Objective: To discuss the referral mechanisms established for safe and expeditious inter-facility transfer of COVID 19 positive patients to ensure their referrals through establishing proper communication channels. Methods: Mobile phone and WhatsApp based groups, administrated by The Indus Hospital were established in April 2020. Through detailed reports and frequent communication, factors like bed and ventilator availability across these facilities are shared. Weekly reports through zoom meetings updating the key stake holders, discussion of problems faced and planning for the week ahead are also done. Result: The establishment of these groups has been successful in ensuring referral to and from The Indus Hospital to various healthcare facilities across Karachi using appropriate ambulance services. Conclusion: The development of referral mechanisms is the need of the day that has been highlighted through the COVID 19 pandemic. It is our hope that these mechanisms are sustained after the pandemic and result in improvement in patient outcome through proper referrals. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2803 How to cite this: Salman S, Saleem SG, Khatri A, Jamal I, Maroof Q, Alam A. Inter-hospital communication and transfer practices during COVID-19 Pandemic in Karachi, Pakistan. A brief overview. Pak J Med Sci. 2020;36(COVID19-S4):---------. doi: https://doi.org/10.12669/pjms.36.COVID19-S4.2803 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Objective: Structured trauma care has proven to improve patient outcomes, and this is more relevant in the low- and middle-income countries (LMICs). The objective of this study was to determine the distribution, etiology, severity and outcomes of trauma patients at the Indus Hospital. Methods: All adult poly-trauma patients presenting to The Indus Hospital from July 2017 to June 2018 were included in this retrospective review. Data was extracted on etiology of trauma, severity of injury, investigations and final disposition of patients. Results: Of 972 trauma patients presenting to TIH Emergency Department, 663 (68.2%) were males with a mean age of 36 (17.4) years. Road traffic accidents (RTAs) led to trauma in 766 patients (78.8%), followed by 121 falls (12.7%). Injury Severity score (ISS) was calculated upon arrival and 528 (54.3%) were found to be critically injured. Median length of stay was 60 (24-720) minutes while none utilized pre-hospital Emergency Medical services. Conclusion: Most trauma patients were males suffering from RTA. Nearly half of the patients were critically injured on arrival. EMS is not utilized by trauma patients. There were gaps identified in the diagnosis and treatment of trauma. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1717 How to cite this:Salman S, Saleem SG, Shaikh Q, Yaffee AQ. Epidemiology and outcomes of trauma patients at The Indus Hospital, Karachi, Pakistan, 2017 – 2018. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S9-S13. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1717 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Background The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting. Methods A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition—measured by increased frequency of diagnosing heat emergencies and improved management—measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention. Results Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention. Conclusion The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.

Objectives: To evaluate the comparative effect of 0.4 % Doxycycline gel and 1% Metronidazole gel as an adjunct to scaling and root planning in the treatment of chronic periodontitis. Study Design: Interventional study. Setting: Department of Periodontology at Isra Dental College, Isra University Hyderabad. Period: October 2017 to April 2018. Material & Methods: A sample of 60 patients of chronic Periodontitis were selected according to inclusion and exclusion criteria through non probability convenience sampling technique. Subjects were divided into 3 groups; GROUP A: Scaling and Root Planning (SRP) + 0.4 % doxycycline gel was applied sub-gingival, GROUP B: Scaling and root planning (SRP) + 1 % metronidazole gel was applied sub-gingival, GROUP C: Scaling and root planning (SRP) alone was performed. Data was recorded on proforma and was analyzed by using SPSS version 22.0. P value significance was taken ≤ or equal to 0.05. Results: Pocket depth at baseline in group A was 4.39± 0.20 which was reduced to 3.78± 0.53 and 3.30 ± 0.17 millimeters at day 10 and after one month respectively. Pocket depth at baseline in group B was 4.45± 0.19 which was reduced to 3.89± 0.51 and 3.34 ± 0.17 millimeters at day 10 and after one month respectively. Pocket depth at baseline is group C was 4.45± 0.18 which was reduced to 4.10± 0.20 and 4.06 ± 0.27 millimeters at day 10 and after one month respectively. Pocket depth at Day 10 in groups A, B and C showed statistically significant. Conclusion: Both Doxycycline and Metronidazole gel proved same efficacy when compared to control group. Since there is no difference in efficacy of doxycycline and metronidazole gels when applied in patients having periodontitis.