Nishtar Hospital Research Articles

Functional Outcome of Posterior Transpedicular Screw Fixation among Patients Presenting with Spinal Tuberculosis

Material and Methods; A series of descriptive case was completed at Neurosurgery Department Nishtar Hospital Multan. The time period for this study was from November 2014- September 2016. After registering the patients, under the supervision of an expert neurosurgeon results of all the clinical examinations, and medical history were recorded. The medical record reported forty-one consecutive patients were treated with one-stage posterior debridement, transpedicular fixation suffering from monosegmental lumbar spinal tuberculosis, between December 2014-August 2016, were prospectively analyzed. Results; Forty one patients were observed for this procedure 25 (61%) were male patients and 16 (39%) of the patients were female with their mean age was 29.58 years ±2 years. The average time between follow-ups was 13.6 ±2.7 months. The average pain score preoperatively was 9.2 ± 2.13 on the VAS scale and postoperatively was 2.5 ± 1.32. This decrease in back pain was statistically significant (0.05142, P > 0.05) and Complication rate was 7.31 % in these patients Conclusion; Our results support one stage posterior fixation procedure with pedicle screw in adults with lumbar spinal tuberculosis as it is safe, effective and yields desired functional outcome. Keywords; Spinal Tuberculosis, Transpedicular screw fixation, posterior debridement.

Different Patterns of Ocular Trauma Presentation in Nishtar Hospital Multan

Objective: The objective of this study was to determine the frequency of ocular trauma among gender and different age groups. And to determine various causative factors and the impact of trauma on ocular structures and visual acuity. Methods: This cross-sectional study was carried out in Ophthalmology department of Nishtar Medical University and Hospital, Multan, Pakistan from May 2021 to August 2021. Data were collected from 142 patients. A questionnaire was devised. Data were analyzed using SPSS V26. Results: Out of 142 patients that were admitted in Ophthalmology ward, 36 (25.40%) were female patients and 106 (74.60%) were male patients with mean age of 15.9 years with standard deviation of 14.5. There was no statistically significant difference between male and female patients (p value=0.2). Cornea was most commonly injured structure and mechanical factors were the most common cause of ocular trauma. Out of 142 patients, 4 (2.80%) got just medical management and 138 (97.20%) patients required surgical intervention while they were also given topical and oral antibiotics and anti-inflammatory drugs. Conclusion: Ocular Trauma is most prevalent among children. Males were affected more than females. The cornea was the most commonly affected structure. Ocular Trauma is one of the leading causes of monocular blindness. Most of the ocular traumas were due to some mechanical factors. Keywords: Ocular Trauma, Multan, Nishtar Hospital, South Punjab

Effectiveness of Ultrasound Guided Trans-versus Abdominis Plane (TAP) Block with Landmark Technique Guided TAP Block for Open Appendectomy

Objective: To compare the analgesic efficacy of ultrasound (US) guided TAP block with landmark technique guided TAP block for management of post-op pain after open appendectomy in patients of acute appendicitis. Methods: In this study, we include 80 patients of acute appendicitis who were planned for open appendectomy were included. The study was conducted from June-2021 to Jan-2022 in Nishtar Hospital Multan. In Landmark TAP group; TAP block was given using bupivacaine (0.25%) after completion of surgical procedure using blind landmark technique. In US TAP group; TAP block was administered under US supervision. VAS Score and time of first rescue analgesia were main study outcomes. Results: Mean age was 33.5±9.9 years in landmark TAP group and 32.8±10.4 years in US TAP group (p-value 0.75). There was no significant difference in mean VAS score at 1, 6, 12 and 18 hours after surgery between the groups, However, after 24 hours of surgery mean VAS score was higher in landmark TAP group; 3.5±1.2 versus 2.9±1.0 in TAP group (p-value 0.02). Time of first rescue analgesia was significantly prolonged in US TAP group; 1320.7±275.9 minutes versus 1180.4±320.7 minutes in landmark TAP group (p-value 0.04). Conclusion: Ultrasound guided TAP block is superior to landmark guided TAP block, as it provides better analgesic outcomes in comparison of landmark guided TAP block. Keywords: Ultrasonography, landmark technique, transversus abdominus plane block.

Managing Mental Health Problems and Quality of Life among Dialysis Patients through Stress Management Intervention

Objective. Chronic diseases and psychological disorders have privileged co morbidity with each other; dialysis patients are also at high risk of internalizing problems. This study investigated the effectiveness of stress management techniques in controlling internalizing problems and kidney disease related quality of life of the dialysis patientsMethod. This study was completed using repeated measure research design with 20 diagnosed kidney patients found high on mental health problems who were randomly selected from initially approached sample of 100 registered patients in Nishtar Hospital Multan. 20 participants were then randomly assigned to intervention and control group equally. Stress management techniques were administered to intervention group only. Pre and post data were obtained on Kidney Disease Related Quality of Life Scale (Hays et al., 1994) and Depression, Anxiety, Stress Scale (Lovibond & Lovibond, 1995). This study was conducted during 2016-2017.Results. Significant differences were found in pre and post-scores on kidney disease quality of life, depression,anxiety and stress for intervention group (t = 5.03, < .001 and t = 8.12, 1.42,3.02 at <0.01 respectively) while insignificant findings were found for control group. It implies that patients after receiving stress management intervention (Meichenbaum, 1993) reported an increase in quality of life and decrease in their symptoms of depression, anxiety, and stress.Conclusion. Stress management techniques have been found effective in improving kidney related quality of life and lowering depression, anxiety, and stress of kidney patients.Implications. The findings of present study are useful for the physicians and family members of kidney patients. Stress management techniques if are employed by kidney patients' professionals in particular and their family members in general can extend the quality of life and let down the depression, anxiety, and stress. Seminars and workshop should be conducted for the awareness of these internalizing problems and importance of stress management.

Comparison of PAP smear and liquid based cytology as a screening method for cervical carcinoma.

Objectives:To compare conventional PAP smear (CPS) and liquid-based cytology (LBC) for cervical carcinoma screening at a tertiary care hospital of South Punjab, Pakistan.Methods:This cross-sectional study was conducted at the Department of Obstetrics and Gynecology, Nishtar Hospital, Multan, Pakistan from January 2021 to June 2021. We included a total of 265 women aged between 20 to 65 years who, presented with complaints related to cervical lesion and unhealthy cervix. The CPS and LBC methods were applied for screening of cervical carcinoma. Findings of both CPS and LBC were compared with histopathological findings to find out sensitivity, specificity, positive predictive value and negative predictive value for both techniques.Results:In a total of 265 women, mean age was noted to be 45.4±6.8 years. White discharge per vagina was the commonest presenting complaint noted in 12 (46.8%) patients. Satisfactory smears were found in significantly more cases with LBC in comparison to CPS (p<0.001). Sensitivity CPS and LBC for the detection of low-grade squamous intraepithelial lesion (LSIL) were found to be 71.8% and 87.2% while for high-grade squamous intraepithelial lesion (HSIL), sensitivity of CPS and LBC were 61.9% and 76.2% respectively. Specificity of CPS and LBC for the detection of LSIL was found to be 97.9% and 98.7% while for HSIL, specificity of CPS and LBC was 98.7% and 99.2% respectively.Conclusion:In comparison to conventional CPS, LBC was found to be better in terms of adequacy of smear and identification of LSIL and HSIL.

Feasibility of Local Anaesthesia in Various Upper Abdominal Surgical Procedures; A Tertiary Care Hospital Study

Background: This study was conducted to evaluate the feasibility of local anesthesia (LA) instead of general anesthesia (GA) in upper gastrointestinal abdominal procedures including open gastrostomy, gastrojejunostomy, gastroduodenal disjunction, jejunostomy and traction esophageal stenting. Materials and Methods: This study was conducted at Thoracic surgery department, Nishtar Hospital Multan, Pakistan from September,1st-December,31st,2020. Out of 147 patients 80 and 67 patients were operated under LA and GA respectively. Age, BMI, gender, procedure performed, etiology, mean time, stay in recovery, PONV, postoperative pain at 4, 8, 12 hours, postoperative sedation and discomfort, within 3-and 7-days postoperative mortality were documented and compared between the two groups. Results: Mean age of the patients in group LA was significantly higher as compared to group GA(p&lt;0.001). Procedure time was 30.06±12.01minutes and 34.42±11.76minutes (p=0.029), mean duration of stay in recovery was 2.31±5.68minutes and 18.80±6.40minutes(p&lt;0.001) in group LA and GA, respectively(p=0.029). Postoperative discomfort was also higher in group GA as compared to group LA(p=0.001). The incidence of PONV was 12.5% and 35.8% in group LA and GA, respectively(p=0.001). Complaint of postoperative pain was 16.2% and 37.3% at 4 hours(p=0.004); 18.8% and 35.8% at 8 hours(p=0.020); and 21.2% and 26.9% at 12 hours(p=0.426) in group LA and GA, respectively. Conclusion: For performing various upper abdominal procedures, LA is safe for the patients who are medically unfit for GA. Moreover, LA is associated with lesser adverse effects as compared to GA. Patient is more comfortable and there is better pain relief in early postoperative period.

Intravenous Tranexamic acid versus placebo during Caesarian section: A comparative study.

Objectives:To evaluate the effectiveness of Tranexamic Acid in preventing postpartum hemorrhage against placebo in high-risk women undergoing cesarean section.Methods:A double-blinded placebo-controlled comparative trial was conducted at the Obstetrics and Gynecology Department of Nishtar Hospital for one year, from 15th June 2020 to 15th June 2021. A total of 60 women who were at high risk of postpartum hemorrhage and had to undergo elective cesarean sections were included in the study. Among them, initial 30 patients were administered Tranexamic Acid before skin incision whereas later 30 were treated as the placebo group. These women were then observed for blood loss during surgery and within 24 hrs. after surgery and any postoperative complications such as thromboembolic events, the need for additional uterotonic agents, and blood transfusions.Results:Out of 60 women, 30 were placed in each group. The groups had no significant difference in terms of baseline data and post-partum hemorrhage-associated risk factors (p>0.05). However, the occurrence rate of primary post-partum hemorrhage (blood loss greater than 1000 ml) was significantly less in a tranexamic acid group than the placebo group (16.6% vs 60%, respectively, p<0.01). Similarly, the requirement of additional uterotonic agents (13.3% vs 43.3%, respectively) and the need for blood transfusion (6.0% vs 23.3%, respectively) was lower in a tranexamic group than in the placebo group.Conclusion:The study highlighted the significance of tranexamic acid in controlling post-partum hemorrhages, the requirement of additional uterotonic agents, improving post-partum hemoglobin, and the need for blood transfusion.

Prevalence and Antibiotic Sensitivity pattern of Bacterial Isolates from Catheterized UTI Patients: A Local Study

Prevalence and multidrug resistance among bacteria in catheter-associated urinary tract infections (CAUTIs) has been on the rise in recent times. Hence, the prevalence rate and antibacterial susceptibility of bacteria in CAUTIs in ICU patients was evaluated. A total of 120 patients admitted to the ICU of Nishtar Hospital, Multan, were recruited for this study. Both gram-positive and gram-negative bacterial isolates were characterized based on biochemical tests including catalase test, oxidase test, indole test, TSI test, citrate test, coagulase test and growth on 6.5% NaCl agar. The prevalence of bacterial species was Escherichia coli (32%), Staphylococcus aureus (26%), Pseudomonas spp. (18%), Proteus spp. (14%) and Enterococcus spp. (2%). A considerable degree of resistance against commonly prescribed antibiotics was observed. Gram negative bacteria showed resistance to ciprofloxacin, piperacillin-tazobactam and amikacin as well as susceptibility to imipenem, tigecycline and polymixin. Gram positive bacteria showed resistance to antibiotics such as piperacillin-tazobactam, ampicillin, gentamicin, oxacillin and ceftazidime suggesting the ineffectiveness of these antibiotics for treating bacterial infections among CAUTI patients and demonstrating the latest trends in antimicrobial drug resistance profile in local population.

DEMOGRAPHIC DIFFERENCES ON CAREGIVER BURDEN, PSYCHOLOGICAL DISTRESS AND HOPELESSNESS AMONG CAREGIVERS OF PSYCHIATRIC PATIENTS

OBJECTIVE: To explore the demographic differences on caregiver burden, hopelessness, and psychological distress among caregivers of psychiatric patients. METHODS: This descriptive cross-sectional study was conducted in Pakistan Institute of Medical Sciences Islamabad and Nishtar Hospital Multan, Pakistan in eight months from 10th April 2019 to 20th November 2019. Purposive sampling technique was used to include 240 caregivers of different age of Psychiatric patients (with different duration of illness and type of illness) which were assessed on Burden Scale for Family Caregivers, Kessler Psychological Distress Scale and Beck Hopelessness Scale. RESULTS: Out of 240 participants, 124 (51.6%) were females and 116 (48.3%) were males, ranging in age from 18 to 45 years. Results disclosed that age group 36-45 years showed significant mean difference on psychological distress and age group 18-35 years showed significant difference on hopelessness at p&lt;0.01. While, caregivers dealing with patients who have illness for more than 20 years have significant mean difference on psychological distress and hopelessness at p&lt;0.05. Caregivers dealing with patients who have less than 5 years of illness have significant mean difference on caregiver burden at p&lt;0.001, and caregivers of patients with schizophrenia have significant mean difference with substance abuse, mood disorder and mental retardation on psychological distress and hopelessness at p&lt;0.05. CONCLUSION: Older adults have higher psychological distress while, young adults have higher level of hopelessness. Caregivers of prolonged mental illness have higher psychological distress and caregiver burden. Caregivers of schizophrenic patients have higher level of psychological distress and hopelessness.

Role of l-arginine in the prevention of pre eclampsia in high-risk pregnancies.

Objective: To compare the efficacy of L-Arginine versus placebo in the prevention of pre eclampsia in high-risk pregnancies. Study Design: Randomized Control Trial. Setting: Department of Obstetrics and Gynecology, Nishtar Hospital Multan. Period: November 2019 to February 2019. Material &amp; Methods: A total of 130 women were included in the study. 65 patients were in L-arginine group or Group A while 65 patients were in placebo group or Group B. In group A, women were prescribed L-arginine 300 grams (Amino Whey Sachet) once a day until delivery and in group B; women were given homologated placebo (starch) once a day until delivery. Efficacy (no preeclampsia occurs during pregnancy) was noted from both groups and recorded. Mean ±SD was presented for quantitative variables like age, gestational age, parity, duration of chronic hypertension, weight, height and BMI. Variables such as age, parity, hypertension, body mass index, gestational age and duration of hypertension were stratified to assess their effect on efficacy. Chi square test was used to make comparison of the efficacy in both groups as well as for post-stratification for both groups. A p value of less than or equal to 0.05 was taken as significant. Results: In L-arginine group efficacy was 92.3% as compared to 69.2% in placebo group (p&lt; 0.000) Table-IV. Conclusion: It can be concluded that L-arginine when given orally at the dose of 300g daily has a considerable role in prevention of pre-eclampsia in pregnant patients with high risk and also has a role in reduction of severity of pre-eclampsia.

Relationship between Uncertainty Tolerance and Acceptance in Postoperative Patients with Cervical Cancer

Background and Objectives: The main objective of the study is to explore the relationship between uncertainty tolerance and positive acceptance of post-surgical patients with cervical cancer and provide reference opinions for gynecological nurses to carry out targeted health education for patients.&#x0D; Methods: This cross sectional study was conducted in Nishtar Hospital Multan with the collaboration of BVH and Avicenna Hospital, Lahore during March 2021 to September 2021. The "Uncertainty Tolerance Scale" and "Positive Acceptance Scale" were used to investigate 233 post-operative patients of cervical cancer.&#x0D; Results: The uncertainty tolerance and acceptance aggressiveness scores were 3.74±0.34 and 1.96±0.20, respectively, with a significant correlation coefficient between uncertainty tolerance and acceptance aggressiveness (r= -0.516, P&lt;0.05).&#x0D; Conclusion: It is concluded that the uncertainty tolerance and positive acceptance levels of patients after cervical cancer surgery were low and were negatively correlated with each other. The gynecological nurses should consider the patients' uncertainty tolerance post-surgery and develop tailored health education and intervention programs to improve the positive acceptance level of post-surgical patients with cervical cancer.

To Determine the Frequency of Necrotizing Enterocolitis in Preterm Infants

Aim: To determine the frequency of necrotizing enterocolitis in preterm infants Place and duration of study: It is a descriptive cross-sectional study in Pediatric Medicine Department, Nishtar Hospital Multan from March, 2021 to August, 2021 Methodology: The preterm neonates were called for follow up every week for 4 weeks to diagnose Necrotizing enterocolitis. Results; Out of 174 cases, 101 (58%) were males while 73 (42%) were females. Necrotizing enterocolitis (NEC) was noted in 61 (35.1%) while NEC in breastfeeding infants was 14/74 (18.9%) and in formula feeding infants NEC was 47/100 (47%). Conclusion; High frequency of necrotizing enterocolitis was observed in this study among formula fed preterm infants as compared to breastfed preterm infants. Keywords; Breastfeeding, formula feeding, Necrotizing enterocolitis

Relationship of Psychological well-being with Depression and Anxiety among Heart Patients

The study was designed to investigate the relationship of psychological well-being with depression and anxiety among heart patients.1 For this purpose, a sample of 200 patients was taken, including 100 men and 100 women, educated uneducated, employed and unemployed volunteers. The sample was taken from Nishtar Hospital, Combined military hospital and other private hospitals in Multan. The age range from 25 to 60 (mean age 43.085).2,3 Objective: To observe the effect of demographic variables (age, education, gender and source of finance) on psychological well-being and depression, anxiety in heart patients. Methods: 1. Low psychological well-being would be positively correlated with depression and anxiety. 2. Older age (above 50) heart patients would have low sense of psychological well-being as compared to younger age (above 35) heart patients. Results: Different statistical procedures were used to determine the relationship of psychological well-being with depression and anxiety among heart patients. Correlation was computed to see the relationship among variables. It was found that there is negative correlation between psychological well-being with depression and anxiety. Since the p-value in less than α (p-value &lt; 0.01), so we reject null hypothesis Ho, and conclude that low psychological well-being is positively correlated with depression and anxiety. Conclusion: This study also finds out important findings on the role of stresses, feeling of worthlessness in depression and anxiety disorder. It is concluded that psychological well-being, depression and anxiety are not significant correlated with each other. Source of income or job and sex of the heart patients have significant effect on psychological well being. However there is no significant difference between men and women regarding the rate of depression and anxiety. Keywords: P-Value, Correlation, Null Hypothesis , Depression

Three year experience of Upper Gastrointestinal Endoscopic procedures at a tertiary care hospital of South Punjab

Introduction: Endoscopy has become a necessity in diagnosing gastrointestinal (GI) disorders. The objective of our study was to evaluate the different indications and findings of upper GI endoscopy. Methods: This retrospective analysis was undertaken at department of Gastroenterology, Nishtar Hospital Multan. Records of all upper GI endoscopic procedures from 1st January 2018 till 31st December 2020 were evaluated. Results: A total 3299 upper GI endoscopic procedures were perfumed during the three-year time period. Mean age was 47 years. Majority of patients were males. Almost 48% of patients belonged to the middle-aged group. The most common indication was upper GI bleeding (57%), followed by dyspepsia (15%). The most common finding was esophageal varices (43%), followed by portal gastropathy (26%) and gastritis (16%). Conclusion: This study concludes that the majority of endoscopies are being undertaken as a result of complications of cirrhosis and portal hypertension. Keywords: Endoscopy, audit, indications, findings

Risk factors associated with mortality in COVID-19 patients in Nishtar Hospital Multan.

Objective: To identify risk factors associated with mortality in COVID-19. Study Design: Retrospective Cross Sectional Study. Setting: Nishtar Hospital Multan. Period: April 2020 to September 2020. Material &amp; Methods: Charts of all PCR confirmed COVID-19 cases expired during the study period. Results: Out of 96 cases, 62(64.6%) were male and 34(35.4%) were female. Sixty five (67.7%) were from urban areas. Niney two (95.8%) patients had a co-morbid condition. Fifty two (54.2%) had diabetes, 42(43.8%) had hypertension, 29(30.20%) had heart disease, 21(21.9%) had chronic kidney disease, 14(14.5%) had chronic lung disease and 5(5.2%) had chronic liver disease. Mean respiratory rate was 25.01±7.80, mean SaO2 was73.99±17.53 and 57(59.37%) had bilateral infiltrates on chest X-ray. Mean CRP was 59.95±46.28, mean S/LDH was 765.92 ±266.61, mean S/Ferritin was 1446.00±1261.69 and mean D-dimer was 1.26±0.45μg/ml. Thirty five (36.45%) had sepsis, 26(27.08%) had cytokine storm, 17(17.7%) had respiratory failure and 13(13.5%) had hypotension. Conclusion: Male gender, old age, diabetes, hypertension, ischemic heart disease and chronic kidney disease were associated with increased mortality in COVID 19. Tachypnea, hypoxia, bilateral infiltrates on chest X-ray and raised inflammatory markers also had poor prognosis. Sepsis, cytokine release syndrome, shock, and respiratory failure were common complications. These high risk patients with COVID 19 should be timely admitted and managed aggressively to improve outcome.

Frequency of different symptoms in patients with COVID-19

Background: COVID-19 is a wide spreading disease starts from Wuhan a city of China in east. Earlier symptoms include fever, cough and fatigue later on patients may present with loss of smell and taste, sore throat, nasal congestion and muscle or joint pain. Its long term effects may include respiratory distress and neurological symptoms. Aim: To determine the frequency of different symptoms in patients with COVID-19 presenting at outpatients department of Nishtar Hospital Multan. Methodology: This cross sectional study was conducted at department of medicine, Nishtar Medical University, Multan, from September 2020 to September 2021. This study was carried out on 200 patients presenting with symptoms of COVID-19 and diagnosis was confirmed after admission. Main variables of study were symptoms of COVID-19 like cough, fever, running nose, breathlessness, headache and palpitations. SPSS version 22 was used for data analysis. Results: Majority of the patients were (60.0%) between age group 46-60 years. The most common symptoms were fever and cough, (79.0%) and (65.0%), respectively. The symptoms recorded between both male and female were almost equal, (standardized residuals&lt;1.96 and p&gt;0.05). But, fever and running nose were most common among the females, (p=0.028) and (p=0.050), respectively. Conclusion: COVID-19 presents with variety of symptoms and fever and cough were most common among these symptoms. COVID-19 positive patients can be present asymptomatically. All persons who come into contact with COVID19 patients should be go through the PCR lab test. Keywords: Novel COVID 19, Acute Respiratory Distress Syndrome, Contagious, Pandemic

Evaluation of bile duct stones extracted by ERCP (Endoscopic Retrograde Cholangio-Pancreatography).

Objective: To determine the frequency of different types of gallstones on ERCP stone extraction from bile duct. Study Design: Cross Sectional study. Setting: Department of Gastroenterology of the Nishtar Hospital Multan. Period: September 2019 to October 2020. Material &amp; Methods: Patients with bile duct stones on imaging of either sex aged 18 – 70 years were included in our study while patients with IHD, malignancies, liver cirrhosis, asthma, TB, COPD, ILD and pregnant women were excluded from our study. During ERCP the gross appearance of extracted stones and related findings were noted. Results: Our study included 139 patients meeting inclusion criteria, of these 139 study cases, 49 (35.3%) were male and 90 (64.7%) were female patients with bile duct stone. Mean age was 45.78 ± 12.05 year (range; 27 – 68 years). Of these 139 study cases, 56 (40.3%) were from rural areas, 83 (59.7 %) were from urban areas, 52 (37.4%) had poor socioeconomic status and 87 (62.6%) were from middle income family background. Diabetes was noted in 35 (25.2%), hypertension in 53 (38.1%) and obesity in 32 (23 %) (Mean BMI was 26.53±214kg/m2). Mean stone size in our study was 15.82 ± 6.34 mm while 78 (56.12 %) had single stones. Pure cholesterol gallstones were noted in 47 (33.8%), mixed cholesterol stones in 71 (51.1%) and brown pigmented gall stones in 21 (15.1%). Conclusion: Mixed cholesterol stones were more frequent followed by pure cholesterol and brown pigmented stones in bile duct gallstones patients. Mixed cholesterol stones were significantly associated with rural residential status and hypertension while brown pigmented stones were residential status, hypertension and obesity.

Comparison of Lidocaine Vs Lidocaine + Ketorolac in Intravenous Regional Anaesthesia (Bier’s Block)

Objective: To compare the duration of anaesthesia and degree of analgesia during intravenous regional anaesthesia using Lidocaine alone and Lidocaine with Ketorolac. Design: An international quasi experimental study. Place and duration: This study was carried out in Nishtar Hospital Multan from 01/01/2006 to 30/06/2006 (6 Months). Results: Patients were divided into two groups A &amp; B. In group A injection Lidocaine 0.5% 40ml was given whereas in group B injection Ketorolac 30mg was add to Lidocaine 0.5% 40ml. The degree of anaesthesia and duration of analgesia were compared in both groups. Haemodynamics were also recorded to see any systemic effects of drugs. Conclusion: We conclude that 30mg Ketorolac added to Lidocaine in IVRA increases degree of anaesthesia and also provide prolonged postop analgesia.

In-Hospital Outcome of Acute Myocardial Infarction in patients receiving Streptokinase

Objective: To study and compare the in-hospital mortality due to acute myocardial infarction in patients receiving thrombolytic (streptokinase) therapy versus those who were not thrombolysed. Methods: This descriptive observational study was conducted at the Coronary care Unit and Cardiology ward of Nishtar Hospital, Multan, from 1St of October 2002 till 30th of April 2003. Four hundred and thirty four patients of acute myocardial infarction who fulfilled WHO criteria of acute myocardial infarction were included in the study. Patients were divided into two groups: patients receiving streptokinase (SK) group and patients not receiving streptokinase (Non-SK) group. In-hospital mortality was our primary endpoint. Mechanical and electrical complications occurring in-hospital after acute myocardial infarction were secondary endpoints. Results: Only 47% patients received streptokinase while 53% did not receive it because of delayed presentation or some other contraindication to streptokinase therapy. Mean age of the SK group was 51.58±11.02 years and Non-SK group was 55.78±10 years. In SK group 170(83.3%) patients were males and 34(16.7%) were females. Only 54(26.5%) diabetics and 150(73.5%) non-diabetics received streptokinase. Streptokinase recipients reached the hospital earlier; mean time of onset of symptoms till arrival at the hospital was 4 hours and 25 minutes while non-recipients took a longer time in reaching to the hospital. There was no significant difference in the infarct territory between the two groups. The Non-SK group had higher Killip class as compared to SK group on presentation to the hospital. In-hospital mortality was 8.3% in SK group and 24.3% in Non-SK group p

Severity of opioid dependence and its relation with psychosocial factors of users.

Objectives: To determine the relationship between severe opioid dependence and psychosocial factors of users Study Design: Descriptive Cross Sectional study. Setting: Department of Psychiatry Nishtar Hospital Multan. Period: Nov 2018 to May 2020. Material &amp; Methods: 196 participants were enrolled through non probability purposive sampling technique. Pearson chi square test was applied to identify significant relationship between severe opioid dependence and psychosocial factors. Result: Mean age of study cases was 30.86 ± 1.66. The frequency of severe opioid dependence was noted in 159 (81.1%) of study participants. Statistical significant relation of severe opioid dependence was noted with age, literacy status, literacy level, marital status, monthly income, route of opioid use, frequency of opioid use per day, previous detoxification treatment and encounters with law enforcement agencies Conclusion: The severity of opioid dependence was high in patients admitted for treatment of opioid use. Severe opioid dependence was related with certain psychosocial factors such as user’s age, literacy status, literacy level, marital status, monthly income, route of opiod use, frequency of opioid use, previous detoxification treatment for opioid use and encounters with law enforcement agencies. This suggests that optimal treatment of severe opioid dependence should include interventions based on individual’s psychosocial needs.