Annals of PIMS (Pakistan Institute of Medical Sciences)
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Frequency of Causes of Unconjugated Hyperbilirubinemia Leading to Exchange Transfusion
Full text linkObjectives: To determine the frequency of various causes of neonatal hyperbilirubinemia requiring exchange transfusion.
Methodology: This descriptive cross-sectional study was conducted from November 20, 2022, to May 19, 2023. in the Department of Pediatric Medicine at the Pakistan Institute of Medical Sciences (PIMS), Islamabad. A total of 110 neonates of either gender, requiring exchange transfusion due to unconjugated hyperbilirubinemia, were included. Inclusion criteria were neonates diagnosed with unconjugated hyperbilirubinemia based on clinical evaluation and laboratory findings. Neonates who had previously received phototherapy or had conjugated hyperbilirubinemia were excluded.
Informed consent was obtained from parents or guardians prior to enrollment. Comprehensive demographic and clinical data, including birth weight, gestational age, gender, and mode of delivery, were collected. The principal investigator assessed each neonate to identify the underlying cause of hyperbilirubinemia, which included isoimmune hemolysis, ABO incompatibility, Rh incompatibility, and other possible etiologies. Assessment involved clinical examination, review of laboratory results, and interpretation of blood group compatibility between mother and newborn. All findings were documented on a structured proforma specifically designed for the study.
Results: The mean gestational age was 37.59 ± 1.74 weeks (Table I). Of the 110 neonates, 73 (66.36%) were male and 37 (33.64%) were female, with a male-to-female ratio of 1.9:1. Among the identified causes of hyperbilirubinemia, Rh incompatibility was the most frequent, observed in 55 (55.0%) cases, followed by ABO incompatibility in 45 (40.90%) cases. Isoimmune hemolysis and other causes accounted for 5 (4.55%) cases each.
Conclusion: Rh incompatibility was found to be the most common cause of neonatal jaundice requiring exchange transfusion, followed by ABO incompatibility and isoimmune hemolysis.
Keywords: Neonatal, Jaundice, Hemolysis, Bilirubin, ABO incompatibility
Antenatal and Intrapartum Risk Factors Associated with Birth Asphyxia in Term Babies
Full text linkObjective: To determine antenatal and intrapartum risk factors associated with birth asphyxia in term babies.
Methodology: This cross-sectional study was conducted in Department of Obstetrics and Gynecology, Unit II, Foundation University Islamabad from Feb 2024 to July 2024. According to the estimated frequency of birth asphyxia, which ranged from 30.5% to 40% or higher case fatality rates with a 5% margin of error and a 95% confidence range, the WHO calculation yielded a sample size of 326 individuals.9 SPSS version II was used for data analysis. Chi square tests were used to determine the frequency and percentages.
Results: The study comprised 326 mothers who were pregnant at term. Maternal ages ranged from 18 to 35 years old, with an average age of 29.4 ± 5.1. 23.9% (n = 78) of the mothers were older than 35, whereas the majority (76.1%, n = 248) were between the ages of 18 and 35. Over half were primigravida (54.0%, n = 176), while 46.0% (n = 150) were multigravida, according to parity analysis. In terms of fetal characteristics, 47.2% (n = 154) of the newborns were female, while 52.8% (n = 172) were male. Therefore, efforts should be made to raise the standard of services related to prenatal and postpartum risk factors.
Conclusion: The present study identifies several important risk factors for birth asphyxia, many of which can be changed by optimizing prenatal and postpartum care. Lowering asphyxia rates and improving newborn outcomes need interventions that focus on maternal anemia, glycemic management, and attentive intrapartum surveillance (particularly for meconium, fetal distress, and placental problems)
A Comparative Study Between Stapler Versus Handsewn Anastomosis in Gastrointestinal Surgery
Full text linkObjective: To contrast outcome of hand-sewn and stapler anastomosis in gastro intestinal surgeries in terms of ‘time required for anastomoses, postoperative complications and Hospital stay.
Methodology: This comparative study was done at Surgical Unit-II, LUH, Jamshoro, on patients aged >18 years, who underwent gastro intestinal surgery scheduled for elective and emergency stapler or hand-sewn anastomosis, of either gender. After diagnosis the patients were randomly selected for both groups Stapler Anastomosis (group A) and hand-sewn Anastomosis (group B). Patients were assessed for time taken during anastomosis, postoperative complications, operative time and post-operative hospital stay. All the data was entered and analyzed by SPSS version 23.
Results: Mean age of cases in stapler anastomosis was 35.74±16.4 years and in hand-sewn Anastomosis was 31.62±14.96 years. Mean operative time in stapler anastomosis was significantly less compared to hand-sewn Anastomosis 35.35±5.34 hours and 60.31±10.29 hours respectively, (P-0.001). Hand–sewn anastomosis gained significantly longer time than stapler anastomosis, 27.10±5.95 minutes and 3.73±1.86 minutes respectively, (P- 0.001). Additionally, postoperative complications were higher among hand-sewn group, as; 17 wound infection cases and 3 anastomosis leakage in stapler anastomosis group, and 22 cases of wound infection, 6 cases of anastomosis leakage, and 3 abdominal abscess cases were in hand-sewn anastomosis group. Subsequently the Hospital stay was significantly higher among hand-sewn group as 10.76±2.24 days as compare to stapler anastomosis 5.58±1.36 days, (P-0.043).
Conclusion: The stapler anastomosis concluded to be a safe, reliable, and adaptable surgical tool, with shorter operative time, decreased complications rate and shorter Hospital stay in contrast to handsewn anastomosis
Effect of Patient Position during Spinal Anesthesia on the Incidence of Post-Dural Puncture Headache after Cesarean Section
Full text linkObjective: To compare the incidence of post-dural puncture headache (PDPH) following spinal anesthesia in parturients undergoing elective cesarean section between the sitting and left lateral decubitus positions.
Methodology: This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, Pakistan, from May 2022 to October 2022. A total of 120 parturients undergoing elective cesarean section under spinal anesthesia were randomly assigned to either the sitting or left lateral decubitus position group. The primary outcome was the occurrence of PDPH within 5 days postoperatively. Secondary outcomes included adverse effects such as hypotension, nausea/vomiting, and bradycardia. Data were analyzed using SPSS version 25.0. Categorical variables were compared using the chi-square test or Fisher's exact test, as appropriate, with a significance level set at p < 0.05.
Results: The incidence of PDPH post-procedure was significantly higher in the sitting group compared to the left lateral decubitus group (33.3% vs. 6.7%). In the sitting position group, 63.3% of women experienced hypotension, 26.7% had bradycardia, and 30.0% reported nausea/vomiting, whereas in the left lateral decubitus group, these figures were 58.3%, 21.7%, and 23.3%, respectively.
Conclusion: This study concludes that the left lateral decubitus position during spinal anesthesia for cesarean section is associated with a lower incidence of PDPH compared to the sitting position
Cord Blood Albumin; A Predictor of Neonatal Jaundice
Full text linkObjective: To determine significance of cord blood albumin as predictor of neonatal hyperbilirubinemia.
Methodology: This cross-sectional was conducted in 6 months from 24-4-2021 to 23-9-2021 at Department of neonatology, Recep Tayyip Erdogan Hospital, Muzaffargarh. Early preterm, late preterm and term neonates, age less than 1 week were included in the study. Patients were divided in three groups on basis of gestational age. Group 1 was included early preterm; group 2 was included late preterm and group 3 was including term neonates. Cord blood samples were taken in sterile vials for serum albumin at birth. Patients were followed from 2nd to 7th day of life for development of jaundice. Patients who had transcutaneous bilirubin more than 5mg/dl were selected for serum bilirubin level estimation.
Results: A total of 73 newborn babies were studied; with an average age of approximately 4.94+1.68 days. There were 52.1% male and 47.9% female babies. There were no significant differences in average blood cord albumin and direct bilirubin levels among these groups. However, significant variations were observed in terms of total bilirubin and indirect bilirubin levels, with early and late preterm babies displaying higher levels compared to term babies. Moreover, the study established significant inverse correlations between cord blood albumin levels and both total bilirubin (r ? -0.389, p = 0.001) and indirect bilirubin levels (r ? -0.313, p = 0.007).
Conclusion: Study provides compelling evidence to support the role of cord blood albumin as a predictor of neonatal jaundice through its observed inverse correlations with bilirubin levels. The findings underscore the potential clinical utility of cord blood albumin as an early diagnostic marker for identifying newborns at risk of developing jaundice
Nutritional Status of Epileptic Children in Rawalpindi, Pakistan; A Cross-Sectional Study
Full text linkObjective: To assess the nutritional status of epileptic children treated at the Pediatric Clinic, to underline a relationship between food intake and disease prevalence.
Methodology: A cross-sectional study was conducted from July to December 2021, involving 240 children aged 2-10 years diagnosed with epilepsy. Data were collected using a 24-hour diet recall method and a food frequency questionnaire. Demographic and clinical characteristics were measured using validated tools, and nutritional status was assessed using the CDC growth chart. Descriptive and inferential analyses were performed using SPSS 22.
Results: Of the 240 children, 55% were under 5 years old, and 58% were male. The mean age was 6 years. Malnutrition prevalence was 58%, with 54% undernourished and 4% overnourished. Urban and rural residency was almost evenly split, and 57% of mothers were ?30 years old, with 64% having primary education. Developmental delays were present in 45% of children, and 54% experienced poor seizure control. Dietary habits showed that 57% ate three times a day, 52% did not consume milk, and 73% followed special diets. Daily sunlight exposure exceeded an hour for 79%, and 60% did not take multivitamins regularly. A significant association was found between family history of epilepsy and the prevalence of malnutrition (p < 0.005).
Conclusion: Malnutrition is prevalent among epileptic children in Rawalpindi, with poor dietary intake contributing to undernutrition and increased disease prevalence, particularly in rural areas. Socioeconomic factors, family history, and dietary habits significantly affect the nutritional status of these children. Interventions are needed to improve their health outcomes
Functional & Radiological Outcomes of Knee Joint After Surgical Treatment of Proximal Tibial Fractures With Hybrid External Fixator
Full text linkObjective: To determine the functional and radiological outcomes of the knee joint in Schatzker Type V and VI proximal tibial fractures treated with a hybrid external fixator.
Methodology: This prospective observational study was conducted in the Department of Orthopedic Surgery, Services Hospital Lahore, from September 2018 to April 2020, following approval from the Hospital Ethical Review Board. Adult patients aged 21 to 70 years with Schatzker Type V and VI proximal tibial fractures were included. Patients with polytrauma, associated head or spinal injuries, or previous injuries around the knee joint were excluded. A total of 60 patients (ages 18 to 70 years) with Schatzker Type V (n=40) and Type VI (n=20) fractures were enrolled. Preoperative knee joint X-rays (anteroposterior and lateral views) were performed. A two-ring hybrid external fixator was applied in all cases. Patients were followed for one year postoperatively, and functional and radiological outcomes were assessed using the Rasmussen Score.
Results: At the final follow-up, the functional Rasmussen Score was excellent in 12 patients, good in 45, and fair in 3 patients. The mean time for bony union was 14.2 weeks. Radiological Rasmussen Scores showed excellent results in 24 patients, good in 32, and fair in 4.
Conclusion: The hybrid external fixator is an effective and reliable treatment option for Schatzker Type V and VI fractures, particularly in cases with significant soft tissue damage. It provides favorable functional and radiological outcomes
Frequency of Refractive Error in Patients with Squint
Full text linkObjective: To determine the frequency of refractive errors in patients with squint at a tertiary care Hospital.
Methodology: A cross-sectional study was conducted at the Department of Ophthalmology, Liaquat University Eye Hospital in Hyderabad from May 2020 to October 2020. A total of 128 patients either exotropia or esotropia were included in this study. Auto refraction and Hirschberg reflex test was done. A refractive error of ?+2 was taken as hypermetropia and ? -2 was taken as Myopia. This information was entered in the proforma and analyzed using SPSS version 20.
Results: The average age of the patients was 6.26±3.09 years. There were 73(5.03%) male and 55(42.97%) female. Hypermetropia was observed in 47.66% (61/128) cases while myopia in 11.72% (15/128) cases. Furthermore, the frequency of hypermetropia was found statistically insignificant according to age, gender, types of squint and Hirschberg reflex p-value (>0.05). Frequency of Myopia was found statistically insignificant across age groups, gender-wise and across different angles of the Hirschberg reflex-value (>0.05), while it was statically significant according to types of squint, (p-0.033).
Conclusion: Study revealed that the hypermetropia emerges as the most prevalent refractive error among the children assessed. It underscores the necessity for all these children to undergo cycloplegic refraction, with glasses being identified as the primary treatment approach. Mass screening initiatives are essential aimed at facilitating early identification and treatment of refractive errors
Prevalence of Salmonella Typhi in Bile of the Patients Undergoing Cholecystectomy at a Tertiary Care Hospital Karachi
Full text linkObjective: To estimate the prevalence of salmonella typhi in bile specimens collected from patients undergoing cholecystectomy at a tertiary care Hospital Karachi.
Methodology: The descriptive cross-sectional study, was conducted at Department of Surgical Unit 21, Jinnah Postgraduate Medical Center, Karachi, from January 2021 to June 2021. Patients with symptomatic Cholelithiasis like sudden pain in the upper right portion of your abdomen which radiate towards right shoulder, nausea, vomiting, undergo cholecystectomy of either gender male or female with age 14 to 60 years were included. After open cholecystectomy, bile was aspirated from the gallbladder at fundus in five ml syringe and long spinal needles was used in case of laparoscopic cholecystectomy to collect bile under vision of telescope. Specimens were sent to laboratory according to protocol for culture sensitivity.
Results: A total of 171 patients who met the inclusion and exclusion criteria were included. Mean age of the patients was 49.39±8.78 years. 83 (48.5%) were male and 88 (51.5%) were female. Prevalence of salmonella typhi in bile specimens collected from patients undergoing cholecystectomy, was found 17.54%. Furthermore, the frequency of salmonella isolate was statically insignificant according to the patient’s gender, diabetes and obesity (p=>0.05), while it was statically significant according to age up to 40 years and residence in rural areas (p-<0.05.
Conclusion: A significant proportion of patients were found to have Salmonella in bile from patients undergoing cholecystectomy. Therefore, close monitoring of patients must be done in all patients with regular follow-up
Heart Failure in Young Adults: Exploring the Risk Factors and Quality Of Life
Full text linkObjective: To determine the risk factors and quality of life among patients presented with heart failure.
Methodology: A descriptive cross sectional study was carried out at cardiology department of Ghulam Muhammad Mahar Medical College Sukkur, during six months from June 2023 to December 2023. All the patients aged 18 to 45 years old, diagnosed as the cases of heart failure diagnosis (based on clinical guidelines, including symptoms such as dyspnea, fatigue, and evidence of cardiac dysfunction (e.g., reduced ejection fraction) for at least six months of either gender were included. Demographic information and clinical data were gathered through patient interviews and review of medical records, documenting symptoms, duration of heart failure. Risk factors were assessed by collecting data on lifestyle behaviors, family history and few laboratory investigations. Minnesota Living with Heart Failure Questionnaire (MLHFQ) was used for quality of life. Data were entered and analyzed using SPSS version 26.
Results: A total of 145 patients were studied with overall mean age of 42.43 years. Out of all 61 (59.2%) were males and 42 (40.8%) are females. 30 (29.1%) had overweight, and 7 (6.8%) patients were obese. Of these, 9 patients (8.7%) are diagnosed with right heart failure, 92 (89.3%) had left heart failure, and 2 patients (1.9%) had congestive heart failure. According to the risk factors 50.5% use tobacco, 12.6% consume alcohol, and 32.0% eat processed food. Chronic conditions include hypertension (24.3%), diabetes with hypertension (11.7%), lipid profile abnormalities 35.9%, and 64.1% are exposed to pollution.
Conclusion: Heart failure among young adults is associated with various modifiable risk factors and a considerable impact on quality of life. Despite the high prevalence of adverse conditions, interventions focusing on lifestyle modifications could potentially improve outcomes