Care Hospitals Of Rawalpindi Research Articles

Acceptance Towards COVID-19 Vaccination in Breast Cancer Patients: An Analytical Cross-Sectional Study in A Tertiary Care Hospital of Rawalpindi, Pakistan

Objective: To determine the level of COVID-19 vaccine acceptance among patients diagnosed with breast cancer. Study Design: Analytical cross-sectional. Place and Duration of Study: The study was conducted in Breast Cancer Outpatient Department located in a tertiary care hospital in Rawalpindi, Pakistan from Nov 2021 to Jul 2022. Methodology: Validated questionnaire was used to collect data from patients diagnosed with breast cancer. Sample size of n=134 was attained using non-probability consecutive sampling. Data was analyzed using SPSS version 22. A p-value of <0.05 was taken as significant. Outcome assessed was whether breast cancer patient’s personal level of knowledge, mindset, motivation, and concerns towards getting about COVID-19 vaccination helped or hindered their acceptance of COVID-19 vaccination. Results: COVID-19 vaccine acceptance was found among 124(92.5%) breast cancer patients. Social media and means of mass communication such as television were significant sources of information for COVID-19 related vaccine information (p<0.05). A strong positive correlation was found between Total Vaccine Acceptance Score with domains of Knowledge (r=0.353, p<0.000), Mindset (r=0.662, p< 0.000), Motivation (r=0.780, p< 0.000) and Concerns (r=0.800, p< 0.000). Higher awareness with positive motivators and mindset of participants lead to greater acceptance of COVID-19 vaccines despite breast cancer diagnosis. Conclusion: High vaccine acceptance was found among breast cancer patients. High scores of COVID-19 disease knowledge, positive mindset and high motivation towards COVID-19 vaccines leading to a higher overall vaccine acceptance.

Sugar Sweetened Beverages (SSBs)-Awareness, Intention and Self-Efficacy Among Low-Income Adults in a Tertiary Care Setting

Objective: To assess the awareness, self-efficacy and intention of Sugar Sweetened Beverages (SSBs) among low-income staff members of a tertiary care hospital. Study Design: Cross sectional analytic study. Place and Duration of Study: Tertiary care hospital in Rawalpindi Pakistan, for 4 months, from May to Aug 2022. Methodology: The research was conducted among low-income urban adults of a tertiary care hospital in Rawalpindi Pakistan.A non-probability purposive sampling technique was used to select a sample of 200 participants. After taking informed consent the data was collected using a validated questionnaire to assess the SSB-related awareness, self-efficacy and intention.The association between SSB-related constructs and demographic factors was analyzed by using chi-square test and a p-valueof ≤ 0.05 was considered as significant. Results: The mean age of the participants was 21(SD=2.9). Majority 124(62%) of the participants were male, while almost two third 150(75%) had a higher secondary education. Remarkably participants had good SSBs related awareness 170(85%), selfefficacy 151(75.5%) and intention 177(88.5%). Whereas 60(30%) of the participants rarely using sugary drinks, comprised of 35(58.3%) females and 25(41.7%) males. However, association between these two variables was statistically significant (p=0.001). Association analysis between sociodemographic with SSB-related constructs, reported significant association between awareness with employment status (p-value=0.05) and self-rated health status (p-value=0.001). Conclusion: The current study concluded that despite less education level and monthly income. Majority of the participants consumed sugary drinks once weekly but not daily with good awareness, self-efficacy and intention, whereas no significant association was evident between gender and SSBs related awareness, self-efficacy and intention.

Evaluation of new-onset BK viruria in post-renal transplant recipients by quantitative PCR

BackgroundThe BK polyomavirus infection poses a substantial challenge for organ transplant recipients due to immunosuppression, resulting in BK virus-associated nephropathy (BKVAN) and a considerable risk of graft loss. Screening and prompt decrease of immunosuppression are essential for averting these consequences. We examined the frequency of BK viruria (viral load in urine) among post-renal transplant recipients, along with its association with age, viral load, and the timing of viral reactivation. MethodsThe prospective cohort study was conducted at the Tertiary Care Hospital in Rawalpindi over a 12-month period, from January 1 to December 31, 2023. Urine specimens from 108 renal transplant recipients were collected and analysed for BK viruria every three months during the follow-up assessments. DNA extraction was performed using TANbead extractor, and amplification was carried out with Bio-Rad CFX-96 thermal cycler using Sacace TM amplification kit. Data was analysed using SPSS version 27. ResultsIn the cohort of 108 renal transplant recipients, BK viruria was detected in 16.7 % of cases. There was a higher prevalence of BK viruria in females (20 %) than males (16 %). The majority of positive cases were within the 41–60 years age group (61.1 %). Most of the patients (66.6 %) had viral loads below 1 million copies/ml. BK viruria was predominantly detected during the third quarter (between 7 and 9 months) post-transplant. The Chi-square test was applied between age and viral load, showing a significant association (p = 0.01). Similarly, gender and viral load also showed a significant relationship (p = 0.019). ConclusionThe study showed the frequency of 16.7 % of BK viruria in our small cohort after renal transplantation during the initial 12 months post-transplant. Age of recipients correlated with viral load and time of viral reactivation: middle-aged recipients had higher viral loads. BK viruria increased progressively over the initial nine months, with peak incidence in the third quarter post-transplant.

Revealing ferritin's significance: A prognostic marker in COVID-19 at a tertiary care hospital in Rawalpindi

Amid the global COVID-19 crisis with over 762 million cases by 2023, reaching 775 million by 2024, this study examines the critical role of ferritin in diagnosing and managing COVID-19, emphasizing its correlation with disease severity and patient outcomes, especially in Pakistan, where data is scarce. At Benazir Bhutto Hospital in Rawalpindi, this study analyzed medical records of 376 COVID-19 patients aged 25-87 between April 2020 to August 2021, categorizing them by severity. Biochemical parameters, as well as ferritin, AST, ALT, urea, creatinine, and LDH, be assessed using Beckman Coulter AU480, with group differences analyzed via nonparametric tests and SPSS 25. Among 376 patients, predominantly aged 45-65 with a male majority (56.6%), 88.2% had comorbidities and 34.8% deceased during hospitalization. Elevated levels of ferritin, AST, urea, creatinine, and LDH were strongly linked to mortality (p < 0.001). The patients in the 66-90 age group had significantly increased risk of death from COVID-19 than those aged 45-65, by an adjusted odds ratio (AOR = 4.973; 95% CI: 2.517, 9.826; p = 0.0001). Additionally, individuals in the upper ferritin tertile were more susceptible to death, with an AOR of 3.443(95% CI: 2.012, 5.892; p = 0.0001) in contrast to those in middle and lower ferritin tertiles. These findings underscore the predictive value of age and ferritin levels in COVID-19 mortality. Increased ferritin levels stand out as a vital indicator, along with age, for forecasting mortality in COVID-19 patients, highlighting the pressing need for prompt intervention and customized treatment approaches.

Respiratory viral infections in bone marrow transplant patients: insights from a tertiary care hospital in Rawalpindi, Pakistan.

To determine the incidence of respiratory viral infections in bone marrow transplant patients. The prospective, descriptive, cross-sectional study was conducted at a tertiary care hospital in Rawalpindi, Pakistan, from September 2019 to August 2020, and comprised respiratory specimens from recipients of haematopoietic stem cell transplant. The specimens were collected in viral transport medium, and were then taken to the Department of Virology. Multiplex polymerase chain reaction was performed on the specimens to ascertain the incidence and prevalence of respiratory viruses. Data was analysed using SPSS 24. Of the 85 subjects, 53(62.35%) were males and 32(37.65%) were females. The overall median age was 20.0 years (interquartile range: 11.0-32.0 years). Respiratory viral infections were detected in 31(36.4%) specimens. Among them, human rhinovirus was detected in 12(38.7%) cases, respiratory syncytial virus in 5(16.1%), influenza A/H3 in 4(13%), human parainfluenza virus-1 in 3(9.7%), adenovirus in 2(6.4%), human parainfluenza virus-3 in 1(3.2%), human parainfluenza virus-4 in 1(3.2%) and human metapneumovirus in 1(3.2%) case. There were 2(6.4%) cases of co-infection. More than one-third recipients of haematopoietic stem cell transplant were found to have respiratory viral infections, highlighting the importance of employing multiplex respiratory polymerase chain reaction in early diagnosis and treatment of such infections.

Evaluation of Awareness levels about foot care and its impact on foot care practices among Diabetic Individuals in Pakistan

Background: This research covers a very important topic in today’s time, diabetic foot care. To prevent its complications, an in depth understanding of awareness levels and practices about foot care among diabetic individuals is very important. Aim: To assess awareness levels about foot care and its impact on foot care practices among diabetic individuals. Methods: The population of the study was composed of the diabetic patients coming to outpatient departments in a tertiary care hospital in Rawalpindi. The study was carried out over a period of 6 months from January 2024 to June 2024. The participants were enrolled through non-probability convenience sampling. 266 diabetic patients participated in the research who met the inclusion criteria. Data was collected by using a structured questionnaire. Results: A total of 266 valid responses were received that were analyzed using SPSS v25, out of which 124 (46.6%) are males and 142 (53.4%) are females. The analysis showed that there is a weak positive correlation between the total knowledge and total practice scores of 0.174 (p value 0.004). Conclusion: Older patients, male population, patients with other chronic diseases, patients who received a formal education about diabetes foot complications, and patients having diabetes for more than 20 years show greater knowledge and better practice to protect from diabetic foot complications. It is imperative to inform people with diabetes that proper foot care is crucial in preventing the formation of wounds. Keywords: Diabetes Mellitus, Diabetic Foot, Chronic diseases, foot care practices

Correlation and Diagnostic Agreement Between Ultrasonography and MRCP in Evaluating Obstructive Jaundice: A Prospective Study

Background: Obstructive jaundice is a clinical condition characterized by the yellow discoloration of the skin, sclera, and mucous membranes due to elevated bilirubin levels caused by bile flow obstruction. Accurate diagnosis of the obstruction's cause and site is essential for effective management. Ultrasonography (USG) is commonly used for initial screening, but it has limitations, especially in visualizing the distal common bile duct (CBD). Magnetic resonance cholangiopancreatography (MRCP) has emerged as a superior, non-invasive imaging modality with higher accuracy in evaluating biliary obstructions. Objective: To evaluate the correlation and agreement between USG and MRCP findings in patients with obstructive jaundice and to determine the diagnostic accuracy of each modality in detecting the level and cause of biliary obstruction. Methods: This prospective cohort study was conducted over six months at a tertiary care hospital in Rawalpindi. A total of 32 patients with clinical suspicion of obstructive jaundice were included. Each patient underwent both USG and MRCP. USG was performed using a GE Logiq-e machine, followed by MRCP on a Philips Achieva 1.5 Tesla MRI scanner. Data were analyzed using SPSS version 25. Pearson's correlation coefficient and kappa statistics were used to assess the correlation and agreement between the two modalities. The diagnostic accuracy of USG and MRCP was compared based on the detection of the level of obstruction and the identification of benign and malignant etiologies. Results: The mean age of the patients was 59.53 ± 13.41 years, with 65.6% being male. MRCP showed a diagnostic accuracy of 97.2% compared to 78.1% for USG. MRCP detected distal CBD calculi with 100% accuracy, while USG missed these in 11 cases. A positive correlation was found between USG and MRCP in detecting the site of obstruction (r = 0.48, p = 0.005), the porta hepatis as the site of obstruction (r = 0.47, p = 0.006), and the ampulla as the site of obstruction (r = 0.47, p = 0.006). However, the correlation for benign etiologies was weak (r = 0.094, p = 0.607), and for malignant etiologies, it was moderate (r = 0.31, p = 0.08). Conclusion: MRCP demonstrated superior diagnostic accuracy compared to USG in evaluating patients with obstructive jaundice, particularly in detecting distal CBD calculi and malignant lesions. While USG remains useful as an initial screening tool, MRCP should be considered the preferred imaging modality when detailed evaluation is required.

ASSESSMENT OF KNOWLEDGE AMONG SURGICAL NURSES REGARDING SURGICAL TIME OUT PROTOCOLS IN THE OPERATING ROOM AT TERTIARY HOSPITAL RAWALPINDI

Surgical Time Out protocols are pivotal for ensuring patient safety in operating rooms (ORs), designed to prevent surgical errors such as wrong-patient surgery and retained surgical instruments. Despite established protocols, adherence varies, with potentially fatal outcomes. Aim: The study aims to assess the knowledge and implementation of Surgical Time Out protocols among surgical nurses at a Tertiary Care Hospital in Rawalpindi, determining the impact on patient safety and surgical outcomes. Methods: We conducted a descriptive cross-sectional study involving 150 OR nurses selected through convenience sampling. A validated questionnaire was employed to collect data on the nurses' knowledge and application of Time Out protocols. Results: Results showed that 68% of nurses had adequate knowledge regarding Time Out protocols, recognizing their essential role in patient safety. Nevertheless, 32% had insufficient knowledge, which could compromise surgical safety. Conclusion: The study concludes that while a majority of nurses understand the importance of Surgical Time Out protocols, there is a significant portion who require further training. It emphasizes the necessity of regular, structured training programs to enhance adherence to Time Out protocols, thereby improving patient safety and reducing preventable surgical complications.

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan.

Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.

Bacterial profile, antimicrobial susceptibility pattern and associated risk factors of urinary tract infection among pregnant women attending tertiary care hospital in Rawalpindi

The study objective to enhance treatment effectiveness by assessing risk factors, bacterial profiles, and antimicrobial susceptibility of uropathogens in pregnant women. During the period from March 2023 to August 2023, we examined 210 urine samples obtained frompregnant women. The samples were subjected to uropathogens isolation, identification and susceptibility testing against thirteen antibiotic classes using the Kirby Bauer disk diffusion method, following standard procedures, to identify uropathogens in cases of significant bacteriuria. In our study there is no significant link found between age, educational level, socioeconomic status, and parity in relation to UTI during pregnancy. In 42% of the samples with significant bacteriuria, Escherichia coli emerged as the predominant uropathogens, followed by Pseudomonas aeruginosa, Staphylococcus saprophyticus, and Klebsiella pneumoniae, in that order. E. coli displayed the greatest resistance to ciprofloxacin and ceftazidime, yet demonstrated high susceptibility to meropenem, imipenem, fosfomycin,and amikacin. Furthermore, a significant portion of K. pneumonia isolates exhibited resistance to ceftazidime and ciprofloxacin. For S. saprophytic, resistance was observed against penicillin and gentamicin, although they displayed 100% sensitivity to vancomycin and 81.2% sensitivity to Nitrofurantoin. The current study findings revealed that factors influencing pregnant women's UTI risk, include age, literacy, residence, multigravida, multipara, infection history, and trimester status. Access to clean water sources also played a role, highlighting the importance of addressing these variables in maternal health toreduce UTI incidence. Screening antenatal patients for UTIs is imperative, and it is advisable to conduct regular screenings for pregnant women. This practice helps monitor uropathogens sensitivity patterns and facilitates the development of antibiotic protocols based on local susceptibility data.

Risk Factors of Postoperative Acute Heart Failure in Elderly Patients After Hip Fracture Surgery.

Background Postoperative acute heart failure (AHF) in elderly patients after hip fracture surgery is a common complication. Therefore, this study aimed to identify the risk factor of AHF after hip fracture surgery among the older population. Methods This retrospective cohort study was performed on 88 admitted patients whose hip fractures were fixed via internal fixation surgery in a tertiary care hospital in Rawalpindi, Pakistan, from January 2022 to March 2023. Recruitment of patients was made through established inclusion and exclusion criteria. Ethical approval and informed consent were also gained before the data collection. A self-designed form was used to collect data. Data analysis was carried out in the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were applied to compare the attributes of the patients with AHF and patients without AHF. Multivariate logistic regression was used to evaluate the association between the postoperative AHF and its potential risk factors. Results Out of 88 enrolled patients, 12 (13.64%) had developed postoperative AHF. Age ≥ 65 years (OR = 2.606, 95% CI = 1.035~4.160, p = 0.010), anemia (OR = 3.178, 95% CI = 1.847~5.990, p = 0.029), hypertension (OR = 2.019, 95% CI = 1.110~4.034, p = 0.012), diabetes mellitus (OR = 2.003, 95% CI = 1.115~4.012, p = 0.015), hypoalbuminemia (OR = 2.486, 95% CI = 1.218~4.619, p = 0.030), and operation time ≥ 120 minutes (OR = 1.702, 95% CI = 1.099~2.880, p = 0.018), were the risk factors of postoperative AHF in elderly patients after hip fracture surgery. Conclusions In the study population, the incidence of postoperative heart failure was significant and age ≥ 65 years, anemia, hypertension, diabetes mellitus, hypoalbuminemia, and operation time ≥ 120 were significantly involved in the development of it. Preoperative identification and management of AHF risk factors could lead to the prevention of postoperative complications.

Improving the Quality and Completeness of Discharge Summaries at a Tertiary Care Hospital in Pakistan: A Quality Improvement Project.

Introduction Discharge summaries (DS) allow continued patient care after being discharged from the hospital. Only a few quality improvement projects (QIPs) focused on assessing and improving the quality and completeness of DS at tertiary care hospitals have been undertaken in Pakistan. This QIPaimed to evaluate and enhance the quality and completeness of DS at a tertiary care hospital in Pakistan to facilitate seamless healthcare transitions. Methods A QIP was conducted in the medical unit of a tertiary care hospital in Rawalpindi, Pakistan. The DS were assessed using the e-discharge summary self-assessment checklist devised by the Royal College of Physicians (RCP). This QIP was done by the plan, do, study, act (PDSA) cycle. The PDSA cycle comprised two audit cycles and an intervention in between them. The first audit cycle (AC) was conducted on 150 DS. Its duration was from March 2023 to June 2023. An educational workshop was conducted before the re-audit cycle (RAC) to address deficiencies and reinforce the implementation of the guidelines provided by the RCP. The RAC was conductedfrom June 2023 to August 2023. 100 DS were studied and analyzed to assess for improvement in the completeness of DS. Frequencies and percentages were calculated in each audit cycle. The Chi-squared test was applied to compare the statistical difference between the results of both audit cycles. Results A total of 150 DS were analyzed in the first AC and 100 DS in the RAC. The results of the first AC show that the details of any allergies were recorded only in 3% of the DS; this percentage significantly improved to 51% after the RAC (p-value <0.05). Relevant past medical history was included in 52% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). Secondary diagnoses were written in 54% and 71% of the DS during the firstAC and RAC, respectively (p-value <0.05). Details of relevant investigations were included in 60% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). The post-discharge management plan was written in 90% and 98% of the DS during the first AC and RAC, respectively (p-value <0.05).The follow-up plan was written clearly in 65% and 93% of the DS during the first AC and RAC, respectively (p-value <0.05). Conclusion The DS was found to be incomplete after analyzing the results of the first AC. The details related to allergies, medications, operations, and procedures were found to be missing in the majority of the cases. No mention of the patient's concerns or expectations was made in the DS. The results of the RAC showed improvement in the level of completeness of DS. The majority of the weak points observed after the first AC seemed to haveimproved after the RAC, which shows that intervention proved to be quite effective in improving the completeness and quality of DS. The RAC showed significant improvement in the completeness of the details relating toinvestigations, allergies, past medical history, secondary diagnoses, and the post-discharge follow-up plan. QIP must be routinely carried out to assess and improve the completeness and quality of DS at hospitals.

Frequency of Needlestick and Sharp Injuries, Their Associated Risk Factors and Safety Measures among Healthcare Workers of Fauji Foundation Hospital, Rawalpindi

Background: Needlestick and sharp injuries (NSSIs) are significant occupational hazards for healthcare workers (HCWs), facilitating the transmission of bloodborne pathogens such as HIV, hepatitis B, and C viruses. Despite known risks, the frequency and associated factors contributing to these injuries in healthcare settings, particularly in developing countries, are not well-documented. Objective: This study aimed to determine the frequency of NSSIs, identify their associated risk factors, and evaluate the safety measures adopted by HCWs in a tertiary care hospital in Rawalpindi, Pakistan. Methods: A cross-sectional study was conducted from May to September 2022 at Fauji Foundation Hospital, Rawalpindi. A total of 250 HCWs, including paramedical staff, doctors, nurses, and allied health professionals, participated in the study. Ethical approval was obtained from the Center of Advanced Studies in Health and Technology research committee and the Head of the Department of Pathology. A structured questionnaire was developed to collect data on demographic characteristics, history of NSSIs, risk factors, and safety measures adopted post-injury. Data were analyzed using SPSS version 25, employing non-parametric tests due to the non-normal distribution of data. Results: Among the participants, 76.8% (n=192) reported experiencing NSSIs at least once during their employment. The highest incidence of NSSIs was observed among HCWs aged 26-30 years (31.6%, n=79) and those with 2-7 years of work experience (50.4%, n=126). The most common risk factors for NSSIs were heavy workload (40%) and recapping of needles (22%). Only 38% (n=95) of HCWs reported the incident, and 44% (n=111) were vaccinated against hepatitis B following exposure. Moreover, 58% (n=145) used personal protective equipment, and 73.6% (n=184) utilized safety boxes for sharp waste disposal post-injury. Conclusion: The study highlights a high prevalence of NSSIs among HCWs, with inadequate reporting and post-exposure prophylaxis. There is a critical need for enhanced training on safe handling of sharps and increased adherence to universal precautions to mitigate the risk of NSSIs in healthcare settings.

BIOFILLER VS PLATELET-RICH PLASMA MESOTHERAPY IN THE TREATMENT OF PERI-ORBITAL HYPERPIGMENTATION.

Peri orbital hyperpigmentation (POH) is a common presentation in dermatological outpatient departments and has multiple causes. Finding an appropriate treatment for POH can be challenging and requires a case-based approach. The objective of this research was to study the effect of Biofiller vs. PLATELET-RICH plasma meso-therapy in the treatment of Peri-orbital hyperpigmentation. Our hypothesis was "Biofillers are better than platelet-rich plasma therapy in the treatment of peri-orbital hyperpigmentation". It was a double-blinded randomized Control Trial (IRCT20230816059168N1) carried out in the Dermatology OPD of a tertiary care hospital in Rawalpindi over 4 months, i.e., 10.07.23 to 10.10.23. Forty-two patients meeting the inclusion criteria were included in the study after taking informed consent. Sampling was done by non-probability randomized sampling using the lottery method. 21 patients were treated with Bio fillers and another 21 with platelet-rich plasma therapy (PRP). Sessions with a 2-week interval were done in each case and results were analyzed by peri-orbital photo-metric pigmentation scale and clinical grading improvement scale rated by a physician. Patient satisfaction and complications were also recorded. Statistically significant difference in results of Group A as compared to Group B, regarding improvement in photo numeric scale, evaluation of efficacy by a blinded dermatologist and patient satisfaction, i.e., p= 0.001, 0.014 and 0.001 respectively. In group A, pain was reported by 3 (14.3%), bruising by 1 (4.76%) and lumps by 2 (9.5%). PRP treated group had more side effects, i.e., 9 (42.8%) reported pain, 6 (28.6%) bruising and 4 (19%) more than one complaint (p-0.001). Biofillers are better than PRP in the treatment of POH.

Emotional Intelligence and Psychological Adjustment among Doctors and Nurses in a Tertiary Care Hospital in Rawalpindi-Pakistan: A Cross Sectional Study

Objective: This study aimed to determine the relationship between EI and the quality of nursing care from the viewpoint of nurses and patients. Methods: This cross-sectional study was conducted at a public sector tertiary care hospital in Rawalpindi, Pakistan, over 6 months from November 2019 to April 2020. The convenience sampling technique was employed. The study groups were qualified practising doctors and nurses including nursing assistants and paramedics. Study groups were provided with a self-administered questionnaire that was filled out after getting consent from the study participants. Data analysis was done by entering it into SPSS version 22. The relationship between emotional intelligence and psychological adjustments among the two groups was assessed by applying an independent T-test. Results: The current study explored that doctors were emotionally intelligent and psychologically well-adjusted as compared to nurses. Females were more emotionally intelligent than males; however, males were better adjusted psychologically. Years of experience had no significant results between both groups, while there was a positive correlation between the department of practice and psychological well-being. Conclusions: It shows that harmonious work environments and friendly interpersonal relationships positively affect the well-being of HCWs and patients. What this indicates is a need to bring about changes within work environments to produce friendly interpersonal relationships and a positive impact on the well-being of HCWs and patients. Keywords: Emotional intelligence, Psychological adjustments, Nursing staff

Clinical and genetic attributes of congenital anomalies ascertained at a tertiary care hospital in Rawalpindi, Pakistan

Objective: Congenital anomalies (CA) or birth defects cause substantial healthcare burden in developing countries. There are few studies from Pakistan on the prevalence-pattern of CA. The purpose of this study was to determine the prevalence-pattern and genetic attributes of CA at a tertiary care facility in Rawalpindi, Pakistan.&#x0D; Methods: In a cross-sectional study design, patients with CA were ascertained from Pediatric and Neonatal Section of Holy Family Hospital, Rawalpindi from March-2022 to June-2022. International Classification of Diseases (ICD-10) and Online Mendelian Inheritance in Man (OMIM) databases were utilized for uniformity in classification. The pattern of CA as well as familial/sporadic nature, syndromic/isolated presentations, and prenatal consanguinity were estimated. Descriptive summaries were generated.&#x0D; Results: A total of 517 independent cases with certain types of CA were recruited. There were eight major and 70 minor categories. Among the major categories, neurological disorders (39.1%) were predominating followed by neuromuscular disorders (21.1%), limb defects (13.5%), musculoskeletal defects (7.4%), blood disorders (4.3%), orofacial defects (3.9%), metabolic disorders (3.7%), and Others (7.1%). The sporadic cases were in majority (72.5%) compared to familial cases (27.5%). Further, 63% patients had syndromic presentations and there were 37% cases with isolated appearances. A total of 70% cases had parental consanguinity.&#x0D; Conclusion: The majority of anomalies were of preventable nature and certain healthcare measures including antinatal care and counseling can be adopted to minimize their burden. Additionally, there is an urgent need to raise awareness of the negative consequences of consanguineous marriages, which constitute a significant risk factor in cases with inherited CA.&#x0D; doi: https://doi.org/10.12669/pjms.39.6.7408&#x0D; How to cite this: Shaheen F, Humayoon QS, Malik S, Mumtaz S. Clinical and genetic attributes of congenital anomalies ascertained at a tertiary care hospital in Rawalpindi, Pakistan. Pak J Med Sci. 2023;39(6):1673-1679. doi: https://doi.org/10.12669/pjms.39.6.7408&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Risk Stratification of Acute-Onset Chest Pain: SVEAT Score Versus HEART and TIMI Scores.

Introduction Acute chest pain is a frequently encountered symptom in the emergency department. Despite the availability of various chest pain risk scores, their effectiveness in identifying low-risk patients suitable for safe and early discharge is inadequate. Moreover, clinical data collected at the initial stage, which has valuable discriminatory ability, is often underutilized. This study aims to assess the effectiveness of the Symptoms, history of Vascular disease, ECG, Age, and Troponin I (SVEAT) score in predicting major adverse cardiovascular events (MACE) in acute-onset chest pain, compared with the pre-existing History, ECG, Age, Risk factors, and Troponin I (HEART) and Thrombolysis In Myocardial Infarction (TIMI) scores. Methodology This prospective study utilizing non-probability convenience sampling was conducted in the emergency medicine department of a tertiary care hospital in Rawalpindi,Pakistan, for a period of five months from July 2022 to November 2022. The study included patients aged >45 years who presented primarily with chest pain lasting for at least five minutes but less than 24 hours and with a lack of acute ECG changes indicative of ST-elevation acute coronary syndrome (STE-ACS). Patients who were hemodynamically unstable were excluded. All patients were assessed for the calculation of SVEAT, TIMI, and HEART scores. All patients were followed for a period of 30 days to assess the incidence of MACE. Results A total of 60 patients were included. The mean age was 61.5±9.1 years while 31 (51.7%) patients were females. Diabetes was the most prevalent comorbidity (n=32; 53.3%). Regarding MACE, nine (15%) patients developed ACS and underwent percutaneous coronary intervention (PCI). Two patients (3.3%) experienced heart failure. Six (10%) patients also underwent PCI in the absence of ACS while two (3.3%) patients developed sudden cardiac death. Area-under-curve (AUC) values were determined for SVEAT (0.843; 95%CI: 0.74-0.94), TIMI (0.742; 95%CI: 0.62-0.86), and HEART scores (0.840; 95%CI: 0.74-0.94). A cut-off level of 3.5 SVEAT points obtained a sensitivity of 63.2% and specificity of 75.6% in predicting 30-day MACE. Conclusion SVEAT score potentially lacks the appropriate sensitivity level to predict a significant number of major adverse cardiovascular events compared to contemporary risk stratification scores. Therefore, the SVEAT criteria need re-evaluation as a screening tool for risk assessment in acute chest pain.

Prevalence of Pancytopenia/ Bicytopenia in Pediatric Population and its Association with Etiology Based on Bone Marrow Findings

Background: An important clinico-haematological condition known as pancytopenia or bicytopenia is brought on by a multitude of disease processes that either directly or indirectly affect the bone marrow. Aim: To ascertain the prevalence of cytopenias in the pediatric population presenting to a tertiary care hospital in Rawalpindi and its correlation with age and gender distribution, clinical presentation, and aetiology. Study Design: Descriptive cross-sectional study. Methodology: It was a descriptive cross-sectional study carried out at Holy Family Hospital in Rawalpindi's hematology division. Using non-probability consecutive sampling, 253 individuals referred for bone marrow testing were included in the study, of which 108 patients had pancytopenia and 108 had bicytopenia. Data was gathered on the patient's mode of presentation, clinical examination, full blood counts, and bone marrow analysis. The data were analyzed using SPSS 22, and descriptive statistics were computed. Using chi-square test with a P value of 0.05 was taken as significant. Results: Bicytopenia was discovered in (133)52.6% of patients and pancytopenia in (120)47.4% of patients. 139 (55%) of the 253 instances involved men, while 114 (45%) were women. Fever 225 (89%), bleeding symptoms 52 (20.5%), and bruising 36 (14.2%) were the most frequent presenting complaints. The most frequent result on examination was pallor234, which was followed by hepatomegaly118 (46.64%) and splenomegaly114 (45.05%). In the total blood count, bicytopenia (133), 52.6%, and pancytopenia (120), 47.4%, were the most common findings. Practical Implication: There is scarcity of such data on paediatric patients, and to the best of our knowledge, no study has analysed the paediatric bicytopenic / pancytopenic patient in our centre. Thus present study was planned inorder to determine the prevalence of different etiology of bicytopenia /pancytopenia and its association with clinico-haematological parameters. Conclusion: It was discovered that bicytopenia/pancytopenia was frequently the reason for bone marrow testing. Three common underlying etiologies acute leukaemia, megaloblastic anemia, and aplastic anemia were discovered. Keywords: Cytopenias, Bone Marrow, Pediatric Population, Clinico-haematological Parameters and Prevalence.

Antibiotic Sensitivity Pattern of Serratia Species from Clinical Samples at a Tertiary Care Hospital in Rawalpindi

Objective. To determine the antibiotic resistance profile of Serratia spp isolated from various clinical specimens. Study Design and Settings: A descriptive cross-sectional study on antibiotic resistance profile of Serratia spp isolated from various clinical specimens was carried out in the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi, from 1st July 2017 to 30th June 2021. Methodology: 464 clinical specimens yielding growth of Serratia spp were included in the study. Serratia spp were identified by using Standard Microbiological procedures. Modified Kirby Bauer disc diffusion method was used for Antibiotic Susceptibility testing. The clinical data was analyzed prospectively from July 2017 to June 2021 for a period of 4 years. The spectrum of diseases caused by Serratia spp along with resistance profiles were analyzed. . Data obtained was analysed using SPSS 24. Results: High yield of this bug was obtained from pus and tissue specimens 150 (32%).130(28%) isolates were retrieved from blood cultures, whereas respiratory specimens contributed to 89(19 %) isolates of Serratia spp. According to the antimicrobial susceptibility pattern, 154 (33.3%) isolates were sensitive to Meropenem, 150(32.2%) were susceptible to Doxycycline and 118 (25.5%) to Amikacin, making them the preferred antibiotics to be used in our setup. Conclusion: Serratia marcescens isolates are increasingly resistant to antibiotics. Clinical isolates of Serratia exhibited highest resistance to Ciprofloxacin, Ceftriaxone, Gentamicin and Piperacillin/tazobactam

Effectiveness of Short Message Service (SMS) based Glycaemic Control

Objective: To find out the effectiveness of short message service (SMS) on glycaemic control among patients with diabetes at a tertiary care hospital in Rawalpindi.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Department of Endocrinology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Jul 2020.&#x0D; Methodology: A total of 218 patients with diabetes were included in the study. Patients were randomized into two groups by lottery method. Group-A received a tailored SMS package daily for six months along with printed dietary instructions, while Group-B was given only printed dietary instructions. After six months, HbA1c levels and other sociodemographic factors were compared among the two Groups A and B.&#x0D; Results: In Group-A (SMS-Group) mean HbA1c levels reduced from 9.3±2.0 to 7.0±0.4 compared to Group-B (non-SMSGroup) with mean HbA1c levels from 9.7±1.8 to 8.8 ±1.4. Before SMS intervention, all variables, including HbA1c levels between the two groups, were insignificant. However, the use of structured SMS-based intervention in Group-A showed a statistically significant reduction in HbA1c levels compared to Group-B (p-value &lt;0.05). The mean difference was 1.77(95% CI:-2.44 to -1.10).&#x0D; Conclusion: This study showed Short Message Service (SMS) effectiveness by significantly reducing glycaemic levels (HbA1c)among people with diabetes compared to conventional methods of diabetic education for glycaemic control.