Annals of PIMS (Pakistan Institute of Medical Sciences)
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Noninvasive Ventilation plus Standard Medical Therapy versus Medical Therapy Alone in Acute Hypercapnic Respiratory Failure due to Post-tuberculous COPD
Full text linkObjective: To compare the efficacy of noninvasive ventilation (NIV) plus standard medical therapy versus standard medical therapy alone in acute hypercapnic respiratory failure due to post-tuberculous chronic obstructive lung disease (COPD).
Material & Methods: This quasi-experimental study was done at the Department of Pulmonology, Fauji Foundation Hospital, Rawalpindi between August 2019 to January 2020 after ethical approval. After informed consent, 80 post-tuberculous COPD patients were enrolled by non-probability sampling. Patients were allocated into two groups with 40 participants in each group; Group A (intervention group) received NIV in addition to standard medical therapy, whereas patients in Group B were given standard medical therapy alone. Following history and examination, baseline arterial blood gases (ABGs) were done.
Results: Mean change in pH, paCO2, paO2 and respiratory rate in group A and group B at 6 hours were 7.38+0.06 vs 7.30+0.03, 44.63+8.24 vs 64.26+5.71, 73.55+14.94 vs 72.67+9.49 and 20.20+2.40 vs 25.32+3.18, respectively. Noninvasive ventilation plus standard medical therapy was more effective than medical therapy alone, with statistically significant results for pH, paCO2, and respiratory rate (p-value=0.001). The patient outcomes had no significant relation with age, gender and duration of post-tuberculous COPD (p-value ?0.10).
Conclusion: Noninvasive ventilation plus standard treatment yields superior results to standard treatment alone in acute hypercapnic respiratory failure due to post-TB COPD. We recommend combination therapy in such patients
Association of Vitamin D Levels and Postpartum Depression
No full textObjectives: To determine the association of vitamin D levels and postpartum depression.Study Design: Prospective cohort study.Study Duration: April 2020 to October 2020.Settings: Department of Obstetrics & Gynecology, PIMS Hospital, IslamabadMethodology: A total of 60 pregnant females were the part of the study where 30 pregnant females with Serum levels of 25(OH) D3 levels ? 20 ng/ml and 30 pregnant females with Serum levels of 25(OH) D3 levels > 20 ng/ml of age 20-35 years were selected. Patients with h/o depressive disorder, multiple pregnancy, CRF, and CLD were excluded. Group A (exposed group) included all pregnant females with Serum levels of 25(OH)D3 levels ? 20 ng/ml while Group B (unexposed group) included all pregnant females with Serum levels of 25(OH)D3 levels > 20 ng/ml. All cases were followed and outcome variable like post-partum depression was noted.Results: The mean age of women in group A was 30.20 ± 5.80 years and in the group, B was 30.13 ± 6.04 years. The mean gestational age in group A was 38.73 ± 1.23 weeks and in the group, B was 38.93 ± 1.05 weeks. The mean parity in group A was 2.13 ± 0.82 and in the group, B was 1.93 ± 1.01. In my study, there is a higher incidence of postpartum depression in women with vitamin D deficiency compared to those with normal vitamin D levels i.e. 73.33% vs 13.33% respectively with a p-value of 0.0004 and a relative risk of 5.50. Conclusion: Finally, this study concluded that there is a higher incidence of postpartum depression in women with vitamin D levels deficiency compared to those with normal vitamin D levels
Diagnostic Accuracy of Transcutaneous Bilirubinometry Versus Serum Bilirubin Level
Full text linkObjective: To assess the diagnostic accuracy of transcutaneous bilirubinometry over serum bilirubin level in newborns with hyperbilirubinemia.
Methodology: This cross-sectional study was conducted at Department of Neonatology, Children Hospital, PIMS Islamabad for six months from 01-09-20 to 28-02-21, included 150 jaundiced neonates of any gender over six months. Exclusion criteria included pre-treated hyperbilirubinemia, very premature or low birth weight infants, congenital abnormalities, or infants of jaundiced mothers. Post ethical clearance and parental consent, neonates were evaluated using the MBJ-20 transcutaneous bilirubinometer, with results compared to serum bilirubin levels. The study identified true and false diagnostic outcomes based on a ?12 mg/dL bilirubin threshold, signifying phototherapy initiation. Data analysis was performed with SPSS 26.0, calculating sensitivity, specificity, and accuracy, and determining diagnostic congruence through Pearson’s correlation and ROC AUC, with a significance threshold at p<0.05.
Results: The mean serum bilirubin level and transcutaneous bilirubin levels were 14.28 ± 2.21 mg/dL and 14.52 ± 2.72 mg/dL respectively, with a mean difference of 0.24± 1.38 mg/dL (t(149) = 2.141, p = .034). This difference demonstrating a statistically significant overestimation compared to serum bilirubin levels. The correlation between transcutaneous and serum bilirubin levels was strong (r = 0.864, p < 0.0001). For the 12 mg/dL phototherapy threshold, the transcutaneous method showed high sensitivity (95.59%) and specificity (78.57%), with an overall test accuracy of 94%. The Area Under the Curve (AUC) for the receiver operating characteristic was 0.962, indicating high diagnostic precision.
Conclusion: Transcutaneous bilirubinometry is a low-cost, noninvasive, and accurate screening test for hyperbilirubinemia with a high sensitivity specificity and positive predictive value (PPV)
Impact of Changing Gloves during Cesarean Section on Postoperative Wound Infection
Full text linkObjective: To compare the frequency of postoperative wound infection with or without changing gloves in women undergoing cesarean section.
Methodology: This comparative study was conducted in the Department of Obstetrics and Gynecology, Sir Ganga Ram Hospital, Lahore, from August 2023 to February 2024. Women aged 18–40 years, with parity <5 and gestational age >32 weeks, undergoing cesarean section were included and randomly divided into two groups. In Group A, the surgical team changed gloves during the procedure, while in Group B, the cesarean section was performed without changing gloves. During follow-up, the cesarean wound was evaluated for healing. Data were analyzed using SPSS version 25.0.
Results: The mean age of the participants was 28.07 ± 6.67 years, and the mean BMI was 24.97 ± 3.88 kg/m². Overall, postoperative wound infection occurred in 13 (16.25%) patients—3 (7.5%) in the glove-changing group and 10 (25%) in the no-glove-change group—showing a statistically significant difference (p = 0.034).
Conclusion: Changing gloves during cesarean section significantly reduces the incidence of postoperative wound infection compared to not changing gloves
Routine Histopathology of Gallbladder After Elective Surgery for Gallstones is Waste of Resources or Justified
Full text linkObjective: To determine the need for routine histopathological analysis of gallbladder specimens post-cholecystectomy in Pakistan, focusing on detecting unexpected pathologies.
Methodology: This descriptive cross-sectional study was conducted at Islamabad Medical Complex, NESCOM, 1st august 2022 to 31st October 2023, involving 534 patients who were diagnosed with gallstones-induced acute or chronic cholecystitis, while excluding those with clinical or radiological indications of gallbladder carcinoma. All surgical specimens were carefully submitted for histopathological analysis, and the collected data were systematically evaluated using SPSS 26 version.
Results: Overall 534 mean age of patients was 49.03 +15.02 years. The chronic cholecystitis was the most frequent histopathological finding (85.0%), followed by acute on chronic cholecystitis (13.5%), while rare lesions included gallbladder polyps (0.7%) and mucinous adenocarcinoma (0.7%). Additionally, the distribution of histopathological outcomes across different age groups (p = 0.527) and between genders (p = 0.988) showed no statistically significant differences.
Conclusion: Study revealed that most gallbladder specimens following elective cholecystectomy for gallstones showed benign pathology, predominantly chronic cholecystitis, with only rare lesions such as gallbladder polyps or mucinous adenocarcinoma, and although incidental malignancy was uncommon, which indicating that the routine histopathological examination remains essential and justified to ensure early detection of unexpected neoplastic changes that could be missed on gross examination
Pulmonary Hypertension Demographics, Frequency and Associated Factors among Chronic Obstructive Pulmonary Disease Patients in Tertiary Care Hospitals
Full text linkObjective: To determine the demographics, frequency and associated factors of pulmonary hypertension among chronic obstructive pulmonary disease (COPD) patients in tertiary care hospitals.
Methodology: This cross-sectional study was done at the Federal Government Polyclinic Hospital and Pakistan Atomic Energy Commission Hospital, from October 2022 to September 2023, included 217 patients with COPD using convenient sampling technique. This study All the patients underwent a comprehensive evaluation to assess the presence, severity, and underlying cause of pulmonary hypertension (PH) after informed consent. Data was collected through a semi-structured proforma with sections of socio-demographic parameters of the participants, environmental risk factors such as smoking, exposure to biomass smoke and clinical comorbidities such as congestive heart failure (CHF).
Results: Out of 217 COPD patients, 116 (53.5%) had pulmonary hypertension. Pulmonary hypertension was more prevalent in males (61.2%) compared to females (42%) (p-value = 0.005). Age group analysis showed a higher prevalence in individuals aged 56-80 years (71.5%) than < 56 years (29.8%) with a p-value of <0.001. A history of smoking (p-value < 0.04) exposure to biomass smoke (p-value <0.00001) and CHF (p-value = 0.010) were significantly related with higher frequency of pulmonary hypertension.
Conclusion: Our study showed that the frequency of pulmonary hypertension is high in COPD patients. Male gender, old age, smoking, exposure to biomass smoke and congestive heart failure are identified as factors increasing the risk of developing pulmonary hypertension
Modified Hematological Sepsis Score in the Early Diagnosis of Neonatal Sepsis
Full text linkObjective: To compare the diagnostic accuracy of modified hematological sepsis score (MHSS) with hematological sepsis score (HSS) in early diagnosis of neonatal sepsis taking blood culture as gold standard.
Methodology: This cross-sectional validation study was done at the Neonatology Department, Children Hospital of Pakistan Institute of Medical Sciences, Islamabad from 1-01-2020 to 30-06-2020 after ethical approval. A total of 80 neonates admitted to the neonatal unit with clinical manifestations suggestive of sepsis or maternal risk factors were enrolled using nonprobability convenient sampling. Babies were assessed in consultation with the senior neonatologist. After informed written consent, their blood samples were sent to the laboratory for blood complete picture, peripheral film and blood culture. Both MHSS and HSS were calculated. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) of MHSS were compared with that of HSS taking blood culture as the gold standard.
Results: Modified hematological sepsis score has a sensitivity and specificity of 84.21% and 75.41% respectively whereas its PPV and NPV are 51.6% and 93.8%. Compared to this, the hematological sepsis score has sensitivity, specificity, PPV and NPV of 78.9% and 67.21%, 42.6% and 91.11%, respectively.
Conclusion: Modified hematological sepsis score has increased sensitivity and specificity in early diagnosis of neonatal sepsis. The diagnostic strength of the modified hematological sepsis score is superior to that of the hematological sepsis score
In-Vitro Analysis of the Anti-Diabetic Potential of Acetone and n-Hexane Extracts of Delonix regia (Gul Mohar) Leaves
Full text linkObjective: To assess the anti-diabetic activity of leaves extract of D. regia in acetone and n-hexane through in vitro analysis.
Methodology: The preclinical study was conducted in the Department of Pharmacology and Therapeutics at Baqai Medical College/University of Karachi,
in November 2022. Freshly harvested D. regia leaves were collected identified, and authenticated by the herbarium of the botany department at Karachi University. The extract was concentrated in rotary vacuum evaporator and kept in a desiccator to maintain their integrity and suitability for further applications. In vitro, anti-hyperglycemic studies were conducted using ?-amylase and ?-glucosidase inhibition assays.
Results: D. regia leaves extract revealed distinct inhibitory activity of ?-amylase and ?-glucosidase. Acetone extract (25 mg/ml) showed 7.8% and 2.5% inhibition, respectively; while the n-hexane extract (25 mg/ml) demonstrated lower activities, 1.4% and 2.0%, respectively.
Conclusion: The present study concludes that polar solvent (acetone) extract of D. regia exhibits more inhibitory potential for ?-amylase and ?-glucosidase as compares to non-polar solvent emphasizing solvent polarity's role in extracting active compounds
Frequency of Iron Deficiency Anemia in 6–60 Months Old Children Presenting with Febrile Seizure
Full text linkObjective: To determine the proportion of iron deficiency anemia (IDA) among children aged 6–60 months presenting with febrile seizures.
Methodology: This cross-sectional study was conducted in the Department of Pediatrics, Ayub Teaching Hospital, Abbottabad, Pakistan, from Jan to December, 2024. Children with febrile seizures were evaluated for IDA using hemoglobin (Hb), mean corpuscular volume (MCV), and serum ferritin levels. Data were collected after obtaining informed written consent from parents/guardians.
Results: Among 116 children with febrile seizures, 60 (51.7%) were aged 6–30 months and 56 (48.3%) were 31–60 months, with a mean age of 28 ± 17.01 months. The mean Hb level was 8 ± 1.46 g/dL, mean MCV was 65 ± 11.13 fL, and mean serum ferritin was 21 ± 2.87 ng/mL. Of the total participants, 68 (58.6%) were males and 48 (41.4%) were females. Iron deficiency was observed in 77 children (66.4%).
Conclusion: This study demonstrates a strong association between iron deficiency anemia and febrile seizures in children. Early detection and management through iron supplementation and dietary modifications may help reduce the incidence of febrile seizures, as IDA is a modifiable risk factor
Comparison of Stent Patency, Biochemical and Clinical Improvement in Plastic Versus Metallic Biliary Stent for Palliation in Malignant Biliary Obstruction in a Developing Country Tertiary Hospital
Full text linkObjective: To compare stent patency, biochemical, and clinical outcomes between partially covered self-expandable metal stents (SEMS) and plastic stents (PS) in patients with malignant biliary obstruction.
Methodology: A prospective observational study was conducted at Faisalabad Teaching Hospital from January to June 2024. Sixty patients with malignant biliary obstruction confirmed by imaging and elevated bilirubin (?1.75 mg/dL) were included. Patients were allocated to PS or SEMS groups based on clinical judgment. ERCP was performed by experienced gastroenterologists. Outcomes assessed included stent patency, biochemical improvement, complications, and reintervention rates. Data were analyzed using SPSS v20 with t-test and Chi-square; p < 0.05 was considered significant.
Results: The PS group included 30 patients (60% male; mean age 57.9 ± 7.9 years), and the SEMS group included 30 patients (66.7% male; mean age 55.7 ± 6.9 years). Pancreatic cancer was the most frequent diagnosis, followed by gallbladder cancer and cholangiocarcinoma. Post-procedural cholangitis was significantly higher in the PS group (80.0%) compared to SEMS (43.3%; p = 0.003). Stent dysfunction occurred in 63.3% of PS versus 33.3% of SEMS (p = 0.021). Mean stent patency was significantly longer with SEMS (190.5 ± 98.7 days) than PS (128.7 ± 54.3 days; p = 0.004). Biochemical improvement and symptom relief were superior in the SEMS group, with fewer reinterventions and shorter hospital stays.
Conclusion: SEMS demonstrated better patency, lower complication rates, and improved clinical outcomes compared to PS, supporting their use as a more effective palliative option in malignant biliary obstruction, especially for patients with longer life expectancy