Annals of PIMS (Pakistan Institute of Medical Sciences)
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Association of Ametropia with Academic Performance and Development of Myopia Among School Children
Full text linkObjective: To evaluate the associations between ametropia, academic performance, and myopia development among schoolchildren.
Methodology: This multicenter observational cross-sectional cohort study was carried out in Ophthalmology Department at Akbar Niazi Teaching Hospital, Islamabad, as well as at Farooq Teaching Hospital and Holy Family Hospital in Rawalpindi, Pakistan, from January 2022 to June 2023. Initially, an analysis was conducted on students in grades 1 through 9 from Rawalpindi and Islamabad to assess the influence of refractive status on their academic performance on an annual basis. Additionally, a longitudinal analysis was conducted on the students to assess the trend in academic performance in relation to refractive changes over a 12-month period. The refractive status was assessed utilizing non-cycloplegic autorefractors.
Results: Total 1880 children, regardless of myopia status were analyzed (mean age: 11.2 years; 1051 males and 829 females). The analysis revealed that hyperopia prevalence was associated to low academic score in grade 1, the year students began primary school (? = ?0.1, p = 0.001). In contrast, myopia prevalence was associated with high academic score in grades 6 and 8, the years when students were preparing for board examinations for primary or secondary school (? = 0.3, p = 0.04; ? = 0.5, p = 0.001). The longitudinal analysis indicated that quicker myopia progression was associated with high score across all grades, after adjusting for factors including parental myopia, BMI, outdoor activities, screen, and reading times (at baseline all grades were as follow; grade 2: ? = 0.04, p < 0.001; grade 3: ? = 0.05, p = 0.001; grade 4: ? = 0.02, p < 0.001; grade 5: ? = 0.04, p < 0.001; grade 6: ? = 0.05, p < 0.001).
Conclusion: Refractive errors indicated an association with academic performance among school children. Children who were in high academic performance tended to exhibit more rapid myopia development
Hematological Variables (NLR, PLR, MLR, MPR, and RPR) as Predictive Markers for Glucose Levels in Patients of Type 2 Diabetes Mellitus
Full text linkObjective: This study explores the association between hematological ratios (NLR, PLR, MLR, MPR, and RPR) and HbA1c in T2DM patients.
Methodology: This cross-sectional study was conducted at HIT-hospital Taxila from December 2022 to December 2023. One hundred T2DM patients aged ? 35 years from HIT Hospital-Taxila were included. They were divided into two groups (Group-I: HbA1c ? 7%, Group- II: HbA1c > 7%). BSF, BSR and HbA1c were analyzed. Hematological parameters were used to calculate the ratios. Statistical analysis was performed using SPSS version 29.
Results: The group with higher HbA1c levels had significantly elevated levels of TC, MPV, PLR, NLR, and MLR. A strong positive correlation of HBA1C with NLR and PLR indicates that uncontrolled diabetes has a strong association with these markers. Stepwise linear regression analysis showed that Model III has better predictive power with a good adjusted R square and significant p-value.
Conclusion: Hematological parameters, especially NLR and PLR correlate well with glycemic control in T2DM and can serve as reliable predictive markers for uncontrolled diabetes. Regular monitoring of these variables may aid in affordable diagnosis and better management of T2DM
Effects of Vitamin D3 as Adjunct Therapy in Chronic Obstructive Pulmonary Disease: A Comparative Cross-Sectional Study
Full text linkObjective: To evaluate the effects of vitamin D3 supplementation on exacerbation rates, lung function, inflammation, and quality of life in COPD patients.
Methodology: A comparative cross-sectional was carried out at the Department of Pulmonology, Mayo Hospital, Lahore over a six-month duration. 92 diagnosed cases of COPD were randomly distributed into two groups. One group received monthly oral Vitamin D (cholecalciferol, 200,000 IU) with standard COPD management, while the other group received a placebo. Follow-up assessments were carried out at baseline, three months, and six months to measure the incidence of exacerbations, COPD Assessment Test (CAT) scores, levels of C-reactive protein (CRP), and pulmonary function (FEV1/FVC).
Results: The vitamin D-receiving group had experienced a significant reduction in exacerbation rates from 73.9% in the one month to 23.9% by the sixth month. Furthermore, the Vitamin D group showed a marked decrease in CRP levels (from 7.85 ± 5.44 to 4.04 ± 3.05), substantial improvements in CAT scores (from 27.52 ± 3.53 to 11.24 ± 3.45), and with rise in FEV1/FVC rising from 48.26 ± 3.85 to 63.69 ± 9.72. The placebo group experienced worsening inflammation and only minimal gains in scoring of CAT score and functioning of the lungs.
Conclusion: Vitamin D supplementation in COPD patients has been shown to markedly decrease exacerbations, and improve lung function tests highlighting the possible utility of Vitamin D in addition to the regular treatment of COPD
Frequency and Determinants of Early Breastfeeding Initiation in Neonates: A Cross-Sectional Study at a Tertiary Care Hospital in Pakistan
Full text linkObjective: This study aimed to determine the frequency of breastfeeding within the first hour of birth and identify barriers to its initiation at a tertiary care hospital in Pakistan.
Methodology: A descriptive study was conducted at Ayub Teaching Hospital, Abbottabad from April to Sept 2024, involving 249 postpartum women. Data were collected using a structured questionnaire and analyzed using SPSS version 23. The study assessed various socio-demographic and clinical factors influencing breastfeeding initiation.
Results: Only 13.25% of neonates were breastfed within the first hour of birth. Key barriers included maternal age (18-25 years), large family size (?6), illiteracy, premature or post-term delivery, cesarean section, neonatal intensive care unit (NICU) admission, and insufficient breast milk production. Mothers aged 26-35 years and those with smaller families were more likely to initiate breastfeeding early.
Conclusion: The low prevalence of early breastfeeding initiation highlights the need for targeted interventions, including the implementation of the Baby-Friendly Hospital Initiative (BFHI) and increased maternal education on breastfeeding techniques. Addressing these barriers could significantly improve neonatal health outcomes in Pakistan
The Antimicrobial Resistance Patterns of Salmonella Typhi Isolates Among Paediatric Patients: A Single-Center Study
No full textObjective: To determine the pattern of Salmonella Typhi isolates among paediatric patients diagnosed with Enteric fever at a tertiary care hospital in Islamabad, Pakistan.
Methodology: This cross-sectional study was conducted in paediatric department. Dr Akbar Niazi Teaching Hospital Islamabad from January 2023-December 2023. Analysis of blood culture and sensitivity data from paediatric patients (2-12 years) diagnosed with enteric fever at a tertiary care hospital in Islamabad, Pakistan, over one-year period. Blood samples were processed using Standard microbiological techniques to confirm Salmonella Typhi and determine antimicrobial susceptibility.
Results: A total of 61 Salmonella Typhi isolates from paediatric patients were analysed with high resistance rates to first-line antibiotics, including Ampicillin (83.1%), Chloramphenicol (75.6%), and Co-trimoxazole (56.1%). Alarmingly,32% of isolates exhibited multi-drug resistance (MDR) and 27% showed extensive-drug resistance (XDR). However, Carbapenems (Imipenem and Meropenem) exhibited high efficacy with sensitivity rates of 98.2% and 98.3%, respectively.
Conclusion: The increasing prevalence of antibiotic resistant Salmonella Typhi strains in paediatric patients necessitates immediate attention and action. Our study emphasizes the urgent need for rational antibiotic use, enhance disease surveillance and develop effective control and prevention strategies to combat the spread of antibiotic-resistant Enteric fever
Bedside Diaphragmatic Ultrasonography as a Predictor of Successful Weaning from Mechanical Ventilation
Full text linkObjective: To assess the predictive value of diaphragmatic ultrasound for successful weaning from mechanical ventilation.
Methodology: This cross-sectional validation study was conducted in the ICU at PIMS from November 2023 to April 2024, on mechanically ventilated patients aged 16–60 years with a pre-illness frailty score of <3 who met weaning criteria. After a successful 1-hour spontaneous breathing trial (SBT), the Rapid Shallow Breathing Index (RSBI) was recorded, and diaphragm ultrasound was performed by an independent anesthetist to measure diaphragmatic excursion (DE) and diaphragm thickening fraction (DTF). Ultrasound assessments were done using curvilinear and linear probes in a semi-recumbent position. Maintaining the spontaneous breathing for 48 hours post-extubation was defined as successful weaning, while failure was defined as needing re-intubation within 48 hours. Data were analyzed using SPSS version 26.
Results: Overall average age of patients was 37.82 years. There were 19 (28.8%) females and 47(71.2%) males. Mean days on mechanical ventilator was 5.48 days. The outcomes of weaning showed that 59 participants (89.4%) were successfully weaned, while 7 participants (10.6%) experienced failure in the weaning process. Further analysis of outcomes of weaning showed insignificant association with the gender and (P>0.05).
Conclusion: Diaphragmatic ultrasound provided a comprehensive assessment of diaphragmatic function and its role in predicting weaning outcomes. The high success rate suggests that diaphragmatic ultrasound could be a valuable tool in clinical practice for identifying patients who are likely to be successfully weaned from mechanical ventilation, thereby improving patient management and outcomes
Perceived Barriers to Physical Activity Among Pregnant Women
Full text linkObjective: To identify perceived barriers to physical activity among pregnant women attending the outpatient department (OPD) of the tertiary care center at PUMHS, Nawabshah.
Methodology: A cross-sectional study was conducted in the Department of Obstetrics and Gynecology, PUMHS,Nawabshah from June to December 2023. Pregnant women aged 18–40 years were included. Data on sociodemographic characteristics and physical activity patterns were collected through a structured questionnaire. Statistical analysis was performed using SPSS version 25, with frequencies and percentages calculated for categorical variables and means with standard deviations for continuous variables.
Results: Of 101 participants, 61.4% were aged 20–29 years and 62% had education up to matriculation. Most were multiparous (60%), housewives (56%), and residents of rural areas (67%). Over one-third (34.7%) were overweight, while 12.9% had obesity (BMI >30). Although 85% received advice regarding exercise from healthcare professionals, 82% reported reducing activity during pregnancy—mainly due to tiredness (39.6%) or fear of miscarriage (36.6%). Lack of time was cited by 20%. About 41% engaged in moderate physical activities, primarily walking less than 30 minutes daily. Psychological issues such as anxiety, depression, poor sleep, and gestational diabetes were more common among less active women.
Conclusion: Many pregnant women remain insufficiently active due to fatigue, fear, and time constraints. Health professionals should counsel women and families about the safety and benefits of regular physical activity to help prevent excessive weight gain, gestational diabetes, preeclampsia, and psychological distress during pregnancy
Comparison of Efficacy of Nebulized Magnesium Sulphate with Intravenous Magnesium Sulphate in Children with Acute Asthma
Full text linkBackground: Acute asthma is a frequent cause of pediatric emergency admissions, requiring prompt management to relieve airway obstruction and prevent respiratory failure. Magnesium sulphate, administered either intravenously or via nebulization, has been used as an adjunct to standard bronchodilator therapy due to its bronchodilatory and anti-inflammatory effects.
Objective: This study aimed to compare the efficacy and safety of nebulized magnesium sulphate with intravenous magnesium sulphate in children presenting with acute moderate-to-severe asthma.
Methodology: A total of 148 children aged 1–12 years with acute asthma were enrolled and randomly assigned into two equal groups. One group received intravenous (IV) magnesium sulphate and the other nebulized magnesium sulphate, in addition to standard asthma therapy. The Pulmonary Asthma Score (PAS) was recorded at baseline, and at 30, 60, 120, 240, and 360 minutes. The duration of Pediatric Intensive Care Unit (PICU) stay, total hospital stay, treatment efficacy, and adverse effects were compared between groups.
Results: Baseline demographic and clinical characteristics were comparable between groups (p > 0.05). Both treatments significantly improved PAS over time, with a faster initial reduction at 30 minutes in the nebulized group (9.53 ± 2.44 vs. 10.32 ± 2.13; p = 0.036). The mean PICU stay was shorter in the nebulized group (3.32 ± 4.23 vs. 5.94 ± 9.78 hours; p = 0.036), as was total hospital stay (28.76 ± 19.21 vs. 47.08 ± 42.71 hours; p = 0.001). Treatment efficacy was similar between groups (p = 0.069). Adverse effects occurred in 29.7% of IV-treated patients but in none of the nebulized group (p < 0.001).
Conclusion: Nebulized magnesium sulphate provides comparable therapeutic efficacy to intravenous administration while offering faster initial improvement, shorter recovery, and a superior safety profile. It represents a safe, effective, and practical alternative for managing acute asthma in children
Serum Zinc Deficiency among Patients having Viral Cirrhosis
Full text linkObjective: To determine the frequency of serum zinc deficiency in patients with viral cirrhosis.
Methodology: Present descriptive cross-sectional study was done at Department of Gastroenterology Isra University Hospital, from January 2020 to July 2020. Patients aged 18 to 60 years, both genders who were presented with viral cirrhosis (Hepatitis B and C) were enrolled. Around 3 to 5 mL of venous blood was collected aseptically from cirrhotic patients for the measurement of serum zinc levels. Blood collection was centrifuged at 3,000 rpm for 10 minutes. Plasma sample analysis for zinc determination was performed on an automated Perkin-Elmer Analyst 300 atomic absorption spectrophotometer in biochemistry department to assess the zinc deficiency. All the collected data were entered into the proforma attached at the end and used electronically for research purpose.
Results: Mean of age of the patients was 49.3±13.4 years. Out of 162 patients, 88 (54.3%) were male while 74 (45.7%) were female. Diabetes mellitus was documented in 61 (37.7%) patients. Serum zinc deficiency was found in 103 (63.6%) patients. Additionally, the zinc deficiency was statistically insignificant according to age and gender of the patients (p=>0.05), while it was significantly higher among diabetes and hypertensive patients (p=<0.05).
Conclusion: Serum zinc deficiency was observed highly prevalent among viral cirrhosis patients, affecting nearly two-thirds of the study population
Addition of Intrathecal Dexmedetomidine Prolongs Subarachnoid Block in Orthopaedic Geriatric Population Undergoing Unilateral TKR
Full text linkObjective: To evaluate and compare the efficacy of intrathecal dexmedetomidine as an adjuvant to local anesthetic versus local anesthetic alone in prolonging subarachnoid block among geriatric patients undergoing unilateral total knee replacement (TKR).
Methodology: This randomized controlled trial was conducted in the Department of Anesthesiology, Fauji Foundation Hospital, Rawalpindi, from April 1, 2023, to December 30, 2023. A total of 60 geriatric patients (aged ?60 years) with American Society of Anesthesiologists (ASA) physical status class II or III, scheduled for unilateral TKR, were enrolled and randomized into two equal groups. Primary outcomes included the time to first analgesic requirement and postoperative pain scores at rest and during movement at 24 hours. Secondary outcomes assessed were the duration of sensory and motor blockade.
Results: The mean age of participants was 68.03 ± 4.54 years (range: 60–76 years), with 60% males and 40% females. Group A demonstrated a significantly prolonged time to rescue analgesia compared to Group B (461.37 ± 21.52 vs. 330.91 ± 18.21 minutes; p = 0.000). Postoperative pain scores were significantly lower in Group A both at rest (3.29 ± 1.78 vs. 4.86 ± 1.52; p = 0.000) and during movement (5.10 ± 1.60 vs. 6.44 ± 1.42; p = 0.001). Furthermore, Group A showed a significantly longer duration of sensory block (379.52 ± 63.74 vs. 304.76 ± 17.67 minutes; p = 0.000) and motor block (390.03 ± 67.23 vs. 259.80 ± 17.62 minutes; p = 0.000) when compared to Group B.
Conclusions: The addition of intrathecal dexmedetomidine to local anesthetic prolongs the subarachnoid block and results in a prolonged duration of need for rescue analgesia and reduces the mean pain score at rest and movement in patients undergoing unilateral TKR