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Background There is conflicting literature pertaining to the risk factors of asymptomatic bacteriuria (ASBU) in diabetic women. ASBU is a well-established risk factor for frequent urinary tract infections (UTIs), and the risk factors that predispose diabetic women to ASBU should, therefore, be evaluated. Objectives This study aims to discern these aforesaid risk factors in type-2 diabetic women, define a population subset at particularly high risk for ASBU, and gauge the efficacy inherent in adhering to an antibiotic regimen in combatting ASBU. Methods An analytical, case-control study was conducted at the Diabetic Clinic of the Holy Family Hospital (HFH), Rawalpindi, Pakistan. The participants included were type-2 diabetic women reporting to the clinic for routine follow-up. Six hundred and sixty-seven urine samples from these type-2 diabetic women were evaluated. Positive cases were those in which patients were diagnosed with ASBU according to the guidelines, while those with no ASBU constituted the control group. Common risk factors for UTI were excluded in both groups. Age, socioeconomic status, hygiene practices, and contraceptive use were matched between cases and controls. Results Nineteen percent of type-2 diabetic women presented with ASBU in our study. The significant risk factors for ASBU were a higher HbA1c level (OR 1.97), more years since the initial diagnosis of diabetes (OR 1.49), a prior UTI history (OR 2.49), excessive antibiotic use (OR 2.72), sodium-glucose cotransporter-2 (SGLT2) inhibitor use (OR 1.75), and proteinuria (OR 1.88) in the multivariate model. Body mass index (BMI), age of the patients, pyuria, and voiding dysfunction manifested no association with ASBU. Antibiotic use was significantly associated with the type of bacterial species precipitating the ASBU. Conclusion The clinicians must keep in mind the association between the various patient parameters and ASBU, especially in prescribing antibiotics to diabetic women. More studies are needed to further elaborate on these risk factors and revise the patient management in at-risk cases for ASBU and UTIs.
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Background End-stage renal disease (ESRD) is a major public health problem with many associated symptoms. Uremic pruritus (UP) develops in 40% of patients on hemodialysis and has major effects on the patient's life. It is also an independent risk factor for increased mortality, and its psychiatric implications remain poorly characterized in our local setup, where it tends to be underdiagnosed and undertreated. Objectives and rationale The study aims to report the prevalence of uremic pruritus in our study population and associate it with various patient parameters, which may define a subset of patients at high risk for this pruritus. We also assess the effects of uremic pruritus on the patient's quality of life (by using the Dermatology Life Quality Index; DLQI) and depressive symptoms (by using the Public Health Questionnaire; PHQ-9). Materials and methods It was a descriptive, cross-sectional study conducted in the nephrology unit of the multi-organ failure (MOF) center of the Holy Family Hospital (HFH), Rawalpindi, Pakistan, from February 2019 to June 2019, during which 173 male patients on hemodialysis were selected. Informed consent was taken from patients and other skin-related causes of pruritis were excluded. Uremic pruritus was defined as pruritis lasting for at least three months after the onset of ESRD. The 5-D, PHQ-9, and DLQI questionnaires were used to assess pruritis, depressive symptoms, and quality of life, respectively. Their Cronbach's Alpha values for 73 responses were 0.83, 0.81, and 0.71, respectively. The descriptive analysis was performed using SPSS v23.0 (IBM Corp, Armonk, NY, US). Spearman's rank-order correlation, independent samples t-test, and one-way analysis of variance (ANOVA) were used to analyze study variables. Results The prevalence of uremic pruritus was 49.1%, with many patients having generalized itching. Unemployment and longer disease duration predisposed the patients towards uremic pruritus, as the mean 5-D score in this subset were greater (p<0.05 in the independent samples t-test). The results of one-way ANOVA were significant (p<0.05), indicating higher 5-D scores in worsening categories of depressive symptoms and quality of life. Spearman's correlation matrix showed that 5-D, PHQ-9, and DLQI scores were strongly correlated with each other. Conclusions The prevalence of uremic pruritus among male hemodialysis patients is high, at 49.1%. It significantly contributes to depressive symptoms and a lower quality of life, which are associated with worse prognosis in hemodialysis patients. Thus, a clinician must keep in mind the psychiatric implications of uremic pruritus and treat it effectively to optimize the patient's medical care.
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Background Medical students face greater academic stress and devote more time to their studies due to the tough nature of medical education, at the cost of sleep and physical activity. Good sleep quality and physical activity improve the mental ability and academic performance of the students. Objectives and rationale The study aims to assess sleep quality and physical activity levels among fourth-year MBBS students of Rawalpindi Medical University. We compare these levels with gender and boarding status and correlate them with the academic performance of the students. This may provide new target areas to improve the academics of students performing below average. Materials and methods It was a descriptive, cross-sectional study conducted in March 2019 on 344 medical students enrolled in the fourth-year MBBS class of Rawalpindi Medical University. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), physical activity levels by the Global Physical Activity Questionnaire (GPAQ), and academic performance by the marks attained in the most recent pathology class test. The students who could not prepare for the test in the usual manner were excluded from the study. Two-hundred nineteen (219) students were part of the final study sample. Data analysis was performed using SPSS v.22.0 (IBM Corp, Armonk, NY, US). A chi-squared test, independent samples t-test, Pearson's correlation, and a multiple linear regression model were used to assess the variables. Results Sleep quality and physical activity were significantly correlated with academic performance (p-values of the chi-square and t-test were <0.000). Pearson's correlation coefficient was -0.69 for PSQI (p<0.000) and 0.62 for GPAQ (p 0.003) with test scores. Gender showed significant association with sleep and physical activity levels (male students had better physical activity level and poorer sleep quality than female students) but no association with test scores. Boarding status was significantly associated with all three variables. Boarders had lower mean test scores and poorer sleep and physical activity indices as compared to non-boarders. The multiple linear regression model was valid (p-value of the F test was <0.000), with beta coefficients of -2.53 ( p=0.002) for sleep quality and 1.37 (p=0.01) for physical activity. The R2 value was 0.84 (84%). Conclusions Our study indicates an overall poor sleep quality and physical activity level among fourth-year medical students, particularly boarding students, who have lower test scores and worse sleep and physical activity levels. In general, male students have better GPAQ scores and female students have better PSQI scores. Both the PSQI and GPAQ scores are significantly correlated with test scores and provide potential target areas to improve the exam performance of the students.
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Introduction Surgical antimicrobial prophylaxis (SAP) means the administration of antibiotics in surgical practice, and it reduces the likelihood of surgical site infections (SSIs). Inappropriate SAP practice regarding the prescription, timing, and duration of antibiotic use prolongs the hospital stay of patients, increases patient morbidity (by exposing them to the adverse effects of antibiotics), promotes bacterial resistance, and puts an economic burden on health care. While developed countries regularly monitor and revise their SAP protocols, there are only a few such researches in developing countries, which is a major setback to proper surgical care. Objectives of the study This study aims to compare the practice of SAP in a tertiary health care hospital of a developing country Pakistan, with internationally recommended protocols and evaluate the impact of knowledge of international guidelines on SAP practice. The results of the study will highlight important shortcomings in prophylactic practice in the hospital and help develop recommendations to improve SAP practice and ensure better surgical care for patients. Materials and methods An observational, cross-sectional study was conducted in the general surgery unit of Holy Family Hospital (HFH), Rawalpindi, Pakistan, from March 2017 to November 2017 during which antimicrobial prophylaxis of 150 general surgery procedures was documented on the basis of six international SAP criteria, which were "indication for use of prophylaxis, timing of preoperative dose, choice of drug, route of administration, duration of postoperative prophylaxis, and the assessment of beta-lactam allergy." The compliance rate (number of procedures following all the six criteria) was calculated for each operating surgical resident. A questionnaire was formulated that assessed the knowledge of 33 surgical residents working at that time regarding the above- mentioned six variables of SAP by six close-ended questions. Their responses were then compared to their compliance rate by chi-square analysis and binary logistic regression in SPSS version 23 (IBM Corp, Armonk, NY, US). A p-value of less than or equal to 0.05 was considered significant. The required ethical approval was obtained from the departmental heads as well as institutional research forum. Results Seventy-four of 150 observed procedures followed all the six international criteria of SAP, giving a compliance rate of 49.33%. Seventeen out of 33 (51%) surgical residents were aware of the guidelines. A chi-square analysis revealed a highly significant association between the awareness of guidelines and the number of compliant procedures performed by a resident (p<0.000). Forty-five out of 74 compliant procedures were performed by residents who were aware of the guidelines (61% of compliant procedures). The odds ratio for awareness and correct prophylaxis was 4.064 (p<0.000). Conclusions The study indicates an overall low compliance rate of 49.33% regarding surgical antimicrobial prophylaxis (SAP) practice in a public health care hospital of a developing country. The most common cause of non-compliance was prolonged postoperative prophylaxis. This study also shows that the knowledge of international guidelines significantly improves the prophylaxis practice by about four times. Hence, proper SAP compliance rate can be increased by actively educating and monitoring surgical residents.
