Annals of PIMS (Pakistan Institute of Medical Sciences)
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Spectrum of Hypertensive Retinopathy in Patients of Acute St Elevated Myocardial Infarction in Tertiary Care Hospital
No full textObjective: To ascertain the prevalence of hypertensive retinopathy in patients with acute ST elevated myocardial infarction.
Methodology: This descriptive cross-sectional study was conducted from May to November, 2019, at the Lady Reading Hospital's Cardiology Department in Peshawar. Patients of all genders, ages 40 to 70, were included. Two skilled ophthalmologists used a RIESTER ophthalmoscope to perform a fundoscopy. After a fundoscopy, consensus was agreed upon, and patients' risk of hypertensive retinopathy was evaluated. Hypertensive retinopathy was stratified by age, gender, smoking status, diabetes, and BMI to assess potential effect modification. Stratified chi-square tests were utilized, with a significance level of P < 0.05. SPSS version 20 was used to enter and analyze all of the data.
Results: The mean age of participants in this study was 58 years, with a standard deviation of 12.73. Male patients constituted 65% of the sample, whereas females accounted for 35%. Twenty-seven percent of the patients had hypertensive retinopathy, while seventy-three percent did not. Furthermore, hypertensive retinopathy showed no statistically significant associations with age, gender, smoking, diabetes mellitus, or BMI; the p-values were greater than 0.05, indicating insignificance.
Conclusion: The study findings conclude that 27% of patients with acute ST-elevated myocardial infarction had hypertensive retinopathy
Endoscopic Third Ventriculostomy versus Ventriculo-Peritoneal Shunt for Infant Hydrocephalus
No full textObjective: To compare the outcome of ventriculo-peritoneal shunt (VP shunt) versus endoscopic third ventriculostomy (ETV) as surgical intervention in management of Infant hydrocephalus.
Methodology: A prospective, randomized controlled trial was conducted at the department of Neurosurgery Nishtar University Hospital between June 2023 and November 2023. Study was conducted on 62 pediatric patients with hydrocephalus, all fewer than two years of age, who underwent cerebrospinal fluid (CSF) diversion through either endoscopic third ventriculostomy (ETV) or ventriculoperitoneal (VP) shunt placement. Patients were randomly assigned to one of two treatment groups: ETV or VP shunt. Randomization was done using a computer-generated sequence to ensure unbiased allocation. The ETV group underwent endoscopic surgery to create an opening in the third ventricle to allow CSF to bypass the obstruction. The VP shunt group received a surgically implanted device to divert CSF from the ventricles to the peritoneal cavity.
Results: Infection was higher in Group VP than Group ETV as 5 (16.1%) and 1 (3.2%), respectively, (p=0.086). Similarly, obstruction was higher in Group VP than Group ETV as 11 (35.5%) and 9 (29.0%), respectively, (p=0.587). Whereas, surgery was revised 16 (51.6%) in Group VP and 13 (41.9%) in Group Erate TV, (p=0.445).
Conclusion: This suggests that ETV presents as a favorable alternative to VP shunt placement due to its reduced risk of postoperative complications and quicker operative duration, while still maintaining comparable efficacy in terms of preventing obstruction, and the necessity for revision surgeries
Disease Spectrum and Outcome of Patients in PICU of Federal Govt. Polyclinic Hospital (FGPC) Islamabad
Get PDFObjective: To summarize the spectrum of disease and outcome in children admitted to the Pediatric Intensive Care Unit of FGPCH.
Methodology: It is a retrospective descriptive study conducted at Pediatric ward and Intensive care unit of Pediatric department of Federal Govt. Polyclinic Hospital, Islamabad from June’2018 to June’2020. The outcome variables are classified as discharge from PICU, death, shift to the ward after stabilization, and referral to other hospitals due to the unavailability of further specialized services.
Results: A total of 424 pediatric patients were included in this study. The overall mean age was 19.6±29.2 months and there were 239 (56.4%) males and 185 (43.6%) females. The most common diagnosis was pneumonia 37.3% (158/424), followed by sepsis and meningitis 14.6% each (62/424 each), and acute gastroenteritis 11.3% (48/424). There were 116 out of 424 (27.4%) who required ventilatory support in the PICU, while the remaining 308 (72.6%) did not require ventilatory support. In terms of outcomes, there were 106 (25.0%) pediatric patients who expired, 277 (65.3%) were shifted to the ward from PICU, 29 (6.8%) were discharged and 12 (2.8%) were referred to a specialized facility. The mean duration of stay was 3.1±2.7 days.
Conclusion: The most susceptible age group was under five years with the highest mortality rate and the most common cause of death is pneumonia preceded by other infections which can be controlled with better preventive measures
Characterization of Gingival Epulis Lesions: A Histological and Morphological Approach
Get PDFObjective: To conduct a clinical and histopathological study of Epulis at Bhittai medical and Dental College, Mirpurkhas.
Methodology: A descriptive cross-sectional study was carried out at the Bhittai medical and Dental College Mirpurkhas. Patients clinically diagnosed with gingival outgrowth, across all age groups and both genders, were included. A provisional diagnosis of epulis was made based on clinical examination. After taking a careful history, relevant clinical features were recorded, and a biopsy procedure was performed using infiltration near the lesion or regional nerve block techniques. The data was documented using a pre-designed proforma and analyzed using SPSS version 22.0.
Results: Out of 50 subjects, 30 (60%) were female and 20 (40%) were male. Most cases involved the maxillary gingiva (anterior or posterior) (62%). The majority of lesions measured between 2cm and 3cm (76%). Lesions typically exhibited a soft consistency (70%), with fewer cases being firm (8%) or hard (22%). Histologically, peripheral giant cell granuloma (PG) was most prevalent (50%), followed by fibrous epulis (42%), peripheral ossifying fibroma (4%), and peripheral giant cell granuloma with features of central giant cell granuloma (PGCG) (4%). No cases of congenital epulis or pregnancy tumor were reported. Histological evaluation revealed no significant gender differences (p-value 0.86).
Conclusion: Clinically, most epulis lesions presented as painless, soft, coral pink masses, typically measuring approximately 2-3 cm in diameter and exhibiting a sessile form and observed more commonly in females, with a predominant occurrence in the maxillary region. Histopathological examination revealed that the most frequent types were fibrous epulis and peripheral giant cell granuloma
Uterine Preservation versus Hysterectomy During Sacrospinous Colpopexy for Uterovaginal Prolapse
Get PDFObjective: To compare the effectiveness and safety of uterine preservation versus hysterectomy during SSC for uterovaginal prolapse.
Methodology: Ninety female patients diagnosed with uterovaginal prolapse were enrolled in a prospective study conducted from March 2023 to February 2024 at Department of Gynecology, Ayub Teaching Hospital Abbottabad. Patients were randomly assigned to either uterine preservation or hysterectomy groups during SSC. Pre-operative assessments included pelvic examinations, imaging studies, and urodynamic evaluations. Surgical outcomes such as operative time, blood loss, complications, and anatomical success rates were recorded. Post-operatively, patients were followed up at regular intervals to assess subjective outcomes including symptoms relief, quality of life improvements, and sexual function.
Results: Both uterine preservation and hysterectomy groups showed comparable anatomical success rates and symptom relief following SSC. Operative time was longer in the uterine preservation group (p = 0.028), while hospital stay was shorter in the hysterectomy group (p = 0.041). No significant differences were observed in intraoperative blood loss (p = 0.102), infection rates (p = 0.076), or prolapse recurrence (p = 0.194). However, reoperation rates were higher in the uterine preservation group (p = 0.012), whereas patient satisfaction was notably higher among those who opted for uterine preservation (p = 0.001).
Conclusion: Uterine preservation during sacrospinous colpopexy appears to be a viable option for treating uterovaginal prolapse, offering comparable outcomes to hysterectomy in terms of anatomical support, symptom relief, and patient satisfaction. This study suggests that the decision between uterine preservation and hysterectomy during SSC should be individualized based on patient preferences, anatomical considerations, and the presence of co-existing conditions
Managing Dyslexia in Pakistan
Get PDFObjective: This study was conducted in special school of Young Muslim Inclusive Education System Wah Cantt, from 2016 till 2023.
Methodology: This cross sectional study, Initially a total of 48 physically healthy children who could communicate verbally but could not manage in mainstream were included. They were placed for 3 months in the school and assessed further by HARP dyslexia screening tool. After these sessions, a statement was issued according to their needs and 37 young persons were identified with dyslexia. Seven children were excluded due to their profound learning disabilities and placed for transition plan. After the diagnosis, care team made (IP) intervention plan for each student that included school and other activities. All the participants after completion of 3 months were assessed for progress and their progress report was noted.
Results: The mean age of the children was 14.05 ± 3.325 years, with maximum 19 (51.4%) children having age from 10-15 years. Mostly 26 (70.3%) children in the study presented with learning disability followed by 11 (29.7%) who presented with developmental delay. The average overall progress of 68.38% with SD of 15.91% was observed in this study sample. More than 75% goals were achieved in 20 (54.1%) children followed by (50-75%) goals were achieved in 11 (29.7%) children. Only 6 (16.2%) children had less than 50% progress after the IEP. The association of progress with age of the child showed that the children in age group of 10-15 years showed significantly (p-value < 0.05) higher rate of progress (73.68% vs. 38.46%) as compared to children of other age groups.
Conclusion: Interventions in education may give students new, efficient reading and learning strategies. Adolescents with dyslexia can learn new reading abilities by working with a qualified professional. A dyslexic child may benefit from a slower learning pace in the classroom since it allows them to absorb material more thoroughly
Relationship Between History/Physical Examination and Radiological Findings with Surgical Findings to Determine the Level of Obstruction
Get PDFObjective: To assess the correlation between the clinical findings and radiological findings with surgical findings in patients with intestinal obstruction and the subsequent determination of the level and severity of the obstruction.
Methods: This prospective observational study was done at the general surgery department of JPMC Karachi, during 12-month from January 2022 to December 2022. Adults aged 15 years and above, clinically and radiologically suggestive of intestinal obstruction and underwent surgical intervention were included. Clinical data was collected through thorough physical examinations and detailed medical history reviews. Parameters such as abdominal pain, distension, bowel sounds, and other relevant symptoms were documented. Radiological investigations were analyzed for evidence of obstruction and its location. Patients who undergone surgical intervention, their operative findings were correlated with clinical and radiological findings. Data analysis was done by using SPSS version 26.
Results: Overall, 44 patients were studied with mean age of 38.59 ± 7.77 years, 56.8% were male and 42.3% female. Common clinical findings included inability to pass gas or stool (97.7%), constipation (95.5%), dehydration (93.2%), and tachycardia (93.2%). Radiologically, air-fluid levels with valvulae connivences were most frequent (52.3%). Intra-operatively, omental bands (22.7%) were the most common finding. There was a significant association between clinical symptoms, such as tenderness and anorexia, with specific intraoperative findings (p=0.004). Radiological findings, particularly air-fluid levels, were strongly associated with surgical diagnoses (p=0.001), highlighting their importance in guiding treatment.
Conclusion: Clinical assessments and abdominal X-rays in diagnosing intestinal obstruction, applicable in only a few instances. It emphasizes the superior diagnostic capability of abdominal CT scans, may enhance the surgeon's understanding of the underlying pathology
Comparative Efficacy of Metformin and Liraglutide in Pediatric Type 2 Diabetes
Get PDFObjective: To assess the safety and efficacy of liraglutide versus metformin in patients with type 2 diabetes in the pediatric age group
Methods: This was an open-label, 24-week randomized controlled experiment. Three to sixteen-year-old Children with type 2 diabetes were randomized to receive either metformin or liraglutide. The main outcome was the variation in HbA1c at week 24. The research was completed by 150 subjects in all, and analysis was done on this cohort.
Results: At week 24, the metformin group had a decrease in HbA1c (p value = 0.001), going from 8.0 ± 0.7% to 7.2 ± 0.8% (53 ± 2 mmol/mol), and in the liraglutide group (p = 0.001), going from 7.7 ± 0.7% to 7.1 ± 0.6% (52 ± 2 mmol/mol). However, the group comprised liraglutide grasped maximum decline more quickly as compared to metformin group. The incidence of hypoglycemia and other parameters studied did not differ significantly across the groups.
Conclusion: During a 24-week period, individuals with T2DM treated with liraglutide and metformin alone had comparable reductions in HbA1c, with no discernible differences in other metrics
Histopathological Evaluation of Abnormal Hepatic Nodules Detected Radiologically and On Gross Examination of Hepatectomy Specimens and Their Relationship with Alpha Fetoprotein Levels
Get PDFObjective: To determine the frequency and pattern of abnormal nodules in Hepatectomy specimens and to evaluate the frequency of elevated serum alpha-fetoprotein (AFP) levels in abnormal hepatic nodules.
Methodology: A Descriptive, cross-sectional survey was conducted from January 2021 to July 2022 in the Department of Histopathology, Sheikh Zayed Hospital Lahore, A non-probability consecutive sampling technique was used. A total of 60 Hepatectomy samples taken from liver explants were included and data was analyzed by SPSS version 23. A chi-square test with a p-value less than 0.05 was considered significant.
Results: The mean age of patients was 47.33±14.74 years. There were 46 (76.67%) male and 14 (23.33%) female patients. On the frequency of etiology, 30 (50.00%) had viral etiology, 05 (8.33%) autoimmune, 06 (10.00%) cryptogenic, 03 (5.00%) NASH, 05 (8.33%) fibrolamellar CA, 07 (11.67%) bud chiari syndrome and 04 (6.67%) liver disease (Figure 4). There were 15 (25.00%) patients with elevated AFP levels. Abnormal nodules were present in 47 (78.33%) patients. On frequency of type of nodules, 11 (23.40%) macro-regenerative nodules, 04 (8.51%) FNH nodules, 06 (12.77%) adenoma nodules, 06 (12.77%) dysplastic nodules (SCC), 08 (17.02%) dysplastic nodules (LCC) and 12 (25.53%) hepatocellular carcinoma.
Conclusion: Viral causes are commonest in liver explant samples. The common histopathological finding was that HCC was identified in 25.53% of cases, and macro-regenerative nodules were identified in 23.40% of patients
Prevalence of Dermatophytes and their Antifungal Susceptibility to itraconazole in Clinically Suspected Patients of TInea Corporis
Get PDFObjective: To assess the prevalence and clinico-mycological characteristics of dermatophyte species in tinea corporis, and determine the susceptibility of isolated dermatophyte species to Itraconazole.
Methodology: This cross sectional study was conducted in Department of Microbiology, Basic Medical Sciences Institute, Karachi from June 2018 to June 2019. A total of 301 samples of skin scraping of the suspected cases of tinea corporis were taken from the patients who visited dermatology OPD of Jinnah Postgraduate Medical Centre. The specimens were taken by scrapping the margin of lesions with a sterile surgical blade and were processed for potassium hydroxide (KOH) mount test. The mycological culture was performed on Sabouraud’s dextrose agar with and without antibiotics and on dermatophyte test medium. Lactophenol cotton blue mount, cellophane tape mount, and biochemical testing were used to identify the species of dermatophytes. The antifungal susceptibility testing was done by micro broth dilution method according to the guideline of Clinical and Laboratory Standard Institute.
Results: The males were affected more than females. Redness/ Erythema was the most common presenting complaint (n= 192, 63.8%) while the most common clinical type was an annular lesion (n= 133, 44.2%). The most common isolated dermatophytes was T. mentagrophytes (n= 38, 45.2.%). There was no resistance seen towards itraconazole for any isolates, though the MICs of itraconazole was within the range in the upper limit for almost every isolate. This indicates the need to optimize the use of itraconazole. Furthermore, because itraconazole is the last medicine in the existing arsenal, so itraconazole must be used wisely
Conclusion: Trichophyton formed the commonest etiological agent and T. mentagrophytes and T. rubrum were found to be the principal causative agent of tinea corporis in our region. Isolates were found to be susceptible to itraconazole, however the MICs were found to be in the upper range