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IntroductionMoral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral... more
IntroductionMoral injury (MI) is a multi-faceted and multidimensional phenomenon. Occupational MI has been studied mainly among military personnel and first responders and is linked to mental health problems. MI encompasses negative moral emotions such as shame, guilt, and anger leading to distress, and impairment in social and occupational functioning. The COVID-19 pandemic predisposed healthcare providers to moral dilemmas, potentially morally injurious events (PMIEs), and MI. We aimed to assess the prevalence and predictors of MI in healthcare providers during the COVID-19 pandemic in Pakistan.Materials and methodsThis cross-sectional study was conducted in July–October 2021 among physician/clinician staff working at teaching hospitals in Lahore. The Moral Injury Symptoms Scale-Health Professionals (MISS-HP) was used to collect data. SPSS 26 was used for data analysis applying Wilcoxon Mann–Whitney U and Kruskal–Wallis tests on non-normally distributed data at α = 0.05. Predictor...
Background: The peripheral joints are particularly vulnerable to the autoimmune disease rheumatoid arthritis. Patients with rheumatoid arthritis often exhibit symptoms of metabolic syndrome. Metabolic syndrome in rheumatoid arthritis is... more
Background: The peripheral joints are particularly vulnerable to the autoimmune disease rheumatoid arthritis. Patients with rheumatoid arthritis often exhibit symptoms of metabolic syndrome. Metabolic syndrome in rheumatoid arthritis is connected with increased morbidity and death. Objective: This study aimed to examine whether or not rheumatoid arthritis patients who had high levels of disease activity also developed metabolic syndrome. Methods: The cohort study was conducted on 64 patients (32 in each group), included via Non-probability convenient sampling. Disease activity score of 28 joints (DAS-28 score) was used to assess the severity of disease activity in patients of rheumatoid arthritis and two groups were developed i.e. group I with score ≥3.2 and group II with score
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The provision of specialised services for persons aged 60 years and above is still lacking in our country. This study was carried out to analyse the pattern of acute & chronic diseases in the geriatric patients admitted at a teaching... more
The provision of specialised services for persons aged 60 years and above is still lacking in our country. This study was carried out to analyse the pattern of acute & chronic diseases in the geriatric patients admitted at a teaching hospital, and to stress on the importance of the field of geriatrics in the teaching hospitals of Pakistan. Patients falling in the geriatric age group, i.e. 60 years and above admitted consecutively at the various department of Sir Ganga Ram Hospital, Lahore, were collected for the study. The pattern of diseases was studied in 200 patients. A proforma was used for the collection of data, which included patient`s personal profile, history, examination, summary of the investigations carried out and the final diagnosis. The patients under study fell in the age range of 60-100 years, 96 females and 104 males. Maximum patients were admitted in the Medical wards, followed by Surgery, Ophthalmology, Obstetrics and Gynaecology, Orthopaedics, ENT and Psychiatry...
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OBJECTIVE To assess disease severity, based on clinical presentation and laboratory investigations. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY COVID-19 Isolation Unit of Mayo Hospital, Lahore from 15th March to 31st... more
OBJECTIVE To assess disease severity, based on clinical presentation and laboratory investigations. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY COVID-19 Isolation Unit of Mayo Hospital, Lahore from 15th March to 31st May, 2020. METHODOLOGY Four hundred and forty-five COVID-19 RT-PCR positive patients of either gender in age group of 18-80 years, admitted in isolation wards, high dependency units (HDUs) and intensive care units (ICUs) of the Hospital, were selected for the study via simple random sampling. Clinical presentations and laboratory investigations were recorded for all patients. Kruskal-Wallis test, Pearson Chi-square test, boxplots and ROC curve were used to analyse the data. A p-value ≤0.05 was considered statistically significant. RESULTS Out of the 445 cases, a male predominance 286 (64.3%) was observed with majority of patients 324 (72.8%) having mild disease, 73 (16.4%) moderate, 25 (5.6%) severe and 23 (5.2%) having critical disease. D-dimer was c...
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Objective: To determine the factors influencing the delay in presentation of symptomatic patients of acute myocardial infarction at hospital emergency depart-ment. Study Design: An observational study.
The prevalence of coronary artery disease (CAD) and its associated morbidity and mortality increase as age advances. Our study was aimed at an alyzing the demographics, risk factors, presentation and mortality of CAD among geriatric p... more
The prevalence of coronary artery disease (CAD) and its associated morbidity and mortality increase as age advances. Our study was aimed at an alyzing the demographics, risk factors, presentation and mortality of CAD among geriatric p atients admitted at Sir Ganga Ram Hospital, Lahore, Pakistan. A total of 200 patients , aged 60 years and above, admitted consecutively to various departments were included in the study. CAD was present in 81(40.5%) patients, 45 (55.5%) females and 36 (45.5%) males. Following risk factors were found in the CAD patients: hypertension in 59(89.8%), diabetes m ellitus in 36(58.1%), dyslipidemia in 4(5%), cardiac failure in 21(25.9%) stable angina in 15(18 .5%) 9(11.2%) had unstable angina; 32 (39.5%) suffered from acute myocardial infarction, symptomatic in 17(21%) and silent in 15(18.5%). Seven (53.9%) patients who died were suf fering from CAD. We concluded that carrying a high index of suspicion in the elderly, even in asymptomatic patients, with early...
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Early constitute a major proportion of our population. Our study at West Medical Unit of Mayo Hospital, Lahore was based on elderly patients presenting with various types of stroke. Out of 206 elderly patients, 28 had stroke. 12 were... more
Early constitute a major proportion of our population. Our study at West Medical Unit of Mayo Hospital, Lahore was based on elderly patients presenting with various types of stroke. Out of 206 elderly patients, 28 had stroke. 12 were female and 16 male. 3 had transient ischemic attack (TIA), 16 suffered from thrombotic stroke and 9 from haemorrhagic event. 6 patients from study group died and 2 left against medical advice. We concluded that stroke is a disease of the elderly imposing major impact on their mortality rates, age being a major risk factor. Hence stress should be laid on the disease as well on the elderly which constitute a major portion of our population.
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Objective: To find out the various causes of acute abdomen in patients suffering from acute dengue illness and its correlation to the disease severity. Material and method: In this study, confirmed dengue patients with severe acute... more
Objective: To find out the various causes of acute abdomen in patients suffering from acute dengue illness and its correlation to the disease severity. Material and method: In this study, confirmed dengue patients with severe acute abdominal pain admitted to Mayo Hospital and Services Hospital, Lahore, were included for analysis. The severity of DF was categorized in accordance with the World Health Organization definition. Informed consent was taken from all patients. In each patient, details such as symptoms, signs were recorded. Investigations including full blood counts, aspartate aminotransferase (AST), alanine aminotransferase (ALT), serum amylase, serum lipase, prothrombin time (PT), blood urea, serum creatinine level, blood culture, ascitic fluid analysis and culture, ECG, chest radiograph and ultrasound and CT scan of the abdomen were done to help establish diagnosis. Results: Out of 350 patients admitted in the wards as dengue fever, 112(32%) suffered from acute abdominal ...
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Objective: To determine the factors influencing the delay in presentation of symptomatic patients of acute myocardial infarction at hospital emergency depart-ment. Study Design: An observational study. Place and Duration of Study:... more
Objective: To determine the factors influencing the delay in presentation of symptomatic patients of acute myocardial infarction at hospital emergency depart-ment. Study Design: An observational study. Place and Duration of Study: Department of Medi-cine, Mayo Hospital, King Edward Medical Univer-sity, Lahore, from June, 2010 to June 2011. Methodology: 300 patients were included in the stu-dy with the following criteria: symptomatic myocar-dial infarction uncomplicated by cardiac arrest, age less than 70 years and presentation less than 24 hours after onset of chest pain. Myocardial infarction was defined as history of characteristic chest pain with either an ECG showing standard changes of myocar-dial infarction, and / or a rise in cardiac markers of more than double the upper normal range. After infor-med consent, the following data was collected from the subjects and entered in a structured proforma: pati-ent demographics, previous cardiac and medical his-tory, duration of...
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The SARS-CoV-2 pandemic continues to expand globally, with case numbers rising in many areas of the world, including the Indian sub-continent. Pakistan has one of the world’s largest populations, of over 200 million people and is... more
The SARS-CoV-2 pandemic continues to expand globally, with case numbers rising in many areas of the world, including the Indian sub-continent. Pakistan has one of the world’s largest populations, of over 200 million people and is experiencing a severe third wave of infections caused by SARS-CoV-2 that began in March 2021. In Pakistan, during the third wave until now only 12 SARS-CoV-2 genomes have been collected and among these nine are from Islamabad. This highlights the need for more genome sequencing to allow surveillance of variants in circulation. In fact, more genomes are available among travellers with a travel history from Pakistan, than from within the country itself. We thus aimed to provide a snapshot assessment of circulating lineages in Lahore and surrounding areas with a combined population of 11.1 million. Within a week of April 2021, 102 samples were sequenced. The samples were randomly collected from two hospitals with a diagnostic PCR cutoff value of less than 25 c...
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Aim: To compare the efficacy of amitriptyline, pregabalin and placebo in alleviating pain associated with diabetic peripheral neuropathy. Method: A total of 150 patients were randomly recruited for the study. Assessment for pain relief... more
Aim: To compare the efficacy of amitriptyline, pregabalin and placebo in alleviating pain associated with diabetic peripheral neuropathy. Method: A total of 150 patients were randomly recruited for the study. Assessment for pain relief was carried out on an 11-point, Likert-like numeric rating scale [NRS]; 0= no pain” to 10=worst possible pain”) over a 7-day baseline period. Following a 1-week washout period without study medications, the participants were divided into 3 groups, each consisting of 70 patients, receiving either placebo, amitriptyline or pregabalin for a period of 6-week .The initial doses of pregabalin and amitriptyline were 75 mg twice daily and 10 mg at bedtime, respectively. Doses were titrated upward as necessary during weeks 1 and 3 of therapy The maximum doses of pregabalin and amitriptyline were 300 mg twice daily and 75 mg at bedtime, respectively. Responders were patients who experienced 50% or more reduction in the baseline pain score on NRS. Results: 210 p...
Background and Objectives: Stigma around COVID-19 is a major barrier in global efforts to control the COVID 19 pandemic. Limited data is available regarding stigma faced by COVID-19 patients in low- and middle-income countries (LMIC). The... more
Background and Objectives: Stigma around COVID-19 is a major barrier in global efforts to control the COVID 19 pandemic. Limited data is available regarding stigma faced by COVID-19 patients in low- and middle-income countries (LMIC). The aim of the current study was to explore the stigma experienced by hospitalized patients with COVID-19 illness in Lahore, Pakistan. Methods: Following Institutional Review Board approval and informed consent, patients were assessed using modified HIV short form stigma scale and open-ended questions. Questions focused on experiences, feelings, and opinions as to how patients feel and how they were treated prior to and during the hospitalization. Data analysis for quantitative data was performed using SPSS-20, while qualitative responses were interpreted by content analysis method. Results: One hundred and fourteen patients were interviewed (Mean age 38.8 years + 15.3) with 53.5% being males. Widespread experience of stigma was reported by patients pa...
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Background: Adverse psychological effects have been associated with COVID-19-related disease containment measures, but little is known about the psychiatric symptoms and distress. Aim: This study aimed to explore and understand the... more
Background: Adverse psychological effects have been associated with COVID-19-related disease containment measures, but little is known about the psychiatric symptoms and distress. Aim: This study aimed to explore and understand the psychiatric symptoms and distress in suspected or confirmed COVID-19 patients isolated and quarantined in hospital. Methods: A mixed methods study was conducted in the COVID-19 units of Mayo Hospital, Lahore, Pakistan; 114 out of 160 adult patients were assessed by telephone using validated scales (Stress Reactions and Adjustment Disorder Checklist, 9-item Patient Health Questionnaire, 7-item Generalized Anxiety Disorder Scale and Insomnia Severity Index) and a few open-ended questions about expectations and anticipated areas of need during hospitalization, including experiences with isolation. Results: The prevalence of adjustment disorder, acute stress disorder, anxiety, depressive symptoms and insomnia was 67.5%, 3.5%, 16.7%, 18.4%, and 29.8% respectiv...