Evaluation of antibiotic utilization pattern and economic outcomes associated with surgical site infection in surgical department of tertiary care hospitals Karachi, Pakistan.

Surgical Site Infection (SSI) has an enormous impact on patients' quality of life. SSIs further stresses on allocation of different health care resources and contribute significantly in terms of high cost of care. This was a prospective study carried out in tertiary care hospitals of Karachi, Pakistan, involving abdominal surgeries and few other surgeries, in patients having 20 years of age and above, were admitted from June 2016 to May 2017. Total number of 554 patients were included. Data was collected in all relevant areas including utilization pattern of antibiotics, cost in term of infected and uninfected patients, the duration of patient stay etc. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) software. P value less than 0.005 was taken as significant. Single therapy of co amoxiclav or along with metronidazole and third generation cephalosporin were the most common prescribed antimicrobial groups. Amikacin most commonly used to treat post-surgical wound infection. Economic cost was high in terms of SSI patients. Duration of stay was found longer in infected patients. It can be concluded that SSI, may prolong length of hospitalization, cause morbidity, upsurge the health care cost and even may lead to mortality.

The circlet effects of Covid-19 pandemic and major crisis faced by developing nation: Now and beyond.

COVID-19 has taken over the world as the largest viral outbreak in the past 100 years. With over 13 million confirmed cases and 0.5 million-plus people dead, it has affected the life around us. With Pakistan being amongst the top 15 countries affected by it, the government of Pakistan has started vaccination, issued SOPs on daily life and smart lockdown continues in the country, but a part of this activity developing countries are still facing even greater difficulties in handling this crisis. This paper was designed to evaluate the status of scientific literature available on Covid-19 pandemic and to relate this situation from Pakistan perspective. A detailed review of published literature was conducted from March 2020 to August 2020. Covid-19, pandemic, Pakistan, healthcare setup, psychological impact, educational activities and challenges SOPs were utilized as key vocabulary. Miscellaneous searching tools including, Science Direct, Embase, PubMed, Google Scholar and Covid-19 portal from Government of Pakistan were visited for relevant information. A total of 30 research commentaries, articles, opinions and editorial letters were selected based on the required information. This article discusses the effects of COVID-19 on society and focus on SOPs introduced and their effects on the physical and mental health of the general public.

Determination of anxiolytic and antidepressant like activity of hydro alcoholic fruit extract of Pyrus communis (L.) and its impact on the memory after chronic dosing in animal models.

The purpose of this study was to evaluate the anxiolytic and antidepressant activity of ethanolic fruit extract of Pyrus communis (pear), in comparison with escitalopram in rodents (rats and mice). Thirty Wistar rats of about 200-250gm and albino mice of 25-30gm, male gender were divided into three groups each comprising of (n=10) animal respectively. Control group received distilled water, positive control received 10mg escitalopram & treated group received 200mg/kg/day of Pyrus communis ethanolic fruit extract orally for 30 days. They were evaluated by using the open field test, forced swim test (FST), plus maze test, light and dark test, hole poking test, stationary rod test, water maze test & cage crossing activity. Results were expressed as mean ± SD. Data was analyzed by using SPSS software (VERSION 21) one way ANOVA followed by Tukey test was used for post hoc analysis. Our result showed that fruit extract had significant antidepressant-like behavior in FST (p<0.001), open field (p<0.05), cage crossing (p<0.001) , significant anxiolytic activity in light and dark box test, plus-maze activity and significantly enhanced learning in water maze and stationary rod test when compared with control. The Pyrus communis fruit extract showed the anxiolytic and antidepressant-like profile in rats and mice. However, further studies need to be carried out in clinical trials for its use in different neuropsychological disorders.

Assesment of predictor variables and clinical consequences associated with surgical site infection in tertiary care setting, Karachi, Pakistan.

Among the well-known Health care-associated infections (HAIs), surgical site infections (SSIs) contribute to considerable high mortality and morbidity rate, substantial prolongation in hospitalization period and extra expenses in terms of treatment cost. This study was aimed to evaluate the predictive variables associated with surgical site infections, and their clinical consequences. This was a prospective, cross sectional study conducted in the surgical department of tertiary care setting in Karachi, Pakistan. Each patient was followed up from the time of admission until time of the discharge postoperatively for 30 days. A total of 554 surgical procedures were performed and 81 SSIs were identified. The predictor variable/risk factors significantly associated with the presence of SSI were age, gender, BMI, ASA score, co-morbid condition, surgical wound class, emergency surgeries, duration of surgery, type of anesthesia, prosthetic implant, pre operative length of stay and pre operative blood transfusion. Outcomes of such studies may be utilized in the design of a multi factorial practice to get better patient's safety and clinical outcomes.

Drug utilization and prescribing pattern of antibiotics in a tertiary care setups; trends and practices.

Irrational, over and misuse of antibiotics arise as global concern in both hospital and community settings and lead to adverse events including antimicrobial resistance, associated health problems, amplified hospitalization stay and cost. Hence, Drug Utilization Evaluation (DUE) studies are designed to evaluate and improve the prescribing, administration and the rational use of medications. The present study was designed to assess the pattern of antimicrobial drug utilization in in-patients cohort of tertiary care setup in Karachi, Pakistan. This cross sectional observational study was conducted in retrospective manner. World health organization (WHO) guidelines and criteria are considered to evaluate the appropriateness of drug use in various disease conditions. ATC/DDD system was applied to determine the study outcome. High frequency of antibiotics utilization found in respiratory tract infections of both lower (LRTI) 16.8% (n=42) and upper (UTI) 13.2% (n=33). The estimated total number of drug units administered per month was greater with cefixime (46) and ciprofloxacin (45) both. DDD/100 bed days drug utilization of antibiotics was higher with ciprofloxacin, cefexime and meropenem (47, 46 and 29.25) correspondingly. In conclusion, the current investigation signifies extensive scope for progress in prescribing trend. Drug adherence to customary guidelines of disease management and constraint policies to endorse judicious drug use may be considered vital in healthcare setup.

Assessment of Frequency and Transience Rate for Ventilator-Associated Pneumonia (VAP) in Geriatric Patients in Tertiary Care Settings of Karachi, Pakistan.

OBJECTIVE: To assess the risk factors, frequency and transience rate for ventilator-associated pneumonia in geriatric patients. STUDY DESIGN: Cross-sectional, descriptive study. PLACE AND DURATION OF STUDY: Various campuses of Ziauddin University Hospital and Civil Hospital, Karachi, from April 2016 to May 2017. METHODOLOGY: Critically ill geriatric patients (aged 60 years and above) in intensive care units, were selected who had received mechanical ventilation. Various risk factors, microbial fate, and related clinical outcomes were measured in the selected cohort of 350 patients. RESULTS: It was found that 72% (n=252) of study population was elderly who received ventilation for more than 48 hours with a higher mortality rate of 59.5%. Frequency of VAP was found to be 18% (n=63). A high rate of VAP was observed in geriatric cohort, i.e. n=47 association of age in VAP (p=0.611) in non-significant while mortality values and admission status were significantly associated with VAP (p<0.001). CONCLUSION: The factual challenge nowadays is to present the real estimate of the clinical consequences of VAP in geriatric cohort. Such studies will help in formulating an optimal institutional policy and rational approach to decrease rates of mortality.