Hospital Karachi Research Articles

Impact Of Number Of Prenatal Visits On Breast Feeding Practices

OBJECTIVE: To determine the impact of several prenatal visits on breastfeeding practices during the first six months of infant life. METHODOLOGY: This prospective cohort study was conducted in Darulsehat Hospital Karachi from August 2021 to August 2022 among pregnant females (36-40 weeks of gestation) regardless of their parity. Multiple pregnancy, intrauterine fetal death and medical disorders were excluded. A Convenient Non-probability sampling technique is used for the selection of participants. Participants were divided into three groups according to their number of prenatal visits. <4, 4-8, >8 and followed three times after childbirth to assess their breastfeeding practices. The first follow-up was done within 48 hours of delivery, the second at three months, and the third after six months of delivery. Each visit is assessed for three breastfeeding practices: exclusive, mixed, or bottle feeding. SPSS version 23 was used for analysis. RESULTS: Two hundred ten participants were interviewed. 78.6% were well-informed about breastfeeding during antenatal visits. Mean antenatal clinic visits of studied samples were 6 (6 - 8).7.1% were found with less than four antenatal visits, 68.1% with 4-8 visits, and only 24.8% had more than eight antenatal clinic visits. The percentage of exclusive feeding is highest in group 3 (>8 visits) i,e; 52.3%, followed by 43% in 4-8 visits and lowest at 4.7% in < 4 antenatal clinic visits samples. CONCLUSION: A more significant number of antenatal visits favorably influence BF practices regarding the commencement and continuation of breastfeeding. KEYWORDS: Prenatal visits, antenatal care, breastfeeding practices, lactation, exclusive breastfeeding, frequency of ANC

Assessment of Depression, Anxiety, and Stress among Health Care Professionals due to Covid - 19

Abstract: Background: The emergence of an undisclosed pneumonia outbreak in Wuhan, China, in December 2019 led to the global spread of Corona virus Disease (COVID-19), declared a pandemic by the WHO on March 12, 2020. Healthcare workers (HCPs) faced unprecedented challenges, with studies revealing elevated stress, depression, and anxiety. Despite differing roles, direct health care providers reported higher psychological distress. The absence of a definitive treatment compounded fears, resulting in anxiety, depression, and stress among patients, Healthcare professionals and normal subject. Objective: To identify the level of anxiety, depression, and stress among health care professionals due to the wave of Covid- 19. Materials and Methods: Analytical cross-sectional survey was done among health care workers who were working in a tertiary care hospitals, Sohail Trust Hospital Korangi Industrial Area, Karachi, and Medicare Cardiac and Dental Hospital, Tariq Road, Karachi from January 2022 to April 2022 in the third wave of Covid-19. The Depression, Anxiety, and Stress Scale-21 Items (DASS-21) self reporting scale based questionnaire was used to examine mental health. During data analysis, descriptive and inferential statistics were calculated in SPSS. Result: Out of 416 participants, 56% were females and 56.2% were single. The mean age of the respondents was 29.36 years (± 5.5). The symptoms of anxiety were reported by 47%, depression by 35% and stress was reported by 21% of participants. The level of anxiety, depression, and stress was higher in male technicians, frontline workers, HCP with chronic illnesses, and those who got covid-19 infection. Based on the results, it was identified that male had higher odds of developing anxiety while female, HCPs belonging to age groups of above 25 years and those with work experience lesser than 5 years showed to have greater odds of having stress. Conclusion: COVID-19 has caused Anxiety, Depression, and Stress among Pakistani healthcare workers. Early intervention with focused strategies and psychological therapies could help to prevent more serious problems.

Factors associated with dropout from outpatient tertiary mental health services

Background and Objective:
 There is a paucity of mental health hospital-based studies from Pakistan that have observed the contributing factors of dropout. This study aims to understand contributing factors to dropouts from mental health services.
 Method:
 This telephonic survey was conducted as a cross-sectional study from dropout outpatients of Karwan-e-Hayat Institute for Mental Health Care, a tertiary mental care hospital in Karachi, Pakistan. Using a simple questionnaire to assess socio-demographic variables, psychosocial assessment, and patient perspectives on treatment termination. A total of 158 participants out of 200 patients provided insight into their dropout experiences.
 Result: 
 Results revealed that younger adults, particularly those aged 18-40, demonstrated a greater tendency to discontinue treatment. Level of education was also associated with dropout rates, with uneducated and less educated individuals showing greater tendencies to drop out of treatment than their educated counterparts. Schizophrenia emerged as a leading psychiatric diagnosis associated with high dropout rates. Lack of insight into psychotherapy, patient dissatisfaction, and geographic distance from treatment centers were identified as key contributors to dropout.
 Conclusion:
 Factors such as age, educational status, diagnosis, insight into the disease, dissatisfaction with the treatment and distance from the treatment center were related to the dropout rate. Insights gained from this investigation advocate for tailored interventions focusing on education, patient satisfaction, and proximity to treatment facilities.

Prevalence of stress among the healthcare providers in a tertiary care hospital in Karachi

Background and Objective:
 Healthcare workers are considered high risk for stress. This study aimed to study the prevalence of stress among the health care providers in a tertiary care hospital in Karachi.
 Methods:
 A cross-sectional study was conducted at Liaquat National Hospital from July to December 2021. All healthcare workers in the vicinity of the hospital including doctors, nurses, allied health specialists, and other healthcare professionals who provide hands-on patient care were included in the study. Data was collected through a pre-designed questionnaire GHQ-12; related to stress symptoms and their impact on daily routine activities. It was in a Google form and forwarded through e-mails. Data was saved and transferred to SPSS later for analysis.
 Results: 
 In terms of stress, the study found that a significant number of health care providers experienced stress n=146 (74.5%). Among the patients who reported experiencing stress, the distribution of stress levels shows that the majority experienced typical stress n=58 (29.6%), followed by severe stress with psychological distress n=56 (28.6%), and distress n=32 (16.3%). The majority of patients fell within the age range of 20-30 years and were female.
 Conclusion:
 There is a high prevalence of stress among the healthcare providers in our hospital. Enhancing productivity and reducing stress at work should be a goal in health care.

Assessing in-hospital mortality and predictors in Patients with contrast-induced nephropathy Following primary percutaneous coronary Intervention.

The contrast-induced nephropathy (CIN) is a common complication of primary percutaneous coronary intervention (PCI) it has been reported to be associated with an increased risk of mortality. The study reported the in-hospital mortality among patients who developed CIN after primary PCI. This descriptive cross-sectional study was conducted on a sample of consecutive who developed CIN after primary PCI at a tertiary care cardiac hospital in Karachi, Pakistan. The CIN was defined as either a relative increase of 25% or an absolute increase of 0.5 mg/dL in post -procedure serum creatinine within 72 hours. The in-hospital mortality status was recorded and clinical and demographic predictors of in-hospital mortality were identified with the help of binary logistic regression analysis. In the study sample of 402 patients, 74.1% (298) were male and the mean age of the study sample was 59.4±11.5 years. The in-hospital mortality rate was 9.7% (39). On multivar iable analysis, an increased risk of mortality was found to be independently associated with inferior wall myocardial infarction (IWMI) with right ventricular (RV) infarction, intra-procedure arrhythmias, and pump failure with an adjusted odds ratio of 3.63 [95% CI: 1.31-10.08; p=0.013], 5.53 [95% CI: 1.39-22.06; p=0.015], and 8.94 [95% CI: 3.99-20.02; p<0.001], respectively. In conclusion, there is a high rate of mortality for patients who develop CIN after primary PCI, and the risk of mortality is further aggravated by the presence of IWMI with RV infarction, intra-procedure arrhythmias, and pump failure.

Efficacy of Oral Apremilast in The Treatment of Alopecia Areata, at The Tertiary Care Hospital, Karachi

Background: Alopecia Areata (AA) presents a significant challenge in dermatology due to its unpredictable nature and psychological impact. Recent studies have focused on oral Apremilast, a phosphodiesterase 4 inhibitor, for its potential efficacy in treating AA. Objective: This study aims to assess the efficacy of oral Apremilast in treating alopecia areata at a tertiary care hospital in Karachi. Methods: A randomized controlled trial was conducted in the Department of Dermatology at Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to June 2023. The study enrolled 85 patients exhibiting various symptoms of AA. Apremilast was administered orally at 30 mg twice daily, following a 5-day initial titration dose. The Severity of Alopecia Tool (SALT score) was employed to measure treatment effectiveness at the outset, 6 weeks, and 12 weeks. Data analysis was executed using SPSS version 23. Results: Participants had an average age of 28.34 years (SD = 4.20), with a gender distribution of 51 women (60.0%) and 34 men (40.0%). The study demonstrated a significant decrease in SALT Scores from 62.42 ± 5.17 to 41.53 ± 13.44 at Week 12 (mean difference: 20.89, 95% CI: 17.86 to 23.92, p-value: 0.0001), indicating a notable reduction in AA severity. Oral apremilast was found to be effective in treating AA in 80.0% of patients. Conclusion: The study concludes that oral Apremilast significantly reduces the severity of alopecia areata, as evidenced by the decline in SALT Scores from baseline to Week 12. These findings suggest that oral Apremilast may serve as a viable alternative treatment for AA, deserving further clinical exploration.

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 Violence against Healthcare Providers on Maternal and Child Health Service Delivery in Karachi

Background There is an increasing global issue with workplace violence against healthcare practitioners. The healthcare system as a whole and individual employee are both hit hard by this. The purpose of this research was to identify the prevalence, nature, and consequences of workplace violence encountered by healthcare workers in maternity and child health service delivery settings in the violent metropolis of Karachi, Pakistan. Methods A quantitative cross-sectional study was conducted among 414 healthcare providers from 14 randomly selected hospitals in Karachi. Participants completed a self-administered questionnaire assessing their experiences of workplace violence, including the type of violence, perpetrators, frequency, and impacts on their health and work performance. Results A shocking 87.9% of healthcare professionals have encountered workplace violence, with verbal/psychological abuse (37.4%) and physical assault (31.6%) being the most prevalent. Violence was most commonly committed by patients' relatives (42.8%) and happened daily (43.2%) or weekly (31.2%). Violence had serious effects, with 87.9% of providers absent 51.9% wanting to resign, and 69.6% feeling PTSD. Violence also lowered paediatric and gynaecology treatment quality. Conclusions Workplace violence is a serious and pervasive problem for healthcare providers in Karachi, with severe consequences for their well-being and the quality of care they provide. Urgent action is needed to address this issue, including stronger enforcement of existing laws, improved hospital security measures, and training for healthcare providers in violence prevention and management strategies. Keywords: workplace violence, healthcare providers, maternal health, child health, healthcare quality

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 &amp; 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&#x0D; 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=

CLINICAL OUTCOME OF GUILLAIN BARRE SYNDROME IN THE INTENSIVE CARE UNIT OF A PEDIATRIC TERTIARY CARE HOSPITAL

Since poliomyelitis was eradicated, Guillain-Barre syndrome has been the leading cause of acute flaccid paralysis globally. Critical care and mechanical breathing may be necessary in extreme circumstances. Among paediatric patients hospitalized in the intensive care unit of a Karachi tertiary hospital, we aimed to quantify the incidence of Guillain-Barré Syndrome clinical outcomes. Cardiology Intensive Care Unit (NICH) in Karachi, Pakistan. January 9, 2020, to July 10, 2020—six months. Children admitted to the intensive care unit at NICH with GBS, as defined operationally, ranging in age from six months to twelve years, were included in the study. They stimulated the posterior tibial nerve (PTN) and common peroneal nerve (CPN), allowing for studying motor nerve conduction and using the median and ulnar nerves to measure compound muscle action potentials' onset delay, amplitude and conduction velocity (CMAPs). Research on the conduction of sensory nerves was carried out to quantify SNAPs in the sural, median, and ulnar regions. All patients were given intravenous immunoglobulin for five days at a 400 mg/kg/day dosage, as per the protocol. Clinical outcomes were evaluated using the HFG scale at discharge and four weeks. The average patient age was 5.81 ± 3.26 years out of 30. Thirteen men (43.3%) and seventeen females (56.7%) were present. Fifteen patients (53.3%) had a history of upper respiratory illness, while seven (23.3%) had a history of gastrointestinal infection. A mean HFG score of 3.03 ±1.90 was recorded. Outcomes were good for 21 patients (56.7%) and deficient for 9 (43.3%). A tertiary care hospital in Karachi reported that 56.7% of children admitted with Guillain-Barre Syndrome had good clinical results in the intensive care unit.

Allergic bronchopulmonary aspergillosis: radiological and microbiological profile of patients presented in an outpatient pulmonary clinic in a developing country.

There is limited data available about allergic bronchopulmonary aspergillosis (ABPA) in Pakistan. The aim of the study was to describe the radiological and microbiological profile of ABPA patients presenting to the outpatient pulmonary clinic of a tertiary care hospital in Karachi, Pakistan. A retrospective study was conducted on ABPA patients who presented to the pulmonary outpatient clinic at Aga Khan University Hospital, Karachi, Pakistan, from January 2017 to December 2019. Data was collected on microbiology and radiology features on predesigned proforma. A total of 7759 asthmatic patients presented at the outpatient pulmonology clinic during the study period. Of the 245 patients labeled as ABPA, 167 fulfilled the inclusion criteria, and 91 (54.5%) were female (mean age 41.9±13.0 years). A high resolution computed tomography scan of the chest was available for 126 patients. Of these, 104 (82.5%) patients had bronchiectasis. Central bronchiectasis was noted in 98 (94.2%), mucus plugging in 71 (56.3%), and hyperinflation was seen in 30 (23.4%) patients. Microbiological testing was available in 103/167 (61.7%) patients. The most common bacterial pathogen was Pseudomonas aeruginosa 32 (31.1%), followed by Hemophilus influenzae 16 (15.5%), and Moraxella catarrhalis 7 (9.7%). Aspergillus fumigatus 17 (23.6%) was the most common mold, followed by Aspergillus flavus 16 (22.2%) and Aspergillus niger 11 (15.3%). Co-infection (bacterial and fungal) was found in 18 (17.45%) patients. Bronchiectasis was frequently observed in our cohort of patients with ABPA. Pseudomonas aeruginosa was found to be common among bacterial pathogens. Isolation of fungus is not uncommon in these patients.

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

Selective screening for inherited metabolic disorders in a tertiary care hospital of Karachi - A retrospective chart review.

Selective high-risk screening of children suspected of having inherited metabolic disorders was conducted jointly by Chemical Pathology section and the Pediatric Department of Indus Hospital and Health Network- (IHHN) from October 2020-March 2022. Tandem mass spectrometry (MS) for newborn screening was recently introduced in a local laboratory. We did a selective high screening of children for metabolic disorders by using MS for neonates and other relevant tests for older children in our hospital. The present study was undertaken to get an estimate of the number of metabolic cases screened and identified after inclusion of an extended workup. This is a retrospective chart review of children who were selectively screened for IMDs. Patients' records with ages ranging from birth to fourteen years of age were retrieved from the electronic records department of IHHN from October 2020 to March 2022. Records were searched for demographic data, history, signs, symptoms, and lab investigations. All relevant information was recorded on a pre-designed questionnaire. A total of 178 children were screened for inherited metabolic disorders. Majority of the children screened were less than one month of age 96 (54%). Consanguinity was noted in 74 (41.5%) children. Most common symptoms observed were failure to thrive in 77 children (43%), hypoglycemia in 45 children (25%), and feeding difficulty in 36 children (20%). Inherited metabolic disorders were confirmed in 12 children out of which five had congenital adrenal hyperplasia, four had cystic fibrosis and three children had congenital hypothyroidism. In the present study, we were able to screen several children after inclusion of an extended metabolic workup. However, confirmation of many disorders like fatty acid oxidation defects, disorders of carbohydrate metabolism, and sphingolipidosis could not be done due to lack of confirmatory tests. We recommend that confirmatory tests of these disorders be included in local labs.

Enhancing antenatal education in Pakistan: an audit and recommendations

BackgroundAntenatal Education equips parents with knowledge for safe maternal health and infant care. It also reduces fear and anxiety during childbirth. ANE curriculum can vary according to country and institute. It can include classes focusing on childbirth, pain relief techniques, mode of birth, parenting, breastfeeding, breathing techniques, etc. Although ANE is widely practiced in developed countries, there is no standard program in developing countries like Pakistan. This study aims to improve antenatal education at a tertiary care hospital in Karachi, Pakistan potentially proposing an upgraded curriculum as a national standard.MethodsThis multiphase study used mix-method design was conducted in the Obstetrics and Gynaecology Department of a tertiary care hospital of Karachi, Pakistan from 2019 to 2021. Phase 1 of the study included reviewing and comparing the hospital’s antenatal curriculum with existing literature, followed by Phase 2, which was a desk review of attendance and patient feedback. The 3rd phase involved IDIs (in depth interviews) from health care workers (Obstetrics experts) to understand their perspectives regarding the ANE and the conducted classes. For phase one, gaps were identified and reported theoretically. For phase two, the annual attendance was recorded and participants’ satisfaction with the classes assessed. Qualitative data from phase 2 and 3 was converted into themes and sub-themes.ResultsThe audit showed a decline in the attendance of antenatal classes due to the pandemic and consequent shift to online sessions. The low attendance in online courses could be attributed to various factors. Patient feedback was generally positive, with a majority expressing high satisfaction levels. Expert feedback highlighted the need for additional topics such as mental health and COVID in pregnancy, as well as fathers' involvement. The curriculum was updated to include these topics and made more interactive with printed handouts for parents.ConclusionA standardized antenatal education covering various topics surrounding pregnancy, childbirth, and postnatal care must be available to parents nationwide.

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.

Frequency of Urinary Tract Infection Among Patients Undergoing Implant Fixation for Acute Trauma.

This study aims to determine the frequency of urinary tract infection (UTI), identify the isolated bacteria, and assess antibiotic sensitivity in patients undergoing orthopedic implant fixation for hip fractures. After ethical approval from the institutional review board, this retrospective cross-sectional study was conducted at the Orthopedic Surgery Department of Dow University Hospital Karachi from June 2022 to June 2023. Through non-probability consecutive sampling, 186 patients above 16 years of age, of either gender, presenting with hip fractures such as intracapsular or extracapsular fractures, who underwent surgical fixation, were included in the study. A urine sample for urinalysis of these patients was sent on admission. Patients who presented with open fractures or those treated with conservative management were excluded from the study. The fracture diagnosis was confirmed on radiographs. All other relevant baseline investigations were also performed before surgery, per protocol, and urine-detailed and cultured reports were followed. In addition, each patient was asked about common symptoms of UTI before surgery and then diagnosed with UTI on positive urine culture and sensitivity (CS). Out of 186 hip fracture patients, 98 (52.7%) were males and 88 (47.3%) were females, with a mean age of 61.03 ± 16.43 (16-96) years. Pre-operative UTI symptoms were reported by 79 patients, including dysuria (16; 20.3%), polyuria (19; 24.0%), and burning (44; 55.7%). UTI was diagnosed on culture and sensitivity report in 65 (34.9%) patients with Escherichia coli as commonly diagnosed bacteria 35 (53.8%), followed by Enterococcus 8 (12.4%), Klebsiella 7 (10.9%), Pseudomonas aeruginosa 3 (4.7%), and Acinetobacter 2 (3.1%) patients. E. coli was sensitive to amikacin, amoxicillin/clavulanic acid, ampicillin, cefixime, ceftriaxone, cefuroxime, ciprofloxacin, colistin, cotrimoxazole, fosfomycin, gentamycin, levofloxacin, meropenem, nitrofurantoin, polymyxin B, and piperacillin-tazobactam. Urinary tract infection is common in patients undergoing orthopedic implant fixation for hip fractures, which can lead to potentially serious outcomes. Overall, hygiene, prompt treatment, and standard protocol should be utilized to treat those infected and minimize the spread.

Assessment of Non-Ischemic Chest Pain and its Association with Socio-Demographic Characteristics among Post Percutaneous Coronary Interventions (PCI) Patients

The most common procedure used in cardiovascular medicine is percutaneous coronary intervention (PCI) that can create some physiological complications, such as decreasing heart rate, mechanical issues, and cardiac arrest among patients. Objective: To determine the frequency of non-ischemic chest pain and its relation with socio-demographic features amongst post PCI patients in a tertiary care hospital in Karachi. Methods: This analytical cross-sectional study was led at National Institute of Cardiovascular Diseases (NICVD) Hospital, Karachi. A total of 195 patients with Post PCI non-ischemic chest pain were recruited by using the Numerical rating scale (NRS). Non-probability purposive sampling technique was used and permission was taken from Institutional Review Board (IRB) of DUHS and Ethical Review Committee (ERC) of NICVD. Data were analyzed by using SPSS Version-26.0. Percentages and frequency were used for categorical variables while, a chi-square test was applied to check the associations of non-ischemic chest pain with demographic features of the patients. Results: In this study, 63.60% of the participants were male. Most of the participants (75.4%) were married. Non-ischemic chest pain was found significantly associated with age, gender, marital status, history of disease and drug history with p-values &lt;0.001, 0.001, &lt;0.001, &lt;0.001, &lt;0.001 respectively. The majority of the participants (90.26%) were suffered with non-ischemic chest pain. Conclusions: This study revealed that majority of the patients suffered with non-ischemic chest pain and moderate pain level was prevailing in the majority of the post PCI patients.

Impact of COVID-19 Pandemic on the Quality of Life of Nurses Working in the Public Sector Tertiary Care Hospitals of Karachi

COVID-19 has a substantial influence related to the quality of life of nurses by increasing the number of patients, which increases the work burden and stress level. Objective: To determine the impact of the COVID-19 pandemic on the quality of life of nurses working in the public sector tertiary care hospitals of Karachi. Methods: Present an analytical cross-sectional study design was employed to determine the quality of life of working by using a non-probability convenient sampling technique to recruit 240 nurses. The quality of life of nurses was assessed by using the McGill Quality of Life (QoL) revised questionnaire. Results were considered significant at p-value of ≤0.05. Results: Out of a total of 240 nurses, most of them 135 (56.2%) were male, 177(73.88%) married, 128, 53.3% Post RN qualification, and 99 (41.2%) 6 to 10 years of working experience. The mean+SD of the overall QoL of nurses was 6.56+2.53. Based on multiple logistic regression analysis, males had 2.79 times better QOL during the COVID-19 pandemic as compared to females (ORadj=2.79, 95% CI: 1.05 - 7.45, p= 0.04). Similarly, married persons had 3.06 times better QOL during the COVID-19 pandemic as compared to others (ORadj=3.06, 95% CI: 2.14 – 3.34, p= 0.003). Conclusions: It is concluded that the COVID-19 pandemic has a significant effect on all aspects of the physical, psychological, existential and social quality of life of nurses working in the public sector tertiary care hospitals of Karachi, Pakistan

Challenges and health outcomes of the exposure to soybean dust in the harbor neighborhood of Karachi, Pakistan: a wake-up call

BackgroundChemical disasters are common worldwide and result from technological failure, war, and terrorism activities. Pakistan imports huge quantities of hazardous chemicals to meet its industrial and energy needs. Hence there is a risk of chemical disaster at the ports, during transportation of such material and processing in the chemical industry. This study aimed to review the challenges and health outcomes of cases of soybean dust exposure in Kemari district (harbor neighborhood) of Karachi, Pakistan.MethodsA cross-sectional survey was conducted with all the affected people from a chemical incident of soybean dust which was reported in the Keamari district of Karachi, Pakistan. Included patients ≥ 18 years who visited the two major tertiary care hospitals of Karachi, Pakistan after the incident between February 17 to 23, 2020. A total of 574 patients were brought to these two major tertiary care hospitals. We collected data on basic demographics, event details, and major signs and symptoms of the affected individuals. Calculated frequencies and percentages for categorical variables. Mean ± standard deviation (SD) was calculated for continuous variables.ResultsThe mean ± (SD) age of the victims were 32 (13.5) years. Of the 574 patients, majority of the patients (n = 319, 56%) were males. In 28 cases (41%), the onset of symptoms occurred at home, in 27 cases (39%) the onset of symptoms started in the workplace and the remaining cases (n = 14, 20%) experienced the first symptoms while roaming around the roadside. The most common reported co-morbidity was a history of asthma (56%), followed by diabetes mellitus (22%). The most common clinical manifestation was shortness of breath, reported in 94% of the cases, followed by neurological symptoms such as drowsiness, unconsciousness, or seizures experienced by 10% of the victims. A total of 9 deaths (1.5%) were recorded.ConclusionA multi-sectoral systematic approach is also required to address these incidents comprehensively including the trained and equipped pre-hospital system, integrated emergency medical response, and community-wide emergency response system.