Annals of PIMS (Pakistan Institute of Medical Sciences)
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End-of-life Care in Intensive Care Unit (ICU) and Attitudes of Healthcare Workers towards caregivers
No full textAim of the study: The aim of this research was to evaluate the attitude of Healthcare workers towards the care of the families of critically ill patients in the ICU, leading to the emergence of specific attitudes, relating them to their demographic and professional characteristics, with the aim of drawing conclusions for the improvement of quality in end-of-life care.
Material and Methods: The sample of the study was 53 conducted at Intensive Care Unit (ICU), Fauji Foundation Hospital, Rawalpindi. Participants included doctors, nurses and medical assistants who completed the survey questionnaire. The questions are about ways in which healthcare workers can help the patient's family during the patient's stay in the ICU.
Results: The results revealed that the healthcare workers (doctors, nurses and medical assistants) took actions related to the information and psychological support of the patient's family. On the contrary, they did not focus on the spiritual / religious needs of the patient and the needs of the family based on their cultural background.
Conclusions: The professional treatment of healthcare works is characterized by compassion and empathy, but it is necessary to train them on important issues related to diversity, including the religious, spiritual values and beliefs of patients and their relatives.
Keywords: health professionals, family, death, communication, care, end of life care, intensive care unit, nurse
Post-Operative Complications of Tonsillectomy between Dissection and Diathermy Method at a Tertiary Care Hospital
Full text linkObjective: To compare post-operative complication after dissection and diathermy tonsillectomy.
Methodology: A Cross-sectional comparative analysis was conducted from August 2018 to July 2019 on a sample of 206 patients undergoing tonsillectomy at the Department of ENT, Liaquat University of Medical & Health Sciences, Jamshoro. Patients between age of 6-18 years of age undergoing tonsillectomy due to chronic recurrent tonsillitis and obstructive hyperplasia of tonsils of either gender were included. Patients were divided in two groups, group A (dissection tonsillectomy) and group B (diathermy tonsillectomy). Data on demographic variables and complications, including hemorrhage, uvular edema, and blood aspiration, were collected. Patients were followed for two weeks to monitor complications. All information was recorded on self-structured questionnaires and analyzed using SPSS version 20.
Results: A total of 206 patients were studied, with a mean age of 12.02 ± 4.12 years. Males were the majority (65.05%). Dissection tonsillectomy had a significantly higher risk of primary hemorrhage (42.9%) compared to diathermy (6.1%) (p = 0.047), while secondary hemorrhage occurred equally in both groups (18.36%). Post-operative pain was significantly higher in the diathermy group (5.6 ± 2.64) than in the dissection group (3.2 ± 2.33) (p = 0.047). Overall hemorrhage was more frequent in dissection tonsillectomy (35.0%) than diathermy (12.6%) (p = 0.001). Other complications, including uvular edema and blood aspiration, showed no significant differences between the two techniques.
Conclusion: The comparative analysis of the study revealed that the diathermy tonsillectomy linked to the significantly higher post-operative pain; it has a lower risk of hemorrhage, with no statistically significant differences in the incidence of uvular edema and blood aspiration between the two techniques
Factors Predictive of Achieving Critical View of Safety in Laparoscopic Cholecystectomy in A Tertiary Care Hospital
Full text linkObjective: To determine the proportion of LC cases in which CVS is achieved and to identify preoperative and intraoperative factors predictive of its achievement.
Methodology: This Cross-sectional study was conducted from April to September 2024 at Islamabad Medical Complex, enrolling 152 consecutive adult patients undergoing elective or emergency LC for benign gallbladder pathology. CVS was defined according to SAGES criteria. Data on demographic, preoperative, intraoperative, and postoperative variables were collected using a structured proforma. Operative difficulty was graded using the modified Nassar scale.
Results: The mean patient age was 46.6 ± 14.5 years, with a male-to-female ratio of 1:2.3. CVS was achieved in 117 cases (77%) and not achieved in 35 cases (23%). Preoperative gallbladder wall thickening >3 mm was significantly associated with CVS failure (p = 0.03). Intraoperative factors linked to CVS non-achievement included higher operative difficulty grades III–V (p < 0.001), severe gallbladder pathology such as mucocele/empyema/gangrene/Mirizzi (p < 0.001), adhesions with the duodenum (p < 0.001) or colon (p = 0.02), abnormal Calot’s triangle anatomy (p = 0.04), operative time >1 hour (p < 0.001), cystic duct ligation with sutures (p < 0.001), non-complete cholecystectomy (p < 0.001), and drain placement (p < 0.001). Postoperatively, CVS non-achievement was associated with prolonged antibiotic use (p = 0.02) and longer hospital stay (p < 0.001). No BDI or conversions occurred.
Conclusion: CVS can be achieved in most LC cases, but its likelihood is reduced by preoperative gallbladder wall thickening, higher operative difficulty grades, severe inflammatory pathology, adhesions, and abnormal anatomy. Early recognition of these predictors facilitates surgical planning, timely use of bail-out strategies, and improved patient safety.
Keywords: Laparoscopic cholecystectomy, Critical View of Safety, bile duct injury, predictors, operative difficulty, gallbladder patholog
Prevalence of Malaria in Febrile Patients Presenting with Thrombocytopenia at LUMHS, Jamshoro
Full text linkObjective: To determine the frequency of malaria in febrile patients presenting with thrombocytopenia at LUMHS, Jamshoro.
Methodology: A cross sectional study was conducted at Department of Medicine, LUMHS, Jamshoro, Hyderabad, during six months from 01-02-2023 till 31-7-2023. Febrile patients with thrombocytopenia, either gender aged 20-80 years were included. Blood sample was obtained from each cases and analyzed for complete blood count (CBC) and malaria diagnosis using Giemsa-stained thin and thick blood smears. Patients were assessed and labeled as malaria-positive based on the presence of malarial parasites under microscopy. After data collection the analysis was done by SPSS version 26.
Results: Overall mean age of the 153 patients was 39.65±14.30 years with male gender predominance 105 (68.6%). Overall, malaria was detected in 67.3% of 153 febrile patients with thrombocytopenia, with Plasmodium vivax being the most common species 60(39.2%), followed by Plasmodium falciparum 30 (19.6%) and mixed infections 13(8.5%). Among all patients, 37.3% had severe thrombocytopenia. Prevalence of malaria found statistically insignificant by gender, residence, or socioeconomic status, though it was slightly higher in rural areas and in patients with platelet counts <50,000/µL (p=>0.005), while there was a significant association between thrombocytopenia severity and parasite type (p= 0.001), as all mixed infections occurred in patients with platelet counts <50,000/µL.
Conclusion: Malarial detections was observed highly prevalent among febrile patients presenting with thrombocytopenia, with Plasmodium vivax being the predominant species, and with a significant association between thrombocytopenia severity and parasite type, as all mixed infections occurred in patients with severe thrombocytopenia
Role of Diclofenac Suppositories in Pain Relief During the Postpartum Period
Full text linkObjective: To compare the efficacy of rectal diclofenac suppositories and oral mefenamic acid in relieving pain during the postpartum period.
Methodology: This randomized controlled trial was conducted at the Department of Obstetrics and Gynecology, Shifa International Hospital, Islamabad, from October 2024 to March 2025. A total of 170 postpartum women meeting inclusion criteria were randomly allocated to receive either rectal diclofenac (100 mg every 8 hours) or oral mefenamic acid (500 mg every 8 hours). Pain levels were assessed using the Visual Analog Scale (VAS) at baseline and 8 hours post-analgesic administration. Pain scores were compared among the two-group using independent sample t-test. A p-value of < 0.05 was considered statistically significant.
Results: The results demonstrated significantly lower mean pain scores in the rectal diclofenac group (2.5 ± 1.1) compared to the oral mefenamic acid group (4.0 ± 1.5; p = 0.004). Both groups exhibited comparable baseline characteristics, including age, BMI, gestational age, and parity. No significant differences were observed in perineal trauma severity, labor duration, or mode of delivery.
Conclusions: The rectal diclofenac has superior analgesic efficacy over oral mefenamic acid in the relief of postpartum pain. Given its effectiveness, safety, and ease of administration, rectal diclofenac is a promising option for managing postpartum pain, particularly when oral analgesics are less effective or poorly tolerated
Diagnostic Accuracy of Shear Wave Elastography in Diagnosing Malignant Breast Lesions Taking Histopathology as Gold Standard
Full text linkObjective: To determine the diagnostic accuracy of shear wave elastography in identifying malignant breast lesions, taking histopathology as gold standard.
Methodology: This cross-sectional validation study was conducted at department of diagnostic radiology, Combined Military Hospital, Lahore from Jan to Dec 2024. A cohort of 170 female patients having clinically suspected breast lesions, aged 20-60 years, irrespective of marital status with breast lesion of duration >1 month and size >1 cm on conventional ultrasonography exhibiting features like spiculations, punctuate calcifications, duct extension and non-compressibility were included in the study. All patients underwent conventional B-mode ultrasonography followed by shear wave elastography. The results of shear wave elastography were then compared with histopathology findings to evaluate its diagnostic accuracy.
Results: Mean age was 45.47 ± 8.73 years. The mean size of the breast lesion was 3.24 ± 1.36 cm while mean duration of the disease was 12.92 ± 5.81 weeks. Shear wave elastography diagnosed 57 (33.5%) patients as having malignant lesions, whereas histopathology confirmed malignant breast lesions in 60 (35.3%). The calculated sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of shear wave elastography with histopathology as gold standard were 84.21%, 89.38%, 80.0%, 91.82% and 87.65% respectively. The incidence of breast cancer in our studied population was 35.5%.
Conclusion: Shear wave elastography is a simple, cost-effective and non-invasive modality that offers improved diagnostic accuracy for identifying malignant breast lesions
Whole Genome Sequencing of ESBL Producing Klebsiella pneumoniae: Systematic Literature Review
Full text linkObjective: It was aimed to conduct a thorough and systematic examination of the available literature referring to the importance of incorporating Whole genome sequencing in interpreting and assessing the genetic structure of ESBL producing Klebsiella pneumoniae
Methodology: This systematic literature search was conducted across multiple databases, mainly including PubMed, Scopus and Web of Science focusing on antimicrobial resistance and genomics.
Results:The review amalgamates an extensive range of research studies, hedging into the genetic determinants, evolutionary patterns, and dissemination mechanisms of Extended spectrum beta lactamase producing Klebsiella pneumoniae from across the globe. Conscientious and careful examination of the relevant studies included in this systematic literature review, together intend to enlighten the thoroughness of comprehension provided by Whole genome sequencing in straightening out the foundations of genetics of ESBL producing Klebsiella pneumoniae. It endeavors to characterize its identified genes responsible for resistance, mutations, mobile genetic elements and the factors associated with dissemination of its resistance traits.
Conclusion: This systematic literature review compiles together and provides not only with a valuable summary of the key factors involved in the understanding of the crucial elements, complex interaction and entangled dynamics of the genetic elements connected with antimicrobial resistance, but also supplements the efforts being carried out globally to combat antimicrobial resistance associated in particular with ESBL producing Klebsiella pneumoniae for effective infection prevention and control.
Comparison of The Efficacy of Dexmedetomidine Versus Tramadol on Post-Spinal Anesthesia Shivering at Abbasi Shaheed Hospital, Karachi
Full text linkObjective: To compare the efficacy of dexmedetomidine versus tramadol on post-spinal anesthesia shivering at Abbasi Shaheed Hospital, Karachi.
Methodology: This Randomized control trial was conducted at Department of Anesthesia, Abbasi Shaheed Hospital, Karachi, from 05-06-21 till 05-12-21. Patients aged 20 to 60 years of either gender, classified as ASA ? II, who developed post-spinal anesthesia shivering were included. Patients were randomly assigned to two groups: Group A received intravenous Dexmedetomidine (0.5 µg/kg, 1 µg/ml concentration) over 10 minutes after shivering began post-spinal block, while Group B received intravenous Tramadol (0.5 mg/kg, 1 mg/ml concentration) over the same period. Outcomes assessed as shivering resolution within 15 minutes, absence of recurrence (grade ?3), and time taken for shivering to stop after drug administration. Data was entered and analyzed using SPSS version 20.
Results: In the dexmedetomidine group, the mean age was 48.21?±?6.24 years, mean time to disappearance of shivering was 12.54?±?1.78 seconds, and mean time to recurrence of shivering was 37.4?±?10.54 minutes. Similarly, in the tramadol group (n = 77), the mean age was 49.48?±?8.41 years, time to disappearance of shivering was 14.52?±?8.56 seconds, and time to recurrence was 32.8?±?11.89 minutes. Efficacy was observed in 73 patients (94.8%) in the dexmedetomidine group and in 60 patients (77.9%) in the tramadol group, with a statistically significant difference (p = 0.01).
Conclusion: Dexmedetomidine was observed to be a useful alternative to tramadol for the management of post-spinal anesthesia shivering, offering faster relief with fewer incidences of nausea and vomiting.
Keywords: Anesthesia, Dexmedetomidine, Tramadol, Shivering, effectivenes
Comparison Between Primary and Secondary Implant Stability of Hybrid Versus Resorbable Blast Media (RBM) Surfaces Using Resonance Frequency Analysis
Full text linkObjective: To compared the primary and secondary stability of implant surfaces made of Resorbable Blast Media (RBM) and Hybrid, sandblasted & acid etched (SBA).
Methodology: This randomized controlled trial (registration number NCT06620315) was conducted in the Department of Prosthodontics at the Institute of Dentistry, CMH Lahore Medical College from June to December 2023. A total of 60 patients were randomly assigned to two groups using the lottery method: Group 1 received Hybrid-SBA implants, and Group 2 received RBM implants. Primary implant stability was measured using resonance frequency analysis (Osstell Mentor) at the time of implant placement, and secondary stability was assessed 12 weeks postoperatively. All implants were placed using a non-submerged technique. A chi-square test was applied to compare RFA scores for primary and secondary implant stability between the two implant types.
Results: Results indicated that Hybrid-SBA implants had higher primary (74.33 ± 3.51) and secondary (75.03 ± 3.00) stability compared to RBM implants (primary: 69.20 ± 4.44, secondary: 71.07 ± 3.98). The mean age of patients in the SBA group was 30.7 years (SD = 6.75), while in the RBM group, the mean age was 31.2 years (SD = 6.23). Although statistically significant differences were not found overall, secondary stability was significantly higher in females with Hybrid-SBA implants.
Conclusion: The findings suggest that Hybrid-SBA implants may offer superior stability, likely due to their rougher surface enhancing osseointegration. This study provided insights into the potential long-term success of different implant surfaces, emphasizing the importance of surface treatment in dental Implantology
Role of Probiotics in the Prevention of Recurrent Upper Respiratory Tract Infections in the Pediatric Age Group
Full text linkObjectives: To determine the role of probiotics in prevention of recurrent upper respiratory tract infection in children.
Methodology: This quasi-experimental study was conducted at Pediatrics department of Combined Military Hospital, Quetta, Pakistan from October 2024 to April 2025 after taking parental informed consent and ethical approval from institution. A total of 64 children with recurrent upper respiratory tract infection were included, selected through non-probability consecutive sampling technique, who were divided into Group-P (probiotic) and Group-S (no probiotics) containing 32 children each. Children were followed up after three months to assess for recurrence. Analysis of data was performed through Statistical Package for Social Sciences (SPSS) software version 22.
Results: Median age was 5.00 (3.00) years. There were 45 (70.30%) male and 19 (29.70%) female patients. Median number of episodes of URTI in three months at the end of study in Group-P was 1.00 (2.00) while in Group-S it was 2.00 (3.00), (p = 0.136). Frequency of recurrence of URTI in Group-P (n = 32) at three months follow up was 9 (28.13%) while in Group-S (n = 32), it was 17 (53.13%), (p = 0.042).
Conclusion: Probiotics can effectively prevent recurrent upper respiratory tract infection in children