Annals of PIMS (Pakistan Institute of Medical Sciences)
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Prevalence of Short-Term Mortality and Assessment of Risk Factors of Unstable Angina and Non-ST-Elevation MI in Patients Admitted at CCU of PMCH Nawabshah
Full text linkObjective: To determine the short term mortality and risk factors in patients withunstable Angina and non-ST elevation Myocardial Infarction at Cardiologydepartment PUMHS Nawabshah (SBA).Method: A cross sectional study was conducted at cardiology department PUMHSNawabshah from June 2023 to Dec 2023. Acute coronary syndrome patients withunstable angina and non ST elevation myocardial infarction, either age and genderwere included. Detailed clinical history along with thorough clinical examination wasdone. Socio demographic details, mortality and risk factors were noted by researcherthrough predesigned Performa. Findings of ECG, laboratory investigations like thepresence of troponin, serum cardiac biomarkers were collected .Data was entered andanalyzed by SPSS version 25, association was confirmed with chi square test at 95%confidence interval.Results: - The study results shows that 3.3% patients having the age group 15-25years,13.3% patients between 26-40 years,36.6% patients between 41-55,46.6%patients came at the age of 56-80 years. Males were 70% and females were 30%. Thecurrent study reveals the risk factors associated with UA/NSTEMI were ashypertension in 46% patients, 41% were smokers, and DM was noted in 46.3%.Hyperlipidemia 49%, positive family history 24.7%, past history of coronary arterydisease in 20%, and renal insufficiency was found in 1% of patients. The complicationrate was 41.5%, 29.6% patients developed left ventricular failure and Arrhythmia in3.3% patients. Renal dysfunction was seen in 1% and 7.6% patients were expired.Conclusion: Left ventricular failure was found highly prevalent and the mortalityrate was observed 7.6%. DM, old Age, hypertension, smoking and dyslipidemiawere recorded as the most common risk factors.Keywords: - Silent ischemia, Un-Stable Angina, Smoking, Hypertension, Dyslipidemia
Biochemical effects of Lycopene on Lipid Parameters in high Sucrose Diet Fed Male Wister Albino Rats
Full text linkObjective: To determine the biochemical effects of lycopene on lipid parameters in high sucrose diet fed male Wister albino rats
Methodology: This six-month experimental study was conducted at the Department of Biochemistry, Liaquat University of Medical and Health Sciences from 1-10-2022 to 30-3-2023. The rats (150–200 g) were divided into four groups (n=15 each): Group A (negative control) received a saline placebo; Group B (positive control) received a sucrose-rich diet (SRD) only; Group C received SRD plus lycopene (40 mg/kg); and Group D received SRD plus lycopene (60 mg/kg). Lycopene was dissolved in corn oil and given daily for 28 days via intragastric intubation. Blood samples were collected after a 12-hour fast and analyzed for lipid levels (cholesterol, triglycerides, LDL, and HDL). Data were analyzed using SPSS 23.0.
Results: Rats on a high-sucrose diet had significantly higher cholesterol (168.4 mg/dl), LDL (68 mg/dl), and triglycerides (100.8 mg/dl) compared to controls (132.7 mg/dl, 48.6 mg/dl, and 70.3 mg/dl, respectively; P < 0.001). Lycopene supplementation lowered cholesterol (157.8 mg/dl in Group C, 149.3 mg/dl in Group D) and LDL (50.8 mg/dl in Group C, 50.4 mg/dl in Group D). HDL, which decreased with sucrose intake (25.9 mg/dl), improved with lycopene (36.1 mg/dl in Group C, 43.1 mg/dl in Group D). Triglyceride levels also reduced with lycopene (92.5 mg/dl in Group C, 79.6 mg/dl in Group D). These results suggest lycopene effectively improves lipid profiles, particularly at higher doses.
Conclusion: Lycopene demonstrated significant lipid-lowering potential, effectively reducing serum cholesterol, triglycerides, and LDL levels while increasing HDL levels. These beneficial effects suggest that lycopene could be a valuable natural option for managing hyperlipidemia, particularly in urban populations in Pakistan
Factors Causing Shunt Malfunction in Pediatric Age Group
Full text linkObjective: To find out factors causing shunt malfunction among pediatric patients.
Methodology: A Cross-sectional observational study, was conducted at Department of Neurosurgery at Pakistan Institute of Medical Sciences, Islamabad. Patients aged between 1st day of life to 12 years, both gender and raised Intra cranial pressure (ICP) requiring VP shunt placement were included. The patients were followed in the post-operative period till discharge. Shunt malfunction was defined as any condition which compromises the shunt function and requires revision surgery or intervention to correct the shunt function. Data was collected according to self-structured questionnaire and analysis was done on SPSS version 26.
Results: Mean age of the patients was 24.29+36.12 months. Males were 84(60.0%) and females were 56(40.0%). Frequency of shunt malfunction was seen in 26(18.60%) of the cases and the most common causative factor was valve malfunction (19.2%), followed by displacement and central nervous system (CNS) infections (each 15.4%). Other causes included proximal catheter obstruction (11.5%), skin infections, and distal catheter obstructions (each 7.7%). Malfunctions occurred most frequently within two weeks post-operation (53.8%). Furthermore, the frequencies of factors responsible, for shunt malfunction were statistically insignificant according to age and gender (p->0.05).
Conclusion: The study revealed that 18.60% of pediatric cases experienced shunt malfunction, primarily due to valve malfunction, displacement, central nervous system infections, and catheter obstructions, with most malfunctions occurring within two weeks post-operation
Doppler Evaluation of Middle Cerebral Artery and Umbilical Artery Pulsatility Index in the Diagnosis of IUGR Taking Clinical IUGR at Birth as Gold Standard
Full text linkdoppler indices as the fetal Middle cerebral artery and the umbilical artery pulsatility index for their diagnostic accuracy and preserve clinically significant IUGR at birth as the gold standard.
Methodology: This descriptive, cross-sectional study was performed at AFIRI, PEMH Rawalpindi from March 30, 2020, to September 29, 2020, AFIRI. There were 123 patients diagnosed with IUGR ranging in age at gestation: 31–40 weeks and ages 31 to 40 years old. Enrollment of all patients in the study was based on inclusion criteria. A 3.5–5 MHz convex array transducer was used to measure doppler indices once fetal biometry was completed. During each examination, each series of measurements was made three times, and the outcomes were averaged.
Results: Following a doppler ultrasonography on all patients, it was discovered that 60 (48.7%) were true positives and 9 (7.3%) were false positives. Of the 54 individuals who tested negative for Doppler, 7 (5.6%) were false negatives, meaning that a clinical examination revealed fetal IUGR after birth, and 47 (38.2%) were true negatives (p=0.0001). In order to diagnose IUGR pregnancies, the Doppler indices overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.55%, 83.93%, 86.96%, 87.04%, and 86.99%, respectively, for the fetal MCA and umbilical artery pulse index
Comparison of Earlier vs Early Start of Norepinephrine in Patients with Septic Shock
Full text linkObjective: To compare the effects of earlier Nor-epinephrine administration i.e. within 40 minutes of initial fluid administration with early Nor-epinephrine administration i.e. 80 minutes of fluid administration in terms of time required to achieve mean arterial pressure of greater 65 mm of Hg and volume of resuscitation fluid administered.
Methodology: This single blind randomized control trial was carried out at Department of Anesthesia and Critical Care Medicine from 1st January 2023-31st December 2023. Patients fulfilling the inclusion criteria i.e. age >18 years having septic shock with Mean arterial pressure of less than 65 mm of Hg requiring fluid resuscitation with vasopressor therapy were enrolled in the study and divided into two groups using computer generated random numbers. Group E patients received Nor-epinephrine infusion at 80 minutes while those belonging to group EL received Nor-epinephrine infusion at 40 minutes after initial fluid administration.
Results: Patients who received EL achieved MAP greater than equal to 65mm Hg earlier with median time of 60 minutes as compared to 80 minutes in group E with p value of 0.000. The median volume administered was significantly lower in group EL that was 2000 ml as compared to 2600 ml in group E with p value of 0.000.
Conclusion: Earlier administration of Nor-epinephrine results in restoration of MAP of 65 mm Hg and requires less amount of crystalloid fluid during volume resuscitation which can improve outcomes for patients with septic shoc
Perceived Relevance of Case Based Learning among 1st and 2nd Year MBBS Students of Basic Medical Sciences
Full text linkBackground: Case Based Learning (CBL), an educational paradigm wherein knowledge of basic sciences is integrated with clinical sciences.
Objectives: To determine which demographical factors tend to influence the relevance of Anatomy, Physiology and Biochemistry among 1st and 2nd year undergraduate MBBS students.
Methodology: This cross-sectional analytical study was carried out on 1st and 2nd year undergraduate medical students at Al-Tibri Medical College for period of six months. Self-design questionnaire was distributed to students after pilot testing. Questionnaire was distributed to students via Google Forms. Students willing to participate were included voluntarily without any repercussions. SPSS version 22.0 was used for data analysis. Chi-square test was applied to test computed scores of perceived relevance of CBL with demographics. P<0.05 was considered statistically significant.
Results: Mean age of students in 1st and 2nd year was 19.76 ± 2.41 and 20.61 ± 2.79 years. In total there were 83 males and 97 females included in the study. 139 students had studied high school from Intermediate Board while 41 had done A levels or Aga Khan Board. The highest rating on Likert scale was observed in question whether CBL should be integrated into the curriculum more extensively (4.02 ± 0.78) and followed up by diversity of cases in CBL helps me understand various clinical conditions better (3.96 ± 0.86).
Conclusion: Highest qualification in terms of Intermediate and A levels significantly affected student’s responses to the relevance of CBL. However age and gender did have a significant impact in some aspects of CBL.
Keywords: Basic Medical Sciences, Case Based Learning, Integrated Curriculum, Modern Teaching Method
Utility and Challenges of Various Types of Central Venous Catheters in Pediatric Bone Marrow Transplant Patients- A Single Center Study
No full textObjective: This study aims to assess the utility and challenges of various available venous access options in pediatric transplant patients of our center.
Methodology: This retrospective study was carried out at bone marrow transplant center of Dr Akbar Niazi teaching hospital Islamabad. Data of bone marrow transplant patients with tunneled & non-tunneled CVCs during early transplant phase were collected from March 2018 to December 2023. The data were entered on SPSS version 2023 for analysis. The association between two categorical variables was assessed using Pearson’s chi square and Fisher‘s exact test. P-value of <0.05 was considered significant.
Results: Out of 48 patients, 30 (62.5%) had tunneled-cuffed Hickman or Broviac central line whereas 18 (37.5%) had non-tunneled central line in the early transplant period. The indwelling period of tunneled CVC and non-tunneled CVP was 38.8±7.1 and 23±7.7 days with p-value of 0.001 respectively. Ooze from insertion site and infection was significantly more frequent in non-tunneled central line with p-value of 0.04 and 0.001 respectively. In case of infection in patients with tunneled central line, escalation to 2nd and 3rd line antibiotics was more frequent (p value 0.014). Tunneled central lines in 46.7% of the patients were removed at the time of discharge and did not require platelet transfusion cover due to stable platelet count of more than 20,000/µl. In cases of removal of tunneled central lines due to febrile neutropenia extensive coverage of single donor platelets (SDP) and/or random donor platelets (RDP), due to special precautions. The removal of non-tunneled central line was a bedside, ward procedure with or without random donor platelet coverage, depending upon clinical requirement.
Conclusion: For venous access in early transplant period both tunneled-cuffed and non-tunneled central lines can be used but special precaution of central line induced infection should be followed meticulously
Short-Term Mortality and Survival among Patients with Acute-On- Chronic Liver Failure: A Prospective Cohort Study
No full textObjective: To evaluate the frequency of short-term mortality (30 days) and survival among patients with acute-on-chronic liver failure (ACLF). Methods: A descriptive cross-sectional was carried out at gastroenterology department of the Asian Institute of Medical Sciences Sindh, Pakistan Patients with acute-on-chronic liver failure (ACLF) aged more than 30 years of either gender were included. The patients were monitored for one month to assess the mortality or survival.Results: Overall average age of 40.9 years. 73.5% were male and 26.5% were female.Organ failure stratification indicated that 51.3% had fewer than three organ failures, while 48.7% had three or more. In terms of 30-day mortality, 61.5% of participants expired, while 38.5% survived. Analyzing mortality by age, gender and etiology was not statistically significant (p = &gt;0.05). Although organ category analysis indicated that mortality was significantly higher in category 2 (p = 0.043).Conclusion: Among patients with ACLF, the short-term mortality was observed to highly frequent and significantly associated to patients with multiple organ failures. The findings underscore the importance of organ failure stratification as a key predictor of outcomes in ACLF, suggesting that early identification and management of organ dysfunction may be critical in improving survival rates.Key words: ACLF, mortality, etiology, predictors
Morgagni Hernia in an Infant; A Case Report
Full text linkCongenital diaphragmatic hernia is a rare anomaly found amongst neonates. Morgagni hernia was first identified in 1761 by Giovanni Battista Morgagni, father of modern anatomical pathology. CDH is commonly asymptomatic but may present with cardiac, respiratory or nonspecific gastrointestinal symptoms. Morgagni hernia is the rarest form of congenital diaphragmatic hernia (CDH). Diaphragmatic hernias include the Bochdalek, hiatal, and paraesophageal hernias. CDH can present as Bochdalek type which commonly occurs on the left side and Morgagni type , though much rarer , on the right side. Type and size of the hernia plays a huge role in determining the manifestation of complications. Herniation of abdominal contents into thoracic cavity is a subsequent manifestation. Failure to thrive and recurrent respiratory tract infections are two most common clinical presentations. Here is the case of a nine-month-old girl initially presenting with GIT symptomology later turned out to have Morgagni type CHD on imaging
Effect of Hyperbaric Bupivacaine Injection Speed of 20 vs 40 Seconds Along with Preload Colloid on Hemodynamics in Caesarean Women
Full text linkObjective: To compare 20 seconds vs 40 seconds hyperbaric bupivacaine speed along with preload colloid in the prevention of hemodynamics like hypotension in caesarean women.
Methodology: This randomized controlled trial study was conducted in Anesthesia Department, Federal General Hospital, Islamabad from November to May 2023. Total 100 women undergoing cesarean section were systematically randomly equally allocated to hyperbaric bupivacaine injection in 20 seconds speed (n=50) or 40 seconds speed (n=50) along with preload colloid. Study outcome was hemodynamics (hypotension, heart rate and side effects) between two groups. The study outcome was measured in terms of patient hemodynamics considered as incidence of hypotension. The incidence of hypotension and nausea were compared using chi-square test. A probability level of 0.05 was considered statistically significant. . Data was analyzed in SPSS version 25.0.
Results: Patients demographics and gestational history was found comparable in the two groups. The average systolic and diastolic BP varied from 4 to 15 minutes after anesthesia induction. The incidence of hypotension was significantly high in the 40 seconds preload colloid group 27 (54.0%) compared to 12 (24.0%) in the 20 seconds group (p-value, <0.001). Rate of nausea was found similar in two study groups.
Conclusion: Incidence of hypotension was significantly high in 40 seconds group compared to 20 seconds injection speed of bupivacaine in this study.