Seasonal influence on postoperative hip fracture complications: Retrospective cohort of more than 1000 patients from a tertiary-care university hospital

Background: Hip fractures account for one of the most debilitating conditions affecting the general population amongst the developed and developing nations. Investigators aimed to study the influence of the ongoing season i.e. whether patients operated upon in summer or winter, on post-operative complications occurring within 30 days of surgical procedure for hip fractures at a tertiary care hospital and level 1 trauma center.Materials and methods: Investigators conducted a non-funded, non-commercialized retrospective cohort of 1045 patients with hip fractures managed surgically. Primary exposure was surgical procedures undertaken during the summer months (April-September). Our primary outcome was determining post-operative complication rates from January 2010 to December 2018 and evaluating impact of the season through univariate and multivariable regression analyses using Cox Proportional Hazard Algorithm with STATA V15. The work has been reported in line with the STROCSS criteria.Results: Age, ASA status, type of procedure, mechanism of injury and Charlson Comorbidity Index (CCI) were identified as significant associated factors with postoperative complications after hip fracture surgery. Although overall results revealed a rising rate of complications during the summer season with a relative risk (RR; 95% CI) of 1.1(0.89-1.32), univariate and multivariable analysis did not show any significant correlations.Conclusions: The results of this study did not demonstrate a significant seasonal variability in the rate of postoperative complications for hip fracture patients operated upon during the hot months of summer. More research is required to analyze postoperative complications in order to optimize patients\u27 outcomes

Do new trainees pose a threat to postoperative complications after hip fracture surgeries? Retrospective cohort of 1045 patients over a decade at a university hospital

Introduction: Induction of new residents and surgical trainees in most institutes occurs once a year. Fresh residents with no experience, may pose a threat to the surgical procedure outcome and there can be a potential increase in patients\u27 morbidity and mortality as a result of this turnover. Literature is inconclusive about this effect. Our aim was to study the new residents\u27 induction effect on postoperative complications after hip fracture surgeries.Methodology: This is non funded non commercialized study from a university hospital. Investigators studied a retrospective cohort of 1045 adult hip fracture patients who were operated at our tertiary care and level 1 trauma centre of a metropolitan city between 2008 and 2018. We defined primary exposure as the time period of new resident\u27s induction (January-March) with the primary outcome in-hospital and 30days postoperative complications. Cox proportional hazard algorithm analysis was done at univariate and multivariable levels reporting Crude Relative Risk (RR) and Adjusted Relative Risk (aRR), respectively. Results were reported in line with STROBE criteria.Results: There were 274 (26%) patients in exposed group out of whom 109 (40%) developed postoperative complications. Interestingly, patients who had their surgeries during the induction period of new residents had 8% less risk of developing postoperative complications. However, result was statistically insignificant at both univariate and multivariable levels with RR; 95% C.I of 0.9 (0.78-1.22) and aRR; 95% C.I of 0.9 (0.78-1.22) after adjusting for the all other independent variables.Conclusion: The association of new residents\u27 induction on postoperative hip fracture surgery complications, although protective, was insignificant after controlling for the potential confounding effect of patients\u27 background and demographic characteristics. We recommend further multi-centre high powered studies to analyze this

Community-based asthma assessment in young children: Adaptations for a multicentre longitudinal study in South Asia

Background: Systematic assessment of childhood asthma is challenging in low- and middle-income country (LMIC) settings due to the lack of standardised and validated methodologies. We describe the contextual challenges and adaptation strategies in the implementation of a community-based asthma assessment in four resource-constrained settings in Bangladesh, India, and Pakistan.Method: We followed a group of children of age 6-8 years for 12 months to record their respiratory health outcomes. The study participants were enrolled at four study sites of the \u27Aetiology of Neonatal Infection in South Asia (ANISA)\u27 study. We standardised the research methods for the sites, trained field staff for uniform data collection and provided a \u27Child Card\u27 to the caregiver to record the illness history of the participants. We visited the children on three different occasions to collect data on respiratory-related illnesses. The lung function of the children was assessed in the outreach clinics using portable spirometers before and after 6-minute exercise, and capillary blood was examined under light microscopes to determine eosinophil levels.Results: We enrolled 1512 children, 95.5% (1476/1512) of them completed the follow-up, and 81.5% (1232/1512) participants attended the lung function assessment tests. Pre- and post-exercise spirometry was performed successfully in 88.6% (1091/1232) and 85.7% (1056/1232) of children who attempted these tests. Limited access to health care services, shortage of skilled human resources, and cultural diversity were the main challenges in adopting uniform procedures across all sites. Designing the study implementation plan based on the local contexts and providing extensive training of the healthcare workers helped us to overcome these challenges.Conclusion: This study can be seen as a large-scale feasibility assessment of applying spirometry and exercise challenge tests in community settings of LMICs and provides confidence to build capacity to evaluate children\u27s respiratory outcomes in future translational research studies

Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan

Objective: To determine population-based estimates of COVID-19 in a densely populated urban community of Karachi, Pakistan.Methods: Three cross-sectional surveys were conducted in April, June and August in low- and high-transmission neighborhoods. Participants were randomly selected to provide blood for Elecsys® immunoassay for detection of anti-SARS-CoV-2 antibodies. Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district RESULTS: We enrolled 3005 participants from 623 households. In Phase 2, adjusted seroprevalence was estimated as 8.7% (95% CI 5.1-13.1) and 15.1% (95% CI 9.4 -21.7) in low and high transmission areas respectively, compared to 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0 - 1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3 - 17.7) and 21.5% (95% CI 15.6-28) in low and high transmission areas, respectively. CRI was 0.31 (95% CI 0.16-0.47) and 0.41(95% CI 0.28-0.52) in low and high transmission neighborhoods respectively in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. IFR was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3 respectively.Conclusion: Continuing rounds of seroprevalence studies will help us better understand secular trends and extent of infection during the course of the pandemic

Community-based asthma assessment in young children:Adaptations for a multicentre longitudinal study in South Asia

BACKGROUND: Systematic assessment of childhood asthma is challenging in low- and middle-income country (LMIC) settings due to the lack of standardised and validated methodologies. We describe the contextual challenges and adaptation strategies in the implementation of a community-based asthma assessment in four resource-constrained settings in Bangladesh, India, and Pakistan. METHOD: We followed a group of children of age 6–8 years for 12 months to record their respiratory health outcomes. The study participants were enrolled at four study sites of the ‘Aetiology of Neonatal Infection in South Asia (ANISA)’ study. We standardised the research methods for the sites, trained field staff for uniform data collection and provided a ‘Child Card’ to the caregiver to record the illness history of the participants. We visited the children on three different occasions to collect data on respiratory-related illnesses. The lung function of the children was assessed in the outreach clinics using portable spirometers before and after 6-minute exercise, and capillary blood was examined under light microscopes to determine eosinophil levels. RESULTS: We enrolled 1512 children, 95.5% (1476/1512) of them completed the follow-up, and 81.5% (1232/1512) participants attended the lung function assessment tests. Pre- and post-exercise spirometry was performed successfully in 88.6% (1091/1232) and 85.7% (1056/1232) of children who attempted these tests. Limited access to health care services, shortage of skilled human resources, and cultural diversity were the main challenges in adopting uniform procedures across all sites. Designing the study implementation plan based on the local contexts and providing extensive training of the healthcare workers helped us to overcome these challenges. CONCLUSION: This study can be seen as a large-scale feasibility assessment of applying spirometry and exercise challenge tests in community settings of LMICs and provides confidence to build capacity to evaluate children’s respiratory outcomes in future translational research studies

Serial population-based serosurveys for COVID-19 in two neighbourhoods of Karachi, Pakistan

Objective: To determine population-based estimates of coronavirus disease 2019 (COVID-19) in a densely populated urban community of Karachi, Pakistan. Methods: Three cross-sectional surveys were conducted in April, June and August 2020 in low- and high-transmission neighbourhoods. Participants were selected at random to provide blood for Elecsys immunoassay for detection of anti-severe acute respiratory syndrome coronavirus-2 antibodies. A Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district. Results: In total, 3005 participants from 623 households were enrolled in this study. In Phase 2, adjusted seroprevalence was estimated as 8.7% [95% confidence interval (CI) 5.1-13.1] and 15.1% (95% CI 9.4-21.7) in low- and high-transmission areas, respectively, compared with 0.2% (95% CI 0-0.7) and 0.4% (95% CI 0-1.3) in Phase 1. In Phase 3, it was 12.8% (95% CI 8.3-17.7) and 21.5% (95% CI 15.6-28) in low- and high-transmission areas, respectively. The conditional risk of infection was 0.31 (95% CI 0.16-0.47) and 0.41 (95% CI 0.28-0.52) in low- and high-transmission neighbourhoods, respectively, in Phase 2. Similar trends were observed in Phase 3. Only 5.4% of participants who tested positive for COVID-19 were symptomatic. The infection fatality rate was 1.66%, 0.37% and 0.26% in Phases 1, 2 and 3, respectively. Conclusion: Continuing rounds of seroprevalence studies will help to improve understanding of secular trends and the extent of infection during the course of the pandemic. &nbsp;</p

Oral health status of chemotherapy patients, subjected to additional oral hygiene instruction at a tertiary care hospital in Karachi Pakistan: Per-post design

Among patients undergoing chemotherapy, disturbances in the oral mucosa is a major concern. Oral complications associated with cancer chemotherapy can be somewhat averted through excellent oral hygiene practices. One of the most significant barriers in the implementation of oral care is lack of knowledge. The purpose of dissemination of oral hygiene education to the patients is to enlighten individuals and groups about the fundamental aspects of their oral health and attempt to change their behavior and encourage them to continue improving their own health. The study aimed to assess gingival and periodontal health of chemotherapy patients before and after the provision of oral hygiene instructions. METHODOLOGY: One group, pre and post-test study was performed to assess the oral health of chemotherapy patients at the Daycare chemotherapy of Aga Khan University Hospital. Oral hygiene instructions were explained with dental study models, leaflets and a short video at the baseline and then patients were followed for next 6-weeks. Oral health was assessed by using Oral Hygiene Index-Simplified (OHI-S) and Community Periodontal Index Treatment Needs (CPITN). Differences in indices were analyzed in STATA version-15.0 using Generalized Estimating Equation (GEE) and Wilcoxon Signed-rank test. RESULTS: Out of 74 enrolled, 53 (72%) patients completed study follow-up. Change in the OHI-S (from poor to fair) was found in 14 (26%) patients (P-value CONCLUSION: Basic oral hygiene instructional intervention can be effective in improving the oral hygiene of chemotherapy patients. Advanced educational programs need to be implemented to observe its influential effects on the oral health status of chemotherapy patient

Oral health of chemotherapy patients before and after provision of oral hygiene instructions at a tertiary care hospital: Pre-post design

Objective: Disturbances in the oral mucosa is a major concern among patients undergoing chemotherapy. One of the most significant barriers in the implementation of oral care is the lack of knowledge. The aim of the study was to assess gingival and periodontal health status of chemotherapy patients before and after the provision of oral hygiene instructions.Methods: A single group, pre-post test was conducted to assess oral health status of patients at the daycare chemotherapy, Aga Khan University Hospital, Karachi, Pakistan. Oral hygiene instructions were given with study models and leaflets. Patients were followed for 6-weeks. Oral health was assessed by using Simplified-Oral Hygiene Index (OHI-S) and Community Periodontal Index (CPI). Differences in indices were analyzed in STATA version-15.0 using Generalized Estimating Equation (GEE) and Wilcoxon Signed-rank test.Results: Out of 74, 53 (72%) patients completed study follow-up. Improvement in the OHI-S was found in 14 (26%) patients (p-value \u3c 0.001). GEE showed that age [adjusted OR = 1.10; 95% CI: 1.03-1.11], current chemotherapy cycle [adjusted OR = 1.19; 95% CI: 0.98-1.46], highest education level [Adjusted OR = 1.37; 95% CI: 1.08-12.7] and cancer therapy [Adjusted OR = 0.12; 95% CI: 0.24-0.55] were significantly associated with the change in OHI-S. Wilcoxon signed-rank test showed positive changes in the CPI (p-value \u3c 0.001).Conclusions: Basic oral hygiene instructional intervention can be effective in improving the oral hygiene of chemotherapy patients. Nurses should also play a key role in providing psychological and nutritional support to patients

Community-based seroprevalence of SARS CoV-2 in an urban district of Karachi, Pakistan

# Background Antibody-based serological tests which target households and communities can estimate the true extent of infection in a population. It minimizes the biases of facility-based selective testing and generates scientific data on disease transmission through household asymptomatic cases. The objective of this study was to determine the seroprevalence and trend of SARS-CoV-2 in a densely populated urban community of Karachi. # Methods Three serial cross-sectional surveys were conducted in November 2020, February 2021, and December 2021 in Karachi's District East. Households were selected to provide serum samples for Elecsys® immunoassay for the detection of SARS-CoV-2 antibodies. All household members were eligible to participate regardless of age and infection status. Bayesian regression was used to adjust for assay performance and estimate seroprevalence. # Results We enrolled 1506 participants from 501 households. In November 2020, adjusted seroprevalence was estimated as 24.0% (95% confidence interval, CI=18.0-31.0), compared to 53.9% (95% CI=45.5-63.2) in February. In December 2021, it increased to 84.9% (95% CI=78.5-92.3). The conditional risk of infection was 41% (95% CI=29.9-51.6), 56.7% (95% CI=50.4--62.6) and 77.8% (95% CI=73.0-81.7) in surveys 4, 5, and 6 respectively. Only 18.7% of participants who had reactive antibodies for COVID-19 were symptomatic. # Conclusions An increase in seroprevalence estimates in Karachi's District East was observed over time. Community-based seroprevalence studies help to estimate the true proportion of the population that has been infected and predicts the spread of the disease in similar settings