Biological and Clinical Sciences Research Journal

The Infection Control Paradox: Exploring Knowledge and Practices of ICU Nurses Across Hospitals in Punjab, Pakistan

2025-10-29T11:56:59+00:00

Hospital-acquired infections (HAIs) continue to pose a serious challenge to patient safety, particularly in intensive care units (ICUs) where patients are most susceptible. Nurses are central to infection prevention and control (IPC), yet a persistent gap between knowledge and practice undermines infection control efforts, especially in resource-constrained healthcare settings such as Pakistan. Objective: This study aimed to evaluate ICU nurses' knowledge and self-reported practices regarding IPC measures and to determine the relationship between these two domains in tertiary care hospitals across Punjab, Pakistan. Methods: A descriptive cross-sectional study was conducted among 150 ICU nurses working in selected public and private tertiary hospitals. Data were gathered using a pre-validated structured questionnaire developed in accordance with World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) guidelines. Knowledge and practice levels were categorized as good (≥75%), moderate (50-74%), or poor (<50%). Data were analyzed using SPSS version 26, applying descriptive statistics, chi-square tests, and Pearson's correlation analysis. Results: The findings indicated moderate levels of knowledge (mean = 11.2 ± 2.1) and practice (mean = 10.6 ± 2.4) among the participants. Only 36% demonstrated good knowledge, while 32.7% exhibited good practices. Notable gaps were found in hand hygiene duration, sterilization techniques, needlestick injury management, and consistent use of N95 masks. Nurses with higher educational qualifications showed significantly better knowledge (p = 0.02), and those with greater years of experience demonstrated better practices (p = 0.01). A strong positive correlation was identified between knowledge and practice scores (r = 0.62, p < 0.001). Conclusion: ICU nurses in Punjab displayed moderate knowledge of IPC but suboptimal implementation in clinical practice. The observed knowledge-practice gap highlights the influence of both personal and institutional factors. Strengthening regular IPC training programs, ensuring continuous supervision, and enhancing resource availability are critical for fostering a robust infection control culture and reducing the burden of HAIs in ICUs.

Frequency of Factors Leading to the Development of Urolithiasis at SIUT, Karachi

2025-10-31T04:46:26+00:00

Urolithiasis is a common urological condition worldwide and a significant cause of morbidity, especially in regions with hot climates and dietary variations such as Pakistan. Understanding the contributing factors is essential for prevention and management. Objective: To determine the frequency of factors leading to the development of urolithiasis at SIUT, Karachi. Methodology: We conducted this study on 385 participants aged 20-70 years presenting with acute renal colic and a confirmed ultrasonographic diagnosis of urolithiasis. Data on predefined demographic and risk factors were collected. Results: The mean age of the 385 participants was 49.49 ± 14.09 years. A majority were male (62.3%), and the most prevalent modifiable risk factor was low water intake (65.7%), which was followed by obesity (51.9%) and aerated beverage consumption (56.4%). Comorbid risk conditions were highly prevalent, including hypertension (37.9%), anemia (48.8%), and diabetes mellitus (28.3%). A strong family history of urolithiasis was reported in 47.5% of the cohort. Other significant factors included an age greater than 50 years (53.8%) and smoking (24.9%). Conclusion: The risk factors leading to the development of urolithiasis were the high frequency of male sex and increasing age, with modifiable risks such as low water intake and comorbid metabolic conditions.

Factors of Non-Adherence to Antihypertensive Medicine in the Elderly Population

2025-10-28T09:13:31+00:00

Hypertension is a leading cause of cardiovascular morbidity and mortality, particularly among the elderly. Despite the availability of effective antihypertensive therapies, medication non-adherence remains a major barrier to optimal blood pressure control. Understanding the multifactorial determinants of non-adherence among elderly hypertensive patients in low- and middle-income countries like Pakistan is essential for designing targeted interventions. Objective: To identify the factors contributing to non-adherence to antihypertensive medication among elderly hypertensive patients attending tertiary care hospitals in Lahore, Pakistan. Methods: A cross-sectional descriptive study was conducted at four public sector hospitals in Lahore from September 2019 to March 2020. A total of 200 hypertensive patients aged ≥60 years were recruited through purposive sampling. Data were collected using two standardized tools—the Drug Attitude Inventory-10 (DAI-10) and the Modified Drug Adherence Work-Up Tool (M-DRAW)—translated into Urdu and validated for internal consistency (Cronbach's α = 0.70 and 0.758, respectively). Descriptive statistics were used to summarize demographic data. In contrast, chi-square, independent t-tests, and ANOVA with post hoc Tukey's test were used to determine associations between demographic and adherence-related variables in SPSS version 20. A p-value <0.05 was considered statistically significant. Results: The mean age of participants was 66.74 ± 5.39 years; 52% were male, and 54.5% had no formal education. Most patients (73.5%) had been under treatment for >6 months, and 53.5% were taking three antihypertensive medications. The majority (68.5%) exhibited unintentional non-adherence, while 31.5% demonstrated intentional non-adherence. Financial burden (50%), pill burden (60.5%), and difficulty in maintaining medication schedules were the most frequent barriers. Condition-related factors (mean 3.0 ± 0.7) were the most significant contributors, followed by patient-related and socioeconomic factors (p< 0.001). Significant associations were found between perceived benefit of therapy and education level (p = 0.017), dose adjustment and number of tablets (p = 0.010), and gender with treatment doubts (p = 0.018). Beliefs and health perceptions more strongly influenced intentional non-adherence, whereas unintentional non-adherence was associated with financial and regimen-related constraints. Conclusion: Non-adherence to antihypertensive medication among elderly patients is a multifaceted issue influenced by socioeconomic, educational, psychological, and treatment-related factors. Condition-related beliefs and patient-related perceptions play a dominant role, particularly in intentional non-adherence. Interventions should focus on patient education, simplifying medication regimens, enhancing family and social support, and providing financial assistance to improve long-term adherence and reduce hypertension-related complications in elderly populations.

Change in 4% lidocaine Instillation in the endotracheal tube (ETT) before and after surgery in patients undergoing surgery under general anesthesia.

2025-10-29T08:36:19+00:00

Post-operative sore throat and airway-related complications are common after general anesthesia with endotracheal intubation. Lidocaine instillation into the endotracheal tube cuff and lumen has been proposed to reduce these complications, but evidence remains variable. Objective: To evaluate the effect of 4% lidocaine instillation on post-operative airway morbidity in patients undergoing surgery under general anesthesia. Methods: A quasi-experimental trial was conducted on 130 patients undergoing various elective surgeries under general anesthesia with endotracheal intubation. Patients were divided into two groups: the lidocaine instillation group (n = 65) and the non-lidocaine group (n = 65). Demographic and intraoperative data were recorded. Airway complications, including sore throat, hoarseness, cough, dysphagia, and laryngospasm, were assessed pre-operatively and post-operatively. Logistic regression analysis was performed to identify predictors of post-operative sore throat. Results: Post-operative airway complications increased significantly compared to pre-operative status, with sore throat (29.2%), cough (32.3%), hoarseness (20.0%), dysphagia (13.8%), and laryngospasm (6.2%) observed after surgery (all p < 0.05). Compared to the non-lidocaine group, the lidocaine group had significantly lower incidence of sore throat (18.5% vs. 40.0%, p = 0.010), hoarseness (12.3% vs. 27.7%, p = 0.032), cough (15.4% vs. 43.1%, p = 0.001), and dysphagia (6.2% vs. 21.5%, p = 0.018). Regression analysis showed that age ≥40 years, female sex, intubation duration ≥2 hours, cuff pressure >30 cmH₂O, and absence of lidocaine instillation were independent predictors of sore throat. Conclusion: Instillation of 4% lidocaine in the endotracheal tube significantly reduces the incidence of common post-operative airway complications. Careful control of cuff pressure and limiting intubation duration further mitigates risk. These findings support the routine use of lidocaine instillation as a simple and effective strategy to improve post-anesthesia airway outcomes.

Benign Breast Changes with Adenosis and Duct Ectasia: Diagnostic Challenges and Clinical Implications

2025-10-27T11:01:13+00:00

Rapidly enlarging breast masses during pregnancy pose significant diagnostic challenges. Physiologic breast changes can mask or mimic underlying pathology, and limited biopsy samples may reveal only benign elements such as adenosis, duct ectasia, or tubular adenoma despite an underlying fibroepithelial lesion. Case Presentation: A 34-year-old pregnant woman in her second to third trimester presented with a 1.5-year history of a progressively enlarging left breast mass that rapidly increased in size and became fungating during pregnancy. Earlier histopathology revealed adenosis and duct ectasia, while fine-needle aspiration cytology (FNAC) was reported as C3 ("atypical, probably benign"). Ultrasonography demonstrated an approximately 11 cm multilobulated, hypervascular, exophytic mass classified as BI-RADS 4 B. A wedge biopsy during pregnancy showed a tubular adenoma. Given the lesion's aggressive growth and clinicoradiologic–pathologic discordance, a total left mastectomy was performed. Final histopathology confirmed a benign phyllodes tumour with skin ulceration and a deep margin of 1 mm. Intervention and Outcome: The patient underwent a total mastectomy with complete tumour removal and no perioperative complications. Considering the close deep margin, structured postoperative surveillance was advised. Conclusion: In pregnancy, rapidly growing breast masses with benign or indeterminate histology warrant escalation to complete excision, especially when clinical, radiologic, and histopathologic findings are discordant. This case underscores diagnostic overlap among adenosis, duct ectasia, tubular adenoma, fibroadenoma, and phyllodes tumour and highlights the importance of margin-oriented surgery and long-term follow-up.