Annals of PIMS (Pakistan Institute of Medical Sciences)
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Efficacy of Melatonin in Treatment of Infantile Colic in Infants Presenting to CMH Quetta OPD
Full text linkObjective: To determine the efficacy of melatonin in treatment of infantile colic presenting to a tertiary care hospital or CMH Quetta.
Methodology: This prospective single group interventional 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 146 infants with colic were included, selected through non-probability consecutive sampling technique. All the infants were given oral melatonin for five days and one week after completion of therapy infants were assessed for improvement in the colic severity. Efficacy was considered to be established in case of achievement of complete resolution of colic. Analysis of data was performed through SPSS version 22.
Results: In this study, 146 infants were included. Median age was 4.00 (2.00) months. There were 77 (52.70%) male and 69 (47.30%) female infants. Median weight was 9.00 (3.00) kg. A total of 65 (44.50%) infants were receiving breast feeding, 52 (35.60%) infants were receiving formula milk feeding and 29 (19.90%) infants were receiving cow milk. Complete improvement/efficacy was achieved in 80 (54.80%) infants, partial improvement was observed in 43 (29.50%) infants while 23 (15.80%) infants had no improvement.
Conclusion: Melatonin is an effective intervention in the management of infantile colic. It resulted in complete recovery in 54.80% of the infants and partial improvement in 29.50% of the infants with colic
Frequency of the Factors Leading to Amblyopia in Children
Full text linkObjective: To determine the factors that influence the distribution of amblyopia in children based on their referral pattern, refractive problems, strabismus, and visual deprivation.
Methodology: This cross-sectional study was conducted at the Ophthalmology Department, Hayatabad Medical Complex, Peshawar. from January 2023 - May 2024 after obtaining approval from the Ethical Committee. 287 Children of either Gender with unilateral amblyopia and their age ranged from 5-15 years were included in the study. Performa were used to gather data and the variables were analyzed using SPSS version 22.
Results: A total of 287 children were evaluated, revealing a slight male predilection, with 51.9% of the affected individuals being male. Refractive errors were identified as the leading causes of amblyopia, with hypermetropia accounting for 36.9% of cases and myopia for 29.6%. Other contributing factors included astigmatism 12.5%, strabismus 11.5%, and visual deprivation 9.4%.
Conclusion: The study shows that refractive errors played a very crucial part in children developing amblyopia. This implies therefore that the above factors need to be detected and addressed early to prevent the adverse effects on the vision. These findings suggest that screening for amblyopia must be performed regularly within the pediatric populations to achieve optimum outcomes for amblyopia intervention
Enhancing Peripheral IV Cannula Management: A Clinical Audit on Optimal Replacement Time, Post-Insertion Documentation, and Rate of Superficial Phlebitis in Surgical Wards
Full text linkUse of Tranexamic Acid to Reduce Bleeding in Head and Neck Reconstructive Surgery
Full text linkObjective: To assess the effectiveness of local infiltration of tranexamic acid in reducing intraoperative bleeding in head and neck reconstruction.
Methodology: This prospective study was conducted at Pakistan Institute of Medical Sciences/ Shaheed Zulfiqar Ali Bhutto Medical University between April and October 2024. Sixty six patients undergoing reconstructive surgery for head and neck defects were allocated into two groups: one receiving local infiltration with a 1:1 mixture of lignocaine (20 mg/ml) and TXA (100 mg/ml), and the other receiving a 1:1 mixture of lignocaine (20 mg/ml) and normal saline. Surgical field hemostasis was graded, postoperative hemoglobin drop was measured at 48 hours, and transfusion needs were recorded. Statistical analyses were performed to compare the results of the groups.
Results: The tranexamic acid group demonstrated significantly better surgical field visibility (mean score 1.85 vs. 3.24, p < 0.01), a lower mean hemoglobin drop at 48 hours (0.53 g/dl vs. 1.42 g/dl, p < 0.01), and reduced transfusion requirements (1 vs. 12 patients). No significant adverse effects were observed during the immediate postoperative period.
Conclusions: Local infiltration of tranexamic acid reduces intraoperative bleeding, improves surgical field visibility, and decreases transfusion requirements without immediate adverse effects. Further studies are recommended to optimize dosing and assess long-term safety.
Keywords: Tranexamic acid, head and neck surgery, reconstructive surgery, bleeding control, local infiltration, surgical hemostasis, intraoperative bleeding, antifibrinolytic agents, surgical field visibility
Prevalence of Human Immunodeficiency Virus in children with Tuberculosis
Full text linkObjectives: To determine prevalence of HIV co-infection in children with TB visiting Tb center Children Hospital, PIMS.
Methodology: This cross sectional study was conducted in Children Hospital, Pakistan Institute of Medical Sciences, Islamabad. from March 2022 to February 2024 after approval from ethical review board. 170 participants were selected from TB center Children hospital PIMs. Written and informed consent was obtained from parents/attendants of all patients. HIV serology of all TB patients coming to TB center children hospital PIMs is advised in routine and HIV serology is available free of cost in our hospital. Demographic data of patients, information regarding type of TB, bacteriological evidence of TB and HIV serology results were entered in a standardized Performa created for our study.
Results: Out of the total 170 TB cases included in our study 5 patients were HIV positive. This represents 2.9% of our study population. Out of these 5 patients, 3 were male and 2 were female. Age of HIV positive patients was widely distributed with the youngest patient being 3 months only and the oldest 11yrs. 4 (80%) HIV positive patients had clinically diagnosed and 1 patient had MTB positive in gastric aspirates. All HIV positive cases had pulmonary TB.
Conclusion: Prevalence of HIV infection in children with Tb was much higher as compared to the prevalence of HIV in general population
Comparison of Increased Dose of Oral Sodium Bicarbonate vs Standard Dose in Reduction of Progression of Chronic Kidney Disease
Full text linkObjective: To compare the effect of an increased dose of oral sodium bicarbonate versus the standard dose on the reduction of CKD progression.
Methodology: A Randomized controlled trial was done at Department of Nephrology, PIMS, Islamabad from January 2023 to December 2023. One hundred and eighty patients aged 18-75 years with Chronic Kidney Disease CKD i.e. kidney damage or glomerular filtration rate (GFR) <60 mL/min/1.73 m2 for 3 months or more, irrespective of cause were enrolled in this study. Selected Patients were suffering from CKD grade III-V (eGfr15-59). Group A received sodium bicarbonate 300mg X 3 X TDS. Group B received sodium bicarbonate 300mg X 2 X TDS, titrated to maintain 21±1 mmol/L. Both groups received standard CKD treatment and were followed up biweekly for 3 months and monthly thereafter.
Results: Group A had 63.3% males and 36.7% females; Group B had 62.2% males and 37.8% females (P=0.877). Demographic features and baseline comorbidities were similar (P>0.05). Mean serum creatinine was 3.4 mg/dL in Group A and 3.3 mg/dL in Group B (P=0.983). Mean eGFR was 30.6 ml/min in Group A and 30.3 ml/min in Group B (P=0.876). Baseline HCO3 levels were 18.7 mmol/L in Group A and 18.5 mmol/L in Group B (P=0.956). Starting doses were 2700 mg/day in Group A and 1800 mg/day in Group B. eGFR was not significantly different at 3, 6, and 9 months. At 12 months, eGFR was significantly lower in Group B (25.3 ml/min) compared to Group A (26.8 ml/min) (P<0.05). Mean percentage decline in eGFR was significantly different at 9 and 12 months, favouring Group A (P=0.001). The rate of CKD progression was significantly lower in Group A at 12 months (P=0.028).
Conclusions: Higher initial doses of sodium bicarbonate in CKD patients resulted in a significantly lower rate of CKD progression at 12 months compared to the standard dose
Outcome of Fast Breathing in Young Infants (0–59 Days Old) Classified as Pneumonia Treated With Oral Amoxicillin
No full textObjective: To see the outcome of fast breathing young infants aged between 0 and 59 daysclassified as pneumonia treated with oral amoxicillin.Methods: A cross-sectional study conducted at the Department of Paediatrics, LiaquatUniversity of Medical and Health Sciences, Jamshoro/Hyderabad, over a period of sixmonths. Infants of either gender, aged 0 to 59 days, presenting with fast breathing anddiagnosed with pneumonia, who refused hospital admission and presented to the Departmentof Paediatrics were included. Patients were treated with oral amoxicillin at a dose of 100mg/kg/day. Follow-up was done at 48 hours to monitor clinical status. The primary outcomewas defined as “cured” if the infant’s respiratory rate was ?60 breaths per minute after sevendays of oral therapy. Infants showing complications were shifted to injectable antibiotics andreferred for admission, while others continued oral treatment. Data were analyzed using SPSSversion 22.0RESULTS: The mean age of studied infants was 26.65±15.28 days. There were145(69.05%) male and 65(30.95%) female. Cure rate was significantly higher after treatmentwith oral amoxicillin at 100mg per kg day (&lt;2kg are given 75mg per kg per day) that is63.81%. here was no significant difference in cure rates by age group (p = 0.083) or gender (p= 0.274), but cure rates were significantly higher in term infants compared to preterm (p =0.007).Conclusion: For cases of fast breathing in young infants without signs of severe infection,oral amoxicillin has proven to be an effective alternative to injectable therapy, particularlywhen referral is refused or not feasible.Key Words: Pneumonia, Oral amoxicillin, Fast breathin
Prevalence of Gingivitis among the Patients Visiting Dental OPD of Bhitai Dental & Medical College Mirpurkhas
Full text linkObjective: To determine the prevalence rate of gingivitis among the patients visiting Dental OPD of Bhittai Dental & Medical College Mirpurkhas.
Methodology: This cross-sectional study was conducted at the dental OPD of Bhittai Dental & Medical College, Mirpurkhas, over six months, from July 2023 to December 2023. All individuals aged over 12 years, of both genders, attending the dental OPD for routine check-ups, dental complaints, or periodontal assessments were included. Each patient underwent a periodontal assessment by a qualified dental professional. The diagnosis of gingivitis was made using standard clinical criteria, including gum redness, swelling, and bleeding on probing. Patients were assessed for gingivitis and its severity using the Gingival Index (GI) to quantify severity. A structured questionnaire was used to record demographic details, oral hygiene practices, and frequency of gingivitis, and the data was analyzed using SPSS version 26.
Results: Mean age of the patients was 28.3 years, with slightly more female (52.2%) than male (47.8%), and the majority were married (69.6%). Gingival bleeding was found in 39.1% of the participants, indicating the presence of inflammation, while 60.9% showed no bleeding. There was an insignificant link between gender and gingival bleeding (p=>0.05), while medication use and poor oral hygiene was significantly associated, with those not on medication experiencing more bleeding (<0.05). Tobacco use did not significantly affect bleeding rates (p=>0.05).
Conclusion: The prevalence of gingivitis among patients visiting the OPD reveal that gingival bleeding is a common clinical sign, affecting approximately 39.1% of participant
Frequency of Advanced Liver Fibrosis among Inactive Hepatitis B Virus Carriers: A Cross-Sectional Analysis
Full text linkObjective: To determine the frequency of advance fibrosis in Hepatitis B virus (HBV) inactive carriers.
Methodology: A cross-sectional study was conducted at the Gastroenterology Outpatient Department (OPD) of AIMS, from September 2020, to March 2021. Adult patients aged 18 to 70 years who had not received previous treatment for HBV, had an HBV viral load of less than 2000 IU, and an SGPT level below 35 U/L were included. HBV inactive carriers were identified by HBV DNA levels below 2000 IU and SGPT under 35 U/L. Advanced liver fibrosis (stage F3 or higher) was assessed using FibroScan, with a median cutoff of 8.2 KPa. Ten liver stiffness readings were averaged for staging. Data were collected using a structured proforma. Data were analyzed with SPSS version 26.
Results: Mean age of the cases was 39.5±6.7 years. In distribution of gender, 86 (68.3%) were male while 40 (31.7%) were female. Advance fibrosis was found in 29 (23%) patients, with most cases clustered in severe stages—F3 and F4—representing nearly 76% of those affected. Advanced fibrosis was more common in those over 40 years and in males, though gender and Diabetes showed a statistically significant association (p <0.05), while obesity and age group showed no significant associations (p >0.05)
Conclusion: Advanced fibrosis was observed to be relatively less prevalent among HBV inactive carriers. Its association with male gender and diabetes indicates that specific subgroups may still be at increased risk
Perinatal Outcomes in Women with Pre-eclampsia Having Raised Serum Uric Acid Levels
Full text linkeclampsia who had elevated serum uric acid levels.
Methodology: This descriptive study was conducted at the Department of Obstetrics and Gynecology, PAF Hospital Islamabad, Sarfraz Rafiqui Complex from Jan 2025 to Mar 2025. The study population was determined using the WHO calculator, considering the prevalence of pre-eclampsia in pregnancy as 25.9% in the local population, with a 95% confidence interval and a 0.08% margin of error. The calculated minimum sample size was 116. Participants were selected through consecutive non-random sampling. Data were collected on maternal demographics, serum uric acid levels, and perinatal outcomes. Statistical analysis was performed by means of SPSS version 23.
Results: Among 116 women detected through pre-eclampsia, those through elevated serum uric acid levels had a higher incidence of adverse perinatal outcomes, including preterm birth, low birth weight, neonatal intensive care unit (NICU) admissions, and perinatal mortality. A statistically significant correlation was observed between raised serum uric acid levels and poor perinatal outcomes (p < 0.05).
Conclusion: Elevated serum uric acid levels in females having pre-eclampsia were related through adverse perinatal results, including preterm birth, low birth weight, and increased NICU admissions. Routine monitoring of serum uric acid levels in pre-eclamptic pregnancies may help in early identification of high-risk cases, allowing for timely intervention to improve perinatal outcomes.
Keywords: Pre-eclampsia, Serum Uric Acid, Perinatal Outcomes, Pregnancy, Hypertensive Disorders of Pregnancy, Maternal Health