Annals of PIMS (Pakistan Institute of Medical Sciences)
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Spectrum of Duodenal & Small Intestinal Diseases in Quetta: A Hospital-Based Study
Full text linkObjective: To determine the spectrum of inflammatory and neoplastic diseases affecting the duodenum and small intestine in patients presenting at a tertiary care hospital in Quetta, Balochistan.
Methodology: This is a retrospective observational study. It was conducted in a tertiary care hospital from April 2021 to January 2025 in Quetta. A total of 152 patients of all ages and both genders who underwent duodenal or small intestinal biopsy were included in the study. Those cases with complete clinical, endoscopic, and histopathological data were analyzed. Histological findings of endoscopic biopsies, incisional biopsies, and excision specimens were assessed. Celiac disease was classified using the Marsh classification. Data was analysed using SPSS version 20. Associations between variables were calculated using Chi-square and Fisher’s exact tests. Statistical significance was set at p<0.05.
Results: The mean age of patients was 31.53 ± 13.81 years, with a male predominance (70.4%). The most common presenting symptoms were anemia (39.5%) and chronic diarrhea (19.1%). Inflammatory and benign conditions accounted for 95.4% of cases, while malignant lesions comprised 4.6%. The most common histopathological finding was chronic non-specific inflammation (61.2%). Celiac disease was reported in 19.7% of cases, predominantly in males, with Marsh stage 1 and stage 3b being the most common subtypes. Giardiasis and Meckel’s diverticulum were each diagnosed in 1.3% of cases. Adenocarcinoma was most common malignant lesion (2%), followed by intestinal lymphomas and gastrointestinal stromal tumors (GISTs).
Conclusion: Inflammatory conditions, especially chronic non-specific inflammation and celiac disease, represent the majority of duodenal and small intestinal pathologies in this area. Although uncommon, malignant lesions remain clinically significant. Histopathological examination of biopsies plays a crucial role in accurate diagnosis and appropriate management
Incidence, Risk Factors, and Outcome of AKI in Preterm Neonates Admitted to the NICU
Full text linkObjective:To determine the incidence, potential risk factors, and outcomes of acute kidney injury (AKI) among preterm neonates.
Methodology: This prospective cohort study was conducted in the neonatal intensive care units (NICUs) of Fatima Memorial Hospital, Lahore, from April 2024 to October 2024. Preterm neonates born between 28 and 36 weeks of gestation were eligible for inclusion. A total of 432 preterm neonates admitted to the NICU of this tertiary care hospital during the study period were enrolled. Neonates with major congenital anomalies or chromosomal abnormalities were excluded. AKI was diagnosed using the modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcomes assessed were in-hospital mortality and duration of hospitalization.
Results: AKI was diagnosed in 178 preterm neonates (41.2%). Maternal anemia emerged as the most significant risk factor, increasing the risk of neonatal AKI by 5.8 times (487%), followed by hemodynamically significant patent ductus arteriosus (hsPDA) (2.89 times; 189%) and mechanical ventilation (1.7 times; 76.8%). In contrast, exposure to antenatal steroids was nephroprotective, reducing the risk of AKI by 63.6%. The mortality rate among neonates with AKI was 16.3% (p < 0.001), with stage 3 AKI demonstrating the highest mortality rate (30%). Kaplan–Meier survival analysis showed a significant reduction in survival duration among neonates with stage 3 AKI, with a mean survival time of 16.51 days.
Conclusion: Approximately two-fifths of preterm neonates in this cohort developed AKI, affecting 178 (41.2%) of the 432 enrolled neonates. Key risk factors included maternal anemia, hsPDA, and mechanical ventilation, while antenatal steroid exposure had a protective effect. Preterm neonates with stage 3 AKI experienced hospital stays that were twice as long and demonstrated a 50% reduction in mean survival (p < 0.001)
Evaluation of the Gag Reflex in Patients Wearing Partial Dentures During Impression Taking
No full textObjective: To determine the frequency of the gag reflex in patient of partial dentures wearerwhile taking impression.Methods: a Cross Sectional descriptive study was done at department of Prosthodontics,Institute of Dentistry, LUMHS, Jamshoro, on 97 prosthodontics patients (removable partialdenture, fixed restoration such as crown, bridge) aged 20 to 60 years and of either genders. Dataregarding demographic characteristics and gag reflex were collected using the Gagging ProblemAssessment Questionnaire (GPA–Patient Short Form). The scores were categorized as mild,moderate, or severe. After all the relevant data collection the analysis was done using IBM SPSSversion 26.Results: Overall mean age of the individuals was 36.93±7.66 years and females were in majority63(64.9%). Out of all partial denture wearers, 92.8% reported experiencing a gag reflex.Additionally the majority of participants (62.9%) had a mild gag reflex, 6(26.8%) had amoderate response, 3(3.1%) reported a severe gag reflex, while 7(7.2%) showed no gag reflex.However the severity of the gag reflex did not show a statistically significant association withage and gender (p-&gt;0.05).Conclusion: This study revealed that a mild to moderate gag reflex was observed the mostcommon among partial denture wearers, particularly during impression procedures involving theupper jaw and posterior oral regions, without its significant association with age or gender.Key words: Partial denture, Gag reflex, Impression
Knowledge, Attitude and Practices of Healthcare Professionals Regarding Disaster Management
Full text linkObjective: To assess the level of knowledge, attitude, and readiness to practice disaster medicine among healthcare professionals. Methodology: A cross-sectional observational study was conducted from November 2024 to January 2025, at the Pakistan Institute of Medical Sciences (PIMS) in Islamabad. A self-administered, validated questionnaire was used to collect the information from the doctors regarding knowledge, attitude and practices about disaster management. Data was analyzed using SPSS version 25.Results: A total of 170 doctors participated in the study, 55.3% (n = 94) were males and 44.7% (n = 76) were females. House officers were the largest percentage of responders (56.5%, n = 96), followed by postgraduates (30%, n= 51). Most of the participants (95.3%, n=162) knew the disaster meaning. However, only 27.1% (n = 46) were aware of their hospital's disaster preparedness plan. 52.4% (n=89) were unclear about the disaster drills. Majority (97.1%, n = 165) agreed that disaster preparedness training should be required for the doctors. Conclusion: There are gaps in disaster preparedness among doctors at PIMS, as many reported lacking formal training, awareness of hospital disaster plans, or participation in drills. A strong consensus among participants supported making disaster preparedness training mandatory, with a high willingness to engage in such programs
Comparison of high dose N-Acetyl cysteine vs. low dose N-acetyl cysteine for prevention of contrast induced nephropathy in patients undergoing Coronary Intervention
No full textObjective:To compare the incidence of contrast induced nephropathy in patients undergoing percutaneous angiography or angioplasty receiving placebo vs 600mg, 1200mg and 1800mg of N-acetyl cysteine for prevention. Methodology: Randomized controlled trial at Pakistan Institute of Medical Sciences, Department of Cardiology from August 2023 to January 2024. 126 patients were enrolled aged 18 90 years undergoing any percutaneous cardiology with contrast medium Lobitridol 350mg/ml. Allocation to one of four groups with 32 participants in Group A, 34 in Group B and C and 26 participants in Group D. Group A patients received hydration with normal saline at 60ml/hr 24 hours pre and post procedure. Group B patients received hydration along with 600mg oral NAC twice a day pre and on the day of the procedure. Similarly group C and D received hydration and 1200mg and 1800mg NAC respectively twice a day 24 hours prior to procedure and on day of procedure. Contrast induced nephropathy was identified as absolute rise in the level of serum creatinine of ?0.5mg/dl or more than 25% from baseline or fall in estimated glomerular filtration rate (eGFR) by ?25%, 48h after contrast administration. Results: Incidence of contrast induced nephropathy at 24 hours was 25% for hydration alone; 17.6%, 8.8% and 11.5% for 600mg, 1200mg and 1800mg doses of NAC with hydration. At 72 hours post procedure the incidence of CIN was 18.8% for hydration alone, 26.4%, 17.6%, and 7.69% for NAC doses of 600mg, 1200mg and 1800mg. No significant association was found with gender, diabetic status, type of procedure, length of procedure or dose of contrast. Conclusion: Usage of higher doses of NAC may decrease incidence of CIN in patient undergoing coronary procedures with contrast agent. The results of our study can not support the use of NAC nor support abandoning the use of NAC. Keywords: N-Acetyl cysteine; CIN; Coronary; PCI; Angioplast
Comparison of complications rate between Double-J ureteral stent and percutaneous nephrostomy in obstructive uropathy due to stone disease: A comparative study.
No full textBackground: Urolithiasis associated with obstructive uropathy appears to be a prevalent issue requiring effective methods for elimination of urinary blockage. The primary objective of this study was to assess the complication profile of PCN and DJ ureteral stenting in patients with stone related obstruction of the urinary tract.
Methods: The current study is a randomized comparative intervention study involving 108 patients aged 18-70 years with obstructive uropathy resulting from urolithiasis and requiring decompression of the urinary tract. Patients were further randomly divided into two equal groups, group A was DJ stent and group B was PCN group. The main outcomes were intraoperative and postoperative cumulative complication rates documented with follow-up between 15 days and 3 months.
Results: There was a higher overall complication rate in the DJ stent group as compared with PCN group (36% vs. 16% p = 0.02). The intraoperative complications were misplacement in 10 patients of the DJ stent group as compared to 3 patients of the control group (p = 0.03) and bleeding in 7 patients of the DJ stent group as compared to 2 patients of the control group (p = 0.04). We also noted that postoperative complications like postoperative urinary tract infections (15% vs. 5%, p = 0.03), stent migration (11% vs. 0%, p = 0.01), postoperative haematuria (13% vs. 4%, p = 0.02) in patients with DJ stents were also higher than in patients in PCN group. The PCN group had less number of complications involving infection and dislodging of the tube than the operating group 3% and 11% respectively with p = 0.02.
Conclusions: This work showed that the complication rate of PCN is significantly less than DJ ureteral stenting in patients with obstructive uropathy due to urolithiasis. The long-term results of PCN treatment can be better in terms of patients’ quality of life.
Keywords: Obstructive uropathy, urolithiasis, Double-J ureteral stent, percutaneous nephrostomy, complication rates
Correlation of Carotid intima media thickness and severity of coronary artery disease.: Correlation of Carotid intima media thickness and severity of coronary artery disease.
No full textBackground: Carotid artery intima-media thickness (CIMT) is widely recognized as a marker for subclinical atherosclerosis and cardiovascular risk. The objective of this study was to investigate the association between CIMT and coronary artery disease (CAD), focusing on its potential as a non-invasive diagnostic tool for CAD severity.
Methods: This cross-sectional study included 125 participants, comprising 77 CAD patients and 48 age- and gender-matched healthy controls, based on the absence of clinical or angiographic evidence of CAD. Demographic data, comorbidities, lipid profiles, ejection fraction, and CIMT measurements were recorded. CIMT was assessed using high-resolution B-mode ultrasonography, with measurements taken from both the right and left common carotid arteries.
Results: CAD patients had a significantly higher mean age than healthy controls (57.55 vs. 52.92 years, p = 0.014) and a greater male prevalence (83.1% vs. 45.8%, p < 0.001). CIMT measurements were notably higher in CAD patients (right CIMT: 1.282 mm; left CIMT: 1.313 mm) compared to controls (right CIMT: 0.892 mm; left CIMT: 0.864 mm), with p < 0.001. Higher CIMT was linked to more severe CAD, especially in patients with triple- and multi-vessel disease. CAD patients also had elevated lipid levels (total cholesterol: 238.68 mg/dL vs. 195.58 mg/dL, p = 0.002; triglycerides: 222.67 mg/dL vs. 171.40 mg/dL, p < 0.001) and a lower ejection fraction (50.03% vs. 54.29%, p = 0.011).
Conclusions: Increased CIMT is strongly linked to CAD presence and severity, highlighting its potential as a non-invasive, cost-effective tool for early detection and risk assessment, especially where angiography is unavailable.
Keywords: Coronary artery disease, carotid artery intima-media thickness, atherosclerosis, cardiovascular risk, non-invasive diagnostic tool, lipid profiles, ejection fraction, CAD severity
Coronectomy of Impacted Lower Third Molar in Close Proximity to Inferior Alveolar Nerve: Evaluation of Outcomes and Complications After One-Year Follow-Up
Full text linkObjectives: This current study was performed to evaluate the outcome after coronectomy of mandibular third molars in terms of complications met during or after the procedure, IAN injury, root migration and need for re operation.
Methodology: This present clinical study was conducted in Oral and Maxillofacial Surgery Department of private dental hospital of Islamabad for 02 years from June 2022 to June 2024. Forty-five mandibular third molars of patients having high risk of IAN injury between the age group of 18 to 45 years, were involved in the study. Preoperatively the lower third molars were assessed clinically and radio graphically. Coronectomy was done and primary closure was achieved. Patients were evaluated postoperatively at 01 week, 06 months and 01 year. Post-operative pain, IAN and lingual nerve injury or any other complications were observed and recorded.
Results: Not a single patient had IAN and lingual nerve injury. Although 03 patients had infection at the coronectomy site after few months and required another surgical removal. However, 3 of our patients were categorized as failed coronectomy due to intra operative mobilization of roots, which were were removed.
Conclusion: The procedure of Coronectomy is effective in avoiding inferior alveolar nerve injury following removal of lower third molars in high risk cases with very low prevalence of complications
Faculty Opinion Regarding Job Satisfaction and Motivation in Medical & Dental Colleges of Islamabad. A Cross-sectional Survey.
Full text linkObjectives: To identify the factors affecting job satisfaction and motivation among the faculty and its relationship between faculty engagement, job satisfaction, and motivation in medical and dental colleges in Islamabad. Methodology: A cross-sectional descriptive study in which faculty of medical and dental colleges in Islamabad participated from June 2023 till September 2023. Data was collected through an online questionnaire from the faculty using a purposive sampling technique.
Results: A total of 314 faculty members participated in this survey. 50.3% were female and 49.7% were male with an age range from 25 years-75 years, having work experience from 2-15 years and more. The majority of respondents expressed satisfaction with their job duties (Mean ± SD = 3.05±1.12) and a sense of camaraderie within their workplace institution (Mean ± SD = 2.96±1.10), indicating positive attitudes in several areas. Furthermore, a sizable percentage obtains enjoyment from research activities (Mean ± SD = 3.35±1.15) and feels valued at work (Mean ± SD = 2.93±1.26). On the other hand, results of this study also reveal negative attitudes towards factors, such as high levels of stress (Mean ± SD = 2.15±1.16), burnout while at work (Mean ± SD = 2.49±1.26), and a sense of being ignored at work (Mean ± SD = 2.42±1.19). Moreover, the respondents frequently report having difficulty juggling their personal and work lives (Mean ± SD = 2.19±1.05).
Conclusion: The findings of this study imply that a supportive institutional culture, professional development opportunities, workload management, and the nature of the work itself all have a big impact on faculty satisfaction. On the other hand, factors that lead to unhappiness include inadequate pay, lack of recognition, and an unbalanced work-life schedule. Institutions must have a thorough understanding of these elements to design and implement programs that support faculty well-being and foster a happier workplace
ULTRASONOGRAPHIC MEASUREMENT OF UTERINE LOWER SEGMENT SCAR THICKNESS IN CASES OF PREVIOUS ONE CAESAREAN SECTION AND OBSTETRIC OUTCOME
No full textABSTRACT
Background: The danger of uterine rupture in future pregnancies is one of the concerns about the long-term effects of uterine scars from prior cesarean births. The thickness of the scar in the lower uterine segment may be measured ultrasonographically to offer important information about the scar's integrity and to assist forecast the likelihood of problems in subsequent pregnancies.
Objective: To determine the association of uterine lower segment scar thickness in cases of previous one caesarean section with obstetric outcome
Methods: This was a cohort study conducted at Department of Radiology, KRL hospital, Islambad, during time period six months from February to July, 2024. Total 123 women were included in the study who had undergone previous one cesarean section (elective/emergency) during their previous pregnancy and willing to go for vaginal birth after cesarean section. All women underwent detailed clinical examination and transabdominal ultrasound evaluation for scar thickness. The adopted cut of value for scar thickness was set at 3. In cases where the scar thickness exceeded 3 mm, a trial of labor was decided upon with the patient's permission; in cases where the scar thickness was less than 3 mm, an elective repeat lower segment cesarean section (LSCS) was decided upon. Outcome variables include type of delivery and neonatal weight.
Results: Among women 61.80% had Vaginal birth after caesarean section and 38.20% had repeat cesarean section. Significant difference was seen in uterine lower segment scar thickness between women who had VBAC and LSCS. Highest frequency of VBAC was seen among women with scar thickness between 3.1-4.0. Weight of neonate had significant association with delivery type. It was observed that neonates with weight >3.5 kg had higher frequency of LSCS. i.e. (p-value<0.001). The area under the curve value for ROC curve was 0.617. The ROC curve suggest that using a cut of value for uterine lower segment scar thickness as 3.15 mm among women with previous one cesarean section could predict VBAC with sensitivity 80.3% and specificity as 61.7%
Conclusion: In the current study, highest rate of successful vaginal birth after caesarean was found in women with scar thickness between 3.1 mm and 4.0 mm.
Key Words: Scar, Thickness, Previous, Caesarean section, lower uterine segment, Ultrasonograph