Intensive Care Units of a Tertiary Care Hospital: A Detailed Study of Patient Symptomatology.

Introduction Nosocomial infection (NI) is a factor of considerable significance in determining the morbidity and mortality of patients admitted to the intensive care units (ICUs). Our aim was to study the frequencies of various symptoms that might emerge due to nosocomial infection (NI) among ICU patients. Materials and methods This was a cross-sectional study conducted in intensive care units of General Medicine, General Surgery and Paediatric wards in Ruth M. Pfau Civil Hospital Karachi, Pakistan, using well-structured questionnaire created after a thorough literature study. Patients who had an ICU admission for more than five days but less than two weeks were set as the inclusion criteria. The remaining patients were excluded from the study.  Results Among the patients who developed gastrointestinal disturbances while in the intensive units, loss of appetite had the highest ratio in the paediatric ICU, whereas vomiting was most prevalent in the surgical ICU and weight loss was the most recurring symptom in the medical ICU. With regard to the respiratory and cardiovascular symptoms, dyspnea stood out in medicine ICU while fatigue was the most evident symptom amidst the paediatrics and surgical ICU patients. Insomnia was the most common neuropsychiatric symptom in the surgical and paediatric ICUs. Insomnia also paralleled tremors frequently in the medical ICU. Conclusion Infections in patients under intensive care in a tertiary care setup are not restricted to a specific type but present variously, as indicated by the type of symptoms the patients develop during their stay.

Evaluation of Hyponatremia in Ischemic Stroke Patients in a Tertiary Care Hospital of Karachi, Pakistan.

Introduction Electrolyte disturbances are commonly found in acute stroke settings. Hypernatremia, hyponatremia and hypokalemia are the commonest types of electrolyte disturbances. Data on electrolyte changes in neurological disorders like stroke is insufficient in Asia. This study aims to quantify the decrease in sodium levels in patients of ischemic stroke and to see whether the presence of co-morbidities like hypertension and diabetes result in decrement in the sodium level of the patients admitted. Methodology This is a cross-sectional study conducted in Ruth M Pfau Civil hospital Karachi on 132 consenting patients diagnosed with ischemic stroke on a clinical and radiological basis using a preformed questionnaire with all the necessary information to evaluate the objective like gender, level of sodium and co-morbidities. The data was analyzed using Chi­squared test using SPSS (Statistical Package for Social Science) software version 22 (IBM, NY, USA). Result The study showed that the majority of the patients (25%) had mild hyponatremia (130-134 mMol/L), only a few (9.8%) had moderate (125-129 mMol/L) or profound (<125) hyponatremia (3.8%) and 17 out of 44 patients who were hypertensive had their sodium levels changed while only 10 out of 17 diabetics had fluctuating sodium levels (p-value = 0.00). We also found out that most of the patients with altered sodium levels were male in the age range of above 55. Conclusion Patients with ischemic stroke do develop hyponatremia, but only with a slight alteration in the sodium levels.

Pattern of Infecting Microorganisms and Their Susceptibility to Antimicrobial Drugs in Patients with Diabetic Foot Infections in a Tertiary Care Hospital in Karachi, Pakistan.

Diabetes mellitus is a universal health problem, with its prevalence in Pakistan making it among the top 10 countries in the world. Approximately 13.9 million people in Pakistan will have developed diabetes by 2030. Diabetic foot ulcer (DFU) is one of the more serious complications of diabetes. If not treated properly, patients may develop diabetic foot osteomyelitis leading to gangrene and amputation. These infections are usually polymicrobial, with Staphylococcus aureus (S. aureus), Proteus, Pseudomonas, and Escherichia coli (E. coli) being among the more common organisms isolated from DFU. This survey of patients with DFU in a tertiary hospital in Karachi, Pakistan found 68.5% of patients had peripheral neuropathy, 57% had chronic osteomyelitis, and 37% and 49% had Wagner grades 2 and 3, respectively. Infections were polymicrobial in 83% of patients, E. coli was isolated from 63%, and S. aureus from 58%. Of the isolated organisms, 95% were sensitive to meropenem and 81% to linezolid.