Tertiary Care Hospitals Of Rawalpindi Research Articles

ASSESSMENT OF KNOWLEDGE AMONG SURGICAL NURSES REGARDING SURGICAL TIME OUT PROTOCOLS IN THE OPERATING ROOM AT TERTIARY HOSPITAL RAWALPINDI

Surgical Time Out protocols are pivotal for ensuring patient safety in operating rooms (ORs), designed to prevent surgical errors such as wrong-patient surgery and retained surgical instruments. Despite established protocols, adherence varies, with potentially fatal outcomes. Aim: The study aims to assess the knowledge and implementation of Surgical Time Out protocols among surgical nurses at a Tertiary Care Hospital in Rawalpindi, determining the impact on patient safety and surgical outcomes. Methods: We conducted a descriptive cross-sectional study involving 150 OR nurses selected through convenience sampling. A validated questionnaire was employed to collect data on the nurses' knowledge and application of Time Out protocols. Results: Results showed that 68% of nurses had adequate knowledge regarding Time Out protocols, recognizing their essential role in patient safety. Nevertheless, 32% had insufficient knowledge, which could compromise surgical safety. Conclusion: The study concludes that while a majority of nurses understand the importance of Surgical Time Out protocols, there is a significant portion who require further training. It emphasizes the necessity of regular, structured training programs to enhance adherence to Time Out protocols, thereby improving patient safety and reducing preventable surgical complications.

Exploring the Demographic and Social Correlates of Burn Injuries: A Comprehensive Study From a Regional Burn Center in Pakistan.

Burn injuries pose significant challenges to both patients and healthcare systems globally. This retrospective observational study, conducted at the burn center in a tertiary care hospital in Rawalpindi, Pakistan, aimed to delineate the patterns of burn injuries and correlate them with demographic and clinical presentations. A total of 99 patients were included, with 54 males and 45 females, ranging in age from three months to 70 years. Flame burns were the most common type (n=69), with the majority being accidental (n=87). Limbs were the most frequently affected body parts (n=32), often with lesser-degree burns (n=28). Notably, self-inflicted injuries were predominantly observed in males (n=7), while assault cases were more common in females (n=4). Statistical analysis revealed significant associations between the degree of burn and the body parts affected, as well as between the mode of injury and the affected body parts. Burn injuries due to assault or self-infliction tended to have higher morbidity rates, often resulting in fatalities. Additionally, the cause of burn injury showed significant associations with the affected body parts, with contact and electric burns affecting limbs and chemical burns mainly affecting the head and face. These findings underscore the need for targeted burn prevention programs, emphasizing first aid education and addressing specific risk factors in high-risk groups and settings. By implementing preventive strategies and evaluating their effectiveness, the burden of burn injuries can be reduced, leading to improved patient outcomes and quality of life.

Bacterial profile, antimicrobial susceptibility pattern and associated risk factors of urinary tract infection among pregnant women attending tertiary care hospital in Rawalpindi

The study objective to enhance treatment effectiveness by assessing risk factors, bacterial profiles, and antimicrobial susceptibility of uropathogens in pregnant women. During the period from March 2023 to August 2023, we examined 210 urine samples obtained frompregnant women. The samples were subjected to uropathogens isolation, identification and susceptibility testing against thirteen antibiotic classes using the Kirby Bauer disk diffusion method, following standard procedures, to identify uropathogens in cases of significant bacteriuria. In our study there is no significant link found between age, educational level, socioeconomic status, and parity in relation to UTI during pregnancy. In 42% of the samples with significant bacteriuria, Escherichia coli emerged as the predominant uropathogens, followed by Pseudomonas aeruginosa, Staphylococcus saprophyticus, and Klebsiella pneumoniae, in that order. E. coli displayed the greatest resistance to ciprofloxacin and ceftazidime, yet demonstrated high susceptibility to meropenem, imipenem, fosfomycin,and amikacin. Furthermore, a significant portion of K. pneumonia isolates exhibited resistance to ceftazidime and ciprofloxacin. For S. saprophytic, resistance was observed against penicillin and gentamicin, although they displayed 100% sensitivity to vancomycin and 81.2% sensitivity to Nitrofurantoin. The current study findings revealed that factors influencing pregnant women's UTI risk, include age, literacy, residence, multigravida, multipara, infection history, and trimester status. Access to clean water sources also played a role, highlighting the importance of addressing these variables in maternal health toreduce UTI incidence. Screening antenatal patients for UTIs is imperative, and it is advisable to conduct regular screenings for pregnant women. This practice helps monitor uropathogens sensitivity patterns and facilitates the development of antibiotic protocols based on local susceptibility data.

Risk Factors of Postoperative Acute Heart Failure in Elderly Patients After Hip Fracture Surgery.

Background Postoperative acute heart failure (AHF) in elderly patients after hip fracture surgery is a common complication. Therefore, this study aimed to identify the risk factor of AHF after hip fracture surgery among the older population. Methods This retrospective cohort study was performed on 88 admitted patients whose hip fractures were fixed via internal fixation surgery in a tertiary care hospital in Rawalpindi, Pakistan, from January 2022 to March 2023. Recruitment of patients was made through established inclusion and exclusion criteria. Ethical approval and informed consent were also gained before the data collection. A self-designed form was used to collect data. Data analysis was carried out in the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Both descriptive and inferential statistics were applied to compare the attributes of the patients with AHF and patients without AHF. Multivariate logistic regression was used to evaluate the association between the postoperative AHF and its potential risk factors. Results Out of 88 enrolled patients, 12 (13.64%) had developed postoperative AHF. Age ≥ 65 years (OR = 2.606, 95% CI = 1.035~4.160, p = 0.010), anemia (OR = 3.178, 95% CI = 1.847~5.990, p = 0.029), hypertension (OR = 2.019, 95% CI = 1.110~4.034, p = 0.012), diabetes mellitus (OR = 2.003, 95% CI = 1.115~4.012, p = 0.015), hypoalbuminemia (OR = 2.486, 95% CI = 1.218~4.619, p = 0.030), and operation time ≥ 120 minutes (OR = 1.702, 95% CI = 1.099~2.880, p = 0.018), were the risk factors of postoperative AHF in elderly patients after hip fracture surgery. Conclusions In the study population, the incidence of postoperative heart failure was significant and age ≥ 65 years, anemia, hypertension, diabetes mellitus, hypoalbuminemia, and operation time ≥ 120 were significantly involved in the development of it. Preoperative identification and management of AHF risk factors could lead to the prevention of postoperative complications.

Spectrum of Hemoglobinopathies in Tertiary Care Hospitals of Rawalpindi and Islamabad

Hemoglobinopathies, including Thalassemia and sickle-cell syndromes are lifelong diseases with a significant impact on patients, families, and healthcare resources. Despite therapeutic progress, Pakistan, located within the Thalassemia belt, lacks comprehensive data on the epidemiology, clinical course, mortality, complications, and treatment outcomes of Thalassemia. Objective: To determine the frequency of haemoglobinopathies in Tertiary Care Hospital of Rawalpindi and Islamabad. Methods: A retrospective cross-sectional study of 7 months was conducted on the local population of Islamabad and Rawalpindi from January 2020 to July 2020. Total 600 patients referred for Hb electrophoresis were initially selected for study. Data from 300 patients were collected from PIMS Hospital, Islamabad, and 300 from Holy Family Hospital, Rawalpindi. Clinical information for each patient was recorded separately, data were statistically analyzed using Microsoft Excel version 2016 and graphs were made on GraphPad Prism version 08. Results: Out of 600 patients from Rawalpindi and Islamabad 227 (37.84%) patients were found to have hemoglobinopathies. Beta Thalassemia trait was the most common disorder among those with hemoglobinopathies (47.13%), followed by beta Thalassemia major (23.34%), sickle Beta Thalassemia (10.57%), sickle cell disease (6.6%), Hb D trait (5.28%), Hb D/beta Thalassemia (3.96%), Hb E trait (2.2%), and sickle cell trait (0.88%). Conclusions: The study showed a significantly high frequency of hemoglobinopathies in the capital city Islamabad and Rawalpindi. β- Thalassemia trait and β- Thalassemia major were found in high frequency among various hemoglobin disorders.

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.

Frequency of Needlestick and Sharp Injuries, Their Associated Risk Factors and Safety Measures among Healthcare Workers of Fauji Foundation Hospital, Rawalpindi

Background: Needlestick and sharp injuries (NSSIs) are significant occupational hazards for healthcare workers (HCWs), facilitating the transmission of bloodborne pathogens such as HIV, hepatitis B, and C viruses. Despite known risks, the frequency and associated factors contributing to these injuries in healthcare settings, particularly in developing countries, are not well-documented. Objective: This study aimed to determine the frequency of NSSIs, identify their associated risk factors, and evaluate the safety measures adopted by HCWs in a tertiary care hospital in Rawalpindi, Pakistan. Methods: A cross-sectional study was conducted from May to September 2022 at Fauji Foundation Hospital, Rawalpindi. A total of 250 HCWs, including paramedical staff, doctors, nurses, and allied health professionals, participated in the study. Ethical approval was obtained from the Center of Advanced Studies in Health and Technology research committee and the Head of the Department of Pathology. A structured questionnaire was developed to collect data on demographic characteristics, history of NSSIs, risk factors, and safety measures adopted post-injury. Data were analyzed using SPSS version 25, employing non-parametric tests due to the non-normal distribution of data. Results: Among the participants, 76.8% (n=192) reported experiencing NSSIs at least once during their employment. The highest incidence of NSSIs was observed among HCWs aged 26-30 years (31.6%, n=79) and those with 2-7 years of work experience (50.4%, n=126). The most common risk factors for NSSIs were heavy workload (40%) and recapping of needles (22%). Only 38% (n=95) of HCWs reported the incident, and 44% (n=111) were vaccinated against hepatitis B following exposure. Moreover, 58% (n=145) used personal protective equipment, and 73.6% (n=184) utilized safety boxes for sharp waste disposal post-injury. Conclusion: The study highlights a high prevalence of NSSIs among HCWs, with inadequate reporting and post-exposure prophylaxis. There is a critical need for enhanced training on safe handling of sharps and increased adherence to universal precautions to mitigate the risk of NSSIs in healthcare settings.

Emotional Intelligence and Psychological Adjustment among Doctors and Nurses in a Tertiary Care Hospital in Rawalpindi-Pakistan: A Cross Sectional Study

Objective: This study aimed to determine the relationship between EI and the quality of nursing care from the viewpoint of nurses and patients. Methods: This cross-sectional study was conducted at a public sector tertiary care hospital in Rawalpindi, Pakistan, over 6 months from November 2019 to April 2020. The convenience sampling technique was employed. The study groups were qualified practising doctors and nurses including nursing assistants and paramedics. Study groups were provided with a self-administered questionnaire that was filled out after getting consent from the study participants. Data analysis was done by entering it into SPSS version 22. The relationship between emotional intelligence and psychological adjustments among the two groups was assessed by applying an independent T-test. Results: The current study explored that doctors were emotionally intelligent and psychologically well-adjusted as compared to nurses. Females were more emotionally intelligent than males; however, males were better adjusted psychologically. Years of experience had no significant results between both groups, while there was a positive correlation between the department of practice and psychological well-being. Conclusions: It shows that harmonious work environments and friendly interpersonal relationships positively affect the well-being of HCWs and patients. What this indicates is a need to bring about changes within work environments to produce friendly interpersonal relationships and a positive impact on the well-being of HCWs and patients. Keywords: Emotional intelligence, Psychological adjustments, Nursing staff

Oral Health Status of Health Care Workers in Tertiary Care Hospitals of Rawalpindi, Islamabad Pakistan

Studies from all around the world have shown that healthcare professionals may encounter a number of obstacles to receiving dental care, which raises the prevalence of oral disorders in this population. In recent years, Pakistan has not done a national oral health assessment on the state of oral health among healthcare workers. Objective: To determine the oral health status of health care workers in tertiary care hospitals using Decayed, Missed, Filled tooth Index. Methods: Descriptive cross-sectional study was conducted utilizing a simple random selection and 385 healthcare workers between the ages of 20-50 years. Healthcare workers were assessed in tertiary care hospitals, and information on caries and gingival health was gathered. For the oral examination, the standards and procedures of the WHO were applied. Results: Only 9.8% of the respondents were healthy and mean DMFT score came out to be 3.28 ± 1.12. Conclusions: Healthcare workers in tertiary have unsatisfactory dental practices, poor attitude related to oral health and general lack of awareness about oral health.

Clinical and genetic attributes of congenital anomalies ascertained at a tertiary care hospital in Rawalpindi, Pakistan

Objective: Congenital anomalies (CA) or birth defects cause substantial healthcare burden in developing countries. There are few studies from Pakistan on the prevalence-pattern of CA. The purpose of this study was to determine the prevalence-pattern and genetic attributes of CA at a tertiary care facility in Rawalpindi, Pakistan.&#x0D; Methods: In a cross-sectional study design, patients with CA were ascertained from Pediatric and Neonatal Section of Holy Family Hospital, Rawalpindi from March-2022 to June-2022. International Classification of Diseases (ICD-10) and Online Mendelian Inheritance in Man (OMIM) databases were utilized for uniformity in classification. The pattern of CA as well as familial/sporadic nature, syndromic/isolated presentations, and prenatal consanguinity were estimated. Descriptive summaries were generated.&#x0D; Results: A total of 517 independent cases with certain types of CA were recruited. There were eight major and 70 minor categories. Among the major categories, neurological disorders (39.1%) were predominating followed by neuromuscular disorders (21.1%), limb defects (13.5%), musculoskeletal defects (7.4%), blood disorders (4.3%), orofacial defects (3.9%), metabolic disorders (3.7%), and Others (7.1%). The sporadic cases were in majority (72.5%) compared to familial cases (27.5%). Further, 63% patients had syndromic presentations and there were 37% cases with isolated appearances. A total of 70% cases had parental consanguinity.&#x0D; Conclusion: The majority of anomalies were of preventable nature and certain healthcare measures including antinatal care and counseling can be adopted to minimize their burden. Additionally, there is an urgent need to raise awareness of the negative consequences of consanguineous marriages, which constitute a significant risk factor in cases with inherited CA.&#x0D; doi: https://doi.org/10.12669/pjms.39.6.7408&#x0D; How to cite this: Shaheen F, Humayoon QS, Malik S, Mumtaz S. Clinical and genetic attributes of congenital anomalies ascertained at a tertiary care hospital in Rawalpindi, Pakistan. Pak J Med Sci. 2023;39(6):1673-1679. doi: https://doi.org/10.12669/pjms.39.6.7408&#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.

Impact of diet on attention-deficit hyperactivity disorder in a tertiary care hospital of Rawalpindi

Background: Attention-deficit hyperactivity disorder (ADHD) is a prevalent neuropsychiatric disorder of children that affects almost all aspects of the life. The role of diet in the management of the ADHD is understudied in Pakistan. This study aimed to assess the impact of different types of diet on the symptoms of ADHD among the children with ADHD. Methods: This descriptive cross-sectional study was conducted among 58 children with ADHD in Rawalpindi. Ethical approval and informed consent were obtained. Patients’ recruitment was done via developed criteria and Convenient sampling technique. Descriptive statistics and one-way ANOVA were used to determine the difference of ADHD severity among various frequencies of different included foods via Conner Parent rating scale-revised short form. Data analysis was performed by SPSS version 25.0. Results: The difference in hyperactivity index, impulsivity, and learning problems score on CPR-RS among various frequencies of carbohydrate, protein rich and fat foods, was statistically significant and with the increase intake of carbohydrate and protein rich foods, the score on CPR-RS of hyperactivity index, impulsivity, and learning problems also goes up. Whereas, with the increase intake of fat rich foods, the score of hyperactivity index, impulsivity, and learning problems goes down. Conclusions: In short, the high intake of carbohydrate and protein rich foods, increase the severity of the symptoms of ADHD, while, high intake of fat rich foods decreases the severity of the symptoms of ADHD among children.

Antibiotic Prescription Trends Among the Paediatric Population Admitted in Tertiary Care Hospitals of Rawalpindi

Objective: To demonstrate the antibiotic usage and trends among paediatric patients admitted to the tertiary care hospital of Rawalpindi.&#x0D; Study Design: Cross-sectional analytical study.&#x0D; Place and Duration of Study: Paediatric In-Patient Department of two Tertiary Care Hospitals, in Rawalpindi Pakistan, from May to Dec 2021.&#x0D; Methodology: After rigorous inclusion and exclusion criteria, 395 admitted patients of the paediatric ward were included in the study from two tertiary care hospitals in Rawalpindi through simple random sampling.&#x0D; Results: A total of 395 patients were included; the mean age was 3.35±4.07 months, ranging from 0 to 45 months. 132(33.4%) patients from Hospital-A and 263(66.6%) from Hospital-B. Out of 395 patients, 35(8.7%) patients were given no Antibiotic, 240(60.8%) were given one antibiotic, 84(21.3%) patients were given two antibiotics, 33(8.3%) patients were given three antibiotics and 3(0.9%) patients were given four antibiotics. Of 360, 340(94.4 %) were given IV antibiotics, and 20(5.6%) were advised oral antibiotics.&#x0D; Conclusion: The youngest children received the most antibiotic prescriptions, progressively decreasing as they aged. irrational use of antibiotics is a significant risk factor to cause antimicrobial resistance.

Assessment of Knowledge, Attitude and Practices Related to Occupational Hazards among Nurses of Tertiary care Hospitals of Rawalpindi

Occupational hazards associated with health are present in every occupation, and they are the leading cause of death. In the medical profession, Nurses constitute the largest group of healthcare workers, and experience a higher rate of workplace hazards exposure than other health care workers. Objective: To assess the knowledge, attitude and practices of occupational hazards among nurses in tertiary care hospitals of Rawalpindi. Methods: A sample of 422 nurses having clinical experience of more than one year were recruited through multistage sampling. A modified, validated and pretested questionnaire was administered. Data were coded into SPSS version-23. Mean ± SD were calculated for (numerical) variables. Frequency and percentage were calculated for categorical variable. For the association, p-value &lt;0.05 was considered significant. Results: The results showed respondents with a mean age of 37.63±6.73. Most had high knowledge 370(87.7%) about hazards in Hospitals, with positive attitude 311(73.70%), Only 218(51.7%) comply safety practice whilst those that did not follow 204(48.3 %) generally associate as deficient of essential safety equipment 222(52.6. %). There was no association between knowledge, attitude, and practices. Conclusions: Satisfactory knowledge, positive attitude and poor practices of nurses are key impediments to nurses. Improve the practices and reduce the exposure of occupational hazards

Risk Stratification of Acute-Onset Chest Pain: SVEAT Score Versus HEART and TIMI Scores.

Introduction Acute chest pain is a frequently encountered symptom in the emergency department. Despite the availability of various chest pain risk scores, their effectiveness in identifying low-risk patients suitable for safe and early discharge is inadequate. Moreover, clinical data collected at the initial stage, which has valuable discriminatory ability, is often underutilized. This study aims to assess the effectiveness of the Symptoms, history of Vascular disease, ECG, Age, and Troponin I (SVEAT) score in predicting major adverse cardiovascular events (MACE) in acute-onset chest pain, compared with the pre-existing History, ECG, Age, Risk factors, and Troponin I (HEART) and Thrombolysis In Myocardial Infarction (TIMI) scores. Methodology This prospective study utilizing non-probability convenience sampling was conducted in the emergency medicine department of a tertiary care hospital in Rawalpindi,Pakistan, for a period of five months from July 2022 to November 2022. The study included patients aged >45 years who presented primarily with chest pain lasting for at least five minutes but less than 24 hours and with a lack of acute ECG changes indicative of ST-elevation acute coronary syndrome (STE-ACS). Patients who were hemodynamically unstable were excluded. All patients were assessed for the calculation of SVEAT, TIMI, and HEART scores. All patients were followed for a period of 30 days to assess the incidence of MACE. Results A total of 60 patients were included. The mean age was 61.5±9.1 years while 31 (51.7%) patients were females. Diabetes was the most prevalent comorbidity (n=32; 53.3%). Regarding MACE, nine (15%) patients developed ACS and underwent percutaneous coronary intervention (PCI). Two patients (3.3%) experienced heart failure. Six (10%) patients also underwent PCI in the absence of ACS while two (3.3%) patients developed sudden cardiac death. Area-under-curve (AUC) values were determined for SVEAT (0.843; 95%CI: 0.74-0.94), TIMI (0.742; 95%CI: 0.62-0.86), and HEART scores (0.840; 95%CI: 0.74-0.94). A cut-off level of 3.5 SVEAT points obtained a sensitivity of 63.2% and specificity of 75.6% in predicting 30-day MACE. Conclusion SVEAT score potentially lacks the appropriate sensitivity level to predict a significant number of major adverse cardiovascular events compared to contemporary risk stratification scores. Therefore, the SVEAT criteria need re-evaluation as a screening tool for risk assessment in acute chest pain.

Prevalence of Pancytopenia/ Bicytopenia in Pediatric Population and its Association with Etiology Based on Bone Marrow Findings

Background: An important clinico-haematological condition known as pancytopenia or bicytopenia is brought on by a multitude of disease processes that either directly or indirectly affect the bone marrow. Aim: To ascertain the prevalence of cytopenias in the pediatric population presenting to a tertiary care hospital in Rawalpindi and its correlation with age and gender distribution, clinical presentation, and aetiology. Study Design: Descriptive cross-sectional study. Methodology: It was a descriptive cross-sectional study carried out at Holy Family Hospital in Rawalpindi's hematology division. Using non-probability consecutive sampling, 253 individuals referred for bone marrow testing were included in the study, of which 108 patients had pancytopenia and 108 had bicytopenia. Data was gathered on the patient's mode of presentation, clinical examination, full blood counts, and bone marrow analysis. The data were analyzed using SPSS 22, and descriptive statistics were computed. Using chi-square test with a P value of 0.05 was taken as significant. Results: Bicytopenia was discovered in (133)52.6% of patients and pancytopenia in (120)47.4% of patients. 139 (55%) of the 253 instances involved men, while 114 (45%) were women. Fever 225 (89%), bleeding symptoms 52 (20.5%), and bruising 36 (14.2%) were the most frequent presenting complaints. The most frequent result on examination was pallor234, which was followed by hepatomegaly118 (46.64%) and splenomegaly114 (45.05%). In the total blood count, bicytopenia (133), 52.6%, and pancytopenia (120), 47.4%, were the most common findings. Practical Implication: There is scarcity of such data on paediatric patients, and to the best of our knowledge, no study has analysed the paediatric bicytopenic / pancytopenic patient in our centre. Thus present study was planned inorder to determine the prevalence of different etiology of bicytopenia /pancytopenia and its association with clinico-haematological parameters. Conclusion: It was discovered that bicytopenia/pancytopenia was frequently the reason for bone marrow testing. Three common underlying etiologies acute leukaemia, megaloblastic anemia, and aplastic anemia were discovered. Keywords: Cytopenias, Bone Marrow, Pediatric Population, Clinico-haematological Parameters and Prevalence.

Gender Based Disparities Among Wide Range of Cardiac Failure Patients Reporting at Benazir Bhutto Hospital Rawalpindi During 2019-2020

Objectives: To determine gender-based variations among cardiac failure patients visiting a tertiary care hospital of Rawalpindi during 2019- 2020.

Study of the Effect of Treatment of Helicobacter pylori Infection in Rheumatoid Arthritis Patients

Objective: To assess the disease activity after treatment of Helicobacter pylori infection in rheumatoid arthritis patients at a tertiary care hospital of Rawalpindi.&#x0D; Study Design: Comparative cross-sectional study.&#x0D; Place and Duration of Study: Department of Rheumatology, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jun to Nov 2021.&#x0D; Methodology: A total of 197 adult patients diagnosed with rheumatoid arthritis and with symptoms of dyspepsia were inducted into this study. First, the disease activity was measured considering parameters such as clinical swollen and tender joints count, disease activity scores 28(DAS-28), visual analogue scale (VAS) and laboratory parameters like erythrocyte sedimentation rate at the start as the baseline. Then, these were repeated after six months, and the differences between the two groups were compared.&#x0D; Results: At the start of the study, patients who were positive for H. pylori had markedly more swollen and tender joint counts and raised ESR values than those in the negative group. In addition, the disease activity score of 28 and pain scores was markedly raised in the positive group. After H. pylori eradication, the H. pylori-positive patients differed significantly (p&lt;0.001) from patients group negative for H. pylori infection in terms of improvement in DAS-28 score, visual analogue score and clinically. Laboratory indices like ESR showed significantly decreased values (p&lt;0.001) in the H. pylori-treated group compared to those not infected with H. pylori.&#x0D; Conclusion: From our results, it is suggested that H. pylori infection has a role in the pathogenesis of rheumatoid arthritis.

Association of Pharmacy Services with Patient Satisfaction in Public and Private Tertiary Care Hospitals of Rawalpindi And Islamabad

Background: The healthcare system in Pakistan is facing a shortage of human resources and appropriate and sustainable financial measures and therefore fails to provide optimum services to the population of Pakistan. Furthermore, research is limited in the healthcare institutes; therefore, there is a scarcity of information about patient satisfaction with pharmacists and pharmacy services in Pakistan. As evident from the inadequate information in the literature, patients’ opinions about the pharmacy services in Pakistan are important. Therefore, the current study was designed to assess patient satisfaction with the pharmacy performance of the outpatient pharmacy and its variation with socio-demographic characteristics in twin cities of Pakistan (Rawalpindi and Islamabad). Method: A cross-sectional study design was used to assess the patient satisfaction through convenience sampling technique. Minimum sample size of 250 respondents who visit pharmacy department of public and private hospital for pharmaceutical care were included in this study. A pre-validated tool was used to assess the patient satisfaction. Data was clean coded and import into spss for analysis. Descriptive and inferential statistic was applied to calculate frequency, standard deviation, mean deviation and p value to find the association among different domain of patient satisfaction with different demographic characteristics of respondents. Result: Current study shows overall patients were satisfied from pharmacy services provided by government and private hospitals. Furthermore, patient satisfaction towards pharmacist medication advice was very good however patient satisfaction towards pharmacist approach was good while patient perception with pharmacy setting, drug availability and cost were underrated. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. No significant difference (p ≥ 0.05) was observed in pharmacy setting drug availability and cost with different gender, age groups and marital status of respondents. However, Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with different level of education patients with less education had better satisfaction as compared to highly educated respondents. Furthermore, Significance difference (p ≤ 0.05) was observed in pharmacy setting drug availability and cost with occupation. Self-employee and government employee had low satisfaction score while other had better satisfactory score. Significance difference (p ≤ 0.05) was observed in pharmacist’s approach with different gender, age groups and qualification. Females had better satisfactory score as compared to female. Younger age group had better satisfaction as compared to elderly. Patients belong to higher educational groups had better satisfaction toward pharmacist approach as compared to low qualification groups respondents. Furthermore, no significant difference (p ≥ 0.05) was observed in pharmacist’s approach with marital status and number of visits Conclusion: Current study concluded that overall patient had average satisfaction score. Patients shows a better satisfaction towards pharmacist behavior/ way of handling the patients, information provided by pharmacist regarding medicine. Patient had less satisfaction towards the location of pharmacy, Availability and affordability of medicine. Patient shows negative satisfaction regarding waiting area and counselling area at indoor patient pharmacy. It has been observed that educated respondents shows high level of satisfaction towards pharmacist availability and information provided by the pharmacist.

Risk Factors of Pilonidal Sinus in a Tertiary Care Hospital of Rawalpindi: A Descriptive Cross-sectional Study

Purpose: Pilonidal sinus incidence is increasing in surgical departments all over the world. Pilonidal sinus is under the influence of several factors. These factors are studied well in various parts of the world; however, these factors are understudied in Pakistan. This study aimed to find out the risk factors of pilonidal sinus among the patients diagnosed with pilonidal sinus.&#x0D; Methodology: This descriptive cross-sectional study was conducted among one hundred and eight patients with pilonidal sinus at Benazir Bhutto Hospital Rawalpindi, for one year from January 2021 to January 2022. Ethical approval and informed consent were obtained before the start of study. Patients’ enrollment was done according to a developed inclusion and exclusion criteria. Convenient sampling technique was also applied for recruitment of participants. Data was collected through a self-designed questionnaire. Descriptive statistics were utilized for the data analysis. Data analysis was performed by SPSS version 25.0 (IBM Corp., Armonk, NY).&#x0D; Findings: Pilonidal sinus frequency was high among the patients who had age group of 11 to 30 years (68.52%), male gender (62.96%), driving profession (37.96%), family history of pilonidal sinus (64.82%), high body mass index(60.18%), daily sitting for more than 6 hours (79.62%), sitting on hard surfaces (63.88%), hairy skin (55.55%), excessive sweating (68.52%), poor hygiene of sacrococcygeal region (77.78%), number of baths less than three times per week (61.11%), and light colored skin (62.04%).&#x0D; Recommendations: This study recommends that health authorities should make people educated regarding the risk factors that lead to pilonidal sinus. The study also recommends that people should reduce their body weight, sit over soft places and should avoid continuous sitting for long periods. People should take care of hygiene, especially of sacrococcygeal regions by shaving hair, drying moisture, and taking frequent baths.

Assessment of the Awareness of Warning Signs and Risk Factors of Stroke in a Tertiary Care Hospital of Rawalpindi: A Descriptive Cross-Sectional Study

Purpose: Stroke incidence is high all over in the world. It has a list of specific warning signs and risk factors. Awareness of people about those warning signs and risk factors is low especially in third world countries. This study aimed to identify the awareness of people about the warning signs and risk factors of stroke.&#x0D; Methodology: This descriptive cross-sectional study was performed in a tertiary care hospital, Rawalpindi, among one hundred for one year from June 2021 to June 2022. Ethical approval and informed consent were waived before the start of study. Patients’ selection was made via a well-defined inclusion and exclusion criteria. Convenient sampling technique was also used for enrollment of participants. Data was collected by using a self-designed questionnaire. Descriptive statistics were put into action for the data analysis. Data analysis was carried out by SPSS version 25.0 (IBM Corp., Armonk, NY).&#x0D; Findings: The warning sign of the stroke about which most of the people were aware was sudden body weakness or numbness (74%) while warning sign about which people were least aware was sudden difficulty in seeing objects by one or both eyes (29%). The most common identified risk factor in people was hypertension (70%) for stroke while least common identified risk factor was family history of stroke (36%). In short, this study indicates people awareness about the warning signs and risk factors of stroke was not up to the mark in study population.&#x0D; Recommendation: There is need to increase the awareness level of people about the warning signs and risk factors of the stroke. This could lead to timely and effective management of stroke and its prevention as well.