Knowledge, attitude and perception of Pakistanis towards COVID-19; a large cross-sectional survey.

BACKGROUND: The Novel Coronavirus Disease (COVID-19) has created havoc globally as countries worldwide struggle to combat this pandemic. Since prevention and social isolation are known to be the only ways to prevent the spread of COVID-19, this has created challenges among the lower-middle income countries (LMIC) including Pakistan, as it battles between an under-resourced healthcare, an economic shutdown, and widespread myths and misconceptions. Therefore, a study was conducted to evaluate the knowledge, attitude and perceptions regarding COVID-19 as public understanding is vital to help facilitate the control of this outbreak. METHODS: A pre-validated online questionnaire was distributed among the general population of Pakistan from 1st to 12th June 2020. Descriptive statistics were analyzed using SPSS v25. Adequate knowledge was assigned as a score of > 4 (range: 0-8) and good perception as a score of > 3 (range: 0-5). Chi-square test was used to determine the significance of difference in knowledge and perception of COVID-19 with socio-demographic characteristics. Logistic regression analysis was run to identify factors associated with adequate knowledge and perception. P < 0.05 was considered as significant. RESULTS: A total of 1200 respondents participated in this study with a wide range of age groups and education. Majority of the respondents had adequate knowledge (93.3%) with a mean score of 6.59 ± 1.35, and good perception (85.6%) with a mean score of 4.29 ± 0.82. Significant differences in knowledge and perception were observed among genders, age groups, education and between students and employees in the healthcare and non-healthcare department. A multivariate analysis revealed a higher educational status and female gender to be significant predictors of adequate knowledge and perception. CONCLUSIONS: Albeit the surge of COVID-19 cases in Pakistan, the participants demonstrated an overall adequate knowledge and good perception towards COVID-19. There is a need to follow the preventive protocols and dissemination of correct information through conducting educational interventions that target safe health practices and provide appropriate information on this infection.

Current state of knowledge of basic life support in health professionals of the largest city in Pakistan: a cross-sectional study.

BACKGROUND: Basic Life Support (BLS) is the recognition of sudden cardiac arrest and activation of the emergency response system, followed by resuscitation, and rapid defibrillation. According to WHO, Pakistan has one of the highest mortality rates from accidental deaths therefore assessment and comparison of BLS knowledge in health professionals is crucial. We thereby aim to assess and compare the knowledge of BLS in doctors, dentists and nurses. METHODS: A multi-centric cross-sectional survey was conducted in Karachi at different institutions belonging to the private as well as government sector from January to March 2018. We used a structured questionnaire which was adapted from pretested questionnaires that have been used previously in similar studies. Descriptive statistics were analyzed using SPSS v22.0, where adequate knowledge was taken as a score of at least 50%. P < 0.05 was considered as significant. Logistic regression was used to identify the factors affecting the knowledge regarding BLS in health care professionals. RESULTS: The responders consisted of 140 doctors, nurses and dentists each. Only one individual (dentist) received a full score of 100%. In total, 58.3% of the population had inadequate knowledge. Average scores of doctors, dentists and nurses were 53.5, 43.3 and 38.4% respectively. Doctors, participants with prior training in BLS and those with 6 to 10 years after graduation were found to be a significant predictor of adequate knowledge, on multivariate analysis. CONCLUSION: Even though knowledge of BLS in doctors is better than that of dentists and nurses, overall knowledge of health care professionals is extremely poor. Present study highlights the need for a structured training of BLS for health care workers.

Gastric volvulus through Morgagni hernia and intestinal diverticulosis in an adult patient: a case report.

BACKGROUND: Morgagni's hernia (MH) is a rare type of congenital diaphragmatic hernia with limited available literature. Late presentations are infrequent and the ones complicated due to gastric volvulus are even rarer. Another uncommon association of MH is with small bowel diverticulosis. We herein discussed a case of gastric volvulus as the content of MH, and small bowel diverticulosis present in a patient concomitantly. CASE PRESENTATION: A 30 year old woman, who presented with a one year history of epigastric burning and indigestion, occasionally associated with pain and vomiting. On clinical examination, no clue to the diagnosis could be ascertained. Her chest and abdominal x-ray indicated an abnormal air-fluid level at right hemithorax, which prompted a Computed Tomography (CT) scan, showing organo-axial gastric volvulus. MH with gastric volvulus was observed during laparotomy and trans-thoracic reduction of the contents was performed, along with repair of the defect. Multiple intestinal diverticuli were also found and the largest diverticulum was excised. CONCLUSIONS: Gastric volvulus through MH is a rare but potentially life-threatening condition. Non-specific symptoms like epigastric pain and vomiting can delay the diagnosis and management, however, advanced imaging techniques like CT scan can speed up this process. After the diagnosis is made, surgical repair should be attempted regardless of symptoms.

Retrograde bullet migration from inferior vena cava into right common iliac vein following gunshot: A case report.

Bullet embolization cases are rare and even rarer are its retrograde migration in the veins. We report the case of a 14 year old male with a gunshot wound to the left side of his chest. CT scan revealed bilateral haemothorax and foreign body in the right common iliac vein. The patient was immediately taken to the operating theatre and median sternotomy performed. Bullet entry tear was found in the inferior vena cava however, the bullet was found lodged in the right common iliac vein and slipped down against the flow of blood. The bullet was left in situ and after the necessary repair the chest was closed and the patient shifted to the CICU and discharged after 4 days in stable condition. Patient was followed after 1 week and reassured and advised for one year follow-up.

Primary Splenic Diffuse Large B-cell Lymphoma: An Atypical Presentation.

Primary splenic diffuse large B-cell lymphoma (PS-DLBCL) is an extremely rare type of non-Hodgkin's lymphoma. It typically presents with abdominal pain and a rapidly enlarging mass, often accompanied by B symptoms. Here, we present a rare presentation of PS-DLBCL in a 54-year-old woman who experienced splenomegaly. A CT scan of her abdomen revealed an enlarged spleen measuring 12 x 15 x 14 cm with a hypodense lesion. Confirmation of diffuse large B-cell lymphoma was obtained through a splenic core biopsy. A subsequent positron emission tomography scan showed a large hypermetabolic and centrally necrotic infiltrative splenic mass without any evidence of pathology in other parts of the body. The patient's condition was classified as stage I PS-DLBCL, and she underwent treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy for four cycles. This case report highlights the unique presentation of diffuse large B-cell lymphoma with exclusive involvement of the spleen and discusses the potential therapeutic role of radiation therapy and R-CHOP without the need for splenectomy.

The Glenn procedure: Clinical outcomes in patients with congenital heart disease in pakistan.

Objectives: Congenital heart defects (CHDs) affect more than 40,000 children annually in Pakistan. Approximately 80' of patients require at least one surgical intervention to achieve a complete or palliative cardiac repair. The Glenn shunt, a palliative procedure is established between superior vena cava (SVC) and the right pulmonary artery to provide an anastomosis offering minimal risk to patients with univentricular heart disease. The aim of this study was to assess the clinical outcomes of the Glenn shunt procedure in patients with complex congenital heart diseases in a developing country like Pakistan. Materials and Methods: A retrospective chart review was conducted on patients who underwent a bidirectional Glenn shunt procedure from July 2006 to June 2017. Data were collected on a structured questionnaire and analyses performed on SPSS version 22. Frequencies and percentages were computed for categorical variables while mean and standard deviation for continuous variables where appropriate. Results: A total of 79 patients underwent the Glenn shunt procedures. The median age was 1.9 years and 54.5' were male. Tricuspid atresia was the primary diagnosis in 30.4' of the patients. Common morbidities included arrhythmias (6.3'), pleural effusion (8.9'), wound infection (3.8'), pneumonia (2.5'), and seizures (3.8'); reopening was required in 2.5' of the patients and 8.8' were readmitted within 30 days of index operation. There were three (3.8') deaths in total. Conclusions: Bidirectional Glenn shunt procedure can be performed safely in patients with ideal characteristics as the first stage palliation and has favorable results with acceptable rate of complications.

Are patients on oral anticoagulation therapy aware of its effects? A cross-sectional study from Karachi, Pakistan.

OBJECTIVE: Oral anticoagulants are one of the most frequently used medications. However, these drugs have a range of side effects including potential life-threatening complications. Little is known regarding the awareness of its side effect profile amongst the patients in Pakistan. Therefore, the aim of this study was to assess the knowledge of oral anticoagulant therapy and its side effects among its users. RESULTS: The mean age was 48.9 ± 15.2 years. Median scores of the participants for knowledge regarding oral anticoagulants and warfarin were 48.7 (8.3-91.7) and 10.3 (0.0-70.0) respectively. Of 207 patients, most notably, 65.7% did not know what side effects to be wary of or how to reduce their occurrence; and most patients were unaware of the interaction between oral anticoagulant drugs and over-the-counter substances such as aspirin, herbal medicines and alcohol. Knowledge of international normalised ratio (INR) was extremely poor with more than 75% of the population not being aware of the target INR range during warfarin therapy. Higher level of education was significantly associated with better knowledge scores. Overall, knowledge of oral anticoagulant therapy and INR monitoring is extremely poor among oral anticoagulant users.

Rare aneurysm of anterior mitral valve leaflet-a case report.

BACKGROUND: Mitral valve aneurysm (MVA) is a saccular outpouching of the mitral leaflet which expands on systole and collapses during diastole. The case of MVA was first described in 1729 by Morand. It is one of the rare entities with a reported incidence of only 0.2-0.29% and no such case reported in Pakistan before. CASE PRESENTATION: A 51 year old female presented with dyspnea and chest pain for 3 months. Upon investigating, trans-esophageal echocardiography (TEE) revealed thickened anterior mitral valve leaflet with rolled up margins, forming an aneurysm, with severe mitral regurgitation. Subsequently, the valve was evaluated intra-operatively for repair but eventually had to be excised and then successfully replaced with a bioprosthetic valve. CONCLUSIONS: TEE is an excellent technique to confirm the diagnosis of a mitral valve leaflet aneurysm, and depending upon the severity of the defect, valve repair can be attempted but replacement becomes the most suitable treatment modality, once repair is deemed impossible. We hereby report a rare case, where timely diagnosis, appropriate surgical intervention and regular post-operative follow up helped in achieving good prognosis of this rare entity.

Tracheal diverticulum as a rare cause of dysphagia.

Tracheal diverticula are rare benign entities characterized by small air-filled invaginations in the paratracheal area. They may be single or multiple, and usually present with nonspecific symptoms. Ideally, computed tomography imaging studies are used to confirm the diagnosis, followed by surgical resection as the treatment of choice. We present the case of a woman with an acquired tracheal diverticulum, with dysphagia as the only presenting symptom.

Tracheal chondrosarcoma and surgical management.

Chondrosarcoma is a cancer of cartilage cells, and despite being a common primary bone tumor, tracheal chondrosarcoma is rare with only 18 cases reported in the literature prior to mid-2016. A 60-year-old gentleman presented with progressively increasing cough, severe stridor, and production of phlegm for approximately 2 years. On admission to our tertiary care hospital, he developed complete obstructive apnea within an hour, and was intubated. A tracheal biopsy was performed, followed by resection. Histopathology confirmed chondrosarcoma of the trachea. The patient tolerated the procedure very well and is currently symptom-free on follow-up, with no signs of recurrence.

Hemoptysis secondary to rupture of infected aortic aneurysm- a case report.

BACKGROUND: Massive hemoptysis is a life-threatening condition and can arise as a complication of various conditions. It rarely occurs as a complication of a ruptured thoracic aortic aneurysm. Even rarer are conditions where pseudoanurysms of aorta result due to infection. CASE PRESENTATION: A 30 year-old female patient presented with left sided chest pain, intermittent fever, cough and massive hemoptysis. A pseudo-aneurysm of proximal descending thoracic aorta at the level of the left Subclavian artery was noted over CT scan. Upon performing a left posterolateral thoracotomy, the aneurysm was seen to have ruptured into the apical segment of left upper lobe, contained mainly by a thrombus. The anterior wall of the pseudoaneurysm was debrided and a bovine pericardial patch was used to repair the aortic defect. Cultures of the tissue obtained showed Enterobacter species, therefore the patient was prescribed 6 weeks of IV antibiotics following surgery. Post-operative CT scan revealed reduced diameter of the aorta. She was discharged in good health and remains well at follow up evaluation. CONCLUSIONS: We present a case of hemoptysis caused by a ruptured descending aorta aneurysm into left lung. The aneurysm was secondary to infection by Enterobacter. Surgical repair of the concerned region of aorta was effective, without any major sequelae. To the best of our knowledge, no such cases have been reported previously.

Breast self-examination awareness and practices in young women in developing countries: A survey of female students in Karachi, Pakistan.

BACKGROUND: Breast cancer is a leading cause of deaths worldwide. In Pakistan, one in every nine women develops breast cancer some time in her life. This high incidence of breast cancer and the poor socioeconomic conditions of Pakistan make breast self-examination (BSE) the best tool for the prevention and early diagnosis of breast cancer. Therefore, the aim of the study was to assess the knowledge, attitude, and practice of BSE among female college students of Karachi, Pakistan. METHODS: A cross-sectional study was conducted on 1000 students from June to December 2016. Data were collected using a pre-piloted questionnaire, and SPSS (version 20) was used for data analysis. Chi-square test was used to determine the significance of the difference in knowledge and attitude among participants who had performed BSE and those who had not. A P < 0.05 was considered statistically significant. RESULTS: The overall response rate was 90.9%. Although 71.4% of the women knew what BSE was, only 33.1% had performed it. Majority of the participants considered that BSE is important in the early detection of breast cancer. With 59.7% of the population having an adequate amount of knowledge, 87.2% had a positive attitude toward BSE. A medical background was found to be a significant predictor for adequate knowledge and a positive attitude toward BSE. CONCLUSION: Despite a positive attitude found among the population toward BSE, its knowledge and practice were inadequate. Educational interventions are required in Pakistan to encourage young women to perform BSE regularly so that breast abnormalities can be detected early on and mortalities can be minimized.

Frequency and predictors of depression in congestive heart failure.

BACKGROUND: Depression in congestive heart failure (CHF) patients can increase morbidity and mortality. Given the ever-rising prevalence of CHF patients with depression, it is vital that we understand the predictors of depression in these patients to identify and better manage these patients. The main objective of this study was to evaluate the frequency and predictors of depression in CHF patients. METHODS: A cross-sectional study was conducted in a tertiary care hospital. Patients with a diagnosis of CHF for more than 6 months based on signs and left ventricular ejection fraction <40% were included. Patients were interviewed with the Patient Health Questionnaire-9 (PHQ-9) consisting of nine items in line with the Diagnostic and Statistical Manual (DSM) - IV criteria to assess depression. Each item was scored from 0 to 3, and a PHQ-9 score of 10 or greater suggested clinical depression. Data were analyzed on SPSS, v22, and a p < 0.05 was considered significant. RESULTS: Of 170 participants, 102 (60%) had depression. Among these 102 patients, 42% (n = 43) had mild depression, and the rest (n = 59) had moderate-to-severe depression. Predictors of depression were New York Heart Association stage 3 or 4 (p = 0.001), previous myocardial infarction (p = 0.001), living without a partner (p = 0.001), lack of a joint family system (p = 0.001), sedentary lifestyle (p = 0.001), aged 70 years or more (p = 0.01), and having been admitted in a hospital at least once in the past two months (p = 0.002). CONCLUSION: Depression is common among patients with CHF. It is associated with multiple factors and needs to be addressed and targeted urgently.

Comparison of Polymerase Chain Reaction and Immunohistochemistry Assays for Analysing Human Papillomavirus Infection in Oral Squamous Cell Carcinoma.

INTRODUCTION: Polymerase Chain Reaction (PCR) and Immunohistochemistry (IHC) are two well-known techniques used for the diagnoses of genetic diseases, tumours and different pathogens. PCR basically amplify regions of DNA within a single molecule which may have etiologic significance, it is a method for in vitro amplification of specific DNA or RNA sequences, whereas IHC is used to verify tissue constituents (the antigens) with the utilization of specific antibodies that can be visualized through staining. AIM: To compare and analyse PCR and IHC for their sensitivity to detect Human Papillomavirus (HPV) in Oral Squamous Cell Carcinoma (OSCC). MATERIALS AND METHODS: This study was based on samples retrospectively collected from 47 patients with primary OSCC who were diagnosed and treated at The Aga Khan University Hospital, Karachi, Pakistan, during the period of January 2010 to December 2013. Inclusion criteria were complete clinicopathologic data, adequate clinical follow up and availability of sufficient paraffin- embedded tumour material. HPV general and type specific 16 and 18 were investigated by means of PCR. HPV immunoreactivity was further investigated by means of IHC. RESULTS: Among the 47 evaluated patients, 32 (68.1%) were male and 15 (31.9%) were female, PCR detected the presence of HPV in 32 (68.1%) patients while IHC showed no positive test results. p53 was positive in 32 (68.1%) patients and negative in 15 (31.9%). HPV type 16 being most prevalent showing positivity in 27 (57.4%) patients whereas, type 18 was positive in only 1 (2.1%) patient. CONCLUSION: We concluded that PCR is more sensitive and reliable when diagnosing and detecting HPV for OSCC rather than IHC as results from IHC were all negative and insignificant, hence PCR should be the first initial diagnostic test for detecting HPV due to its better sensitivity and successful detection of HPV.

Knowledge, Awareness and Self-Care Practices of Hypertension Among Cardiac Hypertensive Patients.

INTRODUCTION: The most prevalent form of hypertension is systolic blood pressure (SBP) and it is considered to be predisposing risk factor for cardiovascular disease. The objective of the study was to assess self-care practices, knowledge and awareness of hypertension, especially related to SBP among cardiac hypertensive patients. METHODOLOGY: A Cross sectional study was conducted on 664 cardiac hypertensive patients, which were selected by non-probability convenience sampling from cardiology outpatient department of three tertiary care hospitals. Face to face interviews were conducted using a pre designed questionnaire. Data was entered and analyzed by SPSS (V17). RESULTS: 81.8%, did not know that hypertension is defined as high blood pressure. 97.1% of the sample population did not know that top measurement of blood pressure was referred to as systolic and only 25.0% correctly recognized normal systolic blood pressure to be less than 140 mmHg. 7.4% of the patients consulted their doctor for hypertension once or twice in a month. Risk factor for high blood pressure most commonly identified by the participants was too much salt intake CONCLUSIONS: The results state that there is an inadequate general knowledge of hypertension among cardiac patients and they do not recognise the significance of elevated SBP levels. There is a need to initiate programs that create community awareness regarding long term complications of uncontrolled hypertension, particularly elevated SBP levels so that there is an improvement in self-care practices of the cardiac patients.

Knowledge, attitudes and perceptions among non blood donor female health care professionals.

INTRODUCTION: Blood donation is necessary in order to maintain an adequate supply of blood to patients who are suffering from any kind of disease or trauma, which requires them to have blood transfusion. Female non-blood donors are generally low in number. Therefore, this research was carried out to assess the main reasons behind the lack of blood donations made by females, and their knowledge, attitude and perceptions towards voluntary blood donation. METHODOLOGY: A cross-sectional study was conducted on 664 female health professionals, who were selected by non-probability convenience sampling from two tertiary care hospitals. A pretested questionnaire was presented to the sample population, and the data was entered and analyzed on SPSS (V17). RESULTS: 94.6 % were aware with the fact that blood is screened for AIDS, Hepatitis B and C before transfusion. Moreover, 83.7% said that they will only donate blood if a family, relative or friend would need it and similarly 83.4%  suggested that they would donate blood if blood donation camps are arranged in hospital premises. 81.8 % thought that blood donors can contract Hepatitis B after donation where as only 29.5% did not blood due already blood loss in menstrual cycle. CONCLUSION: The participants had adequate knowledge about the benefits of blood donation. The most important reason identified for not donating blood is the lack of facilities within the workplace or lack of approach by responsible authorities. The results of the study may help in minimizing the misconceptions of the participants about blood transfusion, which would increase their contribution towards blood donation.