Extensively drug-resistant Salmonella Typhi leading to relapsed urinary tract infection: A case report.

Salmonella enterica serotype Typhi (S Typhi) associated urinary tract infections are exceedingly rare, accounting for less than 1% of cases. Such infections have known to occur in immune-compromised or individuals with urogenital structural abnormalities. With the emergence of extensively drug resistant S Typhi strains in Pakistan, the management of its various unique presentations poses therapeutic challenges. We report the first documented case of a 74 years old male patient presenting with relapsed urinary tract infection secondary to extensively drug resistant S Typhi.

A curious case of expanded dengue syndrome.

Dengue fever (DF) primarily presents with fever, headache, malaise, bleeding manifestations and haemoconcentration. World Health Organization (WHO) classifies DF according to levels of severity: (a) without warning signs; (b) with warning signs, such as abdominal pain, persistent vomiting, fluid accumulation, mucosal bleeding, lethargy, liver enlargement, increasing haematocrit and thrombocytopenia; and (c) severe dengue with severe plasma leakage, severe bleeding or organ failure. Atypical clinical presentations of DF are defined as expanded dengue syndrome: this includes renal, cardiac, hepatic or cerebral damage. We report such a severe case where a young man developed acute kidney injury, acute fulminant liver failure and acute pancreatitis secondary to DF, but recovered.

A Review of Approaches to the Metallic and Non-Metallic Synthesis of Benzimidazole (BnZ) and Their Derivatives for Biological Efficacy.

Heterocyclic compounds are significant lead drug candidates based on their various structure-activity relationships (SAR), and their use in pharmaceutics is constantly developing. Benzimidazole (BnZ) is synthesized by a condensation reaction between benzene and imidazole. The BnZ structure consists of two nitrogen atoms embedded in a five-membered imide ring which is fused with a benzene ring. This review examines the conventional and green synthesis of metallic and non-metallic BnZ and their derivatives, which have several potential SARs, along with a wide range of pharmacological properties, including anti-cancer, anti-inflammatory, anti-microbial, anti-tubercular, and anti-protozoal properties. These compounds have been proven by pharmacological investigations to be efficient against different strains of microbes. Therefore, in this review, the structural variations of BnZ are listed along with various applications, predominantly related to their biological activities.

Knowledge and perception of Sepsis among Doctors in Karachi Pakistan.

Objectives: To assess knowledge and perception among Pakistani physicians towards sepsis. Methods: This cross-sectional study was conducted in Indus Hospital and Health Networks from September 2020 to March 2021. The International Sepsis Survey questionnaire was adapted, and its link was sent to trainee physicians as well as specialists, and consultants practicing in various hospitals via social media. Knowledge and perception were scored and 50% was considered the cut-off score for adequacy. Data was analyzed using SPSS version 26. Results: Analysis was done on 222 respondents who completed the survey. 37.9% of the participants had adequate knowledge. Knowledge regarding sepsis was significantly associated with specialty, ICU/CCU/HDU, and work experience (P-value <0.0001). More recent trainee physicians and those with more experience in critical care areas demonstrated better knowledge. Over 2/3rd of the respondents strongly agreed that sepsis remains one of the unmet needs in critical care today. Conclusion: A common belief exists that sepsis remains a challenge to treat among doctors. Moreover, there is consensus that it is the most frequently miss diagnosed condition in critical care and a dire need exists for its early diagnosis. Additionally, prompt management of presumed sepsis is imperative to improve outcomes.

Epidemiology of in-hospital cardiac arrest in a Pakistani tertiary care hospital pre- and during COVID-19 pandemic.

Objectives: To determine epidemiology of in-hospital cardiac arrest (IHCA) in a tertiary care hospital, pre- and during pandemic. Methods: This is a cross-sectional study of inpatients who experienced an in-hospital-cardiac arrest at a tertiary care hospital in Karachi between August 2019 and August 2020. Outcome variables were return of spontaneous circulation (ROSC) and survival to discharge (StD) and analysis was also done comparing pre- and during pandemic period. Results: A total of 77 patients experienced at least one IHCA event during the 1-year study period. Comparing pre- and during pandemic, ROSC for women was higher during the pandemic albeit not significant (43% vs 50%) in comparison to men (54% vs 10%, p<0.001). During the pandemic, women with IHCA were significantly younger than men (µ ± sd; 36.8 ± 15.3 vs 55.9 ± 12.7, p=0.001,) whereas pre-pandemic, there was no gender differences in mean age. Non-shockable rhythm was more common (92.2%) than shockable rhythm (6.5%). Pre- and during pandemic, there were significant differences in the cause of IHCA for 4H4T (87% vs 100%) and cardiac (36% vs 9%). The proportion of hypoxic patients increased from 50% during pre-pandemic to 91% during the pandemic period, whereas hypo/hyperkalemia decreased from 53% to 34%. Conclusion: Despite the limitation of a small sample size, our study has provided important information regarding the epidemiology and outcomes of IHCA pre- and during pandemic in a busy Pakistani tertiary care hospital. Our finding that gender differences exist in survival pre- and during pandemic needs to be explored further with more hospitals doing comparative studies.

Analysis of challenges faced and the scientific content of a hybrid pediatric surgical conference arranged during the COVID-19 pandemic.

BACKGROUND: Scientific conferences which are considered as an important event for dissemination of research and related academic activities were badly affected during the COVID-19 pandemic. Virtual format for interaction was used as an alternative method to continue such academic discourse. However, this did not provide the same level of communication and interest as that of in-person meetings. With evolving knowledge about the COVID-19 pandemic especially its transmission, role of vaccine, and observing standard operating procedures (SOPs), fear among healthcare providers is mitigated to some extent. Keeping in mind the importance of scientific conferences in the context of sharing knowledge and its impact on the training of faculty members and postgraduate residents, a hybrid conference was planned by the national association of pediatric surgeons.The purpose of this study was to retrospectively review the challenges faced during the organization of this conference as well as to analyze the pattern of registration, number of abstracts received, the gender of the participants and their status, region of the country they represented, type of presentation made, and scientific subject covered. SPSS version 22 was used for data entry. Descriptive and inferential statistics were used to present data. Chi square test was applied to find out the association between categorical variables and a p value < 0.05 was considered as significant. RESULTS: A total of 170 pediatric surgeons and postgraduate residents participated from all over the country and abroad. Nearly half (47.1%) of the registrants were postgraduate residents. Most of the participants (90%) opted for in-person attendance. The venue was selected with a capacity to house more than double the number of registrants with provision of safe distance. Availability of face masks, gloves, and sanitizers was ensured by the organizers. Packed meal boxes were arranged and served at the venue site in an open place on the terrace. A total of 97 abstracts were accepted for presentation that included 57 (58.8%) long oral podium and 40 (41.2%) poster presentations. Most of the studies (n=48-49.4%) were related to the subject of gastroenterology including pancreatico-hepatobiliary system and spleen. Majority of the presenters were male (p = 0.046) and postgraduate residents (p = 0.001). CONCLUSION: It was possible to organize a hybrid annual medical conference where most of the participants preferred physical presence. A rich scientific program was made to cater the needs for pediatric surgical fraternity. Residents made attractive presentations. It was noted that physical presence during clinical conference produced effective communication and learning.

Increased frequency of fibromyalgia among patients with chronic pain presenting to internal medicine clinics of a tertiary care hospital: A cross sectional study.

OBJECTIVE: To estimate fibromyalgia frequency among patients presenting with complaints of chronic fatigue and or generalised body pain for at least six weeks. METHODS: The cross-sectional study was conducted at the Department of Internal Medicine, Indus Hospital, Karachi, between December 2016 and March 2018, and comprised patients of either gender presenting with complaints of chronic fatigue and or generalised body pain for at least six weeks. They were assessed for fibromyalgia according to the 2010 Fibromyalgia Diagnostic criteria questionnaire. The Data was analysed using SPSS 21. RESULTS: Of the 267 patients, 197(73.8%) were females and 70(26.2%) were males. Fibromyalgia was detected in 149(55.80%) patients. The mean age of patients with fibromyalgia was 42.3±14.6 years and it was 38.9±13.7 years in patients without fibromyalgia (p<0.05). No significant association was found between gender and fibromyalgia (p>0.05). CONCLUSIONS: All patients with generalised pain should be evaluated for fibromyalgia and a diagnosis made to reduce the cost of further referrals and investigations, and delay in the management of this debilitating disorder.

The Frequency of Poor Sleep Quality in Patients With Diabetes Mellitus and Its Association With Glycemic Control.

Background and objective Emerging evidence suggests that sleep problems are more common among individuals with diabetes mellitus (DM) than in the general population; these sleep issues are associated with poor glycemic control and they negatively affect the overall prognosis of the disease by increasing cardiometabolic risk. Our study aimed to determine the frequency of poor sleep quality and its association with glycemic control among Pakistani adult patients with DM. Methods This prospective cross-sectional study was conducted at the outpatient department (OPD) of The Indus Hospital (TIH), Karachi, and included 329 participants. To be eligible, participants had to be 14 years or older, should have been visiting the OPD at TIH for six months or more to seek treatment for DM, and had to give informed consent. Participants were assessed for poor sleep quality using the Pittsburgh Sleep Quality Index (PSQI) score and glycemic control using HbA1C levels ascertained through electronic health record review, with higher HbA1C levels reflecting poorer glycemic control. Results Two-thirds of the participants were females (n=212; 64.4%), and approximately 90% of the participants were married (n=292; 88.8%); 57% (n=188) of the participants were found to have poor sleep quality (PSQI of >5) and 233 (70.82%) had poor glycemic control (HbA1C of >7). Interestingly, no significant difference was observed in the PSQI scores between participants with controlled diabetes and those with uncontrolled diabetes. Conclusion Based on our findings, there is a high prevalence of sleep disturbance among Pakistani adults with DM, and we believe this necessitates the fostering of sleep-promoting interventional research in the country, as it might be highly rewarding and would positively affect the overall prognosis for diabetes by improving cardiometabolic risks. However, our results did not indicate any significant association between sleep quality and glycemic control. Further research should be conducted to explore the association between sleep disturbance and DM in Pakistani adults, by employing objective measures of sleep quality and involving a larger sample of individuals with DM to determine if these results hold true.

Frequency and Etiology of Pancytopenia in Patients Admitted to a Tertiary Care Hospital in Karachi.

Introduction Pancytopenia is an important hematologic problem encountered frequently in clinical practice characterized by a reduction in all three peripheral blood cell lineages, i.e., anemia, leucopenia, and thrombocytopenia, caused by myriad disease processes. Our study aimed to determine the frequency and etiology of pancytopenia in patients admitted under internal medicine services in a tertiary care hospital. Method This cross-sectional study was conducted in the in-patient internal medicine department, The Indus Hospital (TIH), Karachi, included 258 patients. To be eligible, participants had to give informed consent, be 14 years or older, and of either sex. The study involved a 20-30-minute interaction with the patient, involving an interview and physical examination, and access to electronic health record data. Results Out of 258 patients studied, 24 (9.3%) were diagnosed with pancytopenia, the male to female ratio was 1:1, no significant difference was observed in the proportion of ethnicity, religion, previous treatment, known infectious disease, and personal and occupational exposure among pancytopenic patients and other non-pancytopenic patients. Fever (n=14, 58.3%) was most common presenting complaint followed by fatigue (n=13, 54.2%) and weight loss (n=7, 29.2%) while most common signs were pallor (87.5% n=21), hepatomegaly (29.2%, n=7), and splenomegaly (25%, n=6). The most common cause of pancytopenia was megaloblastic anemia (n=10, 41.7%), followed by hypersplenism (n=4, 16.6%), acute infectious diseases (n=3, 12.5%), and autoimmune diseases (n=3, 12.5%). Conclusion Our study suggests that pancytopenia is a common finding among our patient population and a larger proportion has a treatable cause, thus carrying a favorable prognosis.

Hypertension-related Knowledge and Its Relationship with Blood Pressure Control in Hypertensive Patients Visiting a Semi-private Tertiary-care Charity Hospital in Karachi, Pakistan.

Introduction Hypertension is one of the leading causes of mortality worldwide. Fifty-four percent of strokes and forty-seven percent of cardiovascular deaths are caused by suboptimal control of blood pressure. Economically developing countries like Pakistan are heavily burdened with an ever-rising epidemic of cardiovascular disease and stroke morbidity and mortality. Therefore, urgent steps are required to treat, as well as modify, risk factors for cardiovascular disease, including hypertension. Purpose The objective of this study was to ascertain the knowledge of hypertension and other sociodemographic variables and their impact on controlling blood pressures in the hypertensive population belonging to the low socioeconomic strata. Methods This cross-sectional study was conducted in the general medicine and cardiology outpatient clinics of a tertiary care charity hospital. Three-hundred thirty-five hypertensive patients of age >24 years were selected and informed consent was obtained. Hypertension-related knowledge was assessed using the Modified "Hypertensive Knowledge-Level Scale (HK-LS)" via a 15-20 min interview. Secondary variables in the questionnaire included social demographics, medical history, and assessment of body mass index (BMI) and blood pressure average values, which were measured during the interview. Knowledge was recorded based on the 33-point modified HK-LS scale, whereas secondary variables were not counted toward the assessment of knowledge. Results The frequencies of low, moderate, and high levels of hypertension-related knowledge were recorded as 2.1%, 79.4%, and 62%, respectively. Among 335 patients, (57.3%) were male, the mean age was 52.5 ± 11.5 years, and 63.6% were professionally active. Median systolic blood pressure (SBP) and diastolic blood pressure (DBP) in hypertensive patients were 140 and 86 mmHg, respectively. Sixty-nine percent of patients reported existing comorbidities, 54% had diabetes, 20.7% had cardiovascular disease, and 24% reported renal disease. No significant association was observed between the levels of knowledge of hypertension and gender, blood pressure (BP) status, professional activity, and age groups (p=0.877, p=0.863, p=0.125, and p=0.400, respectively). Conclusion The majority had adequate knowledge of hypertension but only 64.8% had controlled BP status. This depicts not a lack of knowledge and awareness but rather a lack of prevention of risk factors related to hypertension. Thus, further studies are advised to look into the preventive strategies employed by patients to control their BP and assess their effectiveness.

Prevalence of Metabolic Syndrome in Overweight and Obese Patients and Their Measurement of Neck Circumference: A Cross-sectional Study.

Background The utilization of neck circumference (NC) as a valuable tool to evaluate metabolic syndrome (MetS) is still unclear. MetS has been extensively reported worldwide mainly due to the increasing trend of central obesity and the risk of developing coronary artery disease. In Pakistan, its incidence is reported to be between 18% and 49% among the urban population. Methods This cross-sectional study was conducted at the Indus Hospital, Karachi, Pakistan; in total, 392 patients (body mass index [BMI] >23 kg/m2, age ≥18 years, both genders) were recruited through consecutive sampling, and informed consent was obtained. Results The majority of patients were females (n = 344, 87.8%), and the mean ± SD of age and NC of all patients was 50.5 ± 9.6 years and 38 ± 4.6 cm, respectively. The majority (n = 375, 95.7%) of patients were found to have MetS, with 90% of both males and females having NC ≥38 cm and 34 cm, respectively. Conclusion The prevalence of MetS was found to be very high in overweight and obese patients. Moreover, the majority of patients with MetS were found to have higher NC.

Diabetes Self-care Activities and Their Relation with Glycemic Control in Patients Presenting to The Indus Hospital, Karachi.

Introduction Nowadays, chronic conditions are increasing globally, stressing on self-management and patients' responsibility toward recognizing and resolving issues related to their illness. Diabetes is also a chronic illness, and diabetes-related self-care activities have been shown to be promising towards preventing its complications and achieving optimal glycemic control. Objective 1) To assess the association between glycemic control and diabetes-related self-care activities 2) To evaluate the association of patients' sociodemographic characteristics with diabetes-related self-care activities 3) To examine the impact of patients' sociodemographic characteristics on glycemic control Materials and methods This cross-sectional study was conducted at The Indus Hospital Karachi from February 2019 to July 2019. A total of 288 patients of both genders, age ≥18 years, having type 2 diabetes mellitus with glycated hemoglobin (HbA1c) done within the last three months from the interview date were enrolled in the study using a non-probability consecutive sampling technique. Whereas patients not giving consent for participation in the study, ICU admitted patients, critically ill patients, pregnant women, comatose, patients with type 1 diabetes mellitus, Alzheimer's disease, dementia, coexisting and chronic liver disease were excluded from the study. Results Majority of the patients were female (n=209; 72.6%) and had uncontrolled glycemic control (n=235; 81.6%). Furthermore, less than half of the patients had inadequate diabetes-related self-care activities (n=140; 48.6%). The Mean ± SD of age was 51.9±10.2 years. The significantly higher proportion of patients who have had a duration of illness and treatment ≥3 years had uncontrolled diabetes but adequate diabetes-related self-care activities. Moreover, there was no association between diabetes-related self-care activities and glycemic control. Conclusion There was no significant relationship between diabetes-related self-care activities and glycemic control. Moreover, a higher proportion of patients with a longer duration of diabetes (≥3 years) had poor glycemic control but adequate diabetes-related self-care activities.

Effects of polypharmacy on adverse drug reactions among geriatric outpatients at a tertiary care hospital in Karachi: a prospective cohort study.

BACKGROUND: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, "concurrent use of five or more different prescription medication". Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center. METHODS: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University Hospital April 2012 to March 2013. One thousand geriatrics patients (age ≥ 65 years) visiting ambulatory clinics were identified. They were divided on the basis of exposure (polypharmacy vs. no polypharmacy). We followed them from the time of their enrollment (day zero) to six weeks, checking up on them once a week. Incidence was calculated and Cox Proportional Hazard Model estimates were used. RESULTS: The final analysis was performed on 1000 elderly patients. The occurrence of polypharmacy was 70% and the incidence of ADRs was 10.5% among the study cohort. The majority (30%) of patients were unable to read or write. The use of herbal medicine was reported by 3.2% of the patients and homeopathic by 3%. Our Cox adjusted model shows that polypharmacy was 2.3 times more associated with ADRs, con-current complementary and alternative medicine (CAM) was 7.4 times and those who cannot read and write were 1.5 times more associated with ADRs. CONCLUSION: The incidence of ADRs due to poly pharmacy is alarmingly high. The factors associated with ADRs are modifiable. Policies are needed to design and strengthen the prescription pattern.

Patients' insight of interpreting prescriptions and drug labels--a cross sectional study.

BACKGROUND: Errors in consuming drugs are associated with significant morbidity and mortality, besides an impact on the already overburdened health-care system. Misunderstanding drug labels and prescriptions plays an important role in contributing to adverse drug events. OBJECTIVE: To evaluate abilities to understand prescriptions and drug labels among patients attending tertiary care hospital in Karachi. METHODS: A cross sectional study was conducted at the Aga Khan University Hospital (AKUH), from January to March 2009. After informed consent, 181 adult patients and their healthy attendants were interviewed at AKUH using a standardized questionnaire, which ascertained patient demographics, factors that might increase exposure to health-care personnel as well as the basic knowledge and understanding of prescriptions and drug labels. RESULTS: Out of 181, majority 137(76%) had received graduate or post-graduate degrees. 16 (9%) had received no formal education; of which all were females and 89(84%) of the total females were housewives. Overall, 130(72%) followed only a single doctor's prescription. Majority failed to understand various medical terminologies related to dosage. In the high literacy group, 45(33%) understood once daily OD (p = 0.003), 27(20%) thrice daily TID (p = 0.05), 29(21%) twice daily BD (p = 0.01), 31(23%) thrice daily TDS (p = 0.002) and 43(31%) as needed SOS (p = 0.003) as compared to the group with no formal education, who were unable to comprehend the terms. The most common reason for using more than one prescription was decreased satisfaction with the doctor in 19(39%) and multiple co-morbids as responded by 17(35%) of patients. Knowledge regarding various medical terminologies used for dosage and routes of drug administration were also understood more frequently among the English medium respondents. The elderly identified medicine through color (47%, p<0.001), and were less likely to understand drug indications (p = 0.05) compared to younger subjects. CONCLUSION: Understanding of drug prescriptions is alarmingly low in the community, even amongst the educated. Care givers need to revisit this often ignored aspect of patient care.

Benzodiazepine use in medical out-patient clinics: a study from a developing country.

OBJECTIVE: To estimate the prevalence of Benzodiazepine use in the outpatient setting of general medicine clinics at a single tertiary care centre. METHODS: The prospective prevalence study was conducted in the outpatient setting of Internal Medicine Clinics at Aga Khan University Hospital, Karachi, from November to December 2009. All subjects were interviewed after informed consent and variables were recorded on a specially-designed proforma. Apart from basic demographics and comorbid conditions, duration, frequency and route of benzodiazepine use, as well as the reason and who initiated it was noted. Chi-square test and t test was applied to see the association of socio demographic or clinical factors with the use of benzodiazepine. RESULTS: Of the 355 patients, 129 (36.33%) reported using the drug. The majority (n=86; 24.2%) were taking it on a daily basis. The highest numbers of patients using the drug were suffering from cardiovascular problems, 32 (25%) followed by 22 (17%) from endocrinology. Diazepam equivalent dose was around 7.04+4, with a inter-quartile range of 3-96 weeks. Alprazolam (9%) was the most frequently prescribed Benzodiazepine. CONCLUSION: Benzodiazepine use is alarmingly high in the outpatient clinics of General Internal Medicine Department. There is no implementation of law to prevent its hazardous sale. In this regard all concerned should work collectively for awareness and irrational drug sale and use.

APACHE II scores as predictors of cardio pulmonary resuscitation outcome: Evidence from a tertiary care institute in a low-income country.

AIM: The aim of this study was to demonstrate that APACHE II scores can be used as a predictor of the cardio-pulmonary resuscitation (CPR) outcome in hospitalized patients. METHODS: A retrospective chart review of patients admitted, from 2002 to 2007, at the Aga Khan University Hospital, Karachi, was done for this study. Information was collected on 738 patients, constituting all adults admitted in general ward, ICU, CICU and SCU during this time, and who had under-went cardiac arrest and received cardiopulmonary resuscitation during their stay at the hospital. Patient characteristics, intra-arrest variables such as event-witnessed, initial cardiac rhythm, pre arrest need for intubation and vasoactive drugs, duration of CPR and survival details were extracted from patient records. The APACHE II score was calculated for each patient and a descriptive analysis was done for demographic and clinical features. The primary outcome of successful CPR was categorized as survival >24 h after CPR versus survival <24 h after CPR. Multivariable logistic regression was used to assess the association between the explanatory variables and successful CPR. RESULTS: Patients with APACHE II scores less than 20 had 4.6 times higher odds of survival compared to patients with a score of >35 (AOR: 4.6, 95% CI: 2.4-9.0). Also, shorter duration of CPR (AOR: 2.9, 95% CI: 1.9-4.4), evening shift (AOR: 2.1, 95% CI: 1.3-3.5) and Male patients (AOR: 0.6, 95% CI: (0.4-0.9) compared to females were other significant predictors of CPR outcome. CONCLUSION: APACHE II score, along with other patient characteristics, should be considered in clinical decisions related to CPR administration.

Clinical characteristics and predictors of positive stool culture in adult patients with acute gastroenteritis.

OBJECTIVE: To identify the presenting features and spectrum of pathogens in adult patients with acute diarrhoea and to determine the predictors of stool culture positivity. METHODS: A descriptive study was conducted in a tertiary care hospital from April 1, 2005 to March 31, 2006. Medical records of all consecutive adult patients with history of acute diarrhoea were reviewed between June 2006 to December 2006 for clinical characteristics and laboratory investigations. RESULTS: A total of 454 patients were admitted from April 1, 2005 to March 31, 2006. Stool cultures were performed in 233 (50%) patients, 96 (42%) had positive results. Patients with positive stool culture compared to a negative Culture were found to have a younger mean age (43 vs. 53), greater number of unformed stools (16 vs. 11) and low serum bicarbonate level (16 vs. 20). Vibrio cholerae (86%) was found to be the most prevalent organism followed by Salmonella spp (6%), Campylobacter spp (5.2%), Shigella spp (2%). Ciprofloxacin was given to 97% patients along with fluid administration, and 78% were found to be resistant to quinolones. Most patients recovered before the finalized stool culture results. CONCLUSION: Careful selection of the patients based on their clinical presentation and initial laboratory work up can help to decide ordering of stool culture in adults with diarrhoea. Fluid resuscitation remains the main stay of treatment.

Drug overdose: a wake up call! Experience at a tertiary care centre in Karachi, Pakistan.

OBJECTIVE: To study the characteristics of patients admitted with drug overdose caused either by accidental overdose of the prescribed medications or as an act of deliberate self harm (DSH) at a tertiary care hospital in Karachi, Pakistan. METHODS: A retrospective case series review was conducted at the Aga Khan University Hospital from January 2002 to October 2006. Three hundred and twenty four adult patients admitted with drug overdose were included in the study. RESULTS: Our sample group revealed mean age of 36.2 +/- 17.0 years, more females (59%), housewives (34%), and students (20%). Fifty six percent of patients committing DSH were married (p = 0.001), 81% needed in-patient psychiatric services (p = 0.016) of whom a significantly high number (38%) refused it. Domestic and social issues were rated highest among DSH group (p = 0.003), depression among females was common (p = 0.028) and Benzodiazepines (41%) was the most frequently used drug (p = 0.021). Sub-group analysis of accidental overdoses revealed mean age of 45.6 +/- 19.6 years, single (75.4%) and males (54.1%). Drugs used were mainly Benzodiazepines (18%) followed by Opioids (11%), Antiepileptics (10%) and Warfarin (10%). CONCLUSION: Our study showed that depressed housewives are at greater risk for DSH. Domestic and social issues were rated highest and Benzodiazepines were the most commonly used agents. Most of our patients refused inpatient psychiatric treatment leading us to believe that general awareness of psychiatric illnesses is imperative in our community. High number of accidental overdoses is alarming in older, single males convincing us to believe that existing pharmacy system needs further evaluation and modification.

Career goals of trainee physicians in internal medicine.

OBJECTIVE: To survey Internal Medicine trainees' future career choices and factors influencing their decision-making. DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from November 2006 to January 2007. SUBJECTS AND METHODS: A standard questionnaire was administered to the residents and Interns working in the Department of Internal Medicine of The Aga Khan University Hospital. The questionnaire covered demographic details, specialty choice, work-time distribution and factors influencing career choice. Descriptive statistics were applied. RESULTS: A total of 49 doctors participated with 57% females; and 43% males, having 33% interns and 67% residents. A minority (22%) opted for internal medicine, while 78% selected sub-specialties with cardiology (20%) being the most sought- after sub-specialty. Majority (69%) wanted to spend more time in clinical activities compared to administration (18%) or research (13%). Majority (92%) wanted to work in an academic setting. Availability of a structured training program (61%), ability to practice broad area of medicine (41%) and prestige of the specialty (41%) highly influenced their career choices. Forty one (82%) wanted to proceed abroad for further training and 80% wanted to eventually practice in Pakistan. CONCLUSION: Most of the interviewed under-training physicians wanted to pursue sub-specialty. Clinical work was more attractive compared to research. A structured training program was detrimental in affecting their choices. Majority wanted further training abroad but eventual settlement in Pakistan. The study results can help us create the basis for reforming the current training programs.