Hospital Karachi Research Articles

Knowledge of Nurses Regarding Tracheostomy Care in Tertiary Care Hospital Karachi

Tracheostomy is a surgical procedure in which a surgical opening, called a tracheostomy or stoma, is created in the front of the neck into the trachea (windpipe). This opening provides an alternative airway for breathing when the normal route through the nose and mouth is obstructed or compromised. Objective: To determine the level of knowledge of staff nurses regarding tracheostomy care in Tertiary Care Hospitals in Karachi. Methods: This cross-sectional study was conducted at a Tertiary Care Hospital in Karachi. Fifty participants were recruited through a convenient sampling method. The data were collected from the fifty male and female participants aged 18-50 years old of staff nurses working in the tertiary care hospital. The adopted questionnaire was used for the data collection. Results: The result reveals that 60% were female and 40% were male. Moreover, most nurses 60% had unsatisfactory and 40% had satisfactory knowledge regarding tracheostomy care. Conclusions: This shows a need for additional education and training to enhance nurses' general knowledge and proficiency in delivering the best care for patients with tracheostomies. By filling in this information gap, we can improve patient outcomes and lower the chance of problems from tracheostomy care.

Practices of Physical Therapist Regarding Chest Physiotherapy for Patients Undergoing Open Heart Surgery in Karachi

Background: Despite the critical role of chest physiotherapy in the recovery process post open-heart surgery, there is a paucity of data on the practices of physical therapists in Karachi. With the high incidence of cardiovascular surgeries and the significant burden of postoperative complications, understanding current physiotherapy practices is essential for improving patient outcomes. Objective: The objective of this study was to evaluate the current practices of physical therapists regarding chest physiotherapy for patients undergoing open-heart surgery in Karachi and to identify potential areas for standardization and improvement. Methods: A cross-sectional study was conducted using a questionnaire survey among 40 physiotherapists working in cardiothoracic units across six major hospitals in Karachi. Participants were selected through non-probability convenient sampling, and data on preoperative and postoperative physiotherapy practices were collected. The survey included both open-ended and close-ended questions, with an emphasis on the types of treatments administered during the first five postoperative days. Statistical analysis was performed using SPSS version 25. Results: The mean age of the physiotherapists was 31.20 (SD = 6.8) years with an average working experience of 7.592 (SD = 6.7) years. On the day of surgery, physiotherapy was provided routinely by 7.5%, as needed by 62.5%, and was never provided by 30% of the respondents. From the first to the fifth postoperative day, routine physiotherapy was administered by an increasing majority, peaking at 100% on the second day. Written guidelines for the management of extubated and intubated patients were accessible to 35% and 10% of participants, respectively. Conclusion: There is a substantial engagement in chest physiotherapy post open-heart surgery among physiotherapists in Karachi. However, the variability in practice and the lack of standardized guidelines point towards a need for the development and implementation of standardized protocols to ensure consistent and evidence-based care.

Assessment of the Organizational Commitment among Nurses

Organizational commitment is the extent to which a person may be identified with their membership in a particular organization. Objective: To assess the organizational commitment among nurses. Methods: Utilizing a cross-sectional research approach, this study examined organizational commitment among registered nurses employed in several tertiary care hospitals in Karachi, Pakistan, and enrolled in the Post RN program at Horizon School of Nursing and Health Sciences in Karachi, Pakistan. This study included 71 nurses in total. Three elements of overall organizational commitment are measured by the Organizational Commitment Scale (OCS), established by Balfour and Wechsler in 1996. Results: Study findings show that 35.2% of respondents reported great pride in their affiliation with the company, demonstrating high loyalty and job satisfaction. In addition, 40.8% of respondents strongly agreed with the importance of the organization's values. Moreover, the findings also show that 8.5% demonstrated low commitment, and 60.6% fell into the moderate commitment category. Meanwhile, 31.0% exhibited high commitment. Conclusions: The study revealed a diverse spectrum of commitment levels, with a substantial majority demonstrating moderate commitment. Addressing this issue should be a priority for the organization, focusing on recognizing and appreciating employees' efforts to enhance overall satisfaction and foster a more supportive work environment.

Knowledge of Nurses Regarding Airway Suctioning in Tertiary Care Karachi Pakistan

Proper suctioning is too essential to clear the patient's airway. Nurses should have correct knowledge regarding proper suctioning according to current recommendations to prevent complications. Objective: To assess nurses' knowledge regarding proper suctioning for adult patients. Methods: This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A 50 males and females were selected through convenient sampling by using a cross-sectional study. A self-made questionnaire was used for the data collection. Results: The study findings revealed that 50 participants participated, of which 60% were male and 40% were female. The findings also show that 40% had poor knowledge, 20 had moderate and 40% had high knowledge regarding g airway suctioning. Conclusions: Specifically, 40% of the staff demonstrated poor knowledge, 20% had moderate knowledge, and 40% exhibited a high level of knowledge concerning airway suctioning techniques. Further training and educational interventions may be necessary to improve the overall knowledge and standardize proper suctioning practices among the nurses in the hospital.

Frequency of Burnout Syndrome in Doctors during COVID-19 Pandemic in a Tertiary Care Hospital

Objective: To determine the frequency of burnout syndrome in junior doctors who worked in COVID 19 units of a tertiary care hospital. Study Design: Cross-sectional study. Place and Duration: The study was conducted at Liaquat National Hospital and Medical College Karachi by the Department of Community Medicine during 1st August 2020 to 30th June 2021. Methodology: The study population was house officers, interns, medical officers and junior residents working solely in COVID 19 isolation wards, high dependency units and intensive care units. The data was collected on structured questionnaire which had sections of socio-demography and Maslach Burnout Inventory-Human Services survey (MBI-HSS). MBI-HSS is reliable and validated tool for assessment of burnout syndrome. It evaluates three sub-dimensions of burnout that is emotional exhaustion (EE), depersonalization (DP) and low personal accomplishment (PA). Data analysis was done on SPSS version 21. Results: Total 106 doctors were working in different COVID 19 units and all of them had participated in the study. Majority were females and young. Around 55% of participants had high emotional exhaustion scores. All the participants had high (>9) depersonalization scores, and low (<32) personal accomplishment scores. Doctors working less than eight hours a day had low levels of emotional exhaustion and depersonalization scores and high personal accomplishment as compared to doctors working more than eight hours a day. There was no significant difference in scores among the designations of junior doctors. Conclusion: The health authorities need to take supportive measures to improve mental health of workers for attaining better health outcomes. Keywords: Burnout Syndrome, Maslach Burnout Inventory, Healthcare Workers, COVID 19, Doctors, Tertiary Care. How to Cite This: Siddiqui AF, Abidi SS ,Zainab S ,Quershi K ,Khoso A. Frequency of Burnout Syndrome in Doctors during COVID-19 Pandemic in a Tertiary Care Hospital. Isra Med J. 2023; 15(2): 60-64. DOI: https://doi.org/10.55282/imj.oa1357

Effectiveness of Prophylactic Ketamine on Shivering in Cesarean Section after Spinal Anesthesia

Background: Regional anesthesia, including spinal or epidural techniques, can disrupt the body's ability to regulate temperature, leading to a heightened risk of shivering. Studies have indicated that shivering occurs in up to 55% of patients undergoing procedures under regional anesthesia. To address this issue, numerous medications have been explored for their potential to prevent post-anesthetic shivering. Objective: To assess the effectiveness of prophylactic ketamine on shivering in cesarean section after spinal anesthesia. Study Design: Prospective, randomized, double blind, clinical trial. Settings: Department of Anesthesiology, Surgical Intensive Care Unit and Pain Management, Civil Hospital Karachi Pakistan. Duration: Six months from August 2019 to January 2020. Methods: A total of 60 patients undergoing spinal anesthesia for elective cesarean section were included in this study. Two groups A and B were formed and patients were equally divided into these groups by lottery method. Group A were treated with ketamine 0.5 mg/kg I/V and group B treated with normal saline 0.05ml/kg/I/V. Grade 0-1 shivering was labeled as effective and shivering grade 2, 3 or 4 at 15 minutes after administration of the drug, was considered ineffective. Results: The average age of the patients was 28.33 ± 5.67 Years. Rate of shivering was significantly high in patients who were treated with normal saline than ketamine in which shivering was not observed (53.3 vs. 0% respectively; P value of 0.0005). This implies that effectiveness was significantly high in groups A than group B (100% vs. 46.7%). Conclusion: Ketamine observed to be the effective drug for the treatment of postanesthetic shivering. It should be considered prophylactically in any patient undergoing spinal anesthesia.

COMPARISON OF LIMB SALVAGE WITH MEGA PROSTHESIS VERSUS AUTO GRAFT RECONSTRUCTION AFTER CRYOTHERAPY IN LIMB SARCOMA PATIENTS

Osteosarcoma is the most common primary malignant bone tumor, with children and adolescents being the most at-risk population. It accounts for 2% of all childhood tumors. The main goal of this study was to compare the use of limb salvage with mega prosthesis versus auto graft reconstruction after cryotherapy in patients with limb sarcoma. This retrospective study was conducted at Liaquat College of Medicine and Dentistry Darul Sehat Hospital Karachi from June 2023 to August 2023. The data was collected with the permission of the hospital's ethical committee. A standard uniform management protocol was adopted for each case. All patients were skeletally immature, with the predicted overall growth of less than 3 cm calculated using the Multiplier method. The data was collected from 45 patients with a mean age of 13.8±4.6 years. The predominant type of tumor was Osteosarcoma (77.14%) followed by Ewing Sarcoma and Chondrosarcoma. Five patients required a more extended hospital stay after mega prosthesis as compared to the other group. It is concluded that patients with limb sarcomas treated with Mega prosthesis had better functional outcomes than those treated with autograft reconstruction after cryotherapy.

Metabolic storage disorders at a tertiary care hospital, Pakistan

OBJECTIVE: To determine the clinical spectrum of metabolic storage disorders presenting to a public sector tertiary care hospital in Karachi, Pakistan. METHODOLOGY: This retrospective, cross-sectional study was conducted at the Department of Pediatrics, Dr RKMP Civil Hospital Karachi, in 2021. We reviewed the medical records of patients from January 2015 to December 2020. We included all pediatric patients admitted with suspicion of metabolic storage disorders based on two or more: visceromegaly, developmental delay, regression of milestones, fits without fever, family history of similar illness, and family history of expiry of children due to unknown reasons. Patients of malaria, enteric fever, epilepsy and cerebral palsy were excluded. We noted the demographic and clinical variables and applied descriptive statistics using SPSS version 22. RESULTS: Out of n=140 suspected children, n=40 (28.5%) patients were diagnosed with metabolic storage disorder. Among these, 26 (65%) were Lysosomal, and 14 (35%) were Glycogen storage disorders (LSDs and GSDs). The most common clinical feature of LSDs was faltering growth in 23 (88.4%), while for GSDs, it was abdominal distention and hepatomegaly in 100% of patients. Mucopolysaccharidoses were the most common type of LSD identified in 9(34.6%). Interestingly, family history of similar illness was not a standard feature (19.2% for LSDs and 7% for GSDs). CONCLUSION: Metabolic storage disorders are an emerging concern to pediatric health in our population. Physicians need to keep a high index of suspicion for patients with faltering growth and visceromegaly, with or without a significant family history. KEYWORDS: Glycogen storage diseases; Lysosomal storage diseases; Metabolic diseases; Inborn errors of metabolism; Hepatomegaly; Genetic diseases

Health related quality of life in patients with liver cirrhosis: its determination and correlation with relevant factors

OBJECTIVE: To determine the health-related quality of life (HRQOL) among patients with Cirrhosis of the liver using a short form of liver disease quality of life (SF-LDQOL) instrument, also to correlate HRQOL scores with relevant factors. METHODOLOGY: This is a prospective, cross-sectional study carried out in the medical department of Civil Hospital Karachi from May 2021 to April 2022. One hundred ninety-seven confirmed cases of Cirrhosis from either gender over 18 years of age without malignancy, HIV infection, or Psychiatric/Neurological diseases were enrolled using convenient sampling. The SF-LDQOL instrument assessed HRQOL, summarizing overall disease-targeted HRQOL (0 to 100), where a higher score shows good HRQOL or otherwise. HRQOL was correlated with various sociodemographic factors and the severity of liver cirrhosis. RESULTS: Using SPSS version 23, the SF-LDQOL score was 44±7.3. The severity of liver cirrhosis by (Child Turcotte Pugh) CTP-A correlated weakly (-0.1294), while CTP B and CTP C strongly correlated with SF-LDQOL scores (-0.9894 and -0.9912), respectively. The p-value for CTP A (0.705) is insignificant; however, for CTP B and C (p < 0.00001 & p < 0.00001) is significant. Demographically, the age and income status correlated strongly to SF-LDQOL scores, displaying considerable p-values (p <0.00001 and p < 0.00001). CONCLUSION: Most patients had compromised HRQOL as assessed by well-validated and more disease-specific tool SF-LDQOL score. HRQOL correlated positively with the severity of Cirrhosis by applying CTP and Model of end-stage liver disease (MELD) scoring. Sociodemographic parameters of age and income status also correlated well with HRQOL. KEYWORDS: Cirrhosis of the liver, Child Turcotte Pugh, Model of end-stage liver disease, Health-related quality of life.

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.