Work stress is an integral part of anesthetic practice and has been a subject of many studies. Persistent stress can lead to burnout. There is limited published literature from lower- and middle-income countries where job stressors may be different from high-income countries. The aim of this study was to find out the level of burnout in a cohort of anesthesiologists working in academic institutions in 2 major cities of Pakistan, a low middle income country. We conducted an anonymous survey based on the Maslach Burnout Inventory scale with 3 major components: emotional exhaustion; depersonalization; and burnout in personal achievement. The demographic and other work-related details were collected in a standardized manner. Our response rate was 74.5%. Seventy-seven percent of the participants were residents and 23% consultants. Gender distribution was 66.9% males and 33.1% females. Thirty-nine percent (95% CI, 34.8%–44.1%) showed moderate- to high-level emotional exhaustion, 68.4% (95% CI, 63.9%–72.7%) showed a moderate to high level of depersonalization, and 50.3% (95% CI, 45.6%–55.07%) showed a moderate to high level of burnout in personal achievements. On multivariable analysis, anesthesia not being the primary career choice was significantly associated with all 3-dimensional scales for the whole cohort. Factors significantly associated with emotional exhaustion were Lahore as city of work, >2 nights on call per week, and >40 h/wk work inside the operating room. Depersonalization burnout was again associated with Lahore as city of work, >40 h/wk work inside the operating room, and personal achievement burnout with >2 on-call nights per week. No association was observed for gender, marital status, or having children. In conclusion, a high rate of burnout was identified in anesthesiologists working in 2 major cities in Pakistan. Some new associated factors such as initial choice of specialty and city of work were highlighted. Based on these findings, preventive and coping strategies need to be introduced at institutional and national levels.

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The spectrum of eosinophilic lung diseases comprises a diverse group of pulmonary disorders associated with tissue or peripheral eosinophilia. [Acute eosinophilic pneumonia (AEP)] is an uncommon eosinophilic lung disease that can be idiopathic, but identifiable causes include medications, inhalational exposures and infections. Most cases in the literature are associated with first-time cigarette smoking or resuming smoking. Herein, we present a case of AEP in an elderly man triggered by exposure to secondhand tobacco smoke, in whom a transbronchial biopsy was diagnostic. The patient recovered fully with glucocorticoid therapy without recurrence after avoiding further secondhand smoke.

Objective: To compare the predicted accuracy of PFR with RSBI for successful spontaneous breathing trail before extubation in intensive care unit. Methods: This cross sectional study was conducted at the ICU of Ch. Pervaiz Ellahi Institute of Cardiology, Multan Medical and Nishtar Medical University Hospital from July, 2017 to January, 2019. PO2/FIO2 and RSBI was measured by a different investigator, before and 20 minutes after the start of SBT. Heart rate, blood pressure and oxygen saturation were continuously measured throughout the trial. Trial outcome was labeled as unsuccessful or successful by the investigator who was blinded to the rapid shallow breathing index and PO2/FiO2 measurements. Patients with SpO2>85%, stable hemodynamics (HR and BP change <20%), stable respiration (RR change <50%), and the absence of (i) signs of labored breathing, (ii) emergence or worsened discomfort, (iii) change in mental status, were labeled as successful in bearing the SBT. Patients were divided into two groups i.e. successful and unsuccessful, gender, Age, GOLD stage, APACHE II score, pCO2, pO2, FiO2 and RSBI score were compared between the two groups after putting all the data in SPSS version 23. Chi square tests and Student’s t-test were used on the continuous data and nominal data, accordingly. The specificity, sensitivity, diagnostic accuracy, negative predictive value and positive predictive value of two threshold values of RSBI and PO2/FiO2 ratio were calculated from the 2X2 contingency tables. Results: RSBI threshold of 130 had 40.4% sensitivity, 51.1% specificity, 55.2% positive predictive value, 36.4% negative predictive value and 44.7% diagnostic accuracy while RSBI threshold of 105 had 94.1% sensitivity, 43.6% specificity, 71.4% positive predictive value, 83.2% negative predictive value and 73.8% diagnostic accuracy. pO2/FiO2>250 had 76.9% sensitivity, 24.5% specificity, 60.4% positive predictive value, 41.5% negative predictive value and 55.9% diagnostic accuracy. Conclusion: Even though neither rapid shallow breathing nor the PFR was enough accurate in prediction of successful extubation but rapid shallow breathing index 105 threshold had higher sensitivity and specificity as compared to RSBI threshold 130PFR. Therefore, RSBI105 is more accurate in predicting the outcome of extubation of ICU patients. doi: https://doi.org/10.12669/pjms.35.6.788 How to cite this:Furqan A, Rai SA, Ali L, Ahmed RA. Comparing the predicted accuracy of PO2\FIO2 ratio with rapid shallow breathing index for successful spontaneous breathing trail in Intensive Care Unit. Pak J Med Sci. 2019;35(6):1605-1610.  doi: https://doi.org/10.12669/pjms.35.6.788 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

To determine the diagnostic accuracy of ratio of neck circumference to thyromental distance to predict the difficult intubation in obese patients by using Intubation difficulty scale as gold standard. Study Design: Cross-sectional study. Place and Duration of Study: Jinnah Hospital, Department of Anesthesia, Lahore from August 2013 to July 2014. Methodology: 250 patients were included. Ratio of neck circumference to thyromental distance was measured during preoperative assessment in all patients. Results: There were 59.2% males and 40.8% females with mean age of patients was 37.13+11.64 years. 19.2% patients showed difficult intubation and 80.8% easy. Sensitivity of NC/TM was 89.58% and Specificity 72.77% with positive predictive value of 43.88% and Negative predictive value of 96.71%. Conclusion: Neck circumference to thyromental distance ratio is sensitive method for determining the difficult intubation among obese patients.