Tertiary Care Hospital In Karachi Research Articles

FREQUENCY OF ALLERGIC BRONCHOPULMONARY ASPERGILLOSIS (ABPA) IN PATIENTS ADMITTED WITH ACUTE EXACERBATION OF ASTHMA IN A TERTIARY CARE HOSPITAL IN KARACHI: A PROSPECTIVE OBSERVATIONAL STUDY

Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity reaction to Aspergillus species and often complicates the clinical course of asthma, leading to more severe exacerbations and poor disease control. Despite its clinical relevance, the prevalence of ABPA in asthma patients remains under-reported, especially in developing countries like Pakistan. Objective: This study aimed to determine the prevalence of ABPA among patients admitted with acute exacerbations of asthma at a tertiary care hospital in Karachi, Pakistan. Methods: A prospective observational quantitative study was conducted at the Department of Pulmonary Medicine, Aga Khan Hospital University Karachi, Pakistan from January 2023 to December 2023 in Karachi. The study included 150 isolated patients of either gender, aged between 18 and 80 years, with a clinical diagnosis of asthma or those eligible for spirometry. Data collected included demographic details, past medical history, pulmonary function test results, and serological data for ABPA diagnosis. The presence of ABPA was confirmed by elevated serum total IgE concentration, specific IgE to Aspergillus fumigatus, and radiological findings. Statistical analysis was conducted using SPSS, with p-values < 0.05 considered statistically significant. Results: The study revealed an overall prevalence of ABPA in 20% of the 150 patients with acute asthma exacerbations. Serum total IgE concentration was significantly higher in the ABPA group (450 IU/mL) compared to the non-ABPA group (p < 0.05). Additionally, patients with ABPA had significantly lower FEV1 (60% predicted) compared to those without ABPA (p < 0.05). Conclusion: The study highlights a notable prevalence of ABPA among asthma patients experiencing acute exacerbations. This underscores the importance of raising clinical awareness and implementing timely diagnostic strategies for ABPA in asthma management, which could significantly improve patient outcomes.

A 360-degree evaluation of the professionalism and communication skills of technologists working in the radiology department of a public sector tertiary care hospital in Karachi, Pakistan

BackgroundRadiologic technologists (RTs) are at the forefront of radiology departments and require optimal skills to demonstrate professionalism and effective provider–patient communication. Hence, the objective of this study was to determine the reliability of 360-degree evaluation as a feedback tool to improve competencies in this crucial workforce.MethodsA planned 360-degree evaluation was conducted using a 10-item tool to evaluate communication skills and professionalism among radiological technologists working at Dow University Hospital, Karachi. In total, 311 evaluations of fifteen radiological technologists were conducted while performing various diagnostic radiology procedures at the radiology department of Dow University Hospital. The data were analysed using SPSS version 26 to compute the evaluation scores and the reliability of 360-degree evaluation.ResultsA total of 311 RT-patient interactions were recorded over 48 days, with scores from all three raters. The evaluation tool was found to have good internal consistency for patients, faculty, and RT, with Cronbach’s alpha values of 0.89, 087, and 0.74, respectively. The study found an intraclass correlation of 0.66 (95% CI; 0.58–0.72), showing moderate reliability of the 360-degree evaluation across different raters.ConclusionWe conclude that 360-degree evaluation is a valid and reliable tool for determining the professionalism and communication skills of radiologic technologists and should be incorporated into training programs for formative and summative assessments. However, large-scale multicenter studies are crucial for generalizing these findings and incorporating 360 evaluations in radiological technologist training programs for formative and summative assessments.

Cardiac Syndrome X – A mystery to worry about

Madam, Cardiac syndrome X, by definition means original pain without any evidence of significant CVD visualized on angiogram. Normal angiogram makes it difficult for medical practitioners to detect this syndrome. About 10-20% of persons who undergo coronarography suffers from cardiac syndrome X [1]. It has the highest prevalence in postmenopausal women [2]. Most common indication is symptoms of myocardial infarction in patients [3]. Recent study by Magdalena Piegza et al shows the cardiac syndrome patients suffer from anxiety disorders, depressive symptoms and sleep disturbances [4]. This syndrome brings a great concern to Pakistan as already we have a high rate of anxiety disorders, heart problems and higher ratio of deaths due to CVD. A study conducted on 423 persons in tertiary care hospital in Karachi showed the mean anxiety value to be 28.3% [5]. A complete diagnosis of the syndrome requires proper checkup and follow up, but inadequate procedural managements culminating due to lack of interest and awareness raise a high risk of cardiac syndrome X in Pakistan. A thorough online literary search on the PubMed did not find a single article about this issue pointing to the lack of interest and awareness among the medical practitioners of Pakistan. It has to be made sure by creating awareness driven by seminars and workshops to apprise doctors about this syndrome. A study by the Institute for Health Metrics and Evaluation found that 38% of deaths in Pakistan are due to ischemic heart diseases [6]. This increases the chances of cardiac syndrome X among the local population. Due diligence in medical care and follow up must be applied to patients reaching out with past history of anxietic disorders and ischemic heart problems. Common public awareness is also important and doctors should emphasize on ensuring proper lifestyle including diet, exercise, smoking cessation and weight reduction.

Community-acquired sepsis in the medical intensive care unit – an experience from a lower-middle-income country

Objective: To determine microbiological pathogens and in-hospital mortality in patients admitted with community-acquired sepsis to the intensive care unit in a tertiary-care setting in a low- and middle-income country. Methods: The retrospective, observational study was conducted at the medical intensive care unit of a large tertiary care hospital in Karachi, and comprised data from January 1 to December 31, 2019, and comprised data of patients with community-acquired sepsis who were assessed using the Sepsis-3 criteria. Data was compared between survivors and non-survivors, and independent factors associated with escalation to a higher level of care were identified. Data was analysed using SPSS 23. Results: Of the 135 patients with mean age 49.8±18.0 years, 91(67.4%) were males and 44(32.6%) were females. The most common primary site of infection was the respiratory tract 63(46.7%). In-hospital mortality was noted in 52(38.5%) cases, while there were 83(61.5%) survivors. Serum levels of lactate and bicarbonate as well as urine output, fungal pathogens, septic shock and sequential organ failure were significantly associated with mortality (p<0.05). Conclusions: Clinical and microbiological spectrum of community-acquired sepsis in a low- and middle-income country was found to be different from other regions of the world. Clinicians should keep these differences in mind while managing these critically ill patients. Key Words: Sepsis, Septic shock, Critical care, Drug resistance, Fungi.

Efficacy of human interleukin-11 analogs for treating dengue fever-associated thrombocytopenia: a prospective cohort

AimDengue fever (DF), carried by Aedes mosquitoes, affects millions worldwide. Platelet-inducing human IL-11 analogues may be effective in treating DF-associated thrombocytopenia.MethodologyA prospective study was done at Dr. Ziauddin Hospital, a tertiary care hospital in Karachi, Pakistan, from September 2023 to April 30, 2024.ResultsThis study recruited 300 DF patients characterized by thrombocytopenia (platelet count < 30,000), including 159 in the treatment and 141 in the control group. The median age of patients was 34 ± 11.05 years, with 187 males (62.3%) and 113 females (37.7%). The treatment group had a higher proportion of fever (80%, p < 0.0001) and headache (96%, p = 0.012) compared to the control group; however, no significant changes were observed in other clinical parameters between the two groups. Following treatment for 5 days, platelet counts of the treatment group increased significantly in response to IL-11 treatment compared to the control group at all time intervals (day 0, day 1, day 2, day 3, day 4, and day 5). Following treatment, males consistently exhibited higher platelet counts than females (all p < 0.05). In addition, patients admitted on day 3 of their course of illness showed a significantly slow response to the treatment compared to those admitted on day 5. Although young individuals exhibited a significant increase in platelet count, the age showed no significant intergroup differences.ConclusionsIL-11 analogs have promising potential for treating DF-associated thrombocytopenia. Additional investigation is necessary to refine administration protocols and examine the wider therapeutic ramifications of IL-11 in managing DF.

Risk Factors Associated with Acute Myocardial Infarction (MI) in Individuals Reporting at Tertiary Care Hospitals in Karachi

Risk Factors Associated with Acute Myocardial Infarction (MI) in Individuals Reporting at Tertiary Care Hospitals in Karachi

Role of Xpert PCR kit in assessing MRSA colonization in medical and surgical units of a tertiary care teaching hospital

Background and rationaleMethicillin resistant Staphylococcus aureus (MRSA) colonization increases the risk of MRSA infection. Detecting MRSA colonization can influence postoperative outcomes and prolong hospital stay. The conventional standard culture method for detecting MRSA colonization has limitations in terms of sensitivity and turnaround time. Hence, we sought out use of Xpert PCR kit for prompt evaluation of MRSA colonization to support MRSA prevention in a tertiary care hospital in Karachi, Pakistan.Materials and methodsDuring 1st April-31st December 2022, 290 nasal and skin swab samples were collected from 257 patients and processed using routine culture (as gold standard method) and PCR-based MRSA detection assay (MRSA Xpert).ResultsA total of two hundred and ninety (290) swab samples from 257 patients were obtained, 33 of which were paired. The overall prevalence of MRSA colonization was 12% by both methods, with 90% of cases classified as community-associated (CA-MRSA) whereas 10% as hospital-acquired (HA-MRSA). The colonized group showed a higher subsequent MRSA infection rate (11% vs. 3.5%) compared to the noncolonized group. Culture identified 11% of screening samples as MRSA positive, Xpert MRSA assay showed 100% sensitivity and 95% specificity. The cost of a single MRSA Xpert assay was $50 while MRSA culture cost around $7.50.ConclusionOur study findings suggest that the presence of MRSA colonization in our cohort of patients is consistent with the existing trends in hospital epidemiology. Both conventional culture and Xpert MRSA methods showed comparable efficacy for detection of MRSA colonization. Larger-scale studies are recommended to validate these findings conclusively.

Development and testing of a videogame intervention for symptom management among 8–18 years old children with cancer: a study protocol

IntroductionEvidence shows that cancer treatment-related symptoms could be managed effectively in 8–18 years old children through Digital Health Interventions (DHIs), consequently improving their health-related quality of life (HRQOL). However, limited...

Correlation of Serum Lactate and Shock Index as Mortality Predictor in Polytrauma Patients

In polytrauma patients, serum lactate and hypovolemic shock are critical biomarkers for prognosis and treatment guidance. Elevated lactate levels indicate tissue hypoperfusion and anaerobic metabolism, often correlating with increased mortality. Objective: To analyze the correlation between serum lactate levels and shock index as predictors of in-hospital mortality in polytrauma patients. Methods: A Cohort study was conducted from August 2022 to July 2023 at a single tertiary care hospital in Karachi. Patients were chosen via consecutive sampling techniques and included adult patients with polytrauma injuries (ISS ≥ 15) who survived at least 24 hours. Patients with a history of diabetes were excluded. The serum lactate levels and shock index at the time of admission and over the first 24 hours were the exposures while in-hospital mortality, was the primary outcome. Statistical analyses were conducted using Stata 16.0. Categorical variables were analyzed using the chi-square test. Multivariable logistic regression evaluated mortality risk, adjusting for age, ISS, and shock index. Results: The in-hospital mortality rate in the study was 6.4% with significant predictors of mortality included increasing age (47.05 vs. 27.62 years, p&lt;0.001), higher Injury Severity Scores (ISS) (24 vs. 19, p= 0.02), and elevated shock index at admission (0.84 vs. 0.71, p&lt;0.001). Lactate metrics were strongly associated with mortality, showing significant correlations. Conclusions: Higher serum lactate levels and shock index are strong predictors of mortality in polytrauma patients. Greater age and injury severity also contribute to poorer outcomes.

Assessing the Level of Knowledge Regarding Medication Errors among Nurses in Karachi, Pakistan

One of the key elements influencing hospital service quality and decreasing patient safety in healthcare systems is medical error. In the healthcare industry, medication errors are a frequent source of harm and fatalities. Objective: To assess the level of knowledge among nurses regarding medication errors. Methods: This cross-sectional study was conducted in a tertiary care hospital in Karachi among 120 nurses from January 2024 to March 2024. Participants were selected through a convenient sampling technique. The sample size was calculated by open EPI softer by taking into consideration a 95% confidence level and a 5% margin of error. The data were entered and analyzed by Statistical Package Social Sciences software version 26. Results: According to the study results, 14 (12%) of the participants had a low level of knowledge, and 37 (31%), had a moderate level of knowledge. while 69 (57%) had a high level of knowledge regarding medication errors. Conclusion: This study concluded that most of the nurses had a high level of knowledge regarding medication errors.

Health related quality of life and associated factors among patients treated for ischaemic heart disease in two public sector hospitals of Karachi, Pakistan.

To determine the level of health-related quality of life among patients treated for ischaemic heart disease in two public-sector tertiary care settings. The analytical cross-sectional study was conducted from July to September 2021 at two tertiary care hospitals in Karachi after approval from the ethics review boards of the National Institute of Cardiovascular Diseases and the Dow University of Health Sciences, and comprised patients of either gender treated for ischaemic heart disease after being diagnosed within the preceding year who were coming for follow-up in the outpatient department. Data was collected using the short version of the World Health Organisation quality of life tool. Association of socio-demographic and clinical variables with health-related quality of life was explored. Data was analysed using SPSS 21. Of the 300 patients aged 25-85 years, 212(70.7%) were males and 88(29.3%) were females. The mean total quality of life score was 6.1+/-1.4, while mean general health was 52.6+/-10.5. The lowest score among quality of life subscales was for environmental 44.7+/-15.1, while the highest score was for psychological 60.1+/-10.7 domains. Quality of life was significantly associated with patients' age, education, comorbidities, marital status, monthly income, body mass index, activities of daily living and smoking status (p<0.05). ischaemic heart disease patients had average health-related quality of life in all domains, but showed low quality of life in the environmental domain.

Stakeholders' Perceptions of Hospital-Based Early Childhood Parenting Education Services: A Thematic Analysis

BACKGROUND: Postnatal parental education is deficient yet necessary to enhance the implementation of evidence-based newborn care practices among families. Educating both mother and father is crucial for optimal childhood development, and interventions targeting families can improve childcare practices. Implementing these interventions through systematic policies and protocols in LMIC hospitals is essential. This study explores the perceptions of pregnant women, parents, and healthcare workers regarding parenting education in a tertiary care hospital in Karachi, Pakistan. METHODS: In a qualitative study conducted in a tertiary care hospital in Karachi, Pakistan, participants included pregnant women, parents, and healthcare workers. The study used in-depth interviews with purposively selected participants, consisting of two individuals from each category. Interviews were conducted using a prepared guide, and data collection was performed by trained staff. Interviews were conducted until data saturation was achieved. The interviews were conducted in Urdu, transcribed, and translated into English. Thematic analysis was carried out manually. RESULTS: The analysis of pregnant women's experiences identified themes of personal pregnancy experiences, support systems, and hospital facilities. Women discussed physical, emotional, and financial challenges during pregnancy. They valued support from family and physicians but expressed a need for better educational resources in hospitals. For parents with children under one-year-old, themes included personal experiences, hospital experiences, and educational resources. Parents faced emotional changes, financial challenges, and desired improved work-life balance. They appreciated outpatient care but found lacking in inpatient experiences, particularly in the NICU. Healthcare workers emphasized the role of parents, families, and hospitals, highlighting the importance of teaching and understanding family dynamics. Also suggested improvement in holistic approaches, mandatory educational programs, and integrating parenting readiness into primary care. CONCLUSION: Hospital-based postpartum parenting education enhance overall baby care. Expanding literature emphasizes the importance of high-quality parenting for lifelong development. Identifying efficient programs and resources to enhance parental abilities and foster positive child growth is increasingly important.

Frequency of occupational health hazards and factors responsible among the waste handlers at the tertiary care hospitals of Karachi.

Hospital waste handlers (HWHs) are in contact with contaminated waste that put them at risk for occupational health hazards. The objective of the study was to determine the frequency of occupational health hazards and identify factors contributing to them among the HWHs at tertiary care hospitals of Karachi. A cross sectional survey was conducted from January 2021 till June 2022 on 417 conveniently selected HWHs of the public and private tertiary care hospitals of the Karachi including three Public sector hospitals (Civil Hospital Karachi, National Institute of Child Health, Jinnah Post Graduate Medical Center) and five private sector hospitals (Sohail University Hospital, Darulsehat Hospital, Kharadar General Hospital, Patel Hospital and Hamdard University Hospital) using a structured questionnaire. Chi Square test was applied to determine the differences in occurrence of different hazardous outcomes (Needle stick injury, Sharp Injury, Eye Symptoms, Skin symptoms, Cough) between different groups of age, gender, type of hospitals and status of being trained in Hospital Waste Management (HWM). Around half of the HWHs (52.6%) labeled the bins of the waste according to their level of hazard. Only 17.9% disinfected the infected waste. The proportion of participants who experienced needle stick and sharp injury in the last six months was 16.3% and 15.8% respectively. Majority of them used disposable gloves (95.7%) and face masks (94.3%). One thirds had access to aprons while only 10.5% had access to protective shoes at their work place. HWHs of private sector were significantly less likely to experience Needle stick injuries, skin symptoms, cough, breathing difficulty and throat burning. The HWM practices in tertiary care hospitals of Karachi is far from being satisfactory. HWHs must be trained and monitored for safe disposal of waste.

Prescription writing pattern among the dental practitioners of a tertiary care hospital in Karachi

ObjectiveTo identify the frequency and types of prescription errors, assess adherence to WHO prescribing indicators, and highlight the gaps in current prescribing practices of Junior dental practitioners in a tertiary care hospital in Karachi, Pakistan.MethodsThis cross-sectional study was conducted from January 2021 to March 2021. The study included the prescriptions by house surgeons and junior postgraduate medical trainees for walk-in patients visiting the dental outpatient department. A total of 466 prescriptions were evaluated for WHO core drug prescribing indicators. The prescription error parameters were prepared by studying the WHO practical manual on guide to good prescribing and previous studies. Prescription errors, including errors of omission related to the physician and the patients, along with errors of omission related to the drug, were also noted. The statistical analysis was performed with SPSS version 25. Descriptive analysis was performed for qualitative variables in the study.ResultsThe average number of drugs per encounter was found to be 3.378 drugs per prescription. The percentage of encounters with antibiotics was 96.99%. Strikingly, only 16.95% of the drugs were prescribed by generic names and 23.55% of drugs belonged to the essential drug list. The majority lacked valuable information related to the prescriber, patient, and drugs. Such as contact details 419 (89.9%), date 261 (56%), medical license number 466 (100%), diagnosis 409 (87.8%), age and address of patient 453 (97.2%), form and route of drug 14 (3%), missing drug strength 69 (14.8%), missing frequency 126 (27%) and duration of treatment 72 (15.4%). Moreover, the wrong drug dosage was prescribed by 89 (19%) prescribers followed by the wrong drug in 52 (11.1%), wrong strength in 43 (9.2%) and wrong form in 9 (1.9%). Out of 1575 medicines prescribed in 466 prescriptions, 426 (27.04%) drug interactions were found and 299 (64%) had illegible handwriting.ConclusionThe study revealed that the prescription writing practices among junior dental practitioners are below optimum standards. The average number of drugs per encounter was high, with a significant percentage of encounters involving antibiotics. However, a low percentage of drugs were prescribed by generic name and from the essential drug list. Numerous prescription errors, both omissions and commissions, were identified, highlighting the need for improved training and adherence to WHO guidelines on good prescribing practices. Implementing targeted educational programs and stricter regulatory measures could enhance the quality of prescriptions and overall patient safety.

The cost of care in maxillofacial fractures treatment in relation to the type of fixation and length of stay at a tertiary care hospital of Karachi, Pakistan: A retrospective chart review.

In addition to the clinical burden of trauma, the financial burden is an important aspect of care globally, especially for patients in low- and middle-income countries. The current retrospective review was done of data from January 2015 to December 2020 related to patients of oral maxillofacial trauma management in a tertiary care setting. Analysis of variance was used to determine the mean difference in the cost incurred depending upon the type of trauma and the number of bone plates used in fracture management. Pearson correlation was applied to explore any correlation involving patient age, aetiology and type of fracture, number of bone plates employed and the length of stay in the hospital. No statistically significant differences were noted in the cost among the different groups. The cost of care was significantly (p<0.001) correlated to the length of stay. Other variables, such as the type of fractures and the number of plates, had no significant impact (p>0.05).

A Comprehensive Analysis of Cirrhotic Cardiomyopathy Among Patients with Liver Cirrhosis at Tertiary Care Hospital, Karachi

Objective: To determine the prevalence and complications of cirrhotic cardiomyopathy (CCM) in liver cirrhosis patients at a tertiary care hospital in Karachi, and to analyze associated factors contributing to disease progression. Methodology: This descriptive study was conducted at the Department of Medicine, Civil Hospital Karachi, from October 2020 to April 2021. A total of 95 patients diagnosed with liver cirrhosis were included. Data was collected using a structured format and analyzed using SPSS. Stratification was applied to assess the relationship between cirrhotic cardiomyopathy and key factors such as age, gender, and duration of cirrhosis. The study used echocardiography to evaluate cardiac function, and pro-BNP levels were measured to assess the severity of cardiomyopathy. Results: The mean age of the patients was 43.66±4.87 years, with a mean heart rate of 73.51±12.41 beats/min, pro-BNP levels of 78.63±7.37 pg/ml, and mean cirrhosis duration of 1.65±0.99 years. Of the 95 patients, 15 (15.8%) had cirrhotic cardiomyopathy, while 80 (84.2%) did not. Gender distribution showed 48 (50.5%) males and 47 (49.5%) females. Cirrhotic cardiomyopathy was more common in patients with longer disease duration and higher Child-Pugh scores, but the differences were not statistically significant. Conclusion: Cirrhotic cardiomyopathy is a prevalent but often underdiagnosed complication in liver cirrhosis patients, with significant implications for disease management. Early diagnosis and monitoring are crucial to preventing adverse cardiovascular outcomes in cirrhosis patients.

Dengue Reinfection and Co-infection: A Study of Incidence and Outcomes in Adults Admitted to a Tertiary Care Hospital, Karachi, Pakistan

Aim: To determine the occurrence of re-infection and co-infection with dengue among the adult population in Karachi, Pakistan. In addition, to determine the frequency of various medical complications among dengue patients with or without co-infection and reinfection. And to identify possible risk factors associated with dengue reinfection. Study Design: Retrospective cross-sectional study. Place and Duration of Study: Department of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan, between January 2022 and August 2022. Methodology: A total of 500 adult patients aged 18 years or above; admitted with a confirmed diagnosis of dengue were included in the study. Information was collected regarding clinical and demographic data using structured questionnaire. Data was analyzed using SPSS version 25. Results: The current study reported an incidence of 3.8% for dengue re-infection and an incidence of 19% for co-infection among adult dengue patients. The most common clinical symptoms were fever, nausea, vomiting, and abdominal pain while bleeding, acute kidney injury, and nosocomial infection were the most common complications with a proportion of 10.6% (n=53), 7.8% (n=39) and 4.2% (n=21). The study could not find any statistical association between the socio-demographic factors and disease-related characteristics. Conclusion: This study determines a low incidence proportion of dengue re-infection and co-infection among adult patients admitted with a confirmed diagnosis of dengue infection at a private tertiary care hospital in Karachi. Bleeding, nosocomial infection, and acute kidney injury were identified as the most frequent medical complications among hospitalized dengue patients. The study did not show any statistically significant risk factors associated with dengue re-infection. Large scale multi-center studies are warranted with sufficient sample size and objective assessment methods to determine the incidence of dengue re-infection and co-infection as well as for the identification of risk factors associated with dengue re-infection among the adult population of Pakistan.

Thirty-Day Surgical Morbidity and Mortality in Pelvic and Acetabular Fracture Patients Presenting to a Tertiary Care Hospital in Karachi, Pakistan.

Pelvic fractures, encompassing a spectrum from minor to life-threatening injuries, pose challenges in trauma management. This study focuses on short-term outcomes, exploring morbidity and mortality within 30 days postoperative, among pelvic fracture patients at a tertiary care hospital in Karachi, Pakistan. The majority of pelvic injuries result from intense blunt trauma, with associated risks of concomitant injuries. Pelvic fractures are linked to early complications such as hemorrhage, thromboembolism, and infections, influencing mortality rates. A prospective cohort study involving 53 surgically managed pelvic fracture patients was conducted at Aga Khan University Hospital, Karachi. Variables such as age, gender, comorbidities, mechanism of injury, associated injuries, and presenting vitals were documented. Thirty-day morbidity included surgical site infections, hemorrhagic shock, nerve injuries, and others. Statistical analyses assessed associations between patient characteristics and morbidity. The study revealed a median age of 37 years, with 77% male patients. Most fractures result from motor vehicle accidents. Morbidity occurred in 31.6% of cases, primarily associated with the presence of associated injuries. Postoperative complications included neurological deficits (15.1%) and pulmonary complications (9.4%). No 30-day mortality was reported. The study highlights the importance of a multidisciplinary approach in managing pelvic fractures, emphasizing the association between associated injuries and postoperative morbidity. Comorbidities did not significantly impact morbidity, emphasizing the traumatic nature's independent contribution. Timely presentation (median 20 hours) and efficient trauma systems are crucial for optimal outcomes. This research contributes insights into short-term outcomes following pelvic fracture fixation in a Pakistani tertiary care setting. By exploring a range of parameters, the study emphasizes the need for comprehensive management strategies to minimize complications and improve patient outcomes. Bridging critical knowledge gaps, this research informs clinical decision-making for pelvic fracture patients in this region.

Impact of the Early COVID-19 Pandemic on the Quality of Obstetric Care in a Tertiary Care Center in Karachi, Pakistan.

Objective This study aimed to assess the indirect impactof the COVID-19 pandemic on obstetric quality measures. Materials and methods This cross-sectional study was conducted at a private-sector tertiary care hospital in Karachi, Pakistan. Data were collected for specific antenatal, intrapartum, and postpartum care indicators during the initial six months of the COVID-19 phase (March to August 2020) and compared with baseline measures from the preceding six months before the COVID-19 phase (September 2019 to February 2020) using frequencies and percentages. Results During COVID-19, there was a 10% reduction (pre-COVID: 1041 and during COVID: 946)in outpatient obstetric volumes and a 65% increase(pre-COVID: 240 and during COVID: 396) in clinic cancellations, indicating a decreased influx of antenatal patients. Teleclinics served 8.3% (1429/18279) of the total obstetric patients during this period. Marginal decreases were observed in spontaneous vaginal deliveries 1358 (44%)vs 1049 (42.4%) and labor inductionrates 818 (26.6%)vs 606 (24.2%). Additionally, there was a slight increase in instrumental deliveries, 121 (3.9%) vs 114 (4.6%) during the COVID phase. However, these changes were not statistically significant. Similarly, no substantial impact was observed on elective and emergency C-sections. Notably, there were more cases of primary postpartum hemorrhage (PPH) during the COVID-19 phase 36 (1.17%) vs46 (1.86%), and these changes were statistically significant (p= 0.035). Similar trends were observed for eclampsia (p =0.05) and preeclampsia cases (p-value 0.074). However, other maternal morbidity indicators and intrauterine fetal deaths remained relatively unchanged. NICU admissions increased significantly (p=0.001), while early neonatal deaths remained unaffected. Patient satisfaction rates remained steady for inpatients and improved for outpatients during COVID-19. Conclusion The COVID-19 pandemic primarily affected antenatal volumes, neonatal admissions, and maternal morbidity indicators such as PPH, preeclampsia, and eclampsia. Despite the challenges, patient satisfaction and quality care standards were maintained during COVID-19 through new strategies and revised patient care processes.

Prevalence of chronic kidney disease in children of school going age visiting outpatient department of A Tertiary Care Hospital in Karachi, Pakistan.

Objective: To determine the prevalence of chronic kidney disease (CKD) among children of school-going age. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to December 2023. Methods: A total of 130 children of both genders, aged between 5-15 years, visiting outpatient department of pediatric medicine were analyzed. Demographic and clinical information were noted. Laboratory investigations like urinalysis and serum creatinine were performed. CKD was diagnosed on the basis of “Kidney Disease Outcomes Quality Initiative (KDOQI)” guidelines. Results: In a total of 130 children, 67 (51.5%) children were male. Overall, the mean age was 8.43±2.45 years. Hypertension was diagnosed in 10 (7.7%) children. Anemia was present in 103 (79.2%) patients. The mean hemoglobin, serum creatinine, and blood urea nitrogen were 9.41±1.98 g/dl, 0.48±0.37 mg/dl, and 34.20±33.18 mg/dl, respectively. CKD was diagnosed in 10 (7.7%) children. Among these 10 children diagnosed with CKD, 7 were having CKD stage-1 whereas CKD stage-2 was noted in 3 children. Presence of hypertension (p=0.006), and albuminuria (p&lt;0.001) were associated with CKD. Conclusion: The prevalence of CKD in school going age children was 7.7%. Presence of hypertension, and albuminuria were linked with CKD.