Annals of PIMS (Pakistan Institute of Medical Sciences)
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Clinical Outcomes of Empagliflozin in the Treatment of Acute Heart Failure: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Full text linkObjective: To evaluate the effectiveness of empagliflozin in patients with acute heart failure by conducting a systematic review and meta-analysis of randomized controlled trials (RCTs).
Methodology: The recent systematic review and meta-analysis was conducted by following guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020. Four Electronic databases were used namely: PubMed, EMBASE, Clinicaltrials.gov and Cochrane library to find research articles. The Cochrane risk of bias tool was applied to assess the risk bias of included RCT’s and the pooled analysis was conducted by using RevMan (Review Manager) software version 5.4.
Results: About 13 RCT’s with 72,871 heart failure (HF) patients were analyzed to compare the effectiveness and safety of empagliflozin with placebo. The pooled analysis favored the experimental group as drug has controlled over first HF hospitalization among heart failure patients (Odds Ratio= 0.67; 0.52 to 0.876 Cl: 95%, p=0.13), total HF hospitalization among heart failure patients as (Odds Ratio=0.55; 0.42 to 0.74 Cl: 95%, p<0.00001), and total adverse events (fatal or non-fatal outcomes) among heart failure patients as (Odds Ratio=0.59; 0.40 to 0.88 Cl: 95%, p<0.00001). However, the levels of LVEF and NT-proBNP were reduced as reported through mean difference of LVEF (Mean difference= 0.41; -0.81 to 1.64 Cl: 95%, p<0.00001) and NT- proBNP among empagliflozin and placebo groups (Mean difference= -1.55; -7.00 to 3.91 Cl: 95%, p<0.00001). Conclusion: The findings of recent study reported that empagliflozin, in comparison to placebo, reduced the frequency of first HF hospitalization, total HF hospitalization, and cardiovascular deaths or other adverse events among patients. The levels of LVEF and NT-proBNP were also reduced slightly among group receiving empagliflozin as compared to placebo
Diagnostic Accuracy of Sonographic Breast Imaging Reporting and Data System Classification in Distinguishing Benign from Malignant Masses.
No full textAbstract
Background: Worldwide, breast cancer is the leading cause of death for women. Early identification of breast tumors enhances patient recovery and contributes to more effective treatment approaches. Breast masses can be quickly and non-invasively diagnosed with ultrasound. A standardized method for classifying breast lesions can be obtained by the Breast Imaging Reporting and Data System (BI-RADS), and sonographic BI-RADS facilitates in distinguishing between benign and malignant breast masses.
Methods: This cross-sectional validation study was carried out in the radiology department of KRL, hospital Islamabad. This study was conducted over a period of six months. For suspected breast cancer evaluation, 80 adult female patients, aged 18 to 65, who presented with breast lumps were selected for the study. In order to classify their tumor according to BI-RADS, patients underwent breast ultrasound scanning. The imaging findings from sonographic BI-RADS were validated against histopathology. A 2x2 table was used to calculate diagnostic metrics such as sensitivity, specificity, positive predictive value, and negative predictive value.
Results: The study assessed the diagnostic accuracy of the Sonographic Breast Imaging Reporting and Data System (BI-RADS) classification among patients aged 18–65 years (mean 32.4 ± 11.3 years). Higher breast density (ACR C and D) was prevalent, observed in 77.5% of participants. BI-RADS 2 (benign) accounted for 56.25% of breast masses, while 22.5% of cases were histopathologically confirmed as malignant, predominantly invasive ductal carcinoma (61.1%). Ultrasonography showed excellent performance, with a sensitivity of 84.4%, specificity of 96.3%, and an overall accuracy of 92.4%, underscoring its effectiveness in distinguishing benign from malignant breast masses.
Conclusion: High diagnostic accuracy was proven by sonographic BI-RADS classification in differentiating between benign and malignant breast lesions. The findings emphasize the utility of ultrasonography and BI-RADS in routine breast lesion assessment.
Keywords: Breast cancer, BI-RADS, Ultrasound, Diagnostic Accuracy, Benign Breast Lesions, Malignant Breast Lesions, Histopathology
Frequency of Urinary Tract Infection in Children Presenting with Acute Gastroenteritis in PIMS Islamabad
Full text linkObjectives: To determine frequency of urinary tract infection (UTI) in children presenting with acute gastroenteritis (AGE) in PIMS Islamabad.
Methodology: This observational, cross-sectional study was carried out from June 2022 to December 2022 at pediatric isolation department PIMS Islamabad. A total of 160 children fulfilling the inclusion criteria were included in the study. At the time of inclusion baseline characteristics were documented. After that all the children who presented and admitted with acute gastroenteritis were assessed for presence of urinary tract infection through a standardized “mid-stream†urine sample collection protocol and sending obtained samples to in-hospital laboratory for diagnosis. Data was analyzed using SPSS 22:00.
Results: In our study, mean age of included children was 3.57 ± 1.14 years. 42 (26.25%) male and 118 (73.75%) female children were included. Mean duration of having gastroenteritis was 3.48 ± 1.93 days. Frequency of urinary tract infection in the children who presented with acute gastroenteritis was 24 (15.00%). Most common organism which was isolated as a culprit of UTI was Escherichia Coli 18 (75.00%).
Conclusion: Urinary tract infection (UTI) is a common comorbid condition in children who present with acute gastroenteritis.
Keywords: Acute gastroenteritis, Frequency, UTI
Stress Perception & Their Coping Strategies Among Medical Students of ISRA University, Pakistan
No full textIntroduction:
Students in the medical field experience a wide range of pressures. A high level of stress has been documented in numerous research among medical students. However, very few studies on this topic that originate from Pakistan have focused on the student's physical and mental well-being as well as their professional development. We aimed to evaluate medical student’s views of stress variables, their sources, and their intensity, as well as the coping mechanisms they adopt and their efficacy.
Methodology:
A cross-sectional study was carried out at Al-Nafees Medical College, ISRA
University from Jan 2022 to June 2022. 150 students from first year to third year of medical school were assessed using with the help of Stress Indicators Questionnaire, the Medical Student Stress Questionnaire and BRIEF COPE.
Results:
There were 150 complete responses from the total of 182 sampled students with a response rate of 82%. Among them 52 students (35%) were males and 98 (65%) were females. A high prevalence of stress was found among medical students. 77 students stated a major issue for having severe stress that was having family responsibilities.
Conclusion:
Medical students should receive stress management training when they first enroll in medical school. Academic, psychic and social therapy for students is a sort of student mentoring that can help students perform better by assisting with stress management. The number one stressor identified was revealed to be academic stress
EFFECT OF ANTERIOR/ POSTERIOR COLPOPERINEORRHAPHY ON SEXUAL FUNCTIONS IN HETEROSEXUAL COUPLES
No full textAbstract:
Background: Pelvic organ prolapse (POP) also upsets sex function and quality of life in women. Frequent surgical treatment to correct pelvic anatomy is anterior and posterior colpoperineorrhaphy. Finally, the sexual consequences of these surgeries on women as well as their male partners remain relatively poorly investigated supporting further research to better elucidate sexual outcomes following surgery. Objectives: This study aimed to investigate the sexual functions of heterosexual couples following anterior and posterior colpoperineorrhaphy with emphasis on sexual desire, arousal, orgasm, satisfaction, and pain before and after the operation. Study Design: A Prospective Cohort Study. Setting and duration of study. Gynecology Department of Ayub Teaching Hospital Abbottabad, Pakistan between January 2024 and June 2024. Methods: A prospective cohort study of 100 heterosexual couples was conducted where the females had anterior or posterior compartment defects (>1 cm) and colpoperineorrhaphy was performed after the baseline data. Female sexual functions via the Female Sexual Function Index (FSFI) and male sexual functions via the International Index of Erectile Function 5 (IIEF-5) were assessed pre- and postoperatively. Statistical analyses were performed using paired t-test to determine mean difference in sexual function scores before and six months after surgery. Results: The mean ages of female patients and their spouses were 45.28±6.556 and 48.90±4.092 years respectively. The (baseline) mean IIEF-5 score for men improved from 17.72±3.939 (preoperatively) to 22.08±2.098 (postoperatively) significantly (p <0.001). There was a statistically significant improvement in all 6 areas of sexual function: desire, arousal, lubrication, orgasm and satisfaction, as well as reduction in pain (p < 0.001). Conclusion: Both women and their male partners benefit from anterior and posterior colpoperineorrhaphy with regard to the improvement in sexual functions. These results support the necessity of attention to sexual health issues in treatment for POP. Future studies delineating long-term outcomes and anterior versus posterior repairs are required to provide better advice for our patients.
Keywords: Pelvic organ prolapse, sexual function, colpoperineorrhaphy, FSFI, IIEF-
Prevalence of Wound Infection With New Internal Tension Sutures Technique for Midline Laparotomy Closure
Full text linkObjective: To determine the incidence of wound infections in patients undergoing laparotomy closure using the internal tension sutures technique.
Methodology: This descriptive case series study was conducted at surgery department, JPMC, Karachi. Patients aged 18-50 years, undergoing laparotomy due to any one of perforated viscus, intestinal obstruction, stab wound to abdomen and other intra- abdominal malignancies of either gender were included. Patients underwent laparotomy under general anesthesia, with midline incisions, abdominal irrigation, and drain placement. Closure followed Jenkins' rule using continuous mass closure with Vicryl 1/0 and internal tension sutures. Skin was closed with staples or Prolene 2/0, and postoperative care included antibiotics, nutrition, and analgesics. Patients were followed weekly in OPD, and wound infections were assessed on the 15th postoperative day. Data was recorded by especially designed proforma.
Results: A total of 141 patients undergoing laparotomy were included in this study. Mean age, duration of surgery and weight in our study was 41.90±8.82 years, 105.11±12.25 minutes and 71.9±9.87 years. 69 (48.9%) were male and 72 (51.1%) were female. Out of 141 patients, 07 (5%) and 134 (95%) had and did not have 141 infection. Furthermore the stratification revealed no significant relationship of wound infection with age of the patients, gender, and the BMI, (p->0.05).
Conclusion: Study revealed that internal tension sutures technique reduce the incidence of wound dehiscence in abdominal surgery patients, it may cause postoperative pain and wound infection as evident from the results of our study and therefore should be cautiously applied in patients with a high risk
Effect of Cognitive Behavioral Therapy (CBT) in Post Cardiac Artery Bypass Surgery Patients Co morbid with Depression, Anxiety and its Effect on Quality of Life (QOL)
Full text linkObjective: The objective of this study is to determine the effect of CBT on decreasing anxiety and depression, and improvement of quality of life in post cardiac Artery bypass surgery patients.
Methodology: Sample was randomly selected and divided in to two groups (50 subjects each in experimental and control group). Research tool was HAD- Scale and WHOQOL scale. Study design was comparative and intervention including formal cognitive behavioral therapy weekly sessions and psychometrics tests were applied on both the groups after one week interval. After an initial assessment of participants' anxiety, depression and quality of life the experimental group went under CBT for 8 weekly sessions and control group did not receive any intervention except usual care. Finally, participants' anxiety, depression and quality of life were measured again. Formal approval from hospital ethical committee, written informed consent from participants and basic demographic data were also gathered along with the questionnaire.
Results: Results from the analysis of covariance showed that CBT significantly has improved the anxiety, depression and QOL in experimental group in comparison with control group. Data was represented in Mean (+SD). Demographic and intervention related information was analyzed using chi square tests. Pre to Post comparison of depression and quality of life was done by paired t test. Data was analyzed using MS Excel and SPSS version 16.
Conclusion: CBT can be used as an effective intervention method in cardiac patients with high anxiety or depression level
Exploring the Level of Interest of Faculty Members towards Problem based Learning Process
Full text linkObjective: To explore the knowledge, interest, and perceived barriers among Basic Medical Sciences faculty regarding the implementation of Problem-Based Learning (PBL) at Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro.
Methodology: A qualitative exploratory design using a phenomenological approach was employed. Eighteen faculty members were selected via purposive sampling, representing both PBL-experienced and non-experienced individuals. Semi-structured, face-to-face interviews were conducted and audio-recorded, transcribed verbatim, and analyzed thematically using NVivo.
Results: Five major themes emerged: knowledge of PBL, impact on students, interest promoters and inhibitors, institutional role, and current interest level. Most faculty (16/18) recognized PBL as a student-centered strategy fostering critical thinking and collaboration. However, few had formal training, and many were uncertain about its theoretical underpinnings. Institutional support was identified as a key enabler (14/18), while lack of resources (13/18), inadequate training (12/18), increased workload (13/18), and limited administrative backing (10/18) were prominent barriers. The average faculty interest in PBL was 8.5/10. While faculty expressed enthusiasm for adopting PBL, many stressed the need for structured training programs, gradual implementation, and enhanced logistical support. Faculty also highlighted variability in student engagement and emphasized the importance of tailored strategies to improve participation.
Conclusion: The findings indicate a high level of interest in PBL among faculty at LUMHS. While institutional support exists, successful implementation is hindered by insufficient training, increased workload, and resource limitations. Addressing these challenges through targeted institutional policies, faculty development initiatives, and phased integration of PBL can promote sustainable adoption of this learner-centered teaching method
Comparison of Outcome of K-Wires Versus Plates & Screw Fixation for Management of Hand Fractures
Full text linkObjective: To compare the outcomes of K-wires versus plate and screw fixation in managing hand fractures.
Methodology: This study was conducted at the Department of Plastic Surgery, PIMS, Islamabad, from April 2021 to April 2022. A total of 160 patients (aged 16–65 years) with hand fractures meeting inclusion criteria were included. Patients were followed up for three months, and success was defined as achieving >70% of the normal range of motion. Data analysis was done using SPSS, applying the Chi-square test to compare success rates, with p < 0.05 considered significant.
Results: The mean age was 29.1±5.8 years for the K-wires group and 28.2±5.6 years for the plate and screw group. Males comprised 60% of the K-wire group and 65% of the plate and screw group. Success rates were 76.2% in the K-wire group and 90% in the plate and screw group (p < 0.05).
Conclusion: Plate and screw fixation showed significantly better outcomes than K-wires for hand fracture management. Larger randomized clinical trials are needed to validate these findings