Tertiary Care Hospital In Karachi Research Articles

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<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.

Functional outcome of pertrochanteric fractures undergoing Dynamic Hip Screw versus Proximal Femoral Nail Anti-Rotation Techniques at a Tertiary care hospital of Karachi.

Objective: To find out the functional outcomes as per Harris hip score (HHS) among patients of pertrochanteric fractures undergoing dynamic hip screw (DHS) versus proximal femoral nail anti-rotation (PFNA) at a Tertiary care hospital. Study Design: Non-randomized Controlled Trial. Setting: Orthopedic Section, Department of Surgery, Agha Khan University Hospital, Karachi, Pakistan. Period: 1st August 2023 to 30th January 2023. Methods: A total of 40 patients of age 18 and older with confirmed pertrochanteric fractures were non-randomly allocated to ether fixation with DHS or PFNA. Intra-opeative blood loss and duration of surgery were recorded. The functional outcome assessment was assessed using HHS. Results: In a total of 40 patients, 31 (77.5%) were female. The mean age was 67.63±15.13 years (ranging between 23 to 89 years). The most common mechanism of fall was tipped over loose carpet, noted in 17 (42.5%) patients. The mean intra-operative blood loss in DHS and PFNA groups were 73.75±20.06 ml, and 72.75±23.14 ml, respectively (p=0.885). The mean duration of surgery were 76.6±14.7 minutes, and 115.1±18.3 minutes in DHS and PFNA groups, respectively (p<0.001). Excellent, good, fair, poor, and failed outcomes were reported in 3 (7.5%), 17 (42.5%), 6 (15.0%), 10 (25.0%), and 4 (10.0%) patients respectively. When both groups were compared for outcomes, no statistically significant differences were observed (p=0.339). The mean HHS in DHS, and PFNA groups were 75.26±11.41, and 73.46±14.57, respectively (p=0.666). Conclusion: Functional outcomes as per HHS were relatively similar with DHS and PFNA approaches in patients with pertrochanteric fractures.

Frequency and Resistance Pattern of Carbapenemases (Class A & B) in E. Coli and Klebsiella Species

Abstract: Background: Carbapenems are potent and strong antibiotics that are usually reserved as last resort for bacteria possessing basic antibiotic resistance. These are broad spectrum drugs with more effective coverage against gram negative organisms. The antibiotic resistance pattern observed in bacteria possessing chromosomal group 2f β-lactamases is unique. It involves resistance to carbapenems while remaining sensitive to broadly attacking cephalosporins. Objective: This study aims to provide assessment of frequency of class A & B carbapenamase in E.coli and Klebsiella species producers and establish the resistance pattern from clinical isolates, at a tertiary care hospital in Karachi. Materials and Methods: This is a cross sectional, prospective study conducted at general hospital liyari, Karachi during Jan 2022- Jan 2023. Sample size was calculated as 400. Samples were divided into Urine samples of urinary tract infection patients (n=150), Pus sample from different sites (n=100), Respiratory tract, tracheal aspirates and sputum sample (n=100) and blood sample from suspected septicemia (n=50). SPSS-22 was used to enter and analyze the data. Chi-square test was used to analyze significance between two mean values, keeping ≤0.05 as significant p-value. Result: Distribution of microorganisms were reported as 120 (41.1%), 80 (28.5%), 2 (0.69%), 24 (8.36%), 55 (19.1%) and 6 (2%) of E. coli, Klebsiella Pneumonia, K.Oxytoca, Gram positive. Gram negative and Yeast respectively. The confirmed presence of carbapenemase (CP) was identifies in urine sample as 4/6 (26.6%) E.coli and 2/6 (13.3%) Klebsiella, while pus samples identifies 3/4 (20%) E.coli and 1/4 (6.6%) Klebsiella. Similarly samples of respiratory tract identifies 2/5 (13%) of E.coli and 3/5 (20%) of Klebsiella. The calculated p-value was insignificant with 0.834 and 0.913 for E.coli and Klebsiella respectively. Conclusion: This study concludes that E.coli is by far the most frequently reported microorganism from class B while class A organisms are in lower frequencies. CRE indicated higher resistance from non-β-lactam antibiotics, limiting treatment options. Keywords: Phenotypic, Detection, Resistance, Carbapenemases, E. coli, Klebsiella.

Knowledge of basic life support amongst Medical/Paramedical Professionals, in a Tertiary Care Hospital, Karachi, Pakistan

Background: Cardiopulmonary resuscitation (CPR), a critical skill within basic life support (BLS), is essential for medical professionals in cases of cardiac or respiratory failure. This study aims to evaluate the BLS knowledge and practical application among healthcare professionals at a tertiary care hospital in Karachi, Pakistan, to enhance training outcomes. Objective: The primary objective was to assess the knowledge and practical skills of BLS among medical and paramedical staff at Ziauddin Hospital and identify gaps in training to improve emergency response effectiveness. Methods: This cross-sectional descriptive study involved 400 healthcare workers from various departments of Ziauddin Hospital between February and April 2024. Participants were selected to represent a diverse group of doctors, nurses, and paramedical staff. Data was collected using a standardized questionnaire based on European standards and guidelines from the American Heart Association and the Resuscitation Council. The questionnaire included both theoretical and practical aspects of BLS. Data were analyzed using SPSS version 25, with frequencies, percentages, and chi-square tests applied to assess associations between variables. Ethical approval was obtained from the Ziauddin Hospital Ethical Review Committee, ensuring adherence to the Declaration of Helsinki. Results: The study revealed that 80% of participants knew the abbreviation for BLS. However, only 26.8% correctly identified the immediate action for an unconscious victim. The correct site for chest compressions in adults and infants was known by 88% and 84.5% of participants, respectively. Awareness of AEDs and EMS was high, at 95% and 93%. Practical skills were notably weaker, with significant variability in emergency responses: 26.8% would give two breaths immediately to an unconscious victim, and 76% incorrectly chose to compress the abdomen for a victim submerged in water. The mean age of participants was 27±4.9 years, with a gender distribution of 51.5% female and 48.5% male. Conclusion: While healthcare professionals at Ziauddin Hospital possess strong theoretical knowledge of BLS, there are significant gaps in practical application, especially in emergency scenarios. To improve patient outcomes in emergencies, more practical, scenario-based training is necessary. This study underscores the need for ongoing, hands-on training sessions to bridge the gap between knowledge and practice.

Undiagnosed vertebral fragility fractures in patients with distal radius fragility fractures: an opportunity for prevention of morbimortality in osteoporotic patients in developing countries.

This study's main goal was to look into the frequency, location, kind, and severity of asymptomatic vertebral fragility fractures (VFF) in people who had fractures of the fragility of the distal radius. Although VFF is frequently misdiagnosed, it is linked to higher mortality, morbidity, and hip fracture risk. The study also attempted to investigate the relationship between VFF and certain demographic and lifestyle factors, as well as FRAX data, in this patient population. Between January, 2021, and January, 2022, individuals with low-energy distal radial fractures who presented to the emergency room of tertiary care hospital of Karachi, Pakistan, were the subject of a cross-sectional study and were 45years of age or older except those who fitted the exclusion criteria (n = 208). The thoracic and/or lumbar spine was imaged using radiology, and information on demographics, way of life, and FRAX (Fracture Risk Assessment Tool) was gathered. Using the Genant semiquantitative approach, an impartial and blinded orthopaedist identified VF in the images and determined their severity. SPSS version 20 was used to analyse the data. Two hundred eleven (41.21%) of them were found to have radiographic VFF and only 12 (2.34%) of the 512 patients who were tested were getting osteoporotic therapy. The thoracic spine (32.7%), followed by the lumbar spine (43.12%), was the area most frequently afflicted. In 24.17% of the patients, multiple fractures of the thoracolumbar spine were found. The wedge form (54.5%), followed by biconcave (30.81%) and crush (14.7%), was the most prevalent VFF type. The majority of detected VFF were rated as having a 25-40% height loss (64.9%) then severe (> 40%) fractures (35.1%), according to the Genant grading method. Notably, there were no variations in smoking, drinking, BMI, or FRAX score between patients with and without VFF that were statistically significant. Based on our study's findings, it is clear that osteoporotic vertebral fragility fractures occur in almost half of individuals with distal radius fractures. The lumbar spine is notably the most affected region, predominantly with wedge fractures. Given the high prevalence of asymptomatic vertebral fragility fractures (VFF), proactive measures are necessary to mitigate associated risks. Prioritising comprehensive fall risk assessments for these patients and interventions to enhance bone mineral density and strength are crucial. Early identification of asymptomatic VFF enables timely intervention, optimising patient care and minimising the risk of complications in this vulnerable population.

Enhancing Clinical Outcomes and Quality of Life in Acute Myocardial Infarction Patients Through Standard Clinical Pathway Implementation: A Study From a Public Tertiary Care Hospital in Karachi, Pakistan

Objectives: This study aimed to assess and compare the impact of implementing a standard clinical pathway on clinical outcomes and quality of life among Acute Myocardial Infarction (AMI) patients at Dr. Ruth Katherina Martha Pfau Civil Hospital in Karachi, Pakistan. Methodology: A quasi-experimental non-randomized controlled study was conducted from September to December 2018, involving 220 AMI patients. The control group (110) received standard care, while the interventional group (110) was managed using a standardized clinical pathway. Data was collected using the AMI standard clinical pathway tool and the SF-36 questionnaire. Statistical analysis was performed using SPSS version 22, presenting categorical variables as frequencies and percentages, and continuous variables as mean and standard deviation. Mean differences in clinical parameters and quality of life were assessed using paired sample t-tests with a significance level set at p < 0.05. Results: Among the participants, 50% were in the control group and 50% in the interventional group, with a predominance of males. The quality-of-life scores significantly differed between the control and intervention groups (p < 0.001). Furthermore, significant improvements in quality of life were observed in both male and female patients’ post-intervention (p < 0.001). Conclusion: Implementation of a standard clinical pathway led to improved clinical outcomes and quality of life among AMI patients. This highlights the potential benefits of standardized care pathways in enhancing patient outcomes in similar healthcare settings.

Incidence of Renal Impairment in Elderly Hospitalized Patients

Background: Chronic kidney disease (CKD) is increasingly prevalent among the elderly, leading to progressive kidney function decline and adversely affecting their physical and cognitive well-being. Objective: This study aimed to assess the incidence and effects of renal impairment on physical and cognitive functions in elderly hospitalized patients. Methods: A total of 420 elderly patients admitted with renal impairment to a tertiary care hospital in Karachi were included from January to August 2023. We measured the estimated glomerular filtration rate (e-GFR) and Short Physical Performance Battery (SPPB) score, and collected comprehensive demographic, socioeconomic, and clinical data, including a detailed geriatric assessment. Results: The cohort had a mean age of 78.4±5.8 years, with a nearly even gender split (51.9% male, 48.9% female). Average BMI was 24.8±4.5 Kg/m^2, mean eGFR was 56.6±18.6 mL/min per 1.73 m^2, and mean SPPB score was 4.9±3.5. High prevalence of comorbidities was noted: hypertension (68.6%), diabetes (27.6%), coronary artery disease (28.6%), and others. Renal impairment was categorized as severe (12.9%), mild (27.1%), and moderate (60%). Conclusion: There is a significant correlation between advanced age and renal failure, leading to diminished physical and cognitive capabilities in the elderly, indicating a critical need for integrated care strategies.

Clinical Spectrum of Celiac Disease among Adult Population: Experience from Largest Tertiary Care Hospital in Karachi, Pakistan.

Celiac disease (CD) is a systemic autoimmune enteropathy triggered by dietary gluten in genetically susceptible individuals. Celiac disease affects 0.6-1.0% of the population worldwide. The prevalence of CD in Pakistan is yet unknown due to under diagnosis and lack of awareness. To determine a vast variety of presenting features in subtypes of CD to overcome the burden of disease. This was a prospective, comparative, cross-sectional study conducted at Gastroenterology department of Jinnah Postgraduate Medical Center, Karachi from December 2022 till June 2023. This study included all adult patients ≥18 years diagnosed with CD on the basis of clinical presentation, positive IgA and IgG anti-transglutaminase antibodies (value >12 IU/mL detected by ELISA followed by small intestinal biopsy classified as per Marsh criteria. The data obtained were analyzed on the statistical software SPSS version 23. Descriptive statistics were obtained by frequencies and percentages. About 142 patients were enrolled in the study, 103 (91.5%) had classical CD (CCD) whereas 36 (25%) had non-classical (NCCD). About 89 (62.7%) were females and 53 (37.3%) were males. The mean age was found to be 23 ± 6 years. Nutritional deficiencies including anemia, B12, folate, osteopenia and low body mass index (BMI) <18 was found more in CCD group as compared with NCCD group with significant p-values. Titers of anti-TTG between CCD and NCCD were not statistically significant. Hypothyroidism and PCOS were the most common associated conditions observed in adult CD patients. In conclusion, CD in adults and has diverse presentations. Adults with unexplained extra-intestinal symptoms like anemia and bone pain should be investigated for CD. Butt N, Shahid B, Butt S, et al. Clinical Spectrum of Celiac Disease among Adult Population: Experience from Largest Tertiary Care Hospital in Karachi, Pakistan. Euroasian J Hepato-Gastroenterol 2024;14(1):24-29.

Efficacy of Pegylated Interferon-alpha-2a in Chronic Hepatitis Delta: Experience from a Tertiary Care Hospital in Karachi.

Chronic hepatitis D (CHD) along with chronic hepatitis B (CHB) is an important cause of morbidity and mortality in patients with cirrhosis. It is a potentially curable infection that has long awaited a good treatment option. To ascertain the efficacy of pegylated interferon (PEG-IFN)-alpha-2a in patients suffering from CHD. A tertiary care hospital experience from Pakistan. The study included 207 CHD polymerase chain reaction (PCR)-positive patients treated with PEG-IFN-alpha-2a between July 2020 and October 2022. Virological response rate (PCR negative) at weeks 24 and 48 was the primary endpoint. Secondary outcomes included partial response (>2 log reduction in PCR) and treatment failure rate (<2 log reduction in PCR). A total of 187 patients started PEG-IFN therapy, and 148 patients completed the assigned 48 weeks of therapy. Patients' mean age was 25.7 years with 65% being males. The virological response rate was 40.5% at week 24 and 32.4% at week 48. The partial response rate was 24% at both weeks 24 and 48. The treatment failure rate was 36% at week 24 and 44% at week 48. Hemoglobin, white blood cell (WBC) count, and total bilirubin were found to be predictive of treatment response. Side effects led to treatment discontinuation among eighteen patients and one patient died due to hepatic failure. Therapy with PEG-IFN-alpha-2a shows suboptimal outcomes in patients with CHD. There is a strong need for more effective alternate therapies for CHD patients. Butt N, Usmani MT, Hussain R, et al. Efficacy of Pegylated Interferon-alpha-2a in Chronic Hepatitis Delta: Experience from a Tertiary Care Hospital in Karachi. Euroasian J Hepato-Gastroenterol 2024;14(1):51-55.

Prevalence of Salmonella Typhi in Bile of the Patients Undergoing Cholecystectomy at a Tertiary Care Hospital Karachi

Objective: To estimate the prevalence of salmonella typhi in bile specimens collected from patients undergoing cholecystectomy at a tertiary care Hospital Karachi. Methodology: The descriptive cross-sectional study, was conducted at Department of Surgical Unit 21, Jinnah Postgraduate Medical Center, Karachi, from January 2021 to June 2021. Patients with symptomatic Cholelithiasis like sudden pain in the upper right portion of your abdomen which radiate towards right shoulder, nausea, vomiting, undergo cholecystectomy of either gender male or female with age 14 to 60 years were included. After open cholecystectomy, bile was aspirated from the gallbladder at fundus in five ml syringe and long spinal needles was used in case of laparoscopic cholecystectomy to collect bile under vision of telescope. Specimens were sent to laboratory according to protocol for culture sensitivity. Results: A total of 171 patients who met the inclusion and exclusion criteria were included. Mean age of the patients was 49.39±8.78 years. 83 (48.5%) were male and 88 (51.5%) were female. Prevalence of salmonella typhi in bile specimens collected from patients undergoing cholecystectomy, was found 17.54%. Furthermore, the frequency of salmonella isolate was statically insignificant according to the patient’s gender, diabetes and obesity (p=&gt;0.05), while it was statically significant according to age up to 40 years and residence in rural areas (p-&lt;0.05. Conclusion: A significant proportion of patients were found to have Salmonella in bile from patients undergoing cholecystectomy. Therefore, close monitoring of patients must be done in all patients with regular follow-up.

Frequency and association of H pylori with severity of Gastritis according to age and gender: A Retrospective Study conducted at a Tertiary Care Hospital in Karachi, Pakistan.

Frequency and association of H pylori with severity of Gastritis according to age and gender: A Retrospective Study conducted at a Tertiary Care Hospital in Karachi, Pakistan.

Exploring Oral Health Knowledge and Practices among Early Childhood Caregivers A Cross-Sectional Survey

Early childhood is a crucial developmental phase of a child's well-being, which lays the foundation for their future growth. Lack of good oral practices may cause dental issues during this fundamental phase of development and have a long-lasting impact on a child's overall well-being. This cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, to explore oral health knowledge and practices among the caregivers of young children. A sample of 94 participants, including parents, caregivers, early childhood educators, and healthcare professionals (HCPS), was included through a convenient sampling technique. An online survey questionnaire was administered, which covered various aspects of oral hygiene practices to prevent common oral diseases among children. All statistical analyses were performed using SPSS 22.0. Statistical significance was accepted as p ≤0.05. Results of the study revealed no significant differences in oral health knowledge and practices based on age and gender. However, comparisons based on profession and roles showed a significant difference. Most participants agreed on the importance of regular oral hygiene practices. However, their opinions differed on certain oral hygiene practices, including the frequency of brushing and the timing of the first dental visit. This study underscores the importance of targeted education and interventions to improve oral health outcomes during the critical developmental phase of childhood.

Evaluation of Dyslipidaemia in Patients with Chronic Viral Hepatitis in a Lower Socio-Economic Country

Patients having chronic viral hepatitis do have disturbances in their serum lipid profiles, still the monitoring of dyslipidemia is not a routine part of management in low socio economic countries. Objective: To investigate the status of lipid profile among patients with chronic hepatitis and compare them with non-infected individuals. Methods: A cross-sectional study was done in a Tertiary Care Hospital of Karachi, from 5th September 2022 to 31st May 2023. Patients with chronic hepatitis B and C, diagnosed within two years with a body mass index (BMI) of 25-29.9 kg/m2 were included. Their comparison was done with non-infected individuals of the same BMI. All patients were evaluated with different parameters of lipid profile along with haemoglobin, alanine aminotransferase, albumin and international normalized ratio. Results: Among 521 participants of the study, the grouping was almost equal. The age range was 12-75 years, with an increased number of females in each group. In comparing the different statuses of lipid profile, each parameter including cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, all were significantly much less in patients with chronic viral hepatitis as compared to controls with a p-value of 0.000 in all. Conclusions: It was concluded that Dyslipidaemia is not common among chronic viral hepatitis patients’ despite being overweight, particularly among patients with child’s class A.

Etiologies of first time urinary tract infection in pediatric population in tertiary care hospital Karachi.

Etiologies of first time urinary tract infection in pediatric population in tertiary care hospital Karachi.

Triage implementation in Pakistan: a case of broken healthcare system

Madam, The death toll due to road traffic accidents (RTA) in Pakistan reached 28,170 in 2020, according to WHO. This accounts for 1.93% of all deaths in the World. (1) Mortality due to RTA is an ever-increasing concern and its management, especially in Pakistan, is still a bigger concern. The efficient way of dealing with Trauma is by following globally accepted evidence-based “Advanced Trauma Life Support” guidelines. Triage being the first step in ATLS literally means “to sort”. In other words, identifying the greatest good for greatest numbers. The Emergency Department (ED) rule must be to manage patients based on the severity of problems and not on the order of arrival. Death can be prevented in the patients who benefit the most by getting medical attention the earliest. All the patients escorted and rescued from the place of incident should be sorted rapidly and given a colour-coded tag based on urgency. Onsite triage is the most critical life saving measure. A Karachi based study concluded that most paramedics in ambulances had poor knowledge of pre-hospital management and 72.3% thought they could not do triage. (2) Similarly, another study at the emergency department of a tertiary care hospital in Karachi showed concerningly poor knowledge of triage.(3) Only 5 CPSP accredited public hospitals in Pakistan have emergency medicine as a separate field which results in lack of triage implementation as EDs of most hospitals are run by internal medicine professionals and general surgeons. Simply, implementing triage has shown to reduce and ED mortality (by 3.80%), resources’ utilisation, and length of stay.(4) Punjab, the development hub of Pakistan, provides 22 public hospitals, including only 12 fully functional ones, for dealing with trauma patients. DHQs bearing the burden of all trauma patients of districts are level-III trauma centres lacking in specialised surgical care and categorization of paediatric and adult patients. Other independent trauma care facilities are level-IV trauma centres which act as a relay to stabilise the patients before they are transferred to a better facility. A level-I trauma centre alone can increase 25% survival rate of trauma patients, but unfortunately Pakistan does not have a single level-I trauma centre. (5) Therefore, all Rescue staff must be trained regularly for future enactment of triage to alleviate RTA associated mortality along with upgrading of trauma centres to level-I.

The Effects of Music Therapy on Patients Undergoing Colonoscopy in a Tertiary Care Hospital at Karachi, Pakistan: A Comparative Study

A colonoscopy is a procedure commonly used for the diagnosis of colorectal diseases but may be associated with high levels of anxiety and discomfort, which can lead to complications during sedation and decreased patient comfort and cooperation. This study was conducted at a tertiary care hospital in Karachi to assess the effectiveness of music therapy on pre-procedural anxiety, sedation requirements, pain, and procedure duration among patients undergoing colonoscopies. This comparative study included 110 outpatients. The intervention arm received non-lyrical soft music through earphones before and during the colonoscopy procedure, while the control group did not receive any music. In the intervention arm, significant reductions were seen in pre-procedural anxiety scores (p < 0.001), physiological measures (p < 0.001), sedation doses (p < 0.001), and procedure durations (p < 0.05). Control arm showed an increase in heart rate and systolic blood pressure (p < 0.001). Pain scores were similar for both groups. Music therapy is an effective tool to reduce patient anxiety pre- procedure. It is a simple, safe, and noninvasive relaxing intervention that could be used as an adjunct to sedative medications before and during the colonoscopy procedure.

Patients' experiences with tele-mental health services during COVID-19 in Pakistan.

Although the concept of telehealth is of great interest globally, its potential has not yet been realized in Pakistan. It is therefore essential to explore the perspectives of stakeholders on the technology, particularly for mental health, to be able to increase and improve its use. To assess the perceptions and experiences of patients receiving tele-mental health services, including telepsychiatry and tele-psychotherapy, in Pakistan. For this qualitative exploratory study, we conducted in-depth interviews with 49 individuals at a tertiary care hospital in Karachi, Pakistan. Using the Cresswell framework for content analysis, we identified 3 major themes that focused on the positive and negative aspects of tele-mental health services and made suggestions for enhancing them. Twenty-six of the participants received telepsychiatry, while the remaining 23 received tele-psychotherapy services. Technical literacy, cost of consultation, privacy, and therapeutic alliance were the major challenges identified by the patients, while convenience and the absence of stigma were highlighted as key facilitators for tele-mental health. Tele-consultations reduced travel and waiting time, thus improving access to healthcare. Participants suggested that the processes for booking appointments and making payments should be streamlined and the cost of tele-consultation reduced. This study provides insightful findings on tele-mental health services from the perspectives of patients living in an Asian culture. The major benefits highlighted were destigmatization of mental health and elimination of commuting costs and travel time. There were concerns about privacy, therapeutic alliance and availability and affordability of the technology.

Sleep quality in functional dyspepsia patients: A cross-sectional study from a tertiary care hospital in Karachi.

Objective: To determine sleep quality among functional dyspepsia (FD) patients presenting to gastroenterology out-patient clinic in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: March 2022 to December 2023. Methods: FD diagnosis was established in view of ROME-IV criteria. Sleep quality was evaluated using Pittsburgh Sleep Quality Index PSQI scoring tool. A global score of 5 or more indicates poor sleep quality. Binary logistic regression was applied and odds ratio with 95% confidence level were figured out to assess relationship of patients' profile with FD. Results: In a total of 240 patients, the mean age was 37.3±6.5 years. There were 122 (50.8%) male patients. The most common dyspeptic feature was postprandial fullness (60.4%) followed by early satiety epigastric pain (50%) and epigastric burning (39.6%). Mean PSQI score was 14.7±3.5. Frequency of poor sleep quality among FD patients was 79.2%. None of the parameter was significantly associated with sleep quality except urban residence (p=0.005). Conclusion: Very high burden of poor sleep quality was found among FD patients. While most dyspeptic symptoms did not show a significant association with sleep quality, urban residence emerged as a notable factor.