Annals of PIMS (Pakistan Institute of Medical Sciences)
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Factors Causing for Recurrence of Chronic Sub Dural Hematoma after Burr Hole Craniotomy and Evacuation
Full text linkObjective: To determine the incidence of recurrence of Chronic Sub Dural Hematoma (CSDH) and its associated factors at a tertiary care Hospital.
Methodology: This cross-sectional observational study was conducted at Neurosurgery department at Pakistan Institute of Medical Sciences (PIMS), Islamabad, from February 2024 to October 2024. Patients aged 18 years and above, both genders, underwent diagnosed with CSDH confirmed by imaging (CT or MRI) and drained with burr hole craniotomy and evacuation were included. All patients undergoing burr hole craniotomy and evacuation for the drainage of chronic subdural hematoma (CSDH), (a neurosurgical technique involves creating two or more burr holes in the cranium, through which the dura mater is carefully elevated to access the subdural space. Following this, all the patients were followed during the post-operative period till discharge for recurrent CSDH. All the demographic information, including recurrences and risk factors was entered and analyzed using SPSS version 26.
Results: The study included 145 patients, with an overall mean age of 62.59 years, the majority being male (83.4%). The primary underlying cause was trauma, affecting 69.7% of the patients. The overall recurrence rate of hematoma was 12.4%, with approximately half of the cases occurring within two weeks postoperatively. Male gender was a significant risk factor, with 12 of 18 recurrent cases occurring in males compared to 6 in females (p = 0.041). Bilateral hematomas were also significantly associated with recurrence, as 6 of 7 patients with bilateral involvement experienced recurrence (p = 0.001). Hematoma thickness and midline shift were statistically significant predictors, as all 18 recurrent cases had a thickness >15 mm and a midline shift >10 mm (p = 0.001). Regarding drain tube management, 13 of 18 patients whose drains were removed within 24 hours experienced recurrence.
Conclusion: Recurrences of chronic subdural hematoma observed to be the 12.40%. Male gender, bilateral hematoma, mixed density hematoma, thickness and midline shift were found to be the causative factors for recurrences
Subcutaneous Suction Drain to Reduce Surgical Site Infection in Contaminated Cases of Emergency Laparotomy: A Randomized Controlled Trial
Full text linkObjective: To compare the frequency of surgical site infections (SSIs) in contaminated emergency laparotomy cases between two groups: with and without subcutaneous suction drains.
Methodology: This randomized controlled trial was conducted from December 2024 to February 2025 at the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad. A total of 150 patients aged 18 to 75 years who underwent midline exploratory laparotomy with contamination were included. Patients were randomly assigned to either the subcutaneous suction drain group (n = 75) or the control group without drains (n = 75). Data on demographic characteristics, comorbidities (diabetes mellitus and hypertension), and surgical site infections were collected. Surgical site infections were assessed using standard clinical criteria, including redness, swelling, pain, warmth, and wound discharge.Results: The incidence of surgical site infections was significantly lower in the subcutaneous suction drain group (13.3%) compared to the control group (46.7%) (p < 0.001). Stratified analyses revealed that age, gender, comorbidities, and body mass index (BMI) were significant predictors of SSI risk. Among patients in the control group, younger patients (<40 years) had an infection rate of 44.1%, whereas older patients (>40 years) had an infection rate of 48.8% (p = 0.015).
Conclusion: The use of subcutaneous suction drains significantly reduces the incidence of surgical site infections in contaminated emergency laparotomy cases
Early Versus Late Laparoscopic Cholecystectomy for Acute Cholecystitis
Full text linkObjective: To compare outcomes between early and late laparoscopic cholecystectomy (LC) in patients presenting with acute cholecystitis (AC).
Methodology: This randomized controlled trial was conducted in the Surgical Department of Capital Development Authority Hospital, Islamabad, from 29 October 2019 to 29 April 2020. Patients aged 18–60 years of either gender diagnosed with acute cholecystitis—confirmed on ultrasonography by the presence of gallstones, a positive sonographic Murphy’s sign, gallbladder wall thickening >3 mm, or pericholecystic fluid—were included. Participants were randomly allocated into two groups: Group A (early LC) and Group B (late LC). All patients received standard preoperative and anesthetic management. Surgeries were performed by a single experienced laparoscopic surgeon. Outcomes were assessed in terms of conversion to open surgery, bile leak, and mean hospital stay.
Results: The mean age in the early LC group was 44 ± 10.7 years, compared to 40 ± 11.9 years in the late LC group. In Group A, 40% of patients were male and 60% were female, whereas in Group B, 35% were male and 65% were female. None of the patients in the early LC group required conversion to open surgery, while 9% of patients in the late LC group were converted. Bile leak occurred in 2% (1 patient) of the early LC group compared to 12% (5 patients) in the late LC group. The mean hospital stay was shorter in the early LC group (2 ± 1.29 days) compared to the late LC group (3 ± 2.84 days).
Conclusion: Early laparoscopic cholecystectomy was associated with fewer complications and a shorter hospital stay and appears to be a better treatment option compared to late laparoscopic cholecystectomy in patients with acute cholecystitis
ROLE OF INTRACAMERAL ANTIBIOTICS AS PROPHYLAXIS AGAINST INFECTION IN CATARACT SURGERY
No full textABSTRACT
OBJECTIVE:
This study was conducted to understand the effects of intracameral moxifloxacin in decreasing the incidence of postoperative endophthalmitis after cataract surgery.
MATERIAL AND METHOD:
This was a prospective interventional randomized study conducted in Ophthalmology department, Fauji Foundation Hospital, Rawalpindi, from June 2022 to November 2022. A total of 90 eyes of 90 patients were selected after approval from ethics committee from the Institutional Review Board. Patients were divided into two groups – Group A, received one drop of 5% povidone-iodine 15 minutes before surgery and postoperative antibiotics eye drops 4 times per day for 10 days; group B received the same prophylaxis for endophthalmitis as group A, plus an IC injection of 0.05 mL of commercially available moxifloxacin hydrochloride at 5.45 mg/mL immediately after IOL implant. After intervention, both groups were followed up at one, seven, and thirty days post surgery. Patients were also observed for endophthalmitis. SPSS-26 was used for data analysis.
RESULTS:
The overall mean age in this study was 60.4 + 8.6. Most of the patients were female in both groups i.e. around 87%. None of the case of endophthalmitis found in either group.
CONCLUSION:
On the basis of our study findings, we conclude that the use of intracameral antibiotics should not be considered as “standard of care†in order to prevent the occurrence of endophthalmitis in cataract surgeries.
KEY WORDS:
Cataract surgery, endophthalmitis, intracameral antibiotic, moxifloxaci
Frequency of Multivessel severe coronary artery Disease in patients with Non-ST elevation Myocardial Infarction ( NSTEMI) with markedly raised Cardiac Troponins
No full textObjective: To evaluate the frequency of MVCAD in patients with NSTEMI and markedly raised cardiac troponins, and to assess the associated clinical outcomes and management strategies.
Methodology: A cross-sectional study was conducted from January 2021 to January 2022 at Department of Cardiology, Hayatabad Medical Complex Peshawar. A total of 135 NSTEMI patients with significantly elevated cardiac troponins were included. Comprehensive diagnostic evaluations, including coronary angiography, were performed to assess the presence and extent of MVCAD. Data on demographics, clinical characteristics, management strategies, and clinical outcomes were collected and analyzed.
Results: The mean age of the patients was 64.3 ± 10.2 years, with 60.7% being male. MVCAD was found in 65.9% of patients, with 27.4% having two-vessel disease and 38.5% having three-vessel disease. Patients with MVCAD demonstrated significantly higher rates of recurrent ischemic events (18.7%), heart failure (14.6%), and mortality (7.9%) compared to those with single-vessel disease. Among patients with MVCAD, 65.2% underwent PCI, 23.6% were managed with CABG, and 11.2% received optimal medical therapy.
Conclusion: The study highlights the high prevalence and clinical significance of MVCAD in NSTEMI patients with markedly raised cardiac troponins. These findings underscore the need for comprehensive diagnostic evaluations and aggressive therapeutic strategies to manage this high-risk group effectively. Incorporating these insights into clinical practice can improve outcomes and reduce the burden of coronary artery disease in these patients.
Keywords: , MVCAD, PCI, CABG, Cardiac Troponin
Effectiveness of Zinc Supplementation in Tablet Versus Suspension Form in Acute Diarrhea
Full text linkObjective: The objective of this study is to determine the effectiveness of zinc supplementation in tablets versus suspension form in acute diarrhea.Methods: A comparative study was carried out in the department of Pediatrics, Liaquat University of Medical and Health Sciences Jamshoro/Hyderabad. Children of either gender, aged 5 months to 59 months coming with presentation of acute diarrhea/ recurrent episodes of diarrhea were included. Total 100 children of acute diarrhea were enrolled in this study and they wereequally divided into two groups. All patients were treated according to current IMCI guideline for acute diarrhea. The children in group A were treated with zinc supplement in tablet form whereas those children in group B were treated with zinc supplement in suspension form 14 days. Children in both groups were assessed for duration and frequency of acute diarrhea. All thechildren were assessed on daily basis to determine the stool frequency and duration of acute diarrhea. All the data was entered and analyze by version 26.Results: The majority (54%) of children were aged 6 to 12 months. Zinc supplementation significantly reduced stool frequency in children with acute diarrhea over a 5-day period. On day 1, the overall mean stool frequency was 5.6 ± 2.51, with Group A (tablet) at 5.2 ± 2.22 and Group B (suspension) at 6.0 ± 2.72. By day 2, the mean stool frequency decreased to 2.7 ± 1.63(Group A: 2.6 ± 1.5; Group B: 2.9 ± 1.74). On day 3, the frequency further declined to 1.7 ± 0.94(Group A: 1.8 ± 0.85; Group B: 1.7 ± 1.03). A statistically significant reduction in stool frequency was observed from day 1 to day 5 (p = 0.05), with stool frequency also decreasing as the children&#39;s age increased.Conclusion: Zinc supplementation in tablet and suspension form is equally effective reducing frequency and severity of acute watery diarrhea in children.Key words: Acute diarrhea, zinc supplementation, stool frequency, duration of diarrhea
CA 125 Levels Above 100: A Marker for Deep Infiltrating Endometriosis
Full text linkObjectives: To evaluate serum CA-125 levels above 100 U/mL as a marker for DIE in patients undergoing laparotomy at Bach Christian Hospital, Abbottabad.
Methodology: This cross-sectional study was conducted from January 2023 to August 2024 on women admitted for laparotomy. Preoperative serum CA-125 was measured using electrochemiluminescence immunoassay. Intraoperative findings were documented, and disease staging was performed according to the revised American Society for Reproductive Medicine (rASRM) criteria. Patients were categorized into early-stage (I–II) and advanced-stage (III–IV) disease. Statistical analysis included chi-square test, independent t-test, and ROC curve analysis to determine the diagnostic accuracy of CA-125 ?100 U/mL in predicting DIE.
Results: There were 160 patients in total with mean age of 31.4 ± 6.2 years. Infertility was the most common presenting condition (65%), followed by dysmenorrhea (42%), and chronic pelvic discomfort (48%). Patients with advanced-stage cancer had considerably higher mean CA-125 values (124.6 ± 28.4 U/mL) than those with early-stage disease (58.2 ± 21.7 U/mL, p < 0.001). Among patients with DIE, 72% had serum CA-125 levels above 100 U/mL, compared to 12% in those without DIE (p < 0.001). ROC analysis demonstrated an area under the curve (AUC) of 0.82, with CA-125 ?100 U/mL yielding 76% sensitivity and 89% specificity for detecting DIE.
Conclusion: Serum CA-125 levels above 100 U/mL are strongly associated with deep infiltrating and advanced-stage endometriosis, providing high specificity and predictive value. It may serve as a cost-effective adjunct in preoperative evaluation, surgical planning, and patient counseling, particularly in resource-constrained healthcare settings
Frequency and Characteristics of Hypothyroidism in Neonatal Intensive Care Unit Patients in a Tertiary Care Hospital
Full text linkObjective: To Investigate frequency, clinical and laboratory profiles of hypothyroidism in neonates admitted to the Neonatal Intensive Care Unit (NICU) in a tertiary care hospital.
Methodology: This Prospective, cross-sectional study Neonatology Department, Fatima Memorial Hospital, Lahore, from July 2024 to December 2024. A total of 200 neonates admitted in NICU were included using consecutive non-random sampling. Thyroid function was assessed through serum free T4 and TSH levels, with hypothyroidism diagnosed based on low free T4 or elevated TSH levels and clinical symptoms. Data were analyzed using SPSS 25.0, with statistical significance set at p < 0.05.
Results: Among 200 neonates, 23 (11.5%) were diagnosed with congenital hypothyroidism (CH), while 33 (16.5%) exhibited subclinical hypothyroidism. Low free T4 levels were observed in 21 (10.5%) neonates, and high TSH levels in 36 (18%). Feeding intolerance was the most common clinical symptom noted in 52.5% of cases. Significant maternal factors associated with CH included gestational illness (p = 0.008), antenatal steroid use (p = 0.003), and multiple gestations (p = 0.027). Predominant neonatal risk factors were preterm birth (p < 0.001), cesarean delivery (p = 0.016), and intrauterine growth restriction (IUGR) (p = 0.044). The prevalence of hypothyroidism was higher in preterm (p <0.001) and low-birth-weight neonates (p = 0.191), highlighting the vulnerability of this subgroup.
Conclusion: Congenital hypothyroidism is prevalent in NICU patients, particularly those born preterm or with low birth weight. Maternal and neonatal factors significantly influence the risk
Effects of Graded Dose of Sodium Benzoate on Ovaries of Adult Female Albino Wistar Rats
Full text linkObjective: To determine the gross effects of graded dose dependent affects Sodium Benzoate on ovaries in adult female albino Wistar rats
Methodology: This quasi-experimental study was conducted at the Animal House of Sindh Agriculture University, Tando Jam, using 30 adult female albino Wistar rats (150–200g), randomly divided into three groups: A (control), B, and C. Group A received a regular lab chow diet, while Groups B and C were fed chow mixed with sodium benzoate at doses of 300 mg/kg and 600 mg/kg body weight, respectively. Initial and final body weights were recorded. After the experiment, rats were anesthetized with chloroform and sacrificed using cervical dislocation. Ovaries were extracted, weighed, and preserved in 10% formalin for histological analysis using Hematoxylin and Eosin staining. Data were analyzed using SPSS version 26.0.
Results: Ovarian weight was higher in the control group (0.065g) compared to group B (0.039g) and group C, (p > 0.05). Though, group C showed a significantly higher incidence of blood congestion (66.7%) than group B (25.0%) and the control group (8.3%) (p < 0.004). Cellular hypertrophy rat was significantly higher in group C (70.0%) compared to group B (30.0%) and the control group (0%) (p < 0.001). Oocyte degeneration was also significantly more common in group C (69.2%) than in group B (23.1%) and the control (7.7%) (p < 0.001). Additionally, vacuolation was observed in 61.5% of group C, 30.8% of group B, and only 7.7% of the control group (p < 0.001).
Conclusion: Histological analysis indicated that sodium benzoate may have contributed to increased blood congestion, cellular hypertrophy, and vacuole formation within the ovarian tissue specifically at higher dose