Annals of PIMS (Pakistan Institute of Medical Sciences)
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Comparison Of Mean Newborn Weight In Lateral And Fundal Located Placenta In Pregnant Women
Full text linkObjective: To compare mean newborn weights between pregnancies with lateral and fundal placental locations to determine if placental position affects birth weight.
Methodology: A descriptive analysis is conducted on 120 pregnant women from May, 2020 to November, 2020 utilizing convenient sampling technique. Pregnant females with lateral or fundal placenta position at FGPC hospital Islamabad were taken up for the research. A t test of mean newborn weights between the two groups with level of significance ? 0.05 was used.
Results: The results of this study were that we checked if newborn weight varies with the placental location: lateral compared to fundal. There were 120 singleton pregnancy cases in the research. Results showed a significant difference in the average newborn weight between side (2.57 + 0.33 SD) and fundal placental (2.36 + 0.34 SD) location (p-value = 0.001), where central placental location was associated with lower birth weights. Lower birth weight was correlated with central placentation; further research to verify these findings and suggest appropriate fetal monitoring strategies is needed. These results could help to inform guidelines of gynecologists and healthcare practitioners for these pregnancies in order to reduce neonatal morbidity. The results demonstrated not only large mean newborn weight variability between pregnancies with lateral and fundal placenta site, but also provided evidence for possible placental position - newborn weight association.
Conclusion: This study demonstrated that placental location might be an important factor in fetal growth and birth outcome. These results call for additional study in the field to identify the underlying mechanisms and their potential therapeutic ramifications
Revolutionizing Reproductive Health: A Narrative Review on the Role of AI in Transforming Infertility Care in Pakistan
Full text linkThe integration of artificial intelligence (AI) into infertility care is transforming the field of gynaecology, providing new solutions that improve diagnosis and treatment. AI technology is being used to increase the accuracy of fertility tests, personalized treatment plans, and more accurately predict outcomes. Intelligent models can measure important information such as hormone levels and ultrasound scans. This review explores how AI transforms patient treatment by decreasing diagnostic time and improving patient care and decision-making efficiency. Since there is a disconnect between male infertility, taken care of by urologists, and female infertility managed by gynaecologists, we want to bridge this gap through the use of AI in treatment. This article looks at the institutional and cultural constraints thatfrequently keep husbands from going to infertility consultations with their wives. Infertility is typically viewed as a woman's problem in our conservative settings, which means that she must endure years of treatment. Women continue to receive hormonal treatments until the male element is brought to light because there is an unwillingness on the part of men to get tested. AI can be used to develop treatment regimens that equally incorporate both parties. Current applications, challenges, and future directions of AI in Pakistan and low-resource settings highlight promising opportunities for alleviating the disparity between male and female infertility care. This descriptive review aims to explore the application of AI to improve medical care, provide personalized counseling, and increase diagnostic accuracy. However, the use of AI in infertility care also raises ethical, regulatory, and accessibility issues that must be addressed to ensure that AI is responsible and equitable
Descriptive Epidemiology and Management of Gynecological Malignancies at a Tertiary Care Hospital
Full text linkObjective: To document the frequency and management of various gynecological malignancies presenting at Pakistan Institute of Medical Sciences (PIMS), Islamabad over a period of five years.
Methodology: This descriptive case series study was carried out at the Department of Obstetrics and Gynecology, Pakistan Institute of Medical Sciences (PIMS), Islamabad over a period of five years from September 2019 to August 2024. Non-probability consecutive sampling technique was employed. All patients who presented to the hospital with any gynecological malignancy were included in the study. Non-consenting patients, those with gestational trophoblastic tumors and benign tumors were excluded. Minimum follow up of three years was ensured. The patients received treatment according to established standard protocols.
Results: During the study period, a total of 234 women presented with various gynecological malignancies. The highest frequency was of ovarian carcinoma 162(69.23%), followed by carcinoma cervix 42(17.94%), endometrial carcinoma 24(10.25%), and Carcinoma of the vulva 6(2.56%). Among the ovarian cancers, the share of epithelial tumors was 150(92.6%), germ cell tumors were 9(5.56%), whereas stromal tumors were 3(1.85%).
Conclusion: Cancers of ovary and cervix were the commonest malignancies observed. Delayed presentation with advanced disease was common. Education and awareness about gynecological malignancies on part of the public would help to ensure early presentation and better treatment outcomes. Given the magnitude of the problem, development of a national Cancer registry for gynecological cancers is the need of the hour
Effect of Hemodynamic Management Using the Trend of Perfusion Index in Patients Admitted to the Paediatric Intensive Care Unit
No full textObjective: To determine the effect of hemodynamic management using the trend of perfusion index admitted in Paediatrics intensive care unit.Methodology: A prospective observational study was conducted at Paediatrics Intensive Care unit, Indus Hospital, Karachi. Children admitted in PICU with shock, aged between 2 months to 14 years and both genders were included. A questionnaire was utilized to collect data, including patient baseline demographics and clinical information. Hemodynamic management typically employed for patients with low peripheral perfusion or shock, involved fluid resuscitation and/or inotropic support. The perfusion index, derived from pulse oximetry, measures peripheral perfusion noninvasively by calculating the ratio of pulsatile to non-pulsatile blood flow in peripheral tissues. Statistical package for the social sciences (SPSS v. 26) was used for data entry and analysis.Results: A total of 80 patients were studies with a overall mean age of 6.34+3.23 years. The primary causes of admission were respiratory failure 41.7% and septic shock 33.3%, and others 16.7%. Patients showed a significant improvement in PI(from 0.8 ± 0.3 to 1.5 ± 0.4, p = 0.001 after management, along with stabilization of systolic and diastolic BP and decrease in heart rate (p = 0.001). Mortality was highest among patients admitted for septic shock 30% compared to other causative factors40%, while those with respiratory failure had better outcomes 91.7% discharged. Correlation analysis revealed a strong positive relationship between improvements in PI and survival (p=0.001).Conclusion: Study revealed that the hemodynamic treatment involving resuscitation and inotropic support among patients in PICU. It played a pivotal role in stabilizing vital signs, as reflected in the significant improvements in perfusion index, blood pressure, and heart rate. The interventions were particularly beneficial in patients with respiratory failure, who showed the highest survival rates, while patients with septic shock and cardiac arrest, required more intensive support, had higher mortality rates
Comparison of Upper Lip Bite Test with Modified Mallampati Score for better bedside difficult laryngoscopy predictability in elective surgeries
No full textIntroduction: Accurate pre-operative assessment for predicted difficult intubation can ominously reduce the occurrence of unanticipated difficult intubation. The rationale of the study was to compare the Diagnostic Accuracy of Upper Lip Bite test and Modified Mallampati Score in the prediction of difficult laryngoscopy/airway.
Objective: To compare the Diagnostic Accuracy of Upper Lip Bite Test and Modified Mallampati Score in the prediction of difficult laryngoscopy/airway
Methodology: This prospective observational study was carried out Benazir Bhutto Hospital, Rawalpindi at department of Anesthesia, Intensive Care and Pain medicine, Benazir Bhutto Hospital, Rawalpindi from 1st April, 2023 to 1st October, 2023. . To eliminate the observer bias pre operative assessment of ULBT and MMS for each patient was assessed by single anaesthetist. Laryngoscopy and intubation were performed by an anaesthetist who had experience of more than three years who was blinded to pre-operative ULBT/MMS grade. Cormack Lehane score was noted and used as a marker of difficult laryngoscopy.
Results: For ULBT, the Sensitivity was 78.43%, Specificity was 47.06%, Positive predictive value was 53.33%, Negative predictive value was 74.55% and the Diagnostic Accuracy was 60.17%. When comparing the Modified Mallampati Score to the Cormack-Lehane Test, the Sensitivity was 91.23%, Specificity was 47.54%, PPV was 61.90%, NPV was 85.94% and the Diagnostic Accuracy was 68.64%.
Conclusion: The Modified Mallampati Score had a higher Diagnostic Accuracy when compared to the Upper Lip Bite Test
Relapse of Plasmodium Vivax Malaria and Use of Primaquine in Pediatric Population at Tertiary Care Hospital
Full text linkObjective: To determine the relapse rate of Plasmodium vivax malaria in pediatric patients treated with primaquine.
Methodology: A prospective comparative interventional study was conducted in the Department of Pediatrics at Combined Military Hospital Malir, Karachi, from August 2024 to April 2025. Patients aged 1–12 years who presented with either a first episode or relapse of P. vivax malaria, were clinically stable, and of either gender were included. Children were categorized into a treatment group receiving standard antimalarial therapy with primaquine and a control group receiving standard therapy alone. Relapse was defined as the reappearance of Plasmodium vivax parasites on peripheral blood smear following initially documented successful treatment. Data were analyzed using SPSS version 26.
Results: A total of 132 pediatric patients were included, with a mean age of 7.73 ± 3.58 years and an almost equal gender ratio. At one month post-treatment, relapse occurred in 9.1% of patients in the control group compared with 2.3% in the study group (p = 0.076). At the second month, relapse was significantly higher in the control group (29.5%) than in the study group (5.7%). At the third-month follow-up, the difference was even more pronounced (38.6% vs. 6.8%) (p = 0.0001). Additionally, the 14-day primaquine regimen showed the lowest relapse rates at both 2 months (4.5%) and 3 months (4.5%) compared with the 7-day regimen (6.8% and 9.1%, respectively) and the control group, indicating that prolonged primaquine therapy is most effective in preventing relapse. Furthermore, relapse rates did not differ significantly according to age within the pediatric population (p > 0.05).
Conclusion: The use of primaquine significantly reduced the relapse rate of Plasmodium vivax malaria in pediatric patients compared with standard treatment alone, with the most sustained protection observed with the 14-day regimen
Examining the Relationship between Parental Smoking and Asthma Severity in Children with Bronchial Asthma
Full text linkObjectives: To determine frequency of parental smoking in children with asthma and its association with asthma severity in children.Methodology: This cross-sectional study was conducted at Pediatrics department of Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from October-2024 to April-2025. A total of 120 children, male and female, diagnosed with childhood asthma throughstandard procedure and of any severity based on NAEPP Asthma Severity Classification were included. After that a detailed parental history was taken to determine the smoking status in either of the parent.Results: A total of 120 children were included with a median age of 8 years. There were 81 (67.50%) male and 39 (32.50%) female patients. Median duration of asthma was 8 months. Positive parental smoking history was observed in 66 (55%) children with asthma. Amongchildren with positive parental smoking history (n = 66), 3 (4.54%) had intermittent, 13 (19.70%) had mild persistent, 29 (43.94%) had moderate persistent and 21 (31.82%) had severe persistent asthma while in children with negative parental smoking history (n = 54), 12 (22.22%)had intermittent, 31 (57.41%) had mild persistent, 5 (9.26%) had moderate persistent and 6 (11.11%) had severe persistent asthma, (p < 0.001).Conclusion: Frequency of parental smoking in children with asthma was 55% and it was found to be strongly associated with the severity of childhood asthma.Keywords: Asthma, Bronchial, Parental, Smoking
Comparative Evaluation of the Efficacy of Green Tea vs Normal Saline on Post-Operative Swelling and Pain in Third Molar Surgery
Full text linkObjective: To find effectiveness of green tea mouthwash while comparing it with normal saline in lowering postoperative edema and alleviating pain following impacted mandibular third molars.
Methodology: The study was conducted at Nishtar Institute of Dentistry in Multan from June 30, 2021, to January 31, 2023, and comprised 56 individuals (28 in each group) aged 18-30 with impacted third molars. The study included both males and females between the ages of 18 and 30 who had impacted third molars unilaterally or bilaterally and required extraction. Teeth associated with fracture and pathologies were excluded from study. Panoramic radiography evaluated surgery sites. The study included both males and females between the ages of 18 and 30 who had impacted third molars unilaterally or bilaterally and required extraction. Teeth associated with fracture and pathologies were excluded from study.
Results: The research had 56 participants, with a similar age and gender distribution across the two groups. There were no significant variations in pain levels, edema, surgery length, or post-operative analgesic use between the groups. Group 1 had a significant link between age and pain (p=0.035), but Group 2 did not. Table I-VI includes the full facts.
Conclusion: Rinsing with mouthwash made from green tea daily may help with postoperative issues, like as discomfort, after impacted molar surgery, perhaps minimizing the need for analgesics and preventing adverse effects from antibiotics, NSAIDs, or chlorhexidine mouthwash
Comparative Analysis of CT and MRI in Diagnosis of Enlarged Vestibular Aqueduct Syndrome in Paediatric Candidates of Cochlear Implant
Full text linkObjective: To determine the frequency of LVAS in children with cochlear implant and compared the findings of CT and MRI in terms of measurement of midpoint and external aperture diameters in paediatric candidates of cochlear implant.
Methodology: This was a cross-sectional comparative study that was conducted at a Armed Forces Institute of Radiology and Imaging, Rawalpindifrom 16th August, 2023 till 15th February, 2024. After the parents provided written informed consent, 110 children with cochlear implants were enrolled and examined using a temporal CT scan and an MRI. The results on both modalities were compared and statistical analysis was performed using Statistical Package for social Sciences version 25.0
Results: The mean age of the children was 3.9 2.09 years. Mean midpoint aperture diameter in patients with EVA on CT scan was 1.64 0.09 mm and on MRI was 1.71 0.13 mm (p=0.020). Mean external aperture diameter in children with EVA on CT scan was 2.52 0.40 mm and on MRI was 2.64 0.53 mm (p=0.000). EVA was present in 7 (6.4%) children on CT scan and 8 (7.3%) children on MRI.
Conclusion: In children with cochlear implant, there were significant differences in the midpoint and external aperture diameters as assessed by CT scan and MRI and MRI was able to diagnose more cases of LVAS compared to CT scan and thus should be preferred imaging modality
Role of Bedside Leukoreduction Filters in Mitigating Febrile Non-Hemolytic Transfusion Reactions in Thalassaemia Major Patients
Full text linkObjective: To evaluate the clinical effectiveness of bedside leukoreduction filters in reducing the occurrence of febrile non-hemolytic transfusion reactions (FNHTRs) among patients with beta-thalassemia major, by comparing their frequency in patients receiving blood through a filter versus those without a filter.
Methodology: A retrospective cross-sectional comparative study was conducted at the Thalassemia Centre in collaboration with the Blood Bank, Pakistan Institute of Medical Sciences, from January to March 2024. A total of 1,000 multi-transfused beta-thalassemia major patients with a history of FNHTRs were included and divided into two groups: 500 patients received blood through bedside leukoreduction filters, while 500 received non-filtered blood. Transfused red cell concentrates ranged in storage age from 2 to 14 days. Data were analyzed using SPSS Version 20, and the chi-square test was applied to compare the incidence of FNHTRs between the two groups. A p-value of <0.05 was considered statistically significant.
Results: Among the 500 patients receiving bedside leukoreduced blood, 7 (1.4%) experienced FNHTRs during transfusion, presenting with symptoms such as fever, chills, cold extremities, abdominal pain, and facial flushing. In contrast, 49 (9.8%) patients receiving non-filtered blood developed FNHTRs (p < 0.001).
Conclusion: The incidence of FNHTRs was significantly reduced with the use of bedside leukoreduction filters compared to non-leukoreduced blood. Implementing this simple and cost-effective strategy in resource-limited settings can help prevent transfusion reactions, improve patient and staff satisfaction, and reduce the risk of transfusion discontinuation, prolonged hospitalization, and extensive laboratory investigations