Civil Hospital Karachi Research Articles

Clinical characteristics of COVID-19 patients admitted to the intensive care unit of the largest public-sector hospital in Karachi: A retrospective, observational study.

Objective: To characterize the clinical features of critically ill COVID-19 patients admitted to COVID-ICU and describe their outcomes. Study Design: Retrospective Observational study. Setting: Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Period: May 2020 to September 2021. Methods: The study aimed to investigate the clinical characteristics and outcomes of patients with confirmed or suspected COVID-19 who were admitted to the ICU. Patients in the study period confirmed or suspected COVID-19, admitted to the ICU for more than 24 hours, and committed to full treatment were included this study. Patients with COVID-19 discharged or died within 24 hours of admission were excluded. Results: The most commonly observed symptoms among the patients were shortness of breath (92.5%), fever (91.2%), cough without sputum (39.2%), altered consciousness (11.9%), and muscle aches (8.8%). Acute respiratory distress syndrome (ARDS) was identified as the most prevalent complication among COVID-19 patients, impacting 40.8% of the study population. A significant proportion of COVID-19 patients required mechanical ventilation and cardiac support. Specifically, (41.4%) of the patients required invasive mechanical ventilation, (47.4%) required non-invasive ventilation, and (26.3%) received cardiac support. Laboratory assessment showed that platelet counts varied significantly between survivors and non-survivors, with non-survivors exhibiting lower platelet counts. Gender differences were also observed among COVID-19 patients by age, with males having a higher mean age than females in all age categories, and the difference was statistically significant (p < 0.001) in all age categories except for the 30-44 years age category (p = 0.087). Age-wise recovery and mortality rates were analyzed, and the results showed that among both deceased and recovered patients, the proportion of deceased patients increased with age, while the proportion of recovered patients increased until the age range of 45-59 years for both males and females. The study found that 136 of the patients survived while 275 of the patients succumbed to the disease. Among the survivors, (31.3%) were male, and (36.2%) were female. Conclusion: The study emphasizes the importance of monitoring patients for potential complications and providing them with supportive care. Early detection and management of severe cases of COVID-19 are critical in preventing complications and improving patient outcomes.

COMPARISON OF ALVARADO, RIPASA, AND AIR SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

Accurate and timely diagnosis of acute appendicitis is critical in preventing complications and guiding surgical intervention. The Alvarado, RIPASA, and AIR scoring systems are commonly used diagnostic tools, each with varying performance metrics in different clinical settings. Objective: This study aimed to compare the diagnostic performance and overall accuracy of the Alvarado, RIPASA, and AIR scoring systems for diagnosing acute appendicitis. Methods: This observational study was conducted at Civil Hospital Karachi from December 2023 to May 2024, following ethical approval from the institutional review board. A total of 200 patients aged over 18 years presenting with clinical symptoms suggestive of acute appendicitis were included in the study through non-probability consecutive sampling. Each patient’s data was analyzed using the Alvarado, RIPASA, and AIR scoring systems to evaluate their diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC). Results: The Alvarado score demonstrated a sensitivity of 88.44%, a specificity of 37.04%, and an overall accuracy of 81.50%, with an AUC of 0.667 (p=0.002). The RIPASA score showed a sensitivity of 81.18%, a specificity of 53.33%, and an accuracy of 77.00%, with an AUC of 0.699 (p=0.001). The AIR score displayed a sensitivity of 81.00%, a specificity of 60.00%, and an accuracy of 82.00%, with an AUC of 0.700 (p<0.001). Conclusion: The Alvarado, RIPASA, and AIR scores each demonstrate diagnostic value in identifying acute appendicitis, though their sensitivity and specificity may vary based on the population and clinical setting. Clinicians should consider these variations when selecting a scoring system to optimize diagnostic accuracy for acute appendicitis.

Association of pre-op TSH levels with Thyroid Carcinoma in a Tertiary Care Setup in Karachi, Pakistan

Objectives: This study aimed to explore the relationship between pre-operative TSH levels and the presence of thyroid cancer in patients with nodular thyroid disease in the Pakistani population, using data gathered from patients treated at Dr. Ruth K. M. Pfau Civil Hospital Karachi. Study Design & Setting: A cross-sectional study was conducted at the Dow University of Health Sciences and Dr. Ruth K. M. Pfau Civil Hospital Karachi from January 2022 to December 2022. Methodology: Patients with thyroid swellings (presenting with either solitary nodules or with multinodular goiter), both benign as well as suspected/confirmed malignancy based on FNAC results were recruited in the study. Preoperative TSH levels, along with other clinical data, were collected. Thyroidectomy was carried out in patients fulfilling the criteria for surgery, with specimens sent for histopathology. An independent t-test was used to compare TSH levels between malignant and benign nodules. Results: A total of 82 patients were enrolled. Malignancy was confirmed in 41.5% (25 papillary carcinoma, 9 follicular carcinoma). Significantly higher mean TSH levels were observed in patients with malignant nodules (4.76 IU/mL) compared to those with benign nodules (2.48 IU/mL) (p < 0.001). Conclusion: This study suggests a potential association between elevated pre-operative TSH levels and thyroid cancer in the Pakistani population. These findings warrant further investigation to explore causality and potential underlying mechanisms. The study highlights the value of TSH monitoring, particularly in resource-constrained settings.

Association of Hand Dominance with Mechanism and Type of Hand Trauma in Patients Presenting at Civil Hospital Karachi

Association of Hand Dominance with Mechanism and Type of Hand Trauma in Patients Presenting at Civil Hospital Karachi

DIAGNOSTIC ACCURACY OF BOEY SCORE TO PREDICT 30 DAYS MORTALITY IN PERFORATED PEPTIC ULCER PATIENTS

Perforated peptic ulcers remain a life-threatening condition despite advancements in surgical and medical treatments. Accurate risk stratification of patients can improve outcomes by guiding clinical decision-making. The Boey scoring system is widely used for predicting mortality in patients with perforated peptic ulcers, yet its diagnostic accuracy warrants further evaluation. Objective: This study aimed to evaluate the diagnostic accuracy of the Boey score in predicting 30-day mortality among patients with perforated peptic ulcers. Methods: This cross-sectional study was conducted at the Department of Surgical Unit VI, Civil Hospital Karachi, over a six-month period from December 7, 2020, to June 7, 2021. A total of 149 patients diagnosed with perforated peptic ulcers were included using non-probability consecutive sampling. The Boey score was calculated for each patient based on preoperative shock, comorbid illness, and duration of perforation >24 hours. The primary outcome measure was 30-day mortality. Descriptive statistics were used to assess the frequency distribution of mortality, and the association between Boey score and mortality was analysed using appropriate statistical methods, with significance set at p < 0.05. Results: The study included 149 patients, with a minimum age of 21 and a maximum age of 50. Of the total, 32 patients (21.5%) experienced 30-day mortality. Among patients with a Boey score of 1, 2.68% had 30-day mortality, and 0.67% of patients with a Boey score of 2 died. Patients with a Boey score of 3 had the highest mortality rate, with 18.1% of this group experiencing 30-day mortality. In contrast, 81.9% of patients with a Boey score of 1 to 3 survived beyond 30 days. Conclusion: The Boey scoring system demonstrated vital predictive accuracy for 30-day mortality in patients with perforated peptic ulcers. This scoring tool effectively identifies high-risk patients, allowing for timely and appropriate management. Despite modern treatment advances, perforated peptic ulcer remains associated with significant mortality, particularly in high-risk patients, as identified by the Boey score.

Assessing emergency room leadership of ObGyn residents in a public university teaching hospital of Sindh, Pakistan: a cross-sectional survey

BackgroundLeadership is a critical competency for medical professionals, yet it is often neglected in medical training. For ObGyn residents, leadership training is particularly crucial as it significantly impacts both maternal and newborn outcomes, as well as the operational efficiency of healthcare teams. The main objective of this study was to assess the perceptions of obstetrics and gynecology residents who served as group leaders in the emergency team at the Department of Gynecology, Ward 3, Dr. Ruth K.M. Pfau Civil Hospital Karachi.MethodsA Cross-sectional survey was conducted with purposively sampled 28 year-4 residents who worked as group leaders during last 3 years (from 2018 to 2020) of their residency program at the emergency team in the department of Gynecology Ward 3 Dr Ruth KM Pfau Civil Hospital Karachi. The perceptions on leadership were assessed on 25 items scale sent through a questionnaire on email. Grading of responses was done using a 4-point ordinal scale where 1 meant little importance and 4 was regarded as having great importance. Data was summarized with relevant descriptive statistics and was analyzed on SPSS version 22.ResultsThe mean age of residents was 30.36. The mean leadership scores of the group of residents were calculated to be 77.50 (SD ± 9.57) while 14(50%) residents showed good and 14 (50%) showed excellent leadership skills based on cumulative scores. Of the 25 traits examined in this study, the highest reported trait was humility 3.82 (± 0.39) followed by empowerment 3.68 (± 0.77) and effective communication 3.68 (± 0.77). While responding about learning experiences, 89.3% of participants felt that the experience enhanced their decision-making skills and boosted their confidence in dealing with emergencies.ConclusionOur study highlights the critical importance of leadership development in the training of ObGyn residents, particularly in high-pressure emergency settings. The findings reveal that residents value leadership traits such as humility, empowerment, and effective communication, which are essential for building teamwork and ensuring optimal patient outcomes and patient satisfaction.

Frequency of occupational health hazards and factors responsible among the waste handlers at the tertiary care hospitals of Karachi.

Hospital waste handlers (HWHs) are in contact with contaminated waste that put them at risk for occupational health hazards. The objective of the study was to determine the frequency of occupational health hazards and identify factors contributing to them among the HWHs at tertiary care hospitals of Karachi. A cross sectional survey was conducted from January 2021 till June 2022 on 417 conveniently selected HWHs of the public and private tertiary care hospitals of the Karachi including three Public sector hospitals (Civil Hospital Karachi, National Institute of Child Health, Jinnah Post Graduate Medical Center) and five private sector hospitals (Sohail University Hospital, Darulsehat Hospital, Kharadar General Hospital, Patel Hospital and Hamdard University Hospital) using a structured questionnaire. Chi Square test was applied to determine the differences in occurrence of different hazardous outcomes (Needle stick injury, Sharp Injury, Eye Symptoms, Skin symptoms, Cough) between different groups of age, gender, type of hospitals and status of being trained in Hospital Waste Management (HWM). Around half of the HWHs (52.6%) labeled the bins of the waste according to their level of hazard. Only 17.9% disinfected the infected waste. The proportion of participants who experienced needle stick and sharp injury in the last six months was 16.3% and 15.8% respectively. Majority of them used disposable gloves (95.7%) and face masks (94.3%). One thirds had access to aprons while only 10.5% had access to protective shoes at their work place. HWHs of private sector were significantly less likely to experience Needle stick injuries, skin symptoms, cough, breathing difficulty and throat burning. The HWM practices in tertiary care hospitals of Karachi is far from being satisfactory. HWHs must be trained and monitored for safe disposal of waste.

Dengue fever and prognostic utility of inflammatory markers.

Objective: To determine presence of inflammatory markers i.e. hyper-ferritinemia, elevated lactate dehydrogenase, and liver enzymes in dengue fever and their correlation with different classes of dengue severity, defined by new WHO classification. Study Design: Cross-sectional Analytical study. Setting: Medical Department of Dr. Ruth KM Pfau Civil Hospital Karachi. Period: October 2022 to March 2023. Methods: Conducted in confirmed cases of Dengue fever, after consent all patients were categorized in three i.e. D-W, D+W and SDF groups. Results: 120 patients were included in study. 24 suffered from Severe Dengue Fever (SDF) whereas 28 were in Dengue without warning signs (D-W) group and 68 were in Dengue with warning signs (D+W) group. We found a significant association between liver enzymes (SGPT and SGOT) and dengue severity. SGOT was significantly increased in cases with SDF as compared to D-W and D+W cases (p-value = 0.002). Similarly, ferritin was significantly increased in SDF cases compared to non-severe cohort (p-value <0.001). Using the area under the curve (AUC) of ROC curve, ferritin level (cutoff value of 800), produced a sensitivity of 75% for severe dengue fever. Mean length of stay in patients with non-severe dengue group was 3.63 days vs. 4.3 days in those with SDF (P value 0.002). Conclusion: As dengue is becoming a huge burden especially in developing countries, need to take proper measures to establish disease severity and according to severity resource allocation is cornerstone. Significant higher ferritin levels in severe dengue fever than other dengue groups, observed in our study, making serum ferritin a surrogate marker for dengue to predict the severity of dengue fever.

A Comprehensive Analysis of Cirrhotic Cardiomyopathy Among Patients with Liver Cirrhosis at Tertiary Care Hospital, Karachi

Objective: To determine the prevalence and complications of cirrhotic cardiomyopathy (CCM) in liver cirrhosis patients at a tertiary care hospital in Karachi, and to analyze associated factors contributing to disease progression. Methodology: This descriptive study was conducted at the Department of Medicine, Civil Hospital Karachi, from October 2020 to April 2021. A total of 95 patients diagnosed with liver cirrhosis were included. Data was collected using a structured format and analyzed using SPSS. Stratification was applied to assess the relationship between cirrhotic cardiomyopathy and key factors such as age, gender, and duration of cirrhosis. The study used echocardiography to evaluate cardiac function, and pro-BNP levels were measured to assess the severity of cardiomyopathy. Results: The mean age of the patients was 43.66±4.87 years, with a mean heart rate of 73.51±12.41 beats/min, pro-BNP levels of 78.63±7.37 pg/ml, and mean cirrhosis duration of 1.65±0.99 years. Of the 95 patients, 15 (15.8%) had cirrhotic cardiomyopathy, while 80 (84.2%) did not. Gender distribution showed 48 (50.5%) males and 47 (49.5%) females. Cirrhotic cardiomyopathy was more common in patients with longer disease duration and higher Child-Pugh scores, but the differences were not statistically significant. Conclusion: Cirrhotic cardiomyopathy is a prevalent but often underdiagnosed complication in liver cirrhosis patients, with significant implications for disease management. Early diagnosis and monitoring are crucial to preventing adverse cardiovascular outcomes in cirrhosis patients.

Determination of Correlation between Diabetes Duration and Coronary Artery Disease Severity in Patients Undergoing Coronary Angiography

Background. Coronary artery disease (CAD) is caused by atherosclerotic process in coronary arteries. Due to extraordinary risk for atherosclerosis in diabetic patients, it is also counted as a vascular disease. Diabetes mellitus (DM) is a direct major associated risk factor in the development of cardiovascular disease with some studies from high income countries reporting correlation between duration of DM and severity of CAD. However, data from Pakistan is scarce. The aim. To determine the correlation between duration of DM and severity of CAD in patients undergoing coronary angiography at the tertiary care cardiac center. Materials and methods. This cross-sectional study was conducted in the Department of Cardiology, Civil Hospital Karachi, among 160 patients who were scheduled for coronary angiography with comorbid DM. Correlation between duration of DM and severity of CAD (as assessed by the modified Gensini score) was statistically measured and reported employing Pearson’s correlation coefficient (r). Results. Significant correlation between DM duration and total Gensini score was shown with r = 0.759 and p = 0.000001. With the increase in the duration of DM, the severity of CAD also increased. Conclusion. DM duration is positively associated with the modified Gensini score and the significant determinants of CAD severity tend to be relevant.

Assessment of evidence based care and uniformity of practices through implementation of standardized medical protocols and guidelines in pediatric emergency departments

ObjectiveThis study aims to assess compliance with medical protocols and outcomes, as well as determine the consistency in clinical practice across different Pediatric Emergency Departments (PED) in public sector hospitals of a low-middle income country. MethodsA retrospective analysis was conducted on patients presenting to PEDs of five public sector hospitals, namely Civil Hospital Karachi (PED 1), National Institute of Child Health (PED 2), Abbasi Shaheed Hospital (PED 3), Sheikh Zayed Hospital Larkana (PED 4), and Ghulam Muhammad Mahar College Hospital Sukkur (PED 5). The analysis covered a three-month period from February 1, 2023, to April 30, 2023. Patients diagnosed with Acute asthma, Sepsis, and Septic Shock during the study duration were included. Outcomes for each disease were evaluated based on compliance with standardized protocols.The statistical significance of data was measured by adding the p values. Results110,450 patients visited PED during the study period and mortality rate was 2% (n=2193). 12% (13,240) were diagnosed with the three diseases during the study period. Sepsis was on top (74%, n=9,751), followed by Septic Shock (14%, n=1898), and Acute Asthma (12%, n=1591). The overall compliance rate for the three diseases was 77% (n = 10,240). Adherence to standard protocols were 98% (n = 1561) for acute asthma, 85% (n = 8240) for Sepsis, and 23% (n = 439) for Septic Shock across the five emergency departments. Of the patients who were managed according to standard protocol, 31% (n = 3135) were discharged, 30% (n- 3094) were admitted, 11% (n = 1151) were referred, 15% (n = 1501) left against medical advice and 13% (n = 1359) did not survive. On the other hand, in patients where there was noncompliance to standard protocols, 27% (n = 805) did not survive, 27% (n = 807) were discharged, 24% (n = 710) were admitted, 8% (n = 260) were referred and 14% (n = 418) left against medical advice. The differences in adherence rates among the three diseases were statistically significant (p < 0.001). ConclusionThe overall mortality rate was 2% in these five emergency departments and the medical protocol was followed in every third patient out of fourth in those three diseases. The survival rate till ED disposition was doubled in those patients for whom medical protocols were followed as compared to those for non-compliant. The majority of PED demonstrated good compliance with standardized practices. However, this study identified areas that require attention and further training, especially early recognition and management of septic shock where compliances seem alarmingly low. Our data analysis indicates that adherence to guidelines has resulted in uniformity in clinical practice and the provision of early evidence-based quality care. Nevertheless, there is still room for improvement in ensuring consistent adherence to medical protocols in pediatric emergency settings and thus improving patient outcomes.

Prevention of Uterine Inversion by Using Ultrasonographic Confirmation During Placental Delivery in Dr. Ruth K.M Pfau Civil Hospital Karachi

Objective: To determine the prevention of uterine inversion by using ultrasonographic confirmation duringplacental delivery.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Gynecology Unit II, Dr. Ruth K.MPfau Civil Hospital Karachi, Pakistan from June 2022 to June 2023.Methods: In this research, the total of 180 patients were included with transvaginal deliveries. To preventuterine inversion during placental delivery, regular ultrasonographic was implemented. The placental deliverywas performed with ultrasonographic confirmed placental detachment. The frequency of uterine inversionduring placental delivery was compared before and after the introduction of ultrasonographic images. Inaddition, a comparison was made between the ultrasonographic group and the non-ultrasonographic groupregarding the amount of blood loss during transvaginal delivery and the length of the third stage of labor. TheDescriptive statistics were applied to all parameters Using SPSS Version 26.Results: A total of 180 patients who had transvaginal deliveries, mean age 29 ± 9 years. One hundred and eighty women had transvaginal deliveries before and after the introduction of ultrasonography. Following theultrasonographic confirmation, there was a significant decrease in the frequency of uterine inversion whencompared to the pre-introduction period (43.3% vs. 56.7%, p = 0.001). Due to a number of limitations, theactual rate of ultrasonography performed even after it was introduced ultrasonography was 46.1%.Conclusion: In our investigation, we concluded that with the help of ultrasonographic confirmation of placentaldetachment uterine inversion may be prevented. How to cite this: Abbasi TS, Kubra K, Zarrar T, Tasneem M, Gul P. Prevention of Uterine Inversion by Using Ultrasonographic Confirmation During Placental Delivery in Dr. Ruth K.M Pfau Civil Hospital Karachi. Life and Science. 2024; 5(2): 204-209. doi: http://doi.org/10.37185/LnS.1.1.563

To Determine how the Severity of Pain Relates to the Quality of Sleep Following Tube Thoracostomy

Background: Tube thoracostomy (TT) is a prevalent procedure in the management of various thoracic conditions, including pneumothorax, pleural effusion, and chest trauma. Despite its widespread use, TT is associated with significant complications such as pain and impaired sleep quality, which can affect patient recovery and overall health outcomes. Objective: This study aims to explore the relationship between pain severity and sleep quality following tube thoracostomy and to assess the impact of pain management on postoperative recovery. Methods: A descriptive, prospective, cross-sectional study was conducted at Dr. Ruth K. M. Pfau Civil Hospital Karachi and Dow University of Health Sciences from September 28, 2022, to March 27, 2023. The study included adults aged 18 to 70 who underwent TT for any indication. Patients were excluded if they withheld consent, had a history of substance use, psychological disorders, or were victims of poly-trauma. Pain severity was assessed using a visual analogue scale (VAS) and sleep quality was evaluated using the Richards-Campbell Sleep Questionnaire (RCSQ). Data were analyzed using SPSS version 25, employing descriptive statistics and Spearman correlation tests. Results: The study involved 77 participants with a mean age of 28.33 ± 10.50 years. The mean pain scores on postoperative days 1, 2, and 3 were 8.08 ± 0.66, 6.92 ± 0.99, and 4.92 ± 1.37, respectively. Corresponding sleep quality scores were 17.50 ± 7.53, 36.67 ± 9.84, and 57.50 ± 10.55. A significant negative correlation was found between pain scores and sleep quality scores on day 3 (r = -0.744, p &lt; 0.001). Conclusion: The findings suggest a significant association between lower pain scores and improved sleep quality among patients undergoing tube thoracostomy. Effective pain management may enhance sleep quality and facilitate recovery, highlighting the need for comprehensive postoperative care strategies in these patients.

Investigating the Prognostic Significance of Immune-Nutritional Indices in Esophageal Cancer Patients Following Esophagectomy

Background: Esophageal cancer remains one of the most challenging malignancies to treat, with survival rates significantly influenced by various hematological and nutritional markers. Understanding these markers is critical in optimizing treatment approaches and improving patient outcomes. Objective: This study aimed to investigate the prognostic significance of several markers, including Mean Corpuscular Volume (MCV), Red Cell Distribution Width (RDW), Mean Platelet Volume (MPV), C-Reactive Protein (CRP), Albumin, Total Lymphocyte Count (TLC), CRP Albumin ratio (CAR), and the Prognostic Nutritional Index (PNI), in patients with esophageal cancer undergoing esophagectomy. Methods: A prospective observational study was conducted involving 43 patients diagnosed with esophageal carcinoma at Dr. Ruth K.M. Pfau Civil Hospital Karachi. Data collection included patient demographics, tumor characteristics, and laboratory results obtained from the Hospital Information and Management Security System (HIMSS). Statistical analysis was performed using SPSS version 25, with Kaplan–Meier survival curves and log-rank tests assessing the impact of hematological and nutritional markers on survival outcomes. Results: The majority of patients presented with advanced disease (Stage III and IV) and tumor sizes ranging from 5 to 10 cm. Mean survival times and statistical comparisons were analyzed, but no significant differences in survival based on the markers were observed. For example, patients with low and high PNI values did not show significant differences in survival (Log-rank test p-value = 0.382). Conclusion: The study did not demonstrate significant prognostic differences based on the evaluated hematological and nutritional markers. However, it highlights the importance of considering these factors in the overall management of esophageal cancer, suggesting further research with larger sample sizes and diverse populations is necessary.

Role of Prophylactic Negative Pressure Dressings in Determining the Surgical Site Infection (SSI) on Closed Laparotomy Wounds in Abdominal Surgery: Randomized Controlled Open Label Trial: Vacuum Assisted Closure (VAC) Trial in a Tertiary Care Setup

Background: Surgical site infections (SSIs) continue to pose a significant challenge in postoperative care, particularly in abdominal surgeries, due to their prevalence and the associated increase in morbidity, mortality, and healthcare costs. Despite advancements in surgical techniques and aseptic measures, the incidence of SSIs remains high, underscoring the need for innovative preventive strategies. Objective: This study aims to evaluate the efficacy of vacuum-assisted closure (VAC) dressings compared to standard dressing methods in reducing the incidence of surgical site infections in patients undergoing closed laparotomy wounds in abdominal surgeries. Methods: A randomized controlled trial was conducted over six months at Civil Hospital Karachi, involving 116 patients undergoing abdominal surgeries. Participants were randomly assigned to receive either the VAC dressing or standard dressing postoperatively. The primary outcome measured was the incidence of SSIs within 30 days post-surgery, evaluated using the CDC classification and Southampton wound grading system. Data were analyzed using SPSS version 25.0, employing descriptive statistics, independent t-tests, and Chi-square tests for continuous and categorical variables, respectively. Results: The VAC group demonstrated a significantly lower incidence of SSIs (13.8%) compared to the non-VAC group (96.6%), with statistical significance (p &lt; 0.001). Age and BMI showed significant differences between the groups; patients in the VAC group were younger (mean age 30.84 ± 10.71 years) and had a lower BMI (mean 19.69 ± 4.16 kg/m²) compared to the non-VAC group (mean age 37.31 ± 12.83 years, mean BMI 22.07 ± 4.41 kg/m²). The duration of surgery and length of incision did not significantly differ between the groups. Conclusion: The use of vacuum-assisted closure dressings significantly reduces the incidence of surgical site infections in abdominal surgery patients, offering a superior alternative to standard dressings. This method not only enhances patient outcomes but could also lead to a reduction in healthcare costs by minimizing complications associated with SSIs.

Maternal Stress and its Associated Factors among Working Nurses in Public Sector Tertiary Care Teaching Hospitals, Karachi

Maternal stress has been identified as an epidemic that has a detrimental effect on work productivity and personal and professional growth. Objectives: To determine maternal stress and its associated factors among working nurses in public sector tertiary care teaching hospitals in Karachi, Sindh. Methods: The analytical cross-sectional study was accomplished at Dr. Ruth K.M Pfau Civil Hospital Karachi and Dow University Hospital Karachi. A total of 131 nurses were approached by a convenient non-probability sampling method. The Parental Stress Scale was used for data collection. Data were entered and analyzed by using SPSS version 24.0. Chi-square test was applied out to find an association between maternal stress and associated factors. Results: Nurses reported 72 (55%) mild parental stress, 58 (44.3%) parental moderate stress, and 1 (1%) severe parental stress. Nurses belonging to the younger age group, widowed or divorced, had mild parental stress, while nurses who lived with their husbands had lesser moderate stress. Female participants with one child of either gender, whose more family members were earning, had less tendency to have mild parental stress. A statistically significant association was found between working nurses' parental stress level and age group (p-value=0.005). Conclusions: It was concluded that nurses reported mild, moderate, and severe maternal stress. Hence, it is increasingly imperative to create facilities like daycare centers and offer them the flexibility to perform their job effectively

Frequency of Anemia in Patients with Newly Diagnosed Pulmonary Tuberculosis Presenting at Dr Ruth KM Pfau Civil Hospital Karachi

Frequency of Anemia in Patients with Newly Diagnosed Pulmonary Tuberculosis Presenting at Dr Ruth KM Pfau Civil Hospital Karachi

Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan.

To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi. We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit - Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan-Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival. Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value <0.001) and those with vascular involvement >90 degrees (p value <0.001) showed worse survival outcomes. Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.

COMPARISON OF BLUNT ABDOMINAL TRAUMA SEVERITY SCORING (BATSS) AND CLINICAL ABDOMINAL SCORING SYSTEM (CASS) IN BLUNT ABDOMINAL TRAUMA FOR NEED OF SURGICAL INTERVENTION

Blunt abdominal trauma can result in severe intra-abdominal injuries that may necessitate surgery. Scoring systems such as Clinical Assessment Score for Suspected Abdominal Injury (CASS) and Blunt Abdominal Trauma in Severe Spleen Score (BATSS) aid in predicting the need for surgery but require further evaluation. Objective: To assess the efficacy of the CASS and BATSS scoring systems in predicting the necessity of surgical intervention for patients with blunt abdominal trauma. Methods: This comparative study was conducted at Dr. Ruth K. M. Pfau Civil Hospital Karachi from July 1, 2023, to December 31, 2023. Vital signs on admission, signs of abdominal tenderness, distension, guarding, and organ-specific symptoms were recorded for all participants. Diagnostic imaging findings from studies such as abdominal ultrasound, computed tomography (CT) scans, or X-rays were also collected. The study included a total of 185 participants. Statistical analysis included sensitivity and specificity calculations to compare the predictive accuracy of the CASS and BATSS scoring systems. Results: The mean age of the participants was 35.8±12.67 years, with 87% being males. Road traffic accidents were the most common mode of injury (89%). The BATSS scoring system demonstrated higher accuracy in predicting the necessity of surgical intervention after blunting abdominal trauma, with 65.9% sensitivity and 95% specificity compared to the CASS scoring system. Conclusion: The BATSS scoring system shows superior efficacy in predicting the need for surgical intervention following blunt abdominal trauma compared to the CASS scoring system. This suggests that the BATSS score may be a more reliable tool for clinicians in assessing the severity of abdominal injuries and determining the appropriate course of treatment.

Evaluation of the Progress of Coronavirus Disease-19 Pneumonia using the British Society of Thoracic Imaging Reporting Model: A Validation Study

Abstract: Background: SARS-COV-2 (also known as severe acute respiratory syndrome corona virus-2), emerged as a pandemic and became an overwhelming global concern, causing substantial morbidity and mortality worldwide. Reverse transcription polymerase chain reaction (RT-PCR) is considered a gold standard in detecting clinically symptomatic patients but can have false negative and false positive results. As chest X-Ray (CXR) is considered as a baseline investigation in many hospitals, BSTI reporting model during COVID-19 pandemic has been a useful tool in diagnosis of COVID-19 pneumonia. Objective: To validate the British Society Thoracic Imaging (BSTI) coding system in the evaluation of the progress of the disease severity in patients with coronavirus disease-2019 (COVID-19) pneumonia. Materials and Methods: This is a cross sectional observational study. Total 450 CXRs (which included both the baseline and serial CXRs) of 225 COVID positive patients (RT-PCR positive for COVID-19 on nasal swabs) were included. These were retrospectively reviewed and reported by two Radiologists (having experience of at least 5 years in Radiology Reporting) in Corona Ward in Dr. Ruth K M Pfau Civil Hospital Karachi, Pakistan, for the duration of 10 months from 1st March 2020 till 31st December 2020. BSTI coding system was used to classify and interpret the CXR imaging findings as normal, definitive, indeterminate and non-COVID for baseline (CXR on 1st day of admission) and follow up CXRs (done in between 3rd and 7th day of admission). Data was analyzed using SPSS version 25. Numeric data was assessed for distribution using Shapiro-Wilks test. Median and interquartile range (IQR) were reported for numeric variables. Frequencies and percentages were reported for categorical data. Kappa statistics was applied to assess the agreement between BSTI scoring at baseline and follow-up CXRs. A p-value ≤0.05 was considered as statistically significant. Result: CXRs (including 225 baseline and 225 follow up CXRs) of 225 RT-PCR COVID-19 positive patients were analyzed. Interval change in BSTI coding system was noted, increase in frequency of probable/definitive COVID-19 findings were diagnosed on serial CXRs. The BSTI scoring at baseline and follow-up showed moderate agreement with kappa statistics as 60.3% (p=0.001). Conclusion: BSTI coding system can be helpful to classify the COVID-19 disease on CXR and filter for the prognosis of disease severity in the serial radiographs. Utilization of BSTI reporting model for reporting CXRs, even before RT-PCR, in future COVID pandemic can be considered as a useful tool.