Infection control practices in public sector hospitals of Punjab: a critical analysis.

INTRODUCTION: Infection prevention and control (IPC) is imperative towards patient safety and health. The Infection Prevention and Control Assessment Framework (IPCAF) developed by WHO provides a baseline assessment at the acute healthcare facility level. This study aimed to assess the existing IPC level of selected public sector hospital facilities in Punjab to explore their strengths and deficits. METHODS: Between October and April 2023, 11 public sector hospitals (including tertiary, secondary and primary level care) were selected. Data were collected using the IPCAF assessment tool comprising eight sections, which were then categorised into four distinct IPC levels- inadequate, basic, intermediate and advanced. Key performance metrics were summarised within and between hospitals. RESULTS: The overall median IPCAF score for the public sector hospitals was 532.5 (IQR: 292.5-690) out of 800. Four hospitals each scored 'advanced' as well as 'basic' IPC level and three hospitals fell into 'intermediate level'. Most hospitals had IPC guidelines as well as IPC programme, environments, materials and equipments. Although 90% of secondary care hospitals had IPC education and training, only 2 out of 5 (40%) tertiary care and 2 out of 3 (67%) primary care hospitals have IPC or additional experts for training. Only 1 out of 5 tertiary care hospitals (20%) were recorded in an agreed ratio of healthcare workers to patients while 2 out of 5 (40%) of these hospitals lack staffing need assessment. CONCLUSION: Overall the sampled public sector (tertiary, secondary and primary) hospitals demonstrated satisfactory IPC level. Challenging areas are the healthcare-associated infection surveillance, monitoring/audit and staffing, bed occupancy overall in all the three categories of hospitals. Periodic training and assessment can facilitate improvement in public sector systems.

Epidemiology of acquired aplastic anaemia in Pakistan.

BACKGROUND: Acquired aplastic anaemia is a rare disease which results in morbidity and mortality at a young age. This study was carried out to determine the clinical presentation, haematological parameters and association factors of acquired aplastic anaemia in a cohort of Pakistani patients. METHODS: This was a cross-sectional study conducted at Haematology Department, Shaikh Zayed Hospital, Lahore over 7 years from June 2000 to July 2007. Eighty-two patients of acquired aplastic anaemia were enrolled in the study by non-probability purposive sampling. Their diagnosis was confirmed by complete blood count, bone marrow aspirate and trephine biopsy. The cohort was classified on the basis of severity and the epidemiological, clinical and haematological parameters were analysed. RESULTS: Of the 82 enrolled patients of acquired aplastic anaemia, 49 (59.8%) were males and 33 (40.2%) were females. Mean age of the patients was 27.93 +/- 18.7 years with a range of 1-80 years. The male to female ratio was 1.48:1. Bone marrow cellularity was less than 25 % in 31 (38.0%) cases and between 25-30% in 51 (62%) of patients. Most of the cases were clinically severe aplastic anaemia (68%). In 62 (76%) of the cases no association factors predisposing to aplastic anaemia could be identified. CONCLUSION: Acquired Aplastic anaemia is a disease of all ages. In the second decade and the elderly predominantly severe clinical stages were seen. Males presented at a younger age while females presented at all ages with a somewhat similar incidence. No association factors of Aplastic Anaemia could be identified in majority of the patients.

Clinicopathological analysis of myelodysplastic syndrome according to French-American-British classification.

OBJECTIVE: To evaluate the age of onset, gender ratio, clinical presentation of Myelodysplastic syndrome patients, and to classify these patients according to French-American-British classification on the basis of morphological features in blood and bone marrow. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: The Department of Haematology, Shaikh Zayed Hospital, Lahore, from April 2004 to March, 2007. METHODOLOGY: Fifty patients of primary Myelodysplastic syndrome (MDS) were studied. The patients were classified according to French-American-British (FAB) criteria and the epidemiological, clinical and haematological features of MDS patients were evaluated. Descriptive statistics were used to describe data. RESULTS: There were 31 males and 19 females. The mean age was 41 years. According to FAB classification, 39 cases of refractory anaemia, 1 case of refractory anaemia with ring sideroblast, 6 cases of refractory anaemia with excess of blasts and 4 cases of refractory anaemia with excess of blasts in transformation were identified. The commonest complaint was easy fatiguability affecting 41 cases (82%). Anaemia was the most common finding seen in 47 patients (94%). Pancytopenia was seen in 33 cases (66%). Dyserythropoeisis was present in 42 (84%); dysmyelopoeisis was seen in 21 (42%) and morphologically abnormal megakaryocytes were identified in 29 (58%) of the bone marrow aspirates. Grade- III reticulosis was seen in 9 bone marrow trephine biopsies. Abnormal localization of immature precursors (ALIP) were present in 18 cases. CONCLUSION: MDS was more frequent in young males. Refractory anaemia constituted a major chunk of the disease entity.

Clinico-haematological characteristics in Pakistani patients of primary myelodysplastic syndrome according to World Health Organization classification.

OBJECTIVE: To assess the applicability of WHO classification on a cohort of Pakistani myelodysplastic syndrome (MDS) patients, and determine their epidemiological and clinico-pathological features. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Haematology Department, Shaikh Zayed Hospital, Lahore, from April 2004 to March 2006. METHODOLOGY: Forty six patients of primary MDS diagnosed by World Health Organization (WHO) criteria were included in the study by nonprobability purposive sampling. The cohort was classified accordingly and the epidemiological, clinical and haematological parametres were assessed. Descriptive statistics were used to describe the data. RESULTS: Forty six patients (28 males and 18 females) of primary MDS were included in the study. The mean age was 46.21 years. According to the WHO classification, 12 cases of refractory anaemia, 24 cases of refractory cytopenia with multi lineage dysplasia, 1 case of refractory cytopenia with multi lineage dysplasia and ring sideroblasts, 3 cases of MDS unclassified and 3 cases each of refractory anaemia with excess of blasts I and II were diagnosed. Symptomatic anaemia was seen in 37 cases and pancytopenia was documented in 33 cases. Dyserythropoiesis affected 41 cases. Grade III reticulosis was seen in 7 cases. ALIP was present in 13 cases. CONCLUSION: MDS presented at a young age. Refractory cytopenia with multi lineage dysplasia was the dominant disease category. Further studies are suggested for identifying the cytogenetic abnormalities and del 5q- category.