Major Tertiary Care Hospital Research Articles

Statistical analysis and characteristics of hospital medical waste under novel Coronavirus outbreak

One of thesources of infection as a result of coronavirus disease treatment is the medical waste generated during the health care activities. Since the registration of the first infected case of coronavirus in Jordan the daily number of patients fluctuated from as low as zero to as high as 40 with a recovery ratio and case fatality risk of 39% and 1.7%, respectively. The main objective of the present study is to carry out statistical analysis and assess the generation rates and the composition of the medical waste generated during the treatment of coronavirus pandemic with reference to a major tertiary care hospital in Jordan. Data onthe daily generated waste, number of the admitted patients and on the amounts of consumables like various personal protective equipment, testing kits, and disinfectant used during the treatment of coronavirus disease was obtained. Data was subjected to descriptive statistical analysis to find the average generation rates, 3 days moving average, as well as the frequency distribution of the generated amounts. During 25 days' period, King Abdullah University Hospital has admitted 95 infected patients by coronavirus. The amount of the average rate of the medical waste generated as a result of coronavirus treatment was found to be 14.16 kg/patient/day and 3.95 kg/bed/day, which are more than tenfold higher than the average generation rate during the regular operational days of the hospital. Frequency analysis of the data revealed that the medical waste generation follows log normal distribution with correlation coefficient of 0.89. The distribution is distorted to the right and flatter than the normal distribution curve as judged by the skewness and kurtosis coefficients, respectively, which indicates deviation from normality.

Clinical profile of Alzheimer’s patients: A multihospital based study done in India

Objectives. To find out the risk factors, clinical features, co-morbid conditions and management practices among AD patients. Materials and methods. This study was conducted at three major tertiary care hospitals in Mangalore city of south India. Medical records of confirmed cases of AD over the recent 10 years were analyzed. A semi-structured proforma was used for data collection. Outcomes. Mean age of the 55 AD patients was 81.1±7.6 years. The mean age at diagnosis was 75.95±7.95 years. The age at the onset of AD in 14 (25.5%) patients was from 76 to 80 years. Early onset AD (≤ 65 years) was reported among 9 (16.4%) patients. 35 (63.6%) patients were males and 37 (67.3%) were from urban area. Family history of AD was present among 2 (3.6%) patients. History of depression and traumatic brain injury was present among 5 (9.1%) and 4 (7.3%) patients respectively. History of consumption of alcohol and smoking was present in 9 (16.4%) and 7 (12.7%) patients respectively. Clinical features such as disorientation and recent memory loss was present among 39 (70.9%) and 38 (69.1%) patients respectively. Donepezil was used for the management of AD in 44 (80%) of patients. Non-pharmacological methods like physiotherapy were recommended in 21 (38.2%) AD patients. Conclusions. Considering the varied problems faced by the Alzheimer’s affected patients in terms of co-morbidities and clinical presentation, a multidisciplinary approach for the management of AD is suggested. More non-pharmacologic methods need to be introduced at this setting.

Knowledge and Preparedness of Healthcare Providers Towards Bioterrorism

Introduction: Several emergent circumstances require healthcare providers to be able to recognize the dangerous and uncommon pathogenic agents. An in-depth literature review showed that studies about bioterrorism preparedness amongst healthcare providers from the Middle East, including Saudi Arabia, are lacking. Therefore, we conducted this study to investigate the knowledge and preparedness level of first emergency respondents towards bioterrorism events, which are the emergency department (ED) healthcare providers and the poison control center/clinical laboratory staff. Methods: A cross-sectional study was conducted between at the Emergency departments and poison control centers/clinical laboratories three in major tertiary care hospitals in Riyadh city, Saudi Arabia. The subjects were randomly selected to complete the self-administered questionnaire to collect study outcomes. Results: A total of 1030 participants were included in the final data analysis. The majority were nurses, 516 (50.1%) and doctors 351 (34.1%), and females 550 (53.6%). Overall, the findings revealed a mean knowledge score of 4.92 ± 1.86 out of 12 in the basic concepts of bioterrorism and basic clinical presentations of bioterrorism-related agents. Moreover, the findings showed a mean knowledge score of 22.80 ± 3.92 out of 38 in the bioterrorism preparedness and governing policies and procedures. Respondents who received previous training in bioterrorism preparedness had a significantly higher number of perceived benefits than those not sure and without prior training (z = -2.67, p = 0.008) and (z = - 4.4, p < 0.0001), respectively. About 79.4% of participants did not have previous training in bioterrorism preparedness, but 68.7% expressed willingness in the institution's response and control to assist in the event of a bioterrorist attack. Conclusion: Although healthcare professionals have reported their willingness to assist in bioterrorism events, they need to enhance their knowledge towards bioterrorism preparedness. Funding Statement: The study was funded by King Fahad Medical City, Riyadh, Saudi Arabia. Declaration of Interests: Authors have no conflict of interests. Ethics Approval Statement: The study was reviewed and approved by the institutional review boards at the study site. Participants’ completion of the questionnaire implied their consent to take part in the study.

Molecular Detection of common Carbapenemase Resistance Genes in nosocomial pathogens isolated from Neonatal ICU at a major tertiary care hospital in Mecca

Molecular Detection of common Carbapenemase Resistance Genes in nosocomial pathogens isolated from Neonatal ICU at a major tertiary care hospital in Mecca

Does breast reduction surgery improve health-related quality of life? A prospective cohort study in Australian women

ObjectivesTo assess the health burden of breast hypertrophy and the comparative effectiveness of breast reduction surgery in improving health-related quality of life.DesignProspective cohort study.SettingA major public tertiary care hospital in...

Initial dose of vancomycin in adult patients at a major tertiary care hospital in Saudi Arabia: A retrospective observational study

Background: Therapeutic drug monitoring is commonly performed to confirm the safe and effective use of the vancomycin; however, the facility for it is not available in many hospitals. Many clinicians use conventional fixed dose of 1000 mg every 12 h irrespective of the body weight. Aim: The aim of the study was to assess the appropriateness of vancomycin initial dose in adult patients with normal renal function. Setting and Design: This was a retrospective observational study involving medical records of patients treated with intravenous vancomycin during January 1, 2016–December 30, 2016, at a major tertiary care hospital in southern region of Saudi Arabia. Materials and Methods: The study was conducted based on electronic medical records of the patients who received intravenous vancomycin, aged ≥ 18 years, weighing more than 50 kg, and with normal renal functions during the period of the study. Chi-square tests were used for categorical variables. Multivariable logistic regressions were computed to examine the relationships between the explanatory variables and the appropriateness of vancomycin dose. Results: The study evaluated records of 456 adult patients, of which 63.8% were male. As per vancomycin dose received, 229 patients received suboptimal dosing of vancomycin when the dose was recalculated using actual body weight. The majority of the prescriptions of junior residents (68.5%) were using an optimal initial dose of vancomycin as compared to 43.6% of the senior residents or 48% of the consultants. Conclusions: A significant number of patients were receiving suboptimal initial dose of vancomycin. Junior residents were more meticulous with the initial vancomycin dosing.

The determinants of out-of-pocket health-care expenses for diabetes mellitus patients in India: An examination of a tertiary care government hospital in Delhi.

Objective:To assess the determinants of out-of-pocket (OOP) expenses on diabetes-related treatment incurred in patients attending outpatient clinics in a tertiary care hospital in Delhi, India.Study Design:A cross-sectional analysis of baseline data from a quasi-experimental study was conducted over 8 months in 2016 in a major tertiary care hospital in Delhi.Methods:The study included 375 diabetes patients up to 65 years of age on treatment for at least a year without significant complications. Data were collected through a patient interview schedule.Results:Of the previous six scheduled appointments, at least two missed appointments were seen in 267 (71.2%) patients. The average patient's OOP expenditure on diabetes-related medicines was ₹63.5 a month, a similar amount was spent on traveling to and from health facilities. Sixty-four (17.1%) patients took antidiabetic medication for <85% of the days in the previous 3 months.Conclusion:There exists a high burden of missed clinic appointments among diabetes patients in tertiary care government health settings in India. This appears to be related to the high cost in terms of both time and money involved in attending appointments for the modest benefit of a dispensation of a 15-day drug refill. Health policy measures focused on strengthening medication coverage need to explore the balance of costs and benefits when determining the frequency of clinical appointments in these settings.

Relationship of insomnia, stress, and anxiety with shift work among nurses in the Kingdom of Bahrain

Background and Aim: Insomnia, stress, and anxiety affect the mental wellbeing and distorts the work-life balance of health workers influencing their performance at work. This study aimed to assess the relationship of shift work with insomnia, anxiety, and stress among nurses in a tertiary care hospital in Bahrain. Methods: We used a cross-sectional study design. Our study population was 345 nurses in a major tertiary care hospital in Bahrain. The sample was selected based on the population probability to size method. Nurses completed a questionnaire that contained items, including sociodemographic data, Bergen’s Insomnia Scale, Perceived Stress Scale, and Shift Work Disorder scale. Results: The prevalence of insomnia was highest (85.7%) in the youngest nurses (20 to 30 years), Bahrainis (92.2%), nurses working in Surgical (85.5%) and Pediatrics (80.0%) departments, with 1 to 5 years of shift work experience (81.0%), and 1 to 3 night shifts a month (92.0%). Nurses with very high levels of stress were between the ages of 20-30 years, Bahrainis, had a B.Sc. degree, were in the Pediatrics Department, worked for 4 to 6-night shifts per month, and did not consume caffeinated drinks (p

Advance directive preferences of patients with chronic and terminal illness towards end of life decisions: a sample from Saudi Arabia.

Advance directives towards end of life decisions are seldom used among Arabs. This study aimed at investigating advance care preferences among a sample of Arab patients. This cross-sectional study was undertaken over the period March 2012-March 2013 on a sample of 300 patients with chronic illness in King Fahad National Guard Hospital, Riyadh, a major tertiary care hospital in Saudi Arabia. Mean age of patients in the study was 48.7 years (standard deviation 16.4). There were 104 patients on haemodialysis, 73 with advanced malignancy, 81 with chronic liver disease and 35 with chronic respiratory disease. More than 80% of the respondents felt that the physician should make the decision about cardiopulmonary resuscitation. Over 60% wished to remain at home when their condition deteriorated to impending death. There were no significant correlations between the patients' end of life decision preferences and religiosity, quality of life, disease duration, or other demographic characteristics. Despite a significant lack of knowledge among our participants regarding resuscitation, a majority of patients with chronic illness were willing to discuss the options and were capable of making advance directive plans regarding their health status.

480. Molecular Characterization of Multidrug-Resistant Gram-Negative Pathogens in Three Tertiary Care Hospitals in Egypt

BackgroundHigh rates of AMR among Gram-negative bacilli (GNB) have been reported from Egypt for almost 2 decades. Surveillance and identifying the genetic basis of AMR provide important information to optimize patient care. As there is no adequate data on the genetic basis of AMR in Egypt, we aimed to identify the molecular characterization of multi-drug-resistant (MDR) Gram-negative pathogens (GNP).MethodsThree major tertiary-care hospitals in Egypt participated in the “Study for Monitoring Antimicrobial Resistance Trends” (SMART) from 2014 to 2016. Consecutive GNPs were identified and their susceptibility to antimicrobials were tested. Molecular identification of ESBL, AmpC, and carbapenemase resistance genes was conducted on MDR isolates.ResultsWe enrolled 1,070 consecutive Gram-negative isolates; only one isolate per patient according to the standard protocol of (SMART). During 2014–2015, 578 GNP were studied. Enterobacteriaceae comprised 66% of the total isolates. K. pneumoniae and E. coli were the most common (29.8% and 29.4%). K. pneumoniae and E. coli were the predominant organisms in IAI (30.5% and 30.1%, respectively) and UTI (and 38.9% and 48.6%, respectively), while Acinetobacter baumannii was the most prevalent in RTI (40.2%). ESBL producers were phenotypically detected in 53% of K. pneumoniae, and 68% of E. coli. During 2016, 495 GNP were studied. ESBL continued to be high. For E. coli and K. pneunomiea, the most active antimicrobials were amikacin (≥93%), imipenem/meropenem (≥87%) and colistin (97%). Genetic study of ertapenem-resistant isolates and 50% of isolates with ESBL phenotype revealed ESβL production in more than 90% of isolates; blaCTXM-15 was detected in 71.4% and 68.5% in K. pneumoniae and E. coli, respectively, blaTEM-OSBL in 48.5% and47.5% of K. pneumoniae and E. coli, respectively. Carbapenem resistance genes were detected in 45.4% of isolates. In K. pneumoniae, OXA-48 dominated (40.6%), followed by NDM1 (23.7%) and OXA-232 (4.5%).ConclusionOur study detected alarming rates of resistance and identified many resistance mechanisms in clinical isolates from Egyptian hospitals. These high rates highlight the importance of continuous monitoring of the resistance trend and discovering the novel resistant mechanisms of resistance, and the underscores a national antimicrobial stewardship plan in Egypt.Disclosures All authors: No reported disclosures.

“The incidence of ICU-associated pneumonia in patients admitted to ICU of major tertiary care hospitals”

Background: Despite in techniques advancement to patient care for respiratory tracts are instrumented may complicate the IAP course up to 50% in patients with mechanical ventilation. It requires rapid diagnoses and treatment that is appropriate as per patient condition. Many studies revealed negative impact with delayed administration and antibiotic treatment in IAP patients may increase the hospital mortality and morbidity. The primary objective of the study was to estimate the incidence of IAP in the patient admitted in ICU of tertiary care hospitals in Rawalpindi Pakistan. Study Design: Observational cross sectional study. Setting: ICU units of various tertiary care hospitals in Rawalpindi, Pakistan. Period: One year from Dec 2016-Dec 2017. Materials and Methods: A total 450 subjects were enlisted for the study; these patients were selected randomly. The exclusion criteria include all patients with Acute Respiratory Distress Syndrome (ARDS) or those on long-term antibiotic or steroid therapy and all the pregnant women whereas all the patients of both sexes, kept on ventilator for more than 48 h and above the age of 18 years were included in this study. Results: We enrolled a total of 450 patients for this study. The average age of all the participants was 61.51 + 12.8 with range 36-91. 230(51.1%) of the patients were male whereas 220(48.9%) were females. The Trauma-Pulm contusion was absent in all patients. In ICU 150 (33.3%) were diagnosed with COPD, 150(33.3%) with Asthma, 220(48.9%) with ARDS, 10 (2.2%) with head trauma and 310 (68.8%) with diabetes.200 (44.4%) smokers, 40(8.8%) were having lung cancer, 310(68.8%) were hypertensive and 20 (4.4%) were with Pneumothorax - requiring Chest Tube. Conclusion: We may conclude from our study that ICU associated Pneumonia is a serious issue, that developed with longer hospital stay, duration of mechanical ventilation and re-intubation. By reducing the mechanical ventilation duration, pneumonia can be controlled.

Assessment of Oral Chemotherapeutic Agents Safe Handling Among Healthcare Professionals in Saudi Arabia

Introduction: Traditionally, chemotherapeutic agents are administered as an intravenous infusion. Over the past decade, oral chemotherapy drugs are used increasingly as a treatment modality. The risk of harm and toxicities of oral chemotherapy compared to intravenous dosage form are the same. Application of best practice to ensure safe storage, handling, administration and disposal of oral chemotherapeutic agents is necessary to prevent exposure of the environment, healthcare professionals, patients, family members and caretakers to hazardous substances. Objectives: The objectives of this study are to assess the knowledge of pharmacy staff and oncology nurses about safe handling of oral chemotherapy and to establish recommendations based on study results. Materials and methods: A descriptive survey design was developed. Data was collected through a structured questionnaire consisting of 5 sections (demographic data, storage, handling, disposal &amp; cleaning of contaminated materials and training &amp; education). Data was analyzed using IBM SPSS Statistics for Windows, version 17. Results: We collected 1000 surveys from four major tertiary care hospitals in Riyadh, Saudi Arabia. Most of the surveys were completed by pharmacists (52.6%), pharmacy technicians (26.7%) and oncology nurses (20.7%). The majority of participants had 2-5 years of experience (36.8%). Females composed 58.9% of the study population with five hundred eighty nine participants. Most of participants were working in the inpatient pharmacy (42%). Separating oral anticancer agents (OACAs) from non chemotherapeutic agents was acknowledged by 93.8%. On the other hand, only 16.8% of the participants reported that OACAs should not be stored in alphabetical order with other non chemotherapeutic drugs. Less than half of the participants (42.9%) confirmed the equal risk of harm of OACAs versus intravenous form of chemotherapy. Conclusions: Our results demonstrated lack of knowledge among pharmacists, pharmacy technicians and oncology nurses regarding the risk of harm related to OACAs versus intravenous form of chemotherapy. Therefore, we recommend further education, awareness, development, and implementation of best practice guidelines about oral chemotherapy drugs safe handling in order to prevent any harmful effects to healthcare professionals and caregivers dealing with chemotherapy.

Assessing Pressure Ulcer Knowledge of General and Orthopedic Surgical Residents Using the Pieper Pressure Ulcer Knowledge Test

Objective To determine the knowledge of postgraduate and non-postgraduate general and orthopedic surgical residents regarding pressure ulcer (PU) prevention, staging and wound description. Study Design Cross sectional, descriptive survey. Place and Duration of Study Six major tertiary care hospitals in India, from Sep-2018 to Nov-2018. Methodology All consenting postgraduate and non-postgraduate general and orthopedic surgical residents were included in the study using convenience sampling. An adapted version of Pressure Ulcer Knowledge Test (PUKT) comprising of 47-true/false items was used as a research tool. For every correct response, 1 point was awarded. Whereas, an incorrect or NK response was scored as 0. All the data was entered and analyzed using SPSS version 21. Results A total of 126 trainees comprising 120 (95.23%) males and 6 (4.76%) females participated in the study. The average PUKT score obtained by the surgical residents was 30.2+3.7 (65.65%), thus indicating a “low” level of knowledge. Conclusion The current levels of knowledge regarding PU prevention among the surgical residents in our study was “low”. The authors recommend continuous education for PU prevention in a hospital care setting.

Trend in the use of neo-adjuvant chemotherapy for the management of muscle invasive bladder cancer at a major tertiary care hospital in Pakistan.

e16033 Background: Although the use of Neoadjuvant Chemotherapy (NAC) has now become the standard of care for Muscle Invasive Bladder Cancer (MIBC) in the world, most patients in lower- middle-income countries (LMIC), like Pakistan, are still undergoing upfront surgery despite being ideal candidates for chemotherapy. Multi-disciplinary tumor boards have been critical in the change of this trend in the developed world. We aimed to assess the trends in the use of NAC for patients with muscle invasive bladder cancer before undergoing definitive surgery. Methods: We included patients who underwent surgery for ≥ cT2 MIBC without distant metastasis between 2011 and 2015 at a tertiary care hospital in Karachi, Pakistan. We retrospectively assessed the trends in NAC compared to upfront surgery in these patients. Results: Among the 171 patients included in our study, only 4 (2.34%) received NAC, whereas the other 167 (97.67%) underwent upfront surgery without NAC. Out of the 90 patients who underwent surgery for MIBC between 2011 and 2013, none of them received NAC and underwent upfront surgery. Among the 81 patients with MIBC in 2014 and 2015, 4 patients received NAC before surgery whereas the other 77 underwent upfront surgery. Conclusions: The adoption of NAC for MIBC remains a challenge in lower- middle-income countries such as Pakistan. Introduction of a multidisciplinary tumor board in our hospital since 2014 has shown a slight change in this trend. Better communication between different departments remains the key in significantly changing the trend of a much desired standard of care.

ANTIMICROBIAL RESISTANCE: UNIVERSAL EMERGENCY

Antimicrobial resistance (AMR) is a growing public health threat. Resistant microorganisms (i.e. bacteria, viruses and some parasites) through genetic mutations become too strong that they become resistant to the antimicrobials (i.e. antibiotics, antivirals and antimalarial) over the period.1 These microorganisms are present in our environment, spreading from one person to another and from animals to human beings.2 While a considerable burden of AMR is suspected, it is difficult to quantify mortality, disease load and economic loss related to AMR due to the absence of data in Southeast Asia.3 AMR causes prolonged illness, surplus tests, consumption of expensive drugs, intensive care, compromised surgeries, chemotherapy, disability and death. AMR can jeopardize the achievements of the Sustainable Development Goals (SDGs). Resistance is emerging and spreading globally. Many patients with Klebsiella pneumoniae had developed resistance against Carbapenem (last choice for the treatment of gram-negative bacteria) in all regions of the world. Patients with urinary tract infections caused by Escherichia coli are now resistant to fluoroquinolone. In at least 10 developed countries of the world, third generation Cephalosporins are ineffective against the treatment of gonorrhea. World Health Organization (WHO) does not recommend quinolones for the treatment of gonorrhea anymore and has updated treatment guidelines for chlamydial and syphilis infections. Staphylococcus aureus patients are resistant to first-line drug i.e. methicillin. Resistance to colistin, the last remedy for Enterobacteriaceae, has been detected. Alarmingly, extensively drug-resistant tuberculosis (XDR-TB) and multidrug-resistant tuberculosis (MDR-TB) are types of tuberculosis resistant to no less than four and two of the key anti-tuberculous drugs respectively have emerged. XDR-TB has been identified in 105 countries.4 About 480,000 new cases of MDR-TB have been estimated by WHO during 2014. In 2016, around 490,000 people developed MDR-TB worldwide. Five countries of the Greater Mekong are now resistant to the artemisinin-based combination therapies considered as first-line treatment for Plasmodium falciparum malaria since 2016. All Anti-Malarial treatment options for Plasmodium falciparum are now ineffective along the Cambodia-Thailand border. About 7% of patients in developing countries and 10-20% of patients from developed countries were estimated to have human immunodeficiency virus (HIV) resistant to antiretroviral therapy (ART) in 2010. Antiviral drugs i.e. matrix-2 (M2) inhibitors (Amantadine & Rimantadine) are now ineffective to treat the Influenza A virus. Outbreaks of multidrug resistance Typhoid and sporadic cases of infection with Ceftriaxone-resistant Salmonella typhi have been reported in several countries of the world. Recently Pakistan's first extensively drug-resistant (XDR) Salmonella typhi outbreak (resistant to all antibiotics for Typhoid) has created an emergency in the country. The ongoing outbreak had emerged in the district Hyderabad of Pakistan.5 In May 2018, the official case definitions were agreed by the Regional Disease Surveillance and Response Unit (RDSRU) in Karachi. Out of the 8,188 Typhoid cases, 5,274 cases of XDR were reported till December 2018. Among them 69% of the cases were reported from Karachi, 27% from Hyderabad and 4% from other districts of the Sindh province. Currently, Salmonella typhi in circulation is resistant to first, second as well as third generation Cephalosporins. Currently, azithromycin is the only remaining reliable and cost-effective first-line oral therapy to manage patients with XDR Typhoid in low-resource settings.The risk of XDR Salmonella typhi at the national level is considered high in Pakistan due to insufficient unsafe water supply systems, poor sanitation and hygiene (WASH) practices, poor infection control mechanisms, inappropriate food-handling, low vaccination coverage and limited surveillance of Typhoid fever. At the same time antibiotics are not being prescribed properly to the humans as well as animal sector. Furthermore, AMR confirmatory tests are available only at major laboratories and tertiary care hospitals. All these factors have reduced the ability to track the occurrence, spread and containment of XDR Salmonella typhi in Pakistan. Access to safe water, adequate sanitation, hospital sanitation and cleanliness, hygiene among food handlers, advocacy, social mobilization, sensitization of general practitioners/clinicians, Typhoid conjugate vaccination and development of new antibiotics are the most important recommendations for prevention of the AMR concerning XDR Salmonella Typhi in Pakistan.6-7 Besides, strengthening the surveillance to monitor known resistance, detect new and emerging trends is the need of the hour.

Vitamin D status, determinants and relationship with biochemical profile in women with Type 2 Diabetes Mellitus in Delhi, India

ObjectiveTo determine the burden of vitamin D deficiency and its determinants and to assess the relationship of 25 hydroxycholecalciferol (25-OHD) levels with biochemical parameters linked to health outcomes in women with Type 2 Diabetes Mellitus (T2DM). Material and methodsThis was a hospital based cross-sectional study in the diabetes out-patient department clinic of a major tertiary care hospital in Delhi, India. Adult women with T2DM on treatment for at least 6 months were included in this study. The women who have been given Vitamin D supplementation during the past 6 months were excluded. We assessed Serum 25-OHD, HbA1c, lipid profile and fasting plasma glucose in the patients through standardized laboratory methods. ResultsOne hundred women with T2DM were enrolled of which 22 (22%) had good glycemic control (HbA1c < 7%). Vitamin D deficiency was seen among 77 (77%) and insufficiency among 16 (16%) of the recruited subjects. Younger age group (31–45 years) and illiteracy was significantly associated with vitamin D deficiency (p < 0.05). No association was found between Vitamin D deficiency and HbA1c levels. ConclusionVitamin D deficiency is highly prevalent among women with T2DM. Illiteracy and young age were major determinants of vitamin D deficiency indicating they need special attention and Vitamin D supplementation.

Frequency, Awareness, and Symptoms of Chikungunya Among Patients in a Tertiary Care Hospital of Karachi: A Cross-Sectional Study.

Background Chikungunya fever (CHIKF) is an infectious illness spread by the bite of mosquitoes and caused by an arbovirus known as Chikungunya virus (CHIKV). This disease has become an epidemic in Karachi and various other cities of Pakistan, affecting a large population, especially those from poor, socioeconomically underdeveloped areas. It is proving to be a severe and alarming cause of debility due to its prolonged detrimental effects on the joints. A significant number of cases are reported daily in different hospitals of Karachi, with Civil Hospital being one of the major tertiary care hospitals. The aim of this study is to determine the frequency and symptoms of chikungunya as well as to assess the participants’ awareness about the spread and preventive measures of this disease.MethodsThis is a cross-sectional study that was carried out in Civil Hospital Karachi by approaching patients in the out-patient department (OPD) and the emergency department with complaints of fever and joint pain. All the data was collected via a pre-coded questionnaire during May-June 2017 by taking prior informed verbal consent and were analyzed through Statistical Package for the Social Sciences (SPSS) version 22 software.ResultsThe age group most affected by this disease was the 21-30 years range, which represented almost a quarter of the cases (n=83, 32.17%). Majority of the respondents (n=214, 82.95%) had heard of the disease, mainly due to their own prior experience with it (n=100, 38.76%). Lethargy (n=219, 84.88%), difficulty in walking (n=213, 82.56%), and headache (n=209, 81.01%) were the major symptoms reported apart from fever (n=258, 100.00%) and arthralgia (n=258, 100.00%).ConclusionCHIKF is proving to be a great threat to people as it impairs their quality of life to a great extent. The recent outbreak of chikungunya has victimized a considerable population of Karachi. This study mainly assessed the severity of the disease and its symptoms as well as the lack of awareness among patients. Proper and effective preventive measures can further help to eradicate this disease on a large scale and prevent future epidemics.

Intra-operative tachycardia is not associated with a composite of myocardial injury and mortality after noncardiac surgery: A retrospective cohort analysis.

Myocardial injury after noncardiac surgery (MINS) is a major contributor to peri-operative morbidity and mortality with a reported incidence of about 8%. Tachycardia increases myocardial oxygen demand, and decreases oxygen supply, and is therefore a potential cause of MINS. We tested the hypothesis that there is an association between intra-operative area above a heart rate (HR) of 90 bpm and a composite of MINS and in-hospital all-cause mortality. Retrospective analyses. Major tertiary care hospital, Cleveland, USA. Adults having elective or nonelective noncardiac surgery and scheduled troponin monitoring during the first 3 postoperative days between 2010 and 2015. All-or-none composite of myocardial injury (MINS), defined by a peak postoperative generation 4 troponin T concentration at least 0.03 ng ml, and in-hospital all-cause mortality. Among 2652 eligible patients, 123 (4.6%) experienced MINS within 7 days after surgery and 6 (0.2%) died before discharge. Intra-operative area above HR more than 90 bpm was not associated with the all-or-none composite of MINS and in-hospital mortality, with an estimated odds ratio (95% confidence interval) of 0.99 (0.97 to 1.01) per 1 h bpm increase in area above HR more than 90 bpm. Secondary outcomes were also unrelated to the composite, with estimated odds ratios (98.3% confidence interval) of 0.99 (0.98 to 1.00) for area above HR more than 80, 0.98 (0.92 to 1.04) for area above HR more than 100 bpm, and 0.96 (0.88 to 1.05) for maximum HR. There was no apparent association between various measures of tachycardia and a composite of MINS and death, a result that contradicts previously reported associations between other measures of intra-operative tachycardia and MINS/mortality.

Early Occurrence Cases of Diabetes Mellitus: Clinical Picture in Two Major Tertiary Care Hospitals in India.

Type 1 diabetes mellitus (T1D) is one of the most common endocrine diseases in childhood. However, very limited information is available on this disease. This study was done to assess risk factors, clinical features and management practices in T1D patients. A review of records of 39 T1D cases admitted over the past five years in two hospitals was done. The mean age at diagnosis among males (n=21) was 19.9±10.3 years and among females (n=18) was 12.3±7.5 years (t=2.614, p=0.013). Mean age at diagnosis of patients who were underweight (n=7) was 9.9±4.4 years, compared to 17.8±10.1 years among patients (n=32) with normal or overweight status (t=2.028, p=0.05). The family history of T1D was present among 7(18.0%) cases. The most common symptoms among the cases were fatigue 22(56.4%), polyuria 19(48.7%) and polydipsia 18(46.1%). The most common sign was weight loss 27(69.2%). The most common complications were diabetic nephropathy and skin infections seen each among 10(25.6%) cases. Mean duration of T1D was significantly more among patients with diabetic nephropathy (p<0.001), compared to those without. Mean HbA1c value among patients was 12.9±2.7. It was significantly more among patients with Diabetic Ketoacidosis (DKA) (p=0.012). A short-acting insulin was used in the management of T1D among 59.5% cases. The outcome of the management showed a loss of one patient who developed DKA. Routine growth monitoring and blood glucose analysis is required among T1D cases. The present study provides a database of risk factors, clinical features, and management practices among patients with T1D in this region and addresses several issues important to both patients and their care providers.

Non-communicable disease pattern in adults seeking preventive general health checkup

Non Communicable diseases (NCDs) are now endemic in low and middle income countries. Nepal had a high burden of communicable diseases (CDs) which has now been overtaken by NCDs. Although prevention and control of NCDs is prioritized in national policies and strategies, there is no proper monitoring system. This study aims to review the morbidity pattern among the adults seeking preventive general health checkup in a major tertiary care hospital in Kathmandu. 3000 cases were evaluated. 53.6% were males and 46.4% were females. The mean age of cases was 44.9 yrs. Most of the cases ranged from 40 to 60 years of age. Almost half of them were from Kathmandu district. Nearly 78% participants live a sedentary life. Abdominal obesity was seen in 27.5% of females and 21.7% of males. Nearly 49% of cases were overweight and 24% were obese. Almost 21 % of the cases were smokers and about 36% of them consumed alcohol. Only 9% are vegetarians. 10% have diabetes and 20% have hypertension. 69% of females and 43% of males have less than normal bone mineral density.&#x0D; The government and private sectors must focus on strengthening preventive and curative services for early detection of risk factors and management of NCDs.