Care Hospital In Pakistan Research Articles

An audit of contrast extravasation in patients undergoing contrast enhanced CTs at radiology department in a tertiary care hospital in Pakistan.

To audit the radiology department of a health facility, focusing on contrast extravasations management pre- and post-implementation of a standard protocol. The audit was conducted at the Radiology Department of Shifa International Hospital, Islamabad, Pakistan and comprised reported computed tomography contrast extravasation incidents from January 2017 to December 2019 in the retrospective phase before the implementation of a standard protocol. Post-implementation, re-audit was done prospectively to assess compliance from January 2020 to May 2021. Overall score of >80% was chosen arbitrarily as a qualifying standard for adequate documentation. Of the 49 total cases, 26(53%) related to the first phase and 23(47%) to the second. In the first phase, 2(20%) of the 10 parameters cleared the cut-off mark; 'study performed' 25(96%) and 'limb assessment by technician' 26(100%). In the second phase, 2(20%) parameters failed to clear the cut-off mark; site of cannula/extravasation' 18(78.3%) and 'volume of contrast' 15(65%). Lack of early identification and appropriate management, especially in cases of large-volume extravasation, may result in significant morbidity.

Efficacy of Oral Famotidine in Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2.

IntroductionThe clinical benefit of famotidine has been observed in the management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, its use in the management of SARS-CoV-2 is intriguing and not well established yet. In this study, we aimed to determine the role of famotidine as adjuvant therapy in improving the outcome of patients hospitalized with coronavirus disease-2019 (COVID-19).MethodsThis two-arm open-label randomized interventional study was conducted in the COVID-19 unit of a tertiary care hospital in Pakistan from December 2020 to September 2021. Patients between the ages of 18 to 65 years, hospitalized with COVID-19 infection, were enrolled in the study. Participants were randomized into two groups. The intervention group received 40 mg oral famotidine daily in addition to the standard care and the control group received standard care as per national guidelines for the treatment of COVID-19 in Pakistan.ResultsPatients admitted with COVID-19 who received famotidine took comparatively fewer days to become symptom-free (8.5 ± 1.7 vs. 9.4 ± 1.9 days, p-value: <0.001) and spent fewer days in hospital (8.6 ± 1.6 vs. 10.3 ± 2.2 days; p-value: <0.0001). However, the overall difference in the need for mechanical ventilation and mortality between the interventional arm and placebo was not significant.ConclusionIn this study, adding famotidine to standard treatment of COVID-19 was associated with faster clinical recovery and shorter stay in the hospital. However, there was no difference in the need for mechanical ventilation, need for intensive care unit, and overall mortality. Further large-scale studies are needed to understand the role of famotidine in COVID-19 and its mechanism of action in patients with COVID-19.

Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country.

BackgroundArrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan.MethodsA retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected.ResultsAmongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker.ConclusionsMore than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.

Prevalence of Age-Related Macular Degeneration at a Tertiary Care Hospital in Pakistan

Purpose: To evaluate the frequency of Age Related Macular Degeneration (ARMD) in the patients presenting to a teaching hospital in Pakistan, and to find the most common factors associated with high frequency of ARMD. Study Design: Descriptive Cross-sectional study. Place and Duration of Study: Layton Rehmatullah Benevolent Trust Free Eye Hospital Township Lahore from 1st January 2019 to 30th June 2020. Methods: A total of 720 patients with ages more than 60 years were included. Participants with no media opacity were selected randomly from the outpatient department. After which Informed consent was taken from all participants for taking retinal images. 45 degree retinal images were taken using an Eight megapixel fundus camera (Topcon). Fundus fluorescein angiography and Optical coherence tomography (OCT) were conducted in patients clinically diagnosed with ARMD. A specifically designed proforma was used to document data like age &amp; gender, smoking pattern, visual acuity for far and near vision, and staging of ARMD (if Present). Also recorded were Blood pressure, fasting blood sugar level, cholesterol levels, and height of patient. Results: The number of subjects participating in the study was 720, among which 350 (48.61%) were male while 370 (51.39%) were female. The prevalence of ARMD turned was found to be 5.27% (38/720) in the local population. The frequency of patients having signs of dry ARMD was 25 (65.7%), which were more than those having wet ARMD i.e., 13 (34.3%). Smoking was found to be most commonly associated with ARMD (36%). The second most common association was with hypertension (21%). While Hyperlipidaemia (11%), Diabetes Mellitus type II (10%), and obesity (6%)&#x0D; had a lesser association with ARMD. The prevalence of depression in patients of ARMD was 92.1%. Conclusion: ARMD is most frequent in smokers and they should be educated about this risk.

DAR-GRACE: Diabetes and Ramadan: glycaemic control, physician counselling and patient practices –experience from a tertiary care hospital in Pakistan

Objective: To identify patient practices and knowledge pertaining to Ramadan fasting and to see whether physicians wereproviding adequate counselling and adjusting medications accordingly.Methods: The cross-sectional study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from June to August 2018, and comprised diabetic patients who fasted during Ramadan. A questionnaire was designed to assess patients’ knowledge, risk category, pre-Ramadan counselling, medication adjustment, lifestyle changes, pre- and post- Ramadan glycated haemoglobin levels, and complications during Ramadan. Data was analysed using SPSS 23.&#x0D; Results: Out of 272 diabetics, 176(64.7%) were females. Mean number of fasts kept were 22±10.61. Pre-Ramadan 120(44.1%)patients consulted their physicians and 105(87.5%) of them received relevant counselling. Medications were adjusted inonly 30 (25%) such cases. Overall, 41(15.1%) patients were in the high-risk category, while 109(40.1%) and 122(44.9%) werein the moderate and low-risk categories. During the month, 17(6.25%) were hospitalised due to diabetes-relatedcomplications. Glycated haemoglobin levels fell significantly (p&lt;0.0001).Conclusion: Anomalous patient behaviours and suboptimal physician practices were noticed.Keywords: Diabetes; Ramadan; Pakistan

The Link Between Skull Fracture and Extradural Hematoma in Head Injury Patients who came to a Tertiary Care Hospital in Pakistan

Aim: The purpose of our current study is to see if there is any connection between skull fracture and extradural hematoma in head injury patients who came to the tertiary care hospital in Pakistan. Methods: From January 2020 to December 2021, this descriptive research was conducted at Chandka Medical College, Shaheed Mohtrama Benazir Bhutto Medical University Larkana. The research comprised those patients who have undergone extradural hematoma surgery during study period. Normal skull X-rays being taken, and the type and position of fractures were documented on the X-rays, CT scan, and during surgery. The frequency of skull fracture linked through extradural hematoma was studied in different ages. SPSS version 24.0 was utilized to investigate our current findings. Results: A sum of 130 individuals were operated on for extradural hematoma. In 70 cases, a linear fracture was seen, and in 18 individuals, a depressed skull fracture was seen. Another ten individuals with no radiologically evident fracture reported discovered to also have a fracture line intra-operatively. As a result, 87 (78 percent) of the participants suffered a skull fracture. Here remained no statistically important variation in occurrence of skull fracture among age ranges. Conclusion: Although there is a significant link between skull fracture and extradural hematoma, a normal X-ray does not rule out extradural hematoma. Keywords: Skull fracture, extradural hematoma, head injury, Tertiary Care Hospital, Larkana, Pakistan.

Psychiatric impact on COVID-19 patients isolated in a tertiary care hospital in Pakistan.

Adverse psychological effects have been associated with COVID-19-related disease containment measures, but little is known about the psychiatric symptoms and distress. This study aimed to explore and understand the psychiatric symptoms and distress in suspected or confirmed COVID-19 patients isolated and quarantined in hospital. A mixed methods study was conducted in the COVID-19 units of Mayo Hospital, Lahore, Pakistan; 114 out of 160 adult patients were assessed by telephone using validated scales (Stress Reactions and Adjustment Disorder Checklist, 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale and Insomnia Severity Index) and a few open-ended questions about expectations and anticipated areas of need during hospitalization, including experiences with isolation. The prevalence of adjustment disorder, acute stress disorder, anxiety, depressive symptoms and insomnia was 67.5%, 3.5%, 16.7%, 18.4%, and 29.8% respectively. One male patient tried to commit suicide during the study period. Fear, anger, low mood, anxiety and sleep disturbances were the most notable psychological consequences in qualitative the responses. Inadequate communication, poor ward facilities, concerns about the health of family members and financial problems were the most commonly identified factors leading to distress. Our results show alarmingly high levels of stress-related symptoms - insomnia, depression and anxiety - among COVID-19 confirmed or suspected hospitalized patients. There is a need to incorporate psychological services in the acute phase of illness for prompt recognition and management of psychiatric problems.

Evaluation of potential drug-drug interactions in cancer patients at a tertiary care hospital in Pakistan.

Despite harboring a high burden of cancer patients who are at high risk of potential drug-drug interactions (pDDIs), there is scarcity of published information about pDDIs in cancer patients from Pakistan. To evaluate frequency, pattern, mechanism and factors associated with pDDIs in cancer patients treated at a tertiary care hospital in Pakistan. In this cross-sectional analytical study, a total of 253 eligible ambulatory cancer patients treated at Center for Nuclear Medicine and Radiotherapy Hospital Quetta were evaluated for pDDIs using IBM Micromedex® Drug Interactions. SPSS (version 26) was used for conducting multivariate analysis to find factors associated with the presence pDDIs. A p-value <0.05 was considered statistically significant. A total of 141/253 (55.7%) patients were exposed to at-least one pDDI. A total of 251 pDDIs were noted with a median of one pDDI/per patient (interquartile range:1-2) Majority interactions were of major severity (72.9%), pharmacodynamic (49.8%) and had fair documentation level (64.1%). Anti-cancer drugs were involved in 73.0% pDDIs with doxorubicin as the most commonly involved (40.0%) anti-cancer followed by cyclophosphamide (27.6%) and cisplatin (13.5%). Potential cardiac adverse events made the bulk (33.8%) of predicted events. Receiving >2 anti-cancer (OR = 5.19, p-value = 0.001) and >6 ancillary drugs (OR = 4.16, p-value = 0.033) emerged as the risk factors of pDDIs. The prevalence of pDDIs was within the range reported in published literature. Solid medication review, availability of DDI detecting tools and clinical pharmacist, and paying special attention to the high-risk patients may reduce the frequency of pDDIs at the study site.

Predictors of Outcome of Cirrhotic Patients Requiring Invasive Mechanical Ventilation: Experience From a Non-Transplant Tertiary Care Hospital in Pakistan.

BackgroundPatients with known liver cirrhosis, irrespective of the etiology, have poor outcomes when put on invasive mechanical ventilation in an intensive care unit (ICU) setting. The clinical situation becomes even more complicated when such patients are managed in a non-transplant center. Various factors are associated with poor outcomes, and hence, various scoring systems are available to help determine the prognosis in patients with liver cirrhosis. These scoring systems are broadly classified into two categories, namely, ICU-specific scoring systems and liver disease-specific scoring systems. There is a dearth of data from Pakistan regarding which score better determines the prognosis of patients with liver cirrhosis admitted to the ICU. In this study, we aimed to determine the outcome of cirrhotic patients requiring invasive mechanical ventilation in a non-transplant tertiary care hospital in Pakistan using ICU-specific and liver disease-specific scoring systems.MethodologyA retrospective study design was applied to a record of 88 cirrhotic patients admitted to the medical ICU of a tertiary care teaching hospital in Karachi, Pakistan, from January 2016 to November 2016. Patients with acute hepatitis were excluded. Data on patients’ characteristics, the reason for intubation, hepatic encephalopathy, the need for vasopressor support, and the duration of ICU and hospital stay were collected. Moreover, the first-day Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), Child-Turcotte-Pugh (CTP), and Model for End-Stage Liver Disease (MELD) scores were calculated, with mortality being the primary outcome measure.ResultsThe most common etiology was hepatitis C (52.3%, 46/88). The most common reason for intubation was airway protection (57.9%, 51/88). Overall mortality was 71.6% (63/88). On univariate analysis, CTP score >10, MELD score >18, hepatic encephalopathy, bilirubin, prothrombin time, presence of tense ascites, and APACHE II were significantly associated with mortality. On multivariate analysis, CTP score >10 (odd ratio = 21; 95% confidence interval (CI): 4-104; p < 0.001) was an independent predictor of mortality. Area under curve was 0.89 (95% CI = 0.82-0.96) for CTP, 0.86 (95% CI = 0.77-0.95) for MELD, 0.81 (95% CI = 0.69-0.92) for APACHE II, and 0.81 (95% CI = 0.71-0.91) for SOFA in predicting mortality.ConclusionsCTP and MELD scores are better predictors of short-term mortality in patients with liver cirrhosis requiring invasive mechanical ventilation compared to APACHE II and SOFA scores. CTP score >10 was an independent predictor of mortality.

Renal Amyloidosis: A Clinicopathological Study From a Tertiary Care Hospital in Pakistan.

IntroductionSystemic amyloidosis can affect any organ in the body, but the kidney is the most commonly involved site. It is characterized by the extracellular deposition of insoluble fibrillar proteins. Amyloid deposits can be identified histologically by Congo red stain, which gives apple-green birefringence under polarized light. Typing of renal amyloidosis is done by direct immunofluorescence on frozen tissue. The most common types of amyloidosis seen in renal tissue are amyloid light chain (AL) primary amyloidosis and amyloid A (AA) secondary amyloidosis. Although primary amyloidosis is considered the most common type in western countries, however, in the subcontinent region, secondary amyloidosis is more common.The spectrum of signs and symptoms in renal amyloidosis is variable including isolated proteinuria, nephrotic syndrome, hypertension, hypotension, and renal insufficiency. The present study aims to evaluate the incidence and aetiology of various types of renal amyloidosis, determine their distribution within the kidney, and study various clinicopathological features.ObjectiveThe present study aims to evaluate the aetiology and clinicopathological profile of renal amyloidosis, determine its various types, and their distribution within the kidney.Materials and methodsThis retrospective cross-sectional study was conducted from 1st January 2013 to 31st December 2020 at the Department of Histopathology, Shifa International Hospital (SIH), Islamabad. All renal biopsies diagnosed as renal amyloidosis were included in the study. Data were analysed using SPSS version 23 (IBM Corp., Armonk, NY). Frequency and percentages were calculated for qualitative variables, and mean and standard deviation were calculated for quantitative variables.ResultsA total of 131 cases were diagnosed with renal amyloidosis during the study period of eight years (from 1st January 2013 to 31st December 2020) at SIH. The age range varied from 17 to 82 years. The mean age of the patients was 45 ± 16.33 years. Out of 131 patients, 82 (62.6%) were males and 49 (37.4%) were females. Amongst them, 72 (54%) cases were diagnosed with secondary AA amyloidosis and 16 (12%) cases were diagnosed with primary AL amyloidosis. The rest of the cases 43 (34%) were of indeterminate type. The associated conditions in secondary amyloidosis were tuberculosis in 41 (57%), rheumatoid arthritis in 16 (22%), ankylosing spondylitis in five (7%), lymphoma in three (4%), diabetes in two (3%), and chronic osteomyelitis, chronic heart disease, hepatitis, and vasculitis in one case each (1.7%). Out of 16 cases reported with AL amyloidosis, 10 cases (62.5%) had a history of multiple myeloma. The most common clinical presentation was nephrotic syndrome followed by subnephrotic proteinuria, renal failure, and hypertension.ConclusionThe findings of the present study show underlying etiological factors and clinicopathological characteristics of renal amyloidosis. AA amyloidosis is the most common type of renal amyloidosis in our study and tuberculosis is the most common aetiological factor. AL amyloidosis is less frequent in our population.

Neonatal Morbidity Patterns and Admission Outcomes: A Cross Sectional Study at a Tertiary Care Hospital in Pakistan

Objective: To determine the neonatal mortality and ascertain the disease patterns at neonatal ward in a tertiary care hospital&#x0D; Material and Methods: &#x0D; Design: Hospital based cross sectional study.&#x0D; Participants: Two thousand, two hundred and seventy five neonates were registered using retrospective data from 1st January 2020 to 31st Dec 2020. We recorded gender, birth weight, cause of admission, and admission outcome. Data was analyzed using Microsoft excel data spread sheet.&#x0D; Results: There were 2275 patients registered from CPDR (complete patient data record register) from 1st January 2020 to 31st Dec 2020. The mean birth weight was 2.35 kg, with lowest birth weight of 0.9kg and highest birth weight of 4.8kg (SD 0.8 and SE 0.01, CI 0.025). Out of 2175 admitted neonates 506 (23.2%) died, 1250 (57.4%) were discharged after desired improvement, most common presenting complaint and cause of admission was HIE grade 1 , followed by Sepsis, 418 (18.5%), 380(16.9%), respectively.&#x0D; Conclusions: Hypoxic Ischemic Encephalopathy grade I is the most common morbidity pattern in our study, the mortality rate was observed very high, indicators of birth weight were also poor. There is a great need for improvement of antenatal care for mothers to enhance different measures of newborn welfare and wellbeing.

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.

Prevalence, Genotypic Distribution and the associated Risk Factors of Hepatitis C Infection in Pakistan Pediatric Patients

Hepatitis C virus (HCV) is an important contributor to chronic morbidity and mortality in developing countries. The study’s objective was to determine the genotype distribution and risk factors associated with the transmission of HCV infections in pediatric patients. Rapid screening and confirmation by the enzyme-linked immunosorbent assay (ELISA) were used to analyze 585 pediatric blood specimens hospitalized and visited the outpatient department of the largest tertiary care hospital in Pakistan. Detection and genotyping of HCV RNA were performed using a real-time polymerase chain reaction (RT-PCR). Demographic data and a history of risk factors were gathered through a survey questionnaire. HCV RNA was detected in 323 (72.4%) cases which showed viral load ranging from Log10 IU/mL &lt; 3 to &gt; 6 IU/mL. HCV genotype 3a was detected in 256 (79.3%) cases while type 3b and 1a was observed in 36 (11.1%) and 31 (9.6%) patients, respectively. HCV positivity was significantly associated with the cases from rural areas [p = 0.005; odds ratio (OR) 1.65; 95% CI 1.16-2.23] and also significantly associated with low-income group [p &lt; 0.001; OR 5.75; 95% CI 3.90-8.40]. The primary risk factors associated with HCV transmission in children were family history (p = 0.002), blood transfusion (p = 0.03), surgical procedures (p = 0.02), and history of injections (p = 0.05). HCV genotype 3a is the most common genotype in children. The main risk factors for HCV transmission in children are blood transfusion, surgical procedures, and injection practices by informal health care providers.

Seasonal variation and severity of Diabetic Ketoacidosis in patients at a tertiary care hospital in Pakistan.

Objectives:To asses the seasonal variability in the hospital admissions of Diabetic Ketoacidosis (DKA) patients.Methods:This two year retrospective analysis was carried out from first November 2018 to 31st OCTOBER 2020, which involved medical chart reviewing of all those patients admitted to the Department of Diabetes, Endocrinology and Metabolic diseases, Hayatabad Medical complex, Peshawar, Pakistan with confirmed DKA. Data related to patient demography, past history, biochemical profile and treatment was collected and analysed using SPSS version 25.Results:During the above mentioned 24 months, 104 diabetic patients with confirmed DKA were admitted. Fifty-nine (57%) patients were male. Most of the patients had moderate DKA that is 42(40%). Seasonality was observed with majority of the patient admitted in winter season overall 62(60%). In both the years encounter with DKA patient peaked in January. DKA was found to be more severe in female and in age group 10-15 years. DKA severity was found to be significantly associated with age, gender, previous episodes of DKA, length of hospital stay and non compliance plus infection (p<0.05).Conclusion:We found seasonal variation and peaked cases of DKA in the winter season presenting at a tertiary care hospital in Pakistan. Noncompliance was found to be major contributory factor.

No difference in treatment outcome between patients with nodal versus extranodal diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) has been classified using various parameters, including the site of origin. Studies have reported conflicting outcomes when DLBLC patients were stratified according to the site of origin. This study aimed to investigate the response rate and survival outcomes in nodal versus extranodal DLBCL and compare the results to a region-matched study covering the 1988 - 2005 period. A single-center retrospective cohort study was conducted on all patients diagnosed with DLBCL and treated in a tertiary care hospital in Pakistan during 2014 - 2019. We calculated the mean and median for continuous variables and frequency and percentages for all categorical variables. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves. A Cox proportional hazards model was used to determine the hazard ratio (HR) for OS. Of the 118 patients, 49 patients (41.5%) had nodal disease and 69 patients (58.5%) were diagnosed with extranodal DLBCL. The majority of patients in the nodal and extranodal cohorts presented with Stages III and IV disease (73.4% and 62.3%, respectively). A complete response to (immuno) chemotherapy was achieved in 71.4% of nodal DLBCL patients and 65.2% of extranodal DLBCL patients. The 5-year PFS and median PFS in the entire cohort were 0.8% and 17 m, respectively. The PFS and median PFS in the nodal and extranodal DLBCL cohort were 0% and 1.4%, respectively, and 15 m and 19 m, respectively. The 5-year OS and median OS in the entire cohort were 16.1% and 19 m, respectively. The OS and median OS in the nodal and extranodal DLBCL cohort were 8.2% and 21.7%, respectively, and 19 m and 21 m, respectively. Multivariable linear regression revealed that the ABC phenotype (nodal, HR = 1.37, 95% CI = 1.37 - 3.20; extranodal, HR = 1.65, 95% CI = 1.46 - 3.17; GBC as reference) and double and triple hit DLBCL (nodal, HR = 1.29, 95% CI = 1.19 - 2.81; extranodal, HR = 1.87, 95% CI = 1.28 - 2.43; and non-expressors as reference) are independent negative predictors of OS. DLBCL incidence in the Karachi region has remained comparable but patient composition in the extranodal DLBCL cohort has shifted to predominantly advanced stage. Nodal and extranodal DLBCL were associated with similar PFS and OS profiles and first- and second-line treatment responses. Cell of origin and antigen expression status was independent negative predictors of OS, disfavoring the ABC phenotype and lesions with c-MYC and BCL2 and/or BCL6 overexpression. DLBCL is an aggressive type of non-Hodgkin's lymphoma, however; patients respond well to standard systemic chemotherapy. Extranodal type of DLBCL patients tend to have more residual disease after first-line systemic chemotherapy, but physicians should keep in mind that the subsequent line treatment mitigates its negative impact on survival.

Exploring Areas of Improvement in Postnatal Care Services in a Tertiary Care Hospital in Pakistan

Exploring Areas of Improvement in Postnatal Care Services in a Tertiary Care Hospital in Pakistan

Telemedicine for Rheumatology Patients in Covid-19 Pandemic: Perspectives of Patients.

Telemedicine use for patients with autoimmune rheumatic conditions during the pandemic mandates better characterization. We conducted a telephonic survey on patients who consulted rheumatologists remotely to determine their attitudes toward telemedicine. The study was conducted at Aga Khan University Hospital, a tertiary care hospital in Pakistan which is a lower-middle-income country. Descriptive analyses were performed. Fifty patients visited tele-rheumatology clinic, 35 (70.0%) were female with a mean (SD) age of 47.6 (18.1) years. Majority (27, 54.0%) learned about telemedicine from hospital website and outpatient clinic desk or helpline. Lack of examination was the biggest concern with teleconsultation (18, 22.2%). Most patients (38, 76.0%) agreed to continue teleconsultation beyond the pandemic. Telemedicine is preferable for providing rheumatology outpatient service during and after the pandemic.

A comparison of accuracy of modified early warning score(MEWS), national early warning score(NEWS)and rapid emergency medicine score(REMS) in predicting length of hospital stay and in-hospital mortality in adults presenting to emergency department

Objective: The National Early Warning Score (NEWS) is a system used in many hospitals in the United Kingdom. This study compares the accuracy of NEWS, the Modified Early Warning Score (MEWS) and the Rapid Emergency Medicine Score (REMS) in predicting in-hospital length of stay (LOS) mortality in patients presenting to the emergency department (ED). Methods: A prospective, observational cohort study was conducted in a tertiary care hospital in Pakistan from October, 2014 to December, 2014 All patients ≥16 years were consecutively sampled over three months, presenting to the ED who met the inclusion criteria. Observations were recorded at triage. NEWS, MEWS and REMS were categorized into low, medium and high for regression analysis and compared using receiver operating curve (ROC) analysis. A multivariable logistic regression (MLR) model was used to identify factors associated with LOS and in-hospital mortality. Results: In total, 4032 patients were recruited (mean age, 47 ± 17 years); 52% were male. In-hospital mortality was 5%, mean ED and hospital LOS were 0.15 ± 0.36 days and 1.86 ± 4.26 days, respectively. ROC for in-hospital mortality and LOS for NEWS, REMS, and MEWS were 0.79, 0.72, 0.64 and 0.61, 0.59, and 0.53, respectively. Mortality and LOS increased with increasing early warning scores. Medium and high NEWS had a strong association with mortality and LOS, respectively. Age, LOS, medium, and high NEWS were associated with mortality on MLR. Conclusion: NEWS was a superior scale in predicting LOS and in-hospital mortality in patients presenting to ED as compared to REMS and MEWS.

Experience of the surgical team in COVID-19 in a tertiary care hospital in Pakistan.

Objective: To analyse experience of the surgical team in COVID-19 in a tertiary care hospital in Pakistan. Study Design: Analytical Observational study. Setting: Department of Surgery, Tertiary Care Hospital Sialkot, Pakistan. Period: March to September 2020. Material &amp; Methods: After the permission of ethical review committee (ERC/12/2020), data was collected by all four groups surgeons, Resident and internees, paramedical staff and other staff of surgical teams. A simple, 6 question-questionnaire, manually typed, was distributed to all members willing to complete and return the questionnaire. Data was analyzed by using SPSS-23. Results: Majority (91.27%) of the surgical team members got satisfactory training to handle with Covid-19 Cases. The 80 % was in fear to contract the disease while working in isolation and COVID-19 wards and about (76%) were well adjusted to their newly assigned duties. About 85% of surgical team members experienced prolong duty hours (12 hours a day) related stress and similar percentage participated in the management of surgeries done during this period. Conclusion: Surgical Team participated and adapted to meet the newly assigned duties to lookafter the isolation and COVID-19 wards. Team members experienced stress and fear of contracting disease was a matter of concern. However, it has taken care of all trauma, life-threatening emergencies and oncological cases adhering to use of principles of use of PPEs.

Role of CXR and HRCT in diagnosing COVID-19, a descriptive cross-sectional study, at a tertiary care hospital in Pakistan

ABSTRACT &#x0D; Objectives: Objectives of this study are to do the analysis of chest X-ray and High-resolution CT scan findings in patients who are clinical suspects of COVID-19 infection. The other objective is to classify the radiological findings in mild, moderate or severe diseases according to BSTI criteria for chest X-ray and CTSS for high-resolution CT scan.&#x0D; Methods: This is a cross-sectional descriptive study. A group of 50 patients who were clinically suspected cases of COVID-19 infection, presented to Corona flu filter clinic of Holy Family Hospital (HFH) or admitted to corona isolation wards were included. The time duration of the study was from 15 May 2020 to 15 June 2020. Patients labelled as clinically suspected cases were having positive contact with confirmed positive (based upon positive PCR) patients. Recent travel history from the area having an outbreak. They were having clinical signs/symptoms of fever, cough, and shortness of breath, lethargy and loss of sense of smell or taste. CXR and HRCT was the investigation of choice for all the 50 patients. I also did PCR to make a correlation with the other two tests. All radiological findings were analyzed based upon Fleischner society glossary of terms for thoracic imaging. Two radiologists then assessed CXRs findings based upon BSTI criteria. They marked those CXR findings as low, moderate and high probability for COVID-19 infection. HRCT findings were analyzed using CT-SS, and researchers labelled outcomes as mild, moderate and severe disease. &#x0D; Results: Out of 50 patients, 33(66%) were males, and 17(34%) were females. Mean age was 51 with ages ranging from 30-72 years. Presenting complaints were fever in 42(84%) patients, cough in 37(74%), lethargy in 33(66%), shortness of breath in 41(82%) and loss of sense of smell and taste in 21(42%) patients. Out of these 50, 32(72%) were having positive PCR for COVID-19 infection. On CXR 5(10%) patients showed classic findings which were highly probable for COVID-19. 19(38%) patients showed intermediate results for COVID-19, 7(14%) patients had a low probability of COVID-19 infection on CXRS. Out of 50, 19(38%), patients showed normal CXR with no evidence of COVID-19 infection. We did HRCT of the same patients on the same day; it showed 21(42%)patients with mild disease,23(46%)patients with moderate disease and 6(12%)patients with the severe disease according to CTSI.HRCT of 3(6%)patients was ok with no evidence of illness in bilateral lungs. &#x0D; &#x0D; Conclusion: The role of radiology is crucial in the diagnosis of this viral illness. CXR, with its ability to detect changes of COVID-19 in lungs, should be used as a first-line imaging modality in clinically suspected patients. Moreover, it should also be used for follow up of patients with COVID-19. HRCT is very sensitive in the diagnosis of COVID-19 infection in its milder forms. Due to lack of its widespread availability in countries with inadequate medical facilities, it was not the primary imaging tool/screening tool. Due to risk of infection to radiological staff as well as non-covid-19 patients due to surface contact, due to reduced infection control issues, due to increased burden of ionizing radiations in patients. All these factors limit the role of HRCT as a primary imaging modality for COVID-19 infection