To evaluate operation theatre time utilisation during emergency cases.
The prospective, observational study was conducted at the Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from ...January 17 to April 17, 2020, during which the three dedicated emergency operating rooms at the centre were monitored for time from transferring the patient to the operation theatre till the patient was shifted out after surgery. Data was analysed using SPSS 24.
Of the total 1,287 surgeries performed, 625(48.56%) were included. Of them, 373(59.7%) patients were shifted to the operation theatre once it was ready, while 252(40.3%) were shifted in advance. There were 474(75.8%) male patients, and 151(24.1%) were females. The overall mean age was 32.7±17.4 years (range: ≤1 year to ≥47 years). Mean time of patient transfer to the operating room was 1:17±1:52 hours:minutes. Delay was recorded in 133(35. 6%) cases who were shifted from location when the operation theatre was available. It was caused in 64(17.15%) cases by surgical teams, another emergency surgery in the operating room 24(6.4%) and operating room cleaning 19(5%). The mean waiting time in the holding area was 1:25±1:21hours:minutes, and mean time from induction to surgical incision was 0:34±0:32 hours:minutes. Delays was caused by trainee surgeons in 79(12.64%) cases, and prolonged preoperative patient preparation in 99(15.84%). Mean turnover time was 0:48±0:42 hours:minutes. Delay was caused by post-operative unavailability of ambulance transportation 29(15%), and intensive care unit bed availability 14(7.2%).
Time utilisation of emergency operation theatres can be maximised by improved overall coordination.
ABSTRACT
BACKGROUND & OBJECTIVE: COVID-19 is caused by the SARS-CoV-2 virus. It can lead to mild to severe respiratory illness, as well as death. Nurses are frontline health workers to care the ...COVID-19 patients effectively. The objective of the study was to determine the knowledge, attitude, and practice regarding COVID-19 among nurses working at tertiary care public sector hospitals in Karachi.
METHODOLOGY: Analytical cross-sectional study was conducted at Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, for three months from October to December 2020.
The calculated sample size was 239 nurses of both genders. Non-probability convenient sampling technique was used to access the participants. A validated and open accessed tool was used for data collection. A Chi-square test was used to assess the association of Knowledge, attitude, and practice toward COVID-19 with demographic variables. The level of significance was considered with a p-value ≤0.05.
RESULTS: Out of the total, 145 (59.4%) were female, and a majority of 158 (66.1%) of the study subject's ages ranged from 25-30 years old. Mostly 156 (65.3%) of the study participants had a diploma in nursing. Approximately half of 130 (54.4%) of the participants worked the morning shift. The majority of 209 (87.4%) participants' experiences were two years and above. The gender and work experience of the participants were found statistically significant (p-value<0.05). This also found that more experienced nurses were somewhat better to mean Knowledge (7.87) than less experienced nurses (7.13).
CONCLUSION: It is concluded that most of the study participants had sound Knowledge, a positive attitude towards its remedy, and appropriate practice towards COVID-19.
KEYWORDS: COVID-19, Nurses, Knowledge, Attitude, Practice
Objective: To study the tolerability and efficacy of dolutegravir in naïve and experienced patients, their management and outcome.
Study Design: Cross sectional study.
Place and Duration of Study: ...Ruth KM Pfau Civil Hospital, Karachi Pakistan, from Apr 2018 to Apr 2020.
Methodology: In this study all treatment-naïve and experienced HIV infected patients were included and started on integrase strand-transfer inhibitor dolutegravir (DTG) containing fixed dose combination at Sindh AIDS Control Program (SACP) was conducted. We documented virological suppression, defined as a viral load of <1000 copies/ml, immunological and clinical outcomes.
Results: Eighty-two patients, of whom 53 (64.6%) were ARV naïve and 29 (35.4%) experienced, were started on DTG. Fifty six (68.3%) were males. The median age was 31.6 ± 9. Of 82, 61 returned for their first follow-up visit for assessment and viral load determination. Of 61, adverse effects to DTG were reported in 12 (19.6%), including 9 with pruritis. Of 35 naive patients, 30 achieved virological suppression by 3.3 ± 0.7 months and 1 at 8 months. All 26 experienced patients achieved virological suppression by 4.5 ± 0.9 months. Overall, of 61 patients, 57 (93.4%) achieved virological suppression, of whom 1 had immunelogical failure and none had clinical failure after 6 months of DTG. Three (3.6%) patients died within the first two months ofinitiating DTG.
Conclusion: Dolutegravir has good tolerability, with virological suppression achieved in the majority, including in highly ARV experienced patients.
Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients.
Study Design: Prospective observational study.
Place and Duration of Study: Shaheed ...Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019.
Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia.
Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option.
Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing...
Objective: To study the outcome in fetuses with intracardiac echogenic focus (ICEF) at the time of second trimester scan. Methods: All women with the sonographic findings of ICEF from January 2009 to ...December 2010 were included in this retrospective study. Results: ICEF were found in 71 out of 8226 screened (0.86%) women. Mean maternal age in the population was 26.9 ± 3.9 years. Foci were the isolated marker in 69 (97%) cases. In two cases there were additional findings of choroid plexus cysts. A fetal echocardiograph was done only in 13 (18.3%) patients. Majority of these pregnancies (95.7%) had a normal outcome. Postnatal echocardiograph was performed in 11 neonates (15%) out of which one had a small VSD, and in another case Tetralogy of Fallot was found. In addition, Pulmonary artery hypertension was diagnosed in one case. There was one intrauterine fetal demise and two neonatal deaths in this cohort. Conclusions: The prevalence of ICEF was 0.86% in our study population. About 95.77% of these cases had an uncomplicated perinatal outcome. It was an isolated finding in almost all cases. These findings will be helpful in counseling parents in our setting.
To determine pregnancy loss rate following amniocentesis in a mainstream urban healthcare centre.
We analysed cases of all pregnant women who underwent Amniocentesis at the Foetal Medicine Unit of ...Aga Khan University Hospital, Karachi, during 2001 to 2010. Cases of unknown pregnancy outcome were excluded, and after the process of consent, the final study population was 228 patients. Two operators performed the procedure using 22 G needle.
The mean age of women in the study was 32 +/- 6 years. The commonest indication of the procedure was a previous baby with Down's Syndrome. Majority 197 (86.6%) cases had a normal karyotype. Down's syndrome was 14 (6.1%). Regarding the outcome of pregnancies, it was normal in 173 (77.3%) cases while 2 (0.8%) intrauterine deaths were reported, one of which was within two weeks of the procedure. The number of pregnancy termination was 27 (11.7%). There was one miscarriage which means the pregnancy loss rate in the study population was 0.4%.
In order to have good quality control, healthcare audits are essential on both short-term and long-term basis.
To analyse the factors associated with Caesarean Section (CS) of Nulliparous, Term and Singleton pregnancies with Vertex presentation (NTSV) at a tertiary care hospital.
In this unmatched ...retrospective case-control study, 212 NTSV patients were identified through computerized medical record systems; the data was collected through predesigned Performa by reviewing medical record charts. One hundred six CS and spontaneous vaginal deliveries (SVD) were taken as cases and controls.
The mean maternal age of cases (CS) was 26.64 (SD: 3.9) and of controls (SVD) was 26.7(SD: 3.9) years, whereas mean gestational age was 38.66±1.12 and 38.57±0.9 weeks for cases and controls respectively. Ninety per cent of women in the study group were delivered within 10 hours of active labour. Babies that weighed ≤3kg were 45% and >3kg were 55%. The possibility of being high risk was twice more among those delivered by CS. However, it was not statistically significant (p value 0.077). Labour was induced in 38% patients. The Odds of Induction of Labour (IOL) were two times more and delivering at night was three times more amongst CS. The likelihood of labour exceeding 10 hours was four times (81%) if the patient had a CS. Moreover 48% of the babies weighing >3kg were delivered through CS. Maternal age, high risk pregnancies, gender of baby and epidural analgesia were not statistically significant predictors of mode of delivery (MOD) in this study.
Induction of Labour, night time delivery, prolonged labour and birth weight <3kg were found to be associated with the increased CS rate among NTSV. Therefore further research is required in order to address these factors and to reduce the increasing Caesarean Section.
In Pakistan, the first case of COVID-19 was reported in February of 2020, cases peaked in June, and by January 2021, approximately 500,000 confirmed cases and over 10,000 deaths have been reported. ...There is a lack of data in Pakistan of the demographics, clinical characteristics, and outcome of patients with COVID-19 pneumonia, particularly those with severe illness, which we aim to assess.
This is a single-centered, observational study conducted at the COVID unit of the Shaheed Mohtarma Benazir Bhutto Institute of Trauma in Karachi, Pakistan. A manual medical record review of patients admitted from April 24, 2020 to August 24, 2020 was conducted, and all patients with polymerase chain reaction (PCR) positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) with moderate, severe, and critical COVID-19 pneumonia were included.
Of 299 patients, the median age was 60 years (50-65). Males accounted for 221 (73.9%). Most common symptoms were shortness of breath seen in 270 (90.3%) and fever in 225 (75.3%) patients. Diabetes mellitus (51.2%) and hypertension (50.3%) were the predominant co-morbidities. COVID disease was categorized on admission as moderate in 68 (22.7%), severe in 151 (50.5%), and critical in 80 (26.8%) patients. Survival analysis was done in 252 patients, all of whom received steroids, while tocilizumab was administered to 111 (44%) patients. Hundred (39.7%) patients received non-invasive ventilation (NIV), while 57 (22.6%) were placed on mechanical ventilation. Overall, 95 (37.7%) patients died. Factors associated with mortality included older age with those above 60 years more likely to die (odds ratio OR: 1.925; 95% CI: 1.148-3.228; pvalue: 0.009), presence of co-morbidities (OR 1.843; 95% CI: 0.983-3.456; p value: 0.070), development of cytokine release syndrome (CRS) (73 56.2% vs 57 43.8%, p value: <0.001), acute kidney injury (31 81.6% vs 7 18.4%, p value: <0.001), cardiac complications (12 75% vs 4 25%, p value: 0.002), and sepsis (29 87.9% vs 4 12.1%, p value: <0.001). Non-survivors were more likely to develop acute respiratory distress syndrome (ARDS), having been placed on NIV and mechanical ventilation. Laboratory parameters at final outcome found that in non-survivors, median total leukocyte count, C-reactive protein (CRP), neutrophil lymphocyte ratio (NLR), and lactate dehydrogenase (LDH) were higher, while absolute lymphocyte count and platelet counts were lower which were found to be statistically significant compared to survivors.
In this study of patients with severe COVID-19 pneumonia at a public sector hospital in Karachi, Pakistan, most were males, and the average age was 60 years. Mortality was high, and associated factors included older age, presence of comorbid conditions, and the development of ARDS, CRS, and sepsis.
Awareness and knowledge of Human Papillomavirus (HPV) and HPV vaccine among women are not satisfactory in developing countries. The aim of this study was to assess the role of education in adult ...women about knowledge and awareness of human papillomavirus (HPV) and HPV vaccine.
This cross-sectional study was carried out in women aged 19- 50 years attending the out-patient waiting area of a tertiary care hospital in Karachi from August 2014 to August 2015. Convenience sampling was applied. After their written consent, a selfadministered questionnaire was used to obtain information regarding role of education and awareness, knowledge of human papillomavirus (HPV) and HPV vaccine. A total of 600 women completed the questionnaire.
Mean age of the study participants was 39±10.7 years. About 68% (n=405) had an education level intermediate or less, while 33% (n=195) had a bachelors or higher degree. A total of 56.3% (n=338) women were aged less than 40 years.
Awareness among women varies with the level of education acquired. As shown by results, a lesser proportion of undergraduate women were aware about HPV and its related diseases as compared women at graduate level. Moreover, our study identifies significant gaps in knowledge about sexually transmitted infections, HPV, cervical cancer and its prevention. There is an urgent need to develop public awareness programs targeting the adolescent and young adult women of our country.
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