care

India has a great wealth of various naturally occurring plant drugs which have great potential pharmacological activities. Datura stramonium (D. stramonium) is one of the widely well known folklore medicinal herbs. The troublesome weed, D. stramonium is a plant with both poisonous and medicinal properties and has been proven to have great pharmacological potential with a great utility and usage in folklore medicine. D. stromonium has been scientifically proven to contain alkaloids, tannins, carbohydrates and proteins. This plant has contributed various pharmacological actions in the scientific field of Indian systems of medicines like analgesic and antiasthmatic activities. The present paper presents an exclusive review work on the ethnomedical, phytochemical, pharmacological activities of this plant.

Autophagy is a self-eating process,in which the damaged or excessed cell organelles and misfolded protein aggregates are removed from the cellular microenvironment.Autophagy is generally thought of as a pro-survival mechanism which is not only important for balancing energy supply at times of nutrient deprivation but also in the removal of various stress stimuli to ensure homeostasis.In addition to the target materials of"self"origin,autophagy can also eliminate intracellular pathogens and acts as a de-fense mechanism to curb infections.In addition,autophagy is linked to the host cell's innate immune response.However,viruses have evolved various strategies to manipulate and overtake host cell ma-chinery to establish productive replication and maintain infectious process.In fact,replication of many viruses has been found to be autophagy-dependent and suppression of autophagy can potentially affect the viral replication.Thus,autophagy can either serve as an anti-viral defense mechanism or a pro-viral process that supports viral replication.Hepatitis B virus(HBV)and hepatitis C virus(HCV)are known to co-opt cellular autophagy process as a pro-viral tool.Both viruses also induce mitophagy,which con-tributes to the establishment of chronic hepatitis.This review focuses on the roles of autophagy and mitophagy in the chronic liver disease pathogenesis associated with HBV and HCV infections.

The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.
Arteriovenous Fistula* ; Fistula ; Humans ; Kidney ; Prevalence ; Primary Health Care ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Reoperation ; Risk Factors ; Specialization ; Surgeons

The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.
Arteriovenous Fistula* ; Fistula ; Humans ; Kidney ; Prevalence ; Primary Health Care ; Renal Dialysis ; Renal Insufficiency ; Renal Insufficiency, Chronic ; Reoperation ; Risk Factors ; Specialization ; Surgeons

BACKGROUND: Motor vehicles crashes (MVCs) are the leading cause of injury related morbidity and mortality in developed countries. Recent evidence proves that properly used child seat belts can dramatically reduce the risk of severe and life-threatening injury from MVCs. There are rarities of thought and inspiration regarding the use of child seat belts in our society and region, therefore we lack of data regarding factors and paucity of usage of child seat belts in motor vehicles. This study aimed to assess the knowledge and attitudes of child seat belt usage among the educated population in Karachi, Pakistan. METHODS: Altogether 304 employees were investigated. They were employees of Aga Khan University who were using their cars and having children younger than 10 years old. A cross sectional observational study was designed, and a 36-item questionnaire in English was used to collect data on participants' demographic details, designation, educational level, economic status, validity of driving license, number of children and cars, availability of adult seat belts and child seat belts along with their functionality, awareness, knowledge and attitude toward its use, and reason of not using these devices. SPSS version 20 for Windows was used to analyze the data and the Chi-square test was used. RESULTS: Totally 290 participants were recruited with a response rate of 72％ (212). Of 212 participants, 126 (59％) were male. 154 (72.6％) participants had valid driver licenses, and 154 (72.6％) had adult seat belts in their vehicles. Only 32 (15％) reported regular use of adult seat belts. Although 168 (79.2％) participants had some knowledge about child restrains (CRs), only 65 (22％) had CRs in their cars. Eighty-two (38.7％) participants got the knowledge about CRs and seat belts from media. Mothers were more concerned about the use of CRs than fathers. Only 14 (6.6％) parents were found to use both adult and child seat belts all the time. Of the 157 parents who did not us use CRs, 42 considered unnecessary, 35 lacked relevant knowledge. But 15 parents used CR against their children's wills. CONCLUSIONS: The pattern of CR usage among the employees at Aga Khan University, Karachi is dictated by the unavailability of CR, followed by ignorance, inconvenience, and non-acceptance by their children. The important issue of CR has consistently been ignored over the years and it has never gained enough popularity in Pakistan.

Objective To investigate the restrictive factors in the development of foreign medical education. Methods From the years 2011 to 2013, 350 foreign students conducted a questionnaire survey in Chongqing Medical University, and recovered 339 valid questionnaires. Results Only 33.0%(112/339) students thought that the teacher's English was fluent and 70.2% (238/339) needed to add Chinese class. Additionally, 69.6% (236/339) and 63.1% (214/339) students considered theoretical knowledge and practi-cal experience were not enough. 92.3%(313/339) students came from developing countries in Southeast Asia. 86.1%(292/339) foreign students considered that university management was insufficient. Conclusion The survey found the restrictive factors included students' demand for English and Chinese, lack of medical ex-pertise and practice, the problem of student sources and daily management difficulties and so on.