Tertiary Care Hospital In Lahore Research Articles

Donning Sterile Surgical Gloves - A Prospective Clinical Audit of Young Surgeons at a Tertiary Care Hospital of Lahore, Pakistan.

Background Sterilization and aseptic surgical techniques are the most important keys to successful postoperative outcomes. The standard surgical gloving technique causes early wound healing and reduces morbidity and mortality. Objective To assess the standard technique of donning sterile surgical gloves while scrubbing among young surgeons. Material and Methods This two-week prospective audit involved 60 young residents and house officers after ensuring ethical implications. Participants were observed unannounced for donning sterile surgical gloves in the surgical operation theatre (OT) according to the standard criteria set by World Health Organization (WHO) before and after the relevant intervention. The intervention was made through a clinical lecture, live demonstration, and hands-on sessions. After a detailed literature study, a pro forma was generated to record participants' compliance with 14 steps of donning sterile surgical gloves. Data was sent to a statistician for descriptive analysis. Results About 72.14% of the participants followed the standard criteria of donning sterile surgical gloves before intervention. This percentage raised to 90.71% after the intervention, showing marked improvement. Conclusion Pre-intervention and post-intervention observations showed apparent differences in compliance rates for the standard criteria of donning sterile surgical gloves. This scientific study signifies the need for such clinical audits to boost standard surgical practices, especially among newcomers.

Gender-based analysis of antibiotic prescribing trends for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore

Respiratory tract infections (RTIs), caused by microorganisms such as bacteria and viruses, are a leading cause of morbidity and mortality in children worldwide. Antibiotic resistance is a serious concern, and proper prescribing practices are necessary to avoid life-threatening situations. Thus, this study aims to conduct a gender-based analysis and compare antibiotic prescribing patterns for pediatric patients with respiratory tract infections admitted to a tertiary care hospital in Lahore. This comparative cross-sectional study was conducted at Children’s Hospital in Lahore, Pakistan, for three months and enrolled 250 pediatric patients who met the inclusion criteria, including 155 males and 95 females. Data were collected through face-to-face interviews and reviewing hospital records. The results of the study showed that the average number of drugs per prescription was 3.06 ± 1.29 (male) and 3.12 ± 1.5 (female), while the average number of antibiotics per prescription was 2.25 ± 0.60 (male) and 2.17 ± 0.58 (female). The most prevalent medical conditions were bronchopneumonia (53.55% males and 58.95% females), followed by respiratory distress (20.00% males) and pneumonia (16.13% males and 16.84% females). The most commonly prescribed drugs were J01DD04: Ceftriaxone (78.71% males and 71.58% females), J01CR02: Amoxicillin/Clavulanate (59.35% males and 56.84% females), and J01GB06: Amikacin (41.29% males and 45.26% females). A low percentage of prescriptions had major drug-drug interactions (8.39% males and 10.53% females), while most prescriptions had no drug-drug interactions (81.94% males and 84.21% females). There was no significant difference between male and female patients for caregiver, indications for antibiotic prescriptions, the class of active agent prescribed, and drug interactions. Our study findings indicate that most male and female patients admitted to the hospital with lower respiratory tract infections were prescribed antibiotics alongside analgesics and antipyretics. Furthermore, our analysis revealed minimal drug interactions among the prescribed medications. Importantly, we observed a similar antibiotic prescribing trend among male and female pediatric patients, highlighting the consistency in treatment approaches.

Factors associated with low birthweight among newborns delivered at term in a tertiary care hospital in Lahore

Background: Low birth weight (LBW) is an important risk factor that contributes to mortality of 15-20% of newborn globally. This case-control study was conducted to determine factors associated with low birth weight among new-born delivered at term in obstetrical and gynecological wards of the hospital.
 Patients and methods: Mothers of 150 low birth weight babies born at term were taken as cases and 150 normal weight babies born at same day, were taken as controls. Mothers were interviewed on using a semi-structured and pretested questionnaire. The data was analyzed on SPSS Version 22.0. A p-value <0.05 was considered statistically significant.
 Results: Illiterate mothers had 2.332 odds of having low birth weight babies (0.03, 95% CI = 1.3317 to 4.152). Mothers from low socio-economic status had 3.54 odds of delivering LBW (p-value = 0.000, 95% CI = 2.184 to 5.94). The odds of having low birth weight babies was 4.004 times high in the mothers exposed to passive smoking (p-value = 0.000, 95% CI = 2.477 to 6.474). Hemoglobin value less than 10 gm/dl was found to be significantly associated with odd of having LBW 3.003 in anemic mothers versus non anemic mothers (p-value = 0.0027, 95% CI = 1.279 to 3.227). Mother with parity <3 had 0.0933 odds of having low birth weight babies. Mothers having adequate antenatal care had 0.394 odds of having low birth weight babies.
 Conclusion: Illiteracy, low socio-economic status, employment, anemia, tobacco smoke exposure and inadequate antenatal care were significantly associated with LBW.

Cannabis Abuse among Patients with Schizophrenia

Background: Cannabis is the most frequently used substance among patients of schizophrenia. Past deliberate surveys have reported a strong association between cannabis abuse and schizophrenia. However; the whole frequency of cannabis abuse among schizophrenia patients remains ambiguous, as do the variables influencing this rate. Because cannabis abuse in schizophrenia is presently an active area of research, so there is a requirement for a fresh review particularly in our culture where studies are lacking on this topic. Objective: The current study explores the frequency of cannabis abuse among patients suffering from schizophrenia presenting in a tertiary care hospital of Lahore. Methods: Cross-sectional prospective research design was used. Sample of 381 diagnosed patients of schizophrenia using cannabis for at least one year was selected from Sir Ganga Ram Hospital, by convenient sampling technique. Drug Abuse
 Screening Test was applied for the frequency of cannabis abuse. The data were stored and analysed in SPSS version 20. Results: The results revealed that cannabis abuse was present among 42.3% of the patients with schizophrenia. Chi-square analysis showed that there were significant differences among the frequencies of cannabis abuse regarding various age groups, where young age group had significantly higher ratio of cannabis abuse (p=.04). On using independent sample t-test for marital status and duration of the schizophrenia, it was found that cannabis abuse was significantly higher among unmarried patients (t=-4.24, p=.001), however, no significant differences were found for duration of schizophrenia (t=-1.50, p=0.43). Conclusion: The study highlights cannabis abuse is more prevalent in the males as compared to the females. Young age group of patients is more prone to cannabis. These findings can help to decrease the comorbidity of schizophrenia associated with cannabis abuse.

Patterns of Dyslipidemia Among Acute Coronary Syndrome (ACS) Patients at a Tertiary Care Hospital in Lahore, Pakistan.

Dyslipidemia refers to the presence of abnormalities in lipid parameters. It has become a global issue with a high risk of cardiovascular diseases (CVDs). The aim of the investigation was to find out the pattern and prevalence of dyslipidemia among patients with the acute coronary syndrome (ACS). A cross-sectional study design was used. Data were collected using convenient sampling from 101 patients presenting with ACS, admitted at the critical care unit (CCU) / Rasheeda BegumCardiacCentre (RBCC) of Shalamar Hospital, during a 12-month period from January 2020 to December 2021. Dyslipidemia is diagnosed by testing the lipid profile when there are one or more abnormal readings of the lipid profile. Nearly 43 (42.6%) had ST-segment elevation myocardial infarction (STEMI), 27 (26.7%) had non-ST segment elevation myocardial infarction (NSTEMI), and 31 (30.7%) were categorized as unstable angina (USA). Overall dyslipidemia was present in 84 (83.2%) patients. The prevalence of dyslipidemia was 55 (65%) in male patients and 29 (34.5%) in female patients. Dyslipidemia was present in 39 (90.7%) patients with STEMI, 25 (80.6%) in the USA, and 20 (74.1%) with NSTEMI. The prevalence of dyslipidemia was quite high among ACS patients. The proportion of obese patients was also high in our study. However, dyslipidemia was more frequent in overweight patients.

Physician’s Knowledge and Skill to Complete the Certificate of Cause of Death According to who Guidelines A Survey Among the Doctors of A Tertiary Care Hospital at Lahore\

Background: The medical document certifying the cause of death provides vital data to develop health policies. In spite of very comprehensive guidelines issued by the WHO for thecompletion of death certificates; very few certificate arefound errorfree which might be due to lack of knowledge and practice on the part of physicians issuing that certificate.Purpose of this study is to assess the knowledge and competencies of a doctor in completing a death certificate. Methods: This study was cross-sectional. The population of this study was physicians of a tertiary care hospital of Lahore. A structured questionnaire along with a case scenario was given to 137 physicians having variable working experiences, performing in different clinical departments of a tertiary care hospital of Lahore.The participants were asked to complete the component of cause of death of the certificateonly. The percentage of omissions done by the doctors during the completion of said section was analyzed using the chi square test to establish the association between participant’s characteristics and their relevant responses. Results: Among 137participants working in different clinical departments of a Tertiary Care Hospital at Lahore, 89% were having less than 5 years’ experience and 11% having more than 5 years’ experience. 53% were qualified from public sector, 24% from private sector and 23% from foreign institutes. 77% doctors identified immediate cause of death incorrectly, 83 % did not identify and interpret underlying cause of death correctly; 90 % did notidentify contributory cause of death correctly. In46 % cases mechanism/mode of death was confused with the cause of death. Practical Implication: The correct completion of death certificates would provide an accurate and genuine mortality index essential for framing a national health policy. Conclusion: Physician’s knowledge and skill of completing the death certificates is very deficient and alarming which necessitate periodical and regular training of the physicians on completing the death certificates as per guidelines of the WHO to get an appropriate and valid health statistics effective for future public national health policies and strategies. Keywords (MeSH): Death certificate completion, Medical certification of cause of death, Physician’s knowledge, skill to complete death certificate, Mortality index

Utilization of Immunohistochemistry in Gynecologic Pathology: An Experience at a Tertiary Care Hospital, Lahore-Pakistan

Background: Immunohistochemistry is an adjunct tool in Surgical Pathology. The fast growing use of immunohistochemistry in gynecologic Pathology has revolutionized the fields of tumor diagnostics & research. Objective: The objective of the study was to share & discuss the experience of utility of immunohistochemistry in Gynecologic Pathology, at a tertiary care hospital in Lahore, Pakistan. Patients & Methods: This was a retrospective, descriptive, cross sectional study, carried out at the Pathology Department of Fatima Jinnah Medical University, Lahore. All cases which were diagnosed after the application of immunohistochemistry during the study period from 1st July 2019 to 31st December 2020 were included in the study. Data included age of the patient, marital status, parity, clinical & radiological presentation, histopathological findings & differentials, list of immunohistochemical markers applied to the case with results & final histopathological diagnosis. Data was analyzed using SPSS version 17. Results: A total of 196 cases were included in the study. The age of the patients ranged from 14 years to 82 years with a mean age of 41 ± 7 years. The commonest use of immunohistochemistry was for histological classification of the tumors of the female genital tract, identifying precancerous lesions, differentiating primary from metastatic CA & predicting response to chemotherapy via proliferative index Ki67. The most commonly used immunohistochemical markers were CK, CK7, CK20, CD 3, CD20, ER, PR, VIMENTIN, WT 1, Ki67, CD 117, SMA, INHIBIN, p53 & p63. Practical implication This study shares the experience of use of common immunohistochemical markers in different cases of gynecologic pathology, highlighting & discussing different panels for use in different scenarios, from which other pathologists may benefit. Conclusion: Immunohistochemistry is an important ancillary tool in the evaluation of gynecologic pathology cases. However, it cannot replace conventional histopathology. It should always be used as an adjunct to histopathology, in the proper clinical & radiological context. Keywords: immunohistochemistry, gynecologic pathology, ovarian carcinoma, leiomyoma, dysgerminoma,

Correlation of Radiological Findings (High Resolution Computed Tomography Chest) with Anti-SARS-COV-2 Antibodies in Patients Visiting Tertiary Care Hospitals

Background: Coronavirus (COVID 19) pandemic has taken so many lives and has contributed to an increase in morbidity due to its complications. The research is still in infancy and much has yet to be investigated. Objective: To correlate the HRCT findings on chest with antibody testing in patients visiting tertiary care hospitals in Lahore. Methodology: Three hundred and thirty-two patients with mild, moderate and severe symptoms of COVID 19 were recruited. Those with raised CRP levels were sent for HRCT chest and PCR testing as protocol of the hospitals. All patients were tested with Rapid antibody kits for reactivity. Results: Showed that males were affected more than females. Similarly, non-health care workers were more affected. All patients with bilateral involvement of lungs on HRCT chest and positive PCR findings also tested reactive on antibody testing. However, a few people with bilateral lung involvement and negative on PCR testing got reactive results on Rapid antibody testing. Linear regression model shows significant correlation of HRCT chest findings with Ant-SARC- COV 2 antibodies. Conclusion: HRCT findings (Unilateral and bilateral lung infiltrates) correlated significantly with Anti SARC-COV 2 Antibodies.

Heavy Metal (Arsenic) Induced Antibiotic Resistance among Extended-Spectrum β-Lactamase (ESBL) Producing Bacteria of Nosocomial Origin.

Antimicrobial resistance (AMR) is a leading cause of treatment failure for many infectious diseases worldwide. Improper overdosing and the misuse of antibiotics contributes significantly to the emergence of drug-resistant bacteria. The co-contamination of heavy metals and antibiotic compounds existing in the environment might also be involved in the spread of AMR. The current study was designed to test the efficacy of heavy metals (arsenic) induced AMR patterns in clinically isolated extended-spectrum β-lactamase (ESBL) producing bacteria. A total of 300 clinically isolated ESBL-producing bacteria were collected from a tertiary care hospital in Lahore, Pakistan, with the demographic characteristics of patients. After the collection of bacterial isolates, these were reinoculated on agar media for reidentification purposes. Direct antimicrobial sensitivity testing (AST) for bacterial isolates by disk diffusion methods was used to determine the AST patterns with and without heavy metal. The heavy metal was concentrated in dilutions of 1.25 g/mL. The collected bacterial isolates were isolated from wounds (n = 63, 21%), urine (n = 112, 37.3%), blood (n = 43, 14.3%), pus (n = 49, 16.3%), and aspirate (n = 33, 11%) samples. From the total 300 bacterial isolates, n = 172 were Escherichia coli (57.3%), 57 were Klebsiella spp. (19%), 32 were Pseudomonas aeruginosa (10.6%), 21 were Proteus mirabilis (7%) and 18 were Enterobacter spp. (6%). Most of the antibiotic drugs were found resistant to tested bacteria. Colistin and Polymyxin-B showed the highest sensitivity against all tested bacteria, but when tested with heavy metals, these antibiotics were also found to be significantly resistant. We found that heavy metals induced the resistance capability in bacterial isolates, which leads to higher AMR patterns as compared to without heavy metal tested isolates. The results of the current study explored the heavy metal as an inducer of AMR and may contribute to the formation and spread of AMR in settings that are contaminated with heavy metals.

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

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

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

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

Undiagnosed Diabetes Mellitus in Acute Coronary Syndrome (ACS) Patients

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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