Annals of PIMS (Pakistan Institute of Medical Sciences)
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Preoperative Hyponatremia Indicates Complicated Acute Appendicitis
Full text linkObjective: This study looks at the connection between preoperative hyponatremia and the intensity of severe appendicitis in Punjab.
Methodology: This retrospective observational study was conducted at dept. of general surgery BBH hospital Rawalpindi from August 2022 to December 2023. Data was retrieved from hospital medical records of all non-pediatric recipients who underwent surgery for severe appendicitis with age more than 14 years. A blood sodium concentration of less than 135 mEq/L was defined as hyponatremia. Based on surgical results and/or histology reports, cases were divided into two categories: complex and non-complicated appendicitis.
Results: This research discovered and enrolled 68 participants in total. Elderly and female patients were reported to have complex appendicitis with greater frequency. Significantly higher rates of hyponatremia were seen in patients with severe appendicitis (p < 0.001) and individuals with perforations compared to those without (p 0.048).
Conclusion: The current investigation established a link between complex appendicitis and pre-operative hyponatremia. An inexpensive, standard laboratory test called serum sodium content may serve as an auxiliary marker to help surgeons diagnose gangrenous or perforated severe appendicitis earlier
Unraveling the Relationship between Hypothyroidism and Type II Diabetes Mellitus
Full text linkObjective: To determine the frequency and association between hypothyroidism and Type II Diabetes Mellitus (DM) among patients at a tertiary care hospital.
Methodology: This cross-sectional study was conducted at the Federal Government Polyclinic Hospital, Islamabad from August 2023 to February 2024, enrolled 200 Type II DM patients through non-probability consecutive sampling. Samples for HbA1c and thyroid function tests were collected and analyzed. Data on demographics, clinical history, and laboratory results were statistically evaluated using SPSS 26.0, with significance determined at p<0.05.
Results: In a study of 200 Type II DM patients, key findings include a slight male predominance (54%) and a middle-aged demographic with a mean age of 55.91 ± 9.55 years. The prevalence of hypothyroidism was 17.5%, with subclinical hypothyroidism at 14.5%. Hypothyroidism was significantly more prevalent among females (65.7%) and in the age group 56-65 years, indicating a notable association between age, gender, and thyroid dysfunction (p < 0.001). Obesity (p=0.018) diabetes duration > 10 years (<0.001) was associated with increased risk of hypothyroidism. There was positive correlation between HbA1c and TSH levels (r = 0.176), a weak negative correlation with fT3 levels (r = -0.193) and fT4 levels (r = -0.135).
Conclusion: This study found a significant association between Type II DM and thyroid dysfunction, with hypothyroidism more prevalent in older, obese females and linked to longer diabetes duration, suggesting a need for routine thyroid screening in diabetic patients to manage potential complications effectively
Bone Marrow Involvement In Hodgkin’s lymphoma: Case Report
Full text linkHodgkin’s lymphoma is a malignant lymphoid neoplasm showing specific neoplastic cells and background of reactive non-neoplastic cells. Classical Hodgkin’s lymphoma involves germinal or post germinal center B-cells which are positive for CD15 and CD 30 immunophenotypically. Mixed cellularity classical Hodgkin’s lymphoma occurs in old age and is mostly seen in males. Extra nodal involvement is rare. Bone marrow involvement is considered as stage IV disease and it has poor prognosis. Here we present a unique case of CHL mixed cellularity with bone marrow infiltration showing three different patterns of infiltration
Evaluating the Influence of Nurse Navigators on Patient Satisfaction in High-Risk Pregnancies
Full text linkObjective: To assess the influence of nurse navigators on patient satisfaction and quality of care among women with high-risk pregnancies.
Methodology: This cross-sectional study was conducted at department of Obstetrics and Gynecology at Shalamar Medical and Dental College Lahore on 80 high-risk pregnant patients from February 2024 to August 2024. Patient’s data were collected using a structured, pre-tested questionnaire covering demographic and clinical information, exposure to nurse navigators, perceived quality of care, and patient satisfaction across multiple domains. Responses were measured on a 5-point Likert scale. Data were analyzed using descriptive statistics to assess overall satisfaction with nurse navigators.
Results: Overall patients mean age was 28.6 ± 5.91 years. Based on satisfaction domains there was a high rating, with 70% satisfied with test explanations, 80% with responsiveness to questions, 70% with communication, and over 75% reporting excellent teamwork, comfort, and respect. Additionally 55% felt well informed and involved in care decisions, while 95% valued navigators’ assistance in booking appointments and 85% acknowledged appropriate guidance about their condition as comparatively, before nurse navigators, only 20% rated care as excellent/very good, 20% as good, while 60% rated it fair or poor, demonstrating a clear improvement in quality of care and patient satisfaction. Overall satisfaction of patients with nurse navigators was found to be very high as among 85% rated their experience as excellent, while the remaining 15% rated it as good, reflecting a consistently positive perception of the nurse navigator services in the field of Obs & Gynae.
Conclusion: A significant role of nurse navigators observed in enhancing patient satisfaction among high risk pregnancies as patients reported high levels of satisfaction with the quality of communication, guidance, responsiveness, and coordination of care provided by nurse navigators, in the comparison to before the introduction of nurse navigators
Perinatal Outcomes in Women with History of Chronic Hypertension but Controlled Blood Pressure Before 20 Weeks Gestation
Full text linkObjective: To determine the perinatal outcome in women with prior history of chronic hypertension but controlled BP before 20 weeks of gestation.
Methodology: A descriptive cross-sectional study was conducted at the Department of Gynaecology, Sheikh Zayed Medical College, Rahim Yar Khan, from November 2019, to May 2020, on patients aged 20 to 40 years old with singleton pregnancy of 20 weeks or more with previous history of hypertension but currently on no treatment for last one month or more and with normal blood pressure irrespective of parity. After taking demographic and clinical information the patients were followed every month to look for small for gestational age (SGA), pre-eclampsia and pre-term birth. Data was entered and analysed using SPSS-version 26.0.
Results: Overall mean age was 28.1 ± 3.2 years. Out of all cases, 22% had fetuses small for gestational age, 21% developed pre-eclampsia, and 23% had urinary protein levels below 300 mg/24 hours, while 77% had raised levels. FSGA was most common at ages 26–30 (50%) and pre-eclampsia at 31–40 years (41.9%), both significantly associated with age and parity (p=0.031, p=0.0497), but not with previous cesarean (p>0.05). Preterm birth was more frequent in ages 26–40 and higher parity, while statistically insignificant (p>0.05).
Conclusion: Women with a history of chronic hypertension, even when blood pressure is controlled before 20 weeks of gestation, remain at increased risk for adverse perinatal outcomes
Enhanced Recovery After C-Section; Experience at KGH
Full text linkObjective: To evaluate the effectiveness of the enhanced recovery after cesarean (ERAS) protocol in enhancing postoperative recovery after cesarean delivery versus conventional care at a tertiary care setting.
Methodology: A prospective observational study was conducted at gynae and OBS department of Kharadar General Hospital (KGH) Karachi from April 2024 to Sept 2024. Patients aged 18 years to 40 years old presented with singleton pregnancy and selected for elective cesarean section were included. Both groups underwent the same surgical technique. ERAS group followed a structured protocol with goal-directed IV fluids, early oral intake, mobilization starting within 8 hours, early catheter removal, dressing change at 24 hours, multimodal pain relief, and a shorter course of IV antibiotics followed by oral antibiotics, while control group received standard care with fixed-rate IV fluids, delayed oral intake and mobilization, delayed catheter removal, dressing change on day 3, and a longer duration of IV analgesia and antibiotics. Data were recorded and analyzed using SPSS version 26.
Results: Mean age of participants in the ERAS group was 25.3 years and in control group was 29.7 years. The mean IV fluid duration was markedly shorter in the ERAS group (10.18?±?1.64 hours) vs. control (24.00?±?0.00 hours), (p-0.001). Oral intake began earlier in ERAS group (5.22?±?1.61 vs. 11.87?±?1.62 hours), and mobilization was initiated sooner (7.64?±?1.50 vs. 35.47?±?10.22 hours), both with p-0.001. Removal of catheter and dressing changes also occurred earlier in the ERAS group (p-0.001). IV antibiotics duration was also reduced in ERAS group (25.07?±?3.45 vs. 46.67?±?3.81 hours), while oral antibiotic use was similar (5 days). Additionally the pain scores at 24 hours was found decreased in ERAS group (3.40?±?1.18 vs. 5.91?±?1.52) and hospital stay (1.73?±?0.62 vs. 5.02?±?0.87 days) p- 0.001 respectively.
Conclusion: Implementation of ERAS protocol observed significantly improved postoperative outcomes compared to conventional care, in terms of earlier oral intake and ambulation, reduced durations of IV fluids, catheterization, and antibiotics, better pain control, and shorter hospital stays, enhanced patient comfort, and more efficient use of hospital resources
Role of Probiotics as Adjunct Therapy Along with Standard Care in Decreasing Hospital Stay and Improving Symptoms in Pediatric Patients Admitted with Severe Pneumonia
Full text linkObjective: To determine if probiotics have any role as adjunct therapy along with standard care in decreasing hospital stay and duration of symptoms in patients admitted with severe pneumonia.
Methodology: A randomized controlled trial was conducted at the Children’s Hospital, Pakistan Institute of Medical Sciences (PIMS), from March 2022 to September 2022. A total of 60 patients aged 2 to 24 months, admitted with severe pneumonia, were enrolled over a period of six months using non-probability consecutive sampling. The participants were randomly assigned into two groups using the lottery method: Group 1 (probiotic group) and Group 2 (placebo group). Group 1 received probiotics mixed in milk daily for three consecutive days, while Group 2 received plain milk as a placebo. The primary outcomes measured were the duration of hospital stay, time to resolution of cough, and time to resolution of fever.
Results: Both probiotics and placebo group participants had similar baseline characteristics. Duration of hospital stay, cough and fever all decreased in probiotic group. The average length of hospital stay did not decrease significantly in the probiotic group vs placebo group (6.5 ± 2.74-day vs 7.18 ± 2.23 days, p value=0.314). The average fever duration for probiotic group was 5.93 ± 2.71 days and for placebo group was 7.82 ± 5.15 days with p-value of 0.091 suggesting no statistically significant difference in both groups. The average cough duration was significantly less in probiotics group vs placebo group (9.46 ± 4.34 days vs 12.36 ± 5.63 days, p-value of 0.036).
Conclusion: Probiotics have potential to be beneficial in terms of reducing cough duration when added to standard care of pneumonia but further studies with larger sample size are required to elaborate on the hypothesi
Prevalence of Fatty Liver Disease in Patients Presenting to General Medicine Clinic with Abdominal Pain and Deranged Liver Function Tests at Tertiary Care Hospital Islamabad
Full text linkObjective: To determine the frequency of fatty liver disease in patients presenting with abdominal pain and deranged liver function tests at a tertiary care hospital in Islamabad.
Methodology: This cross-sectional study was conducted using a non-probability sampling technique in the Department of General Medicine, Rawal Institute of Health Sciences, Islamabad, over a period of eight months from March 2023 to October 2023. Adult male and female patients presenting with upper abdominal pain and deranged liver function tests (LFTs) were included. Baseline demographic and clinical data were collected and analyzed using SPSS version 26.0.
Results: A total of 512 patients were screened, out of which 199 (38.86%) were diagnosed with fatty liver disease. Patients with fatty liver were significantly older (mean age: 40.22 ± 6.84 years), had a higher body mass index (BMI: 26.81 ± 2.34 kg/m²), and elevated alanine aminotransferase (ALT: 63.18 ± 29.33 mg/dL). Comorbidities were also more prevalent: diabetes mellitus (n = 63, 31.65%), hypertension (n = 74, 37.18%), and current smoking (n = 41, 20.60%)—all statistically significant (p < 0.05).
Conclusion: The study demonstrates a significant association between fatty liver disease and patients presenting with abdominal pain and deranged LFTs. Advanced age, elevated ALT levels, hypertension, diabetes mellitus, and smoking were found to be important risk factors
Frequency of Spinal Tuberculosis in Diabetics With Highly Suspected Clinical Features of Tuberculous Spine
Full text linkObjective: Spinal tuberculosis is a health condition that cause neurological issue & impacts quality of life. This becomes more challenging when occurred in the diabetic patients. Frequency of spinal tuberculosis among the diabetic cases presenting with the highly suspected clinical features of the tuberculosis spine.Methodology: This was cross sectional study conducted on 300 patients in department of interventional radiology of Ittefaq Trust Hospital situated in Lahore, Pakistan. The inclusion criteria was either gender with age of 30-70 years &amp; strong clinical suspicion of spinal TB. Patients’ blood sugar level of fasting greater then 126mg/dl. Patients were subjected to the MRI for identification of clinical features of the strongly suspected cases. Data entry and analysis was done by using SPSS 25inc. descriptive statistics was calculated along with the application of the chi square test to find out the impact of other variables on of the spinal TB. A p-value 0.05 as significant,Results: 300 patients when evaluated, it was noted that mean age of the patients was 53.47±9.93 years at the time of presentation. Majority of the patients with tuberculosis was male 178(59.7%). Mean duration of the disease was found to be 14.7±9.4 months. Radiological scan was done, and it was clarified that lumbar spine was involved in 240(80%) cases and 2 vertebrae was involved in 170(56.7%) cases. 159(53.4%) patients were having spinal tuberculosis along with diabetes mellitus.Conclusion: It is important to check the diabetic cases with back pain for spinal tuberculosis for early management accordingly
Efficacy and Safety of Dapagliflozin in Type 2 Diabetics With Stage 3A Chronic Kidney Disease
No full textObjective: To evaluate the efficacy and safety of Dapagliflozin that is a sodium-glucose co-transporter 2 (SGLT2) inhibitor in patients with chronic kidney disease stage 3A (CKD 3A) and inadequately managed Type 2 Diabetes Mellitus (T2DM).
Methodology: The randomized controlled trial study was conducted at PIMS Islamabad from January 2022 to December 2022, included 196 patients with T2DM and CKD 3A (eGFR 45-60 ml/min/m²) with inadequate glycemic control (HbA1c 7.0%-11.0%). Patients were assigned to Dapagliflozin 10 mg/day (Group A) and placebo plus standard care (Group B), randomly. After 24 weeks of treatment the HbA1c, eGFR and hypoglycemic events were measured at baseline. Change in HbA1c was used to measure efficacy and safety was evaluated by eGFR changes and hypoglycemic episodes.
Results: Group A showed a reduction in HbA1c levels after 24 weeks with a mean decrease from 8.2% (± 0.71) to 7.7% (± 0.68) (p = 0.002). Group B showed no significant change with a mean HbA1c decreasing from 7.58% (± 0.72) to 7.52% (± 0.38). The eGFR in Group A decreased from 52.14 ml/min/m² (± 4.8) to 51.27 ml/min/m² (± 5.8) and in Group B a decline from 50.8 ml/min/m² (± 6.7) to 47.6 ml/min/m² (± 6.0) (p < 0.000) was observed. In 5% of patients in Group A and 6% in Group B hypoglycemic episodes occurred and there was no significant difference found between the groups in terms of hypoglycemic episodes.
Conclusion: Dapagliflozin effectively reduced HbA1c with no significant impact on eGFR or hypoglycemic events. It can be considered a safe and efficacious treatment option for T2DM patients with CKD 3A