Shaikh Zayed Hospital Research Articles

COMPARISON OF SURGICAL SITE INFECTION IN PATIENTS UNDERGOING SKIN CLOSURE WITH STAPLES VS. SUTURES IN CLEAN ELECTIVE SURGERIES

Thyroidectomy is a common surgical procedure with various techniques for wound closure, including dermal staples and intradermal suturing. Each method has potential advantages and disadvantages, particularly in terms of wound complications, cosmetic outcomes, and postoperative pain. Understanding which technique offers better outcomes in these areas can guide surgeons in selecting the most appropriate method for skin closure after thyroidectomy. Objective: To compare wound complications, cosmetic outcomes, and pain scores between skin closure with dermal staples and intradermal sutures in patients undergoing thyroidectomy. Methods: A prospective study was conducted in the Surgical Department of Sheikh Zayed Hospital, Lahore, from August 2023 to August 2024. The study included 100 adult patients undergoing thyroidectomy for thyroid disease. The patients were randomly divided into two groups: Group A (n=50) received wound closure with dermal staples, and Group B (n=50) received intradermal suturing. Postoperative assessments were conducted at 1, 4, 12, and 24 weeks to evaluate wound complications, cosmetic outcomes, and pain scores. Cosmetic outcomes were measured using the Stony Brook Scar Evaluation Scale and Manchester Scar Scale. Pain was assessed using the Visual Analog Scale (VAS). Results: No surgical site infections were reported in either group. At the 24-week follow-up, cosmetic outcomes measured by the Stony Brook Scar Evaluation Scale were significantly better in Group A (4.12 ± 1.0) compared to Group B (3.32 ± 1.17) (p=0.027). Similarly, the Manchester Scar Scale score was higher in Group A (7.83 ± 1.34) than in Group B (9.20 ± 2.26) (p=0.033), indicating better cosmesis with staples. However, pain scores were significantly higher in Group A than in Group B both immediately after surgery and at the 4- and 12-week follow-ups. Conclusion: The use of dermal staples in thyroidectomy demonstrated better cosmetic outcomes and wound healing compared to intradermal suturing. However, patients who received staples experienced significantly more postoperative pain. While dermal stapling is a safe and effective alternative for skin closure, further studies with larger populations are necessary to corroborate these findings and guide clinical practice.

Prevalence of Vitamin B12 Deficiency in Patients With Type 2 Diabetes Mellitus on Metformin Therapy: A Cross-Sectional Study.

Background Metformin is frequently prescribed as a first-line oral hypoglycemic drug to treat insulin resistance-causing type 2 diabetesmellitus (T2DM). Long-term metformin use results in vitamin B12 deficiency, which is frequently overlooked and undiagnosed. A severe deficit may cause severe anemiaand gastrointestinal, or neurological issues. Studies are scarce onthis issue in Pakistani patients with T2DM. The current study aimed to estimate the prevalence of metformin-induced vitamin B12 deficiency in T2DM patients and to explore how it relates to metformin dosage or duration of therapy. Methodology A descriptive cross-sectional study was conducted on 260 T2DM patients using metformin therapy for more than a year and attending the outpatient diabetes clinic and the medicine department of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan, from August 2022 to October 2023. All socio-demographic, clinical, and general characteristics were collected. Blood samples were taken to measure the serum vitamin B12 levels, and based on these levels, deficient and normal group characteristics were compared. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 23 (Released 2015; IBM Corp., Armonk, New York, United States). Results Based on the serum levels of vitamin B12 of the studied T2DM on the metformin regimen, the overall prevalence of vitamin B12 deficiency was found to be 36.54% (95). The B12 deficiency was higher among the age group of 41-50 years (109, 41.9%), female gender (150, 57.7%, p-value=0.0035), urban residents (194, 74.6%), non-smokers (197, 75.8%), and with a history of chronic disease (131, 50.4%). There was a statistically significant difference in vitamin B12 levels based on T2DM duration (p=0.012), with a higher prevalence in patients with a longer diabetes history of more than two years. There was no discernible statistical relationship between patients receiving different dosages of metformin (odds ratio (OR)=0.8627; 95% confidence interval (CI) (0.5195, 1.4326); p-value=0.568), durations of metformin (OR=0.7400; 95% CI (0.442, 1.2325); p-value=0.247), or intake of vitamin B12 (OR=0.8532; 95% CI (0.5073, 1.4351); p-value=0.549). Conclusion The prevalence of vitamin B12 deficiency impacted more than one-third of T2DM patients using metformin (36.54%). The risk of vitamin B12 deficiency may increase in females with higher metformin dosages and longer durations of treatment. Furthermore, a statistically significant correlation exists between vitamin B12 deficiency and the longer duration of T2DM. These findings highlight the relevance of routinely monitoring serum levels of vitamin B12 among those with T2DM, especially when metformin is being given for over a year or at doses greater than 1000 mg per day. These preventive strategies will aid in the early detection of vitamin B12 deficiency, allowing patients to be treated with supplementation before problems such as anemia or neuropathies arise, resulting in improved quality of life and a lower socioeconomic burden.

EFFECTIVENESS OF MAGNESIUM SULFATE IN TERM NEONATES HAVING PERINATAL ASPHYXIA

In Pakistan, neonatal mortality and morbidity are remarkably high. Birth asphyxia (perinatal asphyxia) is one of the main contributors to this, apart from prematurity, sepsis and other causes. Objective: To assess the effectiveness of magnesium sulfate in term neonates having perinatal asphyxia Methods: This Randomized Controlled Trial was carried out at the Department of Pediatrics, Sheikh Zayed Hospital Rahim Yar Khan from July 2023 to December 2023. The overall sample size was 130 patients (65 patients in each group). Neonates in group A received MgSO through I/V, 3 doses 250mg/kg/dose, 24 hours apart along with standard treatment. Group B was a control group that received 20 ml of normal saline infusion at the same interval with similar supportive and symptomatic treatment with regular monitoring. The outcome in terms of mortality, seizure, early initiation of feed, time to the establishment of full oral feeding, duration of seizures and duration of hospital stay were assessed. All the data was analyzed by using SPSS version 25.Results: In the current study, a total of 130 neonates were enrolled. Among them, moderate asphyxia was observed in 90 (69.23%) patients whereas severe perinatal asphyxia was observed in 40(30.77%) patients. In group A, the mean level of serum magnesium in neonates with moderate asphyxia was 2.81 (±0.20) mEq/L while in neonates with severe asphyxia, it was 2.89 (±0.61) mEq/L. The moderate asphyxia patients in group-A showed significant statistical improvement in terms of seizure control (hours) (14.11±1.22 vs 18.11±1.56; P=0.01), normal cry appearance (Days) (11.1±0.12 vs 13.11±1.29; p=0.03), normal activity appearance (Days) (11.9±0.02 vs12.00±1.51; p=0.01), full oral feed acceptance by sucking (Days) (13.31±0.99 vs 14.61±1.51; p=0.01) and mean hospital stay duration (Days) (14.99±1.66 vs 16.21±1.11; p 0.02). Conclusion: Our study concludes that in asphyxiated newborns, postnatal magnesium sulphate infusion is safe and likely to enhance the short-term neurological prognosis in cases with moderate-grade encephalopathy.

AWARENESS AND ATTITUDES OF ICU NURSES REGARDING POST-EXTUBATION DYSPHAGIA IN TRACHEALLY INTUBATED PATIENTS

Post-extubation dysphagia is a common yet under-recognized condition in intubated patients, which can lead to severe complications. The awareness and attitudes of Intensive Care Unit (ICU) nurses towards post-extubation dysphagia play a critical role in early detection and management of the condition, improving patient outcomes. Objective: To assess the awareness and attitudes of ICU nurses regarding post-extubation dysphagia in intubated patients. Methodology: This cross-sectional study was conducted at the Intensive Care Unit of Sheikh Zayed Hospital, Rahim Yar Khan, from June 2023 to June 2024. One hundred nurses working full-time in general and specialized ICUs were included. Data were collected using a 28-item questionnaire divided into two sections. The first section collected demographic information, while the second assessed knowledge and attitudes toward post-extubation swallowing disorders using 20 specific questions. Statistical analysis, including multivariate analysis, was performed to identify factors associated with knowledge and attitude scores. Results: The average total standard score was 60.87 ± 14.31. The mean knowledge score was 7.54 ± 2.99, with a standard score of 75.40 ± 29.9. The average attitude score was 8.10 ± 2.01, with a standard score of 81.0 ± 20.1. Multivariate analysis revealed that age group 31-35, job title, and job satisfaction were significantly associated with higher knowledge scores. In contrast, attitude scores were significantly associated with sex, job title, age group, and department. Conclusion: The knowledge and attitudes of ICU nurses regarding post-extubation dysphagia in intubated patients are unsatisfactory. Professional training and educational programs are needed to improve critically ill patients' awareness and management of this condition.

POST-MASTECTOMY SURGICAL SITE INFECTION RATES IN FEMALES WITH BREAST CARCINOMA IN PREMENOPAUSAL AGE: A SINGLE CENTER STUDY

Breast surgery, like mastectomy, is generally considered a low-risk procedure for surgical site infections (SSIs), but when SSIs do occur, they can lead to significant complications. Identifying risk factors to improve patient outcomes and minimize complications is essential. Objective: This study aimed to determine the frequency of post-mastectomy surgical site infections (SSI) in premenopausal females with breast carcinoma and to identify the associated risk factors. Methods: This descriptive case study included 100 premenopausal females diagnosed with breast carcinoma who underwent mastectomy at a tertiary care hospital, Shaikh Zayed Hospital Lahore, from April 2024 to August 2024. The age range of participants was 25-45 years, with a mean age of 39 ± 5.3 years. Demographic data, including age, gender, body mass index (BMI), comorbidities, and American Society of Anesthesiologists (ASA) score, were collected. Intraoperative variables such as blood loss (mean: 350 ± 50 ml) and surgery duration (mean: 120 ± 15 minutes) were also recorded. All patients received standard postoperative antibiotic prophylaxis, including cefazolin or clindamycin, for those allergic to penicillin. The surgical site was assessed 30 days postoperatively for signs of infection, including erythema, pus discharge, or fever exceeding 38°C. SSIs were categorized based on the Centers for Disease Control and Prevention (CDC) guidelines into superficial, deep, and organ/space infections. Results: The overall infection rate was 7.5% (n=7). Of these, 4 cases were superficial infections, while 3 involved deeper tissue layers, requiring drainage and further antibiotics. Factors significantly associated with an increased risk of disease in the multivariate logistic regression model included a high wound class (contaminated or dirty; OR: 3.2, p=0.01), elevated ASA score (ASA III-IV; OR: 2.8, p=0.03), high BMI >30 (OR: 3.5, p=0.002), diabetes (OR: 4.1, p=0.001), use of surgical drains (OR: 2.9, p=0.02), and reoperation (OR: 4.3, p=0.005). The mean hospital stay was extended by 4.5 days (from 5.2 ± 1.5 days in non-infected patients to 9.7 ± 3.1 days in infected cases). Conclusion: The study found a post-mastectomy surgical site infection rate of 7.5% in premenopausal females, with significant risk factors including high BMI, diabetes, use of surgical drains, and the need for reoperation. A high wound class and elevated ASA score also predicted increased infection risk. Addressing these modifiable risk factors through optimized perioperative care, such as better glycemic control, judicious use of surgical drains, and minimizing reoperations, may help reduce SSI rates and improve outcomes for breast cancer patients.

A Comparison of Nerve Injury in Cross Versus Lateral Pinning Fixation of Displaced Supracondylar Humerus Fracture.

Supracondylar fracture of the humerus (SCFH) is a common pediatric fracture encountered in orthopedic surgery. The most frequently used pinning methods include cross pinning or lateral pinning with two or three pins. However, complications such as ulnar nerve injury can occur, particularly during medial pinning, which necessitates careful isolation of the ulnar nerve and expert surgical intervention. The objective of this study is to compare nerve injury in cross versus lateral pinning fixation of the SCFH. The observational study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, PAK. Patients in group L (n=55) underwent lateral pinning, while those in group C (n=55) received cross pinning. The patients were followed retrospectively postoperatively until radiological union was achieved. The outcomes were assessed using the Flynn criteria, and nerve injury was evaluated in both groups. The study aimed to compare the postoperative results between the two groups based on the specified criteria. The mean age was 7.28±2.03 years in group L and 8.20±2.21 years in group C. The majority of patients in both groups were male. The left side was more commonly involved, and among the 110 patients enrolled, most sustained the injury while playing. The mean follow-up period was 21.3±1.4 months for group L and 23.5±0.2 weeks for group C. Nerve injuries were reported in six (5.45%) patients in group C, while no nerve injuries were reported in group L. For type III SCFH, lateral pinning fixation has demonstrated itself to be an effective alternative, yielding excellent functional outcomes. This method not only minimizes the risk of iatrogenic nerve injury, particularly to the ulnar nerve but also provides sufficient stability for the fracture. The results from this study suggest that lateral pinning is a reliable option for treating unstable supracondylar fractures, with a favorable safety profile and outcomes comparable to, if not better than, those achieved with cross pinning. This makes it a valuable technique, especially in settings where the risk of nerve injury is a significant concern.

The Factors Associated With Mutant Epidermal Growth Factor Receptor Positivity in Patients With Lung Cancer: A Study From a Tertiary Care Center in Pakistan.

Objective In this study, we sought to elucidate the relationship between demographic and clinical factors and epidermal growth factor receptor tyrosine kinase (EGFR-TK) positivity in patients with advanced-stage lung cancer at a tertiary care center in Pakistan. Methods This analytical cross-sectional study was conducted from February 2020 to July 2023 at Shaikh Zayed Hospital, Lahore, Pakistan, in collaboration with the Centre of Excellence in Molecular Biology (CEMB), University of the Punjab. The study included 70 consecutive patients with advanced-stage lung cancer, and aimed to identify common EGFR mutations (Exon 19 deletion and Exon 21 L858R mutation), determine their frequency, and correlate EGFR-TK mutation positivity with clinical and non-clinical factors. Tissue acquisition and processing involved bronchoscopy, pleuroscopy, or percutaneous ultrasound-guided lung mass biopsy, followed by molecular analysis using polymerase chain reaction (PCR) extraction, amplification, and sequencing. The study employed convenient sampling and included adults aged over 18 years with histologically confirmed lung cancer. Results We enrolled 70 lung cancer patients, with a mean age of 60.87 years, and a male-to-female ratio of 1.4:1. The majority (61.4%) had adenocarcinoma, and 34.3% harbored a mutant EGFR-TK. EGFR mutations were more common in adenocarcinoma (91.7%) and associated with female non-smokers. Binary logistic regression analysis revealed that age <50 years and adenocarcinoma type were significant predictors of EGFR mutations. We found no significant associations with gender, smoking status, or other variables. These findings have implications for personalized treatment approaches in lung cancerpatients. Conclusions Our study reveals a high frequency of occult EGFR mutations (Exon 19 deletion and Exon 21 L858R mutation) in non-small cell lung cancer (NSCLC) patients, particularly among male smokers and female non-smokers. These findings emphasize the importance of routine EGFR mutation testing to identify patients who may benefit from targeted therapies, ultimately improving treatment outcomes.

Financial burden and social implications of chronic liver disease in a patient population group in Pakistan.

To assess economic and social issues faced by cirrhotic patients & its financial burden for developing nations like Pakistan. This cross-sectional study was carried out at the Department of Gastroenterology & Hepatology, Shaikh Zayed Hospital, Lahore, Pakistan during the period between July & December 2019. Patients with liver cirrhosis were recruited and information regarding disease, financial status, treatment expenses & dependency was recorded. A total of 450 patients were recruited, 272 (60%) were males & 178 (40%) were females, with mean age 55.4±6.2 years. HCV was cause of cirrhosis in 86% of cases, 65% were diagnosed incidentally and 39.6% were illiterate. About 82.7% were urban while only 28.7% own their own home. Co-morbid conditions including diabetes, hypertension & ischemic heart disease were present in 54% of cases. Monthly income was <PKR 45,000 in 23% of cases while 47% were non-earning. Our study shows the financial difficulties & dependency faced by patients with liver cirrhosis. Aggressive national screening is required to discover infected patients before cirrhosis develops.

Assessment of psychosocial work environment of doctors

Introduction :Psychosocial work environments pertain to interpersonal and social interactions that influence behavior and development in the workplace.Objective :To test a comprehensive and theory-based psychosocial work environment questionnaire and analyze associations with mental health in a sample of doctors in a tertiary care hospital in Lahore, Pakistan. METHODOLOGY :The design of study is cross-sectional study. It took place at Shaikh Zayed Hospital Lahore, from March 2017 to june 2017.A sample size of 100 working doctors was selected. Technique was non probability. After an informed consent each doctor was given the NRCWE’s Copenhagen short questionnaire consisting of 39 questions. The analysis of data was entered in SPSS 21. . After calculating frequency of data and explaining demographic variables, Independent t test sampling was applied and tables and pie chart was drawn.Results : Results reported worse working conditions in terms of stress, burnout, work family conflict and social support from superiors. High levels of stress and burnout were found. Doctors were almost satisfied with their jobs ( scores near to average but less than average ). Male doctors were found to be more satisfied with their jobs than female doctors.

Pattern of Dental Diseases among patients presenting at a Tertiary Care Hospital

Objective: To determine the pattern of the dental diseases among patients attending dental department of the Sheikh Zayed Hospital Rahim Yar Khan Methodology: The study was carried out at the Dental Outpatient Department (OPD) of Sheikh Zayed Medical College and Hospital. It used a cross-sectional design. The period of the study was June through December 2023. Consecutive sampling was used to enroll a total of 300 patients. Patients of any age with dental conditions, regardless of gender, who were undergoing treatment at the Dental OPD were eligible to participate as long as they fulfilled the inclusion requirements. A predesigned and pretested questionnaire covering relevant study variables including demographic and different dental diseases was used for data collection. For analysis, data were imported into SPSS version 20. Results: A total of 300 patients were included in the study, the mean age was 31±15 years, 181 (60.3%) were females. Most of the patients 160 (53.3%) presented with dental caries, 41(13.7%) with broken down root, 14 (4.7%) with calculus, 14 (4.7%) with gingivitis, 12 (4%) with periodontal disease, 6 (2%) with mal-aligned teeth, 4 (1.3%) with trauma, 1 (0.3%) with staining, 48(16%) with other diseases. About one third 93 (31%) of the patients had duration of disease as more than a year. Conclusion: This study provides valuable insights into the distribution and management of dental diseases in a tertiary care setting. It emphasizes the need for targeted interventions to address dental health disparities and improve access to care in resource-constrained regions. Future research should focus on the socio-economic, environmental, and behavioral determinants of dental diseases to develop effective prevention and treatment strategies. Keywords: Calculus, Caries, Dental diseases, Frequency, Gingivitis,

Assessment of Nutritional Status of Children aged 1-5 years attending the Outdoor Patients Department of Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan

Background: Cytochrome P450 enzymes play vital roles in metabolizing drugs, endogenous compounds, and environmental pollutants. Among them, Cytochrome P450 1A2 (CYP1A2), CYP1A1 and CYP1B are particularly important for activating carcinogens. Computational modeling of CYP1A2 is essential for understanding its interactions with various molecules, substrates, and inhibitors. Objective: To characterize the structure of CYP1A2 and explore the binding of alpha-naphthoflavone to its active site. Study Design: In Silico study (Computational modeling). Place of Study: International Center of Medical Sciences Research (ICMSR), Islamabad, Pakistan. Material and Methods: Using the Swiss PDB Viewer, the structural features of CYP1A2 were assessed, focusing on key residues, motifs, helices, and conserved regions. Results: Our findings identified specific binding sites for Alpha-Naphthoflavone (ANF), highlighting its potential as a potent inhibitor of CYP1A2. This research contributes to our knowledge of the clinical and toxicological implications associated with CYP1A2. Conclusion: Structural differences were found between CYP1A2 and related enzymes, with less than 40% sequence identity compared to several other P450s. The study predominantly compares CYP1A2 with CYP 2A6 and CYP3A4 due to these differences. T he developed structural models offer a fast and precise method for studying CYP1A2, aiding in understanding its role in drug metabolism and toxicology.

Pattern and management of bile duct injuries presented to Hepatobiliary Unit of Shaikh Zayed Hospital Lahore.

Objective: To find out the pattern and management of Bile Duct Injuries (BDIs) presented to Hepatobilliary unit. Study Design: Descriptive Cross Sectional. Setting: Hepatobiliary Unit, Shaikh Zayed Hospital Lahore. Period: November 1, 2022, to April 30, 2023. Methods: Total of 79 patients with Bile duct injuries were included. Demographic data and relevant investigations were performed. BDIs severity was classified using the Strausberg Classification. Patients underwent appropriate surgical interventions, with follow-up for period of 6 months postoperative complications. Results: The mean age was 39.89±10.01 yrs, primarily females (81%). BDI resulted from laparoscopic cholecystectomy in 44.3%, open cholecystectomy in 51.9%, and conversion to open surgery in 3.8% cases. Jaundice (58.2%), bile leak (38.0%), and itching (3.8%) were common presentations. Surgical procedures included hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). BDI classification revealed E2 (57.0%), E3 (36.7%), and E4 (6.3%) cases. Surgical site infection was observed in 11.4% of cases. Postoperatively 5.1% patients experienced anastomotic leaks and only the site of BDI was a significant factor for leak with the p value of &lt;0.001. Conclusion: In conclusion the majority of BDIs were E2 (57.0%), E3 (36.7%), and E4 (6.3%).Procedure performed were hepaticojejunostomy (77.2%), right hepatectomy with hepaticojejunostomy (8.9%), and liver resection + hepaticojejunostomy (13.9%). Anastomotic leaks were significantly linked to the site of BDI.

Association of Breastfeeding with Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis in mothers: A cross sectional survey

Objective: To determine the association of Breastfeeding with Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis in mothers.Methodology: A cross sectional study on randomly selected 280 mothers presented in the outpatient department of Sheikh Zayed Hospital, Rahim Yar Khan for different medical reasons from July to Dec 2023. Data collection commenced after taking ethical approval from the Institutional Review Board of the institute and taking informed verbal consent from study subjects. These mothers were divided into 2 groups. Group 1 which never breastfed their children and group 2 which breastfed their children for more than 6 months. Each group had 140 participants. Subject having history of alcohol consumption or used medicines like glucocorticoids, amiodarone, tamoxifen, and methotrexate were excluded from the study. Biodata of all the participants along with demographic profiles were obtained, who then went through an LFT and Lipid profile blood sampling and an USG abdomen. Results were recorded on a predesigned proforma. Serum ALT, AST, Serum bilirubin, serum LDL, HDL, Triglycerides, and Serum Cholesterol were determined by enzymatic assay and high-performance liquid chromatography methods. Data was analysed using SPSS v.26. Descriptive statistics was used to summarize the data. Mean and standard deviations were reported for continuous variables. Chi square test was used to compare the qualitative variables, with p value of less than 0.05 taken as significant.Results: Mean age ± SD of participants was 40±4 years, with group-1 having mean age of 38.1±5 years and group-2 having 40.4±3 years (p=0.4). The findings showed that frequency of NASH in patients who have not breastfed their children was higher 19 out of 140(13.6%) whereas the mothers who breastfed their children only have 5% frequency of NASH i.e. 7 out of 140 (P value = 0.01). Out of 140 patients who did not breastfeed their children 56 (40.0%) developed NAFLD, contrary to 140 patients who breastfed their children only 20 (14.3%) (P value = 0.00) got NAFLD. Elevated ALT and AST levels are significant for NAFLD and NASH. Lipid profile is a major indicator of NAFL and NASH.Conclusion: The frequency of NAFLD and NASH is significantly low in mothers who breastfed their children. The frequency further decreases if the period of breastfeeding was greater.

Is there any relationship of serum Growth Differentiation Factor 15 and Iron Profile with Age?

Objective: To compare growth differentiation Factor-15(GDF-15), iron and ferritin levels in younger and elderly patients suffering from end stage renal disease on hemodialysis and to determine is there any age-related change in these markers?.Methodology:This cross-sectional comparative study was conducted in the Nephrology Department of Sheikh Zayed Hospital Lahore from January 2018 to December 2018 after getting approval from Institutional Review Board of National Health Research Complex (NHRC) with vide no. F39/NHRC/Admin/IRB/372 Written consent was taken from patients.Group A has less than 60 years, while group B was with patients of greater than 60 years of age.Serum GDF-15, serum iron and ferritin of hemodialysis patients were determined by ELISA. Statistical analysis was done by SPSS 22.0 Results: The total number of patients was 140. Group A has 86 patients (40 male and 46 female). Group B had 54 patients(36 male and 17 female). Group A and Group B participants had serum median (IQR) GDF-15 levels 684(120-1604) and 2650(369-3625)pg/ml respectively, (P value 0.001) Conclusion: GDF-15 levels were significantly elevated in patients greater than 60 years of age and ferritin levels were similar in all age groups.

Reactions and Perspectives of Healthcare Workers against Workplace Violence: A Cross-sectional Study at Sheikh Zayed Hospital Rahim Yar Khan

Background: Workplace violence encompasses acts or threats of physical violence, intimidation, harassment, or disruptive behavior occurring within the workplace environment. Methodology: A cross-sectional descriptive study was conducted at Sheikh Zayed Hospital, Rahim Yar Khan, focusing on healthcare workers including doctors, nursing staff, and pharmaceutical staff. A predefined questionnaire gathered data on demographics, workplace details, experiences of violence, reactions to violence, and attitudes towards workplace violence. Data were analyzed using the Statistical Package for the Social Sciences (SPSS), with the Chi-square test used to assess significant associations (p ≤ 0.05). Results: The study included 192 participants, primarily females (52.08%), with 148 doctors (77.1%) and a majority aged 21-30 years (78.13%). Violence was most prevalent during nighttime shifts and among those with 16-20 years of work experience. Verbal violence was reported by 65.1% of participants (p = 0.011). Staff shortages and increased workload were identified as primary causes of violence by 62.4% of respondents (p = 0.017). Relatives were the most common source of violence, accounting for 61.07% of cases. Following incidents, 61.4% of doctors and 38.6% of nurses reported heightened vigilance (p = 0.03). Conclusion: The study highlights a significant prevalence of workplace violence in healthcare settings, particularly verbal abuse and threats from relatives. Staff shortages and increased workloads were identified as major contributing factors. Organizational interventions and training programs are crucial to mitigate the impact of workplace violence on healthcare workers' well-being.

KNOWLEDGE AND ATTITUDES OF EMERGENCY NURSES REGARDING MEDICATION ERRORS

Medication errors in emergency departments can lead to significant patient harm. Understanding the knowledge and attitudes of healthcare professionals regarding these errors is critical for developing effective prevention strategies. Objective: To assess the knowledge and attitudes of emergency department nurses regarding medication errors. Methods: A descriptive, cross-sectional study was conducted in the Emergency Department of Sheikh Zayed Hospital, Rahim Yar Khan, from March 2023 to March 2024. A total of 150 nurses participated in the study. Data were collected using a 43-item questionnaire available in both Urdu and English. The questionnaire comprised six sections, focusing on knowledge, attitudes, and behaviors regarding medication errors. Responses were recorded on a Likert scale ranging from 1 (totally disagree) to 5 (totally agree). Statistical analysis included descriptive statistics to summarize the responses. Results: The mean age of the nurses was 43.6 ± 16.6 years, with 70% being female and 30% male. A majority of nurses agreed that medication errors can be reduced by calculating drug dosages beforehand (76%), using prepackaged drugs from the pharmacy (62%), and utilizing informative brochures and guidebooks (66%). Attitudes towards error reduction were positive, with recommendations for systematic training of healthcare staff (94%), raising awareness about risk management and prevention (90%), evaluating staff for eligibility (90%), and the importance of reporting and assessing errors (94%). Conclusion: Nurses in the emergency department possess sufficient knowledge and exhibit positive attitudes toward medication errors in the management and administration of IV drugs. However, ongoing training programs and awareness initiatives are essential to update nurses' knowledge and enhance patient safety.

Prevalence and Knowledge of Urinary Incontinence and Awareness about Physical Therapy Treatment among Young Females of Lahore

Background: Urinary incontinence (UI), defined as involuntary urinary dribble at rest or under slight stress, is prevalent among women, particularly those who are pregnant or have had vaginal deliveries. While various treatments, including medical and physical therapy, are available for UI, awareness and knowledge about these treatments among young females remain unclear. This study aims to evaluate the prevalence of UI and the knowledge of physical therapy treatment options among young females in Lahore. Objective: To determine the prevalence and knowledge of urinary incontinence and the awareness of physical therapy treatment among young females in Lahore. Methods: This cross-sectional study included 250 young females aged 16-35 years from Jinnah Hospital Lahore, Sheikh Zayed Hospital Lahore, Ittefaq Hospital Lahore, and General Hospital Lahore. Data were collected using a self-reported quantitative questionnaire, the "International Consultation on Incontinence Questionnaire – Short Form" (ICIQ-SF), which assessed awareness about UI and knowledge of treatment options. Participants were briefed on the questions to ensure accurate responses. Data were analyzed using IBM SPSS Statistics version 25, with results presented as frequencies and percentages. Results: The study involved 250 females with an age range of 16-35 years, of whom 156 (62.4%) were single, and 94 (37.6%) were married. Obstetric data revealed that 16 (6.4%) were nulliparous, 81 (32.4%) were multiparous, 53 (21.2%) had normal labor deliveries, 49 (19.6%) had cesarean section deliveries, and 5 (2.0%) had experienced episiotomy. UI prevalence was found in 83 (34%) participants, with 63 (25%) affected moderately and 24 (10%) severely. Regarding health knowledge, 121 (48.4%) had never heard of UI, and 142 (56.8%) did not know about the presence of medical treatment. Moreover, 196 (78.4%) were unaware of the availability of physiotherapy treatment for UI. Conclusion: The prevalence of UI among young females in Lahore was significant, but the knowledge about UI and its medical treatment was relatively low. Awareness of physiotherapy treatment options was particularly lacking. These findings highlight the need for enhanced educational efforts to improve the understanding and management of UI among this population.

Assessment of evidence based care and uniformity of practices through implementation of standardized medical protocols and guidelines in pediatric emergency departments

ObjectiveThis study aims to assess compliance with medical protocols and outcomes, as well as determine the consistency in clinical practice across different Pediatric Emergency Departments (PED) in public sector hospitals of a low-middle income country. MethodsA retrospective analysis was conducted on patients presenting to PEDs of five public sector hospitals, namely Civil Hospital Karachi (PED 1), National Institute of Child Health (PED 2), Abbasi Shaheed Hospital (PED 3), Sheikh Zayed Hospital Larkana (PED 4), and Ghulam Muhammad Mahar College Hospital Sukkur (PED 5). The analysis covered a three-month period from February 1, 2023, to April 30, 2023. Patients diagnosed with Acute asthma, Sepsis, and Septic Shock during the study duration were included. Outcomes for each disease were evaluated based on compliance with standardized protocols.The statistical significance of data was measured by adding the p values. Results110,450 patients visited PED during the study period and mortality rate was 2% (n=2193). 12% (13,240) were diagnosed with the three diseases during the study period. Sepsis was on top (74%, n=9,751), followed by Septic Shock (14%, n=1898), and Acute Asthma (12%, n=1591). The overall compliance rate for the three diseases was 77% (n = 10,240). Adherence to standard protocols were 98% (n = 1561) for acute asthma, 85% (n = 8240) for Sepsis, and 23% (n = 439) for Septic Shock across the five emergency departments. Of the patients who were managed according to standard protocol, 31% (n = 3135) were discharged, 30% (n- 3094) were admitted, 11% (n = 1151) were referred, 15% (n = 1501) left against medical advice and 13% (n = 1359) did not survive. On the other hand, in patients where there was noncompliance to standard protocols, 27% (n = 805) did not survive, 27% (n = 807) were discharged, 24% (n = 710) were admitted, 8% (n = 260) were referred and 14% (n = 418) left against medical advice. The differences in adherence rates among the three diseases were statistically significant (p < 0.001). ConclusionThe overall mortality rate was 2% in these five emergency departments and the medical protocol was followed in every third patient out of fourth in those three diseases. The survival rate till ED disposition was doubled in those patients for whom medical protocols were followed as compared to those for non-compliant. The majority of PED demonstrated good compliance with standardized practices. However, this study identified areas that require attention and further training, especially early recognition and management of septic shock where compliances seem alarmingly low. Our data analysis indicates that adherence to guidelines has resulted in uniformity in clinical practice and the provision of early evidence-based quality care. Nevertheless, there is still room for improvement in ensuring consistent adherence to medical protocols in pediatric emergency settings and thus improving patient outcomes.

Correlation of DAS 28 Score and Treatment Compliance with Depression and Anxiety in Rheumatoid Arthritis

Background: Rheumatoid arthritis (RA) is a chronic systemic autoimmune disorder characterized by synovial inflammation, joint destruction, and significant disability. Psychological factors, particularly depression and anxiety, are prevalent among RA patients and can impact disease management and treatment adherence. Understanding the relationship between disease activity, treatment compliance, and mental health is essential for comprehensive RA management. Objective: To investigate the correlation between Disease Activity Score 28 (DAS28) and treatment compliance with levels of depression and anxiety in patients with rheumatoid arthritis. Methods: This cross-sectional study was conducted at the Department of Rheumatology and Immunology, Sheikh Zayed Hospital, Lahore, over six months. A total of 130 RA patients were enrolled using non-probability convenience sampling. Inclusion criteria were adults aged 18 years and above, diagnosed with RA based on ACR/EULAR criteria, and compliant with medication for at least three months prior to the study. Exclusion criteria included other autoimmune diseases, significant concurrent medical conditions, history of substance abuse, and recent initiation of biologic treatments. Data collection involved demographic details, RA onset and duration, and assessments of depression and anxiety using the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. RA disease activity was measured using DAS28, and systemic inflammation markers (ESR and CRP) were recorded. Data analysis was performed using SPSS version 25.0, employing descriptive statistics, correlation analysis, and regression analysis to determine the relationships between variables. Results: The study included 59 males (45.4%) and 71 females (54.6%), with a mean age of 49.69 years (SD = 18.82). The mean duration of RA diagnosis was 14.07 years (SD = 8.69). Higher PHQ-9 scores were associated with lower treatment adherence (B = -1.264, p &lt; 0.001), and higher GAD-7 scores also negatively impacted adherence (B = 0.870, p &lt; 0.01). The regression model explained 40.3% of the variance in treatment adherence (R² = 0.403, F(7, 122) = 11.779, p &lt; 0.001). Weak negative correlations were observed between DAS28 ESR and treatment adherence (r = -0.150), indicating that higher disease activity slightly reduced adherence. Conclusion: The study highlighted the significant role of mental health in the management of RA. Depression and anxiety were found to be major barriers to treatment adherence, underscoring the need for integrating psychological care into RA management. Addressing mental health issues could enhance treatment adherence and improve overall disease outcomes. Keywords: Rheumatoid Arthritis, DAS28, Treatment Adherence, Depression, Anxiety, Psychological Factors, Systemic Inflammation, PHQ-9, GAD-7, Chronic Disease Management, SPSS 25.0, Cross-Sectional Study, ACR/EULAR Criteria

EVALUATING THE OCCURRENCE OF NEEDLE STICK INJURIES AMONG NURSING STUDENTS

Needlestick injuries (NSIs) pose significant occupational hazards for nursing students, who are at high risk due to their clinical practice. Understanding their knowledge, attitudes, and practices towards NSIs is crucial for developing effective prevention strategies. Objective: To assess the prevalence of NSIs among nursing students and evaluate their knowledge, attitude, and practice towards NSIs. Methods: This descriptive study was conducted at Sheikh Zayed Hospital Rahim Yar Khan from January 2023 to December 2023. Nursing students from the 2nd to final year were included, given their clinical exposure and high risk of NSIs. Data were collected through an online questionnaire based on previous studies, and distributed via email. Descriptive statistics were used to analyze the data, with means and standard deviations calculated for continuous variables and frequencies and percentages for categorical variables. Results: A total of 280 students participated in the survey. Sixty-seven students (23.9%) experienced NSIs, primarily during recapping (74.6%) and injections (21%). Most students (76.1%) did not report the incidents. The mean NSI knowledge score was 6.5 ± 1.3, and the mean attitude score was 27.5 ± 4.13, indicating a generally positive attitude. One hundred ninety-six students (70%) had received the Hepatitis B vaccine, 152 (54.2%) were worried about NSIs, 201 (71.7%) believed NSIs are preventable, and 150 (53.5%) felt NSIs are neglected. The mean practice score was 14.2 ± 2.1, indicating poor practice. Additionally, 140 students (50%) reported recapping needles before discarding, 98 (35%) wore gloves before injections/venipuncture, 64 (22.8%) practised one-handed recapping, 168 Conclusion: (60%) used personal protective equipment (PPE), and 56 (20%) rinsed with water and soap after an NSI. Nursing students demonstrated good knowledge and a satisfactory attitude towards NSIs; however, their practice levels were low. Enhanced training and strict adherence to safety protocols are needed to improve their practices and reduce the incidence of NSIs.