Preterm births and their associated clinical outcomes in a Tertiary Care Hospital in Lahore.

Abstract: Background: Intrahepatic cholestasis in pregnant women (ICP) is a liver disease that usually reported after 24 weeks of pregnancy with both maternal and fetal complications. ICP is common in general and especially in Pakistani-Asian populations. There is still very little information about fetomaternal outcomes related to ICP in the country. Objective: The aim of this research is to evaluate the fetomaternal outcome of women with ICP in a tertiary health care hospital in Lahore. Materials and Methods: A hospital-based single arm prospective observational study was conducted in the Department of Obstetrics & Gynecology PRTH/RMDC Lahore from September 1, 2024, to January 30, 2025 approval from institutional review Board (Ref no. 441/2024). 78 pregnant women in 2nd or 3rd trimester diagnosed with ICP were included. Diagnosis was based on clinical and laboratory findings. Information was gathered on the predesigned proforma. MS Excel 2007 and SPSS version 26 were used for data analysis. Results: This study has 78 participants with a mean age of 26.42 years. The majority were aged 18-24 years (38.5%), and most had a BMI between 25-29 (42.3%). 64.1% were primigravida and 64.1% had completed primary education. 53.84% delivered full term (37-40 weeks), while 33.3% delivered between 34-36 weeks. The most common pregnancy complication was emergency caesarean section (38.46%), followed by preterm delivery (20.51%). There were 7 cases (8.97%) of spontaneous preterm delivery, 5 cases (6.41%) of intrapartum fetal death, and 1 stillbirth (2.5%). Conclusion: The findings highlight that ICP predominantly affected younger, overweight primigravida with lower educational attainment. Furthermore, the study revealed significant neonatal complications, including low birthweight, respiratory distress, and meconium-staining. Keywords: Intrahepatic cholestasis, Pregnancy complications, Emergency cesarean section, Preterm delivery, Birthweight.

Workplace violence is a significant issue among nurses, particularly in tertiary care hospitals, impacting their well-being and job performance. Understanding the prevalence and types of violence can help develop effective strategies to mitigate these incidents. Objective: To investigate the prevalence, types, frequency, and impact of workplace violence among nurses in tertiary care hospitals in Lahore. Methods: This descriptive cross-sectional study was conducted in various tertiary care hospitals in Lahore over a six-month period following approval. The study population comprised registered nurses, aged 18-65, employed in these hospitals for over a year. A sample size of 108 nurses was calculated using Salvia's formula, with convenient sampling employed for selection. Data were collected using a self-administered structured questionnaire distributed via Google Forms. The questionnaire covered demographics, experiences of violence, perception of safety measures, coping strategies, and suggestions for improvement. Descriptive statistics were calculated, including frequencies, percentages, means, and standard deviations. Comparisons were made using the independent t-test and chi-square test, with a p-value <0.05 considered significant. Results: Verbal abuse was the most prevalent type of violence, experienced by 62.96% of respondents. Other forms of violence included discrimination (11.11%), physical assault (4.63%), bullying (4.63%), and sexual harassment (1.85%). In terms of frequency, 42.59% of nurses experienced violence rarely, 32.41% frequently, and 25.00% occasionally. The impact of workplace violence included increased stress levels (46.30%), negative impacts on mental health (24.07%), reduced work productivity (16.67%), decreased job satisfaction (11.11%), and physical injuries (1.85%). Conclusion: The study highlights the high prevalence and significant impact of workplace violence on nurses in tertiary care hospitals in Lahore. Verbal abuse was the most common form, with substantial proportions of nurses experiencing frequent violence. These findings underscore the urgent need for targeted interventions to mitigate workplace violence and support affected healthcare workers.

Background: Acinetobacter spp. is a highly resistant nosocomial pathogen that leads to a broad range of human infections resulting in high morbidity and mortality. Due to unpredictable MDR patterns of Acinetobacter spp., it is imperative to know the institutional prevalent susceptibility profiles of these residing pathogens. The objective of this study was to determine the antimicrobial susceptibility pattern of Acinetobacter species over the last 8 years in a tertiary care hospital in Lahore, Pakistan.Material and Methods: A retrospective study was carried out in Lahore General Hospital, a tertiary care hospital in Lahore, Pakistan. Eight-year data was gathered from January 2012 to December 2019. All specimens were handled according to standard operating procedures in the microbiology laboratory of the Pathology department of Lahore General Hospital. The Acinetobacter spp. were identified in the laboratory by Gram staining, oxidase test, catalase test and Triple sugar iron fermentation and their antibiotic sensitivity pattern was noted.Results: The highest yield of Acinetobacter spp. from the clinical specimen was isolated from pus followed by tracheal secretion, blood, and urine in the last three years (from 2017 to 2019). Most of the isolates were multi-drug resistant (MDR). There was a progressive increase in resistance of Acinetobacter spp. The highest progression in resistance was observed among the cephalosporin and quinolone group of antibiotics.Conclusions: Increased resistance to commonly used antimicrobials against Acinetobacter species has been observed with the highest resistance to quinolones and cephalosporins.

Background: Respiratory diseases constitute a significant contributor to health issues in neonates, leading to admissions to neonatal intensive care units (NICU), and many of these neonates never recover, resulting in high neonatal mortality rates with respiratory diseases. Objective: To assess the burden of respiratory diseases in hospitalized neonates and determine their outcomes, including discharges and deaths, among those admitted to neonatal intensive care units in a tertiary care hospital in Lahore. Methods: An observational analytical cross-sectional study was conducted on 187 neonates admitted to a neonatology department of the tertiary care hospital in Lahore. Demographical data was collected by using a structured questionnaire. The analyses were conducted using R software. The chi-square test was employed to ascertain the associations between significant factors of respiratory diseases in neonates. Results: Among the respiratory conditions requiring admission, pneumonia (n=92, 49.1%) stood out as the most frequently diagnosed respiratory disease in neonates, followed by respiratory distress syndrome (RDS) (n=53, 28.3%), transient tachypnea of the newborn (TTN) (n=18, 9.62%), and meconium aspiration syndrome (MAS) (n=24, 12.8%). In terms of mortality among these respiratory conditions, pneumonia had the highest frequency (40.5%), followed by RDS (39.2%), MAS (20.2%), in neonates. Conclusion: Respiratory disorders proved to be a prevalent reason for neonatal admissions to the NICU, showcasing a significant association with neonatal mortality, especially in pneumonia, respiratory distress syndrome, and meconium aspiration syndrome.

ABSTRACTObjective:In Pakistan, the rising rate of Escherichia coli (E. coli) resistance has been reported, leading to limited treatment options and contributing to a high morbidity and mortality ratio. This study aimed to analyze changes in antibiotic resistance patterns against commonly prescribed antibiotics in a tertiary care hospital in Lahore, Pakistan, over the span of 10 years.Methodology:A retrospective cross-sectional study was designed to analyze a decade-long (2013-2022) resistance trend of E. coli isolates identified at a tertiary care Shalamar Hospital in Lahore, Pakistan. The frequency of E. coli isolated from different infectious sites across various age groups and their resistance proportions against CLSI-recommended antibiotics was accessed for 10 years.Results:E. coli is a Gram-negative bacterium that has caused a wide range of infections, predominantly urinary tract infections, with increasing antibiotic resistance. The results indicate a resistance rate of 98% to ampicillin, 93% to amoxicillin/clavulanic acid, and 87% and 82% to second and third-generation cephalosporins: cefuroxime, cefotaxime and ceftriaxone, respectively. High susceptibility against carbapenems and polymyxins drugs was also reported. However, over 10 years, an increasing resistance trend was observed against cefuroxime and imipenem and a significant decreasing trend was observed against gentamicin and nitrofurantoin. Likewise, resistance against beta-lactam like cefotaxime, ceftriaxone, and cefuroxime significantly increased compared to imipenem and meropenem compared to mean antibiotic resistance across all age groups.Conclusion:It highlights the emerging resistance trend against commonly prescribed antimicrobial drugs, leading to understanding the longitudinal resistance trends of E. coli in the region.

Objective: This study aimed to assess the outcomes of a universal neonatal hearing screening program in a tertiary care hospital in Lahore. Methods This cross-sectional study was performed at the pediatric medicine and audiology department of Ittefaq Hospital, Lahore from July 1, 2020, to June 30, 2021. 91 infants satisfying inclusion criteria were included. The detailed clinical history of each participant was recorded on a predesigned questionnaire. An otoscopic examination of the ear canal and tympanic membrane was performed. Distortion product otoacoustic emissions (DPOAEs) were used to screen. A signal-to-noise ratio of greater than six decibels in 3 out of 4 frequencies tested was considered as pass. Findings were validated by Brainstem Evoked Response Audiometry (BERA). Data was analyzed using descriptive statistics. Results: Of 91 high-risk infants tested for hearing impairment, 19(20.88%) were diagnosed as having hearing impairment. 5(8.7%) of the full-term neonates had hearing impairment while 5(50%) of the preterm neonates exhibited hearing impairment. Hearing impairment was also reported among infants having a history of neonatal jaundice (26%), fetal distress (40%), birth asphyxia (50%), convulsions (100%), and craniofacial abnormalities (100%). Conclusion: The neonatal hearing screening program is a useful method in the early detection and management of congenital hearing loss in neonates, thereby avoiding any hindrance in speech, language, and cognitive development. Thus, the findings of this study appreciate the importance of countrywide implementation of universal hearing screening programs in newborns Keywords: Neonate, neonatal screening, hearing impairment, hearing screening, early identification, Otoacoustic emission

Basic Life Support (BLS) refers to a set of emergency procedures, including cardiopulmonary resuscitation (CPR), use of an automated external defibrillator (AED), and management of airway obstruction, aimed at sustaining life in cases of cardiac or respiratory arrest. This study aims to assess the current level of knowledge and practices related to BLS among health care professionals in a tertiary care hospital in Lahore. This descriptive cross-sectional study assessed the knowledge and practices of 100 health care professionals regarding Basic Life Support (BLS) at a tertiary care hospital in Lahore. Participants included doctors, nurses, and paramedical staff with at least six months of clinical experience, selected through stratified random sampling. Data were collected using a validated, structured questionnaire based on AHA guidelines. The questionnaire covered demographics, knowledge, and practice through multiple-choice and scenario-based questions. Data were analyzed using SPSS version 25, with ethical approval obtained from the Institutional Review Board of Jinnah Hospital Lahore. The results showed that most participants were aged 21–35 years (40%) and male (55%). Professionally, 42% were nurses, 38% paramedical staff, and 20% doctors, with the highest representation from the general ward (42%). Nearly half (48%) had less than one year of experience. Regarding BLS knowledge, 53% had poor knowledge, 30% moderate, and only 17% had good knowledge. In terms of practice, 73% demonstrated incompetent practices, highlighting a significant gap between knowledge and practical application of BLS among health care professionals.

Pressure ulcers (PUs) remain a critical and preventable challenge in hospital care, especially in resource-constrained settings. Despite formal training, early-career nurses often experience gaps in applying evidence-based PU prevention practices. This study identified the behavioral and contextual predictors of evidence-based PU prevention behaviors among recently graduated nurses in tertiary care hospitals in Lahore, Pakistan, by assessing their level of knowledge, attitudes, and self-efficacy, as well as the impact of clinical exposure, internship training, and perceived barriers to preventive practices. An exploratory design involving 135 BSN graduates who had completed their clinical internships within the past six months were recruited for the study using a purposive sampling method. Data were collected via a structured, self-administered questionnaire composed of validated tools, including the Pressure Ulcer Knowledge Assessment Tool 2.0, the Attitude toward Pressure Ulcer Prevention (APuP) scale, and constructs derived from the Theory of Planned Behavior framework. Descriptive statistics, Spearman correlations, and multiple linear regression were used for analysis. While participants showed moderately positive attitudes and self-efficacy, only knowledge of PU prevention emerged as a statistically significant predictor of evidence-based behavior (p = 0.003). Other factors, such as attitudes, perceived barriers, and clinical decision-making ability, did not significantly influence behavior. Despite high exposure to PU cases, most participants reported limited workshop participation and demonstrated low decision-making accuracy. This study highlights that factual knowledge, rather than attitudinal or perceptual factors, plays a pivotal role in shaping evidence-based PU prevention behavior among newly graduated nurses. This finding emphasizes the need for knowledge-intensive interventions and scenario-based training in early clinical practice. Further longitudinal studies are recommended to evaluate the impact of mentorship and institutional support on sustained preventive behaviors.

Hypertension, characterized by persistently elevated blood pressure, poses severe risks, such as heart damage, artery hardening, and reduced blood and oxygen flow to the heart, which can also lead to kidney damage and stroke. Antihypertensive therapy for pregnant women differs from that for nonpregnant women because most antihypertensive medications used for nonpregnant hypertensive women are contraindicated for pregnant hypertensive patients. This study aimed to compare therapeutic regimens for treating hypertension between pregnant and nonpregnant women in various healthcare facilities. This cross-sectional study was conducted at several tertiary care hospitals in Lahore, Pakistan, recruiting 500 pregnant or nonpregnant female patients aged 18-55 years with hypertension. The data were collected through structured interviews and medical records reviews. Descriptive statistics and chi-square tests were used to analyze the data, with significance set at p < 0.05. A significant difference in area of residence was observed, with 83.2% of nonpregnant women residing in urban areas compared to 52.4% of pregnant women residing in urban areas. A systolic blood pressure between 120 and 139 mmHg was observed in 82.8% of pregnant women, compared to 51.2% of nonpregnant women (p < 0.001). Diastolic blood pressure between 80-99 mmHg was observed in 84.4% of pregnant women and 76.8% of nonpregnant women (p < 0.001). CVDs were more prevalent among nonpregnant women (38.8%), while anemia was more common in pregnant women (25.6%). Pregnant women were primarily prescribed methyldopa (58%), labetalol (56%), and amlodipine (40.4%), whereas nonpregnant women were more frequently prescribed valsartan (39.2%), metoprolol (28.8%), nebivolol (28%), and a combination of furosemide and spironolactone (24%). This study highlighted significant differences in comorbid conditions and antihypertensive treatment regimens between pregnant and nonpregnant women, emphasizing the need for tailored hypertension management approaches. Moreover, safer antihypertensive agents were prescribed to both groups, considering the Food and Drug Administration (FDA) drug categories and the observed comorbid conditions.

Objective: To evaluate the ergonomics practice pattern among medical laboratory professionals to determine the ergonomic deficiencies to improve the workplace quality and safety at a tertiary care hospital in Lahore Methodology: This was a cross-sectional study conducted in department of pathology, King Edward Medical University/Mayo Hospital, Lahore from November 2019 to January 2020. All the workers engaged in all the sections of the clinical laboratory were included in the study. The results were collected using a self-administered questionnaire, which included demographic information, ergonomic practices, workplace layouts and equipment utilization pattern. Individuals were instructed to complete the questionnaires in accordance to their own specific time range and return it after filling. All the data was gathered from the surveys and then coded and securely stored in a database for further analysis and interpretation. Results: Average age of the participants was 26.80±5.70 years. Several participants reported appropriate bench heights (70.7%) and tools within arm’s reach (62.2%), deficiencies were noted in foot and knee clearance, with only 50.0% and 53.7% respectively. Limited provision of foot rails (11.0%) and floor mats (31.7%) for prolonged standing tasks was seen. Seated benches showed similar disparities, with notable deficiencies in adjustable armrests (32.9%) and footrests (29.3%). Microscope usage demonstrated challenges in maintaining neutral posture (65.1%), while pipette use and micro-manipulation tools highlighted the need for improved accessibility and ergonomic support. Conclusion: Study revealed the varying levels of ergonomic appropriateness across the workplace and equipment among medical laboratory workers, with significant inadequacies in foot and knee clearance, the presence of foot rails, floor mats, adjustable armrests, and foot rests. Difficulties in using a microscope, as well as concerns about pipettes and micro-manipulation equipment, underscored the need for improved accessibility and ergonomics.

Background: Breast self-examination (BSE) is a simple, quick, and cost-free method crucial for the early detection of breast cancer, which significantly reduces morbidity and mortality. Health Sciences students, particularly those in nursing, are ideally positioned to serve as role models and educators on this practice. Objective: The objective of this study was to assess the knowledge and practice of BSE among nursing students at a tertiary care hospital in Lahore, with a view to identifying gaps that could be addressed through targeted educational programs. Methods: This observational descriptive cross-sectional study engaged nursing students from various academic levels at a tertiary care hospital in Lahore. Participants were selected through convenience sampling. Adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was ensured. Data were collected via a self-administered structured questionnaire and analyzed using SPSS software version 26, focusing on frequencies and percentages of categorical variables. Results: Of the participants, 63.76% demonstrated a high level of knowledge about BSE, scoring ≥75%. In contrast, 36.23% scored below 75%, indicating a low level of knowledge. Practice of BSE was limited, with only 47% (n=65) of the participants engaging in the practice, and the majority, 53% (n=73), not practicing at all. Conclusion: Although nursing students show a good understanding of BSE, a significant gap exists between their knowledge and actual practice. This discrepancy highlights the need for enhanced educational interventions to encourage regular BSE practice, which is essential for the effectiveness of breast cancer screening and early detection efforts.

Staphylococcus aureus (S. aureus)-associated infections are one of the major threats to public health. The aim of the present study was to determine the antibiotic resistance pattern, as well as the genetic characterization, of methicillin and vancomycin-resistant S. aureus (VRSA) isolated from a tertiary care hospital in Lahore. The S. aureus isolates were isolated from different clinical samples, identified by biochemical testing, and subjected to antibiotic susceptibility testing via the disc diffusion method or broth microdilution method. The methicillin resistance gene (mecA) and vancomycin resistance gene (vanA) were amplified by the polymerase chain reaction. The S. aureus isolates showed high incidences of resistance against methicillin (76%) and moderate incidences of resistance to vancomycin (14%). Isolates were also resistant to several other drugs, such as cefoxitin (76%), ertapenem (83%), ampicillin (81%), tobramycin (78%), moxifloxacin (76%), and tetracycline (74%). An encouraging finding was that 98% of isolates were susceptible to tigecycline, indicating its possible role in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) and VRSA, as well as the multi-drug resistant S. aureus. The mecA gene was detected in 33.3% of tested isolates (10/30), while the vanA gene was also detected in 30% (9/30) of the tested isolates. In conclusion, the frequent presence of methicillin and vancomycin resistance in S. aureus appraises the cautious use of these antibiotics in clinical practices. Furthermore, it is suggested that there should be continuous monitoring of tigecycline treatments in clinical setups in order to delay the development of resistance against it.

Background: Effective nursing handovers are essential for patient safety and continuity of care. Critical thinking and clinical decision-making are vital cognitive skills that ensure structured, accurate, error-free handovers. Despite their importance, research on how these cognitive abilities influence nursing handovers in Pakistan is limited. Objective:This study aims to evaluate the relationship between critical thinking, clinical decision-making, and the quality of nursing handovers among nurses in tertiary care hospitals in Lahore, Pakistan. Study Design:A descriptive cross-sectional study was conducted. Settings: The study was conducted at Services Hospital Lahore and Fatima Memorial Hospital Lahore, both tertiary care hospitals in Lahore, Pakistan. Duration of Study: The study was conducted September 2023 to February 2024. Methods: A total of 171 nurses were recruited using a convenience sampling technique. Data were collected using structured questionnaires, including the California Critical Thinking Disposition Inventory (CCTDI), the Clinical Decision-Making in Nursing Scale (CDMNS), and the Handover Evaluation Scale (HES). Statistical analysis was performed using SPSS version 26, applying descriptive statistics and Pearson’s correlation and regression analysis to assess the associations between the variables. A p-value ≤0.05 was considered statistically significant. Results: The study found that 50.9% of nurses acknowledged the role of critical thinking in nursing handovers, while only 38.6% expressed confidence in their decision-making abilities. A significant positive correlation was observed between critical thinking and clinical decision-making (r = 0.470, p < 0.001) and between decision-making and handover quality (r = 0.528, p < 0.001). Nurses with higher critical thinking scores reported improved handover accuracy and fewer communication errors. However, only 35.1% of nurses had received formal critical thinking training, indicating a significant gap in nursing education. Conclusion: The study confirms that critical thinking and decision-making skills significantly enhance the quality of nursing handovers. The findings highlight the importance of structured training programs and standardised handover protocols in Pakistani hospitals. Integrating evidence-based communication tools like SBAR (Situation, Background, Assessment, Recommendation) into clinical practice is crucial. Future research should focus on interventional studies evaluating the impact of critical thinking training on patient outcomes.

The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

Staphylococcus aureus (S. aureus)-associated infections are one of the major threats to public health. The aim of the present study was to determine the antibiotic resistance pattern as well as the genetic characterization of methicillin and vancomycin resistant S. aureus (VRSA) isolated from a tertiary care hospital in Lahore. The S. aureus isolates were isolated from different clinical samples, identified by biochemical testing, and subjected to antibiotic susceptibility testing via the disc diffusion method or broth microdilution method. The methicillin resistance gene (mecA) and vancomycin resistance gene (vanA) were amplified by the polymerase chain reaction. The S. aureus isolates showed high incidences of resistance against methicillin (76%) and moderate incidences of resistance to vancomycin (14%). Isolates were also resistant to several other drugs, such as cefoxitin (76%), ertapenem (83%), ampicillin (81%), tobramycin (78%), moxifloxacin (76%), and tetracycline (74%). An encouraging finding was that 98% of isolates were susceptible to tigecycline, indicating its possible role in the treatment of methicillin-resistant Staphylococcus aureus (MRSA) and VRSA, as well as the multi-drug resistant S. aureus. The mecA gene was detected in 33.3% of tested isolates (10/30), while the vanA gene was also detected in 30% (9/30) of the tested isolates. In conclusion, the frequent presence of methicillin and vancomycin resistance in S. aureus appraises the cautious use of these antibiotics in clinical practices. Furthermore, it is suggested that there should be continuous monitoring of tigecycline treatments in clinical setups in order to delay the development of resistance against it.