Shifa International Hospital Research Articles

Audiometric Findings in Patients with Age Related Hearing Loss

Aim: To determine the audiometric findings, prevalence of age related hearing loss and association of hearing loss with gender in patients of 60 years and above. Setting and duration of study: This study was conducted in the Department of ENT at Shifa Foundation Community Health Centre (SFCHC), Shifa International hospital, Islamabad, over a period of 5 years from September 2014 to September 2019. Methods: A total of 149 patients were included in the study. All the patients were subjected to audiometry after taking informed written consent. Information regarding the past medical history of all participants regarding ear and hearing disorders and risk factors was taken and recorded. All this information along with demographic information was recorded. Results: The mean age of the participants was 70.72 ± 7.09 years. Most 46 (30.9%) of the patients were between 60 to 65 years old. The proportion of male participants 76 (51%) was slightly higher. In our study sample, 142 (95.3%) of the participants had high-frequency hearing loss, and 129 (86.6%) participants had low-frequency hearing loss. Mostly 62 (41.6%) participants had sloping curve. Most 125 (83.9%) participants were diagnosed with both types of hearing loss. Among male patients flat curve showed a significant (P-value < 0.05) relationship with age and in female patients, flat curve and neither flat curve nor sloping curve showed significant (P-value < 0.05) association with different age brackets. Conclusion: High-frequency hearing loss was the most common type of hearing loss among older patients. Majority of the patients were diagnosed with both types of hearing loss. High-frequency hearing loss was found to be significantly associated with different age brackets. Keywords: Hearing loss, Audiometric findings, High Frequency Hearing Loss,

Effect of Respiratory Muscles Training on Cardiopulmonary Parameters and Quality of Life in Patients with Dilated Cardiomyopathy

Objective: To determine effects of respiratory muscles training on cardiopulmonary parameters and quality of life in patients with dilated cardiomyopathy. Methodology: This Randomized Control Trial was conducted in Shifa International Hospital Islamabad from September 30, 2019 to December 31, 2019 and 22 patients with Dilated Cardiomyopathy were screened. Subjects were divided into 2 groups by sealed envelope sampling method. Bruce protocol according to ACSM guidelines (3 days per week, starting at shorter duration 5-20 min and progress to 30-40 min) was applied in Group 1. Bruce protocol same as in group 1 combined with Incentive spirometry (10-15 repetitions) and slow breathing technique was applied in Group 2. Tools and Outcome measures of study were EF, LV End systolic dimension, LV End diastolic dimension, QOL, PFT (FEV1, FVC, PEF and FEV1/FVC) and Vitals. Data was analyzed on SPSS version 21. Results: All patients in both groups were male with mean age of 51.65±6.5. Group 2 had improvement in LV End systolic dimension (pre training- 53.73+10.57, Post Training- 52.00+11.84), LV End diastolic dimension (pre training- 56.45+13.21, Post Training-55.45+14.08) as compared to Group 1 with LV End Systolic dimension ( pre training- 52.00+6.89, Post Training-51.56+6.71), LV End Diastolic dimension ( pre training- 60.00+6, Post Training-60.00+6.000). Conclusion: Respiratory muscles training by using bruce protocol combined with slow breathing and Incentive spirometry has significant effects on cardiopulmonary parameters and QOL in patients with dilated cardiomyopathy. Keywords: Congestive heart failure, dilated cardiomyopathy, Bruce protocol, Incentive spirometry, slow breathing exercise.

Evaluating the Factors Affecting the Occurrence of Symptomatic COVID-19 Illness after Vaccination

Background: Vaccination against COVID-19 illness is mainstay of undertaking the pandemic. However, it has been frequently observed that many patients developed COVID-19 illness after vaccination. Aim: To find out the factors other than the “mere chance” affecting the development of COVID-19 illness after vaccination so to identify high risk population and to suggest modify their vaccinations accordingly. Study design: Descriptive, retrospective cohort study Place and duration of study: Falahee Foundation Clinics of Shifa International Hospital, Islamabad from 1st February 2021 to 31st July 2021. Methodology: Sixty health care workers (HCW) who got vaccinated were enrolled. Results: 34 (58.6%) were male and 26 (41.4%) were females with mean age of 42±8.3 years. Twenty (33.3%) HCWs developed post vaccination symptoms, 12 of them got their COVID-19 PCR done. Seven (58.33%) had positive PCR and 5 (41.66%)had negative PCR. Female gender and co-morbid conditions affected the post vaccination symptoms and positivity of PCR significantly. Conclusion: Female gender, hypothyroidism, hypertension and celiac disease patients proved high risk for vaccination in our limited cohort. So co-morbid condition need consideration regarding further inquiry and necessary vaccination modifications. Keywords: Factors, Co-morbid, Post-vaccination

Transposition of basilic vein for vascular access for haemodialysis: An experience of a tertiary care hospital.

Basilic vein transposition (BVT) is the preferred permanent haemodialysis access due to better patency and lower infection rates compared to synthetic grafts. The outcomes of BVT cases, performed at Shifa International Hospital, Islamabad, from March 2006 to June 2018, were ambispectively investigated. The primary patency of the fistula was assessed immediately after surgery, at 24 hours, at 7-14 days, at 6-8 weeks and then at 3-6 months. A total of 160 patients were included in the study, out of which 83 (51.87%) were males while 77 (48.12%) were females. Of the total 160 patients, 119 (74.4%) underwent one stage BVT, while 41 (25.6%) underwent two stage BVT. One hundred and thirty-five (84.4%) procedures were successful and survived while in 25 (15.6%) cases it failed. Mean basilic vein diameter was 2.712±0.772 mm. Overall, 10(6.3%) patients had bleeding, 15(9.4%) fistulae thrombosed, 6(3.8%) had steal syndrome and only 1 (0.6%) patient developed pseudo aneurysm. We conclude that BVT is a feasible technique with very good patency rate especially for those patients who have multiple forearm AVF surgeries.

An audit of contrast extravasation in patients undergoing contrast enhanced CTs at radiology department in a tertiary care hospital in Pakistan.

To audit the radiology department of a health facility, focusing on contrast extravasations management pre- and post-implementation of a standard protocol. The audit was conducted at the Radiology Department of Shifa International Hospital, Islamabad, Pakistan and comprised reported computed tomography contrast extravasation incidents from January 2017 to December 2019 in the retrospective phase before the implementation of a standard protocol. Post-implementation, re-audit was done prospectively to assess compliance from January 2020 to May 2021. Overall score of >80% was chosen arbitrarily as a qualifying standard for adequate documentation. Of the 49 total cases, 26(53%) related to the first phase and 23(47%) to the second. In the first phase, 2(20%) of the 10 parameters cleared the cut-off mark; 'study performed' 25(96%) and 'limb assessment by technician' 26(100%). In the second phase, 2(20%) parameters failed to clear the cut-off mark; site of cannula/extravasation' 18(78.3%) and 'volume of contrast' 15(65%). Lack of early identification and appropriate management, especially in cases of large-volume extravasation, may result in significant morbidity.

Use of CD138 as Diagnostic Tool for Chronic Endometritis in Infertility

Background: Chronic endometritis (CE) can present in different ways. Various studies have proved the association between CE and infertility. As the data on the analysis of CD138 immunostain as a diagnostic tool for CE is scarce, this study was designed to compare CD138 with H&E for the diagnosis of CE. Objective: To compare the results of CD138 immunostain with Hematoxylin and Eosin staining for diagnosis of chronic endometritis. Methodology: Study design: Cross-sectional study. Place of study: Shifa International Hospital, Islamabad. Duration of study: January to September 2018. A total of 100 patients meeting selection criteria were included in the study. All patients had at least one-year history of infertility. Specimen were assessed on both H&E and CD138 immunostain and then results were compared. Data were analyzed by using SPSS version 20. Results: A total of 100 biopsies from females having infertility were included in the study. The mean age of patients was 33.4±4.3 years. A total of 32 out of 100 cases were found to be positive on H&E stain and 36 cases were positive on CD138 and 27 cases were true positive and 59 were true negative. Conclusion: CD138 has increased sensitivity in diagnosing Chronic Endometritis as comparing it with conventional H&E staining.

Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis.

Peritoneal carcinomatosis (PC) is a common presentation of several gastrointestinal and gynecological malignancies. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS + HIPEC) is a treatment regimen recently introduced in Pakistan for PC. The goal of cytoreductive surgery is complete removal of macroscopic disease. HIPEC is administered following surgery, with the aim of eliminating disease at a microscopic level. In this study, 11 patients, who underwent CRS+HIPEC at the Shifa International Hospital, Islamabad, Pakistan, were selected. Disease severity was classified using PCI score. There were 54.5% women and 45.5% men with mean age of 48.5 ± 12.5 years. The mean PCI score was 20.3 ± 3.4. The mean time from diagnosis was 12.7 ± 11.6 months. A complete tumor resection (CC-0) was achieved in 10 (90.9%) patients, while the rest were CC-1. The duration of HIPEC circulation was 90 minutes in every patient. Postoperative morbidity was observed in 2 (18.2%) patients. No 30-day perioperative mortality was seen. It was concluded that with effective patient selection, surgical skills and center experience, CRS+HIPEC can have low perioperative morbidity and mortality, and complete cytoreduction leads to prolonged overall survival. Key Words: Peritoneal carcinomatosis, Cytoreductive surgery, Hyperthermic intraperitoneal chemotherapy.

To Determine the Frequency of Mortality in Neonates with Sepsis Having High MPV

Introduction: A high MPV on admission in septic patients may be a useful indicator associated with poor outcome especially when it is associated with decreasing platelet numbers. Objective: To determine the frequency of mortality in neonates with sepsis having high MPV. Material & Method: Study design: Descriptive case series study Settings: NICU, Shifa International Hospital, Islamabad Methodology: All newborns of both genders up to 28th day of life who have culturally proven sepsis or probable sepsis with gestational age of ≥28 weeks, birth weight > 700gms were enrolled. The initial investigations on admission was carried out as per NICU septic screening protocol includes complete blood count CBC, C-Reactive Protein (CRP), electrolytes, renal function tests, blood C/S, urine R/E urine C/S, x-ray chest while the other investigations including CSF analysis, gram staining and culture, tracheal secretions and catheter tips for culture and sensitivity are performed when indicated clinically. Outcome was measured till discharge or death. Results: Mean age of the patients was mean ±SD 6.58 ±5.72 days. Most of the neonates 59 (62.1%) were males whereas 36 (37.9%) were females. Mean CRP, TLC count, platelet count, TLC count at baseline were 21.23 ±42.34, 15190.5 ±4619.32, 254348.42 ±101479.87 respectively. MPV at baseline 10.56 ±0.85 and at 48 hours was 9.96 ±0.81 respectively. Mortality was observed in 22 (23.2%) neonates. Conclusion: The frequency of mortality was found to be 23.2% in neonates with sepsis having high MPV. Keywords: Mortality, Neonates, Sepsis, Mean Platelet Volume

Recurrence Rate of Trigeminal Neuralgia With the Use of Percutaneous Stereotactic Continuous Radiofrequency Ablation at 80°C for 90 Seconds: A Single-Center Study.

IntroductionWith recent development in the treatment of trigeminal neuralgia (TN), percutaneous stereotactic rhizotomy is being widely used as an interventional technique. The purpose of this study was to find the recurrence rate of TN in patients who were treated with stereotactic rhizotomy at 80°C for 90 seconds, in a tertiary care set up in a developing country.MethodologyA retrospective cohort study was conducted at Shifa International Hospital, Islamabad, Pakistan from September 2016 to August 31, 2021. A total of 57 patients (19 males and 38 females) aged 27-90 years old, whose MRI of the brain had ruled out organic or structural pathologies, and who fulfilled the International Classification of Headache Disorders, 3rd edition for TN were recruited for the study. Of these patients, 51 underwent radiofrequency ablation (RFA) of the trigeminal ganglion (one or more branches of the trigeminal nerve (cranial nerve V (CN V)) in the operation theater. Patients having concomitant comorbid conditions like brain tumors, vascular pathologies, or coagulopathies, those who had previously undergone trigeminal ganglion neurolysis with either alcohol or phenol, who were lost to follow-up before the completion of the six months or had not visited back after the procedure, and those on oral anticoagulants and the ones declared high risk or American Society of Anesthesiologists (ASA) 3 and above for general anesthesia were excluded. Ethical approval was obtained and data were collected from the medical records department. The pain was recorded using the Numeric Rating Scale and recurrence was recorded from the follow-up visits of the patient over at least 12 months.ResultsOut of 51 patients, three patients who underwent RFA reported recurrence of the same problem for which they had initially reported to the pain clinic and were treated again with RFA. Five patients came back with the neuralgia of a different but contiguous branch of the same Gasserian ganglion opted for the RFA and were treated with no subsequent recurrences. The initial pain relief rate was 84.31%. At the end of the five-year study period, 16 patients reported variable degrees of sensory deficit, and two patients experienced non-debilitating unilateral reversible motor weakness of the jaw. One patient experienced keratitis due to unintentional loss of corneal reflex and subsequent ipsilateral loss of vision.ConclusionRFA is one of the leading treatment options for TN, with lower recurrence at higher temperatures of the radiofrequency electrode, at the cost of more significant sensory and motor deficits.

Renal Amyloidosis: A Clinicopathological Study From a Tertiary Care Hospital in Pakistan.

IntroductionSystemic amyloidosis can affect any organ in the body, but the kidney is the most commonly involved site. It is characterized by the extracellular deposition of insoluble fibrillar proteins. Amyloid deposits can be identified histologically by Congo red stain, which gives apple-green birefringence under polarized light. Typing of renal amyloidosis is done by direct immunofluorescence on frozen tissue. The most common types of amyloidosis seen in renal tissue are amyloid light chain (AL) primary amyloidosis and amyloid A (AA) secondary amyloidosis. Although primary amyloidosis is considered the most common type in western countries, however, in the subcontinent region, secondary amyloidosis is more common.The spectrum of signs and symptoms in renal amyloidosis is variable including isolated proteinuria, nephrotic syndrome, hypertension, hypotension, and renal insufficiency. The present study aims to evaluate the incidence and aetiology of various types of renal amyloidosis, determine their distribution within the kidney, and study various clinicopathological features.ObjectiveThe present study aims to evaluate the aetiology and clinicopathological profile of renal amyloidosis, determine its various types, and their distribution within the kidney.Materials and methodsThis retrospective cross-sectional study was conducted from 1st January 2013 to 31st December 2020 at the Department of Histopathology, Shifa International Hospital (SIH), Islamabad. All renal biopsies diagnosed as renal amyloidosis were included in the study. Data were analysed using SPSS version 23 (IBM Corp., Armonk, NY). Frequency and percentages were calculated for qualitative variables, and mean and standard deviation were calculated for quantitative variables.ResultsA total of 131 cases were diagnosed with renal amyloidosis during the study period of eight years (from 1st January 2013 to 31st December 2020) at SIH. The age range varied from 17 to 82 years. The mean age of the patients was 45 ± 16.33 years. Out of 131 patients, 82 (62.6%) were males and 49 (37.4%) were females. Amongst them, 72 (54%) cases were diagnosed with secondary AA amyloidosis and 16 (12%) cases were diagnosed with primary AL amyloidosis. The rest of the cases 43 (34%) were of indeterminate type. The associated conditions in secondary amyloidosis were tuberculosis in 41 (57%), rheumatoid arthritis in 16 (22%), ankylosing spondylitis in five (7%), lymphoma in three (4%), diabetes in two (3%), and chronic osteomyelitis, chronic heart disease, hepatitis, and vasculitis in one case each (1.7%). Out of 16 cases reported with AL amyloidosis, 10 cases (62.5%) had a history of multiple myeloma. The most common clinical presentation was nephrotic syndrome followed by subnephrotic proteinuria, renal failure, and hypertension.ConclusionThe findings of the present study show underlying etiological factors and clinicopathological characteristics of renal amyloidosis. AA amyloidosis is the most common type of renal amyloidosis in our study and tuberculosis is the most common aetiological factor. AL amyloidosis is less frequent in our population.

Intra-articular Versus Intravenous Tranexamic Acid in Primary Total Knee Replacement.

BackgroundTotal knee replacement (TKR) is an artificial joint surgical procedure that replaces the damaged articular surfaces of the knee joint. Despite several studies on the efficacy of intra-articular and intravenous Tranexamic acid (TX) use in reducing blood loss following TKR, the route of TXA administration is still an ongoing topic of debate. Our study aimed to compare total knee replacement efficacy (hemoglobin level, hematocrit level, hospital stay, and complications) of intra-articular and intravenous tranexamic acid administration.Material and Methods A Prospective study was conducted at the Department of Orthopedics, Shifa International Hospital, Islamabad. The study duration was six months (August 2020 to February 2021). A sample size of 60 patients was calculated using the WHO calculator. Patients were selected through non-probability consecutive sampling. Patients were randomly divided into two groups; Group A was given intraarticular TXA, while group B was given intra-venous TXA following total knee replacement. Patients were followed for 48 hours. Data were analyzed using SPSS version 24. An Independent T-test was applied, and a P value≤0.05 was considered significant.ResultsA total of 60 patients were included in the study. There were 20 (33.3%) male and female 40 (66.7%). The mean age of patients was 64.4±10.8SD. Post-operative hemoglobin level in group A was 11.09±0.39SD, and in group B was 9.93±1.73SD (p=0.03). Postoperatively, the mean HCT level in group A was 30.53±4.26SD and group B 26.88±5.48SD (p=0.01).ConclusionIntra-articular administration of TXA is more effective than intravenous administration in controlling postoperative blood loss following total knee replacement.

THE IDEAL PROFILE (INCREASE IN B-LINES/DELTA B-LINES) ON LUNG ULTRASOUND FOR DIAGNOSING WEANING INDUCED PULMONARY EDEMA IN VENTILATED PATIENTS

Objective: To ascertain the ideal number of B-lines on lung ultrasound for the diagnosis of weaning induced pulmonary edema in ventilated patients.
 Study Design: Prospective observational study.
 Place and Duration of Study: Department of Medicine, Shifa International Hospital, Islamabad, from Jan to Aug 2020.
 Methodology: All the patients over the age of 18 years who were on mechanical ventilation in a medical intensive care unit were included in the study. The patients were given spontaneous breathing trials as a protocol for weaning from mechanical ventilation. Lung ultrasound was performed on 4 points of anterior chest wall before and after spontaneous breathing trials. Before and after spontaneous breathing trials counting of B lines was done on ultrasound of lung and comparison of increase in B lines (Delta-B-lines) was done with reference diagnosis of weaning induced pulmonary edema diagnosed by intensivist who was blinded to the results of lung ultrasound.
 Results: The study included 42 patients including 23 (54.8%) men and 19 (45.2%) women. 14 cases failed spontaneous breathing trials. Seven cases (16.7%) had weaning induced pulmonary edema. Delta-B-lines ≥6 diagnosed weaning induced pulmonary edema with 100% accuracy. Out of the remaining seven patients with weaning failure but without weaning induced pulmonary edema, 6 (28.6%) had Delta-B-lines ≥6. The ultrasound lung technique had a 100% sensitivity profile to detect weaning induced pulmonary edema and a specificity of 77.78%.
 Conclusion: The study indicates that Delta-B-lines ≥6 diagnosed the weaning induced pulmonary edema with the best accuracy.

Association of Neutrophil to Lymphocyte and Platelet To Lymphocyte ratio with Blood Glucose Regulation in Type 2 Diabetes Patients

INTRODUCTION: 
 Diabetes is characterized by chronic hyperglycemia with disturbances of carbohydrate, protein and lipid metabolism. Disorders of lipid metabolism are common in diabetes causing greater cardiovascular risks. Leukocytosis is a major marker of metabolic syndrome. Both neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) are related to subclinical inflammation worsening the glycemic control. HbA1c is used as a marker of blood glucose regulation.
 OBJECTIVE:
 To investigate the association of neutrophil to lymphocyte ratio and platelet to lymphocyte ratio with blood glucose regulation in patients with type 2 diabetes mellitus.
 
 METHODS:
 This comparative analytical study was conducted in Shifa International Hospital on diabetic patients. Sample size was calculated as 62 by WHO sample size calculator . Non randomized convenient sampling was used. Patients were divided into two groups according to HbA1c level taking 7% as cut off point. Full blood count, lipid profile and liver profile were carried out. Data was analyzed by SPSS version 21. Descriptive statistics were calculated for categorical variables. For quantitative normal and dispersed variables, independent student t and Mann Whitney U test were applied respectively. P Value less than 0.05 was considered significant.
 
 RESULTS:
 Out of total 93 patients,33 (35.4 %) were males and 60(64.5%) were females. The mean duration of disease was 8.26 ± 5.8 years. NLR and PLR were elevated in patients having poor glucose control but that difference was not significant. Significant difference between the groups was found with random blood glucose. LDL, triglycerides , cholesterol ratio, ALT and AST were raised in patients having poor glycemic control.
 
 CONCLUSION:
 Patients having poor blood glucose regulation have increased levels of haematological and serological parameters posing greater cardiovascular health risks to patients with type 2 diabetes

OSTEOPOROSIS WITHIN A COHORT OF POSTMENOPAUSAL PAKISTANI WOMEN USING DUAL X-RAY BONE DENSITOMETRY

OBJECTIVE: To explore the prevalence of osteopenia and osteoporosis within a cohort of Pakistani postmenopausal women with respect to the lumbar spine and hip. METHODS: This cross-sectional study was conducted at Shifa International Hospital Islamabad, Pakistan from September 2019 to Feb 2020. Study comprised of 237 postmenopausal females who visited the outpatient department of the hospital. The T-scores of Bone Mineral density (BMD) data was collected and arranged in three groups: normal, osteopenia and osteoporosis. Data was analyzed to explore the distribution of the data and correlation analyses using R software version 3.6.3. RESULTS: Out of 237 females, majority were ranging in age from 61-70 years (n=110; 46.4%), followed by 51-60 years age group (n=60; 25.3%). Osteopenia was noted in 98 (41.4%) cases in lumber spine and hip area. Osteoporosis was found in 79 (33.3%) and 59 (24.9%) cases in lumber spine and hip region respectively. Mean T score was -1.775±-2.000 and median T score was -1.469 for lumber spine and hip. T-scores distribution of lumbar spine and hip indicated the highest proportion having a sore of -2 SD (n=60; 25.3% each), followed by -3 SD in 52 (21.9%) cases. Bone mass density was negatively correlated with age (p≤0.01). However, no significant difference was found among the BMD values of lumbar spine and hip region. CONCLUSION: Decreased bone density was a common occurrence affecting postmenopausal females and there is increase in degenerative bone loss with increasing age. Hip and lumbar spine region are equally affected by degenerative bone loss.

The impact of interprofessional task-based training on the prevention of surgical site infection in a low-income country

BackgroundTraining is considered instrumental in reducing surgical site infection. We developed training based on authentic tasks, interprofessional learning, and reflective learning for implementation in a low-income country where such training opportunities are rare. This study evaluated the results of training in terms of participants’ acceptance, participants’ knowledge acquisition, and their self-perceived behavior change.MethodsWe included 145 participants in the voluntary training program, comprising 66 technologists (45.5%), 43 nurses (29.7%), and 36 doctors (24.8%) from Shifa International Hospital, Islamabad, Pakistan. We measured “satisfaction” using a questionnaire at the end of the training, “knowledge” through pre-and post-intervention assessments, and “self-perceived behavior change” using a questionnaire and interviews 8 weeks post-training.ResultsPre- and post-test scores showed a significant increase in knowledge. Participants were favorable to the training and eager to participate. They positively applied in practice what they had learned about preventing surgical site infection. Our qualitative data analysis revealed two categories of themes, representing the upsides of the training as it stood, and existing factors or downsides that hindered the effective transfer of learning to practice.ConclusionParticipants were very enthusiastic about the training format. The knowledge test showed a gain in knowledge. Moreover, participants acknowledged that their behavior toward the prevention of surgical site infection in the operating rooms had changed. The use of authentic tasks from daily clinical practice, as well as the interprofessional approach and reflection, were considered to promote the transfer of learning. Although promising, our findings also pointed to obstacles limiting the application of evidence-based knowledge, such as a shortage of supplies and conventional practices.

Outcomes of 27gauge pars plana vitrectomy for a variety of posterior segment diseases.

To report outcomes of 27 gauge pars plana vitrectomy for the management of a variety of simple to complex posterior segment disorders. This retrospective cohort study was conducted at the Shifa International Hospital, Islamabad, Pakistan, and comprised data of all patients who underwent 27 gauge pars plana vitrectomy between July 1, 2015, and June 30, 2019, for a variety of indications. Data noted included age, gender, laterality, diagnosis, pre-operative visual acuity, date of surgery and surgical details, including operating time and complications. Best corrected visual acuity at 3 months was also recorded. Data was analysed using SPSS 21. Of the 574 patients, 355(62%) were males and 219(38%) were females. The overall mean age was 55±16.9 years. There were total 665 eyes as 91(15.8%) patients underwent bilateral surgeries. The most common surgical indications were diabetic tractional retinal detachment 196(29.5%) and vitreous haemorrhage 191(28.7%). Mean operating time was 62± 37 minutes. With the exception of 0.34% cases where 20 gauge fragmatome was used, no case required conversion to 20 gauge system, while 25 gauge trocar was used for silicon oil injection. Per-operative complications included iatrogenic retinal tear 2(0.3%) eyes and supra choroidal silicon oil migration 1(0.15%) eye. Post-operative complications were raised intraocular pressure 7(1.05%), endophthalmitis 1(0.15%) eye, haemorrhagic occlusive retinal vasculitis 1(0.15%) eye and rhegmatogenous retinal detachment 2(0.3%) eyes. Mean best corrected visual acuity improved from 1.62± 0.68 to 0.4± 0.38 logarithm of minimum angle of resolution (p<0.001). The 27 gauge pars plana vitrectomy was found to be a safe and effective procedure for both simple and complex retinal pathologies requiring significant surgical manipulation.

Beyond COVID-19: Prospect of telemedicine for obstetrics patients in Pakistan

ObjectiveTo explore obstetrics patients' experiences with telemedicine during COVID-19 and assess their intent for its future use. DesignAn exploratory design was applied considering that telemedicine was a new phenomenon in Pakistan particularly for antenatal care services during COVID-19. MethodPrimary data was collected through a telephonic survey of 132 respondents randomly selected from the pool of obstetrics patients who used telemedicine services of Shifa International Hospital (SIH) in Islamabad, Pakistan during the pandemic. We changed the survey tool of Medical Group Management Association to the study purpose. Required information included the respondents’ socioeconomic and antenatal characteristics and their telemedicine use experience on four parameters, namely, Appointment, Staff Attitude, Communication, and Telemedicine Services. Patients were inquired about their intent to use telemedicine beyond COVID-19 and the reasons supporting their answer. The data was analyzed descriptively and through t-test mean comparisons and binary logistic regression. ResultsMajority (54%) intend to use telemedicine in future. Average age of respondents was 30 years with gravidity 2.36, parity 1.40 and gestational amenorrhea 27.3 weeks. The respondents average schooling was 9.5 years, marriage duration was 4.5 years and monthly household income was PKR ∼83,000. However, the overall experience of those who were confident in future use of telemedicine was 0.677 points higher and significantly different than those who were not inclined to use it in future. Of those lacking interest in future use of telemedicine, nearly two-third felt in-person visit was more satisfying, 11% needed physical examination, ∼6% experienced long waiting time, 5% each had inadequate access to ICT and online payment facilities, and 6% faced other issues such as excess payments. The binary logistic regression analysis (R2 37.3%) held Medical Consultations and Communications as the most important determinants and could predict nearly two-fifth of variation in respondents’ intent for future use of telemedicine. ConclusionUptake of telemedicine for obstetrics patients is one of the positive externalities of COVID-19 and may appear as a cost-effective and culturally acceptable way to ensure universal coverage of antenatal care in Pakistan. However, telemedicine’s future beyond COVID-19 for obstetrics hinges upon improving users’ experience primarily through consultant and staff trainings and provision of effective communication e.g., in regional languages. Besides, offering physical examination facility and ability to use mobile wallet payment solutions may motivate future use of telemedicine in obstetrics.

Enhanced Recovery After Surgery: Are Benefits Demonstrated in International Studies Replicable in Pakistan?

ObjectivesTo determine the efficacy of enhanced recovery after surgery (ERAS) protocols in terms of frequency of surgical site infection (SSI) and length of hospital stay in patients undergoing colorectal surgeries for colorectal carcinoma.Study designQuasi-experimental study.Setting/Duration of studyDepartment of Surgery, Shifa International Hospital, Islamabad, from May 7, 2019 to November 6, 2019.MethodologyA total of 120 patients with colorectal carcinomas who fulfilled that sample selection criteria were studied. After randomization, patients were divided into two equal groups; one group received management under ERAS while the second group received conventional management. All patients were recorded for length of hospital stay and the development of SSIs. Data were analyzed using SPSS 26.0.ResultsThe mean age was 42.34 ± 14.45 years, with a male majority, i.e., 72 (60%). The mean duration of in-patient stay was 3.45 ± 1.73 days with ERAS and 8.25 ± 1.58 days with conventional management (p < 0.001). A total of 28 (23.3%) SSIs developed, of which nine (7.5%) SSIs occurred with ERAS, while 19 (15.8%) occurred with traditional management (p = 0.031).ConclusionERAS protocols have been demonstrated to be effective, cheap, and safe. There is a tangible reduction in length of hospital stay and incidence of SSIs which translates into reduced utilization of resources and financial costs. However, strict adherence to the protocol may be necessary to obtain the aforementioned benefits, which may be difficult to do in the face of professional, institutional, and personal inertia. Intensive efforts are required to make these protocols more convenient and attractive to implement, so as to facilitate conversion to this management approach.

Wilson Disease in Children; Chelation Therapy or Liver Transplantation? A 10-Year Experience from Pakistan.

BackgroundWilson disease (WD) is a rare genetic disorder with vast clinical presentations and a higher incidence in areas where consanguinity is common. Most patients can be treated with oral chelation, but some require advanced surgical intervention, like liver transplantation (LT). This study aims to review outcomes of WD patients presenting to a tertiary care center over a period of 10 years.Material/MethodsThis retrospective analysis was conducted at Shifa International Hospital, Islamabad, Pakistan. Patients <18 years who were diagnosed with WD per ESPAGHAN guidelines from 2010 to 2020 were included. Presentation, diagnosis, treatment, and LT and its complications were recorded. Follow-ups were recorded, and patients were contacted by phone in cases of interrupted follow-up. Frequencies and percentages of variables were calculated.ResultsA total of 48 patients with WD were identified. Symptomatic disease was seen in 45 patients, with 3 diagnosed on screening. The hepatic form was common (62.2%). Mean age at diagnosis was 9.74 (range 5–17) years, 28 (58.3%) were male, while 17 (35.4%) were female. Urinary copper was increased in all patients (645.82±528.40). Oral treatment with penicillamine was given to 34 (75.5%) patients; 4 (8.9%) died while on oral treatment. Living donor LT was performed in 11 (22.9%) patients, who had a mean King’s Wilson index of 11 (range, 6–14). Currently, all LT patients are alive, with maximum graft survival of 7 years.ConclusionsLT offers a promising treatment with good outcomes in pediatric WD. However, timely diagnosis and management with oral chelation therapy can prolong survival without LT.

Study the Prevalence of Depression in Patients Attending Comprehensive Care Centre, Islamabad, Pakistan

Abstract: &#x0D; Depression is one of the most common neuropsychiatric complications of HIV disease, and this leads to worse HIV-related health outcomes. With 350 million people affected worldwide, rates of depression are roughly two times greater in people living with HIV than in the general population.&#x0D; Objective: Determine prevalence of depression in patients attending Comprehensive Care Centre Shifa international Hospital, Islamabad&#x0D; Design: Descriptive cross-sectional quantitative study. &#x0D; Settings: Shifa international Hospital, Islamabad Comprehensive Care Centre,&#x0D; Methods: This data is from a bigger study ‘prevalence of alcohol use disorders and depression in patients attending Comprehensive Care Centre (CCC). The study population consisted of PLWHA attending the CCC. Two hundred and seventy-two (N=272) participants from CCC attendants were recruited. All consenting male and female aged 18-65 years were interviewed using the researcher’s designed questioner to collect their socio-demographic characteristics. Fully completed questionnaires were entered into excel sheets and analyzed using the Statistical Package for Social Sciences (SPSS) Version 20. &#x0D; Results: The overall prevalence of depression was 23.8%, with mild depression at 9.7%, moderate depression at 10.4% and severe depression accounting for 3.7%, respectively. Depression was associated with alcohol use (p=0.024). A significant difference between depression and age where depression levels worsens as age advances; respondents in age category of 18-21 years had less or no depression compared to those in the age category of 33 years and above. We found an association between depression and employment. Those laid-off work (1/3), and the retired (15%) had more depression compared to the employed (11%) or self-employed 6%, with a P value of 0.55 (borderline). On multivariate analysis severity of depression (OR=5.5, 95% CI of OR [2.1 –14.3], p&lt;0.0001) was associated with male gender (OR=10, 95% CI of OR [3.6 –28.3], p&lt;0.0001).&#x0D; Conclusion: The study findings indicate a high prevalence of depressive symptoms in patients attending the CCC. There is need to set-up appropriate interventions and strategies to reduce the prevalence of mental health disorders into routine HIV clinical care and support.