Fauji Foundation Hospital Research Articles

Comparison of Depression, Anxiety and Stress in Caregivers of Patients with Schizophrenia and Bipolar Affective Disorder

Objective: To compare depression, anxiety, and stress amongst caregivers of patients with Schizophrenia and Bipolar Affective Disorder
 Study Design: Cross-sectional study.
 Place and Duration of Study: Psychiatry Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Nov 2021
 Methodology: One hundred caregivers of patients with Schizophrenia and Bipolar Affective Disorder took part in the study. The “Depression Anxiety Stress Scales” scale assessed depression, anxiety and stress. The difference in both groups was checked by the chi-square test.
 Results: One hundred caregivers (46 caregivers of patients with Schizophrenia and 54 caregivers of patients with the bipolar affective disorder) were recruited. Among caregivers of patients with Schizophrenia, 29(63%) had significant depression, 33(71%) had anxiety, and an equal proportion had stress. Of those who cared for patients with bipolar affective disorder,16(29.6 %) had depression, 29(53.7 %) had anxiety, and 25(46.29%) had stress. Depression, anxiety, and stress among caregivers had a statistically significant association with clinical diagnosis in our target population (p-valve 0.002, 0.033, 0.007), respectively.
 Conclusion: Depression, anxiety, and stress are significantly higher among caregivers of patients with Schizophrenia as compared to caregivers of patients with bipolar affective disorder. Our findings have identified a significant need for supporting caregivers of patients with serious mental illness.

Relationship of Demographic Variables and Level of Disease Awareness Among Systemic Lupus Erythematosus Patients; a Tertiary Care Hospital Study

Objective: To determine the relationship between demographic variables and the level of disease awareness among patients of Systemic lupus erythematosus (SLE).
 Study Design: Cross-sectional study
 Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi Pakistan, from Mar 2019 to Jan 2020.
 Methodology: The study included 150 patients, diagnosed with systemic lupus erythematosus according to SLICC criteria. A self-made questionnaire was used, including three sets of questions. The first set collected information on socio-demographic characteristics, and the second set gathered information regarding the symptoms and treatment. While, the third was based on aetiology, aspects of life affected and sources of disease knowledge.
 Results: A total of 150 participants' data was analysed; the majority of those were females. The mean age was 36.19±12.08 years and 17.3% of the patients had adequate knowledge of the disease. There were no statistically significant differences in awareness based on gender, education level and geographical distribution.
 Conclusion: SLE is a two-pronged sword that affects patients' mental and physical health. Patient awareness remains an important aspect of disease management which is currently not emphasized appropriately. At the community and national levels, measures must be taken to promote and create awareness regarding SLE.

Evaluation of Serum Vitamin D Levels Among Patients with Viral Warts

Objective: To evaluate serum levels of 25-hydroxyvitamin D (25-OHD) in patients with viral warts.
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Dermatology Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Jul to Dec 2020.
 Methodology: One hundred patients were included in the study, 50 with viral warts (Group-1) and 50 without warts (Group2). Our study included both male and female patients of 10 to 60 years of age. Three categories were made according to their serum vitamin D levels. First, all participants were tested for serum vitamin D levels using ELISA.
 Results: In Group-1, 20(40%) had insufficient, and 25(50%) had deficient vitamin D levels. A statistically significant decrease in serum 25-OHD levels (p = 0.004) was found in patients with viral warts. In Group-2, 9(18%) had insufficient, and 2(4%) had deficient vitamin D levels. The mean serum vitamin D level was 22.61±10.11 in Group-1 and 45.12±24.60 in Group-2, resulting in a significant difference between patients with viral warts and those without viral warts regarding serum vitamin D levels (p=0.004).
 Conclusion: Patients with viral warts have deficient vitamin D levels.

Umbilical Cord Blood Bilirubin and Determination of Neonatal Hyperbilirubinemia

Objective: To determine accuracy of cord blood bilirubin in identifying significant neonatal hyperbilirubinemia. Methodology: A Cross sectional study was conducted in Pediatric department of Fauji Foundation Hospital Rawalpindi from Jan.2019 to June 2019. Cord blood samples were sent for the blood group and bilirubin levels. Neonates with cord bilirubin level > 2mg/dl and < 5 mg/dl were enrolled and admitted for 3 days and serum bilirubin level were done on 3rd day. Those developing significant hyperbilirubinemia were further investigated for hemoglobin, reticulocyte count, Coomb’s test and other causes. Results: Total 74 newborns at >35 weeks of gestation were included in the study of which 35 (47.3%) were male and 39 (52.7%) were female (male: female: 1:1.1). The data was analyzed using SPSS 17. At 3rd day of life mean ± SD cord blood bilirubin was 8.4 ± 2.7 mg/dl, mean direct bilirubin was 1.6 ± 0.9 mg/dl and mean indirect bilirubin was 6.8 ± 2.3mg/dl. Significant hyperbilirubinemia developed in 16 (21.6%) newborns at >35 weeks of gestation, who had a cord blood bilirubin level of > 2 mg/dl, so that the accuracy of cord blood bilirubin level (true positives) in determining significant hyperbilirubinemia was 21.6%. Conclusion: Cord blood bilirubin level >2mg/dl in all healthy term newborns predicts significant hyperbilirubinemia.

Adverse Childhood Experiences in Patients Admitted with Depression at A Tertiary Care Hospital in Pakistan

Objective: To consider adverse childhood experiences in patients admitted to a tertiary care hospital in Pakistan with depressive disorder.
 Study Design: Comparative cross-sectional study.
 Place and Duration of Study: Fauji Foundation Hospital, Rawalpindi Pakistan from Sep 2018 to Aug 2020.
 Methodology: All the patients who were admitted to the psychiatry ward of the hospital after being diagnosed with depression were included in the study. Detailed history and mental state examination were carried out on all patients by a psychiatrist, and the adverse childhood experience questionnaire was administered. 
 Results: Out of 400 patients admitted with a diagnosis of depressive episode in the hospital during the study period, 59(14.75%) were males, and 341(85.25%) were females. The mean age of the study participants was 39.49±8.926 years. 153(38.25%) did not have significant adverse childhood experiences, while 247(61.75%) had significant adverse childhood experiences. The severity of depressive episodes and substance use had a statistically significant relationship with the presence of significant adverse childhood experiences in our study participants (p-value<0.001).
 Conclusion: The presence of significant adverse childhood experiences was alarmingly high in patients admitted with a depressive episode in our study. These experiences were associated with the more severe forms of depressive illness and comorbid illicit substance use.

TOLERANCE AND ACCEPTABILITY OF INTRAVENOUS KETAMINE THERAPY FOR TREATMENT RESISTANT DEPRESSION: A MIXED METHODS ASSESSMENT

Objectives: This study was conducted to evaluate the response of treatment resistant depression to IV ketamine therapy protocol and explore the perspectives of patients regarding the acceptability of this treatment modality. Study Design: Mixed methods assessment including Quasi experimental design and Qualitative interviews. Place and Duration of Study: The study was conducted at Department of Psychiatry, Fauji Foundation Hospital, Rawalpindi from Jan to Jun 2022. Subjects and Methods: Through purposive sampling, 14 patients of treatment resistant depression were made part of the sample. Hamilton Rating scale for Depression (HAM-D) was used to measure response to 6 Ketamine infusions administered over 2 weeks. Paired t-test was applied to analyze changes in HAM-D scores compared to pretreatment baseline at 1 hour, 2 weeks and 1 month after last dose of ketamine using SPSS 26.0. Semi structured interviews were conducted to explore the attitudes of patients regarding ketamine treatment. Thematic analysis was carried out and data driven themes were identified. Results: There was a statistically significant improvement in severity of depression scores at 1 hour and 2 weeks after the last dose of ketamine. This effect was not significantly sustained at 1 month after the last dose. Some patients expressed initial hesitation related to safety of this treatment, citing comparisons with General anesthesia. By the end of treatment, most patients were keen to be advocates for the access to Ketamine therapy due to experiencing rapid transformational effects on severe depressive symptoms. Conclusion: IV Ketamine therapy was found to be a rapid, effective and acceptable tool for treatment resistant depression; however its longer-term effects could not be established.

Association of Vitamin D with Biochemical Severity Markers in Dengue Patients

Background: Dengue fever is a common virus that has rapidly spread to all parts of the world. Dengue causes two critical disease dengue shock syndrome and dengue hemorrhagic fever. Aim: To determine whether vitamin D levels and the severity of dengue are linked in any way. Study design: Cohort study Place and duration of study: Department of Medicine, Fauji Foundation Hospital Rawalpindi from 15-08-2022 to 15-11-2022. Methodology: The patient's sample was collected to monitor the complete blood picture, including total leukocyte count and hemoglobin, hematocrit, platelets, etc. The severity of dengue was assessed by looking at platelet counts and hematocrit. Results: The mean age was 29.19±16.80 years. There were 51% females and 49% males in the study. Vitamin D levels and platelet levels were weakly correlated with each other (rs= -.408, p= .000). There was a strong, negative correlation between Hb and Vitamin D levels, which was statistically significant (rs= -.704, p= .000). Similarly, hematocrit and highest MCHC also had a strong inverse significant correlation with Vitamin D level (rs= .698, p = .000 and rs= .751, p= .000, respectively). Surprisingly, there were significantly higher vitamin D levels in severe dengue patients than in non-severe ones (p<0.01). Conclusion: Vitamin D levels were higher in severe dengue cases compared to less severe ones, indicating a possible role of vitamin D as a cofactor for predicting disease severity. It is suggested that maintaining an ideal vitamin D level can help avoid the progression of asymptomatic dengue to dengue hemorrhagic fever or dengue shock syndrome. Keywords: Vitamin D, Biochemical severity markers, Dengue

Frequency of Dyslipidemia in Ischemic Strokes Involving Different Regions of Brain

Background: Most strokes are ischemic; the type of artery involved can affect the prognosis and clinical symptoms. The risk factors for stroke include high blood pressure, diabetes, smoking, and elevated cholesterol. It has been demonstrated that lipid profile levels and the prognosis of stroke are related. Aim: To determine the frequency of dyslipidemia in ischemic stroke patients based on the location of the infarct. Study design: Cross-sectional study Place and duration of study: Department of Medicine, Fauji Foundation Hospital Rawalpindi from 10 August to 10 January 2022. Methods: Four hundred patients with MRI-proven ischemic stroke were enrolled. The blood samples were obtained, and a lipid profile was used to determine the lipid abnormalities (dyslipidemia). Results: Middle cerebral artery involvement was the most frequently observed among the enrolled ischemic stroke patients, i.e., 54.8%. The overall frequency of dyslipidemia was 92.3%; hypercholesterolemia, hypertriglyceridemia, high LDL, and low HDL was present in 47.8%, 50.8%, 33.8%, and 93.8%, respectively. All patients with middle cerebral artery involvement had low HDL levels, 34.25% had high LDL levels, 41.10% had high triglyceride levels, and 54.79% had high cholesterol levels. A significant effect of age, gender, recurrent stroke, and location of infarct was observed on the frequency of dyslipidemia. Conclusion: The frequency of dyslipidemia in ischemic stroke patients in Pakistan is relatively high. This emphasized how important it is to reduce these population-wide modifiable risk factors. Keywords: Stroke, Dyslipidemia, Ischemic stroke, Lipid profile

Association of Sociodemographic Factors and Vitamin-D Levels with the Severity of Depressive Symptoms

Objective: To study the association of sociodemographic factors and Vitamin D levels with the severity of depressive symptoms in patients with depression.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Psychiatry Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from May to Nov 2021.
 Methodology: This study included all the patients diagnosed with depression per ICD 10 criteria by the consultant psychiatrist. Depression was further categorized in severity using Beck’s Depression Inventory. Vitamin D levels were sent to all the patients diagnosed with depression in the laboratory of our hospital. The cut-off score of less than 50nmol/l was taken as low vitamin levels.
 Results: Out of 103 patients studied, 23(22.3%) had mild, 49(47.6%) had moderate, and 31(30.1%) had severe depression. In severely depressed patients, 19(61.3%) were above 50 years of age, 12(38.7%) had no formal education, and 21(67.7%) had low vitamin D levels. Among mildly depressed patients, 5(21.7%) were above 50 years of age, 2(8.7%) had no formal education,and 17(73.9) had low vitamin D levels. We found that vitamin D levels, age of the patient, and level of education had a statistically significant relationship with the severity of depression, (p-valve less than 0.05).
 Conclusions: The level of vitamin D, age, and the level of education had a significant association in the target population with the severity of depressive symptoms.

Experience of permacath placement in patients with end stage renal failure in a tertiary hospital

Background & objective: Renal failure patients often need hemodialysis to optimize the deranged fluid and electrolyte balance in their blood. It involves drawing patients’ venous blood, route it through the hemodialysis (HD) machine and pump it back into the blood circulation. Frequent HD is conveniently performed through large bore, double lumen catheters and to prevent infection it is tunneled for a few centimeters. We conducted this retrograde study to determine the frequency of complications of tunneled permacath insertions in patients with end stage renal disease (ESRD) undergoing hemodialysis in our tertiary hospital Methodology: This retrograde descriptive study was conducted at Department of Anesthesiology, Fauji Foundation Hospital, Rawalpindi. from 1st Jan, 2019 – 1st Jan 2023. We searched and included data from the patient records of 804 patients in whom permacath was inserted for hemodialysis under ultrasound guidance and follow-up was done for 8 weeks. Data was retrieved and stored on a Performa and was analyzed on SPSS version 16. Results: Out of 812 permanent catheters passed in 804 patients, 19% had complications. The most common complication was catheter thrombosis (8%), followed by local site bleeding (5%), infection (3%), arterial prick (2%) and hematoma formation (1%). Conclusion: Tunneled permacath central venous catheter can be used in patients undergoing hemodialysis until maturation of arteriovenous fistula. It is quite a safe procedure under ultrasound guidance, but strict vigilance is required to prevent short-term and long-term complications. Key words: Central Venous Catheters; Renal Dialysis; Thrombosis; Hematoma; Kidney Failure, Chronic; Fluoroscopy; Ultrasonography. Citation: Ali L, Ali T, Mustafa SI, Qureshi AA. Experience of permacath placement in patients with end stage renal failure in a tertiary hospital. Anaesth. pain intensive care 2022;27(2):726−730; DOI: 10.35975/apic.v27i2.2357 Received: June 24, 2023; Revised: September 26, 2023; Accepted: November 15, 2023

Incidence of surgical site infections in clean and clean contaminated surgeries

Background: Health care-associated infections (HAI) continue to be a significant global community health issue and a concern to patient safety despite significant progress in infection control strategies. Among the most often reported illnesses acquired in hospitals are surgical site infections (SSI) (HAI). Methods: This prospective observational study was held in the various Surgical departments of Bakhtawar Amin Trust Teaching Hospital Multan and Fauji foundation hospital Peshawar cantt.April, 2022 to September, 2022. The study comprised a total of 400 individuals who underwent clean and clean contaminated procedures. Data on comorbidities, post-operative stay, kind of surgery, length of operation, use of prosthesis, day of SSI event, demographics, and re-suturing were gathered and evaluated. Pus aspirate/swab from patients suspected of having SSI was sent for culture and sensitivity testing. Results: The study covered 400 clean contaminated and clean surgeries. 5 percent of cases developed SSI. There was a correlation between SSI and age group, gender and also depends on the procedure type as emergency or elective. The stay in hospital was prolonged post-operatively (>7 days) in 14 (70%) patients who acquired SSI. 13 (65%) of the patients with SSI had co-morbidities. E.

Frequency of phantom limb pain, limb sensation and stump pain among amputees

Objective: To quantify the frequency of phantom limb pain, limb sensation and stump pain among amputees aging 20–75 years. Methods: An observational cross-sectional study was done. A population of 75 amputees were selected using non-probability convenient sampling and after setting the inclusion and exclusion criteria. Standard questionnaires; Groningen Questionnaire Problems after Arm Amputation (GQPAA) and Groningen Questionnaire Problems after Leg Amputation (GQPLA), were filled by interviewing the patients. All the patients were approached in the hospitals. Data was collected from Pakistan Institute of Medical Sciences, Islamabad and Fauji Foundation Hospital, Rawalpindi. The duration of study was 6 months from June 2021 to December 2021. Results: After compiling all the results from the questionnaires, it was unveiled that among 75 amputees, mean age was 43.12±11.43 years. Out of these amputees, 53.3% were upper limb amputees and 46.7% were lower limb amputees. the frequency of phantom sensation was 62.7%, 57.3% reported phantom limb pain and 84% experienced stump pain. Conclusion: The study concluded that most prevalent among the population was stump pain, which was followed by phantom limb sensations and the least prevalent of these three was phantom limb pain among the population.

Ganglion Impar Block For Chronic Coccydynia.

Coccydynia is also known as coccygodynia or coccygeal neuralgia. Coccyx is a triangular bone located within the vertebral column. The cause of coccydynia is unknown in the literature; however, it is found to be common among obese individuals, particularly females. The probability of women having coccydynia is five times higher than among men, which may result from larger pressure during pregnancy and child delivery. It is treated well with ganglion impar block. The aim of our study was to assess pain relief after Ganglion Impair Block with subsequent improvement in quality of life. A single-arm study was done in the department of Pain Medicine, Fauji Foundation Hospital, Rawalpindi from July 2021 to June 2022. A total of 50 patients with ≥3 months' coccygeal pain of either gender aged between 20-60 years unresponsive to analgesics & anti-inflammatory medications with no laboratory abnormalities were included. Fluoroscopic guided trans-sacro‑coccygeal ganglion impair block was done with alcohol neurolysis. The patients were observed for 1 hour in the recovery room to record post-intervention complications that may occur like hypotension, bradycardia, signs, and symptoms of cardiotoxicity or neurotoxicity etc. and evaluated for pain scores on the basis of the numeric rating scale (NRS). Data collected was analyzed using the statistical package for social scientists (SPSS) version 21. The quantitative data, i.e., age and NRS score were analyzed using mean and standard deviation and compared between pre and post-intervention periods. The data from 50 patients who completed the follow-up period were used for analysis. The average age of the patients was 42.9±8.39 years, with a range of 38-60 years. Based on the data obtained, 30% of the patients experienced trauma (that is falling on the coccyx region). The mean score from NRS before intervention was 7.80±0.16 which decreased to 0.96±0.35, respectively, and this difference was statistically significant (p-value, <0.001). Ganglion Impar neurolysis is highly effective in the treatment of chronic coccydynia.

Evaluation of Serum Vitamin D Levels in Patients with Vitiligo

&#x0D; Objective: To evaluate serum vitamin D levels in patients with vitiligo and compare them to the healthy controls.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Dermatology Outpatient Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Nov 2019 to Apr 2020.&#x0D; Methodology: The study included 75 patients with vitiligo (Group-1) and 75 healthy controls (Group-2). Complete blood count, urea and creatinine, liver function tests, TSH, fasting plasma glucose, vitamin B12 levels, serum calcium and vitamin D levels were performed. In addition, vitamin D levels were compared in both groups.&#x0D; Results: The mean age of Group-1 was 32.81±20.59 years, and Group- 2 was 40.13±16.09 years. In Group-1, deficient vitamin D levels were seen in 17(22.7%) of cases, insufficient in 25(33.3%) and 33(44.0%) had normal levels. In Group-2, 10(13.3%) had deficient levels, 10(13.3%) had insufficient levels and 55(77.3%) had normal levels. Patients with vitiligo had low serum 25(OH)D levels compared to controls, and this difference was statistically significant (p=0.001).&#x0D; Conclusion: Low serum vitamin D levels are seen in patients with vitiligo compared to controls.

Evaluation of Serum Vitamin-D Levels in Patients with Alopecia Areata

Objective: To evaluate serum vitamin-D levels in patients with Alopecia areata compared to healthy controls.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Dermatology Outpatient Department, Fauji Foundation Hospital, Rawalpindi Pakistan, from Nov 2019 to Apr 2020.&#x0D; Methodology: The study included 70 patients with Alopecia areata (Group-1) and 70 healthy controls (Group-2). Complete blood count, TSH, urea and creatinine, fasting plasma glucose, liver function tests, serum Calcium and vitamin-D levels were performed.&#x0D; Results: The mean vitamin-D levels of Group-1 were 38.28±22.07ng/mL, and the mean vitamin-D levels of Group-2 were 39.61±18.36ng/mL. In Group-1, deficient vitamin-D levels were seen in 14(20.0%) of Group-1, and insufficient in 19(27.1%) and 37(52.9%) had normal levels. In Group-2, 10(14.3%) had deficient levels, 16(25.0%) had insufficient levels and 44(62.9%) had normal levels. No statistically significant difference seen between Group-1 and Group-2.&#x0D; Conclusion: There is no association between vitamin D level and Alopecia Areata.

Prevalence and Virulence Factors of Vaginal Candidiasis Among Females Collected in Tertiary Care Hospital, Khyber Pakhtunkhwa

Background: The genus Candida includes about 200 different species, but only a few species are human opportunistic pathogens. Candida albicans is a commensal and opportunistic pathogenic agent that causes infection in immune compromised individuals. This work was conducted to study the detection of virulence factors of Candida spp. in clinical female samples from tertiary care hospitals of Kohat. Methods: This cross-sectional study was conducted during April to July 2017. Patients data and samples were collected from Liaqat Memorial Hospital (LMH), Fauji Foundation Hospital, and Family Health Hospital, Kohat. Morphological identification was done by using different media i.e SDA and PDA. Further identification was done through gram staining and germ tube method. Results: A total of one hundred and sixty (n=160) clinical samples were collected from outdoor patients, in which only 50 were Candida positive. Among all the 50 isolates of 13(26%) Candida spp. were germ tube positive. Further identification were done through Chrome Agar in which 17(34%) isolates were C. albicans, followed by 19(38%) were C. tropicalis, and 4(8%) isolates were C. glabrata. Detection of virulence factors is done by different methods in which 30(60%) isolates showed phospholipase activity in which 12(24%) of Candida spp. were large positive. In haemolytic activity showed 28(56%) strong haemolytic activity, 5(10%) were weak positive. Candida positive patients high 36 (72%) in 21 to 40 years. Conclusion: In the present study, the results concluded that patient infected with Candida are highly virulent as about more than 60% of Phospholipase, Biofilm and Haemolytic positive. Candida species have high prevalence rate among 21 t0 40 years from the rest of very late and early age. Finding novel antibacterial chemicals is highly advised in view of the study's findings. Additionally, it is crucial to assess the candida resistant patterns at the genomic and proteomic levels in order to identify the genes causing the patterns of antibiotic resistance. Keyword: Candida, Virulence Factors, Germ Tube, Chrome Agar, opportunistic pathogens, Haemolytic positive, Gram staining, Germ tube method.

Serum calcium levels as biomarkers of birth asphyxia in neonates

&lt;p&gt;Background and objective: Birth asphyxia is a common pathological condition seen in newborns with increased morbidity and mortality. Grave consequences following birth asphyxia require earlier recognition of the precipitating factors and prompt treatment in intensive care units. Multiple electrolyte imbalance has been related to this condition. This study aimed at determining the mean serum total calcium levels in neonates with birth asphyxia.&lt;/p&gt;&#x0D; &lt;p&gt;Methods: This cross sectional study was performed at the neonatal intensive care unit of the Pediatric Department of Fauji Foundation Hospital, Rawalpindi, Pakistan over a period of 6 months. A total of 100 full-term neonates of either gender with evidence of birth asphyxia of any stage were enrolled on their first hour of birth. Serum calcium levels were estimated in each neonate at 24 hours after birth.&lt;/p&gt;&#x0D; &lt;p&gt;Results: A total of 60 (60%) neonates were males. Mean serum calcium levels were found to be 7.64 mg/dl &amp;plusmn; 0.59 with no significant difference among males and females (7.67 &amp;plusmn; 0.64 and 7.59 &amp;plusmn; 0.50 mg/dl, respectively). Neonatal distribution in Stages I, II, and III was 64 (64.0%), 23 (23.0%), and 13 (13.0%), respectively. Hypoxic-ischemic encephalopathy stage stratification with mean serum calcium levels with higher stages deciphered significant correlation (7.89 &amp;plusmn; 0.54, 7.36 &amp;plusmn; 0.28, and 6.88 &amp;plusmn; 0.28 mg/dl, respectively, in stage I, II, and III).&lt;/p&gt;&#x0D; &lt;p&gt;Conclusion: Markedly decreased levels of mean serum calcium were seen in higher hypoxic stages with ischemic encephalopathy hence delineating a linear correlation with the onset and progression of disease.&lt;/p&gt;

Superbugs with Antibiotic Resistance; The Frequency of Community-Acquired MRSA Isolation on Frequently Touched Surfaces by Public

Objective: to detect the presence of Methicillin-Resistant Staphylococcus Aureus (MRSA) on frequently touched surfaces in the community, like handles and seats of shopping trolleys and to identify disinfecting practices of the grocery store owners.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Grocery stores in Rawalpindi, Pakistan from Jun to Nov 2019.&#x0D; Methodology: A total of 200 swabs from two separate surfaces of 100 trolleys were collected, with 100 samples each from handles and the seats. Trolleys from seven different grocery stores in Rawalpindi Pakistan, were selected by multistage sampling. The swabs were presented to the Microbiology laboratory at Fauji Foundation Hospital, Rawalpindi Pakistan to test for bacterial presence.&#x0D; Results: The samples showed growth on 65% of trolley handles and 66% of trolley seats. Trolleys washed once in 6 to 12 months, had 42.5% bacterial growth. Staphylococcus Aureus was present on 42 % of both surfaces, with 24% MRSA on Trolley handles and 18% on trolley seats. The significant association was observed in Bacterial growth on the handles of trolleys and servicing frequency of shopping trolleys with the p-value of &lt;0.001.&#x0D; Conclusion: MRSA strain was alarmingly detected on shopping trolleys, a community-use item. Grocery store keepers following guidelines for the trolleys’ sanitation along with regular monitoring can protect staff and the general public. In addition, it is important to impart health education to the general public regarding disease transmission through such sources and their preventive strategies.

PATHWAY TO CARE: HEALTH BELIEF MODEL AND BARRIERS IN MENTAL HEALTH SETTINGS

Objective: This study was planned to assess the pathway to mental health care including the health belief model and barriers faced by patients at a private tertiary care psychiatric facility in Rawalpindi, Pakistan Study Design: Cross sectional research Place and duration of study: This study was conducted from June to Dec 2016 at Fauji Foundation Hospital, Rawalpindi. Subjects and Methods: Through consecutive sampling, 246 patients presenting to the study venue were made part of the sample. A semi structured questionnaire was used to identify the symptom origin according to their health belief model as well as the barriers to care. Study variables were summarized using Descriptive statistics, and Chi square test was applied for association between common barriers to care and relevant socio-demographic variables using SPSS 20.0. Results: Out of 246 patients (61.4% females and 38.6% males), the majority of patients (39%) believed in a physical origin of their mental health symptoms followed by supernatural (32.9%) and psychological causes (28%). The most commonly reported type of barrier to care was Structural (68%) including Financial constraints and Lack of easy access to specialist resources whereas Attitudinal barriers such as Low perceived need and Perceived side effects of psychiatric medications were found in 22% of the cases. Stigma associated with psychiatric illnesses was reported by 10% cases. The educational status, locality of residence and monthly family income were significantly associated with structural and attitudinal barriers to mental health care. Conclusion: Patients with low literacy rates, rural based living and socioeconomic disadvantage are more likely to report structural and attitudinal barriers to accessing mental health services.

Value of ileo-ascending colic end to side anastomosis after ileocaecal resection.

Objective: To assess the outcome of end to side Ileo-Ascending Colic anastomosis in patients undergoing emergency and elective Ileo-Caecal resection in non-malignant cases. Study Design: Cross Sectional Descriptive study. Setting: Department of Surgery at Fauji Foundation Hospital Rawalpindi. Period: January, 2018 to December, 2020. Material &amp; Methods: A Total of 40 patients with ileo-caecal benign pathology presenting with generalized peritonitis and intestinal obstruction were studied. All patients underwent laparotomy either in emergency or as planned procedure. After dealing with the primary pathology an end to side ileo-ascending colic anastomosis was performed in all cases. Cases of ileo-caecal disease that required an ileostomy or underwent ileo-transverse colic anastomosis were excluded from the study. Anastomosis was performed in conventional two layers with vicryl 3/0. Variables studied were; indication for surgery, per-operative findings and post-operative complications like anastomotic leakage, surgical site infection, burst abdomen and systemic sepsis. Data was analyzed on SPSS (v 26). Results: There were 30 females (75%) and 10 male patients (25%). Age range was 18-72 years with mean age 43.62 years. Common clinical indication of surgery was intestinal obstruction 11 cases (27.5%) followed by generalized peritonitis 10 cases (25%) and trauma 9 cases (22.5%). Post-operative diagnosis in most patients was ileo-caecal tuberculosis 14 cases (35%) followed by trauma to ileo-caecal region 9 cases (22.5%). Anastomotic leakage occurred in 1 patient (2.5%) who underwent second look laparotomy and re-anastomosis. Surgical site infection occurred in 3 cases (7.5%). There was one fatality (2.5%) due to uncontrolled systemic sepsis. Conclusion: An end to side ileo- ascending colic anastomosis in conventional two layers is a safe and reliable procedure after emergency or planned ileo-caecal resection. It saves the patient from ileostomy, preserves colonic length and avoids formation of blind loop.