Tertiary Care Hospital In Lahore Research Articles

Awareness Regarding Causes of Infertility among Out-patients at a Tertiary Care Hospital in Lahore, Pakistan

Objectives: To assess the general awareness regarding infertility and its causes; and identify, key knowledge gaps if any, related to the subject. Study Design: A cross-sectional study. Period: January, 2019 to December 2019. Setting: Lady Willingdon Hospital, Lahore, Pakistan. Material and Methods: Data collection was done by convenient sampling technique, from the 500 female participants (18 years and above) through an interview-based questionnaire (Cardiff Fertility Knowledge Scale, CFKS) , there was an assessment of the knowledge related to the causes leading to infertility such as lifestyle, smoking, use of contraception, infections of genital tract etc. There was determination of the association between socio-demographic variables and their mean knowledge scores. Data were analyzed using SPSS version 20. Results: The majority of the participant population (67%, n=340) was married, about more than half of the population was unemployed (n=280) compared to the employed population (n=220). While, nearly half of the participants (n=248, 49.5 %) did not believe that males and females contribute to infertility equally. The mean knowledge score of the study participants was 12.95 ± 2.48 points. The participants (n=165, 32%) believed that the previous usage of the intra-uterine device leads to infertility. Moreover, more than half of the participants (n=278, 55.9%) wrongly believed that a male partner achieving erection is a sign of fertility. Education (p=0.019) and marital status (p=0.03) were the only demographic factors that showed major differences with mean knowledge scores. Conclusion: It was found out that the awareness in the general population about the infertility and its causes was lacking. It is important that the education regarding the fertility related issues be more common, that can be planned through various awareness programs, workshops and seminars. This in turn can help the couples by directing them to seek timely and more focused medical help. Keywords: Infertility, knowledge, awareness, developing country.

Factors Responsible for Severity of Infection in COVID-19 Patients: A Multicenter Study

Background & Objective: After the Spanish Flu world has seen epidemics of SARS and MERS; however, these epidemics have no comparison to the magnitude of devastation caused by COVID-19. This virus originated from Wuhan, China and spread to every nook and corner of the world within weeks. In three months World Health Organization had labeled it as a pandemic. This novel deadly virus shows no discrimination of race or age. Everyone is equally at risk of developing the infection; however, clinical severity is thought to be influenced by age and the presence of comorbids. Furthermore, an increased rate of intensive care admissions, length of stay, need for mechanical ventilation, and mortality have been reported in patients with COVID-19 infections having comorbids.The objective of this study was to evaluate the Factors responsible for clinical severity of COVID 19 infection in patients presenting to tertiary care hospitals in Lahore. Methods: This Descriptive observational study was conducted simultaneously at three tertiary care hospitals in Lahore. A total of 200 confirmed patients with COVID-19 infection by RT PCR were included in the study. The case records of all the inpatients in the General Corona ward, Isolation wards, HDUs and ICUs were analyzed. Data analysis was performed in SPSS 20. Age, gender, and comorbid including Diabetes, hypertension, ischemic heart disease were recorded and their relationship with the severity of COVID 19 infection was studied by applying the Spearman's rank correlation and Fisher's exact test. Results: Out of the total 200 patients 54.5% were male and 45.5% were female, with a mean age of 58.29 ± 15.20 years. Critical and severe disease was seen in 33% and 63% of patients respectively. Most frequent comorbids reported were Hypertension (HTN), Diabetes (DM), ischemic heart disease (IHD), and lung diseases. A statistically significant positive association was observed between the severity of COVID 19 infection and increased age, diabetes. Hypertension was most frequently reported comorbid but association was not statistically significant. However, patients who had HTN along with ischemic heart disease had a statistically significant positive association with the severity of the disease . Conclusion: Advanced age, diabetes Mellitus and hypertension when present in patients with ischemic heart disease have a statistically significant association with clinical severity of patients suffering from COVID 19 infection.

Causative Factors of Tooth Wear among Patients Visiting a Tertiary Care Hospital in Lahore

Background: Tooth wear, or as it is also often referred to as non-carious tooth surface loss (TSL), can be described simply as ‘the pathological non-carious loss of tooth tissue’. Tooth wear is often multifactorial in nature, making clinical diagnosis difficult. Identification of the etiology is essential for the successful management of the pathology. Methods: A total of 120 patients of both male and female with tooth wear were selected from dental OPD. Patients with age group 25-65years with tooth wear in at least two teeth according to basic erosive wear examination (BEWE) were included. Questionnaire covering primary risk factors that might cause tooth wear was used Data was analyzed using SPSS version 24.0. Results: Out of the 120 tooth wear patients, 69(57%) were male and 51(43%) were females. tooth wear presented more in males as compared to females. 42.24% patients reported with habit of tea consumption and 32.5% with cold drinks. 45% males and 43.4% females had gastric reflex disease. 60.9% male patients had problem of bruxism and clenching. Conclusion: This study reported that TSL has a multifactorial etiology. Parafunction, gastro esophageal reflux disease (GORD) and consumption of carbonated drinks were the most commonly observed causative factors. Keywords: Tooth wear, Erosion, Abrasion, Attrition, Causative factor

Undiagnosed Diabetes Mellitus in Acute Coronary Syndrome (ACS) Patients

Introduction: Diabetes mellitus is a significant precursor of CAD. Patients hospitalised for suspected myocardial infarction had type 2 diabetes at higher rates than the general population, increasing the likelihood of cardiovascular complications. Hospitalized individuals with CAD have a worse prognosis if they also have diabetes mellitus. Objective: With this study, we want to quantify the prevalence of unrecognised diabetes mellitus among Acute Coronary Syndrome patients at a tertiary care hospital in Lahore. Study design: Cross sectional study Setting: Department of Cardiology, Bahria Town Hospital, Lahore Duration: Six months (09-2018 to 03-2019) Data collection procedure: One hundred forty patients who fulfilled the study's inclusion and exclusion criteria were included. Using a standardised questionnaire, we were able to collect information such as age, gender, and type of ACS (STEMI, Non-STEMI, or unstable angina). Diabetes was diagnosed by measuring fasting blood sugar and haemoglobin A1c in a serum sample of 3 cc. It was noted that untreated diabetes mellitus was present. Results: There were 110(78.6%) males and 30(21.4%) females in our study. The mean age of patients was 57.08±12.72 years. The mean height was 171.95±14.37 cm, mean weight was 80.70±11.23 kg and mean BMI was 26.89±3.64. There were 63(45%) patients with family history of diabetes. There were 60(42.9%) patients with Non-STEMI, 52(37.1%) with STEMI and 28(20%) with unstable angina. The mean HbA1c of the patients was 6.11±0.86. There were 10(7.1%) patients with undiagnosed Diabetes mellitus. Conclusion: 7 percent of ACS patients have diabetes mellitus that has not been diagnosed. Keywords: Undiagnosed Diabetes Mellitus, Acute Coronary Syndrome, type 2 diabetes, family history, STEMI,

Job Satisfaction of Nursing Students Working at a Pakistani Military Hospital in Lahore, Pakistan

Aims: To assess overall job satisfaction of military student nurses in a tertiary care hospital in Lahore and to assess their satisfaction with salary, working environment, attitudes and behaviours of other healthcare professionals, patients and administration. Methodology: This analytical cross-sectional study was carried out at the Institute of Nursing at CMH Lahore Medical College from January to March 2022. Convenience sampling was used to select 152 nursing students enrolled at the college. A structured questionnaire was used to collect data on job satisfaction in terms of variables like satisfaction with salary, work environment, workload, attitude of healthcare professionals, patients, and management. SPSS 20 was used for data analysis. Results: Out of 152 nurses, the majority, 95 (62.5%) expressed overall job satisfaction, with 85 (55.9%) and 126 (82.8%) being satisfied with their salary and working environment respectively. The majority of nurses also expressed satisfaction with attitudes of healthcare professionals, patients, and administration. However, the majority had reservations over not getting enough time to rest and insufficient holidays. Conclusion: The majority of nurses from our study appeared satisfied with their job, salary, and overall working environment. The majority also expressed satisfaction with attitudes of their healthcare colleagues and patients. It is recommended to ensure better job satisfaction by reducing workload and providing entertainment facilities. Keywords: Job satisfaction, Nursing, Burnout

Aetiology and antibiotic susceptibility pattern of bacterial pathogens in respiratory specimens of COVID-19 patients on respiratory support: A tertiary care hospital study.

Objective: To describe aetiology and antibiotic susceptibility pattern of bacterial pathogens in respiratory specimens of covid-19 patients on respiratory support in tertiary care hospital of Lahore. Study Design: Descriptive study. Setting: Microbiology Department, CMH, Lahore. Period: May 2021 to October 2021. Material & Methods: A total 107 isolates from 145 patients who were COVID-19 positive and on respiratory support were included in the study. Bacterial isolates were isolated from clinical samples according to standard protocol of culturing and incubation. Antibiotic sensitivity, carbapenamase detection was done according to CLSI 2021. Molecular identification of carbapenem resistant genes blaIMP and blaVIM was determined by PCR. Results: A total of 107 bacterial isolates were isolated from clinical specimens. A. baumannii was the most common isolated organism. Colistin and aminoglycosides were found to be the most effective antibiotics. Among carbapenem resistant isolates 89.5% were MHT positive and among these 59 (86.8%) were MBL positive. Among MBL positive isolates, 5.61% and 29.91% were positive for blaIMP and blaVIM respectively. Conclusion: Patients admitted for COVID-19 treatment are at higher risk of acquisition of secondary bacterial infections and antibiotic resistance among such pathogens is at alarming.

Covid-19 and Intensive Care Unit: Infection, Contact Time & Procedures Performed

Background: Safety of front-line health care workers dealing with critically ill patients is of prime importance during COVID-19 pandemic. We have limited skilled workforce and intensive care units (ICU). Aim: To determine the frequency of COVID 19 among ICU staff and find association with contact time and procedure performed. Methods: A comparative cross-sectional study was conducted on 95 subjects working in ICU settings of tertiary care hospitals of Lahore. Data was collected about COVID-19 infection, prevention practices, contact time & procedures performed through google forms. Data was entered & analyzed by SPSS v23 while performing descriptive statistics, T Test, Chi square test & binary logistic regression. Results: Among 95(100%) subjects 25(26.31%) had covid-19 infection whereas 70(73.68%) did not had infection. Age> 30(p=.041), female gender (p=.022), use of re-useable personal protective equipment PPE(p=.009), contact time (p=.020), performing procedures: Nebulization(p=.023) & non-invasive positive pressure ventilation (p=.011) were significantly associated with COVID-19 infection among ICU staff. Conclusion: There was high frequency of COVID-19 infection among ICU staff. Age> 30, female gender, re-useable PPE, contact time, performing procedures: Nebulization & non-invasive positive pressure ventilation were significantly associated with COVID-19 infection among ICU staff. Keywords: COVID-19, Contact time, Intensive care unit, Infection, Procedures

Psychological Challenges and Coping Strategies Adopted by ICU Nurses during COVID-19 Pandemic in Lahore, Pakistan

Objectives: To explore the psychological challenges faced by Intensive Care Unit (ICU) nurses during COVID-19 pandemic and to determine the coping strategies which were used by ICU nurses to combat psychological and emotional stress during the health crisis. Study Design: Qualitative phenomenological approach was used to explore the insights of ICU nurses. Study Subjects: Data were collected from 12 ICU nurses till data saturation. Place and Duration: This study was completed in between August 02, 2021 to January 01, 2022 and was conducted at University of Health Sciences Lahore in collaboration with four tertiary care hospitals of Lahore. Results: Results of this study revealed that the situation was very chaotic. ICU nurses were prone to stress, fear and anxiety because they were more exposed to coronavirus than any other health care professional. The responses of the COVID-19 ICU nurses were categorized into three main themes. Psychological impact of the pandemic in the early stages, social effects of the pandemic and coping strategies. Conclusion: This study concluded that COVID-19 pandemic had a great impact on the psychological well-being of ICU nurses. Despite of adverse conditions, nurses had adopted certain strategies such as family support, religious support and infection prevention protocols which helped them to reduce their stress and fear during the COVID-19 outbreak. Key words: Coronavirus, pandemic, COVID-19 outbreak, psychological experiences, coping strategies, ICU Nurses

Extensively Drug-Resistant Typhoid Outbreak in Pakistan, Experience at a Tertiary Care Hospital in Lahore; A Tip of An Iceberg

Objective: To provide a laboratory-based surveillance report of typhoid fever cases diagnosed at a tertiary care hospital in Lahore during the ongoing outbreak.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Microbiology, Combined Military Hospital, Lahore Pakistan, from Mar 2018 to Jun 2019.
 Methodology: All positive blood culture samples that yielded the growth of Salmonella Typhi were included in the study. The samples were dealt with according to standard microbiological procedures. Antimicrobial susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) guidelines.
 Results: During the study period, (377) Typhoidal Salmonellae were isolated, of which 327 (86.7%) were Salmonella Typhi and 50 (13.3%) were Paratyphi A. The percentage of XDR Salmonella isolates was 41.9%.
 Conclusion: Extensively drug-resistant typhoid fever cases reported in this study represent just the tip of an iceberg. Therefore, nationwide surveillance efforts must be undertaken along with implementing effective preventive measures.

Audit of Operative Notes Against Royal College of Surgeons Guidelines in a Tertiary Health Care Surgical Unit in Lahore.

Operative notes are important documentation made by the surgical team after a surgical procedure. They outline what happened during the surgery and several aspects of post-operative instructions. The aim of this audit was to compare current practices regarding documentation of these operative notes in a tertiary care hospital in Lahore. The standards used were the recommendations made in the good surgical practice guidelines by the Royal College of Surgeons (RCS) of England in 2014.A prospective closed-loop audit was conducted using a checklist constructed using the RCS guidelines. In the first audit, which was done to analyze current practices, 44 consecutive handwritten operative notes were evaluated. The findings of this initial audit were presented to the surgical team in a local meeting and recommendations were made. Forty-eight consecutive operative notes were then analyzed in the re-audit done after an interval of one month. The findings of the re-audit were presented to the surgical team.An overall 35.7% improvement was noted in the documentation of operative notes after the completion of the audit cycle. Certain parameters analyzed, such as thromboprophylaxis, antibiotic prophylaxis, and anticipated blood loss, were much more frequently documented in the re-audit.In our study, implementation of recommendations such as restructuring of the operative notes pro forma and improving awareness regarding the RCS guidelines significantly improved the quality of operative notes that were being documented. Such audits should be conducted regularly to maintain and improve the standards of documentation in all surgical units.

Role of Computed Tomography Scan in the Management of Pediatric Acute Bacterial Meningitis: An Experience from a Tertiary Care Hospital in Lahore

Background: Acute Bacterial Meningitis (ABM) is not an uncommon ailment seen both in developing and developed countries. For the patients presenting with fever and seizures, the trend of doing CT scan brain is on the rise, which may not be justifiable in all cases. Objective: To determine the frequency of radiological findings on computed tomography (CT) of the brain among children presenting with acute bacterial meningitis. Materials & Methods: This cross-sectional study was conducted in Department of Pediatrics KEMU/Mayo Hospital Lahore after IRB approval. Patients with CSF-proven ABM whose CT brains had been performed were enrolled retrospectively, and the presence of hydrocephalus, cerebral infarct, edema and abscess as per CT report were recorded. Data were stratified for age, gender and duration of symptoms. Chi-square test was applied to compare findings in stratified groups. Results: A total of 165 ABM patients with a mean age of 6.2 ±1.3 years; 68.5% (113) males and 31.5% (52) females were included. CT brain was normal in 92 (55.8%), while 29 (17.6%) had cerebral edema, 20 (12.1%), 11 (6.7%) and 13 (7.9%) had cerebral infarct, hydrocephalus and cerebral abscess respectively. Conclusion: Computed Tomography is a useful tool for detecting intracranial complications of ABM. But routine use of CT-brain in every patient without clear indications should be avoided to decrease the risk of radiation exposure as well as to save resources. Keywords: Acute bacterial meningitis, Children, Cerebrospinal fluid, Computed tomography, complications

A Study of Empirical Use of Proton Pump Inhibitors in Indoor Patients

Background: Proton pump inhibitors are amongst most widely used gastric protectants due to their effectiveness. However, there are concerns about their over utilization, patient safety and socioeconomic burden. Aim: To evaluate empirical use, risks and hazards associated with over- usage of Proton pump inhibitors (PPIs). Methodology: A descriptive cross-sectional study was conducted at a tertiary care hospital in Lahore from July to August 2021. Seventy five patients were randomly picked up from indoor wards of the hospital. Patient’s demographic data and frequency of PPIs usage was recorded. Route of administration, adverse effects and indications of proton pump inhibitors were also noted in percentages. Results: All patients were prescribed PPIs on their admission day. Among them, two patients were concomitantly taking H2 Receptor Blockers. Seventy eight (78 %) users were administered PPIs through intravenous route, while rest were given once daily oral formulation. Fourty two (42) % of patients were not prescribed PPIs according to AGA criteria. Moreover, 12% of our sample population suffered from different adverse effects like diarrhea, abdominal pain, bone pain and headache. The results of our study clearly indicated frequent use of PPIs in indoor patients as a prophylaxis of SRMD. Conclusion: Keeping in view the incorrect use of antiacids and their adverse effects including increased risk of enteric and hospital acquired infection, unnecessary use of PPIs in admitted patients should be monitored regularly. MeSH words: PPIs, SRMD, NSAIDs, AG

Prevalence Of Neck and Back Pain Among Gynecologists and Obstetrics in Tertiary Care Hospital of Lahore

Neck pain is identified as the ache, irritation and discomfort in the area below your head up to third Thoracic vertebrae. It can radiate to shoulders, arms and fingers also. The presenting complaints of cervical patients include headache, stiff neck, stress, muscle pain, fever, and tenderness, radiating pain, weakness in the arm and difficulty in lifting or gripping activities. Patients may also present with numbness, tingling and weakness of the arm. Objective: To determine the prevalence of neck and back pain among gynecologists and obstetrics in different tertiary care hospitals of Lahore. Methods: The cross-sectional study included 310 gynecologist and obstetrics that were recruited using non-probability convenience sampling. The cases of the neck pain were recruited from the obstetrics and gynecology department of different hospitals including: Fatima Memorial Hospital, Shalimar Hospital, Services Hospital, Mayo Hospital and Sir Ganga Ram Hospital, Lahore. Research was completed within six months from 23 October 2021 to 30th April 2022. Results: Among 310 participants, 196 (63.2%) reported neck pain among which; 153 (44.4%) gynecologists reported pain two times per week. Out of total, 306 (98.7%) reported fatigue especially on long days. Results regarding pain area showed that 196 (63.2%) had neck pain, 64 (24.6%) had back pain and 50 (16.1%) had shoulder pain. Results regarding frequency of pain showed that out of 310 (100%), 153 (49.4%) had pain 2 times per week and 105 (33.9%) had pain 0-2 times per month. Conclusions: Prevalence of low back pain was 20.65% whereas prevalence of neck pain in gynecologists was 63.23%. The study suggests that neck pain and fatigue were common in gynecologists and obstetrics. They lack of postural awareness and don’t follow ergonomics principles during surgical procedures.

Nurses Knowledge and Practices Regarding Tracheostomy Care in ICU Patients

Background: Tracheostomy care in ICU patients is a basic nursing procedure. It can lead to many complications and is associated with a lot of distress among clients. Study design: Cross sectional descriptive study. Methodology: Total of 75 nurses were recruited in study that involved ICU of three tertiary care hospitals in Lahore. Convenient sampling technique was used. For data collection a self-structured questionnaire was used. The collected data was analyzed by using SPSS version 25. Chi Outcome was applied with p-value of less than 0.05 as significant. Results: There was significant association (p-value <0.05) between nurses knowledge and practice regarding tracheostomy care in ICU patients. The majority of the nurses > 65% had adequate knowledge. Conclusion: The findings of the current study revealed, that nurses are having adequate level of knowledge and practices regarding tracheostomy in managing tracheostomy in ICU patients. Hence, health care settings are required to provide organized clinical guidelines and protocols for patient’s safety. Keywords: Tracheostomy Care, Assessment, Knowledge and Practice.

Does Having a Chronic Liver Illness Make One More Likely to Become Melancholic and Anxious?

Background: Chronic liver disease is a highly prevalent illness globally and in Pakistan as well. The current study was designed to investigate the prevalence of anxiety and depression in patients with chronic liver disease (CLD) in hospitalized patients. Methods and materials: Agha khan University anxiety and depression scale (AKUADS), a questionnaire developed natively in Urdu language, was the instrument used for the study. Admitted patients with the diagnosis of chronic liver disease at a tertiary care hospital in Lahore were invited to take part in the study. A total of 107 patients volunteered to take part in the study (29.9% females) from February 2018 to November 2018. Descriptive statistics was employed to report the prevalence of anxiety and depressive disorders in the study population and independent samples T-test was used to analyze the gender difference between the participants. Results: All study participants scored above the cut-off score of 20 on AKUADS. No significant gender difference was seen among the study participants on mean AKUADS scores. Conclusions: The prevalence of depressive and anxiety disorders is very high in patients with CLD. These patients should be assessed for the presence of depressive and anxiety symptoms on a frequent and routine basis. Recognition and treatment of depressive and anxiety symptoms at an early stage may lead to avoidance of many adverse outcomes related to CLD. Keywords: Depression, Anxiety, Chronic liver disease

Knowledge and Perception of Electronic Health Record among Nurses

Background: Proper Nursing documentation covers all aspects of health care such as assessment standards, proper diagnosis, and identification of problems, planning and implementation of interventions. Aim: To assess the Nurses’ Knowledge and Perceptions regarding Electronic Documentation. Study Design: Descriptive cross sectional study. Methodology: The study was conducted at Institute of Nursing University of Health Sciences Lahore Pakistan whereas the data was collected at four tertiary care Hospitals of Lahore. A Non-probability convenient sampling was used. A sample of n=310 nurses was recruited for this study. A self-administered questionnaire was filled by each participant in about 30minutes. The questionnaire included three parts such as demographic data, Knowledge questions and Perception questions. The collected data was analyzed by using SPSS version 26. Chi square ware applied with P-value< 0.05 as significant. Results: It was found that 26.45% of the study participants had poor knowledge regarding the electronic documentations who scored less than 50% of the correct responses. 32.58% of the nurses have average knowledge and they answered 50 to 65% correct questions. 37.74% participants’ nurses answered 65-80% correct and have good knowledge regarding the electronic documentation. It was also found that 78.71% of the nurses had positive perceptions regarding electronic documentation. Conclusion: It was concluded that there was lack of proper knowledge level but the perceptions toward the electronic documentation was positive among the participant nurses. Keywords: Knowledge, Perception, Electronic Documentation and Nurses.

Serum Estradiol levels during First Trimester of Pregnancy

Aim: To investigate serum estradiol levels during first trimester. Methods: It was a descriptive, cross-sectional study, conducted on pregnant women between 18 to 35 years of age presenting during first trimester in obstetric unit of a tertiary care hospital in Lahore, Pakistan. Ultrasonography was done to confirm the viability of fetus. 53 women with nonviable pregnancy were included Group 1 and 28 women with viable fetus and no complication were included in Group 2. Those having any systemic illness or history of estrogen intake were excluded. Using aseptic measures, venous blood samples were taken, and serum was separated. Serum estradiol levels were measured by using immunoenzymometric assay (EIA). Median serum Estradiol levels were compared. Receiver operative characteristics (ROC) curve was plotted. Results: Median serum estradiol levels of women with viable pregnancy 150.49 ng/mL (71.01-393.75) were significantly higher than abortion group 9.96ng/mL (2.87-37.7). A cut off value 47.9ng/ml of serum estradiol is 82% sensitive and 81% specific for a viable pregnancy. Conclusion: Optimal serum estradiol levels are necessary for viability of pregnancy. Keywords: Estradiol, pregnancy, abortion, first trimester, early pregnancy failure.

Incidence of Facial Palsy and its Impact on Quality of Life of Patients

Objective: This study was planned to assess the frequency of facial palsy in general population and its impact on the quality of life of patients. Method: This descriptive crossectional investigation was conducted in Neurology department of a tertiary care hospital of Lahore from March, 2021 to June, 2022. Sample size was 168 patients with facial palsy out of 246. Data was collected using purposive sampling technique. Frequencies and percentages were calculated for gender, incidence of facial palsy and quality of life. Mean and standard deviation was calculated for age. Results: Total number of patients had facial palsy were 168 out of 246 which was 68.29%. Males were 36.90% whereas females were 63.10%. Face palsy of left side was found among 34.25% patients and 65.75% patients had facial palsy of right side. Conclusion: Incidence rate of facial palsy was above average and patients reported poor quality of life after facial palsy. Keywords: Facial Palsy, Quality of Life, Depression, Facial nerve.

Incidence and Surgical Outcome of Intraventricular Tumors at a Tertiary Care Hospital in Lahore, Pakistan

Objectives: To determine the incidence and outcome of intraventricular tumors treated micro-surgically at the Punjab Institute of Neurosciences, Lahore, Pakistan.
 Materials and Methods: A retrospective study of a series of 42 patients with the initial diagnosis of intraventricular tumors who underwent microsurgical resection over a period of 04 years. The extent of resection was decided by post-operative imaging (CT Brain), performed on immediate or 1st post-op day, and by MRI on outdoor follow-up after an average of 4 weeks. Post-operative complications and the Glasgow outcome scale were also recorded.
 Results: The majority of patients presented with nonspecific symptoms. 47.6% patients presented with headache, nausea/vomiting (40.5%), decreased vision (21.4%), fits (19%) and hydrocephalus (9.52%).29patients (72.5%) underwent microsurgical excision through the anterior transcortical approach, followed by 08 (19.05%) via the posterior transcortical approach. GTR was achieved in 33 (78.57%). Based on histopathology reports, 14 (33.3%) were ependymomas, 11(26.2%) meningiomas, 07 (16.67%) sub-ependymomas, 5 (11.9%) central neurocytomas, and 2(4.76%) Choroid Plexus Papilloma. Significant postoperative intraventricular bleed was noted in 04 (9.52%) patients, minor I/V bleed in 06 (14.28%), hydrocephalus in 07 (16.67%), subdural collection in 02 (4.76%), and motor deficit in 03 (7.15%) patients. Based on Glasgow Outcome Scale, 32 (76.2%) had GOS5/5, 7 (16.67%) with GOS 4/5, while 02 patients expired in the postoperative period.
 Conclusion: Intraventricular tumors require special neurosurgical consideration. Early diagnosis, better preoperative planning, and an adequate microsurgical approach are necessary to achieve maximum safe resection and improvement in patients’ symptoms and overall condition.

Evaluation of Bi-Lateral Co-Infections and Antibiotic Resistance Rates among COVID-19 Patients in Lahore, Pakistan.

Background and Objective: Bacterial infections are among the major complications of many viral respiratory tract illnesses, such as influenza and coronavirus disease-2019 (COVID-19). These bacterial co-infections are associated with an increase in morbidity and mortality rates. The current observational study was conducted at a tertiary care hospital in Lahore, Pakistan among COVID-19 patients with the status of oxygen dependency to see the prevalence of bacterial co-infections and their antibiotic susceptibility patterns. Materials and Methods: A total of 1251 clinical samples were collected from already diagnosed COVID-19 patients and tested for bacterial identification (cultures) and susceptibility testing (disk diffusion and minimum inhibitory concentration) using gold standard diagnostic methods. Results: From the total collected samples, 234 were found positive for different bacterial isolates. The most common isolated bacteria were Escherichia coli (E. coli) (n = 62) and Acinetobacter baumannii (A. baumannii) (n = 47). The E. coli isolates have shown the highest resistance to amoxicillin and ampicillin, while in the case of A. baumannii, the highest resistance was noted against tetracycline. The prevalence of methicillin resistant Staphylococcus aureus (MRSA) was 14.9%, carbapenem resistant Enterobacteriaceae (CRE) was 4.5%, and vancomycin resistant Enterococcus (VRE) was 3.96%. Conclusions: The results of the current study conclude that empiric antimicrobial treatment in critically ill COVID-19 patients may be considered if properly managed within institutional or national level antibiotic stewardship programs, because it may play a protective role in the case of bacterial co-infections, especially when a patient has other AMR risk factors, such as hospital admission within the previous six months.