Private Tertiary Care Hospital Research Articles

Assessment Tool by UNICEF and LATCH Scoring System for Identification of Inadequacy of Breastfeeding in Early Neonatal Period: An Observational Cross-sectional Comparative Study

Background: Breast milk is the most ideal nourishment for a neonate with a high level of bio-efficacy. Learning the right breastfeeding technique is a challenging job, especially for new and young mothers; hence, there is a need for a valid and reliable measuring tool to determine the adequacy of breastfeeding. Objective: To check the adequacy of breastfeeding in mother–neonate dyads using breastfeeding assessment tools by comparing UNICEF and LATCH scoring systems and to test the reliability of the tools through test–retest reliability. Design: An observational cross-sectional comparative study. Setting: Department of Neonatology, Fortis Escorts Hospital, Jaipur, Rajasthan, India. Methods: All stable neonates of ≥34 weeks gestational age born at the private tertiary care hospital were included in the study. Dyads in which breastfeeding was initiated within 6 hours of life were assessed using both LATCH and UNICEF tools on days 1 and 2 of life in the case of normal vaginal delivery and on days 1, 2 and 3 in caesarean deliveries, and were further followed up on days 5 and 7. Results: The median LATCH score and UNICEF score for breastfeeding showed an increase throughout the assessment period. A moderately positive correlation (Spearman’s rho = 0.732) was noticed between the two scores on day 1 of the assessment. On day 2 (Spearman’s rho = 0.81) and day 3 (Spearman’s rho = 0.735), a high positive correlation between the two tools was observed. However, day 4 revealed a low positive correlation (Spearman’s rho = 0.456). Meanwhile, the follow-up scores of both tools showed a high positive correlation (Spearman’s rho = 0.713). Conclusion: The study evidenced a positive correlation between the LATCH and UNICEF scores; both scoring systems displayed a good percent agreement on all the five assessment days. The test–retest reliability was high between the tools on days 1 and 2.

Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study

Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2–3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value < 0.01, 95% CI: 1.3–5.1). There is insignificant association found between the prevalence ratio of GDM in women with periodontal disease in our setting. Women who are overweight or tend to gain weight should be closely monitored and guided to take dietary measures.

Feasibility of a nurse-led, mHealth-assisted, and team-based collaborative care model for heart failure care in India: Findings from a multi-stakeholder qualitative study

Background Heart failure (HF) management is often challenging due to poor adherence to GDMT and self-care. Continuous monitoring of patients by a dedicated care manager may enhance adherence to self-care and treatment and prevent hospitalisations. For the adoption and acceptance of a collaborative care model (CCM) for HF management in Indian settings, understanding the perspectives of all stakeholders regarding its various components and feasibility is needed. Therefore, we aimed to obtain perceptions of potential challenges to care and suggestions on multiple components of the proposed CCM in managing HF and its feasibility. Methods In-depth interviews were done among HF patients, caregivers, nurses, and cardiologists from private, co-operative, and public sector tertiary care hospital settings that cater to HF patients in Kerala, India. An in-depth interview guide was used to elicit the data. Data were analysed using Python QualCoder version 2.2. We used a framework method for the analysis of data. Results A total of 22 in-depth interviews were conducted. We found that the existing care for HF in many settings was inadequate for continuous engagement with the patients. Non-adherence to treatment and other self-care measures, was noted as a major challenge to HF care. Healthcare providers and patients felt nurses were better at leading collaborative care. However, various barriers, including technical and technological, and the apprehensions of nurses in leading the CCM were identified. The stakeholders also identified the mHealth-assisted CCM as a potential tool to save money. The stakeholders also appreciated the role of nurses in creating confidence in patients. Conclusions A nurse-led, mHealth-assisted, and team-based collaborative care was recognised as an excellent step to improve patient adherence. Effective implementation of it could reduce hospitalisations and improve patients' ability to manage their HF symptoms.

Validation of Difficult Airway Physiological Score (DAPS) in Critically Ill Adults Undergoing Endotracheal Intubation in the Emergency Department

Background. Critically ill patients have increased risk of cardiovascular collapse following endotracheal intubation due to physiological instability. This study aims to validate the Difficult Airway Physiological Score (DAPS) in adults to predict the risk of serious outcomes in the emergency department of a tertiary care private hospital. Methods. This is a cohort study conducted in the emergency department (ED) from 2021 to 2022. Difficult Airway Physiological Score (DAPS) was derived from a sample of 1021 patients through a retrospective study. The variables in the score were age, gender, time of intubation, vitals and vomiting at presentation, pH &lt;7.3, fever, physician’s anticipation for patient decline, and agitation. The model performance was assessed prospectively on a separate dataset (n = 326) using train-test split method. Postintubation desaturation, hypotension, cardiac arrest, and mortality postintubation were the serious outcomes. ROC analysis, sensitivity, specificity, PPV, and NPV were used to assess score validity. Results. Our study includes 326 patients, of which 123 (37.7%) were males and 203 (62.2%) were females. The sample was divided into high-risk (DAPS ≥10) group, n = 194 with mean age of 52 (SD = ±18) years, and low-risk (DAPS &lt;10) group, n = 132 with mean age of 47.7 (SD = ±17.4) years. The shock index ≥0.9 was in 128 (66%), while it was &lt;0.9 in low-risk n = 111 (84%), p value &lt;0.001. Similarly, pH &lt;7.3 was seen in 70 (36.1%) in high-risk group compared to 4 (3%) in low-risk group, p value &lt;0.001. Cardiac arrest was observed in 56 (17.2%) patients, of which 45 (23.2%) were in high-risk and 11 (8.3%) in low-risk groups (p&lt;0.001). Hypotension was the primary outcome in the high-risk group 100 (51.5%) versus 32 (24.2%) in low-risk group (p&lt;0.001). The DAPS of 10 had an area under the curve of 0.865 (0.71–0.84). The sensitivity of DAPS was 78.5%, specificity 77.9%, and accuracy 78.2%. Conclusion. The score can accurately predict serious outcomes in critically ill adult patients with physiologically difficult airway demonstrating good sensitivity and specificity.

Experiences of cardiac care nurses related to the management and delayed removal of trans-radial band of patients at a private tertiary care hospital, Islamabad.

To explore the experiences of cardiac care nurses in managing transradial band of patients in a tertiary care setting. The exploratory, descriptive, qualitative study was conducted at a private-sector tertiary care hospital in Islamabad, Pakistan, from March to September 2021, and comprised registered cardiac care nurses with >6 months of relevant experience. Data was collected through face-to-face interviews using a semi-structured interview guide. Data was analysed qualitatively using the Creswell and Creswell framework. Of the 10 nurses, 5(50%) were males and 5(50%) were females. In terms of age, 5(50%) were aged <25 years. Cardiac specialisation had been done by 2(20%) nurses, and none of the subjects had formal training related to transradial band. The main theme that emerged from the data was nurses' management of patients with transradial band, and the three categories were nurses' knowledge and practices about transradial band, reasons for delayed transradial band removal, and strategies to minimise complications. To minimise transradial band-related complications, in-service training of nurses and ensuring a safe nursepatient ratio are necessary.

AWARENESS, UTILIZATION, AND SATISFACTION OF SEHAT CARD PLUS AT A TERTIARY CARE HOSPITAL IN KHYBER PAKHTUNKHWA: A CROSS-SECTIONAL STUDY

Over 930 million individuals worldwide face significant financial barriers when seeking essential healthcare services, with more than 100 million people annually being pushed into extreme poverty due to healthcare expenses. The main objective of this study is to find the awareness, utilization, and satisfaction of Sehat Card Plus at a tertiary care hospital in Khyber Pakhtunkhwa. This cross-sectional study was conducted at a private tertiary care hospital in Peshawar, Khyber Pakhtunkhwa, from August 2022 to January 2023. The study included 463 patients visiting the tertiary care hospital. A structured questionnaire was developed to gather data on participants' awareness of the Sehat Card Plus program, their utilization of the card for healthcare services, and their satisfaction with its benefits and coverage. Data was collected from 463 patients. The mean age was 42±11.5 years, with 45% female and 55% male participants. Socioeconomic status analysis revealed that 67% of participants belonged to low-income households, while 17% were classified as middle-income and 16% as high-income. 82% of respondents were aware of the Sehat Card Plus program, with television/radio being the most common source of awareness (33%), followed by word of mouth (29%) and social media (27%). However, only 73% knew who was eligible for the program, and 53% knew the services covered. It is concluded that awareness of the Sehat Card Plus program is notable, but substantial gaps exist in understanding eligibility criteria and covered services among participants. Satisfaction with services under this program is moderately high, and the population has a significant demand for the government to introduce similar schemes.

Assessing the Safety and Effectiveness of Bipolar Technology in Transurethral Prostate Resection: A study in a Tertiary Care Private Hospital

Background: Benign enlargement of prostate (BEP) is a common affliction among aging males, predominantly emanating from the transition zone of the prostate, resulting in lower urinary tract symptoms. Despite the availability of diverse treatment modalities, transurethral resection of prostate (TURP) has conventionally served as a benchmark intervention. Recently, there has been a growing interest in bipolar energy techniques, spurred by their potential advantages in mitigating complications such as TUR syndrome and surgical bleeding. Objectives: The main aim of the study to evaluate the safety profile (including serum sodium and hemoglobin reductions, clot retention, TUR syndrome, catheterization duration, and hospital stay) and efficacy (resection rate, maximum flow rate increase, and International Prostate Symptom Score reduction) within the bipolar technique for the TURP. Methods &amp; Materials: A prospective observational study was conducted at the Department of Urology, Square Hospitals Ltd, Dhaka, Bangladesh, spanning December 2020 to November 2021. The study employed comprehensive preoperative assessments, including bipolar transurethral resection of the prostate (B-TURP) using Olympus ESG-400 energy platform. Surgical parameters, postoperative monitoring, and statistical analysis were meticulously executed to evaluate outcomes and complications for symptomatic benign enlargement of prostate. Results: In a sample of 50 individuals undergoing bipolar transurethral resection of the prostate (B-TURP), the distribution of ages revealed 66.97±7.95 years as the bipolar system's average age, ranging from 53-82 years. The majority resided in urban areas (62%), with family income predominantly in the 25000-50000 bracket (42%). Preoperative baseline variables, including IPSS, Qmax, serum hemoglobin, and sodium levels, exhibited similar values between groups. Intraoperatively, the mean resection rate was 0.56±0.16 gm/min. Postoperatively, B-TURP resulted in a slight ......

Covid-19 related isolation and risk of post-traumatic stress disorder in patients presenting to tele-clinics at a private tertiary care hospital in Karachi.

The objective of this study was to assess the psychological impact of isolation on individuals with Covid-19 and determine the experiences of people in isolation. All adults with Covid-19 who reported to the infectious disease tele-clinic were included in the study; participants were sent the survey form via email. The email was sent to 146 people and 47 responses were received. IES-R questionnaire was submitted to all individuals on Day 7 of quarantine, along with a qualitative questionnaire. The mean score on IES-R for all the respondents was 18.77. Out of 47 participants, for 6 (12.8%) PTSD was a clinical concern, 3 (6.4%) participants had a probable diagnosis of PTSD, and 6 (12.8%) participants scored high enough to suppress immune function. The majority of participants reported stress due to confinement in an isolated space and interruption in daily routine, specifically work-related routine. Praying, meditation, and having social support helped the participants cope with the isolation.

Insight into Stenotrophomonas maltophilia Infections in a Tertiary Care Teaching Hospital in Western India and Review of Literature: A Retrospective Observational Study

Introduction: Stenotrophomonas maltophilia (S. maltophilia) is a ubiquitous and opportunistic pathogen of growing importance. This gram-negative, non fermenter is widely distributed in moist hospital environments. It is intrinsically resistant to a number of antibiotics, making it a challenge both for the clinician and the microbiologist. Very sparse data is available from Western India regarding this emerging pathogen. Aim: To determine the prevalence and spectrum of infections caused by S. maltophilia and to provide an overview of associated co-morbidities, antibiotic susceptibility pattern of these isolates, and clinical outcomes. Materials and Methods: This retrospective observational study was carried out in a tertiary care private hospital (Mahatma Gandhi Hospital) in Jaipur, Rajasthan, India over a period of one year (July 2021-June 2022). A total of 11,170 samples were received in the microbiology laboratory for bacterial culture and susceptibility testing during the study period and processed as per standard protocols. Only one isolate per patient was included for the purpose of the study. Culture identification and antibiotic susceptibility testing was done using the VITEK-2 automated system. Data regarding patients’ demographic profile, epidemiological profile, baseline characteristics, comorbidities, laboratory findings, and clinical outcome were tabulated in an Excel worksheet and analysed. All statistical analysis was done using the Software Statistical Package for the Social Sciences (SPSS) version 20.0. Results: Fourteen patients were found to have S. maltophilia infection during the study period. The majority of patients had respiratory tract infection and bacteraemia. All isolates were from inpatients, more than two-thirds being from the Intensive Care Unit (ICU). A high level of susceptibility was seen to routinely recommended drugs, with 100%, 93% and 79% being susceptible to minocycline, levofloxacin and co-trimoxazole, respectively. All patients (except one) were successfully managed and discharged. Conclusion: S. maltophilia is an emerging opportunistic pathogen and is associated with a plethora of clinical conditions. Early and accurate diagnosis by embracing automation in microbiology laboratories is essential to identify this pathogen. S. maltophilia infections have a favourable outcome when diagnosed and treated timely

Survival Rate and Short-term Outcomes of Extremely Preterm Infants: A Tertiary Care Center Experience from the Private Sector

Background: Premature birth is one of the leading causes of death in the world. The global incidence of prematurity ranges from 5% to 11% of all births. The aim of this study was to assess the outcome of extremely preterm infants born below 29 weeks in our institution, with regard to survival and major short-term outcomes, and compare our results with national and international centers. This study is the first to be conducted in a private tertiary care hospital in Saudi Arabia. Materials and Methods: This was a retrospective descriptive cohort study that reviewed the medical records of preterm infants admitted to the neonatal intensive care unit at the International Medical Center, Jeddah, Kingdom of Saudi Arabia, between January 2014 and January 2020. We compared our results to the national data from King Faisal Specialist Hospital and Research Center-Riyadh, King Abdulaziz Medical City (KAMC)-Jeddah and KAMC Riyadh, King Abdulaziz Medical City-Alhasa, the National Institute of Child Health and Human Development Neonatal Research Network, and the Canadian Neonatal Network. Results: A total of 92 preterm infants were included: 3, 8, 17, 17, 29, and 18 infants with a gestational age of 23 weeks, 24 weeks, 25 weeks, 26 weeks, 27 weeks, and 28 weeks, respectively. The mean gestational age was 25 weeks and 5 days. Fifty-four infants (58.7%) survived to hospital discharge. In terms of short-term outcomes, 13% had bronchopulmonary dysplasia, hemodynamically significant ductus arteriosus was present in 27%, and retinopathy of prematurity was found in 13%, necrotizing enterocolitis was diagnosed in 5.4%, while late-onset sepsis was reported in 23.9% of infants. Conclusion: Our study represents outcomes of Extremely Preterm Infants in a single Private tertiary Care Center from Saudi Arabia with a comparison to national and international data. Though it cannot be generalized our data can be used as an add-value cohort toward establishing countrywide neonatal network to better plan regional resource allocation and utilization and facilitate ongoing audit, benchmarking, and overall quality improvement initiatives.

Sleep hygiene a neglected paediatric identity - A cross-sectional study.

Sleep is the physiological need of any human being; its role in paediatric mental and physical development is irreplaceable. However, in recent days, the rising trend of childhood obesity makes it essential to assess the sleep hygiene of the children to know if there is any adjacent association. 1. To estimate the prevalence of poor sleep quality using Sleep Hygiene Index Scoring. 2. To determine the association of sleep quality with academic performance and body mass index among the school children. The present cross-sectional study was conducted among 322 children aged between 7 and 12 years attending paediatric OPD of a private tertiary care hospital, Puducherry. Using Sleep Hygeine Index scoring with the cut off 16, prevalence of poor sleep quality was assessed and its association with BMI and academic performance was determined. Frequency, proportion, and Chi-square test were used for analysis; P value < 0.05 was considered statistically significant. The mean age of the participants was 8.8 ± 2 years, and most of them were boys. Around 53% of the children had poor quality of sleep, and there was a positive association between poor sleep quality with obesity (P value: 0.0003) and unfavourable academic performance (P value: 0.00001). Sleep hygiene importance should be taught to the parents and periodical assessment helps in predicting the neglected reason for obesity and poor academic performance, which could be managed easily with small lifestyle changes.

Evaluation of the use of antibiotics using the anatomical therapeutic chemical/defined daily dose and Gyssens methods in pneumonia patients at a tertiary care general hospital in Medan

Background: The impact of irrational antibiotic usage in pneumonia patients is an increase in resistance, an increase in drug side effects, and a failure of therapy that causes patients' health to deteriorate, lowering their quality of life and raising their treatment costs. The primary objective of this study is to assess the extent to which antibiotics are being used rationally in the inpatient facility of a private tertiary care hospital located in Medan. Methods: The present study employs an observational design with a prospective cross-sectional approach, carried out within the timeframe of September to November 2022. The evaluation of antibiotic utilization was conducted utilizing the anatomical therapeutic chemical (ATC)/defined daily dose (DDD) methodology and the Gyssens methodology. Results: The findings of the study indicate that a significant proportion of individuals diagnosed with pneumonia fell between the age range of 46 to 55 years, comprising 23.4% of the overall patient population. Moreover, the male gender was found to be the most prevalent, accounting for 55.81% of the 278 patients who satisfied the inclusion criteria. The findings from the evaluation of antibiotic utilization, employing the ATC classification system and DDD methodology, yielded a rate of 145.72 DDD per 100 days of care. Ceftriaxone exhibited the highest value, reaching 87.59 DDD/100 days of treatment. The evaluation of the Gyssens approach yielded a total of 254 patients who were administered antibiotics in an appropriate manner (category 0), while 24 patients were found to have received unsuitable antibiotics (categories I-VI). Conclusions: Based on the findings of this study, it can be inferred that the utilization of antibiotics within the hospital under investigation remains inadequate in terms of both quantity and quality.

ImprovedOutcomes of UpperGastrointestinalEndoscopy with Intensive Counselling and Videotapes; ARandomized Controlled Trial

Objective: The purpose of the study that we are currently conducting is to advise patients, implement various measures (such as videotapes), and permit patients' family members to accompany them inside the endoscopy room for the duration of the process in order to improve patients' levels of compliance. Material and Methods: A randomized control trial study was conducted in tertiary care private hospital from March to August 2022. Each group has 125 participants. Consecutive sampling was done in study period and participants were randomly allocated to intervention or control groups. Group A, the intervention group, received counselling about EGD'ssafety and comfort and saw videotapes. Patients'family member was allowed to stay in the endo-scopic room during the procedure. Group B received simply standard protocol counselling. The self-developed questionnaire included socio-demographic characteristics, and an endoscopist assessed procedure difficulty and compliance. Data were entered into SPSS version 20. Compliance, endoscopist evaluation, and esophago-gastroduodenoscopy duration were compared between groups. Results: A total of 250 study participants were included in the study. 125 were randomized in Group A and 125 were randomized in Group B. The most common comorbidities in study participants were diabetes, hypertension and ischemic heart disease. The chi-square test was used to access the time of the procedure, tolerated procedure, and endoscopist assessment between group A and group B. There was a statistically significant improvement in terms of these outcomes with the intervention. Conclusion: Extensive counselling, videotapes, and allowing family members to stay in the endoscopy room improves the outcomes of patients in terms of the time of the procedure, tolerated procedure, and endoscopist assessment.

Effectiveness of Standardized Nursing Care Plan on Nurses’ Usability Regarding Quality Nursing Care in Private Tertiary Care Hospital Lahore

Nursing care entails both an art and a science, involving the provision of tailored patient care based on individual healthcare requirements. The nursing care plan is instrumental, serving as a precise guide for nurses in delivering patient-centered, high-quality care. It functions as a roadmap, enabling nurses to monitor the patient's response to treatment and make necessary adjustments to meet medical needs. Challenges such as excessive workload, absence of policies, inadequate resources, understaffing, and unavailability of assessment forms hinder the effective utilization of nursing care plans Objective: To evaluate the effect of standardized nursing care plan on nurses` usability of nursing process during patient care. Methods: A quasi-experimental study was conducted at a Tertiary Care hospital Lahore Pakistan. A stratified Random sample of n=47 participants intervention group was recruited. A validated questionnaire of Nurses’ usability of standardized nursing care plan consisted of 23 items. Data were analyzed through SPSS version 21. Results: Majority of the participants 44.7% (n=21) were between 26-30 years of age, 46.8% of the participants (n=22) had working experience between 1-4 years, 70.2% (n=33) of them having nursing diploma, 23.4% (n=11) were attained Post RN BSN. A significant difference was found between Nurses` usability scores before and after intervention as evident by p=0.000 with mean and SD of 2.8085+0.79778 and 3.7872+0.41369, respectively. Conclusions: It is evident from results that standardized nursing care plan has a significant effect on nurse’s usability that improve the quality of nursing care in Hospital.

Obsession to fairness and topical steroid induced acne: A situation analysis of patients presenting in dermatology clinic at a private hospital in Karachi.

To determine the frequency of acne and other relevant side effects as well as the pattern of topical steroid and fairness cream use among patients presenting with steroid and fairness cream use at dermatology OPD in a tertiary care private hospital in Karachi. A cross-sectional survey was conducted from April, 2020 to December, 2020 in a private tertiary care hospital in Karachi. In total, 226 patients with a positive history of topical steroids and/or fairness creams use in the past six months were included in the study. Information was collected about sociodemographic characteristics; topical corticosteroid uses while clinical examination of facial skin was performed by a dermatologist. Data were analyzed using SPSS version-19. The median age of study participants was 26 years with an interquartile range of 10 years. This frequency of corticosteroid induced acne was highest i.e., 83.6% (n=189) followed facial erythema and telangiectasia i.e., 50.9% (n=115) 47.8% (n=108) respectively. The estimated median duration of using topical steroids or fairness creams or both was six months with an IQR of four months. The study found statistically significant differences in the reasons of using topical corticosteroids or fairness creams on the face on the basis of differences in the level of education and marital status. In Karachi, both, men and women are equally obsessed with fair skin tone and use topical steroids and fairness cream. The use of corticosteroid or fairness cream-induced facial acne is alarmingly high among patients presenting in a dermatology clinic in Karachi.

Identifying key factors contributing to treatment costs for snakebite envenoming in private tertiary healthcare settings in Tamil Nadu, India.

India suffers ~58,000 annual deaths due to snakebites. The 'Big Four' snakes (Russell's viper, Indian cobra, common krait, and saw-scaled viper) that are responsible for most bites cause diverse clinical effects. Delayed treatment increases the risk of serious complications and treatment costs. Although government hospitals offer free treatment for snakebites in India, most patients opt for private healthcare, which is an out-of-pocket expense as they often lack health insurance coverage. This study aims to analyse snakebite treatment costs in private tertiary care hospitals in Tamil Nadu, India and identifies the key factors contributing to treatment costs. The treatment cost details for 913 snakebite victims were collected from 10 private tertiary care hospitals across Tamil Nadu. The data were classified into hospital, pharmacy, investigation, and laboratory costs, and analysed to determine various factors that contribute to the costs. The results demonstrate that the average treatment costs vary widely for different snakes. The hospital and pharmacy costs are higher than investigation and laboratory costs for all snakebites. Notably, Russell's viper bites cost significantly more than the bites from other snakes. Overall, the type of snake, nature of complications, specialist treatments required, and arrival time to hospitals were identified as some of the key factors for higher treatment costs. These data demonstrate that ~80% of snakebite patients can be treated with INR 100,000 (~GBP 1000 or USD 1200) or less. This study emphasises the urgent need to improve rural medical care by providing appropriate training for healthcare professionals and essential resources to facilitate early assessment of patients, administer the initial dose of antivenom and refer the patients to tertiary care only when needed. Moreover, the outcome of this study forms a basis for developing appropriate policies to regulate snakebite treatment costs and provide affordable medical insurance for vulnerable communities.

Impact of Frontline Staff’ Behaviors and Waiting Time on the Patients’ Behavior in the Outpatient Departments (OPDs): A Cross-Sectional Study of Tertiary Care Hospitals

Healthcare is a crucial service whereby frontline workers' behavior and waiting time play more critical roles in the quality of the service than other services. As patients are exposed to a more unstable psychological state, their behavioral dissonances may hinder the quality of care provided. The behavioral patterns of both the employees and the patients are critical aspects of healthcare leadership and management alike This study explored the impact of frontline employees and waiting times on the patient’s behavior. A quantitative, cross-sectional approach was applied with deductive logic to conduct this study. A pre-validated structured questionnaire, adapted and cited from different sources, was administered among patients in five major, private tertiary care hospitals in Karachi, Pakistan through a non-probability judgmental sampling. The findings revealed a significant effect of both the behavior of employees and waiting time on the patients’ behavior. Policymakers may utilize the study findings to train empathy and a patient-centric approach to modify the behavior of employees to counter unpleasant patient behavior and produce satisfaction leading to improved quality of care.

Frequency of extra pulmonary complications in critically ill COVID-19 patients and their association with inflammatory markers and hypoxia: Retrospective analysis at a tertiary care hospital in Karachi, Pakistan.

This study aimed to determine the incidence of extra pulmonary complications among critically ill COVID-19 patients requiring invasive mechanical ventilation and association of these complications with various inflammatory markers and degree of hypoxia. A retrospective cohort study was conducted among 173 adults in Karachi having COVID-19 and were admitted to ICU in a tertiary care private hospital between August 2020 to July 2021. The median age of patients included in the analysis was 61 years (IQR; 16). Acute kidney injury, septic shock, cardiac injury, and electrolytes imbalance were the most frequent extra pulmonary complications with proportion of 65.3% (n=113), 63.6% (n=110), 61.8% (n=107) and 33.5% (n=58). Statistically significant differences in the median serum levels of ferritin were observed among male versus female, critically ill covid patients with and without ICU mortality as well as patients with and without hospital mortality (p-value <0.05). Significantly higher serum levels of d-dimer were noted among patients who developed acute liver injury or NSTEMI, or had ICU stay of > 3 days or received mechanical ventilation for >2 days. Acute kidney injury, septic shock, cardiac injury, and electrolytes imbalance were the most common extra pulmonary complications among mechanically ventilated COVID-19 patients with ARDS. Higher serum d-dimer levels were associated with acute liver injury, NSTEMI, ICU stay longer >3 days and invasive mechanical ventilation >2 days. Higher serum ferritin levels are associated with male sex and serve as an important predictor of ICU as well as hospital mortality.

Urgent need for the introduction of Tenecteplase in Pakistan: A Call to action for improved stroke and Mi Care.

Madam, Tenecteplase is a recombinant tissue plasminogen activator (tPA) that is used in many countries worldwide for reperfusion in acute ischemic stroke (AIS) and STEMI because of its longer half-life and high fibrin specificity compared to other tPAs (e.g., alteplase) and Streptokinase.1 Tenecteplase binds with fibrin-rich clots using its fibronectin finger-like and kringle-2 domains. The binding allows the protease domain to cleave the Arg/Val bond, converting plasminogen into plasmin, which breaks the fibrin matrix of the thrombus, resulting in clot dissolution. While Stroke and MI remain in the top 5 leading causes of death in Pakistan2, this highly efficient thrombolytic agent is not yet accessible in most hospitals for reperfusion in acute ischemic stroke and myocardial infarction cases. Many studies offer promising results, with tenecteplase being a better thrombolytic agent for acute ischemic stroke and STEMI than alteplase. In India, studies declare tenecteplase effective and safe in STEMI patients with clinically successful thrombolysis reported in 80.67% of patients, while intracranial hemorrhage associated with tenecteplase was only 0.39%.3 Tenecteplase is more efficient and at least as safe as alteplase for acute ischemic stroke. According to a meta-analysis involving 2031 patients, the patients given Tenecteplase showed higher recanalization rates (ARD=0.11, 95%CI) and early neurological improvement (ARD=0.10, 95% CI) compared to patients given alteplase.4 Tenecteplase also has a lower cost and a more favorable pharmacokinetic profile allowing bolus injection. Regrettably, Tenecteplase is not yet accessible in Pakistan due to unclear political and administrative factors, and border restrictions. Studies claim that only six hospitals in Pakistan currently offer intravenous thrombolytic therapy with alteplase, all being private tertiary care hospitals.5 While the world is adopting Tenecteplase instead of alteplase because of its better results, a more favourable side effects profile, and lower cost, our healthcare system is still dependent on SK for IV thrombolysis in cases of STEMI, which too is sometimes not available in many hospitals. In light of available evidence suggesting Tenecteplase as a better alternative to alteplase and Streptokinase, the health government and hospital policymakers should consider introducing tenecteplase in Pakistan as the standard care for STEMI, New Onset LBBB (Left Bundle Branch Block), Acute Ischemic Stroke, Prosthetic Valve Thrombosis, Pulmonary Embolism, and Deep Venous Thrombosis.

Dual Energy X-ray Absorptiometry Scanning for Osteoporosis Detection: Analysis of Patients at a Tertiary Care Hospital.

Dual-energy X-ray absorptiometry (DEXA) scanning is a rapid and accurate noninvasive procedure utilized to measure bone mineral density (BMD) and diagnose osteoporosis. The primary objective of this study was to assess the prevalence of osteoporosis in different regions of the body using DEXA scanning in patients attending a tertiary care private hospital. Additionally, we aimed to raise awareness about approved diagnostic methods for osteoporosis. For this retrospective study, a sample size of 384 participants was determined. The selection of participants was based on convenience sampling, considering their availability and accessibility. Data were collected from adult patients aged 18 years and above who underwent DEXA scanning. The information was compiled using Microsoft Excel, obtained from the patient's treating physicians, and evaluated by two medical graduates. Statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY). The findings unveiled an overarching osteoporosis prevalence of 38.5%, accompanied by distinctive figures of 38.7%, 8.9%, and 38.4% in the lumbar, hip, and forearm regions, respectively.Furthermore, the occurrence of osteopenia was found in 33% of participants in the lumbar region, 35.1% in the hip region, and 39.7% in the forearm region. Additionally, no significant association was found between gender and overall osteoporosis prevalence, suggesting that the susceptibility to osteoporosis did not significantly differ between genders. Moreover, the study emphasized the variations in bone density across different skeletal regions, with the forearm region displaying the lowest mean T-score and Z-score. The results of this study on osteoporosis prevalence in the lumbar, hip, and forearm regions indicate varying rates among these skeletal sites. Notably, both male and female patients demonstrated an equal susceptibility to developing osteoporosis. Interestingly, the forearm region emerged as the most common site for osteoporosis in males (34.6%), while the lumbar region was the most common in females (41.6%).