Hospital Karachi Research Articles

Exploring the quality of life of pediatric trainees: Mixed-method explanatory design.

Healthcare workers are at a higher risk of burnout. The aim of the study was to explore the professional quality of life (QOL) i.e. {Compassion Satisfaction (CS), Burnout (BO) and Secondary Traumatic Stress (STS)} and association of different trainee factors on QOL amongst Pediatric specialty trainees at a private tertiary care hospital in Karachi, Pakistan. By using a mixed methods explanatory design, pediatric trainees experience of the prior year was measured in 2019 and 2020 through a predefined scale at Aga Khan University Hospital, Professional Quality of Life (ProQOL), followed by focused group discussions. Mean sums of CS, BO and STS were the primary measures assessed and the associations of different trainee factors were to explore experiences of Pediatric trainees towards the residency program, themes and subthemes were created after focused group discussions. We surveyed a total of 118 pediatric responses (n=60 and n=58) during two years.Trainees from both years showed similar moderate level for mean sum of scores for all three components; CS, BO and STS. No significant association was observed with gender, place of living or year of residency. Opinions and perceptions of the trainees in qualitative analysis revealed both positive and negative impacts on the quality of life of the trainees. This study delves into the professional quality of life and offers valuable understanding into the specific events encountered by trainees.

Dietary habits in patients presenting with chronic constipation at Tertiary Care Hospital, Karachi.

Objective: To determine dietary habits in patients presenting with chronic constipation (CC) at tertiary care hospital in Karachi. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital. Period: June 2022 to December 2022. Methods: Patients of age 18 years and above of either gender, presenting with history of CC were enrolled. Dietary fiber intake was determined on the basis of self-reported history. Dietary fiber intake was categorized as higher fiber intake, medium fiber intake and low fiber intake. Data was entered in SPSS version 26 to perform statistical analysis. Results: Total 190 patients were enrolled with median age and disease duration of 40 (IQR=29-55) years and 16 (IQR=9-24) months respectively. Majority of the patients were males (n=121, 63.7%). Around three-fourth people had low fiber intake (72.6%), nearly quarter had medium level of fiber intake (26.3%) and very few had high intake (1.1%). Fiber intake was significantly higher among those with low literacy. Less fiber intake was significantly seen with patients having dyslipidemia and weight loss. Water glass consumption per day was significantly higher among those with medium to high fiber intake. Conclusion: The present study analyzed that fiber intake was quite low among CC patients. General public should be educated regarding importance of dietary fiber for disease cure and better gut health particularly those who are lower educated patients and those with dyslipidemia.

Frequency, clinical presentation and management of primary amenorrhea in a tertiary care setting.

We aimed to determine frequency, clinical presentation, etiology and management in patients presenting with primary amenorrhea in tertiary care setting. This was a case series conducted in outpatient Department of Gynecology and Obstetrics unit II, Dr. Ruth K. M. Pfau Civil Hospital Karachi from 1st July 2019 to 30th June 2022. A total of 20,102 patients attended Gynaecology outpatient department in these three years. We included 41 cases with primary amenorrhea. Information collected on a specially designed proforma included history, physical examination, hormonal workup, ultrasound, radiological investigations and karyotyping results. Data was entered and analyzed by SPSS version 26.0. The frequency of PA was 41(0.2%). The mean age was 17.93± 4.27 years (range13-37). Majority 38(92.6%) were unmarried, educated till secondary 24(58.5%), of normal height 28(68.2%) and normal BMI 30(73%). Main associated complaint was cyclical lower abdominal pain 8(22%). Most common cause found was Mullerian dysgenesis 17(41.46%). Others were chromosomal disorder 10(24.39%), imperforate hymen 6(14.63%), constitutional delay 5(12.19%), transverse vaginal septum 2(4.87%) and congenital adrenal hyperplasia 1(2.43%). The chromosomal analysis revealed 46XX in 31(75.6%), 45XO/45XO Mosaic in 6(14.63%) and 46XY in 4(9.75%) patients. Surgical correction was possible in 14(41.66%) patients, hormone replacement therapy (HRT) was given in 10(22.2%) and rest treated with placebo. Primary amenorrhea is a significant problem in adolescent girls. We found Mayer Rokitansky- Kuster- Hauser syndrome (MRKH) syndrome as the commonest cause in our series. There is need to promptly identify the patients who need medical, surgical or psychological management. It is also required to make local strategies and guidelines for evaluation, management and long term follow up.

ASSESSMENT OF NUTRITIONAL STATUS TO DETERMINE THE PREVALENCE OF MALNUTRITION IN PATIENTS UNDERGOING SURGERY FOR COLORECTAL CARCINOMA USING INA SCORE

Colorectal cancer (CRC) is the third most commonly diagnosed malignancy worldwide. Malnutrition is a critical factor influencing postoperative morbidity and mortality in CRC patients. Surgical trauma exacerbates the metabolic response, increasing the risk of malnutrition-related complications such as cancer cachexia and reduced efficacy of postoperative chemotherapy or radiotherapy. This study aimed to assess the prevalence of malnutrition in patients undergoing surgery for colorectal carcinoma using the Instant Nutritional Assessment (INA) score. Objective: To determine the frequency and degree of malnutrition in patients undergoing resection surgery for colorectal carcinoma using the INA score. Methods: This cross-sectional study was conducted in the Department of Surgery at Dr. Ruth K. M. Pfau Civil Hospital Karachi over six months, from October 1, 2022, to March 31, 2023. A total of 93 patients undergoing elective resection for colorectal carcinoma were enrolled. Demographic and clinical data, including histological diagnoses, were recorded using a predesigned proforma. Nutritional status was assessed using the INA score, based on serum albumin levels and blood lymphocyte counts. Malnutrition was classified into four degrees according to operational definitions. Data analysis was performed using SPSS version 19. Results: The mean age of participants was 47.60 ± 12.87 years. Of the 93 patients, 56.99% were male, and 43.01% were female. The frequency of malnutrition was 27.96% (26/93), with malnutrition degrees distributed as follows: 8 patients (30.8%) with first-degree, 5 patients (19.23%) with second-degree, 9 patients (34.62%) with third-degree, and 4 patients (15.38%) with fourth-degree malnutrition. Conclusion: A significant proportion of patients undergoing surgery for colorectal carcinoma were found to be malnourished. These findings underscore the necessity for routine preoperative nutritional assessments and timely interventions to improve surgical outcomes and enhance the effectiveness of postoperative therapies. Incorporating nutritional support as a standard component of colorectal cancer care can mitigate the risk of cancer cachexia and associated complications.

Factors associated with the survival of oral cavity cancer patients: a single institution experience from Karachi, Pakistan

BackgroundOral cavity cancer (OCC) represents a significant public health burden in South Asia, ranking as the most prevalent cancer affecting males in Pakistan and contributing considerably to morbidity and mortality. The objective of this study was to evaluate the survival rates in patients diagnosed with OCC in the Pakistani population and identify the factors influencing survival.MethodsThis was a retrospective cohort study conducted at the Aga Khan University Hospital Karachi, Pakistan. A total of 2238 cases diagnosed with OCC from May 2011 through December 2020, who met the inclusion criteria, were included. Survival analyses at 1-, 3- and 5-year intervals were performed using the Kaplan-Meier method. Adjusted hazard ratios (HR) and their 95% confidence intervals (CIs) were estimated using a Cox regression model to identify the factors significantly influencing survival.ResultsAmong all cases, 54.0% were diagnosed in individuals 50 years of age and below and 73.0% were tobacco users. Overall survival, 1-year, 3-year, and 5-year survival rates were 54.9%, 88.9%, 81.6%, and 75.9% respectively. After adjustment for all the significant confounding and prognostic factors, age was an important factor showing that adults > 50 years had poorer survival compared to ≤ 50 years (HR = 1.43, 95% CI = 1.11–1.83). Poorly differentiated grade of OCC compared to well-differentiated grade (HR = 2.49, 95% CI = 1.61–3.84) and stage IV compared to earlier stages (HR = 3.56, 95% CI = 2.13–5.94) were also associated with poor survival.ConclusionNotably, there was a high occurrence of late stage (III and IV) OCC in individuals aged ≤ 50 years, with the buccal mucosa being the most common site involved. Moreover, a large proportion of our patients had a history of tobacco use. Patients with advanced-stage disease and poorly differentiated grade showed poor survival. Therefore, public awareness about tobacco control for OCC prevention and earlier diagnosis of OCC is urgently needed in our Pakistani population.

Stress and its associated factors in mothers with preterm infants in a private tertiary care hospital of Karachi, Pakistan: an analytical cross-sectional study

ObjectivesThis goal of this research is to present a comprehensive method for evaluating stress and the factors that contribute to it in mothers of premature babies.DesignAnalytical cross-sectional study.SettingData were collected...

Detection of BRCA-1 gene mutations in epithelial ovarian tumors at tertiary care hospital Karachi

ABSTRACT Background: Ovarian cancer is the most common and lethal gynecological malignancy. Ovarian malignancy is the 3rd most common cancer in Pakistan. More than 90% ovarian cancers are of epithelial cell origin, about 24-40% such cancers have hereditary or sporadic mutation in the BRCA-1 or BRCA-2 genes. The present study was designed to detect BRCA-1 gene mutations in different histological sub-types of epithelial origin of benign, borderline and malignant ovarian tumors. Methods: This cross-sectional study was based on the analysis of BRCA-1 gene mutations in the epithelial origin of benign, borderline and malignant ovarian tumors received at the department of Pathology, Basic Medical Sciences Institute, Jinnah Post graduate Medical Centre, from 01-01-2011 to 31-12-2015. A total of 80 diagnosed cases were selected and analyzed for PCR. Results: BRCA-1 gene mutations were detected in 22 (27.5%) cases out of the 80 randomly selected epithelial ovarian tumors. Serous cyst adenocarcinoma was the commonest including 63% cases. BRCA-1 gene mutations were also positive in other epithelial ovarian tumors, including Mucinous cyst adenocarcinoma (13.6%), Endometroid adenocarcinoma and Mixed Mullerian tumor (4.5% each). In addition mutations were also detected in borderline tumors including Mucinous borderline tumor (9.09%) and Seromucinous borderline tumors (4.5%).The observations and results of the study were elaborated with the assistance of tables, figures and photomicrographs. Conclusion: BRCA-1 gene mutations manifestations were identified in a large number of serous malignant ovarian tumor cases. Small percentages of borderline and malignant mucinous tumors, endometroid adenocarcinoma and mixed mullerian tumor were also positive for BRCA-1 gene mutations.

Primary prevention of cardiovascular diseases among women in a South Asian population: a descriptive study of modifiable risk factors

ObjectiveThe aim of this study was the assessment of modifiable risk factors of cardiovascular diseases (CVD) among women versus men at a newly developed preventive cardiology clinic of a large...

Knowledge, fear and acceptance rate of spinal anesthesia among pregnant women scheduled for cesarean section: a cross-sectional study from a tertiary care hospital in Karachi

BackgroundWorldwide, the cesarean section (c-section) rate is rising. Globally, regional anesthesia in the form of spinal anesthesia (SA) is considered the first choice in uncomplicated c-section cases for safe maternal and neonatal outcomes. This study aimed to ascertain knowledge, acceptance, and fears of SA among patients scheduled for c-section in a tertiary care hospital.MethodsThis cross-sectional study was performed in the Anesthesia Department, Hamdard University Hospital, Karachi, from April to September 2023. Knowledge was assessed using a self-designed questionnaire with a total of 7 questions. Data was entered in SPSS version 26 to perform statistical analysis.ResultsA total of 303 females were enrolled, with a mean age of 26.5 ± 4.5 years and a median gestational age of 37 (IQR = 36–37) weeks. 93.7% of women agreed to receive SA. 63% heard the term regional anesthesia before, 12.2% heard about general anesthesia, and 17.5% heard about SA. 23.4% of participants scored 7 out of 7, 39.9% had a score of 6 out of 7, and 36.6% had a score of ≤ 5. Among 129 (42.6%) females having fear, the commonest fear was limiting lower limb functions post-surgery (93.8%), followed by post-operative vaginal pain (91.5%), intra-operative pain (80.6%), post-operative backache (76.7%), having visuals of surgery (72.9%), back injury (56.6%), headache (46.5%), nausea/vomiting (31%), and being nude (24%).ConclusionThe present study analyzed that although the majority of female agreed to receive spinal anesthesia, they had a fear of it. Knowledge of spinal anesthesia was not remarkable among the study population. Proper education regarding anesthesia should be given to patients to overcome fears related to spinal anesthesia.Clinical trial numberNot applicable.

Knowledge and awareness of emergency department residents and physicians regarding the management of dentofacial traumatic injuries: a cross-sectional study

BackgroundMajority of patients with Dento-Facial Traumatic Injuries (DFTI) seek initial care at an Emergency Department (ED). The timely management of DFTI is of utmost importance in determining long-term prognosis of the tooth and the patient’s overall quality of life. Thus, knowledge and awareness of ED residents & physicians regarding the management of DFTI is crucial for better patient outcomes. Numerous studies have investigated the knowledge of ED specialists regarding initial management of dental trauma, however, scientific evidence in this domain is scarce in our region.ObjectiveThe aim of this study was to evaluate the knowledge and awareness of ED residents and physicians regarding diagnosis and management of DFTI using a web-based survey on REDCap.MethodsAn observational cross-sectional study was conducted among the ED residents and physicians of private and public hospitals in Karachi, Pakistan. Data was collected through a web-based questionnaire, sent via email to the participants. The survey comprised of questions assessing their knowledge regarding the diagnosis and management of various dental and maxillofacial injuries. Responses from the participants were graded as low, moderate or high knowledge levels according to a pre-determined criteria. Pearson’s chi-square test was applied to determine the association between knowledge scores.ResultsThe total response rate was 47.6%. Out of 116 participants, 49 (42%) responses were received from physicians and 67 (58%) from residents. The overall knowledge level of participants was low (46.6%) and there was no significant difference in the knowledge level between residents and physicians (p = 0.157). Participants who had received formal training in dental trauma (p = 0.038) and those with more years of clinical experience (p = 0.004) had higher knowledge scores, that were statistically significant.ConclusionsThe knowledge and awareness of ED residents and physicians in dental trauma management was generally low. Specialized training courses are required to provide timely and adequate management of traumatic dental injuries in order to improve patient-related outcomes.

Clinical characteristics of COVID-19 patients admitted to the intensive care unit of the largest public-sector hospital in Karachi: A retrospective, observational study.

Objective: To characterize the clinical features of critically ill COVID-19 patients admitted to COVID-ICU and describe their outcomes. Study Design: Retrospective Observational study. Setting: Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. Period: May 2020 to September 2021. Methods: The study aimed to investigate the clinical characteristics and outcomes of patients with confirmed or suspected COVID-19 who were admitted to the ICU. Patients in the study period confirmed or suspected COVID-19, admitted to the ICU for more than 24 hours, and committed to full treatment were included this study. Patients with COVID-19 discharged or died within 24 hours of admission were excluded. Results: The most commonly observed symptoms among the patients were shortness of breath (92.5%), fever (91.2%), cough without sputum (39.2%), altered consciousness (11.9%), and muscle aches (8.8%). Acute respiratory distress syndrome (ARDS) was identified as the most prevalent complication among COVID-19 patients, impacting 40.8% of the study population. A significant proportion of COVID-19 patients required mechanical ventilation and cardiac support. Specifically, (41.4%) of the patients required invasive mechanical ventilation, (47.4%) required non-invasive ventilation, and (26.3%) received cardiac support. Laboratory assessment showed that platelet counts varied significantly between survivors and non-survivors, with non-survivors exhibiting lower platelet counts. Gender differences were also observed among COVID-19 patients by age, with males having a higher mean age than females in all age categories, and the difference was statistically significant (p < 0.001) in all age categories except for the 30-44 years age category (p = 0.087). Age-wise recovery and mortality rates were analyzed, and the results showed that among both deceased and recovered patients, the proportion of deceased patients increased with age, while the proportion of recovered patients increased until the age range of 45-59 years for both males and females. The study found that 136 of the patients survived while 275 of the patients succumbed to the disease. Among the survivors, (31.3%) were male, and (36.2%) were female. Conclusion: The study emphasizes the importance of monitoring patients for potential complications and providing them with supportive care. Early detection and management of severe cases of COVID-19 are critical in preventing complications and improving patient outcomes.

Investigating Cesarean Section Trends: A Study Using the Modified Robson Classification in a Tertiary Care Setting.

The cesarean section (CS) rate is steadily rising in developed and developing nations. While CS is often perceived as a life-saving intervention, it comes with associated dangers for both the presentand future pregnancies. The Robson criteria classify CS into 10 groups with further sub-divisions based on the gestational age, various pregnancy categories, prior obstetrical records, and the progress of labor and delivery. This retrospective record review was conducted at Aga Khan University Hospital in Karachi, Pakistan. A non-probability consecutive sampling method was employed to enroll all 1198 pregnant women who underwent CS delivery between July 1st and December 31st, 2022. A total of 2616 deliveries were performed during the study period; among these, 1198 (45%) were delivered by CS. Out of 10 groups of Robson Criteria, Group 5 emerged as the primary contributor to the overall CS rate, making up approximately 34.3% of cases, followed by Group 10, which contributed to28.5% of cases. Group 2 contributed 16.4% of cases in total, with subgroup 2A constituting 12% of the overall rates, and Group 1 was found to be the fourth contributing category (5.1%), succeeded by Group 6 (4.9%), Group 4 (3.9%), and Group 8 (3.4%). The Modified Robson Criteria was foundto be an effective and easy-to-comprehend tool, which assists in monitoring the indications of CS and aids in devising strategies to reduce itsrates in clinical practice.

COMPARISON OF ALVARADO, RIPASA, AND AIR SCORING SYSTEM IN DIAGNOSIS OF ACUTE APPENDICITIS

Accurate and timely diagnosis of acute appendicitis is critical in preventing complications and guiding surgical intervention. The Alvarado, RIPASA, and AIR scoring systems are commonly used diagnostic tools, each with varying performance metrics in different clinical settings. Objective: This study aimed to compare the diagnostic performance and overall accuracy of the Alvarado, RIPASA, and AIR scoring systems for diagnosing acute appendicitis. Methods: This observational study was conducted at Civil Hospital Karachi from December 2023 to May 2024, following ethical approval from the institutional review board. A total of 200 patients aged over 18 years presenting with clinical symptoms suggestive of acute appendicitis were included in the study through non-probability consecutive sampling. Each patient’s data was analyzed using the Alvarado, RIPASA, and AIR scoring systems to evaluate their diagnostic accuracy, sensitivity, specificity, and area under the curve (AUC). Results: The Alvarado score demonstrated a sensitivity of 88.44%, a specificity of 37.04%, and an overall accuracy of 81.50%, with an AUC of 0.667 (p=0.002). The RIPASA score showed a sensitivity of 81.18%, a specificity of 53.33%, and an accuracy of 77.00%, with an AUC of 0.699 (p=0.001). The AIR score displayed a sensitivity of 81.00%, a specificity of 60.00%, and an accuracy of 82.00%, with an AUC of 0.700 (p<0.001). Conclusion: The Alvarado, RIPASA, and AIR scores each demonstrate diagnostic value in identifying acute appendicitis, though their sensitivity and specificity may vary based on the population and clinical setting. Clinicians should consider these variations when selecting a scoring system to optimize diagnostic accuracy for acute appendicitis.

FREQUENCY OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA) IN PATIENTS ADMITTED WITH ACUTE EXACERBATION OF ASTHMA IN A TERTIARY CARE HOSPITAL IN KARACHI: A PROSPECTIVE OBSERVATIONAL STUDY

Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus species and often complicates the clinical course of asthma, leading to more severe exacerbations and poor disease control. Despite its clinical relevance, the prevalence of ABPA in asthma patients remains under-reported, especially in developing countries like Pakistan. Objective: This study aimed to determine the prevalence of ABPA among patients admitted with acute exacerbations of asthma at a tertiary care hospital in Karachi, Pakistan. Methods: A prospective observational quantitative study was conducted at the Department of Pulmonary Medicine, Aga Khan Hospital University Karachi, Pakistan from January 2023 to December 2023 in Karachi. The study included 150 isolated patients of either gender, aged between 18 and 80 years, with a clinical diagnosis of asthma or those eligible for spirometry. Data collected included demographic details, past medical history, pulmonary function test results, and serological data for ABPA diagnosis. The presence of ABPA was confirmed by elevated serum total IgE concentration, specific IgE to Aspergillus fumigatus, and radiological findings. Statistical analysis was conducted using SPSS, with p-values < 0.05 considered statistically significant. Results: The study revealed an overall prevalence of ABPA in 20% of the 150 patients with acute asthma exacerbations. Serum total IgE concentration was significantly higher in the ABPA group (450 IU/mL) compared to the non-ABPA group (p < 0.05). Additionally, patients with ABPA had significantly lower FEV1 (60% predicted) compared to those without ABPA (p < 0.05). Conclusion: The study highlights a notable prevalence of ABPA among asthma patients experiencing acute exacerbations. This underscores the importance of raising clinical awareness and implementing timely diagnostic strategies for ABPA in asthma management, which could significantly improve patient outcomes.

Benzodiazepines: Predominant Reported Acute Poisoning to Private Sector Tertiary Care Hospitals in Karachi

Background: Acute poisoning is a major medical emergency that translates into morbidity and mortality across all age groups, it is a potentially preventable cause of illness and death. This study was carried out to assess the epidemiological information of acute poisoning among the general population presented to the three campuses of a private tertiary care teaching hospital in Karachi, Pakistan. Method: The cross-sectional study was conducted at three campuses of a private tertiary care teaching hospital, Dr. Ziauddin Hospital in Karachi, comprising of records from January 1, 2018, to December 31, 2022, of patients reporting acute poisoning. These records were accessed after getting approval from the Ethical review committee. Consecutive sampling technique was applied while data was collected. All cases of acute poisoning reporting to the emergency department with complete records were included. While data of those with any other diagnosis or incomplete record were excluded. Descriptive analysis was performed for quantitative variables. For categorical data frequency and percentages were extracted. The chi-square test was used to associate categorical variables. P value less than 0.05 was taken as statistically significant. Results: The total number of cases was n=518 out of which n=235 (45.4%) were males while n=283 (54.6%) were females and the maximum number of cases n=111 (21.4%) were associated with Benzodiazepines followed by insecticide poisoning and ingestion of rodenticides. Conclusions: The most susceptible groups to acute poisoning were found to be women and children. A prevalent agent that caused toxicity was benzodiazepines; the biggest number of cases occurred in April, while the lowest number occurred in December. The year 2020 was linked to the highest number of cases.

A 360-degree evaluation of the professionalism and communication skills of technologists working in the radiology department of a public sector tertiary care hospital in Karachi, Pakistan

BackgroundRadiologic technologists (RTs) are at the forefront of radiology departments and require optimal skills to demonstrate professionalism and effective provider–patient communication. Hence, the objective of this study was to determine the reliability of 360-degree evaluation as a feedback tool to improve competencies in this crucial workforce.MethodsA planned 360-degree evaluation was conducted using a 10-item tool to evaluate communication skills and professionalism among radiological technologists working at Dow University Hospital, Karachi. In total, 311 evaluations of fifteen radiological technologists were conducted while performing various diagnostic radiology procedures at the radiology department of Dow University Hospital. The data were analysed using SPSS version 26 to compute the evaluation scores and the reliability of 360-degree evaluation.ResultsA total of 311 RT-patient interactions were recorded over 48 days, with scores from all three raters. The evaluation tool was found to have good internal consistency for patients, faculty, and RT, with Cronbach’s alpha values of 0.89, 087, and 0.74, respectively. The study found an intraclass correlation of 0.66 (95% CI; 0.58–0.72), showing moderate reliability of the 360-degree evaluation across different raters.ConclusionWe conclude that 360-degree evaluation is a valid and reliable tool for determining the professionalism and communication skills of radiologic technologists and should be incorporated into training programs for formative and summative assessments. However, large-scale multicenter studies are crucial for generalizing these findings and incorporating 360 evaluations in radiological technologist training programs for formative and summative assessments.

Cardiac Syndrome X - A mystery to worry about.

Madam, Cardiac syndrome X, by definition means original pain without any evidence of significant CVD visualized on angiogram. Normal angiogram makes it difficult for medical practitioners to detect this syndrome. About 10-20% of persons who undergo coronarography suffers from cardiac syndrome X [1]. It has the highest prevalence in postmenopausal women [2]. Most common indication is symptoms of myocardial infarction in patients [3]. Recent study by Magdalena Piegza et al shows the cardiac syndrome patients suffer from anxiety disorders, depressive symptoms and sleep disturbances [4]. This syndrome brings a great concern to Pakistan as already we have a high rate of anxiety disorders, heart problems and higher ratio of deaths due to CVD. A study conducted on 423 persons in tertiary care hospital in Karachi showed the mean anxiety value to be 28.3% [5]. A complete diagnosis of the syndrome requires proper checkup and follow up, but inadequate procedural managements culminating due to lack of interest and awareness raise a high risk of cardiac syndrome X in Pakistan. A thorough online literary search on the PubMed did not find a single article about this issue pointing to the lack of interest and awareness among the medical practitioners of Pakistan. It has to be made sure by creating awareness driven by seminars and workshops to apprise doctors about this syndrome. A study by the Institute for Health Metrics and Evaluation found that 38% of deaths in Pakistan are due to ischemic heart diseases [6]. This increases the chances of cardiac syndrome X among the local population. Due diligence in medical care and follow up must be applied to patients reaching out with past history of anxietic disorders and ischemic heart problems. Common public awareness is also important and doctors should emphasize on ensuring proper lifestyle including diet, exercise, smoking cessation and weight reduction.

Community-acquired sepsis in the medical intensive care unit: An experience from a lower-middle-income country.

To determine microbiological pathogens and in-hospital mortality in patients admitted with communityacquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country. The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019 of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with in-hospital mortality were identified. Data was analysed using SPSS 23. Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). Multi-drug-resistant organisms were isolated in 39 (28.9%) patients. In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure assessment score were significantly associated with mortality (p<0.05). Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients.

Obliged to follow your command: examining how and when servant leadership affects service performance

PurposeThis study is undertaken to explain how servant leadership affects employees’ service performance through their felt obligation toward their leaders. Furthermore, the study explores how the relationship between felt obligation and service performance is moderated by performance pressure.Design/methodology/approachThe data were collected from 312 manager–subordinate dyads working in private sector hospitals of Karachi. The data were analyzed through covariance-based structural equation modeling.FindingsThe study found that employees’ performance is affected by servant leadership and felt obligation toward managers. Furthermore, the study found that felt obligation toward leader mediates the relationship between servant leadership and employees’ performance. Finally, the study found that the relationship between felt obligation toward leader and employees’ performance was not contingent upon perceived performance pressure.Originality/valueThe study confirms the mediating role of felt obligation toward leaders linking servant leadership to employees’ service performance. The study also tests the moderating role of performance pressure influencing the relationship between relationship between felt obligation toward leaders and employees' service performance.

UNIVERSAL PRECAUTIONS: Knowledge, compliance and perceived barriers among dental practitioners of public and private dental institutes in Karachi

Objective: To assess the knowledge and use of universal precautions for blood-borne pathogens and to assess the perceived barriers of adherence to universal precautions at workplace among dentists at public and private dental hospitals in Karachi. In addition, the frequency of exposure to blood-borne pathogens and needle stick injuries among dentists in the last six months. Methodology: A cross-sectional analytical study was conducted in the dental institutes of Karachi. The study tool was a self-administered healthcare professional questionnaire inquiring about respondent characteristics, knowledge level, universal precautions practices, compliance with UP, and body fluid exposure. Of the 500, 370 questionnaires were completed and included in the study. Results: Dentists at both public and private institutes showed the highest percentages (&gt;90%) for statements about HIV/Hepatitis B and C and the route of transmission of these pathogens. Of the 12 up practices, dentists at both institutes showed higher compliance values (&gt;80%) for 5 statements. Overall compliance (at least 60% responses were always in category) was 48% in public practitioners and 13.5% in private institutes. The perceived barriers in UP practices were identified as: unavailability of policies posted in department (pub: 30%, pvt: 82.3%), tough job duties (pub: 50%, pvt: 37.2). Altogether, 309 exposure incidents were reported by dentists in the public sector and 235 in the private sector for the last 6 months before the study. Conclusion: It was concluded that dentists at both institutes have adequate knowledge of blood borne pathogens and adhere to most of universal precautions practices. In the public sector, dentists have a comparatively lower number of factors that interfere with universal precautions than private institutes. Dental institutes should be vigilant about UP adherence among dentists working in OPDs.