Blood stream infections in Stevens Johnson Syndrome and Toxic Epidermal Necrolysis: Risk factors and association with poor outcome.

Background & Objective: Blood Stream Infections (BSI) are considered a significant cause of morbidity and mortality in patients with Stevens Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN). We aimed to identify risk factors for BSI upon admission, highlight clinical and microbiological findings and ascertain the frequency of mortality in patients with BSI in SJS/TEN.

Methods: A retrospective cross-sectional study over 12 years (2011-2022) was performed in the department of medicine at a tertiary care hospital in Pakistan.

Communication skills of residents: are they as good as they think?

Purpose: To evaluate the current communication skills of resident physicians and identify areas for improvement.

Study Design: Using a cross-sectional design, data from medical students, residents, fellows, and faculty were assimilated at one of the largest academic medical centers in a low-and-middle-income country via a self-administered, validated survey with a 5-point LIKERT scale. One-way ANOVA was used to compare intra-group means, followed by the Bonferroni test, with a p-value <0.

Impact of a Medication Reconciliation Improvement Package on Adherence to Medication Reconciliation Among Internal Medicine Physicians: A Quality Improvement Project in a Lower-Middle Income Country.

Medication reconciliation is one of the best measures to prevent medication-related errors at the time of admission and discharge of patients. We conducted a quasi-experimental study to evaluate the impact of a Medication reconciliation improvement package (intervention) on adherence to medication reconciliation at the time of admission in Department of Internal Medicine. The study included all adult patients admitted to internal medicine from August 2019 to December 2020.

Patient-resident physician communication - a qualitative study to assess the current state, challenges and possible solutions.

Background: Patients perceive effective patient-doctor communication as an important metric when evaluating their satisfaction with health systems. Hence, optimal patient-physician communication is fundamental for quality healthcare. High-income countries (HICs) have extensively studied patient-resident communication.

No healthcare coverage, big problem: lack of insurance for older population associated with worse emergency general surgery outcomes.

Introduction: Older populations, being a unique subset of patients, have poor outcomes for emergency general surgery (EGS). In regions lacking specialized medical coverage for older patients, disparities in healthcare provision lead to poor clinical outcomes. We aimed to identify factors predicting index admission inpatient mortality from EGS among sexagenarians, septuagenarians, and octogenarians.

Comparison of five different disseminated intravascular coagulation criteria in predicting mortality in patients with sepsis.

Objective: Even though patients with sepsis and DIC have a higher mortality rate compared to those without DIC, screening for DIC is not currently part of sepsis management protocols. This may be due to a lack of literature on the frequency of DIC occurrence in sepsis patients, as well as the absence of evidence on the optimal DIC criteria to use for identifying DIC and predicting mortality among the five criteria available. To address this gap, this study investigates the predictive value of five different criteria for diagnosing DIC and its relationship to patient outcomes in our population of sepsis patients.

A Rare Occurrence of Ectopic Parathyroid Carcinoma Presenting as a Case of Recurrent Fractures.

Ectopic parathyroid tumors are uncommon, accounting for only 6% of parathyroid adenomas, and even fewer cases are attributed to parathyroid carcinomas. While ectopic parathyroid carcinoma in the anterior mediastinum is a rare condition, the occurrence of recurrent skeletal fractures in the presence of mild hypercalcemia is even rarer. In this report, we present the case of a 52-year-old man with a medical history of hypertension, chronic kidney disease, and a previous right-sided intertrochanteric fracture of the femur one year earlier.

Disparities in patient-resident physician communication and counseling: A multi-perspective exploratory qualitative study.

Effective communication between physicians and patients plays an integral role in clinical care. Gaps in a physician's ability to ensure effective communication, especially with patients from diverse backgrounds, are known causes of medical errors. This study explores the potential biases and disparities in patient-resident communication, which may influence a patient's quality of care.

Barriers to research productivity amongst postgraduate trainees: results from a survey of 333 medical and surgical residents.

Purpose: We aimed to determine the perceptions of, barriers to, and predictors of research engagement amongst residents at a national level in Pakistan.

Methods: This cross-sectional study used REDCap for online survey dissemination to residents from 12 institutes accredited by the national accreditation body (College of Physicians and Surgeons Pakistan) for core medical and surgical specialties. Logistic regression was used to estimate associations between likelihood of publications and participant characteristics.

Pyrolysis of Mixed Date Stones and Pistachio Shells: Identification of Bio-Oil and Utilization of Bio-Char as Activated Carbon Precursor.

Thermal pyrolysis of mixed date stones and pistachio shells in a semi-batch reactor was addressed in this study. The highest yield of liquids (51.20 %) was produced at 500 °C, 90 min, 20 °C/min heating rate, and 50 mesh particle size.

Interleukin-6 (IL-6) as a Predictor of Clinical Outcomes in Patients with COVID-19.

Background: Interleukin-6 (IL-6) has been known to be involved in immune regulation, inflammatory response, and metabolism. It is also recognized as the major cause to underscore the pathology of severe COVID-19 patients. However, it remains to be seen if IL-6 is superior to other inflammatory biomarkers in ascertaining clinical severity and mortality rate for COVID-19.

Leveraging the vantage point - exploring nurses' perception of residents' communication skills: a mixed-methods study.

Introduction: Effective communication is key to a successful patient-doctor interaction and improved healthcare outcomes. However, communication skills training in residency is often subpar, leading to inadequate patient-physician communication. There is a dearth of studies exploring the observations of nurses - key members of healthcare teams with a special vantage point to observe the impact of residents' communication with patients.

Telemedicine for Rheumatology Patients in Covid-19 Pandemic: Perspectives of Patients.

Telemedicine use for patients with autoimmune rheumatic conditions during the pandemic mandates better characterization. We conducted a telephonic survey on patients who consulted rheumatologists remotely to determine their attitudes toward telemedicine. The study was conducted at Aga Khan University Hospital, a tertiary care hospital in Pakistan which is a lower-middle-income country.

Lower limb axonal mononeuropathies as sequelae of COVID-19: a case report and review of literature.

Background: Neurological symptoms and complications of Coronavirus disease 2019 (COVID-19) were seldom discussed in the literature initially. Neurological symptoms such as headache, dizziness, anosmia, hypogeusia, and neuralgia are, however, now being reported commonly. Mononeuropathies are rare complications of COVID-19, with most cases associated with prolonged intensive care stay.

Tocilizumab in critically ill COVID-19 patients: An observational study.

Tocilizumab decreases inflammatory response in the cytokine storm which is one of the mechanisms behind the development of ARDS in COVID-19 patients. The objective of our study was to determine response of tocilizumab in patients suffering from COVID-19 by analyzing clinical parameters and inflammatory markers. A single-arm observational retrospective study was conducted from March 15, 2020 to March 15, 2021.

Triggering and protective factors of burnout in medical resident physicians in a lower-middle-income country: A cross-sectional study.

Background: Residents and interns are prone to emotional and physical exhaustion, also known as burnout. Burnout has not been studied much in physicians working in lower-middle income countries. We conducted this study to determine the burden of burnout among internal medicine residents and to identify triggering and protective factors associated with burnout.

Association of vitamin D deficiency and disease activity in systemic lupus erythematosus patients: Two-year follow-up study.

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE.

Patients And Methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis.

Background Neutrophil to lymphocyte ratio (NLR) can be easily calculated from the white cell differential count and is considered an auspicious marker for predicting different diseases, including sepsis. In this study, we aimed to compare the efficacy of NLR as a sepsis marker by comparing it with other markers of sepsis, such as C-reactive protein (CRP), procalcitonin, and the Sequential Organ Failure Assessment (SOFA) score. Methods A cross-sectional analytical study was conducted at the Aga Khan University Hospital from July 2019 to December 2019.

A Fatal Case of Primary Amoebic Meningoencephalitis (PAM) Complicated with Diabetes Insipidus (DI): A Case Report and Review of the Literature.

is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries.

Knowledge and Beliefs Regarding Thalassemia in an Urban Population.

Background:  Thalassemia is one of the most common genetic blood disorders in Asia. Consanguineous marriages and avoiding pre-marital and antenatal screening are common in Pakistan due to psychosocial, cultural, and religious factors. Few studies have investigated the beliefs regarding thalassemia, especially in a developing country.

The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock.

Background: Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock.

Aim: The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO.

Material And Methods: This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support.