Annals of PIMS (Pakistan Institute of Medical Sciences)
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Detecting Hepatic Steatosis Among Potential Liver Donors by Using Non-Invasive Methods
Full text linkObjective: To evaluate the effectiveness of non-invasive methods in detecting hepatic steatosis among potential liver donors.
Methodology: This cross-sectional descriptive study included 67 potential liver donors, recruited via consecutive non-probability sampling over a two-year period (2021-2023). Data collection involved a semi-structured questionnaire covering demographics and biochemical indicators like serum bilirubin, cholesterol levels, ALT, AST, platelets, INR, and GGT. Hepatic steatosis was assessed using Fasting Lipid Profile, Fibroscan/Shearwave ultrasonography, and Liver Attenuation Index (LAI) from CT scans. Descriptive statistics were applied, and gender-based variations in biochemical markers, CAP, and LSM were analyzed using independent t-tests. Chi-square tests evaluated gender differences in steatosis identified by pathology and CAP. A significance level of P < 0.05 was used.
Results: Of the 67 donors, 49 were males, with a mean age of 30.1 ± 8.8 years. Pathology revealed mild steatosis in 35 and moderate steatosis in 5 donors. Ultrasound showed normal liver echotexture in 47 subjects, while 18 had fatty liver. CAP findings indicated mild steatosis in both genders, with females showing higher values (P = 0.02) and more advanced steatosis (P < 0.01). Mean LSM was 4.6 ± 1.53 kPa, indicating normal liver stiffness. LAI findings suggested 37 donors required further evaluation. Among overweight donors, 22% had advanced steatosis compared to 14% in the healthy-weight group.
Conclusion: Ultrasound-directed CAP, LSM, and BMI are effective non-invasive tools for diagnosing hepatic steatosis in potential liver donors
Spectrum of Vaccine Preventable Diseases Amongst Children in Isolation Ward of Tertiary Care Hospitals
Full text linkOBJECTIVE:
The objective of the study is to determine the spectrum of vaccine preventable diseases amongst children in pediatric medical unit of tertiary care hospitals and also determine its relationship with the vaccination status.
METHODOLOGY:
It was a cross sectional study held at isolation ward of pediatric therapeutic division of The Children’s Hospital and University of Child Health Sciences and Shaikh Zayed Hospital Lahore from December 2019 to November, 2020. We included children aged between 2 months to 16 years. After getting parental consent, precise history taken and examination done. Patients admitted with different vaccine preventable diseases analyzed.
RESULTS:
One hundred and twenty patients were enrolled. Amongst them, 55.83% were male and 44.17 % were female. Amongst spectrum of diseases, most common was chicken pox 43(35.83%) followed by measles 32(26.6 %), tetanus 20 (16.6%), diphtheria 13(10.83 %), mumps 12 (10%).
CONCLUSION:
Amongst diseases, chicken pox was the commonest one. Non-vaccination is the major reason that children are presenting with these potentially morbid diseases. Moreover, vaccine against varicella should be included in EPI Programme for our country.
 
Comparison of Effects of Preserved and Preservative Free Anti-Glaucoma Drugs in Causing Dry Eyes
Full text linkObjective: The aim of this study was to assess the potential impact of antiglaucoma medication preservatives on ocular surface health and the subsequent development of dry eye symptoms.
Methods: A non-randomized controlled trial study was conducted from March 2023 to June 2023.The study enrolled 32 patients, with 16 participants in each group. Patients meeting the inclusion criteria, including confirmed diagnosis of glaucoma and stable ocular health, were allocated to Group A(preserved medication) or Group B(preservative-free medication).Tear Film Break-Up Time(TBUT) and Schirmer's test were employed as objective indicators of tear film stability and tear production respectively. Measurements were recorded at baseline and after a 3-month duration of medication use.
Results: At 1st visit, mean TBUT was 10.87 sec and mean Schirmer's test was 13.75 mm in group A while in group B it was 11.25 sec and 14.56 mm respectively. After 3 months of medication use, mean TBUT and mean Schirmer’s was 9.62 sec and 11.81 mm respectively in group A while in group B it was 10.18 sec and 13.18 mm respectively. The results showed that initial ocular status was similar in both groups however the decrease in values showed ocular surface deterioration. Notably group A demonstrated a more substantial decline in tear production compared to group B.
Conclusion: This study underscores the importance of both preserved and preservative-free anti-glaucoma medications. Although both may potentially exacerbate dry eye symptoms to a greater extent, preservative-free anti-glaucoma may offer benefits in maintaining ocular surface health with long-term use
The Role of Salivary Micro RNAs as a Diagnostic Marker in Early Detection of Oral Squamous Cell Carcinoma
Full text linkOBJECTIVE: To assess the diagnostic role of salivary microRNA for early detection oforal squamous cell carcinoma and to compare the salivary microRNA with Biopsy in thediagnosis of oral squamous cell carcinoma.Methodology: The descriptive cross-sectional study was conducted in the department of pathology and molecular laboratory, department of oral &amp; maxillofacial surgery of Liaquat University of Medical Health Sciences, Jamshoro / Hyderabad.Inclusion Criteria: All histopathologicaly diagnosed OSCC patients of both genders with age group 18 years and above will be included in the study after taking their informed consent. Whole saliva samples (inactivated) were collectedfrom subjects diagnosed as OSCC and controls. The subjects were counseled to avoid eating, drinking, smoking or oral procedures for at least 1 h prior to the collection of saliva. Subjects are asked to rinse their mouth well with distilled drinking water for one minute before taking the saliva samples. After five minutes of oral rinsing spit 5 mL of saliva into a 50 mL sterile tube placed on the ice. The tube should remain on ice while collecting the saliva samples. Fourhundred microliters of the whole saliva mixture (200 ?L whole saliva and 200 ?L RNA later),and 400 ?L of the supernatant saliva was used for RNA extraction. Saliva samples wereextracted using the mirVana™ miRNA Isolation Kit according to the manufacturer&#39;s guideline(Ambion Inc., Austin, TX). Whole saliva samples were preserved with RN Alater (QIAGENInc., Valencia, CA) and supernatant saliva samples were preserved with SUPE Rase. In™ (Ambion Inc., Austin, TX). The data was entered in the statistical package for social sciences for windows (SPSS) V: 26.RESULTS: A total of 120 samples of oral squamous cell carcinoma were taken, which met theinclusion criteria. Mean age of the patients was 47.45+10.85 years. 85(70.8%) were married and35 (29.2%) were unmarried. 90.0% were married and 5.0% were unmarried, while 5.0% werewidow. Cigarette smoking, paan, chaalia and naswar were the commonest cause of the oralsquamous cell carcinoma. Lips, buccal mucosa and tong were the commonest t sites of the oralsquamous cell carcinoma. 16.7% cases had positive family history of oral squamous cellcarcinoma. Out of all study subjects, most of the cases 59.2% had moderately differentiatedSCC, 30.0% cases had well-differentiated SCC and 10.8% of the cases had poor differentiatedSCC. Out of all study subjects, 87.5% of the patients had positive micro-RNA expression.Micro-RNA expression was significantly associated, with poorly differentiated squamous cellcarcinoma (p=0.016).
CONCLUSION: Study revealed that the salivary miroRNA expression were significantlypositive in patients of OSCC. Therefore, salivary microRNA could be considered as a useful andadvantageous biomarker for the detection and tracking of OSCC across various levels of tissueabnormalitie
Unveiling the Economic Impact of Allied Health Professionals in Pakistan's Healthcare Landscape
Full text linkPsoriasis Area and Severity Index and its Correlation with Liver Function Test
Full text linkObjective: To determine Psoriasis Area and Severity Index score and its association with LFT values in patients of psoriasis.
Methodology: This cross-sectional study, was done on patients visiting the skin OPD of LUMHS Jamshoro/Hyderabad. Diagnosed patients of Psoriasis, aged between 18 and 50 years and both genders were included. A 5cc blood sample was collected from each individual to evaluate the LFT. Psoriasis Area and Severity Index (PASI) scores was defined based on the percentage of body surface area affected by psoriasis lesion. All the information was entered and analyzed using SPSS version 26.
Results: The mean age of the patients was 44.81±11.10 years. Out of the total 102 patients, 74.5% were male patients and 25.5% were female. The mean duration of psoriasis was 6.46 ± 4.49 years. Out of all 32.4% had mild psoriasis (PASI < 7), 40.2% had moderate psoriasis (PASI 8-12), and 27.5% had severe psoriasis (PASI > 12). Regarding LFT values, 73.5% had elevated alanine transaminase (ALT), 32.4% had elevated aspartate transaminase (AST), 70.6% had elevated alkaline phosphatase (ALP), 68.6% had elevated bilirubin, and 67.6% had elevated gamma-glutamyl transferase (GGT). AST and GGT levels rise significantly linked to PASI (p- <0.05). Conversely, for ALP and Bilirubin levels, there is no significant difference across severity of PASI (p- >0.05).
Conclusion: Patients with severe psoriasis exhibit a predisposition to hepatic dysfunction. Study observed abnormalities in liver function tests (LFT) among psoriatic patients, suggesting a potential link to liver disease development
Integral Nuclear Proteins in Cell Signaling in relation to Oral Cancer and its treatment modalities; A Systematic Review
Full text linkObjective: To advance our understanding of the integral nuclear protein's role in cell interaction and their capacity as diagnostic and therapeutic targets in oral cancer treatment. Methodology: This review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The data of our systematic review were collected from six search engines i.e HEC Digital Library, PubMed/Medline, Elsevier, Wiley Online Library, Google Scholar and Wolter Kluwer, from the year 2014 to 2024. In order to conduct this review, studies selection was done based on the following criteria which includes Articles with Abstract containing integral nuclear proteins Cell signaling and Oral cancer, Top fifty most cited articles based on their citation count and articles containing role of Integral nuclear proteins in cancer treatment. Results: In order to carry out this study, forty studies were searched and assessed which discussed the role of integral nuclear proteins in cell signaling and recent advancements describing the application of these proteins as a diagnostic tool in oral cancer detection and prevention. Conclusion: This systematic review describes the application of role of integral nuclear protein plays in pathophysiology of Oral cancer and that it can be used as a diagnostic parameter as well as treatment for oral cancer. However, this review did not discuss regarding the individual proteins role in cancer treatment and their use as a diagnostic and preventive tool such as role of YAP (Yes-associated protein) and p53.This research may have missed some studies written in language other than English.
Impact of 3D virtual reality on teaching and learning human anatomy among undergraduate students
Full text linkObjective: To assess how impact 3D-VR is in improving the retention of human anatomy knowledge among undergraduate students compared to traditional methods.
Methodology: This convergence mixed method study was carried out in anatomy department of HBS Medical and Dental College, Islamabad, from February to December 2023. The study was evaluated learning outcomes, specifically knowledge retention score in short-term and long-term, in undergraduate students by 3D-VR vs traditional models. Additionally, it sought to capture experience of students and perspectives by 3D-VR teaching and learning method.
Results: The post-test score (indicative of short-term knowledge retention) by 3D-VR in both groups of male and female was significant high than traditional method (p ? 0.001). 3D-VR also achieved significant high follow-up score (indicative of long-term knowledge retention) in both groups compared to traditional method. While the knowledge score in all tests of 3D-VR and traditional method for females was high than males. Post-test score (indicative of short-term knowledge retention) and follow-up score (indicative of long-term knowledge retention) in 3D-VR method of females was significant high than males (p ? 0.001).
Conclusion: 3D-VR is effective method for knowledge retention in short-term and long-term in undergraduate students. Undergraduate students demonstrated 3D-VR as a learning method that offers substantial advantages for studying human anatomy versus traditional method
Effectiveness of Aggressive Intraoperative Pulmonary Recruitment Maneuver in Limiting Immediate Postoperative Pathological Atelectasis Immediately before Weaning from Cardiopulmonary Bypass
Full text linkObjective: To determine effectiveness of aggressive Intraoperative Pulmonary recruitment maneuver before weaning in limiting immediate postoperative pathological Atelectasis in patients with coronary artery bypass surgery
Methodology: This retrospective analysis was conducted at Heart and Vascular Institution, Kulsum International Hospital, Islamabad from November 2019 to 12th April 2023. All patients with elective coronary artery bypass surgery were included. In group A (n=20) the recruitment maneuver was initiated before weaning from bypass while in group B, the protocol recruitment maneuver was not initiated. The immediate postoperative pathological atelectasis based on chest x-ray was compared between two groups.
Results: In this study, 40 patients with mean age 55.7 ± 5.2 years were included. There were 15 (75.0%) males and 5 (25.0%) females in group A while in group B there were 17 (85.0%) males and 3 (15.0%) females. In group A, post-operative chest x-ray demonstrated one basilar angle obliteration consistent with atelectasis in 1 (5.0%) patient. In group B, 12 (60.0%) patients demonstrated more than three basilar angles obliteration. There were 4 (20.0%) patients each with four basilar angles obliteration and one angle obliteration.
Conclusion: Initiation of aggressive intraoperative pulmonary recruitment maneuver before weaning from bypass prevents atelectasis than in patients in whom aggressive intraoperative pulmonary recruitment maneuver was not initiated.
Does a Short Interim Between Two Pregnancies Adversely Influence Maternal Outcome – A Study From South Punjab
No full textObjective: To explore the impact of short interpregnancy intervals on maternal healthcare utilization and access in the context of South Punjab.
Methodology: This cross-sectional study was done at gynae and OBS department of Combined Military Hospital Multan from October 2019 to April 2020. Women of reproductive age group (18-42 years) who had at least one previous pregnancy and women had a recorded interpregnancy interval (time between the last delivery and conception of the current pregnancy (< 18 months) were included. The interpregnancy interval was calculated as the time between the date of delivery of the previous pregnancy and the date of conception of the current pregnancy, based on participants' self-reported information and/or available medical records. Maternal health outcomes were assessed, including obstetric complications like preterm birth, low birth weight, anemia, premature rupture of membranes PROM and postpartum hemorrhage PPH. All the information was entered and analyzed using SPSS version 26.
Results: Overall mean age of the patients was 29.23 ± 2.11 years. Majority of patients had a gestational age greater than 38 weeks (61.1%), and resided in rural areas (66.1%). Additionally, a significant proportion of patients were illiterate (69.5%). PROM was found in 40.20% of the patients, 13.0% women had developed PPH and preterm deliveries were occurred in 19.70% of the women. Maternal adverse outcomes including PROM, PPH and preterm deliveries were statistically insignificant according to maternal age, parity and obesity (p-<0.05).
Conclusion: A short interval of less than 18 months between pregnancies has been identified as a factor contributing to increased risks of PROM, PPH, and preterm births. This implies that repeated unplanned pregnancies with short intervals may elevate the likelihood of adverse maternal outcomes