Annals of PIMS (Pakistan Institute of Medical Sciences)
Not a member yet
815 research outputs found
Sort by
Comparison of treatment outcomes in childhood pneumonia with or without rickets Introduction
No full textObjective: To compare the treatment outcomes among children with pneumonia with or withoutrickets presentation.Methods: This comparative study was conducted on 190 children diagnosed with pneumonia,who were divided into two equal groups: 95 children with rickets and 95 without rickets. Studywas done at Department of Pediatric Medicine, Recep Tayyip Erdogan Hospital Muzaffargarh.The rickets was diagnosed based on clinical features and radiological and biochemical findings.Patients received standard pneumonia management according to institutional guidelines.Treatment outcomes were assessed in terms of duration of fever, need for oxygen therapy, lengthof hospital stay, and treatment failure, across the groups. Data were analyzed using appropriatestatistical tests, and a p-value < 0.05 was considered statistically significant.Results: Paediatric patients with rickets showed a significantly longer duration of fever(p=0.001) and prolonged stay in Hospital stay p=0.001 compared to non-rickets patients. Failureof treatment was more frequent in the rickets group (22.1 % vs 9.5 %) p = 0.018. The severepneumonia and oxygen requirement were significantly higher in children with rickets in contrastto non-rickets patients (31.6 % vs 15.8 %) and (48.4 % vs 27.4 %), p= 0.004 respectively.Average clinical recovery time was also significantly delayed in children with rickets.Additionally, the rate of complications also being significantly higher among children withrickets, while the mortality rate was low and almost similar across the p=0.05).Conclusion: The childhood pneumonia with rickets was observed with significantly poortreatment outcomes, and these patients required more intensive supportive care and showedhigher rates of treatment failure compared to those without rickets.Key words: Pneumonia, Rickets, Children, Treatment failure, Mortalit
Incidence and Outcomes of Renal Derangements in Covid-19 Patients of a Tertiary Care Hospital
Full text linkObjective: To assess the incidence and outcomes of acute kidney injury in patients diagnosed with Covid-19.
Methodology: This cross-sectional study was carried out in the department of medicine, Shaikh Khalifa Bin Zayed Al Nahyan Hospital/CMH, Rawalakot, AJK, Pakistan from May 2021 to May 2023. Total 676 patients (ages ? 18 years) admitted with Covid-19 confirmed through polymerase chain reaction (PCR) having normal renal function tests (RFTs) at admission were included in the study. RFTs were done during admission and patients were followed up for outcome. The kidney disease improving global outcome (KDIGO) staging system was employed to classify the stages of acute kidney injury (AKI). The Clinical Progression Scale (CPS) of WHO, which rates the severity of Covid-19 outcomes from 0 (uninfected) to 10 (death), was utilized.
Results: Patients mean age was 56.1±16.1 years. Among 676 patients, 350 (51.8%) developed AKI. According to clinical progression scale, only 2 (0.3%) patients were uninfected, 540 (79.8%) experienced mild symptoms, 98 (14.5%) were of moderate symptoms, 12 (1.8%) suffered from severe symptoms and 24 (3.6%) were dead. Comprises stage 1 (46%), stage 2 (27.4%) and stage 3 were (26.5%). Among the patients of AKI, 326 (93.1%) were discharged from hospital on home medication and 24 (6.9%) patients died (p < 0.05).
Conclusion: Acute kidney injury develops commonly in patients of Covid-19. AKI need to be managed effectively to prevent worst future outcomes
Beta 2 Adrenoceptor Polymorphism and Response to Salbutamol in Asthmatics of Punjabi Origin in Islamabad
Full text linkObjectives: To associate single nucleotide polymorphism of adrenoceptor beta2 gene (Arg16Gly rs 1042713) with bronchial asthma in patients of Punjabi ethnicity in Islamabad and to compare pharmacogenetic aspect by salbutamol responsiveness in asthmatics with and without single nucleotide polymorphism of adrenoceptor beta2 gene (Arg16Gly rs 1042713).
Methodology: This cross-sectional study was conducted in Physiology department of Al-Nafees Medical College & Hospital Islamabad in collaboration with Islamabad Diagnostic Center and COMSATS University Islamabad from January 2021 to June 2022. A total of 289 asthmatics and 289 non-asthmatics were enrolled. Genotype was done by Restriction Fragment Length Polymorphism-Polymerase Chain Reaction (RFLP-PCR) method. Salbutamol responsiveness was done based on symptomatic improvement by bronchial Asthma Control Test (ACT) of Global Initiative for Asthma (GINA).
Results: Risk estimation calculations between asthmatics and non-asthmatics showed no association with polymorphism as depicted by nonsignificant chi square p value (0.9), odds ratio (95% confidence interval); OR (CI); 0.98 (0.70-1.33) and chi square p value (0.8), OR (CI); 1.0 (0.71-1.51) in dominant and recessive model respectively. Salbutamol responsiveness revealed strong association with AA genotype as reflected by highly significant chi square p value 0.0001, OR (CI); 7.5 (4.1-13.7) between AA vs AG and chi square p value 0.0001, OR (CI); 8.4 (4.2-16.8) between AA vs GG respectively.
Conclusions: There was no evidence of association of single nucleotide polymorphism of adrenoceptor beta2 gene (Arg16Gly rs 1042713) with bronchial asthma in Punjabi ethnics of Islamabad. Comparison of salbutamol responsiveness revealed AA homozygotes better responders than AG and GG carriers
Assessment of Drug Toxicity and Mortality in Children with Classical Hodgkin Lymphoma on ABVD/COPDAC Protocol – A Single Centre Study
Full text linkObjective: To assess the frequency of drug toxicity and mortality associated with ABVD/COPDAC protocol in children with classical Hodgkin Lymphoma at IHHN, Karachi.
Methodology: A prospective observational study was conducted over six months at the pediatric Oncology Unit of IHHN, Karachi, from April 2023 to September 2023, involving patients less than 16 years diagnosed with classical Hodgkin’s lymphoma and with normal cardiac function on echocardiography. The NCI Common Terminology Criteria for Adverse Events (CTCAE) was used to report toxicity and adverse effects. Toxicity was assessed over a total of eight chemotherapy cycles, and the total numbers of chemotherapy cycles assigned were based on the stage of the disease and the treatment group. Data was analyzed using SPSS version 26.
Results: 152 patients with Classical Hodgkin Lymphoma (mean age 9.45±3.43 years, male predominance 80.3%), toxicity was assessed over eight treatment cycles. In Cycle I, 5.9% had neutropenia, while 91.4% had no toxicity. In Cycle II, neutropenia was observed in 19.1%, with 76.3% reporting no toxicity. Cycle III showed 9.2% with neutropenia and 90.8% without toxicity, while Cycle IV recorded 12.5% with neutropenia and 83.6% without toxicity. Across Cycles V-VIII, neutropenia ranged from 5.3% to 14.5%, with 83.6% to 94.1% experiencing no toxicity. Cardiotoxicity and other severe toxicities were rare throughout all cycles. The overall mortality rate was low at 1.3%, with a 98.7% survival rate.
Conclusion: Study revealed varying levels of toxicity basis on treatment cycles and the overall mortality rate was low at 1.3%, with survival arte as 98.7%. Toxicity and mortality rates were statistically insignificant across the treatment groups, indicating that the ABVD/COPDAC protocol is generally safe and effective for this patient population
Umbilical Cord PRP Is Better in Relieving Pain in Patients of Knee Osteoarthritis as Compared to Autologous Venous PRP
Full text linkObjective: To evaluate the effectiveness of umbilical cord blood platelet-rich plasma (CB-PRP) and autologous venous platelet-rich plasma (A-PRP) in the pain relief and knee functional improvement for patients with early-stage knee osteoarthritis (OA).
Methodology: This observational study carried out in the Anesthesia Department of a CDA Hospital , a tertiary care hospital in Islamabad. Sixty patients with Kellgren-Lawrence Grade 1–2 knee OA were randomized into 2 groups with 30 patients in each group, in the CB-PRP and A-PRP group. Aseptically injected PRP into the joint. Outcomes included the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline, 4 weeks, 12 weeks, and 24 weeks. The analysis was done by SPSS statistical software (version 26). We considered p-value < 0.05 as statistically significant.
Results: CB-PRP displayed significant improvement on VAS scores at all follow-ups compared with A-PRP (weeks 4: 3.69 ± 0.87 vs. 6.31 ±1.03 p < 0.001). KOOS scores at 24 weeks were also greater in the CB-PRP compared to the placebo group (75.12 ± 6.76 vs. 62.34 ± 7.12; p < 0.001). There was a steady improvement in WOMAC scores in both groups of patients, and a significant difference in favor of CB-PRP was found at 24 weeks (2.44 ± 0.73 vs 3.00 ± 0.71, p = 0.040). There were no significant adverse events.
Conclusion: CB-PRP was more effective than A-PRP in pain reduction and functional improvement total scores in early knee OA
Diagnostic Outcomes of ERCP in a Cohort of 56 Patients: A Clinical Observational Study
No full textObjectives: Cytogenetic abnormalities significantly impact the prognosis of patients with chronic lymphocytic leukemia (CLL). Among these, deletion 13q14.3 is the most frequent abnormality detected by fluorescence in situ hybridization (FISH). This mutation is associated with a better prognosis. This study aimed to evaluate the frequency and prognostic significance of this mutation in the Pakistani population.
Materials and Methods: This retrospective study was conducted at Aga Khan University Hospital, Karachi, Pakistan, from January 2015 to December 2022. Hematological parameters and FISH data were obtained from the hospital’s electronic medical records. Progression-free survival (PFS) and overall survival (OS) were analyzed using Kaplan-Meier analysis, and the impact of FISH-detected mutations on the prognosis and outcomes of patients with CLL was evaluated.
Results: The most common mutations identified in the sample were deletion 13q14.3 (27%, n=28 out of 150), deletion 11q22 (13%, n=10), trisomy 12 (7%, n=6), and TP53 mutations (6%, n=4). Notably, 47% (n=99) of patients had no detectable mutations on FISH. Patients with the deletion 13q14.3 mutation exhibited a higher mean PFS (128.9 months, 95% CI: 114.4–143.5) compared to the overall patient cohort (68.1 months, 95% CI: 31.5–68.4). Additionally, these patients had a longer mean OS (127.0 months, 95% CI: 112–141) compared to the overall sample (67.0 months, 95% CI: 44.9–73.6).
Conclusion: This study demonstrates that deletion 13q14.3 is the most common cytogenetic abnormality in Pakistani patients with CLL and is associated with a better prognosis, as evidenced by significantly improved progression-free and overall survival
Changes in Central Corneal Thickness & Intraocular Pressure after Phacoemulsification
Full text linkObjective: To determine the deviations in central corneal thickness (CCT) and intraocular pressure (IOP) after phacoemulsification.
Methodology: A descriptive observational study performed at the Institute of Ophthalmology, Liaquat University Medical & Health Science (LUMHS) Jamshoro from March to September 2022. Patients aged 45 years and above, of either gender, diagnosed with senile cataract and undergoing phacoemulsification with intraocular lens (IOL) implantation were included. Surgeries were carried out under local anesthesia using the phacoemulsification technique, followed by IOL implantation. CCT and IOP were measured before and after surgery using a pachymeter and Goldmann applanation tonometer, respectively. Postoperative follow-up were assessed on day 1, week 1, 4th week and at 6th week. All collected data were entered and analyzed using SPSS version 22.
Results: Results shows that there is 7.42% enhancement occurred in CCT on first day of surgery as compared to pre-operative mean reading, which also impacted on IOP readings that increased by 6.42% from pre-operative day. But these readings adjusted gradually. The results and findings of the research study exposed that there is not significant change occurred after surgery in CCT and IOP. Only at 1st day of surgery CCT increased due to surgical intervention due to which IOP reading is also found high and it must not be preserved until the central corneal thickness is also considered.
Conclusion: Both CCT and IOP temporarily increase after phacoemulsification, showing the most pronounced rise on the first postoperative day, but gradually stabilize with significant improvement by the first week and near-complete return to baseline by the sixth week
Association of Acne Vulgaris with mental health and quality of life among Acne Vulgaris patients
Full text linkObjectives: To determine the level of anxiety (HADS-A) and depression (HADS-D) and to find out association of mental health and Quality of life among acne vulgaris patients.
Methodology: It was a comparative cross-sectional study conducted in Dermatology OPD of PIMS Islamabad from January to June 2025, in which age and gender matched cases and controls were enrolled from through non-probability purposive sampling. Those who were diagnosed with acne vulgaris were considered as cases (Group A), while those who were not diagnosed with acne vulgaris or any skin disease (e.g. patient attendants accompanying the patients) were considered as healthy controls (Group B). Study participants filled the anxiety (HADS-A), depression (HADS-D). Quality of Life (DLQI) questionnaires and Global Acne Grading System (GAGS) score were measured for cases. Descriptive and inferential statistics was applied using SPSS v26.
Results: This study included a total of 153 male participants (cases=70; controls=83) with the mean age of 20.6±3.9 years. Mean GAGS score amongst cases was 21.3±7.3 and mean total DLQI score of cases was 6.15±4.9. Correspondingly, mean HADS-A and HADS-D score among all the participants was 4.36±4.4 and 4.45±3.9 respectively. HADS-A and HADS-D mean scores are slightly higher in cases (i.e. 4.7 and 4.9 respectively) (p>0.05). DLQI showed positive correlation (r=0.50) with HADS-D and HADS-A (p<0.001). Mostly moderate to severe acne patient had higher DLQI but very severe acne had relatively milder effect on DLQI. Consecutively, highest GAGS score was observed in patients with higher duration of acne.
Conclusions: Our study concluded that acne does not cause any significant mental health issue including anxiety and depression. No association of acne vulgaris with mental health issues and QoL is reported in our study. Furthermore, advance longitudinal studies are required which should include female population and larger sample size
Effects of Preoperative Administration of Dexamethasone on Postoperative Pain in Patients Undergoing Laparoscopic Cholecystectomy
Full text linkObjective: To determine the effect of single dose administration of dexamethasone on post-operative pain in patients undergoing laparoscopic cholecystectomy.
Methodology: This randomized control trial was conducted at PAF Hospital Islamabad from January 2023 till June 2023. Ninety-two patients of both genders underwent laparoscopic cholecystectomy and were randomly assigned to two groups. Group A was given 8 mg dexamethasone (dissolved in 100ml 0.9% isotonic normal saline) intravenously 30 minutes before induction of anaesthesia (n=46). Group B patients received 100ml 0.9% normal saline only (n=46). Episodes of pain were recorded using VAS (visual analogue scale) at baseline, 1 hour, 3 hours, 6 hours, 12 hours and 24 hours post-anaesthesia.
Results: Age range in this study was from 20 to 60 years. Out of 92 patients, 51 were males and 41 were females with male to female ratio of 1.2:1. VAS was 5.17 ± 1.10 in group A and 5.02 ± 1.14 in group B at baseline, 4.87 ± 0.86 in group A and 4.85 ± 0.87 in group B at 1 hours, 3.46 ± 1.00 in group A and 4.65 ± 0.74 in group B at 3 hours, 2.93 ± 0.95 in group A and 4.50 ± 0.78 in group B at 6 hours, 3.11 ± 0.77 in group A and 4.50 ± 1.09 in group B at 12 hours. VAS score of Group A were lower (2.41 ± 1.39) than that of Group B (4.61 ± 0.77) at 24 hours.
Conclusion: Single dose of dexamethasone at the time of induction of anaesthesia significantly decrease the pain in 24 hours of laparoscopic cholecystectomy
Comparison of Preoperative Temporal Bone High-Resolution CT with Intraoperative Findings in Patients with Cholesteatoma
No full textObjective: To evaluate the use of a preoperative HRCT temporal bone for determining the amount and involvement of neighboring tissues by Cholesteatoma.
Methodology: This cross sectional validation study was conducted at the department of Radiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from 1st July 2023 to 31st December 2023. The study pertains 40 suspected patients of middle ear cholesteatoma, included through consecutive sampling. The preoperative examination was bilateral temporal bone HRCT imaging, followed by intraoperative findings. For statistical significance, both findings were compared. Severity of the disease was also assessed through disease severity assessment index. SPSS v25 software was used for statistical analysis. P-value <0.05 was considered significant.
Results: The average age of 40 cases of cholesteatoma was 36.73±18.22 years. The male to female ratio in the study was 2:3. We observed 16 different findings in our study and the results showed that HRCT results are associated with intraoperative findings against all structures with p value 0.000. The sensitivity specificity analysis showed that HRCT gives an unconfirmed results with a very low sensitivity for detecting facial canal erosion, tegmen erosion, LSCC erosion and sinus tympani and facial recess involvement.
Conclusion: HRCT temporal bone scan clearly demarcates soft tissue density in the middle ear and mastoid with surrounding bone erosions, as well as anatomical differences. We concluded that HRCT is a helping tool for detecting the involvement of neighboring tissues by cholesteatoma