Outcome of Kangaroo Mother Care in Preterm, Low Birth Weight Neonates; A Randomized Control Trial

In a recent meta-analysis, based on 13 randomized control trials, the researchers concluded that the neonates care with KMC at least 6 hours per day got significant weight gain as compared to the Non-KMC group with a mean difference 8.99 gm per day. They also concluded that the infants received KMC for less or equal to 02 hours per day not showed a significant difference in weight gain as compared to controls.1

An indirect evaluation of medical residents’ research writing skills by research synopsis review

Objective: To scrutinise the research proposals of medical residents for inadequacies in writing dissertation synopsis. Method: The analytical cross-sectional study was conducted at the regional centre of the College of Physicians and Surgeons Pakistan, Islamabad, Pakistan, and comprised synopsis from January to June 2020 of postgraduate residents attached with different hospitals in Rawalpindi and Islamabad.  For evaluation purposes, an institutional checklist was used that had 4 domains: general, epidemiological, statistical, and bibliographical review. These were assessed by a single epidemiologist. Data was analysed using SPSS 21. Results: Of the 400 research proposals, 224(56%) were submitted by male and 176(44%) by female residents. Also, 208(52%) proposals were submitted by residents at public-sector hospitals, and 114(28.5%) by those at private-sector hospitals, while 78(19.5%) were from military hospitals. Significant association of errors was found with training institutions, speciality and duration of training (p0.05). Conclusion: Majority of the research proposals lacked correct understanding of all the concepts related to research. Difference in research writing skills across specialties and training institutions may be related to the lack of availability of research assistance and good mentorship. Key Words: EBM, Residents, CPSP, Research, EBP, Epidemiology, Statistics

Comparison of Preoperative Temporal Bone High-Resolution CT with Intraoperative Findings in Patients with Cholesteatoma

Objective: To evaluate the use of a preoperative HRCT temporal bone for determining the amount and involvement of neighboring tissues by Cholesteatoma. Methodology: This cross sectional validation study was conducted at the department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from 1st July 2023 to 31st December 2023. The study pertains 40 suspected patients of middle ear cholesteatoma, included through consecutive sampling. The preoperative examination was bilateral temporal bone HRCT imaging, followed by intraoperative findings. For statistical significance, both findings were compared. Severity of the disease was also assessed through disease severity assessment index. SPSS v25 software was used for statistical analysis. P-value <0.05 was considered significant. Results: The average age of 40 cases of cholesteatoma was 36.73±18.22 years. The male to female ratio in the study was 2:3. We observed 16 different findings in our study and the results showed that HRCT results are associated with intraoperative findings against all structures with p value 0.000. The sensitivity specificity analysis showed that HRCT gives an unconfirmed results with a very low sensitivity for detecting facial canal erosion, tegmen erosion, LSCC erosion and sinus tympani and facial recess involvement. Conclusion: HRCT temporal bone scan clearly demarcates soft tissue density in the middle ear and mastoid with surrounding bone erosions, as well as anatomical differences. We concluded that HRCT is a helping tool for detecting the involvement of neighboring tissues by cholesteatoma

Effect of Induction of Early Meconium Evacuation using Glycerin Suppositories in Promoting Feeding Tolerance in Low Birth Weight Infants

ABSTRACTObjective: To determine the effect of Induction of early meconium evacuation using glycerin suppository in promoting feeding tolerance in low birth weight infants Methodology: This quasi experimental study was conducted in the department of neonatalogy, Pakistan Institute of Medical Sciences (PIMS), Islamabad. 120 neonates were included in both groups of the study. Standard treatment was given in control group whereas in intervention group along with standard treatment glycerin suppository was used. Preterm neonates who were low birth weight and of either gender were included in the study. The neonates with major congenial malformation, hemodynamic unstable, known cases of metabolic disease and confirmed cases of coagulopathy were excluded in the study. SPSS version 26 was used to analyze the data. Independent sample t test was used to compare the time to achieve full feed and time to achieve complete evacuation of meconium between two 2 groups. p value 0.05 was considered as significant. Results: The mean gestational age was 30.30±1.19 weeks. Out of 240, 127 (52.9%) neonates were male. All neonates included in the study have a very low birth weight range from 1 to 1.6 kg with a mean weight of 1.32±1.29 kg. The intervention group showed a significant low time to achieve full feed and low time to achieve complete evacuation of meconium 11.21±1.54 and 4.99±1.16 days as compared to the control group 12.73±1.46 and 5.97±1.1 days, with p value 0.000. Conclusion: Glycerin suppository helps to reduce the time to achieve full evacuation of meconium. Keywords: Full Enteral Feed (FEF), Glycerin Suppository, Meconium, Preterm Birth, Very Low Birth Weight (VLBW

Burns in South Asia: Outcomes from South Asian burn registry (SABR)

Background: South Asian region contributes 59 % to the global mortality due to burns. However, we find a paucity of literature on the outcomes of burns from low- and middle-income countries (LMICs). South Asian Burn Registry (SABR) is a facility-based burns registry that collected data on in-patient burn care. This study assesses factors associated with mortality, length of hospital stay at the burns center, and functional status of burn patients.Methods: Prospective data was collected from two specialized public sector burn centers between September 2014 - January 2015 from Bangladesh and Pakistan. Multivariable logistic, linear, and ordinal logistic regression was conducted to assess factors associated with inpatient-mortality, length of hospital stay, and functional status at discharge, respectively.Results: Data on 883 patients was analyzed. Increased association with mortality was observed with administration of blood product (OR:3, 95 % CI:1.18-7.58) and nutritional support (OR:4.32, 95 % CI:1.55-12.02). Conversely, antibiotic regimens greater than 8 days was associated with decreased mortality (OR:0.1, 95 % CI:0.03-0.41). Associated increase in length of hospital stay was observed in patients with trauma associated with their burn injury, history of seizures (CE:47.93, 95 % CI 12.05-83.80), blood product (CE:22.09, 95 % CI:0.83-43.35) and oxygen administration (CE:23.7, 95 % CI:7.34-40.06). Patients who developed sepsis (OR:6.89, 95 % CI:1.92-24.73) and received blood products during hospitalization (OR:2.55, 95 % CI:1.38- 4.73) were more likely to have poor functional status at discharge.Conclusion: This study identified multiple factors associated with worse clinical outcomes for burn patients in South Asia. Understanding these parameters can guide targeted efforts to improve the process and quality of burn care in LMICs

Factors associated with emergency department disposition among burn injury patients: Analysis of prehospital and emergency care characteristics using South Asia Burn Registry (SABR) data

Introduction: Improvement in burn injury data collections and the quality of databanks has allowed meaningful study of the epidemiologic trends in burn care. The study assessed factors associated with disposition of burn injury patients from emergency department accounting for pre-hospital care and emergency care.Methods: This prospective observational pilot study of the South Asia Burn Registry project was conducted at selected public sector burn centers in Bangladesh and Pakistan (September 2014 - January 2015). All age groups with an initial presentation to the burn centers were enrolled. Descriptive and regression analysis is presented.Results: A total of 2749 patients were enrolled. The mean age was 21.7 ± 18.0 years, 55.3% were males, and about a quarter were children \u3c 5 years. About 46.9% of the females were housewives. Scald burns were common among children (67.6%) while flame burns were common among adults (44.3%). About 75% of patients were brought in via non-ambulance mode of transport. More than 55% of patients were referrals from other facilities or clinics. The most common first aid given pre-hospital was the use of water or oil. About 25% were admitted for further care. The adjusted odds of being admitted compared to being sent home were highest for children \u3c 5 yrs, those with higher total body surface area burnt, having arrived via ambulance, scald and electrical burn, having an associated injury and inhalational injury.Conclusion: The study provides insight into emergency burn care and associated factors that influenced outcomes for patients with burn injuries