Knowledge of Nurses on the Management of Dengue Fever In Tertiary care Hospitals of Lahore and Rawalpindi

Objective: Assess the knowledge among nurses regarding the management of dengue fever working in tertiary care hospitals of Lahore and Rawalpindi.Study Duration: The study was completed in 2015 from March to Oct.Methodology: The proposed study design for this study is cross sectional descriptive study design. A sample of 280 staff nurses working in tertiary care hospitals were selected from Lahore and Rawalpindi hospitals by using method of non-probability convenient sampling. Data was collected by self-administered questionnaire. The data was analysed by SPSS version 20 and Microsoft Excel. Data was represented in the form of figures, tables, graphs, statistical association was found by using Chi-Square test among level of knowledge and demographic variables.Results: The results indicate that a major proportion of staff nurses 227 (76%) were having poor level of knowledge as they scored less than 50% of scores on knowledge based questions and only 4% were found with excellent knowledge according to arbitrary scale.Conclusion: The findings of study suggest that there is an inadequate knowledge of diploma nurses working in great strength in tertiary care hospitals of Lahore and Rawalpindi and there is a need to build a proper educational training programme for diploma nurse

Characteristics of Critically ill Obstetric Patients Admitted to the ICU at a Tertiary Care Centre

Objective: To ascertain the characteristics, admission indications, interventions, and outcomes of obstetric patients admitted to ICU.Methodology: A retrospective, descriptive study was conducted at Lady Reading Hospital's ICU in Peshawar, Pakistan (January 1 to December 31, 2022). During this time, a total of 1560 patients were received in the ICU, out of which 132 full filled our inclusion and exclusion criteria. Characteristics of patients, reasons for admission, interventions, demographic information, obstetric history, length of stay, and outcomes were collected through a retrospective review of medical records. Statistical analysis was performed using SPSS software version 21.0.Results: Among the 1,560 admissions in ICU, 132 were obstetric cases (8.5% of all ICU admissions). Majority of these patients had a mean age of 27.05 ± 6.23 years, with mean ICU stay duration of 6.55 ± 7.05 days. Among these, hypertensive disorders of pregnancy were identified in 47 patients (35.6%). Obstetric hemorrhagic disorders accounted for admission in 40 patients (30.3%). Out of the 132 patients, 26 (19.6%) did not survive. Highest mortality rates were of those admitted with fulminant hepatic failure (2 patients, 66.7%). Among patients admitted for direct obstetric reasons, post-natal septicemia caused the highest mortality (3 patients, 37.5%). Ventilatory support was required by 113 patients (85.6%) and vasopressor support was administered to 87 patients (65.9%) of the patients. Conclusions: To decrease maternal mortality and improve healthcare for pregnant individuals, it is crucial to focus on hypertensive disorders of pregnancy and obstetric hemorrhage. Addressing these issues, along with providing effective post-natal sepsis treatment, can contribute to a reduction in mortality rates.Keywords: Obstetric hemorrhage, Pre-Eclampsia, Post-natal septicemia, Mortalit

SURVIVAL OUTCOMES IN EARLY GLOTTIC CARCINOMA; A SINGLE INSTITUTION EXPERIENCE

Purpose: Laryngeal cancers are amongst the most common cancers affecting head and neck region. In this study, we analyse the overall survival (OS) following hypofractionated radiotherapy (RT) in early stage glottic carcinoma treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore. Methods: Between October 2003 and June 2009, 87 patients with early stage glottic carcinoma were treated with hypofractionated RT. All patients were included in the study. The ratio of male: female is 94%:6%. Mean age was 62 years (range 31–83 years). 66% of the patients were smokers. AJCC stage was T1a in 76%, T1b 20% and T2 in 4% of the patients. Histological distribution was; squamous cell carcinoma 97%, verrucous carcinoma 2% and squamous cell spindle variant 1%. Median follow-up time was 59 months (range 4–122 months). RT dose was 55 Gy in 20 fractions over a period of 4 weeks. Median RT treatment time was 28 days (range 23–35 days). Patients that lost to follow-up were contacted through telephone. Results: The 10-year OS was 83%. Patterns of failure was 7 local and 1 distant while 1 patient had persistent disease. 15 patients were dead at the time of study. Cause of death; 13 patients died due to Ischemic heart disease and 2 due to primary disease. Conclusion: Hypofractionated RT 55 Gy in 20 fractions seems to achieve good OS while offering potential for optimizing resources usage. Key words: Glottic carcinoma, hypofractionated, overall survival, radiotherapy

Strategies to cope claustrophobia during magnetic resonance imaging examination

Background: Claustrophobia associated with MRI scan is a well-recognized problem all over the world. The unpleasant psychological experience during MRI can lead to premature cancellation of the study resulting in non-interpretable data. In addition, performing future studies on the claustrophobic patient may not be possible leading to non-utilization of an important diagnostic modality. This study was conducted with the aim to determine a cheap and short intervention which can be applicable to small radiology set up as well.Methods: A prospective study was conducted at a tertiary care hospital from October 2016 to December 2016. Accompanying someone was the first strategy used to coped MR imaging claustrophobia followed by placebo (multivitamin), listening Quran and closed eye (blindfold). All those patients who failed to respond in these strategies were finally labeled as an unsuccessful candidate. Listening of Quran was selected as one of the tools as all the patients were Muslims in present study.Results: Among 84 claustrophobic patients, a closed eye was the most successful strategy found effective in (13) 81.2%, followed by placebo 66.7% patients, listening Quran (7) 30.4%, accompanying someone (15) 17.85% while 4% patients remained claustrophobic after application of all strategies. Significant association of accompanying someone and placebo was observed with education (p-value 0.037) and age of the patients (0.016) respectively.Conclusions: In general, placebo, being accompanied by someone and blindfold were found to be the most effective strategies to cope with MRI related claustrophobia. However, the success of these strategies is also dependent on certain factors like age, education status and socioeconomic status of the patients

Distribution, Severity and Radiologic Features of Intracranial Stenosis in Asymptomatic Pakistanis.

Background: Intracranial atherosclerotic disease (ICAD) is the most common ischemic stroke subtype globally. It accounts for 30–50% of all ischemic strokes in Asians. Aims—The aim of the study is to report the frequency of asymptomatic ICAD and its associated Magnetic Resonance Imaging (MRI) findings. Methods: 200 adult participants were recruited from the Radiology Departments of two major diagnostic centers in Karachi. Eligible participants were confirmed for the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS). QVSFS negative subjects underwent MRI on a 1.5 Tesla scanner. Images were centrally reviewed on Di com Viewer 3.0 with electronic calipers to calculate the degree of ICAD. Results: Mean age of subjects was 37.1 years (S.D 15.1) with 50.5% men (n=101) and 49.5% women (n=99). Asymptomatic ICAD was found in 34.5% (n=69) subjects. Of the 3800 intracranial arteries studied, 2.2% (n=88) had biological disease. 20.5% (n=18) of these vessels had atherosclerotic irregularities, 43.2% (n=38) had mild stenos is, 11.4% (n=10) had moderate stenos is, 5.7% (n=5) had severe stenos is while 19.3% (n=17) were completely occluded. The posterior cerebral artery (42% of stenosed arteries, n=37) was most affected. 23.5% (n=47) of subjects had peri-ventricular lucencies, 10.5% (n=21) had brain atrophy while 3.5% (n=7) had silent brain infarcts. There was a significant association between asymptomatic ICAD and peri ventricular lucencies (PR 1.59; 95% CI 1.35–1.99) Conclusion: Asymptomatic ICAD is common in young Pakistanis, with no gender predilection; it preferentially affects the posterior circulation. Silent infarcts are rare compared to peri ventricular lucencies and atrophy

Study protocol: asymptomatic intracranial atherosclerotic disease in pakistanis.

Background : Intracranial atherosclerotic disease (ICAD) is the most frequent subtype of ischemic stroke globally. It is important to describe the determinants of early ICAD as a strategy to prevent strokes from clinically evident and progressive ICAD. Our objective is to report the determinants of asymptomatic ICAD by linking the presence or absence of ICAD on magnetic resonance angiogram (MRA) with detailed risk assessment in asymptomatic adults. Methods : This is an observational cross-sectional analytical study. We plan to recruit 200 adult participants from the radiology departments of two tertiary care centers of Karachi, Pakistan. The participants will first be screened for the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS). QVSFS negative will be participants will be eligible. After written informed consent, participants will undergo detailed medical, sociodemographic, lifestyle, and anthropometric evaluation by a detailed interview. They will, in addition, undergo MRA to study the presence, degree, and distribution of asymptomatic ICAD. All MRA scans will be reviewed centrally by vascular neurologists blinded to clinical information. These images would be reviewed on DICOM Viewer 3.0 used for calculating the degree of stenosis using Warfarin–Aspirin Symptomatic Intracranial Disease (WASID) study defined criteria employing electronic calipers. A sample size of 200 will achieve 80% power for detecting a minimum difference of 20% in the prevalence of exposure factors (medical and lifestyle) between asymptomatic ICAD positive and ICAD negative persons. This study will generate regional data on risks for ICAD development and prevention in a high-risk susceptible population

Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis.

Background: Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region. Methods: The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin–Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios. Results: Of the 200 participants, ICAD was found in 34.5% (n = 69) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45 years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association. Conclusion: ICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Knowledge of Nurses on the Management of Dengue Fever In Tertiary care Hospitals of Lahore and Rawalpindi

Objective: Assess the knowledge among nurses regarding the management of dengue fever working in tertiary care hospitals of Lahore and Rawalpindi.Study Duration: The study was completed in 2015 from March to Oct.Methodology: The proposed study design for this study is cross sectional descriptive study design. A sample of 280 staff nurses working in tertiary care hospitals were selected from Lahore and Rawalpindi hospitals by using method of non-probability convenient sampling. Data was collected by self-administered questionnaire. The data was analysed by SPSS version 20 and Microsoft Excel. Data was represented in the form of figures, tables, graphs, statistical association was found by using Chi-Square test among level of knowledge and demographic variables.Results: The results indicate that a major proportion of staff nurses 227 (76%) were having poor level of knowledge as they scored less than 50% of scores on knowledge based questions and only 4% were found with excellent knowledge according to arbitrary scale.Conclusion: The findings of study suggest that there is an inadequate knowledge of diploma nurses working in great strength in tertiary care hospitals of Lahore and Rawalpindi and there is a need to build a proper educational training programme for diploma nurse