Evaluation Of Interdepartmental Calls Generated In 8 Tertiary Care Hospitals Of Northern Pakistan.

Objectives: To assess the quality of medical call writing in multiple tertiary care hospitals based on a variety of parameters. METHODS: The cross-sectional study was conducted in 8 tertiary care hospitals across Pakistan from May 27 to June 27, 2021, and comprised residents and consultants aged 25-60 years regardless of gender and specialty. Data was collected using questionnaires related to demographic and professional characteristics, quality of calls received, quality of calls sent, and opinion regarding improvements to the existing system. Data ws analysed using SPSS 22. RESULTS: Of the105 participants, 65(62%) were residents and 40(38%) were consultants. General surgery team received referrals most frequently 26(24.7%). History of the patient along with relevant examination findings were mentioned in 4(3%) and 6(5%), respectively (p=0.6 vs p=0.5). The timeline was mentioned by 10(9.5%), (p=0.09), and it was inconsistent with the clinical relevancy in 13(12.3%) cases (p=0.5). The working diagnosis for which the patient was admitted in a particular service was mentioned in 35(33.3%) of the generated calls (p=0.01). CONCLUSIONS: The call referral system deserved more attention in order to improve communication among the physicians. Analysis of the quality of referral letters should be part of initial and continuing medical education.

Transcatheter Palliation of a Young Infant With Obstructed Supracardiac Total Anomalous Pulmonary Venous Connection.

Obstructed total anomalous pulmonary venous connection is a life-threatening pediatric cardiac emergency. Infants usually present in critical condition with marked respiratory distress, severe metabolic acidosis, and central cyanosis. Urgent cardiac surgical intervention, despite its high risk, is necessary in order to save the life of the patient. A two-month-old female infant presented to our tertiary care hospital with dense cyanosis and metabolic acidosis. She required mechanical ventilation, but her oxygen saturation did not improve. Her 2D transthoracic echocardiography revealed obstructed supracardiac total anomalous pulmonary venous connection with adequate interatrial communication and severe pulmonary hypertension. After discussion with the family and pediatric cardiac surgical team, it was decided to offer her transcatheter relief of obstructive ascending channel. She underwent successful balloon angioplasty of stenosed levoatrial cardinal vein (vertical vein) with remarkable improvement in blood flow and vessel caliber. She was extubated and her oxygen saturation rose from the high seventies to low eighties immediately after the procedure. She is scheduled for cardiac surgical repair within the next few days. Transcatheter angioplasty is a workable option in stabilizing very sick young infants with obstructed total anomalous pulmonary venous connection, especially supracardiac ones.

Vagal Paraganglioma: A Rare Finding in a 31-Year-Old Male.

Vagal paraganglioma is a rare finding that develops from paraganglionic tissue found around the vagus nerve; it has a prevalence of 0.012% of all tumors. It is the third most common paraganglioma of the head and neck but still accounts for less than 5% of these tumors, and it has a well-established female prevalence. It is a difficult tumor to identify early based on its symptoms alone and only a thorough investigation can help solidify its diagnosis. In this report, we discuss a presentation of this phenomenon that is not only unique in its manifestation but also a very difficult diagnosis due to its deceptive presentation and multiple extensions. These masses need a good surgical regime to be removed properly and postoperative complications are very frequent in most of these cases.

Acute Limb Ischemia in a Patient With COVID-19 Pneumonia.

COVID-19, which is caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), is known to cause a myriad of complications along with the typical lower respiratory tract involvement. One of the emerging complications is a hypercoagulable state leading to venous or arterial thromboembolism. These complications are more common in those presenting with a severe disease with significantly elevated inflammatory markers. Although co-morbid illnesses play a role in worsening such complications, yet they are not the main determinants as these complications also occur in those without any co-morbid illness. Here, we report a case of a 64-year-old male with severe COVID-19 pneumonia presenting with acute limb ischemia with a non-salvageable limb who required subsequent amputation of the affected limb.

A Rare Case of Homocysteinemia Presenting With Multiple Aneurysms in an Adolescent Boy.

Thoracoabdominal aortic aneurysm (TAAA) is primarily a disorder of the elderly; the condition, however, is rare in children, for whom the misdiagnosis is not uncommon. It is one of the leading causes of death in the older age group worldwide, with a 4:1 male to female ratio. There are no real data about the incidence of aortic aneurysms in childhood. Although rare, an aortic aneurysm can be an important cause of mortality in children and adolescents. We present a case of an adolescent boy with a left coronary artery aneurysm, left axillary artery aneurysm, and TAAA type-IV caused by the metabolic disease homocysteinemia. He was referred to our facility when the complicated picture of the disease was discovered.

Awareness about sexually transmitted diseases in women related to their age, education and income.

This study was conducted to assess the level of awareness about sexually transmitted diseases in females of different age groups and to investigate the role that education and social status may play in their knowledge. It was a cross-sectional study, conducted at the CMH Lahore's Gynaecology and Obstetrics out-patient department, from June 2019 till July 2019. Three hundred and thirty-seven participants were interviewed, after obtaining a written informed consent. These participants were females who presented at the CMH Gynaecology & Obstetrics OPD, with any particular complaint. Those who did not give consent were not included in the study. The participants were given a hard copy of the questionnaire to fill and any queries that they had were answered on the spot. Data was analysed using SPSS version 23. Of the 337 participants interviewed, 158 were aged 26-35 years; 71 were undergraduates and 99 had completed post graduate studies. To determine their socioeconomic status, they were asked about their family income; 205 participants belonged to families with an income of less than Rs50,000. Most participants (229) had presented to the OPD for a routine pregnancy check-up. Of the 337 participants, 244 attested to know about STD's and the most common source of their knowledge was through TV (142), followed by the internet (137); 251 participants were familiar with limited STDs such as AIDS and Hepatitis B. The study showed that age, level of education, and income have a profound effect on the knowledge regarding sexually transmitted diseases amongst the women in Pakistan.