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OBJECTIVE: To determine the patterns of demographics, clinical presentation, and outcome among dengue patients treated at Dr. Ruth K.M. Pfau Civil Hospital, Karachi. METHODOLOGY: This retrospective cross-sectional study comprised 1003 suspected dengue cases presented at Dr. Ruth K. M. Pfau Civil Hospital, Karachi, between September 2019 and February 2020. Medical records of 328 patients who tested positive for dengue infection on immune chromatographic technique (ICT) for recombinant NS1 antigen and/or IgM serology were included in the analysis. RESULTS: Among 1003 suspected cases, 328 cases were laboratory-confirmed dengue fever; 82.3% (n=270) presented with acute dengue infection as they were positive for NS1 antigen only. 13.1% (n=43) of the patients were IgM-positive, whereas 0.9% (n=3) were positive for IgG. 3.6% (n=12) of the laboratory-confirmed dengue patients were positive for both NS1antigen and IgM. The majority of the dengue patients were from the district of South Karachi. Among all in-patients, 77 % (n=94) of the patients presented uncomplicated dengue fever, while 21.3% (n=26) of hospitalized dengue patients presented with dengue hemorrhagic fever. However, 1.6% (n=2) of hospitalized patients presented with dengue shock syndrome. Mortality was 1.6% (n=2). CONCLUSION: We conclude that the epidemiology of dengue infection and seasonal disease variability in Pakistan's urban settings has not changed over the last decade but warrants continuous monitoring due to climate change. The disease is still more prevalent among young males with a classic presentation of dengue fever. Dengue hemorrhagic fever is relatively less common, while very few patients develop dengue shock syndrome, contributing to mortality.

Background: Antimicrobial resistance surveillance is essential for empiric antibiotic prescribing, infection prevention and control policies and to drive novel antibiotic discovery. However, most existing surveillance systems are isolate-based without supporting patient-based clinical data, and not widely implemented especially in low- and middle-income countries (LMICs). Methods: A Clinically-Oriented Antimicrobial Resistance Surveillance Network (ACORN) II is a large-scale multicentre protocol which builds on the WHO Global Antimicrobial Resistance and Use Surveillance System to estimate syndromic and pathogen outcomes along with associated health economic costs. ACORN-healthcare associated infection (ACORN-HAI) is an extension study which focuses on healthcare-associated bloodstream infections and ventilator-associated pneumonia. Our main aim is to implement an efficient clinically-oriented antimicrobial resistance surveillance system, which can be incorporated as part of routine workflow in hospitals in LMICs. These surveillance systems include hospitalised patients of any age with clinically compatible acute community-acquired or healthcare-associated bacterial infection syndromes, and who were prescribed parenteral antibiotics. Diagnostic stewardship activities will be implemented to optimise microbiology culture specimen collection practices. Basic patient characteristics, clinician diagnosis, empiric treatment, infection severity and risk factors for HAI are recorded on enrolment and during 28-day follow-up. An R Shiny application can be used offline and online for merging clinical and microbiology data, and generating collated reports to inform local antibiotic stewardship and infection control policies. Discussion: ACORN II is a comprehensive antimicrobial resistance surveillance activity which advocates pragmatic implementation and prioritises improving local diagnostic and antibiotic prescribing practices through patient-centred data collection. These data can be rapidly communicated to local physicians and infection prevention and control teams. Relative ease of data collection promotes sustainability and maximises participation and scalability. With ACORN-HAI as an example, ACORN II has the capacity to accommodate extensions to investigate further specific questions of interest.

Objective: To study the tolerability and efficacy of dolutegravir in naïve and experienced patients, their management and outcome. Study Design: Cross sectional study. Place and Duration of Study: Ruth KM Pfau Civil Hospital, Karachi Pakistan, from Apr 2018 to Apr 2020. Methodology: In this study all treatment-naïve and experienced HIV infected patients were included and started on integrase strand-transfer inhibitor dolutegravir (DTG) containing fixed dose combination at Sindh AIDS Control Program (SACP) was conducted. We documented virological suppression, defined as a viral load of

Abstract Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients. Study Design: Prospective observational study. Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019. Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia. Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option. Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing.