Annals of PIMS (Pakistan Institute of Medical Sciences)
Not a member yet
815 research outputs found
Sort by
Oral Health Care Status and Barriers to Accessing Oral Health Care Services in Geriatric Population
Full text linkObjective: To evaluate the oral health status and identify major barriers to accessing dental care among the geriatric population.
Methodology: This descriptive cross-sectional study was conducted at Institute of Health Management and Research Sciences from November 2024 to May 2025, on elderly individuals aged 60 and above attending the dental OPD of LUMHS. Overall 150 elderly individuals aged >60 years, both genders, who were able to respond the study questionnaires were included. After taking demographic information, oral health status and barriers to accessing dental care were evaluated. SPSS version 26 was used for data analysis.
Results: Average age of individuals was 63.9+3.99 years. Males were in majority 56.0%. Oral health was note fair or poor, with half not using any dental prosthetics. Financial barriers (58.7%) and fear of dental visits (56%) were the main barriers. Only 41.3% visited dentists regularly, and preventive services were underutilized (8%). Cost and lack of awareness were key reasons for avoiding dental care. Despite 49.3% considered oral health very important and 82.7% were satisfied with available services.
Conclusion: Most of the elderly individuals observed with poor oral health, with limited access due to financial, social, and awareness-related barriers despite high satisfaction among those receiving care
Efficacy of PECS Block In Perioperative Period For Pain Management In Patients Undergoing Elective Breast Surgery
No full textObjective: To compare the effectiveness of intraoperatively performed PECS block (without the ultrasound guidance) and no regional blocks in controlling postoperative pain and opioid use among patients undergoing elective modified radical mastectomy (MRM) and Mastectomy.Methodology: Study Design: Randomised controlled trial.Duration and Place of Study: This study was conducted from Oct 2024 to march 2025 in Pakistan Institute of Medical Sciences, Islamabad. A randomized, controlled prospective study will be a study of 60 female (ASA I- II) patients who are to undergo MRM and Mastectomy. The patients were randomized into two groups, Group P (PEC group): Received PECS block intraoperatively under directview (surgeon assisted) and Group C (Control group): Received standard general anesthesia without block. Primary outcome: Requirement of Analgesia. Secondary outcomes: Total Opioid use in 24 hours, Mean time to first rescue analgesic request,Visual Analogue Scale (VAS).Results : The average time to first rescue analgesia was similar between the PECS block groupand control group (70.04 + 44.01 vs. 54.44 + 31.01 minutes; p =0.118). There was nosignificant difference in the total intraoperative tramadol intake (104.14 ± 15.02 mg vs.96.82 ± 30.62 mg; p = 0.244). The Tramadol requirement postoperative rescueanalgesia and the percentage of the patients rescued by the analgesia remained similar in the groups (p > 0.05). The mean VAS pain scores of the two groups in all the time points assessed (1, 2, 4, 6, 12, and 24 hours after the operations) were significantly lower and no differing VAS pain scores between the two groups were found to be statistically significant.Conclusion: PECS block, when used intraoperatively, is safe and effective as a supplement togeneral anesthesia among patients that undergo elective modified radical mastectomy.It was proven to be more effective in terms of postoperative pain scores measured withthe Visual Analog Scale (VAS) at pre-specified postoperative intervals and cumulativeopioid consumption at 24 hours post operation significantly reduced compared topatients who received no block. Safety was measured using the incidences ofperioperative and postoperative complications associated with the block and no adverseevents associated with the blocks. It was also related to the decreased incidence ofopioid-related adverse effects when PECS block was used, which contributes to theeffectiveness of multimodal analgesia with PECS block in breast cancer surgery
Cost Out-of-Pocket Expenses with Cardiovascular Diseases at PMCH Nawabshah – COUP Study
No full textObjectives: To evaluate out-of-pocket (OOP) healthcare expenditures and associated factors among patients with cardiovascular diseases (CVDs) presenting at PUMHS Nawabshah.
Methodology: This cross-sectional study was conducted among 200 diagnosed CVD patients attending inpatient and outpatient cardiology services at PUMHS SBA from October 2023 to March 2024. All adult patients of both genders presenting with any cardiovascular disease at the cardiology department were enrolled. Patients were assessed for sociodemographic characteristics, type of cardiovascular disease, duration of illness, and direct medical and non-medical expenses, including consultation fees, medications, diagnostic tests, transportation, and hospital stay. Descriptive statistics were used to calculate the mean and median OOP costs. Appropriate statistical tests were applied using SPSS version 23, with a p-value of <0.05 considered statistically significant.
Results: The overall mean age of participants was 59.3 ± 14.36 years, and the majority were males (67.6%). The mean annual medication cost was 117,735.31 PKR. Patients were hospitalized an average of 2.02 times per year, with a mean total of 9.63 inpatient days annually, incurring a mean annual hospitalization cost of 68,191.50 PKR. Yearly transportation-related expenses averaged 35,946.04 PKR. Collectively, the overall mean annual out-of-pocket expenditure per patient was 259,908.06 PKR. Out-of-pocket spending exceeding 10% of household income was observed in all patients, indicating that every participant in the study faced financially catastrophic healthcare costs. Additionally, a significant majority of patients (97.2%) reported borrowing money to meet their treatment expenses, and 73.8% were compelled to sell household assets to finance their care.
Conclusion: Individuals with CVDs faced a considerable out-of-pocket financial burden, primarily driven by medication and diagnostic costs, which adversely influenced treatment adherence and health outcomes
Altered Sleep Pattern in Patients of Acute Myocardial Infarction at Cardiology Ward of Liaquat University of Medical & Health Sciences
Full text linkObjective: To determine the frequency of altered sleep patterns among patients with acute myocardial infarction admitted to the cardiology ward of Liaquat University of Medical & Health Sciences.
Methodology: This prospective observational study was conducted in the Department of Cardiology, Liaquat University Hospital (LUMHS), from September 2023 to March 2024. Patients of both genders, aged 20–65 years, presenting with acute myocardial infarction were included. Sleep patterns were assessed using both open- and close-ended questions, and any deviation from the normal sleep pattern was considered abnormal. Associations between altered sleep patterns and baseline as well as clinical parameters were evaluated, with a p-value < 0.05 considered statistically significant.
Results: The overall mean age of the patients was 54.04 ± 8.82 years. Male patients constituted a higher proportion compared with females (62.82% vs. 37.28%). The overall frequency of altered sleep patterns among patients admitted with acute myocardial infarction was 40.69%. A higher prevalence of altered sleep patterns was observed among males, married individuals, urban residents, housewives, patients belonging to the middle socioeconomic class, those with normal body mass index, non-smokers, patients presenting with typical chest pain, and those diagnosed with non–ST-elevation myocardial infarction (NSTEMI); however, these associations were not statistically significant (p > 0.05). Depression was the only variable that showed a statistically significant association with altered sleep patterns among patients with acute myocardial infarction (p = 0.04).
Conclusion: The prevalence of altered sleep patterns was notably high among patients admitted with acute myocardial infarction. However, depression was the only factor significantly associated with sleep deviation in this population
The Diagnostic Significance of Cytokeratin 13 & 17 Expression in Oral Mucosal Biopsies by Immunohistochemical Technique
Full text linkObjective: To find out immunohistochemical (IHC) profile of cytokeratin 13 and 17 expression in oral premalignant and malignant epithelial lesions.
Methodology: This descriptive cross-sectional study was conducted at, pathology department of Liaquat University of medical and health science Jamshoro from January 2017 to June 2019. Excisional biopsy samples of patients of all age groups, both gender with complain of oral mucosal epithelial lesions were enrolled. Oral mucosal biopsies were fixed in 10% formalin, routinely processed, and stained with H&E for histopathological diagnosis. Immunohistochemistry for Cytokeratin 13 and 17 was performed on paraffin sections after deparaffinization and blocking of endogenous peroxidase activity. Tissue sections were kept moist throughout the procedure and mounted on FLEX IHC slides. All the relevant pathological and clinical data were recorded using study proforma and analyzed by SPSS version 20.
Results: Patient’s mean age was 40.45+11.94 years and males were in majority 63.4%. Buccal mucosa, cheek and tongue were most common sites of biopsy, 32.8%, 21.6% and 31.3% respectively. CK13 was positive among 73 cases. CK17 was positive among 96 cases. Leukoplakia, sub mucous fibrosis, ulcers were significantly associated with CK13 p=0.003, while leukoplakia and squamous cell carcinoma were significantly associated with CK 17 p=0.001.
Results: A total of 139 cases were included. The mean age of patients was 40.45 ± 11.94 years. Males constituted the majority (63.4%). The most common biopsy sites were buccal mucosa (32.8%), cheek (21.6%), and tongue (31.3%). Most patients (78.4%) reported symptoms for 1 to 3 months. Leukoplakia was the most frequent oral lesion, observed in 22.3% of cases.
CK13 positivity was observed in 73 cases, while CK17 was positive in 96 cases. CK13 expression was significantly associated with leukoplakia, submucous fibrosis, and ulcers (p = 0.003). CK17 expression showed significant association with leukoplakia and squamous cell carcinoma (SCC) (p = 0.001). Histologically, dysplasia was significantly associated with positive CK13 expression, whereas SCC was significantly associated with CK17 expression, both with statistically significant p-values.
Conclusion: CK13 is a useful immunohistochemical marker for epithelial dysplasia, while CK17 serves as a reliable diagnostic marker for squamous cell carcinoma. CK13 expression was significantly higher in cases of leukoplakia, submucous fibrosis, ulcers, and epithelial dysplasia. CK17 was more frequently expressed in cases of leukoplakia and SCC
Maternal and fetal outcomes in pregnant women Presenting with burn injuries at PIMS Islamabad
No full textObjective: To evaluate the clinical characteristics, trimester-wise presentation, and fetomaternal outcomes of pregnant women presenting with burn injuries at Pakistan Institute of Medical Sciences (PIMS), Islamabad.
Methodology: This retrospective cohort study was conducted in collaboration between the Burn Center and Maternal and Child Health (MCH) Department at PIMS from May 2008 to October 2024. A total of 33 pregnant women with burn injuries were included after ethical approval and informed consent. Data regarding age, gestational age, total body surface area (TBSA), type and mode of burn, trimester-wise obstetrical management, and maternal and fetal outcomes were collected using a structured questionnaire. Burn severity was calculated using the Wallace Rule of Nines. Data were analyzed using SPSS version 25. Primary outcomes included maternal and fetal survival, while secondary outcomes assessed the impact of TBSA and management strategies on outcomes.
Results: The majority of patients were aged 21–30 years (63.6%). Distribution across trimesters was comparable. Flame burns were most common (75.8%), and 97% were accidental. Maternal survival was 39.4%, while fetal survival was 30.3%. Mortality strongly correlated with TBSA (p < 0.001), with 100% fetal mortality observed in burns exceeding 70% TBSA. Outcomes improved significantly over time (p = 0.007) with multidisciplinary care. Supportive therapy yielded better maternal survival in first and second trimesters, while delivery in the third trimester resulted in improved fetal survival. No-intervention management was associated with the poorest outcomes.
Conclusion: Burn severity is the strongest predictor of fetomaternal mortality. Early multidisciplinary management and trimester-specific obstetrical strategies significantly improve survival outcomes in pregnant burn patients
Comparison of Diode Laser Tonsillectomy and Bipolar Cauterization Tonsillectomy
No full textObjectives: To compare the outcomes of diode laser tonsillectomy and bipolar cauterization tonsillectomy in terms of intraoperative efficiency, postoperative recovery, and complications.
Methodology: This prospective comparative study carried out at Rawal Institute of Health Sciences (RIHS), Islamabad from January 2023 to December 2023. A total of 100 patients were randomly selected for the diode laser tonsillectomy procedure and bipolar cauterization tonsillectomy. Various details such as intraoperative parameters, postoperative pain, time to start a normal diet, and the complication/s that ensued were documented and compared.
Results: The mean age of the patients was 26.5±5.2 years, with gender distribution was 50% male and 50% females. Diode laser tonsillectomy resulted in shorter operating time (25.0±5.0 min), decreased blood loss (5.0±2.0 ml), reduced pain score at day 7 (1.5±0.5 points) and faster postoperative recovery than bipolar cauterization (p < 0.001). The frequency of secondary haemorrhage in the diode laser patients (2%) was also noticeably less.
Conclusion: Diode laser tonsillectomy is characterized by fewer post-operative complications, shorter time of treatment, and faster healing compared to classical methods of tonsillectomy due to high cost it is not popular
Enhanced post total knee replacement recovery by using intraarticular intraoperative cocktail injections
Full text linkObjective: To assess the advantages of a specific cocktail combination in TKR patients, focusing on postoperative pain relief and enhanced recovery of knee mobility.
Methodology: This prospective, double-blinded, placebo-controlled study was conducted at Akbar Niazi Teaching Hospital, Islamabad, from January 2022 to December 2024. Sixty consecutive patients underwent unilateral TKR were enrolled, with 30 receiving an intraoperative intraarticular cocktail injection (intervention) and 30 receiving normal saline (control). Postoperative pain for each knee was assessed using visual analog scale (VAS), and time required to attain 90° of knee flexion was recorded for both groups. The collected data were analyzed utilizing SPSS v 23. Changes in pain scores within the groups across follow-up periods were analyzed using repeated measures ANOVA
Results: The patients were between 55 and 85 years old (mean was 63.2±9.2 years), and males were 66.7%. Patients who received the cocktail injection experienced significantly less pain than the control group during the first 48 hours and achieved 90° of knee flexion in a significantly shorter time.
Conclusion: Intraoperative intraarticular cocktail injection significantly alleviates early postoperative pain and enhances early knee mobility
Efficacy of Ligasure use in Total Thyroidectomy at a tertiary care Hospital
No full textObjective: To evaluate the effectiveness of the ligasure small jaw (LSW) device in achieving hemostasis during total thyroidectomy.
Methodology: This study is conducted as a retrospective observational study at Akbar Niazi Teaching Hospital, Islamabad. Eighty-six patients underwent thyroidectomy using LSW between April 2021 till April 2024 were studied. Liga Sure is an advanced bipolar vessel-sealing device that uses a combination of controlled pressure and radiofrequency energy to permanently seal blood vessels up to 7 mm in diameter, providing effective hemostasis with minimal thermal spread. Parameters including per operative findings of intraoperative bleeding and operative time and postoperative findings of voice change and hospital stay were assessed. After approval from the ethical board, data was collected as a qualitative research study and entered on standard SPSS sheet version 26.
Results: A total of 86 patients were observed during the study period. Per operative findings of intraoperative bleeding measured by the visual gauze method showed 6ml gauze blood in 39.5% and more than 6ml gauze blood in 26.8% and rest of the patients were having 3ml-6ml gauze blood. The mean surgery time noted was 92.07±6.34 minutes.64% of the patients had hospital stay of 1-2 days. Only 1 patient had voice hoarseness which was improved after giving stat dose of steroid. The use of Liga Sure demonstrated effective hemostasis, acceptable operative time, short hospital stays, and a low complication rate in patients undergoing total thyroidectomy.
Conclusion: The results demonstrated that LSW effectively minimized intraoperative bleeding, reduced operative time, and preserved recurrent laryngeal nerve function, with minimal complications. Comparative analysis with traditional ligation techniques, diathermy or bipolar devices confirmed the efficiency and safety of LSW
Efficacy of Dexamethasone in preventing post spinal hypotension in elderly patients undergoing orthopedic surgery; A Randomized Control Trial at a tertiary care hospital
No full textObjective: To compare the efficacy of single pre-operative dose of intravenous Dexamethasone vs placebo in elderly patients undergoing orthopedic surgeries in spinal anesthesia in terms of number of hypotensive episodes.
Methodology: After ethical approval and clinical trial registration (NCT07052864), study was carried out at Department of Anesthesiology and Critical Care Medicine, PIMS Hospital, Islamabad from 30th June 2025 to 30th August 2025. A total of 134 patients were enrolled who were 50 years to 100 years belonging to ASA I & II. Group A patients were given single preoperative dose of dexamethasone 8?mg IV in 100?ml normal saline 1 hour before induction of spinal anesthesia in the pre-operative area while group B patients were given placebo.
Results: The incidence of intra operative hypotension was significantly higher in group B than group A. The incidence in group B was 70% and in group A it was 45% with p value being 0.003. Similarly intraoperative phenylephrine consumption was 0.00 (50.00) in group A while in group B it was 50.00 (200.00) with p value being 0.02.
Conclusion: Prophylactic administration of Intravenous Dexamethasone is effective in preventing post spinal hypotension and reducing intraoperative vasopressor requirements among elderly patients undergoing lower limb orthopedic surgeries