Antenatal Complications in Grand Multipara Presented at Tertiary Care Hospital

Background: Grand multiparity considered as a risk factor of obstetrics because of the recorded complications linked to the condition. Grand multiparity typically considered as the distinctive reason for the raised, maternal and fetal morbidity and mortality because of expanded incidence of adverse outcome during pregnancy and birth. Objective: To determine frequency of antenatal complications in grand multipara. Study Design: Cross-sectional study. Settings: Department of Obstetrics and Gynecology, Jinnah Postgraduate Medical Centre, Karachi Pakistan. Duration: Study duration was six months from March 2016 September 2016. Methodology: Total 212 patients were included in this study. Anemia was taken as Hb of 11g/dl, PIH was taken as BP of >140/90mmHg after 20 weeks of gestation with or without proteinuria on two or more occasion 6 hours apart and placenta previa was confirmed via ultrasonography. All the information was collected via study proforma. Results: Patients mean age was 34.90±3.51 years. Most of the patients 96.7% had parity 5-9. Anemia was found 69.8% and pregnancy induced hypertension was 22.2%, while placenta previa was found to be 18.9%. Antenatal complications including anemia, pregnancy induced hypertension and placenta previa were found to be statistically insignificant according to age, parity and BMI, (p->0.05). Conclusion: Most common antenatal complication in this study was anemia followed by hypertension and placenta previa. Grand multiparity is at a greater risk of antenatal complications.

Tramadol or Nalbuphine; Which One is Superior for Analgesia in Post-Operative Period after Percutaneous Nephrolithotomy

Background: Kidney stones has got high prevalence worldwide especially in our part of world and per-cutaneous nephrolithotomy (PCNL) is gold standard operative modality for renal stone management. Pain control after PCNL is the most important task for treating surgeon as effective pain control causes smooth patient recovery in post-operative period. For analgesia, many drugs can be used, out of which tramadol and nalbuphine always been in comparison for effective analgesic activity. Objective: To compare efficacy of tramadol and nalbuphine as potent analgesic in patients after PCNL. Study Design: A prospective randomized study. Settings: Department of Urology and Kidney Transplantation, Allied Hospital/Faisalabad Medical University, Faisalabad and Department of Urology, DHQ Hospital/Faisalabad Medical University, Faisalabad Pakistan. Duration: From September 2016 to September 2020 (4 Years). Methodology: 286 patients undergoing PCNL for either gender and sides enrolled in study according to inclusion and exclusion criteria. Patients divided into Group A (Administered with tramadol) and Group B (administered with nalbuphine) and patients evaluated for pain up to 48 hours after surgery using 11-point numerical pain rating scale rating from0-10 where 0 is no pain, 1-3 mild pain, 4-6 moderate pain, 7-9 severe pain and 10 as worst pain and use of rescue analgesia observed in either groups. Data obtained and statistical evaluation done. Results: 286 patients enrolled from age 15-75 years with mean age of 40.2 years. Among 286 patients, 161 were male and 125 were female patients. Both groups A and B having 143 patients each. Analysis showed that tramadol has superiority over nalbuphine and need of analgesia is more in patient given nalbuphine (118 vs 31) as maintenance analgesic agent in post-operative period after PCNL. Conclusion: This study showed that tramadol has superiority over nalbuphine for analgesia after PCNL.

Assessment of Nutritional Status of School Children in Public and Private Sector Schools by Anthropometry

Background: Nutrition is the real determinant of human health. The development of children into healthy adults is dependent on their growth, in a healthy environment and having balanced nutrition. Objective: (1) To determine the association of nutritional status of children with their age, sex and socioeconomic status. (2) To compare the nutritional status of government school children and private school children. Study Design: Comparative cross-sectional. Settings: Study was conducted in two schools of Faisalabad, Pakistan. Government Girls high school, Punjab Medical College (PMC), Colony Faisalabad and The Smart School, Faisalabad. Duration: Eight months from Jan 01, 2020 – Aug 30, 2020. Methodology: The study was conducted on 200 children, including males & females, to compare weights and heights among government (government) and private (private) schools. Age groups ranging from 9 above to 14 years were being studied. The data was collected by taking anthropometric measures, height and weight, of the students. To assess the nutritional status, the anthropometric measurement of WHO 2007 reference was used as Weight for Age Z-score (WAZ), Height for Age Z-score (HAZ) and Body Mass Index (BMI) for Age Z-score (BAZ). Descriptive statistics and Pearson’s correlation test were used for statistical analysis. Data was analyzed statistically by using SPSS version 20. Results: The weight of private school children (39.3400 ± 2.39199) was normal as they have adequate diet as compared to government school children (38.7500 ± 1.43812) while 2% children were over weighted. Height of private school children (147.7600 ± 5.04949) was more as compared to government school children (146.8100 ± 4.34310). Statistically Pearson Correlation between weight of private and government school’s children was highly significant, p=0.000, df= 1, CI= 95%. Demographic information with height and weight of the children were taken. Z-score was calculated and graphs were plotted. A value within ± 2 SD in these graphs was considered as normal. Conclusion: Socio-economic status affects the availability and quality of food. For under-weight Children, unhygienic and low-quality food/stuffs are the major contributing factors.

Circumcision; A Comparative Study Between ZACH Self-Locking Clamp & Bone Cutter

Background: The circumcision has been performed for religious, ethnic and medical response. In Pakistan 85%-90% of circumcisions are performed by traditional circumcisers. The surgical technique for circumcision involves traditional bone cutter. Objective: To compare the results of one of the most commonly performed surgical procedure, circumcision, by bone cutter and ZACH self-locking circumcision clamp method in terms of complications such as trauma to glans, bleeding and infection along with cosmetic outcome. Study Design: Randomized control trial. Settings: Department of Surgery in Allied Hospital, Faisalabad Pakistan. Duration: September 2018 to November 2019. Methodology: Total 160 patients were selected from OPD on the basis of non-probability consecutive sampling. After careful history taking and physical examination, patients fulfilling the criteria were identified into two equal groups, one underwent circumcision with Bone Cutter and the other with Zach self-locking circumcision clamp. Parents were instructed to follow up in the surgical OPD after seven days for assessment and earlier in case of any complication. Results: There was significant difference in terms of bleeding, superficial infection, cosmetic appearance and trauma to glans (P-value > 0.05). Conclusion: Zach self-locking clamp proved to be safe and effective technique with reproducible results as compared to bone cutter.

Comparison of Early and Delayed Laparoscopic Cholecystectomy in Acute Cholecystitis

Background: Laparoscopic Cholecystectomy is now accepted as being safe for acute cholecystitis. However, it has not become routine, because the exact timing and approach to the surgical management remains ill define. Careful selection of patients, the knowledge of typical procedure-related complications, and their best treatment are the key points for a safe Laparoscopic Cholecystectomy. Objective: To compare the early and delayed Laparoscopic Cholecystectomy in the acute phase in terms of frequency of conversion to open cholecystectomy. Study Design: Randomized clinical trial. Settings: Department of Surgery, Divisional Headquarter Hospital, Faisalabad. Punjab Medical College, Faisalabad Pakistan. Duration: Study was carried out over a period of six months from June 2018 to May 2019. Methodology: A total of 152 cases (76 cases in each group) were included in this study. All patients were randomly allocated to either group i.e., group -A early Laparoscopic Cholecystectomy and group-B delayed Laparoscopic Cholecystectomy. Results: Mean age was 39.09 + 8.8 and 37.05+ 8.5 years in group- A and B, respectively. In group-A, male patients were 48 (63.2%) and female patients were 28 (36.8%). Similarly, in group-B, male patients were 41 (53.9%) and female patients were 35 (46.1%). Conversion to open cholecystectomy was required in 6 patients (7.9%) of group-A and 16 patients (21.0%) of group – B. Significant difference between two groups was observed (P= 0.021). Conclusion: Early laparoscopic cholecystectomy for acute cholecystitis is safe and feasible in terms of less frequency of conversion to open cholecystectomy.

Clinicopathological Variants of Breast Cancer in a Tertiary Care Hospital in Pakistan

Background: Breast cancer is a growing phenomenon among females which has ever-lasting ramifications on the patient as well as the family. The only way of subjugating breast cancer is through an efficient and effective screening and subsequent treatment process. Objective: This study aimed at identifying the different clinicopathological patterns of breast cancer and the age group most frequently targeted by CA breast. Study Design: A prospective study. Settings: Fauji Foundation Hospital (FFH), Rawalpindi and Foundation University Medical College (FUMC) Pakistan. Duration: Six months from January 2018 to June 2018. Methodology: This study included 224 female patients, irrespective of their nationality by convenience sampling, who underwent any kind of breast surgery. The patients were evaluated according to their age, side of breast involved, site of lump in the breast, histopathology report and type of lesion (inflammatory, benign or malignant). The data was entered and analyzed using IBM SPSS version 25. Results: Our study sample of 224 individuals was found to have about 23 different histopathological variants of breast cancer. Invasive ductal carcinoma was found in almost all age groups and it was also the most common variant (80.8%), followed by invasive lobular carcinoma (4%). Majority of the cases were recorded in the elderly age bracket from 55 to 65 years. Right breast was found to be involved in 53.6% of the cases whereas left breast involvement was at 44.2%. 5 patients had lesions in both of their breasts. Upper outer quadrant was affected in 88% females followed by upper inner quadrant (6.7%). All four quadrants were involved in only 3 patients. Conclusion: This study concluded that invasive ductal carcinoma is the commonest clinical as well as pathological type of CA breast. 181 females out of a total of 224 had invasive ductal carcinoma. Therefore, this particular breast cancer type merits our special attention. Our study further concluded that most of the breast pathologies were found in elderly females aged between 55 and 65 years.

Satisfaction from Online Education among Undergraduate Students of Health Sciences in Punjab during Covid-19; An Online Survey

Background: The lockdown strategy has been implemented globally to contain the spread of current pandemic of COVID-19. Educational institutes around the globe are facing challenges and online learning is being carried out to avoid face to face contact during lockdown. Students have to adapt entirely new methods of learning through information technology. Objective: To assess the satisfaction level of health science students with online learning and use of internet during Covid-19 lock down in Punjab. Study Design: Cross-sectional survey. Settings: The data was collected from different institutes of Punjab using an online survey. Duration: Three months from May 2020 to July 2020. Methodology: A convenient sample of sample (N) 357 undergraduate medical students were included based on the response submitted through online questionnaire. Volunteer undergraduate students of MBBS, BDS, DPT, and Pharm D were included. The level of satisfaction was measure using Online Learning/Distance Education Questionnaire. Data was evaluated by SPSS version 22. Frequency tables and percentages was used to measure categorical variables. Results: 41 were males and 316 Females with mean age of 20.5±8.5. 15.6% Most of them had taken more than 03 courses online on computer for educational purpose. More than half students responded that they were motivated to attend online lectures. 23.52 % thought that they can pass any course is on internet-based study. 27.45% considered online and in physical classes as same. The access of internet was not issue for 50.98% students and 37.53% think that course can be completed online. Conclusion: The students were satisfied from online education during this time of transition of conventional classes to online classes. More than half of them felt no issue of internet and 37% think that course can be completed in this mode of education.

Peril Elements of Infection Severity, Disease Non-Improvement, Case Fatality and Management of Sars-Cov-2 in Sargodha Region Pakistan

Background: Corona virus is +ve stranded RNA virus pervasive in most of the atmospheres and towards the end of year 2019 it originated a pandemic as emerging microorganism which started in Wuhan city of China causing mild respiratory illness to severe acute hypoxemic respiratory distress syndrome in humans causing lot of deaths. Thanks to Almighty ALLAH that its virulence has been decreased in recent past in Pakistan due to better government planning and preventive measures. Objective: To manage moderate to severe COVID- 19 patients with pneumonias in HDU/ attached wards with central oxygen supply and to observe peril elements of infection severity, non-improvement and case fatality. Study Design: Descriptive, cross sectional, multicenter and heterogenous study of fifty COVID positive patients. Settings: High Dependency Unit & Isolation (Pulmonology ward) District Head Quarter Hospital Sargodha & Niazi Teaching Hospital (OPD), Sargodha Pakistan. Duration: From 15 May 2020 to 30 June 2020. Methodology: Fifty COVID- 19 patients over eighteen years of age presented with moderate to severe illness were enrolled for management in this study. Patients having +ve RT- PCR test (nasopharyngeal swab) for COVID-19/ CT chest with pneumonias, pyrexia, cough, tachypnoea with or without confusion, coma, dehydration, fits, low oxygen saturation, feeding difficulties, myocardial or renal injuries, raised liver enzymes, dysfunctional coagulation, expeditious disease advancement with respiratory failure (ARDS) were included in this study for management. Results: Every patient was admitted for moderate to severe COVID 19 pneumonias, tachypnoea etc. Eleven patients needed high flow nasal oxygen (HFNO) humidified oxygen or noninvasive ventilation (NIV) and non-rebreather mask and two patients required invasive ventilation, 24 patients (48%) patients had diabetes mellitus with complications, 8 patients (16%) had chronic obstructive airway disease (COAD) or asthma on steroids and hypertension with complications was diagnosed in 6 (12%) patients as well. As a whole two critically ill (one old aged diabetic) patients died over one and a half month of study period. Conclusion: COVID-19 can be a fatal disease especially in patients with old age, chronic illnesses (diabetes, COAD, hypertension and chronic renal failure etc.), immunocompromised states, early detection with management is of great value. This study interprets that early usage of NIV (CPAP and HFNO) diminishes respiratory failure symptoms, worsening of disease and the need for invasive ventilation.

Psychological Impact of Covid-19 Pandemic on the Healthcare Workers of a Tertiary Care Hospital of Lahore

Background: The psychological stress associated with the COVID-19 pandemic can have long-term effects on the health and coping abilities of HCWs. COVID 19 has exhausted the healthcare workers globally both physically and mentally. This article focuses on the Psychological stresses faced by the healthcare workers of a tertiary setup. Objective: To determine the psychological impact of the COVID-19 pandemic on the healthcare workers (HCWs) of a tertiary care hospital of Lahore. Study Design: Descriptive, cross-sectional study. Settings: Sharif Medical City Hospital, Lahore Pakistan. Duration: From July 2020 to August 2020. Methodology: A total of 82 healthcare workers were enrolled in the study on a voluntary basis by convenient sampling technique and filled an online questionnaire including demographic information, informed consent, validated Depression, Anxiety and Stress Scales (DASS-21) and the factors causing psychological distress. The data was analyzed using the Statistical Package for the Social Sciences (SPSS) version 24. Results: Out of 82 HCWs, 47(57.3%) had stress, 42(51.2%) had depression and 29(35.4%) had anxiety. Most of the HCWs with stress had mild and moderate stress. The majority of the HCWs were suffering from moderate depression and moderate anxiety. The most common factor causing psychological stress among HCWs was the fear of getting infected with COVID-19 followed by chances of spreading the disease to family members and the non-availability of personal protective equipment. Conclusion: The COVID-19 pandemic has a great psychological impact on the healthcare workers in Pakistan. A large proportion of HCWs suffered from stress (57.3%), depression (51.2%) and anxiety (35.4%). The most common factors causing psychological distress in HCWs were the fear of getting infected with COVID-19 (80.5%), chances of spreading the disease to family members (65.9%) and the non-availability of personal protective equipment (59.8%).

Assessment of Malnutrition in Chronic Liver Disease Patients with the Child Pugh Classification at a Large Tertiary Care Center in Karachi, Pakistan

Background: Child Pugh classification is an easy-to-use method that allows Physicians to assess malnutrition in patients suffering from CLD. Objective: To determine the frequency of malnutrition at different stages of chronic liver disease in accordance with Child Pugh classification. Study Design: The type of study is a cross-sectional study. Settings: Medical Unit III Civil Hospital, Karachi Pakistan. Duration: Six months from 31st May 2016 to 30th November 2016. Methodology: All the patients between the age 30 to 60 years who are known cases of CLD secondary to hepatitis B, C or both, with active signs of CLD were included. All the patients having debilitating co-morbidities likes malignancy, TB, psychiatric, etc. were excluded. Anthropometric evaluation and lab investigation at the time of admission were performed for all the patients. Results: The average age was 48.12±8.521 years and duration of disease was 5.48±3.792 months. There were 61.54% male and 38.46% females. Hepatitis-B was observed in 19.91% (n=44) cases, Hepatitis-C was 62.44% (n=62.44) and both hepatitis B and C was observed in 17.65% (n=39) cases. According to Child Pugh score, 9.5% cases were in class A, 32.58% were in class B and 57.92% were in class C. Frequency of malnutrition in chronic liver disease patients was 62.44% (138/221). Rate of malnutrition was significantly high in class B and C (p=0.002). Rate of malnutrition was also observed to be significantly high in those cases who were positive for both hepatitis like B and C (p=0.001). Effect of duration of cirrhosis was also not statistically significant with malnutrition. Conclusion: Malnutrition was significantly common among chronic liver disease patients regardless of viral etiology. Child Pugh B & C patients were found to have more significant malnourished states.