Tertiary Care Hospital In Lahore Research Articles

Trend of Antimicrobial Resistance Among Salmonella Typhi Isolated from Pediatric Population Presenting at a Tertiary Care Hospital in Lahore

<p><strong>Background and Objective:</strong> Typhoid fever caused by Salmonella typhi (S. typhi) is an important cause of morbidity and mortality worldwide. The emergence of resistance against the first and second line of drugs has limited the range of drug choices for its treatment. Therefore, the present study was designed to assess the status of drug resistance in S. typhi isolated from the blood samples of pediatric patients reporting at a leading tertiary care hospital in Lahore.</p>
 <p><strong>Methods:</strong> This descriptive study was conducted at the Pathology Department of Allama Iqbal Medical College, Lahore, Pakistan, over a period of 2 years. A total of 1,306 blood samples were aseptically collected from the pediatric population of Jinnah Hospital, Lahore, Pakistan, after obtaining informed assent from the parents/guardians. The samples were transferred into a Bact/Alert blood culture bottle. After the detection of microbial growth by the Bact/Alert 3-D system, bacterial isolates were identified by standard microbiological procedures. VITEK 2 compact automated identification and antimicrobial susceptibility testing instrument (bioMerieux) was used for the antimicrobial sensitivity testing. Data were entered and analyzed by using Statistical Package for the Social Sciences version 21.0.</p>
 <p><strong>Results:</strong> A total of 235 out of 1,306 (17.9%) blood culture samples yielded bacterial growth, among which 62.5% (n = 147) were S. typhi. Among 147 S. typhi isolates, 70.6% were multidrug resistant, while 63% were extensively drug resistant (XDR). Maximum resistance against first-line drugs observed was for ampicillin (79.4) and co-trimoxazole (67.2).</p>
 <p><strong>Conclusion: </strong>The emergence and spread of XDR S. typhi with a high level of resistance are quite alarming, leaving limited treatment options for the pediatric population. Moreover, increasing resistance to antibiotics demonstrates the quick waning of the efficacy of available first and second-line drugs in the treatment of typhoid fever.</p>

Analysis of Near-Miss Events and Errors in Handling Thyroid Specimens; A Gross Room Experience from a Pathology Lab

<p>Background and Objective: Thyroid specimens constitute a major bulk of the head and neck surgical specimens received at the Pathology Departments. Careful handling of the specimens in the grossing room will result in an efficient reporting of useful histological parameters required for patient management and prognosis. The objective of this study was to analyze different errors and near-miss events in the grossing of thyroid specimens in the surgical pathology gross room of a Tertiary Care Hospital in Lahore, Pakistan.</p>
 <p>Methods: A cross-sectional analysis was done on different thyroid specimens received at the Pathology reception of Lahore General Hospital, Lahore, Pakistan, from January 2022 to April 2023. Different types of errors involved in standard gross examinations were studied. Data were entered using SPSS version 23.0.</p>
 <p>Results: Errors observed in the preanalytical phase included the use of inappropriate fixative (15.2%), insufficient clinical information (76.5), mislabeled jar/request form (7.6%), and loss of specimen (8%). Grossing errors included insufficient grossing notes (12.2%), cutting thick slices (10.7%), missing lesions on gross examination (9.9%), inappropriate inking (6.9%), overfilling cassette with large tissue sections (6.9%), mislabeled cassettes (93.8%), and incomplete submission of capsule (2.3%).</p>
 <p>Conclusion: This study concludes that errors and near-miss events in handling thyroid specimens can be avoided by effective training of the handling staff and grossing residents. Collaboration between clinical wards and histopathology laboratories can also be helpful in this regard.</p>

Cross-sectional study on the etiological causes of cervical lesions among patients without caries in Lahore, Pakistan

Background and Aim: Non-carious cervical lesions (NCCLs) are defined as any deterioration of the tooth tissue in terms of abrasion, composition, and erosion during normal and/or pathological function. The present study aimed to assess different etiological causes of cervical lesions among patients without caries in the population of Lahore, Pakistan. Materials and Methods: A cross-sectional analytical study was carried out on 62 patients aged 16-60 years in the Department of Dentistry of a Tertiary Care Hospital of Lahore, Pakistan from July 2022 to December 2022. Patients were categorized into two groups: Group-I (Non-carious dental lesions patients) and Group-II (without non-carious dental lesions patients). All the patients underwent clinical examinations and answered a questionnaire which included inquiries related to oral hygiene, personal impressions, eating habits, teeth appearance and functionality, and it also emphasized on the different etiologies of non-carious dental lesions.Results: Out of the total 62 patients, the study and the control groups consisted of 38 (61.3%) and 24 (38.7%) patients respectively. Age-wise distribution of the patients was as follows: 19 (30.6%) in 16-30 years, 12 (19.4%) in 31-45 years, and 31 (50%) in 46-60 years.

Correlation Between Computed Tomography Severity Score and Patient Prognosis In Cases of Covid-19 Pneumonia: A Retrospective Study

Objective: To Find the association between CT severity score and patient prognosis in cases of COVID-19 pneumonia in a tertiary care hospital in Lahore. Method: It was a retrospective descriptive observational study, carried out at Chaudhary Muhammad Akram Teaching and Research Hospital, Lahore. We enrolled 80 patients clinically suspected of having COVID-19 pneumonia and showing characteristic HRCT features of the same in our study using consecutive sampling technique. Patient prognosis was classified into patients recovered and patients expired. A CT severity score (CTSS) consisting of 25 points wasdeployed to categorize disease as mild, moderate and severe. Statistical package for social sciences (SPSS) version 20 was utilized for statistical analysis.Association between patient prognosis and CT severity scoreof COVID -19 infection was studied by applying the Pearson correlation. Results: 19 (100%) out of 19 patients with mild CTSS recovered, 32 (80%) out of 40 patients with moderate CTSS recovered while 8 (20%) expired and 11 (52.4%) out of 21 patients with severe CTSS recovered while 10 (47.6%) expired.A statistically significant positive association (p = 0.001) was observed between patient prognosis and CT severity score in COVID-19 patients. Conclusion: A positive association exists between CT severity score and patient prognosis in cases of Covid-19 pneumonia

Prevalence of periodontitis in patients with rheumatoid arthritis

Background and Aim: Rheumatoid arthritis (RA) patients are more susceptible to the initiation of severe periodontitis which can ultimately intensify their systemic inflammation associated with RA. The present study aimed to determine the incidence of periodontitis in rheumatoid arthritis patients. Materials and Methodology: A cross-sectional analytical study was carried out on 168 rheumatoid arthritis patients in the Department of Dentistry and Internal Medicine of a Tertiary Care Hospital of Lahore, Pakistan from January 2022 to December 2022. All the patients were inquired about their demographic details, medical history and smoking habits. A detailed periodontal examination of full mouth was done and plaque index, clinical attachment level (CAL) and probing pocket depth (PPD) was measured. Rheumatoid factor (RF)’s presence, number of tender and swollen joints, erythrocyte sedimentation rate (ESR); Disease Activity Index (DAS) and hand radiographs were the different RA parameters which were recorded. Periodontal conditions were then associated and correlated with RA parameters. Results: Out of the total 168 RA patients, there were 142 (84.5%) females and 26 (15.5%) male patients. The overall mean age was 48.6 ± 8.64 years. The overall mean DAS score and disease duration was 4.58 ± 1.32 and 9.58 ± 6.8 years respectively.

Molecular Characterization of Extensively Drug Resistant Salmonella Enterica Serovar Typhi Clinical Isolates from Lahore, Pakistan.

The emergence of extensively drug-resistant (XDR) typhoid in Pakistan has endangered the treatment options available to manage this infection. Third generation cephalosporin were the empiric choice to treat typhoid fever in Pakistan, but acquisition of ESBLs have knocked them out of the arsenal. The current empiric choice is azithromycin which is vulnerable to resistance too. This study aimed to assess the burden of XDR typhoid and the frequency of resistance determinants in blood culture samples collected from different hospitals in Lahore, Pakistan. A total of 835 blood cultures were collected from different tertiary care hospitals in Lahore during January 2019 to December 2021. Among 835 blood cultures, 389 Salmonella Typhi were identified, and 150 were XDR S. Typhi (resistant to all recommended antibiotics). Antibiotics resistance genes of the first-line drugs (blaTEM-1, catA1, sul1, and dhfR7) and second line drugs (gyrB, gyrA, qnrS, ParC and ParE) were investigated among XDR S. Typhi. There were different CTX-M genes isolated using the specific primers, blaCTX-M-U, blaCTX-M-1, blaCTX-M-15, blaCTX-M-2, blaCTX-M-8 and blaCTX-M-9. Antibiotic resistant genes of the first-line drugs were isolated with different frequency, blaTEM-1 (72.6%), catA1 (86.6%), sul1 (70%), and dhfR7 (56%). Antibiotics resistance genes of second-line drugs were isolated as: gyrB (60%), gyrA (49.3%), qnrS (32.6%), parC (44%) and parE (28%). Among CTX-M genes, blaCTX-M-U (63.3%) was the most frequent followed by blaCTX-M-15 (39.3%) and blaCTX-M-1 (26%). Our study concluded that XDR isolates circulating in Pakistan have acquired first-line and second-line antibiotic resistant genes quite successfully along with CTX-M genes (ESBLs) rendering them resistant to the third generation cephalosporins as well. Emergence of azithromycin resistance in XDR S. Typhi which is currently used as an empiric treatment option is worrisome and needs to be monitored carefully in endemic countries like Pakistan.

Utility of Fast Scan in Blunt Abdominopelvic Trauma Patients in Lahore District

Background: To evaluate the utility of fast scan in blunt abdominopelvic trauma patients in the emergency department of tertiary care hospitals in Lahore district. Focused assessment with sonography for trauma (FAST) has been used as the first assessment in diagnosing patients with trauma in the last decade, and we have heard people questioning its authenticity and reliability, and many other things. Methodology: The study design was cross-sectional .This study was conducted at various tertiary care hospitals of Lahore, in the time duration of 3 months from January 2022 to March 2022. One hundred and six (106) patients with blunt abdominopelvic trauma were assessed by Fast scan using 2-5MHz transducer. Results: Out of 106 patients 59(55.7%) were males and 47(44.3%) were females with ages ranged between 2 to 72 years. Road traffic accidents accounted for 50% cases, 17% were due to fight while 23.6% were due to fall and 9.4% were due to assault. Of the total patients, 69.8% had negative scan while 30.2% had positive scan. Majority (6.6%) of positive scans were of splenic injury. Of all the positive scans 17% of the cases had abdominal pattern of injury while pelvic and abdominopelvic cases were 9.4% and 2.8% respectively. Practical implication: Our aim of doing this research study was to learn the benefits of performing Fast scan in BAT patients. We were able to look through possible aspects of pathology of abdomen and pelvic of traumatic patients arriving.FAST Scan is the single most valuable imaging modality in the early assessment and diagnosis of blunt abdominopelvic traumas with an aspect of safety &cost-effectiveness. Conclusion: Fast scan can be used in the initial assessment of blunt abdominopelvic trauma patients and it is verily preferred in hemodynamically stable patients. Keywords: FAST Scan, Blunt traumatic patients, Emergency department, Hemodynamic stability.

Diet in Pregnancy and Preeclampsia: Is There An Association?A Hospital Based Matched Case Control Study

Introduction: Preeclampsia has been rated amongst leading causes of feto-maternal morbidity and mortality but its etiology still remains not very clear.
 Aims & Objectives: To study the association of intake of certain food items with preeclampsia.
 Place and duration of study: This was a matched case-control study, carried out in tertiary care hospitals of Lahore during February 2019 to March 2020.
 Material & Methods: One hunded and thirty-two subjects were recruited based on predetermined inclusion and exclusion criteria. Matching was done for age, gestational period, parity, education status, and income status. Information on consumption of various food items was recorded on food frequency questionnaire and results were analyzed to determine risk of developing preeclampsia by computing Odds Ratio. Data entry and analysis was done using SPSS version 20., p value ? 0.05 was taken as significant.
 Results: Milk, meat and fruits consumption in study group did not show statistically significant association with preeclampsia (OR 0.51, 0.69, 1.75 and p-value=0.194, 0.211, 0.114 respectively), while consumption of green leafy vegetables shows statistically significant difference between Cases and Control. Higher risk of developing preeclampsia was seen in Cases with deficient intake of green leafy vegetables than in Controls with regular intake (Odds ratio=3.51 and p-value=0.001).
 Conclusion: Deficient consumption of green leafy vegetables is associated with higher risk of preeclampsia in pregnant women.

Frequency of antibiotic resistance in enteric fever both naïve and treated patients in our population.

Objective: To assess the antibiotic resistance in enteric fever in our population. Study Design: Observation study. Setting: OPD and indoor patients in three tertiary care hospitals of Lahore. Period: May 2018 to September 2018. Material & Methods: We selected patients with symptoms and signs of enteric fever randomly in our out door and ER departments. Blood cultures were sent before start of any antibiotic. Patients with Positive culture were enrolled for this study. Results: We enrolled 180 patients, including 123 (68.3%) male patients and 57 (31.7%) were female patients. We divided these patients in three groups, below 25 years 38(21.1%) patients, from 26 to 50 years 98(54.4%), and above 50 years 44(24.4%) patients. Out of 180 patients 138(76.7%) patients took antibiotic before coming to us, 42 (23.3%) were naïve patients. We found 108 (60%) patient having quinolone resistance and 72 (40%) were sensitive to floroquinolones, 88 (48.9%) patients were cephalosporin resistant and 12 (6.7%) were macrolide resistant. We did not check the sensitivity of chloramphenicol, ampicillin and nalidixic acid as it is already proven resistance of these antibiotics. Among all patients quinolones resistance was much higher and resistance against cephalosporin is also increasing and few cases were found to be resistant to even macrolides, although resistance against macrolides is low up to now. Conclusion: Antibiotic resistance is gradually increasing rapidly even against those drugs which were proven very effective against salmonella typhi and paratyphi infections. Younger population (26-50years) had much more resistance than below 25 and above 50 years patients. Due to such prevalence of antibiotic resistance, few antibiotics are left for the treatment of enteric fever, which lead not only to high morbidity and mortality in these patients but a great financial burden for developing countries like Pakistan. Patients with positive blood culture of salmonella were included in this study. Patients with other causes of fever, malaria, Tb, respiratory infections, and with negative blood culture.

Exploring areas of improvement in postnatal care services in a tertiary care hospital in Lahore.

Poor postnatal care can increase morbidity and mortality. This study assessed the current deficiencies in quality of postnatal care provided to mothers in Lady Aitchison hospital, Lahore when compared to WHO standards and identifies the areas for quality improvement. It is a descriptive cross-sectional study which employs quantitative method to collect and analyze the data. It was conducted to include ninety-six maternities attending the wards of Lady Aitchison Hospital, Lahore during January 2022 to February 2022. Consenting post-partum mothers were selected by random sampling and interviewed by using a structured proforma. Among 96 mothers, 56% were below 25 years of age, 39% had secondary education, with more than one child (71%) and 57% visited for the first time. Majority of mothers, were given medicine timely (82%) and found the attitude (85%) and information (83%) provided by the healthcare workers helpful. Their subjective satisfaction rate with staff was 90%. The main areas of concern were lack of proper examination guidelines and facilities, limited information to mothers regarding neonatal care and substandard interior of hospitals. The statistics on the detailed maternal and neonatal examination showed that it was left out in 30% to 50% patients. Information regarding the danger signs of mothers and neonates was not given in 69% and information on family planning was provided to only 28%. Contentment with the infrastructure of the hospital was subpar and it was suggested that the sanitary conditions of washrooms and the paraphernalia of the wards i.e., ACs and beds needed improvement. This study suggests that in developing countries like Pakistan, majority of the patients were satisfied by the services of healthcare workers. The prime improvement area is the infra-structure of the hospital which can be upgraded to provide better quality facilities in terms of air-conditioning, washrooms and well-designed areas for extensive examination of breast, pelvis, abdomen and neonates. There is also need for introduction of standard guidelines for postnatal care.

Knowledge and Attitude of Nurses towards Hepatitis B and C Prevention and Transmission

Background: Nurses are considered a key member of health care delivery system who are providing essential care to their clients. Aim: To assess knowledge and attitude of charge nurses, working in tertiary care hospitals of Lahore. Study Design: Cross-sectional descriptive study. Methodology: A sample size of 272 staff nurses working in four tertiary care hospitals of Lahore were enrolled by using method of non-probability convenient sampling. Data was collected by adopted questionnaire. Data was analyzed by SPSS software, version 23. Results were compiled and presented as frequencies and percentages. Frequencies were computed for categorical variables. Chi-square / Fisher’s exact test was used to determine the association of knowledge and attitude. A p-value ≤ 0.05 was taken as significant. Results: The result revealed that 36.4% nurses had good level of knowledge and 9.6% nurses had excellent knowledge related to Hepatitis B and C prevention and transmission. Majority of the participants 76.5% depicted positive attitude. Practical Implication: Nurses are the primary source of information for the public, so it's critical to assess their knowledge and attitudes about these disorders. A better understanding of health workers' knowledge and attitudes about the risk of liver disease, particularly among nurses, will aid in the creation of suitable preventative initiatives for this demographic. This study helped in Program planning for monitoring and improving the nursing care services at health care setups. Conclusion: We concluded that beside a sub optimal level of knowledge of viral Hepatitis B and C, nurses have been willingly providing care to their clients with positive attitude. Keywords: Patient Satisfaction, Nursing Care, Prevention and Knowledge.

Etiological Profile of Hereditary Hemolytic Anemia among Patients Presenting in Tertiary Care Hospital of Lahore

Background: Hereditary hemolytic anemia is a frequent genetic condition that can have varied levels of morbidity and death. These genetic diseases raise the burden on the patient as well as society and pose a serious threat to public health. Aim: To determine the frequency of various causes of hereditary hemolytic anemia among patients in a tertiary care hospital. Methodology: It was a descriptive cross sectional study. Patients (n=252) were enrolled through probability convenient sampling. The study was conducted at Pathology Laboratory, Jinnah Hospital, Lahore. Blood samples were taken from all patients for complete blood count, peripheral smear, reticulocyte count, indirect bilirubin, serum lactate dehydrogenase, and direct antiglobulin test. Median corpuscular fragility (MCF) >4.45g/l NaCl was considered positive. Quantitative enzyme-based assays of Glucose 6 phosphate dehydrogenase were determined spectrophotometrically by using Pointe scientific G6PD reagent. Data were entered and analyzed using SPSS v25.0. A p-value of 0.05 was used to define statistical significance after post-stratification analysis using the chi-square test. Results: age range in this study was from 1 to 60 years with a mean age of 29.3±9.5 years. According to causes of heredity hemolytic anemia distribution, Thalassaemia major 137(54.4%) was the most common cause followed by Thalassaemia intermedia at 41(16.3%), Sickle Cell Anemia at 34(13.5%), Heredity spherocytosis as 31(12.3%) and Glucose-6 phosphatase deficiency as 9(3.6%). Practical Implication: As there is a high incidence of anemia among our population and there is lack of local data that specifically addresses this health issue thus current study was planned. This study highlighted that educating the entire medical community could help lower the prevalence of thalassemia major and emphasise the need of diagnosing the thalassemia trait and provide premarital and prenatal counselling. Conclusion: It was concluded that majority of hereditary hemolytic anaemias were hemoglobinopathies, which place a heavy strain on families and society. The occurrence of these conditions can be reduced in large part by prevention. Keywords: Heredity Hemolytic Anemia, Heredity Spherocytosis, Thalassaemia Trait and Prention.

CBCT as a novel pre-op non-invasive method to determine the location of Greater Palatine Foramen

Aim: To determine the greater palatine foramen position with reference to Maxillary molar teeth among patients presenting in a tertiary care hospital in Lahore by using cone beam computed (CBCT). Method: In this cross sectional studywhich was conducted at Fatima Memorial Hospital located in Lahore, in which a total of 80 patients were included. Informed consents and demographic details were noted. Cone beam computed tomography was taken in Planmeca Promax 3D Mid (60-120 kV; 9-33 s; 200 um voxel size) of all subjects. As per operational definitions, linear measurements for location of greater palatine foramen were measured. All the information was recorded in a specifically designed form. Results: Onaveragethe age ofpatients in this study was 39.35±11.19 years, 38(47.50%) patients were male. On left and right side the most common position was between middle and mesial face of third molar noted in 45(56.25%) and 43(53.75%) patients respectively. Conclusion: The most common position both sides was the position between middle and mesial face of third molar followed by position between distal face and middle of third molar in patients reporting in a tertiary care hospital located in Lahore by using cone beam computed tomography (CBCT) Keywords: Greater palatine foramen, cone beam, CT,

Bedbug infestation in Lahore hospitals.

Bedbug infestation has been reported globally, but there are few reports about this parasite of public health importance in Pakistan. This is the first study on bedbug infestation in a healthcare setting in Lahore, Pakistan. To study bedbug infestation in public sector hospitals in Lahore, Pakistan. This cross-sectional study was conducted in 86 wards of 2 tertiary care hospitals in Lahore during October and November 2019, using nonprobability sampling technique. Ward supervisors were interviewed using a self-developed structured questionnaire and wards were examined for bedbugs or their markers. Evidence of bedbug infestation was found in 72.1% of the wards. There was no significant difference in infestation rate between the 2 hospitals but there was a significantly lower incidence of infestation in wards that implemented control measures (25.8% vs 74.2%). No control measures were implemented in 53.4% of the wards sampled. Bedbug infestation was rife in the 2 hospitals studied and knowledge about identification and eradication of the pest among ward supervisors was inadequate. Control measures, where applied, were substandard and not evidence-based.

Cliniciopathological Spectrum of Skin and Soft Tissue Swellings at a Tertiary Care Hospital of Lahore, Pakistan.

Background Skin and soft tissue swellings (SSTS) frequently present in dermatology, plastic surgery, and general surgery departments. While a general surgeon can take care of excisable lesions, people typically seek plastic surgery for cosmetic reasons. According to the signs and symptoms, soft tissue and skin lesions must be removed, and it is crucial to maintain cosmesis following their removal. Objective The aim of this article is to describe the clinical and histopathological types, sites, laterality, and postoperative complications of SSTS. Material and methods This retrospective study was conducted at the Department of Plastic and Reconstructive Surgery, Lahore General Hospital, Lahore, Pakistan in November 2022. We studied admitted patients from July 1, 2020 to June 30, 2022 for SSTS excision. Data on patients' demographics, associated features of SSTS, and their postoperative complications was gathered using Google Docs-generated proforma and sent to a statistician for the computation of results via a Microsoft Excel-generated spreadsheet. Results Out of the total 60 patients, 66.7% of the lesions were found in women. The mean age at presentation came out to be 34.16±17.42 years. Nevi with 16.7% were the most common SSTS in our study. The most common site of presentation of SSTS was the scalp and face in 63.3% of cases. Fever was the most frequently encountered post-excision complicationin 40% of patients. Conclusion A comprehensive history, clinical examination, signs and symptoms, and the histology of the lesion, all play a crucial role in the management of such swellings. Surgery was the definitive treatment option for SSTS. There were very few major complications in a handful of patients.

FREQUENCY OF METABOLIC SYNDROME IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS PRESENTING AT A PUBLIC SECTOR TERTIARY CARE HOSPITAL OF LAHORE: A CROSS- SECTIONAL STUDY

Background and Objective: Metabolic syndrome is characterized by central obesity, deranged lipid profile, high blood pressure and abnormally high levels of blood sugar. It is an independent risk factor for cardiovascular disease. Systemic Lupus Erythematosus (SLE) is an autoimmune disease that can affect joints, skin, brain, lungs, kidneys, and blood vessels. The extent to which metabolic syndrome is frequent in our population is less known. The objective of this study was to assess the frequency of metabolic syndrome amongst SLE patients. Methods: This cross-sectional study was undertaken in a public sector tertiary care hospital of Lahore from February 2021 through August 2021, including 110 confirmed SLE cases. After institutional approval and taking an informed consent, blood pressure, fasting and random blood sugar levels and fasting lipid profile were measured. Central obesity was assessed using waist circumference. Data were transferred to SPSS 21 for descriptive and inferential analyses. Frequencies were determined using numbers and percentages. Results: Of 110 SLE patients, 14 (12.3%) were males and 96 (87.7%) were females. Mean age of SLE patients was 42.9± 9.9 years. Mean BMI was 28.7±4.7 kg/m2. The frequency of metabolic syndrome in studied SLE patients was 37/110 (33.6%). Conclusion: Systemic lupus erythematosus patients had abnormally high serum triglyceride and cholesterol levels, diabetes mellitus, central obesity, high levels of fasting plasma glucose and hypertension. Therefore, one-third of SLE patients may have metabolic syndrome in our population.

ASSESSMENT OF CAUSE OF DEATH AND INTERNAL ORGANS OF HUMAN BODIES OF COVID-19 PATIENTS RECEIVED FOR AUTOPSIES TO A TERTIARY CARE HOSPITAL OF LAHORE.

Background and Objective: COVID-19 cause extensive effects on virtually all organs. It causes inflammation, endothelitis, vasoconstriction, hypercoagulability, and edema. Different organs may be affected at different times. Hence we aim to determine the cause of death and pattern of the injuries to the internal organs among the dead bodies of patients diagnosed with coronavirus disease. Methods: This Cross-sectional study was conducted in the Department of Forensic Medicine, Allama Iqbal Medical College, Lahore over a 1-year period from 2021 to 2022. 150 autopsies of COVID-19-positive patients who died from Covid, during the peak era were received. Autopsies were performed and internal organs were carefully examined clinically along with histopathological evidence. Reports were assessed and the presence or absence of single or multiple organ dysfunction was recorded. The data was recorded in a proforma and entered and analyzed in SPSS version 25. Results: The mean age of dead bodies at the time of death was 54.5 ± 14.73 years. 112 (74.7%) of these patients were males while 38 (25.3%) were females. The mean duration of COVID-19 was 14.22 ± 9.41 days and the mean duration of death until the presentation of the body for autopsy was 21.89 ± 6.37 hours. Out of 150 cases, death due to respiratory failure was observed in 67 (44.7%) cases, renal failure in 21 (14.0%) cases, liver failure in 18 (12.0%) cases, Venous thromboembolism in 16 (10.7%) cases, meningitis in 10 (6.7%) cases, intestinal perforation was observed in 9 (6.0%) cases, in 5 (3.3%) cases, peritonitis was observed and cardiac failure in 5 (3.3%) cases. Conclusion: There are higher chances of organ failure in patients suffering from COVID-19, as proven by autopsies of COVID-19 cases.

Exploring The Experience of Mothers of Premature Babies: A Phenomenological Study

Premature birth of babies is a one of the major public health problems all around the world. Objective: To explore the experience of mothers of preterm babies when their baby is admitted in a tertiary care hospital of Lahore. Methods: This study was conducted in the Neonatology department of Children’s Hospital, Lahore, Tertiary Care Hospital, Pakistan from June 2022 to December 2022. Semi structured face-to-face individual interview was used to obtain data from the 12 participants who were purposively selected for the study. The audio recorded data collected was translated into English and transcribed verbatim. Analysis was done with the help of computer assisted software called NVIVO-12. By using the Coliazzi’s method of phenomenological analysis the codes generated from NVIVO-12 were organized into sub-categories, categories, sub-themes and themes. Results: Three themes emerged with sixteen subthemes. The themes are: Mixed emotional feelings of the mothers; Mother’s satisfaction about care and support from Health Care Professionals; Mother-baby interaction in NICU. Mothers were worried due to unexpected emergency premature delivery and baby’s status and had uncertainty related to delivery outcome and the baby’s life. Participants have good interaction babies while the Kangaroo Mother Care and Breast Feeding and they applaud HCPs. Conclusions: Mothers were concerned about the survival of premature babies admitted to the NICU. They showed different emotions like fear, anger, sadness, worry, tension, lack of confidence, hope, gratefulness, courage and spiritual faith in Allah. They expressed the feelings of satisfaction about care, treatment counseling and teaching by HCPs.

Emerging Patterns in Antimicrobial Susceptibility Profiles of Pseudomonas SPP- Hospital Based Study

Background: There is an emerging trend of pseudomonas infections in immune-compromised patients, specifically in hospital settings. The flagship member of this family is Pseudomonas aeruginosa, which is a major infectious agent. This study assessed the distribution and susceptibility patterns of Pseudomonas species isolated from various specimens as a part of surveillance program, in order to devise antibiograms. Aim: To determine frequency & antimicrobial sensitivities of Pseudomonas species in a tertiary care hospital from Lahore. Study design: Retrospective, descriptive, cross sectional study Place & duration of study: Conducted in a tertiary care hospital in Lahore, from January 2021 to January 2022. Methods: Thirty two isolates of Pseudomonas species from different clinical specimens were isolated in microbiology section of a tertiary care hospital during a period of 13 months. MacConkey and blood agar were utilized for culturing of organisms. Gram staining, oxidase, and catalase testwere utilized for phenotypic characterization. Antibiotic susceptibility testing against anti-pseudomonal drugs was performed according to the Clinical and Laboratory Standards Institute guidelines (CLSI) 2021. Results: The inference drawn at the end of study was that, out of thirty two isolates of Pseudomonas species received and pus was the most common specimen (46.8%), followed by 18.75% from urine specimens. 62.5% of the pseudomonas species were obtained from male patients. The most affected age group was 40-60 years, followed by 1-20 years. The most sensitive options turned out to be Imipenem (65.6%) and Pipericillintazobactam (62.5%), followed by 59.3% sensitivity in Amikacin. The least sensitive options in the study isolates were Aztreonam (15.6%) and Ticarcillin clavulanic acid (25%). In 18% of pseudomonas species isolated from urine cultures, fosfomycin was 83.3%, whereas nitrofurantoin turned out to be 50% sensitive. Conclusions: The steadily rising resistance in Pseudomonas species againstavailable antibiotics optionsnecessitates their use inlife-threatening and hospital acquiredinfections. Keywords: Peudomonas, Flouroquinolones, Carbapenem

Emergence of multidrug-resistant ST11 blaKPC-2 producing Klebsiella pneumoniae coharboring blaCTX-M and blaSHV in Pakistan.

Carbapenemases are primarily responsible for the intensified spread of multidrug-resistant (MDR) K. pneumoniae by virtue of antibiotics overuse. Therefore, frequent investigation of high-risk clones especially from developing world is crucial to curtail global spread. In this observational study, 107 K. pneumoniae were retrieved and confirmed genotypically from April 2018 to March 2020 from tertiary care hospitals in Lahore, Pakistan. Carbapenemases and extended-spectrum β-lactamases were verified by Polymerase Chain Reaction and Sanger sequencing. Multilocus sequence typing and plasmid replicon typing were used to assign clonal lineages and plasmid replicons. Among the K. pneumoniae, 72.9% (78/107) strains were carbapenem resistant (CR) with 65.4% (51/78) exhibiting carbapenemase producing phenotype. Among CR K. pneumoniae 38.5% (30/78) strains exhibited the following carbapenemase genotypes: blaNDM-1 (26.7%, 8/30), blaOXA-48 (26.7%, 8/30), blaKPC-2 (20.0%, 6/30), blaVIM (10.0%, 3/30), blaNDM-1/blaOXA-48 (10.0%, 3/30), blaOXA-48/blaVIM (3.3%, 1/30) and blaOXA-48/blaIMP (3.3%, 1/30). Tigecycline and polymyxin-B retained susceptible profile. β-lactam drugs showed intermediate to high resistance. The occurrence of CR K. pneumoniae infections was significantly associated with wound (39.7%, p = 0.0007), pus (38.5%, p = 0.009), general surgery (34.6%, p = 0.002) and intensive-care unit (26.9%, p = 0.04). blaKPC-2 producing K. pneumoniae coharboring blaCTX-M/blaSHV (66.7%) and blaCTX-M (33.3%) exhibited sequence type (ST) 258 (n = 4) and ST11 (n = 2) sequence types with IncFII, IncN, IncFIIA, IncL/M and IncFIIK plasmids. This is the first report describing the emergence of MDR blaKPC-2 producing K. pneumoniae ST11 coharboring blaCTX-M and blaSHV in Pakistan.