Annals of PIMS (Pakistan Institute of Medical Sciences)
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Assessing the Efficacy and Safety of Ivabradine as Adjunctive Therapy in Acute Heart Failure: A Prospective Clinical Trial
Full text linkObjective: To compare the clinical outcome in terms of efficacy and safety of Ivabradine as adjunctive therapy in patients with acute heart failure.
Methods: A prospective clinical trial was conducted involving patients admitted with acute heart failure, who were randomized to receive either standard care alone or standard care with adjunctive Ivabradine therapy. Efficacy endpoints included improvement in symptoms, left ventricular ejection fraction (LVEF), and reduction in heart rate. Safety endpoints encompassed adverse events, including bradycardia and hypotension. Data were collected at baseline, during treatment, and at follow-up visits.
Results: The mean age (67.5 vs. 68.2 years), Gender distribution, mean ejection fraction (35.7 ± 5.2 vs 36.1 ± 4.8), NYHA class, and prevalent comorbidities were comparable between both groups. The mortality rate (10% vs. 15%), and hospital readmissions (20% vs. 30%, p=0.12) showed no significant difference between both groups. The improvement in NYHA class (65% vs. 50%, p=0.04) was significantly (P-value > 0.05) higher in the treatment group. Treatment group demonstrated a significantly greater increase in ejection fraction (mean change 4.8% vs. 2.3%, p<0.001). Clinical outcomes, heart rate reduction, 6-minute walk distance, reduction in NT-proBNP, all-cause mortality and rate of heart failure hospitalizations were found significantly (p-value < 0.05) better in treatment group.
Conclusion: This prospective clinical trial suggests that Ivabradine as adjunctive therapy in acute heart failure is efficacious in improving symptoms and reducing heart rate, with a favorable safety profile. These findings support the consideration of Ivabradine as an adjunctive treatment option in acute heart failure management.
Keywords: Ivabradine, acute heart failure, adjunctive therapy, clinical trial, efficacy, safety
Comparison of Outcome of Septoplasty with and without Intranasal Splintage in Patients Admitted to a Tertiary Care Hospital, Peshawar
Full text linkObjective: To compare outcome of septoplasty with and without intranasal splints in patients admitted in Khyber Teaching Hospital, Peshawar
Methodology: A Randomized controlled trial was done at department of ENT, Khyber Teaching Hospital, Peshawar from 21-01-2020 to 21-07-2020. Patients with diagnosis of symptomatic DNS, aged between 15 to 30 years, both genders and undergoing septoplasty for symptomatic Deviated Nasal Septum for primary surgery were included. Patients were randomly allocated into two groups using a coin toss method. Patients in group A were subjected to intranasal splintage packing while patients of group B were not be subjected to intranasal splintage. Patients in both groups was assessed on the first postoperative day, for degree of pain. Follow-up visits were scheduled after first and third weeks following the surgery. All the data was entered and analyzed in SPSS Version 23.0.
Results: The mean age of the whole sample was 22.7 ± 4.9 years. Average age in the group A was 22.3 ± 4.9 years compared to 23.3 ± 5.0 years (p = 0.271). 60% in group A were males compared to 61.7% in group B (p = 0.852). On follow-up, out of an overall sample of 120, mild, moderate, and severe pain and bleeding were recorded in 35%, 45%, and 20% (pain) and 35%, 30%, and 35% (bleeding), respectively. In group A, 30% had mild pain compared to 40% in B group (p = 0.467), 50% in A group had mild bleeding compared to 20% in B group (p = 0.002), 30% in A group developed crusting compared to 20% in the B group (p = 0.206), and 20% in the A group had synechiae compared to 10% in the B group (p = 0.125).
Conclusion: The outcome of septoplasty with splints not observed significantly differ from septoplasty without splints, except in the case of postoperative bleeding
Effectiveness of Leucodepletion Filters in Reducing Adverse Transfusion Reactions in Multi-Transfused Beta Thalassaemia Major Patients
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Outcomes of Primary Percutaneous Coronary Intervention (PCI) in ST-Segment Elevation Myocardial Infarction (STEMI) Patients with Cardiogenic Shock
Full text linkObjective: To assess the effects of primary percutaneous coronary intervention (PCI) in patients who had cardiogenic shock complicating an ST-segment elevation myocardial infarction (STEMI).
Methodology: In January 2021–December 2021, 250 STEMI patients who had primary PCI and manifested with cardiogenic shock were included in this prospective observational analysis. Information was gathered on clinical presentation, procedure specifics, demographics, and outcomes, such as major adverse cardiovascular events (MACE) and in-hospital mortality. With significance set at p<0.05, statistical analysis was carried out using SPSS version 26.0.
Results: The majority of the patients in the research group were male, and a sizable fraction of them were between the ages of 31 and 60. In-hospital death rates were high overall, and they were especially high for elderly patients rates in the range of 61 to 75 years old reached 25%. Age has a significant influence on outcomes, as seen by the fact that MACE rates likewise rose with age. Patients in severe shock were often placed on mechanical circulatory support, which helped to improve hemodynamic stability. Reduced left ventricular function, multi-vessel disease, advanced age, and delayed presentation were important predictors of death.
Conclusion: The study demonstrates that while primary PCI is essential for managing STEMI patients with cardiogenic shock, high mortality and adverse event rates remain challenging. These findings highlight the need for timely intervention, enhanced support strategies, and the development of tailored management protocols to improve patient outcomes in this high-risk group
Changes in Central Corneal Thickness After Phacoemulsification Surgery
Full text linkObjective: To determine the mean change in central corneal thickness after phacoemulsification surgery
Methodology: This quasi experimental study was carried out at Liaquat University Eye Hospital, Hyderabad from June 2019 to May 2020. All the patients with age from 40 to 80 years having cataract with no associated ocular diseases like uveitis, glaucoma, subluxated lens, pseudo-exfoliation (PXF), as assessed on slit lamp examination, either gender, were included. Selected cases were referred to ward for preoperative assessment and CCT measurement on Ultrasound Pachymetry by Principal investigator and finally by a senior Ophthalmologist. The Phaco surgery, for all cases, was performed by the same Ophthalmic surgeon. CCT was measured again one day after Phaco; and noted on a CCT Assessment Proforma. Each participant’s ophthalmic examination would include: Best corrected visual acuity, cataract assessment (Slit lamp biomicroscopy) and CCT measurement by ultrasound pachymetry.
Results: On central corneal thickness comparison before and after surgery, thickness was 539.08+33.35 before surgery, while after surgery it was found 583.37+30.55 with significant difference p-value 0.01. No significant difference was found before and after surgery in both age groups P-value 0.24 and 0.87 respectively. No significant difference was found in central corneal thickness between both genders before and after surgery p-value 0.05 and 0.72 respectively.
Conclusion: We concluded that the mean central corneal thickness increased after phacoemulsification surgery
Antibiotic Prescription Patterns and Resistance Profiles in tertiary Care Hospital Patients: A Comprehensive Analysis to combat Antimicrobial Resistance
Full text linkObjectives: To evaluate antibiotic prescribing patterns and antimicrobial resistance profiles among patients presenting to tertiary care hospitals affiliated with Dera Ghazi Khan Medical College.
Methodology: A cross-sectional analytical study was conducted from June 2023 to May 2024. Using a 95% confidence interval and a 5% margin of error, a sample size of 384 patients was calculated. Data were collected through structured questionnaires and microbiological reports, capturing demographic details, types of infections, prescribed antibiotics, and antibiogram results. Statistical analysis was performed using SPSS version 26, with chi-square tests applied to explore associations between irrational prescribing practices and antimicrobial resistance.
Results: Empirical prescription of broad-spectrum antibiotics was noted in 76.3% of cases, with ceftriaxone being the most frequently prescribed agent (29.2%). Alarming levels of bacterial resistance were documented, with Escherichia coli showing 65% resistance to amoxicillin-clavulanate, Klebsiella pneumoniae exhibiting 58% resistance to ciprofloxacin, and Acinetobacter baumannii showing 30% resistance to meropenem. The findings revealed a statistically significant correlation between misdiagnosis and increased resistance rates (p < 0.01).
Conclusion: The study highlights an urgent need for robust antibiotic stewardship programs, enhancement of diagnostic capabilities, and the establishment of stringent regulatory policies to address the rising threat of antimicrobial resistance in tertiary care settings
Frequency of Culture-Proven Sepsis in Neonates Born to Mothers with Premature Rupture of Membranes
Full text linkObjectives: To determine frequency of culture proven sepsis in neonates born to mother with premature rupture of membranes (PROM).
Methodology: This observational cross-sectional study was carried out from June 2022 to December 2022 at department of neonatology PIMS Islamabad. A total of 305 neonates fulfilling the inclusion criteria were included in the study. At the time of inclusion baseline characteristics were documented. After that blood samples of all the children with signs and symptoms of neonatal sepsis were sent for blood culture and sensitivity for diagnosis confirmation, organism identification and antibiotic sensitivity. Data was analyzed using SPSS 22:00.
Results: In our study, mean gestational age of neonates was 38.33 ± 1.84 weeks. There were 177 (58.04%) male and 128 (41.96%) female. Mean duration of PROM was 20.98 ± 1.44 hours. Frequency of culture proven sepsis in neonates born to mother with PROM was 82 (26.88%). Most common organism which was isolated in blood cultures was Klebsiella spp. 40 (48.78%).
Conclusion: Premature rupture of membranes increases the chances of neonates to acquire sepsis. Special care should be taken for such neonates in NICU for improved outcomes.
Keywords: Neonate, Organism, PROM, Drug sensitivity, Sepsis
Frequency of Anatomical Variations in Appendix Position in Appendectomy
Full text linkObjective: To determine the age and gender distribution of various anatomical positions of the appendix in patients underwent appendectomy.
Methodology: This descriptive cross-sectional study was done at Farooq Teaching Hospital and Akbar Niazi Teaching Hospital, Islamabad , over a two years period from March 2021 to March 2022, involving 350 appendectomy patients. The anatomical location of appendix was analyzed in patients underwent appendectomy across various age groups and genders. The appendix length was measured from its base to tip using a nylon thread. The length of thread was measured using a vernier caliper. The appendix external diameter was measured at its widest point using vernier caliper.
Results: The patient’s average age was 36.6 years, with 58% males and 42% females. There were more males than females in the study. The appendix anatomical positions were observed as follows: retrocecal was most common, found in 50% of cases, followed by pelvic in 26%, retroileal in 10%, subcecal in 7.4%, paracecal in 6%, and subhepatic in 0.6% of cases. The highest incidence was observed in 21 to 40 years age group (56.6%). The association was observed significantly among appendix length and various age groups. The mean appendix length was 58 mm in males and 52 mm in females. The mean appendix external diameter was 75 mm in males and 69 mm in females.
Conclusion: The retrocecal position was the most frequently observed location in this study. Given that appendix is the organ in the abdomen with the greatest variability, these findings are valuable for surgeons’ performing appendectom
Evaluation of Pulmonary Dysfunctions in Iron Overloaded Beta Thalassaemia Children: A Study at Teaching Hospital of Rahim Yar Khan, Pakistan
Full text linkObjectives: To evaluate the pattern of pulmonary dysfunction in iron overloaded beta thalassaemia children and its correlation with serum ferritin.
Methodology: This cross-sectional study was conducted from April 2024 to September 2024 in the Department of Pathology and Department of Pulmonology, Sheikh Zayed Medical College/Hospital, Rahim Yar Khan. Transfusion dependent thalassaemia children bearing more than 10 years of age, ferritin levels greater than 1,000 ng/mL and bearing record of more than 20 transfusions were included in the study. Standardized pulmonary function test was conducted with spirometry. Serum ferritin levels were used to measure iron overload.
Results: A total of 115 individuals were examined; 47 percent were female, and 53 percent were male. Spirometry revealed respiratory impairment in 10.43% of patients with obstructive patterns and 31.30% with restrictive patterns. The average ferritin level observed was 3167.5 ng/ml. Of these, 2.6% were highly obstructive, 4.3% moderately restricted, 5.7% mildly restrictive, and 11.3% were very restrictive. 58.3% of the total had normal values. The degree of pulmonary impairment and ferritin levels did not appear to be related.
Conclusion: In children with iron over loaded transfusion dependent on thalassaemia disease, restrictive pattern is the most common pulmonary dysfunction. Patients with abnormal PFTs ought to have their compliance with the transfusion programme and re-evaluation of chelation therapy. It is necessary to use spirometry to screen all children for thalassaemia for early diagnosis of respiratory impairment