To develop an effective antimicrobial strategy for the management of chronic osteomyelitis. Observational study. Place and Duration of the Study: Departments of Microbiology and Orthopaedics, Combined Military Hospital Malir, Karachi, Pakistan, from January 2021 to February 2022. Bone biopsies of 45 enrolled participants were taken for microbiological evaluation. Intravenous antibiotic therapy was begun as per empirical therapy based on the local antibiogram and antibiotic policy. Once the susceptibility pattern was available, targeted therapy started and continued for 28 to 42 days. Patients were evaluated based on inflammatory markers and clinical conditions for a minimum of six months to a maximum of one year. Out of the 45 patients, the majority 29% were soldiers, 40% belonging to the age group of 31-60 years. The common predisposing factor was trauma/fractures followed by diabetes and implants leading to chronic sinus discharge and decubitus ulcers. The most commonly isolated organism was Staphylococcus aureus (38%) followed by Methicillin-resistant Staphylococcus aureus (MRSA) (31%). Cotrimoxazole and Rifampicin turned out to be good treatment options. Only 4.4% showed unsatisfactory prognosis, nonetheless, no mortality was observed during the course of treatment. In this study, highly resistant strains were observed with limited treatment options for chronic osteomyelitis, however, effective stewardship programmes with accurate diagnostic reporting and judicious use of antimicrobials can prevent overuse of the valuable resources. Antimicrobial stewardship, Osteomyelitis, Methicillin-resistant Staphylococcus aureus, Empirical therapy, Antimicrobial resistance.

Aim. This research study aims to examine the professional quality of life (ProQOL) among healthcare workers (HCWs) in Pakistan during the fourth wave of COVID-19. Background. Under intense pressure to fight the coronavirus disease 2019 (COVID-19) pandemic, HCWs are more likely to experience psychological problems. Numerous investigations carried out in the past at various points during the pandemic have shown that COVID-19 has had important detrimental effects on HCWs. However, there are many unknowns with regard to ProQOL for HCWs. Methods. This is a cross-sectional study conducted with Pakistani HCWs who performed their duties during the fourth wave of COVID-19. Data were collected between January 1 and March 31, 2022. A total of 258 HCWs took part in the study evaluating ProQOL. The significance level was <0.05. Results. Most respondents were males (79.1%), and 20.9% were females. The scores of secondary traumatic stress (STS), burnout (BO), and compassion satisfaction (CS) were 24.03 ± 3.79, 19.18 ± 2.92, and 35.29 ± 4.37, respectively. Compared with higher-income groups, HCWs with lower incomes were significantly (P<0.001) more likely to experience psychological issues. Males had lower BO and STS than female HCWs (P<0.001). Similarly, doctors had a lower STS than nurses (P<0.05). HCWs who worked hours per day longer had a heavier STS (P<0.001). Conclusion. This study shows low BO levels, moderate CS levels, and STS levels among HCWs. HCWs with lower salary were at a higher risk of mental distress due to the pandemic. HCWs who worked for long hours and had less income had more STS and BO. HCWs who were dissatisfied with their works had poor CS. Implications for Nursing Management. It is supposed that these results may help HCW managers to improve job satisfaction and rewards while reducing working hours and workload to improve the ProQOL of HCWs fighting COVID-19. The government should focus on the mental health of HCWs, enhancing their satisfaction and allocating sufficient resources.

Despite a recent increase in the representation of female authors in scientific literature, a significant gap persists concerning the inclusion of women in research. This necessitates the analysis of published literature from a gender perspective. This study aimed to provide gender distribution in authorship in the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020. Bibliometric analysis was conducted using the Scopus database. Two reviewers were selected to search the database. We included the 100 most-cited articles on foodborne outbreak investigations. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel version 2016. The citation data, including total citations, citations per year, and representation of women as first and senior authors, was analyzed in terms of frequencies, mean, median, and interquartile range. The correlation between journal impact factor and the representation of women in high-impact factor journals was determined. A p-value of <0.05 was considered significant. Most of the top-cited articles were published between 2001 and 2010 (n=47). The top 3 most-cited articles were from the USA. Of the total 100 articles, women were the first and last authors in 46% and 28% of the articles, respectively, reflecting a significant gender gap. However, the proportion of females as principal investigators gradually increased from 25% (n=10/30) to 52% (n=24/47) during the period 2001-2010 and to 92% (n=12/13) during 2011-2020. The USA had the highest number of included articles (n=48), and women were principal authors in 56% (n=27) of them. The lowest representation of women was observed in Austria, Denmark, Japan, Netherlands, New Zealand, Nigeria, Portugal, and the United Kingdom. Women are under-represented in published literature on food-borne pathogen outbreaks. Although the representation of women as principal authors has recently increased, disparities still exist at the senior-author level, calling for women's advancement in academic science.

Hepatic Veno occlusive disease (VOD), also known as sinusoidal obstruction syndrome (VOD/SOS), is a post-transplant life threatening complication. In this study, we aimed to discuss the incidence, management and outcome of VOD in post allogenic transplant patients of beta thalassemia major (BTM). A prospective study was conducted in Armed Forces Bone Marrow Transplant Center, between 2001-2022. A total of 385 fully Human Leucocyte Antigen (HLA) matched BTM patients, with Ursodeoxycholic acid for prophylaxis, were included in the study. Incidence of VOD was calculated through cumulative incidence estimates. Chi square test and Mann Whitney test were used to compare discrete and continuous variables respectively. VOD was diagnosed and graded according to European Society for Blood and Marrow Transplantation EBMT Pediatric diagnostic criteria. Risk factors for VOD were grouped as recipient, transplant and donor related. Univariate analysis was performed by log-rank test. All patients who developed VOD were managed primarily with fluid restriction and strict input output monitoring. Statistical analyses were performed using SPSS v 25.0. Out of 385 transplant patients, forty developed VOD. Median time from date of transplant till onset of VOD was 14 days (range 6-30). Cumulative incidence of all grade VOD was 10.39% (95% CI, 7-14). Eleven out of 40 patients who developed VOD died. Cumulative incidence of Transplant related mortality (TRM) for patients with and VOD was 20.5% (95% CI, 16.6-25.1) vs 27.5% (95% CI, 16.1-42) (p value 0.318) respectively. Among risk factors, age of recipient and fibrosis (p value of 0.04 and 0.000 respectively) were found to be significantly associated with VOD. Careful selection of transplant candidates before transplant can help reduce the incidence of VOD.

This study was conducted to assess the pattern of spine trauma in patients presenting to Khyber Teaching Hospital in terms of etiology, level of injury, type of fracture, and neurologic deficit. This cross-sectional study was conducted at the Department of Orthopedic Surgery at Khyber Teaching Hospital, Peshawar. Patients presenting with spinal cord injuries were included. Etiology, level of injury, types of fracture, and the neurologic deficit were recorded and assessed. The Chi-square test was used to assess the association. The mean age of the patients was 33.28±9.63 years. There were 88 (69.3%) males and 39 (30.7%) females. Fall from height (50.4%) was the most prevalent etiology, followed by RTA (30.7%). Thoracolumbar spine injury (49.6%) was the most prevalent level of spinal injury, followed by cervical spine injury (29.9%). Most patients had type A fractures 43.3%), and type B (37%) was the second leading fracture. The neurologic deficit was seen in 54.3% of patients. Fall from height is the most common cause of spinal traumas in our country, and road traffic accidents are the second leading cause. Thoracolumbar spine injury was the primary presentation of the spinal injury location, and type A was the most common type of fracture. The majority of the patients had a neurologic deficit.

Monitoring arterial blood gases (ABGs) is essential for neonates requiring mechanical ventilation. End-tidal CO2 (EtCO2) emerges as a promising alternative for long-term monitoring due to its less intrusive and faster measurement. However, the relationship between EtCO2 and ABGs PaCO2 in mechanically ventilated neonates remains unclear. This study aims to ascertain the reliability of EtCO2 as a surrogate marker for ABGs PaCO2 in neonates on mechanical ventilation at Combine Military Hospital (CMH) Rawalpindi. This prospective observational study was conducted at CMH Rawalpindi between October 15, 2022, and July 15, 2023. The study included 100 neonates in the CMH Rawalpindi Neonatal Intensive Care Unit (NICU) requiring mechanical ventilation within the first 28 days of life. ABG blood samples were collected at predefined intervals, and capnography assessed EtCO2. The association between ABGs PaCO2 and EtCO2 was evaluated using Pearson's correlation coefficient. The study cohort comprised 52 male and 48 female neonates with an average age of 4.7 days, all undergoing mechanical ventilation. ABGs and EtCO2 were monitored for up to 24 hours, revealing a significant positive association between ABGs PaCO2 and EtCO2 (P &lt; 0.01, Pearson's correlation value = 0.82). The Bland-Altman plot indicated a mean bias of -2.3 mmHg with limits of agreement from -8.1 to 3.5. The association remained consistent across age, sex, and respiratory distress severity. In neonates receiving mechanical ventilation at CMH Rawalpindi, EtCO2 and ABGs PaCO2 exhibit a positive correlation. EtCO2 emerges as a potentially reliable option for quick and less invasive monitoring of PaCO2 levels in this population.

The current study assessed the knowledge of the medical students regarding the nature of radiation, associated risks, and protective measures. A cross-sectional study was conducted among international students enrolled in different medical colleges/universities in Xian, PR China. A self-developed and self-reported questionnaire was used for the current study. The descriptive statistics was carried out to summarize the finding of the study. Chi-square and Fisher exact tests were conducted to assess the association of the demographics with knowledge level. A total of 796 students responded among 980. Most of the participants fell in the age range of 20-25 years (42.6%), being male (67.1%) and having bachelor's education (56.7%). Participants with previous experience was 58.7%. The age group of 20-25 years (p < 0.001), being male (p < 0.001), having bachelor education (p < 0.001), and previous experience (p = 0.009) was significantly associated with moderate to good knowledge. The overall knowledge about the nature of radiation (96%) and associated risk (82%) was good, but regarding protection, 59% of the participants showed good knowledge. Most of the participants showed satisfactory result. However, the knowledge regarding protection measures was poor in almost half of the population.

To find the effectiveness of distal sodium channel blocks in managing lumbosacral radicular syndrome. Open-labelled, non-randomised, single-group, prospective, pilot study. Place and Duration of the Study: Pain Clinic of Armed Forces Institute of Rehabilitation Medicine (AFIRM) Rawalpindi, Pakistan, from January to June 2022. Patients having low back pain radiating to L5/S1/both dermatomes with severity of numerical rating scale (NRS) score of more than 4/10 were included. Straight leg raise (SLR) and NRS score were noted down at baseline and at 30 minutes, 24 hours, 1 week, and 4 weeks post-distal sodium channel block (DSCB). DSCB was performed at beta 1, 2, 3, and 5 portals using 2 ml of 2% injection plain lignocaine + 1 ml (40 mg) injection triamcinolone + 7 ml distilled water. Statistical analysis was done using Statistical Package for Social Sciences (SPSS) 21. Out of 50 patients, 24 (48%) were females and 26 (52%) were males. No serious procedural complications were noted. Post-DSCB, follow-up was done for 4 weeks. A significant fall in NRS and an increase in SLR score were observed at every visit. Results were statistically significant (p<0.001) when mean NRS and SLR scores at every follow-up were compared for pre- and post-DSCBs. DSCB reduced pain and improved SLR in patients even at 4 weeks of follow-up. Advantages included immediate pain relief, easy to perform as outdoor procedure, cost-effective and a time buying alternative procedure allowing for the analgesic effect of medicine to kick in. Radiculopathy, Low-back pain, Epidural spinal injection, Sciatica, Pain management, Distal sodium channel blocks.

Major Adverse Cardiovascular Events (MACE) and and Cerebrovascular Accidents (CVA) have become primary areas of interest due to the ongoing focal research in cardiovascular diseases. Objective: To assess the frequency of major adverse cardiac events and cerebrovascular accidents for intracoronary tirofiban and intravenous tirofiban. Methods: It was a comparative study conducted at the Punjab Institute of Cardiology, Lahore from March 2019 to March 2020. A total of 250 patients of both genders, aged between 20 to 65 years were enrolled in this study who had STEMI and have high thrombus burden or TIMI flow grade &lt; 3 during primary PCI. They were divided into two groups namely intracoronary tirofiban group and intravenous tirofiban. The impact of intracoronary tirofiban versus intravenous tirofiban outcomes were assessed. Results: Statistically insignificant difference in MACE (myocardial infarction, cerebrovascular accident &amp; revascularization) between intracoronary &amp; intravenous tirofiban groups was noted. The frequency distribution for cerebrovascular accidents (CVA) showed that haemorrhage was found similar in both groups. Ischemic stroke, in patients of the intracoronary tirofiban group compared with intravenous tirofiban group, was 1 (0.8%) vs 3 (2.4%) with p-value 0.348 respectively. Reversible ischemic neurological deficit (RIND) was found in 3 (2.4%) in the intracoronary and 4 (3.2%) in the intravenous group. Transient ischemic attack (TIA) found in the intracoronary was 8(6.4%) whereas in the intravenous group was 9 (7.2%). Conclusions: The results of our study make us conclude that tirofiban when given intracoronary or intravenous does not show any significant difference for major adverse cardiac events and cerebrovascular accidents.

Alopecia areata patients can choose from a variety of therapy methods. Each method has advantages and limitations, and its suitability varies for each patient. The medical usefulness of topical corticosteroids in AA is yet debatable. Objective: To assess the effectiveness of topical tacrolimus 0.1% vs. topical clobetasol propionate 0.05% while treating alopecia areata. Methods: Randomized-controlled trial (Double blind) conducted in Dermatology Department, CMH-Abbottabad, from November 2022 to April 2023. The seventy (70) patients with alopecia areata who attended to OPD of CMH Abbottabad between the ages of 20 and 50 were included. The non-probability consecutive sampling method was used. For up to 3 months, patients in Group A used clobetasol propionate 0.05% twice daily, while patients in Group B used topical tacrolimus 0.1% twice daily. Patients were evaluated at the start of each session, four weeks later, eight weeks later, and twelve weeks later. The SALT score was used to estimate hair loss at presentation and during the 3-month follow-up. The degree of response has been characterized by following hair re-growth as excellent (&gt;75%), marked (51-75%), moderate (26-50%), or mild (25%). A p-value of &lt;0.05 was considered significant. Results: When the efficacy was compared, 26 (74.3%) patients in group-A (mean age 35.23+7.87 years) shown excellent response, while 14 (40%) patients in group-B (mean age 34.29+7.87 years) with significant p-value was 0.028. Conclusions: Clobetasol propionate 0.05% was more efficacious as a therapy choice for stimulating hair re-growth in patients.