Ziauddin Hospital Research Articles

Benzodiazepines: Predominant Reported Acute Poisoning to Private Sector Tertiary Care Hospitals in Karachi

Background: Acute poisoning is a major medical emergency that translates into morbidity and mortality across all age groups, it is a potentially preventable cause of illness and death. This study was carried out to assess the epidemiological information of acute poisoning among the general population presented to the three campuses of a private tertiary care teaching hospital in Karachi, Pakistan. Method: The cross-sectional study was conducted at three campuses of a private tertiary care teaching hospital, Dr. Ziauddin Hospital in Karachi, comprising of records from January 1, 2018, to December 31, 2022, of patients reporting acute poisoning. These records were accessed after getting approval from the Ethical review committee. Consecutive sampling technique was applied while data was collected. All cases of acute poisoning reporting to the emergency department with complete records were included. While data of those with any other diagnosis or incomplete record were excluded. Descriptive analysis was performed for quantitative variables. For categorical data frequency and percentages were extracted. The chi-square test was used to associate categorical variables. P value less than 0.05 was taken as statistically significant. Results: The total number of cases was n=518 out of which n=235 (45.4%) were males while n=283 (54.6%) were females and the maximum number of cases n=111 (21.4%) were associated with Benzodiazepines followed by insecticide poisoning and ingestion of rodenticides. Conclusions: The most susceptible groups to acute poisoning were found to be women and children. A prevalent agent that caused toxicity was benzodiazepines; the biggest number of cases occurred in April, while the lowest number occurred in December. The year 2020 was linked to the highest number of cases.

Efficacy of human interleukin-11 analogs for treating dengue fever-associated thrombocytopenia: a prospective cohort

AimDengue fever (DF), carried by Aedes mosquitoes, affects millions worldwide. Platelet-inducing human IL-11 analogues may be effective in treating DF-associated thrombocytopenia.MethodologyA prospective study was done at Dr. Ziauddin Hospital, a tertiary care hospital in Karachi, Pakistan, from September 2023 to April 30, 2024.ResultsThis study recruited 300 DF patients characterized by thrombocytopenia (platelet count < 30,000), including 159 in the treatment and 141 in the control group. The median age of patients was 34 ± 11.05 years, with 187 males (62.3%) and 113 females (37.7%). The treatment group had a higher proportion of fever (80%, p < 0.0001) and headache (96%, p = 0.012) compared to the control group; however, no significant changes were observed in other clinical parameters between the two groups. Following treatment for 5 days, platelet counts of the treatment group increased significantly in response to IL-11 treatment compared to the control group at all time intervals (day 0, day 1, day 2, day 3, day 4, and day 5). Following treatment, males consistently exhibited higher platelet counts than females (all p < 0.05). In addition, patients admitted on day 3 of their course of illness showed a significantly slow response to the treatment compared to those admitted on day 5. Although young individuals exhibited a significant increase in platelet count, the age showed no significant intergroup differences.ConclusionsIL-11 analogs have promising potential for treating DF-associated thrombocytopenia. Additional investigation is necessary to refine administration protocols and examine the wider therapeutic ramifications of IL-11 in managing DF.

Role of Suprachoroidal versus Intravitreal injection of triamcinolone: In diabetic macular edema.

Objective: To assess the efficacy of suprachoroidal versus intravitreal injection of triamcinolone in diabetic macular edema. Study Design: Randomized Controlled Trial. Setting: Department of Ophthalmology, Ziauddin Hospital Kemari, Karachi. Period: 1st November 2022 and 30th October 2023. Methods: The study observed 71 eyes of 59 patients diagnosed with Diabetic macular edema. All patients that met the inclusion criteria were divided into two groups, Group A Suprachoroidal Triamcinolone and Group B Intravitreal Triamcinolone. Results: This research encompasses 71 eyes from 59 patients diagnosed with diabetic macular edema, divided into two groups based on their chosen treatment. Group A consisted of 34 patients, whereas Group B comprised 37 patients. The average age of patients in both groups was 43.6±6.2. Baseline visual acuity and macular thickness were recorded in both groups and compared after treatment. Significant improvement was observed in both groups, particularly notable in the 3rd month. The suprachoroidal triamcinolone injection exhibited a more stable response, accompanied by lower complication rate. Conclusion: In conclusion, the comparative analysis of Suprachoroidal Triamcinolone acetate and Intravitreal Triamcinolone Acetate showed a more significant improvement in IOP and CMT in the suprachoroidal group as compared to intravitreal. Hence Suprachoroidal injection was seen as the treatment of choice in treatment of Diabetic Macular Edema.

Effectiveness of subacromial steroid injection and hydrodilatation in the treatment of adhesive capsulitis: A comparative analysis.

Objective: To compare the effectiveness of Subacromial Steroid Injection (SAI) and Hydrodilatation in treating adhesive capsulitis (frozen shoulder). Study Design: Observational study. Setting: Department of Orthopedic, Dr. Ziauddin Hospital, Located in North Nazimabad, Karachi, Pakistan. Period: March 2023 to September 2023. Methods: Included 138 participants with primary adhesive capsulitis. Participants were divided into two groups: one received hydrodilatation and the other received SAI. The Disability of Arm, Shoulder, and Hand (DASH) Score and Visual Analogue Scale (VAS) were used for pre and post-treatment assessments at intervals of 2 weeks, 6 weeks, and 6 months. SPSS version 23 was used to analyze the data. Results: Both groups show significant reductions in pain scores and DASH scores over time (p-value&lt;0.05 for changes within each group). There are significant differences in pain scores and DASH scores between the groups at 6 weeks, 12 weeks, and 6 months (p-value&lt;0.05), with the hydrodilatation group showing better outcomes. Moreover, the mean reduction in pain scores and DASH scores from pre-treatment to 6 months is significantly greater in the hydrodilatation group compared to the SAI group (p-value&lt;0.05). Conclusion: While both Hydrodilatation and SAI are effective in reducing pain and improving functionality in patients with adhesive capsulitis, Hydrodilatation appears to be more effective in achieving these outcomes, particularly in terms of pain management and functional improvement.

Effects of concurrent training on glycemic and vascular parameters among patients with T2DM-associated Peripheral Artery Disease.

To evaluate the effects of CT to improve HbA1C and ABI among the T2DM-associated PAD population. A randomized, single-blinded, two-arm trial was conducted at the Department of Rehabilitation Sciences of Dr. Ziauddin Hospital in Karachi between July to September 2023. A total of 80 T2DM-associated PAD patients were included and randomly divided into Experimental Group (n=40) and Control Group (n=40), using the sealed envelope method. Experimental group patients received Concurrent Training (CT), whereas Control Group patients underwent Aerobic Training (AT) for 12 weeks. Both groups received thirty-minute sessions three times a week that was progressed to 60 minutes over 12 weeks. HbA1C and ABI were measured at baseline and after 12 weeks. Analysis revealed an average age of 46.75±3.59 and the duration of T2DM for developing PAD is 14.82±2.23 on average. Findings revealed that both training groups were significantly effective (p<0.000) at 95% CI in improving glycemic and vascular parameters after 12 weeks. Subsequently, findings showed that the CT group showed more significant improvement than AT group in improving HbA1C for glycemic control (p=0.002, CT: pre: 9.53±1.406, post: 7.81±0.81, AT: pre: 8.74±0.908, post: 8.15±0.83) and ABI for systemic blood flow (p=0.0001, CT: pre: 0.84±0.03, post: 0.94±0.03, AT: pre: 0.82±0.02, post: 0.86±0.02). CT showed a two-fold improvement in glycemic control and arterial blood flow than AT group, which represents that CT is an effective therapeutic approach for T2DM-associated Fontain's stage IIa PAD rehabilitation.

EFFECTIVENESS OF STRENGTHENING EXERCISES IN IMPROVING FUNCTIONAL ACTIVITIES OF HEMIPLEGIC PATIENTS

Background of the Study: To determine the Effectiveness of Strengthening (Resistance) exercises in improving functional activities such as gross motor function and walking stance in stroke patients. Methodology: A Quasi experimental study was conducted. A Quasi experimental study was conducted; patients were selected from the OPD setting of Dr. Ziauddin Hospital, Saifee Hospital and the National medical center. Data was divided into two groups. Group 1 case and group 2 controls. The patients included in group 1, received Strengthening exercises. While, the other group received exercises other than strengthening such as Balance and Coordination Exercises, Flexibility Exercises, Functional Training and Gait Training, after which their improvement was recorded at the end of 4 weeks for 3 months. The critical outcomes evaluated subsequently to resistance training using therabands and minimal weights along with gait assessment, and functional training. Gait assessment, post-treatment using a 6-minute walk test (6MWT) and functional activities assessment scales using a Barthel Index. Results: The clinical intervention revealed significant results, showing that strength on the effected side increased post treatment as the calculated P-value was less than 0.05, also the mean leg strength for the RT group (pre walk_ 1.94 and 2.28 for control at baseline improved (post walk _to 2.71 for RT group and 1.60 for controls respectively after 3 months., suggested that resistance training produced marked improvement in performing functional activities of hemiplegic patients. Conclusions: Hence, it is concluded that the strengthening exercises including resistance band training and physio ball for upper limb and resistance training for lower limb were shown to improve Muscle strength and cause considerable improvement in performing the activities of everyday living and gait strength and core stability in patients suffering from stroke. Also, improving their social interactions and participation in everyday life.

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

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

Treatment Related Acute Toxicities Between Treatment with 3D-CRT and IMRT in Localised Prostate Cancer.

To compare the acute toxicities of two radiation treatment techniques, intensity modulated radiation therapy (IMRT), and 3-dimensional conformal radiation therapy (3D-CRT) in localised prostate adenocarcinoma. Descriptive study. Place and Duration of the Study:Department of Oncology, Dr. Ziauddin Hospital, Karachi, Pakistan, from July 2016 to June 2022. Patients with localised prostate adenocarcinoma who underwent treatment using two different advanced radiotherapy techniques i.e., IMRT and 3D-CRT were recruited during the study period. They were followed up for six months for acute gastrointestinal (GI) and genitourinary (GU) adverse events (acute toxicities) related to both treatment modalities according to Modified radiation therapy oncology group (RTOG) criteria. The acute toxicities were assessed at the 2nd, 4th, and 6th week during treatment and at the 3rd and 6th month after treatment. There were 78 patients, with 39 patients in each group. The mean age was 68 ± 10 years in the 3D-CRT and 68 ± 07 years in the IMRT group. Patients in the IMRT group exhibited markedly lower treatment-related acute GI and GU effects at the end of 4th and 6th weeks for anorectal pain (p = 0.04) and (p = 0.01) and burning micturition (p = 0.003) and (p = 0.01), respectively. Furthermore, at 3 months anorectal pain (p = 0.02), loose stools (p = 0.005), and burning micturition (p = 0.01) were present and at 6 months anorectal pain was (p = 0.01) still present. Radiation therapy modalities 3D-CRT and IMRT both showed acceptable toxicity profile in the management of localised prostate cancer, while IMRT group exhibited significantly lower treatment-related acute GI and GU effects. 3D-CRT (3-Dimensional Conformal Radiation Therapy), IMRT (Intensity-Modulated Radiation Therapy), Radiation toxicity.

Documentation for Orthopaedic Surgery: An Audit to Ensure Compliance with the Most Recent Guidelines

Background: Consistent and thorough documentation in orthopaedic surgery is critical for ensuring quality patient care and protecting the legal interests of surgeons. Adherence to the Royal College of Surgeons (RCS) guidelines is fundamental to achieving this. However, studies have identified a persistent deficiency in compliance with these guidelines across various surgical specialities. Objective: The audit aimed to evaluate the existing compliance of orthopaedic surgical documentation with RCS guidelines at Dr. Ziauddin Hospital and to implement a tool to improve documentation practices. Methods: A closed-loop, two-cycle audit was conducted. The first cycle retrospectively analysed 200 surgical notes from January to July 2023, using a standardized operation sheet to assess compliance with RCS guidelines. Identified deficiencies were addressed by introducing an aide-memoir in all orthopaedic operating rooms. The second cycle prospectively analysed 100 surgical notes from August to October 2023 to evaluate the impact of the intervention. Results: The initial audit revealed a 0% compliance rate in documenting the date, time, and type of surgery (elective or emergency). Following interventions, the second cycle showed significant improvements, with compliance rates rising to 100% for date and time, and to 87% for identifying the surgery type. Additional documentation parameters such as the recording of the assistant's name and incision details also improved, though exact numerical increases were not specified. Conclusion: Introducing an aide-memoir significantly enhanced compliance with RCS surgical documentation guidelines. This simple, effective tool facilitated a remarkable improvement in the quality of operative notes, underscoring the need for regular audits and potential integration of electronic documentation systems.

ASSOCIATION OF PHYSICAL AND NEUROPSYCHIATRIC MORBIDITIES WITH THE SEVERITY AND MORTALITY OF COVID-19 PATIENTS IN PAKISTAN

Objective: This study aimed to find out the association of co-morbidities; risk factors and complications, with the severity and mortality of Covid-19 patients in our set of population Methodology: Covid-19-positive patients (151) ages 18-80, were recruited, (June 2022 to May 2023) from Ziauddin Hospital, after informed consent and approval from Ethics Committee. The questionnaire recorded patients’ demographic variables, laboratory investigations, past medical history, and family history. Follow-up co-morbidities, recovery, death, or LAMA (Leave Against Medical Advice) data was taken from hospital records. Analyses were done using (SPSS) software. P-values of &lt;0.05 were considered significant. Results: Out of 151 patients; females were 56 (37%) and males 95 (63%). Among these 82(54.3%) recovered, 52(34.4%) passed away and 17(11.2%) LAMA. Deaths in males 40(26.4%), were higher, compared to females 12(7.9%). Overall 84 (56%), suffered severe infection, 24 (16%) moderate and 43 (28%) mild. The most common risk factors were complications of the heart (hypertension) 35(42.7) followed by diabetes 27 (32.9) (p&lt;0.001). Neuropsychiatric manifestations such as depression 36(23.8), was highest among post covid-19 complications, 14 (17.07%) patients had stroke out of which 9(17.3) could not survive. The most common cause leading to covid 19 severity was Pneumonia 76(80%) then diabetes 63(80%) and hypertension 69(78%) (p&lt;0.001). Majority of patients, 88(58.3%) were above 50 years of age, 35(23.2%) between 25-50 and 28(185%) &lt;25 years. Conclusion: The most common risk factor of Covid-19 were complications of the heart and diabetes. Highest post covid-19 complication among survivors was depression. The highest complication leading to death was Pneumonia.

A Rare Complication of Percutaneous Endoscopic Gastrostomy Tube Placement: Early Buried Bumper Syndrome (BBS)

Early Buried Bumper Syndrome (BBS) is a rare complication of Percutaneous Endoscopic Gastrostomy (PEG) tube placement where the internal bolster gets “buried” in the gastrocutaneous fistulous tract. BBS is usually a late complication. We present a case of early BBS, in Radiology Department of Dr Ziauddin Hospital, Karachi. Patient presented with fever and oozing from the side of PEG tube. CT scan abdomen findings revealed, the bumper of the percutaneous endoscopic gastrostomy tube retracted in subcutaneous fat just adjacent to the gastric wall and seen in the left sided rectus sheath outside the gastric lumen. Contrast was given through the peg during the procedure which show no extravasation of contrast in adjacent soft tissues. These findings consistent with early buried bumper syndrome.

Proximal Fibular Osteotomy Vs Proximal Fibular Osteotomy with Intra-Articular Hyaluronic Acid: Difference in Terms of Pain Relief and Functional Outcome

Background: Knee osteoarthritis (OA) is a complex, progressive illness marked by cartilage deterioration and adjacent bone enlargement, and management is challenging due to poor connective tissue self-regeneration. This study compared the effects of proximal fibular osteotomy (PFO) alone versus PFO with intra-articular hyaluronic acid injections (IAHA) among patients presenting with knee OA. Methods: A quasi-experimental study was done at Ziauddin Hospital’s orthopedics department from March 2020 to March 2021. Patients with medial compartment knee joint OA requiring surgery aged≥40 years and BMI of &lt;30kg/m2 were included. All participants were assigned into two groups, PFO was done alone in group A (n=30) and with IAHA in group B (n=30). Both groups had their medial joint spaces measured and documented pre- and post-operatively, as well as their Oxford knee score and visual analog scale (VAS). SPSS version 25 was used and the normality of data was assessed using Shapiro-Wilk’s test. The mean difference (post-pre) was compared using the Mann-Whitney U test. A p≤0.05 was statistically significant. Results: A total of 60 patients were included with a mean age of 51.30±4.87 in Group A and 50.83±6.17 in Group B. Outcomes in both groups were improved considerably with a significant p&lt;0.0001 in groups, in terms of pain and function determined using Oxford knee score, medial joint space measurement, and VAS score. Conclusion: PFO alone and PFO with IAHA show significantly improved results in terms of functional outcomes, but the use of IAHA in combination with PFO, has considerably better results in terms of pain relief.

Effect of Body Mass Index and Ankle Dorsiflexion in Planter Fasciitis Patients; Performance Perspective

Objective: To determine the effects of body mass index and ankle dorsiflexion in patients with plantar fasciitis.Study Design: A cross-sectional.Place and Duration of Study: The study was carried out at the Department of Physical Therapy of the two leading tertiary care centers, Advance Orthopedic &amp; Reconstructive Institute &amp; Dr. Ziauddin Hospital Karachi, Pakistan from August 2022 to June 2023.Methods: Sixty-Four participants were recruited from the physical therapy departments of two tertiary care centers in Karachi by convenience sampling. The study focuses on the impact of demographics on the performance of plantar fasciitis patients. The measurement tools used in this are BMI (Body mass index), NRS (Numeric rating scale), LEFS (Lower extremity functional scale), and Goniometer. The data were analyzed by SPSS version 23.0. Results: Our findings show that plantar fasciitis is more common in the obese-II category with reference to BMI, females are more affected than males with reference to gender, the middle age group is more affected with reference to age and dorsiflexion angle of patients is less than normal range shows the directly proportional of demographics with the performance of patients with plantar fasciitis.Conclusion: Our study showed the positive effect of ankle dorsiflexion angle and BMI, gender, pain, and age on the physical performance of plantar fasciitis patients.&#x0D; How to cite this: Lata P, Hayat S, Kumar V, Hassan MF, Batool S, Sandeela KA, Jamil K. Effect of Body Mass Index and Ankle Dorsiflexion in Planter Fascitis Patients; Performance Perspective. Life and Science. 2024; 5(1): 113-119. doi: http://doi.org/10.37185/LnS.1.1.461

Role of Alanine Transaminase and Transient Elastography in Categorising Nonalcoholic Fatty Liver Disease Subgroups.

To investigate the association of alanine transaminase (ALT) with transient elastography grades to define various nonalcoholic fatty liver disease (NAFLD) groups for disease status. Cross-sectional, descriptive study. Place and Duration of the Study: Gastroenterology Outpatient Clinic, Ziauddin Hospital, from January to December 2022. This study included 194 NAFLD patients. Demographic data, body mass index, enzymes, and transient elastography (TE) findings were recorded. NAFLD patients were categorised as nonalcoholic fatty liver (NAFL), nonalcoholic steatohepatitis (NASH), steatofibrosis (significant fibrosis F2-F3 with normal ALT), and cirrhosis using TE grades. The median age of the patients was 44 [IQR 18.25] years; 146 (75.3%) were males. Out of 194 NAFLD patients, 21 (10.8%) were NAFL, 116 (59.8%) were NASH, 14 (7.2%) showed steatofibrosis, and 43 (22.2%) were cirrhotic. On transient elastography, the majority were with S3 steatosis (n=107, 55.2%) and 59 (30.2%) had F0-F1 fibrosis. There was a statistically significant difference in the mean rank of age, ALT, AST, and GGT levels within 4 groups of NAFLD (p <0.001). Most of the patients with all the stages of fibrosis had increased ALT levels (p=0.034). This study concluded that a combination of ALT levels and transient elastography findings could be considered for differentiating uncomplicated steatosis from NASH, steatofibrosis, and cirrhosis, hence limiting the use of liver biopsy. This may prove a reliable way to measure the severity of the disease. Nonalcoholic fatty liver disease, Cirrhosis, Transient elastography.

Assess the Burden of Caregivers of Cancer Patients at a Tertiary Care Hospital in Karachi, Pakistan

The burden faced by caregivers of cancer patients is a critical aspect of healthcare, influencing both the well-being of the caregivers and the quality of patient care. Objective: To assess caregivers' burden of cancer patients at a Tertiary Care Hospital in Karachi, Pakistan. Methods: The cross-sectional study was conducted at Zareen Cancer and Research Centre (ZCRC) at Dr. Ziauddin Hospital Karachi, Pakistan. The target population for this study was adult informal family caregivers who were actively taking care of histologically diagnosed cancer patients receiving treatment. Moreover, a 22-item standardized validated Zarit Burden Interview (ZBI) questionnaire was used to collect data. Results: The study findings revealed that 18% of caregivers feel okay or have No to Mild Burden. The largest group 64%, is Mild to Moderate Burden. Around the same, 18%, Moderate to Severe Burden. Conclusions: Based on the findings, 64% face moderate burdens, with an additional 18% enduring higher, moderate to severe burdens. This reveals widespread challenges and stress among caregivers, emphasizing the need for enhanced support and resources to ease their strain and improve their well-being.

Incidence Of Acute Kidney Injury In Mild, Moderate And Severe Cases Of Coronavirus Disease

Objective: The purpose of this research was to determine the incidence of Acute Kidney Injury (AKI) in COVID-19-affected patients Methods: This retrospective cohort study was conducted at Ziauddin Hospital Clifton Campus from June to December 2020. Adult patients with AKI or acute-on-chronic kidney disease (ACKD) were included in a retrospective study. Patients infected with SARS-CoV2 and renal involvement were directed towards the ICU/Nephrology departments which have the expertise to perform laboratory analysis, radiography and institution of treatment. Supplemental oxygen use was documented. The research also assessed information about therapy (antivirals, immunomodulators, RRT) and results (renal function recovery or death). Results: After excluding patients with obstructive AKI, a total of 180 (mean age 50.1 years) of 104 males and 76 females were included in the research. 120 patients were found to have prerenal, and 60 had intrinsic AKI with significant differences between mild, moderate, and severe cases (p=0.004). Acute kidney injury (AKI) survivors had a complete recovery rate of 70%, a partial recovery rate of 22%, and a hemodialysis dependency rate of 8%. Conclusion: Patients with severe COVID-19 infection often develop more severe AKI, and those in the severe or critical stages often exhibit proteinuria and dipstick hematuria. Long-term follow-up for COVID-19 patients should be done to evaluate its influence on renal outcome, and larger samples are required to elucidate the association between COVID-19 and renal damage. Keywords: Coronavirus Disease, Renal Replacement Therapy, proteinuria, dipstick hematuria

One Year Review Compairing Mortality Following DHS Vs PFN

Objective: The objective of my study is to compare the mortality following DHS vs PFN. Study Design: Observational retrospective study. Place of study: Department of Orthopedic &amp; Spine Surgery, Dr. Ziauddin Hospital. Duration: January 2020 to December 2021. Methodology: Patients were divided into 2 groups according to the surgical implant used. Group A with DHS implant, Group B with PFN and mortality is being checked in each group till 1-year post-operative time period by contacting each patient. Age, Gender, co morbidities, surgical procedure performed, fracture pattern (extracapsular, intracapsular) time of injury data was collected from registry of the hospital after taking permission from the authorities involved. Results: The study included 94 patients. Minimum age was 40 years and maximum age was 95 years, and mean age was 71.11. Out of which 61 (64.8%) patients are included in group A in which DHS was done, 33(35%) patients in group B with PFN implants, (Table 1) Mean age in group A is 72.9 (SD 14.0), group B 67.7 (SD 13.3), (Table 1) In group A 16 patients (26.2%) had mortality within 1 year. In group B 2 patients (6%) has mortality within 1 year. (Table 2) There is significant association of increased mortality in patients with DHS implants (group A) with p value &lt;0.005. (Table 2) Mortality was raised in males that is 10 (22.7%) and in females 8 patients (16%). However, no significant association was found p(0.33). (Table 3) Out of 94 patients 54 patients are ASA III with multiple comorbid and other are ASAII and ASA I. Mortality was higher in patients with ASA III 54 patients (57%) and it was not statistically significant with p (0.168). (Table 4) Conclusion: This study shows increased mortality in patients with DHS implants as compared to patients with PFN implants.

Outcomes of oncoplastic breast surgery compared to breast-conserving surgery in breast cancer patients in a developing country: a retrospective cohort study.

Breast-conserving surgery (BCS) with adjuvant radiotherapy remains the standard of care for early breast cancers in Pakistan. We sought to compare the outcomes of BCS with oncoplastic surgery (OPS), a relatively infrequent approach to breast cancer treatment in the country. This retrospective cohort study was conducted at Aga Khan University Hospital and Ziauddin Hospital in Karachi. Patients who had biopsy-proven Stage-I to III breast cancer and underwent either OPS or BCS between August 1, 2016, and December 31, 2021, were identified and followed for 30 days. Data were collected by reviewing patient files and electronic records. A total of 481 patients were included in the study, where 204 (42.4%) underwent BCS and 277 (57.6%) underwent OPS. Mean tumor volume (146.8 vs. 90.4 cm3), and postoperative complications (2.2 % vs. 0%) were higher in OPS while the frequency of positive margins was greater in the BCS group (15.7 % vs. 2.2 %). There were no significant differences in the histologic type of tumor between the two groups. OPS is a valid alternative approach to breast cancer treatment that can be offered to women with early stage, locally advanced, multifocal or tumors at complex locations owing to the reduced occurrence of positive margins and thus lowered re-excision rates.

Donor Health Questionnaire and Physical Examination as a Tool for Re-Examination of Causes for Donor Deferral in a Tertiary Care Hospital

Objective: To reassess the reasons for blood donor deferrals as per donor history questionnaire and physical examination findings. Study Design: Cross-sectional study. Place and Duration of Study: Blood Bank, Dr. Ziauddin Hospital, Karachi Pakistan, from Jan 2017 to Dec 2020. Methodology: After approval from the Ethical Review Committee, all donors reporting at the blood bank were included. All donors were interrogated via a detailed donor health questionnaire. Data for donor history and physical examination findings were retrieved from the Blood Bank Information Software System (BBIS). Results: During the study period, 33,095 donors reported at the.Blood Bank. Of the total donors, 25,531(77.1%) were accepted and donated blood, while 7564(22.9%) were deferred for different reasons. The majority of donations were from males (32773,99.0%), and female donations accounted for 1%, while females accounted for more deferrals as compared to males. Most deferrals were due to low Hemoglobin (2722,36%), followed by injection/needle stick injuries (1994,26.4%).Less common causes observed were donors not feeling fit for donations, medications, etc. Conclusion: In our study, the deferral rate was 22.9%, with low haemoglobin being the most common cause, followed by injections/needle stick injuries.

FACTORS LEADING TO TRANSIENT TACHYPNEA OF NEWBORN (TTN) IN BABIES, DELIVERED BY SPONTANEOUS VAGINAL DELIVERY AT TERTIARY CARE HOSPITAL KARACHI

Neonatal respiratory distress is a common issue, and one of its types is Transient Tachypnea of the Newborn (TTN), which happens when leftover lung fluid is not removed from the body on time. TTN usually occurs within the first 24 to 72 hours after delivery. This study aims to determine the frequency of TTN in newborns delivered vaginally and spontaneously at a tertiary care hospital in Karachi and identify the factors that may contribute to the condition. The study adopted a cross-sectional design and was conducted in the Neonatal Intensive Care Unit of the Department of Pediatric Medicine, Ziauddin Hospital, Karachi. After obtaining the necessary approvals, the study lasted for 9 months, from December 2021 to September 2022. Both quantitative and qualitative data were collected, assembled, and analyzed. Stratification was employed to adjust for effect modifiers, and a chi-square test was used to test for statistical significance with a p-value of 0.05. The study included 153 patients who met the inclusion and exclusion criteria. The average gestational age, height, weight, OFC, length of hospital stay, and mother's age were 30.7 ± 4.3 weeks, 49 ± 1.79 cm, 3.01 ± 0.38 kg, 36.65 ± 1.08 cm, 3.92 ± 4.65 days, and 39.8 ± 2.78 weeks, respectively. Of the 153 patients, 71 (46.4%) were male and 82 (53.6%) were female. 44.4%, 31.4%, 45.1%, and 31.4% of the patients had maternal diabetes, PROM, obesity, and low APGAR scores, respectively. The study found maternal diabetes and obesity were the primary risk factors for TTN in newborns. The study emphasizes the importance of good antenatal and obstetric care to detect any early problems during pregnancy that may contribute to the incidence of TTN.