Validation of Difficult Airway Physiological Score (DAPS) in Critically Ill Adults Undergoing Endotracheal Intubation in the Emergency Department.

Background: Critically ill patients have increased risk of cardiovascular collapse following endotracheal intubation due to physiological instability. This study aims to validate the Difficult Airway Physiological Score (DAPS) in adults to predict the risk of serious outcomes in the emergency department of a tertiary care private hospital.

Methods: This is a cohort study conducted in the emergency department (ED) from 2021 to 2022.

Thirty-year trends of triple burden of disease in the adult population of Pakistan.

Background: The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades.

Derivation of the Difficult Airway Physiological Score (DAPS) in adults undergoing endotracheal intubation in the emergency department.

Background: Prediction of serious outcomes among patients with physiological instability is crucial in airway management. In this study, we aim to develop a score to predict serious outcomes following intubation in critically ill adults with physiological instability by using clinical and laboratory parameters collected prior to intubation.

Method: This single-center analytical cross-sectional study was conducted in the Emergency Department from 2016 to 2020.

Pediatric Appendicitis Score for Identifying Acute Appendicitis in Children Presenting With Acute Abdominal Pain to the Emergency Department.

Objective: To determine the diagnostic accuracy of Pediatric Appendicitis Score (PAS) in predicting appendicitis in children presenting with acute abdominal pain to the Emergency Department (ED) of a private hospital in Pakistan.

Methods: This validation study was through retrospective chart review of children between 4-18 years of age with clinical suspicion of acute appendicitis, presenting to the pediatric ED. Diagnostic accuracy was determined using sensitivity, specificity, predictive values, and area under the curve (AUC).

Perceptions, challenges and experiences of frontline healthcare providers in Emergency Departments regarding Workplace Violence during the COVID-19 pandemic: A protocol for an exploratory qualitative study from an LMIC.

Introduction: Workplace violence (WPV) against Healthcare Workers (HCWs) has emerged as a global issue. Emergency Department (ED) HCWs as front liners are more vulnerable to it due to the nature of their work and exposure to unique medical and social situations. COVID-19 pandemic has led to a surge in the number of cases of WPV against HCWs, especially against ED HCWs.

Global Surgery Hackathons: A Case Study From Pakistan.

Hackathons aim to solve problems in a selected field by bringing together people from multiple domains and combining their expertise. Global surgery is an emerging field with a huge burden of disease and massive implications for bettering health care. In this study, we describe the first Global Surgery Hackathon held in Pakistan and analyze the impacts of the hack and post-hack incubation.

Innovation in emergency medicine; a perspective from a low middle income country, Pakistan.

Creativity and innovation are essential life skills in the 21st century. These skills are even more important in the healthcare sector of a resource limited country like Pakistan. The acquisition and implementation of innovation is necessary in the field of emergency medicine in Pakistan to troubleshoot challenges like rising emergency room visits while facing lack of resources.

Effectiveness of High-Fidelity Simulation in Training Emergency Medicine Physicians in Point of Care Ultrasonography in Pakistan: A Quasi-Experimental Study.

Background Point-of-care ultrasound (PoCUS) is frequently utilized in emergency medicine (EM), with an extended-focused assessment with sonography in trauma (e-FAST) being the most widely used PoCUS modality. This modality is not only time- and cost-efficient, but it is highly accurate in the diagnosis and management of surgical patients in the emergency department, as well as being highly predictive of patient outcomes. Targeted training is essential to ensure a learner's confidence in image acquisition, interpretation, and translation of knowledge to making clinical decisions.

Initiating Narrative Medicine at a Medical College in Pakistan: Achievements, Challenges, and Opportunities.

Writing has always been a part of medicine, but it was largely used as a means to disseminate objective data. With changing times, qualitative writing in the form of narrative medicine (NM) is fast coming to the forefront. Data in the field from high-income countries have shown an enhancement in empathy and professionalism alike, for both patients and health care practitioners.

Clinical emergency care research in low-income and middle-income countries: opportunities and challenges.

Disease processes that frequently require emergency care constitute approximately 50% of the total disease burden in low-income and middle-income countries (LMICs). Many LMICs continue to deal with emergencies caused by communicable disease states such as pneumonia, diarrhoea, malaria and meningitis, while also experiencing a marked increase in non-communicable diseases, such as cardiovascular diseases, diabetes mellitus and trauma. For many of these states, emergency care interventions have been developed through research in high-income countries (HICs) and advances in care have been achieved.

Association of Plasma Levels of Nitric Oxide Oxidative Metabolites with Acute Stroke in Patients Presenting to the Emergency Department of a Low-Middle Income Country.

Introduction: Acute stroke incites an inflammatory reaction in the brain's microvasculature, activating formation of nitric oxide oxidative metabolites, nitrate and nitrite (NOx, collectively), measurable in plasma. Our objectives were to investigate plasma NOx in patients with acute stroke presenting to the Emergency Department (ED) and to determine if it could (i) differentiate between ischemic and hemorrhagic stroke; (ii) predict clinical outcomes.

Methods: A cross-sectional study was conducted in the ED of Aga Khan University Hospital, from January 1 to December 31, 2016.

A Case for Global Surgery in Pakistan: Implementation Through Multi-Disciplinary Engagement.

The increasing disparity in healthcare access in Pakistan requires immediate intervention in the form of informed policy and appropriate implementation of such a policy. The implementation of a global surgery framework in Pakistan has the potential to improve healthcare access and parity in rural areas. Benefitting from the lessons learned through previous attempts at implementing centrally planned health programmes, This paper makes the case for a decentralised approach in facilitating the implementation of a Global Surgery framework in Pakistan.

Child abuse in Pakistan: A qualitative study of knowledge, attitudes and practice amongst health professionals.

Child abuse is a global problem and pervades all cultures and socio-economic strata. The effects can be profound and life altering for victims. There is substantial literature from high income countries about signs of abuse, but a dearth of data from low and middle income countries like Pakistan.

The clinical respiratory score predicts paediatric critical care disposition in children with respiratory distress presenting to the emergency department.

Background: Respiratory distress is a common presenting complaint in children brought to the Emergency Department (ED). The Clinical Respiratory Score (CRS) has shown promise as a screen for severe illness in High Income Countries. We aimed to validate the admission CRS in children presenting to the ED of a Low-to Middle Income Country.

Teaching children road safety through storybooks: an approach to child health literacy in Pakistan.

Background: Road traffic injuries (RTIs) commonly affect the younger population in low- and-middle-income countries. School children may be educated about road safety using storybooks with colorful pictures, which tends to increase the child's interest in the text. Therefore, this study assessed the use of bilingual pictorial storybooks to improve RTI prevention knowledge among school children.

The Art of Healing through Narrative Medicine in Clinical Practice: A Reflection.

The art of medicine has roots that lie deep in developing the biopsychosocial connection. Understanding a human body (both its physiology and pathology) along with components of emotional and spiritual cores can lead to provision of excellent medical care and better outcomes. The harmonization of psychosocial consequences of a biological disease is helpful not just for health care professionals but also for patients.

Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country.

Background: Timely identification of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care (POC) testing is being increasingly utilized in the emergency department (ED). We examined the accuracy and time-saving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients.

Paediatric innovation in Pakistan: our experience and a call to action.

Standardisation in paediatric medicine may have the unintended effect of stifling innovation. Thinking outside the box becomes even more important in low-income to middle-income countries like Pakistan, where a large paediatric population requires healthcare. In addition, there is always a lack of funds, making an innovative, low-cost and high impact solution all the more necessary.