Civil Hospital Karachi Research Articles

Comparison of complete nasal packing with and without integrated airways.

To compare the effects of nasal packing using a Nasopore nasal packing with and without an airway tube on postoperative pain, SpO2, nasal obstruction, and difficulty in breathing complaints. This comparative study was conducted at Dow University of Health Sciences (DUHS), DMC Civil Hospital Karachi between September 18, 2021, to May 19, 2022. A total of 70 patients who underwent septoplasty for septal deviation and chronic hypertrophic rhinitis were equally divided into two groups. Group-A patients received nasal packing using a Nasopore nasal packing with an airway tube, and Group-B patients received nasal packing using a Nasopore nasal packing without an airway tube. Post-operation Nasal pain sensations were measured using the Wong-Baker Faces Pain Rating Scale at 2 and 12 hours. SpO2 was measured at 30 minutes pre-operatively with an O2 saturation monitor and 12 hours post-operatively during sleep. The postoperative pain at two hours and 12 hours was compared between the two groups, and a significant difference was observed. In Group-A, the average SpO2 decreased > 4% from baseline in 5.7% patients, and 37% in Group-B. A significant difference was observed in the severity of nasal obstruction and difficulty breathing, P-value < 0.05. It is concluded that septoplasty followed by applying nasal packing with integrated airway reduces postoperative pain and improves oxygen saturation compared to nasal packing without integrated airways.

Autosomal Recessive Congenital Icthyosis with Cataract – A Case Report from Pakistan

The ichthyoses are a diverse group of disorders with variable clinical presentations. There are syndromic and non-syndromic forms with multiple associated features. The association of autosomal recessive congenital icthyosis (ARCI) with cataract is a rare phenomenon and no such case has been reported in recent literature. We hereby report the case of a 5-year-old female patient, a product of consanguineous marriage, who presented to the pediatric department of Dr. Ruth K.M Pfau Civil Hospital Karachi, Pakistan, with the complaint of rough skin with scaling and peeling over the entire body since birth due to congenital icthyosis. Shefurther developed complaints of reduced vision which later was diagnosed as cataract. Her previous two siblings had similar illness and they expired. Widespread scaling is the defining feature of ichthyosis specifically when it comes to ARCI it manifests at birth and can later progress to any spectra of illness. A multidisciplinary approach is required for the management of such patient. J MEDICINE 2023; 24(2): 155-157

Association of Visceral Fat Index with Coronary Collateral Circulation in Patients with Coronary Artery Disease

Abstract: Background: Coronary collateral circulation (CCC) is a network of anastomosing channels, established by heart in response to ischemia of myocardium. Hypertension, diabetes mellitus, and BMI are well established risk factors for development of poor CCC. Good CCC minimizes symptoms of angina, reduce the size of infarcts and prevent adverse cardiac events. The current research study was designed to find out the association of visceral adiposity and development of CCC among patients with coronary artery disease. Materials and Methods: The prospective study, conducted in Civil Hospital Karachi, comprised of 270 patients of coronary artery disease. According to the Rentrop Cohen categorization, patients were placed into two groups: the group with good collateral circulation having Rentrop grades i2-3 (n = 140) and the group with poor collateral circulation having Rentrop grades i0-1(n = 130). Rentrop score was determined by angiography. Segmental multi-frequency bioelectrical impedance analyzer was used to determine body fat mass and body muscle mass. Using Omron body fat and weight measurement systems, visceral fat index (VFI) was evaluated to determine the composition of visceral adipose tissue. SPSS was used for data analysis (Version 22). To assess the independent risk factor for poor CCC, logistic regression analysis was used. ROC curve was constructed to assess the efficacy of VFI in identifying CCC. Results: Overall, good collateral circulations were observed in 51.9% (n=140) of CAD patients, whereas poor collateral circulations were ound in 48.1% (n=130) of patients. Poor CCC was significantly associated with hypertension (OR=3, 95%CI= 0.111-8.231, p = .001) and VFI (OR=2, 95%CI= 1.451-3.567, p =.001). ROC analysis revealed a VFI &gt; 9 to be a potential predictor of poor CCC with AUC=0.9, sensitivity of 95.00% and specificity of 86%. Conclusion: The current study concluded that greater VFI and concomitant hypertension considerably increase the likelihood of having poor CCC, therefore, visceral adiposity can be considered as a potential target for preventing poor collateral circulation in patients with established cardiac disease.

Responding to burns - is our practice adequate?

Madam, Around 90% of burn related injuries are seen in low- and middle-income countries. Misfortune of such incidents lies in the fact that most of these are either preventable in the first place or can be efficiently managed before the casualty reaches the healthcare centre. According to a study1 conducted in Burns Ward of Civil Hospital Karachi, around 1,979 patients with burn-related injuries were admitted in just two-year period. Out of which, 715 patients (36.12%) expired. This mortality rate was higher in females (39.40%) and in people older than 60 (47.90%). A massive chunk of these deaths was accidental (95.80%), imposing the need to address the root cause of the issue. Another study2 showed that around 76% of students had never attended any formal training related to burns first aid management which is quite alarming. This again implies the extreme necessity to train and enable the masses to face burn related accidents. Another real dread comes with the prevalence of myths in the community that lead to the worsening burn wounds at home. According to a study3 conducted in POF hospital in Wah Cantt, a statistically significant (81.28%, p&lt;0.05) number of people lacked the understanding of burns first-aid. A vast fraction did not take immediate action upon facing a burn wound, making awareness sessions an exigency for such epidemiology. Another similar study4 interviewed parents and showcased that around 86.8% of parents didn’t irrigate the burn wound with tap water, which is considered a standard intervention for burn injury. Instead, a significant ratio (30%, p&lt;0.05) of parents used traditional remedies, among which toothpaste application (16.70%) tops the list. FRIP (First Response Initiative of Pakistan) is a non-governmental organization founded in 2010 aimed to educate the masses about the pre-hospital management of traumatic and non-traumatic injuries. One such aspect of its curriculum is burn management. Over more than ten years, it has instilled a standard method of burn wound care based on AHA’s (American Heart Association) guidelines among the masses and has taught ways to prevent it too. The effectiveness of such workshops is evidenced in a relevant study5 which reveals that a statistically significant difference (p&lt;0.05) existed after similar sessions conducted as illustrated in Figure 1. These figures prove the importance of first aid workshops and the crucial role FRIP plays in solving pre-hospital burn management problems.

Frequency, sociodemographic features and variations in clinical presentation of steroid induced dermatophytosis from a tertiary care hospital of Karachi.

Objective: To evaluate the increase in frequency of tinea incognito along with its current presentation and etiologic features. Study Design: Cross-sectional study. Setting: Dermatology Outpatient Clinic, Dr. Ruth Pfau Civil Hospital Karachi, Dow University of Health Sciences. Period: July to November 2023. Material &amp; Methods: It is a retrospective cross-sectional study done on subjects who were diagnosed with dermatophystosis from outpatient clinic of dermatology at Dr. Ruth Pfau Civil Hospital Karachi. The subjects were inquired about predisposing factors, drugs and family history, along with examination of the site of infection. The Statistical Program for Social Sciences (SPSS) version 21 was used for the analysis of data. Results: In this study, tinea corporis was determined to be the most frequent site of dermatophytoses (77.2%) with most of the participants being females (66.1%). Topical steroids were most commonly utilized (71.7%), whereas 44.9% of the population used steroid of moderate potency. Significant association of steroid use was found with itching (p = 0.019), pustules (p = 0.019) and erythroderma (p = 0.012) when compared with secondary signs and symptoms of dermatophytosis. Conclusion: This study concluded that wider prevalence, easy access and differentiable modes of application of steroids without proper consultation have worsened the clinical picture of dermatophytosis and increased the likelihood of recurrent infections.

Correlation between Infantile Vitamin D Insufficiency and the Incidence of Acute Lower Respiratory Tract Infections

Background: The deficiency of Vitamin D is a common nutritional problem that is often overlooked. However, increasing evidence shows that vitamin D has a vital role in building immunity and protecting against respiratory tract infections. The researchers found that people with lower serum vitamin D levels had a higher chance of experiencing severe respiratory tract infections. It is suggested that a deficiency of vitamin D may be a risk factor for severe respiratory tract infections. Objectives: This study investigated the correlation between vitamin D concentration and the severity of acute respiratory tract infections in infants. Study design: An analytical cross-sectional study Place and Duration This study was conducted in unit 1 Civil Hospital Karachi from April 2022 to April 2023. Methodology: The study examines the link between serum vitamin D concentration and severe acute lower respiratory tract infections (ALRTI) in children aged one month to one year. The study included two groups: a case group of children with severe ALRTI and a control group of children without the infection. The primary outcome measure involved assessing the serum concentration of vitamin D in the two study groups. Results: The median age of the case group was 5 months, with an interquartile range (IQR) of 4.75 months. The median age of the control group was 4 months, with an IQR of 4 months. The baseline demographic and anthropometric characteristics exhibited no significant differences between the two groups. Nevertheless, it was observed that the median vitamin D levels in the case group were significantly lower compared to the control group (p &lt; 0.05). Conclusion: The findings of our study indicate that vitamin D deficiency represents a significant risk factor for childhood pneumonia, particularly in the context of severe Acute Lower Respiratory Tract Infections (ALRTI). We found that a significant number of infants with ALRTI had a severe deficiency in vitamin D. Notably, the deficiency was seen more in infants who were exclusively breastfed. These findings suggest that increasing vitamin D quantity in diets can help to reduce the chance of severe ALRTI. Keywords: Respiratory Tract Infections, Infants, Vitamin D

Comparison of Simple Penile Dressings following Hypospadias Repair: does it really matter?

Background: Hypospadias repair requires an appropriate wound dressing to prevent complications, but there is a lack of studies comparing the efficacy of different dressings. Aim: To compare the clinical outcomes of occlusive hydrocolloid dressing and petroleum-impregnated gauze with zinc oxide adhesive plaster, and recommend an appropriate dressing based on efficacy, availability, and cost-effectiveness. Methods: We performed a retrospective cohort study on paediatric patients who had undergone hypospadias repair between August 2017 and November 2020 at Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. All the patients receiving one of the two wound dressings, occlusive hydrocolloid dressing (group A) or petroleum-impregnated gauze with zinc oxide adhesive plaster (group B) during primary or secondary hypospadias repair, operated by the same paediatric surgeon were included in this study. Patients with missing data were excluded. There was only one patient lost to follow up in this study. Results: A total of 64 male hypospadias patients with a mean age of 6.0 ± 3.4 years were included in this study. Group A patients (n=37) received a thick 10 x 10 cm occlusive hydrocolloid dressing whereas, in Group B patients (n=27), a 2.5 x 10 cm petroleum-impregnated gauze with zinc oxide adhesive plaster was applied over the wound. In group A, five patients (13.5%) suffered post-operative fistula and wound dehiscence. Whereas, in group B, the post-operative fistula was seen in three patients (11.1%). This study provides evidence-based information to clinicians and healthcare providers regarding the use of wound dressings for hypospadias repair. By demonstrating the efficacy of a cheaper and more accessible dressing, this study could help improve access to care and reduce costs for patients, especially in resource-limited settings. Conclusion: Occlusive hydrocolloid dressing and petroleum-impregnated gauze are equally effective in the healing of hypospadias repair wounds. The simpler and cheaper petroleum-impregnated gauze may be preferable in resource-limited settings. Keywords: Hydrocolloid dressing; Petroleum impregnated gauze; Paraffin gauze; Hypospadias

Frequency of Adverse Reaction in Antenatal Booked Patients of a Tertiary Care Centre Receiving Intravenous Iron Isomaltoside

Aim: To determine the frequency of adverse reaction in antenatal patients of Civil Hospital Karachi receiving intravenous iron isomaltoside for the treatment of iron deficiency anaemia. Methodology: A six months cross sectional study was undertaken at the department of Obstetrics &amp; Gynaecology Civil Hospital Karachi. In this study women who weighted &lt; 75 kg at the time of presentation to the antenatal clinic received 1000 mg parenteral iron isomaltoside infusion. Women with body weight ≥ 75 kg on the same occasion received 1500 mg parenteral iron during a minimum infusion of 30 min, diluted in 100–500 ml of saline. The patients who received parenteral iron were kept under observation in a secluded quiet room and directed to lie on her back on a comfortable bed. The researcher monitored the patient during and thirty minutes after the end of infusion to assess the adverse reactions. Results: The mean age of the women was 27.2 + 4 years, mean gestational age was 36 + 4 weeks. Out of 276 women, 17 (6%) experienced the adverse reactions. Majority (&gt;94%) developed mild reaction which did not require any treatment. The adverse effects were significantly associated with younger age &lt;30 years (p value .03), gestational age &lt; 36 weeks (p value .001), use of tobacco (p value .001), hypertension (p value .001) and diabetes (p value .001) Conclusion: Findings of the study concludes that the use of a single high-dose infusion (up to 1500 mg) of paranteral iron (isomaltoside) during pregnancy is effective and safe for treating IDA in this population. Keywords: Adverse reaction, antenatal booked patients, Intravenous iron isomaltoside.

Endoscopic Aspiration and Marsupialization for Colloid CYST

Background: Colloid cyst is a benign intracranial tumor found in the anterior third ventricle. Due to location of this tumor, it has propensity to cause obstruction to CSF flow causing hydrocephalus. Treatment options include excision or aspiration of cyst through open or endoscopic procedures or CSF diversion procedures. Recent years have seen a shift towards endoscopic approach to treatment of colloid cyst due to its relative simplicity among endoscopic procedures and other favorable patient related factors. We share our experience with endoscopic aspiration and marsupialization of colloid cyst. Methods: This descriptive retrospective study was done at Neuro surgery department of Neurosurgery, SMBB Institute of Trauma, Dow University of Health Sciences, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Data of patients who had endoscopic aspiration and marsupialization of colloid cyst between February 2017 and October 2020. Patient demographics, clinical presentation, radiological features, operative course and post-operative course was recorded. Clinical or radiologic recurrence was noted on follow-up. Results: Ten patients were operated during the study period. Headache was most common presenting symptom. Mean size of cyst was 21mm. There was incomplete aspiration in 3 patients as observed per-operatively and by residual cyst content on immediate post-operative CT scan which disappeared completely on subsequent scans. CSF leak was observed in 3 patients and 2 developed meningitis. No symptomatic recurrence occurred. Conclusion: Endoscopic aspiration with marsupialization of cyst wall is a safe and effective technique for treatment of colloid cyst. Incomplete aspiration of cyst contents may not require further intervention as the radiological resolution of cyst is observed over time. Further follow-up and larger sample size is needed to further establish the safety and efficacy of this procedure. Keywords: colloid cyst, endoscopic, follow-up studies

Current Sensitivity Pattern of Salmonella Species in Children Presenting at a Tertiary Care Hospital

Background: Enteric fever is a common and treatable pediatric bacterial infection, but emerging drug resistance has been a real challenge for treating physicians. Since 2016, Pakistan is facing the epidemic of Extensively drug resistant (XDR) salmonella typhi. Objective: To determine the clinical presentation and current pattern of sensitivity of salmonella species in children diagnosed with enteric fever. Study Design: Descriptive, Cross sectional Place and Duration of Study: Pediatric department of Dr. Ruth K. M. Pfau Civil Hospital Karachi, from July to December 2022. Methods: Medical records of patients 1 month to 12 years of age, diagnosed as enteric fever on positive blood culture for salmonella, were inducted into the study by non-probability convenient sampling. The clinical manifestations of patients and sensitivity and resistance patterns of salmonella were recorded. Data was analyzed using SPSS version 22. Results: A total of 140 children had enteric fever, out of which 60.7% were male. Mean age of the patients was 4.48+2.47 years. Most common symptom was fever in 140 (100%), followed by anorexia in 97 (69.2%) and abdominal pain in 70 (50%). Blood culture reports showed Extensive drug resistance in 105 (75%), Multi drug resistance in 3 (2.14%) and Non-resistance in 7 (5%). Salmonella Typhi isolates were sensitive to Carbapenems in 140 (100%), Azithromycin 139 (99.2%) and Piperacillin/Tazobactam in 60 (42.8%). Conclusion: XDR enteric fever is still the most common resistance pattern identified in admitted patients with enteric fever. Large scale public health measures and antibiotic stewardship are required to fight this disease. Keywords: Typhoid fever, Salmonella Typhi, Drug resistance, Infection, Epidemic

Correlation of HbA1c with Serum Iron & Transferrin Saturation in Non-Diabetic Patients with Iron Deficiency.

To determine correlation of HbA1c with serum iron and transferrin saturation in non-diabetic patients with iron deficiency. This cross-sectional comparative study was conducted at Dr Ruth KM Pfau Civil Hospital Karachi from 15th September 2021 to 14th March 2022, on non-diabetic patients based on fasting blood sugar (FBS) of <100 mg/dl. Patients were divided into two groups. Group one included patients having iron deficiency anemia (ID), whereas group two included same number of age and sex matched healthy subjects taken as controls, without ID. Blood sample was taken for HbA1c, CBC, serum iron and total iron binding capacity. Transferrin saturation (TSAT) was calculated. Comparison of quantitative variables with ID and non-ID group was done by Student's t-test. Correlation of HbA1c with iron &TSAT was done in both groups using Kendal tau-b test, as data was not normally distributed. Out of 230 patients, 83 (36.1%) were males while 147(63.9%) were females. Mean age of patients was 43.7±13.28 years. Mean HbA1c level was significantly high in ID group (5.89±0.43) as compared to non-ID group (5.52±0.50) with a p-value <.001. The HbA1c levels correlated negatively with hemoglobin, serum iron levels and transferrin saturation with a p-value <.001. Low serum Iron and TSAT was related to elevation in HbA1c value. Iron deficiency needs to be corrected before HbA1c interpretation.

Frequency of Development of Atrial Fibrillation After Coronary Artery Bypass Grafting in Different Age Groups

Atrial fibrillation is a known complication in patients having coronary artery bypass grafting (CABG) surgery with a Post- up to 32% after CABG reported incidence up to 32%. Objective: To determine the frequency of development of atrial fibrillation after coronary artery bypass grafting surgery in different age groups. Methods: This was an observational prospective cross sectional study, conducted at department of cardiac surgery Dr Ruth.K.M.Pfau Civil Hospital Karachi. The sample size of 199 was calculated. All patients between the ages of 30-70years. Irrespective of gender, refer for CABG surgery was included in the study. Two groups were made on the basis of their age, group 1, 30-50 years and group 2, 51-70 years. Those patients who came for CABG along with valve replacement and or other concomitant surgery were not included in my study. Results: After data collection through Performa data analyzed on SPSS 17.0. As per results 20.1% individuals in the study developed atrial fibrillation. Male to female ratio was 3: 1. In Group 1, 16.6% patients developed Atrial Fibrillation and in group 2 21.58% developed Atrial Fibrillation with p value of 0.85. Hypertension was a commonest co-morbid and present in 56.2% patients in this study. Conclusion: The study concluded that the frequency of development of atrial fibrillation after CABG as 20.10 %. Patients with positive family history of coronary artery diseases and smokers have significantly higher risk to develop atrial fibrillation after surgery.

PSYCHOLOGICAL IMPACT OF RIGHT HAND TRAUMA IN LABOR GROUP

OBJECTIVE: To determine the correlation between mean Disabilities of Arm, Shoulder, and Hand (DASH) scores and Impact of Event Scale-revised (IES-R) scores in laborer with right hand trauma. METHODS: This correlational study was carried out at the Department of Plastic Surgery, Civil Hospital Karachi, Pakistan from January 2022 to June 2022. The inclusion criteria were laborers of any gender, age ≥18 years, presenting with right hand trauma having dominant hand infection and were medically fit and well and had no systemic illness. The severity of symptoms was assessed via DASH questionnaire. While psychological impact was assessed via IES-R. RESULTS: Out of 60 patients, 56 (93.3%) were males and 4 (6.7%) were females. Mean age of the patients was 45.07±14.96 years. Majority (n=50; 83.3%) of the patients were married. Overall, a moderate positive correlation was observed in between DASH score and IES score (r: 0.503, p: &lt;0.001). Further stratification revealed moderate significant correlation of IES and DISH score for married workers (r: 0.578, p: &lt;0.001), &gt;5 years of experience (r: 0.663, p: &lt;0.001); whereas strong positive correlation was observed for crush injury (r: 0.943, p: &lt;0.001), puncture injury (r: 0.970, p: &lt;0.001) and cut injuries (r:0.754: p=0.012). CONCLUSION: This study revealed a considerable relationship of DASH scale and psychological impairment in patients with right hand trauma. Worker who have gone through right hand trauma due to crush, puncture or cut injuries, married and those having more than 5 years of experience should be considered as high-risk population for psychological impairment.

Frequency of Glucose 6 Phosphate Dehydrogenase Deficiency in Neonates Presenting with Jaundice

Objective: Frequency of Glucose – 6- Phosphate Dehydrogenase deficiency in neonates presenting with jaundice Study design: A cross-sectional study Place and Duration: Pediatric department, civil hospital Karachi from January to June 2019 Methodology: The study included all infants who were hospitalized in the neonatology unit with jaundice. At the beginning of the trial, the parents of each neonate gave their assent after being assured that there would be no monitoring burden placed on the parents for the examinations. When entering the hospital, the researcher himself completed a predesigned proforma that asked for specific details about the patient's age, sex, ethnicity, jaundice onset age, consanguinity, and family history of G6PD deficiency. Investigations on newborns included measuring serum bilirubin and looking for signs of G6PD deficiency. (Estimation of G6PD enzymes). Sigma Diagnostic G6PD Reagent was used to estimate the G6PD enzymes for the qualitative, visual, and calorimetric assessment of G6PD deficit in red blood cells. When the sample's deep blue colour changes Results: 174 infants with jaundice in total were included during the study period. Participants in the study had an average age of 16.12 +/- 7.2 days. 95 (54.6%) of the 174 study participants were men, and the male-to-female ratio was 1.2:1. It started at an average age of 8.83.8 days. 79 (45.5%) out of a total of 117 (67.2%) participants are Pathans by consanguineous marriage. 23 (13.2%) of the 174 subjects were G6PD deficient. According to a stratified analysis, out of 23 G6PD-deficient newborns, 11 (47.8%) were between 1 and 11 days old, 19 (82.6%) were between 0 and 6 days old, and 14 (60.8%) had blood bilirubin levels below 15 mg/dl. Conclusion: It was concluded that G6PD is a common cause of neonatal jaundice in our setup. Keywords: Neonates, Jaundice, G6PD deficiency

Fentanyl-Propofol Versus Ketamine-Propofol Combination for Sedation and Recovery in ERCP: A Double-Blinded Randomized Clinical Trial

Objective: The main goal of this study was to investigate the groups receiving fentanyl-propofol (fentP) against ketamine-propofol (ketP) in ERCP in terms of sedation, rescue sedation requirement, and recovery scores. Additionally, evaluated were the procedure's hemodynamic changes, postoperative pain score, complications, and endoscopist satisfaction. Methodology: A double-blinded randomized clinical trial was undertaken at the Dr. Ruth K.M. Pfau Civil Hospital Karachi's endoscopic room (DUHS) for six months. By using OPEN EPI sample size calculator, sample size was calculated. A total of 124 patients for elective ERCP were randomized into two groups by SNOSE protocol. Groups A and B, fentanyl-propofol (fentP) and ketamine-propofol (ketP), respectively, each contain 62 patients. All patients were given a loading dose of propofol 0.5 mg/kg, followed by a 75 ug/kg/minute infusion. The group fentP received fentanyl 1ml/kg (1 ug/kg) and the group ketP received ketamine 1ml/kg (0.5mg/kg). Ramsay sedation scores, the necessity for rescue sedation, and the Aldrete score post-operatively were noted. Hemodynamics during surgery and complications were also noted. Results: Sedation began noticeably earlier than usual in the group B at 0, 2 and 4 minutes (p-value &lt;0.05), whereas sedation scores were higher in the group A at 8,10, and 15 minutes (p-value &lt;0.05). Early sedation in the group B led to less consumption of rescue sedation doses (p-value &lt;0.01). However, recovery scores were comparable in each groups (p-value &gt;0.05). Conclusion: We were able to conclude that during ERCP, ketP had a significantly faster sedative onset than fentP, with less complication and a quicker recovery. Keywords: Propofol, KetP, FentP, ketamine, fentanyl, Sedation, Analgesia, ERCP, Monitored Anesthesia care.

Maternal and Perinatal Outcome of Perimortem Caesarean Section

Aim: To describe characteristics, etiological factors, maternal and perinatal outcome of perimortem Caesarean section. Design: Prospective study Setting: Emergency Room of Department of Obstetrics &amp; Gynecology Unit IDr.Ruth KM Pfau Civil Hospital &amp; Dow Medical College, Karachi. Methodology: This study was carried out in the Department of Obstetrics and Gynaecology, Civil Hospital Karachi from November 2020 to March 2021. All women who were presented in emergency in a collapsed state were included in the study and those women who were brought dead were excluded. Clinical details including age, gestational age, reason for perimortem Caesarean section, perinatal and maternal outcome were recorded on a predesigned proforma. Results: A total of 27 women underwent perimortem Cesarean section. The mean age of women who underwent PMCS was 266.5 years, and mean gestational age was 35±4weeks. Sixteen (59%) women were referred from either primary care or small clinics. Majority 15(55%), underwent PMCS within 5 minutes of maternal collapse and 12(44%) underwent PMCS, after 5 minutes of collapse. Septic shock 21(77%) was the main etiological factor for PMCS, followed by hypertension and cardiomyopathy 2(7%) each. Twenty three (85%) women survived, following PMCS, whereas 4(14%) died. Reasons for maternal death included hepatic encephalopathy(1), peripartum cardiomyopathy(2), eclampsia(1). The perinatal mortality was high, with only 14(51%) live birth and mean APGAR score at 1 and 5 minutes was 3. The mean stay in intensive care was 37 35 hours, whereas mean stay in ward was 5739 hours. Practical implications: This study suggests that if perimortem caesarean section accomplished in a timely manner, it can improve fetomaternal outcome. Conclusion: Perimortem Caesarean section can improve upon maternal survival. Greater awareness among doctors, multidisciplinary approach, proper documentation and information for family members are cornerstone of this emergency procedure. Keywords: Perimortem Cesarean section, septic shock,eclampsia,postpartumhaemorrhage, maternal mortality.

EVALUATING THE SUCCESS RATE OF VAGINAL DELIVERY AFTER CAESAREAN SECTION

: The retrospective study was conducted in the Department of Gynecology Dr. Ruth K. M. Pfau Civil Hospital Karachi, from February 2021 to February 2022, for the evaluation of factors associated with the success of TOLAC (trial of labor after cesarean delivery) and to identify variables for predicting the success of TOLAC in subjects with prior Caesarean section (CS). A total of 315 women were included in the study. They were divided into the validation cohort (n=20, 63%) and the training cohort(n=295, 93.6%). The primary endpoint was the success rate of vaginal delivery. The results showed that of 315 participants, 264 (83.8%) women had successful TOLAC and vaginal delivery, and 51 (16.1%) had ERCS. According to multivariate analysis, BMI-estimated birth weight, gestational age &lt;41 weeks, rupture of membranes, and cervix Bishop score ≥5 was significantly associated with the success of TOLAC. Results suggest that TOLAC has a high success rate in women with a history of c-sections.

Current status and challenges of robotic surgery in Pakistan.

Current status and challenges of robotic surgery in Pakistan.

Characterising paediatric mortality during and after acute illness in Sub-Saharan Africa and South Asia: a secondary analysis of the CHAIN cohort using a machine learning approach

A better understanding of which children are likely to die during acute illness will help clinicians and policy makers target resources at the most vulnerable children. We used machine learning to characterise mortality in the 30-days following admission and the 180-days after discharge from nine hospitals in low and middle-income countries (LMIC). A cohort of 3101 children aged 2-24 months were recruited at admission to hospital for any acute illness in Bangladesh (Dhaka and Matlab Hospitals), Pakistan (Civil Hospital Karachi), Kenya (Kilifi, Mbagathi, and Migori Hospitals), Uganda (Mulago Hospital), Malawi (Queen Elizabeth Central Hospital), and Burkina Faso (Banfora Hospital) from November 2016 to January 2019. To record mortality, children were observed during their hospitalisation and for 180 days post-discharge. Extreme gradient boosted models of death within 30 days of admission and mortality in the 180 days following discharge were built. Clusters of mortality sharing similar characteristics were identified from the models using Shapley additive values with spectral clustering. Anthropometric and laboratory parameters were the most influential predictors of both 30-day and post-discharge mortality. No WHO/IMCI syndromes were among the 25 most influential mortality predictors of mortality. For 30-day mortality, two lower-risk clusters (N=1915, 61%) included children with higher-than-average anthropometry (1% died, 95% CI: 0-2), and children without signs of severe illness (3% died, 95% CI: 2-4%). The two highest risk 30-day mortality clusters (N=118, 4%) were characterised by high urea and creatinine (70% died, 95% CI: 62-82%); and nutritional oedema with low platelets and reduced consciousness (97% died, 95% CI: 92-100%). For post-discharge mortality risk, two low-risk clusters (N=1753, 61%) were defined by higher-than-average anthropometry (0% died, 95% CI: 0-1%), and gastroenteritis with lower-than-average anthropometry and without major laboratory abnormalities (0% died, 95% CI: 0-1%). Two highest risk post-discharge clusters (N=267, 9%) included children leaving against medical advice (30% died, 95% CI: 25-37%), and severely-low anthropometry with signs of illness at discharge (46% died, 95% CI: 34-62%). WHO clinical syndromes are not sufficient at predicting risk. Integrating basic laboratory features such as urea, creatinine, red blood cell, lymphocyte and platelet counts into guidelines may strengthen efforts to identify high-risk children during paediatric hospitalisations. Bill & Melinda Gates FoundationOPP1131320.

Liver and Renal Injury with Remdesivir Treatment in SARS-CoV-2 Patients.

To determine the effect of Remdesivir on liver enzymes and renal functions in SARS-CoV-2 patients. This prospective cohort study was conducted at Dr. Ruth KM Pfau, Civil Hospital Karachi between 1st December 2021 to 31st January, 2022. All patients of severe SARS-CoV-2 infection who received Inj. Remdesivir for five days as per protocol of SARS-CoV-2 management were included. Biodata of selected patients including age, gender, diabetic, hypertensive status was recorded. Patients Liver Function Tests and Serum Creatinine were performed on days 0, 3, 5, 7 and 14. This study included 85 patients, out of which 55 (64.7%) were males and 30 (35.3%) were females. Out of 85 patients, Remdesivir was stopped in 3 (3.5%) patients. Among these three patients Remdesivir was stopped in one patient on day three because of decrease in CrCl to <30 ml/min. His CrCl improved after stopping Remdesivir. In the remaining two patients, Remdesivir was stopped due to increase in ALT to greater than 10 times from normal values on day three. Similarly, in these two patients the ALT improved after stopping Remdesivir. Only three patients developed adverse effects resulting in stopping of Remdesivir, however these were reversible on stopping the drug. Therefore, Remdesivir is a relatively safe drug and well tolerated in SARS-CoV-2 patients.