Knowledge and perception of hand hygiene among health care workers of a tertiary care military hospital: a descriptive study

Objective: To determine the knowledge and perception of doctors and paramedical staff about hand hygiene of a tertiary care military hospital

Study Design: Cross sectional descriptive study

Place and Duration of Study: Study was conducted at tertiary care military hospital, from Aug 2016 to Jan 2017

Material and Methods: The sample size 196 was calculated using World Health Organization sample size calculator. Permission from administrative authorities was taken. Purposive sampling technique was used. World Health Organization's knowledge and perception structured self-administered questionnaire was used with minor amendments for the data collection. The percentage's in knowledge and perception domain of >75 Percent determined good, 50-75 Percent fair and <50 Percent poor

Results: There were 88 [45 Percent] paramedical staff, 49 [25 Percent] doctors and 59 [30 Percent] nurses while overall 103 [52.5 Percent] were male and 93[47.5 Percent] female. The age of 160 [81.5 Percent] study participants ranged 21-40 years. The overall mean score of knowledge was 64.1 Percent and perception 72.5 Percent. The paramedical staff presented with lowest mean score in knowledge 60.6 Percent and perception 74.9 Percent. While doctors scored highest 64.6 Percent in knowledge domain and nurses scored highest in perception domain 82.2 Percent. There was no statistical significant difference of knowledge and perception of hand hygiene between and within doctors, nurses and paramedical staff knowledge [p-value 0.799 and p-value 0.515 respectively]

Conclusion: The overall knowledge and perception of study participants about hand hygiene was fair. However, doctorsand nurses' perception of hand hygiene was good

Frequency of stress among pilots of a base

Objective: To determine the frequency level of stress among the pilots stationed at a base in Pakistan

Study Design: Cross-sectional descriptive study

Place and Duration of Study: Study was carried out at an air base of Pakistan from April to July 2013

Material and Methods: All aviators on active flying duties with no past psychiatric history were included in this study. After taking consent and permission from authorities each pilot was given two self-reporting forms consisting of life inventory composed of thirty items depicting recent life changes. Life events included in this scale ranged from highest score of 100 for death of spouse to minimum score of 11 for minor violations of law. The stress questionnaire included a symptoms list with five possible responses of never, seldom, sometimes, often and regular. Pilots were to choose most appropriate response that fitted best for the last six months. This questionnaire consisted of 75 items. Items covered almost all physical, psychological and cognitive symptoms that might occur in stress

Results: A total of 74 aviators participated in this study. On stress inventory 31 [42%] pilots had no significant problems in their lives, 22 [30%] had mild stress, and 17 [23%] pilots had moderate stress while only 4 [5%] pilots exhibited to have major stress. Results of stress questionnaire reveal that 35% of pilots had below average stress level, 27% pilots had above average stress levels, 23% of the pilots showed average person's stress level, and 9.45% of the pilots that is only 7 out of 74 exhibited high stress level

Conclusion: Majority of Pakistani pilots have reported low level of stress

Comparison of hyperuricemia in type 2 diabetics on low dose aspirin and not on low dose aspirin

To compare the frequency of hyperuricemia in type 2 diabetes patients who are taking low dose aspirin with those patients who are not taking low dose aspirin. Quasi experimental study. This study was carried out at Military Hospital Rawalpindi for a period of two years [June 2006-May 2008]. Sixty diabetic patients were selected who were taking low dose aspirin comparing group A and sixty diabetic patients who were not taking aspirin were placed in group B. These patients were selected from the OPD through non probability convenience sampling. All these patients were being followed up in medical outpatient quite regularly on fort-nightly basis. Data had been collected through a carefully designed questionnaire. In group A, 90% of the patients had uric acid less than 445umol/l and 10% of the patients had uric acid more than 445umol/l. whereas in group B 100% of the patients had uric acid less than 445umol/l, there was a statistically significant difference between the two groups [p< 0.05]. Aspirin in low doses cause hyperuricemia and regular monitoring of uric acid is mandatory to prevent its adverse effects

Colonoscopy in children

To study the safety and diagnostic yield of colonoscopy in children and see the pathological pattern in those who underwent biopsy of the lesion. Retrospective analysis was carried out on paediatric colonoscopies that were carried out at Military Hospital, Rawalpindi over 5 years. All children presenting with lower gastro intestinal bleeding, chronic diarrhea and abdominal pain were subjected to colonoscopic examination. The procedure was done after 72 hours preparation, under Ketamine sedation. Mucosal biopsies were taken where indicated and polypectomies were performed using snare and electrocautery. A total of 190 children [111 boys, 79 girls; mean age 5.7 +/- 3.5 years] were included in the study. A diagnosis could be made in 162 [85.2%] patients which included polyps [138], colitis [18] and miscellaneous causes [6]. On histology, colitis was further defined into nonspecific colitis in 15 cases with 6 showing features suggestive of ulcerative colitis. Eosinophilic colitis was seen in 3 cases. Majority [78%] of polyps were in the rectosigmoid colon and all were juvenile hamartomatous polyps except two which were adenomatous polyps. Mean age for children with colitis and polyps were 6.5 and 5.1 years respectively. There was no procedure-related complication. Rectal bleeding was the major indication for colonoscopy and majority of the cases had polyps. Colonoscopy is a safe procedure in children and can be carried out under conscious sedation. All patients with rectal bleeds should undergo colonoscopy and this instruments should be available in all tertiary care pediatric units

Ketamine sedation for pediatric gastrointestinal procedures

To study the safety and efficacy of Ketamine for pediatric gastrointestinal procedures. Quasi-experimental study. Military hospital Rawalpindi over a period of 11 years from January 1999 to December 2009. The study was conducted in a series of children receiving ketamine administered by pediatric gastroenterologists skilled in basic airway management to facilitate pediatric gastrointestinal procedures. Patient's data was recorded for each sedation to determine age, gender, indication, effectiveness of the sedation and adverse effects. Initial dose of Ketamine 1.0 mg/kg was administered. A second dose of Ketamine 1.0 mg/kg was given after 2 to 3 minutes if adequate sedation had not been achieved. Subsequent doses of 0.5 to 1.0 mg/kg Ketamine were given as necessary and adverse events associated with the sedative regimen were documented. Ketamine was administered to 954 patients who underwent G.I. endoscopies, ranging in age from 2 months to 17 years with mean age of 6.6 years [SD +/- 3.5]. Six [0.6%] patients experienced a significant drop in O[2] saturation [<85%] that required interruption of the procedure and/or mild stimulation/ oxygen supplementation. Increased oral secretions, requiring repeated oral suction was noted in most patients undergoing these procedures. Inadequate sedation was noted in just ten patients [1%]. Two patient [0.2%] developed laryngospasm. Vomiting at recovery from sedation was noted in 35 [3.7%] patients. Myoclonic jerks and involuntary movements were noted in 5 [0.5%] patients. No episode of aspiration was observed. No patient required intubation or bag/mask ventilation. Pediatric gastroenterologists skilled in ketamine administration and basic airway management can effectively administer this drug to facilitate gastrointestinal procedures

Frequency of hepatitis B and hepatitis C in multi-transfused beta thalassemia major patients

To determine the frequency of hepatitis B and C virus infection among children with beta thalassemia major registered at Military Hospital Rawalpindi. Descriptive Study. The study was carried out at Military Hospital Rawalpindi, from 1st September 2008 to 31st August 2009. Children attending Thalassemia Centre Military Hospital Rawalpindi for regular blood transfusion were registered. They belonged to different ethnic groups and came from different parts of the country. Their demographic data was recorded, detailed history taken and physical examination was carried out. Their serum samples were tested for hepatitis B surface antigen and anti HCV antibody assay with third generation commercial ELISA method. During the study, 141 patients of beta thalassemia major were screened. Out of them 50 patients [35.5%, 95% confidence interval 27.8-43.5] were found hepatitis C virus antibody positive and 1 patient [0.7%] hepatitis B surface antigen positive. One patient [0.7%] had both hepatitis B and C virus infection. Mean age of hepatitis C infected patients was 10.4+3.85years [range 2-16 years]. Mean age of uninfected patients was 6.1+ 3.59 years. [p value 0.000]. In addition, the results indicate that higher prevalence of anti-HCV was significantly associated with longer duration of transfusion [p value <0.003]. In spite of the fact that screened blood is used for transfusions, still a large number of patients have been found infected with hepatitis C. Therefore more accurate techniques are required for screening of blood to prevent transfusion associated transmission

Parenteral iron therapy in malnourished children

To evaluate the safety and efficacy of intravenous iron sucrose complex in the treatment of iron deficiency anemia in malnourished children who are unable to tolerate oral iron supplementation or are unresponsive to oral supplementation because of gastrointestinal dysfunction or iron malabsorption. Prospective interventional study. This study was carried out at Department of Paediatrics Combined Military Hospital Quetta over 24 months of period from 1st November 2002 to 31st October 2004. Each selected patient was given total calculated amount of iron sucrose complex. The iron deficit was calculated by using following formula: Total Iron Deficit [mg] = Body wt [Kg] x [target Hb - Actual Hb] x 0.24 + Depot Iron [mg]. Target Hb is 13 G/dl and depot iron is 15 mg/Kg. Iron sucrose complex was diluted in 0.9% Normal saline and was given intravenously over 3-4 hours. To assess the efficacy of Iron sucrose complex serial samples were analyzed for Hemoglobin [HB], Hematocrit [Hct], Red Blood cell indices, Reticulocyte count and serum Ferritin. Total iron deficit was administered over 2 to 3 weeks time. A total of 17 malnourished children with weight for age below -2SD, completed intravenous iron sucrose infusion. Tolerance of intravenous iron sucrose was good except in one, who had transient episode of lethargy. Mean Hemoglobin at presentation was 6.6G/dl [Range: 4.9G/dl-8.4G/dl]. Six weeks after giving intravenous iron therapy mean Hemoglobin was 10.5 G/dl, with average increase of 3.9G/dl [range 3.0G/dl-5.3G/dl]. Intravenous iron supplementation with Iron sucrose complex is quite safe and efficient way of replenishing iron body stores and significantly increasing the hemoglobin concentration in malnourished iron deficient children