Hospitals Of Punjab Research Articles

Multiattribute Decision-Making of TQM Performance of Hospitals Using TQM Digraphs

Total quality management (TQM) is a dynamic philosophy that incorporates gradual and uninterrupted improvements. The total quality is accomplished if all the desired goals including quality of product, reputation in market, services, low cost of product, employee and customer satisfaction, optimum utilization of resources, work environment, and so on are attained. As far as the Pakistani perspective is concerned, TQM as a strategic tool is not appropriately used to optimize its performance. Public healthcare in Pakistan is one of the most ignored sectors with regard to its service quality implementation and delivery. The public sector hospitals are one of the major primary healthcare providers, but the facilities they provide do not meet the desired requirement. This study addresses six TQM attributes to analyze the TQM performance of various public sector teaching hospitals in the province Punjab of Pakistan. The data was obtained from medical experts. The TQM performance to study the behavior of TQM implementation in hospitals is evaluated using TQM digraphs. The hospitals are ranked according to the TQM performance index, which is obtained from TQM digraphs. The technique to find the most effective attribute for a hospital is also proposed. The TQM digraph approach not only focuses on the significance of attributes independently but also incorporates the relative importance of one attribute over another. Also, this approach is very flexible that can incorporate new attributes and market variation so that continuous improvement may be possible. Moreover, the results obtained in this approach are not limited to beneficial for benchmarking of teaching hospitals in Punjab on the TQM basis, but these can also help indicate the particular attribute that is more needed to be improved for a particular hospital to increase its TQM performance.

Spiritual Care Competences among Health Care Professionals in Pakistan: Findings from a Cross-Sectional Survey

Introduction: There is a gap in healthcare literature related to the spiritual competence of physicians and nurses practicing in South Asian Muslim communities. To fill that gap, the Spiritual Care Competence Questionnaire (SCCQ) was applied which was developed to address multi-professional spiritual care competences. Materials and Methods: A cross-sectional study among 294 health professionals (61% physicians, 17% nurses, and 22% other professions) in 10 hospitals in Punjab, Pakistan. Results: The highest scoring competences were “Dealing with patients/Communication competences”, while “Team Spirit” scored lowest. There were no gender related differences, but there were effects related to professions. “Team Spirit”, “Dealing with patients/Communication competences”, and “Empowerment competences” scored significantly higher in nurses as compared to physicians and other health care professionals, while there were no significant differences for their “Perception/Documentation competences”. These competences were not relevantly related to the intensity of their prayer/meditation activity. Conclusions: Health care professional from Punjab were preferred to tolerate the pain and the suffering of patients and their relatives rather than to talk about spiritual care issues. Their spiritual care competences were less developed. Thus, there is a clear need for further specific education and training of health professionals.

Frequency of Uncontrolled Diabetes Mellitus in Late 3rd Trimester and Its Association with Maternal Outcome

Diabetes mellitus is a metabolic disorder characterized by elevated blood and tissue glucose levels due to absolute or relative insulin deficiency. In addition to a number of systemic complications, diabetes in pregnant women is associated with poor perinatal outcome. A recent study claimed that not merely the presence of diabetes but also poor glycemic control during pregnancy is associated with adverse maternal outcome. However, the available evidence was limited while there was no such local published material which necessitated the present study.
 OBJECTIVE: The objectives of this study were to determine the frequency of uncontrolled diabetes mellitus in late 3rd trimester among diabetic pregnant women presenting at a teaching hospital in Punjab and to compare the maternal outcome among pregnant women with controlled versus uncontrolled diabetes mellitus.
 STUDY DESIGN: It was a descriptive case series.
 SETTING: Research was conducted at Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital Lahore.
 DURATION: Duration of study was 6 months after the approval of synopsis from 01/08/2017 to 31/12/2017 (4 months) and 01/04/2018 to 31/05/2018 (2 months).
 MATERIAL AND METHODS: This study involved 217 diabetic pregnant women aged between 18-35 years presenting after 34 weeks of gestation. HbA1c levels were acquired and those with ?6% HbA1c levels were labeled to have uncontrolled diabetes. Frequency of polyhydramnios, cesarean delivery and postpartum hemorrhage was noted and compared between women with controlled and uncontrolled diabetes. A written informed consent was obtained from every patient.
 RESULTS: The mean age of the patients was 30.1±3.9 years while the mean gestational age was 39.6±1.6 weeks. Majority (n=190, 87.6%) of the patients were aged between 26-35 years followed by 27 (12.4%) patients aged between 18-25 years. There were 75 (34.6%) primiparas and 142 (65.4%) multiparas. 36 (16.6%) patients had pre-pregnancy diabetes while 181 (83.4%) patients had gestational diabetes. 74 (34.1%) patients were taking oral hypoglycemic while 143 (65.9%) patients were on insulin. HbA1c levels ranged from 5.5% to 7.7% with a mean of 6.5±0.66%. Taking a cut-off value of ?6.0%, 146 (67.3%) patients had uncontrolled diabetes. 46 (21.2%) patients had polyhydramnios, 146 (67.3%) patients required cesarean delivery and 31 (14.3%) patients acquired post-partum hemorrhage. The frequency of polyhydramnios (27.4% vs. 8.5%; p-value=0.001), cesarean delivery (84.9% vs. 31.0%; p-value<0.001) and postpartum hemorrhage (21.2% vs. 0.0%; p-value<0.001) was significantly higher in patients with uncontrolled diabetes.
 CONCLUSION: A substantial proportion of diabetic women in late 3rd trimester had poor glycemic control and had significantly higher frequency of polyhydramnios, cesarean delivery and postpartum hemorrhage than women with good glycemic control which advocates routine monitoring and strict glycemic control in diabetic pregnant women to improve the maternal outcome in future practice.

ADVERSE DRUG REACTIONS OF ANTI-EPILEPTIC DRUGS IN PEDIATRIC AGE GROUP IN A TERTIARY CARE TEACHING HOSPITAL; A CROSS-SECTIONAL STUDY

Objectives: In this cross-sectional study, the aims were to analyze the incidence and pattern of adverse drug reactions (ADRs) of antiepileptic drugs in pediatric patient. Most common adverse effect and most common drug causing adverse effect were evaluated. Methods: Study was conducted over 60 Patients for 6 months in out-patient basis pediatric department in Rajindra Hospital associated with GMC, Patiala, a tertiary care teaching hospital in Punjab. The patient diagnosed by the Pediatrician with epilepsy who fulfilling inclusion and exclusion criteria was enrolled after taking informed consent. ADRs were noted using Pediatric Epilepsy Side Effect Questionnaire at clinic visit and any other adverse effects reported by patients. Results: In this study, a total of 60 children were enrolled. The mean age was 10.26±3.70, median were 11.00. 41 (68.33%) patients were boys and 19 (31.67%) were girls. In Cognitive ADRs with anti-epileptic drugs, there were total 17 ADRs reported. Valproate was causing most cognitive ADRs (32.43%). Among all cognitive ADRs, attention difficulty was the commonest complains. There were no motor and behavioral ADRs reported. Total 27 general neurological ADRs reported, which was highest reported ADRs. Among general neurological, Clobazam was causing highest ADRs (55.56%). 10 patients also reported tremor as another ADR and Clobazam causing most (22.22%). Conclusion: In the present study, boys were developing more epilepsy than girls. Valproate was causing most ADRs. Among all cognitive ADRs, attention difficulty was the most common ADR. General neurological ADRs were highest reported ADRs.

Frequency of Hepatic Encephalopathy in Post liver Transplant Patients

Objective: The objective of this study was to determine the frequency of hepatic encephalopathy in post liver transplant patients at a tertiary care hospital in Punjab. Study Design: It was a descriptive case series. Setting: Research was conducted at Department of Gastroenterology, Shaikh Zayed Hospital Lahore. Duration: Duration of study was 6 months after the approval of synopsis from 05/08/2017 to 04/02/2018. Material and Methods: This study involved 139 patients of both genders aged between 30-70 years diagnosed of chronic liver disease and undergoing liver transplantation. Patients were followed in the post-transplant period and hepatic encephalopathy was diagnosed using West Haven Criteria ≥Stage I during 4 weeks period after transplant. A written informed consent was obtained from every patient. Results: The mean age of the patients was 48.1±8.6 years. Most of the patients were aged between 51-65 years (59.0%) followed by 35-50 years (41.0%). There were 90 (64.7%) male and 49 (35.3%) female patients in the study group with a male to female ratio of 1.8:1. Chronic hepatitis C was the most frequent underlying cause and was observed in 105 (75.5%) patients followed by chronic hepatitis B (12.9%) and autoimmune hepatitis (11.6%). Post-transplant hepatic encephalopathy was diagnosed in 17 (12.2%) patients. 10 (7.2%) patients had stage-I, 5 (3.6%) patients had stage-II and 2 (1.4%) patients had stage-III encephalopathy. There was no significant difference in the frequency of post-transplant hepatic encephalopathy across age (p-value=0.988), gender (p-value=0.997) and underlying cause (p-value=0.714). Conclusion: Hepatic encephalopathy was observed in a substantial proportion of patients undergoing liver transplantation for chronic liver disease which warrants routine monitoring of such patients in the post-operative period so that timely identification and management can improve the outcome among such cases. Keywords: Chronic Liver Disease, Liver Transplant, Hepatic Encephalopathy

Causes of Alarmingly High Frequency of Covid 19 Infection in Health Care Workers: A Third World Perspective

Background: Covid 19 infection is spreading like a wild fire world wide. More worrisome thing is that it has spread in health workers too which are the sole care takers of affected patients, despite of use of personal protective equipments and taking other precautions. Aim: To conduct a study at local level to see causes of high frequency of Covid 19 infection in health care workers. Methods: We conducted a cross sectional observational study in which we enrolled 195 doctors, nurses and paramedics from different hospitals of punjab ,who were affected from covid 19 infection and gave them a questionnaire to fill regarding use of mask, (surgical, cloth, n=95)/duration of its use, use of surgical cap, goggles, soap or hand sanitizer use/frequency, technique of donning/doffing of PPE etc,to find out that where is the fault. Results: Out of total 195 participants 148 were doctors from various specialties, departments and with different work experience.47 were nurses and other paramedical staff including lab workers, pharmacists, ward boys and others. Out of 195 participants 42(21.5%) did not use PPE (cover-all with surgical apron, mask KN-95 or N-95, goggles/face shield) whereas 153(78.5%) used it. Conclusion: We concluded at the end of our study that improper doffing techniques, overuse of masks for more than 3 days,and infrequent hand washing may be the reasons for increased rate of infection and need to be dealt promptly. Keywords: Covid 19 infection, health care workers, high frequency of infection

Perception, Attitude, and Confidence of Physicians About Antimicrobial Resistance and Antimicrobial Prescribing Among COVID-19 Patients: A Cross-Sectional Study From Punjab, Pakistan.

Background: Patients with coronavirus disease 2019 (COVID-19) could experience multiple coinfections, and judicial antimicrobials, including antibiotics, is paramount to treat these coinfections. This study evaluated physicians’ perception, attitude, and confidence about antimicrobial resistance (AMR) and antimicrobial prescribing in patients with COVID-19. Methods: A self-administered and validated online questionnaire comprised of six sections was disseminated among physicians working in public sector hospitals in Punjab, Pakistan, using the convenience sampling method from April to May 2021. The study also assessed the validity and reliability of the study questionnaire using exploratory factor analysis and Cronbach’s alpha. In addition, the descriptive and inferential statistics present survey results. Results: A total of 387 physicians participated in this study. The study showed that the questionnaire demonstrated good internal consistency (Cronbach’s alpha = 0.77). Most physicians (n = 221, 57.1%) believed that AMR is a considerable problem in Pakistan. Less than a quarter of respondents (n = 91, 23.5%) consulted with local antibiotic resistance data to prescribe antibiotics in COVID-19 patients. However, the respondents were confident to select a suitable antibiotic (n = 229, 59.2%). More than three-quarters of the respondents believed that advice from a senior colleague ( n = 336, 86.8%), infectious disease (ID) physician (n = 315, 81.4%), and implementing antimicrobial stewardship programs (ASPs) could facilitate appropriate prescribing of antibiotics in COVID-19 patients. Multivariate logistic regression revealed that physicians with more than 10 years of experience had higher odds of consulting local guidelines for antibiotic therapy (OR, 4.71 95% CI: 1.62–13.73, p = 0.004) than physicians with less than 5 years of experience. Similar trends were found for consulting national guidelines and local resistance data to select an empiric antibiotic therapy. Conclusion: AMR-related awareness was optimal among physicians. Only a few physicians looked up local antibiotic resistance data before prescribing antibiotics to COVID-19 patients empirically. The significant approaches advised by physicians to reduce AMR risk among COVID-19 patients were the implementation of ASPs combined with advice from ID physicians.

Lessons for the future-psychosocial perspectives of vaccine literacy among beneficiaries at a COVID-19 vaccination center in a tertiary teaching hospital in Punjab, Northern India: A qualitative analysis

Background: Due to the unprecedented magnitude of the current Coronavirus disease 2019 (COVID-19) pandemic, vaccine development was fast-tracked; yet, there were barriers to vaccination uptake. Aim and Objectives: The objectives of this study were to understand the factors promoting vaccination and the barriers to vaccination, to explore the infection prevention and control practices followed after vaccination. Materials and Methods: A qualitative study using in depth interviews, both face to face and telephonic; among beneficiaries willing to participate and given at least one dose of COVID-19 vaccine in the institutions’ vaccination center, stratified sampling technique was used. Informed consent was obtained. Absolute confidentiality was ensured. The interviews were recorded and transcribed verbatim and validated by back translation into vernacular. The results obtained were analyzed using framework approach and categorized into themes and subthemes and valid conclusions drawn. Results: Various factors promoting willingness for vaccination and barriers perceived by the participants in their community, social, and occupational setting have been revealed in the present study. Availability of vaccine along with clear and accurate information can go a long way in overcoming vaccine hesitancy and promoting vaccine literacy. Conclusion: Clear and accurate information should be disseminated. The role of social media, mass media, and dissemination of information by word of mouth cannot be undermined. It is hoped that results of the present study will aid in formulating future vaccination programs.

Epidemiological correlates of hepatitis C infection- A case control analysis from a tertiary care hospital.

ABSTRACTBackground:Hepatitis C virus (HCV) infection is considered one of the growing public health problems. Identification of HCV-associated risk factors is pivotal for developing appropriate prevention strategiesObjectives:To determine the epidemiological variables of HCV infection in a tertiary care hospitalMethods:This hospital-based case-control study was conducted in a tertiary care hospital in Punjab on 320 subjects, including 160 cases and controls each. Cases and controls were matched by age (±5 years), gender, and residence. A patient ≥18 years of age fulfilling the biomarker criteria with or without clinical criteria diagnosed in the last 1 month was considered as a case. The information on socio-demographic characteristics and previous exposures to selected risk factors was collected through detailed interviews of the subjects. Analysis was performed using SPSS 20 statistical software. Odds ratio (OR) with 95% confidence interval (CI) was calculated to measure the strength of association between cases and controls for each risk factorResults:Odds of having HCV infection was significantly higher among those with a history of blood transfusion (OR: 2.30, 95%CI: 1.14–4.63), dental procedure (OR: 4.82, 95%CI: 2.38–9.77) and intravenous injection/infusion from quacks (OR: 3.26, 95%CI: 1.47–7.19), injectable drug use (OR: 26.69, 95%CI: 3.55–200.24), non-injectable drug use (OR: 2.37, 95%CI: 1.44–3.90), tattooing (OR: 7.91, 95%CI: 2.31–27.08), and piercing from street hawkers (OR: 2.25, 95%CI: 1.18–4.29). Multivariate analysis identified history of blood transfusion, dental procedure, intravenous injection/infusion from quacks, injecting drug use, and piercing as independent risk factors for HCV infectionConclusion:The study identified multiple risk factors for acquiring HCV infection and suggest appropriate interventions targeting high-risk populations.

Attitudes and Behaviors of Health Care Professionals Towards Preventive Measures Against COVID-19

The purpose of this study is that healthcare professionals play the most significant role in tackling pandemic COVID-19 and are considered as the most vulnerable and at-risk population for infection. An effective response to a pandemic depends on the attitudes and behaviors of physicians, nursing, staff, lab technicians, and other support staff. The study was conducted to explore the attitudes and behaviors of health care professionals towards preventive measures against COVID-19. The study was designed following the positivistic research paradigm hence cross-sectional survey research was selected as the most appropriate design. For the purpose of data collection, a self-administered structured questionnaire was developed and used. The survey was conducted during the month of March 2020 in Punjab through an online data collection method from 150 health care professionals working in various public sector hospitals in Punjab. The questionnaire was uploaded on the survey monkey website and shared on various social media platforms to collect data in order to get responses. Results show that self-reported anxiety level is high among physicians and nurses as compared to technical and support staff. Data shows that there are significant differences in attitudes and behaviors towards preventive measures against pandemic COVID-19 between physicians and nurses especially about the adoption of various techniques for improving immunity. It was also found that there are significant attitudinal and behavioral differences according to sex, region of residence, and marital status of health care professionals.

Perceptions of pharmacists towards drug shortages in the healthcare system of Pakistan and its impact on patient care: findings from a cross-sectional survey

ObjectiveThis study aimed to explore pharmacists’ perceptions on drug shortages and its impingement on the Pakistani healthcare system, in particular on patient care.DesignOnline questionnaire survey.Setting and participantsHospital pharmacists from five...

Evaluation of patient and Family-Centered Care; a Survey of Neonatal and Paediatric Intensive Care Units

Aim: To evaluate the application of the principles of Patient and Family-centered Care Methodology: A cross-sectional study was conducted in the Pediatric and Neonatal Intensive care unit of a tertiary care hospital in Punjab, Pakistan. IRB approval was granted, and the study spanned a period from January 2019 to June 2019. A questionnaire was created to survey the pediatric patient's parents. Data analysis was done using SPSS 25. Results: A total of 158 responses were recorded. The majority of the parents felt that patient and family-centered care was not being applied to the admitted patients' management plans in the pediatric and neonatal ICUs. Conclusion: The treatment of patients in the pediatric and neonatal ICUs was not following the principles of patient and family-centered care. Therefore, further studies are required to improve the ease of access, alongside limiting the barriers to the patient and family-centered care in Pakistan. This way, patients can benefit from improved outcomes associated with PFCC. Keywords: Neonatal intensive care unit (NICU), intensive care unit (ICU), pediatric intensive care unit (PICU), patient and family-centered care (PFCC).

Antibiotic consumption among hospitalized neonates and children in Punjab province, Pakistan

ABSTRACT Background Periodic surveillance of antibiotic consumption in the form of point prevalence studies is a quick and robust methodology to evaluate prescribing trends in hospitals. The current study was undertaken to document antibiotic consumption among neonates and children from hospitals in Pakistan. Methods This large multicenter study using the World Health Organization standardized methodology and AWaRe (Access, Watch, and Reserve) classification examined antibiotic consumption for suspected bacterial infection among neonates and children admitted hospitals in Punjab, Pakistan. Results A total of 708 beds of children wards of the 16 health facilities were examined. Almost all (97%) hospitalized children were prescribed antibiotics on the day of the assessment with 2.6 antibiotics per patient. The three most common indications were respiratory tract infections (31.58%), sepsis (26.52%), and prophylaxis for medical problems (10.30%). The three most frequently prescribed antibiotics were ceftriaxone (24.2%), amikacin (23.2%), and ampicillin (16.7%). Almost half of the antibiotics were prescribed from the ‘Access’ (49.5%) and ‘Watch’ (45.5%) categories under the AWaRe classification. However, no antimicrobial was prescribed from the ‘Reserved’ category. Conclusions Our findings indicate that empirical antimicrobials use among hospitalized children is highly prevalent in Pakistan. The utilization of ‘Watch’ category of antimicrobials is frequent, stressing immediate action.

Health Literacy and Health Risk Behaviors among Cancer Patients

Cancer is accounted as serious problem that affects people all over the world. Cancer is becoming more common in Pakistan as a result of a lack of health facilities, limited medical equipment, and a lack of doctors with specialized knowledge. The link between health risk behavior and health literacy among cancer patients is investigated in this study. Patients from four government sector hospitals in Punjab, Pakistan, were recruited randomly to provide the data. The data was gathered using a well-structured questionnaire. Critical health literacy (r =.469**),communicative (r =.660**), Functional (r =.370**), and health risk behaviour were discovered through correlation analysis.

Bacteriological profile and antimicrobial susceptibility pattern of endotracheal tube secretion of patients in ICUs of a tertiary care hospital in Punjab

Healthcare associated pneumonia (HAP)is second most common HCAIs that occur in 27% critically ill patients. Eighty-six percent of HAP are associated with mechanical ventilation and termed as ventilator associated pneumonia (VAP). VAP due to multidrug resistant has also increased in recent past. To isolate and identify the bacterial pathogens in endotracheal tubes aspirates of ICUs patients and study their antimicrobial susceptibility pattern.A prospective longitudinal study was conducted in the Microbiology laboratory of a tertiary care hospital over a period of six months after clearance from institutional Research Committee and Ethical Committee. All the samples of ETT secretions received in Clinical Microbiology lab from ICU patients and fulfilling the criteria for VAP were included in this study. Samples were processed as per standard protocol and organisms were identified on the basis of gram staining, colony characters and biochemical tests. Antibiotic sensitivity was performed by Kirby Bauer disc diffusion method as per CLSI guidelines. : A total of 100 samples of ET secretions were collected and proceeded for culture. Out of 100 samples, 76 (76.0%) were positive for bacterial growth. Among 76 positive cultures, a total 80 bacterial isolates were obtained as some cultures were showing polymicrobial growth. Five (6.26%) isolates were Gram Positive bacteria and 75(93.7%) were Gram negative. The most frequent isolates were 35(43.7%) followed by , isolates were sensitive to colistin while resistant to ampicillin and amoxiclav. isolates were sensitive to colistin and resistant to ampicillin, amoxiclav, ciprofloxacin, cefixime, piperacillin tazobactam. isolates were sensitive to colistin while resistant to ampicillin, amoxiclav, ceftizidime and piperacillin tazobactam. In our study antimicrobial pattern of isolated bacteria shows multidrug resistant pathogens which are associated with VAP and limit therapeutic options.

Assessment of Knowledge and Preparedness of Healthcare Worker Regarding Current COVID-19 Crisis

Background: COVID 19 has become a major health issue and has globally affected masses and increased mortality in all parts of the world. Therefore, with limited information available healthcare workers faced a multitude of problems and challenges in managing the affected individuals globally and to no surprise with developing information database regarding this disease; many lost their lives. Aim: To assess the understanding of healthcare worker regarding COVID-19 pandemic and their competence in dealing with the current situation and to ascertain whether HCWs are actively participating in activities that hell them deal with the outbreak. Study design: Descriptive cross sectional survey Place and duration of study: Department of Medicine, Shaikh Zayed Hospital, Lahore from 26th September 2020 to 30th May 2020. Methodology: Three hundred and sixty eight individuals participated in survey throughout Pakistan. The questionnaire consisting of four parts designed according to available data on coronavirus and study participants were tested for their knowledge and preparedness through multiple questions. All healthcare workers from different designation, specialties and hospitals participated for this research. Results: Two hundred and eighty seven aged less than 35 and rest were above 35.68.5% were from public sector and rest worked in private hospitals.340 people participated from hospitals in Punjab and remaining were from other parts of Pakistan. Internet was major source of information. Study participants stated themselves as prepared in dealing with COVID 19 matters however, knowledge based questions were not answered correctly by many individuals. Conclusion: This research was meant to identify the gaps in information and take measures to provide better health practices. The correct answers percentage was higher for more experienced individuals and who are acutely dealing with Covid infection. Also, the people who had prior exposure to some other outbreak made the right choices most of time. Keywords: COVID-19, Coronavirus, Knowledge, Preparedness, Healthcare workers, Attitude, Awareness

PREVALENCE OF NEAR MISS AND MATERNAL DEATHS AND ITS MATERNAL AND PERINATAL OUTCOMES: A RETROSPECTIVE STUDY

Objectives: The objective of the study was to determine maternal mortality ratio (MMR), maternal near miss incidence ratio (MNM IR), MNM to mortality ratio (MNM: MD), and mortality index (MI) and to know the prevalence, demographic distribution, causes and feto-maternal outcome of maternal near miss and maternal deaths. Methods: A retrospective review of near miss and maternal mortality over a period of 20 months in a tertiary teaching hospital in Punjab. Results: MMR was 998 MNM IR was 24.20/1000 live births. Maternal near miss mortality ratio was 2.4:1. MI was 29.21%. The most common cause of maternal mortality was hypertension, which was seen in 14 (53.84%) women. Among near miss cases, the most common complication noted was hemorrhage, seen in 40 (63.49%) cases. Among maternal deaths, 7 (26.92%) women delivered vaginally, 6 (23.07%) women underwent emergency cesarean section. Among near miss cases, 20 (31.74%) women delivered vaginally, 13 (20.63%) women underwent cesarean section while 7 (11.11%) had cesarean hysterectomy. Laparotomy for ruptured ectopic pregnancy was done in 6 (9.52%) women, 7 (11.11%) women had dilatation and evacuation, 3 (4.76%) had exploration of Uterovaginal canal. Preterm birth has seen in 8 (12.69%) in maternal deaths and 23(36.50%) in maternal near miss. Intrauterine fetal demise occurred in 4 (6.34%) in maternal deaths and 2 (4.87%) in near miss. Conclusion: The review of near miss cases is important to identify response of health care system to medical emergencies and provides opportunities to improve the quality of service.

Assessment of Adherence to the Core Elements of Hospital Antibiotic Stewardship Programs: A Survey of the Tertiary Care Hospitals in Punjab, Pakistan.

Background: To restrain antibiotic resistance, the Centers for Disease Control and Prevention (CDC), United States of America, urges all hospital settings to implement the Core Elements of Hospital Antibiotic Stewardship Programs (CEHASP). However, the concept of hospital-based antibiotic stewardship programs is relatively new in Low- and Middle-Income Countries. Aim: To appraise the adherence of the tertiary care hospitals to seven CEHASPs. Design and Setting: A cross-sectional study in the tertiary care hospitals in Punjab, Pakistan. Method: CEHASP assessment tool, (a checklist) was used to collect data from the eligible hospitals based on purposive sampling. The check list had 19 statements to cover seven CEHASPs: Hospital Leadership Commitment, Accountability, Pharmacy Expertise, Action (Implement Interventions to Improve Antibiotic Use), Tracking Antibiotic Use and Outcomes, Reporting Antibiotic Use and Outcomes, and Education. For each statement, a response of “YES”, “NO” or “Under Process” constituted a score of 2, 0 and 1, respectively, where the higher the scores the better the adherence. Categorical variables were described through descriptive statistics, while independent t-test computed group differences. Result: A total of 68 hospitals (n = 33 public, n = 35 private) participated with a response rate of 79.1%. No hospital demonstrated “Perfect” adherence. Roughly half private (48.6%) and more than half public (54.5%) sector hospitals were “Poor“ in adherence. Based on the mean score, there was no significant difference between the private and the public hospitals in terms of comparison of individual core elements. The two most neglected core elements emerged as top priority area were: Reporting Antibiotic Use and Outcomes and Tracking Antibiotic Use and Outcomes. Conclusion: The current response of Pakistan to implement hospital-based antibiotic stewardship programs is inadequate. This study points out significant gaps of practice both in public and private tertiary care hospitals. A majority of the core elements of antibiotic stewardship are either absent or ”Under Process”. The deficiency/priority areas mentioned require immediate attention of the concerned stakeholders in Pakistan.

Prospective study to analyze clinico-epidemiological profile of patients presenting with liver abscess at tertiary care centers

Background: Liver abscess is an ancient disease bothering mankind since ages and continues to be a common health problem in India. Both of its subtypes i.e., amoebic and pyogenic, continues to pose serious challenge to the Indian health care system.Aims and objectives: To determine the demographic profile of patients, to assess type of liver abscess prevalent in the region and to assess etiological factors of the disease.Methods: Study was conducted in two tertiary care and referral hospitals in the Indian national capital region and a govt. hospital in Punjab from 01 July 2016 to 31 December 2019 and the patients were followed up till June 2020 with the last recruited patient getting a six month follow up. Diagnosis was confirmed by sonography and examination of aspirate. Positive routine bacteriological culture of the pus and a positive response to routine antibiotics made up for the pyogenic liver abscess category.Results: Liver abscess commonly affects middle aged males of low socioeconomic status. Diabetics and alcohol (both Indian made foreign liquor and the local country liquor) are biggest risk factors. Majority have raised leukocyte counts while Alkaline phosphatase is the most commonly deranged liver function test marker, raised to more than twice of the normal range in most cases. Right lobe involvement, right sided pleural effusion and raised right hemidiaphragm are seen in plain chest X-ray. Fever and pain abdomen are the most common presenting complaints. USG abdomen is an effective diagnostic modality that also serves to guide intervention procedures.Conclusions: Early diagnosis and timely intervention produces best results.International Journal of Human and Health Sciences Vol. 05 No. 04 October’21 Page: 473-477

Prevalence of Typhi DOT IGM positive results in COVID-19 patients at primary and secondary health care hospitals in Punjab, Pakistan.

Objective: To determine prevalence of Typhi dot IgM positive results in COVID-19 patients at primary and secondary health care hospitals in Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Tehsil Head Quarter Hospital of Burewala and District Head Quarter Hospital of Vehari. Period: 1st March 2020 to 30th June 2020. Material & Methods: Study was done among diagnosed cases of COVID-19 after taking ethical approval from ethical review board. Results were assessed by using SPSS version-24. Results: Males were predominant (71.30%) in our study as COVID-19 positives than the females. Most of the patients (51.70%) were from middle aged group, i.e. 31-60 years. Only 7.40% patients were from elder age group (more than 60 years). More than half of the patients (51.90%) were found to be positive with IgM typhi dot test. We repeated the tests and found the same results. We also calculated the prevalence of typhoid positive cases in COVID patients according to different demographic variables. As far as gender is concerned, our result was highly statistically significant when associated with typhoid positive results among COVID patients (P=0.0001). Males were predominantly having high rate of typhi dot IgM positives (71.30%) than females. Middle aged patients were found to be more affected by typhi dot positive results. Conclusion: It is concluded that there is a high and significant ratio of typhi dot positive results for IgM in COVID patients at Vihari district.