Kharadar General Hospital

Typhoid fever burdens low- and middle-income countries, especially children. Despite being curable, it now resists first-line antibiotics. This study aims to understand antimicrobial resistance patterns associated with multidrug-resistant (MDR) and extensively drug-resistant (XDR) typhoid fever cases in Pakistan. We conducted a retrospective review of blood culture-confirmed typhoid cases from 5 large laboratory networks in Pakistan over a period of 3 years (2017-2019). Data were analyzed for 464 956 blood culture specimens, of which Typhi and Paratyphi were isolated in 23 924 (5%) of all blood cultures done. Sindh had the highest proportion of S. Typhi cases (72%) of all positive cases, followed by Punjab with 46.9%. The 5-14-years age group had the highest proportion of S. Typhi (MDR: 46.1%; XDR: 44.2%), followed by the 2-4-years age group (MDR: 27%; XDR: 26.2%). XDR isolates of S. Typhi were found in 57%. Most S. Typhi isolates were resistant to ampicillin (79.8%), chloramphenicol (80.8%), cefixime (64.6%), ciprofloxacin (66.4%), ceftriaxone (63.3%), and co-trimoxazole (80.2%). Most S. Paratyphi isolates were responsive to antibiotics, ampicillin (97.2%), chloramphenicol (98.6%), cefixime (99.5%), ceftriaxone (99.5%), and co-trimoxazole (98.7%). Resistance to ciprofloxacin was 85.9%. Both S. Typhi and S. Paratyphi were susceptible to azithromycin and imipenem, whereas 99.8% of S. Typhi and 100% of S. Paratyphi were sensitive to meropenem. Increased prevalence of culture-confirmed XDR S. Typhi cases was observed in 2019 as compared with 2017, presumably due to the outbreak of XDR in Sindh.

This study aimed to investigate the prevalence of cervical smear abnormalities among 63 women, aged 30 to 60 years, and to identify potential risk factors. The overall prevalence of abnormal cervical smears was 29.8%, with no significant age-related variation across the three age groups: 30–40 years (27.5%), 40–50 years (26.8%), and 50–60 years (33.8%) (p=0.608). Parity was not associated with cervical smear abnormalities, as the prevalence was similar in women with 1–3 births (30.3%) and those with 4–6 births (28.6%) (p=0.812). A significant association was observed between partner HPV status and abnormal cervical smears (p=0.015), with women whose partners tested positive for HPV having a higher prevalence of abnormal smears (47.1%) compared to those with HPV-negative partners (26.0%). While 16% of participants reported a history of smoking and 34% used oral contraceptives, neither factor showed a significant relationship with cervical abnormalities. The findings highlight the importance of partner HPV status in the development of cervical abnormalities and emphasize the need for focused HPV screening and preventive measures.

Rectal foreign bodies (RFBs) are foreign bodies in the rectum that pose a challenge to the surgeons in the emergency department. We report a case of an RFB; the patient was a 30-year-old man who put a glass bottle into his rectum on his own. The 10-cm bottle was successfully retrieved through the transanal approach without complication. The patient had no sign of injury or bleeding after the procedure. The patient was stable and was discharged with counseling to avoid such conduct. An effective approach for extraction is to have a structured protocol encompassing prompt diagnosis, extraction techniques, and post-removal assessment. In addition, there is a psychological aspect to RFBs that requires counseling and patient education.

Surgical bleeding is a common concern in soft-tissue procedures, often necessitating interventions to minimise blood loss and associated complications. Tranexamic acid (TXA), an antifibrinolytic agent, has been widely used to reduce surgical bleeding. However, the comparative effectiveness of local versus systemic TXA administration remains an area of ongoing investigation. Objective: The present study aims to evaluate the role of local tranexamic acid in preventing surgical bleeding in soft-tissue surgery. Methods: After the ethical approval from the institutional review board, this retrospective observational study was conducted at Kulsum Bai Valika Hospital, Karachi, from 1st April 2023 to 30th April 2024. Through non-probability sampling, a sample of 100 patients, aged 20-80 years, either gender, who underwent different soft tissue surgeries that included general surgery, orthopaedics, and gynaecology, were included in the present study. TXA treatment was grouped according to the type of surgery involved and the method used to apply the TXA. The three groups were local TXA, systemic TXA, and no-TXA groups. Local TXA meant that TXA was applied directly to the surgery site, while systemic TXA was given through a drip. Results: The mean blood loss was 499.16 mL in the Local TXA group, 557.84 mL in the Systemic TXA group, and 552.45 mL in the No TXA group (p= 0.668). However, the incidence of postoperative bleeding was significantly lower in the Local TXA group (26%) compared to the Systemic TXA (33%) and No TXA groups (57%) (p=0.0025) Conclusion: In conclusion, the present study is confirmative of the effectiveness of local TXA application in the reduction of postoperative bleeding in soft tissue surgery procedures.

Background: This medical review examines whether Lady Reading Hospital Peshawar follows IDSA recommendations when obtaining blood and urine cultures before starting antibiotics for new patients coming from ED. The accuracy of blood and urine culture tests depends on proper specimen collection procedures yet healthcare teams only stick to these methods inconsistently which leads to inappropriate antibiotic use and raises patient risks. Methodology: Staff from Lady Reading Hospital reviewed 200 past patient records through HMIS to perform this analysis. Our sample consisted of blood cultures taken from 100 patients alongside 100 urine tests. The review examined to what extent healthcare facilities followed IDSA recommendations and aimed for 95% implementation accuracy. The research team gathered information about patients such as age, culture testing schedule, and antibiotic treatment details. The audit uncovered system challenges affecting patient care and doctors' decision structures. Results and Discussion: The examination revealed poor culture practices with tests taken before antibiotics only in 10% of blood culture cases and 2% of urine culture cases which fell far below the desired 95% rate. The busy ED environment made clinicians rush the processing of patient samples which led to reduced adherence to antibiotic protocols and increased the risk of developing drug-resistant bacteria. Conclusion: The audit shows Lady Reading Hospital does not follow proper guidelines by taking diagnostic cultures before starting antibiotic treatment. Clinicians need education and workflow changes plus real-time monitoring to meet IDSA rules and help patients get better results.

Objective: To evaluate the effectiveness of the enhanced recovery after cesarean (ERAS) protocol in enhancing postoperative recovery after cesarean delivery versus conventional care at a tertiary care setting. Methodology: A prospective observational study was conducted at gynae and OBS department of Kharadar General Hospital (KGH) Karachi from April 2024 to Sept 2024. Patients aged 18 years to 40 years old presented with singleton pregnancy and selected for elective cesarean section were included. Both groups underwent the same surgical technique. ERAS group followed a structured protocol with goal-directed IV fluids, early oral intake, mobilization starting within 8 hours, early catheter removal, dressing change at 24 hours, multimodal pain relief, and a shorter course of IV antibiotics followed by oral antibiotics, while control group received standard care with fixed-rate IV fluids, delayed oral intake and mobilization, delayed catheter removal, dressing change on day 3, and a longer duration of IV analgesia and antibiotics. Data were recorded and analyzed using SPSS version 26. Results: Mean age of participants in the ERAS group was 25.3 years and in control group was 29.7 years. The mean IV fluid duration was markedly shorter in the ERAS group (10.18?±?1.64 hours) vs. control (24.00?±?0.00 hours), (p-0.001). Oral intake began earlier in ERAS group (5.22?±?1.61 vs. 11.87?±?1.62 hours), and mobilization was initiated sooner (7.64?±?1.50 vs. 35.47?±?10.22 hours), both with p-0.001. Removal of catheter and dressing changes also occurred earlier in the ERAS group (p-0.001). IV antibiotics duration was also reduced in ERAS group (25.07?±?3.45 vs. 46.67?±?3.81 hours), while oral antibiotic use was similar (5 days). Additionally the pain scores at 24 hours was found decreased in ERAS group (3.40?±?1.18 vs. 5.91?±?1.52) and hospital stay (1.73?±?0.62 vs. 5.02?±?0.87 days) p- 0.001 respectively. Conclusion: Implementation of ERAS protocol observed significantly improved postoperative outcomes compared to conventional care, in terms of earlier oral intake and ambulation, reduced durations of IV fluids, catheterization, and antibiotics, better pain control, and shorter hospital stays, enhanced patient comfort, and more efficient use of hospital resources.

Background: Nurse-patient communication is a unique clinical skill in the healthcare professions that promotes good quality care and patient outcomes. This communication can be disrupted by many barriers that impact the therapeutic relationship and deliver of care. Purpose: The study aims to identify the barriers affecting nurse-patient communication at primary health centers in Almadina Munawara City, Saudi Arabia. Methods: A cross-sectional study was performed among 212 nurses and 214 patients utilizing a self-reporting questionnaire. A version of the same file was then uploaded into NVivo, and data that were coded under all communication barriers including language discordance among patients and healthcare providers (e. g., subtheme: patient prefers a mother tongue speaking doctor), cultural-religious difference and environmental cues between the involved parties to determine their importance in this context as well (see Table 2). Results: The results showed that language, cultural and environmental differences had an extensive influence on how nurses communicated with patients. Key barriers included nurse shortages, limited communication time and low income. Our results suggest that these barriers differ in their effect with language barrier and habitat disturbance being the most important ones. Conclusions: This study concludes that nurse-patient communication is a complex multi-sectional process, constrained by numerous barriers. Strategic intervention aimed at addressing these barriers can strengthen nurse-patient interaction and accelerate patient care. Communication remains a cornerstone in all the best practices of delivering healthcare effectively and keeping patients happy.

Quintuplet pregnancies are associated with significant perinatal morbidity and mortality. The spontaneous quintuplets are a rare occurrence, and the survival is extremely rare. The first quintuplets known to survive infancy to adulthood were the Dionne Quintuplets, born in 1934. Kharadar quintuplets born in 2006, in Karachi Pakistan, were the first set of quintuplets who were born alive and reached their adolescence. A 30-year old women, presented at Kharadar General Hospital (KGH) during the 28th week of gestation for pregnancy evaluation. She was diagnosed with a quintuplet pregnancy with no gross foetal abnormality on ultrasound abdomen. The patient had premature rupture of membrane at 30th week of gestation, and emergency caesarean section was performed. All five quints were born alive, had normal APGAR scores, were premature, and had low birth weight. After birth, all quints were immediately shifted to the neonatal intensive care unit. After a 10 day hospital stay, all quints were discharged. In 2023, all quints celebrated their 17th Birthday.

Objective: To estimate the prevalence of salmonella typhi in bile specimens collected from patients undergoing cholecystectomy at a tertiary care Hospital Karachi. Methodology: The descriptive cross-sectional study, was conducted at Department of Surgical Unit 21, Jinnah Postgraduate Medical Center, Karachi, from January 2021 to June 2021. Patients with symptomatic Cholelithiasis like sudden pain in the upper right portion of your abdomen which radiate towards right shoulder, nausea, vomiting, undergo cholecystectomy of either gender male or female with age 14 to 60 years were included. After open cholecystectomy, bile was aspirated from the gallbladder at fundus in five ml syringe and long spinal needles was used in case of laparoscopic cholecystectomy to collect bile under vision of telescope. Specimens were sent to laboratory according to protocol for culture sensitivity. Results: A total of 171 patients who met the inclusion and exclusion criteria were included. Mean age of the patients was 49.39±8.78 years. 83 (48.5%) were male and 88 (51.5%) were female. Prevalence of salmonella typhi in bile specimens collected from patients undergoing cholecystectomy, was found 17.54%. Furthermore, the frequency of salmonella isolate was statically insignificant according to the patient’s gender, diabetes and obesity (p=>0.05), while it was statically significant according to age up to 40 years and residence in rural areas (p-<0.05. Conclusion: A significant proportion of patients were found to have Salmonella in bile from patients undergoing cholecystectomy. Therefore, close monitoring of patients must be done in all patients with regular follow-up.

Objective: The purpose of this study was to examine the incidence of benign and malignant parotid tumors, as well as their age and gender distributions, and histomorphological characteristics. Study Design: Retrospective study Place and Duration: Liaquat University of Medical and Health Sciences, Jamshoro in the duration from July, 2022 to December, 2022. Methods: The department of pathology examined a total of 47 Parotid tumor specimens. Sections were obtained, processed, and paraffin-embedded after specimens were formalin-fixed. Slides were prepared, hematoxylin and eosin was used to stain them, and then the paraffin blocks were sliced. (WHO) histological type was used to categorize the cancers. The gathered data were statistically examined. Results: There were majority 26 (55.3%) males and 21 (44.7%) females in this study. Among all, 34 (72.3%) cases had benign tumor and 13 (27.7%) cases were had malignant tumor. Among 34 cases of benign tumor, pleomorphic adenoma was the most common found in 17 cases and in malignant tumor mucoepidermoid carcinoma was the most common found in 6 cases. Majority of the cases of benign tumor were aged between 30-50 years. Conclusion: Parotid tumors are significant even though they are uncommon because they exhibit a great variety of morphologic variability between various tumor types and occasionally even within a single tumor mass. Hence, a precise diagnosis is crucial and may be made by a histological study. Keywords: Histopathological Examination, Parotid Tumors, Mucoepidermoid Carcinoma, Pleomorphic Adenoma