Bolan Medical Complex Hospital Research Articles

Exploring Medical Professionalism amongst Postgraduate Trainees of Bolan Medical Complex Hospital Quetta

Introduction: The traditional educational system has concentrated on cognition acquisition and skills essential for physician practice. However, medical educationists are focusing more on good professional doctors now, having a cognitive foundation to work alongside their social roles as a physician-to-be. Aims and Objectives: To assess medical professionalism amongst postgraduate trainees at Bolan Medical Complex Hospital, Quetta. Place and Duration of study: Bolan Medical Complex Hospital, Quetta during February 2024. Material and Methods: A cross-sectional study was conducted to determine professionalism utilizing a pre-validated questionnaire termed Professionalism Assessment Tool (PAT) from 47 Postgraduates (PGs) of the Neurosurgery, General Medicine, and Psychiatry departments. Data was entered and analyzed using SPSS version 29 was used to calculate frequencies and percentages. The chi-square test was utilized to evaluate the association between professional years and items. A p-value of ? 0.05 is considered significant. Results: All 18 PGs from the psychiatry department, 23/36 (64%) from General Medicine, and all 6 from Neurosurgery filled out the questionnaire. 55.3%(n=25/47) were above 25 years of age, The majority were males (n=31, 66%) and 34% females, 36% (n=17/47) PGs were from 1st year of training. Item no 1 and 5 of Domain I and Domain 3 present the highest percentage score (52.4%) respectively. Highly statistically significant results (p-<0.001) were obtained between professional years of training and items 4, 6, 1, and 3 of Domain 2, 3, and 4. Conclusion: PGs followed feedback to improve and meet their learning goals. PGs understood their professional responsibilities and felt qualified to finish assignments to the highest standard reliably and courteously. They were aware of the benefits of working in teams, and they took feedback to help reach their learning goals.

Rate of Arteriovenous Fistula Stenosis and Access Recirculation among Individuals Receiving Maintenance Hemodialysis

Background: Arteriovenous fistula stenosis and access recirculation in hemodialysis represent critical challenges, influencing the efficiency of vascular access and dialysis treatment outcomes. Objective: The objective is to assess the prevalence of arteriovenous fistula (the AVF) stenosis as well as access recirculation (AR) in patients of hemodialysis. Study Design: Cross sectional study. Settings: Department of Nephrology, Bolan Medical Complex Hospital, Quetta. Duration: From 1st April 2022 to 1st September, 2022. Methods: Adult patients having age 18 years to 80 years receiving maintenance hemodialysis 3 times in a week were included in this study. Patients who were willing to provide informed consent participated in the study. Patients with active infections or sepsis, with a history of vascular access interventions within the last three months, pregnant or lactating women as well as patients with cognitive impairment were excluded from study. Outcome variables will be incidence of AVF Stenosis which was determined by regular ultrasound assessments and monitoring of clinical symptoms. Statistical analyses were performed using SPS version 22. Results: The study comprised 150 maintenance hemodialysis patients with a mean age of 55±10. Age distribution showed that 20% were between 18-40 years, 53.3% between 41-60 years, 23.3% between 61-80 years, and 3.3% were older than 80 years. Sixty percent (60%) of the participants were male, while 40% were female. The mean duration of AV fistula use was 3.21± 2.65 years, with 14.66% having duration of 6-12 months, 41.33% between 1-3 years, and 44% using AV fistulas for more than 3 years. Seventy-five point three percent (75.3%) of patients had hypertension, 40.0% had diabetes mellitus, and 28.0% had cardiovascular disease. Additionally, 16.7% of patients presented with other comorbidities. Out of total 25 (16.7%) patients were affected by arteriovenous fistula (AVF) stenosis, while access recirculation was observed in 20 patients (13.3%). Conclusion: In conclusion, our study reveals a notable incidence of arteriovenous fistula (AVF) stenosis and access recirculation among maintenance hemodialysis patients. The observed associations with age and AVF duration underscore the complexity of vascular access complications.

Drug susceptibility, Prevalence and effect of Pseudomonas aeruginosa on wound healing of burn patients.

To determine the prevalence, antibiotic susceptibility and effect of Pseudomonas aeruginosa in relation to burn patients. The cross-sectional study was conducted at the Centre for Advanced Studies in Vaccinology and Biotechnology, University of Balochistan, Quetta, Pakistan, from March 2018 to May 2021, and comprised pus swab cultures were isolated from inpatients with 2nd and 3rd degree burns aged up to 60 years at Bolan Medical Complex Hospital and Sandeman Provinical Hospital, the two main government tertiary care hospitals in Quetta. The samples were immediately cultured, and evaluated using biochemical tests, antibiotic susceptibility and molecular identification using polymerase chain reaction. Data was analysed using SPSS 20. Of the 720 burn wound samples, 424(58.9%) were positive for Pseudomonas aeruginosa; 304(42%) males and 120(16%) females (p<0.02). The overall mean age of the patients was 27.7±6.2 years (range: 1-60 years). The mean total burn surface area was not significantly different in positive 29.6±6.2% and negative 30.3±6.2% cases (p>0.05). The time leading to skin grafts in positive patients was 29.5±6.5 days compared to 22.3±6.3 days for negative patients (p< 0.007), and the time required for wound healing was 25.0±4.7 days and 16.7±5.2 days, respectively (p<0.001). Length of hospital stay of Pseudomonas aeruginosa positive patients was 38.0±7.8 days compared to 32.1±6.8 days for negative patients (p<0.001). Nosocomial infections and multidrug resistance species were observed frequently at the burn wound site. P. aeruginosa.

Knowledge of risk factors and preventive measures of Hepatitis B and Hepatitis C among Health care workers at Bolan Medical Complex Hospital, Quetta.

Background: This study aimed to determine the frequency of adequate knowledge regarding risk factors and preventive measures of Hepatitis B and C among healthcare workers (HCWs) at Bolan Medical Complex Hospital, Quetta. Methodology: A cross-sectional study of 141 participants was conducted at Bolan Medical Complex Hospital, Quetta, after obtaining approval from the ethical review board of Bolan Medical Complex Hospital, Quetta. The sample size was calculated, keeping the prevalence of adequate knowledge of risk factors and preventive measures of Hepatitis B and Hepatitis C among healthcare workers at 62.5%, the margin of error d=8%, and 95% confidence level. The study continued from 1st January to 31st June 2016. All healthcare workers between 25 to 60 years of age, working in a hospital for more than six months, were included in the study. While all the non-consenting participants, those with anti-HCV and HBsAg positive analyzed via ELIZA methods, were kept in the exclusion criteria. The enrolled healthcare workers were interviewed, and knowledge of hepatitis risk factors and preventive measures was assessed using a 10-item structured self-administered questionnaire. The data were analyzed using SPSS version 19.0. Results: The mean age of the study participants was 33.16 ± 8.31 years. The majority were female (69.50%) and &gt; 40 years old (70.92%). Most of the enrolled healthcare workers were doctors (61.70%). The mean service duration was 7.85 ± 9.10 years. Out of 141 HCWs, 71(50.35%) had adequate knowledge of risk factors and preventive measures for Hepatitis B and C. Doctors had significantly more adequate knowledge than staff nurses (76.05% vs. 23.94%; p=0.000). Moreover, those with more formal educational years had significantly adequate knowledge of Hepatitis B and C risk factors and preventive measures than those with lesser educational years (p&lt;0.05). Conclusion: According to the survey findings, there is an adequate level of knowledge among the enrolled HCWs.

Antibiotic Over Prescription In Irreversible Pulpitis- A Perception-Based Study In Quetta, Pakistan

Introduction: In early phase of irreversible pulpitis, there is normally no clinically significant sings of infections specially bacterial infections but still there are a lot of dental practitioners that prescribe antibiotics in case of irreversible pulpitis, though there is limited data evidence that the antibiotic penicillin cause reduction in percussion sensitivity and pain (Nagle, Reader, Beck, &amp; Weaver, 2000).There is increasing trend by dental prescription regarding over use of antibiotics in treatment of orofacial and endodontic infections and the culture in these dental infections isolated those pathogens that are multi drug resistant towards commonly prescribed antibiotics (Rôças &amp; Siqueira Jr, 2013).&#x0D; Setting: Sandeman Provincial Hospital and Bolan Medical Complex Hospital Quetta.&#x0D; Study Duration: Duration of this study was 6 months that is from March till August 2021.&#x0D; Results: Majority (n=68,55.3%) of respondents were general dental practitioners followed by operative dentistry respondents (n=21,17.1%). Majority (n=54,43.9) of prescribers were having perception that analgesic should be prescribed and perform concurrent pulpectomy while (n=25, 20.3%) of prescribers had perception that in patients with irreversible pulpitis, prescribe antibiotics, analgesics and perform concurrent pulpectomy whereas majority (n= 6) of orthodontics would Immediately prescribes analgesic and schedule for RCT later. Prescribers having experience of 1 to 10 years would prescribe analgesic and perform concurrent pulpectomy.&#x0D; Conclusion This study concluded that majority of dental practitioners had perception of prescribing antibiotics in irreversible pulpitis while there were still a good number of those dental prescribers that had perception of prescribing analgesics and performing concurrent Pulpectomy.&#x0D;

Frequency of Thyroid Carcinoma in Multi Nodular Goiter

Objective: The objective of this study was to determine the frequency of thyroid carcinoma in patients presenting with multinodular goiter in BMCH. Study Settings: Research was conducted at Department of General Surgery, Bolan Medical Complex Hospital Quetta. Material and Methods: Eighty four patients from both the genders with age between 20-75 years presenting with multinodular goiter since 3 months and meeting inclusion criteria were included in this study after taking informed written consent. All the thyroidectomies were done by consultant general surgeon of the hospital. Post-operatively all the patients were managed as per hospital protocol. Post thyroidectomy specimen was sent for histopathology for diagnosis of thyroid malignancy as per operational definition. All the other findings of study variables such as age, gender, place of residence, BMI (weight in Kg/Height in m2), family history of malignancy, diabetes, hypertension, smoking (&gt;5 cigarettes/day for 2 years) and duration of goiter were noted in a predesigned proforma. Results: The mean age of the patients was 37.4±14.0 years. Majority (n=48, 57.1%) of the patients were aged between 25-50 years, followed by 23 (27.4%) patients aged &lt;25 years and 13 (15.5%) patients aged &gt;50 years. There were 17 (20.2%) male and 67 (79.8%) female patients with a male to female ratio of 1:4. Family history of thyroid malignancy was positive in 11 (13.1%) patients. Thyroid carcinoma was detected in 12 (14.3%) patients with multinodular goiter. When stratified, the frequency of thyroid carcinoma was significantly higher among smokers (29.2% vs. 8.3%; p-value=0.014) and those with positive family history of thyroid cancer (36.4% vs. 11.0%; p-value=0.047). However, no statistically significant difference was observed across various subgroups of patients based on age (p-value=0.978), gender (p-value=1.000), BMI (p-value=1.000), duration of goiter (p-value=0.928), place of residence (p-value=1.000), diabetes (p-value=0.928) and hypertension (p-value=0.858). Conclusion: In the present study, we observed that a substantial proportion of patients with multinodular goiter had concealed thyroid carcinoma particularly smokers and those with positive family history which warrants careful pre-operative evaluation of such patients for thyroid malignancy so that it may be identified well in time and appropriate management may be initiated to improve outcomes in future practice. Keywords: Multinodular Goiter, Thyroid Carcinoma, Positive Family History, Smoking

Hurdles of intravenous thrombolysis in acute ischemic stroke at Balochistan

Background and objective:&#x0D; Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan.&#x0D; Methods:&#x0D; A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data was collected, tabulated, and statistically analyzed using an IBM Statistical Package for the Social Sciences (SPSS), version 20.&#x0D; Results:&#x0D; Out of 272 patients, 156 patients were male and 116 patients were female. Only two patients presented within 4.5 hours of onset of acute ischemic stroke, 27 patients within 13- 24 hours,44 patients within 25-72 hours and 171 patients beyond three days. Two-hundred patients first took advice from faith healer (peer), 50 patients from general practitioner and 22 patients preferred neurologist.&#x0D; Conclusion:&#x0D; Very few patients presented within Alteplase window. Major reason of delay was contacting faith healer first. There is necessity of awareness campaigns to overcome this hurdle and to minimize barriers for improving access to thrombolysis and specialized stroke care in Balochistan.

Comparison of Zinc-Probiotic Combination Therapy to Probiotic Therapy Alone in Treating Acute Diarrhea in Children

Objective: To compare the efficacy of zinc-probiotic combination therapy and probiotic therapy alone in the treatment of acute pediatric watery diarrhea. Study Design: Randomized Clinical Controlled trial. Setting: The study was completed at The Department of Pediatrics, Unit I, Bolan Medical Complex Hospital, Quetta, Pakistan from July 2021 to January 2022. Methodology: A total number of 144 children of either gender aged 3 months to 5 years presented with acute watery diarrhea were included. Patients were randomly allocated into either Group-A (zinc supplementation with probiotics) or Group-B (only probiotics) for the treatment of acute diarrhea. Relief from diarrhea and duration of diarrhea were the main study end-points. Results: In a total of 144 children, the mean age was 27.04+14.43 months while the mean duration of diarrhea was 8.05+5.18 hours. On comparison of recovery from diarrhea, all the 72 children who received combination of probiotics and zinc were recovered from diarrhea, while 4 children (5.6%) children did not recovered from diarrhea within 5 days after starting the treatment in probiotics alone group (p=0.04). Duration of diarrhea was 27.63±14.22 hours in probiotics plus zinc group and 38.86±20.70 hours in probiotics only group (p&lt;0.001). Practical Implications: Combination of probiotics with zinc resulted in early recovery among children with acute diarrhea but further randomized controlled trial enrolling large sample size from local population are necessary to verify the findings of this study. Conclusion: Combination of probiotics and zinc was superior as compared to the probiotics alone in the treatment of acute diarrhea in children. Keywords: Diarrhea, probiotics, recovery, stool, treatment, zinc.

Frequency of Hyponatremia in Tuberculous Meningitis Patients

Back Ground: A severe inflammation of the meninges is often referred to as meningitis. Hyponatremia has been associated with tuberculous meningitis in numerous studies. Objective: To assess the frequency of hyponatremia in tuberculous meningitis patients Methodology: This cross sectional study was carried out at the department of Neurology Bolan Medical Complex Hospital, Fatima Jinnah Institute of Chest Diseases and Sheikh Khalifa Bin Zayyed Al Nahyan Medical Complex Quetta for duration of one year from September 2021 to September 2022. All the required data like name, gender and presence or absence of hyponatremia were documented in a special proforma designed for this research. Data analysis was carried out by using SPSS version 23. Results: In our study, totally 210 patients were included. The male participants in our study were 94 (44.76%) while female participants were 116 (55.24%). The mean sodium level in serum was observed to be 133 with SD of ± 4.29. The overall frequency of hyponatremia in tuberculous meningitis patients was 113 (53.81%). Conclusion: Our study concludes that the frequency of hyponatremia in tuberculous meningitis patients was very high (53.81%). Hyponatremia may have serious implications, including serious neurological problems and death, if it is not properly diagnosed and treated early Keywords: Frequency, hyponatremia, tuberculous meningitis

Stress anxiety and depression level amongst nurses working at tertiary care hospital

Background: Nurses are expected to offer patients with high-quality care in all healthcare settings and are seen as an essential member of the health care workforce. Objective: To assess the stress anxiety and depression level amongst nurses working at tertiary care hospital. Methodology: The current cross sectional study was carried out at Balochistan Institute of Psychiatry and Behavioral Sciences and Bolan Medical Complex Hospital Quetta from November 2010 to May 2020. A pre-designed questionnaire was distributed amongst all the nurses who fulfill the inclusion criteria. Data collection was done by self-completed scale of Depression, Anxiety and Stress Scale 21 (DASS-21). The SPSS version 24.0 was used to input and analyze the data. Results: In the current study, totally 150 nurses were enrolled. The male nurses were 45 (30%) while female nurses were 105 (70%). The mean age with standard deviation in the current study was 36 (±4.12) years. In the current study, 30 (20%) nurses were normal, 18 (12%) were with mild depression, 52 (34.66%) were moderate, 45 (30%) were severe and 5 (3.33%) nurses were observed with very severe depression.

Gender wise difference in depression level amongst patients with type 2 diabetes mellitus

Background: The World Health Organization estimates that 220 million individuals worldwide have diabetes mellitus, with 80% of those people living in poor nations and a death rate of 5% annually. Objective: To assess the gender wise difference in depression level amongst patients with type 2 diabetes mellitus. Methodology: The current cross sectional study was carried out at Balochistan Institute of Psychiatry and Behavioral Sciences and Bolan Medical Complex Hospital Quetta from August 2019 to August 2020. Informed consent was taken in written from all the participants. A pre-designed proforma was then used to collect all the required information’s. The SPSS version 24.0 was used to input and analyze the data. Results: In our study, a total of 120 type 2 diabetes mellitus patients were enrolled. The male participants in our study were 60 (50%) while female participants were 60 (50%). The mean age (SD) in our study was 46 (12.1) years. Based on the gender wise difference of depression amongst diabetic patients, mild depression was observed amongst 36 (30%) females and 27 (22.5%) males; Moderate depression was observed amongst 18 (15%) females and 9 (7.5%) males while severe depression was observed amongst 28 (23.33%) females and 18 (15%) males.

Examining the Role of Magnetic Resonance Imaging (MRI) in Cerebral Ischemic Stroke: A Cross-Sectional Study

Objective: The aim of this study is to examine the role of Magnetic Resonance Imaging (MRI) when detecting cerebral ischemic stroke. Study design: A cross-sectional study Place and Duration: This study was conducted at Sandeman Provincial Hospital/ Bolan medical complex hospital Quetta, Quetta from March 2021 to March 2022 Methodology: Age and gender distribution of infarcts was done to find out the territory and location of the blood vessels involved. Overall, 52 individuals were involved in this research. Every patient was clinically suspected to have a cerebral ischemic stroke during the time span of our research. HDXT software with 1.5 Tesla 16 channel GE was used to perform the MRI scans. FLAIR axial, T1WI axial, T2WI axial and coronal, ADC maps, and gradient echo axial were the sequences used. SWI was optional. Results: The age group which was above 60 years included more percentage of males than females. It was seen that in the age group above 60 years, infarction was the most common and hypertension was the most common risk factor. Hemiplegia (Weakness) was seen to be the most common clinical presentation. It was seen that middle cerebral artery (MCA) territory infarcts had a slight rise on the right side. On the diffusion-weighted imaging (DWI), restricted diffusion was seen from subacute as well as acute infarcts along with a low apparent diffusion coefficient (ADC)valves. T2 FLAIR was normal in acute infarcts, but changes were reflected by DWI. Practical implication : Expanding the rationale for acute stroke thrombolysis may be more rationally accomplished by comprehending the clinical implications of numerous valuable MRI findings and thoroughly incorporating those factors into treatment decision-making. Conclusion: No radiation hazard is seen in MRI and it is non-invasive. The multiplanar imaging ability and grey-white resolution of the MRI perceive the subtle lesions. Infarcts are detected early due to the sensitivity of MRI to altered water content. Keywords: magnetic resonance imaging, stroke, cerebral infarcts,

Frequency of depression amongst patients with Parkinson disease at tertiary care hospital of Quetta

Background: Depression and anxiety are frequent mood problems associated with Parkinson disease (PD). The occurrence of mood disorders has, however, only been the subject of a small number of investigations. Objective: To assess the frequency of Depression amongst patients with Parkinson disease at tertiary care hospital of Quetta. Methodology: The current cross sectional study was carried out Balochistan Institute of Psychiatry and Behavioral Sciences and Bolan Medical Complex Hospital Quetta from December 2019 to December 2020. All those individuals were selected for study which has confirmed PD diagnosed by one or more than single Neurophysicians. A standard and well-defined questionnaire was used and then score was assigned using Beck Depression inventory- II (BDI-II) to depression evidences. The SPSS version 24.0 was used to input and analyze the data. Results: In our study, totally 40 patients were enrolled. The male patients were 36 (90%) while female patients were 4 (10%). The mean age (SD) in our study was 52 (11.6) years.

Depression prevalence amongst patients with hepatitis C

Background: Globally, hepatitis C is a serious health concern, and it is also becoming an alarming infection in our nation. The World Health Organization estimates that the hepatitis C virus infects 3% of people worldwide. Various study reported association of depression with hepatitis C virus infection. Objective: To assess the depression prevalence amongst patients with hepatitis c. Methodology: The current cross sectional study was carried out at Balochistan Institute of Psychiatry and Behavioral Sciences Quetta and Bolan Medical Complex Hospital Quetta from January 2019 to January 2020. Informed consent was taken in written from all the participants. Depressive symptomatolgy based on DSM 1V criteria was noted. A pre-designed proforma was then used to collect all the required information’s. The SPSS version 24.0 was used to input and analyze the data. Results: In the current study, a total of 120 hepatitis C patients were enrolled. There were 66 (55%) males and 54 (45%) females. Te mean age (SD) of the patients in our study was 42 (11.23) years. The overall frequency of depression amongst patients with HCV was 102 (85%).

Assessment of Infection Control Practices in Bolan Medical Complex and Sandeman Provincial Hospital of Quetta, Balochistan, Pakistan

Pakistan has a double burden of disease, with more than 40% of the population suffering from infectious diseases. Therefore, in order to lower the risk of dangerous, avoidable infections among patients and healthcare staff, effective hospital infection control programmes are crucial from both an economic and a therapeutic standpoint. The goal of the study was to locate any gaps in current infection control and preventive procedures. The two teaching hospitals Bolan Medical Complex and Sandeman Provincial Hospital in Quetta were the sites of this cross-sectional investigation. In the SAMPLE, 161 people participated. The Statistical Package for Social Sciences (SPSS) version 16.0 was used to analyse the data, which was gathered via data sheets and questionnaires. The findings revealed that the Infection Control Committee (ICC) member's view of health-associated infections (HAIs) was ultimately determined to be inconsequential (P=0.6), and their perception that the staff education level may be a contributing factor was also shown to be unimportant (P=0.1). The operation theatre, labour room, lab and blood bank, OPD, and wards at BMC were evaluated in reference to the steps taken there for infection control and prevention, and the results were observed 30, 25, 15, 14, and 15 accordingly. It was shown that the primary reason for the poor results was the negative perception of the ICC towards infection control and prevention. Therefore, it is necessary to alter how ICC is seen.

Frequency of depression amongst patients with lower limbs physical disability

Background: A congenital, developmental, mental, or physical defect that has the potential to seriously interfere with a person's daily activities is referred to as a disability. People with impairments are susceptible to a wide range of secondary issues, such as pain, fatigue, depression, obesity, and other unknown causes. Objective: To assess the frequency of depression amongst patients with lower limbs physical disability. Methodology: The current study was cross sectional, carried out at Balochistan Institute of Psychiatry and Behavioral Sciences and Bolan Medical Complex Hospital Quetta from March 2019 to March 2020. Patient Health Questionnaire (PHQ-9) was employed to assess the depression. A pre-designed proforma was then used to collect all the required information’s. The SPSS version 24.0 was used to input and analyze the data. Results: In our study, totally 220 patients were enrolled. The male patients were 154 (70%) while female patients were 66 (30%). The mean age (SD) in our study was 42 (4.1) years. Distribution based on PHQ-9 score shows that 132 (60%) patients were observed with PHQ-9 score of less than 4 whereas 88 (40%) patients were observed with PHQ-9 score of more than 4.

Antenatal depression and anxiety amongst women during pregnancy at tertiary care hospital

Background: The most vulnerable time for a woman to have issues with her mental health is during her reproductive years. Due to the expected uncertainty that comes with pregnancy, also in healthy women, pregnancy could cause considerable level anxiety and depression. Objective: To assess the antenatal depression and anxiety amongst women during pregnancy. Methodology: The current cross sectional study was carried out at Balochistan Institute of Psychiatry and Behavioral Sciences and Bolan Medical Complex Hospital Quetta from January 2020 to January 2021. A pre-designed proforma was then used to collect all the required information’s. In the current study depression was assessed by using Hamilton Depression Rating Scale while anxiety was assess by using Hamilton Anxiety Rating Scale. The SPSS version 24.0 was used to input and analyze the data. Results: In the current study, totally 250 pregnant women were included. The mean age of participants with standard deviation was 26 (±2.12). Based on Hamilton Depression Rating Scale, mild depression was observed in 87 (34.8%) participants; moderate depression was observed in 75 (30%) while severe and very severe depression was observed amongst 25 (10%) and 20 (8%) respectively.

Drug Utilization Pattern in Elderly Hospitalized Patients in Tertiary Care Hospitals of Quetta, Pakistan

Background: Changes in Pharmacokinetics and pharmacodynamics in different age groups, especially in elderly age group, have extensively been documented and studied and concurrent chronic diseases may underlie polypharmacy in elderly. Aim: The aim of this study was to assess drug utilization pattern in elderly hospitalized patients in tertiary care hospitals of Quetta. Methods: Specifically, designed questionnaire based, cross sectional study was conducted in Bolan Medical Complex Hospital and Sandeman Provincial Hospital Quetta with total of 397 participants. Non-Probability convenience sampling technique was used in this study. Cronbach alpha test was applied to check reliability of questionnaire, Cronbach alpha value was 0.886 that is acceptable range. Results: Majority of the participants were from age group 60 to 70 years (n=301, 75.8%), fever and cough were present in majority of hospitalized patients (n=180,11.7%). Majority (n=232, 58.4%) of participants were having uncontrolled disease with yearly health service utilization of more than 3 times (n=234, 58.9), medication recommended to majority (146, 36.8%) of participants were 4. Ceftriaxone was mostly prescribed in cough (n=162,90%), hypertension (n=114, 67.1%), fever (n=154, 85.6%) of cases, while in gastritis omeprazole was mostly prescribed (n=84, 73.7%). Most of the hospitalized patients were complaint to ceftriaxone, omeprazole, dimenhydrinate and diclofenac sodium. Conclusion: Ceftriaxone was most prescribed drugs among elderly patients that were admitted in different specialty departments. Most of the elderly patients had uncontrolled disease status. This study concluded that the compliance to medication was 82.1% of elderly patients.

Analysis of Different Factors Associated with Re-Laparotomy After Cesarean Section Deliveries at a Tertiary Care Hospital: A Retrospective Study

Aim: To evaluate factors that are associated with re-laparotomy after cesarean section. Study design: Retrospective study Place and Duration: This study was conducted at Sheikh Zaid Hospital Quetta, Bolan Medical Complex Hospital Quetta, Jinnah Medical and Dental College karachi, Sandeman Provincial Hospital Quetta, Mekran Medical College Teaching Hospital Turbat Kech, Pakistan from the year 2019 to 2021 Methodology: For this research interview sessions with patients were conducted. Clinical examinations were done and Bed Head ticket (BHT) was used for examining the medical history of patients. All the information related to age, parity, indications of caesarian section, and gestational age were observed including time interval of re-laparotomy from caesarian section. Furthermore, information related to clinical features of re-laparotomy, duration of re-laparotomy, and outcomes were also kept for statistical analysis. Results: Over two years, we observed 22192 cases of caesarian deliveries. Out of these 37 emergency caesarian required re-laparotomy procedure. We observed non-progress of labor as a major indication of LUCS in the primary caesarian section comprised of 21.62% of cases. Another dominion indication of the caesarian section was reported as CPD (5.40%), meconium stained liquor (MSL) with Bradycardia (10.81%), and PROM in 10.81% of cases. Rectus sheath hematoma was a major indication of re-laparotomy in 29.7% of cases while 27.02% of cases in our study reported peritoneal hemorrhage. Conclusion: Findings of our study revealed that unnecessary usage of caesarian surgery on patient leads to severe complications resulting in re-laparotomy. Factors like rectus sheath hematoma, Intra-peritoneal hemorrhage and abscess are the dominant reasons for re-laparotomy. Keywords: Caesarian section, Gynecology, Re-laparotomy

Feto-Maternal Outcome after Trial of Vaginal Delivery in Women Having the History of Previous Caesarean Section: A Cross-Sectional Study in Pakistan

Aim: To determine the fetus and maternal outcome on the trial of vaginal delivery after a previous single Caesarean Section (CS). Study design: A cross-sectional study Place and Duration: This study was conducted at Bolan Medical Complex Hospital Quetta from January 2021 to December 2021 Methodology: A total of 108 cases were incorporated in the study who had a previous single CS. Patients' vital signs, fetal cardiac activity, pain and tenderness of the lower abdomen, and fetal distress were observed extensively during the labor. Data was collected with pre-designed Performa, and written informed consent was obtained on a consent form. The hospital committee was given authorization, and the data was analyzed for outcomes. Results: A total of71 patients (65.7%) had a successful vaginal delivery, while 37 (34.3%) required a repeat emergency cesarean section. Out of 71 vaginal deliveries, 47 (66.2%) were between the ages of 19 and 30 years, while 24 (33.8%) were between 31 and 45 years. Out of 37 instances, 22 (59.5 %) were between the ages of 19 and 30 years, while 15 (40.5 %) were between 31 and 45 years. The distribution of cases according to fetal distress in emergency cesarean section patients showed that 8 cases (21.6%) experienced fetal distress, and 29 (78.4%) did not develop any fetal complication. Conclusion: This study demonstrates the higher frequency of fetal distress in CS than vaginal delivery. Pregnant patients should be encouraged to have vaginal deliveries to reduce future morbidity related to CS. Keywords: Caesarean Section, Emergency cesarean delivery, Feto-maternal, vaginal delivery