Tertiary Care Hospital In Karachi Research Articles

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.

A retrospective study of mandibular fractures in tertiary care hospitals of Karachi.

Objective: To check the prevalence and causes of mandibular Fracture in the teaching hospital of Karachi Pakistan. Study Design: Crossectional, Observational, Retrprospective. Setting: Department of Oral & Maxillofacial Surgery, Karachi Medical and Dental College Abbasi Shaheed Hospital Karachi and Department of Oral and Maxillofacial Surgery Baqai Dental College University, Karachi. Period: 1st December 2018 to 30th November 2019. Methods: This study was based on randomly selected cases of one year of work at the Department of Oral and Maxillofacial Surgery Abbasi Shaheed Hospital Karachi and Department of Oral and Maxillofacial Surgery Baqai Dental College Baqai Medical University Karachi. Results: Road traffic accident like Bike accidents were top in position with 69 %, falls were next in position with 12 %, assault were recorded 10%, sports injuries were 7% and fire arm injuries2%. Mandibular fractures were found to occur at a rate of 22.1% in the parasymphysis, 12.8% in the body, 11.42% at the angle of the jaw, 12.1% in the condyle, 12.14% in the dento alveolar area, 6.4% in the symphysis, and 2.85 % in the ramus. Conclusion: To properly reduce and fix the fractures, a variety of treatment methods were employed. It has been determined that most patients were masculine and between the ages of 20 and 50. The most frequent locations for mandibular fractures were the parasymphysis and body, and the most common cause of trauma in the study participants was auto accidents.

Comparison of efficacy of intraoperative intravenous 5% dextrose versus intravenous ringer lactate for prevention of postoperative nausea and vomiting in patients undergoing elective laparoscopic cholecystectomy.

Objective: To assess the effectiveness of intraoperative intravenous 5% dextrose in contrast to intravenous Ringer lactate for averting postoperative nausea and vomiting among individuals undergoing elective laparoscopic cholecystectomy at a Tertiary Care Hospital in Karachi. Study Design: Randomized Control Trial. Setting: Department of Anesthesia, Dow University of Health Sciences, Located at Civil Hospital in Karachi. Period: 25-09-20 to 25-03-21. Methods: Patient data was collected in a prospective manner following verbal consent. A total of 60 patients, meeting the diagnostic criteria, were incorporated in the study. A concise medical history was obtained, and demographic details were recorded in the performa. Data was all variables were collected and analysed using SPSS version 22. Results: This study encompassed a total of 60 patients. In the dextrose group, the mean age, duration of surgery, length of hospital stay, height, weight, and BMI were 48.21±6.24 years, 2.54±1.78 hours, 4±2.54 days, 147±4.21 cm, 71.7±7.25 kg, and 28.9±5.14 kg/m2, respectively. Conversely, in the ringer lactate group, these values were 49.48±8.41 years, 2.97±1.56 hours, 4±1.89 days, 158±5.28 cm, 78.7±9.87 kg, and 29.6±4.91 kg/m2. The efficacy for preventing postoperative nausea and vomiting was 80% for the dextrose group and 36.7% for the ringer lactate group in our study. Conclusion: Administering preoperative fluid supplementation with dextrose resulted in a reduced occurrence of postoperative nausea and vomiting (PONV) in comparison to ringer lactate.

Association of periodontal disease with gestational diabetes mellitus among postpartum women at a private tertiary care hospital of Karachi, Pakistan: a cross-sectional study

Due to the overlapping aetiology of Gestational Diabetes Mellitus (GDM) and Periodontal disease (PD), which are prevalent metabolic disorder and chronic inflammatory disorder in pregnant women respectively, they are often at risk of developing both diseases simultaneously. This study aims to evaluate the association of periodontal disease and gestational diabetes mellitus among post-partum women who delivered within 24 h at private tertiary care hospital, Karachi, Pakistan. Analytical cross sectional study with sample size of 178 by non- probability purposive sampling, a total of 101 postpartum women (57%) were diagnosed with periodontal disease and 50 (28%) were GDM positive. Of those who had PD, 35% (n = 35/101) were GDM positive. An insignificant association of the prevalence ratio of GDM in women with periodontal disease was found. [PR = 1.7; 95% CI: 0.2–3.2; p-value 0.07] A statistically significant association was found between the prevalence ratio of GDM in women with obesity. It was 2.6 times compared to women who were not obese (p value < 0.01, 95% CI: 1.3–5.1). There is insignificant association found between the prevalence ratio of GDM in women with periodontal disease in our setting. Women who are overweight or tend to gain weight should be closely monitored and guided to take dietary measures.

An analysis of critical illness scores among patients admitted to intermediate care units (IMCUs) at a tertiary care hospital in Karachi, Pakistan

An analysis of critical illness scores among patients admitted to intermediate care units (IMCUs) at a tertiary care hospital in Karachi, Pakistan

CORRELATION OF TUMOR MARKERS HER2 NEU ER PR AND KI 67 IN BREAST CANCER PATIENTS

: Every year, more than a million women are diagnosed with breast cancer, and over 700.000 of them have positive for hormone receptors (FIR). The expression of key markers, such as ER and PP, and clinical circumstances show specific biological traits. Risk factors may have a role in the development of some hormone receptor-positive breast cancers. Objective: The objective of this study was to investigate the correlations between key tumor markers, including HER2, ER, PR, ALP, and KI67, in hormone receptor-positive breast cancers. Methods: Tumour tissue samples were collected for histopathology (10% neutral buffered Formalin-fixed paraffin-embedded tissue specimens) during Trucut biopsy or mastectomy at the oncology department of a tertiary care hospital in Karachi from October 2022 to July 2023. Tissues were analyzed under a light microscope for tumor hormone receptors at a tertiary care hospital in Karachi. Results: There were several significant correlations observed between HER 2 NUE, KI 67, ER, and PR. Specifically, a weak negative correlation was noted between HER 2 NUE and KI 67, while weak positive correlations were observed between HER 2 NUE and both ER and PR. Additionally, a weak positive correlation was found between ER and HER 2 NUE, PR, and KI 67, and a weak positive correlation existed between PR and ER, HER 2 NUE, and KI 67. Finally, KI 67 displayed a weak positive correlation with HER 2 NUE, PR, and ER. Conclusions: Her two nurses, ER, ALP, KI 67, and breastfeeding, are significantly and directly related. PR is not significantly related to other mentioned tumor markers.

Frequency of tracheal intubation associated adverse events and contributing factors in the Pediatric Intensive Care Unit (PICU).

Objective: To determine the frequency of adverse events associated with immediate tracheal intubation in children (1-18 years) from Pediatric Intensive Care Unit of Tertiary Care Hospital of Karachi, Pakistan. Study Design: Observational study. Setting: PICU of the Aga Khan University Hospital Karachi. Period: September 2020 to August 2021. Methods: A total of 183 intubations occurred during the study period. Data was extracted using the pre-designed peri-intubation proforma, data recorded on the checklist by the observer (Staff) who was fully trained by the Physician, later on compared by the researcher using the video recorded laryngoscopy used during the intubation procedure. Results: There were 183 intubations occurred during study period. Maximum intubations were in age group of 1-5 years (27.3%) and among total intubations, there were 11(6%) intubation related complications occurred. 6 (3.3%) cases have hypoxia, 3 (1.6%) bradycardia and 2 (1.1%) others (hypotension and esophageal intubation). Majority of the complications were observed during morning hours with statistically significant association. 63.60% TI related cases survived whereas 36.40% of them expired, 54.5% stayed in PICU for 0-10 days. Conclusion: Tracheal intubation related adverse events were 6% and majority of them lead to hypoxia. Physiological and mechanical complications with the procedure do occur inspite of our best efforts. Recognizing the complications associated with tracheal intubation can help physicians better care for patients requiring intubation.

Cardiac Arrest Reported During First Cycle of High Dose Cisplatin Intravenous Infusion at a Tertiary Care Hospital Karachi, Pakistan

Rationale: Cardiac toxicity with cisplatin is not common, therefore the cardiac evaluation and investigations are not performed routinely before giving high dose cisplatin unless there are risk factors. After this incident of cardiac arrest there is a need to be more vigilant. Patients History: 48 years old male diagnosed case of squamous cell carcinoma tongue was electively admitted for the infusion of chemotherapeutic drug high dose Cisplatin (100 mg/m2) at daycare oncology. The patient in this case had no previous history of high blood pressure, high cholesterol level, cardiac problem, chest pain or chest discomfort. There is no prior history of hypertension, dyslipidemia, any cardiac anomaly, chest pain or discomfort. He also denied any history of addiction including any form of tobacco or alcohol. All baseline investigations, including complete blood count, Liver function test, serum creatinine, 24 hours ‘urine for creatinine clearance, serum electrolytes, hepatitis B and C were normal. Tissue biopsy, CT scan and ECHO prior to treatment was normal. Patients, as per instruction of primary physician has to receive cisplatin 100mg /m2 concurrent with radiation therapy. Result: Patient suddenly became unconscious in washroom after receiving 50% of cisplatin infusion, as per chemotherapy protocol patient must receive potassium and magnesium in infusion over three hours as per standard guidelines, patient remains well after receiving this electrolytes infusion. After giving pre-chemotherapy which included injection Ondansetron 8 mg. Injection dexamethasone 12 mg and tablet aprepitant 125 mg and capsule esomeprazole 40 mg and after giving pre-chemotherapy injection cisplatin 100 mg/m2 intravenous started infusion duration was over one hour after half an hour of infusion patient wants to go for passing urine and went with attendant to wash room, he suddenly becomes unresponsive, this event was identified by attendant when patient not came back from washroom who was standing near door. Despite multiple cycles of CPR, the patient could not be revived and remained in asystole. Death was declared to the family members after 45 minutes.

Unveiling colistin resistance in extensively drug-resistant microorganisms among ICU patients of tertiary care hospital Karachi, Pakistan

Objective: To determine the prevalence of extensively drug-resistant (XDR) microorganisms in the intensive care unit (ICU) of a tertiary care hospital in Karachi and to identify the presence of colistin resistance (CLR) among these XDR isolates. Material and Methods: A cross sectional study was carried out in the ICU of a tertiary care hospital from August 2022 to February 2023 and various clinical samples of XDR Gram negative bacilli (GNB) were collected from ICU. These specimens were processed by following the guidelines established by the Clinical and Laboratory Standards Institute (CLSI), Agar and broth microdilution methods were used to assess the colistin susceptibility of XDR isolates. Results: The study focused on 100 extensively drug-resistant (XDR) specimens. K. Pneumoniae dominated (32%), followed by E. coli (23). Among the 100 XDR, 89% were colistin susceptible, and 11% were resistant, tested by agar and broth microdilution. Of the 11% CLR, P. aeruginosa was most common, with the highest resistance in urine specimens. Colistin resistance was highest for P. aeruginosa (45%), followed by A. baumannii (18%), E. coli (18%), K. Pneumoniae (9%), and K. oxytoca (9%). CLR isolates were mainly (27%) from urine. Conclusion: Prolonged hospital stays and antibiotic pressure can lead to CLR development. Labs should monitor XDR closely, implementing measures to minimize antibiotic resistance. Controlling colistin resistance through stewardship is crucial. Keywords: Extensively drug resistant, Colistin resistant, Minimum inhibitory concentration, Nasobronchial lavage

Frequency Of Anxiety in Pre-Operative Surgical Patients in the Tertiary Care Hospitals, Karachi

Background: Preoperative anxiety significantly impacts patient outcomes and healthcare delivery, with varying degrees of prevalence reported globally. Understanding and managing this anxiety are crucial for improving surgical experiences and patient recovery. This study focuses on tertiary care hospitals in Karachi, aiming to elucidate the frequency and determinants of preoperative anxiety among elective surgery patients. Objective: To ascertain the prevalence of preoperative anxiety among patients awaiting elective surgeries in various surgical units of tertiary care hospitals in Karachi and to identify significant contributing factors. Methods: In a prospective cross-sectional design, 400 patients scheduled for elective surgeries across six surgical units were assessed using the Amsterdam Preoperative Anxiety and Information Scale (APAIS). SPSS version 24 facilitated the analysis, focusing on global anxiety prevalence and its associations with demographic and clinical variables. Results: The study revealed a 62.0% prevalence of preoperative global anxiety. The APAIS scores indicated higher anxiety related to the surgery (mean = 7.27 ± 2.31) compared to anesthesia (mean = 5.14 ± 2.35). Significant associations were found between anxiety levels and age groups (p=0.002), surgical procedures (p&lt;0.001), and type of anesthesia (p&lt;0.001). ENT and urology patients exhibited notably higher anxiety, at 75.0% and 68.0% respectively. Multivariate analysis demonstrated a significant impact of gender on preoperative anxiety, with females showing increased vulnerability [aOR 1.91 (95% CI 1.13-3.21); p=0.015]. Conclusion: Preoperative anxiety remains a prevalent concern, with female patients exhibiting higher levels of anxiety than their male counterparts. The findings advocate for targeted counseling and informational support for patients, especially females, prior to surgery and anesthesia consultations, underscoring the need for healthcare professionals to address and mitigate preoperative anxiety effectively.

Long working hours and obstetric complications: A cross-sectional study among female doctors

ObjectiveTo investigate the effects of long working hours on pregnancy complications and obstetric outcomes among female doctors working in tertiary care hospitals of Karachi. Study designA cross-sectional study was conducted on 149 female MBBS graduates (mean age: 33.5 ± 7.3 years) who had conceived at least once, currently working in two tertiary-care hospitals of Karachi. Data was collected through a self-administered questionnaire containing questions regarding demography and course of 1st pregnancy of the participants including working hours, antenatal and natal complications. Means and standard deviations were calculated for continuous variables with frequencies and percentages for categorical variables. The association between long working hours and different antenatal and natal complications was investigated using Chi-square test and T-test. ResultsOut of 149 participants included in final analysis, 85.9 % doctors gave birth to alive babies while 12.8 % had miscarriages and 1.3 % had stillbirth. Mean working hours during the three trimesters were found to be 53.76, 53.66 and 48.7, respectively. 43 % doctors experienced at least one antenatal complication during their pregnancy. Women who worked more than or equal to 55 h per week during 1st, 2nd and 3rd trimester of their pregnancy experienced more antenatal complications than women who worked less than 55 h (p-value=0.042, 0.021 and 0.018 respectively). 61.7 % females experienced at least one natal complication, most common of which was induction of Labour (39.1 %). Natal complications were significantly associated with increased workload during 2nd trimester (mean 58 vs 46 h, p-value 0.040). Doctors belonging to surgical specialty had 2.7 times higher risk of developing at least one natal complication than doctors of medical specialty (95 % Cl: 1.235–5.870). ConclusionLong working hours during pregnancy are associated with antenatal complications among female doctors. Natal complications were only significantly related to long working hours during 2nd trimester of pregnancy, however, female surgeons are more prone to develop natal complications than doctors belonging to medical specialties.

The Inter-Observer Agreement Between Resident and Consultant Radiologists in Reporting Emergency Head CT Scans

Objectives: To determine the inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans. Materials and Methods: This descriptive cross-sectional retrospective study was performed in a tertiary care hospital Karachi from 1st October 2021 to 31st march 2022. Total of 111 number of patients of 18-70 years of age of either gender who underwent emergency Head CT scans were included. Patients who came for follow-up CT scans were excluded. CT findings were interpreted by the radiology resident on duty. Subsequently, these CT images were interpreted by a consultant radiologist, and the decision of both resident and faculty member CT was correlated for inter-observer agreement. Results: The mean age was 47.47 ± 14.20 years. The majority of the patients 46 (41.44%) were between 56 to 70 years of age. Out of these 111 patients, 72 (64.86%) were male and 39 (35.14%) were female with a ratio of 1.9:1. Discrepancy between resident and consultant radiologists in reporting emergency head CT scans is seen in 6 (5.41%) patients. Inter-observer agreement between resident and consultant radiologists in reporting emergency head CT scans was found to be 94.59% with a kappa “κ” value of 0.885 which showed a very strong agreement. Conclusion: This study concluded that little discrepancy was found in inter-observer agreement between the radiology residents and the faculty members for interpretation of CT images of Head.

FREQUENCY OF EMERGENCY PERIPARTUM HYSTERECTOMY AND FACTORS LEADING TO IT IN PREGNANT WOMEN AT TERTIARY CARE HOSPITAL

FREQUENCY OF EMERGENCY PERIPARTUM HYSTERECTOMY AND FACTORS LEADING TO IT IN PREGNANT WOMEN AT TERTIARY CARE HOSPITAL

Frequency of microscopic colitis in patients presenting with chronic diarrhea.

Objective: To evaluate frequency of microscopic colitis in patients presenting with chronic diarrhea at a tertiary care hospital in Karachi, Pakistan. Study Design: Descriptive Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: January, 2022 to June, 2022. Material &amp; Methods: Patients presenting in out-patient department of age &gt;18 years of any gender with history of diarrhea &gt;1 month, normal thyroid tests, negative serology for Celiac disease (Anti TTG IgA and IgG), and normal colonoscopy findings including terminal ileum were enrolled in the study after written informed consent. MC diagnosis was established using clinical diarrhea history and colonic biopsy findings. Results: Total 130 patients were analyzed with median age of 38 (IQR= 28-55) years. Nearly half were females (n=67, 51.5%). All patients had normal colonoscopy findings. Out of 130 patients, microscopic colitis was seen among 7(5.4%) cases out of which 5(3.8%) had lymphocytic colitis and 2(1.5%) had collagenous colitis. Patients with and without MC shared the same characteristics. Conclusion: A lower microscopic colitis frequency was found in the studied sample. Lymphocytic microscopic colitis is predominant than collagenous microscopic colitis.

Frequency of prolonged colonoscopy and its associated factors among adults: An experience of A Tertiary Care Hospital in Karachi, Pakistan.

Objective: To determine frequency and factors associated with prolong cecal intubation among adults undergoing colonoscopy in a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Gastroenterology, Liaquat National Hospital, Karachi, Pakistan. Period: September 2022 to June 2023. Material &amp; Methods: The study comprised patients undergoing elective colonoscopies, regardless of gender and age, who were at least eighteen years old. Cecal intubation time longer than ten minutes was regarded as a prolonged colonoscopy duration. The Aronchick scale, which is used to evaluate the quality of bowel preparation. The association between the patient's characteristics and the prolonged cecal intubation was investigated using logistic regression. P-values were considered statistically significant if they were less than or equal to 0.05. Results: Total 281 patients were enrolled into the study. Median age of patients was 40 (IQR=30-50) years and majority were males 66.5%. Median cecal intubation length and time was 90 (IQR=80-100) cm and 7 (IQR=5-10) minutes. Prolonged intubation was seen among nearly one-fifth of total patients (19.1%). Odds of prolonged cecal intubation were significantly lower patients of age &lt;50 years, relatively higher body mass index (BMI), out-patients, patients with excellent quality of bowel preparation and among those cases in which colonoscopies were performed by consultant. Conclusion: Proportion of prolonged cecal intubation was high particularly among older age, female gender, patients with lower BMI, past surgeries and poor quality of bowel preparation.

Parental Satisfaction with Health Care During Child Hospitalization at Tertiary Care Hospital Karachi

Pediatric care in hospital settings necessitates a comprehensive approach that considers not only the medical needs of the child but also the satisfaction and involvement of their parents or guardians. Parental satisfaction with healthcare services during their child's hospitalization is crucial for shaping their overall experience and ensuring quality care. Objective: To assess the level of satisfaction among parents of pediatric patients receiving care at a tertiary care hospital in Karachi, Pakistan. Methods: A cross-sectional study was conducted at the National Institute of Child Health Hospital in Karachi from October to December 2023. A total of 50 parents or blood-related guardians actively caring for pediatric patients were included in the study. Data were collected using a structured questionnaire comprising socio-demographic information and a 20-item Likert scale to measure parental satisfaction. Statistical analysis was performed using SPSS version 26.0. Results: The statistical results indicate that 26% had low satisfaction 28% moderate and 46% had high parental satisfaction with health care during child hospitalization at a tertiary care hospital in Karachi. Conclusions: The stats show mixed feelings among parents about the healthcare during their child's hospital stay in a Karachi tertiary care hospital. While 46% were happy with the services, indicating a good experience, 26% weren't satisfied. Another 28% felt okay. This means improvements are needed to address the concerns of the dissatisfied group and enhance overall satisfaction levels.

Patients Satisfaction Towards Quality of Nursing Care at a Public Sector Tertiary Care Hospital Karachi

Care is seen as a significant element of health amenities. The most anticipated health outcomes are achieved by providing treatments that are effective, efficient, and cost-effective. Objective: To assess the level of patient’s satisfaction towards the quality of nursing care at a public sector tertiary care hospital in Karachi. Methods: This cross-sectional study was accompanied by 312 patients admitted to public sector hospital. Non-probability purposive sampling technique was used for data collection. Those patients who have been admitted for more than three days in various departments. Data were collected after approval Institutional Review Committee (IRC) of the Dow Institute of Nursing and Midwifery (DIONAM) and the Ethical Review Committee (ERC) of the National Institute of Cardiovascular Disease (NICVD). Data were analyzed on SPSS-version 25.0. Frequency and percentage were measured from categorical data. An Independent t-test was run to find out the relationship of patient’s satisfaction and with demographic characteristics of the study participants. Written informed consent was obtained from all participants. Results: The findings highlighted that the majority (55%) of the study participants were male and 79% were married. Furthermore, the highest satisfaction level (90.7) was found in the domain of nurse’s communication, and the lowest level of satisfaction score 81.8% found in the discharge domain. Moreover, the overall patient’s satisfaction score of all domains was 93.3%. Conclusions: The findings of this study concluded that the majority of the admitted patients strongly agreed with the quality of nursing care. Furthermore, the nurse’s communication domain showed a higher level of satisfaction among all domains.

Effectiveness of Chest Physiotherapy in Broncho Pulmonary Clearance in Respiratory Distress Neonates

Purpose: Globally, the mortality rate of respiratory distress has been quite high due to unability to maintain oxygenation and overcome abnormal work of breathing. Chest Physical therapy, apart from providing advantageous outcomes to the adults, chest physical therapy is pivotal for newborns too but differs in terms of physiology and anatomy. Various chest physiotherapy techniques including percussions, vibrations, and compressions are quite effective in reducing mortality rate in neonates.Many studies has been conducted worldwidely, but still there has been limited data in Pakistan about the effect of bronchopulmonary clearance in neonatal intensive care unit, so this study was conducted to find the effectiveness of chest physiotherapy in neonatal intensive care unit&#x0D; Materials and Methods: This was the non-randomized controlled trial study conducted in tertiary care hospital of karachi , Pakistan. Total 40 samples collected through convenient based sampling were included in this study . The inclusion criteria including gestational age more than 37 weeks with atelactasis, mucous plugging, airway compromised, intubated or extubated, hospital admission, and chest complications where as exclusion criteria included cardiopulmonary instability, post surgery, pre term, intra ventricular hemmorage, fits or epilepsy, failure to thrive, and on consistent feed. Bronchopulmonary Clearance techniques such as Percussions , Compressions, and Vibrations along with suctioning and postural drainage were performed routinely twice daily session one in morning and one in evening was performed for total 14 days which means total 28 sessions of chest physiotherapy was implemented and chest xray, sp02, Heart rate, and respiratory rate was measured pre and post the sessions.&#x0D; Findings: The mean age of the participants were 37.050±5.57, out of which 20(52.5%) were females and 19(47.5%) were males. Result showed that post chest xray after chest physiotherapy was .2500±.49355 and post session spo2 was 2. .075 ± 4.56513. The chest physiotherapy was statistically significant in mucociliary clearance, lung expansion, preventing atelectasis, airway clearance, and other chest complications (0.008).&#x0D; Implications to Theory, Practice and Policy: Limitations of this study were that small sample size was taken, and data was collected from one tertiary care hospital of Karachi so it doesn’t showed generalization. Further studies in terms of large sample size are required for validity and reliability of this research.

Comparison of the Efficacy of Tazarotene 0.045% versus Halobetasol Propionate 0.01% Lotion for the Treatment of Scalp Psoriasis at Tertiary Care Hospital, Karachi

Background: Psoriasis is a chronic, genetically determined inflammatory skin condition characterized by erythematous plaques with silvery scales, affecting about 2% of the global population. It significantly impacts patients' quality of life, encompassing physical, emotional, and psychosocial dimensions. While the use of topical corticosteroids (TCS) with tazarotene has shown benefits in plaque psoriasis treatment, limited data are available on the efficacy of combining halobetasol and tazarotene. Objective: This study aimed to compare the efficacy of Tazarotene 0.045% cream (TAZ) versus Halobetasol Propionate 0.01% lotion (HP) for the treatment of scalp psoriasis at a tertiary care hospital in Karachi, providing insight into their comparative effectiveness and informing clinical decision-making. Methods: A randomized control trial was conducted at the Dermatology Department of Jinnah Postgraduate Medical Centre, Karachi, from August 2022 to February 2023. Ninety participants with scalp psoriasis were recruited and randomly assigned to two groups: Group A (n=45) received Tazarotene 0.045% cream, and Group B (n=45) received Halobetasol Propionate 0.01% lotion, both applied once daily for 6 weeks. The primary outcome was the change in Investigator's Global Assessment (IGA) score from baseline to week 6. Data analysis was performed using SPSS version 25, focusing on descriptive statistics and inferential analyses to evaluate treatment efficacy. Results: The study observed a significant reduction in IGA scores from baseline in both groups, with Group A (TAZ) showing a decrease from 3.89 ± 0.68 to 1.29 ± 0.62 and Group B (HP) from 3.87 ± 0.66 to 2.49 ± 0.62. The paired difference in IGA scores indicated a more pronounced improvement in the TAZ group (2.60 ± 0.75) compared to the HP group (1.37 ± 0.57), with significant differences between the groups (p&lt;0.0001). Treatment success was observed in 82.2% of participants in the TAZ group compared to 51.1% in the HP group, with an odds ratio of 4.424 (95% CI: 1.690—11.578; p=0.002). Conclusion: Tazarotene 0.045% cream demonstrates significantly greater efficacy in treating scalp psoriasis compared to Halobetasol Propionate 0.01% lotion. The findings suggest Tazarotene as a preferable treatment option for scalp psoriasis, offering a better therapeutic outcome.

Effectiveness of port site bupivacaine infiltration in postoperative pain reduction after laparoscopic cholecystectomy: A randomized controlled trial from a tertiary care hospital.

Objective: To determine the effectiveness of port site bupivacaine infiltration in postoperative pain reduction among patients undergoing LC in a tertiary care hospital in Karachi, Pakistan. Study Design: Randomized Controlled Trial. Setting: Department of Anesthesia, Hamdard Hospital, Karachi, Pakistan. Period: April 2022 to September 2022. Material &amp; Methods: Patients of either gender aged between 18-45 years, undergoing elective laparoscopic cholecystectomy were included. Twenty ml of 0.25% bupivacaine solution were locally injected into the intervention group at the port locations. Treatment for the control group was consistent with standard of care. Post-surgery, to measure the severity of the pain, a visual analogue scale (VAS) was utilized and compared. Results: In a total of 170 patients, age, weight, systolic and diastolic blood pressure, ASA grade, SPO2, and the duration of the surgery were not substantially different between the two study groups at baseline (p&gt;0.05). Post-operatively, from third hour till ninth hour pain score, abdominal pain, incisional pain and shoulder pain were significantly lower among the group received local infiltration of bupivacaine. No significant differences were seen at 12th hour. Median time to rescue analgesia was 12 (IQR=6-12) hours and 6 (IQR=6-9) hours among the intervention and control group (p&lt;0.001). Conclusion: This study found lower pain intensity and higher time of rescue analgesia to be associated with local infiltration of bupivacaine at port as compared to control group in the early post-operative period among patients underwent laparoscopic cholecystectomy.