Annals of PIMS (Pakistan Institute of Medical Sciences)
Not a member yet
815 research outputs found
Sort by
The Relative Efficacy of Topical and Systemic Antibiotic Therapy in Preventing the Development of Pyogenic Granulomas in Burn Patients
Full text linkPyogenic granuloma (PG) is a benign vascular tumor commonly seen in children, typically emerging on the skin or mucosal surfaces. This case series examines ten instances of PG following second-degree burns, presenting unique clinical features and treatment responses. PG, often a result of trauma rather than infection, can mimic other vascular lesions and requires accurate diagnosis to distinguish it from conditions like Kaposi's sarcoma and deep mycosis. The series includes cases of burn injuries caused by various substances, such as hot milk, oil, and boiling water, leading to PG formation. Treatment strategies varied based on the severity and complications of the burns, including bacterial and fungal infections. Standard burn care, including topical antibiotics and dressings, was employed initially, with advanced therapies and surgical interventions applied as needed. Notably, individualized treatment based on microbiological results improved outcomes significantly. This study underscores the necessity for precise diagnosis and tailored therapy to manage burn-related PG and associated infections effectively. Future research should focus on standardized burn care protocols and the impact of antimicrobial treatments on burn healing
Effect of Dexamethasone Intraligament Injection on Post-Endodontic Pain in Patients with Symptomatic Irreversible Pulpitis
Full text linkObjective: This study aimed to evaluate the efficacy of intraligamentary dexamethasone injection in reducing post-endodontic pain among patients with symptomatic irreversible pulpitis.
Methodology: A descriptive case series was conducted at the Department of Dentistry, Ibn-e-Siena Hospital, Multan, from October 2023 to April 2024. A total of 155 patients aged 18–65 years, presenting with irreversible pulpitis of less than seven days’ duration, were enrolled using non-probability consecutive sampling. After informed consent, all patients received a pre-operative intraligamentary injection of dexamethasone (0.4 mL) using a pressure syringe following standard anesthesia. Single-visit pulpectomy was performed 30 minutes post-injection by an experienced endodontist. Postoperative pain was assessed at six hours using a Visual Analogue Scale (VAS). Treatment success was defined as VAS < 3. Data were analyzed using SPSS v23, and chi-square test was applied to assess associations; p < 0.05 was considered significant.
Results: Of the 155 patients, 72 (46.5%) were male and 83 (53.5%) were female, with a mean age of 38.6 ± 10.4 years. Successful pain control was achieved in 109 (70.3%) patients, while 46 (29.7%) experienced persistent pain (VAS ? 3). No statistically significant association was observed between treatment success and gender (p = 0.404), laterality (p = 0.928), or tooth location (p = 0.411).
Conclusion: Preoperative intraligamentary injection of dexamethasone significantly reduced post-endodontic pain in patients with symptomatic irreversible pulpitis, with a success rate of 70%. Incorporating this approach into routine endodontic practice can enhance patient comfort and improve clinical outcomes
Comparative Analysis Between Paracetamol vs Placebo During Labour in Primigravida in Terms of Cervical Dilatation and Adequate Analgesia
Full text linkObjective: To evaluate a comparative analysis of paracetamol versus placebo during labour in primigravida women in terms of cervical dilatation and adequacy of analgesia.
Methodology: This randomized controlled trial was carried out in the Obstetrics and Gynaecology Department of Patel Hospital, Karachi, from June 2023 to December 2023. All primiparous women with singleton pregnancies, cephalic presentation, active labour, and gestational age greater than 37 weeks were included. The women were randomly categorized into two groups: the intervention group 1000 mg 1 g paracetamol with oxytocin augmentation) and the control group (oxytocin augmentation alone. Cervical dilatation was measured in centimeters from the onset of active labour greater than 4 cm) to full dilatation 10 cm. Pain scores were measured using the Visual Analogue Scale VAS, where participants rated their pain. Changes in pain scores over time were analyzed to determine the analgesic efficacy of paracetamol compared to placebo. Pain scores were assessed at regular hourly intervals until full cervical dilatation or delivery. Data were entered and analyzed using SPSS version 26.
Results: A total of 80 women with term pregnancies were studied, with an overall mean age of 24.22 years.
Conclusion: Paracetamol administration as an adjunct to oxytocin augmentation was found to be significantly effective in promoting faster cervical dilatation and significantly reducing labour pain
Correlation of Triglycerides to Glucose Index With the SYNTAX Score in Patients of Acute Coronary Syndrome
Full text linkObjective: To determine the severity of triglycerides to glucose index and its correlation with the SYNTAX score in patients presenting with ACS.
Methodology: An analytical type of cross-sectional study was done in the Department of Cardiology CPEIC, Multan. 200 patients with ACS were enrolled, their fasting triglycerides and glucose were sent, and all underwent coronary angiography during hospitalization. The Triglycerides-Glucose index was calculated, and after descriptive statistics, the proportion of ?8.8 TyG was determined. Following it, the correlation of TyG with the syntax score was measured and a p-value of ? 0.05 was found significant. Effect modifiers were controlled by data stratification.
Results: There were 162 (81.0%) male, mean age 46.52±14.41 years and mean BMI was 24.43±4.07 kg/m2. 119 (59.5%) patients had severe ?8.8 TyG, mean SYNTAX score I was 24.01±2.29, and mean TyG index was 8.71±0.92.A significant positive correlation between the Syntax score and TyG index, ( r: 0.924, p<0.001). After data stratification correlation was high and significant in males, age group of 51-65 years, BMI from 25 to 29.9 kg/m2, smokers, hypertensives, and diabetic patients
Conclusion: Triglyceride Glucose Index is positively correlated with syntax score. TyG being an inexpensive and quick tool can be used as the coronary artery disease severity predictor
Surgical Site Infection in Primary versus Delayed Primary Closure in Complicated Appendicitis
No full textObjective: The objective of the study was to compare the frequency of SSI of primary versus delayed primary closure among the patients with complicated appendicitis. Materials & Methods: A randomized controlled trial having110 patients with the diagnosis of complicated appendicitis was conducted at the General Surgery Department, District Headquarters Hospital Rawalpindi, from February 28, 2021 to August 27, 2021. The wound of the patients included in group A was washed using normal saline (NS), and rectus muscle and skin were closed with prolene 1 and silk 2-0 vertical mattress sutures in primary closure (PC), respectively. On the other hand, the wound of the patients included in group B was washed with NS and rectus muscles were closed with prolene 1-0 while sutures were not applied to skin and a saline-soaked gauze dressings was placed for delayed primary closure (DPC) on the 5th postoperative day. The presence or absence of SSI was assessed for 7 days post-operatively. Results: The patients in group A and group B had mean age of 37.05 ± 5.99 and 38.67 ± 6.99 years, respectively. Most of the patients (54.55%) fell within the age range of 15 to 40 years. Of 110 patients, 68.18% and 31.82% were males and females, respectively. The SSI was reported in 9.09% and 25.24% patients with primary closure and delayed primary closure, respectively (p = 0.023). Conclusion: The frequency of SSI is less in patients with primary closure in complicated appendicitis as compared to delayed primary closure.
Keywords: Complicated appendicitis, Surgical site infections, Primary Closure, Delayed primary closur
Hypothyroidism in Patients with Non Alcoholic Fatty Liver Disease (NAFLD)
Full text linkObjective: To determine the frequency of hypothyroidism in patients diagnosed with Non-alcoholic fatty liver disease (NAFLD) presenting at Liaquat University Hospital, Hyderabad.
Methodology: A descriptive cross-sectional study was conducted over six months, from January to July 2023, in the Department of Medicine, Liaquat University Hospital, Hyderabad. Patients aged 20 to 60 years of either gender with a clinical diagnosis of NAFLD for at least three months were included. Each patient was evaluated for hypothyroidism through laboratory analysis of a 2cc venous blood sample, and relevant data were recorded using a predesigned proforma. Post-stratification associations were analyzed using chi-square test taking a p-value ? 0.05 as statistically significant.
Results: An overall mean age of the patients was 39.56 ± 10.45 years, comprising 54.7% males and 45.3% females. Overall hypothyroidism was detected in 93 individuals (38.0%). Additionally post-stratification analysis showed that hypothyroidism was significantly more common among females (57.9%), rural residents (54.4%), patients with longer disease duration, hypertension, obesity and smokers (p-0.001), while no significant difference was found across different age groups (p = 0.93).
Conclusion: A high frequency of hypothyroidism was observed among patients with NAFLD, suggesting a potential link between thyroid dysfunction and fatty liver disease
Comparison of Success Rate between Two Different Surface Treated Miniscrews with Conventional Miniscrews during Fixed Orthodontic Treatment
Full text linkObjective: To determine the success rate between two different surface treated miniscrews and conventional miniscrews during fixed orthodontic treatment.
Methodology: This prospective, split-mouth, comparative clinical study was conducted at Orthodontics Department of Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) Dow university Hospital karachi, from October 2024 to March 2025. Patient with fixed orthodontic therapy with requirement of absolute anchorage, patients with good oral hygiene and healthy periodontal status, aged 15 to 30 years of either gender were included. Individuals assigned to two groups, with Group A receiving sandblasted miniscrews on the right side and conventional miniscrews on the left, whereas Group B received acid-etched miniscrews on the right side and conventional miniscrews on the left side. The success was defined as the ability to maintain anchorage throughout orthodontic treatment without clinically detectable mobility. SPPS-26 version was used for data analysis.
Results: The success rate was significantly higher in Sandblasted miniscrew 80% as compared to 56.6% in conventional group (0.047). The success rate of Acid-Etched miniscrew was also found significantly higher 86.6% compared to conventional group 53.3% (p=0.010). However, the success rate was compared between Acid-Etched miniscrew and Sandblasted miniscrew, no significant difference was observed as p-value < 0.05.
Conclusion: Success rate of acid-etched surface miniscrews and Sandblasted miniscrews differed significantly. However, significant difference has been found in success rate between surface treated miniscrews with conventional miniscrews
Enhancing Diagnostic Accuracy in Symptomatic Breast Diseases: The Role of Ultrasound with Mammography
Full text linkObjectives: To evaluate the diagnostic performance of mammography and ultrasound, individually and in combination, in patients presenting with symptomatic breast disease.
Methodology: A cross-sectional validation study was conducted in the Department of Surgery at a PAF hospital in Islamabad, affiliated with Air University, from January 2025 to August 2025. A total of 120 female patients with breast symptoms underwent standard two-view mammography and targeted breast ultrasound. Imaging findings were categorized using the BI-RADS classification and correlated with histopathology, which served as the gold standard. Diagnostic parameters, including sensitivity, specificity, predictive values, and overall accuracy, were calculated.
Results: The mean age of the patients was 44.2 ± 10.8 years, with the majority belonging to the 41–50-year age group. Mammography demonstrated a sensitivity of 76.2% and a specificity of 79.5%, while ultrasound showed a sensitivity of 90.5% and a specificity of 85.9%. When both modalities were combined, sensitivity increased to 95.2%, specificity to 91.0%, and overall diagnostic accuracy to 92.5%. The negative predictive value was highest for the combined approach (97.3%), thereby minimizing false-negative results.
Conclusion: The combination of ultrasound with mammography significantly improves diagnostic accuracy in symptomatic breast disease compared with either modality alone and should be incorporated into routine clinical practice
Application of WHO ICD-PM Classification for Perinatal Death (PND) in a Tertiary Care Hospital
Full text linkObjective: To apply the WHO ICD-PM classification for systematically identifying and categorizing perinatal death causes, improving reporting, understanding risk factors, to reduce mortality.
Methodology: This was a retrospective cross-sectional study conducted in Gynae unit 1 of Dr. Ruth KM PFAU Civil Hospital Karachi from Jan 2019 to Dec 2020. All PND occurring during this period were classified according to WHO ICD–PM classification. Data was analyzed by SPSS–24. Chi square test applied to detect significance based on P–value <0.05.
Results: Total 8309 women delivered with 639 PND during the study period of which 82.8% were stillbirth and 110 were neonatal deaths. Most common cause of antepartum deaths were antepartum hypoxia and disorder of fetal growth) which were mainly associated with M4 maternal condition. Intrapartum deaths were caused by intrapartum events in 73.87% cases, mainly due to complications of labour and delivery (M3). Neonatal deaths were mainly related to intapartum events (M3) or low birth weight (N9) and mainly associated with maternal complication of pregnancy (M2). In 13.6% of antepartum deaths no maternal cause could be assigned, as compared to 1.87% in intrapartum deaths and 1.8% in neonatal groups.
Conclusion: The ICD–PM observed to be a applicable PND classification system which can be utilized to plan appropriate evidence-based national strategy to reduce perinatal deaths
Impact of MCH Service Utilization on the Uptake of Modern Contraceptives in Pakistan: Evidence from PDHS 2017-18
Full text linkObjective: To examine whether the use of MCH service increases women's early adoption of contraceptives or not.
Methodology: The current study uses the data from the fourth round of the Pakistan Demographic and Health Survey (PDHS) carried out in 2017-18. The PDHS is a survey of 12,815 nationally representative sample households. It is the collaborative effort of the DHS Program, ICF funded by USAID, and the National Institute of Population Studies (NIPS), Pakistan.
Results: The survey covered 13,118 ever-married women in the reproductive age group of 15-49 years. Among the participants, 79% did not use any contraceptive method within 12 months following birth 16 % used a modern method and the rest of 5% are using the traditional method. The results of the multinomial logistic model show that the utilization of MCH services has a positive association with contraceptive uptake. 1 unit increase in media exposure would significantly raise 0.36 units of use of modern contraception methods. Women with secondary or higher education levels have used modern contraceptives, that is with a 1 unit rise in educational level to secondary and higher there would be a 0.3 and 0.44 unit rise in the use of modern contraceptive methods as compared to never-users.
Conclusion: An increase in the usage of contraceptives in Pakistan may result from the need for more assistance in improving the use of maternal healthcare. To overcome persistent discrepancies in healthcare utilization, it is advised that resources be allocated to rural communities that are poorer and have lower levels of education.
Key words: Contraceptive, Family planning, Methods, Pakistan Demographic and Health Surve