Prevalence of MRSA in Rawal Institute of Health Sciences Islamabad & its Antibiotic Susceptibility Pattern

Objective: To determine the prevalence of MRSA infection and its antibiotic susceptibility pattern in patients undergoing abdominal and vaginal surgeries. Material and Method: A retrospective observational study was conducted at Rawal General & Dental Hospital, Islamabad from September 2017 to September 2018 and data of approximately 300 patients were retrieved which included culture and sensitivity reports of wound and vaginal swabs of patients undergoing abdominal and vaginal surgeries to see prevalence of MRSA and antibiotics to which it is susceptible .Obesity was a risk factor and patients with immune-compromised status were not included. Result: Female patients were most affected 87%. Of the total cases, patients between ages 21 to 30 years were more frequent. The rate of MRSA was 37.0% in this study. There were 63% patients who showed methecilline resistance. Linezolid was more effective in MRSA and was sensitive in 81%. &nbsp

Depression, Anxiety and Stress in Female Doctors: A Cross Sectional Study from Rawalpindi

Introduction: Studies have shown that toiling in the medical field, especially in comparison to other professions is stressful. There is evidence that depression leads to reduced productivity in the workplace. Poor clinical judgement, increased chances of error in patient care and absenteeism all lead to reduced quality of work. Female doctors, in particular, are vulnerable to mental health issues owing to elements such as bullying, workplace sexual harassment, long working hours, frantic shifts, and domestic commitments. Materials and Methods: Over a six-month period (June 2020 to November 2020), we conducted a cross-sectional survey in three tertiary care hospitals in Rawalpindi, two of which were public sector and one private sector. We collected 328 samples by means of non-probability consecutive sampling. We used the Depression, Anxiety, and Stress Scale (DASS), a 42-item questionnaire via Lovibond and Lovibond with a Cronbach’s alpha of 0.89. Mean and SD of DASS total and subscale scores were compared for subjects stratified by age, marital status, designation, hospital status, and monthly household income via Student t-test and ANOVA. Results: The total mean DASS score reported by our participants was 31±26.92. Total mean DASS scores were significantly greater in House Officers and decreased as the designation rank increased (p=0.007). Mean DASS subscale scores showed that the junior female doctors were significantly more anxious (p=0.004) and depressed (p=0.041) compared to the senior doctors. However, there was no significant difference in stress scores, indicating that all the female doctors that participated were experiencing stress regardless of their designation. There was also no significant difference in DASS scores between private and public sector hospitals. Conclusion: Female doctors working in tertiary care hospitals of Rawalpindi reported depression, anxiety, and stress. Steps need to be taken to reduce risk factors for these mental health issues in order to boost workplace satisfaction and productivity

Impact of Legislated and Best Available Emission Control Measures on UK Particulate Matter Pollution, Premature Mortality, and Nitrogen-Sensitive Habitats

Past emission controls in the UK have substantially reduced precursor emissions of health-hazardous fine particles (PM2.5) and nitrogen pollution detrimental to ecosystems. Still, 79% of the UK exceeds the World Health Organization (WHO) guideline for annual mean PM2.5 of 5 μg m-3 and there is no enforcement of controls on agricultural sources of ammonia (NH3). NH3 is a phytotoxin and an increasingly large contributor to PM2.5 and nitrogen deposited to sensitive habitats. Here we use emissions projections, the GEOS-Chem model, high-resolution data sets, and contemporary exposure-risk relationships to assess potential human and ecosystem health co-benefits in 2030 relative to the present day of adopting legislated or best available emission control measures. We estimate that present-day annual adult premature mortality attributable to exposure to PM2.5 is 48,625 (95% confidence interval: 45,188-52,595), that harmful amounts of reactive nitrogen deposit to almost all (95%) sensitive habitat areas, and that 75% of ambient NH3 exceeds levels safe for bryophytes and lichens. Legal measures decrease the extent of the UK above the WHO guideline to 58% and avoid 6,800 premature deaths by 2030. This improves with best available measures to 36% of the UK and 13,300 avoided deaths. Both legal and best available measures are insufficient at reducing the extent of damage of nitrogen pollution to sensitive habitats. Far more ambitious reductions in nitrogen emissions (>80%) than is achievable with best available measures (34%) are required to halve the amount of excess nitrogen deposited to sensitive habitats

Impact of legislated and best available emission control measures on UK particulate matter pollution, premature mortality, and nitrogen-sensitive habitats

Past emission controls in the UK have substantially reduced precursor emissions of health-hazardous fine particles (PM2.5) and nitrogen pollution detrimental to ecosystems. Still, 79% of the UK exceeds the World Health Organization (WHO) guideline for annual mean PM2.5 of 5 μg m−3 and there is no enforcement of controls on agricultural sources of ammonia (NH3). NH3 is a phytotoxin and an increasingly large contributor to PM2.5 and nitrogen deposited to sensitive habitats. Here we use emissions projections, the GEOS-Chem model, high-resolution data sets, and contemporary exposure-risk relationships to assess potential human and ecosystem health co-benefits in 2030 relative to the present day of adopting legislated or best available emission control measures. We estimate that present-day annual adult premature mortality attributable to exposure to PM2.5 is 48,625 (95% confidence interval: 45,188–52,595), that harmful amounts of reactive nitrogen deposit to almost all (95%) sensitive habitat areas, and that 75% of ambient NH3 exceeds levels safe for bryophytes and lichens. Legal measures decrease the extent of the UK above the WHO guideline to 58% and avoid 6,800 premature deaths by 2030. This improves with best available measures to 36% of the UK and 13,300 avoided deaths. Both legal and best available measures are insufficient at reducing the extent of damage of nitrogen pollution to sensitive habitats. Far more ambitious reductions in nitrogen emissions (>80%) than is achievable with best available measures (34%) are required to halve the amount of excess nitrogen deposited to sensitive habitats

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Comparison of Manual Vacuum Aspiration Versus Conventional Evacuation of Retained Products

Objective: To compare the efficacy and safety of evacuation of Retained products of conception (ERPc) and Manual Vaccum Aspiration (MVA) in women experiencing a first-trimester miscarriageMaterials and Method: A comparative study was conducted at Rawal General & Dental Hospital, Islamabad from Sept 2016 to Sept 2017 and consisted of one hundred patients which were divided into two groups i.e. group 1 (ERPc) & group 2 (MVA). Data were extracted comparing the outcome in terms of safety and efficacy in both groups. Group 1 received General anaesthesia, while group 2 received paracervical block. Patients with a bleeding disorder, uterine anomalies, gestational trophoblastic disease and septic abortion were excluded from the study.Result: Primary outcome measures were efficacy and safety and complete evacuation were similar in both groups while secondary outcome included Hospital stay, operating time and need for evacuation was less in group 2 (MVA) as compared to group 1 (ERPc). The efficacy of group 2 was 98 % and group 1 is 94 % in the evacuation of the uterus.Conclusion: In patients with early pregnancy loss, treatment with MVA with local anaesthesia is an effective and safe alternative to Conventional Evacuation of Retained Products performed in general anaesthesia or sedation and it is more convenient and feasible for low socio-economic population