Effectiveness of Prophylactic Negative Pressure Wound Therapy in Preventing Post-surgical Wound Infection of Abdominal Wounds Compared to Conventional Dressing; A Randomized Controlled Trial

Objective: To compare the effectiveness of prophylactic negative pressure wound therapy in preventing post-surgical wound infection of abdominal wounds compared to conventional dressings. Methodology: This randomized controlled tial was conducted in the Department of General Surgery, Unit-1, Pakistan Institute of Medical Sciences Hospital, Islamabad, from September 2020 to February 2021, using consecutive sampling technique. 120 patients who were planned for elective and emergency abdominal surgeries, were randomly divided into two groups by lottery method. In Group A, the negative suction dressing was applied while in Group B, the post-operatively closed incisional wound site was covered with pyodine dressing. Chi-square test was applied for comparison between both groups on the basis of surgical site infection (SSI) occurrence, abscess, wound dehiscence, and seroma formation. Two sample t-test was applied to compare the length of stay across both groups. A p-value of ?0.05 was considered significant. Results: SSI developed in 13 out of 120 patients during the follow-up period. SSI developed in 5% of patients in group A and 16.7% of patients in group B (p-value=0.04). The mean length of hospital stay was 9.1 ± 2.9 days in group A compared to 11.2 ± 5.9 days in group B (p-value=0.02). Both groups had no significant difference in abscess formation, seroma formation and wound dehiscence. Conclusion: The rate of SSI was significantly lower, and the mean length of hospital stay was significantly shorter in patients who were administered negative pressure wound therapy (NPWT) compared to those who were applied with conventional dressing with pyodine

Interaction, Management and Response of Healthcare Workers Towards Workplace Violence Events

Objective: To evaluate the interaction, management and response towards WPV events by HCW’s of emergency department Methodology: We conducted this cross-sectional study using World Health Organization’s tool to collect quantitative data on workplace violence (WPV) amongst universally sampled 164 health professionals working in an emergency department at Nishtar hospital Multan from June-August 2019 after taking an inform consent. All physically present health professionals who have been working there including paramedics, doctors, & nurses, were part of research. Results: Out of 164 healthcare employees, males were ninety-seven while females were sixty-seven. All the subjects said that they work in shifts, anytime between 18h00 (6 PM) and 07h00 (7 AM), and interact with patients/clients during work as well. Only 11% reported that they have routinely direct physical contact (washing, turning, lifting) with patients/clients. When talking about response to the incident, approximately one-third of the participants sought help from association, almost half of the HCW’s reported to their senior staff, 13.5% subject sought help from union, merely 3.5% HCW told the person to stop whereas, 4.5% told family/friends Conclusion: Health professionals working in shifts, and also interacting with patients/clients faced violence and mostly reported to their senior staff, or sought help from their association

Association between Hyperuricemia and Ischemic Stroke in patients admitted in Medical ward in a tertiary care hospital Multan

Objective: To assess the association of Hyperuricemia with Ischemic Stroke Methodology: This case-control study was carried out at the department of Medicine Nishtar 2 Tertiary Care Hospital in Multan from June 2023 to Dec 2023.  At the time of admission, the serum uric acid level was tested in addition to other standard laboratory tests. Patients' information was gathered using a pre-made proforma only after written informed permission was obtained from the individuals, their spouses, or relatives in the case of patients with aphasia or decreased awareness. Version 24 of the statistical program for the social sciences (SPSS) was used to analyze the data. A p-value of less than 0.05 and an OR greater than one were deemed statistically significant. Results: In the current study, 60 patients were cases and 60 were healthy control. In cases there were 33 (55%) males and 27 (45%) females while in healthy control, the males were 30 (50%) while females were also 30 (50%). In patients with ischemic stroke, the frequency of hyperuricemia was 26 (43.33%), while in controls, it was 15 (25%). Compared to controls, ischemic stroke patients had a 3.11-fold increased incidence of hyperuricemia. Accordingly, hyperuricemia (p=0.002) is a substantial risk factor for ischemic stroke. In individuals aged 30 to 50, ischaemic stroke and hyperuricemia were significantly associated (p = 0.001). Additionally, ischaemic stroke patients had a 4.15-fold increased incidence of hyperuricemia compared to control subjects. On the other hand, there was no significant correlation (p = 0.29) between hyperuricemia and ischaemic stroke in the 51–70 age range. Additionally, there was a 2.1-fold increased incidence of hyperuricemia in ischaemic stroke patients. Conclusion: Patients with ischemic stroke had a considerably greater prevalence of hyperuricemia (43.33%). Furthermore, those who have had an ischemic stroke are 3.11 times more likely to get hyperuricemia. Hyperuricemia may thus be looked at as an additional ischemic stroke risk factor. However, further study is required before regular uric acid levels may be advised

Effects of Measles Vaccine and Its Associated Risk Factors Among Children Presenting in a Tertiary Care Hospital, Rawalpindi/Islamabad

Objectives: To identify risk factors associated with the development of measles among children under 12 years of age in a tertiary care hospital in Rawalpindi/Islamabad and to determine the effectiveness of measles vaccination in the study population. Methods: A retrospective case control study was done from January 2022 to January 2023 at the Department of Pediatrics, Holy Family Hospital (HFH), Rawalpindi & PAEC General Hospital, Islamabad. Total 600 children were included in the study. The hospital data record had children under the age of 12 with measles. Case controls were enrolled without measles at the same hospital, matched for age and sex. Study outcomes were analyzed by multivariant regression test adjusted with age and sex. Results: The average age of the children was 32.24±14.58 months. Mothers with low education were mostly have measles [OR: 4.1, 95% CI: 1.9-6.5, for primary schooling and OR: 1.1, 95% CI: 0.7-2.0, for matriculation]. Children with measles were mostly not breastfed during the first 2 years of life [OR: 0.8, 95% CI: 0.5-1.4]. Cases were also more likely to have never been vaccinated [OR: 8.2, 95% CI: 5.5-15.0] and never vaccinated other children at home [OR: 6.5, 95% CI: 4.5-10.0]. Conclusion: The study concluded that breastfeeding and proper weaning practices are necessary to eradicate measles

Comparing the Complications in Central Venous Catheterization by Ultrasound Guidance vs Anatomical Landmark Technique in Critical Ill ICU Patients

Objective: To compare the complication rates during central venous catheterization using ultrasound guidance versus the anatomical landmark technique in critical ill ICU patients. Methodology: A prospective comparative study was conducted in intensive care unit (ICU) of Farooq Teaching Hospital, Rawalpindi from December 2023 to June 2024. Total 127 critically ill ICU patients with acute surgical or medical conditions requiring central venous catheterization (CVC), such as hypotension, dehydration, or required blood resuscitation, where periphery approach was not feasible, underwent CVC insertion. Patients were randomly divided into two groups: one group underwent ultrasound-guided CVC insertion, while the other group used anatomical landmark technique. The rate of complications was measured between the groups. Results: Mean age of the patients was 46.5±11.2 years. The mean time from skin puncture to blood flashback was 104±172 sec in ultrasound group compared to 401±587 sec in landmark group. Among 127 patients, 61 underwent catheterization using ultrasound guidance, while 66 underwent catheterization using the anatomical landmark technique. The complication rates between the two groups were compared. The complications experienced by patients included multiple attempts (>1 puncture), pneumothorax, improper cannulation, hematoma, arterial punctures, incisional bleeding, and ecchymosis. In ultrasound group, 11.5% of patients experienced complications, compared to 28.8% in anatomical landmark group (p = 0.016). Conclusion: Ultrasound-guided central venous catheterization was associated with fewer complications and a higher success rate (correct placement of the CVC), making it easier to perform. This procedure simplicity is linked to enhanced safety and patient comfort

Psoriasis Area and Severity Index and its Correlation with Liver Function Test

Objective: To determine Psoriasis Area and Severity Index score and its association with LFT values in patients of psoriasis. Methodology: This cross-sectional study, was done on patients visiting the skin OPD of LUMHS Jamshoro/Hyderabad. Diagnosed patients of Psoriasis, aged between 18 and 50 years and both genders were included. A 5cc blood sample was collected from each individual to evaluate the LFT. Psoriasis Area and Severity Index (PASI) scores was defined based on the percentage of body surface area affected by psoriasis lesion. All the information was entered and analyzed using SPSS version 26. Results: The mean age of the patients was 44.81±11.10 years. Out of the total 102 patients, 74.5% were male patients and 25.5% were female. The mean duration of psoriasis was 6.46 ± 4.49 years. Out of all 32.4% had mild psoriasis (PASI < 7), 40.2% had moderate psoriasis (PASI 8-12), and 27.5% had severe psoriasis (PASI > 12). Regarding LFT values, 73.5% had elevated alanine transaminase (ALT), 32.4% had elevated aspartate transaminase (AST), 70.6% had elevated alkaline phosphatase (ALP), 68.6% had elevated bilirubin, and 67.6% had elevated gamma-glutamyl transferase (GGT). AST and GGT levels rise significantly linked to PASI (p- <0.05). Conversely, for ALP and Bilirubin levels, there is no significant difference across severity of PASI (p- >0.05). Conclusion: Patients with severe psoriasis exhibit a predisposition to hepatic dysfunction. Study observed abnormalities in liver function tests (LFT) among psoriatic patients, suggesting a potential link to liver disease development

Spectrum of Lower Respiratory Bacterial Pathogens and their Antimicrobial Susceptibility in a Tertiary Care Hospital at Rawalpindi

Objective: To study the spectrum of bacterial etiological agents causing lower respiratory tract infections and their antimicrobial susceptibility pattern in a tertiary care hospital at Rawalpindi. Methodology: A descriptive, cross-sectional study was conducted in the department of Microbiology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from June to December 2021. Total 130 patients with lower respiratory tract infections (LRTIs) irrespective of age and gender were included in the study while patients of pulmonary tuberculosis, fungal diseases and patients having prior antibiotic therapy before sample collection were excluded. Non quantitative cultures were performed for sputum, non- directed bronchial lavage (NBL), pleural fluid and quantitative cultures for bronchoalveolar lavage (BAL) and endobronchial (EB) washings specimens. Antibiotic susceptibility was performed using Clinical and Laboratory Standards Institute (CLSI) 2021 guidelines. Results: Pseudomonas aeruginosa (26.9%) was found to be the most prevalent bacterial pathogen followed by Klebsiella pneumoniae (23%). Both Gram negative and Gram-positive bacteria showed highest antimicrobial resistance to flouroquinolones. Gram negative bacteria were more susceptible to aminoglycosides and carbapenems. Gram positive bacteria were most susceptible to linezolid and vancomycin. Staphylococcus aureus was isolated from 8 samples, of which 5(62.5%) were Methicillin-resistant Staphylococcus aureus (MRSA). Conclusion: This study concluded that the most frequent bacterial pathogen causing lower respiratory tract infections was Pseudomonas aeruginosa and both Gram negative and Gram-positive bacteria showed highest antimicrobial resistance to flouroquinolones

Association of E-Cadherin Expression with Histological Type and Grade of Gastric Adenocarcinoma

Objectives: To determine the immune expression of E-Cadherin in gastric adenocarcinomas and its association with tumor histological type and grade to evaluate its prognostic significance. Methodology: This descriptive cross-sectional study was conducted at the Pakistan Institute of Medical Sciences Islamabad, from December 2017 to January 2021. Eighty-one patients from both genders, aged 21 to 83 years, undergoing gastric biopsies and Gastrectomy specimens to diagnose gastric adenocarcinoma were included in our study. Immunohistochemical processing was performed and the results were interpreted by the consultant pathologist for the expression of E-cadherin on gastric adenocarcinoma. The data were analyzed with SPSS version 17. Results: There was a significant statistical association between loss of E-Cadherin with histological type of adenocarcinoma (p = 0.000). In total 81 cases, there were 53 (65%) cases of intestinal type adenocarcinoma and 28 (35%) cases of diffuse type adenocarcinoma. Of the 28 cases with diffuse type gastric Adenocarcinoma, 10 cases showed complete loss of E-Cadherin. This complete loss of Cadherin was also seen in four out of 53 cases of intestinal adenocarcinoma, all of which were poorly differentiated intestinal type of adenocarcinomas. Total cases of well differentiated type of adenocarcinoma were nine; all of these showed high expression of E-Cadherin.  Conclusion: There is a strong association of E-Cadherin expression with the histological type and grade of gastric adenocarcinoma according to Lauren’s classification. As the grade of the adenocarcinoma gets higher there is more loss of E-Cadherin expression which proves its prognostic significance. It was also established that gastric adenocarcinoma is a disease of elderly with male predominance

Comparison between Ultrasound-Guided and Traditional Palpatory Approaches of Proximal Transradial Access for Coronary Angiography and Intervention

Objectives: To compare the efficacy and safety of ultrasound-guided versus traditional palpatory approaches of proximal transradial access (TRA) for coronary angiography and intervention. Methodology: This cross-sectional analytical study was carried out from September 2023 to February 2024 at the Cardiology Department of Fauji Foundation Hospital, Rawalpindi after ethical approval. After obtaining informed consent, 75 patients who presented with ischemic heart disease and underwent coronary angiography and /or percutaneous primary coronary intervention with proximal TRA were included by convenient sampling. In 37 patients of Group I, the traditional palpatory technique was used whereas, in 38 patients of Group II, the ultrasound-guided technique was used. The Statistical Package for the Social Sciences (SPSS) version 25 was used for data analysis. Results: The first pass success rate was 92.1% in Group II versus 75.7% in Group I with statistical significance. The mean cannulation time was greater in Group I than in Group II (p-value = 0.001).  The switchover to another procedure was 35.1% in Group I and 0% in Group II. Hematoma formation occurred in 24.3% of patients in Group I and 10.5% of patients in Group II but was not significant. Loss of radial pulse at 2 months was reported in 5.4% and 2.6% of the patients in Group I and Group II, respectively (p-value=0.53). Conclusion: Ultrasound-guided transradial access is associated with improved patient outcomes as compared to traditional approach. It has a higher first-pass success rate, reduced mean cannulation time, and lower frequency of switchover procedure. However, the difference in hematoma formation and loss of radial pulse between the two groups is not significant

Comparison of the Outcome Between Ligasure and Conventional Suture tie Techniques in Patients Undergoing Thyroidectomy

Objective: To compare the outcome between ligasure and conventional suture tie techniques in patients undergoing thyroidectomy. Study setting and duration: This study was conducted in the department of general surgery, DHQ hospital Dera Ghazi Khan, over a period of one year from September 2022 to September 2023. Subject and methods: This randomized controlled study was conducted on 60 patients divided in two groups, group a (ligasure technique and group b (conventional suture technique) having age 30-65 years either male or female gender presented to undergo thyroidectomy. Patients undergoing chemotherapy, recurrent cases and bleeding diathesis (INR > 1.5) were excluded. The participants were randomly assigned to group A and group B through draws method using sealed opaque envelopes. All the surgical procedures were performed as per institutional protocol by consultant surgeon with ? 5-year post-fellowship experience. All the patients received anesthesia as per hospital protocol. Results: This study was conducted on 60 patients divided in two groups equally, group a (ligasure technique) and group b (conventional technique). The mean age in group A was 47.80±11.54 years and 44.83±10.38 years in group B. among patient in group A 10 (33.3%) patients had total thyroidectomy while 20 (66.7%) patients had subtotal thyroidectomy and in group B 12 (10%) patients had total thyroidectomy while 18 (60%) patients had subtotal thyroidectomy. Group A had significantly shorter operative time (62.07±3.09 mins vs 69.70±3.18 mins, P = 0.0001) as compared to group B. According to the comparison of total blood loss between both groups, group A had significantly lower blood loss (56.27±2.50 ml vs 68.57±2.92) as compared to group B. Conclusion: It can be concluded that ligasure technique had better outcomes as compared to conventional suture tie technique. The mean operative time and blood loss was significantly lower in ligasure technique as compared to conventional suture technique. Keywords: Conventional technique, ligasure, mean operative time, post-operative blood loss, thyroidectom