Nutritional status and its associated factors among the geriatric population in outpatient clinics of a tertiary care hospital in Karachi, Pakistan.

Context: Elderly malnourishment remains a largely unexplored area, despite having a significant effect on the level of mortality and morbidity. This study aims to explore the level of malnourishment and identify those at risk of malnourishment among the elderly population presenting to a teaching hospital in Karachi. Aims: To assess nutritional status and its associated factors among the elderly population. Settings and Design: This study was conducted in outpatient clinics of family medicine at a teaching hospital and its outreach primary care centres from December 2020 to December 2021. The study design was cross-sectional. Materials and Methods: The prevalence of malnourishment and at risk of malnourishment with its associated factors were assessed using the Mini-Nutritional Assessment (MNA) scale as a screening tool among the elderly population (65 years and above) presenting to the family medicine OPDs of a teaching hospital. Statistical Analysis: Data were analysed using the Statistical Package for the Social Sciences (SPSS) version 21. Results: A total of 191 patients were recruited into the study, and the majority of them were males (66.5%). Median age and body mass index (BMI) of participants were 70 (IQR = 74-65) years and 24 (IQR = 27-21) kg/m2, respectively. The median MNA scores were 23.5 (IQR = 20.5-26). A total of 92 (48.2%) participants were found to have a normal nutritional status, 81 (42.4%) were found to be at a risk of malnourishment, and 18 (9.4%) were malnourished. On the multivariable regression model, BMI and ability to manage finances were significantly associated with malnourishment. Conclusion: This study shows an alarmingly high rate of the elderly population at risk of developing malnourishment, and financial independence and increasing BMI were associated with a decreased risk of malnourishment.

Knowledge, attitude, and practices of parents regarding the red flags of developmental milestones in children aged 0-5 years in Karachi, Pakistan: a cross-sectional study.

BACKGROUND: Developmental delays in children are assessed in four basic domains: gross motor, fine motor, social, and language. Early years of life are crucial in a child's development, so it is imperative that parents be aware of developmental milestones to facilitate early diagnosis and treatment in case of a developmental delay. This study assessed parental knowledge, attitude, and practices regarding children's developmental milestones and associated "red flags". METHODS: A cross-sectional study was conducted at the Department of Pediatrics at Liaquat National Hospital, Karachi. 390 parents, who had at least one child under 5 years of age, with no diagnosed developmental delay, were interviewed during outpatient clinic visits. The questionnaire consisted of three components to assess parental knowledge, attitude, and practices. RESULTS: 59% and 54% of parents had poor knowledge of gross and fine motor milestones respectively; In the social domain, 56% of the respondents had inadequate knowledge. 42% had inadequate knowledge of language milestones; 29% of parents strongly agreed that their pediatricians provide satisfactory information regarding red flags of developmental milestones. 60% of parents strongly agreed that their child's developmental delay would be a cause of concern for them. In the case of developmental delay, 55% of parents said they would consult a general pediatrician, 11% preferred a pediatric neurologist, 21% opted for a developmental pediatrician and 13% opted for a family physician. Residence and family systems were found to be associated with language-related milestones with significantly higher odds of knowledge among urban residents than rural ones and a significantly lower likelihood of language milestones knowledge among joint families than nuclear families. Female gender was found to be significantly associated with positive attitude. CONCLUSION: The majority of our respondents showed considerably poor knowledge regarding developmental milestones. This highlights the need to devise ways to educate parents on this subject to enable them to vigilantly monitor their child's developmental status and any associated abnormalities and ultimately facilitate the right course of action.

Tunneled dialysis catheter utilization and patency: A retrospectiveprospective study from a tertiary care hospital in Karachi Pakistan.

Objectives: To assess the patency of tunnel dialysis catheters and their results in patients in a tertiary care setting. METHODS: The retrospective-prospective, observational study was conducted at the Department of Interventional Radiology, Liaquat National Hospital, Karachi, from September 2021 to February 2022, and comprised records of patients who underwent tunnel dialysis catheters placement from July 2019 to December 2020. Data regarding age, gender, residence, comorbidity, catheter placement site, use of antibiotics before catheter insertion, reasons for catheter removal, and total catheter days was retrieved from the medical record. Data was analysed using STATA 14. RESULTS: Of the 134 patients, 74(56.9%) were males and 56(43.1) were females. The overall median age was 65 years (interquartile range: 56.75-70.25 years). Catheters were electively removed in 97(72.4%) patients, while in 19(14.2%), 16(11.9%) and 2(1.5%) cases, catheters were removed due to infections, blockage and physical damage, respectively. Mortality due to catheter-related complications was not found. Incidence per 10,000 catheter days of overall infection, bacteraemia and other infections during one year was 8.4, 5.3 and 3.1, respectively. Overall infection-free survival rate was seen for 19 patients (survival rate=67.6%). Survival rate from catheter removal was seen in 36 patients (survival rate=53.2%). CONCLUSIONS: When all precautions were followed to circumvent catheter-related issues, tunnel dialysis catheters were found to be a viable option for haemodialysis until permanent access for dialysis is gained or a kidney transplant is performed.

Antenatal anxiety and depression: Frequency and correlates during the COVID-19 pandemic in Pakistan.

Context: Mental health ailments like anxiety and depression are common during the antenatal period. Uncertainty during COVID-19 pandemic has markedly increased its prevalence in the general population. Pregnancy, being emotionally and physically exhausting, makes mothers more susceptible to developing mental disorders like anxiety and depression. Aims: To investigate prevalence and associated risk factors of antenatal anxiety and depression among women in Karachi, Pakistan. Settings and Design: This cross-sectional study was conducted in the department of obstetrics and gynecology during May 2020 till May 2021. Methods and Material: The study explored anxiety, depression, and associated factors in pregnant women attending antenatal clinics at a tertiary care hospital located in Karachi, Pakistan, during the COVID-19 pandemic by using the hospital anxiety and depression scale (HADS) as a screening tool. Statistical Analysis: Data was entered in SPSS version 21 for statistical analysis. Results: A total of 390 patients were enrolled in the study with mean age of 28.06 ± 4.52 years. Mean week of pregnancy at the time of enrolment into the study was 32.7 ± 3.1. Prevalence of anxiety and depression was 46.7% and 33.1%, respectively. On multivariable analysis, polyhydramnios was a risk factor of anxiety, whereas low income and unplanned pregnancy were substantially linked to depression. Fear of visiting doctor was a common risk factor for both anxiety and depression. Conclusion: In a catastrophe like the COVID-19 pandemic, attempts to address heightened anxiety during antenatal visits will undoubtedly benefit maternal and fetal mental health. As a response, strategies to manage high anxiety symptoms should be taken into consideration.

Frequency and predictors of depression among the elderly population of Karachi.

Context: Depression among the elderly is falsely considered as a normal part of aging and hence remains un-diagnosed in the majority. Elderly people are at a high risk of depression, which may produce a negative impact on their quality of life. Depression is a potentially treatable condition; hence, it is worthwhile to explore its burden in order to ensure its timely evaluation and management. Aims: To determine the frequency and predictors of depression among the elderly population of Karachi. Settings and Design: The current study was a cross-sectional study, conducted in out-patient clinics of a tertiary care hospital and its out-reach centers located in different areas of Karachi. Methods and Material: Patients aged 60 years and above were enrolled in the study. Demographic profiles and physical health conditions were investigated. Depression was assessed using Geriatric Depression Scale-15. Statistical Analysis: Data were entered in SPSS version 21 for statistical analysis. Results: A total of 232 participants were enrolled into the study with a median age of 65.8 [inter-quartile range = 61-69] years. Out of 232 participants, 186 (80.2%) were found to be depressed. In the multi-variable model, employment status, financial issues, and peer groups were left as independent predictors of depression. Conclusion: The current study found a significant burden of depression among elderly people in Karachi. Employment status, financial problems, and relationship with peers have been identified as risk factors of depression. There might be over-reporting of depression as the data collection was conducted during the coronavirus disease 2019 first wave. Hence, further community-based research is warranted to confirm the findings.

Covid-19 pandemic-prevalence of depression, anxiety and insomnia during Covid-19 lockdown and its associated factors in Karachi, Pakistan.

We aimed to determine the frequency of depression, anxiety and insomnia; identify associated factors; and compare these outcomes amongst a privileged and underprivileged class of Pakistan. A cross-sectional online and face to face survey was conducted in Karachi from April 2020 to May 2020. Validated depression (World Health Organization self-reporting questionnaire), anxiety (general anxiety and depression scale) and insomnia (insomnia severity index) scales were used. Out of 447 participants, the majority were less than 30 years (63.8%) and females (57.7%); 20.8% study participants belonged to poor or very poor socioeconomic status; 17% respondents were from lower middle status and 38% belonged to the higher middle or rich class. Depression, anxiety and insomnia were identified in 30%, 30.63% and 8.5% of participants, respectively. The prevalence of depression, anxiety and insomnia among privileged people was 37.8%, 16.6% and 11.3% respectively whereas among underprivileged were 17.8%, 16.6% and 4.1% respectively. There were significant differences in frequencies of depression (p<0.001), anxiety (p<0.001) and insomnia (p=0.009) among the privileged and underprivileged classes. We found a high prevalence of depression, anxiety and insomnia among both the privileged and underprivileged Pakistani population and a policy needs to be devised to ensure the mental health of Pakistani population.

Prevalence of erectile dysfunction and associated factors among males visiting family medicine clinics in a Tertiary Care Hospital in Karachi, Pakistan.

BACKGROUND: The burden of erectile dysfunction (ED) among the developed countries is found to be quite high. However, there is a paucity of data among developing countries to know its actual burden and factors associated with it. METHODS: The current study is cross-sectional and was conducted in Family Medicine clinics of Liaquat National Hospital during May 2017-January 2018. A total of 450 males participated in this study with the age range of 24-77 years. More than half of the participants were graduates or above. RESULTS: On multivariable analysis, age (aOR = 5.47, 95% CI: 2.74-10.89), alcohol use (aOR = 5.23, 95% CI: 1.45-18.84), diabetes (aOR = 6.61, 95% CI: 3.27-13.36), and current smoking (OR = 2.41, 95% CI: 1.35-4.31) were significantly associated with ED. ED risk was significantly lower in those who either attended secondary school (aOR = 0.33, 95% CI: 0.13-0.88) or were at least graduates (aOR = 0.40, 95% CI: 0.17-0.96) than illiterate when model was adjusted for other covariates. CONCLUSION: Erectile dysfunction in a Pakistani male population highlights the need for routine screening at the primary care level. There is a possibility that the actual burden is underreported due to cultural stigmatization; hence, further research is warranted to validate the findings.

COVID-19 Pandemic Prevalence and Risk Factors for Depression Among Health Care Workers in South Asia.

Health care workers (HCW) are especially vulnerable to developing mental health problems in pandemic situations. The impact may be much devastating in developing countries due to fragmented health care system. Our study aims to explore the underlying burden of depression and its related factors among health care workers in South Asian countries. Data was collected through an online survey. A total of 476 health care workers including doctors, nurses, and paramedical staff participated from Pakistan, India, and Sri Lanka. A validated WHO Self Reporting Questionnaire (SRQ-20) was used to screen for Depression. A 25.7% prevalence of depression was reported among health care workers. Almost 70% of them were either not satisfied or partially satisfied with the provided personal protective equipment. On multivariable analysis, females gender (aOR=1.80, 95% CI: 1.11 - 2.90), fear of unprotection (aOR=1.80, 95% CI: 1.11 - 2.90), confirmed COVID-19 case in workplace (aOR=1.98, 95% CI= 1.18 - 3.33) and family (aOR=2.98, 95% CI: 1.02 - 8.70) were found to be independent predictors of depression among healthcare workers. Depression among HCW in South-Asian countries is quite alarming. This may jeopardize attention to other non-COVID health problems which are still on a priority in developing countries.

COVID-19 pandemic- knowledge, perception, anxiety and depression among frontline doctors of Pakistan.

BACKGROUND: COVID-19 is a global pandemic and has become a major public health burden worldwide. With already fragile healthcare systems it can have long lasting effects in developing countries. Outbreaks especially a pandemic situation evokes fear related behaviors among healthcare professionals and there is always an increased risk of mental health disorders. Therefore, this study aims to determine knowledge and perception about this pandemic, prevalence and factors associated with anxiety/depression among frontline physicians of Pakistan. METHODS: Data were collected through an online survey released in the last week of March-2020. 389 frontline physicians from all four provinces and 65 cities of Pakistan participated. Survey questionnaire consisted of 4 parts including informed consent section, demographic section, knowledge and perception about COVID-19 pandemic and assessment of depression through World Health Organization Self-reporting questionnaire (SRQ-20). A score of 8 or above on SRQ-20 was used as cut-off to label the participant as depressed. Data was analyzed using SPSS version22. RESULTS: A 43% prevalence of anxiety/depression among frontline physicians of Pakistan was reported. Almost all the doctors had moderate to high knowledge score. Majority of participants marked N-95 mask as "essential" during aerosol generating procedures, assessing patients with respiratory symptoms, in COVID patient-care area, ER triage and direct care of COVID-19 patient. Only 12% of the doctors were fully satisfied with the provision of PPEs and almost 94% felt unprotected. In multivariable model, assessing more than five COVID suspects/day (aOR = 2.73, 95% CI: 1.65-4.52), working 20 h/week or less (aOR = 2.11, 1.27-3.49), having children among household members (aOR = 1.58, 95% CI: 1.00-2.50) and moderate to low knowledge of the infection (aOR = 2.69, 95% CI: 1.68-4.31) were found to be independent predictors of anxiety/depression among physicians. CONCLUSION: Anxiety/depression among more than a third of frontline doctors of Pakistan warrants the need to address mental health of doctors caring for patients during this pandemic; control modifiable factors associated with it and explore the effectiveness of interventions to promote psychological well-being of physicians.

Rapid virological&End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C.

OBJECTIVE: To determineRapid & End treatment response of patients treated with Sofosbuvir in Chronic Hepatitis C at tertiary care hospital. METHODS: It was an observational study conducted at Memon Medical Institute from January 2016 to July 2017. The inclusion criteria for patients was 18 years of age or older, having chronic infection with HCV. Total=201 received sofosbuvir with or without interferon in our OPDs. Patients were categorized into Treatment naïve, treatment experienced and decompensated chronic liver disease. Pregnant patients and those not willing to participate were excluded. Initially genotyping and Quantitative HCV RNA test was done. RESULTS: A total of 201 subjects were included in the study with mean age of the patients was 46.22± 14.41 years. Of 201 patients, n= 131 (65.2%) chronic hepatitis C, compensated cirrhosis n= 47(23.4%), and with decompensated cirrhosis n=23(11.4%). Most commonly genotype 3 n= 180 (89.6%) was present followed by genotype 1 n=9(4.5%), genotype 2 n=1(0.5%), genotype 4 n=1(0.5%). Of patients with genotype 3, 123 received dual therapy and 57 were given triple therapy. After one month of therapy HCV RNA by PCR, 200(99.5%) achieved RVR, 199(99%) achieved ETR and SVR achieved in 178(88.5%) while remaining 1 patient did not achieved RVR, 2 ETR and 12 patients did not achieved SVR and remaining 11 SVR lost follow up. CONCLUSION: Sofosbuvir has shown to be very effective andsuccessfulwith achievement of virological response with little or no resistance in all genotypes mainly genotype 3 treated in our study population. The promising results of our study will aid in better outcomes and therefore help in eradication of the virus.