Civil Hospital Karachi Research Articles

Optimizing Orthopedic Operative Notes: A Closed-Loop Audit and Interventional Approach for Improved Practices

Maintaining accurate and clear medical records is crucial for effective patient care. These records, detailing a patient's evaluation, management plan, surgical procedures, and post-operative instructions facilitate a seamless communication and care during the initial postoperative phase. The Royal College of Surgeons issued Good Surgical Practices guidelines in 2008 and updated them in 2014, setting parameters for operative notes. This audit aimed to evaluate handwritten operative note-keeping practices in Orthopedic Unit I at Dr. Ruth K.M. Pfau Civil Hospital Karachi in comparison to these established guidelines. The audit was conducted in two cycles between March and June 2023. In each cycle, 58 operative notes were evaluated against Good Surgical Practices (RCS) guidelines using a predefined form. After the initial audit, a meeting with the department team highlighted findings, stressed the importance of accurate operative notes, and introduced a new RCS-compliant format approved for implementation. Surgeons adapted to the new format during a 2-week period, followed by the second phase of the re-audit. The results were shared within the department to ensure ongoing improvement. In the initial audit, compliance with the RCS guidelines was observed at 40.7%. After implementing the new note format, significant enhancements were noted in 20 out of 22 parameters, resulting in an overall compliance rate of 64.8% and an improvement of 24.1%. Significant improvements were observed in recording patient identification, prosthesis details, antibiotic prophylaxis, surgical complications, incision name, theater anesthetist's name, and anticipated blood loss. However, documentation of 'any additional procedures performed and the reason why' and 'DVT prophylaxis' showed minimal to no improvement. The survey reveals notable gaps in orthopedic operative note documentation, emphasizing the limitations of traditional handwritten notes and a lack of adherence to operative notes guidelines. Rectifying this is crucial for optimal patient care, maintaining precise records, and minimizing legal risks.

Assessment of Vaccination Coverage Among Measles Cases in Children Aged 10 Months to 5 Years at Civil Hospital Karachi

Background: Measles remains a global health concern, particularly in developing countries, and despite improvements in global vaccination efforts, certain regions, including Pakistan, continue to report cases. This study aims to assess the frequency of vaccinated children among measles cases, shedding light on potential vaccine failure factors. Methodology: A comprehensive analysis was conducted on 139 children diagnosed with measles in an emergency department. The vaccination status of each child was determined through a thorough examination of their vaccination history and available vaccination cards. In cases where records were unavailable, relevant data were meticulously recorded on a standardized Performa. Results: Among the 139 children studied, 30.94% were found to have received vaccinations, and only 35.9% had completed the recommended two-dose schedule. The average age for receiving the first and second doses was 9.6±1.05 months and 15.67±0.82 months, respectively. Conclusion: The findings underscore that a substantial proportion of measles cases occurred in unvaccinated or partially vaccinated children, emphasizing the critical role of complete immunization. However, despite vaccination efforts, many children still contracted the disease, indicating the necessity for further in-depth research in this domain.

Comparison of Efficacy between Myo-Inositol versus Metformin in Women with Polycystic Ovary Syndrome

Objective: To compare the effectiveness of myo-inositol versus metformin in treating women with polycystic ovary syndrome.Study Design: Cross-sectional study.Place and Duration of Study: The study was carried out at the Department of Gynae Unit II, Dr. Ruth. K.M. Pfau th th Civil Hospital Karachi, Pakistan from 7 February 2019 to 6 August 2019.Methods: All eligible patients who visited the hospital were enrolled. The group-Aincluded females who received myo-inositol (n=35), whereas the group-B included females who received metformin (n=35). Females in the myo-inositol group were administered 1 gram of myo-inositol twice daily, while those in the metformin group were administered 500 mg of metformin twice daily. Regular follow-up visits were scheduled every two months, and the efficacy of the treatment was assessed after six months. Efficacy was evaluated in terms of the normalization of menstrual cycles and the achievement of ovulation.Results: The mean age in the myo-inositol and metformin groups was 23.92±3.70 and 23.68±4.23, respectively. The mean weight in the myoinositol and metformin groups was 59.23±2.07 and 61.79±5.92, respectively. Notably, the efficacy rates for the myo-inositol and metformin groups were 68.57% and 20%, respectively with p-value=0.001.Conclusion: Myo-inositol was found to demonstrate significant superiority over metformin in the treatment of polycystic ovary syndrome.How to cite this: Latif N, Rajar S, Yousuf M, Imtiaz S, Abbas S, Jamali Z. Comparison of Efficacy Between Myo-Inositol versus Metformin in Women with Polycystic Ovary Syndrome. Life and Science. 2024; 5(1): 48-53. doi: http://doi.org/10.37185/LnS.1.1.486

Effectiveness of Prophylactic Ketamine on Shivering in Cesarean Section after Spinal Anesthesia

Background: Regional anesthesia, including spinal or epidural techniques, can disrupt the body's ability to regulate temperature, leading to a heightened risk of shivering. Studies have indicated that shivering occurs in up to 55% of patients undergoing procedures under regional anesthesia. To address this issue, numerous medications have been explored for their potential to prevent post-anesthetic shivering. Objective: To assess the effectiveness of prophylactic ketamine on shivering in cesarean section after spinal anesthesia. Study Design: Prospective, randomized, double blind, clinical trial. Settings: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital Karachi Pakistan. Duration: Six months from August 2019 to January 2020. Methods: A total of 60 patients undergoing spinal anesthesia for elective cesarean section were included in this study. Two groups A and B were formed and patients were equally divided into these groups by lottery method. Group A were treated with ketamine 0.5 mg/kg I/V and group B treated with normal saline 0.05ml/kg/I/V. Grade 0-1 shivering was labeled as effective and shivering grade 2, 3 or 4 at 15 minutes after administration of the drug, was considered ineffective. Results: The average age of the patients was 28.33 ± 5.67 Years. Rate of shivering was significantly high in patients who were treated with normal saline than ketamine in which shivering was not observed (53.3 vs. 0% respectively; P value of 0.0005). This implies that effectiveness was significantly high in groups A than group B (100% vs. 46.7%). Conclusion: Ketamine observed to be the effective drug for the treatment of postanesthetic shivering. It should be considered prophylactically in any patient undergoing spinal anesthesia.

Metabolic storage disorders at a tertiary care hospital, Pakistan

OBJECTIVE: To determine the clinical spectrum of metabolic storage disorders presenting to a public sector tertiary care hospital in Karachi, Pakistan. METHODOLOGY: This retrospective, cross-sectional study was conducted at the Department of Pediatrics, Dr RKMP Civil Hospital Karachi, in 2021. We reviewed the medical records of patients from January 2015 to December 2020. We included all pediatric patients admitted with suspicion of metabolic storage disorders based on two or more: visceromegaly, developmental delay, regression of milestones, fits without fever, family history of similar illness, and family history of expiry of children due to unknown reasons. Patients of malaria, enteric fever, epilepsy and cerebral palsy were excluded. We noted the demographic and clinical variables and applied descriptive statistics using SPSS version 22. RESULTS: Out of n=140 suspected children, n=40 (28.5%) patients were diagnosed with metabolic storage disorder. Among these, 26 (65%) were Lysosomal, and 14 (35%) were Glycogen storage disorders (LSDs and GSDs). The most common clinical feature of LSDs was faltering growth in 23 (88.4%), while for GSDs, it was abdominal distention and hepatomegaly in 100% of patients. Mucopolysaccharidoses were the most common type of LSD identified in 9(34.6%). Interestingly, family history of similar illness was not a standard feature (19.2% for LSDs and 7% for GSDs). CONCLUSION: Metabolic storage disorders are an emerging concern to pediatric health in our population. Physicians need to keep a high index of suspicion for patients with faltering growth and visceromegaly, with or without a significant family history. KEYWORDS: Glycogen storage diseases; Lysosomal storage diseases; Metabolic diseases; Inborn errors of metabolism; Hepatomegaly; Genetic diseases

Health related quality of life in patients with liver cirrhosis: its determination and correlation with relevant factors

OBJECTIVE: To determine the health-related quality of life (HRQOL) among patients with Cirrhosis of the liver using a short form of liver disease quality of life (SF-LDQOL) instrument, also to correlate HRQOL scores with relevant factors. METHODOLOGY: This is a prospective, cross-sectional study carried out in the medical department of Civil Hospital Karachi from May 2021 to April 2022. One hundred ninety-seven confirmed cases of Cirrhosis from either gender over 18 years of age without malignancy, HIV infection, or Psychiatric/Neurological diseases were enrolled using convenient sampling. The SF-LDQOL instrument assessed HRQOL, summarizing overall disease-targeted HRQOL (0 to 100), where a higher score shows good HRQOL or otherwise. HRQOL was correlated with various sociodemographic factors and the severity of liver cirrhosis. RESULTS: Using SPSS version 23, the SF-LDQOL score was 44±7.3. The severity of liver cirrhosis by (Child Turcotte Pugh) CTP-A correlated weakly (-0.1294), while CTP B and CTP C strongly correlated with SF-LDQOL scores (-0.9894 and -0.9912), respectively. The p-value for CTP A (0.705) is insignificant; however, for CTP B and C (p < 0.00001 & p < 0.00001) is significant. Demographically, the age and income status correlated strongly to SF-LDQOL scores, displaying considerable p-values (p <0.00001 and p < 0.00001). CONCLUSION: Most patients had compromised HRQOL as assessed by well-validated and more disease-specific tool SF-LDQOL score. HRQOL correlated positively with the severity of Cirrhosis by applying CTP and Model of end-stage liver disease (MELD) scoring. Sociodemographic parameters of age and income status also correlated well with HRQOL. KEYWORDS: Cirrhosis of the liver, Child Turcotte Pugh, Model of end-stage liver disease, Health-related quality of life.

Effect of Infectious Diseases Specialist Consultation on the Management and Outcome of Patients in a Public Sector Hospital

Aim: To assess the effect of infectious diseases specialist consultation on the management and outcome of patients in a public sector hospital. Materials and Methods: This was a prospective cohort study in which a total of 313 patients were enrolled. This study was conducted in Dr Ruth Km Pfau Civil Hospital Karachi. The study duration was 6 month from 1st January, 2023 to 30 June, 2023. Data were collected from the medicine, surgery and allied departments of Civil Hospital Karachi by the study investigators themselves. For statistical analysis we used SPSS Version 25. Results: We included a total of 313 patients in our study, with a mean age of 52.31±10.51 years and an average length of stay of 13.04±5.50. These patients were distributed across various departments, with 91 (29.1%) from medicine, 110 (35.1%) from surgery, and the remaining 112 (35.8%) from other allied departments. The majority of patients, 63 (20.1%), were diagnosed with bacteremia, while 52 (16.6%) had urine infections, and 56 (17.9%) experienced urinary tract infections (UTI). Other diagnoses included Ventilator-associated pneumonia/hospital-acquired pneumonia (17.9%), Mixed infections (3.2%), Necrotizing Fasciitis (11.2%), Peritonitis (9.6%), Pancreatitis (2.6%), Surgical Site Infections (SSI) (6.4%), Diabetic foot infections (4.5%), Osteomyelitis (4.8%), and Meningitis (3.2%) respectively. Patients were categorized based on the etiology of infection, revealing that 14 (4.5%) patients had unexplained fever. Additionally, malaria was found in 21 (6.7%) patients, Dengue in 32 (10.2%), Tuberculosis in 27 (8.6%), ATT-induced hepatitis in 9 (2.9%), Multidrug-Resistant Organisms (MDROs) in 148 (47.3%), Methicillin-resistant Staphylococcus aureus (MRSA) in 49 (15.7%), Fungal infections in 11 (3.5%), and Viral infections in 2 (0.6%). Regarding outcomes, 229 (73.2%) patients exhibited clearance of bacterial or fungal cultures, 13 (4.2%) showed no disability at the time of discharge, 229 (76.7%) demonstrated improvement in signs and symptoms, and mortality occurred in 1 (0.3%) patient. Conclusion: It was concluded that consulting with experts in infectious diseases has a major impact on patient management and results. Keywords: Infectious Disease specialist, management, consultation.

Frequency of Re-Fracture in Osteoporotic Patients

Aim: To determine the frequency of re-fracture in osteoporotic patients presenting @ SMBBMU Larkana Subject and Methods: This is Descriptive Cross-sectional study, accompanied at Department of Orthopedics, SMBBMU and Civil hospital Karachi, for period of 6 months from 19-07-2018 to 19-01-2019. Total of 130 osteoporotic patients with previous fracture were included in this study. Brief histories for the duration of present complain and history of previous fracture was taken. Presence of pain, tenderness and mobility at the site of trauma was noted. X rays Anterio-posterior/Lateral of the effected site was done and presence of fracture with break in the continuity of the bone was considered as re-fracture. Data was collected on structured proforma. Results: A total of 130 osteoporotic patients with previous fracture were selected in our study. The average age of the patients was 58.77±4.27 years. Average duration of presenting complains and previous fractures were 3.93 ± 0.87 days and 7.11±1.23 months. There were 1:1 male to female ratio. Out of 130 patients, 68.46% were type II diabetic, 83.85% were hypertension. Frequency of re-fracture in osteoporotic patients was observed in 8.46% (11/130) Conclusion: Fracture is common presentation in osteoporotic bones. Our study showed that rates of re-fracture range up to 8.46% in patients with an initial osteoporotic fracture, depending on the type of initial fracture. Keywords: Osteoporosis, Osteoporotic fractures, fracture and Re-fracture.

Impact of Psychiatric Internship on Medical Graduates: Quasi Experimental Study

Background: Physical health is incomplete without mental health; despite this fact Psychiatric teaching and training of medical health professionals is an undermined area especially in developing countries like Pakistan. This study is aimed to determine the impact of knowledge, attitude and perception towards Psychiatry and also possible change in the career choice of medical graduates (house job interns) of public sector hospital of Karachi after doing internship in Psychiatry Methods: This Quasi experimental study was conducted in 40 medical graduates house job interns who were doing 12 weeks internship in Psychiatry department of Dow Medical College & Dr Ruth K.M.Pfau Civil Hospital Karachi from April 2020 to March 2021 on quarterly basis. A Self synthesized pretested questionnaire was employed twice at pre internship and post internship levels and two semi structured questions were also administered to qualitatively compare their responses. SPSS-19 was applied to
 statistically analyze the result and paired sample t-test was used to compare both pre and post internship scores Results: There was found statistically significant impact of psychiatric internship on medical graduates (preinternship; M=52.2, SD=10.8 and post internship M=60.6, SD=8.3); t(39)=-4.6,p=

Outbreak of Burkholderia Cepaciae Bacteremia in Neonatal Units of a Public Sector Hospital in Karachi, Pakistan

Aim: This study aimed to determine the occurrence of Burkholderia cepaciae outbreak in neonatal units, identifying the source, defining the best therapy for B. Cepaciae, and enhancing infection control practices. Methods: All neonates with BCC bacteremia during the study period were included. Data were gathered through the microbiology database, medical charts, laboratory data, and infection control surveys. Disk diffusion methodology was used in accordance with CLSI. Information from environmental cultures and feedback was included in the study. Results: The results showed varying patient demographics across the three pediatric wards, with differences in weight, gender distribution, hospital stay duration, and diagnoses. Trends of outbreak were identified with varying patterns in different wards. An intervention was performed, leading to general improvements in infectious disease control practices, and Burkholderia cepaciae was found to be most sensitive to Levofloxacin and Trimethoprim-Sulfamethoxazole. Conclusion: The study identified suspected sources and defined susceptibility profiles for empirical therapy for B. Cepaciae, contributing to the prevention of future outbreaks. Challenges in implementation underscore the need for proper administration and continuous emphasis on correct implementation of infection control practices. Keywords: BCC bacteremia, neonates, outbreak, Burkholderia cepaciae, infection control practices, Civil Hospital Karachi

Comparison of Biometric Formulae for Intra Ocular Lens Power Calculation

Purpose: To determine the accuracy of different biometric formulae for intraocular lens power (IOL) calculation in predicting a target postoperative refraction within ± 1.0 diopters in patients with long axial length undergoing phacoemulsification. Study Design: Cross sectional study. Place and Duration of Study: Department of Ophthalmology and visual sciences, Unit 1 Dow University of Health Sciences, Dr. Ruth KM Phau Civil Hospital Karachi from February 2019 to August 2019. Methods: The study included 45 eyes with cataract and preoperative uncorrected visual acuity ranging from 6/60-6/12, axial length of 24.5 to 27.0 mm with no other ocular problem. IOL power was calculated with SRK-T, Holladay 1 and Haigis formula installed in optical biometer AL-Scan (Nidek Co, Ltd., Gamagori, Japan) and by Barrett universal 2 formula from http://www.apacrs.org/barrett_universal2/. Patients underwent phacoemulsification by single surgeon. Follow up included refractive status using Autorefractokertometer, URK-700 (Unicos Co., Ltd., Korea) at 6th week post-operatively. Deviation of actual postoperative refraction from the predicted target preoperative refraction were calculated and values within ± 1.0 diopter were considered accurate. Data was analyzed using SPSS version 22. Results: Outcome in terms of postoperative refractive error (+1D to -1D) with respect to biometric formula showed 100% accuracy using Haigis formula, 90% accuracy using SRK-T formula, 72.72% accuracy using Barrett universal II formula and 66.67% accuracy using Holladay-1 formula. Conclusion: Haigis formula proved to be more reliable and accurate than SRK-T, Holladay 1 and Barrett universal II formulae for calculation of intraocular lens power in eyes with long axial length.

Robotic-assisted surgery in Pakistan: its Pros and Cons

Dear Editor, Robotic surgery, is a state-of-the-art technique that enables surgeons to carry out complex procedures with greater accuracy. (1) The system's purpose was to assist surgeons in doing intricate operations while still doing laparoscopy. The system incorporates 3 basic components namely; is 1. Patient’s cart, with robotic arms.; 2. The vision cart incorporated with the hardware to run the system including the camera and the light controls;3. The surgeon’s console, a platform where surgeon controls the movements of the robotic arms. All three are linked by fiber optics. Telesurgery is possible, thanks to the network connection of the surgeon's console. This is how the first robotic surgery was performed, with the patient located in Strasbourg, France, and the surgeon doing the procedure located in the United States. (2) Clinical outcomes for robotic surgery are better than those for conventional laparoscopy; benefits include a lower complication rate, a shorter hospital stay, less post-operative pain, and better aesthetic results. The disadvantage is that training and a committed team are needed. The medical trolley is fairly heavy. The lack of tactile feedback to the surgeon is one of the main disadvantages of robotic surgery. The price of the system, including upkeep, is another barrier. (3) In Pakistan, the Sindh Government Qatar Hospital in Karachi hosted the first DVS system deployment in 2011. But after a few operations, this system did not show the promising outcome, most likely as a result of insufficient experience and technical support. In 2013, the second robotic platform (DVSi), which was more advanced and of a higher generation than the first, was placed in the Civil Hospital Karachi. (4) Surgical treatments were started in cooperation with the Sindh Institute of Urology and Transplantation (SIUT), which has performed over 500 operations to date. The effectiveness of this program has also been effectively aided by the Sindh government, which funds 150 cases each year. (5) A robotic platform costs about Rs 300 million, with the annual maintenance contract accounting for 10% of the total cost. The average price due to the sparse usage of tools (10 procedures) is around Rs. 529,310.571. (6,7) ---Continue

Role of C-Reactive Protein as a Predictor of Difficult Laparoscopic Cholecystectomy.

Cholelithiasis is one of the most common diseases encountered in gastroenterology. Laparoscopic cholecystectomy can be labelled as difficult if the surgery continues for more than 60minutes or if the cystic artery is injured before ligation or clipping. Predicting difficult laparoscopic cholecystectomy can help the surgeon to be prepared for intraoperative challenges such as adhesions in triangle of Calot, injury to cystic artery or gall stone spillage; and improve patient counseling. In this cross-sectional study, we evaluated 269 patients with diagnosed cholelithiasis and planned for laparoscopic cholecystectomy in the general surgery department of Civil Hospital Karachi. After approval of the institution review board of the Civil Hospital, the data of all the patients was collected along with informed consent. The patients were selected via nonprobability, consecutive sampling. The prevalence of difficult LC during procedure was 14.5% (39/269). Contingency table showed the true positive, negative and false positive and negative observation and using these observation to compute accuracy. Sensitivity, specificity, PPV, NPV and accuracy of serum c-reactive protein (CRP) in predicting the difficult laparoscopic cholecystectomy in patients of cholelithiasis was 87.2%, 97%, 82.9%, 97.8% and 95.5% respectively. Effect modifiers like age, gender and BMI were controlled by stratification analysis and observed that diagnostic accuracy was above 90% in all stratified groups as presented in the following tables. 175 (65.06%) of 279 patients were females indicating female predominance. In general, 41 patients (15.05%) had CRP serum levels greater than 11mg/dL out of which 34 patients had to undergo difficult laparoscopic cholecystectomy (DLC), while 223 out of 228 patients with serum CRP levels of less than 11mg/dL did not face any difficulty during their cholecystectomy. Similar results have been acquired across all age groups and both genders. C Reactive Protein is a potent predictor of difficult laparoscopic cholecystectomy and its conversion preoperatively. Patients with preoperatively high C Reactive Protein CRP levels in serum have more chances of complication intraoperatively and increased chances of conversion from laparoscopic to open surgery. Preoperative C Reactive Protein (CRP) with values >11mg/dL was associated with the highest odds of presenting difficult laparoscopic cholecystectomy (DLC) in our study. This value possesses good sensitivity, specificity, PPV, and NPV for predicting DLC in our population.

Frequency of Uterine Rupture and Its Maternal and Fetal Outcomes of Uterine Rupture among Pregnant Women

A uterine rupture is when the uterine wall is torn during labor or right after birth. It is although not common but when occurs it is catastrophic obstetrical emergency for both mother and fetus needs prompt diagnosis and expert management. Moreover it may leads women to irreversible infertility as it rottenly ends at hysterectomy. Objective: To determine the frequency of uterine rupture and its maternal and fetal outcomes among pregnant women. Methods: This Cross Sectional study was conducted at Civil Hospital Karachi in the department of Obstetrics and Gynecology Unit II from 8th December 2018 to 7th June 2019. A total of 317 pregnant women of gestational age >28 weeks, fulfilling the inclusion criteria were enrolled .The data were collected on prepared proforma. Results: This study includes 317 patients with age ranges from 25 to 35 years with mean age of 28.44 ± 3.62 years. In this study, frequency of uterine rupture among pregnant women was found in 7(2.2%) women and maternal mortality 1(7.69%). Conclusions: Findings of this study suggests that uterine perforation is still high and remained important factor for maternal and fetal outcome.

A Clinical Audit of Mental State Examination Documentation Among Psychiatric Residents in a Tertiary Care Hospital

Introduction: Modern psychiatry uses Mental State Examination (MSE) as a tool for collecting data and assisting a psychiatrist in developing patient’s working psychiatric diagnosis. There are currently no national criteria on a definitive format of MSE, nor do the bulk of psychiatry training programs insist upon it. However, to ensure proper documentation of MSE results, following a structured format is needed, ensuring that all relevant components of the examination are covered. For this, we conducted this clinical audit regarding proper MSE documentation within the Psychiatry department of a tertiary care hospital. Methods: The study was conducted in the Department of Psychiatry, Civil Hospital Karachi between 15-02-2023 till 15- 04-2023 after approval by Head of Department. A standardized MSE format consisting of 11 parameters of psychiatric analysis was prepared according to British Medical Journal (BMJ) and Oxford University Press guidelines. The parameters incorporated appropriate date, time, and signature of the examining doctor, in addition to proper documentation of appearance, behavior, speech, mood and affect, suicidal and homicidal risk, thought process, perception, cognition (Orientation, attention, concentration, memory and abstract thinking), insight, judgement, and event notes/progress notes sections. The study was divided into two cycles. A retrospective analysis to detect the shortcomings of MSE documentation was done (sample size n=30), followed by a second cycle, in which a standardized MSE template was provided to all psychiatric residents to examine patients prospectively for the next 4 weeks. Data was analyzed using SPSS software to compare the improved changes in MSE documentation. Results: The result showed that all 11 parameters were recorded correctly, however certain sub-parameters were recorded poorly. The least recorded parameters were date of examination (53.3%), Physical stigmata (43.3%), psychomotor retardation (16.7%), and signs of Extrapyramidal symptoms (10.0%), speech assessment (46.7%), suicidal risk (20.0%), and homicidal risk (13.3%), perception assessment [Illusion (16.7%), depersonalization (13.3%), derealization (16.7%) and memory assessment. Documentation of event notes/progress notes was also recorded poorly (33.3%)]. There was an overall improvement in the documentation pattern of all the 11 parameters of MSE during the second audit cycle. The parameters and sub-parameters with an improvement included physical stigmata (66.7%), psychomotor retardation (76.7%), signs of Extrapyramidal symptoms (83.3%), speech assessment (90.0%), suicidal risk (83.3 %%), homicidal risk (83.3%), perception assessment [Illusion (86.7%), depersonalization (86.7%), derealization (80.0%)] and memory assessment. Patient’s name and registration number were perfectly recorded with a percentage of 100% in the first audit cycle, however it declined to 86.7% in the second cycle. There were also marginal improvements in documentation of date of examination and examining doctor’s name. Conclusion: The introduction of an MSE format and consultant supervision of records improved the standard of MSE recording as well as basic medico-legal requirements by psychiatric trainees

ROBOT-ASSISTED SURGERY IN PAKISTAN: A SWOT ANALYSIS

The Sindh Government Qatar Hospital in Karachi installed Pakistan's first DaVinci S (DVS) system in 2011. Later, in 2013, Civil Hospital Karachi adopted more advanced DaVinci Si (DVSi) robotic equipment. Recently, in April 2023, the Pakistan Kidney and Liver Institute (PKLI) performed Radical Nephrectomy Robot-assisted Surgery. Essential search terms were finalized for a systematic review, and selection criteria were defined. The finalized keywords were entered into Pub-Med, Pakmedinet, and ERIC databases, resulting in 2084 articles. Grey literature was searched through Google Scholar, yielding 509 articles. After the initial screening of 437 out of 509 studies, 72 articles met the eligibility requirements according to the PRISMA guidelines. However, 39 articles were excluded, leaving 33 to be incorporated into the study. A successful robotic surgery program requires well-trained operating room personnel, dedicated surgeons, supportive hospital administration, adequate financial resources, and a strong marketing strategy. Despite meta-analyses indicating that robotic surgery has not outperformed conventional surgery, marketing can help mitigate the high treatment costs by increasing the number of patients, thereby ensuring the program's long-term viability.

Frequency of Low Birth Weight in Patients with Gestational Hypertension

Preterm birth and low birth weight are just two negative fetal outcomes that are linked to PIH. The WHO divides infants into three categories based on birth weight and gestational age: Small for gestational age, Appropriate for gestational age, and Large for gestational age. LBW babies are those who weigh less than 2.5kg within 24 hours of birth, according to these standards. Objectives: To determine the frequency of low birth weight in patients with gestational hypertension. Methods: This Descriptive study was done in department of Obstetrics and Gynecology unit III, Civil Hospital Karachi from 16th February 2019 to 15th August 2019. We enrolled 89women diagnosed with gestational hypertension meeting the criteria. Informed consent was taken. Results: Age range in this study was from 20 to 45 years with majority of the patients 52 (58.43%) were between 18 to 30 years of age. Mean gestational age was 39.51±2.7 weeks. Frequency of low birth weight in patients with gestational hypertension was found in 27 (30.34%) patients. Conclusions: This study concluded that frequency of low birth weight in patients with gestational hypertension is very high.

Glutathione and Oxidized Low-Density Lipoprotein as Biomarkers of Oxidative Stress in Essential Hypertension

OBJECTIVE: This study aimed to compare the serum levels of Glutathione and Oxidized Low-Density Lipoprotein in early hypertensive and normotensive subjects and to evaluate the diagnostic accuracy of these biomarkers for detecting oxidative stress in essential hypertension. METHODOLOGY: An analytical cross-sectional study was conducted at Civil (Dr. Ruth K.M. Pfau) Hospital Karachi from July 2020 to March 2021 after approval from the ethical committee. After informed consent, the serum oxidized low-density lipoprotein and glutathione levels were measured with ELISA's help in 40 normotensive and 40 early hypertensive participants. The results were analyzed by SPSS 21, keeping a significant p-value at <0.05. RESULTS: The median levels of Oxidized Low-Density Lipoprotein were higher in hypertensive than in normotensive (i.e. 31.47 ng/ml vs. 15.27 ng/ml). The median levels of glutathione were also raised in hypertensive compared with normotensive(i.e. 15.69 ng/ml vs. 4.46 ng/ml). The differences were significant (p-value <0.001). Both markers showed adequate diagnostic accuracy, sensitivity and specificity to detect oxidative stress in early hypertension. CONCLUSION: Oxidized Low-Density Lipoproteins are raised in early hypertension, endorsing the detrimental role of oxidative stress, while the levels of glutathione are increased to compensate for and combat increased oxidative stress in early hypertension. These biomarkers can be utilized clinically to discern the burden of oxidative stress in early hypertension. KEYWORDS: Essential hypertension, Glutathione, Oxidized low-density lipoprotein, Oxidative stress, Reactive oxygen species

Clinical Profile and Predictors of Outcome of Guillain Barre Syndrome Variants among Children Admitted in the Pediatric Department of a Tertiary Care Hospital, Karachi

Background: Guillain Barre Syndrome (GBS) is one of the leading cause of Acute Flaccid Paralysis presenting in pediatric emergency, marking incidents in Asian countries as 3-4 per 100, 000 population. To improve outcome, an accurate and early recognition of predictors of bad prognosis is required. Objective: To identify requirement of intensive monitoring and aggressive treatment to help the health system in decreasing morbidity and mortality associated with Guillain Barre Syndrome. Materials and Methods: This is a cross-sectional study, conducted at Dr. RKMP Civil Hospital Karachi. Medical records of patients >3 months to 12 years of age, admitted with diagnosis of Guillian Barre syndrome from Jan 2017 to June 2022 were reviewed. Data was analyzed in SPSS version 23. For independent variables, frequency and percentage was used. Results: A total of 46 patients were enrolled in the study, mean age of study participants was 80.26 ± 31.7 months. The most common variant of GBS identified was AIDP in 19 (41.3%) followed by ASMAN 14 (30.4%). A positive association between winter season with 2.7 (95% CI 1.4-5.8) and progression within 7 days with 3.2 (95% CI 1.9-6.7) was found with mortality. Conclusion: Acute inflammatory demyelinating polyneuropathy was the most common variant of Gullian-Barre syndrome with male predominance. Presentation in winter seasons and progression of disease in less than 7 days are risk factors for mortality. Bulbar palsy is an independent risk factor for mechanical ventilation, irrespective of GBS variant. Keywords: Acute inflammatory demyelinating polyneuropathy (AIDP), Guillain Barre Syndrome (GBS), Pediatric population, Bulbar palsay, Areflexia, Acute motor axonal neuropathy (AMAN).

Exploring gender disparities in burn injuries: A retrospective study at a burns centre in Karachi, Pakistan

IntroductionBurn is defined as any injury due to heat or acute trauma, according to the International Society of Burns Injury (ISBI). A neglected aspect of our country is the gender-specific pattern of burn injuries. This study aims to highlight the gender-based disparities of burns injuries and overcome the drastic effects of burns on an individual's life. MethodThe data from the burns centre of Dr Ruth.K.M.Pfau Civil Hospital Karachi from Jan 1, 2021, to Dec 31, 2021, were retrospectively analyzed to perform this study. Different variables such as aetiology, circumstances, residence, age, TBSA, degree and occupation were recorded from the patient's files. They were compared by gender to find out any existing correlation. ResultsThe estimated sample size was 375, 180(48%) females, and 195(52%) were burned males. A significant correlation was found for gender with a degree of burns, aetiology, age, occupation, and residence. Whereas circumstances of burns and TBSA were non-significantly correlated to gender. ConclusionIn conclusion, our study determined that men most commonly suffer from burn injuries. In contrast, thermal injury is the most dominant etiological factor in every age group in both genders. Several risk factors are associated with a specific gender, requiring adaptive prevention and management approaches to culminate this issue.