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PurposeStudy DesignLocation and Duration of StudyMethodologyResultConclusionTo determine the patterns of uveitis evident in patients presenting at the Uveitis Department of a tertiary care eye hospital located in Karachi, Pakistan.Prospective cross-sectional studyThis study was conducted at Layton Rahmatullah Benevolent Trust (LRBT) Tertiary Teaching Eye Hospital-Korangi, Karachi, Pakistan from August 2020 to July 2023.This prospective study was conducted at the Uveitis Department of LRBT Tertiary Teaching Eye Hospital, Karachi, Pakistan, from August 2020 to July 2023, following ethical review board approval. Patients underwent detailed history-taking, clinical examination by a uveitis specialist. Informed written consent was obtained. Demographic data were recorded, excluding post-opendophthalmitis cases. Laboratory tests and ocular investigations were performed when necessary.In this study, 5791 patients were analysed, with a predominance of females (55.4%) and a mean age of 38.22 ± 13.06 years. Bilateral eye involvement was found in 60.4% of cases, and the most common uveitis types were anterior (35.1%) and pan-uveitis (28.9%). Non-infectious uveitis (72.14%) was more prevalent, with idiopathic uveitis being the most common cause (33.2%). Significant associations were found between anatomical locations of uveitis and various clinical characteristics (age, gender, eye involvement and infection status). For instance, anterior uveitis was more commonly associated with unilateral eye involvement, while bilateral eye involvement was more frequent in cases of pan-uveitis and posterior uveitis. Additionally, infectious aetiology was more prevalent in pan-uveitis and posterior uveitis (p < 0.001).The primary aim of this study was to determine the patterns of uveitis cases observed at a tertiary eye care hospital in Karachi, Pakistan. The predominant aetiology identified was idiopathic uveitis. Nevertheless, it is essential to recognize that the determined prevalence may be subject to the inherent limitations of this study, notably pertaining to financial barriers and limited availability of diagnostic modalities. [ABSTRACT FROM AUTHOR]

Background: Health-care providers are prone to either physical, verbal, or both type of violence either by patients or their relatives with majority studies conducted in developed countries with paucity in developing countries like India. Aims and Objectives: This study was conducted to estimate the prevalence of different types of work-place violence and to assess the various factors associated with it among the health-care providers. Materials and Methods: It was a cross-sectional study conducted among total of 253 health-care providers, consisting of both Senior and Junior Residents and Nursing staffs for a period of 6 months. Data were collected, and then entered in MS-Excel with both descriptive and statistical analysis done using IBM-SPSS v23.0. Results: It was observed that 89.72% of the health-care providers experienced violence, where 66.01% of them experienced verbal type, while 23.71% of them experienced both, that is, verbal and physical. It was noted that majority of the health-care providers experienced verbal form of violence due to excessive crowd of attendant, that is, 123 (73.65%). Other factors such as not attending patient for a long time and lacunae of empathy towards patient/attendant have strong association with significant result for violence toward health-care providers, adjusted odds ratio (aOR) =4.69 (2.06-10.66), P=0.001 and aOR=4.52 (1.23-16.65), P=0.014, respectively. Conclusion: This study of workplace violence among health-care providers revealed that majority, that is, nursing staffs experienced verbal violence because they deal with patients and their attenders for maximum time in a day during their duty hours and also due to less experience. [ABSTRACT FROM AUTHOR]

Introduction: Iron deficiency anemia (IDA) is a major public health issue, particularly in developing countries like India, where malnutrition and limited access to healthcare exacerbate the problem. In the Sub-Himalayan region, the coexistence of IDA with deficiencies in Vitamin B12 and folic acid poses an additional challenge to healthcare providers. This study focuses on the prevalence of these combined deficiencies and aims to shed light on the complex interplay between iron, Vitamin B12, and folic acid metabolism in anemia. Aims: To assess the prevalence of iron deficiency anemia among patients in a tertiary care hospital in the Sub-Himalayan region Materials and Methods: This is a cross-sectional observational study conducted at a tertiary care hospital in the Sub-Himalayan region of India. The study was carried out over a period of 1 year, focusing on patients diagnosed with anemia.100 Patients were included in this study. Result: In our study, 5 (5.0%) patients had Normal Range, 13 (13.0%) patients had Mild Deficiency, 15 (15.0%) patients had Moderate Deficiency and 67 (67.0%) patients had Severe Deficiency. The value of z is 9.1335. The value of p is < .00001. The result is significant at p < .05. In our study, 1 (1.0%) patient had Alfa thalassemia trait, 1 (1.0%) patient had Beta thalassemia trait, 1 (1.0%) patient had HbE carrier, 7 (7.0%) patients had HbE disease, 14 (14.0%) patients had HbE trait and 76 (76.0%) patients had Normal Pattern in HPLC. Conclusion: This study demonstrates a strong correlation between iron deficiency anemia and deficiencies in Vitamin B12 and folic acid in the Sub-Himalayan region of India. The coexistence of these deficiencies complicates the management of anemia and necessitates a more comprehensive diagnostic approach. The findings underline the need for nutritional interventions and public health strategies to address these deficiencies in resource-limited settings. [ABSTRACT FROM AUTHOR]

Background: Infections involving sterile body fluids, such as cerebrospinal, pleural, peritoneal, synovial, and pericardial fluids, can lead to severe complications if untreated or improperly managed. Increasing antimicrobial resistance in these infections poses a critical challenge to patient care, especially in resource-limited settings like India. This study aims to assess the bacteriological profile and antibiotic susceptibility patterns of pathogens isolated from sterile body fluids in a tertiary care hospital, providing insights for empiric therapy optimization. Material & Methods: This cross-sectional study was conducted on 661 sterile body fluid samples collected from patients with suspected infections at a tertiary care hospital in India from March 2022 to February 2024. Samples underwent Gram staining, culture on selective media, and standard biochemical tests for bacterial identification. Antibiotic susceptibility testing was performed using the Kirby-Bauer disk diffusion method, with interpretations based on Clinical and Laboratory Standards Institute (CLSI) guidelines. Data on patient demographics, clinical history, isolated pathogens, and resistance profiles were recorded and analyzed. Descriptive statistics were used to summarize prevalence rates, while chi-square tests were employed for comparing resistance rates, with significance set at p<0.05. Results: The most frequently isolated pathogens in our study were Staphylococcus aureus (13.4%), Klebsiella pneumoniae (14.5%), and Escherichia coli (13.0%), with notable resistance observed to commonly used antibiotics, including methicillin in S. aureus (45.5%) and third-generation cephalosporins in K. pneumoniae (58.3%) and E. coli (61.9%). Gram-positive bacteria showed high resistance to penicillin, while gram-negative isolates had a substantial prevalence of extended-spectrum beta-lactamase (ESBL) producers. The overall incidence of multidrug-resistant (MDR) organisms was high, emphasizing the need for targeted antibiotic stewardship strategies. Conclusion: This study highlights the high prevalence of MDR pathogens in sterile body fluid infections, necessitating cautious empiric antibiotic selection. Findings underscore the importance of implementing routine antibiotic susceptibility testing and hospital-based antibiograms to enhance infection control practices and reduce treatment failures. Establishing effective antimicrobial stewardship programs is critical in limiting resistance trends and improving patient outcomes in resource-constrained healthcare settings. [ABSTRACT FROM AUTHOR]

The high frequency of P. aeruginosa was found in pus, urine and section tip in collected clinical samples as they yielded the isolates 32, 16 and 12 in number. Antibiotic susceptibility pattern reveals that cefeprime (n = 44) was the most effective drug against most of the isolated Pseudomonas aeruginosa pathogen followed by meropenem (n = 43), gentamicin (n=42) and amikacin (n=41), whereas moderate to least susceptibility was recorded against levofloxacin (n = 37), piperacillin and ciprofloxacin (n = 36), imepenem (n=34), ceftazidime (n=31), colistin (n=01). In the current study, carried out in Shri Mahant Indiresh Hospital, Dehradun (A tertiary care hospital) indicated the high prevalence of P. aeruginosa among patients of varied age group (from children to elderly people). Most vulnerable age group were from 20yr to 40 yr and 40yr to 60yr. The highest numbers of Pseudomonas aeruginosa were isolated from male patient (69%) in comparison to the female patient i.e., (31%). [ABSTRACT FROM AUTHOR]

Background: Health-care providers are prone to either physical, verbal, or both type of violence either by patients or their relatives with majority studies conducted in developed countries with paucity in developing countries like India. Aims and Objectives: This study was conducted to estimate the prevalence of different types of work-place violence and to assess the various factors associated with it among the health-care providers. Materials and Methods: It was a cross-sectional study conducted among total of 253 health-care providers, consisting of both Senior and Junior Residents and Nursing staffs for a period of 6 months. Data were collected, and then entered in MS-Excel with both descriptive and statistical analysis done using IBM-SPSS v23.0. Results: It was observed that 89.72% of the health-care providers experienced violence, where 66.01% of them experienced verbal type, while 23.71% of them experienced both, that is, verbal and physical. It was noted that majority of the health-care providers experienced verbal form of violence due to excessive crowd of attendant, that is, 123 (73.65%). Other factors such as not attending patient for a long time and lacunae of empathy towards patient/attendant have strong association with significant result for violence toward health-care providers, adjusted odds ratio (aOR) =4.69 (2.06–10.66), P=0.001 and aOR=4.52 (1.23–16.65), P=0.014, respectively. Conclusion: This study of workplace violence among health-care providers revealed that majority, that is, nursing staffs experienced verbal violence because they deal with patients and their attenders for maximum time in a day during their duty hours and also due to less experience.

OBJECTIVE: To assess the effectiveness of recitation of the Quranic verses on depressive symptoms among cancer patients. METHODOLOGY: This Pre-Post quasi-experimental single-group study was conducted from December 2021 to January 2022 in the Oncology department at Dr. Ziauddin Hospital Karachi. A total of 50 depressed Cancer patients participated in the study. Participants were recruited through the Consecutive sampling technique, which included being Muslim, having a one-month hospital stay, and a diagnosis of depression. Participants were assessed through the Hamilton Depression Scale (HAM-D). Data was analyzed through frequency and proportions for variables, and median and interquartile range differences were compared using the Wilcoxon signed-rank test. The association of depression was checked by Spearman rank correlation. RESULTS: Out of 50 participants, 32(64%) were males, and 18(36%) were females; 46(92%) were married; 50(100%) participants were belongs to Muslim religion and had a length of stay for 1 to 3 months durations. The comparison of HAM-D total scores revealed a median of 20.5 (IQR= 21-20) in the pre-test, which decreased to 13 (IQR= 14-12) in the post-test after one month of intervention. This reduction was statistically significant (p

Background: Worldwide, stroke is the most common cause of death after coronary artery disease (CAD). The risk factor stratification and prognostication of stroke patients are vital in planning and allocating health-care resources. Methods: We conducted a prospective, comparative observational study. Fifty age- and sex-matched cases each of ischemic stroke (IS) and intracerebral hemorrhage (ICH) stroke were enrolled, and baseline demographic, risk factor profile, Glasgow Coma Scale, modified Rankin scale (mRS), and Barthel Index (BI) were recorded, and the cases were followed up for 90 days or till death. We looked at the risk factors associated with IS and ICH and functional outcome of IS vis-à-vis ICH using mRS and BI at 90 days postenrollment. We also compared the mortality of IS vis-à-vis ICH. Results: The presence of hypertension (100% vs. 88%) and smoking (50% vs. 26%) was significantly higher in ICH (P < 0.05). The presence of diabetes mellitus (40% vs. 18%) and CAD (12% vs. 2%) was significantly more in IS cases (P < 0.05). Consumption of alcohol was more prevalent in ICH patients compared to IS patients (30% vs. 24%). Based on mRS and BI at 90 days, ICH cases had significantly poorer functional outcome compared to IS cases (P < 0.0001). Mortality of IS cases (4%) was also significantly less compared to ICH cases (30%). Conclusions: A combination of hypertension, smoking, and history of alcohol consumption had a higher predilection for the occurrence of ICH, whereas a combination of hypertension, diabetes mellitus, and CAD favored the occurrence of IS. The functional outcome of cases of ICH 90 days poststroke was significantly poorer compared to IS cases. The most important factors for poor outcome of ICH cases were more stroke severity at baseline compared to IS cases and the presence of intraventricular hemorrhages in some cases. Mortality was also found to be more in patients with ICH compared to IS.

Introduction Throughout history and up until the present, there has been a medicine shortage. In the early 1920s, there was a shortage of insulin, which is when drug scarcity first appeared in the records. Drug shortages are now more prevalent globally than they were back then. The goal of this essay is to pinpoint the key components that make up a definition for medication shortages and to pinpoint the circumstances that should be considered when reporting drug shortages in databases. Understanding the factors that led certain organizations to create their own definition of a medicine shortage was crucial for achieving these goals. The pharmaceutical regulatory environment can be connected to several reasons why there are medication shortages, including parallel trading, quality standards, and business choices to halt or reduce manufacturing. The many rules governing medicine shortages have not yet been the subject of a thorough investigation. This protocol’s objective is to analyze the pertinent legislative and regulatory frameworks in the European pharmaceutical system that affect medication shortages. The objectives of the study will be the non–availability of drugs at an outpatient pharmacy and to analyze the reason of non–availability of drugs. Methods An observational study will be adopted in this study. It includes a collection of data from the patient coming to the outpatient pharmacy of AVBRH Sawangi (Meghe) Wardha. Expected result It can lead to delayed treatment for patients seeking alternative medication. It can also lead to increased healthcare costs if patients seek alternative treatments that are more expensive or require additional medical care. The unavailability of drugs can also lead to frustration and anxiety for patients who need medication to manage their health condition. It can also negatively impact the reputation of the hospital.

Urinary tract infections (UTIs) are among the most common bacterial infections, posing significant public health challenges due to increasing antimicrobial resistance (AMR). This study aims to assess the prevalence, demographic characteristics, microbial profile, and antimicrobial resistance patterns in Indian patients with UTIs admitted to intensive care unit. A total of 154 patients with positive UTIs were included in this cross-sectional study. The prevalence data including demographics, microbial isolates, and antimicrobial susceptibility patterns were collected. Additionally, risk factors for multidrug resistance uropathogens were assessed using multivariate analyses. The patient cohort had diverse demographic, with a slight male predominance of 52.6% (n = 81). The most common comorbidities were hypertension 59.1% (n = 91) and diabetes mellitus 54.5% (n = 84). The microbial profile was dominated by gram-negative bacteria, particularly Escherichia coli 26.62% (n = 41) and Klebsiella pneumoniae 17.53% (n = 27). The predominant gram-positive and fungal isolate was Enterococcus faecium 7.14% (n = 11) and Candida spp. 18.83% (n = 29), respectively. Substantial resistance was noted against common antimicrobials, with variations across different pathogens. Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, exhibited high MDR rates, emphasizing the challenge of antimicrobial resistance. Multivariate logistic regression identified age groups 50–65 and over 65, and prolonged catheterization as significant risk factors for MDR infections. A significantly high resistance rate among pathogens emphasizes the need for judicious antimicrobial use. Our findings emphasize the necessity of ongoing surveillance and tailored interventions based on local pathogen prevalence and antibiogram data to effectively address the threat of AMR threat for better management of UTI management in ICU settings. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To assess the effectiveness of recitation of the Quranic verses on depressive symptoms among cancer patients. METHODOLOGY: This Pre-Post quasi-experimental single-group study was conducted from December 2021 to January 2022 in the Oncology department at Dr. Ziauddin Hospital Karachi. A total of 50 depressed Cancer patients participated in the study. Participants were recruited through the Consecutive sampling technique, which included being Muslim, having a one-month hospital stay, and a diagnosis of depression. Participants were assessed through the Hamilton Depression Scale (HAM-D). Data was analyzed through frequency and proportions for variables, and median and interquartile range differences were compared using the Wilcoxon signed-rank test. The association of depression was checked by Spearman rank correlation. RESULTS: Out of 50 participants, 32(64%) were males, and 18(36%) were females; 46(92%) were married; 50(100%) participants were belongs to Muslim religion and had a length of stay for 1 to 3 months durations. The comparison of HAM-D total scores revealed a median of 20.5 (IQR= 21-20) in the pre-test, which decreased to 13 (IQR= 14-12) in the post-test after one month of intervention. This reduction was statistically significant (p<0.05). CONCLUSION: The Quranic verses recitation is an effective and safe therapy for reducing depressive symptoms among cancer patients. The depression score significantly reduced after this intervention [ABSTRACT FROM AUTHOR]

Objective: This study is designed to identify the attributes of Evidence-Based Practice demonstrated by postgraduate residents in tertiary care hospitals in KPK, Pakistan. Material and Methods: A cross-sectional study was conducted at tertiary care government hospitals in the Khyber Pakhtunkhwa (KPK) province from March to August 2023. To achieve a 95% confidence level with a margin of error of 5%, the study aimed to collect data from a sample of 301 participants. This sample size was determined based on the assumption that the expected proportion of the population with the characteristic of interest is 31%. The instrument to assess healthcare professionals ‘perceptions, behavior, self-efficacy, and attitudes toward evidence-based health Practice (I-SABE) was used to collect data, and SPSS version 23 was used for data analysis. Results: Nearly half, or 48.4% (152 respondents), of the overall sampled population identified as male. This is a little higher than the percentage of women, which was 38.9% (122), with the majority in their second residence year 29.6% (93 respondents). With an average age of 34, the three main specialties represented were medicine, surgery, and gynecology. Self-efficacy, attitude, behavior, and patient care outcome scores of 24.22, 14.35, 30.07, and 24.49 on average were reported by residents, showing a modest level of confidence in their EBP skills. Confidence intervals and clinical trial measures were unclear to 42% (132) of respondents. Insufficient data (8.9% or 28 respondents) and problems with resource availability and time restrictions (14.3% or 45) were obstacles to the deployment of EBPs. Despite widespread support for medical research methods, consistent implementation was absent. Residents’ confidence grew as training continued, with little significant gender difference in self-efficacy scores. Increased confidence correlated with improved behavior. Conclusion: Although medical research techniques are generally appreciated, their consistent implementation remains a challenge. The adoption of evidence-based practices (EBP) faces various obstacles, including limited resources and knowledge gaps. As residents progress through their program, their confidence and use of EBP concepts increase. [ABSTRACT FROM AUTHOR]

Objective: To appraise the dietary perception and knowledge of cardiac patients visiting Outpatient department of a tertiary care hospital. Methods: A cross sectional study of 466 patients attending cardiac outdoor clinic at a tertiary care cardiac hospital in Rawalpindi, Pakistan were selected through convenient sampling from January to April 2021. Patients included in the study were above 18 years of age and had a cardiac disease. A structured questionnaire in English and Urdu was drafted with questions related to patient demographics, dietary perception and knowledge. Results: Among 466 patients, 60% (n=280) were males and 40% (n=186) were females whereas 14% (n=66) of the patients were uneducated and 15% (n=68) had completed postgraduate education. In this study 23% (n=106) of the participants used internet to search nutrition related information and 72 % (n=339) of the patients consider their lifestyle to be healthy. Majority (n=261, 56%) of the patients had no idea regarding sodium consumption. 46% (n=215) of the patients had no knowledge regarding the effects of bakery items on cardiac health. Conclusion: Dietary Knowledge plays a predominant role in the management of cardiac disease. The study concluded that cardiac patients had inadequate knowledge regarding dietary intake in cardiac disease and has high prevalence of dietary myths and misconceptions. Strategic plan including nutritional awareness program and intensive counseling sessions should be designed to increase dietary knowledge of cardiac patients. [ABSTRACT FROM AUTHOR]

Background: Early Onset Neonatal Sepsis (EONS) is a serious blood infection mainly microbial in nature and has worse health complications. Metabolic acidosis is one of such complications that occur due to acid-base imbalance and may result in lectic acidosis, myocardial depression, hypoperfusion, shock and even death in severe cases. Despite of its significance, limited local literature is available in this regard. Aims were to determine frequency of metabolic acidosis in early onset neonatal sepsis among neonates presenting in a tertiary care hospital. This was cross sectional study. Methods: Present study was conducted in department of Children's Hospital and Institute of Child Health Lahore. The data was collected through Non probability consecutive sampling from 242 neonates aged ≤72 hours of either gender diagnosed as EONS. Data was entered and analyzed in SPSS 22. For association, Chi-square test was applied and p-value ≤0.05 was considered as significant. Results: The mean age of patients was 36.49±18.33 hours with 137(56.61%) male and 105(43.39%) female cases in this study. The frequency of metabolic acidosis was 67(27.69%) of the cases with no association with age, birth weight, gestational age and gender (p-values >0.05). Practical Implication: Even recently, no local study has published the frequency of metabolic acidosis or found its association directly with EONS in Pakistan. Therefore, metabolic acidosis if found in EONS neonates, then in future every patient with early onset sepsis should be screened and can be managed timely. Conclusion: It is concluded that very high statistics of metabolic acidosis, i.e., 27.69% so every patient with early onset sepsis should be screened for metabolic acidosis to reduce worse health outcomes. [ABSTRACT FROM AUTHOR]

The main aim is to study on prescribing patterns of anti-diabetic drugs for patients with type- II diabetes mellitus. Out of 457 patients screened, 426patients were enrolled according to inclusion and exclusion criteria. Among them 62.44% were males and 37.55% were females. The study found to be a higher incidence of diabetes among elderly patients, with a high incidence in the age group between 41-60 years (50.70%) and followed by 61‑80 years (19.24%). The study resolved that most of the patients were suffering from diabetes for 5 to 10 years, 221 (73.94%) of duration years followed by 1 to 5 years, 94 (22.06%). A total of 1565 drugs were prescribed in the overall study period. 68.62% were diabetic drugs, 13.41% hypertensive drugs, 07.85% NSAIDs, 07.66% asthmatic drugs, 03.57% antidepressants, and 04.40% supplements of drugs. The study resolved that drugs were prescribed as monotherapy was 49.76%, two drug therapy were 36.61%, three-drug therapy were 08.45% and four-drug therapy was 05.16%. In this study, 426 anti-diabetic drugs prescribed, among that, the physician’s most well-liked single-drug therapy more than multiple drug therapy and also the most often prescribed category was Biguanides category of anti-diabetic agents. Among Biguanides, Metformin was the foremost often utilized anti-diabetic drugs. The foremost prevalent combination of the drug was a two-drug therapy of Biguanides +sulfonylureas, among these combinations, Metformin + Glimipride was the foremost often utilized anti-diabetic drugs. Followed by 3 drug therapy were Biguanides +sulfonyl ureas+ thiazolidinedione and 4 drug therapies were Biguanides + sulfonylureas + DPP 4 inhibitors + thiazolidinedione.Pharmacists can contribute drastically to promote the rational use of medicines, even in resource-limited settings. This, of course, requires strong collaboration between different institutions and commitments of the pharmacists to the cause. Pharmacist medication review, patient counseling and telephone follow-up can limit the Adverse Drug Reactions. Medication discrepancies before and after discharge were common targets of intervention. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic overburdened the healthcare system and affected the mental health of healthcare workers. Yoga has proven to improve mental health correlates, within diverse population groups, including healthcare workers. Considering the pandemic-imposed restrictions, this trial was designed to study the feasibility and effect of tele-yoga intervention on burnout, sleep quality, depression, anxiety, stress, mindfulness, and immune markers of healthcare workers on COVID-19 duty. Methods: This randomized controlled trial was conducted in a tertiary care hospital. Tele-yoga intervention was delivered five days a week for 8 weeks. Stanford Professional Fulfilment Index (SPFI), Pittsburg Sleep Quality Index (PSQI), Depression Anxiety and Stress Scale (DASS-21), Mindfulness Attention Awareness Scale (MAAS) were used to assess the burnout, sleep quality, depression, anxiety, stress and mindfulness. Blood samples were assessed for TNF-α, IL-6 and serum cortisol levels. Results: A total of 147 healthcare workers were screened to achieve a sample size of 90 (45 each in tele-yoga intervention and control group). Of the 45 subjects in the intervention group, 35 attended at least 50 % of sessions over 8 weeks, at the rate of 3.35 sessions per week. Nearly 37.14 % of subjects among 35 were able to attend more than 70 % of the tele-yoga sessions. At the endline, 35 in the intervention and 37 in the control group completed the outcome questionnaires. On both per protocol (PPA) and intention to treat analyses (ITT) the burnout index, PSQI, anxiety and stress scores and IL-6 and serum cortisol level were significantly lower among the tele-yoga group compared to control group participants (p

Introduction Throughout history and up until the present, there has been a medicine shortage. In the early 1920s, there was a shortage of insulin, which is when drug scarcity first appeared in the records. Drug shortages are now more prevalent globally than they were back then. The goal of this essay is to pinpoint the key components that make up a definition for medication shortages and to pinpoint the circumstances that should be considered when reporting drug shortages in databases. Understanding the factors that led certain organizations to create their own definition of a medicine shortage was crucial for achieving these goals. The pharmaceutical regulatory environment can be connected to several reasons why there are medication shortages, including parallel trading, quality standards, and business choices to halt or reduce manufacturing. The many rules governing medicine shortages have not yet been the subject of a thorough investigation. This protocol’s objective is to analyze the pertinent legislative and regulatory frameworks in the European pharmaceutical system that affect medication shortages. The objectives of the study will be the non–availability of drugs at an outpatient pharmacy and to analyze the reason of non–availability of drugs. Methods An observational study will be adopted in this study. It includes a collection of data from the patient coming to the outpatient pharmacy of AVBRH Sawangi (Meghe) Wardha. Expected result It can lead to delayed treatment for patients seeking alternative medication. It can also lead to increased healthcare costs if patients seek alternative treatments that are more expensive or require additional medical care. The unavailability of drugs can also lead to frustration and anxiety for patients who need medication to manage their health condition. It can also negatively impact the reputation of the hospital.

Background: Hypertension is a serious public health issue in the general population, with a considerable proportion of cases inadequately being treated. Methods: This hospital-based prospective study was carried out at our tertiary care teaching hospital between November 2019 and November 2021. One hundred patients who were recently diagnosed to have hypertension were studied. Results: The age of the subjects ranged from 31 to 78 years with a mean age of 49 years. Of these, 40% were in the 40–49 years’ age group; there were 68 males. The body mass index (BMI, Kg/m2) distribution of the study subjects showed 22% with normal weight, 62% in overweight and 16% in obese category. Microalbuminuria was evident in 28% of newly diagnosed hypertensives. The sex-wise distribution of microalbuminuria revealed that 17 of 68 males (25%) and 11 of 32 females (34.4%) had microalbuminuria. Conclusions: The chronicity of hypertension, age and BMI were the main factors determining microalbuminuria.

Background: The antibiotic resistance is on a rise globally due to irrational use. This survey evaluated the prescribing patterns of antibiotics in tertiary care hospital in Abbottabad. Study type,settings& duration: This observational, descriptive, and prospectivestudy was carried outin divisions of Gynecology, General Medicine, Pediatric Surgery,Orthopedicsand Pulmonology, Tertiary Care Hospital, Abbottabad, KPK from 2019to 2020. Methodology:An antibiotic prescribing pattern survey was carried out among the patients of hospital. Medical case sheets of patients and drug charts were used to record in standardized performs. Results:Total 203 patients on antibiotics were included in the study. Antibiotics prescribed in Gynae Department were UTIs 57%, LSCS 35%, NVD 20%, wound infection 16.6%, D&C 10%, SVD 10%, RTIs 6.6%, Extraction 6.6%, Stitch removal 6.6%, Hysterectomy 5%, Ectopic Pregnancy 5% post ovectomy 3.3% Uterine bleeding 3.3%, & most common dosage form:, Tablets: 56.6%,Capsules: 40%, Syrups:3.33% in Pead’s Department URTI 62%, Cold and fever 10%, Eye Infection 8%, LRTI 6% , in dosage form: Syrups: 82%. Drops: 12%, Injection: 4%, Tablet: 2%. In Surgical ward Ceftro:35%,Titan:20%, Grasil:20%,Flagyl:10%, Kefzol:5%, Ampiclox:5%, Bestrix:5%. In General OPD, RTI 48%, Wound Infection 18%, fever 14%, UTIs 8.33%, Pneumonia 1.66% the most prescribed dosage form, Injection :28%, Syrup:12%, Drops:8.0% Tablets: 8.0%, Capsules: 6.0%. In orthopedic ward: Grasil:22.2%, Amikacin:19.3%, Oxidil:18.8%, Titan:11.11%, Cefbactam:11.11%, Kefzol:10%, Sulperazone:5.55%, , Augmentin:5.55%, Gentacin:2.7%, Most prescribed dosage form: Injection :100%,Tablets, Capsules and Syrup 0%. In Pulmonary disease department Respiratory tract infection 55% and in Bronchitis are 35%. Most commonly prescribed dosage form: Injection :50%, Tablets :45%, Capsules :5%, Syrup, and Drops 0%. Mainly Augmentin was prescribed as a combination therapy. Most antibiotics were prescribed for 5-7 days. Conclusion:The survey indicates that the use of antibiotic in tertiary care hospital is very high and is not rational.

BACKGROUND: Diabetes is a significant cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation. Diabetes is a growing challenge in India, with an estimated 8.7% diabetic population (between 20 and 70 years). The macrovascular disease is the primary pathogenic mechanism underlying coronary heart disease (CHD). Microvascular disease may play a prominent role in CHD development in diabetic individuals. Diabetic retinopathy (DR) is a specific marker of microvascular disease in type 2 diabetes. It is unclear, however, if the presence of DR signifies an increased risk of CHD. OBJECTIVES: 1. To assess the proportion of DR and 10-year risk of developing CHD among study subjects 2. To assess the relationship between DR and CHD risk. MATERIAL AND METHODS: A cross-sectional study was conducted between January 2021 and November 2023 at a tertiary hospital in Tumkur among patients with type 2 diabetes mellitus. Data were collected using a pretested semi-structured questionnaire, and subjects were examined for DR and 10-year risk of developing CHD and data were analyzed. RESULTS: Among the study subjects, 65% were male, 74.3% were on oral hypoglycemic drugs, and 12.9% had a family history of CHD. DR was seen in 49.3% of study subjects. 10% of study subjects hada ≥ 40% risk of developing CHD. There was a statistically significant association between DR and the risk of CHD (P < 0.01). CONCLUSION: DR may be associated with increased cardiovascular disease risk. A careful cardiovascular assessment and follow-up may be required in individuals with DR.

Background: Hypothyroidism is a condition that develops due to the deficiency of circulating thyroid hormones. The correlation between psychiatric disorders and thyroid status is a major concern. Aim and Objective: The present study was conducted to assess the prevalence of depression and anxiety in such patients and to determine the associated risk factors. Materials and Methods: It was an observational and cross-sectional study conducted among 256 patients diagnosed with hypothyroidism attending the department of general medicine and endocrinology in a tertiary care hospital for 2 months. The study participants were selected based on inclusion and exclusion criteria. The permission from the institutional ethics committee was obtained and informed written consent was taken from all the study participants. The questionnaire was a standardized tool. Data were entered in Microsoft Excel worksheet 2013 and analysis was done using the SPSS software trial version 21. Results: Out of 256 study participants, the majority 204 (79.7%) were female. In the present study, 27.3% of study participants had mild depression, 19.10% had moderate depression, 10.5% had severe depression, and 10.5% of study participants had very severe depression. In the present study, 17.6% of study participants had a mild form of anxiety, 23% had moderate anxiety, and 7.7% had severe anxiety. Conclusion: Any patient on treatment for hypothyroidism for longer clinical periods must be screened for depression and anxiety symptoms and treated accordingly.

Abstract Background Studies have shown that Omicron breakthrough infections can occur at higher SARS-CoV-2 antibody levels compared to previous variants. Estimating the magnitude of immunological protection induced from COVID-19 vaccination and previous infection remains important due to varying local pandemic dynamics and types of vaccination programmes, particularly among at-risk populations such as health care workers (HCWs). We analysed a follow-up SARS-CoV-2 serological survey of HCWs at a tertiary COVID-19 referral hospital in Germany following the onset of the Omicron variant. Methods The serological survey was conducted in January 2022, one year after previous surveys in 2020 and the availability of COVID-19 boosters including BNT162b2, ChAdOx1-S, and mRNA-1273. HCWs voluntarily provided blood for serology and completed a comprehensive questionnaire. SARS-CoV-2 serological analyses were performed using an Immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Antibody levels were reported according to HCW demographic and occupational characteristics, COVID-19 vaccination and SARS-CoV-2 infection history, and multivariate linear regression was used to evaluate these associations. Results In January 2022 (following the fourth COVID-19 wave in Germany including the onset of the Omicron variant), 1482/1517 (97.7%) HCWs tested SARS-CoV-2 seropositive, compared to 4.6% in December 2020 (second COVID-19 wave). Approximately 80% had received three COVID-19 vaccine doses and 15% reported a previous laboratory-confirmed SARS-CoV-2 infection. SARS-CoV-2 IgG geometric mean titres ranged from 335 (95% Confidence Intervals [CI]: 258–434) among those vaccinated twice and without previous infection to 2204 (95% CI: 1919–2531) among those vaccinated three times and with previous infection. Heterologous COVID-19 vaccination combinations including a mRNA-1273 booster were significantly associated with the highest IgG antibody levels compared to other schemes. There was an 8-to 10-fold increase in IgG antibody levels among 31 HCWs who reported a SARS-CoV-2 infection in May 2020 to January 2022 after COVID-19 booster vaccination. Conclusions Our findings demonstrate the importance of ongoing COVID-19 booster vaccination strategies in the context of variants such as Omicron and despite hybrid immunity from previous SARS-CoV-2 infections, particularly for at-risk populations such as HCWs. Where feasible, effective types of booster vaccination, such as mRNA vaccines, and the appropriate timing of administration should be carefully considered.

Background: Frozen shoulder was introduced as Adhesive capsulitis by Naviesar in 1947. It commonly occurs between 40 and 70 years and is more common in females than males. Bilateral movements occur in 10-40 % of cases. It is mostly seen in patients with Diabetes mellitus. Patients with frozen shoulders are managed by Physiotherapy, medications (NSAIDs), corticosteroid injection, Arthrography infiltration, and manipulation. If not managed conservatively, surgical options are also available. The symptoms of the Frozen Shoulder can be reversed after the treatment has been taken. So, it is important to check whether the physiotherapy treatment is beneficial from a long-term perspective or not. Materials and Methods: A total of 37 patients participated in this study, 20 were females and 17 were males. Previous demographic and assessment data of these patients were recorded. Patients who were undergoing treatment were called to the Physiotherapy OPD and their pain, range of motion, and SPADI scale were assessed- A statistical analysis of comparison of previous and present scores was done by using a computerized method. Results: Statistical analysis showed significant improvement in pain and SPADI score in pre and post-test periods (p values of Visual analogue scale were 0.0628 for at rest, 0.009 for on activity, and 0.0033 for SPADI. Range of motion was not showing significance (p-value is more significant than 0.05), it was maintained throughout during pre and post-test periods. Conclusion: In statistical analysis, Pain and SPADI assessment showed significance, and Range of motion did not show significance in the pre and post-test. Hence, we conclude that treatment taken in Tertiary care hospitals is effective in patients with Frozen shoulders in a long-term perspective. [ABSTRACT FROM AUTHOR]

Background & Objectives: Psychosocial stress has a detrimental effect on nurses' work performance. A safe working environment is significant in providing nurses with safe and satisfactory care. The objective of study was to assess the frequency of psychosocial stress of nurses and determine the relationship between psychosocial stress of nurses and safety attitude towards nurses' performances at Tertiary Care Hospital, Karachi. Methods: Analytical cross-sectional study was conducted at Dr. Ruth KM Pfau Civil Hospital, Karachi, and Dow University Hospital Karachi for six months, from December 2020 to May 2021. A total 260 participants were approached by a non-probability purposive sampling. Pearson's correlation was used to establish the relationship between the psychosocial stress of nurses and different parameters of their safety attitude. The Chi-square test was applied for the association between demographic factors of nurses with their psychosocial stress levels. A p-value of <0.05 was considered as significant. Results: The majority of nurses, 180 (69.2%), described poor health, while 54 (20.8%) had good health, and only 10% (26) of nurses reported their best health status. Three parameters were negatively correlated and statistically significant with psychosocial stress, namely: teamwork (r-0.13<0.002), job satisfaction (r-0.15<0.028), and perception of management (r-0.34<0.000). The result of the study indicated that gender (P-value<0.000), marital status (P-value<0.0037), and institution (P-value <0.005) were significantly associated with safety attitude score. Conclusion: Most of the nurses had poor health, which was significantly related to teamwork, job satisfaction and perception of management, and stress recognition. [ABSTRACT FROM AUTHOR]

BACKGROUND: Diabetes is a significant cause of blindness, kidney failure, heart attacks, stroke, and lower limb amputation. Diabetes is a growing challenge in India, with an estimated 8.7% diabetic population (between 20 and 70 years). The macrovascular disease is the primary pathogenic mechanism underlying coronary heart disease (CHD). Microvascular disease may play a prominent role in CHD development in diabetic individuals. Diabetic retinopathy (DR) is a specific marker of microvascular disease in type 2 diabetes. It is unclear, however, if the presence of DR signifies an increased risk of CHD. OBJECTIVES: 1. To assess the proportion of DR and 10-year risk of developing CHD among study subjects 2. To assess the relationship between DR and CHD risk. MATERIAL AND METHODS: A cross-sectional study was conducted between January 2021 and November 2023 at a tertiary hospital in Tumkur among patients with type 2 diabetes mellitus. Data were collected using a pretested semi-structured questionnaire, and subjects were examined for DR and 10-year risk of developing CHD and data were analyzed. RESULTS: Among the study subjects, 65% were male, 74.3% were on oral hypoglycemic drugs, and 12.9% had a family history of CHD. DR was seen in 49.3% of study subjects. 10% of study subjects hada ≥ 40% risk of developing CHD. There was a statistically significant association between DR and the risk of CHD (P < 0.01). CONCLUSION: DR may be associated with increased cardiovascular disease risk. A careful cardiovascular assessment and follow-up may be required in individuals with DR. [ABSTRACT FROM AUTHOR]

Background: Studies have shown that Omicron breakthrough infections can occur at higher SARS-CoV-2 antibody levels compared to previous variants. Estimating the magnitude of immunological protection induced from COVID-19 vaccination and previous infection remains important due to varying local pandemic dynamics and types of vaccination programmes, particularly among at-risk populations such as health care workers (HCWs). We analysed a follow-up SARS-CoV-2 serological survey of HCWs at a tertiary COVID-19 referral hospital in Germany following the onset of the Omicron variant. Methods: The serological survey was conducted in January 2022, one year after previous surveys in 2020 and the availability of COVID-19 boosters including BNT162b2, ChAdOx1-S, and mRNA-1273. HCWs voluntarily provided blood for serology and completed a comprehensive questionnaire. SARS-CoV-2 serological analyses were performed using an Immunoglobulin G (IgG) enzyme-linked immunosorbent assay (ELISA). Antibody levels were reported according to HCW demographic and occupational characteristics, COVID-19 vaccination and SARS-CoV-2 infection history, and multivariate linear regression was used to evaluate these associations. Results: In January 2022 (following the fourth COVID-19 wave in Germany including the onset of the Omicron variant), 1482/1517 (97.7%) HCWs tested SARS-CoV-2 seropositive, compared to 4.6% in December 2020 (second COVID-19 wave). Approximately 80% had received three COVID-19 vaccine doses and 15% reported a previous laboratory-confirmed SARS-CoV-2 infection. SARS-CoV-2 IgG geometric mean titres ranged from 335 (95% Confidence Intervals [CI]: 258–434) among those vaccinated twice and without previous infection to 2204 (95% CI: 1919–2531) among those vaccinated three times and with previous infection. Heterologous COVID-19 vaccination combinations including a mRNA-1273 booster were significantly associated with the highest IgG antibody levels compared to other schemes. There was an 8-to 10-fold increase in IgG antibody levels among 31 HCWs who reported a SARS-CoV-2 infection in May 2020 to January 2022 after COVID-19 booster vaccination. Conclusions: Our findings demonstrate the importance of ongoing COVID-19 booster vaccination strategies in the context of variants such as Omicron and despite hybrid immunity from previous SARS-CoV-2 infections, particularly for at-risk populations such as HCWs. Where feasible, effective types of booster vaccination, such as mRNA vaccines, and the appropriate timing of administration should be carefully considered. [ABSTRACT FROM AUTHOR]

Introduction: Burn wound infections are a significant cause of morbidity and mortality among burn patients. Understanding of the prevalent bacterial etiologies and their antimicrobial susceptibility patterns within a healthcare facility is crucial for optimizing management strategies. Methods: This retrospective descriptive study was conducted over a four-year period at the Department of Microbiology in a tertiary care facility. We analyzed swab and pus samples collected from burn wound patients admitted to the Department of Plastic Surgery. Demographic data, including age and gender, were collected. Positive bacterial cultures underwent Gram staining and culture for identification. Biochemical tests were used for species-level identification. Antimicrobial susceptibility testing was performed using the disk diffusion method according to CLSI guidelines. Statistical analyses were carried out using SPSS software version 23 employing the chi-square test. Results: Out of 750 swab and pus samples analysed, 556 (74.1%) yielded positive bacterial cultures. Gram-negative bacteria predominated, accounting for 475 (85.4%) isolates, while 81 (14.6%) were Gram-positive. The most prevalent pathogens were Pseudomonas aeruginosa (175, 31.47%), Klebsiella pneumoniae (100, 17.99%), and Acinetobacter baumannii (68, 12.23%). Notably, 80.5% of P. aeruginosa isolates exhibited multidrug resistance (MDR). Among Staphylococcus aureus isolates, 37 (72.7%) were methicillin-resistant (MRSA). Conclusions: Among all isolates, P. aeruginosa was the most prevalent bacterial pathogen. S. aureus was the most prevalent Gram-positive organism. 72.7% of S. aureus isolates were MRSA. The high prevalence of multidrug-resistant P. aeruginosa and MRSA underscores the importance of implementing an antimicrobial stewardship program guided by local antibiograms. [ABSTRACT FROM AUTHOR]

Background: Hypertension is a serious public health issue in the general population, with a considerable proportion of cases inadequately being treated. Methods: This hospital-based prospective study was carried out at our tertiary care teaching hospital between November 2019 and November 2021. One hundred patients who were recently diagnosed to have hypertension were studied. Results: The age of the subjects ranged from 31 to 78 years with a mean age of 49 years. Of these, 40% were in the 40-49 years' age group; there were 68 males. The body mass index (BMI, Kg/m2) distribution of the study subjects showed 22% with normal weight, 62% in overweight and 16% in obese category. Microalbuminuria was evident in 28% of newly diagnosed hypertensives. The sex-wise distribution of microalbuminuria revealed that 17 of 68 males (25%) and 11 of 32 females (34.4%) had microalbuminuria. Conclusions: The chronicity of hypertension, age and BMI were the main factors determining microalbuminuria. [ABSTRACT FROM AUTHOR]

The Emergency Department is a fast-paced setting where nurses must deal with crucial situations such as psychologically disturbed patients. Therefore, this study has been conducted to investigate the knowledge of nurses to manage psychiatric patients in the emergency unit of a tertiary care hospital in Lahore, Pakistan. A descriptive-analytic design was conducted from January 21, 2023, to March 15 2023 at an emergency unit in Jinnah Hospital, Lahore. The study instrument was designed to meet the objectives of the current study, which consists of two parts: the first part includes the demographical data for nurses; the second part includes the knowledge management Scale 32 items (KMS). The study shows nurses have a good level of knowledge of items related to knowledge about the treatment of psychiatric disorders at the emergency unit as seen among 89.4%. The study concluded that most nurses have a good level of knowledge' about the treatment of psychiatric disorders at emergency units. Training and counselling sessions of nurses should be conducted to manage the psychiatric patients effectively. [ABSTRACT FROM AUTHOR]

Background: To determine the clinical profile of Childhood Lichen Planus (LP) in Pakistani patients presenting to Dermatology outdoors of a Tertiary Care Hospital. It was a crosssectional study, conducted at the Dermatology Outpatient of a Tertiary Care Hospital in Pakistan from December 2021 to December 2023. Methods: All new patients with either gender up to the age of 15 years with clinical diagnosis of LP were included. Clinical data was recorded for each patient separately. Physical examination was performed to determine the type of disease, presence or absence of Koebner phenomenon and the presence of other associated diseases. The data collected was analyzed using Statistical Package for Social Sciences (SPSS) version 23. Results: The mean age of onset was 9.792±2.774 and mean duration was 11.63±6.83 months. Pruritus was found in 51 (94.4%) patients. Classic LP was found in 35 (64.9%) cases, hypertrophic LP was found in seven (13.0%) cases and linear LP was found in six (11.1%) patients. Lichen planopilaris, actinic lichen planus and atrophic lichen planus were seen in one (1.9%) patient each. Nail involvement was seen in 5 (9.3%) patients with only one (1.9%) having nail only lichen planus. Similarly, mucosal involvement was seen in 7 (13.0%) patients and only two (3.7%) patients had mucosal only lichen planus. Conclusion: Lichen planus is uncommon in children. Childhood LP largely resembles adult LP. There is no significant gender predominance. Nail Lichen planus and mucosal LP are rare and family history and associated systemic diseases are found very rarely. [ABSTRACT FROM AUTHOR]

Diabetic foot ulcer is a debilitating complication of long‐standing diabetes mellitus. Patients lose their earning potential, face repeated hospitalizations, and are forced to bear heavy treatment costs. This places an enormous financial burden on the patients and their families. This study seeks to ascertain the out‐of‐pocket expenditure among these patients and correlate it with their risk factor profile. In this hospital‐based cross‐sectional study, a total of 154 patients with diabetic foot ulcers or amputations have been studied with an elaborate patient questionnaire and relevant clinical examinations. The costs incurred and the risk factors of the patients were analyzed for statistical association. The median total annual out‐of‐pocket expenditure for the management of diabetic foot ulcers among the study participants was found to be ₹29 775 (₹9650–₹81 120) ($378.14 [$122.56–$1030.22]). Out of the total expenditure, 58.49% went towards direct medical costs, 5.64% towards direct non‐medical costs, and 35.88% for indirect costs. Medications, ulcer dressing and periodic debridement have accounted for 79.26% of direct medical costs. Transportation (61.37%) and patient's loss of income (89.45%) account for the major costs under the direct non‐medical and indirect cost categories, respectively. A high ulcer grade and area, long ulcer duration, and past history of ulcers have higher expenditure. Patients seeking treatment from private establishments and those engaged in professional/skilled occupations have higher expenses. Adequate dressing of foot ulcers and proper footwear are associated with lower treatment expenditure. 68.8% of the participants have faced catastrophic expenditure due to treatment costs of diabetic foot ulcers. Adequate glycaemic control and proper foot care are necessary. Patients must seek medical care at the earliest in case of foot ulceration. Clinicians must provide proper wound care, institute effective antibiotics, and manage the complications. Government and insurance schemes are required to alleviate the patients' financial burden. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the frequency, pattern, and etiology of mandibular fractures at a tertiary care hospital, in Karachi Study Design: Retrospective, cross-sectional study. Setting: Abbasi Shaheed Hospital, Karachi, Pakistan Methodology: The study was initiated in Outpatient Maxillofacial Surgery Department of Abbasi Shaheed Hospital Karachi. The duration of the study was 5 years and six months. Data of mandibular trauma was evaluated. In this retrospective, cross-sectional study the patients were recruited through convenience sampling and the inclusion criteria was patients from both genders suffered from mandibular trauma of mandibular region. Patients who suffered from the trauma of face other than mandible were excluded. The sample size of the study was 464. A questionnaire was designed to enquire into the demographic details like age, sex, etiology, and site of fracture. The data was analyzed on SPSS version 17.0. Results: The majority of patients were males i.e. 384 (82.8%) while 80 (17.2%) were females. The most common type of fracture was combination fractures followed by parasymphysis i.e. 142 (30.6%) and 79 (17%) respectively. Road traffic accident was the major cause of trauma i.e. 332 (71.6%) followed by fall 96 (20.7%). Cross tabulation was done between different variables. Association of gender with etiology and type of fracture revealed non-significant p-value while the association of age with etiology revealed significant p-value. The highest number of mandibular fracture cases due to RTA were reported in the year 2019. Conclusion: It has been concluded that the frequency of mandibular trauma is quite high with male dominance. The most susceptible site of trauma is the combination and parasymphseal region and the most common etiology were road traffic accidents.

Abstract Background Patient satisfaction is a vital metric for assessing healthcare quality and delivering patient-centered care. It can predict service utilization patterns by determining healthcare users’ contentment with their providers. Consequently, evaluating patient satisfaction and its underlying factors is crucial to maintaining the quality of healthcare services. The present study aimed to assess patient satisfaction and its determinants in a tertiary care public hospital in Nepal. In this research, a cross-sectional design was employed to examine patient satisfaction within the Outpatient Department of Mental Hospital Lagankhel, Nepal. The study adopted a systematic random sampling approach for respondent selection, and stringent measures were implemented to uphold the validity and reliability of the collected data. To assess patient satisfaction comprehensively, the Patient Satisfaction Questionnaire-III (PSQ-III), developed by the RAND Corporation, was employed in conjunction with relevant sociodemographic variables. Utilizing mean scores and percentages, we calculated satisfaction levels across various dimensions. Additionally, a multinomial logistic regression analysis was conducted to investigate the relationships between patient satisfaction dimensions and sociodemographic characteristics. Results This study encompassed perspective of 206 participants, with 57.3% representing patient relatives and 51% being male, median age of 32 years (standard deviation: 12.53). Notably, patients reported higher levels of satisfaction, particularly within the interpersonal relationship dimension, while the technical quality domain received comparatively lower satisfaction ratings. Multinomial logistic regression analysis underscored the significance of sociodemographic factors in shaping patient satisfaction, with age (p = 0.008), type of residence (p = 0.001), occupation (p = 0.0019), income status (p = 0.014), time to reach the healthcare facility (p = 0.013), and insurance enrollment status (p = 0.017) all demonstrating significant associations. These findings illuminate the intricate qualities of patient satisfaction within our healthcare context, offering actionable insights for enhancement and guiding the trajectory of future research endeavors. Conclusions Overall patient expressed satisfaction with service provided by tertiary care hospital, however continuous improvement remains essential. Conducting large-scale, nationwide studies across hospital tiers is vital. This data-driven approach empowers policymakers to allocate resources effectively, inform decision-making, and enact policies that exceed patient expectations, fostering a healthcare system of unparalleled excellence.

Background: Ventral hernias comprise the second-most common hernia presentation, or 21–35% of all hernia types in the surgical world. Ventral hernias include incisional, umbilical, epigastric, and spigelian hernias, among others. This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Aims and Objectives: This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Materials and Methods: Forty-five cases of ventral hernias treated were studied prospectively from January 2021 to June 2022, in which each patient was evaluated thoroughly and surgery was planned to obtain a satisfactory outcome. The distribution of ventral hernias with respect to age, sex, comorbidities, and risk was recorded. Common presenting symptoms of ventral hernias, diagnosis, and complications were studied. The data collected was entered in a proforma, tabulated, and statistically analyzed. Results: Females were affected much more than males. Out of the three types of hernia that were studied, umbilical hernia showed more incidence (n=23/51%), followed by incisional hernia (n=15/33%), and epigastric hernia (n=7/16%). The most common age presentation was in the fourth and fifth decades. The most common type of mesh repair was pre-peritoneal repair in 28 (62%). The pain was relatively more common post-surgery complications, as noted in 11 (24%). In 100% of the cases, swelling was the complaint, followed by pain (18.8%). Obesity was the most common etiological factor in the development of ventral hernias (60%), followed by diabetes (35%). Conclusion: The most common ventral hernia was an umbilical hernia. Ventral hernias are more common in females. Obesity and diabetes are observed to be the major predisposing risk factors. Good pre-operative evaluation and preparation, sound anatomical knowledge, and meticulous attention to surgical detail are the most important factors for the prevention of postoperative complications. In view of the limited period of follow-up, we were not in a position to comment on recurrence rates, but when proper surgical procedures are adopted along with pre-operative correction of comorbid factors, results will always be excellent.

Background Acute appendicitis is a typical surgical emergency requiring prompt and accurate diagnosis for timely intervention. This prospective observational comparative study aims to assess the diagnostic efficacy of two scoring systems, the Yash scoring system and the Fenyo-Lindberg scoring system, compared to the gold standard of histopathological diagnosis. The study is conducted at A.V.B.R.H., a tertiary care hospital in Central India, focusing on providing valuable insights into the comparative performance of these scoring systems in the local patient population. Methods The study adopts a prospective observational comparative design, enrolling clinically diagnosed cases of acute appendicitis from the outpatient and inpatient departments of the Surgery department at A.V.B.R.H. Patients willing to undergo surgery are included. At the same time, those with complicating factors or contraindications are excluded. Data collection involves thorough clinical evaluations, scoring system assessments, and comprehensive investigations, with histopathology as the reference standard. Statistical analyses include descriptive statistics, comparative analyses, primary outcome assessments, and regression analyses, ensuring a robust evaluation of the diagnostic efficacy of the scoring systems. Expected Outcome Anticipated outcomes include a comprehensive understanding of the diagnostic efficacy of the Yash and Fenyo-Lindberg scoring systems in acute appendicitis. The study aims to identify which scoring system demonstrates superior accuracy, sensitivity, and specificity, providing valuable information for clinical decision-making. The results will contribute to optimizing diagnostic protocols for acute appendicitis, potentially influencing patient management and surgical interventions. This study’s findings are expected to be relevant to the local setting and broader contexts, enhancing the knowledge surrounding acute appendicitis diagnosis.

Introduction This study protocol outlines a comprehensive investigation into the impact of phototherapy on electrolyte levels in newborns with hyperbilirubinemia. With a focus on neonates admitted to the Neonatal Intensive Care Unit (NICU) at Jawaharlal Nehru Medical College and AVBR Hospital, Sawangi, Wardha, Central India, the research aims to contribute valuable insights into the physiological changes associated with this common neonatal condition. The study’s introduction highlights the rationale, significance, and gaps in current knowledge, emphasising the need for a detailed exploration of electrolyte dynamics before and after phototherapy. Method The methodology involves a descriptive, interventional cross-sectional design with a calculated sample size of 264 neonates. Standardised protocols for data collection, including serum electrolyte analysis and urine-specific gravity assessment, will be employed. Inclusion and exclusion criteria are clearly defined to ensure a homogenous study population. Statistical analyses, utilising R Studio 4.3.1 will encompass descriptive statistics, comparative analysis, correlation analysis, and multivariate analysis to explore the nuanced relationships between variables. Rigorous ethical considerations and transparency in reporting will guide the data collection process. Expected Result Anticipated outcomes include a nuanced understanding of changes in serum electrolyte levels following phototherapy and the correlation of these changes with the treatment duration. The study is poised to shed light on the impact of gestational age and birth weight on electrolyte responses. Through rigorous statistical analysis, the research aims to provide evidence-based insights that can inform neonatal care protocols. The anticipated findings hold the potential to influence clinical practices, enhancing the quality of care provided to newborns with hyperbilirubinemia undergoing phototherapy.

Background Nontuberculous Mycobacterial (NTM) diseases present unique clinical challenges and are increasingly recognised as significant contributors to respiratory and extrapulmonary morbidity. This study protocol outlines an observational and cross-sectional investigation aiming to comprehensively understand the clinical profile of NTM disease, including its prevalence, risk factors, and clinical features, in patients at a tertiary care hospital in central India. Methods Over two years, from July 2022 to June 2024, a convenience sample size will be recruited from TB suspects meeting inclusion criteria. Comprehensive data collection will be conducted, including demographic information, clinical history, radiological findings, microbiological test results, and risk factor assessments. Statistical methods will be applied to the collected data, including descriptive statistics, comparative analysis, risk factor assessments, and multivariate analyses. Expected Results The study aims to provide valuable insights into the prevalence and clinical manifestations of NTM disease, shedding light on the risk factors contributing to its occurrence. The statistical analyses will identify key factors associated with NTM disease and characterise its clinical and radiological features.

Background Surgical site infections (SSI) remain a significant concern in the realm of surgical interventions, posing a threat to both patient well-being and healthcare systems. This study protocol outlines a rigorous investigation aimed at assessing the effectiveness of pre-operative antibiotic prophylaxis in the prevention of SSIs in clean and clean-contaminated surgical cases within the tertiary care setting of central India. The primary aim is to determine the best suitable antibiotic regimen, optimal timing for administration, and the associated economic burden of SSIs. Method The study utilizes a Randomized Controlled Trial (RCT) design with four intervention groups, each receiving distinct antibiotic prophylaxis protocols. Comprehensive post-operative monitoring, adhering to the Centers for Disease Control and Prevention (CDC) guidelines, will be employed to identify SSI occurrences. Key data collection points include clinical evaluations, temperature monitoring, wound inspection, pain assessments, and culture and sensitivity testing. Expected outcome The study also emphasizes post-operative follow-up assessments, incorporating outpatient visits at 15-, 30-, and 90-days post-surgery. These evaluations will be instrumental in assessing the time duration for effective prophylactic antibiotic administration and determining the economic burden associated with SSI. The findings of this research endeavor hold the potential to enhance patient outcomes, minimize SSI incidences, and reduce the economic impact of SSIs on healthcare systems. By optimizing pre-operative antibiotic prophylaxis practices, this study aims to advance evidence-based guidelines for SSI prevention in clean and clean-contaminated surgical cases. CTRI REF/2023/07/070549

Background Congenital heart diseases (CHDs) in neonates often present complex clinical scenarios, and the association with extra-cardiac anomalies adds a layer of intricacy to their management. This study protocol outlines a comprehensive investigation into the prevalence and clinical outcomes of extra-cardiac anomalies in neonates diagnosed with CHDs. The study addresses gaps in current knowledge regarding this specific patient population, situated in the Neonatology unit of Jawaharlal Nehru Medical College and AVBR Hospital, Sawangi, Wardha, Central India. Methods Utilizing a descriptive, interventional cross-sectional design, the study will enrol neonates meeting inclusion criteria—diagnosis of CHDs with concurrent extra-cardiac anomalies. Rigorous data collection will involve detailed clinical histories, thorough physical examinations, and the compilation of relevant investigations, including diagnostic imaging and laboratory results. The study’s temporal scope spans three years, ensuring a robust representation of the neonatal population. Statistical analysis, employing chi-square tests, Fischer’s tests, and independent t-tests, will explore relationships between demographic and clinical characteristics, contributing to a nuanced understanding of this complex interplay. Expected Results Anticipated outcomes of this study include a precise estimation of the prevalence of extra-cardiac anomalies in neonates with CHDs. Furthermore, insights into this specific patient cohort’s clinical outcomes and management will be gained. The study aims to unravel the intricate relationship between demographic factors, clinical characteristics, and extra-cardiac anomalies in CHD patients through meticulous data analysis. These findings are poised to inform clinical practice, enhance patient care strategies, and set the stage for further research in this critical area of neonatal medicine.

Background Oral cavity malignancies pose a significant health burden, necessitating accurate diagnostic tools for optimal treatment planning. This cross-sectional study investigates the role of Computed Tomography (CT) in evaluating oral cavity malignancies, focusing on tumor thickness and nodal staging. The study is conducted in a tertiary care hospital in Central India, aiming to enhance diagnostic precision in this region. Methods A prospective, cross-sectional design is employed over two years. Patients with clinical or biopsy-proven oral cavity carcinoma are included after obtaining informed consent. CT scans are performed using a standardized protocol, and imaging findings are correlated with histopathological staging. Statistical analyses, including descriptive statistics, bivariate analysis, correlation analysis, and multivariable modeling, are conducted using SPSS version 27.0. Expected Outcome Anticipated outcomes include a comprehensive understanding of the accuracy of CT in evaluating tumor thickness and nodal stage in oral cavity malignancies. The study aims to delineate the extent and depth of soft tissue and bony invasion, assess nodal metastases, and correlate radiologic findings with histopathological results. The expected findings will contribute valuable insights into the utility of CT in the clinical management of oral cavity malignancies, potentially influencing treatment decisions and improving patient outcomes.

Background: The WHO defines LBW as "Birth weight less than 2500 grams" regardless of gestational age. Being born with a low birth weight also incurs enormous economic costs, including higher medical expenditures and social service expenses, and decreased productivity in adulthood. Objective: To study distribution of newborns' according to pregnancy related factors and its association with newborns' birth weight. Methods: An institutional based cross-sectional study. New-borns delivered at study institute were considered as study participants. Estimated final sample size was 500. Guardians (mothers) were face-to-face interviewed and also recorded data were collected from the case file and Mother and Child Protection Card. Results: Prevalence of LBW newborns was higher in mothers with late ANC registration, <4 ANC visits, chronic medical conditions, infection during pregnancy, PIH, anemia, consuming tobacco, exposure to second hand smoke, LSCS/Assisted delivery, in female newborns', current pregnancy birth order number more than 2, in pre term newborns' and mothers with bad obstetric history. Conclusion: Create awareness and adoption of suitable family planning methods. Need to do early (within 12 weeks) ANC registration with minimum four ANC visits for better pregnancy outcome. Effective tracking and suitable intervention provided to improve current pregnancy outcome. Health care professional should pay special attention to high-risk pregnancy. Develop social culture in such a way that females are neither addicted nor exposed to any tobacco containing products in their life. [ABSTRACT FROM AUTHOR]

Background: Ventral hernias comprise the second-most common hernia presentation, or 21–35% of all hernia types in the surgical world. Ventral hernias include incisional, umbilical, epigastric, and spigelian hernias, among others. This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Aims and Objectives: This study was undertaken to know the different clinical types, age incidence, and predisposing factors for ventral hernia and to study the complications. Materials and Methods: Forty-five cases of ventral hernias treated were studied prospectively from January 2021 to June 2022, in which each patient was evaluated thoroughly and surgery was planned to obtain a satisfactory outcome. The distribution of ventral hernias with respect to age, sex, comorbidities, and risk was recorded. Common presenting symptoms of ventral hernias, diagnosis, and complications were studied. The data collected was entered in a proforma, tabulated, and statistically analyzed. Results: Females were affected much more than males. Out of the three types of hernia that were studied, umbilical hernia showed more incidence (n=23/51%), followed by incisional hernia (n=15/33%), and epigastric hernia (n=7/16%). The most common age presentation was in the fourth and fifth decades. The most common type of mesh repair was pre-peritoneal repair in 28 (62%). The pain was relatively more common post-surgery complications, as noted in 11 (24%). In 100% of the cases, swelling was the complaint, followed by pain (18.8%). Obesity was the most common etiological factor in the development of ventral hernias (60%), followed by diabetes (35%). Conclusion: The most common ventral hernia was an umbilical hernia. Ventral hernias are more common in females. Obesity and diabetes are observed to be the major predisposing risk factors. Good pre-operative evaluation and preparation, sound anatomical knowledge, and meticulous attention to surgical detail are the most important factors for the prevention of postoperative complications. In view of the limited period of follow-up, we were not in a position to comment on recurrence rates, but when proper surgical procedures are adopted along with pre-operative correction of comorbid factors, results will always be excellent. [ABSTRACT FROM AUTHOR]

Background: Telemedicine has increasingly become a critical component in enhancing healthcare delivery, particularly in specialized fields like anesthesia. This study aimed to evaluate the feasibility, effectiveness, and patient satisfaction of using telemedicine for preoperative anesthesia assessments at a tertiary care hospital in Odisha, a region with diverse geographic and healthcare infrastructure challenges. Materials and Methods: In this observational study, 200 elective surgery patients were randomized into telemedicine and control groups for preoperative anesthesia assessment. Data on assessment completion, patient satisfaction, identification of anesthesia-related issues, consultation times, and follow-up requirements were collected and analyzed using descriptive and inferential statistics. Results: The telemedicine group demonstrated a 98% completion rate for preoperative assessments, significantly higher patient satisfaction scores in overall satisfaction (p=0.03), and more efficient consultation times compared to the control group (p<0.001). There were no significant differences in the identification of anesthesia-related issues between groups, indicating that telemedicine is as effective as in-person assessments in clinical efficacy. Conclusion: Telemedicine offers a viable and beneficial alternative for preoperative anesthesia assessments, enhancing patient satisfaction and efficiency without compromising the quality of care. These findings support the broader adoption of telemedicine in preoperative care, especially in regions facing healthcare accessibility challenges. [ABSTRACT FROM AUTHOR]

Background: The antibiotic resistance is on a rise globally due to irrational use. This survey evaluated the prescribing patterns of antibiotics in tertiary care hospital in Abbottabad. Study type, settings & duration: This observational, descriptive, and prospective study was carried out in divisions of Gynecology, General Medicine, Pediatric Surgery, Orthopedics and Pulmonology, Tertiary Care Hospital, Abbottabad, KPK from 2019 to 2020. Methodology: An antibiotic prescribing pattern survey was carried out among the patients of hospital. Medical case sheets of patients and drug charts were used to record in standardized performa. Results: Total 203 patients on antibiotics were included in the study. Antibiotics prescribed in Gynae Department were UTIs 57%, LSCS 35%, NVD 20%, wound infection 16.6%, D&C 10%, SVD 10%, RTIs 6.6%, Extraction 6.6%, Stitch removal 6.6%, Hysterectomy 5%, Ectopic Pregnancy 5% post ovectomy 3.3% Uterine bleeding 3.3%, & most common dosage form:, Tablets: 56.6%,Capsules: 40%, Syrups:3.33% in Pead's Department URTI 62%, Cold and fever 10%, Eye Infection 8%, LRTI 6%, in dosage form: Syrups: 82%. Drops: 12%, Injection: 4%, Tablet: 2%. In Surgical ward Ceftro:35%,Titan:20%, Grasil:20%, Flagyl:10%, Kefzol:5%, Ampiclox:5%, Bestrix:5%. In General OPD, RTI 48%, Wound Infection 18%, fever 14%, UTIs 8.33%, Pneumonia 1.66% the most prescribed dosage form, Injection :28%, Syrup:12%, Drops:8.0% Tablets: 8.0%, Capsules: 6.0%. In orthopedic ward: Grasil:22.2%, Amikacin:19.3%, Oxidil:18.8%, Titan:11.11%, Cefbactam:11.11%, Kefzol:10%, Sulperazone:5.55%,, Augmentin:5.55%, Gentacin:2.7%, Most prescribed dosage form: Injection :100%,Tablets, Capsules and Syrup 0%. In Pulmonary disease department Respiratory tract infection 55% and in Bronchitis are 35%. Most commonly prescribed dosage form: Injection :50%, Tablets :45%, Capsules :5%, Syrup, and Drops 0%. Mainly Augmentin was prescribed as a combination therapy. Most antibiotics were prescribed for 5-7 days. Conclusion: The survey indicates that the use of antibiotic in tertiary care hospital is very high and is not rational. [ABSTRACT FROM AUTHOR]

Introduction: Secondary bacterial and fungal infections are a significant concern in COVID-19 patients, particularly those critically ill and requiring intensive care. This retrospective study investigated the prevalence and spectrum of secondary infections among COVID-19 patients admitted to the intensive care unit (ICU) at a tertiary care hospital in Navi Mumbai. Additionally, we explored the association between secondary infections and patient comorbidities. Methods: We performed a single-center, retrospective cohort study of 3234 COVID-19 patients admitted to a tertiary care hospital in Navi Mumbai, India, between August 2020 and August 2021. Microbiological data from various clinical specimens, including blood, sputum, bronchoalveolar lavage (BAL) fluid, urine, and tissue cultures, were retrospectively analyzed. Patient demographics and comorbidities were extracted from medical records. We employed descriptive statistics and Pearson's Chi-square test for data analysis to identify associations between secondary infections and patient characteristics. Results: Among the 3234 COVID-19 patients, 195 (6.02%) presented with clinical features suggestive of secondary infections. Microbiological analysis confirmed secondary infections in 98 patients (3.03%), with a culture positivity rate of 50.3%. Among bacterial isolates, Klebsiella pneumoniae was the most prevalent (43.28%), followed by Acinetobacter baumannii (25.37%). Aspergillus spp. emerged as the dominant fungal pathogen. Notably, Escherichia coli isolation was significantly associated with various specimen types (P < 0.001). However, no significant correlation was found between secondary infection rates and patient comorbidities. Conclusion: Gram-negative bacteria, specifically K. pneumoniae and A. baumannii, were the primary pathogens responsible for secondary infections in our cohort of critically ill COVID-19 patients admitted to the ICU. These findings underscore the importance of ongoing surveillance and monitoring of secondary infection trends, including fungal pathogens, to inform and optimize management strategies in this high-risk population. [ABSTRACT FROM AUTHOR]

Introduction: Trauma is foremost reason behind the mortality and morbidity worldwide among all age groups. Trauma remains the vital public health issues worldwide and is independent of socioeconomic condition of a country. Incidence of trauma is still increasing with increase in incidence of violence, road traffic accident, assault and violence. Trauma will still remain if all medical and surgical diseases are overcome. Aims and Objectives: The aims and objective of our study was to evaluate the spectrum, pattern, mechanism and outcome of trauma patient presenting at tertiary care hospital. Results: Trauma patient visited to tertiary care hospital were 1926 (with 73% male and 27% female). Most common age group was 21-30 years. Most common mechanism of trauma was RTA which include 60% patient followed by fall. Most common site of injury was extremities followed by head and neck injuries. 28% of trauma patient were hospitalized. 66% of hospitalized patients were managed conservatively while 34% of the were managed surgically. 92% of the trauma patients were survived while mortality was only 8%. Conclusions: RTA is most common form of trauma affecting most commonly young male in their third decade of life. Health education and behaviour change among the youngster about trauma may reduce the trauma injuries. [ABSTRACT FROM AUTHOR]

Introduction: Diabetes is a long-lasting, inflammation-related metabolic disorder which is diagnosed by hyperglycemia. Increased blood glucose level adversely impacts the inflammatory response to periodontium leading to more severe gingivitis and periodontitis. Therefore, periodontitis and diabetes reciprocally and adversely affect each other. Objective: To assess and compare the oral health condition of Diabetic and non-Diabetic periodontitis patients. Method: A non-experimental case control study was conducted among 100 diabetic and 100 non-diabetic periodontitis patients. The control group was matched by age and gender. The study was conducted for a period of ten months. A cheek list was prepared to generate the caries and CPITN index (Community Periodontal Index of Treatment Needs) index. Result: The prevalence of dental caries scored at least one was relatively more in non-diabetics (88%) than in diabetics (65%). However, the periodontal diseases (pyorrhea) prevalence was more in diabetic periodontitis patients (97%) in compared to non-diabetics (53%). The odds ratio for CPITN Index indicated that the periodontitis patients who had diabetes were about 111.6 times (OR = 111.6, 95% CI 14.9- 832.02) more likely to have sub- gingival pocket more than 6mm in depth. Conclusion: Diabetes is an important health care problem. The evidence suggests that oral health care providers can have a significant, effective and positive effect on the oral and general health of patients with diabetes mellitus. Update Dent. Coll. j: 2024; 14(1):10-14

Objective: The aim of this cross-sectional study was to assess the oral health-related quality of life (OHRQoL) in a cohort of 500 patients diagnosed with precancerous lesions and conditions at a tertiary care hospital in Central India. Methods: 500 patients with confirmed precancerous oral lesions and conditions were recruited for the study. The Oral Health Impact Profile (OHIP-14) questionnaire, a validated instrument consisting of 14 items, was used to assess the OHRQoL of the participants. The OHIP-14 questionnaire scores were statistically analyzed using appropriate methods. Results: The majority of the participants were with a mean age of 48 years. The mean OHIP-14 score was calculated to be 45.1, indicating the overall impact of oral health on the quality of life of patients with precancerous lesions and conditions. The individual domains most affected were functional limitations and physical pain. Conclusion: This study demonstrates that promoting oral health awareness and regular screenings in the community is needed to prevent the progression of oral precancerous conditions and ultimately reduce the burden of oral cancer.