The Combined Military Hospital Rawalpindi is a tertiary care military hospital in Rawalpindi. It is headed by a Major General from the Army Medical Corps (Pakistan). It provides specialized treatment to the armed forces personnel, their immediate families as well as civilians..
Background Advanced Cardiovascular Life Support (ACLS) training is essential for improving outcomes in cardiac arrest; however, retention of knowledge and skills remains a challenge, particularly among healthcare workers with variable prior exposure. Focused, modular training approaches may enhance learning by reducing cognitive overload, especially in resource-limited settings. Methods The objective of this study was to evaluate the effectiveness of a focused educational intervention on a single ACLS algorithm in improving knowledge, skills, and self-perceived confidence among healthcare workers, and to assess short-term retention at one week. It was a Quasi-experimental pre–post study. This study was conducted at a 200-bedded facility in Murree, Pakistan. This study was conducted among 30 healthcare workers, including nurses and paramedical staff. Participants underwent a one-day workshop focusing on shockable and non-shockable rhythm algorithms, incorporating interactive lectures, demonstration, and hands-on practice. Knowledge (12-item MCQ), skills (8-step simulation checklist), and confidence (5-item Likert scale) were assessed at baseline, immediately post-intervention, and at one-week follow-up. Data were analyzed using repeated measures ANOVA with Bonferroni-adjusted pairwise comparisons. Results Significant improvements were observed across all three domains following the intervention. There was a statistically significant effect of time on knowledge (F = 43.5, p < 0.001), skills (F = 274, p < 0.001), and confidence (F = 54.6, p < 0.001), with large effect sizes, particularly for skills (partial η² = 0.904). Post hoc analysis demonstrated significant improvement from pre- to post-intervention and from pre-intervention to one-week follow-up across all domains (p < 0.001). At one week, knowledge showed a small but statistically significant decline compared to immediate post-intervention (p = 0.019), while changes in skills (p = 0.151) and confidence (p = 1.000) were not statistically significant, indicating retention of these domains. Conclusion A focused, simulation-based ACLS training intervention targeting a single algorithm significantly improves knowledge, skills, and confidence among healthcare workers, with short-term retention of skills and confidence. However, early decline in knowledge highlights the need for periodic reinforcement. Targeted modular training may represent an effective and practical approach for ACLS education, particularly in mixed-skill and resource-limited settings.
Background and Aims:Catheter-associated bloodstream infections (CABSI) cause a significant clinical and financial burden in nephrology. This study aimed to identify the clinical risk factors and prevalent pathogens associated with CABSI among hemodialysis (HD) patients at a tertiary care hospital in Pakistan. Methods:This cross-sectional study included 150 patients (aged 18 years or older) with CABSI undergoing HD via central venous catheters (tunneled and non-tunneled) at CMH Hospital, Multan, over a 6-month period. We recorded clinical details and collected dual blood samples (catheter and peripheral vein) for culture assessment. The primary outcomes were identifying clinical risk factors and determining the prevalence of causative bacterial pathogens. Results:The mean age of the sample was 61.91 ± 8.02 years, comprising 60.66% males and 39.33% females. The average duration of the catheter was 38.59 ± 18.7 days. Gram-negative bacteria (83/150, 55.33%) were more prevalent than Gram-positive bacteria (67/150, 44.66%) in these infections, with the most common pathogens being Pseudomonas aeruginosa (27/150, 18.00%) and Methicillin-resistant Staphylococcus aureus (MRSA) (25/150, 16.67%). Modifiable risk factors included prolonged catheter use (> 30 days), femoral site insertion, underlying comorbidities, and anemia. Conclusion:Prolonged catheter use and femoral insertion are major modifiable risk factors for CABSI in hemodialysis patients. With Gram-negative pathogens like Pseudomonas aeruginosa and MRSA predominantly responsible, targeted empirical antimicrobial strategies and early arteriovenous fistula creation are crucial to mitigate infection risks in resource-limited settings.
Femur neck fracture is a significant cause of mortality and morbidity in the U.S. This study examines the long-term temporal trends in femur neck fracture-related mortality among individuals aged ≥ 65 in the United States from 1999 to 2023. A retrospective analysis of death records listing International Statistical Classification of Diseases, Tenth Revision code S72.0 (femoral neck fracture) as the underlying cause of death was conducted using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research database from 1999 to 2023. We analyzed crude and age-adjusted mortality rates (AAMRs) per 100,000 population. Joinpoint regression analysis was used to calculate annual percent changes and evaluate trends across various demographics and geographics in the U.S. Between 1999 and 2023, femur neck fractures caused 323,534 deaths among U.S. adults aged ≥ 65 years. The AAMR peaked at 39.6 in 2002 and declined to 22.4 in 2023. A significant drop occurred from 2002 to 2018 (annual percent change -3.00 P < .05). Males (30.81), Non-Hispanic (NH) Whites (34.35) and rural areas (41.47) showed the highest AAMR among their demographic and geographic counterparts. Further, among states, Montana (58.9) and Minnesota (58.8) had the highest cumulative AAMRs. Despite overall declines in mortality among individuals with femur neck fractures, persistent disparities by sex, race, and geography highlight the need for targeted prevention strategies.
Infantile Osteopetrosis is a rare inherited bone disorder characterized by a reduced or complete lack of osteoclast function, leading to defective bone resorption and increased bone density. The defective osteoclast differentiation or function is of hemopoietic origin, thus making Hematopoietic stem cell transplantation (HSCT) the only curative treatment option for this condition. This retrospective study analysed the data of 10 cases of osteopetrosis, undergoing fully HLA-matched HSCT, at AFBMTC from April 2016 to December 2025. Among the cohort, 6(60%) were male with a mean age of 16.09 ± 14.39 months at the time of HSCT. Genetic mutation analysis was available in only four cases (3 had TCIRG1, and 1 case had RANK mutation). All patients received myeloablative conditioning with Fludarabine and Busulfan. Bone marrow harvest was the source of stem cells in all cases except one. Cyclosporine-induced hypertension was the most common complication documented in 100% of cases, followed by Neutropenic fever in 9(90%) cases, mucositis in 6(60%) cases, and VOD in 3 cases (30%). Acute GVHD was documented in 3 (30%) cases, while chronic GVHD was documented in 2(20%). Two (20%) cases had post-HSCT hypercalcemia. Mixed Chimerism was observed in 8 cases (80%) in the first 100 days but did not affect transplant outcomes. OS and DFS for the study were 80%. The cause of death was refractory seizures in one patient, while another patient died due to gut GVHD and septicemia. HSCT at an early age in IO can lead to a good quality of life in this potentially fatal disease.
BACKGROUND:Lung cancer is the leading cause of death worldwide, and about 40% to 70% of lung cancer patients have chronic obstructive pulmonary disease (COPD). The aim of this study is to analyze lung cancer and COPD-related mortality trends among older adults in the U.S. and to assess shifts in trends across different divisions of demographics and geographics. METHODS:We assessed CDC WONDER (Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiology Research) death certificates on which both lung cancer and COPD were listed as either underlying or contributing cause of death from 1999 to 2024. Age-adjusted mortality rates (AAMRs) per 100,000 and annual percent changes (APCs) were calculated and measured across different demographic and geographic subdivisions. RESULTS:Overall, 582,373 deaths were recorded with AAMR declining from 58.7 in 1999 to 43.8 in 2024, showing significant falls between 2006-2018 (APC -1.96*; p < 0.05) and later from 2021 to 2024 (APC -2.66*; p < 0.05). Males (68.1) persistently had higher AAMRs than females (41.1). From races/ ethnicities, the highest AAMR was reported in NH whites (58.3), while non-metropolitan areas (67.2) and the region of the Midwest (60.8) represented the highest rates among geographics. CONCLUSION:Although AAMR declined from 1999 to 2024, significant disparities persist, highlighting the need for targeted interventions and resource distributions among males, NH Whites, and non-metropolitan areas in the U.S.
