Burnout and Health Related Quality of Life among emergency physicians working at emergency at Tertiary Care Hospital in Lahore Pakistan.

Objective: To determine frequency of burnout in emergency physicians and to identify its impact on their health-related quality of life (HRQOL). Methods: In this cross-sectional study, physicians from departments with emergency cover of Jinnah Hospital Lahore were included. Their burnout and HRQOL scores using Maslach Burnout Inventory (MBI) and Short Form (SF)-36 respectively were determined in March 2022. Burnout scores were graded as low, moderate and high and were correlated with domains of HRQOL using chi X2 and analysis of variance (ANOVA). Results: One hundred fifty physicians were included with mean age 26.2 (±2.59), male to female ratio 0.78:1 (66/84) and House Officer (HO) to Postgraduate Resident (PGR) ratio 1.94:1 (99/51). High burnout was identified in 76 (50.7%) participants while 48 (32%) had moderate and 26 (17.3%) had low burnout. Males scored better than female physicians in vitality (0.008), general mental health (0.004), and mental component summary (0.01) domains of HRQOL. Doctors with high burnout had significantly lower scores in both physical component summary (p-value 0.004) and mental component summary (p-value < 0.0001) domains of HRQOL. Conclusion: Physicians working in emergency settings have high frequency of burnout and it adversely affects their mental and physical health related quality of life.

Predicting common bile duct stones: Comparison of SAGES, ASGE and ESGE criteria for accuracy.

Objective: To determine accuracy of SAGES, ASGE and ESGE criteria for predicting presence of common bile duct (CBD) stones. Methods: In a prospective study at Jinnah Hospital Lahore from March 2021 to February 2022, patients with suspected CBD stone were stratified in High risk (HR), intermediate risk (IR) and low risk (LR) for SAGES, ASGE and ESGE criteria. All patients underwent ERCP and risk strata were analyzed using SPSS 22® for sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. Results: In 90 patients with mean age 45.18(±14.87) and male/female ratio 0.64(35/55), area Under Curve (AUC) for predicting CBD stones was 0.75, 0.81and 0.83 for HR and 0.28, 0.52 and 0.52 for IR group while it was 0.53, 0.81 and 0.53 for absence of stone in LR group of SAGES, ASGE and ESGE criteria respectively. HR groups had accuracy of 81.1%, 86.7% and 87.8% in predicting CBD stone while LR criteria had 68.8%, 86.7% and 68.1% accuracy in predicting absence of CBD stone for SAGES, ASGE and ESGE respectively. Conclusion: HR strata of SAGES, ASGE and ESGE scores have excellent accuracy in predicting CBD stones whereas IR and LR criteria are suboptimal for excluding CBD stones.

Factors affecting the outcome of hospitalization among liver cirrhosis patients.

OBJECTIVES: To determine the factors affecting the outcome of hospitalization in patients suffering liver cirrhosis hospitalized to tertiary care hospital, Gujranwala, Pakistan. METHODS: After informed consent, the data of liver cirrhosis patients with age >12 years hospitalized from June 2016 to May 2017 was collected by purposive sampling. The outcome of the hospitalization in term of 'death' and 'no death' was noted. Statistical analysis was done using SPSS version 25. Bivariate analysis as well binary logistic regression was performed to ascertain the effect of different predictors like gender, age, history of diabetes mellitus, etiology of cirrhosis, presence of hepatic encephalopathy at presentation, presence of upper GI bleed, and tracheobronchial aspiration on the likelihood that death would be the outcome in liver cirrhosis patients. RESULTS: Amongst total of 1304 patients, 15.7% died during hospitalization. The mean age of those who died was 58.08 + 14.49 years. Bivariate analysis suggested that mortality was significantly higher in group of patients who had hepatic encephalopathy at presentation (p<0.01), no upper gi bleed (p<0.01), and who got tracheobronchial aspiration during hospitalization (p<0.01). It did not differ significantly in male/female gender (p=0.504), diabetic/non-diabetic groups (p=0.652), with viral/non-viral etiology of cirrhosis (p=0.918). Binary logistic regression revealed that patients who had tracheobronchial aspiration were 12.392 times more likely to die than who had no tracheobronchial aspiration. Similarly, patients who presented in hepatic encephalopathy were 7.862 times more likely to die than who presented without hepatic encephalopathy. CONCLUSION: The inpatient mortality rate amongst cirrhotic patients was high. Age, gender, history of diabetes, viral etiology of cirrhosis did not significantly contribute in the mortality of these patients. The patients who presented in hepatic encephalopathy, and who suffered tracheobronchial aspiration during hospitalization were more likely to die. Excellence in hepatic encephalopathy management and prevention from aspiration can effectively reduce the mortality rate of cirrhotic patients in our hospitals.

Response And Tolerability Of Sofosbuvir Plus Daclatasvir In Elderly Patients With Chronic Hepatitis-C.

BACKGROUND: The approval of direct acting anti-viral drugs has expanded the treatment access to all patient populations including elderly patients, who were previously neglected. We evaluated the response and tolerability of sofosbuvir plus daclatasvir in old age patients >60 year infected with HCV. METHODS: In this prospective observational study, 100 patients were enrolled and were divided into two groups: aged 60-69 (group A) and aged 70 and older (group B). All the patients were given sofosbuvir plus daclatasvir. Sustained virologic response at 12 weeks was the primary endpoint. Response and tolerability of treatment were analysed and compared between these patient groups. RESULTS: Hundred patients aged ≥60 years were treated with sofosbuvir plus daclatasvir. Sustained virologic response rate was 91% in group A (aged 60- 69 year) and 87.8% in group B (aged 70 year and older). No significant adverse effect was noted in both groups. No treatment discontinuation was encountered. CONCLUSIONS: Direct acting antiviral drug therapy is highly efficacious and safe for the treatment of HCV in older adults.