District Headquarters Research Articles

Pattern of medication utilization in hospitalized patients with COVID-19 in three District Headquarters Hospitals in the Punjab province of Pakistan

PurposeIn Pakistan, a wide range of repurposed drugs are recommended to manage hospitalized patients with COVID-19. Therefore, the current study was conducted to evaluate the pattern of utilization of repurposed drugs and other potential therapeutic options among hospitalized patients with COVID-19 in Pakistan. MethodsThis retrospective, multicenter, descriptive study enrolled consecutive hospitalized patients with COVID-19 who were admitted between March 1, 2021, and April 30, 2021, from three District Headquarter Hospitals in the Punjab province of Pakistan. We described patient and clinical characteristics and medications, stratified by COVID-19 severity during hospitalization: mild, moderate, and severe. In addition, an analytical study of drug utilization was conducted. FindingsA total of 444 hospitalized patients with COVID-19 were included. Remdesvir, corticosteroids, antibiotics, and antithrombotics were administered to 45.0%, 93.9%, 84.9%, and 60.1% of patients, respectively. Specifically, dexamethasone was the most commonly used corticosteroid among the included patients (n = 405; 91.2%), irrespective of their clinical severity. Only 60.1% of patients hospitalized with COVID-19 in our cohort received antithrombotic therapy, and the prevalence of use was especially low (27.8%) in patients with mild illness. Of 444 patientsscreened, 399 (89.9%) patients had been discharged, and 45 patients (10.1%) died. ImplicationsWe provided an important glimpse into the utilization patterns of several medications of interest for the treatment of COVID-19 in Pakistan, which had not been entirely evidence-based, especially concerning systemic corticosteroids and antibiotics.

A Cross Sectional Study on Hypokalemia in Patients with Acute Myocardial Infarction

Introduction: Hypokalemia was found to be more common in women, those with hypertension, and those on chronic diuretic therapy.
 Objectives of the Study: The main objective of the study is to analyse the hypokalemia in patients with acute myocardial infarction.
 Materials and Methods: This cross sectional study was conducted in District Head Quarter Teaching Hospital Faisalabad during 2019 to 2020. The data was collected from 100 male and female patients with myocardial infarction. The effect of plasma potassium concentration on patient survival after a myocardial infarction is investigated. 
 Results: The data was collected from 100 patients of MI. Mean age of male patients was found to be 64.12±12.34 and female patients was 46.21±10.24. There was statistically significant decrease in serum sodium and potassium levels in study group among both the ages compared to normal healthy control group. Serum sodium, potassium, chloride, calcium levels were significantly lower in the AMI patients and magnesium levels were slightly raised among cases than controls.
 Conclusion: It is concluded that reduction in sodium level was assessed only in patients with AMI as compared to healthy persons. Estimation of serum electrolyte is of utmost importance for diagnosis and prognosis of AMI.

Frequency of dental caries in 1-5 years aged children and its impact on their quality of life

Oral diseases can vastly depreciate the individual’s quality of life. It has also been considered as the most important oral health burden worldwide. It can also have significant implications on the functional, mental, and social well-being of the individual. This has been found as a preventable dental and oral health issue which have also been amongst the most prevalent chronic disease. Objectives: To estimate the frequency of dental caries and its impact on the quality of children’s life in Hafiz- Abad, Pakistan. Methods: It was a cross sectional analytics based study spanning around nine months. Three hundred and seventy children (aged between 1-5 years) were included as subjects, who visited the District Headquarter (DHQ) hospital, Hafiz Abad, Lahore, Pakistan. Dental caries were measured by using decayed missing filled (DMF) index. Data was collected and analyzed by using SPSS version 23.0. Results: A high prevalence frequency of 243 (65.7%) were found suffering from dental caries. High prevalence of dental caries (70%) in children of low literate parents has been found statistically significant (p=0.035). As far as brushing frequency is concerned 93.8% children were not found brushing their teeth prior to breakfast. Theassociation between brushing frequency prior to breakfast and formation of dental caries was found statistically significant (p<0.001). Conclusion:High prevalence of dental caries coupled with high severity level was found associated with the worse dental and oral hygiene awareness levels amongst the preschool children and their parents

Effective Voting Ensemble of Homogenous Ensembling with Multiple Attribute-Selection Approaches for Improved Identification of Thyroid Disorder

Thyroid disease is characterized by abnormal development of glandular tissue on the periphery of the thyroid gland. Thyroid disease occurs when this gland produces an abnormally high or low level of hormones, with hyperthyroidism (active thyroid gland) and hypothyroidism (inactive thyroid gland) being the two most common types. The purpose of this work was to create an efficient homogeneous ensemble of ensembles in conjunction with numerous feature-selection methodologies for the improved detection of thyroid disorder. The dataset employed is based on real-time thyroid information obtained from the District Head Quarter (DHQ) teaching hospital, Dera Ghazi (DG) Khan, Pakistan. Following the necessary preprocessing steps, three types of attribute-selection strategies; Select From Model (SFM), Select K-Best (SKB), and Recursive Feature Elimination (RFE) were used. Decision Tree (DT), Gradient Boosting (GB), Logistic Regression (LR), and Random Forest (RF) classifiers were used as promising feature estimators. The homogeneous ensembling activated the bagging- and boosting-based classifiers, which were then classified by the Voting ensemble using both soft and hard voting. Accuracy, sensitivity, mean square error, hamming loss, and other performance assessment metrics have been adopted. The experimental results indicate the optimum applicability of the proposed strategy for improved thyroid ailment identification. All of the employed approaches achieved 100% accuracy with a small feature set. In terms of accuracy and computational cost, the presented findings outperformed similar benchmark models in its domain.

Sonographic Evaluation of Ectopic Pregnancies

This study was carried out in the Radiology Department, District Head Quarter Teaching Hospital (D.H. Qr) and Dera X-Rays / Ultrasound Clinic. Dera Ismail Khan, NWFP, by performing abdominal and pelvic ultrasonography of all the suspected patients and endo-vaginal of selected cases by comparing with other modalities used for the diagnosis of pregnancy especially the ectopic. Eighty-five percent cases of ectopic pregnancies were diagnosed by abdominal / pelvic ultrasonography, while this ratio was increased up to 95% by endo-vaginal ultrasonography in those cases where the abdominal sonography was not helpful for accurate diagnosis. The study concluded that increased availability of ultrasonography leads to improve quality in the detection of ectopic pregnancy. It is necessary to screen all the patients with first trimester cramping and bleeding by ultrasonography.

High-yielding seeds in unyielding environments: Examining the learning process of maize and bean producers in eastern and midwestern Uganda

This paper examines the learning process by which farmers come to a decision to use newly introduced seeds which were promoted through demonstration plots in midwestern and eastern regions of Uganda. Framed as social and material interactions, we investigated the learning process of the demonstration plots using data from focus group discussions, interviews and a survey amongst 983 individuals. The results reveal several constraints that impede learning, resulting in an overall low awareness and adoption of the introduced seeds. Some of the most prominent constraints resulted from the selection of location and demonstration plot host, the distance of agro-dealers, at district headquarters, limited interactions amongst farmers and irregular involvement of farmers in the demonstrations. Moreover, the prominent role of agro-dealers at field days suggests that informing farmers about where to buy seeds was considered more important than explaining farmers how to grow these seeds profitably. This commercial focus of field days and demonstrations plots had negative consequences for the social learning. This paper contributes to the learning and adoption literature by showing that interactions amongst actors can improve or reduce the balance between didactic, social and environmental learning.

Evaluation of Oral Health Related Quality of Life in Patients Diagnosed with Head and Neck Cancer Receiving Radiotherapy

Objective: To evaluate the oral health related quality of life in patients diagnosed with head and neck cancer receiving radiotherapy. Design of the Study: It’s a case control study. Study Settings: The study was conducted at department of Oncology Holy Family Hospital, Rawalpindi and District Headquarters Hospital, Rawalpindi from Feb 2021 to Sep 2021. Material and Methods: Total 300 patients aged 18 years and above diagnosed with head and neck cancer undergoing radiotherapy for a minimum period of 1 month were included in this study. Oral Health Impact Profile (OHIP-14) is a 14 item pre-validated questionnaire graded on five point Likert scale used to assess Oral Health related Quality of Life based on seven dimensions of impacts of oral conditions on people’s OHRQoL. Pearson correlation and Spearman’s correlation were used to find out correlation between oral health status and quality of life. Results of the Study: Among Head and neck cancer group: 45(30.0%) were 35 to 44 years; 44(29.3%) were 45-64 years and 41(27.4%) were 65-74 years age group. Among Head and neck cancer group: 99(66.0%) were males and 51(34.0%) were females. The overall Mean SF-12 scores of head and neck cancer patients was significantly lower as compare to control patients (30.89±4.66 36.14±3.75<0.001). Mean oral health-related quality of life (OHIP-14) was significantly lower in head and cancer group patients as compared to controls (18.35±7.48 vs. 11.14±8.18; <0.001). Conclusion: It is proved that radiotherapy have a serious influence on oral health of the patients. Considering the influence of radiotherapy on oral health of the patient, assessment of the oral cavity should be done in routine assessment by the dentistry consultant. The OHIP-14 questionnaire has evident to be consistent and valid instrument for assessment of quality of life related to oral health in cancer patients. Among cancer patients this questionnaire should be considered in the protocol of the treatment about complications of oral health and for their optimal well-being. Keywords: cancer, quality of life, oral-health, head and neck cancer

TRAINING NEEDS IN MAJOR SUBJECT AREAS FOR BASE LINE WORKERS IN THE FISHERIES SECTOR OF ASSAM

Capacity building of baseline workers is one of the most important factors in ensuring better performance. In the fishery sector of Assam all the Fishery Demonstrators (FD) are the grassroot functionaries of the sector and they play vital roles to carry out the various activities. Keeping this in mind, a study was conducted to find out the nature and intensity of training needs and to identify the preference in respect of duration, location, method, type and other relevant aspects pertaining to training and capacity building. It was found that the FDs felt that the aspects of water and soil quality were greatly needed, followed by the aspects of disease, fish seed, breeding, extension, feeding, resource management, culture, marketing, official and capture fishery. It was also found that the most of the FDs were middle aged, fairly experienced, hail from rural background, has undergone one in-service training, belong to medium monthly family income group are posted near the district H.Q and residing in rented house. There were no significant differences in Training Need Quotient (TNQ) between FDs who are from rural and urban area. The respondents preferred either October to December or January to March as the training season. Most of the FDs preferred training of two weeks duration outside the state, followed by College of Fisheries, Directorate of Fisheries and District Headquarters. They were of the opinion that equal emphasis should be given to both theory and practical aspects during the training programme. Key words: Training needs, Fishery demonstrators, Assam

CLINICAL STUDY TO EVALUATE THE EFFICACY OF YAVAKSHARA PRATISARANA IN THE MANAGEMENT OF TUNDIKERI (CHRONIC TONSILLITIS)

Introduction: The symptoms of Tundikeri resembles with Chronic Tonsillitis. This disease is more frequent in young and middle aged adults. If not treated in time, chronic tonsillitis may lead to Middle ear infection, Rheumatic fever, Nephritis, Rheumatic heart disease and many other systemic complications.Looking into above facts there is a need of treatment which can prevent complications of the disease as well as reduces the recurrence effectively. In this study an effort has been made to evaluate the efficacy of Yavakshara pratisarana in Tundikeri (Chronic Tonsillitis). Materials and methods: The present study was an open labelled, single arm, clinical study in Tundikeri (Chronic Tonsillitis) (n=30) selected using convenience sampling technique with pre and post design conducted in a tertiary Ayurveda healthcare centre attached to a teaching institute, situated at the district headquarters in South India. 31 patients fulfilling the inclusion criteria suffering from Tundikeri w s r to Chronic Tonsillitis were selected with the intervention of Yavakshara pratisarana in single sitting. Results: The effect of therapy was assessed before and after treatment, the results were statistically analyzed; it showed significant changes in subjective parameters like Katina shopha,Mandaruk ,Galaragata,Galoparodha ,Halitosis,Enlarged Jugulodigastric lymph nodes, and Objective parameter- ESR Conclusion: Yavakshara pratisarana has shown better efficacy in subjective parameters likeKatinashopha,Mandaruk,Galaragata,Galoparodha,Halitosis,EnlargedJugulodaigastric lymph nodes , and Objective parameter like- ESR KEY WORDS: Tundikeri, Yava kshara, Pratisarana.

Association Of Tinnitus With Depression And Anxiety In Hypertensive Patients

Background: Tinnitus is a condition that can be objective or subjective. The form of tinnitus most often associated with psychosocial co-morbidities is subjective tinnitus.Objective: The aim of our study was to determine the association of tinnitus with depression and anxiety in hypertensive patients.Methodology: It was cross sectional study. A total of 159 (100) % patients with hypertension were screened for presence of tinnitus in medical outpatient department of district headquarter hospital Vehari from July 2020 to March 2021. All of them were asked to complete a standardized Tinnitus handicap inventory questionnaire (THI) to assess severity of tinnitus followed by otoscopy. Depression and anxiety were measured using the Beck depression and anxiety inventories.Results: Tinnitus is strongly linked to anxiety and depression, according to the findings.Conclusions: All tinnitus patients should be screened for mental illness because of the strong connection between tinnitus, depression, and anxiety. These complex disorders should be handled by a multidisciplinary team that includes cognitive behavioral treatment and likely pharmacological therapy.

Study of Guillain-Barre syndrome etiology in Pakistani patients.

To examine clinical features, biochemical markers, demographic features, antecedent infections, frequency and treatment strategies related to Guillain-Barré syndrome. The case-control study was conducted at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, and the District Headquarters Hospital, Rawalpindi, Pakistan, from 2018 to 2020, and comprised Guillain-Barré syndrome patients in group A and healthy controls in group B. The patients were diagnosed on the basis of clinical presentation, nerve conduction study, electromyography, cerebrospinal fluid analysis and biochemical profile. Data was analysed using SPSS 23. Of the 167 subjects, 90(54%) were in group A and 77(46%) were in group B. The mean age of group A was 40.20±14.90 years, while there were 61(67.7%) males and 29(32.2%) females compared to 50 (64.93%) males and 27 (35.06%) females with mean age 38.40±12.34 years in group B. Acute inflammatory demyelinating polyneuropathy was the most common electrophysiological variant of Guillain-Barré syndrome 41(46%). There was significant difference in mean interleukin-17 levels between group A 23.12±3.41 pg/ml and group B 8.82±2.49 (p<0.05). Gastrointestinal infection was the most common preceding infection 51(56.66%). The mean cerebrospinal fluid protein was 100.83±51.32g/dl and albumiocytologic dissociation was found in all the four variants (p= 0.005). Guillain-Barré syndrome affected patients regardless of age, while males were more affected than females. Majority of the patients had an antecedent infection before disease onset. Increased levels of interleukin-17 showed involvement of autoimmunity. Albuminocytologic dissociation differentiated it from poliomyelitis.

Prospective Study of the HCV-RNA Genotype 3a Diagnosed Patients Treated with Sofosbuvir and Peg Interferon Alpha-3

Background: Hepatitis C Virus (HCV) is a global health emergency. Every year, thousands of individuals suffer from HCV. HCV if not treated, may manifest severe hepatic complications, many of which have fatal outcomes. Various therapeutic strategies are currently used to eradicate the virus from the patient’s body. Treatment of the HCV patient depends largely on the genomic typing. Objectives: The aim of the present study was to assess the comparison between Sofosbuvir and Peg-Interferon alpha in patients diagnosed with HCV RNA genotype 3a. Methodology: A prospective case cohort study had been conducted in District Headquarter Hospital, Sargodha, Pakistan. Patients diagnosed with HCV genotype 3a were enrolled in the study and randomly divided into 2 groups. Group I was assigned Sofosbuvir 400 mg and group II Peg-Interferon alpha 3 million units. Both the groups were also administered ribavirin. The study was conducted for a period of 24 weeks and efficacy was determined by the decline in the viral RNA load. Results: Each group had 50 patients of which majority were males. Compared to males, females had higher viral RNA load. However, the efficacy of both the treatment drugs was similar in both the genders. Comparatively, Sofosbuvir group showed better efficacy than Peg-Interferon group with significant difference in mean HCV RNA at the end of the study (p < 0.05). Conclusion: Although, Sofosbuvir and PEG-Interferon both demonstrated efficacy in reducing the viral RNA load, Sofosbuvir is more efficacious and better tolerated in the management of HCV RNA genotype 3a infection.

COVID-19 among Healthcare Workers of Teaching Hospitals Affiliated with Rawalpindi Medical University

Objectives: To overview COVID-19 scenario among healthcare workers in teaching hospitals of Rawalpindi Medical University&#x0D; Subjects &amp; Methods: A cross-sectional descriptive research was done among 482 coronavirus infected healthcare professionals from three teaching hospitals (Holy Family Hospital, Benazir Bhutto Hospital and District Head Quarters) that were affiliated with Rawalpindi Medical University during January 2021. Healthcare workers with COVID confirmation via RT-PCR testing reports were included in the study through consecutive sampling. Their demographic profile, workplace attributes, clinical manifestations, oxygen saturation, source of infection, re-infection, hospitalization, requirement for oxygen supply and disease severity according to COVID-19 adult cases categorization were inquired. Data analysis was done by means of SPSS version 25.0.&#x0D; Results: Mean age of 482 healthcare workers was 29.6 ± 5.7 years. Mainstream (69.1%) of our study participants was constituted by female healthcare staff. Majority (34%) were postgraduate trainees followed by 29% nurses and 20% house officers. Mean duration of sickness was 13.6 ± 6.4 days. About 63.1% of study subjects were COVID infected during July –December 2020. About 4.8% healthcare personnel were asymptomatic and 78% caught infection from their workplace. Approximately 82% suffered from fever while 71.4% and 55.8% went through bodyaches and cough respectively. Out of 39 hospitalized workers, 23 required oxygen supply for their vitality. Severe COVID infection was determined only among 5.4% healthcare professionals.&#x0D; Conclusion: Healthcare workers are more susceptible to acquire COVID infection from their workplace. In view of this vulnerability, firm compliance to preventive measures against coronaviurs infection by healthcare staff and general public is deemed necessary for their viability.

Past and Future Perspectives for Hepatitis B and C in Pakistan.

BackgroundHepatitis B and C are viral infections of the liver transmitted by blood contamination. These infections are endemic in Pakistan and put a tremendous burden on its healthcare system. We conducted this study to assess the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Gujranwala, Pakistan, from 2010 to 2015 and determine the trend of future infections for a prediction of the disease burden by 2030 so policymakers can make informed decisions.MethodsWe conducted a retrospective cross-sectional study of 66,308 healthy blood donor samples at District Headquarters Teaching Hospital in Gujranwala from January 2010 to December 2015. Samples were screened for HBV and HCV using the kit method, and data were analyzed using IBM SPSS Statistics for Windows, version 20.0 (IBM Corp., Armonk, NY). We applied a least squares regression to our results to predict HBV and HCV incidence in 2030.ResultsA total of 715 samples (1.08%) were positive for HBV and 1,846 samples (2.78%) were positive for HCV. Our projections indicate that 3.25% of patients in Pakistan will be positive for HBV, and 6.36% will be positive for HBC by 2030.ConclusionWe found an unexpectedly greater burden of HBV and HCV in the recent past than at current levels. The predicted percentages of future burden over the next decade were alarmingly high. These data necessitate implementing preventive and therapeutic measures by policymakers to reduce the disease burden and mortality in Pakistan.

IDENTIFYING FACTORS ASSOCIATED WITH THE USE OF A SCALED-UP POSTPARTUM FAMILY PLANNING PROJECT IMPLEMENTED IN PUNJAB, PAKISTAN

Pakistan has one of the highest unmet needs for family planning among low and middle-income countries. Postpartum family planning (PPFP) is considered to have the potential of significantly improving the contraceptive prevalence rate and reducing the unmet need for family planning. Jhpiego (John Hopkins Affiliate) implemented a PPFP pilot project in the district headquarter hospital of Mandi Bahauddin. The key interventions of the Jhpiego pilot were to improve services pertinent to PPFP. Based on the successes of the pilot, the interventions were scaled up to other health facilities. The present study aims to identify the factors associated with the utilization of the postpartum family planning health project implemented in the health facilities once the scale-up activities ended and comparing it with the pilot facility. A cross-sectional survey with a sample of 410 women using postpartum care services in the facilities was conducted using a structured questionnaire. The findings indicated that the complete set of interventions were not present in the facilities. Postpartum family planning method uptake was low (26%) along with the shortage of contraceptives supplies. Multivariate logistic regression was conducted to identify the predictors for the current use of postpartum family planning. The predictors identified that women with the age of 25 years and above with 3 or more children, who attended antenatal care visits and were counselled on PPFP were more likely to adopt/use PPFP in the postpartum period. The findings indicated scale-up was limited and the interventions were not sustained once the donor support ended.

Assessment of health system preparedness to deal with the second wave of COVID-19 in a remote tribal district Surguja, Chhattisgarh, India-April 2021

Background: Present study was conducted to assess the preparedness of the Surguja district to curtail COVID-19.Methods: We conducted a cross-sectional observational study from May 2020 to March 2021 through records of 2 primary health centres areas selected by convenient sampling (farthest and nearest to district headquarters). Data on existing facilities and logistics was from district headquarters. Preparedness was assessed through checklist. Observations were presented as rates, ratios and proportions. Standard error of difference between two proportions was used as test of significance and p value≤0.05 was considered significant.Results: For Surguja district population of 925938 (65% rural), overall attack rate was 1.15%, case fatality rate was 0.96% (102/10636); there was 1 DCH, 9 DCHC, 6 CHCs, 25 PHCs, 3 upgraded PHCs, 197 subcentres, 12 CCC, 01 RT-PCR laboratory and 228 COVID vaccination centres. There were 1151 isolation beds; 300 with oxygen support (26%); ICU beds 134 (11.60%) with 34 ventilators. Cumulative 258229 tests; antigen 67.90%, test positivity rate 4.10% (urban 8.2%, rural 1.7%). This urban-rural difference in test positivity rate was statistically significant (p&lt;0.001). Health care workers, 94.81% (12722/13418) had received one dose of vaccine with 53.36% (6789/13418) both doses. Above 45 years eligible population; 66.68% (154254/231331) received one dose of vaccine.Conclusions: Surveillance and management of COVID-19 were as per GOI guidelines issued. However, to enhance response we recommended strict implementation of appropriate behaviour in community, establishment of containment zones/facilities for high risk population in urban area blocks and increasing laboratories with RT-PCR testing in appropriate proportions.

Seroepidemiology and associated risk factors of hepatitis B and C virus infections among pregnant women attending maternity wards at two hospitals in Swabi, Khyber Pakhtunkhwa, Pakistan.

Hepatitis B and C infections are global issues that are associated with a massive financial burden in developing countries where vertical transmission is the major mode and remains high. This cross-sectional study was designed to investigate the seroepidemiology and associated risk factors of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among 375 pregnant women attending antenatal care health facilities at Bacha Khan Medical Complex (BKMC) Shahmansoor and District Head Quarter (DHQ) Hospital Swabi, Khyber Pakhtunkhwa, Pakistan. From a total of 375 pregnant women selected using systematic random sampling from both hospitals, 10 ml of blood samples were collected and alienated serum was examined for indicators identification through the Immuno-Chromatographic Test (ICT) and 3rd Generation Enzyme-Linked Immunosorbent Assay (ELISA). A pre-structured questionnaire was used to collect the socio-demographic data and possible risk factors. The data was analyzed via SPSS 23.0 statistical software. A chi-square analysis was performed to determine the association between variables. P-value < 0.05 was set statistically significant. The overall frequency of HBV and HCV among 375 pregnant women involved in the study was 3.7% and 2.1% respectively. None of the pregnant women were co-infected with HBV and HCV. Dental extraction (P = 0.001) and blood transfusion (P = 0.0005) were significantly allied with HBV infection while surgical procedure (P = 0.0001) was significantly associated with HCV infection. Moreover the sociodemographic characteristics: residential status (P = 0.017) and educational level (P = 0.048) were found significant risk factors of HBsAg and maternal age (P = 0.033) of anti-HCV, respectively. HBV and HCV infections are intermediary endemic in the study area. A higher prevalence of HBV was detected among pregnant mothers with a history of dental extraction, history of blood transfusion, resident to the urban area and low educational level. The age and surgical procedures were the potential risk factors found significantly associated with HCV positivity among pregnant mothers in our setup. Future negotiations to control vertical transmission should include routine antenatal screening for these infections early in pregnancy and the requirement of efficient preventive tools including the birth dose of the hepatitis B vaccine in combination with hepatitis B immune globulins to the neonate.

Burnout and Empathy: A Cross-Sectional Study among Resident Physicians in Public Sector Hospitals of a Developing Country

The main objective of our study was to determine the prevalence of burnout and to identify various socio-demographic factors which are associated with resident burnout. As a secondary objective, we aimed to assess levels of empathy among the residents. A descriptive cross-sectional study was performed among residents working in Holy Family Hospital, Benazir Bhutto Hospital, and District Headquarter Hospital, all of which are situated in district Rawalpindi of Punjab, Pakistan. Data were collected from January 2019 to April 2019 using a convenient sampling technique. The participants were requested to complete Maslach Burnout Inventory to measure burnout and Jefferson Scale of Physician Empathy to measure empathy from January 2019 to April 2019. For data analysis IBM SPSS © version 25.0 was used. Descriptive statistics were used to summarize the quantitative variables. Chi-square test was used to determine the association between burnout and categorical variables. Then, those independent variables with p-value &lt; 0.05 were subjected to binary logistic regression to identify predictors of burnout. A P-value of &lt; 0.05 was used as the criterion for statistical significance and OR with 95% confidence interval was used to indicate the strength of association. Independent sample t-test was used to assess empathy among the groups. The prevalence of burnout in our sample was 78%. The average burnout score of the sample was 81±13.45. Weekly working hours (p-value &lt; 0.05) and the type of specialty (p-value &lt; 0.05) were significantly associated with resident burnout. Residents working more than 80 hours were more prone to develop burnout [AOR 2.700(1.42-5.120)]. Medical residents were found to be at a higher risk of developing burnout as compared to surgical residents [(AOR 2.097(1.16-3.78)]. Residents working less than 80 hours per week had more empathy scores as compared to residents working more than 80 hours and this result was statistically significant (p-value &lt; 0.05). However, no significant difference in empathy was found for age, gender, marital status, and posts. Therefore, weekly working hours should be reduced to diminish burnout and increase empathy, thereby, promoting the quality of care being delivered to the patient. Moreover, efforts should be made to reduce burnout in medicine residents so that we may promote the doctor-patient relationship.

Wheat Pill Poisoning: Management and outcome in cases reported in DG Khan District.

Objective: To determine the clinical manifestations and prognosis of victims presenting with wheat pill poisoning. Study Design: Prospective Cohort Study. Setting: Emergency Department in District Headquarter Hospital DG Khan. Period: February 2019 to January 2020. Material &amp; Methods: Patients admitted with history of accidental or suicidal wheat pills poisoning were followed over a period of 3 to 6 months. Symptomatic treatment was initially given for 2-3 hours. The patients were retained in CCU for 24 hours before shifting to ward. Research tool (proforma) was designed for collection and interpretation of data. Acute Physiology and Chronic Health Evaluation Score 2 (APACHE-2) score was used for prognosis and recovery. Result: Out of 96 victims of aluminum phosphide ingestion male/female ratio was 2:1, 64% (n= 64) were females and 36% (n=32) were males. Higher incidence was found in age group (16–25 years (n= 27 victims). Overall mortality was 63 (65.6%). Conclusion: Wheat pill was a poison of choice among teens and adults in Pakistan as it is freely available and cheap. Arrhythmia and metabolic acidosis are the major causes of death after wheat pills ingestion. Coconut oil was found effective in delaying the absorption.

A CLINICAL STUDY TO EVALUATE THE ANTIHYPERGLYCEMIC ACTIVITY OF BHANDIRA

Introduction: Madhumeha (Diabetes mellitus) is a life style related, multifactorial disease with multiple facets involving all the Srotas, Dhatus and the Ojas. Madhumeha is a Vataja variety of Prameha, which manifests either due to Margavarana or due to Dhatu Kshaya. Diabetes mellitus is a clinical syndrome characterized by Hyperglycemia due to absolute or relative deficiency of insulin. Diabetes and its complication pose a major threat to future public health resources throughout the world. In this study an effort has been made to evaluate the Madhumehahara karma (Antihyperglycemic activity) of Bhandira (Clerodendrum infortunatum auct Non Linn) Materials and methods: The present study was an open labelled, single arm, clinical study in Madhumeha (Diabetes mellitus) (n=30) selected using convenience sampling technique with pre and post design conducted in a tertiary Ayurveda healthcare centre attached to a teaching institute, situated at the district headquarters in South India. 32 patients fulfilling the inclusion criteria suffering from Madhumeha w s r to Diabetes mellitus were selected with the intervention of Bhandira patra vati 3 Twice in a day (BD) for 30 days. Results: The effect of therapy was assessed before and after treatment, the results were statistically analyzed; it showed significant changes in subjective parameters like praboota mutrata, avila mootrata, kshudadikya, karapada daha, and Objective parameter- Fasting Blood Sugar (FBS), Post Prandial Blood Sugar (PPBS), Fasting Urine Sugar (FUS), Post Prandial Urine Sugar (PPUS) Conclusion: Bhandira patra vati in a dose of 3 BD before food has shown better efficacy in subjective parameters like praboota mutrata, avila mootrata, kshudadikya, karapada daha, and Objective parameter like- FBS, PPBS, FUS, PPUS KEY WORDS: Madhumeha, Anti-hyperglycaemic, Bhandira patra vati