Annals of PIMS (Pakistan Institute of Medical Sciences)
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Mode of Delivery in Patients With Gestational Diabetes Mellitus
Get PDFObjective: To determine the frequency of mode of delivery in patients with gestational diabetes mellitus.
Methodology: The Descriptive study was conducted from August 2024 to November 2024 at the Department of Obstetrics and Gynaecology, ATH Abbottabad.
A total of 139 women with singleton pregnancies diagnosed with GDM after 36 weeks of gestation were included. The sample size was calculated using the WHO sample size calculator, considering a 95% confidence interval, a 5% margin of error, and an expected frequency of 10% for instrumental deliveries. Data collection included demographic information, pregnancy details, and delivery outcomes.
Results: The mean age of participants was 29.76 ± 4.74 years, with a mean gestational age of 38.49 ± 0.96 weeks. The average parity was 1.63 ± 1.12, and the mean BMI was 29.26 ± 3.68 kg/m². The majority of participants (60.4%) resided in rural areas. The mode of delivery distribution was as follows: 57.6% spontaneous vaginal delivery, 7.2% instrumental delivery, and 35.3% cesarean section.
Conclusion: GDM significantly impacts the mode of delivery, with age and BMI being key determinants
Exploring the Various Radiological Observations and Appearances in Patients with Dengue Fever; A Retrospective Observational Approach
Get PDFObjective: To assess the range of radiological observations in patients testing positive for dengue serology.
Methodology: This retrospective, observational study was conducted at Islamabad Diagnostic Center, Islamabad from September 2022 to March 2023. The Ethical Committee approved this study. All the individuals who arrived at the IDC, Islamabad, complaining of fever and tested positive for dengue serology, from September 2022 to March 2023, were included in our study. A total of 240 patients met these criteria. Patient details, including age and gender, were obtained from the center’s computer system.
Results: Severe cases of dengue fever, including thrombocytopenia, were observed in 62 out of 240 patients (25.83%), while mild clinical presentations were noted in rest of the 178 patients (74.16%). The most mutual radiological outcome was wall edema of the gall bladder (figure 2a), seen in 113 out of 240 patients (47.08%). This was followed by ascites (2b), that were observed in 38.33% (n=92) cases. Hepatomegaly was noted in 10.83% (n=26) (2c), splenomegaly in 3.75% (n=9) (2d) respectively.
Conclusion: Dengue fever presents with a variety of manifestations. Imaging techniques, especially ultrasound, can be employed to promptly identify the characteristics and complications of dengue fever in emergency situations, even when serological tests are unavailable or delayed
Association of Contrast-Induced Nephropathy with Adverse In-Hospital Outcomes in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction
Get PDFObjective: To assess the association of contrast-induced nephropathy (CIN) and adverse in-hospital outcomes in patients undergoing primary angioplasty for acute myocardial infarction (AMI).
Methodology: A prospective cohort study was done in National Institute of Cardiovascular Disease (NICVD), Karachi from January 2019 to January 2020. After taking informed written consent clinical examination was done and blood investigations were done at the time of admission and repeated on 3rd day for in hospital outcome i-e atrial fibrillation, cardiogenic shock, and acute pulmonary edema and CIN.
Results: Total of 249 patients with AMI undergoing PPCI were included. Out of all 99(39.7%) were females and 150(60.3%) were males with mean age of 54.82+7.888 years. The in-Hospital outcome atrial fibrillation, cardiogenic shock & acute pulmonary edema in exposed group were seen in 27(10.8%), 37(14.9%) & 29(11.6%) respectively, while in non-exposed group these were noted in 8 (3.2%), 9(3.6%) & 10 (4%) respectively.
Conclusion: The patients who developed CIN after primary angioplasty for AMI observed with higher adverse in-hospital outcomes in contrast to those who did not developed renal impairment, indicating that the occurrence of CIN worsens the clinical progression during hospitalization and rises the complications risk
Comparison of the Efficacy of Combined Therapy with Oral Tamsulosin Plus Oral Diclofenac and Tamsulosin Alone in Time & Rate of Expulsion of Distal Ureteric Stones
Get PDFObjectives: To compare the effectiveness of combined therapy with Tamsulosin and Diclofenac sodium and Tamsulosin alone in the rate and time of expulsion of distal ureteric stones of size ranging from 5-<9mm.
Methodology: This randomized clinical trial study was conducted at Benazir Bhutto Hospital Rawalpindi and Institute of Kidney Diseases-Hayatabad Medical Complex Peshawar from December 2019 to December 2020. All male and female patients presenting to the urology OPD diagnosed with unilateral distal ureteric stones on X-ray KUB were recruited using systematic random sampling and divided into two groups: Group A (study group) and Group B (control group). Patients with odd numbers were assigned to Group A, while those with even numbers were assigned to Group B. Group A received Tab. Tamsulosin 0.4mg OD and Tab. Diclofenac sodium 75mg BD for 21 days. Group B received Tab. Tamsulosin 0.4 mg OD for 21 days and acetaminophen 500mg SOS.
Results: The clinical trial revealed that in the group of patients receiving Tamsulosin and diclofenac, the rate of expulsion of distal ureteric stones was improved with a statistically significant difference. Time of expulsion of stones in two groups wasn’t statistically different.
Conclusions: Tamsulosin and Diclofenac sodium given together have added effect /benefit as compared to Tamsulosin alone in the rate and time of expulsion of distal ureteric stones
C-reactive Protein Levels as A Predictor of Difficult Laparoscopic Cholecystectomy
Get PDFObjective: To determine the mean C-reactive protein (CRP) levels preoperatively among patient with Acute Cholecystitis to predict difficulty of Laparoscopic Cholecystectomy on Nassar Grade.
Methodology: This cross-sectional study was conducted in General Surgery Department, PAEC General Hospital, Islamabad from 30/01/2023 to 31/07/2023
This study was conducted in the Department of General Surgery, PAEC General Hospital, Islamabad. 150 patients having symptomatic gallstones were enrolled in the study. CRP level was determined preoperatively in all patients. All patients underwent LC. Intraoperative difficulty level was determined using the Nassar grade. Mean CRP level was compared between the 5 grades Nasser scale, by applying ANOVA test keeping p-value ? 0.05 as significant.
Results: A total of 150 patients with symptomatic gallstones were enrolled for the study. The mean age of the patients was 47.29+/-13.75 years. 34 (22.7%) were male and 116 (77.3%) were female. The mean WBC count of our patients was 9075.27+/-3437.46/µL. The mean CRP level of our patients was 31.01+/-61.32 mg/dL. The mean CRP level was significantly higher in patients with grade 4, followed by grade 3, grade 2 and grade 1 (p-value < 0.01).
Conclusion: Our study concluded that there is a significant link between higher CRP levels and increased Nassar grades, indicating a positive relationship between elevated CRP levels and greater intraoperative difficulty during LC
Incidence of Radial Artery Loss Among Cases After Coronary Angiography
Get PDFObjective: To evaluate the incidence of radial artery loss among patients following coronary angiography.
Methodsology: A prospective cohort study was carried out at Cardiology Department of PIMS from January 2022 to December 2023. Patients aged 18 years old or above, both gender who were undergoing coronary angiography radial route for various indications in cardiac center at PIMS were included. All patients had radial artery cannulation with 6 French sheath. Patient who had only coronary angiography, their sheaths were removed just after completion of the procedure. Patients who had PCI their sheaths were removed after 4 hours of completion of procedure. Patients who had PCI were loaded with antiplatelet medications. Patients were followed in OPD after 2 to 3weeks. All of the information was entered and analyzed using SPSS version 26.
Results: Mean age of the patients was 56.52+10.69 years. Male were 70.3%, and females were 29.7%. Left radial artery was not palpable in 0.2% (1 patient). For the right radial artery, 10.3% had a non-palpable artery. Overall, this data indicates that 10.8% of the patients had a non-palpable right radial artery after the procedure. There was no significant association found of radial artery loss with age, gender, diabetes, hypertension and smoking history (p=>0.05), however its incidence observed significantly higher among patients who underwent PCI (p-0.001).
Conclusion: The incidence of asymptomatic complication of radial artery loss observed to the be 10.8% among patients undergoing coronary angiography via radial route. However, PCI was noted to be a significant predictor
Association of Hypocalcemia with In-Hospital Outcomes in Patients with Heart Failure
Get PDFObjective: To determine the association of hypocalcemia with in-hospital outcomes in terms of in-hospital mortality in patients with heart failure.
Methodology: This descriptive Study was done at department of Cardiology, LUMHS, Jamshoro, from March 2022 to March 2023. Patients aged 18 to 80 years old both genders, patients who were present with heart failure were included. Baseline investigations, including serum calcium levels, were performed, with hypocalcemia defined as serum calcium levels <8.7mg/dL. Patients were then categorized based on the presence or absence of hypocalcemia and assessed for in-hospital mortality. Data analysis was conducted using SPSS version 24.0.
Results: The mean age of the patients was 63.84 years with a standard deviation of 15.55 years and mean serum calcium level was 8.80 mg/dL. Among the patients, 69.4% were male and 30.6% were female. Among patients of heart failure, the in-Hospital mortality was 18.3%. The overall frequency of hypocalcemia in patients with heart failure was 19.40%. Among patients how died during hospital stay, 2.6% had hypocalcemia, while 16.8% were died without hypocalcemia, the p-value 0.316 indicated that the association of hypocalcemia was statistically insignificant (p-0.316). The P-values for gender and diabetes mellitus were significant (<0.05), indicating a correlation between these factors and hypocalcemia, while age and hypertension showed insignificant associations with hypocalcemia (>0.05)
Combatting Burkholderia Cepacia in Neonatal Intensive Care: Burkholderia Cepacia in Neonatal Intensive Care
No full textWe are writing to bring your attention to a serious issue concerning the emerging threat of Burkholderia cepacia infection in the Neonatal Intensive Care Unit (NICU) and the subsequent challenges in its management. B. cepacia, a risky pathogen for hospital-acquired infections, poses significant health risks to patients due to its high fatality and mortality rates (1). Its emergence as a major pathogen in hospital settings is concerning, particularly in light of its strong intrinsic drug-resistant profile and the emergence of acquired drug resistance patterns (2). While it was initially thought to be linked to contamination from pharmaceutical products like sanitizers and disinfectants, it is now emerging as a deadly pathogen among ICU patients (3)
Comparison of Hemodynamic Effect of Propofol and Ketofol during Induction of Anaesthesia in General Surgery Patients
Get PDFObjective: To determine the comparison of homodynamic effect of propofol and ketofol duringinduction in general surgery patients.Study design: Randomized control trialSetting: Department of Anesthesia, Surgical ICU and Pain management, Civil Hospital Karachi.Duration: Seven months from June 2019 to January 2020.Methods: Patients scheduled for elective general surgery procedures, aged 20 to 60 years, bothmale and female patients were included. Patients were randomly allocated into two groups.Group A received a combination of ketofol while Group B received propofol as the inductionagent. After recording of the base line values of mean arterial pressure patient was induced usingpropofol or ketofol. Mean arterial pressure readings were noted at 30 seconds after druginjection, as well as at 1 minute, 5 minutes, and 10 minutes after intubation, to capture theimmediate hemodynamic effects of the drugs and to observe any potential changes over timefollowing intubation.Results: The average age of the patients was 37.38±13.78 years. Out of 64 patients, 30(46.9%)were male and 34(53.1%) were female. Homodynamic effect was significantly high in thosepatients who received ketofol than those who received propofol (100% vs. 59.4% p=0.0005).The findings observed also with significant differences in hemodynamic effects between the twogroups, even after controlling for age, gender, and ASA classification (p-&lt;0.05).Conclusion: Combination of Ketofol with ketofol was observed to be the betterhemodynamically as compared to Propofol. Additionally, the use of ketofol reduces the cost ofinduction and decreasing the economic burden on the patient
Improved Clinical Outcome with Cyclosporine in Patients with Moderate to Severe COVID-19 Infection
Get PDFObjective: To investigate the potential benefits of adding cyclosporine to the presently recommended conventional treatment for COVID-19 disease.
Methodology: A retrospective cross-sectional research was carried out on COVID-19 patients with moderate-to-severe severity who were admitted to Lahore General Hospital's ICU (intensive care unit) or HDU (high dependency care unit from 2020 to 2021. Patients aged 18 to 70 with moderate to severe illness were included, while those with specific conditions were excluded. Data on symptoms, oxygen saturation levels, and medication usage were collected and analyzed using statistical tests. The assessment of outcome decreased dependence on oxygen in ICU/HDU was assessed through a combination of different drugs (treatment), especially the inclusion of Cyclosporine, which was done with Chi-square and Binomial tests.
Results: In the study 46% are male and 54%are females. 71% of patients suffer fever while 69% observed shortness of breath out of which 44% had cough. On presentation 30.8% were mild cases (out of which27% converted to moderate on second day), 17.3% fall in moderate cases while 51.9% are severe COVID cases while on treatment day 7 results shows 30.6% patients are oxygen free, 10% cases are moderate cases while 19% were severe cases.53.8% remain alive while deaths are 46.2% which is a good number in ICU/HDU cases.
Conclusion: Cyclosporine use should be considered in SARS-CoV-2 moderate and severe disease because it not only improves the disease severity, reduces oxygen demand and improves mortality