Sexual Perversion Leads to Laparotomy

Insertion of objects/stuff in bodily orifice is not unusual. There are many causes of penetration of bowel with different objects inserted via anus as to achieve sexual pleasure, to satisfy lust, self-injury, malingering and human trafficking is known for centuries. There are different household products used by the people to satisfy their lust/sexual desire but the objects/stuff used for this purpose mainly cylindrical and a type of soft texture. These objects are known for potential damage to gastrointestinal tract but it also affects other parts of the body and may create different inner complications, which needs to be evaluated and managed accordingly. Sometimes, management only requires local intervention, but if complications are build up like perforation develop needs laparotomy, broad-spectrum antibiotic therapy, repair of perforation with or without colostomy.

Frequency, Factors and Pattern of Delayed Presentation for Dialysis in Advanced Kidney Disease Patients Visiting Tertiary Care Hospital

Background: Globally the burden of chronic kidney diseases is increasing. It is often a silent disease until the most advanced stages when symptoms develop. Late referral and presentation to a nephrologist for CKD management is the major issue. Objective: To determine the frequency, factors and pattern of delayed presentation for dialysis in advanced kidney disease patients visiting tertiary care hospitals. Methods: The current cross-sectional study was conducted in Memon Medical Institute Hospital and Dow University of Health Sciences Ojha Campus Karachi Pakistan from December 2019 to March 2020. Patients who presented in the hospital for first-time dialysis with advanced kidney diseases were included in the study. The threshold of patient presentation after a month of advice for dialysis is used to categorize the patient presentation as delayed or non-delayed. Proforma was designed to collect data and SPSS version 21 was used for analyzing the collected data. Results: A total of 214 participants were recruited into the study. The median age of the participants was 40 (29.75 - 53) years. The majority were male (71%) and belonged to rural areas (63.1%). 50.9% of the patients presented with a delay of more than a month. The delayed presentation was significant among those belonging to rural areas (p=0.009) with higher median creatinine (p=0.002) and lower levels of education (p=0.001). The most frequent presentation was high blood pressure (89.3%), followed by oliguria (66.8%). Oliguria was significant among patients with delayed presentation (p=0.003). Patient perception for the delayed presentation was looking for transplant (69.2%) and fear of needle prick (52.3%). Conclusion: Delayed presentation for dialysis at tertiary care centers is a frequently seen issue particularly in patients belonging to rural areas presenting with a symptom of oliguria and fluid overload. Seeking alternative options such as renal transplants and fear of needles are the major reasons for delayed presentations in our study.

Adermatoglyphia (Loss of Fingerprints) in Young Female Patient Having the Conditions of Hyperhidrosis and Atopic Dermatitis

This is a case of Adermatoglyphia or simply a loss of fingerprints in a young female patient in her 20s having a condition of hyperhidrosis and atopic dermatitis. At a young age, this condition can be very frustrating and give the patient a red flag in his/her carrier and during international travel. The patient faces problems in unlocking smartphones and electronic devices. The patient has to keep a medical certificate from a certified Dermatologist all the time for proof of this condition. Adermatoglyphia is not recognized as a problem in society and law enforcement agencies are not aware of this condition in detail, all over the world.

Assessing Family Medicine Residents’ Communication Skills in Oman Using the Communication Assessment Tool: A Cross-sectional Study

Objective: Primary care physicians are the first means of access to further healthcare services and act as a doorkeeper for different specialties at the secondary and tertiary levels; thus, communication skills are one of the most vital skills to be taught to residents in the family medicine specialty. This study aimed to evaluate the communication skills of family medicine residents in Oman from the perspective of their patients. Methods: This cross-sectional study was performed at the Family and Community Medicine Clinic of Sultan Qaboos University Hospital as well as various Ministry of Health training health centers in Muscat, Oman. An Arabic version of the validated 14-item Communication Assessment Tool (CAT) was used to evaluate patients’ perceptions regarding the communication skills of family medicine residents at the end of their consultation. Data were collected between September 2020 and May 2021 from 602 patients who received care or interacted with 60 residents from the Oman Medical Specialty Board (OMSB) Family Medicine Residency Program at different residency levels. Results: The mean percentage of CAT items rated as excellent was 73.8%. The item “Treated me with respect” was most commonly rated as excellent (84.2%), whilst the item "Involved me in decisions as much as I wanted" was least frequently rated as excellent (62.0%). Various factors were found to significantly affect CAT rating, including residency level, type of clinic, number of times seeing the same resident, and the patient's education level. In contrast, other factors such as time of consultation, the gender of either the resident or the patient, and the nationality of the patient did not affect CAT rating. Conclusion: Some areas of weakness especially with the item "encouraged me to ask questions" and involved me in decisions as much as I wanted" identified in the communication skills of OMSB family medicine residents. These findings are comparable with those reported by similar studies worldwide.

Sensitivity Pattern of Salmonella Typhi from Blood Culture in Paediatric Population

Background: The bacterium Salmonella enterica serovar typhi causes typhoid fever which is a life-threatening systemic infection that mainly occurs in developing countries of the world and remains a major public health issue. Paratyphoid fever is caused by Salmonella enterica serovars Paratyphi A and B and (infrequently C). Appropriate and immediate antimicrobial therapy is required for the prevention of complications and mortality due to enteric fever. Therefore, this study is designed to investigate the current sensitivity pattern of Salmonella typhi so that appropriate antibiotics can be initiated on time. Objective: To determine the sensitivity pattern of Salmonella typhi in enteric fever among the pediatric population visiting a tertiary care hospital. Methods: This cross-sectional study was carried at the Department of Pediatrics in National Institute of Child Health Karachi from 13-12-2019 to 13-06-2020 after acquiring ethical approval from the hospital committee. There were 149 children aged 3-12 years of either gender diagnosed with enteric fever selected for this study. Patients' information was collected on pre-designed proforma. Blood of five milliliters quantity was drawn and sent to the pathology department within 12 hours of the admission. Salmonella typhi was identified by biochemical testing of the suspicious non-lactose fermenting colonies. Mueller Hinton Agar medium was used for testing antibiotic sensitivity. The sensitivity of the drug was interpreted as Sensitive, Intermediate and Resistant based on inhibition zone size. Results: The average age of the children was 5.56±2.39 years. Sensitivity for meropenem, azithromycin was 100% and 93.3% respectively while the sensitivity of ciprofloxacin was 53.7%. Ampicillin, Co-trimoxazole, Chloramphenicol and Ceftriaxone were more than 80% resistant. Conclusion: Our study confirms the sensitivity for meropenem, azithromycin, ciprofloxacin. Ampicillin, Co-trimoxazole, Chloramphenicol and Ceftriaxone showed higher resistance. This study emphasizes the need for continuous evaluation and judicious use of antimicrobials, considering the ever-changing antibiogram.

Spectrum and Antibiotic Resistance Pattern of Uropathogens Causing Urinary Tract Infection Among Inpatients and Outpatients: An Experience of a Tertiary Care Hospital in Karachi, Pakistan

Objective: To determine the spectrum and antibiotic resistance pattern of uropathogens causing urinary tract infection among inpatients and outpatients in a tertiary care hospital in Karachi Methods: This descriptive cross-sectional study was conducted in the Department of Microbiology, Sindh Institute of Urology and Transplant, Karachi, The study was conducted from March 2016 to March 2017 after taking approval from the Hospital Ethics Committee. Urine specimens were analyzed to establish a diagnosis of UTI and identify uropahtogens. The antibiotic susceptibility pattern of uropathogens was studied using disc diffusion method against the following antibiotics; fosfomycin, ampicillin, amoxicillin-clavulanate, nitrofurantoin, cefotaxime, ceftazidime, amikacin, cefoxitin, imipenem and vancomycin. Results: A total of 480 samples of UTI were received during the study period. The average age of patients was 54.79±12.09 years. The majority of samples came out positive from the male gender (65%) and in-patient department (n=400, 83.3%). The highest prevalent microorganism was E.coli (82.1%) followed by Klebsiella spp (14%), Pseudomonas aeruginosa (1%), Proteus mirabilis (1%), Morganella morgannii (1%) and Staphylococcus aureus (0.8%). All microorganisms were highly resistant to augmentin, cefoxitin, cefotaxime, ceftazidime. Only pseudomonas aeruginosa was highly resistant to imipenem (60%). Pseudomonas aeruginosa (100%), E.coli (86.8%) and Klebsiella spp (71.6%) were highly sensitive for Amikacin (100%). Morganella morgannii (80%) and Proteus Mirabilis (40%) were mainly resistant to Fosfomycin. Only E.coli was sensitive to nitrofurantoin (74.1%). Conclusion: The presented study demonstrated that gram-negative bacteria was the most frequent cause of urinary tract infection. Microorganisms showed variable resistance to different antibiotics. The first line of antibiotics should be rationally selected by physicians to treat urinary tract infections.

Health Inequalities Among Women in Developing Countries

Disparities or variations in the achievement of a person or a group in terms of health can be defined as health inequalities. Access to quality health services is restricted by gender inequality resulting in preventable morbidity and mortality in women. This paper will highlight the health inequalities among women in developing countries by analyzing the results of selected abstracts through scoping review. It will develop an understanding of how health services are prioritized and utilized by females in developing countries. In the developing world, men seek medical advice more often than women who prefer either self-management or delay seeking formal treatment only when their symptoms get worse. The efforts taken to reduce these inequalities and in addressing health-related issues are not sufficient and require more efforts by the implementers and policymakers. Investment in education and improving women in making their own decisions about health can support a reduction in inequality in health by changing the cultural and social environment of a country.

Case Report of Treatment Resistant Pyoderma Gangrenosum

This is a case of a 38-year-old married female diagnosed with Pyoderma Gangrenosum (PG) for 4 years. This patient was very anxious and frustrated. The patient was using all the standard treatments for PG, oral steroids 40mg/day, colchicine 2mg/day, topically tacrolimus 0.1%, topically metronidazole, oral 3rd generation of cephalosporin antibiotics 1gm/day, and oral dapsone 100mg/day but lesion was getting worse. The patient family and her husband were very supportive and all the negative options of physical and mental abuse, and not taking proper medicine have been completely ruled out by taking a detailed history from the patient alone. The patient is willing to get the cure and take and apply for all the medicines properly. All the other diseases have been ruled out that can be associated with PG such as inflammatory bowel diseases, trauma, vasculitis, arthritis, etc. The patient has been to many physicians but has not been able to get better and the lesion is getting worse day by day and because of this patient started the symptoms of depression and start losing weight. PG is a very worrisome disease and usually, PG cure rate is unpredictable. Patients having PG have emotional problems too because of lesions. The patient usually isolates herself from society and lost all her confidence.

The Influence of Socio-Demographic Characteristics on Patient Satisfaction in Family Medicine Clinics of Karachi

Objective: To determine the association of patients' satisfaction with demographic and socio-economic characteristics of patients visiting the family medicine clinics of the Aga Khan University. Design: Cross-sectional study Place and Duration of Study: The study was conducted at family medicine clinics at the Integrated Medical Service Centers, Aga Khan University, Karachi, from 10th January 2017 to 9th July 2017. Material and Methods: A total of 160 consecutive patients (48 males and 112 females, age range 18 – 65 years) visiting the family medicine clinics were recruited with informed consent. A validated questionnaire consisting of 18 items was administered to all patients who consented to participate in the study. The reasons for dissatisfaction were also assessed. Descriptive statistics were calculated. Stratification was done, and the association of satisfaction with age, gender, marital status, education, and economic status was investigated using the chi-square test. The p-value ≤0.05 was considered significant. Results: Out of a total of 160 study participants, 86.3% indicated their satisfaction, while 13.8% were found to be dissatisfied with the services at the family medicine clinic. The most common reason (50%) for dissatisfaction among the dissatisfied patients was the state of OPD facilities. On chi-square analysis, gender (p=0.028), education level (p=0.010) and socioeconomic status (p=0.002) were found to be significantly different among satisfied and dissatisfied patients. On multivariable analysis, education, marital status and socioeconomic status were found to be independently associated with patient satisfaction. Conclusion: The results showed that higher satisfaction was associated with higher education, higher socioeconomic status and higher among the widowed population.

Reflections of an Earliest Established Screening and Testing Facility for COVID-19 in the Largest Metropolis, Pakistan

As the world struggles to deal with the COVID-19 pandemic, this article talks about the experience and findings of the first COVID-19 screening facility in a tertiary care hospital in Karachi, Pakistan. Department of Family Medicine at Aga Khan University (AKU) took initiative where COVID-19 screening of stable patients first began in a dedicated area. Since testing kits were limited and community spread had not started, nurses would screen every walk-in patient based on the presence of fever, cough, travel history and exposure to COVID-19 positive patient in the last 14 days, and advise swab testing if indicated. Out of 742-screened patients, approximately 66% were males and 34% were females. 38% of patients reported fever and 54% of patients reported cough. 8% (65) patients checked all three screening criteria of cough, fever and international travel exposure whereas 35% were asymptomatic. The majority had clinical exposure (38.3%) followed by public exposure (33.4%) and international travel exposure (19.8%).