Hospital Karachi Research Articles

Evaluation of the Progress of Coronavirus Disease-19 Pneumonia using the British Society of Thoracic Imaging Reporting Model: A Validation Study

Abstract: Background: SARS-COV-2 (also known as severe acute respiratory syndrome corona virus-2), emerged as a pandemic and became an overwhelming global concern, causing substantial morbidity and mortality worldwide. Reverse transcription polymerase chain reaction (RT-PCR) is considered a gold standard in detecting clinically symptomatic patients but can have false negative and false positive results. As chest X-Ray (CXR) is considered as a baseline investigation in many hospitals, BSTI reporting model during COVID-19 pandemic has been a useful tool in diagnosis of COVID-19 pneumonia. Objective: To validate the British Society Thoracic Imaging (BSTI) coding system in the evaluation of the progress of the disease severity in patients with coronavirus disease-2019 (COVID-19) pneumonia. Materials and Methods: This is a cross sectional observational study. Total 450 CXRs (which included both the baseline and serial CXRs) of 225 COVID positive patients (RT-PCR positive for COVID-19 on nasal swabs) were included. These were retrospectively reviewed and reported by two Radiologists (having experience of at least 5 years in Radiology Reporting) in Corona Ward in Dr. Ruth K M Pfau Civil Hospital Karachi, Pakistan, for the duration of 10 months from 1st March 2020 till 31st December 2020. BSTI coding system was used to classify and interpret the CXR imaging findings as normal, definitive, indeterminate and non-COVID for baseline (CXR on 1st day of admission) and follow up CXRs (done in between 3rd and 7th day of admission). Data was analyzed using SPSS version 25. Numeric data was assessed for distribution using Shapiro-Wilks test. Median and interquartile range (IQR) were reported for numeric variables. Frequencies and percentages were reported for categorical data. Kappa statistics was applied to assess the agreement between BSTI scoring at baseline and follow-up CXRs. A p-value ≤0.05 was considered as statistically significant. Result: CXRs (including 225 baseline and 225 follow up CXRs) of 225 RT-PCR COVID-19 positive patients were analyzed. Interval change in BSTI coding system was noted, increase in frequency of probable/definitive COVID-19 findings were diagnosed on serial CXRs. The BSTI scoring at baseline and follow-up showed moderate agreement with kappa statistics as 60.3% (p=0.001). Conclusion: BSTI coding system can be helpful to classify the COVID-19 disease on CXR and filter for the prognosis of disease severity in the serial radiographs. Utilization of BSTI reporting model for reporting CXRs, even before RT-PCR, in future COVID pandemic can be considered as a useful tool.

Re-emergence of Diphtheria. A Case Report in a Pediatric Emergency at a Tertiary Care Hospital in Karachi

Diphtheria, caused by Corynebacterium diphtheria, is an acute bacterial infection that primarily affects the respiratory system. With the availability of diphtheria vaccines, the incidence of the disease has significantly decreased globally. However, in recent times, there has been a concerning resurgence of diphtheria in various parts of the world, including Pakistan, and hence presents a unique and pressing public health challenge, as evidenced by our case study exclusively reported from the pediatric emergency department. The study highlights the importance of early recognition and management of diphtheria cases and the need for booster doses in the EPI program to prevent this deadly disease re-emergence.

SPINAL ANATOMY AND BEYOND: INVESTIGATING DEGENERATIVE DISC DISEASE

Degenerative disc disease is a common manifestation in routine spine imaging; this finding is partly attributable to physiological aging and partly to a pathological condition, and sometimes, this distinction is simply not clear. The study's main objective is to find the spinal anatomy and investigate degenerative disc disease in spinal patients. This mixed-methods study was conducted in a public hospital in Karachi, Pakistan from March 2023 to September 2023. Fifty patients diagnosed with DDD are enrolled, with comprehensive clinical assessments conducted to evaluate symptomatology, functional impairment, and radiological findings. Additionally, advanced imaging modalities, including MRI and CT scans, elucidate structural changes within the spinal column. Preliminary analysis reveals a mean disc height loss of 3.2 mm (±0.8) across the study cohort, with significant variability observed among individual patients. Annular tears are prevalent in 70% of cases, predominantly localized to the lumbar spine. Furthermore, facet joint degeneration is evident in 85% of patients, with a mean grade of 2.4 (±0.6) on the Pfirrmann scale. Correlation analysis demonstrates a moderate positive correlation (r = 0.56, p < 0.001) between disc height loss and severity of clinical symptoms. It is concluded that this study provides the complex pathology of degenerative disc disease (DDD) and its impact on spinal anatomy. Through a comprehensive investigation involving clinical assessments and advanced imaging techniques, we have elucidated the spectrum of degenerative changes within the intervertebral discs and facet joints.

Frequency of microscopic colitis in patients presenting with chronic diarrhea.

Objective: To evaluate frequency of microscopic colitis in patients presenting with chronic diarrhea at a tertiary care hospital in Karachi, Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: January, 2022 to June, 2022. Material & Methods: Patients presenting in out-patient department of age >18 years of any gender with history of diarrhea >1 month, normal thyroid tests, negative serology for Celiac disease (Anti TTG IgA and IgG), and normal colonoscopy findings including terminal ileum were enrolled in the study after written informed consent. MC diagnosis was established using clinical diarrhea history and colonic biopsy findings. Results: Total 130 patients were analyzed with median age of 38 (IQR= 28-55) years. Nearly half were females (n=67, 51.5%). All patients had normal colonoscopy findings. Out of 130 patients, microscopic colitis was seen among 7(5.4%) cases out of which 5(3.8%) had lymphocytic colitis and 2(1.5%) had collagenous colitis. Patients with and without MC shared the same characteristics. Conclusion: A lower microscopic colitis frequency was found in the studied sample. Lymphocytic microscopic colitis is predominant than collagenous microscopic colitis.

Frequency of prolonged colonoscopy and its associated factors among adults: An experience of A Tertiary Care Hospital in Karachi, Pakistan.

Objective: To determine frequency and factors associated with prolong cecal intubation among adults undergoing colonoscopy in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: September 2022 to June 2023. Material & Methods: The study comprised patients undergoing elective colonoscopies, regardless of gender and age, who were at least eighteen years old. Cecal intubation time longer than ten minutes was regarded as a prolonged colonoscopy duration. The Aronchick scale, which is used to evaluate the quality of bowel preparation. The association between the patient's characteristics and the prolonged cecal intubation was investigated using logistic regression. P-values were considered statistically significant if they were less than or equal to 0.05. Results: Total 281 patients were enrolled into the study. Median age of patients was 40 (IQR=30-50) years and majority were males 66.5%. Median cecal intubation length and time was 90 (IQR=80-100) cm and 7 (IQR=5-10) minutes. Prolonged intubation was seen among nearly one-fifth of total patients (19.1%). Odds of prolonged cecal intubation were significantly lower patients of age <50 years, relatively higher body mass index (BMI), out-patients, patients with excellent quality of bowel preparation and among those cases in which colonoscopies were performed by consultant. Conclusion: Proportion of prolonged cecal intubation was high particularly among older age, female gender, patients with lower BMI, past surgeries and poor quality of bowel preparation.

Protocol: revolutionizing central nervous system tumour diagnosis in low- and middle-income countries: an innovative observational study on intraoperative smear and deep learning.

The aim of this study is to assess the feasibility and implementation of a novel approach for intraoperative brain smears within the operating room, which is augmented with deep learning technology. This study is designed as an observational to evaluate the feasibility and implementation of using an innovative approach to intraoperative brain smears within the operating room, augmented with deep learning technology. The study will be conducted at Aga Khan University Hospital in Karachi, Pakistan, from May 2024 to July 2026, with an estimated sample size of 258. A neurosurgical trainee, trained by the study neuropathologist, will prepare and examine the smears under a microscope in the operating room. The findings of the trainee will be documented and compared to routine intraoperative consultations (smear and/or frozen section) and final histopathology results obtained from the pathology department. Additionally, the study will incorporate artificial intelligence tools to assist with the interpretation of smear and a telepathology interface to enable consultation from an off-site neuropathologist. The results of this study will hold significant potential to revolutionise neurosurgery practices in lowand middle-income countries by introducing a cost-effective, efficient, and high-quality intraoperative consultation method to settings that currently lack the necessary infrastructure and expertise. The implementation of this innovative approach has the potential to improve patient outcomes and increase access to intraoperative diagnosis, thereby addressing a significant unmet need in LMICs.

Parental Satisfaction with Health Care During Child Hospitalization at Tertiary Care Hospital Karachi

Pediatric care in hospital settings necessitates a comprehensive approach that considers not only the medical needs of the child but also the satisfaction and involvement of their parents or guardians. Parental satisfaction with healthcare services during their child's hospitalization is crucial for shaping their overall experience and ensuring quality care. Objective: To assess the level of satisfaction among parents of pediatric patients receiving care at a tertiary care hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted at the National Institute of Child Health Hospital in Karachi from October to December 2023. A total of 50 parents or blood-related guardians actively caring for pediatric patients were included in the study. Data were collected using a structured questionnaire comprising socio-demographic information and a 20-item Likert scale to measure parental satisfaction. Statistical analysis was performed using SPSS version 26.0. Results: The statistical results indicate that 26% had low satisfaction 28% moderate and 46% had high parental satisfaction with health care during child hospitalization at a tertiary care hospital in Karachi. Conclusions: The stats show mixed feelings among parents about the healthcare during their child's hospital stay in a Karachi tertiary care hospital. While 46% were happy with the services, indicating a good experience, 26% weren't satisfied. Another 28% felt okay. This means improvements are needed to address the concerns of the dissatisfied group and enhance overall satisfaction levels.

Patients Satisfaction Towards Quality of Nursing Care at a Public Sector Tertiary Care Hospital Karachi

Care is seen as a significant element of health amenities. The most anticipated health outcomes are achieved by providing treatments that are effective, efficient, and cost-effective. Objective: To assess the level of patient’s satisfaction towards the quality of nursing care at a public sector tertiary care hospital in Karachi. Methods: This cross-sectional study was accompanied by 312 patients admitted to public sector hospital. Non-probability purposive sampling technique was used for data collection. Those patients who have been admitted for more than three days in various departments. Data were collected after approval Institutional Review Committee (IRC) of the Dow Institute of Nursing and Midwifery (DIONAM) and the Ethical Review Committee (ERC) of the National Institute of Cardiovascular Disease (NICVD). Data were analyzed on SPSS-version 25.0. Frequency and percentage were measured from categorical data. An Independent t-test was run to find out the relationship of patient’s satisfaction and with demographic characteristics of the study participants. Written informed consent was obtained from all participants. Results: The findings highlighted that the majority (55%) of the study participants were male and 79% were married. Furthermore, the highest satisfaction level (90.7) was found in the domain of nurse’s communication, and the lowest level of satisfaction score 81.8% found in the discharge domain. Moreover, the overall patient’s satisfaction score of all domains was 93.3%. Conclusions: The findings of this study concluded that the majority of the admitted patients strongly agreed with the quality of nursing care. Furthermore, the nurse’s communication domain showed a higher level of satisfaction among all domains.

Predictors of neurocognition outcomes in children and young people with primary brain tumor presenting to tertiary care hospitals of Karachi, Pakistan: a prospective cohort study

IntroductionPrimary brain tumors are a common cause of morbidity and mortality in children and young people (CYP) globally. Impaired neurocognitive function is a potential severe consequence in primary brain tumor (PBT) survivors. There are no in-depth studies from low- and middle-income countries (LMICs) to inform management and follow-up. The research questions of this study were as follows: Are the sociodemographic factors (lower age of CYP, female gender, low socioeconomic status, low parental education), disease-related factors (high grade of tumor, presence of seizures, presence of hydrocephalous), and treatment-related factors (adjuvant therapy, no surgical intervention, post-treatment seizures, placement of shunts) associated with decline in neurcognition outcomes 12 months post-treatment in CYP with PBTs?MethodsA prospective cohort study was conducted from November 2020 to July 2023 at the Aga Khan University Hospital and Jinnah Postgraduate Medical Centre, tertiary care hospitals in Karachi, Pakistan. All CYP aged 5 to 21 years with a newly diagnosed PBTs were eligible. The neurocognition assessment was undertaken by a psychologist at two points, i.e., pre-treatment and at 12 months post-treatment using validated tools. The verbal intelligence was assessed by Slosson Intelligence tool, revised 3rd edition (SIT-R3), perceptual reasoning by Raven’s Progressive Matrices (RPM), and the Processing Speed Index by Wechsler Intelligence Scale (WISC V) and Wechsler Adult Intelligence Scale (WAIS-IV). The data were analyzed by STATA version 12 software. Generalized estimating equation (GEE) was used to determine the factors associated with the mean change in 12 months post-treatment verbal and non-verbal neurocognition scores. Unadjusted and adjusted beta coefficients with their 95% confidence intervals were reported.ResultsA total of 48 CYPs with PBTs were enrolled, 23 (48%) of them were lost to follow-up and 10 (21%) died. The remaining 25 (52%) were reassessed 12 months after treatment. On multivariable analysis, a significant decline in verbal intelligence scores at 12 months was predicted by post-treatment seizures beta = − 20.8 (95% CI, − 38.2, − 3.4), mothers having no formal educational status and lower household monthly income. Similarly, a significant decline in perceptual reasoning scores was also predicted by post-treatment seizures beta = − 10.7 (95% CI, − 20.6, − 0.8), mothers having no formal education and having lower household monthly income. Worsening of processing speed scores at 12 months post-treatment were predicted by tumor histology, post-treatment seizures beta = − 33.9 (95% CI, − 47.7, − 20.0), lower educational status of the mother, and having lower household monthly. However, an improvement was seen in processing speed scores after surgical tumor resection.ConclusionIn this novel study, the post-treatment mean change in verbal and non-verbal neurocognition scores was associated with sociodemographic, tumor, and treatment factors. These findings may have potential implications for targeted early psychological screening of higher risk CYP with PBTs. Identification of these predictors may serve as a foundation for developing more cost-effective treatment thereby alleviating the burden of neurocognitive morbidity. However to establish generalizability, future research should prioritize larger-scale, multicountry studies. (Trial registration: ClinicalTrials.gov Identifier: NCT05709522)

Effect of COVID-19 Vaccination on Pregnancy Outcomes - A Cross-Sectional Comparative Study

Abstract 
 Background: Pregnant women are at increased risk of complications from COVID-19. Vaccination during pregnancy offers protection for mothers and newborns. This study aimed to assess the impact of COVID-19 vaccination on birth outcomes.
 Methods: A cross-sectional comparative study was conducted among 200 pregnant females (100 vaccinated, 100 unvaccinated) who delivered at a hospital in Karachi, Pakistan. Vaccination status, trimester of vaccination, and birth outcomes (preterm delivery, stillbirth) were compared.
 Results: Most vaccinated mothers received Sinopharm (47%) or Sinovac (39%). No significant differences were found in preterm delivery (10% vs 10%) or stillbirths (3% vs 2%) between vaccinated and unvaccinated groups. Additionally, no significant associations were observed between vaccination status and other maternal or fetal outcomes, including mode of delivery and pregnancy complications.
 Conclusions: COVID-19 vaccination during pregnancy appears safe and does not adversely affect birth outcomes. Routine vaccination should be recommended for pregnant women to prevent COVID-19 complications and protect both mothers and newborns.
 
 Keywords: COVID-19, vaccination, pregnancy, birth outcomes, Pakistan

Comparison of the Efficacy of Tazarotene 0.045% versus Halobetasol Propionate 0.01% Lotion for the Treatment of Scalp Psoriasis at Tertiary Care Hospital, Karachi

Background: Psoriasis is a chronic, genetically determined inflammatory skin condition characterized by erythematous plaques with silvery scales, affecting about 2% of the global population. It significantly impacts patients' quality of life, encompassing physical, emotional, and psychosocial dimensions. While the use of topical corticosteroids (TCS) with tazarotene has shown benefits in plaque psoriasis treatment, limited data are available on the efficacy of combining halobetasol and tazarotene. Objective: This study aimed to compare the efficacy of Tazarotene 0.045% cream (TAZ) versus Halobetasol Propionate 0.01% lotion (HP) for the treatment of scalp psoriasis at a tertiary care hospital in Karachi, providing insight into their comparative effectiveness and informing clinical decision-making. Methods: A randomized control trial was conducted at the Dermatology Department of Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to February 2023. Ninety participants with scalp psoriasis were recruited and randomly assigned to two groups: Group A (n=45) received Tazarotene 0.045% cream, and Group B (n=45) received Halobetasol Propionate 0.01% lotion, both applied once daily for 6 weeks. The primary outcome was the change in Investigator's Global Assessment (IGA) score from baseline to week 6. Data analysis was performed using SPSS version 25, focusing on descriptive statistics and inferential analyses to evaluate treatment efficacy. Results: The study observed a significant reduction in IGA scores from baseline in both groups, with Group A (TAZ) showing a decrease from 3.89 ± 0.68 to 1.29 ± 0.62 and Group B (HP) from 3.87 ± 0.66 to 2.49 ± 0.62. The paired difference in IGA scores indicated a more pronounced improvement in the TAZ group (2.60 ± 0.75) compared to the HP group (1.37 ± 0.57), with significant differences between the groups (p<0.0001). Treatment success was observed in 82.2% of participants in the TAZ group compared to 51.1% in the HP group, with an odds ratio of 4.424 (95% CI: 1.690—11.578; p=0.002). Conclusion: Tazarotene 0.045% cream demonstrates significantly greater efficacy in treating scalp psoriasis compared to Halobetasol Propionate 0.01% lotion. The findings suggest Tazarotene as a preferable treatment option for scalp psoriasis, offering a better therapeutic outcome.

Effectiveness of Chest Physiotherapy in Broncho Pulmonary Clearance in Respiratory Distress Neonates

Purpose: Globally, the mortality rate of respiratory distress has been quite high due to unability to maintain oxygenation and overcome abnormal work of breathing. Chest Physical therapy, apart from providing advantageous outcomes to the adults, chest physical therapy is pivotal for newborns too but differs in terms of physiology and anatomy. Various chest physiotherapy techniques including percussions, vibrations, and compressions are quite effective in reducing mortality rate in neonates.Many studies has been conducted worldwidely, but still there has been limited data in Pakistan about the effect of bronchopulmonary clearance in neonatal intensive care unit, so this study was conducted to find the effectiveness of chest physiotherapy in neonatal intensive care unit
 Materials and Methods: This was the non-randomized controlled trial study conducted in tertiary care hospital of karachi , Pakistan. Total 40 samples collected through convenient based sampling were included in this study . The inclusion criteria including gestational age more than 37 weeks with atelactasis, mucous plugging, airway compromised, intubated or extubated, hospital admission, and chest complications where as exclusion criteria included cardiopulmonary instability, post surgery, pre term, intra ventricular hemmorage, fits or epilepsy, failure to thrive, and on consistent feed. Bronchopulmonary Clearance techniques such as Percussions , Compressions, and Vibrations along with suctioning and postural drainage were performed routinely twice daily session one in morning and one in evening was performed for total 14 days which means total 28 sessions of chest physiotherapy was implemented and chest xray, sp02, Heart rate, and respiratory rate was measured pre and post the sessions.
 Findings: The mean age of the participants were 37.050±5.57, out of which 20(52.5%) were females and 19(47.5%) were males. Result showed that post chest xray after chest physiotherapy was .2500±.49355 and post session spo2 was 2. .075 ± 4.56513. The chest physiotherapy was statistically significant in mucociliary clearance, lung expansion, preventing atelectasis, airway clearance, and other chest complications (0.008).
 Implications to Theory, Practice and Policy: Limitations of this study were that small sample size was taken, and data was collected from one tertiary care hospital of Karachi so it doesn’t showed generalization. Further studies in terms of large sample size are required for validity and reliability of this research.

Effectiveness of port site bupivacaine infiltration in postoperative pain reduction after laparoscopic cholecystectomy: A randomized controlled trial from a tertiary care hospital.

Objective: To determine the effectiveness of port site bupivacaine infiltration in postoperative pain reduction among patients undergoing LC in a tertiary care hospital in Karachi, Pakistan. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Hamdard Hospital, Karachi, Pakistan. Period: April 2022 to September 2022. Material & Methods: Patients of either gender aged between 18-45 years, undergoing elective laparoscopic cholecystectomy were included. Twenty ml of 0.25% bupivacaine solution were locally injected into the intervention group at the port locations. Treatment for the control group was consistent with standard of care. Post-surgery, to measure the severity of the pain, a visual analogue scale (VAS) was utilized and compared. Results: In a total of 170 patients, age, weight, systolic and diastolic blood pressure, ASA grade, SPO2, and the duration of the surgery were not substantially different between the two study groups at baseline (p>0.05). Post-operatively, from third hour till ninth hour pain score, abdominal pain, incisional pain and shoulder pain were significantly lower among the group received local infiltration of bupivacaine. No significant differences were seen at 12th hour. Median time to rescue analgesia was 12 (IQR=6-12) hours and 6 (IQR=6-9) hours among the intervention and control group (p<0.001). Conclusion: This study found lower pain intensity and higher time of rescue analgesia to be associated with local infiltration of bupivacaine at port as compared to control group in the early post-operative period among patients underwent laparoscopic cholecystectomy.

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

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

Frequency of neuro-imaging in the emergency room in patients with vertigo: A cross-sectional study at a tertiary care hospital in Karachi, Pakistan.

To determine the frequency of neuro-imaging and the prevalence of positive findings in patients with vertigo visiting an emergency room of a low-middle-income-country, Pakistan. This is a retrospective cross-sectional study conducted in the emergency room of the Aga Khan University Hospital, a 550 bedded tertiary care teaching facility located in Karachi, Pakistan. The frequency of neuro-imaging in patients visiting emergency room with vertigo during 20 years (2000-2020), their findings and disposition was calculated in percentages. A cost-analysis was performed in Pakistani Rupees & US Dollars to estimate the financial burden. During the emergency room visits for vertigo, neuro-imaging (CT scans, MRIs, or both) was conducted for 159 patients, accounting for 70.98% of the cases. Out of these, 64 individuals (40.25%) received a positive diagnosis, which included acute infarcts, hemorrhages, metastases, space-occupying lesions, and meningeal enhancements. Interestingly, among those with negative findings, the 98 patients faced significantly higher costs, amounting to Rs.4,108,000 ($22,449), in contrast to the positive cases, which incurred Rs.2,496,600 ($13,642). The frequency of obtaining neuro-imaging tests in patients with vertigo were significantly high in our study. In addition, there was a significant financial burden associated with neuro-imaging especially for our low-middle-income country.

Safety of fasting in diabetic and non-diabetic patients with stable chronic kidney disease during Ramadan.

To assess the safety of fasting in diabetic and non-diabetic patients with stable CKD during Ramadan. This prospective observational study was conducted at three secondary and tertiary care hospitals of Karachi during the month of Ramadan from 25th March to 7th May 2022. Patients who met the eligibility criteria were assessed pre-Ramadan, and their baseline blood pressure, serum urea, creatinine, electrolytes, uric acid, and estimated glomerular filtration rate (eGFR) were documented and tracked over the course of Ramadan and up to one week post-Ramadan. Deterioration in renal functions (defined as a rise of ≥30% in serum creatinine from the baseline or the decline of ≥25% in eGFR from the baseline) was observed during the month of Ramadan. A total of 68 patients (34 males and 32 females) with the mean age 58.7±12.16 years were included in the study. Out of 66 patients, 38 were diabetic and 28 were non diabetic. Majority 23(34.8%) were stage-3a and 23(34.8%) were stage-4 followed by stage-3b in 14(21.2%), stage-2 in 3(4.5%) and stage-5 in 3(4.5%) patients respectively. Statistically significant improvement in pre and post Ramadan values of systolic and diastolic blood pressure, serum creatinine and uric acid levels were found in both diabetic and non-diabetic group (P value <0.0001). Our study shows no worsening of renal functions in both diabetic and non-diabetic patients with stable CKD who intended to fast.

Health-Related Quality of Life Assessment for Liver Cirrhosis Patients at a Tertiary Care Hospital in Karachi, Pakistan.

Background The global health challenge of cirrhosis affects millions of individuals. Still, there is a notable lack of research on the health-related quality of life (HRQOL) of cirrhosis patients, especially in specific regions. This study aims to assess the impact of cirrhosis onHRQOL, including factors influencing it in a tertiary care setting in Pakistan. Methodology A cross-sectional study was conducted on a cohort of 115 patients diagnosed with cirrhosis, confirmed on imaging. HRQOL was measured using the short-form 36 (SF-36) survey. Furthermore, socioeconomic factors and self-rated health perceptions regarding HRQOL were recorded. Factors Influencing HRQOL domains in liver cirrhosis patients were also analyzed. Results Among 115 liver cirrhosis patients, 63.5% (N=73) were aged 40-60 years, and 73.9% (N=85) lived primarily in urban areas. HRQOLassessments highlighted moderate disability in physical functioning (62.6 ± 26.5) and notable impacts on mental health, emotional well-being, and bodily pain. Statistical analysis demonstrated the complexity of factors influencing HRQOL. Physical functioning was significantly associated with a higher Child-Turcotte-Pugh class, diabetes mellitus, hypertension, smoking status, and family monthly income (p-value < 0.05). While the duration of liver cirrhosis showed a significant association with bodily pain (p < 0.05). Additionally, residence status with social well-being (p-value = 0.01), and family monthly income with vitality (p-value < 0.05). Conclusion Our study in Pakistan highlights significant impacts on the HRQOLof liver cirrhosis patients, affecting physical function, mental health, emotional well-being, and bodily pain. Factors influencing HRQOL include liver disease severity, comorbidities, and socio-economic status.Recommendations include educational programs and specialized nursing care to address diverse challenges.The findings stress the importance of a personalized approach to patient care, urging urgent, targeted efforts to improve the health-related standard of life for cirrhotic patients.

Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives.

Adolescents' Mental Healthcare (MHC) is influenced by numerous factors, and adolescents occasionally seek professional help for mental health (MH) issues. These factors become more complex within low-middle-income countries (LMICs); therefore, this study aims to understand barriers and facilitators to access mental health services among adolescents aged 10 to 19 years old from the perspective of users (parents) and providers (Mental Healthcare Providers - MHPs). Using a qualitative exploratory design, a semi-structured interview guide was developed using Andersen's health service utilization model. In-depth interviews were conducted with MHPs (n = 21) and parents of adolescents (n = 19) in the psychiatry department of public and private hospitals in Karachi, from October-December 2021. Data was thematically analyzed using an inductive approach. The findings revealed a consensus of users and providers in all three categories of the Andersen model and referred the compulsion as the major driving force to MHC access and utilization rather than personal choices. Within pre-disposing, need, and enabling factors; the participants highlighted a unique perspective; users regarded frequent migration, daily wage loss, and women's societal status as barriers while the need for marriage and patient willingness were stated as facilitators. Whereas, MHPs indicated societal tolerance, the burden on the health system, and the absence of Child and Adolescent Mental Health (CAMH) services as major gaps in service delivery. Service utilization is mainly facilitated by the severity of illness rather than healthy choices and beliefs, and accessibility and affordability. It is therefore imperative to prioritize adolescent MH through promotion and prevention approaches and address service delivery gaps to prevent treatment delays via task-shifting and capacity building of the health workforce.

Determination of Inducible Clindamycin Resistance and Correlation with Vitek2 Inducible Clindamycin Resistance Test in Staphylococcus aureus Isolated from Clinical Samples.

To compare the performance of Vitek2 with the gold standard D test in terms of inducible clindamycin resistance (ICR) detection. Descriptive study. Place and Duration of the Study: Indus Hospital and Health Network Karachi, Pakistan, from November 2021 to April 2022. Standard operating procedures of the laboratory were followed for processing of clinical samples. Methicillin-resistant Staphylococcus aureus (MRSA) isolates were included. The isolates from the same patient within two-week time period were excluded. Clinical laboratory standards institute guidelines were followed for performing and interpreting D test. The results of the D test were compared with Vitek2 results for ICR. A total of 313 isolates were MRSA, of which 93 isolates tested positive for ICR on both the D test and Vitek2. Nine isolates were positive for ICR on Vitek2 and negative on the Kirby-Bauer disk diffusion method. One isolate tested positive on the disk method and negative on Vitek2. Vitek 2 appeared to give false positive results. Reporting false susceptibility of clindamycin can cause therapeutic failure which can markedly affect the patient's outcome. This discordance needs to be investigated further with a large sample size and stringent observation of D-test results to pick laboratory error. Methicillin-resistant Staphylococcus aureus, Inducible clindamycin resistance, D zone, Vitek2.

Prescription Pattern in patients with Acute Tonsillitis, attending Outpatient Department

Background: Acute tonsillitis is a major health problem among children and adults which is badly effects the quality of life. Aim: To determine the antimicrobial prescription pattern in patients with acute tonsillitis, attending ENT OPD of Kulsumbai Valika, Social Security, Post Graduate Teaching Hospital Karachi.. Methodology: This cross-sectional study was conducted among the patients attending the outpatient of ENT, with acute tonsillitis. Study was conducted in Outpatient of ENT department of Kulsumbai Valika Social Security S.I.T.E. Hospital, Karachi. from 1st January 2023 to 31st December 2023. Data collection was done from the prescription of each patient. Statistical analysis was carried out using SPSS version 23. Results: A total of 210 acute tonsillitis patients, with 116(55.23%) were male. Mean number of the drugs in prescription 4±1.4. All the prescriptions included antimicrobials, 185(88%), and NSAIDs. Amoxicillin / Clavulanic acid (24.8%) and Ceftriaxone (12.2%) were the most commonly prescribed antimicrobials. Parenteral route was preferred in 113(53.8%). None of the patients was offered culture or sensitivity test of the microorganisms. Practical implication: Acute tonsillitis patients admitted and started parenteral antibiotic along with anti-inflammatory drugs. Conclusion: Antimicrobials thosewere prescribed in almost all cases of acute tonsilitis, and most frequently prescribed were Amoxicillin / Clavulanic acid and Cefixime. Injectable antibiotics were also prescribed very frequently. Most of the patients were given just one antibiotic. This study findings highlighted the gaps the rational practices in drug prescribing for acute tonsilitis. Keywords: Acute tonsillitis, Amoxicillin,antimicrobials, Clavulanic acid, Cefixime, prescription.