Annals of PIMS (Pakistan Institute of Medical Sciences)
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Bacterial Profile and Antibiotics Susceptibility Pattern of Isolates from Urine Culture of Children with Urinary Tract Infection
Full text linkObjective: We conducted a study to know the local Bacterial Profile and Antibiotics Susceptibility Pattern of Isolates from Urine Culture of Children with urinary Tract Infection.
Methodology: It was a descriptive cross-sectional study on children up to 16 years of age with UTI, during the period of October 2022 to April 2023. The recorded variables were demographic. Data was recorded from computer records and presented as frequency.
Results: Out of 134 children, 94(70%) were females. Escherichia coli (E.Coli) 84(63%) was the commonest isolate followed by Enterococcus sp. 30(22%) and Klebsiella sp. 14(10%). Enterococcus sp was mostly isolated from less than one year of age, 13/30 (43%), while E.coli was mostly isolated from 1-8 years of age, 38/84(45%). E.Coli was sensitive to Fosfomycin (93%), the Carbapenems (92%) Aminoglycosides (78%) and Nitrofurantoin (78%). The antibiotic showing highest sensitivity, in case of Enterococcus was, Linezolid (100%) followed by Vancomycin (95%) and Fosfomycin (65%). Our study shows increased resistance to third generation cephalosporins. Klebsiella sp. was the most resistant one, showing less than 50% sensitivity to most of the antibiotics.
Conclusion: The urinary tract infections (UTI) in children are highest with E. coli followed by Enterococcus, Klebsiella and Pseudomonas. According to our results Imipenem, Amikacin, Nitrofurantoin, Meropenem and Cefoperazone-sulbactum are the best options for selecting empirical antibiotics for the treatment of the most common pathogen that is E.coli for suspected UTI in children in our regional area. Generation of local antibiograms should be on regular basis. The definitive therapy should be initiated only after culture and antibiotic susceptibility testing
Frequency of Hyperprolactinemia in Patients with Alopecia Areata
Full text linkObjective: To determine the frequency of hyperprolactinemia in patients with alopecia areata (AA).
Methodology: This Cross sectional descriptive study was carried out at Department of Dermatology, Liaquat University Hospital, from June 2020 to March 2020. There were 201 patients of alopecia areata for > 1 year duration of either gender were included. Following a clinical evaluation, individuals diagnosed with alopecia areata underwent further assessment of serum prolactin levels. A 2 cc venous blood sample was collected from each participant under sterile conditions and sent to the hospital laboratory for analysis. The serum prolactin level ? 20 µg/L was considered as hyperprolactinemia. The data was collected on pre-designed proforma
Results: The average age of the patients was 42.37±10.42 years. There were 111(55.22%) males and 90(44.78%) females. Frequency of hyperprolactinemia in patients with alopecia areata was 70.15%. The frequency of hyperprolactinemia was statistically insignificant based on age, gender, diabetes, hypertension and obesity (p=>0.05).
Conclusion: Increased prolactin levels were observed to be highly frequent among patients with alopecia areata, suggesting that it may contribute to autoimmune mechanisms and serve as a biomarker for disease severity, while due to inconsistencies in existing research, further studies are needed to clarify its clinical significance and potential role in treatment
Frequency and Pattern of Firearm Injuries in Pediatric Population
No full textObjective: To look into frequency, pattern and outcome of firearm injuries in pediatric population.
Methodology: Observational descriptive study was conducted at Department of Pediatric Surgery KEMU/Mayo Hospital Lahore Pakistan from January 2020 to December 2020. After obtaining ethical approval, all patients admitted in pediatric surgery department with firearm injuries were included in this study. Data (age, sex, site of injury, mode of injury and management done) was recorded on a detailed Proforma. Results were analyzed and compared with national and international literature.
Results: A total of 121 cases presented in our department during one year. 85 (70.24%) were males and 36(29.75%) were females. Fifty two patients (43.3%) were admitted, 4(3.3%) refused admission, and 2(1.6%) were absconded. Sixty three patients(52%) with minor injuries were treated in emergency and discharged on the same day. Predominant age group was 7 to 10 years. Abdomen and limbs were common sites of firearm injuries followed by chest, back and other sites. Ninety seven(80.8%) patients got injury by stray bullets while 22(18.3%) got accidental injury. There were 2(1.2%) homicidal injuries in our series. 10(8.3%) patients needed chest intubations while 12(10%) patients required exploratory laparotomy. From exploratory laparotomy group 4(3.3%) patients expired
Correlation of Plasma Homocysteine Level in Patients with Metabolic Syndrome
Full text linkObjective: To determine the correlation of homocysteine level with metabolic syndrome (MetS) among patients presented at LUMHS.Methodology: This cross-sectional prospective study was conducted at Medicine department of Liaquat University of Medical and Health Sciences, from Dec 2020 to June 2021. Patients presented with metabolic syndrome, aged 18 to 60 years and of either gender were included. A 3ml blood sample was obtained from each patient to measure the homocysteine level. All the data will be recorded in self-made proforma and analysis was done using SPSS 20.0 version.Results: Total 90 patients of metabolic syndrome were studied; with mean age was 46.62+14.82 years, mean HDL 34.93+8.14 mg/dL and mean triglyceride as 210.97+20.50 mg/dL. Mean albumin level was 25.76+8.48 mg/g and mean homocysteine level was 15.94+5.72 mcmol/L. Overall hyperhomocysteinemia was found in 72.2% patients, which was further statistically insignificant based on genders, hypertriglyceridemia and low HDL level p-values were quite insignificant (>0.05), while its was statistically significant based on microalbuminuria (p-0.001).Conclusion: Hyperhomocysteinemia was observed to be highly frequent among patients with metabolic syndrome. Microalbuminuria was positively correlated with homocysteine levels
Burdens and Benefits of Continuous Glucose Monitoring Use in Patients of Type 1 Diabetes Mellitus
Full text linkObjective: The present study is designed to scan the positive outcomes and the barriers that hinder continuous glucose monitoring use in our set-up experienced by type 1 diabetes mellitus patients.
Methodology: In this cross-sectional study data was collected from all the patients and parents of patients with type 1 diabetes mellitus on insulin therapy enrolled with Meethi Zindagi. Data was collected through nonprobability convenience sampling from July to December 2023. The burdens and benefits of technology were assessed through a validated questionnaire in continuous glucose monitoring users and non-users. patients were distributed in two groups; CGM users and non-users to assess the burdens and benefits of CGM use.
Results: Out of 84 study participants, 60% were males and 40% were females. A total of 53 participants were continuous glucose monitoring users while 31 were non-users. Users described more benefits with significant p-values. Device users with HbA1c < 7% and participants of 01 and 13-18 years of age agreed with managing hypoglycemia, a sense of security, reduced finger prick frequency and better diabetes care with the device. Strong agreement about alarm usefulness was reported by parents of children of 1 year of age. Device users for >1-3 years reported stress-free diabetes care with this device. Among all the burdens, strong agreement was found with the high cost of sensors.
Conclusion: The study delivers evidence-based data on the benefits of continuous glucose monitoring for all type 1 diabetes mellitus individuals. At the same time, specific barriers should be identified and addressed to increase the use of continuous glucose monitoring
Outcome of Neonatal Sepsis in Preterm Neonates in Relation to Gestational Age
Full text linkObjective: To determine the outcome of neonatal sepsis in preterm neonates in relations to gestational age among preterm neonates presenting with sepsis at tertiary care hospital.
Methodology: A descriptive study was conducted at Department of Pediatrics, LUMHS, Jamshoro, from December 2021 to June 2022, on preterm neonates with sepsis presenting to the emergency department were included. After a detailed medical history and physical examination, patients were treated according to clinical indications and hospital protocols, and subsequently followed until discharge to assess outcomes. All the information was entered and analyzed using SPSS version 26.
Results: Overall mean age of the neonates was 5.7 ± 6.05 days, and out of them 32.8% were boys and 67.2%) were girls. Based on outcomes, feed intolerance was in 22.4% neonates, weight gain in 7.7%, respiratory distress in 70.7%, hypoglycemia in 4.3%, hypothermia in 9.5%, necrotizing enterocolitis in 16.4%w, and intra-ventricular hemorrhage in 21.5% neonates. Gestational age showed no significant effect on neonatal outcomes (p = 0.991). Birth weight was significantly associated (p = 0.010), with neonates 1.5–2.5 kg showing higher adverse outcomes. Mode of delivery was not significant (p = 0.538), while male neonates had higher rates of complications.
Conclusion: Respiratory distress observed to be a most common complication followed by feed intolerance, necrotizing enterocolitis and intra-ventricular hemorrhage while the outcomes were insignificantly related to the gestational age. Further large-scale work is recommended for validation of current findings
Effect of 24 hours Hospital Discharge Versus 48 hours Discharge after a Planned Cesarean Delivery on Postpartum Outcomes; A Randomized Single-Blind Controlled Clinical Trial
Full text linkObjective: To determine the comparative effect of 24 hours discharge versus 48 hours discharge post cesarean section delivery on maternal satisfaction as well as post-partum complication.
Methodology: This randomized controlled trial study was conducted in the Department of Gynecology and Obstetrics at Recep Tayyip Erdogan Hospital, Muzaffargarh from December 2023 to May 2024. Women aged 18 to 35 years undergoing elective cesarean section with a singleton pregnancy, regardless of parity or gravidity, were included and were randomly assigned into two groups particularly as Group A included 106 women discharged 24 hours after cesarean section, while Group B included 106 women discharged 48 hours after cesarean section. Patients were assessed pain intensity, surgical site infection, puerperal sepsis, endometritis, readmission, delayed postpartum hemorrhage and satisfaction of the patients and at the 7th postoperative day. Relevant data were entered and analyzed using SPSS version 21.0.
Results: Mean age of patients was almost similar in both groups (27.16 ± 6.29 years in Group A and 26.63 ± 6.04 years in Group B). Patients in Group A showed significantly higher early mobility (92.5% vs. 77.4%, p = 0.002) and overall maternal satisfaction (86.8% very satisfied vs. 64.2% in Group B, p = 0.001). Moderate pain was more frequent in Group A (91.5%), whereas severe pain was higher in Group B (22.6%). Additionally the postpartum complications were low and not statistically significant between the groups (p > 0.05).
Conclusion: Early discharge 24 hours proved to be safe and effective, resulting in higher early mobility, less severe pain and significantly greater maternal satisfaction compared to 48-hour discharge, without increasing postoperative complications; however, further multicenter studies are needed to validate these findings
Navigating Vascular Pipelines: A Comparison of Amputation free Survival and Two-year patency between Open and Endovascular Revascularization in Patients with Peripheral Arterial Disease; A Retrospective analysis.
Full text linkObjective: Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral arterial disease and is associated with high risks of limb loss and mortality. Both open surgical bypass and endovascular revascularization are established treatment options; however, comparative long-term outcome data from South Asian populations are limited. This study aimed to compare two-year primary patency and amputation-free survival between open surgical and endovascular revascularization in patients with CLTI.
Methodology: This retrospective observational cohort study was conducted at a tertiary care university hospital in Islamabad. Medical records of patients with CLTI who underwent lower-limb revascularization between January 2020 and January 2022 were reviewed. Patients were grouped according to the type of intervention: open surgical bypass or endovascular revascularization. Baseline demographics, comorbidities, procedural details, and outcomes were collected. The primary outcome was two-year primary patency, while the secondary outcome was two-year amputation-free survival. Kaplan–Meier survival analysis and appropriate statistical tests were used for comparison.
Results: A total of 109 patients were included, of whom 67 (61.5%) underwent surgical bypass and 42 (38.5%) underwent endovascular intervention. Two-year primary patency was 70.1% in the surgical group and 78.7% in the endovascular group (p = 0.091). Two-year amputation-free survival was 77.6% following surgical revascularization and 80.8% following endovascular intervention, with no statistically significant difference between groups (log-rank p = 0.092).
Conclusion: Both open surgical and endovascular revascularization provide comparable and acceptable two-year patency and amputation-free survival in patients with CLTI. Treatment decisions should be individualized through multidisciplinary discussion, considering anatomical factors, comorbidities, and patient-specific risks
Association Between Clinical Risk Scores (GRACE, HEART) and Angiographic Disease Complexity Among Women with Non-ST Elevation Myocardial Infarction
Full text linkObjectives: To determine the correlation of GRACE score and HEART score with angiographic disease complexity, as indicated by SYNTAX score in females with NSTEMI.
Methodology: This cross-sectional study was conducted at Fauji Foundation Hospital, Rawalpindi in six months from June 2024 to November 2024. After informed consent, 170 females who presented with NSTEMI were enrolled by convenient sampling. The GRACE and HEART scores of the patients were calculated. The patients then underwent primary percutaneous coronary angiography and SYNTAX score was estimated to determine angiographic disease complexity. Patients were divided into two groups: Group I having SYNTAX score <33 and Group II with SYNTAX score >33. Correlation of GRACE and HEART scores was seen with the SYNTAX score. The statistical analysis was carried out by the Statistical Package of the Social Sciences (SPSS) version 25.
Results: There was a significant difference in age, diabetes mellitus and hypertension between the patients with SYNTAX score <33 and >33.A significant difference existed in GRACE and HEART scores between the two groups, with higher scores in patients with SYNTAX score >33. When the correlation was seen between GRACE Score and SYNTAX score, the Pearson correlation coefficient was 0.605 showing strong correlation and p-value was significant (0.001). The Pearson correlation coefficient was 0.508 for HEART and SYNTAX scores with moderate significant correlation (p-value=0.001).
Conclusion: There is a strong and significant correlation between GRACE and angiographic disease severity, as indicated by SYNTAX score. Similarly, the association between HEART and SYNTAX scores is moderately significant. The GRACE and HEART scores are significantly higher in patients with SYNTAX score >33
Metastatic Axillary Lymphadenopathy in Breast Cancer: Diagnostic accuracy of Ultrasound Combined with Ultrasound Guided Fine Needle Aspiration
Full text linkObjective: To detect sonographic criteria for detection of metastatic involvement of axillary lymph nodes (ALN) and to detect accuracy of ultrasound combined with ultrasound guided FNAC in staging workup of breast cancer.
Methodology: A prospective cross-sectional study was conducted in the Radiology Department of the Sindh Institute of Urology and Transplantation (SIUT), Karachi, from October 2020 to October 2021. The study included patients diagnosed with either symptomatic or screen-detected breast cancer who underwent preoperative ultrasound evaluation of the breast and axilla. Fine-needle aspiration biopsy (FNAB) was performed on axillary lymph nodes with sonographic features suggestive of malignancy using an 18-gauge needle attached to a 10 mL disposable syringe. The aspirated samples were reviewed by a histopathologist. The diagnostic performance of ultrasound and ultrasound-guided FNAC was compared to the final histopathological findings of surgically excised axillary lymph nodes. Data were analyzed using SPSS version 20.
Results: The mean age of the study participants was 48.05 ± 11.3 years. Ultrasound alone demonstrated a sensitivity of 60.9%, specificity of 39.5%, and overall accuracy of 79%. When combined with FNAC, diagnostic sensitivity increased to 92%, specificity to 85%, and accuracy to 53.1%. Notably, the highest diagnostic accuracy was observed with the combined use of ultrasound and FNAC, yielding a sensitivity of 81.8%, specificity of 62.0%, and overall accuracy of 74.6%. The combined approach also achieved the highest positive predictive value (78.9%) and negative predictive value (66.1%), indicating superior diagnostic performance.
Conclusion: The combined use of ultrasound and ultrasound-guided FNAC proves to be a highly effective and reliable diagnostic modality for detecting metastatic axillary lymphadenopathy in breast cancer patients. This dual approach enhances diagnostic accuracy and supports its integration into the preoperative staging protocol for breast carcinoma