Annals of PIMS (Pakistan Institute of Medical Sciences)
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Assessment of Psoriasis Severity Using Psoriasis Area and Severity Index (PASI) and its Association with Lipid Profile Parameters
Full text linkObjective: To explore potential association between specific lipid profile parameters and PASI scores in psoriatic patients at a tertiary care Hospital.
Methodology: A descriptive cross-sectional study was carried out on patients attending the skin outpatient department and the Diagnostic Research Laboratory of the Department of Physiology at Liaquat University of Medical & Health Sciences Jamshoro/Hyderabad, from February to August 2022. Diagnosed patients of Psoriasis between 18 and 50 years, male and female were included. A 5ml blood sample was taken from each participant in fasting and the samples were used to perform a lipid profile analysis. All financial costs related to the investigations were covered by the researchers.
Results: The average age of patients with psoriasis was 45.99±10.33 (range 18-60 years). Out of the total 102 patients, 76 (74.5%) were male patients and 26 (25.5%) were female. The mean duration of psoriasis was 6.46 ± 4.49 years. For total cholesterol, 60 patients (58.8%) had increased levels > 200 mg/dL, in 68 patients (66.7%) low-density lipoprotein (LDL), increased levels > 130 mg/dL, in terms of high-density lipoprotein (HDL), in (57.8%) patients it was <40 mg/dL, while for triglycerides, in (87.3%) patients had increased levels > 150 mg/dL. Patients with moderate and severe psoriasis exhibited higher rates of abnormal lipid profiles compared to those with mild psoriasis. Significant p-values were found for total cholesterol, LDL, and HDL levels, indicating associations with psoriasis severity. However, triglyceride levels showed no significant difference across the severity groups.
Conclusion: This study revealed elevated lipid profiles among psoriatic patients, potentially contributing to lipid profile abnormalities. The high frequency of dyslipidemia observed is closely linked to the severity of psoriasis
Susceptibility Profiles of Isolated Bacteria from Pneumonia Patients in Medical ICU
Full text linkObjective: To determine the susceptibility profiles of isolated bacteria from pneumonia patients in medical ICU.
Methodology: This cross-section observational study was conducted in the Medical ICU of Pakistan Ordinance Factories (POF) Hospital, Wah Cantt, Pakistan, between February and July 2023. The study included 100 patients aged ? 18 years, presented with severe symptoms of lower respiratory tract and exhibited bacterial growth. The patients’ samples were collected from sputum, blood, tracheal secretions, bronchoalveolar lavage, and sent to hospital laboratory for sensitivity and culture analysis. Following overnight incubation, the agar plates were examined for bacterial growth and colonial morphology.
Results: Among 100 patients, 48% were female and 52% male. The mean age of the patients was 58.6±14.5 years. 75% of patients were discharged from ICU, while 25% died. Sputum specimens were collected from 60% of patients, blood specimens from 21% of patients, tracheal secretions from 10% of patients, and bronchoalveolar lavage from 9% of patients. 30% tested positive for Klebsiella pneumoniae, and Acinetobacter baumannii. Pseudomonas aeruginosa was detected in 20% of patients, while E. coli was found in 7% of patients. Among gram-positive bacteria, 6% of patients tested positive for Staphylococcus aureus, 3% for MRCONS, 2% for MRSA, and 2% for coagulase-negative staphylococcal organisms.
Conclusion: Significant levels of antibiotic resistance observed in isolates of gram-negative and gram-positive bacteria. The presence of increased resistance to multiple antibiotics indicates a high incidence of multidrug-resistant gram-positive and gram-negative organisms
Predictive Role of Total and Lipid Bound Sialic Acid in Oral Precancerous Condition
Full text linkObjective: To determine the role of total sialic acid (TSA) and lipid bound sialic acid (LBSA) as the early predictors / indicators of oral cancer and precancerous in study subjects.
Methodology: A cross-sectional study was conducted at the Department of Biochemistry, Basic Medical Sciences Institute, in collaboration with the clinical oncology ward of Jinnah Postgraduate Medical Centre, Karachi from June 2019 to December 2019. Participants were categorized into three groups: oral cancer (Group A), oral precancer (Group B), and healthy controls (Group C). Blood samples (8 ml) were collected for biochemical analysis of TSA and LBSA levels. Serum proteins were measured using the Biuret reaction method, while TSA and LBSA were quantified via a colorimetric method involving sialic acid's reaction with resorcinol, producing a pink chromosphere measured at 580 nm using a spectrophotometer. Statistical analysis was performed using SPSS.
Results: In the Pre-cancer group, TSA levels were significantly higher (78.7 ± 16.62 mg/dl) compared to the Control group (60.2 ± 4.27 mg/dl), (p-0.001). Similarly, LBSA levels were also elevated in the Pre-cancer group (22.7 ± 2.06 mg/dl) compared to Controls (19.8 ± 3.18 mg/dl), (p-0.001). The TP levels were markedly higher in the Pre-cancer group (11.3 ± 2.37 g/dl) compared to the Control group (6.2 ± 0.61 g/dl), (p-0.001). Conversely, the TSA/TP ratio was lower in the Pre-cancer group (7.4 ± 2.72) compared to Controls (9.6 ± 1.26), (p- 0.001).
Conclusion: The TSA and LBSA levels were observed significantly elevated in the pre-cancer group, while the TSA/TP ratio was notably lower and the findings indicating that the TSA and LBSA may serve as potential biomarkers for the early detection of oral pre-cancerous conditions, highlighting their predictive role in the progression towards oral cancer
Diagnosis of Bone Erosion in Patients of Allergic Fungal Rhinosinusitis on Computerized Tomography Scan
Full text linkObjective:To determine the frequency of bone erosion on computerized tomography (CT) scans in patients with allergic fungal Rhinosinusitis in Pakistan.
Methodology: A Prospective observational study was conducted at ENT department of Pak Fazaia Medical College PAF Hospital, Islamabad City, from Feb 2023 to Jan 2024.A total of 125 patients diagnosed with Allergic Fungal Rhinosinusitis according to Bent and Swain criteria were enrolled. Patients were then categorized based on the extent and site of bone erosion. SPSS version 27 selected for data analysis, after initial calculation of mean and standard deviations or frequency percentages test of significance (chi square test for categorical variables and t-test for numerical variables) was applied. P values ?0.05 was taken as significant.
Results:Out of 47 bone erosion patients, 51.1% patients had mild, 19.1% had moderate and 29.8% patients had severe level of disease. The distribution of site and subsite in bone erosion patients were shown in table. II. Ethmoid was seen in 27.7% patients, frontal was seen in 17.0% patients, sphenoid was seen in 25.5% patients, andmaxillay was seen in 29.8% patients.
Conclusion: Allergic Fungal Rhinosinusitis often leads to significant bone erosion, which can be effectively detected through a CT scan. The maxillary sinus is the most commonly affected site among the paranasal sinuses
Trichoscopy as a Useful Tool to Diagnose Telogen Effluvium
No full textObjective: To determine the efficacy of Trichoscopy in diagnosing telogen effluvium (TE) at a tertiary care Hospital.
Methodology: This cross-sectional study was conducted in Dermatology department, PNS Shifa Hospital, Karachi from December 2022 to May 2023. Overall 100 individuals with clinically confirmed telogen effluvium of either gender were included. Individuals with TE underwent trichoscopic imaging of the frontal, vertex, temporal, and occipital scalp using the HEINE DELTA 20T dermoscope without liquid media. High-resolution images and videos were captured and independently evaluated by two expert dermatologists to ensure diagnostic utility. The SPSS version 26 statistical analysis program was used for data entry and analysis.
Results: The mean age of the patients was 32.7 ± 8.4 years, with mean disease duration of 4 ± 2 months. Among the 100 patients, 47 (47%) were men, and 53 (53%) were women. Perifollicular scaling (95%) was the most frequent trichoscopic finding in our study, followed by hair diameter diversity (48%), vellus hair (42%), perifollicular pigmentation (33%), and yellow spots and scalp discoloration (27%). Trichoscopic findings in telogen effluvium showed significant differences between frontal and occipital regions. Vellus hair, HDD, yellow dots, perifollicular pigmentation and Perifollicular scaling were significantly more common in the frontal area, while scalp discoloration was significantly higher in the occipital region (p=<0.05).
Conclusion: Trichoscopy has proven to be an effective, non-invasive diagnostic tool for identifying telogen effluvium. Comparing trichoscopic findings between the frontal and occipital regions helps differentiate telogen effluvium from androgenetic alopecia, enabling early and accurate diagnosis while minimizing the need for invasive procedures
Comparative Study of Clinical Profile of Patients with Solitary versus Multiple Gall Stone
Full text linkObjective: To compare the clinical profiles of patients with solitary versus multiple gallstones, focusing on symptom distribution and diagnostic findings.
Methodology: This prospective comparative study was conducted in the Department of General Surgery at AIMS Hospital, Muzaffarabad, from July to December 2023. Patients aged ?18 years with newly diagnosed solitary or multiple gallstones confirmed by ultrasound were included. Exclusion criteria were common bile duct stones, previous cholecystectomy, gallbladder malignancy, pregnancy, and incomplete records. Patients were grouped as solitary or multiple gallstones based on imaging. Demographic data, clinical presentation, and associated features were documented using a structured proforma. Statistical analysis was performed using chi-square tests, with p <0.05 considered significant.
Results: Among 58 patients, 34 (58.6%) had solitary gallstones and 24 (41.4%) had multiple. The mean age was 46.2 ±13.3 years; females predominated (82.8%). Most patients were symptomatic (93.1%). Common symptoms included upper abdominal pain (86.2%), nausea/vomiting (89.7%), right shoulder pain (65.5%), and back pain (60.3%). Jaundice was rare (8.6%). Comparative analysis revealed no statistically significant differences in individual symptoms between groups (p >0.05). However, severe pain was significantly more frequent in solitary stone patients (37.9%) compared to multiple stones (12.1%) (p =0.035).
Conclusion: Both solitary and multiple gallstones commonly present with similar symptoms such as abdominal pain and nausea. However, solitary gallstones were associated with a higher prevalence of severe pain. These findings emphasize the need for individualized assessment in gallstone management
Serum Magnesium Level According To Severity of Hepatic Encephalopathy among Chronic Liver Disease Patients
Full text linkObjective: To determine the mean serum magnesium levels in patients with chronic liver disease (CLD) and its association with severity of hepatic encephalopathy (HE).
Methodology: This cross-sectional study was conducted over six months, from October 2, 2020, to April 1, 2021, in Medicine department of Liaquat University Hospital, Hyderabad/Jamshoro. A total of 65 known cases of chronic liver disease with hepatic encephalopathy, of various ages and both genders, were included in the study. Serum magnesium levels were measured, and their association with grades of hepatic encephalopathy was analyzed using appropriate statistical tests. Data entry and analysis were performed using SPSS version 21.
Results: Mean serum magnesium level for the entire sample was 1.10?±?0.51 mg/dL. Most participants (37%) were between 40 and 59 years of age and males were predominant, 61.5%. Most of the patients had moderate to severe hepatic encephalopathy, with Grade III (35.4%) being the most common, followed by Grade IV (26.2%). Hypomagnesemia was identified in 67.9% of the patients. No difference was observed in magnesium levels between patients with mild (Grade I-II) and severe (Grade III-IV) hepatic encephalopathy, as both groups had the same average level of 1.10 mg/dL (p > 0.99). Additionally, there was no significant impact of age, gender, or duration of disease on magnesium levels among CLD patients (p > 0.05).
Conclusion: Hypomagnesemia was observed to be highly prevalent (67.9%) among patients of CLD, with no significant difference in serum magnesium levels across different grades of hepatic encephalopathy
Addressing Workplace Violence: An Examination of Existing Policies, Measures, and Response Strategies
Full text linkObjective: To evaluate existing measures, policies to deal with WPV events at a tertiary care hospital.
Methodology: This cross-sectional study was conducted at Nishtar Hospital Multan from June-August 2019on 164-universally sampled-healthcare employees of an emergency department, after taking ethical approval and participants' informed consent.
Results: There were 164 healthcare personnel; 67 of them were women and 97 were men. Approximately one-third of the participants said that action was taken by the management/employer to investigate the causes of incidence they faced. Thirty-five percent HCW’s reported that their employer or supervisor offer to provide with the counselling and an opportunity to speak about/report it. All the HCW’s were of the view that their employer developed specific policies on health & safety, physical WPV. All HCW’s reported that security measures, staff trainings and investment in human resource development existed as measures to dealt with WPV events.
Conclusion: Security measures, staff trainings existed as measures to dealt with WPV events. Specific policies on health, safety, physical WPV, verbal abuse & harassment also existed but needs to be firmly implemented. Educational programs & awareness by media are required for HCWs, patients, as well as their relatives