Appropriateness of musculoskeletal soft tissue swelling ultrasound scans

This audit's purpose was to assess the appropriateness of referrals from primary and secondary care for soft tissue lumps and bumps ultrasounds (US) that are being performed in a university teaching hospital imaging department and compare against the British Sarcoma Group (BSG) national guidelines. This is on the background of increasing referrals for ultrasound scans of soft tissue lumps with limited clinical information in the face of increasing workload in the imaging department. This was a retrospective study, analysing data for all US performed for soft tissue swelling - over a one-month period. We focused on all US undertaken in the imaging department for June 2019 (pre-COVID) allowing for a 24 month follow-up period. Indications and findings were recorded. The requests were assessed regarding appropriateness by comparing to NICE and BSG guidelines. 200 ultrasound scans were undertaken during the one month period;14 paediatric patients were excluded from the data. The majority of referrals were from primary care (92%). Of the 186 cases analysed, 102 cases (54%) did not contain any appropriate clinical information as per the guidelines and no descriptive features were mentioned. Of the 81 cases (44%) that did contain relevant clinical information, 14 cases (17%) mentioned clinical features that, according to the guidelines, did not require ultrasound imaging and hence were also inappropriate. This audit shows the significant proportion of inappropriate requests from primary care. There was a lack of relevant clinical information on requests for US soft tissue, making it difficult to ascertain which patients need to be offered a direct access US in the required twoweek time frame. Considerations for improving the quality of referrals include presenting the audit within primary care teams to enhance referrer education and ratifying an US request system with a flowsheet proforma to ameliorate the referral process.

ASSESS THE TREATMENT ADHERENCE OF ANTIHYPERTENSIVE MEDICATIONS DURING COVID-19, A MULTICENTER CENTER STUDY OF PAKISTAN

Objective: Important challenging factor for health care professionals is to ensure the treatment adherence of hypertension during COVID-19. To prevent the cardiovascular problems, adherence is one of essential parameter among the patients. The current study was designed to assess the treatment adherence of antihypertensive medications during COVID-19. Methodology: The descriptive, cross-sectional and multi-center study was conducted in 4 different clinical settings of two major cities of Sindh, Pakistan. The sampling method was systemic and patients were enrolled in the study from June to December 2021. Only those patients were selected who had confirmed diagnosis for hypertension and taken atleast one antihypertensive medications. A total of 1428 hypertensive patients were taken part in the study. Using self-administered adherence scale i.e. SDAS-14, the data were analyzed accordingly. Results: According to SDAS-14, the patients were categorized on score of adherence scale i.e. more than 10 means good adherence, 5-9 were medium adherent and less than 5 no or less adherent. Out of total 1428 patients, the average age was 58 years + 9 years. Majority were of male gender. Based on BP measurements and a series of questions were asked that showed low level of adherence were found during COVID-19. High educational level (OR 2.64, 95% CI 1.46-3.36) and ARBs treatment (OR 0.76, 95% CI 0.61-0.91) were independent predictors of good adherence. Conclusion: The study reflects that during COVID-19 the level of adherence was low due to unavailability of medications and access to the health care professionals. More over the values of blood pressure was also not under control due to no exercise. The education is directly professional to the high level of adherence.

ATYPICAL PRESENTATION OF FAT EMBOLISM SYNDROME IN AN IMMUNOCOMPROMISED PATIENT

SESSION TITLE: Systemic Diseases with Deceptive Pulmonary Manifestations SESSION TYPE: Rapid Fire Case Reports PRESENTED ON: 10/18/2022 12:25 pm - 01:25 pm INTRODUCTION: Fat embolism is a syndrome that can occur during orthopedic procedures or fractures of the long bones, especially the femur and tibia. It can affect multiple organs, including the brain, skin, and lungs, causing the triad of altered mentation, petechiae, and hypoxemia. Here, we present a case of a 54-year-old woman at risk for graft versus host disease (GVHD) who presented with dyspnea a few weeks after an orthopedic procedure. Initial chest radiograph was notable for parenchymal infiltrates, and she was initially treated with antibiotics without improvement. CASE PRESENTATION: A 54-year-old woman with a history of leukemia, stem cell transplantation years ago, GVHD (skin liver, ocular, oral, joints (not lung), with clinical and cytogenetic remission underwent total hip arthroplasty. Two weeks later, she developed lethargy and dyspnea and presented to the emergency department. She was found to have an elevated WBC of x19.5 k/ul (normal 4.1-9.3k/uL) with a left upper lobe consolidation on the chest radiograph (Figure 1). She was treated empirically for pneumonia and discharged with a 7-day course of levofloxacin. Despite completing the course of antibiotics, her dyspnea worsened, and she presented to the emergency department two weeks later with worsening hypoxemia. Computed tomography (CT) of the chest showed bilateral diffuse ground-glass opacities (GGOs) with patchy consolidations in a broncho-vascular distribution (Figure 2). She was negative for COVID-19, Influenza A, B and Legionella urinary antigen. The differential diagnosis included infection and GVHD among others. She underwent bronchoalveolar lavage (BAL). The Gram stain and the culture did not suggest an infection. Pathology from BAL returned significant for reactive bronchial and squamous cells with lipid-laden macrophages. She was started on steroids. Her clinical status improved dramatically, and she was eventually discharged. At a 3-month follow-up her symptoms had improved. Her CT scan also showed significant improvement (Figure 3). DISCUSSION: Our case highlights the successful diagnosis of fat embolism in the lungs in a patient with complicated medical history. Fat embolism usually presents as ground glass opacities. However, the diagnosis was more challenging in this case due to a significant time lapse between her surgery and her presentation to the hospital. She also lacked the other common signs of fat embolism including altered mentation and skin changes. Therefore, other etiologies, such as GVHD, bacterial or viral infection were initially strongly considered. CONCLUSIONS: The diagnosis of fat embolism syndrome condition should still be suspected despite a delay from the initial surgery. Diagnosis in immunocompromised patients requires a detailed workup to rule out other etiologies. Reference #1: Johnson, M. J., & Lucas, G. L. (1996). Fat embolism syndrome. Orthopedics, 19(1), 41-49. Reference #2: Newbigin, K., Souza, C. A., Torres, C., Marchiori, E., Gupta, A., Inacio, J., … & Peña, E. (2016). Fat embolism syndrome: state-of-the-art review focused on pulmonary imaging findings. Respiratory medicine, 113, 93-100. Reference #3: Swiatek, K., Kordic, G., & Jordan, K. (2018). An Unlikely Presentation of Fat Embolism Syndrome. Chest, 154(4), 686A. DISCLOSURES: No relevant relationships by Raheel Anwar No relevant relationships by Boris Medarov

Policies, practices, and perspectives related to online education amid the COVID-19 pandemic: A case study of a public HEI in Pakistan

The education sector in Pakistan has been the adversely hit because of the COVID-19 pandemic. The ensuing situation brought with it numerous challenges for academia, teachers, and students coupled with unique opportunities for stakeholders involved in the teaching-learning process. This chapter captures the impact of COVID-19 on higher education in Pakistan with special reference to the policy framework for online education at HEIs provided by the federal regulatory body (i.e., higher education commission) and its implementation at a large-scale, public, professional university in Karachi as a case. Using the case-based method, empirical evidence about the policy adoption, pedagogical design, and implementation with monitoring and evaluation are presented along with all three main stakeholders' (management, teachers, and learners) perspectives and experiences. © 2022, IGI Global.

Assessment of knowledge believes and myths regarding the use of mask in covid-19 outbreak in karachi pakistan

Objective: To assess the general perspective of population their believes and myths regarding the pandemic outbreak and use of mask as precautionary measures. Methods: A Cross-sectional observational study conducted from January-June 2020, among the general population of Karachi. Total 470 participant age range of 18-60 years were included in the study. Data was analyzed by SPSS version 21.0, for descriptive statistics. Correlation between variables was assess by Kruskal Wallis Test, spearman rank correlation was established to assess the significant correlation between Knowledge, myths and practices. Result: Out of 470 respondents, 74.31% were male and 25.69% of female. More than half of respondents aged between 51 to 70 years i.e. 53.92%. While 21.76% respondents were categorized in illiterate category. The mean rank score for knowledge, myths and practices were 217.95±2.1, myths score was 236.07±2.1, 241.12±2.1 respectively. The spearman rank correlation was established between knowledge myths and practices, a significant correlation between was established by Knowledge-myths (r= 0.0176, p= 0.015), knowledge-practices (r= 0.0174, p= 0.001) however myths-practices (r= 0.0170, p< 0.001). Believes and myths related to the mask was concerned i.e. 56.1 were using N-95 masks, 89% respondents reused the masks, 59.1% used the mask between 2 to 5 times. Wearing mask is not a precautionary measure was mainly found as a myth in respondents i.e. 78.7%. 67.2% respondents had myths about unnecessary use of mask. The study highlighted the non-optimal behavior and practice with regards to the use of preventive measure including the use of mask in the pandemic outbreak. © 2020 Assiut University. All rights reserved.

An old therapy, convalescent plasma, for coronavirus disease-19: Do we have all the answer?

BACKGROUND: Coronavirus (CoV) disease (COVID-19) has become a global health pandemic by early 2020;it has pushed the health-care system to its limit. From the initial estimates, 15% of COVID-19 patients caused by severe acute respiratory CoV 2 syndrome present with severe symptoms and requires hospitalization or even intensive care. There is no specific treatment against COVID-19, particularly for those with severe symptoms. Desperation caused by COVID-19 has driven clinicians to try an alternative therapies with little or even no-evidence previously. Convalescent plasma therapy (CPT) has emerged as a promising COVID-19 therapy. AIM: We aimed to review current state of convalescent plasma therapy. METHODS: We summarize the historical CPT, COVID-19 pathology and evaluate potential of CPT for COVID-19;raising the question regarding routinely administrating CPT to the COVID-19 patients, whether it is safe and effective. RESULTS: From cases in Indonesia and other countries, there is bunch of examples that healthcare workers being negatively stigmatized in case of COVID-19. They lost their rights to have a normal life in this pandemic era. A reasonable basis is found in many literatures to advocate the CPT. Convalescent plasma from COVID-19 patients who had been recovered with high neutralizing antibody titers was reported to be effective on transfusion to other COVID-19 patients. CONCLUSION: CPT is one good option to treat COVID-19 patients, but it not without risk;many potential candidate treatment that promising in theory but somehow fall apart when translated into clinical study;only time will tell, including our ongoing CPT clinical study.