Annals of PIMS (Pakistan Institute of Medical Sciences)
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Dental Patients' Misconceptions, myths and Fears About the Scaling Procedures: An Age-Related Analysis from a Public Sector Hospital
Full text linkwith scaling procedure among Patients with respect to age groups visiting a Public Sector Hospital.
Methodology: This Questionnaire based cross sectional survey was conducted in school of dentistry, Islamabad September 2023 to August 2024. Three hundred and fifty participants filled the questionnaire where reluctance and apprehension of dental patients toward scaling procedure in light of myths and fears was answered. Patients having permanent teeth were included in the study, whereas, those having deciduous or mixed dentition were excluded. Quantitative data in terms of age, gender, fears and myths was collected, analyzed and tabulated in frequencies and percentages.
Results: Total 284 (81.1%) males and 66 (18.9%) females participated in this study where 44 (26.7%) participants belonged to 14-24 years of age, 51(30.9%) pertaining 25-34 years and 70 (42.4%) belonged to 35 or above years of age. Participants belonging to 35 – above years did not consider anxiety, painful side effects, tooth surface roughness, cross infection fear, high cost, increased tooth mobility, gap and sensitivity as barriers of scaling. Descriptive statistics was done.
Conclusions: Current study concluded that middle aged and elderly participants were regular dental visitors having less misconceptions and myths regarding scaling and its beneficial effects
An Investigation of Clinical Features of Head and Neck Cancers in a Tertiary Care Hospital
Full text linkObjective: To investigate the clinical features of individuals with head and neck cancer at a tertiary care hospital.
Methodology: A retrospective cross-sectional analysis was conducted at the Histopathology Department of Combined Military Hospital (CMH) in Lahore, Pakistan, duration from August 2019 to September 2024. Total 250 cases, confirmed through histopathological analysis and above 20 years of age, were included in the study. The cancer sites encompassed the nasopharynx, oral cavity, oropharynx (specifically lip, tongue, tonsil, mouth floor, gingiva, and retromolar trigone), larynx, pharynx, salivary glands, and sinonasal region. The outcomes were to investigate the tumor site in HNC, assess the histological HNC frequency, analyze the HNC stages of tumor node metastasis, and explore the etiological factors contributing to HNC. Failure rates were documented with regard to the type of recurrence, whether it was local, systemic, or distant.
Results: Among the cases, majority (85.2%) were male, and 14.8% were female. The patients mean age was 55.0±20.2 years. The most prevalent age was 40–59 years, representing 55.2% of the cases. The oral cavity was the frequent primary tumor site, observed in 35.2%, followed by the nasopharynx in 20%. Squamous cell carcinoma was the most prevalent type of HNC, observed in 75.2%. The frequency of HNC varied across TNM stages, ranging from stage 0 to stage 4, with 65.2% of cases classified as stage 4. Smoking alone was identified as the most prevalent risk factor for cancer, primarily in the oral cavity, followed by the larynx.
Conclusion: The increasing incidence of HNC has led to high morbidity and mortality in the Pakistani, primarily due to risk factors such as smoking, tobacco use in various forms, and alcohol consumption
Effect of Preoperative Oral Midazolam Sedation on Separation Anxiety and Emergence Delirium Among Children Undergoing Inguinal Hernia Repair Under General Anesthesia
No full textObjective: To determine the effect of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing inguinal hernia repair under general anesthesiaMethodology: Present Descriptive cross sectional study was done at Department of Anaesthesia, Abbasi Shaheed Hospital, Karachi, on 82 children undergoing inguinal hernia repair were included in this study. Children age, weight, height was measuredand pre medicated with 0.5 mg/kg (maximum total dose was 20 mg) of oral Midazolam in 20 ml of 10% sodium citrate solution, 30 min prior to induction. Premedication was done 10–15 min prior to separation from parents and 20–25 minprior to intubation. ALL information were noted in the proforma attached as annexure.Results: The average age of the patients was 44.44±19.12 years. Effectiveness of preoperative oral midazolam sedation on separation anxiety and emergence delirium among children undergoing inguinal hernia repair was 60.98% and 74.39%respectively.Conclusion: Oral preoperative Midazolam in a dose of 0.5 mg/kg might be a useful treatment adjunct in reducing parental separation anxiety, and for ease of anesthesia induction. Preoperative Midazolam sedation has no reducing effect on postoperative ED in children undergoing dental treatment under general anesthesia
To Evaluate the Role of Intravenous Urography in Acute Uropathology, Does Duration of Symptoms have a Role in its Diagnostic Yield? A Retrospective Chart Review
No full textObjectives: To evaluate the effects of demographics like age, gender, and duration of symptoms of uropathology on the yield of intravenous urography.
Methodology: Retrospective chart review, done in the department of Radiology, Pakistan Institute of Medical Sciences, PIMS Islamabad. Data was collected from patients record from august to October for a period of 3 months. All patients whose intravenous urography was performed were retrospectively analysed for demographics and duration of symptoms and clinical data for each patient. The data was collected on a premade proforma
Results: Out of 117 patients studied, 81(69.23%) had some uropathology, while 36 (30.76%) did not show any pathology.53 (45.29) patients were in the age group 35-45 years and the overall 70 (59.82%) patients were male and 47 (40.17%) female. Calculus disease (stone) was seen in 87 (74.35%) patients. 43 (36.75%) had shorter duration of symptoms (less than 4 weeks) while 74 (63.24%) had larger duration (more than 4 weeks). 21 (48.83%) out of 43 patients with short duration had normal findings while 15 (20.27%) out of 74 who had longer duration had normal findings.
Conclusions: Patients with shorter duration of symptoms had more negative results so intravenous urography should not be done in all cases and should be reserved only for chronic cases
Exploring the Link Between Environmental Pollution and Epilepsy
Full text linkEnvironmental pollution is a highly challenging global problem, and its impact on neurological disorders, including epilepsy, poses a significant threat to the worldwide healthcare system and economies. The most frequent pollutants which contaminate the air, water and soil are particulate matter (PM2.5, PM10), nitrogen dioxide (NO2), sulfur dioxide (SO2), carbon monoxide (CO), ground-level ozone (O3), heavy metals, pesticides, and industrial chemicals. Environmental pollution causes 6.7 million premature deaths annually, and 89% of fatalities occur in low-middle-income countries. About 68% of outdoor air pollution-related premature deaths were due to ischemic heart disease and strokes. Neurological disorders are increasingly recognised as significant causes of death and disability worldwide. Epilepsy is a chronic neurological disorder that affects 50 million people worldwide. However, its exact causal relationship with environmental pollution is still poorly understood. Therefore, this review examined the association between environmental pollutants and the incidence, prevalence, and progression of epilepsy and the pathophysiological mechanisms involved between air pollution and epilepsy. This review explores evidence from epidemiological and experimental studies, identifying the significant pollutants implicated in epilepsy and elucidating their neurotoxicity pathways
Accuracy of Testicular Fine Needle Aspiration Cytology to rule out Obstructive and non-obstructive Azoospermia
No full textObjective: To establish if testicular aspiration can separate men with obstructive from those with non-obstructive azoospermia.
Methodology: This cross-sectional study was carried out from June 2023 to May 2024 at Mayo Hospital, Lahore. All patients included in the study (n=50) were found to be azoospermic. Sensitivity, specificity, PPV, NPV and the overall diagnostic accuracy were examined by looking at FNAC findings and comparing them with the testicular biopsy results.
Results: Testicular FNAC demonstrated high diagnostic accuracy in differentiating OA from NOA, correctly classifying 92% of cases (46/50) compared to biopsy. It showed 95.6% sensitivity and 88.9% specificity, with strong agreement with histopathology (?=0.83). ROC analysis revealed excellent discriminative ability (AUC=0.923, 95% CI: 0.852-0.994). While FNAC reliably identified spermatogenic patterns, 8% of cases (4/50) were misclassified, emphasizing the need for clinical correlation in borderline scenarios.
Conclusion: FNAC of the testicle offered great reliability in differentiating obstructive azoospermia from non- obstructive azoospermia and was less invasive compared to testicular biopsy. A limited number of cases being misclassified suggests that health professionals should exercise careful interpretation
Comparative Study Between Total Laparoscopic Hysterectomy and Abdominal Hysterectomy in Management of Benign Gynaecological Conditions
Full text linkBackground: Hysterectomy is a frequent surgery performed for benign diseases of the reproductive system: fibroids, endometriosis, and abnormal uterine bleeding. The most conventional methods have been the AH; however, the fast-growing minimally invasive alternatives such as TLH have been found to differ significantly regarding recovery and complications.
Aim: The objective of this work will be to assess TLH and AH in terms of effectiveness and adverse effects considering patients’ outcomes in benign gynaecological diseases treatment.
Method: A propensity score matched prospective cohort study was performed among women with benign pathology necessitating hysterectomy at BMC and LUMHS Jamshoro. The patients were grouped according to type of surgery done, as those who underwent TLH and those who underwent AH. The preoperative, intraoperative, and postoperative factors measured were age, BMI, operative time, volume of blood loss, pain, length of hospital stay, and complications. Descriptive analyses and t-tests and chi-square tests were used in order to assess the differences in the results.
Results: TLH proved to provide direct benefits over AH; less intra operative blood loss of 150 mL as compared with 300 mL; shorter hospital stay of two days as opposed to five days and faster recovery period of three weeks instead of six weeks. Therefore, evaluating the outcome results we can state that both pain scores and postoperative complications were lower in the TLH group. However, TLH was associated with total operative times greater than TLAP (120 minutes compared with 90 minutes). Patient satisfaction was higher in the TLH group as the feasibility score demonstrated (9/10 vs 7/10), besides, the overall costs were lower due to decreased complication rate and faster rehabilitation period.
Conclusion:The systematic review of TLH over AH has outlined numerous traces and representations of benefits of TLH over AH in terms of patient safety, recovery and satisfaction therefore eligible patients are encouraged to opt for TLH. But the longer operative time and the requirement of specialized knowledge and skills bear the issue of routine based surgical planning and execution. The findings of the study should be used for future research based on long-term outcomes of the treatment as well as costs of implementing the approach
Serum Ferritin as a Predictive Biomarker for Glycemic Control in Type 2 Diabetes; A Cross-sectional Analysis
Full text linkObjective to determine whether serum ferritin is associated with glycemic control, measured by HbA1c, in Pakistani adults with T2DM.
Methodology: A descriptive cross-sectional study was conducted at Nishtar Medical University/Hospital, Multan, from 24 August 2022 to 24 February 2023. Consecutive adults aged 30–70 years with physician-diagnosed T2DM of >2 years’ duration were enrolled (n = 151). Patients on iron therapy, with anemia, acute infection, blood donation, pregnancy, or chronic renal/hepatic disease were excluded. Serum ferritin (chemiluminescent immunoassay) and HbA1c (HPLC) were measured. Elevated ferritin was defined as >250 ng/mL in males or >120 ng/mL in females. Correlations were assessed with Spearman’s ?; chi-square tests were used post-stratification. Significance was set at p ? 0.05.
Results: Mean age was 48.8 ± 10.8 years; 57.0 % were female. Median HbA1c was 7.7 % (IQR 3.3); 58.9 % (n = 89) had uncontrolled diabetes (HbA1c ? 7 %). Median ferritin was 96 ng/mL (IQR 131), with elevated levels in 30.5 % of participants. HbA1c correlated positively with ferritin (? = 0.252, p = 0.002). Elevated ferritin was more common in uncontrolled versus controlled diabetes (44.9 % vs 9.7 %; p < 0.001). The HbA1c-ferritin correlation remained significant among females, obese patients, rural residents, non-hypertensive individuals, and those without a family history of hypertension.
Conclusions: Serum ferritin is independently associated with poorer glycemic control in Pakistani adults with T2DM and may serve as a practical adjunct biomarker for risk stratification in routine care. Prospective studies are needed to validate its predictive value and explore therapeutic strategies targeting iron overload.
Keywords: Serum ferritin, Type 2 diabetes mellitus, Glycemic control, Biomarke
Use of Continuous Glucose Monitoring Sensors for Type 1 Diabetes Management and its Effect on Glycemic Control
Full text linkObjectives: To determine the frequency of use of Continuous glucose monitoring (CGM) sensors in individuals with type 1 diabetes mellitus (T1DM). To compare the levels of glycosylated haemoglobin (HbA1c) between CGM users and non-users along with its association with demographics and other variables.
Methodology: In this cross-sectional study, data was collected through non-probability convenience sampling, from all patients with TIDM (from June 2023 to November 2023) enrolled with Meethi Zindagi. After ethical permission, self-structured proforma was filled by patients and parents of patients <12 years having T1DM, under insulin therapy. Participants were divided into Group 1 (CGM Users) and Group II (CGM non-users).
Results: Out of the total 84 participants, 63% were CGM users. Among CGM users, 60% were male and 59% were children up to 12 years of age. The levels of HbA1C in CGM users were significantly lower compared to non-users. HbA1C levels have a strong negative correlation with the duration of using CGM and the frequency of scanning.
Conclusion: Our data offers initial proof that CGM could serve as an effective instrument across patients of T1DM, to give better glycemic control. The more frequently the CGM sensor is scanned by the user better be glycemic outcomes. The promising role of CGM use for a longer duration helps in effective diabetes management
Role of Neutrophil and Lymphocyte Ratio to Predict the Prognosis of Acute Ischemic Stroke
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Objective: To determine the predictive value of the Neutrophil-to-Lymphocyte Ratio (NLR) in assessing the prognosis of acute ischemic stroke (AIS).
Methodology: This prospective cross-sectional study was done at Medicine and neurology departments of Isra University Hospital Hyderabad from March 2021 to February 2022. Patients aged 18 years or old, both genders who were presented at the neurology department with stroke (based on clinical features and confirmed on CT or MRI scan) within 24 hours of symptom onset were included. A 5ml blood sample was obtained from each patient for CBC. NLR was calculated by dividing the absolute neutrophil count by the absolute lymphocyte counts. The National Institutes of Health Stroke Scale (NIHSS) score was assessed upon admission and at the time of discharge.
Results: Mean age of the patients was 59.85+13.89 years. Females were in majority 52.9% and males were 47.1%. The overall mean NLR is 10.80, and the differences across stroke severity are statistically significant (p = 0.049). Regression analysis indicated that the NLR is a significant predictor of AIS severity at both admission and discharge. At admission, NLR explains 9.5% of the variance in NIHSS scores (R² = 0.095) with an F-value of 6.536 and a p-value of 0.013, showing statistical significance. Each unit increase in NLR is associated with a 0.268 increase in NIHSS score. At discharge, NLR explains 23.8% of the variance in NIHSS scores (R² = 0.238), with each unit increase in NLR corresponding to a 0.826 increase in NIHSS score (p = 0.000), indicating a stronger relationship between NLR and stroke severity.
Conclusion: The NLR has been identified as a strong predictor of acute ischemic stroke severity, accounting for a significant portion of the variance in NIHSS scores at admission. Given its ease of measurement and its significant association with stroke severity, further large-scale studies are recommended to explore the underlying mechanisms of this relationship