Teaching Hospital In Karachi Research Articles

Benzodiazepines: Predominant Reported Acute Poisoning to Private Sector Tertiary Care Hospitals in Karachi

Background: Acute poisoning is a major medical emergency that translates into morbidity and mortality across all age groups, it is a potentially preventable cause of illness and death. This study was carried out to assess the epidemiological information of acute poisoning among the general population presented to the three campuses of a private tertiary care teaching hospital in Karachi, Pakistan. Method: The cross-sectional study was conducted at three campuses of a private tertiary care teaching hospital, Dr. Ziauddin Hospital in Karachi, comprising of records from January 1, 2018, to December 31, 2022, of patients reporting acute poisoning. These records were accessed after getting approval from the Ethical review committee. Consecutive sampling technique was applied while data was collected. All cases of acute poisoning reporting to the emergency department with complete records were included. While data of those with any other diagnosis or incomplete record were excluded. Descriptive analysis was performed for quantitative variables. For categorical data frequency and percentages were extracted. The chi-square test was used to associate categorical variables. P value less than 0.05 was taken as statistically significant. Results: The total number of cases was n=518 out of which n=235 (45.4%) were males while n=283 (54.6%) were females and the maximum number of cases n=111 (21.4%) were associated with Benzodiazepines followed by insecticide poisoning and ingestion of rodenticides. Conclusions: The most susceptible groups to acute poisoning were found to be women and children. A prevalent agent that caused toxicity was benzodiazepines; the biggest number of cases occurred in April, while the lowest number occurred in December. The year 2020 was linked to the highest number of cases.

Maternal Stress and its Associated Factors among Working Nurses in Public Sector Tertiary Care Teaching Hospitals, Karachi

Maternal stress has been identified as an epidemic that has a detrimental effect on work productivity and personal and professional growth. Objectives: To determine maternal stress and its associated factors among working nurses in public sector tertiary care teaching hospitals in Karachi, Sindh. Methods: The analytical cross-sectional study was accomplished at Dr. Ruth K.M Pfau Civil Hospital Karachi and Dow University Hospital Karachi. A total of 131 nurses were approached by a convenient non-probability sampling method. The Parental Stress Scale was used for data collection. Data were entered and analyzed by using SPSS version 24.0. Chi-square test was applied out to find an association between maternal stress and associated factors. Results: Nurses reported 72 (55%) mild parental stress, 58 (44.3%) parental moderate stress, and 1 (1%) severe parental stress. Nurses belonging to the younger age group, widowed or divorced, had mild parental stress, while nurses who lived with their husbands had lesser moderate stress. Female participants with one child of either gender, whose more family members were earning, had less tendency to have mild parental stress. A statistically significant association was found between working nurses' parental stress level and age group (p-value=0.005). Conclusions: It was concluded that nurses reported mild, moderate, and severe maternal stress. Hence, it is increasingly imperative to create facilities like daycare centers and offer them the flexibility to perform their job effectively

CHARACTERISTICS AND PATTERNS OF PSYCHIATRIC ILLNESS AMONG CHILDREN AND ADOLESCENTS AT A TERTIARY CARE HOSPITAL IN KARACHI PAKISTAN

Objective To assess the patterns of psychiatric illness among children and adolescents presented at psychiatric clinic of a public sector teaching hospital in Karachi, Pakistan. Study Design A cross sectional study Place and Duration of the study The study was conducted at the Child and Adolescent Psychiatry outpatient clinic of the National Institute of Child Health (NICH) in Karachi, during February 2019 to October 2019. Methodology Using consecutive, non-probability sampling, all male and female participants, age less than 18 were recruited from the study setting. Data collection was done using a pre-designed semi-structured proforma. The data was analyzed using descriptive statistics. Results A total of 250 pediatric patients visiting the psychiatric clinic were enrolled in this study. These included 161 (64.4%) males and 89 (35.6%) females. Mean age was 9.55 ±3.374 years. 31 (12.4%) patients reported directly to the psychiatry clinic while 160 (64%) patients were referred from pediatric medicine clinics. The remaining 59 (23.6%) patients were referred from adult psychiatry clinics. 126 (50.4%) were diagnosed to have stress and related disorders, 85 (34%) patients were diagnosed with neurodevelopmental disorders. About 5 (2%) patients were diagnosed with psychotic and mood disorders, 34 (13.6%) were diagnosed with other nonspecific disorders. Conclusion The study reveals a male predominance among children and adolescents at a public sector hospital, with a high referral rate from pediatricians. The diverse mental health issues include stress, neurodevelopmental, and other diagnoses, highlighting the need for deeper investigation and targeted clinical attention.

Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. To assess nutritional status and its associated factors among the elderly population. This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Early vs. interval approach to laparoscopic cholecystectomy for acute cholecystitis: a retrospective observational study from Pakistan.

Laparoscopic cholecystectomy (LC) is the preferred treatment for acute cholecystitis (AC). However, the optimal timing for LC in AC management remains uncertain, with early cholecystectomy (EC) and interval cholecystectomy (IC) being two common approaches influenced by various factors. This retrospective study, conducted at a tertiary care teaching hospital in Karachi, Pakistan, aimed to compare the outcomes of EC vs. IC for AC management. Patient data from January 2019 to September 2019 were analyzed with a focus on operative complications, duration of surgery, and postoperative hospital stay. The inclusion criteria were based on the Tokyo Guidelines, and patients underwent LC within 3 days of symptom onset in the EC group and after 6 weeks in the IC group. Among 147 eligible patients, 100 underwent LC (50 in each group). No significant differences were observed in the sex distribution or mean age between the two groups. The EC group experienced fewer operative complications (12%) than the IC group (34%), with statistically significant differences observed. Nevertheless, no substantial variations in operative time or postoperative hospital stay were observed between the groups. Reduced complications in the EC group underscore its safety and efficacy. Nonetheless, further validation through multicenter studies is essential to substantiate these findings.

Emotional Intelligence: An Overlooked Element of Dental Education

Introduction: Emotional intelligence (EI) refers to a collection of abilities connected to self-control, self-motivation and the capacity to identify emotions. In order to treat patients with a special, tailored approach, the dentist must also be skilled in comprehending the impact of the patient's behavior. Methods:This cross-sectional study was conducted using a e-based questionnaire at a dental teaching hospital in Karachi, Pakistan. A total of 110 student participated in the study by answering 30 questions of trait emotional intelligence questionnaire short form (TEIQUE-SF). The data was evaluated using SPSS version 26 from 93 completely filled questionnaires. Results: On the basis of the mean and standard deviation of data, the majority of responses appeared to fall within the range of neutral or agree on Likert scale. The coefficient alpha (α) values for EI factors of overall data set range from small (0.46) to large (0.72), with no gender related differences. The Spearman's correlation test indicated statistically significant results between the EI factor traits except emotionality & sociability. Conclusion:It is important for dental students and faculty to understand the concept of EI and emphasize the likelihood of this to be included in the curriculum and clinical training. Keywords:Behaviour, Dental Students, Emotional Intelligence, Social Intelligence.

Caregiver Strain and its Associated Factors in Autism Spectrum Disorder in Karachi, Pakistan.

Todetermine the frequency of caregiver strain and its associated factors in Autism Spectrum Disorder (ASD) at a tertiary care teaching hospital in Karachi, Pakistan. An analytical cross-sectional study. Place and Duration of the Study: Psychiatry inpatient and outpatient units at The Aga Khan University Hospital, Karachi, Pakistan, from December 2018 to December 2019. The study participants were caregivers of ASD. Data were collected from the inpatient and outpatient departments using Caregiver Strain Questionnaire (CGSQ), and a demographic questionnare. Data were analysed using descriptive and inferential analysis. A total of 76 caregivers participated in the study. Among them, 61 (80.3%) were females and 15 (19.7%) were males, with mean age of 37.09±6.91 years. The overall caregiver strain (both subjective and objective) was reported to be severe by 11.8%, moderate by 47.4% and low by 40.8%. About 50% of the participants had a low objective strain on CGSQ whereas 59.2% of the participants subjectively felt the strain to be at moderate level. An association was found between the gender of the participants and subjective strain (p=0.016), and gender with internalised subjective strain (p =0.002). Parentingof a child with ASD involves challenges and demands support. This study supports the recommendation that the caregivers need access to appropriate means to channelize their strain and manage their role productively. Autism, ASD, Stress, Burden, Caregiver, CGSQ, Pakistan.

Microbiological Assessment of Dental Unit Water Lines at a Tertiary Care Dental Teaching Hospital in Karachi

Microbiological Assessment of Dental Unit Water Lines at a Tertiary Care Dental Teaching Hospital in Karachi

Perception of Ethics and Professionalism Teaching among Dental Professionals at a Teaching Hospital in Karachi

Background: Health care professionals come across many ethically difficult situations in their clinical practices and community; the students should be equipped with skills to resolve ethical and professional issues.
 Methodology: A cross-sectional study was conducted at Baqai dental college, Karachi. All the faculty members and house officers of the dental teaching hospital were included in the study. The tool used for the data collection was a structured questionnaire, for drawing views of the participants on professionalism and ethics teaching. The survey instrument evaluated two domains; attitudes 25 items, and goals 19 items on ethics and professionalism education. Data were recorded and analyzed in SPSS 24. To compare the responses of both the groups, that is, the house officers and the faculty member’s independent t-test was applied to compare the mean scores. A p-value of ≤ 0.05 was considered significant.
 Results: The questionnaire was circulated to a total of 157 participants (75 faculty members and 82 house officers) with a 100% response rate. The faculty members and the house officers showed a positive attitude regarding ethics, professionalism, and teachings. The participants agreed with the goals that can be achieved by incorporating professionalism and medical ethics in education. The participant strongly affirmed the learning and teaching of professionalism (4.06 ± 0.989).
 Conclusion: The realization of the need to teach ethics and professionalism by dental professionals is the first step to bringing change in their daily clinical practice and interpersonal qualities.
 Keywords: Ethics, Professionalism, “Education, Medical”, “Personality development”, “Social Desirability”.

Prevalence of low back pain among medical doctors of the teaching hospitals in Karachi, Pakistan: A cross-sectional survey.

Our goal was to deduce the prevalence of low back pain among medical doctors in the teaching hospitals of Karachi, Pakistan, along with its associated variables and the functional disability accompanying it. This cross-sectional study was conducted among medical doctors from Creek General Hospital and United Hospital, affiliated with United Medical and Dental College, Karachi, Pakistan. A sample of 80 participants was included in this study, and a non-probability convenient sampling with randomization was utilized. Using a three-part questionnaire that included the Oswestry Disability Index, all participants were scrutinized for low back pain with its characteristics, associated risk factors, and functional disability. Seventy percent of medical doctors included in this study suffered from the problem of low back pain, with 68% experiencing it over the last 3 months to 1 year. Furthermore, 89% and 11% suffered from minimal and moderate disability, respectively, affecting day-to-day and work life. Moreover, this study also found a significantly positive association (p value < 0.05*) of low back pain with age and work-related characteristics and was more common in those with work experience between 1 and 10 years, >8 working hours, >4 standing hours, and belonging to the surgery and medicine specialties. The association was significantly positive according to the chi-square/Fischer exact test. Our study addressed the evidence that low back pain is prevalent among medical doctors in teaching hospitals in Karachi, Pakistan, potentially affecting patient treatment and student education and accentuating the need for further intervention and research among doctors worldwide.

The Status Epilepticus in Adults: Results from a Tertiary Care Teaching Hospital in Karachi, Pakistan

Background: Status epilepticus is one of the common neurological emergencies associated healthcare costs, morbidity and mortality worldwide. The prevalence is more in extreme ages, in adults as well as in children. However, it can occur at any age. Aim: The aim of this study was to determine the possible causes and outcomes of status epilepticus in adults. Method: Across-sectional study was conducted in the department of Neurology, at Jinnah Postgraduate Medical College, Karachi during January 2015 to March 2016. All patients of either gender between 18-60 years of age diagnosed for status epilepticus, presented within 24 hours of their first episode of status epilepticus were included in the study. Patients were examined for the assessment of nature, type and presence or absence of precipitating factors (noncompliance, systemic infection, head trauma and central nervous system infections). Data was entered and analyzed by using SPSS version 19.0. Results: A total number of 241 patients were recruited. We observed that the patients with no previous history of epilepsy 41(17%) had central nervous system infections, followed by head trauma 27(11%), systemic infections 22(9%) and 3(1.2%) were stroke. In patients who were known case of epilepsy 70(29.0%) patients were found non-compliant to Anti-Epiliptic Drug while 30(12.4%) patients were found to have hyponatremia. In 48(19.9%) patients no obvious cause was found. Conclusion: Status epilepticus is not common in our setup and predominant type is convulsive status and none of our patients have non convulsive status. Most common precipitating factor was infections followed by trauma. Further studies of bigger dimension are needed to substantiate these findings. Bangladesh Journal of Medical Science Vol. 22 No. 01 January’23 Page : 128-134

RELATIONSHIP OF LIFESTYLE AND DIETARY HABITS OF SOUTH-EAST ASIAN (PAKISTANI) POPULATION WITH CARDIOVASCULAR DISEASES: A CASE-CONTROL STUDY

Objectives: Cardiovascular disease (CVDs) is the leading cause of deaths globally. Apart from traditional risks, multiple indigenous factors are implicated to impact disease courses. Lifestyle factors distinct to South Asians may predispose to disease or serve a protective effect. Our study objective was to determine the Relationship of lifestyle and dietary habits of South-east Asian (Pakistani) population with cardiovascular diseases. Methodology: A case-control study was conducted from April to October 2021 in a two-thousand bedded university teaching hospital in Karachi, Pakistan. Out of 400 participants, 189 were cases with a documented cardiovascular event and 211 were controls. Participants &gt;18 years were included whereas pregnant females and patients with congenital heart defects were excluded. A structured questionnaire was designed and implemented, and anthropometrics were recorded. Chi-square test, independent sample t-test and multivariate analysis were utilized via SPSSv23. P-value &lt;0.05 was considered significant. Results: From 400 participants, 189 cases and 211 controls were identified. 53.4% of the people consuming open spices had CVDs while 46.6% did not. While only 37% of people using home cooked spices had CVDs with an OR= 0.51(0.3-0.84, 95% CI, p=0.08). Our results showed an inverse or no relationship of high BMI with CVDs. No statistically significant results were observed of diabetes and hypertension with CVDs. Conclusion: Based on our results, home grounded condiments have a protective effects on CVD than open spices. With reference to CVD, poor lifestyle habits and anthropometric profiles of our controls indicate a need for urgent preventive measures at population level.

Breaking bad news: a descriptive study of physicians' perspective of Sindh, Pakistan.

To assess the perception and attitude of physicians related to breaking bad news. The cross-sectional study was conducted at three teaching hospitals in Karachi and Mirpurkhas, Pakistan, from April 2019 to February 2020, after approval from Hamdard University, Karachi, and comprised physicians of either gender having direct patient contact. Data was collected using a questionnaire based on literature. The questionnaire was pilot-tested before distribution among the subjects. The responses were categorised with respect to age, gender and professional experience. Data was analysed using SPSS 25. Of the 230 subjects, 119(51.7%) were females. The overall mean age was 34.5±8.8 years and mean professional experience was 9.1±8.2 years. Overall, 19(8.3%) subjects believed they had a very good ability to deliver bad news, while 26(11.3%) avoided telling the patient the truth about diagnosis, prognosis and treatment. Age had a significant association with correctly defining breaking bad news (p<0.05). The skill level related to breaking bad news was found to be deficient.

Characteristics and patterns of individuals who have self-harmed: a retrospective descriptive study from Karachi, Pakistan

BackgroundSelf-Harm (SH) is a major global public health problem under-researched in Pakistan due to religious and legal implications. This study aims to identify the characteristics and patterns among patients with SH and factors associated with the intent to die.MethodThis retrospective descriptive study where SH cases presented to private tertiary care teaching hospital in Karachi, Pakistan, from January 2013 to December 2017 were extracted from HIMS records. Details related to demography, history, associated factors, access to methods used, and intent to die were collected on a structured proforma and analysed using STATA version 14. ResultsA total of 350 cases were analysed. More than half of the reported cases were in the age group 20–39 years. Though only one-fourth of the SH cases had a past psychiatric history, it was found to be significantly (P-value < 0.05) associated with intent to die. Notably, 81% of the cases do not have a history of SH. Drug overdose (61.6%) and insecticides (36.6%) were the two most common methods used. Depression was identified in nearly half of the cases. The most common reason for attempting SH was inter-personal relationship issues (54.3%).ConclusionThis paper provides recent data on the characteristics and patterns associated with the intent to die of individuals who have self-harmed. In most cases of SH, past psychiatric history was not evident. Current psychiatric diagnosis and young adults were favoured in this study. The data from this study has limited representation for all demographic representation of SH cases from Pakistan as being from a single private hospital. There is a need for further research on SH in Pakistan.

Availability of Operative Surgical Experience and Supervision for Competency-Based Education: A Review of A General Surgery Program at A Tertiary Care Teaching Hospital in Pakistan.

In view of importance for competency-based education (CBE), we undertook a self-study to elicit the available operative surgical workload and supervision for residents in the general surgical residency program at the teaching hospital in Karachi. This was a cross-sectional study spanning a 5-year period between January 2015 and December 2019. The numbers of surgical residents during this period were identified. Five procedures were selected as core general surgical procedures: incision and drainage of superficial abscess, laparoscopic appendectomy, laparoscopic cholecystectomy, open inguinal hernia repair, and perianal procedures. Trends of the number of residents per year and the numbers of procedures per year were determined. The mean number of core procedures per eligible resident during their entire training was calculated to represent potential operative surgical experience and were benchmarked. The ratio of the average number of residents rotating in general surgery per year to the number of attending surgeons was determined as a measure of available supervision. The mean total number of general surgical residents per year was 31.2 (range 28-35). The numbers of core general surgical procedures were consistent over the years of study. Potential exposure of eligible residents to each core procedure during their entire training was: 19.5 cases for incision and drainage of superficial abscess; 89 cases for laparoscopic appendectomy; 113.6 for inguinal hernia repair, 267.5 for laparoscopic cholecystectomy and 64.5 for perianal procedures. The average yearly residents to full-time attending surgeons' ratio was 2.5. The workload of core general surgical procedures at AKUH was higher than the Accreditation Council for Graduate Medical Education (ACGME) recommended volumes for operative surgical experience for residents in the US. This method of assessing the potential of a surgical program for transitioning to CBE appears practical and can be generalized.

ALTERING THE MARKING OF THE REVERSE POSTERIOR INTEROSSEOUS ARTERY FLAP

BackgroundFull-thickness defects on the dorsum of the hand requires thin, soft, and pliable skin for which there are limited locoregional flaps. The reverse posterior interosseous artery (PIA) flap based on the communicating artery fulfills all above requirements and can reach upto the fingers. However, there has been discrepancy in the surface marking of the flap and the anatomical position of the vessel pedicle. We share our alteration with the marking and ease of harvesting this flap.Method and materialThis is a prospective study conducted at a private teaching hospital in Karachi, over a period of 2 years from November 2017 to December 2019. After taking consent and ensuring confidentiality of all patients who had PIA flap reconstruction, we collected patient's demographic details, mode of injury, and flap surface area. We altered the described skin marking and took measures to prevent venous congestion and noted the outcomes in term of flap congestion and flap loss.ResultsTwenty-eight patients with a mode age of 32 years were operated during this period. The majority (64.2%) had a motor vehicle accident and machine injuries. The mean surface area of flaps was 6 × 10 cm2, and 11 (39.2%) flaps had venous supercharging. All patients had a 10-20° wrist extension splint for 2 weeks. The mean follow-up of the patients was 14 ± 5 days, and 6 (21.4%) flaps developed a minimal marginal flap loss, which was managed conservatively.ConclusionBy minimally altering our surface marking, we experienced a easy and quick harvesting of this flap. However, one has to be vigilant and take all described precautions for venous congestion.

Predictors of Outcome of Cirrhotic Patients Requiring Invasive Mechanical Ventilation: Experience From a Non-Transplant Tertiary Care Hospital in Pakistan.

BackgroundPatients with known liver cirrhosis, irrespective of the etiology, have poor outcomes when put on invasive mechanical ventilation in an intensive care unit (ICU) setting. The clinical situation becomes even more complicated when such patients are managed in a non-transplant center. Various factors are associated with poor outcomes, and hence, various scoring systems are available to help determine the prognosis in patients with liver cirrhosis. These scoring systems are broadly classified into two categories, namely, ICU-specific scoring systems and liver disease-specific scoring systems. There is a dearth of data from Pakistan regarding which score better determines the prognosis of patients with liver cirrhosis admitted to the ICU. In this study, we aimed to determine the outcome of cirrhotic patients requiring invasive mechanical ventilation in a non-transplant tertiary care hospital in Pakistan using ICU-specific and liver disease-specific scoring systems.MethodologyA retrospective study design was applied to a record of 88 cirrhotic patients admitted to the medical ICU of a tertiary care teaching hospital in Karachi, Pakistan, from January 2016 to November 2016. Patients with acute hepatitis were excluded. Data on patients’ characteristics, the reason for intubation, hepatic encephalopathy, the need for vasopressor support, and the duration of ICU and hospital stay were collected. Moreover, the first-day Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA), Child-Turcotte-Pugh (CTP), and Model for End-Stage Liver Disease (MELD) scores were calculated, with mortality being the primary outcome measure.ResultsThe most common etiology was hepatitis C (52.3%, 46/88). The most common reason for intubation was airway protection (57.9%, 51/88). Overall mortality was 71.6% (63/88). On univariate analysis, CTP score >10, MELD score >18, hepatic encephalopathy, bilirubin, prothrombin time, presence of tense ascites, and APACHE II were significantly associated with mortality. On multivariate analysis, CTP score >10 (odd ratio = 21; 95% confidence interval (CI): 4-104; p < 0.001) was an independent predictor of mortality. Area under curve was 0.89 (95% CI = 0.82-0.96) for CTP, 0.86 (95% CI = 0.77-0.95) for MELD, 0.81 (95% CI = 0.69-0.92) for APACHE II, and 0.81 (95% CI = 0.71-0.91) for SOFA in predicting mortality.ConclusionsCTP and MELD scores are better predictors of short-term mortality in patients with liver cirrhosis requiring invasive mechanical ventilation compared to APACHE II and SOFA scores. CTP score >10 was an independent predictor of mortality.

Magnitude and pattern of anxiety levels with gender wise predilection of coping strategies amid resident doctors of emergency department.

Objectives:To screen and assess the severity level of anxiety, its influencing factors along with the gender-wise predilection of coping strategies among resident doctors working in accident and emergency departments.Methods:A transverse study was conducted amongst 260 resident doctors of accident and emergency department of different teaching hospitals of Karachi from October 2020 until March 2021. A demographic sheet containing questions related to factors, GAD-7 (Generalized Anxiety Disorder) and Brief COPE were used to measure the severity level of anxiety and coping strategies. Data was scored according to the standard scoring procedure for each subscale and for further statistical analysis SPSS Version 21 was used.Results:Out of all participants, 68.1% were <30 years of age, 63.1% were females while 54.2% were single. The findings of the study showed the prevalence of anxiety within the range of normal (38.1%), mild (35.0%), moderate (16.9%) and severe (10.0%). Gender (p= 0.001), marital status (p= 0.040) and job satisfaction (p= 0.007) among resident doctors were significantly associated with level of anxiety. Deemed to coping strategies, the most frequently were planning (n=145, 90.0%), acceptance (n=141, 87.6%), and religion (n=137, 85.1 %). All coping strategies were mostly opted by females except substance abuse.Conclusion:More than a half of the resident doctors manifested with mild to severe anxiety disorder, which highlights the need for psychological support programs to minimize anxiety levels and to ensure a healthy environment at workplace for the health practitioners.

NDM Production as a Dominant Feature in Carbapenem-Resistant Enterobacteriaceae Isolates from a Tertiary Care Hospital.

The worldwide spread and increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is of utmost concern and a problem for public health. This resistance is mainly conferred by carbapenemase production. Such strains are a potential source of outbreaks in healthcare settings and are associated with high rates of morbidity and mortality. In this study, we aimed to determine the dominance of NDM-producing Enterobacteriaceae at a teaching hospital in Karachi. A total of 238 Enterobacteriaceae isolates were collected from patients admitted to Jinnah Postgraduate Medical Centre (Unit 4) in Karachi, Pakistan, a tertiary care hospital. Phenotypic and genotypic methods were used for detection of metallo-β-lactamase. Out of 238 isolates, 52 (21.8%) were CRE and 50 isolates were carbapenemase producers, as determined by the CARBA NP test; two isolates were found negative for carbapenemase production by CARB NP and PCR. Four carbapenemase-producing isolates phenotypically appeared negative for metallo-β-lactamase (MBL). Of the 52 CRE isolates, 46 (88.46%) were blaNDM positive. Most of the NDM producers were Klebsiella pneumoniae, followed by Enterobacter cloacae and Escherichia coli. In all the NDM-positive isolates, the blaNDM gene was found on plasmid. These isolates were found negative for the VIM and IPM MBLs. All the CRE and carbapenem-sensitive isolates were sensitive to colistin. It is concluded that the NDM is the main resistance mechanism against carbapenems and is dominant in this region.

Perceptions and experiences of healthcare providers during COVID-19 pandemic in Karachi, Pakistan: an exploratory qualitative study

ObjectiveTo explore healthcare provider’s perspectives and experiences of the barriers and facilitators to treat and manage COVID-19 cases.Design and settingWe conducted an exploratory qualitative study using a purposive sampling approach,...