Tertiary Care Hospital In Lahore Research Articles

Evaluation of Knowledge among Nurses about Pressure Ulcer in a Tertiary Care Hospital, Lahore

Background: Pressure ulcers are a prevalent issue in healthcare settings, leading to significant morbidity and increased healthcare costs. Nurses play a crucial role in the prevention and management of these conditions, yet gaps in knowledge can affect patient outcomes. The study aimed to assess the knowledge of nurses at a tertiary care hospital in Lahore, Pakistan, a setting where pressure ulcer management is critical yet understudied. Objective: This study aimed to evaluate the current level of knowledge among nurses regarding pressure ulcer prevention and management, and to identify any significant differences in knowledge across various critical care settings within the hospital. Methods: A cross-sectional descriptive study was conducted at Shalamar Hospital, Lahore, involving 125 staff nurses and nursing interns selected via simple random sampling. Participants were required to have at least six months of experience in general wards. Data were collected using a validated questionnaire, assessing knowledge of pressure ulcer management. Ethical approval was obtained from the Shalamar College of Nursing's ethical committee. Data analysis was performed using SPSS version 25 and Microsoft Excel, applying descriptive and inferential statistics, including the Chi-square test, with a significance level set at p<0.05. Results: The study revealed that 68.8% (86/125) of nurses had average knowledge, 29.6% (37/125) demonstrated good knowledge, and only 1.6% (2/125) exhibited poor knowledge regarding pressure ulcer management. Notably, nurses in the Surgical Intensive Care Unit (SICU) and High Dependency Unit (HDU) displayed the highest levels of knowledge, whereas those in the Medical Intensive Care Unit (MICU), Cardiac Care Unit (CCU), and Emergency Room (ER) had comparatively lower knowledge levels. Conclusion: The majority of nurses at Shalamar Hospital possessed an average level of knowledge concerning pressure ulcer management. There is a critical need for targeted educational interventions to enhance knowledge and practices, particularly in units where nurses showed lower knowledge levels. Improving nurse education in pressure ulcer management could significantly impact the quality of patient care and reduce the prevalence of these injuries.

Post-Cholecystectomy Biliary Leak and its Management in a Tertiary Care Hospital of Lahore City: A Cross Sectional, Descriptive Study

Background and Objective: Leakage of bile after open or laparoscopic cholecystecmy is rare, but if occurred, is associated with higher risk of morbidity and mortality. The objective of this study was to describe the experience of managing post-cholecystectomy biliary leak in a tertiary care hospital of Lahore, Pakistan.Methods: In this descriptive, cross sectional study, twenty-two cases were included using purposive sampling technique. These cases presented with bile leakage after cholecystectomy (open and/or laparoscopic) over the period of 3.5 years in a surgical unit. The patients were managed on case-to-case basis using a standardized revised algorithm. All patients were managed by ultrasonography guided drainage, and laparoscopic wash with control of sepsis. Magnetic Resonance cholangiopancreatography (MRCP) was conducted to classify injury using Strasberg's classification and managed according to the injury type. Data were managed and analyzed using SPSS version 25 and described using frequency and percentages.Results: Cases were aged between 30-60 years and out of 22 patients, twelve presented with bile leaks through drain left in-situ (55%), six presented with peritonitis with drain in-situ (27%), four patients (18%) had abdominal distension and peritonitis. Firty-one percent patients were managed by ultrasound guided drainage and in 9/22 patients laparoscopic wash and drain placement was done. In six patients, ERCP with stent was used. In 5/22 patients, hepaticojejunostomies were performed.Conclusion: Post-cholecystectomy iatrogenic biliary leak can be managed by drain placement, abdominal wash and antibiotics. Presented algorithm will help surgeons to manage post-cholecystectomy biliary leak effectively with low risk of mortality and morbidity.Keywords: Bile duct disease, post-operative complications, Common bile duct injuries, Biliary fistula , fistula biliary, biliary leakage, Cholecystectomy  

Knowledge and Practice Regarding Breast Self-Examination (BSE) among Nursing Students Working in A Tertiary Care Hospital Lahore, Pakistan: An Observational Descriptive Cross Sectional Study

Background: Breast self-examination (BSE) is a simple, quick, and cost-free method crucial for the early detection of breast cancer, which significantly reduces morbidity and mortality. Health Sciences students, particularly those in nursing, are ideally positioned to serve as role models and educators on this practice. Objective: The objective of this study was to assess the knowledge and practice of BSE among nursing students at a tertiary care hospital in Lahore, with a view to identifying gaps that could be addressed through targeted educational programs. Methods: This observational descriptive cross-sectional study engaged nursing students from various academic levels at a tertiary care hospital in Lahore. Participants were selected through convenience sampling. Adherence to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement was ensured. Data were collected via a self-administered structured questionnaire and analyzed using SPSS software version 26, focusing on frequencies and percentages of categorical variables. Results: Of the participants, 63.76% demonstrated a high level of knowledge about BSE, scoring ≥75%. In contrast, 36.23% scored below 75%, indicating a low level of knowledge. Practice of BSE was limited, with only 47% (n=65) of the participants engaging in the practice, and the majority, 53% (n=73), not practicing at all. Conclusion: Although nursing students show a good understanding of BSE, a significant gap exists between their knowledge and actual practice. This discrepancy highlights the need for enhanced educational interventions to encourage regular BSE practice, which is essential for the effectiveness of breast cancer screening and early detection efforts.

Comparison of metformin and repaglinide monotherapy in the management of newly diagnosed diabetes mellitus type 2: a prospective study

Comparison of metformin and repaglinide monotherapy in the management of newly diagnosed diabetes mellitus type 2: a prospective study

Does Colchicine Prevent Progression to Artificial Ventilation in Covid-19 Positive Patients? A Study from Lahore, Pakistan

Objective: To find out the effect of colchicine in prevention of progression to artificial ventilation in Covid-19 patients including young and elderly patients. Material and Methods: Study was conducted from 1st April 2020 till 30th September 2020 in a private, tertiary care hospital of Lahore. A retrospective cohort study was conducted on conveniently selected 179 PCR or radiologically confirmed Covid-19 positive adult and elderly, male and female patients admitted in Covid ward and Intensive care Unit (ICU) using the electronic as well as paper-based record. Amongst these patients, 33 patients were given colchicine, 137 recovered and 20 progressed to invasive ventilation. Result: Total 179 patients were included int the study and 96 (53.6%) were males and 83 (46.4%) were females. 52.5% had Diabetes mellitus, 58.7% had hypertension, 27.9% had ischemic heart disease, 8.4% had renal disease, 6.7% had lung disease/smoker. The average length of stay in hospital was 6.569±6.355 days. The outcome and progression to artificial ventilation in the patients who were given colchicine as compared to those who were not given colchicine were not statistically significant with a p value of 0.053 and 0.619, respectively. Conclusion: Colchicine has not shown a significant improvement in the outcome of Covid-19 and does not help in prevention of progression to invasive ventilation irrespective of age, gender, and co-morbidities.

Assessment of level of Burnout among Health Professionals in Lahore, Pakistan

Objectives: The prime objective of this study is to access the level of burnout among healthcare professionals using BAT tool. Also, the association of job satisfaction and workload factors is tested with burnout.   Study Design and setting: A cross-sectional multi-centered study in Lahore during the month of August 2022 to Jan 2023. The data was collected from healthcare professionals in three tertiary care hospitals in Lahore. Methodology: The data was collected from clinicians and staff nurses. The required sample size was calculated as 172. Data was collected using Burnout Assessment Tool (BAT) proposed by Schaufeli (2020). BAT was initially proposed with 33 items. BAT-S was the proposed 33-item version with four core dimensions and two secondary dimensions. The average score for each dimension was calculated and interpreted as given by Schaufeli in user manual for BAT-S. Results: Exhaustion was high among 55.8% of the participants. Mental distance was high among 34.3% of the participants whereas it was normal among 46.5%. Nearly 90% of the participants were satisfied from their jobs, committed to their jobs and accept responsibilities. Job satisfaction was significantly associated with burnout level. Lack of organizational influence and poor internal communication were statistically significantly related with level of burnout. Conclusion: The study was conducted to highlight the level of burnout among healthcare professionals. We found that very high level of burnout was observed in cognitive impairment followed by emotional impairment. The average level of burnout was more common among participants with job satisfaction and good internal communication.

Nurses Knowledge and Attitude Regarding Infection Control Practices

Background: Infection control practices are crucial in minimizing the risk of healthcare-associated infections (HAIs) in hospital settings. Adequate knowledge and positive attitudes among nurses towards these practices are essential for effective implementation and patient safety. Objective: This study aimed to evaluate the knowledge and attitudes of nurses regarding infection control practices at a tertiary care hospital in Lahore, Pakistan. Methods: A descriptive cross-sectional study was conducted involving 150 registered nurses from various departments including ICU, ER, and pediatric wards. Participants were selected using a convenient sampling technique. Data were collected via a validated questionnaire assessing knowledge and attitudes toward infection control practices. Descriptive statistics, frequency distributions, and reliability analysis (Cronbach’s Alpha) were performed using SPSS version 25. Results: The study revealed that 47.3% (71/150) of nurses had excellent knowledge, 22.0% (33/150) had good knowledge, and 30.7% (46/150) had poor knowledge about infection control. Regarding attitudes, 94.7% (142/150) of nurses exhibited a positive attitude towards infection control measures. The majority of participants were young, with 97.3% (146/150) between the ages of 21-30. Experience levels varied, with 81.3% (122/150) having between 1 to 3 years of experience. Conclusion: The findings indicate that while there is a good level of knowledge and a very positive attitude towards infection control among nurses, continuous education and training are needed to address gaps in knowledge and ensure high standards of practice are maintained.

Knowledge and Practices of Nurses Regarding Aseptic Techniques for Infection Prevention in Operating Room at Tertiary Care Hospital

Background: Surgical site infections (SSIs) remain a significant concern in operating rooms, largely influenced by the adherence to aseptic techniques by healthcare professionals. Despite the critical role of operating room nurses in preventing these infections, gaps in knowledge and practice persist, affecting the overall quality of patient care in tertiary healthcare settings. Objective: This study aimed to assess the knowledge and practices of operating room nurses regarding aseptic techniques for infection prevention in tertiary care hospitals. Methods: A descriptive cross-sectional study was conducted at a tertiary care hospital in Lahore, involving 130 operating room nurses with over a year of service. The study employed purposive sampling to administer a validated questionnaire assessing demographic data, knowledge, and practices related to aseptic techniques. Data were collected from January to March 2023 and analyzed using SPSS version 25, employing descriptive and inferential statistics to explore the relationship between demographic factors and knowledge/practices of aseptic techniques. Results: The study found that 60% of nurses were aware that a gown is considered sterile in specified areas, and 54.6% understood the contamination risks of dropped sterile packages. Approximately 62.3% recognized the importance of maintaining a safe distance during procedures. Despite these knowledge indicators, 94% of nurses routinely practiced sterile techniques, and 91% adhered to proper handwashing protocols. However, the overall level of knowledge concerning aseptic techniques was low, with significant gaps that could potentially impact patient safety. Conclusion: The study highlights a discrepancy between the knowledge and practices of operating room nurses regarding aseptic techniques, indicating a critical need for enhanced training and continuous education to bridge these gaps and improve infection control measures in surgical settings.

Knowledge, Attitude and Practice of Nurses Regarding Therapeutic Communication at Tertiary Care Hospital

Background: Effective communication in healthcare settings is pivotal for enhancing patient outcomes and fostering a cooperative environment between patients and healthcare providers. Therapeutic communication specifically plays a crucial role in establishing a rapport between nurses and patients, which can significantly impact the quality of care provided. Objective: The study aimed to evaluate the knowledge, attitudes, and practices of nurses regarding therapeutic communication within tertiary care hospitals in Lahore, identifying areas for potential improvement. Methods: A descriptive cross-sectional study was conducted over nine months using a validated questionnaire to assess the knowledge, attitudes, and practices of nurses. A total of 154 nurses were randomly selected using Slovin’s formula for sample size determination. Data collection involved demographic and professional experience details, followed by specific questions on therapeutic communication. The Statistical Package for the Social Sciences (SPSS) Version 25.0 was utilized for data analysis, employing descriptive and inferential statistics to interpret the data. Results: The results showed that 33.1% of nurses exhibited low knowledge levels, 39.0% moderate, and 27.9% high knowledge about therapeutic communication. Regarding attitudes, 57.1% of nurses displayed a positive attitude while 42.9% had a negative attitude towards therapeutic communication. In practice, 61.7% of nurses demonstrated good practice of therapeutic communication, whereas 38.3% displayed poor practices. Conclusion: The study concluded that while there is a moderate understanding and positive attitude towards therapeutic communication among nurses, significant portions still require further training and improvement. Enhanced educational programs focusing on therapeutic communication could bridge existing knowledge gaps and refine practices, thereby improving patient care outcomes.

ASSESSMENT OF SURGICAL TREATMENT STRATEGIES OF IATROGENIC GIANT FEMORAL ARTERY PSEUDOANEURYSMS

Iatrogenic giant femoral artery pseudoaneurysms pose significant clinical challenges, necessitating prompt intervention to prevent complications. Despite advancements in endovascular techniques, optimal surgical strategies remain unclear. This study aimed to evaluate surgical treatment's technical and clinical outcomes for these pseudoaneurysms. Objective: To assess the technical success and clinical outcomes following surgical repair of iatrogenic giant femoral artery pseudoaneurysms. Methods: This retrospective cohort study was conducted at a tertiary care hospital in Lahore, Pakistan between July 2022 and July 2023. A total of 60 patients diagnosed with iatrogenic giant femoral artery pseudoaneurysms underwent surgical repair. It was followed up for one, three, and six months using Duplex ultrasound and CT angiography. Data were analyzed to evaluate surgical techniques, technical success rates, and postoperative outcomes. Statistical analysis was performed using descriptive statistics and chi-square tests. Results: All patients (n=60) underwent successful surgical repair with various techniques: primary repair (n=30), repair with vein patch angioplasty (n=15), interposition reversed saphenous vein graft (n=10), and interposition synthetic Dacron graft (n=5). Technical success was achieved in 100% of cases, with no limb loss or intraoperative/postoperative mortality. The presenting symptoms were resolved in all patients, with one case of postoperative groin wound infection being effectively managed with antibiotics and debridement. Conclusion: Open surgical repair of femoral pseudoaneurysms demonstrates excellent technical feasibility and serves as a first-line treatment for iatrogenic giant femoral artery pseudoaneurysm-associated complications. These findings support surgical intervention as a practical approach to managing these challenging cases.

Burden and Outcomes of Respiratory Diseases in Hospitalized Neonates at a Tertiary Care Hospital in Lahore: A Cross-Sectional Study

Abstract Background: Respiratory diseases constitute a significant contributor to health issues in neonates, leading to admissions to neonatal intensive care units (NICU), and many of these neonates never recover, resulting in high neonatal mortality rates with respiratory diseases. Objective: To assess the burden of respiratory diseases in hospitalized neonates and determine their outcomes, including discharges and deaths, among those admitted to neonatal intensive care units in a tertiary care hospital in Lahore. Methods: An observational analytical cross-sectional study was conducted on 187 neonates admitted to a neonatology department of the tertiary care hospital in Lahore. Demographical data was collected by using a structured questionnaire. The analyses were conducted using R software. The chi-square test was employed to ascertain the associations between significant factors of respiratory diseases in neonates. Results: Among the respiratory conditions requiring admission, pneumonia (n=92, 49.1%) stood out as the most frequently diagnosed respiratory disease in neonates, followed by respiratory distress syndrome (RDS) (n=53, 28.3%), transient tachypnea of the newborn (TTN) (n=18, 9.62%), and meconium aspiration syndrome (MAS) (n=24, 12.8%). In terms of mortality among these respiratory conditions, pneumonia had the highest frequency (40.5%), followed by RDS (39.2%), MAS (20.2%), in neonates. Conclusion: Respiratory disorders proved to be a prevalent reason for neonatal admissions to the NICU, showcasing a significant association with neonatal mortality, especially in pneumonia, respiratory distress syndrome, and meconium aspiration syndrome.

Levofloxacin loaded chitosan and poly-lactic-co-glycolic acid nano-particles against resistant bacteria: Synthesis, characterization and antibacterial activity

BackgroundWith the global increase in antibacterial resistance, the challenge faced by developing countries is to utilize the available antibiotics, alone or in combination, against resistant bacterial strains. We aimed to encapsulate the levofloxacin (LVX) into polymeric nanoparticles using biodegradable polymers i.e. Chitosan and PLGA, estimating their physicochemical characteristics followed by functional assessment as nanocarriers of levofloxacin against the different resistant strains of bacteria isolated from biological samples collected from tertiary care hospital in Lahore, Pakistan. MethodsLVX-NPs were synthesized using ion gelation and double emulsion solvent-evaporation method employing chitosan (CS) and poly-lactic-co-glycolic acid (PLGA), characterized via FTIR, XRD, SEM, and invitro drug release studies, while antibacterial activity was assessed using Kirby-Bauer disc-diffusion method. ResultsData revealed that the levofloxacin-loaded chitosan nanoparticles showed entrapment efficiency of 57.14% ± 0.03 (CS-I), 77.30% ± 0.08(CS-II) and 87.47% ± 0.08 (CS-III). The drug content, particle size, and polydispersity index of CS-I were 52.22% ± 0.2, 559 nm ± 31 nm, and 0.030, respectively, whereas it was 66.86% ± 0.17, 595 nm ± 52.3 nm and 0.057, respectively for CS-II and 82.65% ± 0.36, 758 nm ± 24 nm and 0.1, respectively for CS-III. The PLGA-levofloxacin nanoparticles showed an entrapment efficiency of 42.80% ± 0.4 (PLGA I) and 23.80% ± 0.4 (PLGA II). The drug content, particle size and polydispersity index of PLGA-I were 86% ± 0.21, 92 nm ± 10 nm, and 0.058, respectively, whereas it was 52.41% ± 0.45, 313 nm ± 32 nm and 0.076, respectively for PLGA-II. The XRD patterns of both polymeric nanoparticles showed an amorphous nature. SEM analysis reflects the circular-shaped agglomerated nanoparticles with PLGA polymer and dense spherical nanoparticles with chitosan polymer. The in-vitro release profile of PLGA-I nanoparticles showed a sustained release of 82% in 120 h and it was 58.40% for CS-III. Both types of polymeric nanoparticles were found to be stable for up to 6 months without losing any major drug content. Among the selected formulations, CS-III and PLGA-I, CS-III had better antibacterial potency against gram+ve and gram-ve bacteria, except for K. pneumonia, yet, PLGA-I demonstrated efficacy against K. pneumonia as per CSLI guidelines. All formulations did not exhibit any signs of hemotoxicity, nonetheless, the CS-NPs tend to bind on the surface of RBCs. ConclusionThese data suggested that available antibiotics can effectively be utilized as nano-antibiotics against resistant bacterial strains, causing severe infections, for improved antibiotic sensitivity without compromising patient safety.

Evaluation of the Vitamin B12 Deficiency in Megaloblastic Anemia in Tertiary Care Hospital, Lahore.

Background: Megaloblastic anemia is a hematologic disorder characterized by the presence of large, immature red blood cells due to a deficiency in vitamin B12 or folate. It remains a significant public health issue globally, affecting various populations across different age groups and dietary habits. Objective: The objective of this study was to evaluate the prevalence and implications of vitamin B12 deficiency in the development of megaloblastic anemia in a tertiary care hospital in Lahore. Methods: A cross-sectional analysis was conducted on 85 patients over a period of four months. Ethical approval was secured in line with the Declaration of Helsinki. Participants included both genders with hemoglobin levels <10 g/dl or mean corpuscular volume >95 fL, excluding pregnant women and individuals with primary diseases such as hepatic, renal, or cancerous conditions. Verbal consent was obtained before blood sample collection. CBC parameters were analyzed using a Mindray hematology analyzer, and vitamin B12 levels were measured via ELISA. Statistical evaluation was performed using SPSS version 25.0. Results: The mean hemoglobin levels for males and females were 10.06 ± 3.10 g/dl and 9.61 ± 3.25 g/dl, respectively. The mean MCV for males was 99.94 ± 6.63 fL, and for females, it was 100.25 ± 7.90 fL. Vitamin B12 levels averaged at 489.92 ± 468.10 pg/ml for males and 440.19 ± 419.47 pg/ml for females. Of the patients, 47.05% had normal B12 levels, 25.88% were deficient, and 27.05% had high levels of B12. Conclusion: Vitamin B12 deficiency was prevalent among patients with megaloblastic anemia and was independent of gender or age. The findings suggest a strong need for enhanced nutritional awareness and screening practices to identify and treat this deficiency early in at-risk populations.

Maxillofacial trauma and its management presenting at a tertiary care hospital in Lahore during Covid-19 pandemic.

The objective of this study was to assess the patterns of maxillofacial injuries, aetiology and their management during the pandemic of Covid-19 in a tertiary care hospital in Lahore, Pakistan. This is a single center, prospective cross-sectional study. Patients from all age groups who presented at the Emergency room of Jinnah Hospital Lahore and managed by the Oral and Maxillofacial Surgery Department during 1st December 2020 till 31st January 2021 were included. Data were analyzed using IBM SPSS for Windows, Version 20.0. Total 202 patient were analyzed, 161 (79.7%) were male and 41 (20.3%) were females. Male to female ratio was 4:1. About fifty three percent of patients belonged to the age group 15-35 years. The most common cause was road traffic accidents (RTA), followed by fall. Eighty-three (41.1%) had only soft tissue injuries without any bony fracture and 119 (58.9%) had facial bones fractures. Zygomatic bone fracture was most common (53.8%) followed by mandible fracture (31.1%). Sixty-one out of 119 patients with fractures were treated with Open Reduction Internal Fixation (ORIF). Three patients had complete loss of vision because of facial trauma. Only 56 (28%) patients were managed under General Anaesthesia. During the initial pandemic era, a large majority of patients presenting with maxillofacial injuries were young male adults. The most common cause of maxillofacial trauma was RTAs. Soft tissue injuries were predominant followed by facial bone fractures and zygomatic bone was more frequent among the fracture cases. Covid-19 pandemic increased the difficulties faced in the management of maxillofacial trauma patients.

Barriers in Implementing Evidence-Based Practice among Nurses at Tertiary Care Hospitals of Lahore

Evidence-based practice is a technique used in solving clinical issues regarding patient care by integrating well-designed evidence. It also takes into account patient preferences to promote quality of care and improve patient outcomes. Objectives: To identify the barriers in implementing evidence-based practice among nurses and to identify personal and organizational obstacles in implementing EBP. Methods: A descriptive cross sectional quantitative study design was used. Total sample size was 116 staff nurses of the tertiary care hospital with experience more than three years. The study was conducted at two tertiary care hospitals of Lahore; Jinnah hospital, Lahore, Fatima Memorial hospital, Lahore. Results: The findings showed that biggest barrier in implementing EBP are lack of health care facilities to empower nurses with EBP environment (72.4%). Conclusions: This study concluded that financial situation of country which leads to inadequate health care resources and equipment’s for EBP implementation. Identifying the barriers that affect the implementation of EBP can become a stepping stone for the commencement of discussion concerning the elimination of these barriers from the healthcare sector and finding ways to resolve existing problems. 

Correlation of glycated hemoglobin with serum uric acid levels among type 2 diabetic patients: a cross-sectional study

Background: Diabetes Mellitus Type 2 (DMT2) is one of the commonest disorders of endocrinology which is characterized by the raised blood glucose level due to insulin resistance in body cells. This study was aimed to determine the correlation between the glycated hemoglobin (HbA1c) and serum uric acid (SUA) in patients with DMT2. Methods: This cross-sectional study was conducted in a tertiary care hospital of Lahore. 73 Patients’ recruitment was made via convenient sampling technique and a developed inclusion and exclusion criteria. Self-structured proforma was used for data collection. Data analysis was done in SPSS version 25.0. Results: From total patients, 40 (54.79%) were women while 33 (45.21%) were men. Means of different variables like age, HbA1c, and serum uric acid level were 54.98 years with standard deviation (SD) of ±11.67 years, 7.90 with SD of ±1.85%, and 7.51 with SD of ±0.81 respectively. 32 (43.83%) patients had good glycemic control whereas 41 (56.17%) patients had poor glycemic control. The frequencies of hyperuricemia and normal SUA in study population were 35 (47.94%) and 38 (52.06%) respectively. The means of the HbA1c across gender had statistically significant difference. Difference in the means of the SUA level, across gender and between patients with hyperuricemia and normal SUA level, was also statistically significant. Moreover, correlation between the HbA1c and SUA was positive and statistically significant. Conclusions: In a nutshell, this study suggests that increase in SUA level, worsen the glycemic control by raising glycated hemoglobin level among patients with DMT2.

Association of ABO and RH Blood Groups with Gestational Diabetes Mellitus in Patients Attending a Tertiary Care Hospital of Lahore, Pakistan

Objective: To find out any association of ABO and Rh blood groups with gestational diabetes mellitus (GDM). Study Design: Comparative cross-sectional study. Place and Duration of Study: Pathology and Gynecology departments of Combined Military Hospital-Lahore from Jun to Sep 2020. Methodology: A total of 250 patients of GDM and 250 pregnant ladies with normal glucose tolerance (NGT) were included in the study. The Oral glucose tolerance test (OGTT) was performed with a 75g glucose load, and results were interpreted according to the American Diabetes Association 2020 criteria. Blood glucose samples were taken in sodium fluoride containers in fasting conditions, 1 hour and 2 hours post-glucose load. Samples for blood groups were obtained in plain and EDTA containers. Blood glucose samples were analyzed using the Hexokinase method's automated chemistry analyzer, Cobas c-501. ABO and RhD blood grouping were carried out by forward and reverse techniques in the blood bank of CMH Lahore. Results: A total of 250 (50%) pregnant ladies with OGTT suggestive of Gestational Diabetes Mellitus and 250 (50%) pregnant ladies with OGTT suggestive of Normal Glucose Tolerance (NGT) were included in the study. No statistically significant difference was observed with ABO and RhD blood groups among them (p=0.944). Conclusion: There is no significant association found between ABO and RhD blood groups with Gestational Diabetes Mellitus.

Fibroadenoma of the Breast Occurring Synchronously in Twin Sisters- A Case Report

<p>Fibroadenomas (FAs) are the most common benign tumors of the breast in young females. Most of the time, it presents as a well-circumscribed, painless, firm to hard, mobile, and slow-growing unilateral or bilateral breast lump. The median age of its presentation is 25 years with rare occurrence after menopause. The exact etiology of FA is still unclear. Unopposed estrogen in the growing breasts of young females is considered as a main factor in its pathogenesis. Family history and development of FA in identical twins are suggestive of genetic contribution to the pathogenesis of these tumors.</p>
 <p>This is a case report of young twin sisters who presented at a tertiary care hospital in Lahore with a complaint of a synchronously developed unilateral breast lump. Fine needle aspiration cytology was planned after taking a detailed history and clinical examination of both patients. Diagnosis of FA was confirmed radiologically and through cytological examination. To the best of the authors’ knowledge, this is the first case of its kind reported from Pakistan.</p>

Frequency of Job Satisfaction and its influencing Factors Among Nurses Working in Tertiary Care Hospital of Lahore

Backgroud: 
 The level of patient care directly correlates with nurse job satisfaction. Nurses are more likely to experience job discontent due to increased work demands, which could have an impact on their productivity. 
 Objective: 
 This study's objective was to ascertain the level of job satisfaction and contributing factors among the nurses at Lahore's tertiary care hospital.
 . 
 Methods: 
 A cross-sectional study was carried out in 2022 between June and August. Following an informed consent, 170 nurses employed by tertiary care hospitals were included in the study. The self-administered questionnaire was handed to the nurses, who completed it. The researcher assembled all of the information. Frequency and percentages were determined for quantitative data, and the chi-square test was used to determine whether there was a statistically significant difference between variables for categorical variables. In order to create the results, SPSS (version 23) was used.
 Results: In this study 124(73%) out of 170 nurses were satisfied. .Relationship between intrinsic factors such as choice of profession(p-value= .004), nature of job (p-value =.003) and extrinsic factors like relationship with patients and colleagues, time pressure, opportunity to develop were found significantly associated with job satisfaction having p-value =.001,.030,.012 and .031 respectively. Nurses (4%) working in intensive care unit showed dissatisfaction due to time pressure.
 Conclusion: This study shows that most of the nurses were satisfied with their job. Which can be further improved by reducing the working hours and providing career development opportunities and job security in form of permanent jobs to nurses.

Practices of Informed Consent for Emergency Procedures at a Tertiary Care Hospital in Lahore, Pakistan.

Background The purpose of obtaining informed consent is to ensure that patients undergoing any medical or surgical intervention are neither deceived nor coerced. Accurately estimating surgical risks is critical for shared decision-making and informed consent. Probable complications and alternative procedures should be presented to the patient so that they can freely choose an operative option. However, this factor is difficult to carry on in emergencies where an urgent decision is required. Objective This study aimed to assess the ongoing clinical practices of informed consent in emergency surgeries at a tertiary care facility. Materials and methods A cross-sectional survey was carried out from March 2022 to June 2022 at the Department of General Surgery, Lahore General Hospital, Lahore, Pakistan, with patients who had undergone surgical procedures under local, spinal, or general anesthesia within 24 hours of presentation. A Google Form (Google Inc., Mountainview, CA) was designed, containing a predefined set of 32 standard questions, and patients were interviewed in their native language to assess their satisfaction regarding the pattern and components of emergency informed consent. Categorical data were assessed using measures of central tendency, frequencies, and percentages. Results A total of 169 patients were selected for the study. Only 1.6% of them signed the consent form themselves, while 93.5% of the forms were signed by their first-degree relatives. Verbal consent was taken in 4.8% of cases. In 88% of cases, informed consent was obtained by the house surgeons. The majority of patients, i.e., 78.2%, were not able to read the written consent form; however, 83.1% understood the verbal information. About 66.3% of patients agreed that they were informed about the nature of their disease, while 67.5%, 14.8%, and 13.7% affirmed that they were explained the nature of surgical intervention, associated risks, and type of anesthesia, respectively. Overall, 59.5% of patients felt satisfied with the process of informed consent. About 91.1% of the patients believed that their decisions were unaffected by the procurement of informed consent. Conclusion The existing practices of informed consent and comprehension by the population were found to be substandard. Physicians seem to ignore bioethics, and patients appear to be unaware of their basic rights. Although practiced at our center, not all components of informed consent were communicated to the patients. The risks of the procedures and the mode of anesthesia used were not well addressed by doctors. There is a grave need to educate the medical community about the legal and ethical aspects of informed consent, as well as the public masses regarding their rights.