Annals of PIMS (Pakistan Institute of Medical Sciences)
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Postoperative Outcomes of Low Pressure versus Standard Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy
Full text linkObjective: To compare outcomes in laparoscopic cholecystectomy performed with either low-pressure pneumoperitoneum (LPP <12 mm Hg) or standard-pressure pneumoperitoneum (SPP >12 mm Hg).
Methodology: This randomized trial was conducted over six months, from September 2020 to March 2021, with data prospectively collected from patients. Patients aged 20-60 years with symptomatic gallstones were divided between Group A or Group B randomly, with 31 patients in each group. Group A underwent surgery with low-pressure pneumoperitoneum (LPP), whereas Group B underwent surgery with standard-pressure pneumoperitoneum (SPP). Postoperative ileus was assessed at six hours, while shoulder tip pain was evaluated at 24 hours post-surgery, and comparisons were made between both groups.
Results: There were 16 males and 15 females in group A and 14 males and 17 females in group B. Mean age in Group A was 40.35±7.27 years and in Group B 42.28±6.95 years. Group A had an average hospital stay of 1.06 ± 0.21 days and Group B had 1.09 ± 0.37 days. 10 patients (32.3%) experienced right shoulder tip pain in the LPP group as compared to 19 patients (61.3%) in the SPP group (p=0.021). Paralytic ileus was noticed in 6 patients (19.4%) in Group A and 16 patients (51.6%) in Group B (p<0.007).
Conclusion: LLP is a possible and safe option that significantly reduces postoperative shoulder tip pain and paralytic ileus, facilitating earlier bowel recovery compared to standard-pressure pneumoperitoneum
Role of Probiotic and Racecadotril as an Adjuvant Therapy in Management of Acute Watery Diarrhea in Children
Full text linkObjective: To see the role of nonspecific antidiarrheal agents as Probiotics and Racecadotril as an adjuvant therapy among children presenting with acute watery diarrhea
Methodology: This cross-sectional comparative study was conducted in Pediatric Department Fatima Memorial Hospital Lahore from July 2023 to December 2023. One hundred and sixty children were included in this study and were equally divided in two study groups. Probiotics was given in Group A and Racecadotril treatment was given in Group B (1.5 mg/kg every eight hours). The effect of both agents was evaluated at 24 hours and 48 hours after admission in terms of improvement in the stool consistency.
Results: Out of 160 children, 97 (60.6%) were male. The mean age was 15.73 ± 9.75 months. The average duration of diarrhea before starting treatment was 2.51 ± 1.21 days, with an average of 13.56 ± 3.85 stools per day. The average number of episodes was significantly lower with Racecadotril (8.08 ± 2.97 on day 1 and 3.68 ± 1.98 on day 2) compared to Probiotics (10.01 ± 3.79 on day 1 and 7.45 ± 2.92 on day 2) with p value 0.000 on both day 1 and day 2 comparison. The result showed that Racecadotril demonstrated better efficacy compared to probiotics with significant improvement in stool grades on the first and second day of treatment (p value 0.000 and 0.001, respectively).
Conclusion: We concluded that Racecadotril is significantly more effective in treating acute watery diarrhea in children
Diagnostic Accuracy and Clinical Effectiveness of MRI in Evaluating Perianal Fistula: A Comparison With Surgical Findings as the Gold Standard
Full text linkObjective: To evaluate MRI's diagnostic validity and effectiveness in detecting perianal fistula, using surgical findings as the gold standard.
Methodology: This cross-sectional validation study was conducted at the Radiology Department of KRL Hospital from January 5, 2022, to March 25, 2023. A non-probability consecutive sampling method was used to select participants, including all successive patients meeting the inclusion criteria. Sensitivity and specificity were evaluated to evaluate the diagnostic performance of MRI. Variables including patient characteristics, clinical traits, and imaging data were examined to uncover possible correlations with diagnostic accuracy. SPSS 21 software was used for statistical analysis. P-value <0.05 was considered significant.
Results: Among the 49 study participants, MRI was able to detect perianal fistulas with a sensitivity of 92.3%. The level of specificity was high, at 90%. Diagnostic accuracy of MRI was 91.8% for the presence of abscesses and complex fistulous tracts.
Conclusion: Based on the positive overall diagnostic performance in this small sample, this research implies that MRI has the potential as a diagnostic tool for detecting perianal fistula. But the small sample size could have affected how statistically significant the results were. It is necessary to do more research with larger sample numbers to confirm these findings and assess the effect of variables, such as abscesses and intricate fistulous tracts, on the precision of MRI
Histomorphologic patterns of hepatoblastoma observed in a tertiary care hospital
Full text linkBackground: Hepatoblastoma is one of the most common malignant childhood tumors with diverse histologic patterns. Recent advances in imaging, pathologic evaluation ,risk stratification, neo-adjuvant treatment and surgical interventions have remarkably improved the survival status of these patients in the developed world. In developing countries like Pakistan successful outcome with limited resources is still challenging for the clinicians and pathologists. Histopathology plays an important role in timely correct diagnosis leading to prompt clinical management and survival.
Materials &Methods: 34 cases of hepatoblastoma of both genders were recorded. Clinical presentation,radiology,serum AFP level , histopathologic diagnosis and outcome data were collected and analyzed.
Results: Out of 34 cases,24 were male and 10 were female with median age of diagnosis was 3 years. Most children were presented with abdominal distension 19 cases and right sided hepatic lesion 21 cases. The most common histopathologic type was mixed mesenchymal and epithelial 35% followed by fetal type(20%),epithelial type (17%),embryonal and small cell types(6%),macro trabecular type (11%) and pleomorphic type(2%). Elevated AFP level was observed in more than 90% of cases.
Conclusion: The most common histopathologic type was mixed epithelial and mesenchymal with male predominance was observed.
Key words: hepatoblastoma, fetal, histomorpholog
Diagnostic Accuracy of Shear Wave Elastography to Differentiate Solid Hepatic Lesions in Benign and Malignant Lesions
Full text linkObjective: To determine the diagnostic accuracy of shear wave elastography (SWE) to differentiate solid hepatic lesions in benign and malignant lesions using triphasic computed tomography (CT) scan and histopathology as standard methods.
Methodology: This descriptive cross-sectional study was conducted in Radiology Department, Dr Ruth K.M. Pfau Civil Hospital Karachi from March to September 2023. Elastography was performed on 96 patients with at least single solid hepatic lesion >1cm in diameter within depth of <5cm from hepatic capsule. Elastography findings were compared with triphasic CT scan and histopathology. The primary performance outcome of SWE were determined in term of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy against triphasic CT scan and histopathology.
Results: Out of 96 patients, 51 (53.1%) were males and 45 (46.9%) were females with a mean age of 50.31±11.29 years (Range: 18-70 years). The mean size and depth of the focal hepatic lesion was 4.3 ± 0.92 cm and 3.5 ± 1.2 cm. Cholangiocarcinoma was the stiffest malignant lesion with mean stiffness of 30.5±8.53kPa while the focal nodular hyperplasia was the stiffest benign lesion with mean stiffness of 13.65 ± 5.36kPa. Overall sensitivity, specificity, PPV, NPP and diagnostic accuracy of SWE in diagnosis of focal hepatic lesions were 93.9%, 83.3%, 92.5%, 86.2% and 90.6% respectively with cutoff value of 14.0 kPa.
Conclusion: SWE found to be a useful and easy non-invasive imaging modality to distinguish between benign and malignant focal hepatic lesions with high sensitivity, specificity and NPV, which aid in reliable exclusion of malignancy
Feasibility and Safety of Low Pressure Pneumoperitoneum in Laparoscopic Cholecystectomy
Full text linkObjective: To observe the feasibility and safety of low pressure pneumoperitoneum in laparoscopic cholecystectomy in terms of changes in liver enzymes, operative time, post- operative pain and postoperative hospital stay.Material and methods: This comparative Cross Sectional Study was conducted at department of Surgery, LUMHS/Jamshoro from November 2023. Patients with gallstones planned for laparoscopic cholecystectomy were included. Patients were randomly assigned to either the low-pressure or standard-pressure pneumoperitoneum groups. During surgery, patients in the low-pressure group were have pneumoperitoneum established and maintained at &lt;10 mmHg, while those in the standard-pressure group was have it maintained at 14-15 mmHg. The operative time, from the first incision to the closure of the last port site, was recorded. Postoperatively, liver enzyme levels were measured at 6, 24, and 48 hours to monitor changes in liver function. Postoperative pain and duration of the hospital stay were recorded. The safety of low-pressure pneumoperitoneum was evaluated by comparing complication rates between the two groups. Data was analyzed using SPSS software version 26.Results: Overall patient’s mean age was 40.74 +12.37 years with female predominance83.9%. Findings showed that patients in the low-pressure group had better outcomes as,none of them had changes in liver function tests, while 11.3% in the standard-pressuregroup did (p = 0.006). The surgery time was shorter in the low-pressure group (33.79minutes vs. 44.93 minutes, p = 0.001). They also felt less pain (average score 2.72 vs.4.38, p = 0.001), had less drain output (23.73 ml vs. 46.96 ml, p = 0.001), and stayed inthe hospital for a shorter time (1.47 days vs. 2.08 days, p = 0.001).Conclusion: Study revealed that the low-pressure pneumoperitoneum observed to be thefeasible and safe alternative to standard pressure pneumoperitoneum, with certainpotential benefits including reduced operative time, lower postoperative pain, and shorterhospital stays, while maintaining safety with no significant impact on liver enzymelevels.
Key words: Laparoscopic cholecystectomy, low pressure pneumoperitoneum, Pain, Optative time, Hepatic enzyme
Association Between Dengue Skin Rash and Disease Outcome in A Tertiary Care Hospital.
Full text linkObjective: The objective of this research work is to build upon existing knowledge by exploring the relationship between dengue skin rashes and disease course in a tertiary healthcare center.
Methods: This descriptive cross sectional study was conducted in Dermatology department at HBS General Hospital, Islamabad. from January 2024 to August 2024. Total 188 confirmed dengue fever patients was performed. Researchers documented demographic information together with clinical features as well as laboratory findings and disease outcomes of all these patients. Dermatologists evaluated the presence, morphology and distribution of skin rashes. Disease severity was classified according to the 2009 WHO dengue guidelines.
Results: Skin rash was observed in 17.6% (n = 33) of patients, with maculopapular rash being the most common type (75.8%, n = 25). Patients with skin rash had significantly milder disease outcomes. 87.9% of the patients with skin rash had non severe dengue while only 12.1% of patients with skin rash had severe dengue. While in the patients without skin rash, 69% had mild disease while 31% had severe dengue (p <0.001). Laboratory findings revealed higher platelet counts (87,000 ± 23,000/?L vs. 53,000 ± 18,000/?L, p < 0.001) and lower hematocrit levels (37.9 ± 4.1% vs. 42.2 ± 5.0%, p = 0.002) in patients with rash. The patients with skin rash required less hospitalization of 4.4 ± 1.5 days compared to 6.6 ± 2.1 days (p < 0.001), while the occurrence of complications (9.1% vs. 25.8%) including hemorrhage and organ failure (p = 0.003) also showed lower rates. Multivariate analysis identified the absence of skin rash as an independent predictor of severe dengue (aOR = 3.18, 95% CI: 1.68–6.02, p < 0.001).
Conclusion: The presence of skin rash in dengue patients is associated with milder disease outcomes, which includes higher platelet counts, lower hematocrit levels, shorter hospitalization, and fewer complications. Routine clinical practice that includes dermatological examinations allows better risk stratification for dengue patients
Student Perceptions of Mentorship: A Comparative Study of Undergraduate Medical and Dental Students in Islamabad, Pakistan
Full text linkObjectives: This study aims to compare the perceptions, experiences, and expectations of mentorship among undergraduate medical and dental students in Pakistan
Methodology: A quantitative, comparative cross-sectional study was conducted at HBS Medical and Dental College, Islamabad from August and November 2023. Data was collected from 312 students using a validated, Likert-scale-based survey questionnaire. Purposive sampling was employed to select participants. The survey gathered demographic information and assessed students’ perceptions of their mentors and the mentorship programs. Data were analyzed using SPSS version 26.
Results: The sample included a diverse group of students in terms of gender, program type, and level of education (mean age: 21.9 years; 50.3% male). While the majority of students felt respected and guided by their mentors, fewer perceived their mentors as role models. MBBS students rated their mentorship experiences more positively than BDS students, particularly in areas of mutual respect, comfort in sharing, and mentor understanding. Although both groups reported similar levels of stress and impact on professional reputation, BDS students showed a slightly greater reduction in mentoring-related stress. Overall, perceptions of mentorship varied among participants.
Conclusion: Mentorship programs tailored to the specific needs of students play a critical role in supporting their satisfaction, career development, and personal growth. Effective mentorship fosters a collaborative environment that benefits both mentors and mentees. A deeper understanding of mentorship dynamics can enhance the quality of these relationships, ultimately contributing to academic and professional success
Antioxidant Potential Calotropis Procera leaves, flowers, and latex, Zanthoxylum Armatum Dried Seeds, and Syzygium Aromaticum Dried Flower Buds
Full text linkObjectives: This study evaluates the antioxidant potential of Calotropis procera leaves, flowers, and latex, Zanthoxylum armatum dried seeds, and Syzygium aromaticum dried flower buds.
Methodology: The extracts were prepared using methanol, acetone, and chloroform as solvents. Antioxidant activity was assessed using the DPPH (1,1-Diphenyl-2-picryl-hydrazyl) free radical scavenging method, with ascorbic acid serving as the standard. Phytochemical screening identified secondary metabolites such as flavonoids, terpenoids, glycosides, and more.
Results: The results revealed that C. procera leaves and flowers exhibited the highest antioxidant activities, with Methanolic extracts showing the most significant radical scavenging potential. Methanolic extracts of S. aromaticum dried flower buds also demonstrated substantial antioxidant activity.
Conclusion: This comparative analysis underscores the therapeutic potential of these plants in managing oxidative stress-related diseases.
Keywords:Antioxidant potential, Calotropis Procera Leaves, Dried Flower Buds
Response Evaluation with Definitive Chemoradiotherapy in Carcinoma of the Esophagus
Full text linkObjective: i) To evaluate the treatment outcomes of patients with carcinoma of the esophagus receiving definitive chemoradiation using IMRT with concurrent chemotherapy and ii) To assess patient demographics and disease characteristics in relation to treatment response and patterns at a single tertiary care center.
Methodology: This prospective cohort study was conducted in the Department of Radiation Oncology at Shifa International Hospital from June 2024 to November 2024. A total of 133 patients with biopsy-proven esophageal carcinoma, aged 16 to 65 years, were enrolled using non-probability consecutive sampling. All patients received definitive chemoradiation, consisting of either 5040 cGy in 28 fractions or 5400 cGy in 30 fractions delivered via intensity-modulated radiation therapy (IMRT), along with concurrent chemotherapy. Chemotherapy regimens included either weekly carboplatin (AUC 2) and paclitaxel (50 mg/m²) for five weeks, or cisplatin (75 mg/m² on day 1) combined with continuous infusion of fluorouracil (1000 mg/m²/day for 96 hours) during weeks 1 and 5 of external beam radiotherapy.
Results: Out of 133 patients, 78 (63%) were males and 55 (37%) were females. Most patients (n = 79, 59%) had stage II disease, while 46 (34%) had stage III disease. An objective complete response was achieved in 66 patients (61%), while partial response was observed in 67 patients (38%). The majority of patients achieving complete response had squamous cell carcinoma histology (66%). No patients died or experienced disease progression during treatment. Grade 3 mucositis occurred in 7 patients (5%), grade 3 dysphagia in 9 patients (7.5%), and grade 3 myelosuppression in 3 patients (2.2%).
Conclusions: Patients treated with definitive concurrent chemoradiotherapy (CCRT) for non-metastatic carcinoma of the esophagus demonstrated promising outcomes, with a complete remission rate of 66%. Complete response was more frequently observed in patients with squamous histology. A significant correlation was noted between radiological stage and pathological complete response, with stage II patients showing the highest frequency of complete responses