Comparison of current and emerging strategies for treating hepatic encephalopathy.

Objective: To compare the efficacy of rifaximin and metronidazole which are the most commonly used antibiotics used in treating this disorder. Study Design: Randomized Controlled Trial. Setting: Department of Medicine, Sharif Trust Hospital. Period: Jan 2018 to July 2018. Material & Methods: In this study cirrhotic patients irrespective of etiology were enrolled. West Haven Criteria (WHC) was utilized for grading the symptoms of HE at baseline and after 7 days of treatment. The study subjects were further subdivided into two groups: rifa group and metro group, and were given rifaximin and metronidazole respectively along with lactulose. The efficacy of the treatment and adverse effects in both the groups were estimated. Results: Total 180 subjects with HE (grade- III or IV) were selected, 90 subjects were subdivided into each group. Out of 90 subjects of Rifa group, efficacy of treatment was noted in 14 (15%) patients and out of 90 subjects of Metro Group, treatment was found effective in 45 (50%) patients with p value of 0.0001. Conclusion: The conclusion of this study is that metronidazole is superior to rifaximin in terms of efficacy in the management of an acute phase of hepatic encephalopathy due to chronic liver cirrhosis. Hence, due to its cheaper cost and a good safety margin its use is recommend in poor resource settings.

Prevalence of various pathogens isolated from urine cultures causing urinary tract infections in Bakhtawar Amin Trust Hospital, Multan

Objective: This study is conducted to ascertain the microbial agents along with their prevalence leading to urinary tract infections in patients admitted in Bakhtawar Amin Hospital, Multan with manifestations of urinary tract infections. Design: Descriptive observational study Place and duration of study: Department of Microbiology Bakhtawar Amin Medical & Dental College & Hospital, Multan from January 2021 to July 2021. Material and Methods: A total of 220 positive urine cultures were analyzed in this study extended for six months. All the appropriate details like age, gender, major presenting complaints, history of catheterization etc were noted. All the isolated urinary pathogens were recorded along with their frequency and percentages. Results: Out of these 220 patients with positive urine cultures, majority (63.6%) were male. Gram negative bacteria (E. Coli) constitute the major bulk of urinary pathogens followed by Candida. Conclusion: Urinary tract infections were commonly seen in men in our region. E. Coli was the most frequently encountered bacteria. A large number of Candida species were segregated in immunocompromised critically ill ICU admitted patients. Keywords: Urinary tract infection, culture, pathogens, E.Coli, Candida.

Role of Oral Tranexamic Acid in Treating Patients of Melasma in A Charity Hospital of Lahore

Objective: To evaluate the efficacy and safety of oral tranexamic acid (TA) in the treatment of melasma Method: This was a descriptive, cross sectional study which was performed in department of dermatology in Akhtar Saeed Trust Hospital, Lahore from April till December 2019. 70 patients of moderate to severe melasma were enrolled regardless of gender, > 18 years of age. 250 mg oral TA was given BD for 3 months along with broad spectrum topical sunscreen. Follow up done on monthly basis, 2 months after stopping the treatment. Photographs were taken at first visit & MASI (melasma area severity index) scoring done at start & after 3 months of treatment. Side effects were noted down if present. Results were recorded & analysed using SPSS. Results: A total of 70 patients were enrolled, 44 females and 26 males. Mean age of patients was 30.7. There was a significant decrease mean 3.4 in MASI scoring at 12 wks of treatment. 25 patients had good, 22 had fair, 7 had fair response to TA. No serious side effects were noted at end of treatment. No reversal of melasma was recorded at 2 months after stopping treatment. Conclusion: Oral tranexamic acid is a quick & effective treatment of patients of melasma. Key words: Melasma, tranexamic acid, treatment.

A Study to Assess the Knowledge regarding Cervical Cancer among staff Nurses in P.S. Medical trust Hospital, Thalakulam, K.K. District.

A descriptive study was conducted to assess the level of knowledge regarding cervical cancer among staff nurses in P.S. Medical Trust Hospital, Thalakulam at Kanyakumari District. Based on the convenient sampling technique, 20 subjects from P.S. Medical Trust Hospital, were selected. Question was given 15% of staff nurses having adequate knowledge 30% of the staff nurses having moderate knowledge and 55% of the staff nurses having inadequate knowledge. There is a significant association between knowledge and sex and there is no significant association between knowledge and (age, education, year of experience and type of family) the selected demographic variables.

To Study the Association between Weather and Frequency of Cataract Surgeries Performed Over Three Years in four different hospitals of Lahore, Punjab

Aim: To study the association between weather and frequency of cataract surgeries performed over the year in four different hospitals of Lahore, Punjab. Place and duration of study: The data of 8375 patients who underwent cataract surgeries over last three years 2017, 2018 and 2019 from four different hospitals, Medicare Eye hospital, Jinnah Hospital, Akhtar Saeed Trust Hospital and Lahore General Hospital, was collected. Study design: It was a cross sectional survey. Non-probability conventional sample was used. The data was analyzed by SPSS-20 and presented in forms of bar charts and line graphs. Methods: Total 8375 patients were selected from previous records for our study from four different centers. The hospitals were Akhtar Saeed trust hospital, Jinnah hospital,Lahore general hospital and Lahore Medicare Eye center. Lahore General hospital (LGH) and Jinnah Hospital are from government sector. Akhtar Saeed Hospital is a trust hospital and Lahore Medicare is a private Hospital.All patients with unilateral or bilateral cataract with age above 40 years were included where as patients under 40 years, cataract planned under general anesthesia and patients who had cataract associated with retinal attachment were excluded. Results: Total patients included in our study were 8375.There were 4439 (53%) men and 3936 (47%) women. Out of these 3721 (44.43%) from Jinnah hospital, 2498 (29.83%) were from Lahore General Hospital, 1676 (20.01%) from Medicare and 480 (5.73%) from trust Hospital. In Jinnah hospital, the highest number of cataract surgeries were observed in months of March 500 (13.44%), October 375 (10.08%) and February 341 (9.16%) and months with a smaller number of cataract surgeries were July 201 (5.40%), June 185 (4.9%) and August 170(4.57%).In LGH three months showing maximum number of patients were October313(12.53%), November 285(11.41%) and April 281(11.25%) and minimal in July 158(6.33%), August 128 (5.12%) and June 99(3.96%). Conclusion: It was clear from results of our study that higher number of cases were seen in months of March, April and October and the lowest number of surgeries were observed in months of June, July and August on an average. A definite seasonal variation was observed in number of cataract surgeries performed over the year, in different eye hospitals of Lahore (Punjab) Pakistan. Keywords: Cataract, Surgery, Seasonal variation

136 Readmissions to Hospital Following A Decision to Eat and Drink with Acknowledged Risk with Support From the Forward Care Bundle

Introduction The FORWARD care bundle (Feeding via the Oral Route With Acknowledged Risk of Deterioration) is used to support patients with dysphagia eating and drinking with acknowledged risk (EDAR) at our Trust. Key aims of FORWARD include improving advanced care planning (ACP) and avoiding unnecessary readmissions. This study aimed to determine the incidence of EDAR related readmissions (RR-EDAR) after FORWARD, and the effects of ACP and discharge location. Methods Retrospective review of all patients supported by FORWARD during admissions between January 2018 and December 2019. Data were collected on number and reasons for in-Trust hospital readmissions 6 months post-discharge, preferred place of care ACPs in event of EDAR related deterioration and discharge destination. Readmission reasons were classified as RR-EDAR (e.g. chest infection, reduced oral intake) and no relation to EDAR. Means (SD) and percentages are presented with comparisons using Fishers Exact Test. Results 316 patients were included; mean (SD) age 81(12). 64% (n = 202) of patients were discharged alive, 36% (n = 114) were alive at 6 months. 38% of live discharges (n = 75) were readmitted and 52% (n = 39) of these patients were RR-EDAR. Mean (SD) RR-EDAR number was 11, and 18% (n = 7) of patients had RR-EDAR >1 (range 1–5). RR-EDAR was only 7% (n = 4) in patients wishing to remain at home vs 25% (n = 33) in those without a documented place of care (p < 0.01). RR-EDAR was 23% (n = 29) in patients discharged to a private home vs 10% (n = 6) discharged to nursing/care homes (p < 0.05). Conclusions The majority of FORWARD patients are not readmitted. RR-EDAR comprises half of all readmitted patients and some have multiple admissions. Fewer patients with ACPs were RR-EDAR suggesting these are effective. Most patients RR-EDAR were from private homes, suggesting residential care may provide more support. Further work includes increasing ACPs, supporting patients with multiple RR-EDAR and those discharged to private homes.

Frequency of Diabetic Retinopathy and Factors for Suboptimal Diabetic Control in Type 2 Diabetic Patients in a Trust Hospital of Pakistan

Purpose: To find out the frequency of diabetic retinopathy and factors responsible for poor diabetic control in patients with type 2 diabetes in a trust hospital. Place and duration of Study: Akhtar Saeed Medical College, from January 2018 to December 2019. Study Design: Descriptive cross-sectional study. Methods: Total 395 diabetic patients belonging to lower socioeconomic class were included in the study. Type 1diabetes, age below 20 years, high myopia, papilledema, dense cataract, corneal scar and patients on dialysis were excluded. Age, gender, duration of disease, family history of diabetes, drugs used for diabetic control, compliance with drug, random serum sugar level at presentation, HBA1c level, best corrected visual acuity, slit lamp and fundus findings were noted. Results: There were 270 (68.4%) females and 125 (31.6%) males (total 395). Random serum sugar was below 200mg/dl in 188 (47.6%). Family history of diabetes was positive in 145 (36.7%). Duration of diabetes was below ten years in 288 (73%). Visual acuity was less than 6/60 in 36 (6.3%) patients. HbA1c was within normal range in only 124 (31.4%). CSMO was present in 199 (50.37%) patients. Diabetic retinopathy was observed in 57 (14.43%) patients. Patients using oral hypoglycemic agents were 225 (57%), on insulin 151 (38.23%) and19 (4.8%) were using both oral drugs and insulin. Compliance was poor in 294 (74.4%). Conclusion: Poor monetary resources compounded with lack of knowledge about disease, misconceptions regarding insulin and imbalanced diet are big hurdles in achieving optimal glycemic control in lower socio-economic class. Key Words: Diabetic Retinopathy, glycated hemoglobin (HbA1c), blood serum sugar, clinically significant macular edema.

HUBUNGAN KARAKTERISTIK PASIEN TERHADAP TINGKAT KEPERCAYAAN ATAS PELAYANAN YANG DIBERIKAN OLEH DOKTER RESIDEN DI RUANG RAWAT INAP RUMAH SAKIT UMUM PUSAT SANGLAH DENPASAR TAHUN 2017

ABSTRAKSalah satu faktor yang paling mempengaruhi kepercayaan pasien adalah kualitas pelayanan yang diberikan, dimana pentingnya karakteristik pasien sebagai penentu utama pembentukan persepsi terhadap suatu pelayanan di rumah sakit. Tujuan penelitian ini adalah untuk mengetahui hubungan karakteristik pasien terhadap tingkat kepercayaan pasien atas pelayanan yang diberikan oleh dokter residen. Penelitian ini dilakukan di Ruang Rawat Inap Kelas III RSUP Sanglah Denpasar. Desain penelitian menggunakan rancangan Cross Sectional analitik kuantitatif. Sampel diambil dengan teknik consecutive sampling sebanyak 109 responden. Analisis data dilakukan dengan uji statistik Chi Square Fisher Exact’s untuk melihat hubungan karakteristik pasien terhadap tingkat kepercayaan atas pelayanan yang diberikan oleh dokter residen. Hasil penelitian menunjukkan bahwa ada hubungan antara karakteristik pendidikan pasien (p=0,014) dan karakteristik umur (p=0,043) dengan tingkat kepercayaan pasien atas pelayanan dokter residen. Tetapi tidak ada hubungan antara jenis kelamin (p=0,104) dan pekerjaan (p=0,751) dengan tingkat kepercayaan pasien atas pelayanan dokter residen. Karakteristik umur responden rata-rata 42,02 pada kelompok umur ? 45 tahun, jenis kelamin perempuan, pasien lebih banyak berpendidikan SMA/SMK dan berstatus bekerja. Pasien memiliki tingkat kepercayaan yang tinggi atas pelayanan dokter residen (82,57%). Ada hubungan antara karakteristik pendidikan dan karakteristik umur dengan tingkat kepercayaan pasien atas pelayanan dokter residen. Untuk mencapai target kepercayaan pelanggan, dapat dilakukan dengan menjelaskan pelayanan yang diberikan oleh dokter residen kepada pasien yang memiliki umur lanjut usia serta berpendidikan rendah.Kata Kunci : Kepercayaan Pasien, Rumah Sakit, Karakteristik ABSTRACTPatient’s Trust is one factors that influences the quality of services provided by hospital. In order to determine the level of patient trust, hospital needs to comprehend the characteristic of patients for decision making related to services provides by the hospital. The purpose of this study was to find out the relationship of patient characteristic towards level of trust for the service provided by resident doctors. This research was conducted in class III inpatient room at Sanglah Hospital Denpasar. This study is a cross sectional with quantitative approach. Samples were taken by consecutive sampling technique with 109 respondents. Data analysis was performed with Chi Square Exact’s Statistical Test to find out the relationship of patient characteristics toward level of trust in the services provided by resident doctors. Patient characteristic in this study include age, sex, education, and occupation. Study found that 90 respondents (82,57%) had high level of trust in the services provided by resident doctors .There was a relationship between the characteristics of patient education (p=0.014) and age characteristics (p=0.043) with the level of patient trust in the services of resident doctors. But there is no relationship between sex and occupation with p value 0.104 and 0.751 respectively. Therefore, to achieve target of customer trust, it can be done by explaining the services provided by resident doctors to elderly patients and low education.Keywords : patient trust, hospital, characteristics