Care Hospitals Of Peshawar Research Articles

FREQUENCY OF PIPERACILLIN/TAZOBACTAM RESISTANCE IN SPONTANEOUS BACTERIAL PERITONITIS PATIENTS

Spontaneous bacterial peritonitis (SBP) is a serious infection in patients with chronic liver disease, requiring prompt antibiotic therapy. Due to growing resistance to first-line antibiotics like ceftriaxone, piperacillin/tazobactam is often used as a second-line treatment. However, emerging resistance to piperacillin/tazobactam poses a significant clinical challenge. Identifying local resistance patterns is crucial for optimizing treatment, particularly in resource-limited settings like Peshawar, Pakistan. Objective: To determine the frequency of piperacillin/tazobactam resistance among patients with spontaneous bacterial peritonitis at a tertiary care hospital in Peshawar, Pakistan. Methods: This cross-sectional study was conducted over five months at Lady Reading Hospital, Peshawar from 18th April to 18th September. A total of 169 patients aged 16 to 75 years with SBP secondary to chronic liver disease were included using non-probability consecutive sampling. Demographic and clinical data were collected, and ascitic fluid samples were cultured to assess resistance to piperacillin/tazobactam. Data were analyzed using descriptive statistics and chi-square tests to examine associations. A p-value < 0.05 was considered statistically significant. Results: Piperacillin/tazobactam resistance was found in 9.5% (16/169) of SBP patients. Resistance was observed in 8.0% (7/88) of Escherichia coli isolates and 11.1% (9/81) of other bacterial isolates (p = 0.04). Resistance rates were slightly higher in the 46–75 age group (11.0%, 11/100) compared to the 16–45 age group (7.3%, 5/69). Male patients had a resistance rate of 10.2% (11/108), while female patients showed 8.2% (5/61). Conclusion: This study highlights significant resistance to piperacillin/tazobactam among SBP patients in Peshawar, particularly in non-E. coli bacteria. These findings underline the need for personalized antibiotic regimens and ongoing surveillance to address growing antimicrobial resistance in chronic liver disease patients.

Analyzing the Role of Mechanical Bowel Preparation on Surgical Outcomes in Colorectal Surgery

Despite improved postoperative recovery from the use of minimally invasive procedures and enhanced recovery after surgery protocols in recent decades, colectomy is still associated with morbidity. Surgical site infections range from trivial wound infections to potentially deadly colonic anastomotic leaks. Objectives: To compare the outcome results regarding postoperative complications of Mechanical Bowel Preparation and Non-Medical Bowel Preparation groups in elective colorectal surgery at a Tertiary Care Hospital in Peshawar, Pakistan. Methods: The research was a quasi-experimental study. In this study, 210 patients were included; they were divided into 2 groups: Mechanical Bowel Preparation Group and the Non-Mechanical Bowel Preparation Group. Data were collected through electronic health records. The data were analysed using SPSS software version 26.0. Descriptive statistics, such as the Chi-Square test, were applied to the results. Results: There was no statistically significant difference regarding the surgical outcomes and the demographics between the Mechanical Bowel Preparation and Mechanical Bowel Preparation groups. The escalation of the surgical site infection looked lower when the Mechanical Bowel Preparation was not in use i.e 20 (19.05%) in the Mechanical Bowel Preparation group and 14 (13.33%) in the Non-Mechanical Bowel Preparation group, but it did not seem to be, statistically significant; p-value=0.261014. The anastomotic leak rates and intra-abdominal collection rates do not differ significantly between the two groups; p>0.05. Conclusions: It was concluded that there was no statistical significance between the groups of mechanical bowel preparation and non-mechanical bowel preparation concerning surgical site infections, anastomotic leakages, and other colorectal surgery complications.

Retrospective, cross-sectional study of the determinants of acute flaccid paralysis among children in Pakistan

Background: Timely diagnosis of acute flaccid paralysis is very crucial in developing countries like Pakistan, because this will have significant impact on management. Aim: To assess the surveillance, aetiology and epidemiology of acute flaccid paralysis in a tertiary care hospital in Peshawar, Pakistan. Methods: This retrospective, observational study was conducted at the Paediatric Department of Lady Reading Hospital, Peshawar, in 2022. Data on all children aged 1 month to 15 years and diagnosed with acute flaccid paralysis were retrieved from the electronic medical records and patient files of the hospital. The data were analysed using SPSS version 27. Results: Eighty-eight (1.34%) of the 6544 patients admitted to the paediatric ward met the inclusion criteria for acute flaccid paralysis; 63 (71.6%) of them were male, 25 (28.4%) female, mean age 6.68 ± 3.86 (mean ±SD) years. Guillain Barre Syndrome was diagnosed in 36 (40.9%) of them, meningoencephalitis in 26 (29.5%), septic arthritis in 6 (6.8%), and hypokalaemia paralysis and cerebrovascular accidents in 5 (5.7%). Three (3.4%) of the patients had post-diphtheria neuropathy and 1 (1.1%) had poliomyelitis. In-hospital mortality was 2.3% (2). Conclusion: Although acute flaccid paralysis is vaccine-preventable and its infectious aetiology is low, its surveillance in Pakistan should be continued to reduce occurrence and progress towards polio eradication.

A Comparison of Oral and Intravenous Treatments in Managing Spontaneous Bacterial Peritonitis

Abstract Background: In cirrhotics, spontaneous bacterial peritonitis (SBP) is a potentially fatal illness that requires immediate antibiotic administration. This meta-analysis aimed to examine the effectiveness of IV and oral antibiotics in patients with SBP. Objectives: We compared the efficacy, safety, and cost-effectiveness of oral vs intravenous antibiotic therapy for the treatment of SBP using data from a retrospective cohort analysis. Study design: Retrospective cohort study Place and duration of study: A tertiary care Hospital in Peshawar from Jan 2022 to Jan 20243 Methods:At Tertiary Care Hospital Peshawar, a Retrospective Cohort Study was conducted including all patients diagnosed with SBP between January 2022 and January 2023. The patients were split into two groups based on the kind of antibiotics administered: Group B: patients in need of ampicillin, cephalosporines, or IV IV therapy; Group A: patients on oral antibiotics and ciprofloxacin/cotrimoxazole with norfloxacin (patient 44). Patients who were eighteen years of age or older were eligible for inclusion. Based on an ascitic PMN cell count of ≥250 cells/mm³ and positive bacterial cultures, they were diagnosed with hospital-acquired SBP. Secondary peritonitis and serious co-morbidities requiring non-study antibiotic therapy were excluded criteria. Results:Group B, which received metronidazole orally, had an 85% resolution rate and an in-hospital mortality rate.The highest mortality rate and length of hospital stay were determined to be 10% and 7 ±3 days, respectively. With a 90% resolution rate and a roughly 8% overall mortality rate, Group B only needed to stay in the hospital for 10 (±4) days. 15% recurrences in Group A Group B: 12 percent recurrences Conclusion:Oral antibiotics are statistically no different from IV in terms of mortality, length of stay, or other outcomes when used to treat SBP. The proven outcomes back up the introduction of oral therapy for individuals who qualify in order to improve adherence and save costs. Keywords: Oral antibiotics, Systematic & individual, IV therapy

Risk Factors and Mortality Outcomes in Elderly Patients With Bloodstream Infections: A Retrospective Analysis.

Background The objective of our investigation was to evaluate the mortality rate and predictor factors that are associated with bloodstream infections (BSIs) in elderly patients who are admitted to the internal medicine ward. Materials and methods A retrospective cross-sectional analysis was conducted at a 550-bed tertiary care hospital in Peshawar, Pakistan, from January 2021 to June 2022. The study involved elderly inpatients aged 65 and older with positive culture results detected within two days of admission. Data collection involved demographic and patient-related risk variables, BSI-related risk factors, and environmental risk factors, with statistical analysis performed using the StatisticalPackage for the Social Sciences (IBM SPSS Statistics forWindows,IBMCorp., Version 26.0, Armonk,NY). Results Of the total study sample (n=186), 103 (55.4%) survived while 83 (44.6%) did not. The non-survivor group had a higher median Sequential Organ Failure Assessment (SOFA) score (6 vs. 2, p<0.0001) and Charlson Comorbidity Index (5 ± 2 vs. 3 ± 2, p<0.0001), with more frequent immunosuppression (25.3% vs. 8.7%, p=0.001). Additionally, gram-positive bacteria were more common in non-survivors (42% vs. 10%, p<0.0001), while gram-negative bacteria were more prevalent in survivors (73% vs. 36%, p=0.002). Conclusions Our research validates that BSIin older adults is a serious condition that is linked to a substantial death rate during hospitalization. The biggest determinant of death in older patients with BSIis the severity of clinical symptoms evaluated by the SOFAscore upon admission. It is imperative to acknowledge that respiratory-inducedBSIsare the most fatal, and patients who are hospitalized and admitted to the intensive care unit (ICU) are at an elevated risk.

A Comparative Study of the Epidemiology and Risk Factors of Chronic Kidney Disease Among Rural and Urban Residents in Peshawar, Pakistan.

Background and objective Chronic kidney disease (CKD) poses a significant global public health challenge, especially among the Asian population who experience higher prevalence and more rapid disease progression. This study aimed to compare the epidemiology and risk factors associated with CKDbetween rural and urban residents in Peshawar, Pakistan. Materials and methods A cross-sectional study involving adult patients with CKD was conducted at a public tertiary care hospital in Peshawar between July 2023 and January 2024. To collect data, a tool was developed based on existing literature. CKD was defined as follows: a low estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2, albuminuria (urine albumin-creatinine ratio >3 mg/mmol), or a combination of both low eGFR and albuminuria. The prevalence of moderate to severe CKD, adjusted for place of residence, was calculated. Statistical analysis was performed using SPSS Statistics V. 26 (IBM Corp., Armonk, NY). Results Among the study sample, 114 (41.45%) patients hailed fromrural areaswhile 161 (58.55%) resided in urban areas. Urban patients had a higher prevalence of albuminuria levels below 30 mg/g than rural patients (83.2% vs. 76.3%, p=0.00). Additionally, the mean eGFR was slightly higher among rural residents. Rural patients had a higher prevalence of hypertension, and there was a noticeable disparity in the occurrence of kidney stones, with rural residents experiencing a greater incidence. Patients living in urban areas showed a higher level of understanding of risk factors and reported taking preventive measures for CKD. Factors associated with moderate to severe CKD included living in urban areas and having a medical history of diabetes and hypertension (p=0.00). No significant association was observed between behavioral factors and the severity of CKD. Conclusions Urban residents exhibited higher rates of CKD and albuminuria and had a greater awareness of CKD risk factors. In contrast, rural areas had a slightly higher mean eGFR and greater prevalence of hypertension and kidney stones.Diabetes and hypertension were key predictors of moderate to severe CKD.

Assessment of Medication Adherence Using Malaysia Medication Adherence Assessment Tool in a Tertiary Care Hospital in Peshawar, Pakistan

Assessment of Medication Adherence Using Malaysia Medication Adherence Assessment Tool in a Tertiary Care Hospital in Peshawar, Pakistan

Assessment of Medication Adherence Using Malaysia Medication Adherence Assessment Tool in a Tertiary Care Hospital in Peshawar, Pakistan

Assessment of Medication Adherence Using Malaysia Medication Adherence Assessment Tool in a Tertiary Care Hospital in Peshawar, Pakistan

Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Hospital in Peshawar

OBJECTIVES To examine demographic characteristics, diagnosis on admission, and clinical outcomes in terms of morbidity and mortality of all those obstetric patients who were shifted to the Intensive care unit. METHODOLOGY This retrospective study was conducted in Gynae Unit A, Medical and Surgical intensive care units of Khyber Teaching Hospital Peshawar from 1st January 2021 to 31st December 2022. All the obstetric patients admitted to medical or surgical intensive care units were included, i.e., pregnant women or women admitted within six weeks after delivery to medical or surgical ICUs. Data about the patient’s demographics, obstetric/medical history, diagnosis on admission, reason for shifting to Intensive care units, course and treatment, ICU course, length of stay, outcome, and maternal mortality were obtained.RESULTSThe ICU admission rate of obstetric patients in the study period was 0.7%. The age group of 26-30 years was most commonly seen in our study, where 35(40%) of our cases fell, followed by the 21-25 age group (19.5%).27(31%) of our patients were primigravidas and 60(69%) were multigravidas.21(24%) were antenatal,65(75%) were postnatal and 1(1%) was ectopic. Postpartum hemorrhage was the most common indication(24%) for which patients were referred to the intensive care unit, followed by Eclampsia in 15(17%) and placenta accreta in 13(15%). Causes of mortality for the ICU admissions were shock and ARDS in 1(7%) each, DIC in 5(33%), and Cardiac arrest in 8(53%) cases. Fifteen patients expired in the intensive care unit during the study period, making the mortality rate 17%. CONCLUSION Strengthening critical care is important for saving the high-risk obstetric population. A structured ICU with an interdisciplinary approach is necessary to reduce high-risk obstetric mortality.

Association between Premenstrual Syndrome and Job Performance among Nurses Working in Tertiary Care Hospitals Peshawar

Background: The relationship between premenstrual syndrome (PMS) and job performance is a subject of growing interest, particularly in high-stress environments like critical care nursing. Premenstrual syndrome (PMS) can significantly affect the well-being of individuals, with potential implications for their daily functioning. Critical care nurses, tasked with demanding responsibilities, operate in a high-pressure environment where job performance is of utmost importance. Understanding the potential association between PMS and the job performance of these nurses at tertiary care hospitals in Peshawar is essential to enhance both the nurses' working conditions and the quality of care they provide to patients. Objective: The objective of the study was to find out the association between premenstrual syndrome and job performance among nurses working in tertiary care hospitals in Peshawar. Methods: A correlational study was conducted to achieve the objective. A well-validated questionnaire tool and purposive sampling technique were employed. The total population for this study was 346 nurses from three tertiary care hospitals in Peshawar: 240 participants from Lady Reading Hospital (LRH), 58 from Khyber Teaching Hospital (KTH), and 48 from Hayatabad Medical Complex (HMC). The sample size was calculated using Rao soft software, resulting in a required sample size of 183. Accordingly, 127 participants were selected from LRH, 31 from KTH, and 25 from HMC. Data collection tools included demographic information, general knowledge, menstrual characteristics, symptoms during premenstrual syndrome (PMS), and job performance assessments. Data analysis involved calculating frequencies, percentages, means, and standard deviations using SPSS version 25.0. Pearson correlation tests were used to examine the association between PMS and job performance, with graphical representations for descriptive statistics. Ethical approval was obtained from relevant authorities, and the study adhered to the Declaration of Helsinki principles. Results: The majority of participants were in the age range of 26 to 30 years (55.7%). There was a statistically significant positive correlation between PMS and job performance (r=0.298, p&lt;0.01). The correlation analysis also showed a significant negative correlation between PMS and marital status (r=0.191, p=0.01). The sample consisted predominantly of nurses with post-RN qualifications (48.6%), and 60.1% were unmarried. The findings suggest that as PMS symptoms increase, job performance tends to decrease. Conclusion: This study delved into the association between Premenstrual Syndrome (PMS) and job performance among critical care nurses, revealing a significant relationship between the two. The findings underscore the importance of recognizing the potential impact of PMS on the professional lives of critical care nurses and highlight the need for further attention and support in this regard. As healthcare institutions strive to optimize the well-being and productivity of their nursing staff, this study adds a crucial dimension to understanding the factors influencing job performance. Interventions and strategies can be tailored to address the challenges posed by PMS, ultimately fostering a more conducive work environment and enhancing the overall quality of patient care.

Prevalence and Association of Risk Factors for Plantar Fasciitis Among Nurses in Government Tertiary Care Hospitals of Peshawar

Background: Plantar fasciitis is a common cause of heel discomfort and pain, resulting from inflammation of the plantar fascia, a thickened fibrous aponeurosis extending from the medial calcaneal tuberosity to the metatarsal heads. It affects more than 1 million people worldwide annually, with a lifetime prevalence that may reach 10% of the general population. Despite its widespread impact, the exact incidence remains unknown. Objective: This study aimed to determine the prevalence and associated risk factors of plantar fasciitis among nurses working in government tertiary care hospitals in Peshawar. Methods: A cross-sectional survey was conducted over six months, utilizing a convenient sampling technique. A total of 332 female nurses aged 25 to 50 years with clinical duties exceeding five hours per day participated in the study. Data were collected using the Plantar Fasciitis Pain and Disability Scale and the Visual Analogue Scale (VAS) for pain intensity. Face-to-face interviews and physical assessments were conducted by trained healthcare professionals. Statistical analysis was performed using SPSS version 25.0, with descriptive statistics calculated for quantitative variables and Chi-Square tests used to examine associations between variables. Ethical approval was obtained from the Institutional Review Board, and informed consent was secured from all participants. Results: The mean age of participants was 29.8042 ± 3.67743 years. The mean total score for plantar fasciitis was 31.4096, and the mean VAS score was 1.9458. Pain occurrence per week was reported as 1-2 days by 44.0% of participants, 3-4 days by 46.7%, and 5-7 days by 9.3%. Pain was most commonly worse in the afternoon (35.8%) and interfered with walking occasionally (52.7%). High heel standing was uncomfortable for 54.5% of participants. A significant relationship was found between age and VAS scores (p=0.001), as well as between high heel usage and increased pain levels (p=0.000). Conclusion: The mean score of plantar fasciitis among the nurses was below the threshold indicating significant prevalence. However, a significant association was found between high heel usage and plantar fasciitis, suggesting that footwear choices play a critical role in the development of this condition. Ergonomic interventions promoting supportive footwear and regular breaks are recommended to mitigate the risk of plantar fasciitis among nurses.

Antimicrobial Resistance and Associated Risk Factors for Clostridium difficile in Patients Attending Tertiary Care Settings.

To determine the incidence of antimicrobial-resistant emerging pathogens, Clostridium difficile, and its associated risk factors in tertiary care setups of Pakistan. This cross-sectional prospective study was conducted from January 2019 to December 2020, to determine the prevalence and antimicrobial resistance patterns of C. difficile strains isolated from 450 stool specimens of patients suffering from diarrhea hospitalized in tertiary care hospitals in Peshawar, Pakistan. The stool samples of the patients were processed for culture and detection of toxin A and toxin B by enzyme-linked immunosorbent assay (ELISA) and tpi PCR. The drug sensitivity test was performed for antibiotics including ampicillin, cefixime, cefepime, amoxicillin, nalidixic acid, sulpha/TMP (SXT), chloramphenicol, metronidazole, vancomycin, ciprofloxacin, levofloxacin, and imipenem. Of 450 stool specimens, 108 (24%) were positive for C. difficile by stool culture, whereas 115 (25.5%) were only positive for C. difficile toxins based on ELISA and PCR (128 (28.6%). Of 108, 90.7% (n = 98) isolates were resistant to one antibiotic, and 90 (83.4%) were resistant to three or more antimicrobials. The highest resistance rates were found against penicillin (83.3%) followed by amoxicillin (70%), nalidixic acid (61%), and metronidazole (38%), and the lowest resistance was found against vancomycin (6.4%) and imipenem (3.7%). CDI was statistically significantly correlated with increased age, use of antibiotics, abdominal surgeries, use of proton pump inhibitors and H2a, and presence of comorbidities. The high frequency of C. difficile in Peshawar, Pakistan, indicates that CDI is an important nosocomial infection in different hospitals. The results will be helpful for clinicians to redesign control and therapeutic strategies in hospitals.

EFFECT OF DAPAGLIFLOZIN ON CARDIOVASCULAR OUTCOMES IN HFREF PATIENTS: IMPACT OF DIABETES MELLITUS TYPE 2 STATUS

Dapagliflozin has shown promise in the treatment of heart failure with reduced ejection fraction (HFrEF), but its effects in patients with and without diabetes remain unclear. Objective: This study aimed to assess the effects of dapagliflozin in HFrEF patients, both with and without diabetes. Methods: From January to July 2023, a six-month case-control study was conducted in the cardiology department of a Tertiary Care Hospital in Peshawar, Pakistan. All patients received an additional dose of dapagliflozin (10 mg) alongside their usual treatment plans. The primary outcome was a composite of heart failure exacerbation or cardiovascular death. Data analysis was performed using SPSS version 22. Results: Patients with diabetes mellitus type 2 (DMT2) exhibited a higher rate of cardiovascular death (22%) and hospitalization for heart failure (14.4%) compared to those without diabetes. The hospitalisation rate for heart failure was also higher in the DMT2 group (12.21%) than in the non-diabetic group (8.6%). Over the trial period, cardiovascular death occurred in 12.44% of patients with DMT2 compared to 7.30% in those without DMT2. Patients with diabetes experienced a significantly higher number of first and recurrent hospitalizations for heart failure and cardiovascular death compared to those without diabetes (32.45% vs. 19.20%, p=0.021). Conclusion: Dapagliflozin therapy in HFrEF patients demonstrated varying effects between those with and without diabetes. The study underscores the importance of personalised management strategies considering comorbid medical conditions. Despite dapagliflozin treatment, patients with both heart failure and diabetes continued to experience cardiovascular complications, highlighting the need for individualised treatment plans that account for a patient's complete medical profile.

Insights into Standard Precaution Knowledge and Adherence among Healthcare Workers: Evidence from Tertiary Care Hospitals in Peshawar, Pakistan

Healthcare workers (HCWs) are at risk of being exposed to blood-borne infections when performing clinical activities, hence conventional measures must be followed. The study conducted in Peshawar was motivated by the inadequate adherence to standards in Pakistan. Objective: To evaluate tertiary care hospitals' healthcare workers' (HCWs) awareness of and adherence to standard precautions. Methods: Over the course of six months, 421 HCWs employed in a variety of public and commercial tertiary healthcare settings in Peshawar, Pakistan, participated in cross-sectional research. Convenient sampling was employed in the selection of participants. Three portions of a standardized questionnaire addressing adherence, knowledge, and demographics were administered. For data analysis SPSS version 27® was used, evaluating adherence and knowledge using scoring methods. Results: The majority of participants (78.1%) were new in their areas, and 68.2% had completed standard precautions training. Although the majority of healthcare workers (HCWs) showed high understanding (67.46%), there were still significant gaps in their knowledge, especially when it came to false beliefs about HIV and Hepatitis patient care. However, there was excellent adherence, particularly for trash disposal (73.6%) and hand hygiene (91.4%). When it came to knowledge and adherence, doctors outperformed lab technicians and nurses. Conclusions: Despite knowledge limitations, healthcare workers (HCWs) in Peshawar displayed outstanding adherence to basic procedures, going beyond theoretical comprehension. This underscores the importance of practical implementation in healthcare settings.

Abstract LB290: Whole exome analysis of oral squamous cell carcinoma in local patients at tertiary care hospitals in Peshawar, Pakistan

Abstract The Precision Medicine Lab (PML) has been mandated by the Federal Government in 2018 to pilot precision medicine in Pakistan using genomics in oral cancer. With the Indian subcontinent as its capital, oral squamous cell carcinoma (OSCC), also dubbed as ‘poor man’s cancer', constitutes 90% of all head and neck cancers and is the highest incidence cancer found in Pakistani males. Backed by a bio-repository of clinical samples as well as a catalogue of primary cell clines, PML takes a multi-omic approach to discovering new, actionable biomarkers for diagnostic, prognostic and therapeutic applications. With all necessary ethical approvals obtained from IRBs at each site along with written informed consent from each patient, treatment-naive biopsy-confirmed patients of OSCC were recruited in two main tertiary care hospitals in Peshawar, Pakistan. Our cohort was predominantly older with 37.84% between 41-60 years, late-stage with 78.46% presenting in stage IV and self-reportedly non-alcohol consuming (96.9%). About 44.6% reported the use of smokeless tobacco while 30.8% reported the use of both smoked and smokeless tobacco. Majority of the tumours were located in the buccal mucosa (29.2%), alveolar region (27.7%) or the vestibular region (24.6%). We obtained blood and tumour samples for matched-pair whole exome sequencing, transcriptomics and metabolomics as well as generation of primary cell lines. We also obtained saliva samples for oral microbiome analysis. Combined with the patient’s clinical history and digital histopathology images, this helps us create a multi-omic stack that we intend to make available for integrated machine learning experiments. With our whole exome sequencing now complete, we undertook a preliminary analysis for this late breaking abstract. Raw reads were aligned to the GRCh38.p14 reference genome and were called for germline and somatic SNPs and INDELs using GATK (v4.5). Mutational analysis was conducted using the maftools (v2.18.0) package in R (v4.3) by comparing against the COSMIC SBS Signature database (v3.2). We report MUC12 (100%), ZNF717 (100%), FOLR3 (86%), EPPK1 (79%) and SPATA31A6 (79%) as the top mutated genes in the subset of exomes analysed thus far for our cohort. Genes reported previously including TP53, NOTCH1 and PIK3CA appear to rank lower on the list. In terms of cancer-related pathways, RTK-RAS (92.8%), Hippo (92.8%) and Notch (78.5%) were affected in most of the samples. To our knowledge, we describe for the first time the mutational landscape in an OSCC cohort from the Pakistani population. We also go beyond whole exomes as our multi-omic approach offers the potential on machine learning experiments to identify putative mutational signatures and biomarkers for OSCC that can be of diagnostic, prognostic and therapeutic value to the local (Pakistani and Afghan) patient population. With the availability of primary cell lines for every patient, we also intend to undertake experimental validation of high priority targets using primary patient-derived cell lines in the lab. Citation Format: Hina Zamir, Khudeja Salim, Madina Sherdil, Aqsa Hussain, Yusra Ilyas, Arsalan Riaz, Momal Agha, Zainab Jahan, Khadim Shah, Yasir Rehman Khattak, Fahim Uddin, Zahid Qayyum Shah, Zubair Durrani, Muhammad Mushtaq Khattak, Johar Ali, Faisal F. Khan. Whole exome analysis of oral squamous cell carcinoma in local patients at tertiary care hospitals in Peshawar, Pakistan [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 2 (Late-Breaking, Clinical Trial, and Invited Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(7_Suppl):Abstract nr LB290.

Comprehensive Analysis of Salmonella Species Antibiogram and Evolving Patterns in Empirical Therapy: Insights From Tertiary Care Hospitals in Peshawar, Pakistan.

Background Typhoid fever presents a significant challenge in developing nations, exacerbated by the emergence of antibiotic-resistant strains due to widespread prevalence and overuse of antibiotics. This study seeks to assess the antibiogram profiles of Salmonella species isolated from blood cultures of patients hospitalized at two prominent tertiary care hospitals in Peshawar, Pakistan: Khyber Teaching Hospital (KTH) and Hayatabad Medical Complex (HMC). By examining these profiles, the research aims to provide valuable insights into the evolving landscape of antibiotic resistance in the context of typhoid fever management. Materials and Methods This retrospective cross-sectional study utilized data gathered from two hospitals in Peshawar, KTHandHMC. Cases of enteric fever were identified based on positive blood cultures for Salmonella species. The study encompasses demographic information, seasonal prevalence, and antibiogram profiles of 3,137 cases that were presented between 2017 and 2023. Results Among the total 3,137 cases, males accounted for the majority, comprising 63% (2,044 cases). Particularly notable was the clustering of cases among children and adolescents aged one to 24 years. The incidence peaked during the months of summer and spring, from April to September. In terms of Salmonella Typhi isolates, considerable resistance was noted against first-line antibiotics such as amoxicillin/clavulanate (80.1%), co-trimoxazole/trimethoprim-sulfamethoxazole (66.6%), and chloramphenicol (86.9%), as well as against ceftriaxone (79.7%) and ciprofloxacin (51.6%). Conversely, certain antibiotics displayed higher sensitivity patterns, including meropenem (97.8%), doripenem (99.5%), imipenem (97.7%), ertapenem (96.5%), polymyxin B (99.4%), colistin (98.1%), and tigecycline (97.3%). Despite a limited sample size of 214 specimens, fosfomycin demonstrated a remarkable sensitivity of 93.4%. Sensitivities of amikacin and gentamicin were 90.7% and 81.5%, respectively. However, the sensitivity of azithromycin was concerning, standing at 66.5%. The antibiogram pattern for Salmonella exhibited significant and drastic changes. Conclusion In conclusion, this study sheds light on a higher prevalence of typhoid fever among males, with a notable seasonal peak observed during the summer and spring months. The age group most affected spans from one to 24 years. Salmonella isolates displayed significant resistance to conventional first-line antibiotics, alongside ciprofloxacin and third-generation cephalosporins. Azithromycin exhibited lower sensitivity compared to amikacin, gentamicin, and fosfomycin. The research advocates for the empirical use of amikacin, gentamicin, fosfomycin, and meropenem in the treatment of typhoid fever in Pakistan. Urgent measures, including regular Salmonella antibiogram surveillance, antibiotic stewardship, public health education, and Salmonella vaccination programs, are deemed crucial for primary disease prevention.

AWARENESS, UTILIZATION, AND SATISFACTION OF SEHAT CARD PLUS AT A TERTIARY CARE HOSPITAL IN KHYBER PAKHTUNKHWA: A CROSS-SECTIONAL STUDY

Over 930 million individuals worldwide face significant financial barriers when seeking essential healthcare services, with more than 100 million people annually being pushed into extreme poverty due to healthcare expenses. The main objective of this study is to find the awareness, utilization, and satisfaction of Sehat Card Plus at a tertiary care hospital in Khyber Pakhtunkhwa. This cross-sectional study was conducted at a private tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, from August 2022 to January 2023. The study included 463 patients visiting the tertiary care hospital. A structured questionnaire was developed to gather data on participants' awareness of the Sehat Card Plus program, their utilization of the card for healthcare services, and their satisfaction with its benefits and coverage. Data was collected from 463 patients. The mean age was 42±11.5 years, with 45% female and 55% male participants. Socioeconomic status analysis revealed that 67% of participants belonged to low-income households, while 17% were classified as middle-income and 16% as high-income. 82% of respondents were aware of the Sehat Card Plus program, with television/radio being the most common source of awareness (33%), followed by word of mouth (29%) and social media (27%). However, only 73% knew who was eligible for the program, and 53% knew the services covered. It is concluded that awareness of the Sehat Card Plus program is notable, but substantial gaps exist in understanding eligibility criteria and covered services among participants. Satisfaction with services under this program is moderately high, and the population has a significant demand for the government to introduce similar schemes.

Nurses Knowledge regarding Blood transfusion in Hayatabad Medical Complex, Peshawar

Background: Blood transfusion is a critical and life-saving procedure in medical practice, necessitating high levels of knowledge and competency among healthcare providers, particularly nurses, to ensure patient safety and minimize risks associated with transfusion. Despite its importance, gaps in knowledge and training among nursing professionals can significantly impact the quality of care and patient outcomes. Objective: This study aimed to assess the knowledge of nurses regarding blood transfusion practices at a tertiary care hospital in Peshawar and to identify educational gaps that could be addressed to improve the safety and efficacy of transfusion services. Methods: A cross-sectional descriptive study was conducted among Registered Nurses working at Hayatabad Medical Complex, Peshawar. A total of 206 nurses were recruited using convenience sampling. The blood transfusion knowledge questionnaire, adapted from previous studies with modifications to include demographic questions and specific queries related to blood transfusion, was used for data collection. Statistical analysis was performed using SPSS version 25, focusing on calculating means, standard deviations, frequencies, and percentages. Results: The study found that 63.60% of the participants were female, and the majority (52.4%) were aged between 31 to 40 years. Regarding blood transfusion practices, 89.3% correctly identified the use of a blood transport box for transporting blood from the blood bank to the ward. Furthermore, 90.77% acknowledged checking the details on the bag label and blood request form as the first step in collecting a blood bag. However, the study highlighted a moderate level of overall knowledge about blood transfusion among nurses, with significant gaps in training and education noted. Conclusion: The findings suggest that while nurses at the tertiary care hospital in Peshawar have a reasonable understanding of some aspects of blood transfusion practices, there is a clear need for enhanced training programs and the inclusion of comprehensive transfusion medicine education in nursing curricula. Addressing these gaps is essential for improving patient safety and the overall quality of care in transfusion services.

Knowledge of Nurses Regarding Palliative Care in Tertiary Care Hospitals of Peshawar: A Cross-Sectional Study

Background: Palliative care represents a crucial element in enhancing the quality of life for patients facing life-limiting illnesses. Despite its importance, there exists a significant gap in knowledge among nurses, who are pivotal in delivering this care. The literature reveals diverse levels of understanding and practices across different healthcare settings globally, underscoring the need for focused research and educational interventions in specific regions, including Pakistan. Objective: This study aimed to assess the knowledge of nurses regarding palliative care in tertiary care hospitals in Peshawar, Pakistan, identifying key areas for improvement and contributing to the global discourse on enhancing palliative care education and practices among nursing professionals. Methods: A cross-sectional study design was employed, with a sample size of 377 nurses selected through convenient sampling from August to November 2023. The Palliative Care Quiz for Nurses (PCQN) was utilized to assess knowledge across three domains: philosophy and principles, control of pain and other symptoms, and psychosocial aspects. Data were analyzed using SPSS version 25, employing descriptive statistics and chi-square tests to examine the association between demographic variables and knowledge levels. Results: The study found that 61.3% of participants were female, with the majority (81.5%) born between 1991 and 2000. Regarding educational background, 53.3% were Post RN nurses, 45.6% BSN Graduate Nurses, and 1.1% MSN Graduate Nurses. The PCQN results indicated that 31.8% of nurses demonstrated good knowledge of palliative care, while 37.7% exhibited a lack of knowledge. Notably, post RN nurses showed higher knowledge levels compared to their BSN and MSN counterparts. Conclusion: The findings highlight a substantial need for targeted palliative care education and training among nurses in Peshawar, Pakistan. Tailored educational programs, continuous professional development, and specific interventions are essential to bridge the identified knowledge gaps, ensuring that nurses are equipped to provide high-quality palliative care.

A Comparative Study of Doctors and Nurses Regarding the Knowledge, Attitude and Practice of Basic Life Support in Tertiary Care Hospitals of Peshawar

Background: Basic Life Support (BLS) is a critical skill set for healthcare providers, enabling them to offer immediate assistance in cardiac emergencies. In Peshawar, Pakistan, the knowledge, attitude, and practice of BLS among doctors and nurses in tertiary care hospitals have not been extensively studied, despite the region's significant healthcare demands. Understanding these aspects can inform targeted improvements in BLS training and preparedness. Objective: This study aimed to evaluate and compare the knowledge, attitudes, and practices regarding BLS among doctors and nurses working in tertiary care hospitals in Peshawar, identifying gaps and areas for enhancement. Methods: A comparative cross-sectional study was conducted from July to October 2023. The sample comprised 249 healthcare professionals (102 doctors and 147 nurses) selected through convenience sampling. Participants were assessed using a validated questionnaire adapted from previous research, covering demographics, knowledge, attitude, and practice related to BLS. Data analysis utilized SPSS version 27, with descriptive statistics summarizing demographics, and inferential statistics (independent samples T-test) examining associations between knowledge levels and demographic variables. Results: The majority of participants were aged 26 to 30 years (47.4%), with nurses representing 59% of the sample. Knowledge assessment showed that 86.3% correctly identified the BLS abbreviation, but only 10.8% knew the correct first response for an unresponsive individual on the road. About 33.3% of participants displayed poor knowledge, with 49.0% demonstrating average knowledge. In practice scenarios, 56.2% exhibited poor practice. No significant differences were found in knowledge and practice based on gender or experience. Conclusion: The study highlights significant gaps in BLS knowledge and practice among healthcare providers in Peshawar's tertiary care hospitals, despite generally positive attitudes towards BLS. The findings underscore the need for enhanced BLS training programs, emphasizing practical skills and regular updates to guidelines. Addressing these educational gaps is crucial for improving patient outcomes in cardiac emergencies.