Tertiary Care Hospital In Pakistan Research Articles

Exploring preference for delivery methods for a Psychosocial Intervention for Prenatal Anxiety: A Qualitative Study from a Tertiary Care Hospital in Pakistan

Exploring preference for delivery methods for a Psychosocial Intervention for Prenatal Anxiety: A Qualitative Study from a Tertiary Care Hospital in Pakistan

Validation of postnatal growth and retinopathy of prematurity (G-ROP) screening guidelines in a tertiary care hospital of Pakistan: A report from low-middle income country.

Retinopathy of Prematurity (ROP) significantly contributes to childhood blindness globally, with a disproportionately high burden in low- and middle-income countries (LMICs) due to improved neonatal care alongside inadequate ROP screening and treatment facilities. This study aims to validate the performance of Postnatal Growth and Retinopathy of Prematurity (G-ROP) screening criteria in a cohort of premature infants presenting at a tertiary care setting in Pakistan. This cross-sectional study utilized retrospective chart review of neonates admitted to the neonatal intensive care unit (NICU) at The Aga Khan University Hospital, Pakistan from January 2018 to February 2022. The complete G-ROP criteria were applied as prediction tool for infants with type 1 ROP, type 2 ROP, and no ROP outcomes. Out of the 166 cases, 125 cases were included in the final analysis, and remaining cases were excluded due to incomplete data. ROP of any stage developed in 83 infants (66.4%), of whom 55 (44%) developed type 1 ROP, 28 (22.4%) developed type 2 ROP, and 19 (15.2%) were treated for ROP. The median BW was 1060 gm (IQR = 910 to 1240 gm) and the median gestational age was 29 wk (IQR = 27 to 30 wk). The G-ROP criteria demonstrated a sensitivity of 98.18% (95% CI: 90.28-99.95%) for triggering an alarm for type 1 ROP. The G-ROP criteria achieved 100% sensitivity (95% CI: 87.66 to 100%) for type 2 ROP. The overall sensitivity of G-ROP criteria to trigger an alarm for any type of ROP was 98.8% (95% CI: 93.47 to 99.97%). Thus, the G-ROP screening model is highly sensitive in detecting at-risk infants for ROP in a Pakistani tertiary care setting, supporting its use in LMICs where standard screening criteria may not suffice.

Efficacy of Remdesivir on Clinical Outcomes in COVID-19 Patients: A Study in a Tertiary Care Hospital in Pakistan

Efficacy of Remdesivir on Clinical Outcomes in COVID-19 Patients: A Study in a Tertiary Care Hospital in Pakistan

Mortality Audit in the Head and Neck Surgery Ward: A Retrospective Study in a Tertiary Care Hospital of Pakistan

Mortality Audit in the Head and Neck Surgery Ward: A Retrospective Study in a Tertiary Care Hospital of Pakistan

Exploring treatment outcomes in Stage II-III rectal cancer patients undergoing neoadjuvant therapy at a tertiary care center in Pakistan: a comprehensive analysis of pathological outcomes.

Rectal cancer treatment has transformed in recent years, with neoadjuvant treatment (NT) and total neoadjuvant treatment (TNT) aiming to enhance pathological responses. This pioneering study in our country delves into rectal cancer management, offering crucial insights by examining pathological outcomes in patients treated with the NT and TNT approach, shaping the evolving landscape. In this retrospective-cohort study spanning January 2017 to December 2022 at a tertiary care hospital in Pakistan, ethical approval was obtained to examine outcomes of two treatments. Patients were divided into TNT (chemoradiation and pre-surgery 5 FU-based chemotherapy) and NT (chemoradiation, surgery, and subsequent 5 FU-based chemotherapy). The primary end-point was response rates-no response, pathological complete response (pCR), near complete response (near CR), and partial response (PR). The Chi-Square Test for Independence assessed the association between treatment response and type (TNT or NT). Data analysis used STATA MP 64; significance was set at p < 0.05 for all two-tailed tests. We analyzed 77 patients, 60 underwent standard neoadjuvant chemoradiation, and 17 followed the total neoadjuvant approach. Predominantly male, most were > 65 with ECOG 0-1. The TNT group showed higher response rates (76% vs 62%, p = 0.039), with 40.38% achieving pCR. In the overall population, pCR and near-CR were similar (27.2% vs 26%), while PR were 14%. Treatment characteristics correlated significantly with chemotherapy type, concurrent chemoradiation, LVI, PNI, and T, N, M staging (p < 0.05). Median overall survival was not reached, and mean survival was 89.1months (CI: 95.0 to 83.3). Side effects varied, with notable differences in neuropathy, diarrhea, oral mucositis, and thrombocytopenia between NT and TNT groups. Our study adds to evidence favoring neoadjuvant approaches in managing rectal cancer in pakistan. Demonstrating a favorable pcr rate, ongoing research with extended follow-up is essential, given the dynamic landscape of rectal cancer treatment for improved patient outcomes.

Frequency of major congenital malformations in neonates born in three tertiary care hospitals of Pakistan.

Objective: To assess the frequency of major congenital anomalies in newborns delivered in three different hospitals of Pakistan. Study Design: Cross Sectional study. Setting: Department of Pediatrics Hameed Latif Teaching Hospital, Lahore, Ittefaq Hospital Lahore and HITEC-IMS Taxilla. Period: Jan 2023 to November 2023. Methods: 205 neonates who met the inclusion criteria were included in the study from labour room of Hameed Latif Teaching Hospital Lahore, Ittefaq Hospital Lahore and HITEC-IMS Taxilla. Informed consent was obtained from parents. Demographic variables (name of mother, gender, birthweight and gestational age at birth) were recorded. Then neonates were admitted in NICU and evaluated for presence of congenital malformations including cardiovascular system defects, limbs anomalies, genitourinary system, central nervous system and chromosomal anomalies. All data was entered in specially designed performa. Results: We found that overall gestational age was greater than 32 weeks with mean age of 37.190±2.00 weeks. Mean birth weight was 2.938±0.31 Kg. Frequency and %age of patients according to gender was 60% males and 40% females. Major congenital malformation was seen in 2.9% patients. Among infants with major congenital malformations, cardiovascular system defects were seen in 33.3% infants, limb anomalies 16.7%, genitourinary system 16.7% and central nervous system defects were 33.3%. Parents of 67.7% of cases were cousins. It was observed that only 32.3% of the mothers had taken the recommended daily dose of folic acid in antenatal period. Conclusion: Central nervous system and cardiovascular system defects were the most prominent anomalies detected. Prenatal diagnosis may be helpful in decreasing mortality by offering early termination.

PREVALENCE OF PSYCHOACTIVE SUBSTANCE USE AMONG SECURITY GUARDS AT TERTIARY CARE HOSPITAL: A CROSS-SECTIONAL STUDY

Introduction: Drug addiction is a prevalent problem in Pakistan, and screening tools are available for diagnosis. Seeking guidance from healthcare professionals is important for appropriate treatment. Assessing addiction among security personnel is important for safety and policy formulation Aims &amp; Objectives: This cross-sectional study aims to investigate drug addiction screening and its correlates among security guards in a tertiary care hospital. Materials &amp; Methods: This cross-sectional study was conducted at Sheikh Zayed Medical College/Hospital in Rahim Yar Khan, Pakistan. Purposive convenience sampling was used to select a sample size of 184 Results: The study conducted among 184 security guards showed significant associations between gender, marital status, and age categories. A considerable proportion of guards were found to be overweight, had increased blood pressure, and substance use in the form of nicotine-related substances was found to be The study highlights the need for interventions promoting healthy lifestyles and substance use education and prevention efforts among security guards in such settings. Conclusion: This study revealed a prevalence of substance use among security guards in a tertiary care hospital in Pakistan and identified the need for interventions to promote healthy lifestyles and substance use education/prevention. Seeking guidance from healthcare professionals and implementing public health initiatives to address drug addiction and promote healthy lifestyles among security personnel are crucial.

Evaluation of knowledge of healthcare professionals regarding tracheostomy care: a cross-sectional study at a tertiary care hospital in Pakistan

BackgroundTracheostomy is considered the oldest and the most effective operative procedure for patients admitted to intensive care units and in emergencies. The study’s objective was to evaluate healthcare providers’ knowledge regarding tracheostomy care.ResultsAll healthcare professionals directly involved in the provision of care to patients with tracheostomy were included and asked to fill out the questionnaire. The response rate was 87.63%. Out of 50, the mean comfort score was 37.69. 70.6% of participants reported having a comfort score equal to or more than 70%. Out of 10, the mean score was 5.29. Only 20.9% of participants were able to score equal to or more than 70%. The results demonstrate that healthcare professionals’ knowledge of tracheostomy care was below par. Only those who were experienced in this field were able to score above average.ConclusionThe assessment of knowledge in tracheostomy care highlights the significance of ongoing education and training in the healthcare field. As medical practices evolve, it is imperative for healthcare providers to stay updated with the latest guidelines and techniques to provide the highest standard of care.

Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan

Objective: To determine the pattern, tumor characteristics of esophageal cancer (EC) and survival of esophageal carcinoma patients presenting to upper GI Unit at Dr. Ruth K.M. Pfau Civil Hospital Karachi.&#x0D; Methods: We conducted a retrospective analysis of histologically confirmed EC patients from 2016 to 2021 at Upper GI Unit – Dr. Ruth K.M. Pfau Civil Hospital, Karachi. Data were collected using a filled Proforma, medical records, pathology reports and surgical notes, and patients or their family members were contacted for informed consent. Statistical analyses were performed using STATA version 16.0. Time to event was measured from the date of diagnosis to the date of the last follow-up or recorded death. Descriptive statistics and survival analyses, including Kaplan–Meier method and log-rank test, were employed. Univariate and multivariate Cox regression analyses were conducted to assess independent predictors of survival.&#x0D; Results: Total 152 patients with a median age of 45 (range 80-15) years were enrolled in this study. Clinical stages-III, IV-A and IV-B were identified in 35.5% (n = 54), 23.7% (n = 36) and 34.2% (n = 52), respectively. Total of 62% (n=94) had died at median follow up of 9.56 months and three years overall survival rate was 10.0%. Univariate survival analysis revealed that patients with clinical stage-II (p-value 0.002) and patients treated with combined surgery plus chemo-radiotherapy (p-value 0.040) was significantly associated with lower risk of mortality among other stages and treatment modality groups. Conversely, patients having metastasis (p value &lt;0.001) and those with vascular involvement &gt;90 degrees (p value &lt;0.001) showed worse survival outcomes.&#x0D; Conclusion: Our study reveals a three years survival rate of 10.0%, emphasizing the formidable challenge of advanced-stage malignancies. Clinical stage, vascular involvement, and metastasis emerged as significant predictors of mortality. Moreover, integrating surgery with chemo-radiotherapy significantly improved three years survival (36.8% vs. 14.2%). Despite single-center limitations, our findings provide crucial regional insights into esophageal carcinoma outcomes.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.7582&#x0D; How to cite this: Qureshi S, Khan S, Quraishy MS, Zaheer S. Esophageal cancer patient survival: A retrospective study from a tertiary care hospital in Pakistan. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.7582&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Diphtheria-Associated Myocarditis: Clinical Profiles and Mortality Trends in a Tertiary Care Hospital in Pakistan.

Corynebacterium diphtheriae infection, causing diphtheria, is a public health concern, particularly in developing nations like Pakistan. Despite immunization efforts, recent outbreaks since 2022 have emphasized the continuing threat. This study focuses on describing the clinical characteristics of children with diphtheria-induced myocarditis and exploring the association between early cardiac abnormalities, future fatality rates, and contributing factors. A one-year cross-sectional study was undertaken at Lady Reading Hospital MTI Peshawar, encompassing 73 pediatric patients diagnosed with diphtheria-associated myocarditis. Data, including demographic characteristics, cardiac enzymes, and serial ECG and echocardiography data, were gathered from the health management information system (HMIS). Institutional Ethical Committee approval was obtained, and informed consent was waived due to its retrospective nature. Gender distribution within the study was balanced, with 35 males (47.9%) and 38 females (52.1%). ECG data revealed various prevalence rates: 27.4% for rhythm abnormalities, 20% for conduction abnormalities, 6.8% for ischemia alterations, and 20.5% for normal findings. Treatment measures included anti-diphtheria serum (ADS) in 87.7% and temporary pacemaker placement (TPM) in 13.7% of patients. Echo findings indicated a variety of cardiac dysfunctions: 53.4% with no dysfunction, 9.6% mild malfunction, 6.8% with moderate dysfunction, and 30.1% with severe dysfunction. The categorization of creatine kinase (CK), lactate dehydrogenase (LDH), and troponin I (Trop I) gave insights into the biochemical aspects. This study gives a full insight into the clinical symptoms of diphtheria-induced myocarditis in children. The findings can help establish a foundation for ongoing study into potential gender-related trends in clinical outcomes, contributing to improved care and preventative methods.

Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan

Objective: To investigate the association and risk estimation of ABO blood group distribution and clinical attributes in patients with Knee Osteoarthritis.&#x0D; Method: This was a hospital-based study conducted at, Liaquat University Hospital Hyderabad from December, 2019 to December, 2022 to investigate this least researched area of highly prevalent musculoskeletal disease in Pakistan. Non-Probability Convenience Sampling was used for selecting 190 cases of confirm Knee Osteoarthritis patients diagnosed by Orthopedic surgeon based on standard clinical and radiographic criteria. Data were analyzed using IBM-SPSS version 23.0. Percentages and frequencies were counted for categorical data. Pearson Chi Square test and fisher’s exact test were used to check the association and Multinomial Logistic Regression was used to estimate the risk for moderate and severe kellgren grading Knee Osteoarthritis (KOA) cases with ABO blood grouping in comparison of mild Kellgren grading.&#x0D; Results: A total of 190 cases of Knee Osteoarthritis (KOA) were included in the study. Females (61.6%) and patients with age 50 and above were 40.5 % were found in greater proportion. Majority (41.6%) were classified radiologically as mild cases with O group (39.5%) and positive Rh antigen (95.8%). Strong association (p = &lt;0.01) was found between gender, age group and ABO blood group with KOA radiological Kellgren and Lawrence score.&#x0D; Conclusion: There is strong relation in between radiological grading of knee osteoarthritis severity and A blood group, gender and age.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.8865&#x0D; How to cite this: Shaikh SR, Atta Ur Rahman A, Makhdoom A. Analysis of human ABO Blood Group as a risk factor with knee osteoarthritis at tertiary care hospital in Pakistan. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8865&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines

Objective: To determine trend of following medical advice and safety of high-risk diabetic patients during Ramadan practicing updated IDF DAR guidelines.&#x0D; Methods: The cross-sectional study was conducted at Outpatient Department of Diabetes, Endocrinology and Metabolic Disorders Hayatabad Medical Complex Peshawar, Pakistan from April to June 2022, and comprised of high-risk diabetic patients (&gt;6.0) based on updated IDF-DAR guidelines 2022 intending to fast. A questionnaire was designed to document patient risk factors score, type and duration of diabetes, HbA1c, comorbidities and complications developed during Ramadan. Data was analyzed using SPSS 20.&#x0D; Results: Among all 130 participants, 78(60%) followed medical advice and did not fast and 52(40%) patients fasted against medical advice during month of Ramadan. Out of 130 participants, 89.2% were having type-2 diabetes Mellitus, 55.4% were female and mean age of participants was 52+14.6.40%. In fasting group, 57.7% were in the age range of 16 to 50 years while in non-fasting group 69.2% participants were more than 50 years old (P-value 0.031). There were 80.8% female participants in fasting group versus 38.5% in non-fasting group (P-value 0.001). Hypoglycemia occurred in 58.3% patients in fasting group and 29.3% non-fasting group. (P-value 0.021). On the other hand, 27.8% patients in fasting group and 55.2% of non-fasting group had hyperglycemia (P-value 0.025).&#x0D; Conclusion: Despite advised against fasting in these high-risk patients as per IDF DAR guidelines, almost half of patients fasted considering fasting a religious obligation. Those who fasted had significant hypoglycemia despite adjustment of medications as in guidelines. There is need of more intensive education before fasting, especially in high-risk diabetic patients.&#x0D; doi: https://doi.org/10.12669/pjms.40.5.8007&#x0D; How to cite this: Farooq Q, Ghaffar T, Malik SE, Aamir AH. Safety of high-risk diabetic patients during Ramadan at a tertiary care hospital in Pakistan, practicing updated IDF DAR guidelines. Pak J Med Sci. 2024;40(5):---------. doi: https://doi.org/10.12669/pjms.40.5.8007&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Improving the Quality and Completeness of Discharge Summaries at a Tertiary Care Hospital in Pakistan: A Quality Improvement Project.

Introduction Discharge summaries (DS) allow continued patient care after being discharged from the hospital. Only a few quality improvement projects (QIPs) focused on assessing and improving the quality and completeness of DS at tertiary care hospitals have been undertaken in Pakistan. This QIPaimed to evaluate and enhance the quality and completeness of DS at a tertiary care hospital in Pakistan to facilitate seamless healthcare transitions. Methods A QIP was conducted in the medical unit of a tertiary care hospital in Rawalpindi, Pakistan. The DS were assessed using the e-discharge summary self-assessment checklist devised by the Royal College of Physicians (RCP). This QIP was done by the plan, do, study, act (PDSA) cycle. The PDSA cycle comprised two audit cycles and an intervention in between them. The first audit cycle (AC) was conducted on 150 DS. Its duration was from March 2023 to June 2023. An educational workshop was conducted before the re-audit cycle (RAC) to address deficiencies and reinforce the implementation of the guidelines provided by the RCP. The RAC was conductedfrom June 2023 to August 2023. 100 DS were studied and analyzed to assess for improvement in the completeness of DS. Frequencies and percentages were calculated in each audit cycle. The Chi-squared test was applied to compare the statistical difference between the results of both audit cycles. Results A total of 150 DS were analyzed in the first AC and 100 DS in the RAC. The results of the first AC show that the details of any allergies were recorded only in 3% of the DS; this percentage significantly improved to 51% after the RAC (p-value <0.05). Relevant past medical history was included in 52% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). Secondary diagnoses were written in 54% and 71% of the DS during the firstAC and RAC, respectively (p-value <0.05). Details of relevant investigations were included in 60% and 88% of the DS during the first AC and RAC, respectively (p-value <0.05). The post-discharge management plan was written in 90% and 98% of the DS during the first AC and RAC, respectively (p-value <0.05).The follow-up plan was written clearly in 65% and 93% of the DS during the first AC and RAC, respectively (p-value <0.05). Conclusion The DS was found to be incomplete after analyzing the results of the first AC. The details related to allergies, medications, operations, and procedures were found to be missing in the majority of the cases. No mention of the patient's concerns or expectations was made in the DS. The results of the RAC showed improvement in the level of completeness of DS. The majority of the weak points observed after the first AC seemed to haveimproved after the RAC, which shows that intervention proved to be quite effective in improving the completeness and quality of DS. The RAC showed significant improvement in the completeness of the details relating toinvestigations, allergies, past medical history, secondary diagnoses, and the post-discharge follow-up plan. QIP must be routinely carried out to assess and improve the completeness and quality of DS at hospitals.

Factors Affecting Health-Promoting Behaviors in Patients Diagnosed with Myocardial Infarction

Background: Cardiovascular diseases, including myocardial infarction (MI), represent a significant global health burden, particularly in developing countries like Pakistan. Health-promoting behaviors (HBs) play a crucial role in the management and prevention of MI, potentially reducing morbidity and mortality rates among affected individuals. Objective: This study aimed to identify the factors influencing health-promoting behaviors among patients diagnosed with myocardial infarction and to evaluate the level of engagement in such behaviors. Methods: A cross-sectional descriptive study was conducted at a tertiary care hospital in Pakistan from September 2022 to June 2023. The study population consisted of 318 patients diagnosed with MI (ST and non-STEMI), selected through purposive sampling. Data were collected on demographic characteristics, health behavior data using the Song-and-Lee Health Behaviors Checklist, and analyzed using SPSS version 25 for descriptive and inferential statistics, including independent t-tests, ANOVA, and multiple linear regression. Results: The overall mean score of health-promoting behaviors among participants was 2.14 ± 0.21, indicating a moderate level of engagement. The highest mean score was observed in eating behaviors (2.26 ± 0.34), while the lowest was in health responsibility (2.00 ± 0.40). Gender and smoking status significantly influenced health-promoting behaviors, with females and non-smokers exhibiting better HB scores. Significant differences in HBs were noted across gender, co-morbidity, and history of hospitalization, but not within age, BMI, and smoking groups. Conclusion: The study concluded that myocardial infarction patients exhibit a moderate level of engagement in health-promoting behaviors, with significant variations influenced by gender and smoking status. There is a need for targeted nursing strategies to enhance health-promoting behaviors, particularly focusing on dietary habits, smoking cessation, and health responsibility among MI patients.

Vulvodynia prevalence and associated psychosexual problems in middle-aged diabetics at a tertiary care hospital in Pakistan

Background &amp; Objective: Vulvodynia is a significant clinical disorder in women but it remains a neglected health problem in many societies. The present study was aimed to identify the frequency of vulvodynia in the diabetic and non-diabetic population and its association with common psychosexual problems in the population of Khyber Pakhtunkhwa, Pakistan. Methods: This study is cross sectional descriptive investigation and conducted in tertiary care hospital (Lady Reading Hospital, Peshawar) in 2018-2019. A total of 75 cases categorized into diabetic and non-diabetic groups were collected under the supervision of qualified gynecologists. Groups were compared on the basis of demographics, symptom frequency, psychological and clinical data, using a pre-designed proforma. Results: The incidence of vulvodynia in women with type 1 and type 2 diabetes (n = 50) and in the non-diabetic population (n = 25) was 66.6% and 33.3%, respectively. The vulvodynia severity score based on Friedrich`s criteria in diabetes was 80% and in non-diabetes it was 40%. The cotton bud swab test severity index was 80% in diabetes and 40% in non-diabetes. The erythema rating scale score in diabetes was 81% and in non-diabetes it was 39%. Finally, psychological and psychosexual problem frequency in diabetes was 100% and in non-diabetes was 88%. Conclusions: Women with diabetes had a fourfold risk of vulvodynia up to middle age as compared to non-diabetics in Peshawar, Pakistan. Diabetics with vulvodynia possessed a nine-fold risk of experiencing psychological symptoms of depression (OR = 9.33; 95% Cl 1.0-88.6) and an even higher risk of somatic depression symptoms.

Cardiac Implantable Electronic Device (CIED) Infections, Associated Risk Factors and Optimization in Reducing CIED Infections; An Experience of Tertiary Care Hospital of Pakistan

Objective: To determine the frequency of infections in cardiac implantable Electronic device patients, identify risk factors, and look for optimization in reducing Cardiac Implantable Electronic Device infections, with a resultant decrease in mortality and morbidity, decrease in hospital stay, and total expenditure. Study Design: Cross-sectional study. Place and Duration of Study: Electrophysiology Department of National Institute of Cardiovascular Diseases, Karachi Pakistan, from Jul 2019 to Jun 2020. Methodology: The study was conducted on the patients with cardiac implantable devices. Adult patients of either genderwith cardiac implantable Electronic device and infection were included. Epicardial leads and surgical site infections within six weeks were excluded. Results: One thousand and forty-six (1046) patients were enrolled in the study. There were 596(57%) male patients. 385(36.8%) patients were implanted with single chamber pacemakers, 390(37.3%) with dual chamber pacemakers, 146(14%) single chamber ICD (implantable cardiac defibrillator), 67(6.4%) dual-chamber cardiac implantable Electronic device, 46(4.4%) CRT-D, 12(1.1%) TPM, 134(12.8%) Re-do, 114(10.9%), 114(10.9%) generator change, 20(1.9%) leads revision, 26(2.5%) patients had extraction. The rate of CIED infection was 34(2.1%). The association of the study parameters with infection rate revealed that type of device (p=0.002), extraction, suture type, and post-procedure hematoma (p&lt;0.001) had a statistically significant relationship with infection rate.Conclusion: The Cardiac Implantable Electronic Device infection rate was 2.1%. Hypertension and diabetes were common risk factors, and left ventricular dysfunction was common in high-energy devices with multiple leads and repeated procedures.

Sarcoid Uveitis: An Experience from a Tertiary Care Hospital in Pakistan.

Objectives: The Primary objective was to find the frequency of Sarcoid Uveitis among the patients pre- sented with Uveitis.The secondary objective was to follow the patients of sarcoid uveitis over treat- ment.. Methods: We did an observational prospective study, after acquiring ethical review letter from IRB Medicine department outpatient services of Jinnah Medical College Hospital Korangi was used where patients with Uveitis were referred for evaluation of systemic disease during jan 2019 to dec 2020. These patients underwent history, examination and biochemical and radiological investigations and were followed over a period of 1 year to see response to treatment. Results: A total of 372 patients presented with established uveitis out of which 36 patients i.e. 66 eyes presented to our eye clinic with decrease in vision with a mean age of 42±2 years. Among 36 patients, 89% presented with redness of eye and 72% presented with eye pain where as 8 % pre- sented with photophobia and floaters. Biochemically &gt;10mg/dl calcium was observed in 18(50%) pa- tients and ACE level was found to be more than 40nmol/ml/min in 30(83.3%) patients. Among them 32 (88.9%) patients showed resolved inflammation whereas 2(5.56%) showed a change in inflamma- tion and 2(5.56%) showed no change. Conclusion: We found sarcoid uveitis as fairly common cause of uveitis. The patients were treated with the standard treatment of steroids and immunosuppressants i.e. Azathioprine and we concluded that use of steroids and immunosuppressant improved the outcome in our patients. The patients re- sponded fairly well to the designed treatment.

Impact of Timely Assessment for Risk of Fall by Using Morse Scale in Adult Medical &amp; Surgical Unit of Tertiary Care Hospital in Pakistan

Background: Patient falls in healthcare settings are a significant concern, impacting patient safety and healthcare outcomes. The Morse Fall Scale (MFS) has been widely recognized as an effective tool for assessing fall risk among hospitalized patients. Despite its widespread use, there is a need for a comprehensive evaluation of its effectiveness, implementation challenges, and the perceptions of healthcare staff towards its utility. Objective: This study aims to evaluate the effectiveness of the MFS in reducing patient falls in a tertiary care hospital and to assess healthcare staff's perceptions regarding its usability and impact on patient care. Methods: A retrospective data analysis was conducted, examining fall events from July 2020 to December 2020, before the implementation of the MFS, and from January 2021 to May 2021, after its implementation. The study included all adult patients admitted to the medical and surgical units, excluding those from ambulatory care units and the emergency department. Staff perceptions were gauged through a survey assessing the ease of use, time efficiency, and effectiveness of the MFS in identifying high-risk patients. Data analysis utilized SPSS version 25 for statistical evaluation. Results: The implementation of the MFS was associated with a significant reduction in fall rates, from a total of 9 falls in the six months prior to implementation to zero falls in the five months post-implementation. Survey results indicated that 89% of nurses found the MFS quick and easy to use, 63% reported that it took less than 3 minutes to complete an assessment, 98% found the scale easy to understand, 95% stated it helped identify high-risk patients, and 97% felt comfortable tailoring interventions based on the MFS scores. Conclusion: The MFS effectively reduced fall rates in the hospital setting, with healthcare staff affirming its ease of use and effectiveness in identifying at-risk patients. These findings support the continued use and further refinement of the MFS as a critical component of patient safety strategies.

Predictors of clinical outcomes in patients with sepsis: A retrospective study from a tertiary care hospital in Pakistan.

To assess associations between various clinic-demographic factors and clinical outcomes among patients treated for sepsis. The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of all patients aged >18 years diagnosed with sepsis from January to December 2019. Multivariable logistic regression was used to evaluate independent associations between predictors and outcomes. Data was analysed using R packages. Of the 1,136 patients, 621(54.6%) were male and 515(45.3%) were female. The overall mean age was 59.05±16.91 years. Female gender (odds ratio: 1.029; 95% confidence interval: 1.03-1.64) was found to be an independent predictor of septic shock, while hypertension (odds ratio0.75; 95% confidence interval: 0.59-0.95) emerged as a protective factor. Chronic kidney disease (odds ratio: 1.539; 95% confidence interval: 1.14-2.07) was an independent predictor of prolonged length of stay, while older age appeared to be protective (odds ratio: 0.98; 95% confidence interval: 0.98-0.99). Mortality was associated with a significantly lower odds of Escherichia coli on culture (odds ratio: 0.26; 95% confidence interval: 0.12-0.54). Independent associations were found between specific patient characteristics and adverse clinical outcomes.

Evolving Spectrum of Dengue: A Two-Year Experience From a Tertiary Care Hospital in Pakistan

Evolving Spectrum of Dengue: A Two-Year Experience From a Tertiary Care Hospital in Pakistan