Efficacy of platelet rich plasma application in comparison to conventional dressing therapy in partial thickness burn wound

To determine the efficacy of Platelet Rich Plasma application in comparison to conventional dressing therapy in partial thickness burn wound . Comparative analytical study. This study was carried out at Department of Burns, Civil Hospital Karachi from March 2011 to January 2013. A comparative analytical study was conducted to determine the efficacy of Platelet Rich Plasma application in comparison to conventional dressing therapy in partial thickness burn wound at Department of Burns, Civil Hospital Karachi. All the admitted patients of either sex having age between 20-40 years, victims of fire and scald burn, having partial thickness burn with 10-30% of TBSA involved. Patients were divided into two groups on random basis. In group [A], Platelet Rich Plasma [PRP] application was given with three day gap between two applications until full recovery of the wound. While in group [B] conventional dressing therapy was adopted till full recovery of wound. All 30 patients of group A, selected for PRP application, were recovered maximally within 18 days [6 therapies with a gap of 3 days]. Whereas in other 30 cases, of group B selected for conventional dressing therapy, it took minimum 21 days or more for complete recovery. Hence recovery was found slow in conventional dressing therapy as compared to PRP and it is statistically significant at P,0.05. Platelet-rich plasma application in non-healing deep partial and full thickness burn wound accelerate the wound healing as compared to conventional dressing therapy and is very effective in preparing healthy beds for grafting and provides 100% graft take.Now it is up to the Burns surgeon to select it for rapid results to save time and cost with availability of more beds in Burn Centre

Hypertension in working and non working women attending OPD of a tertiary care private sector hospital in Karachi

To compare the frequency of hypertension in working and non- working women attending OPD of a Private sector hospital of Karachi. Comparative Cross Sectional Study A comparative cross sectional survey of women visiting medical OPD was conducted in a private sector hospital of Karachi from January 2010 to November 2011. Study was conducted on working and non working women having age 20 years and above coming for treatment in OPD of a Private sector hospital of Karachi from January, 2011 to November 2011. Taking ethical consideration, data was collected by interviewing method. Besides socio-economic data, Blood pressure, weight and height were measured to calculate BMI for defining obesity. BMI more than 30 were considered obese. Data was analyzed by using statistical package SPSS version 16.0. Chi square test was applied to see the significance difference in both the groups at P<0.05. Over all 540 women included in the study, 250[46.3%] were working women and 290 were non-working [53.7%]. Among the working women 88[35.2%] were hypertensive whereas among non working women 173 [59.7%] were hypertensive [p<0.000]. Most of the hypertensive working women were of the age group 40-49 years [44.4%] whereas hypertensive non working women were of age group 30-39 years. Among the working women 38% were obese while in non working women 56% were obese. Our study shows that hypertension and obesity is more common in non working women as compare to working women and its shows that it's not the working which is the risk for developing hypertension rather there are other factors which increases the risk of hypertension and there is need of further studies

Screening for tuberculosis among household contacts of index patients

Household contacts of sputum positive pulmonary TB cases are at a high risk of getting infected with tuberculosis therefore symptomatic or vulnerable individuals should be screened and treated early. To determine the prevalence of pulmonary tuberculosis in the households contacts of index patients having pulmonary tuberculosis infection using standard diagnostic tests and refer the positive cases to DOTS program for treatment. This national descriptive study was conducted in seven Centers of PMRC throughout Pakistan form November 2010 to March 2012. A total of 580 index adult patients suffering from pulmonary tuberculosis, being treated at DOTs Centers of major tertiary care hospitals of Karachi, Lahore, Multan, Peshawar and Quetta living within 5-8 kilometers of the hospital, who consented to participate in the study were selected from the DOTs centres. Generally one but occasionally two close contacts of these index patients [spouses, parents or siblings] were called to the hospital for screening of TB using chest Xray, smear microscopy and tuberculin skin test. Out of 800 contacts screened, 125 [15.6%] were positive on sputum smear examination while 113 had infiltration on X-rays along with positive tuberculin skin test [Indurations of >10 mm] making a definitive diagnosis of TB. Calcified lesions were seen on X-rays in another 91 cases giving evidence of past infection, however 26 of these were AFB positive indicating either the relapse of disease or active lesion. Low grade fever and weight loss were the most significant findings in contacts that were positive on sputum smear and radiology. Almost 15.6% household contacts of pulmonary tuberculosis patients have pulmonary tuberculosis. Health care providers in general and DOTs staff in particular should be trained to inform all index cases that their close contacts especially those suffering from weight loss and fever should be screened for tuberculosis and treated if required

Pattern of diseases, reason of visiting and waiting time at various stages of tertiary hospital

Objectives: To determine the frequency of diseases in children, reasons of visiting out patients department of tertiary care children, hospital and to evaluate the waiting time of patients at different stages of treatment

Study Design: Descriptive observational study

Place And Duration: National Institute of Child Health, Karachi from October 2007 to July 2008

Methodology: Patients up to 13 years of age attending OPD were recruited in to study using simple random sampling procedure. Sample size was 400

Results: Children were selected from three OPDs of NICH, Karachi. Majority of patient were below 5 years of age [69.7% [n=279]]

Mean age was 3.53years + 3.3 with range 155 months [1-156]. The main diseases in medical OPD were respiratory problem 19.43 % [n=34], followed by renal problems 17.7% [n=31], and GIT problem 13.7% [n=24]. In surgical OPD, trauma and fracture 23.2% [n=36], hernia 17.42 % [n=27], and urology 15.5 % [n=24] were important problems in children. Respiratory distress 31.43% [n=22], sepsis 18.61% [n=13], NNJ+ 17.1% [n=12], and constipation 11.43% [n=8], were theicommon disorders in infants attending well baby clinic. Mean number of visits per patient was 2.5 +1.9 [range 1-20]

Conclusion: Most frequent disorders in medical OPD were respiratory problem, trauma and fracture in surgical OPD, and respiratory distress, sepsis and neonatal jaundice at well baby clinic. Availability of free of cost facilities was the main reason for attending the OPD

To evaluate the presence and spread of environmental pathogens and their sensitability. an epidemiological survey of the microbiological monitoring at burns ward civil hospital Karachi

To evaluate the presence and spread of environmental pathogens and their sensitability at burns ward civil hospital Karachi. Descriptive observational study. This study was conducted at Burns Center, Civil Hospital, Karachi during 2012. Samples were collected of air and examined through air microbe index. Samples of water were collected from different sources. Similarly samples were also collected from clothes, nails, hairs and hands of all the Health care personnel working in the burns ward. These samples were sent for culturing to conclude for presence of bacteria. Staphylococcus Aureus was the major organism obtained from the samples in the burns ward. The organism was also detected from the nasal swabs taken from some staff members. Being the most common cause of nosocomial infection it is necessary to take appropriate steps to cut the probable route of transmission. E.coli and Pseudomonas strains were also detected from the environment of the burns ward. E.coli was also detected in the food trays of the patient a probable route of transmission. Many of these strains were resistant to antibiotics which made it further difficult to treat them. Strains of Enterobacteriaceae, Proteus Mirabilis, Klebsiella and Citrobacter were collected from our personnel and were responsible for some hospital acquired infections. Staphylococcus Aureus was the major organism found. The major routes of transmission of opportunistic organisms were tap water and our staff members. Proper hygiene measures and awareness programs for the staff members should be carried out to aware them of the importance of hygiene

Frequency of chemical burn and mortality rate in admitted patients at a tertiary care hospital of Karachi

Developing countries have a high incidence of burn injuries creating a fear or respect public health problem. Acid assault is one of the most savagely violent of crime which aims to punish the victim or to destroy the victim's social life. This violent usually occurs in third world countries like Pakistan, Bangladesh, and Iran etc. In Pakistan 7 to 17 burn admissions annually recorded during the study period. To assess the epidemiological factors in terms of incidence morbidity and mortality and the effect of social and cultural issues associated with the chemical burns. A cross sectional retrospective Place and Duration of Study: This study was conducted in burns ward of Civil Hospital Karachi from May 2004 to Oct2010. All the patients were identified the etiology and the extent of damage that was produced as a result of throwing corrosive chemicals. Overall 127 patients record were included in study. It was more commonly found in younger age group i.e. 21 -30 years. The incidence was much more in males [74.0 %] as well as stratified by age. Majority of the patients [90.6%] were burn with Accidental. Moreover, the patients who had 3RD degree burn [41.9%] that leads to more mortality in our circumstances. Septicemia was the leading cause of death. The burn injury was significantly associated with degree of burn, depth, extent and mode of injury. The most common incidence found was accidental followed by assault. Lack of information about the catastrophic outcome of this action plus the wide spread availability of strong destructive chemicals are the main reasons for the rising incidence of this crime. The majority of deep burns were on homicidal. So measure should be taken to generate awareness for protective measures, immediate first aid, proper professional treatment, restriction in availability of acid, implementation in the existing law regarding the bail of accused etc to prevent these accidents and ensure safety

To compare the rate of mortality among fire burn inhalational and non inhalational injuries in admitted patients at burns centre Civil hospital Karachi

To compare the rate of mortality in fire burn inhalational and non inhalational injuries. Retrospective, comparative study. The study was conducted at Burns centre, Civil Hospital, Karachi from January 2009 to December 2010. The study was conducted on admitted patients at Burns centre, Civil Hospital, Karachi. All male young male patients aged 20 to 40 years admitted in Burns ward [Civil Hospital, Karachi] suffering with fire burn inhalation or fire burn non inhalation injuries with burnt surface area between 20% - 50% were included in this study. Patients were followed until discharged or death. Out of total 300 male, 150 in each group having age between 20 and 40 years with 20% to 50% of burnt surface area and had sustained severe burn injuries admitted to Burn centre were included in the study. Of these, patients with fire burns inhalational injuries were at high incidence of mortality rate i.e. 66/150 [44%] as compared to non inhalational injuries i.e. 42/150 [28%] [P<0.05]. We conclude that patients with fire burn inhalation injuries are at increased risk of death, because in addition to severe cutaneous burns it also causes acute inflammation and damage of the respiratory system

Assessment of knowledge, attitude and practices pattern of hand washing in some major public sector hospitals of Pakistan [a multi-center study]

To assess knowledge, attitude and practices of hand washing in major Public sector Hospitals of Pakistan and see the differences in practices in different levels of health care workers. Cross sectional hospital based survey conducted in all provinces of Pakistan in major tertiary care hospitals. A Cross sectional hospital based survey was conducted on knowledge, attitude and practices of hand washing in doctors, nurses and paramedical staff. From each hospital 10 OPD's and 10 wards i.e. 2 medical, 2 Surgical, Gynae, Peads, Dermatology, Eye, ENT, and Causality/ICU were selected and from each unit. Four doctors, four nurses and two paramedical staff were interviewed. A total of 3243 respondents were interviewed. Of these 87.3% had knowledge of hand washing. Hand washing facilities were available at 75% places and 69% respondents practiced hand hygiene, but only 58.8% washed their hands for more than 20 seconds. Majority used antibacterial soap bought by them. Rush of the patients, shortage of time, non availability of soap and water and lack of encouragement by seniors were the major causes for low hand hygiene practice. Almost 25% sites in major public sector tertiary hospitals did not have hand washing facilities but where available most health care providers were using them. Majority despite having knowledge, need motivation and continuous education of hand hygiene. Facilities of hand hygiene should be made available

comparative study on factors causing job dissatisfaction among serving doctors at teaching hospitals of Hyderabad, Pakistan

To determine the main factors of job dissatisfaction among doctors serving in teaching hospitals of Hyderabad, Pakistan. One public sector teaching hospital, i.e., Liaquat University of Medical and Health Sciences Jamshoro and one private teaching hospital, i.e., ISRA University Hospital Hyderabad was selected as study places. Doctors working on contract, part time or having service less than one year were excluded. A pre- tested mailing questionnaire was sent to each one and their response was analyzed on SPSS version 15. Out of 300 questionnaires, 248 were received correctly. Among the respondents, 76.2% doctors were found to be completely dissatisfied with their jobs. Whereas, the mean score for satisfaction characteristics were lowest for working environment [2.12 +/- 0.07], Pay and Perks [2.13+0.08] and work load [2.14 +/- 0.08]. Only the category of Professor showed total satisfaction being 67%, while qualification wise analysis showed none of the degree holders was totally satisfied. On the basis of this study, showing dissatisfaction of hospital doctors towards job conditions, it is suggested to improve job conditions/characteristics with emphasis on the improvements in working environment, pay scale and work load

Survey of statistical methods and type of articles published in the selected Pakistani medical journals from 1999 to 2007

To determine the frequency of type of articles and statistical methods used in 6 leading Pakistani medical journals of 1999 to 2007. All the original articles, case report, review articles and short communications published in 1999 to 2007 of those journals were reviewed. Total number of articles reviewed was 5001. The information recorded from these journals was: types of article; any statistical methods used and correctness of statistics. Out of 5001 articles reviewed, 1110 [22.2%] were case reports, 3395 [67.9%] were original articles, 213 [4.3%] were short communications, and 283 [5.7%] were review articles. The percentage of case reports was increased from 17.6% to 26.1%, while the percentage of original articles was reduced from 73.1% to 64.4%. Fifty nine percent of the original articles either did not contain any statistics or used only descriptive statistics. Seventy seven percent of the original articles have used appropriate statistics for making inferences. There is a significant improvement in the use of statistics during the study period of 9 years. However with the introduction of systematic review, Chochran library and Meta Analysis, advanced techniques of biostatistics are needed to understand these types of articles

Knowledge, attitude and practices of breast self examination [BSE] in women of Karachi

To assess the knowledge, attitude and practices of breast self examination [BSE] in women attending gynecological units of major public sector hospitals of Karachi. Cross sectional survey. All women of age between 20-50 years of either marital status attending Gynae OPD of Civil Hospital and Jinnah Postgraduate Medical Center, Karachi from May 2010 to December 2010 were included in the study. A verbal consent of each participant was obtained before collecting the data. The data was collected through a structured questionnaire have information on socio economic data, knowledge about breast self examination, symptoms, risk factors and preventive methods regarding breast cancer, attitude of the respondent and practices regarding breast self examination. Out of 412 respondents, majority belongs to 30-39 years age group [43.7%]. Knowledge about breast self examination was found in only 22.8% respondents. Knowledge about symptoms, risk factors and preventive measures regarding breast cancer were 25.3%, 28.7% and 26.0% respectively. However majority of the women 98.9% who have the knowledge were practice the breast self examination monthly or fortnightly. The attitude regarding breast self examination was very encouraging as 97.3% of the respondents promised not only to adopt it in future but also recommend it to their relatives and other friends. The knowledge about breast self examination was very low in the respondent which is the easier way of early detection of different breast diseases specially, breast cancer. However those who know it are doing it well. The attitude of the respondents was very encouraging. Awareness programme should be developed to promote it for early detection of breast cancer

Current Bacteriological profile in Fire-burn victims and their associated mortality at the Burns Centre, Karachi Pakistan

This study attempts to document the current bacteriological profile from pertinent specimens of fire burn victims in our setting with respect to the time related variations in the isolation of microbial species, extent of their burn injury and their effect on mortality rate. During a three year period [Jan 2008 to Dec 2010], a prospective study was conducted on 477 fire burn victims at the Burns Centre of Civil Hospital, Karachi, with the exclusions of electrical, chemical and other forms of burn injury. Blood, pus, urine and wound biopsy samples were collected and cultured according to standard laboratory protocols. The data was analyzed according to the age, gender, time related changes, percentage of burn surface and the mortality rate. Total 477 patients were included in our study. Multiple specimens were collected [n=732] of which 649 [88.7%] cultures were positive for different organisms. Staphylococcus aureus was the commonest organism isolated in fire burn patients. During 1[st] week S. aureus was predominant [31.6%] followed by Pseudomonas. After 1[st] week S. aureus [24.6%] and Pseudomonas [25.5%] isolation rate became similar. Mortality rate due to infections was 18.9% in the subjects. S.aureus was the commonest cause of infection in fire burn patients in our setting followed by Pseudomonas. These suggests that hygiene should strictly be maintained around burn patients to avoid opportunistic infections

Comparison of oral versus injectable vitamin-D for the treatment of nutritional vitamin-D deficiency rickets

To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D. Case control. It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004. Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin-D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups A and B. Group A was given oral vitamin-D and group B was given intramuscular injection of vitamin-D on the first day and then they were followed for two more visits at 30 and 90 days with clinical, biochemical and radiological examinations to assess the outcome. There were 50 confirmed cases of rickets in each group. The mean age was 10.9 +/- 5.1 months and 14.7 +/- 8.1 months in group A and B respectively. In these children, clinical features were weakness, difficulty in walking, frontal bossing, ribcage deformity and widening of wrist were seen. After one dose of vitamin-D [cholecalciferol], there was appreciable gain of weight and height and raised levels of alkaline phosphatase became normal during follow-up. Radiological florid rickets and non-florid rickets in both groups healed clinically during follow-up period. Oral and injectable forms of vitamin-D [cholecalciferol] were effective but injectable form was shown to be statistically significant. There were no undesirable side effects and both forms of treatment were well-tolerated

Non-compliance - awareness and attitude of psychiatric patients regarding out patient follow-up at civil hospital, Karachi

To determine the awareness, attitude and causes of non-compliance of psychiatric patients attending the out patient follow up treatment at Psychiatry Department, Civil Hospital, Karachi. A cross-sectional study. The study was conducted from July 2003 to February 2004 at Civil Hospital, Karachi. A pre-coded pre-tested questionnaire especially designed for this study was used. Non-complaint patients attending the Out Patient Department [OPD] were selected by systematic random sampling method. Non-compliance was defined as attending the OPD after a lapse of 15 days or more from the previous visit. Variables were described in percentages, mean and standard deviation. Proportions were compared using chi-square test. Non-compliance in follow-up was recorded as 18% in the 100 selected patients. Majority [65%] patients were of the middle age group i.e. 30-49 years with mean age 32.71 +/- 10.85 years. Similarly majority of the patients were illiterate [54%], belonged to low-income group [64%] and were unskilled workers [34%]. Family history of the same disease was found in 24% patients. Satisfaction of family members from the treatment compared to non-medical faith-healers were statistically significant at p<0.01. The main reasons for non compliance of follow-up treatment were [i] the patients denial of having any psychiatric disease [14%], [ii] irregular intake of medicines [14%] and [iii] lack of money for either commutation or purchase of medicine [11%]. Only 41% patients were taking the medicines regularly in the prescribed doses and 32% patients could not afford the cost of the prescribed medicine. Among the studied cohort of psychiatric out patients, non-compliance was 18%. Patients' denial of his disease and non affordability of patient regarding his treatment expenditures were the major causes. Awareness and satisfaction of patients and their family members regarding the increase efficacy and reliability of medical doctors compared to non-medical faith healers, had significant impact over the patients compliance

Knowledge, attitude and practice patterns of handwashing in major public sector hospitals of Karachi

To determine the knowledge, attitude, and practice pattern of hand washing in medical professionals of some public sector hospitals and determine the variations in different groups and also check the availability of hand washing facilities at these sites. A questionnaire based study was conducted at 10 wards and 10 OPD's of six major public sector hospitals of Karachi. From each unit, 5 staff members [2 doctors 3 paramedics] were selected A precoded proforma was used to collect the information. A total of 386 individuals were interviewed and rest could not be accessed due to non availability. Of the total only 68.8% had sufficient knowledge about the benefits of hand washing while the facility was available at only 16.8% [16/96] units. Although 59% of those interviewed said that they were adopting the practice of hand washing but when observed only 8.9% doctors and staff were practicing it. Majority [62.7%] used the toilet soap for hand washing which they purchased themselves. Only 33.4% individuals thought that soap and water were adequate for disinfection whereas others [66.6%] did not think so. Attitude of 48.7% doctors and 66.2% paramedical staff was positive for adopting the hand washing practices provided the facility was available to them. Main reason for not washing hands was non availability of the facility and heavy rush of patients. To prevent nosocomial infection, the hospital management should provide hand-washing facilities at all sites where patients are examined. Seniors should make sure that they adhere to this practice and also keep a check on their juniors. Health education should be provided regularly through print and visual media and workshops

Existing record keeping system in government teaching hospitals of Karachi

A Study to determine the deficiencies in the existing record keeping system in government teaching hospitals of Karachi was conducted from 01.01.1998 to 30.11.1998. A total of 9725 pre-coded proformas were filled from 136 units of all the hospitals including out patient departments [OPD], wards, and emergencies. Majority of the records [52.2%] were retrievable within one hour. The mean with S.D of patients seen per day at all the hospitals were 122.49 +/- 92.25 [57 OPDs], 30.04 +/- 16.24 [75 wards] and 186.25 +/- 145.80 [4 emergencies]. In majority units [57.4%], the stationery for record keeping was either not provided or not enough provided. Only 39.0% units have 75% or more required information on records. The important information [except age] i.e. temperature, pulse rate, blood pressure, diagnosis, weight, prescribe dose, history of patient, laboratory findings, previous record and discharge report were lacking. It is therefore essential that uniform OPD, ward and emergency slips should be developed having all important quarries. So that data could be utilized for research purposes along with better planning and management of the hospital and procurement plan of the government

Diseae pattern, seasonal variation and major cause of death in indoor patients at medical units of civil hospital, Karachi

A descriptive study to determine the disease pattern, seasonal variation [if any] and major cause of death in admitted patients of all medical units of Civil Hospital, Karachi was conducted. A total of 851 records of all five medical units were randomly selected from July 1999 to June 2000. The mean age of patients was 44 years and 26 percent were below 30 years of age. Majority of the patients [78 percent] belonged to Karachi. Out of these 36.5 percent patients came from District South where this hospital is located. The mean duration of stay was 9.3 +/- 7.4 days. Liver disease was the main cause of admission on single disease basis as well as co - disease basis. This also remained higher in all the seasons except between Jan-March period, when respiratory disease was on the top. Out of 851 patients, 155 [18.2 percent] deaths were recorded. Liver disease was also the main cause of death in indoor patients followed by CVA, Respiratory, TB, and Cardiac diseases. Out of 155deaths, 89 [57.4 percent] died within 60 hours of admission, showing that majority came to this hospital at terminal stage of the disease

Profile of patients attending civil hospital, Karachi

A study involving 2000 patients randomly selected from six major out patient departments of civil hospital, Karachi was conducted during 1993-95 to find out the profile of patients attending this hospital. Majority of the patients were illiterate belonging to low income group and residing in the same district in which the hospital is located. The ratio of adults and children below 15 years of age was 1: 1.5. The main reason for attending Civil hospital, Karachi was just to get free treatment along or with some other reasons. 71% patients did not know the nearest government dispensary of the area. 62% patients were either children or a lady who could not move alone in the society so they brought some one with them. The time has come that role of local government dispensaries should be increased with better performance, providing some additional facilities and increasing their awareness in the general population

Functional analysis of patients flow in out patient department of civil hospital Karachi

A study to assess the functional analysis of the outpatient department of Civil Hospital, Karachi was conducted on 2000 patients during 1993-95. Each patient was followed from entrance in the hospital to leave the hospital. Mean time spent by the patients on one way from leaving home to enter in the hospital was 45.4 +/- 31.4 minutes [range 5 - 300 minutes], where as mean time spent in the hospital was 30.7 +/- 20.3 minutes [range 6 -185 minutes]. 71% of the patients got all the medicines from the hospital. Awareness of local government dispensaries may be increased to reduce the rush at a teaching hospital. Some more facilities like laboratory test, x-ray, minor operations, ultrasound etc, may be provided at these local dispensaries so that people give more attention to these dispensaries. Simultaneously, filter clinics should be established at hospital level to get general patients for medical students and complicated patients for postgraduate students