Patterns of Admission in Intensive Care Unit of Tertiary Care Hospital

Background: It is well known that early appropriate referrals of critically ill patients to an ICU can significantly reduce the mortality. At the same time, improper admissions to ICU limits bed availability that adversely affects ICU functioning. Objective: To determine the patterns of admissions and outcome in Medical and Surgical Intensive care Units.Material & Methods: A retrospective review of all patients admitted in medical and surgical ICU of Pakistan Institute of Medical Sciences, Islamabad from 2014 to 2016 was done. Data was collected from admission registers and patients’ files. Data was analyzed using SPSS software version 20.0. Chi-square test was applied and P-value < 0.05 was considered significant.Results: Study recruited data of 1652 patients admitted to intensive care unit of PIMS hospital. There were 769(46.5%) males and 883(53.5%) females. Among all the patients, 503(30.4%) were admitted to medical intensive care unit while 1149(69.6%) were admitted to surgical intensive care Unit. 684(41.4%) had undergone mortality while 968(58.6%) remained alive. Overall mean length of hospital stay was 7.4±4.1SD, mean length of mechanical ventilation 4.1±2.1SD and mean length of supplemental ventilation was 1.5±0.11SD. Acute abdomen (13.1%) and head injuries (12%) were most common causes for admission in ICU. Statistically significant association between years (2014, 2015 & 2016) and disease (p=0.000), years and mortality (p=0.000), years and age (p=0.000), intensive care unit and gender (p=0.01), intensive care unit and age (p=0.02) was reported.Conclusion: Acute abdomen and Head injuries had highest number of admissions in Medical and Surgical intensive care unit of PIMS hospital. Developing a well-equipped trauma ICU with adequately trained staff will help improve the outcome of patients

Efficient synthesis of 2-amino-6-arylbenzothiazoles via Pd(0) Suzuki cross coupling reactions : potent urease enzyme inhibition and nitric oxide scavenging activities of the products

In general, benzothiazole derivatives have attracted great interest due to thier pharmaceutical and biological importance. New 2-amino-6-arylbenzothiazoles were synthesized in moderate to excellent yields via Suzuki cross coupling reactions using various aryl boronic acids and aryl boronic acid pinacol esters and the antiurease and nitric oxide (NO) scavenging activity of the products were also examined. The most active compound concerning urease enzyme inhibition was 6-phenylbenzo[d]thiazole-2-amine 3e, with an IC50 value of 26.35 µg/mL. Compound 3c, 6-(4-methoxyphenyl) benzo[d]thiazole-2-amine, exhibited the highest nitric oxide percentage scavenging at 100µg/mL

Knowledge, attitude and practices of skilled birth attendants towards immediate postpartum family planning services

Provision of contraceptive services at the time of delivery is called immediate postpartum family planning (PPFP). Technical advisory group comprising of international experts has identified provision of immediate PPFP as one of the High Impact Practices . It can help in addressing the public health concern of high maternal, newborn and infant mortality. In Pakistan, PPFP uptake is reported only as 22% with 64% unmet need for FP in first year postpartum period leaving majority of women vulnerable to an unwanted pregnancy. The best opportunity for increasing the spacing between births is when a woman is in postpartum period, hence integrating FP services as a core component of maternity services is essential. In adoption of PPFP, Health Service Providers (HSPs) can be one major influencing factor and can strongly affect the clients\u27 behavior in attaining FP services. However, to maximize the role of service providers, it is important to understand the viewpoint of the providers and their concerns. The aim of this study was to evaluate HSPs\u27 knowledge, attitude and practice regarding immediate PPFP. Method: It was a descriptive, cross-sectional study done in ten selected public secondary and tertiary care hospitals in Karachi, Pakistan which have round the clock maternity care facilities. Study participants were accredited skilled birth attendants (doctors and nurse/midwives/LHVs). Interviews were completed on 237 SBAs on a specially designed questionnaire. Analysis of data was done by Statistical Package of Social Sciences (SPSS) versionl9 . Descriptive analysis for demographic information and practices of SBAs was done in the form of frequencies and percentages. Results: Of the total sample, 59% were Doctors and 41% were Mid-level providers. 78% of the SBAs had received FP Training whereas nearly quarter of SBAs (22%) were not trained for these services. Appropriate knowledge and attitude of participants was assessed by assigning scores. According to our cutoff value almost equal percentage of Doctors and Mid-level providers were knowledgeable about PPFP. The analysis also shows that 56% of Doctors and 35% of Mid-level providers were supportive towards immediate PPFP. Majority of SBAs considered provision of PPFP services their responsibility and expressed willingness to get trained for these services. However, one third of the Doctors and nearly half of the Mid-level providers mentioned providing these services as time consuming. Nearly 30% of these SBAs have the misconception that religion prohibits FP practices. Data revealed that 72% SBAs are presently providing these services and 28% SBAs are not offering immediate PPFP to their clients. Out of the SBAs who were not providing these services the main reasons were time constraint and fear of medical complications. Barriers to provision of immediate PPFP were lack of knowledge and skills. It is interesting to note that 30% of Midlevel providers were not permitted by Head of Departments to provide these services thus an opportunity of task sharing is missed. Conclusion: The findings of the study help to conclude that Government and other stakeholders need to work on knowledge enhancement and behavior change of all types of HSPs towards family planning in general and PPFP in particular. This will increase contraceptive uptake which is a proven strategy for addressing high maternal and neonatal mortality issues in Pakistan. Key Words: Immediate postpartum family planning, Health service providers, knowledge, attitude, practices

Effectiveness of Roflumilast in Treating Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

From PubMed via Jisc Publications RouterHistory: accepted 2022-03-03Publication status: epublishBackground Chronic obstructive pulmonary disease (COPD) is a chronic airflow obstructive condition. The mainstay of treatment is to avoid exacerbation and manage the symptoms. Roflumilast is being used as a part of treatment to reduce the inflammatory process in this disease. Method This systematic review and meta-analysis were conducted following the provided guidelines. PubMed, Cochrane Library, and Cinahl were considered for searching the desired studies selected until 19 June 2021. The eligibility criteria for inclusion and exclusion were set before selecting studies. Result Five hundred eighty (580) studies were identified at the beginning. Removal of duplicates was done using Endnote software. The eligibility criteria, including the randomized controlled trial study design and others, were applied for screening the title and abstracts. Six studies were selected for the qualitative analysis. After assessing the data from these studies, it was found that roflumilast is an effective drug to treat COPD. Roflumilast plays an essential role in improving quality of life, inflammatory process, and clinical improvement. The drug's mild to moderate adverse effects were observed, but no significant severe adverse events were reported, and the drug was well tolerated. Conclusion Roflumilast is a valuable drug that can be used for its beneficial effects on COPD exacerbation. The benefits of the drug outweigh its adverse effects. [Abstract copyright: Copyright © 2022, Naseem et al.

Patterns of Admission in Intensive Care Unit of Tertiary Care Hospital

Background: It is well known that early appropriate referrals of critically ill patients to an ICU can significantly reduce the mortality. At the same time, improper admissions to ICU limits bed availability that adversely affects ICU functioning. Objective: To determine the patterns of admissions and outcome in Medical and Surgical Intensive care Units.Material & Methods: A retrospective review of all patients admitted in medical and surgical ICU of Pakistan Institute of Medical Sciences, Islamabad from 2014 to 2016 was done. Data was collected from admission registers and patients’ files. Data was analyzed using SPSS software version 20.0. Chi-square test was applied and P-value < 0.05 was considered significant.Results: Study recruited data of 1652 patients admitted to intensive care unit of PIMS hospital. There were 769(46.5%) males and 883(53.5%) females. Among all the patients, 503(30.4%) were admitted to medical intensive care unit while 1149(69.6%) were admitted to surgical intensive care Unit. 684(41.4%) had undergone mortality while 968(58.6%) remained alive. Overall mean length of hospital stay was 7.4±4.1SD, mean length of mechanical ventilation 4.1±2.1SD and mean length of supplemental ventilation was 1.5±0.11SD. Acute abdomen (13.1%) and head injuries (12%) were most common causes for admission in ICU. Statistically significant association between years (2014, 2015 & 2016) and disease (p=0.000), years and mortality (p=0.000), years and age (p=0.000), intensive care unit and gender (p=0.01), intensive care unit and age (p=0.02) was reported.Conclusion: Acute abdomen and Head injuries had highest number of admissions in Medical and Surgical intensive care unit of PIMS hospital. Developing a well-equipped trauma ICU with adequately trained staff will help improve the outcome of patients

Supporting Depressed Mothers of Young Children with Intellectual Disability: Feasibility of an Integrated Parenting Intervention in a Low-Income Setting

As a lifelong condition, intellectual disability (ID) remains a public health priority. Parents caring for children with ID experience serious challenges to their wellbeing, including depression, anxiety, stress and health-related quality of life. Integrated parenting interventions, which have been well evidenced for depressed mothers, may also effectively support depressed parents with a child with ID in low-resource settings such as Pakistan, and in turn optimise child outcomes. We conducted a mixed-method rater-blind feasibility randomised controlled trial, which assessed the feasibility and acceptability of the Learning Through Play in My Own Way Plus (LTP-IMOW Plus) intervention. Mothers who screened positive for depression (n = 26) with a young child (age 3–6 years) with ID were recruited from two low-resource community settings. Participants in the intervention arm (n = 13) received 12 group sessions of LTP-IMOW Plus and others (n = 13) received routine care. The intervention was feasible and acceptable with 100% retention and 100% session attendance. The intervention improved depression, anxiety, parenting stress and child socialisation score outcomes relative to the routine care arm. The framework utilised to analyse the qualitative interviews with seven participants at pre-intervention identified a range of struggles experienced by the mothers, and at post-intervention, found improved knowledge of child development and practices, improved mother–child relationships, recommendations for the intervention and perceived practical barriers and facilitators. The findings highlight the prospects for a clinical and cost-effective trial of an integrated parenting intervention to manage long-term parental mental health needs and improve child outcomes

A facile synthesis of new 5-aryl-thiophenes bearing sulfonamide moiety via Pd(0)-catalyzed Suzuki–Miyaura cross coupling reactions and 5-bromothiophene-2-acetamide: As potent urease inhibitor, antibacterial agent and hemolytically active compounds

The present study reports a convenient approach for the synthesis of thiophene sulfonamide derivatives (3a–3k) via Suzuki cross coupling reaction. This method of synthesis involved the reactions of various aryl boronic acids and esters with 5-bromthiophene-2-sulfonamide (2) under mild and suitable temperature conditions. The compounds synthesized in the present study were subjected to urease inhibition and hemolytic activities. The substitution pattern and the electronic effects of different functional groups (i.e., Cl, CH3, OCH3, F etc.) available on the aromatic ring are found to have significant effect on the overall results. The compound 5-Phenylthiophene-2-sulfonamide 3a showed the highest urease inhibition activity with IC50 value ∼ 30.8 μg/mL compared with the thiourea (used as standard) having IC50 value ∼ 43 μg/mL. Moreover, almost all of the compounds were examined for the hemolytic activity against triton X-100 with positive results obtained in most of the cases. In addition, the antibacterial activities of the derivatives of 5-arylthiophene-2-sulfonamide and 5-bromothiophene-2-acetamide were also investigated during the course of the study