Management of community acquired pneumonia by Family Physicians

Background and Objective: Community Acquired Pneumonia [CAP] is a major burden on health system with significant mortality and morbidity. Family Physicians [FPs] can play important role. To determine management strategies and prescription of FPs regarding CAP

Methods: A multicenter cross sectional survey was done in 10 cities of Pakistan from November 2014 to January 2015. Self-administered questionnaire was filled by 110 Family Physicians

Results: Of total 71% of FPs reported to work in high prevalence areas for respiratory ailments. Only 32% of FPs used PSI and 34% CURB 65 for assessment of severity. It was alarming to note that only 58% of FPs treats severe pneumonia with Intravenous antibiotics while rests were comfortable with oral route

The overall use of quinolones to treat CAP, irrespective of severity, in combination or as single agent was > 60%

Duration of antibiotics for severe pneumonia was sub optimal [<10 days]. Only 52.8% patients came back for follow-up so true outcome cannot be anticipated

Conclusion: Major deficiencies were treatment of severe pneumonia in community, inappropriate use of quinolones and poor knowledge of recent guidelines. This can lead to emergence of resistant bacteria and high mortality and morbidity

To evaluate the outcome of sacrococcygeal pilonidal sinus excision using karydakis technique

Objective: To evaluate the outcome of sacrococcygeal pilonidal sinus excision using karydakis technique. Study Design: Prospective case series study. Place and Duration of Study: This study was carried out in the Department of General Surgery Unit 111, Ward 26, Jinnah Post graduate Medical Centre, Karachi form March 2005 to Feb 201 2. Materials and Methods: The study included 85 consecutive patients who underwent pilonidal sinus excision by karydakis technique fulfilling the inclusion criteria. We excluded the cases of pilonidal abscess and the cases which came with acute infections. Patients under 12 years were also excluded. A prospective method of data collection was utilizes by filling in the proforma designed for the study. A complete record of the procedure, follow up was done initially on weekly basis for one month and then fortnightly for 6 months and subsequently monthly for 30 months. Results: Total of 85 patents were included in our study in which 68 [80%] were male and 17 [20%] were female. The mean age of the group was 30.56 years. All patients were followed postoperatively for 30 months. Mean hospital stay was 2.5 days. Majority 63[74.1%] of the patients underwent smoothly without major complication. In all 85 patients wound closed with prolene 210 interrupted sutures. In 9[10.6%] patients developed minor wound infection while 4[4.7%] patients develop wound dehiscence and 3[3.52%] patients develop recurrence. In all 85 patients prophylactic antibiotics amoxicillin + clavulanic acid 1.2gm was used. In infected patients accounting to a total of 13[15.3%], both major and minor infections were included and appropriate antibiotic was used as indicated in the culture and sensitivity report. Conclusion: Karydakis technique is superior to midline excision surgery. It is associated with significantly shorter complication rate, shorter hospital length of duration, rapid healing, cost effective, good cosmetic satisfaction, a high patient satisfaction rate and low rate of recurrence

Knowledge and practices of basic life support amongst the ambulatory staff in Karachi

To assess the Knowledge and Practice of Basic Life Support in the ambulatory staff services in Karachi. Cross Sectional Study This study was conducted at Sindh Medical University [JSMU] from March 1st to October 30[th], 2011. Sample size of 283 was drawn using non- probability purposive sampling, ambulance staff members belonging to 10 ambulance services in the city, mainly Aman Foundation, Edhi, Chippa, Khidmat-e-Khalq Foundation were interviewed through structured questionnaire. The data was collected and analyzed on SPSS version 17. Out of the 283 ambulatory staff members, 72.5% of the staff had no knowledge of Basic Life Support, 27.4% had knowledge. 14% answered correctly about the position in which a heart attack patient should be placed, 90% answered wrongly about patient whose clavicle had been fractured. 72% of the ambulatory staff actually checked oxygen flow in the tank after they had put the mask on the patient, 65% of the staff had removed the helmet of accident patients.64.8% had no idea about the respiratory rate, pulse count of an adult, 76.2% didn't know about the complications of an Intravenous installation. The study proved major lapses in knowledge and practices in Basic Life Support for ambulatory staff. Implementation of first aid's protocol are fully neglected, yielding an ambulance service that might let the patients suffer undue circumstances and also directly affects major indicators of primary health care