Care Hospital In Karachi Research Articles

Attitude and Behavior of Maternal Health Care Providers During Child Birth in a Tertiary Care Hospital in Karachi

Background: Pakistan is among the most populous countries of South East Asia with very high maternal mortality rate. One of the reasons of this elevated maternal mortality is non-availability of skilled workers at the time of labour. Objective: The study was carried out to see the frequency of abuse and disrespect during childbirth at a public sector hospital of Karachi and whether it affects their choice regarding the place of delivery in future pregnancy or not? Methodology: A cross sectional study was done after ethical review board approval and consent. A prevalidated questionnaire was used to collect the data from 476 women after their delivery but before they get discharged from the heath facility. Descriptive statistics were calculated and Univariate and multivariate analysis was done using spss 25. Result: Out of 466 patients, 401 (86%) reported some kind of disrespect and abuse from health care providers. Around 60% responded that they were not introduced to the health provider while 30% complained regarding the lack of involvement during and before the procedure. Almost 25% participants complained that no barrier was used to cover them during the procedure. Conclusion: Given study revealed that the occurrence of non-dignified maternity care is frequent in the area studied. Hospital administration and health policy makers should make sure and reinforce the training of health personnel who exhibit non dignified behavior towards laboring woman. This will help in reducing the maternal humiliation and psychological trauma of vulnerable women in public sector hospitals. Moreover maternal health will also improve as more women will attend health care facility for labour and delivery. Keywords: Disrespect, Abuse, Respectful maternity care, Facility delivery, maternal health

Effectiveness of Standardized Nursing Care Protocol Post Cardiac Catheterization to Reduce Hematoma Development

Background: Hematoma development is the most common vascular access complication among post-cardiac catheterization patients. It requires safe and standardized nursing care protocol, as well as qualified and skilled health providers to obtain good outcomes of management. The vascular complications were severe and increased the length of stay in the hospital. Timely recognition and management can diminish their burden.
 Objectives
 
 To evaluate the effectiveness of Standardized Nursing Care Protocol Post cardiac catheterization to reduce hematoma development.
 To assess the association of hematoma development between procedure site (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) among post-cardiac catheterized patients.
 
 Methodology: This quasi-experimental (post) study was conducted at Coronary Care Units at tertiary care hospitals in Karachi. In this study, a total of 108 post-cardiac catheterized patients participated. The patients were divided into two groups; the interventional group and the control group. In the control group, 54 post-cardiac catheterized patients were selected and data were taken based on inclusion criteria who received routine holistic nursing care post-procedure and have been discharged. Besides 54 patients participated in the interventional group who received Standardized Nursing Care Protocol post-cardiac catheterization including proper patient assessment, compression techniques, interventions pre, during and post sheath and TR-band removal to discharge instruction by the principal investigator (PI). The data was collected through patients’ assessment sheets and hematoma scales for the identification of hematoma development rate among post-cardiac catheterized patients. The non-probability consecutive sampling technique was accomplished for the collection of data.
 Findings: The rate of hematoma development in the (control) group was reflected at 18 (33.3 %) while after the implementation of the standardized nursing care protocol the rate of hematoma development was 9 (16.6%) in the (interventional) group out of 54 (50%) post-cardiac catheterized patients. There was a significant difference between the (control) and (interventional) groups regarding the rates of hematoma development post-cardiac catheterization i.e. the P values were 0.037 ˂ 0.05. Thus, the standardized nursing care protocol post-cardiac catheterization was effective in the reduction of hematoma development. Furthermore, the radial site procedure reflected fewer rates of hematoma development 8 (14.81%) as compared to the femoral site procedure 19 (35.1%) among post-cardiac catheterized out of 54 (50%). The P-value was 0.058 > 0.05 there was no association between hematoma development and procedure site in the (interventional and control) groups post-cardiac catheterization. Similarly, the P-value was greater than 0.05 hence there was no association between hematoma development and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization.
 Conclusion: The implementation of Standardized Nursing Care Protocol post-cardiac catheterization was effective for the reduction of hematoma development in the (intervention) group while there was an association of hematoma development between the (control and interventional) groups. However, there was no association between hematoma development and site procedure (radial and femoral) and comorbidities (diabetes, hypertension, and obesity) post-cardiac catheterization.

Comparison of the ultrasonography guided catheterization with the landmark technique in internal jugular vein catheterization.

Objective: To determine the differences in using the ultrasound guided technique as compared to the landmark technique for the cardiac catheterization procedures. Study Design: Cross-sectional study. Setting: Civil Hospital, Karachi. A Large Tertiary Care Hospital in Karachi, Pakistan. Period: November 2018 to November 2019. Material & Methods: Patients were divided into two groups, those who underwent catheterization through the landmark procedure and those who had the ultrasound guided procedure done. Various clinical and laboratory investigations were performed and recorded for the patients. The inclusion criteria was all the patients whose complete data was available in our archives, between the ages of 18 and 80 years, and belonging to the ASA Classification I to III, an international normalized ratio (INR) of <1.5 and platelet counts of >50,000 mm3. Results: The study population n= 600 patients, the mean age of patients was 65.2 +/- 10.6 years. We did not find any statistically significant differences in the age comparisons of the two groups, having a P-value of 0.3. Similarly, no difference was found in between genders, having a P-value of 0.8. When it comes to the duration of the bypass procedure there was no significant difference, the p value was 0.7. The success rate of the procedure was 89.79% in the landmark group and 98.07% in the ultrasound group, the P-value was significant at 0.04 respectively. Conclusion: The ultrasound-guided central venous catheterization is an effective and safer option when compared to the landmark technique.

Prevalence of Metabolic Syndrome in Young Patients with Acute ST Elevation Myocardial Infarction (STEMI)

Background: The metabolic syndrome is linked to several conventional and rising pro-thrombotic and pro-inflammatory cardiac risks. Most patients with cardiovascular disease have metabolic syndrome; however, the occurrence and connection of its various elements aren't obvious. There isn't any research regarding the occurrence of Metabolic Syndrome in young patients with acute STEMI. Objective: The purpose of this study was to figure out the occurrence of metabolic syndrome (MS) in young patients shown ST-Elevation Myocardial Infarction (STEMI) at a tertiary care hospital in Karachi, Pakistan. Material and Methods: The research was conducted on 170 patients with STEMI. Body mass index was measured. Smoking level, metabolic syndrome (MS), and aspects of the metabolic syndrome (BMI >23 kg meter per square, high blood pressure, hypertriglyceridemia, low-plasma HDLc, and affected fasting plasma glucose) were noted. Descriptive statistics were used, and stratification was done in the study. Fisher exact test and post-stratification by square test were used during the research study. P-value ≤0.05 was regarded as significant. Results: There were 42.2% women and 57.6% men with a mean age of 29.84±7.96 years. Metabolic syndrome (MS) was positive in 64.7 per cent of sufferers. BMI >23 kg meter per square was noticed in 97.1 per cent of patients. High blood pressure in 72.4 per cent of patients. Hypertriglyceridemia in 77.65 per cent of patients, Low plasma HDLc in 44.1 per cent of individuals, and affected fasting plasma glucose in 47.1 per cent of patients. Conclusion: It had been determined by research findings that the occurrence of metabolic syndrome in young patients having STEMI was higher. The common element was BMI >23 kg/m2, Hypertension, and Hypertriglyceridemia. Keywords: Prevalence, Young Patients, Metabolic Syndrome (MS), STEMI, Aspects of MS

Change in perception and behavior of patients/attendant and healthcare workers after ?ntroduction of low-cost violence prevention interventions at emergency department of a tertiary care hospital in Karachi

Background: Objective of the study was to assess the effect of the intervention on patients/attendant’s awareness of their rights and responsibilities, Healthcare Workers (HCWs) experiences on patients/attendant’s behavior, and their ability to be responsive to them. Methods: This Quasi-Experimental Pre-Post-study was conducted in September 2019 to February 2020 at the Emergency department [ED] of a public sector hospital for 6 months. Pamphlets and Posters on the rights and responsibilities of patients/attendants and HCWs and awareness videos were introduced. HCWs were trained on de-escalation skills, communication, information sharing, and improving responsiveness towards patients and attendants. The assessments were done before and after the interventions with a gap of two month. The qualitative aspect was assessed through 12 Focus Group Discussions (FGDs) and thematic analysis was conducted. The effect of intervention on HCWs responsiveness was done using quantitative tools. All HCWs in emergency department (ED) and a total of 200 patients and attendants were interviewed before and after the intervention. Data analysis was done by applying paired T-test (for HCWs) and independent T-test (for patients and attendants. Results: There was a significant positive difference (<0.001) in the overall score of responsiveness of HCWs as reported by the patients and attendants. Conclusion: The qualitative assessment revealed that interventional training assisted HCWs in better understanding the patient's expectation; however, the patient and attendant educational component was less effective in changing their behavior. Conclusion: Violence in emergency healthcare settings is inevitable; however, its impact and intensity can be reduced significantly by building the capacity of HCW’s in prevention and de-escalation skills. Training on the component of responsiveness related to autonomy, confidentiality, respect, and reduce waiting showed improvement at the end.

To Determine the Mean Glycemic Changes after Vitamin D3 Supplement in Children with Type I Diabetes Mellitus and Vitamin D Deficiency Presenting at a Tertiary Care Hospital in Karachi

Introduction: Glucose Homeostasis can potentially be affected by Vitamin D. Vitamin D deficiency has been identified as a global problem with an estimated one billion people worldwide suffering from vitamin D deficiency or insufficiency. Vitamin D deficiency (VDD) is a global health issue and is on the rise in Pakistani pediatric population. Type 1 diabetes (T1D) also negatively impacts bone health and is associated with a modest reduction in bone mineral density (BMD) and strength (7,8) Given the negative impact of vitamin D inadequacy and T1D on bone health, Adolescent with both conditions have multiple risk factors for increased skeletal fragility. In this study we evaluated glycemic changes after vitamin D3 supplement in patients with type I diabetes mellitus and vitamin D deficiency.
 Objective: To determine the mean glycemic changes after vitamin D3 supplement in children with type I diabetes mellitus and vitamin D deficiency presenting at a tertiary care hospital in Karachi.
 Methodology: A quasi experimental study design was conducted on 40 children who were presenting in OPD of NICH Karachi for six months. All patients were subjected to demographics and detailed history for Type 1 Diabetes and Vitamin D deficiency. Immunoturbidometry for HbA1C and ELISA for 25OHD was performed. Vitamin D3 supplement was advised as per operational definition. Insulin dose was recorded by parents for three months. 25OHD and HbA1C levels were measured following Vitamin D3 supplements. Statistical analysis was performed to analyze the significance.
 Results: We observed a significant difference in mean HbA1c level at pre-treatment and post treatment was 9.89±2.04 and 8.42±1.87 respectively with Vitamin D3 supplements, with p-value 0.001.
 Conclusion: Vitamin D3 supplement improves HbA1C in patients with type I diabetes and vitamin D deficiency.

In-hospital Outcomes of Primary Percutaneous Coronary Intervention in Patients Presenting with acute ST Elevation Myocardial Infarction in a Tertiary Care Hospital in Karachi

Background: Although primary percutaneous coronary intervention (PPCI) is now frequently performed in Pakistan, there is little data available regarding its outcomes in tertiary care hospitals of Pakistan. This study was designed to determine the outcomes, and assess the factors influencing these outcomes of PPCI.
 Methods: It is a retrospective study conducted on the data of patients who presented to the department of Cardiology, Dr. Ruth K.M. Pfau Civil Hospital Karachi from October 2017 to March 2019 with acute ST-elevation myocardial infarction (STEMI) and underwent PPCI. A total of 115 patients were included in this study.
 Results: Out of the 115 patients, 111 had a successful PPCI. The total mortality was 2.6% (3 deaths). One of the patients was reported to have a stent thrombosis. No emergency coronary artery by-pass graft (CABG) was performed and none of the patients had a stroke or any major bleeding. An accelerated idioventricular rhythm (AIVR) was noted in 23 (20%) of the patients. Pre-procedure 87% of the patients had thrombolysis in myocardial infarction (TIMI) grade 0 and only 11.3% were having TIMI flow grade 1. Post procedure a vast majority of the patients (97%) achieved TIMI flow grade 3.
 Conclusions: Our study reports a very high success rate of PPCI which is consistent with the data reported from the Western countries. A major limitation of our study was the relatively small sample size. A larger sample size would have better predicted outcomes considering this is one of the few such studies in this region. Further studies with larger sample size and long-term follow up outcomes are recommended.

Comparison of Clinical Characteristics and Outcome Between Vaccinated and Non-Vaccinated Patients of Covid-19 During the Delta Variant-Dominated Fourth Wave in a Tertiary Care Hospital in Karachi, Pakistan.

IntroductionIn Pakistan, the fourth wave of coronavirus disease 2019 (Covid-19) started around July 2021, which was dominated by the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The vaccination drive to immunize the people of Pakistan against Covid-19 was also going on during this period. There were multiple types of vaccines being administered to the people of Pakistan, as the vaccines had been procured from multiple sources. Some people had apprehensions about different vaccines being administered in the country. The purpose of this study was to compare the clinical characteristics and outcome of the patients vaccinated against Covid-19 with those of the non-vaccinated patients during the fourth wave of Covid-19 in Pakistan Naval Ship (PNS) Shifa Hospital.MethodsThe cross-sectional descriptive study was performed at PNS Shifa Hospital Karachi, from July to October 2021. All the Covid-19 patients treated in PNS Shifa Hospital during the “fourth Covid-19 wave” were interviewed. Their medical records were accessed, and they were followed up till their discharge from the hospital. The vaccinated and non-vaccinated patients were compared for differences in their age or gender distribution, the severity of illness, comorbidities, and mortality.ResultsThere were 884 participants in the study: 664 (75.11%) men and 220 (24.89%) women. There were 493 patients below 40 years of age, 233 were 40-59 years old, and 158 were aged 60 and above. One hundred and sixty-nine patients had one or more comorbidities, including hypertension, diabetes mellitus, ischemic heart disease, various malignancies, bronchial asthma, and chronic kidney disease. There were 63 (7.13%) obese patients, 28 of whom developed severe disease.Five hundred and four (57%) patients were vaccinated and 380 (47%) were non-vaccinated. Among the vaccinated patients, the effect of Covid-19 was mild in 58.37%, moderate in 36.11%, severe in 0.79%, and critical in 4.37%. Among the non-vaccinated patients, the effect of Covid-19 was mild in 40.26%, moderate in 46.58%, severe in 3.16%, and critical in 10%. The difference in disease severity between the two groups was statistically significant (p<0.05).ConclusionVaccinated Covid-19 patients had significantly lower severity of disease and displayed better outcomes when compared to non-vaccinated patients during the fourth Covid-19 wave dominated by the Delta variant of the SARS-CoV-2 virus.

Outcome of Cataract Surgery at Secondary Eye Care Facility in Karachi

Purpose: To find out visual outcome of cataract surgery at secondary eye care hospital in Karachi, Pakistan. Study Design: Surgical audit. Place and Duration of study: Al-Baseer Eye Hospital, Karachi from January 2019 to January 2021. Methods: A total of 1540 cataract surgeries were performed. Patients referred from distant eye camps (outside of city limits) were not included. Data collection was done using hospital medical records on patient’s age, sex, pre-operative best-corrected visual acuity (BCVA), surgical complications, visual acuity(VA) at 1st post-operative day, 1, 3 and 4 – 16 post-operative weeks, BCVA at 4 – 16 post-operative weeks and causes of poor visual outcome (BCVA worse than 6/60) at 4 – 16 post–operative weeks. For data analysis, IBM SPSS Statistics 23 was used. Results: Out of 1540 cataract surgeries, 81% (1248) cases underwent phacoemulsification with intraocular lens implantation. Mean age at the time of surgery was 56.24 ± 11.45 years. Males were 54.9% (845) while 45.1% (695) were females. Rate of intraoperative complications was 0.9% (14 cases). Posterior capsule rupture occurred in 0.8% (13 cases), and zonular disinsertion in 0.1% (1 case). At 4 – 16 weeks post-operatively, follow–up rate was 53.8% (828 patients); and the percentages of patients with good, borderline and poor BCVA were 94.7% (784 cases), 2.3% (19 cases), and 3.0% (25 cases) respectively. Conclusion: Good visual outcome can be obtained after cataract surgery at a secondary eye hospital, provided the surgeons and operating room team are trained, well equipped and follow aseptic measures. Key Words: Phacoemulsification, Cataract, Posterior capsule, Blindness.

Translation and Validation of Bristol Female Lower Urinary Tract Symptoms Questionnaire for Urinary Incontinence in Urdu.

BackgroundIn this study, we aimed to translate and validate the 19-item version of the Bristol Female Lower Urinary Tract Symptoms (Bristol FLUTS) Questionnaire in Urdu among women experiencing urinary incontinence at a tertiary care hospital in Karachi, Pakistan.MethodologyA cross-sectional validation study was conducted in the urology clinic at Aga Khan University Hospital, Karachi, Pakistan, between April and September 2021. After forward and backward translation of the Bristol FLUTS questionnaire, content validation was done by six experts, followed by the administration of the questionnaire to 10 respondents in the pilot phase of the study. In total, 207 participants were approached to fill the final version of the translated questionnaire. Overall, 188 respondents filled out the questionnaire, including 94 women with urinary incontinence and 94 women from the community to test construct validity. Finally, 30 women with urinary incontinence were asked to fill the form again two weeks later to determine test-retest reliability. Cronbach’s alpha was employed to assess the internal consistency of the questionnaire.ResultsThe questionnaire displayed good content validity for reliability (content validity index: 0.84) and clarity (0.89). The scores reported by cases were significantly higher than the controls in all but the sexual function domain, suggesting good construct validity. Cronbach’s alpha of 0.81 signified good internal consistency, and a Pearson’s coefficient of 0.993 (p < 0.001) comparing responses at baseline and after two weeks indicated good test-retest reliability.ConclusionsThe Urdu translation of the Bristol FLUTS is a valid and reliable questionnaire that can be used in the clinical setting.

Cardiac Complications in COVID-19 Infected Patients Admitted in a Tertiary Care Hospital in Karachi

The objective of the current cross-sectional study was to determine the frequency, types, associations, and outcome of cardiac complications in hospitalized COVID-19 infected patients. This study was conducted at Dr. Ziauddin University Hospital, Clifton campus, Karachi, from 1st April 2020 to 31st March 2021. A total number of 1,050 patients were included in the study through consecutive sampling with the diagnosis of COVID-19 infection. Patients were labeled as having complications secondary to COVID pneumonia only after comparing their hospital's clinical course with their baseline status. The independent variables were age, gender, cardiovascular risk factors (smoking status, diabetes mellitus, and hypertension), while the dependent variables were cardiac complications including acute coronary syndrome, myocarditis, pericarditis, and arrhythmias. The Association of complications with independent variables was analyzed by applying the Chi-Square test and statistical significance was set at a P-value of ≤0.05. There were 599 (57.0%) males and 451 (43.0%) females with the mean age of the participants being 55.1 years (± 13.08) years. Diabetes and hypertension were present in 451 (43.0%) and 490 (46.6%) patients respectively. Out of 1050 patients, the primary endpoint occurred in 55.6% of patients, including 23.1% acute coronary syndrome, 19.3% arrhythmias, 10.8% myocarditis, and 2.2% pericarditis. Analysis of secondary endpoint showed that 31.1% of patients had severe disease out of which the mortality was 39.4%. Acute coronary syndrome and atrial fibrillation are frequent complications, especially in those with severe disease and multi-organ dysfunction. Furthermore, the incidence of these complications is higher in patients with multiple co-morbidities. Considering the devastating impact this pandemic has had globally, it is important to know the cardiac involvement this condition can have along with the debilitating outcome so that healthcare facilities can be upgraded to provide better care to save lives.

Trends in Weight Gain Among Breastfed Infants Versus Bottle-Fed Infants at a Tertiary Care Hospital in Karachi, Pakistan

BackgroundInfants need to be exclusively breastfed up to six months of age, and breastfeeding should be continued up to two years of age along with complementary food. In Pakistan, the majority of newborns are not exclusively breastfed. This study was done to compare weight gain between breastfed infants and non-breastfed infants at a tertiary care hospital in Karachi, Pakistan.MethodologyThis observational cohort study was conducted at the well-baby clinic and vaccination center of the National Institute of Child Health, Karachi, Pakistan, from January 2021 to December 2021. A total of 360 normal term babies (180 in each group) with age below 11 months on either exclusively breastfeeding or other milk feed were included. Data were collected by the duty senior staff nurse of the well-baby clinic and monitored on daily basis by the researchers. The sociodemographic characteristics of mothers of breastfed and non-breastfed babies and birth weight, length, and BMI Z scores of babies in both groups were compared.ResultsIn a total of 360 babies, there were 192 (53.3%) boys and 168 (46.7%) girls. Overall, the mean maternal age was calculated to be 28.1±6.2 years, ranging between 18 and 37 years. The employment status of mothers (p=0.0117) and monthly income of parents (p=0.0388) were significantly different between groups. The mean weight gain in the exclusively breastfeeding group was 4.0±0.5 kg between the first and fifth visit (final visit) in comparison with 4.5±0.5 kg in the non-breastfeeding group (p<0.0001).ConclusionNon-breastfed babies gained significantly more weight in comparison with exclusively breastfed babies. More multicenter trials involving a large proportion of populations are needed to further verify the findings of the present study.

PREDICTING DEVELOPMENT OF CRITICAL ILLNESS IN PATIENTS WITH COVID-19 PRESENTING TO A TERTIARY CARE HOSPITAL IN A DEVELOPING COUNTRY

Background: With the increasing number of COVID-19 patients and limited resources available to accommodate them, there is a need for risk stratification tools to ensure better utilization of resources. Methods: We conducted a retrospective observational cohort study in patients discharged from the COVID designated areas of a large tertiary care hospital in Karachi, Pakistan from the 1st of May to the 31st of July, 2020. 581 patients were included and the COVID GRAM score was calculated at the time of admission and patients developing critical disease as per COVID GRAM study criteria (need of intensive care unit admission, invasive ventilation or death) after 24 hours of admission were noted. Results: The mean age of the study population was 56.3±14.8 years. Patients that developed critical illness (as per COVID GRAM study criteria) beyond 24 hours after admission had higher COVID GRAM scores at admission versus those that did not (183.2±80.7 versus 130.3±42.6). The Area under the Receiver Operator Curve for the COVID gram score to predict critical illness in the study population was 0.802 (95% confidence interval, 0.753–0.850). On binary logistic multivariable regression analysis, the COVID GRAM and SOFA scores on admission and need of ICU admission during hospitalization were significant predictors of mortality 24 hours after admission. Conclusions: The COVID GRAM score is a useful risk assessment tool and can be used for appropriate allocation and prioritization of resources where they are most needed.

THE Missed dose error among nurses working at tertiary care Hospitals, Karachi

BACKGROUND &amp; OBJECTIVE: Medication administration error (MAE) has been recognized as a serious health related issue that can lead to surge mortality and morbidity. In addition, it may rise hospitalization that, will increase the ratio of the patient. This study was accomplished to determine the missed dose error among nurses working at tertiary care hospitals in Karachi.&#x0D; METHODOLOGY: This analytical cross-sectional study was accomplished at Dr. Ruth K.M. Pfau Civil Hospital and Dow University Hospital, Karachi, for the period of six months from February to July 2018. The calculated sample was 204 nurses of both genders. Nurses having one year of working experience and licensed with Pakistan Nursing Council had been invited for the study. The participants were approached by a non-probability convenient consecutive sampling method. The adopted and validated questionnaire was utilized to gather the data. The data was entered and analyzed by using SPSS version 21.0.&#x0D; RESULTS: Out of 204 subjects, 106 (52%) were male. With respect to age, 168 (82.3%) of respondents had age below 35 years. The percentage of missed medication doses was reported to be 12.3%. In this study, nurses to patients ratio, and timing of medication administration were found statistically significant with missed dose errors p-value≤0.05.&#x0D; CONCLUSION: The study finding showed a small frequency of missed dose errors among nurses working in tertiary care public sector hospitals, Karachi. The majority of missed doses were recorded in the morning shift, and nurses who had more patients ratio.

The Utility of Frozen Sections in the Evaluation of Clear Margins in Oral Squamous Cell Carcinomas: A Cross-Sectional Study From a Tertiary Care Center.

Background and objectiveHead and neck cancers are prevalent in Pakistan. Oral squamous cell carcinomas are primarily treated via surgical removal, and complete surgical resection is the paramount prognostic factor. A resection margin of 5 mm on the final histopathology report has been accepted as adequate in the existing literature. Negative margins on the frozen section do not guarantee adequate disease-free resections on the final histopathology report. In this study, we aimed to ascertain how accurately tumor-free margins can be detected on frozen sections, which are reported intraoperatively compared to permanent sections of the same tissues reported after proper staining in oral squamous cell carcinoma patients.MethodsA cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan; 94 patients presenting between January and October 2016 were included in this study and a total of 432 tumor margins were assessed.ResultsAmong the total 94 patients included in the study, 79% were male and 21% were female. Buccal mucosa was the most commonly involved subsite (57%), followed by the tongue (25%). The most common T stage was T4 (33%), followed by T2 and T3 at 28% and 21% respectively, while the most common N stage was N0 (55%) followed by N1 at 16% and N2 at 22%. The sensitivity of the frozen section in comparison to the permanent section was found to be 50%, while specificity was calculated to be 99.8%. The positive predictive value was 75% and the negative predictive value was 99.3%.ConclusionThe frozen section is a highly useful tool for the evaluation of tumor margins. However, while it has high diagnostic accuracy rates, it can produce altered results and therefore requires high clinical correlation.

Profile of Geriatric Patients Attending the Emergency Department of a Tertiary Care Hospital in Karachi: A Cross-Sectional Study.

Background and ObjectivesThe emergency department (ED) is the most important unit of a hospital and is often visited by an ever-increasing proportion of geriatric patients. However, in Pakistan, there is an inadequacy of geriatrics specialists. The objective of this study was to assess the profile of geriatric patients in the ED. We considered main diagnoses, frailty, and other factors that help to come up with certain findings that may assist with policymaking and initiatives for better geriatric care in Pakistan.MethodsA cross-sectional study was conducted at a hospital in Karachi, Pakistan. The study population comprised 101 patients aged 65 years and older who attended the hospital’s ED from July to September 2021. Data were collected by taking the patients’ histories.ResultsThe majority of patients were aged between 65 and 70 years. The most common diagnoses were: gastrointestinal disorders, cerebrovascular accidents, and neurologic disorders. More than half of the patients were found to be frail by the five-item FRAIL questionnaire. The mean Charlson Comorbidity Index score was 5.37 ± 1.88.ConclusionIt was concluded that the need for geriatric care is worth mentioning since it imposes a significant burden on the ED. The geriatric patients had a higher risk of being on the critical list as most of them were frail and suffered from multiple severe comorbidities. Our results can assist in the development of geriatric emergency medicine and acute care systems in Pakistan.

Association Between Intra Uterine Fetal Demise (IUFD)/ Still Birth (SB) and Factors Associated with it in Patients Visiting at Tertiary Care Hospital

Objective: To determine the association between Intra Uterine Fetal Demise (IUFD)/ Still Birth (SB) and factors associated with it in patients visiting at tertiary care hospital in Karachi. Study Design: Observational Case Control Study Place and Duration: This study was conducted in the department of Obstetrics &amp; Gynecology, Aga Khan University Hospital (AKU), Karachi, Pakistan. Duration was six months from September 26, 2018 to March 25, 2019. Materials and Methods: All patients who fulfilled the inclusion criteria were included in the study. Women with (Intra Uterine Fetal Demise/ Still Birth) were enrolled as cases and women with live Birth were enrolled as control group. Informed consent was taken after explaining the procedure, risks and benefits of the study. Associated factors such as pre-eclampsia, fetal growth restriction, gestational diabetes mellitus, obstetric cholestasis, antepartum hemorrhage, were taken from the antenatal record to assess the association with IUFD. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: Mean±SD of age in case was 26.65±3.98 with C.I (25.78----27.51) and in control was 27.60±3.90 with C.I (26.75----28.44) years. In group wise distribution of gender of fetus 42 (50.0%) boys and 42 (50.0%) girls were enrolled in case and 34 (40.47%) boys and 50 (59.53%) girls were included in control group. Rate of growth restriction was 2 times more likely in cases as compare to control with [OR 2.00] while the rate of antepartum hemorrhage was 1.2 times more likely in cases as compare to control with [OR 1.205] and P value found to be non-significant i.e.(P=0.223 and 0.575) in growth restriction and antepartum hemorrhage respectively. Conclusion: It is to be concluded that, the incidence of intrauterine fetal deaths in our population is higher than that reported from developed countries. This is associated with preeclampsia, obstetric cholestasis, diabetes mellitus pregnancy-induced hypertension, illiteracy and low socioeconomic status. Keywords: Still Birth, Parity,Intra Uterine Fetal Demise

The Cavity as a Lasting Abode for Tuberculous Bacilli: An Observational Study.

The aim of this study was to determine the factors associated with persistent sputum positivity at the end of 2 months of treatment in patients presenting with (drug-susceptible) pulmonary tuberculosis at a tertiary care hospital in Karachi. A cross-sectional study was conducted at the Department of Chest Medicine (Ward 12), Jinnah Postgraduate Medical Center (JPMC), Karachi, over 6 months. A sample of 73 consenting, newly diagnosed, smear-positive drug-susceptible pulmonary tuberculosis patients was studied. Demographic (age, gender, height, weight and duration of tuberculosis, BMI, socioeconomic, occupational, marital, educational and residential statuses) and clinical factors (chest X-ray extent and cavities, initial smear results, diabetic and smoking statuses) which may be associated with sputum non-conversion were entered in a proforma. Patients were followed up at 2 months of treatment with a sputum smear. Data analysis was done on SPSS (Statistical Package for Social Sciences-version 20.0). Rate of sputum positivity after 2 months of anti-tubercular drug treatment was 17.8%. None of the above-mentioned demographic and clinical factors was associated with persistence of sputum positivity except for the presence of CXR cavities, which made it 5.5 times more likely that the patient would remain smear-positive at 2 months (p = 0.035). The finding of chest radiograph cavities makes it highly likely that a pulmonary tuberculosis patient may remain infectious or have an unfavorable outcome despite taking treatment for 2 months. Clinicians and national policy-makers should thus bear in mind the implications this can have with regard to disease control and therefore pay particular attention to such patients in terms of stringent monitoring and directly observed treatment short-course (DOTS) provision.Supplementary InformationThe online version contains supplementary material available at 10.1007/s42399-021-01098-6.

Prevalence of the Usage of Smokeless Tobacco in Patients Presenting With Stroke in a Tertiary Care Hospital.

BackgroundStroke is one of the leading causes of disability, long-term morbidity, and mortality. The key modifiable risk factors for stroke are largely driven by demographic changes and various social adaptations. Smokeless tobacco consumption is high in developing countries with less awareness of its potential health risks.AimThis study was designed to determine the prevalence of usage of smokeless tobacco in patients presenting with stroke in a tertiary care hospital in Karachi.MethodsThis is a cross-sectional study conducted at the Department of Neurology of Dr. Ruth K. M. Pfau Civil Hospital in Karachi. A total of 192 patients were enrolled during the study period of six months, from September 2018 to March 2019. All consenting patients were recruited who presented with stroke and fulfilled the inclusion criteria. All patients were assessed by a trained neurologist.ResultsA total of 192 patients with stroke were included. There were 146 (76%) males and 46 (24%) females with a mean age of 53 ± 6.1 years. The highest percentage (39%) of cases was illiterate. A majority (64%) of patients presented belonged to a lower socioeconomic background. Out of 192 stroke patients, 131 (68.2%) consumed smokeless tobacco. ConclusionThe frequency of smokeless tobacco consumption was found to be high in stroke patients who require the attention of the physician on modifiable risk factors.

Surgical Management During the COVID-19 Era at a Private Tertiary Care Hospital of Karachi, Pakistan: A Cross-Sectional Study.

BackgroundThe coronavirus disease 2019 (COVID-19), declared a pandemic in March 2020, has affected the entire healthcare system, including the surgical practice. Guidelines for the management of surgical patients during this COVID-19 era need to be established to provide timely yet safe surgical care. In this study, we aimed to evaluate the outcomes of the COVID-19 testing algorithm established for surgery patients presenting to a tertiary care hospital in Karachi, Pakistan, and to compare the outcomes among patients who underwent elective versus emergency surgery.MethodologyThis is a cross-sectional study conducted at a tertiary care hospital in Pakistan to apply and assess the outcomes of the COVID-19 testing algorithm established for patients presenting for surgery. We included all patients who underwent any surgery from May to October 2020. The total sample size was 6,846. The data were analyzed using SPSS version 23 (IBM Corp., Armonk, NY, USA). The categorical variables were assessed using the chi-square or Fisher’s exact test. A p-value of <0.05 was considered significant.ResultsA total of 6,846 surgeries were performed from May 1 to October 31, 2020. In total, 74% of the surgeries were elective procedures. We observed that a significantly higher proportion of emergency surgery patients tested positive for COVID-19 (4.2%) compared to elective surgery patients (25/5,063, 0.5%). A higher proportion of surgeries were performed in September (1,437, 21%) and October (1,445, 21%) while the lowest number of surgeries were performed in May (625, 9.1%). From week one to week five, a higher proportion of emergency surgeries were performed (32%) compared to elective surgeries (25%). Only 1.9% of the patients who were undergoing surgery were COVID-19 positive, with the highest number of COVID-19 cases presenting in June. Overall, 74 (4.2%) of the COVID-19-positive patients underwent emergency surgeries.ConclusionsThe timely establishment of well-defined guidelines for surgical management during the pandemic allowed us to provide timely and effective surgical care to patients with the priority of minimizing the spread of COVID-19 and preventing unnecessary deferral of surgeries.