Care Hospital In Karachi Research Articles

Assessment of the Organizational Commitment among Nurses

Organizational commitment is the extent to which a person may be identified with their membership in a particular organization. Objective: To assess the organizational commitment among nurses. Methods: Utilizing a cross-sectional research approach, this study examined organizational commitment among registered nurses employed in several tertiary care hospitals in Karachi, Pakistan, and enrolled in the Post RN program at Horizon School of Nursing and Health Sciences in Karachi, Pakistan. This study included 71 nurses in total. Three elements of overall organizational commitment are measured by the Organizational Commitment Scale (OCS), established by Balfour and Wechsler in 1996. Results: Study findings show that 35.2% of respondents reported great pride in their affiliation with the company, demonstrating high loyalty and job satisfaction. In addition, 40.8% of respondents strongly agreed with the importance of the organization's values. Moreover, the findings also show that 8.5% demonstrated low commitment, and 60.6% fell into the moderate commitment category. Meanwhile, 31.0% exhibited high commitment. Conclusions: The study revealed a diverse spectrum of commitment levels, with a substantial majority demonstrating moderate commitment. Addressing this issue should be a priority for the organization, focusing on recognizing and appreciating employees' efforts to enhance overall satisfaction and foster a more supportive work environment.

Knowledge of Nurses Regarding Airway Suctioning in Tertiary Care Karachi Pakistan

Proper suctioning is too essential to clear the patient's airway. Nurses should have correct knowledge regarding proper suctioning according to current recommendations to prevent complications. Objective: To assess nurses' knowledge regarding proper suctioning for adult patients. Methods: This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A 50 males and females were selected through convenient sampling by using a cross-sectional study. A self-made questionnaire was used for the data collection. Results: The study findings revealed that 50 participants participated, of which 60% were male and 40% were female. The findings also show that 40% had poor knowledge, 20 had moderate and 40% had high knowledge regarding g airway suctioning. Conclusions: Specifically, 40% of the staff demonstrated poor knowledge, 20% had moderate knowledge, and 40% exhibited a high level of knowledge concerning airway suctioning techniques. Further training and educational interventions may be necessary to improve the overall knowledge and standardize proper suctioning practices among the nurses in the hospital.

Metabolic storage disorders at a tertiary care hospital, Pakistan

OBJECTIVE: To determine the clinical spectrum of metabolic storage disorders presenting to a public sector tertiary care hospital in Karachi, Pakistan. METHODOLOGY: This retrospective, cross-sectional study was conducted at the Department of Pediatrics, Dr RKMP Civil Hospital Karachi, in 2021. We reviewed the medical records of patients from January 2015 to December 2020. We included all pediatric patients admitted with suspicion of metabolic storage disorders based on two or more: visceromegaly, developmental delay, regression of milestones, fits without fever, family history of similar illness, and family history of expiry of children due to unknown reasons. Patients of malaria, enteric fever, epilepsy and cerebral palsy were excluded. We noted the demographic and clinical variables and applied descriptive statistics using SPSS version 22. RESULTS: Out of n=140 suspected children, n=40 (28.5%) patients were diagnosed with metabolic storage disorder. Among these, 26 (65%) were Lysosomal, and 14 (35%) were Glycogen storage disorders (LSDs and GSDs). The most common clinical feature of LSDs was faltering growth in 23 (88.4%), while for GSDs, it was abdominal distention and hepatomegaly in 100% of patients. Mucopolysaccharidoses were the most common type of LSD identified in 9(34.6%). Interestingly, family history of similar illness was not a standard feature (19.2% for LSDs and 7% for GSDs). CONCLUSION: Metabolic storage disorders are an emerging concern to pediatric health in our population. Physicians need to keep a high index of suspicion for patients with faltering growth and visceromegaly, with or without a significant family history. KEYWORDS: Glycogen storage diseases; Lysosomal storage diseases; Metabolic diseases; Inborn errors of metabolism; Hepatomegaly; Genetic diseases

Factors associated with dropout from outpatient tertiary mental health services

Background and Objective:
 There is a paucity of mental health hospital-based studies from Pakistan that have observed the contributing factors of dropout. This study aims to understand contributing factors to dropouts from mental health services.
 Method:
 This telephonic survey was conducted as a cross-sectional study from dropout outpatients of Karwan-e-Hayat Institute for Mental Health Care, a tertiary mental care hospital in Karachi, Pakistan. Using a simple questionnaire to assess socio-demographic variables, psychosocial assessment, and patient perspectives on treatment termination. A total of 158 participants out of 200 patients provided insight into their dropout experiences.
 Result: 
 Results revealed that younger adults, particularly those aged 18-40, demonstrated a greater tendency to discontinue treatment. Level of education was also associated with dropout rates, with uneducated and less educated individuals showing greater tendencies to drop out of treatment than their educated counterparts. Schizophrenia emerged as a leading psychiatric diagnosis associated with high dropout rates. Lack of insight into psychotherapy, patient dissatisfaction, and geographic distance from treatment centers were identified as key contributors to dropout.
 Conclusion:
 Factors such as age, educational status, diagnosis, insight into the disease, dissatisfaction with the treatment and distance from the treatment center were related to the dropout rate. Insights gained from this investigation advocate for tailored interventions focusing on education, patient satisfaction, and proximity to treatment facilities.

Prevalence of stress among the healthcare providers in a tertiary care hospital in Karachi

Background and Objective:
 Healthcare workers are considered high risk for stress. This study aimed to study the prevalence of stress among the health care providers in a tertiary care hospital in Karachi.
 Methods:
 A cross-sectional study was conducted at Liaquat National Hospital from July to December 2021. All healthcare workers in the vicinity of the hospital including doctors, nurses, allied health specialists, and other healthcare professionals who provide hands-on patient care were included in the study. Data was collected through a pre-designed questionnaire GHQ-12; related to stress symptoms and their impact on daily routine activities. It was in a Google form and forwarded through e-mails. Data was saved and transferred to SPSS later for analysis.
 Results: 
 In terms of stress, the study found that a significant number of health care providers experienced stress n=146 (74.5%). Among the patients who reported experiencing stress, the distribution of stress levels shows that the majority experienced typical stress n=58 (29.6%), followed by severe stress with psychological distress n=56 (28.6%), and distress n=32 (16.3%). The majority of patients fell within the age range of 20-30 years and were female.
 Conclusion:
 There is a high prevalence of stress among the healthcare providers in our hospital. Enhancing productivity and reducing stress at work should be a goal in health care.

Efficacy of Oral Apremilast in The Treatment of Alopecia Areata, at The Tertiary Care Hospital, Karachi

Background: Alopecia Areata (AA) presents a significant challenge in dermatology due to its unpredictable nature and psychological impact. Recent studies have focused on oral Apremilast, a phosphodiesterase 4 inhibitor, for its potential efficacy in treating AA. Objective: This study aims to assess the efficacy of oral Apremilast in treating alopecia areata at a tertiary care hospital in Karachi. Methods: A randomized controlled trial was conducted in the Department of Dermatology at Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to June 2023. The study enrolled 85 patients exhibiting various symptoms of AA. Apremilast was administered orally at 30 mg twice daily, following a 5-day initial titration dose. The Severity of Alopecia Tool (SALT score) was employed to measure treatment effectiveness at the outset, 6 weeks, and 12 weeks. Data analysis was executed using SPSS version 23. Results: Participants had an average age of 28.34 years (SD = 4.20), with a gender distribution of 51 women (60.0%) and 34 men (40.0%). The study demonstrated a significant decrease in SALT Scores from 62.42 ± 5.17 to 41.53 ± 13.44 at Week 12 (mean difference: 20.89, 95% CI: 17.86 to 23.92, p-value: 0.0001), indicating a notable reduction in AA severity. Oral apremilast was found to be effective in treating AA in 80.0% of patients. Conclusion: The study concludes that oral Apremilast significantly reduces the severity of alopecia areata, as evidenced by the decline in SALT Scores from baseline to Week 12. These findings suggest that oral Apremilast may serve as a viable alternative treatment for AA, deserving further clinical exploration.

CLINICAL OUTCOME OF GUILLAIN BARRE SYNDROME IN THE INTENSIVE CARE UNIT OF A PEDIATRIC TERTIARY CARE HOSPITAL

Since poliomyelitis was eradicated, Guillain-Barre syndrome has been the leading cause of acute flaccid paralysis globally. Critical care and mechanical breathing may be necessary in extreme circumstances. Among paediatric patients hospitalized in the intensive care unit of a Karachi tertiary hospital, we aimed to quantify the incidence of Guillain-Barré Syndrome clinical outcomes. Cardiology Intensive Care Unit (NICH) in Karachi, Pakistan. January 9, 2020, to July 10, 2020—six months. Children admitted to the intensive care unit at NICH with GBS, as defined operationally, ranging in age from six months to twelve years, were included in the study. They stimulated the posterior tibial nerve (PTN) and common peroneal nerve (CPN), allowing for studying motor nerve conduction and using the median and ulnar nerves to measure compound muscle action potentials' onset delay, amplitude and conduction velocity (CMAPs). Research on the conduction of sensory nerves was carried out to quantify SNAPs in the sural, median, and ulnar regions. All patients were given intravenous immunoglobulin for five days at a 400 mg/kg/day dosage, as per the protocol. Clinical outcomes were evaluated using the HFG scale at discharge and four weeks. The average patient age was 5.81 ± 3.26 years out of 30. Thirteen men (43.3%) and seventeen females (56.7%) were present. Fifteen patients (53.3%) had a history of upper respiratory illness, while seven (23.3%) had a history of gastrointestinal infection. A mean HFG score of 3.03 ±1.90 was recorded. Outcomes were good for 21 patients (56.7%) and deficient for 9 (43.3%). A tertiary care hospital in Karachi reported that 56.7% of children admitted with Guillain-Barre Syndrome had good clinical results in the intensive care unit.

Allergic bronchopulmonary aspergillosis: radiological and microbiological profile of patients presented in an outpatient pulmonary clinic in a developing country.

There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 patients labeled as ABPA, 167 fulfilled the inclusion criteria, and 91 (54.5%) were female (mean age 41.9±13.0 years). A high resolution computed tomography scan of the chest was available for 126 patients. Of these, 104 (82.5%) patients had bronchiectasis. Central bronchiectasis was noted in 98 (94.2%), mucus plugging in 71 (56.3%), and hyperinflation was seen in 30 (23.4%) patients. Microbiological testing was available in 103/167 (61.7%) patients. The most common bacterial pathogen was Pseudomonas aeruginosa 32 (31.1%), followed by Hemophilus influenzae 16 (15.5%), and Moraxella catarrhalis 7 (9.7%). Aspergillus fumigatus 17 (23.6%) was the most common mold, followed by Aspergillus flavus 16 (22.2%) and Aspergillus niger 11 (15.3%). Co-infection (bacterial and fungal) was found in 18 (17.45%) patients. Bronchiectasis was frequently observed in our cohort of patients with ABPA. Pseudomonas aeruginosa was found to be common among bacterial pathogens. Isolation of fungus is not uncommon in these patients.

Enhancing antenatal education in Pakistan: an audit and recommendations

BackgroundAntenatal Education equips parents with knowledge for safe maternal health and infant care. It also reduces fear and anxiety during childbirth. ANE curriculum can vary according to country and institute. It can include classes focusing on childbirth, pain relief techniques, mode of birth, parenting, breastfeeding, breathing techniques, etc. Although ANE is widely practiced in developed countries, there is no standard program in developing countries like Pakistan. This study aims to improve antenatal education at a tertiary care hospital in Karachi, Pakistan potentially proposing an upgraded curriculum as a national standard.MethodsThis multiphase study used mix-method design was conducted in the Obstetrics and Gynaecology Department of a tertiary care hospital of Karachi, Pakistan from 2019 to 2021. Phase 1 of the study included reviewing and comparing the hospital’s antenatal curriculum with existing literature, followed by Phase 2, which was a desk review of attendance and patient feedback. The 3rd phase involved IDIs (in depth interviews) from health care workers (Obstetrics experts) to understand their perspectives regarding the ANE and the conducted classes. For phase one, gaps were identified and reported theoretically. For phase two, the annual attendance was recorded and participants’ satisfaction with the classes assessed. Qualitative data from phase 2 and 3 was converted into themes and sub-themes.ResultsThe audit showed a decline in the attendance of antenatal classes due to the pandemic and consequent shift to online sessions. The low attendance in online courses could be attributed to various factors. Patient feedback was generally positive, with a majority expressing high satisfaction levels. Expert feedback highlighted the need for additional topics such as mental health and COVID in pregnancy, as well as fathers' involvement. The curriculum was updated to include these topics and made more interactive with printed handouts for parents.ConclusionA standardized antenatal education covering various topics surrounding pregnancy, childbirth, and postnatal care must be available to parents nationwide.

Assessment of Non-Ischemic Chest Pain and its Association with Socio-Demographic Characteristics among Post Percutaneous Coronary Interventions (PCI) Patients

The most common procedure used in cardiovascular medicine is percutaneous coronary intervention (PCI) that can create some physiological complications, such as decreasing heart rate, mechanical issues, and cardiac arrest among patients. Objective: To determine the frequency of non-ischemic chest pain and its relation with socio-demographic features amongst post PCI patients in a tertiary care hospital in Karachi. Methods: This analytical cross-sectional study was led at National Institute of Cardiovascular Diseases (NICVD) Hospital, Karachi. A total of 195 patients with Post PCI non-ischemic chest pain were recruited by using the Numerical rating scale (NRS). Non-probability purposive sampling technique was used and permission was taken from Institutional Review Board (IRB) of DUHS and Ethical Review Committee (ERC) of NICVD. Data were analyzed by using SPSS Version-26.0. Percentages and frequency were used for categorical variables while, a chi-square test was applied to check the associations of non-ischemic chest pain with demographic features of the patients. Results: In this study, 63.60% of the participants were male. Most of the participants (75.4%) were married. Non-ischemic chest pain was found significantly associated with age, gender, marital status, history of disease and drug history with p-values <0.001, 0.001, <0.001, <0.001, <0.001 respectively. The majority of the participants (90.26%) were suffered with non-ischemic chest pain. Conclusions: This study revealed that majority of the patients suffered with non-ischemic chest pain and moderate pain level was prevailing in the majority of the post PCI patients.

Clinical Characteristics and Long-Term Outcome of Patients with Bio-Prosthetic Mitral Valve – Experience From a South Asian Country

Objectives: The aim of this study is to evaluate clinical characteristics and long-term outcome of the patients with bio-prosthetic mitral valve replacement at a tertiary care hospital of a South Asian country.
 Methodology: The study is a retrospective observational observational study involving patients who underwent bio-prosthetic mitral valve replacement at a tertiary care hospital in Karachi, Pakistan, between 2006 and 2020, and had at least two complete echocardiograms. Patients with incomplete clinical data, no electronic reports of echocardiograms, and mechanical mitral valve replacement were excluded.
 Results: This is a retrospective observational study, conducted at a tertiary care hospital. We included a total of 502 patients who underwent bio-prosthetic mitral valve replacement from the year 2006 to 2020. Patients were divided into two groups based on normal functioning bio-prosthetic mitral valve and bio-prosthetic mitral valve dysfunction (BMVD). Out of 502 patients, 322 (64%) were female, mean age at the time of surgery was 49.42 ± 14.56 years. Mitral regurgitation was more common, found in 279 (55.6%) patients followed by mitral stenosis in 188 (37.5%) patients. Mitral valve replacement was done as an elective procedure due to NYHA II to IV symptoms at the time of surgery in 446 (88.8%) patients. In the mean follow-up of 6.59 + 2.99 years, bio-prosthetic mitral valve dysfunction (BMVD) was observed in 183 (36.5%) patients. However, re-do mitral valve surgery was done in only 49 (9.8%) patients. Comparing the two groups, individuals with normal functioning bio-prosthetic mitral valve had a mean age of 51.6 + 14.27 years, while those with BMVD had a mean age of 45.639 + 14.33 years at the time of index surgery (p value=0.000). There were more long-term complications including heart failure (n = 16, 8.74%), atrial fibrillation (n = 11, 6.01%) and death (n = 6, 3.28%) in BMVD group which were statistically significant.
 Conclusion: This study is distinct because it demonstrates the outcomes of bio-prosthetic valve replacement in a relatively younger South Asian population. Due to rapid degeneration of bio-prosthetic valve in younger patients, a significant number of cases developed BMVD along with poor long-term clinical outcomes even at a short follow up period of less than ten years. These findings are like international data and signify that mechanical mitral valve replacement may be a more reasonable alternative in younger patients.

Three-dimensional computed tomography analysis of the atlanto-dental interval in a healthy Karachi population: a single-center retrospective cross-sectional study

Background: The atlantoaxial joint has a complex anatomical configuration and has a wide range of mobility. Traumatic, inflammatory, and neoplastic joint pathologies frequently affect this joint. The aim of this retrospective cross-sectional study was to evaluate the atlanto-dental intervals (ADI) in patients who underwent computed tomography (CT) scans of the neck and cervical spine in at a Tertiary Care Hospital in Karachi, Pakistan. Methods: This was a retrospective cross-sectional study conducted at a tertiary care hospital in Karachi between 1 January 2021 and 31 December 2021, following approval from the hospital ethical review committee. Patients above the age of 15 who underwent CT scans were included, while individuals with a history of cervical trauma, infection, rheumatoid arthritis, or congenital anomalies, as well as those younger than 15 years old, were excluded. CT scans were performed using a multidetector scanner utilizing a standardized protocol. Sagittal and coronal images were reconstructed. ADI measurements, including anterior ADI (AADI), posterior ADI (PADI), and lateral ADI (LADI) on both sides, were determined using appropriate bone window settings. A radiologist with a minimum of 3 years of experience analyzed the CT scans. Results: The mean age of the patients was 49.3±17.7 years (age range: 16–85 years). The mean AADI was 1.4±0.4 mm, with a range of 0.0–2.1 mm. The mean PADI was 19.1±1.9 mm, with a range of 13.8–24.6 mm. The mean left LADI measurement was 3.3±1.2 mm with a range of 1.2–10.0 mm, and the mean right LADI measurement was 3.2±1.1 mm with a range of 1.2–6.3 mm. Conclusion: Our study examined the ADI in patients who underwent CT scans of the neck and cervical spine in Karachi. The findings provide valuable insights into the relationship between ADI measurements, age, and sex. These results contribute to our understanding of the anatomical variations in this region, which may aid in the diagnosis and management of cervical spine disorders.

Effect of Diabetes type-II on Eye disease and its risk factors; A Logit Model Analysis

To know the effect of Diabetes type-II on Eye disease and its risk factors in a tertiary eye care hospital in Karachi. This was a cross-sectional study with retrospective data collection. The data was retrieved from January to June 2019 from the Hospital Information Management System (HIMS) software of the Institute. Non-probability purposive sampling method was used to collect data. Inclusion criteria were all the diabetics type-II patients came for routine check-ups at Diabetes Eye Department irrespective of age, gender and duration of diabetes. Statistical analysis was done using STATA version 13.0 software for windows. A total of 6090 cases were analyzed. Mean age of the participants was 51.01±10.8 years. There were 2954 (48.5%) male and 3136 (51.5%) female observed in this study. Table 1 shows the results of the binary logistic regression analysis with coefficients and their standard errors (S.E.), Wald test values, p values, odd ratios, and 95% confidence intervals for odds ratios. When all explanatory variables treat as continuous variables, we found that all variables which include age, height, random blood sugar (RBS) and duration of diabetes was statistically significant at the significance level 0.05 except weight and fasting blood sugar (FBS) for individual regression slope coefficients. This study reveals findings through binary logistics regression analysis. It indicates that there is an association found in the patients of eye disease with age, height, weight, RBS, FBS. This stated that there were some risk factors observed in these variables related to eye disease. Those who have the disease have risk factor to developed the others associated disease.

Lifestyle Impacts of Extended Nursing Shifts Among Nurses: A Study in Tertiary Care Hospitals in Karachi, Pakistan

A significant concern in healthcare settings is extended hours' effect on nurses' health. Objective: This study aims to explore the lifestyle impacts of extended nursing shifts among nurses at tertiary care hospitals in Karachi, Pakistan. Methods: This cross-sectional study was conducted in three tertiary care hospitals in Karachi, Pakistan, among 100 nurses. Results: Study findings reveal that majority, 87%, believe it hinders decision-making, while 88% see sleep deficits and 88% note time constraints for exercise. Communication quality is a concern for 76%. 78% see knowledge transfer issues when nurses hand over responsibilities, and 58% think religious activities are impacted. Opinions vary on patient care quality (50% positive). Stress levels concern 80%, social lives are disrupted for 91%, and physical health effects concern 93%. Additional worries include inadequate diet (39%), nurses working long shifts are exhausted (91%), child care neglect (89%), altered eliminatory patterns (84%), life expectancy (32%), memory problems (69%), hormonal disruptions (76%), workplace conflicts (88%), and infection risk (88%). Finally, 76% perceive high absenteeism. Conclusions: The findings underscore significant concerns about the negative impact of long working hours on nurses' health and performance. To address these issues, it is recommended that healthcare institutions prioritize implementing structured shift rotations and providing adequate breaks to mitigate the adverse effects of extended shifts on nurses' wellbeing and patient care quality.

FACTORS LEADING TO TRANSIENT TACHYPNEA OF NEWBORN (TTN) IN BABIES, DELIVERED BY SPONTANEOUS VAGINAL DELIVERY AT TERTIARY CARE HOSPITAL KARACHI

Neonatal respiratory distress is a common issue, and one of its types is Transient Tachypnea of the Newborn (TTN), which happens when leftover lung fluid is not removed from the body on time. TTN usually occurs within the first 24 to 72 hours after delivery. This study aims to determine the frequency of TTN in newborns delivered vaginally and spontaneously at a tertiary care hospital in Karachi and identify the factors that may contribute to the condition. The study adopted a cross-sectional design and was conducted in the Neonatal Intensive Care Unit of the Department of Pediatric Medicine, Ziauddin Hospital, Karachi. After obtaining the necessary approvals, the study lasted for 9 months, from December 2021 to September 2022. Both quantitative and qualitative data were collected, assembled, and analyzed. Stratification was employed to adjust for effect modifiers, and a chi-square test was used to test for statistical significance with a p-value of 0.05. The study included 153 patients who met the inclusion and exclusion criteria. The average gestational age, height, weight, OFC, length of hospital stay, and mother's age were 30.7 ± 4.3 weeks, 49 ± 1.79 cm, 3.01 ± 0.38 kg, 36.65 ± 1.08 cm, 3.92 ± 4.65 days, and 39.8 ± 2.78 weeks, respectively. Of the 153 patients, 71 (46.4%) were male and 82 (53.6%) were female. 44.4%, 31.4%, 45.1%, and 31.4% of the patients had maternal diabetes, PROM, obesity, and low APGAR scores, respectively. The study found maternal diabetes and obesity were the primary risk factors for TTN in newborns. The study emphasizes the importance of good antenatal and obstetric care to detect any early problems during pregnancy that may contribute to the incidence of TTN.

Obsession to fairness and topical steroid induced acne: A situation analysis of patients presenting in dermatology clinic at a private hospital in Karachi.

To determine the frequency of acne and other relevant side effects as well as the pattern of topical steroid and fairness cream use among patients presenting with steroid and fairness cream use at dermatology OPD in a tertiary care private hospital in Karachi. A cross-sectional survey was conducted from April, 2020 to December, 2020 in a private tertiary care hospital in Karachi. In total, 226 patients with a positive history of topical steroids and/or fairness creams use in the past six months were included in the study. Information was collected about sociodemographic characteristics; topical corticosteroid uses while clinical examination of facial skin was performed by a dermatologist. Data were analyzed using SPSS version-19. The median age of study participants was 26 years with an interquartile range of 10 years. This frequency of corticosteroid induced acne was highest i.e., 83.6% (n=189) followed facial erythema and telangiectasia i.e., 50.9% (n=115) 47.8% (n=108) respectively. The estimated median duration of using topical steroids or fairness creams or both was six months with an IQR of four months. The study found statistically significant differences in the reasons of using topical corticosteroids or fairness creams on the face on the basis of differences in the level of education and marital status. In Karachi, both, men and women are equally obsessed with fair skin tone and use topical steroids and fairness cream. The use of corticosteroid or fairness cream-induced facial acne is alarmingly high among patients presenting in a dermatology clinic in Karachi.

Assessment of potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients admitted to tertiary care hospitals.

Meningitis is an important cause of morbidity and mortality in children and adults. Its treatment strategy varies with age and gender. To assess potential drug-related problems (PDRP) and clinical outcomes in bacterial meningitis patients, a multicenter, clinical, descriptive, cross-sectional prospective observational study in 120 patients admitted to different tertiary care hospitals in Karachi was conducted. It includes both males 48% and females 52% belonging from all age groups i.e. peadiatrics (01 to 12 years), adults (18 to 65 years), and geriatrics (66 to 75 years). Out of these 72 patients were admitted in the public sector and 48 patients were admitted in private sector hospitals. Nosocomial infections were developed in 41% of patients during their stay at the hospital. Potentially nephrotoxic drugs were administered to all BM patients, these drugs should be administered carefully. Majorly Ceftriaxone was administered to 86% of patients, Vancomycin 71%, and meropenem 73% whereas 68% of patients were administered piperacillin-tazobactam. Organisms involved as causative agents in the majority of patients are Neisseria meningitides, Pseudomonas aeruginosa and, Streptococcus pneumoniae. DRPs impacted patient clinical outcomes in presence of many other factors like comorbidities, DDIs, Nis, administration of potentially nephrotoxic drugs, and administration of watch group and reserve group antibiotics without having culture sensitivity test, even after having CST no principles of de-escalation for antibiotics were done, which is a very important factor for hospitalized patients having IV antibiotics. The mortality rate among BM patients was 66%. The majority of patients (87%) stay at the hospital was 1-10 days. The present study helped in the identification of DRPs along with some other factors affecting the clinical outcomes in patients suffering from bacterial meningitis. Healthcare professionals should receive awareness and education on the importance of CST before initiating antibiotic therapy. Pharmacist-led medication review is necessary and should be followed to avoid negative outcomes and serious consequences related to DRPs.

Association of Myeloma in Patients of Chronic Kidney Disease; A Single Centered Study

Objective: To evaluate the frequency along with socio-demographic factors and clinical features of myeloma in patients with chronic kidney disease (CKD) presenting at a tertiary care hospital in Karachi, Pakistan. Study design and setting: It was a cross-sectional study conducted at the Department of Nephrology and Hematology, Liaquat National Hospital, Karachi, Pakistan from Jan 2022 to Jul 2022. Methodology: Patients of age>18 years of either gender having chronic kidney disease were included in the study. Detailed data regarding socio-demographic factors, clinical features and presence of multiple myeloma was obtained. Myeloma was diagnosed in the patients using WHO criteria i.e. presence of M-protein in urine or serum, presence of clonal plasma cells in bone marrow, and related tissue or organ failure. Data was entered and analyzed using SPSS version 25. Results: The median age of the patients with chronic kidney disease was 54 years and most of them were males (63%). Myeloma was detected in only 14 patients with CKD. The proportion of myeloma was similar across chronic kidney disease stages, and statistically there was no significant association between chronic kidney disease stages and myeloma with pvalue=0.08. There were no differences in hemoglobin, serum calcium, serum albumin, serum total protein, albumin/globulin (A/G) ratio, ESR, comorbid in patients with and without myeloma (p>0.05). Conclusion: The frequency of myeloma among patients with chronic kidney disease was low.

Immunohistochemical Expression of Nkx3.1 in Prostatic Adenocarcinoma and Benign Prostatic Hyperplasia at a Tertiary Care Hospital in Karachi

OBJECTIVES To determine NKX3.1 expression in prostatic adenocarcinoma and benign prostate hyperplasia on Immunohistochemistry at a tertiary care hospital in Karachi. METHODOLOGY 74 prostatic specimens were recruited in this comparative cross-sectional study at the Department of Pathology, Pakistan Navy Station Shifa Hospital, Karachi, from January 2018 to February 2019. Of these, 37 specimens were of prostatic adenocarcinoma, and 37 were benign prostate hyperplasia. All specimens were subjected to immunohistochemical staining with NKX3.1. Statistical analysis was done by using SPSS version 23.0. The association of the extent of NKX3.1 staining between the adenocarcinoma and hyperplasia group was assessed using the Chi-square test x2. RESULTSOf the 37 cases of benign prostatic hyperplasia subjected to NKX3.1 staining, 32 showed positive staining with strong to moderate intensity. No staining was observed in 5 cases. 37 cases of adenocarcinoma prostate stained for NKX3.1 revealed positive staining in 30 cases with strong to moderate intensity. Negative staining was seen in 7 cases. The prostatic adenocarcinoma showed a statistically significant association of NKX3.1 positivity compared to benign prostatic hyperplasia cases. The p-value was found to be 0.03. CONCLUSION NKX3.1 staining was highly specific for prostate epithelium, as it was positive in most cases. This immune marker was useful for distinguishing prostatic origin in the context of metastatic lesions. Adding NKX3.1 protein staining to a panel of features may add value to the diagnosis if applied in the appropriate clinicopathologic context.

Impact of Frontline Staff’ Behaviors and Waiting Time on the Patients’ Behavior in the Outpatient Departments (OPDs): A Cross-Sectional Study of Tertiary Care Hospitals

Healthcare is a crucial service whereby frontline workers' behavior and waiting time play more critical roles in the quality of the service than other services. As patients are exposed to a more unstable psychological state, their behavioral dissonances may hinder the quality of care provided. The behavioral patterns of both the employees and the patients are critical aspects of healthcare leadership and management alike This study explored the impact of frontline employees and waiting times on the patient’s behavior. A quantitative, cross-sectional approach was applied with deductive logic to conduct this study. A pre-validated structured questionnaire, adapted and cited from different sources, was administered among patients in five major, private tertiary care hospitals in Karachi, Pakistan through a non-probability judgmental sampling. The findings revealed a significant effect of both the behavior of employees and waiting time on the patients’ behavior. Policymakers may utilize the study findings to train empathy and a patient-centric approach to modify the behavior of employees to counter unpleasant patient behavior and produce satisfaction leading to improved quality of care.