Annals of PIMS (Pakistan Institute of Medical Sciences)
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Vitamin D Deficiency in General Paediatric Population Presented in Combined Military Hospital, Malir
Full text linkObjective: To determine the frequency of vitamin D deficiency in paediatric population presented at combined military Hospital, Malir.
Methodology: This descriptive cross-sectional designed study was conducted at the Pediatric Outpatient Department (OPD) at combined military Hospital, Malir, from July to November 2021. Children aged 6 months to 12 years, both boys and girls presented to the pediatric department for routine care, nutritional concerns, or nonspecific symptoms potentially related to micronutrient deficiency were included. A 3–5 mL sample of venous blood was collected aseptically from each participant for biochemical assessment of the vitamin D and vitamin D (25-hydroxyvitamin D) level <20 ng/mL was considered deficient. All the relevant information was entered and analyzed using SPSS version 26.
Results: Out of all 54.5% were female and 45.5% were male. Most children (47.7%) were 1–5 years old. Around half (50%) children were found to have vitamin D deficiency, while 31.8% had insufficient levels, and only 18.2% had sufficient. Sunlight exposure, type of dairy product intake, fish and meat intake, and socioeconomic status had significant associations with serum vitamin D levels p <0.05.
Conclusion: A higher prevalence observed of vitamin D deficiency among children, and found to be strongly linked to inadequate sunlight exposure, poor dietary intake, and low socioeconomic status
Predictors of Allergic Airway Disease in Children Under Two Years of Age
No full textObjective: To determine the frequency of factors responsible for allergic airway disease in children <2 years of age.
Methodology: This descriptive cross-sectional study was conducted at the Department of Pediatrics, LUMHS, Jamshoro, from October 2022 to April 2023. Children under 2 years of age diagnosed with allergic airway disease were included in the study. Both boys and girls with a disease duration of at least 3 months were enrolled. The assessed factors included family history of asthma, cow’s milk protein allergy, allergic rhinitis, low socioeconomic status, maternal education level, respiratory tract infection, and prematurity. All collected data were entered into Microsoft Excel and subsequently analyzed using SPSS version 23.
Results: The patients’ ages ranged from 5 to 24 months (mean: 12.28 ± 3.40 months). Of the total participants, 84 (69.4%) were male and 37 (30.6%) were female. The contributing factors identified were family history of asthma in 21 (17.4%) patients, cow’s milk protein allergy in 59 (48.8%), allergic rhinitis in 53 (43.8%), low socioeconomic status in 28 (23.1%), primary-level maternal education in 56 (46.3%), matric-level education in 50 (41.3%), above-matric education in 15 (12.4%), respiratory tract infection in 49 (40.5%), and prematurity in 31 (25.6%).
Conclusion: Cow’s milk protein allergy and allergic rhinitis were the most common contributing factors to allergic airway disease in children under 2 years of age, exceeding the contribution of respiratory tract infections and prematurity
Establishing a Prediction Model for Successfully Planned Endotracheal Extubation in Preterm Neonates: An Answer to Many Questions
No full textObjective: To establish the prediction model for successfully planned endotracheal extubation in preterm neonates. Study Design: Prospective cohort studyPlace and Duration of Study: This study was conducted at Neonatal ICUs of Fatima Memorial Hospital Lahore, from February 2023 to October 2024.Methodology: The study included 255 preterm neonates (28–35 weeks gestation) intubated <7 days and extubated for the first time before 30 days of age. Successful extubation was labeled as no need for reintubation within 72 hours following extubation. Demographics, prenatal, and peri-extubation data were collected analyzed using multivariate logistic regression to identify independent predictors. Receiver operating characteristic (ROC) analysis assessed model discrimination, and a nomogram was constructed for individualized prediction.
Role of Structured Infection Prevention and Control Training Program in Reducing Surface Contamination and hospital acquired infections: A Single Centre Study
Full text linkObjective: To assess the impact of a structured IPC training program on reducing surface contamination and the frequency of HAIs. The findings aim to support effective infection control strategies and improved outcomes in healthcare settings.
Methodology: Retrospective interpreted time series (ITS) analysis of monthly environmental cultures from six critical areas of Tertiary care teaching hospital (June 2022 to Dec 2023) was conducted. Surface culture reports and HAI records were analyzed before and after IPC training implementation. Descriptive statistics and chi-square tests assessed the changes in surface contamination and HAI rates.
Results: Among 619 environmental samples from six critical areas, 32 (5.1%) showed microbial growth. Positive cultures rates declined significantly across study period from 11.9% to 3.1% and 1.7% following IPC program implementation (df = 2, p < 0.001). ICUs had highest contamination, predominantly Gram-positive cocci, including coagulase-negative Staphylococci. Hospital-acquired infections decreased in critical areas, with a significant shift after IPC implementation ( df = 3, p = 0.019).
Conclusion: There is a significant impact of implementation of infection prevention and control policies followed by regular and structured training sessions of healthcare professionals on surface bacterial contamination of critical areas and hospital associated infections in a tertiary care hospital
Assessment of the Anti-hyperglycemic Effects of Rosemary (Salvia Rosmarinus) Compared to Glimepiride in Alloxan induced Diabetic Rabbits
No full textObjectives: To observe the antihyperglycemic effect of rosemary (Salvia rosmarinus) in alloxan-induced diabetic rabbits.
Methodology: This experimental study was conducted at the Department of Pharmacology and Therapeutics, Liaquat University of Medical and Health Sciences (LUMHS), in collaboration with the Animal House of the Agriculture University, Tando Jam, from November 2023 to April 2024. A total of 24 adult healthy male rabbits weighing between 1.5 and 2.5 kg were included. The rabbits were divided into four groups: Group A (normal control) and Group B (diabetic-induced control) received 0.9% NaCl, while Group C (diabetic-induced) received Rosmarinus officinalis 250 mg/kg, and Group D (diabetic-induced) received glimepiride 2.5 mg/kg. Leaves of Rosmarinus officinalis were dried, powdered, and prepared as an ethanolic extract. After the experiment, blood samples were collected from the femoral vein, centrifuged, and analyzed for serum glucose levels. Hyperglycemia was defined as a blood glucose level above 200 mg/dL. Data were entered and analyzed using SPSS version 26.
Results: Fasting blood sugar (FBS) levels showed a significant reduction in Groups C and D compared with Group B by day 28. Specifically, in Group C, FBS decreased from 252.8±2.5 to 181.3±2.3 mg/dL, and in Group D from 255±1.8 to 197.16±2.5 mg/dL (p<0.05), indicating significant efficacy of Rosmarinus officinalis in improving FBS levels in diabetic rabbits.
Conclusion: Rosmarinus officinalis effectively reduced glycemic concentrations in alloxan-induced diabetic rabbits
Popliteal Artery Injuries in Motorcycle Accidents Following Posterior Knee Dislocation: Surgical Outcomes of Saphenous Vein Graft Repair — A Single-Center Case Series from Nishtar Hospital, Multan
No full textObjective: To assess the surgical outcomes and early functional recovery of patients undergoing great saphenous vein graft repair for popliteal artery injuries following posterior knee dislocations caused by motorcycle accidents.Study Design: Descriptive case series.Place and Duration of Study: Plastic Surgery and General Surgery Departments, Nishtar Hospital, Multan, from January 2021 to December 2024.Methodology: This study included 21 male patients aged 12 years and older who sustained posterior knee dislocations due to motorcycle-related trauma. All patients had intraoperatively confirmed injuries to the popliteal artery and underwent arterial reconstruction using reversed autologous great saphenous vein grafts. Fasciotomy and orthopedic stabilization were performed as required. Patients who presented more than 12 hours after trauma with non-viable limbs or incomplete follow-up data were excluded. Graft patency was evaluated with Doppler ultrasonography on days 2 and 7, and with CT angiography at six months. Functional outcomes were assessed at 12 weeks using the Lower Extremity Functional Scale (LEFS).Results: All patients achieved limb salvage, with no amputations recorded. Graft patency at six months was confirmed in all cases. The mean LEFS score was 65.0 ± 4.1, with 18 patients (85.7%) achieving scores of 60 or higher, reflecting satisfactory recovery. Postoperative complications occurred in 5 patients (23.8%) and included wound infection, early graft thrombosis, seroma, and wound dehiscence—all managed conservatively.Conclusion: Timely revascularization using reversed saphenous vein grafts offers excellent outcomes in terms of limb salvage, graft durability, and early functional recovery in patients with motorcycle-related popliteal artery injuries
Resolution of Type 2 Diabetes After Sleeve Gastrectomy
Full text linkObjective: To determine the resolution of type-II diabetes mellitus (DM) after sleeve gastrectomy (SG) among patients by evaluating glycemic control, medication use, and weight loss.
Methodology: A prospective observational study was done at the Nescom hospital, Islamabad, from August 2022 to September 2023. Both male and female individuals aged 18 years old or above, morbidly obese with BMI greater than35 kg/m and with diagnosis of type –II DM undergoing laparoscopic sleeve gastrectomy were included. Laparoscopic sleeve gastrectomy was done using a standardized four-port technique. A possible large curvature of the stomach was resected, starting 6 cm proximal to the pylorus up to the angle of His. The 36-Fr bougie was used to calibrate the sleeve. Postoperative care started with a liquid diet and structured follow-up at POD3, 2 weeks, and 6 months. At each visit, BMI, fasting glucose, and HbA1c were recorded. Data were documented on a study proforma and analyzed using SPSS version 26.
Results: Overall mean age of the individuals was 47 ± 8 years with 63.3% being female and 36.7% males. Before the surgeries, 66.7% required hypoglycemic drugs and 53.3% were on insulin. Average HbA1c decreased significantly from 8.9% preoperatively to 8.2% on POD3, 7.1% at 2 weeks, and 5.9% at 6 months (p < 0.001). The plasma glucose levels declined from 202.7 mg/dL (POD3) to 138.4 mg/dL at 2 weeks and 100.8 mg/dL at 6 months (p < 0.001). Additionally, the excess weight loss was improved steadily, from 4.1% at POD3 to 11.7% at 2 weeks and 35.1% at 6 months (p < 0.001). However, there were no significant gender-based differences were observed in HbA1c, plasma glucose, excess weight loss, or BMI (all p > 0.05).
Conclusion: LSG is an effective intervention for achieving significant weight loss, improving glycemic control, and reducing plasma glucose levels in Pakistani patients with T2D. These findings support the use of LSG as a valuable tool for managing obesity-related T2D in diverse populations. Further research with larger sample sizes and longer follow-up periods is recommended to validate these results and elucidate the underlying mechanisms
Prevalence of Hyponatremia in Patients With Moderate to Severe Bronchiolitis
Full text linkObjective: To estimate the frequency and severity of hyponatremia in infants hospitalized with moderate–severe bronchiolitis and to assess its association with the severity of disease and length of stay (LOS).
Methodology: It was a single-centre cross-sectional study of consecutive infants with moderate–severe bronchiolitis conducted at Pediatric Medicine Department, Federal Government Polyclinic (FGPC) Hospital, Islamabad, from 01-11-2023 to 30-04-2024. Patients were selected by clinical diagnosis using Pediatric Respiratory Severity Score (PRESS) at presentation. Serum sodium was measured and hyponatremia categorized by standard thresholds. Associations with clinical severity and LOS were tested with chi-square and correlation analyses. Multivariable logistic regression was applied to adjust for confounding variables like age and gender. SPSS version 27 was used for analysis and a P<0.05 was considered significant.
Results: Data of total of n=135 eligible infants were analysed. Hyponatremia was found in 62.2% of cases (mild 63.1%, moderate 36.9%, severe 0%) and was significantly associated with bronchiolitis severity (P<0.001) and longer durations of hospital stay (P<0.001). Serum sodium showed a strong negative correlation with PRESS (r=-0.712; P<0.001) and LOS (r=-0.594); P<0.001). In multivariable adjusted models, severe (vs moderate) bronchiolitis carried markedly greater odds of a higher hyponatremia category (aOR 6.27; 95% CI 2.25–17.45; P<0.001).
Conclusions: In infants with bronchiolitis, a low admission serum sodium levels track with higher PRESS and longer LOS. An admission sodium check is recommended along with PRESS-based triage. This will help in identifying children who need closer observation
Evaluation Of Postoperative Pain With Resin Based Sealer vs Zinc Oxide Eugenol Based Sealer After Single Visit Endodontic.
No full textObjective: The aim of this study is to compare the postoperative pain after single visit endodontics using zinc-oxide eugenol sealer and resin-based sealer.
Introduction: Complete root canal system obturation and disinfection, as well as periradicular tissue healing, are the objectives of root canal therapy. One of the key concerns of endodontic practice is pain management both during and after root canal therapy.
Methodology: A prospective, randomized, double-blind clinical trial was conducted at school of dentistry from June 2023 to November 2023 on 180 patients. The study included patients aged 18-60, ASA Class 1 or 2, with single-rooted teeth suffering from symptomatic irreversible pulpitis. Exclusions were made for ASA Class 3-5 patients, those with immature apices, severe periodontal issues, recent analgesic use, and those needing root canal treatment on multiple teeth. Single visit RCT was planned in single rooted teeth as per presentation and these patients were divided in to two groups, in Group A patients zinc oxide eugenol-based sealer was used and in group B resin based sealer was used. Per-operative, postoperative at 24H and 48H pain perception was calculated through VAS. Data was analyzed through SPSS software v20.0.
Results: The mean age of Group A was 32.38±8.28 and Group B was 32.14±8.58. Around 51% of from Group A were male as compare to 34.4% male patients in group B. Majority (53%) of Group A patients have Mild pain as compare to 42% in Group B patients. P value was significant at post-operative pain after 24H and 48H of treatment in either group.
Conclusion: in this investigation found that, between 24 and 48 hours after endodontic therapy, zinc oxide eugenol-based sealers have a slightly higher incidence of discomfort than resin-based sealers
Comparison of Endothelial Cell Density Post- Phacoemulsification between Diabetic and Non- Diabetic Patients
No full textObjective: To compare the corneal endothelial cell density (CED) after phacoemulsification for cataract surgery between type II diabetic patients and non-diabetic patients.
Methodology: This comparative cross-sectional study was conducted at Sindh Institute of Ophthalmology and Visual Sciences, Hyderabad, from August 2021 to January 2022. Patients aged between 35 and 60 years, both genders presented with cataract of any duration and undergoing uneventful phacoemulsification cataract surgery were included. One day before phacoemulsification, CED was measured using by Topcon SP 3000P Specular Microscope. During surgery, total operative time, pre-operative CED and post- operative CED were measured. Patients were reviewed postoperatively to measure CED after 1 week through a pre-designed proforma.
Results: There were 279 patients enrolled in the study. The mean corneal endothelial cell density pre- operatively was noted 2522.22 ± 181.59 cells/mm2 which was post significantly decreased as 1702.00 ± 73.56 cells/mm2 (p=0.001). Most importantly, the mean post-operative CED was significantly lower among diabetes patients (1671.96 ± 48.64 cells/mm²) compared to non-diabetics (1840.09 ± 81.91 cells/mm²), (p = 0.001), indicating significant more endothelial cell loss after surgery, among diabetic patients.
Conclusion: Diabetic patients observed with significantly more CED loss following phacoemulsification compared to non-diabetic cases, expected due to the prolonged structural and metabolic alterations in the corneal endothelium resulting from chronic hyperglycemia