Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University <p>The Annals of Pakistan Institute of Medical Sciences (APIMS) is the Official quarterly and open access journal of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Pakistan. Previously two separate medical journals of this institute were being published, namely, JPIMS started from 1990 and the Journal of Surgery 1991. They were officially merged into one journal APIMS in 2005. Annals of PIMS is recognized by Pakistan Medical and Dental Council (PMDC), Higher Education Commission of Pakistan ( Y category), CPSP <a href="" target="_blank" rel="noopener">(</a> index in EBSCO Host &amp; Base from Germany. </p> Shaheed Zulfiqar Ali Bhutto Medical University en-US Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 1815-2287 <p><a href="" rel="license"><img style="border-width: 0;" src="" alt="Creative Commons License" /></a><br />This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> Respiratory Parameters during Different (Menstrual, Luteal) Phases of the Menstrual Cycle in Healthy Adult Female <p><strong>Objective: </strong>To compare the respiratory parameters during different (menstrual, luteal) phases of the menstrual cycle in healthy adult female</p> <p><strong>Methodology:</strong> This comparative study was conducted in research lab physiology department of (LUMHS) Liaquat University of medical and health sciences Jamshoro after approval of Research Ethics Committee of LUMHS. Study duration was 6 months.&nbsp; All adult healthy non-pregnant females aged between 18 and 24 years were Included. The subjects&nbsp;were notified regarding the purpose and methodology of current research. All the participants were examined regarding&nbsp;the menstrual cycle in two phases (luteal&nbsp;and menstrual). The preliminary clinical,&nbsp;respiratory system examination was performed. Each participant was advised to visit the Physiology Lab on a particular date for pulmonary function test during&nbsp;menstrual (1-5th day) and luteal&nbsp;(19-22nd day) phases of menstrual cycle,&nbsp;based on their menstrual history. Using the Power lab AD tools 15:HT Computerized Spirometer and parameters recorded on Labtutor software, the participants were made to undertake pulmonary function testing in distinct menstrual cycle stages (menstrual and luteal). All the data was collected via study proforma and analysis of data was done by SPSS version 20.</p> <p><strong>Results<em>: </em></strong>A total of 255 women were studied, their mean age was 20.03+6.30 years and mean BMI was 20.38±1.39. Out of all 10 females were married and 245 females were unmarried and their mean duration of menstrual cycle was 28.62±1.35 days. Mean FVC value was significantly higher in luteal phase as compared to menstrual phase. i.e. Luteal Phase: 2.57 vs. Menstrual Phase: 2.50, (p-0.016).&nbsp; Average FEV1 value was significantly higher in luteal phase as compared to menstrual phase. i.e. Luteal Phase: 2.61 vs. Menstrual Phase: 2.53, (p-0.009). Although mean PEF value and Mean FEV1/FVC value were also significantly higher in luteal phase as compared to menstrual phase (p-&lt;0.05).</p> <p><strong>Conclusion:</strong> Pulmonary functions as well as respiratory efficiency were significantly improved in the luteal phase as compared to menstrual phase of menstrual cycle, which were enumerated in this study thus suggesting a possible beneficial role of progesterone in improvement of respiratory parameters. The reason could be the bronchodilator effect of progesterone, its level remains higher during this phase. Clinicians treating young female patients suffering from respiratory disorders may keep this in mind about the phases of menstrual cycle while prescribing bronchodilator drugs. Also, conditions like, premenstrual asthma can be better tackled with the help of these observations.</p> Hira Saeed Khan Saima Naz Shaikh Rizwan Ali Canna Kavita Bai Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-05-06 2022-05-06 18 1 Comparative Study of Single- Versus Split-Dose Polyethylene Glycol Electrolyte Solution Before Undergoing Colonoscopy <p class="root-block-node"><span class="red-underline"><strong>Objective: </strong></span>To compare the outcome of consumption of a single versus split-dose polyethylene glycol electrolyte solution in patients undergoing colonoscopy in the morning.</p> <p class="root-block-node" data-changed="false" data-paragraphid="19"><span class="red-underline"><strong><span data-startindex="0" data-endindex="12" data-paragraphid="19">Methodology: </span></strong></span>A randomised controlled trial was conducted at the Department of Gastroenterology, Sir Ganga Ram Hospital, <span data-startindex="120" data-endindex="125" data-paragraphid="19"><span class="red-underline">Lahore</span></span> from April to July 2021. A total of 274 patients undergoing colonoscopy<span data-startindex="198" data-endindex="198" data-paragraphid="19"><span class="red-underline">,</span></span> who fulfilled the selection criteria were included through a "non-probability, consecutive sampling technique". The patients were randomly divided into two groups. In group <span data-startindex="373" data-endindex="375" data-paragraphid="19"><span class="red-underline">A, </span></span>single dose of PEG was administered. Group B was administered a split dose of PEG which was to be consumed in two parts, <span data-startindex="497" data-endindex="503" data-paragraphid="19"><span class="red-underline">1st in </span></span>evening before colonoscopy and the second in the morning. The patients then underwent colonoscopy. Efficacy was <span data-startindex="616" data-endindex="626" data-paragraphid="19"><span class="red-underline">labelled if</span></span> adequate cleaning of the intestines <span data-startindex="664" data-endindex="667" data-paragraphid="19"><span class="red-underline">and </span></span>BBPS score of <span data-startindex="682" data-endindex="682" data-paragraphid="19"><span class="red-underline">≥</span></span>6 were achieved during colonoscopy. All this procedure was noted on a proforma. Data was entered and <span data-startindex="784" data-endindex="791" data-paragraphid="19"><span class="red-underline">analyzed</span></span> <span data-startindex="793" data-endindex="795" data-paragraphid="19"><span class="red-underline">by </span></span>using SPSS version 20.0.</p> <p class="root-block-node" data-changed="false" data-paragraphid="21"><strong>Results:</strong><span class="red-underline"><strong> </strong></span>In the single dose group, the mean age of patients was 45.15<span data-startindex="70" data-endindex="72" data-paragraphid="21"><span class="red-underline"> ± </span></span>13.37 years, 68 (49.6%) patients were male, 69 (50.4%) patients were female, efficacy of the procedure was achieved in 54 (39.4%) patients, and the mean BBPS score was 4.99<span data-startindex="244" data-endindex="246" data-paragraphid="21"><span class="red-underline"> ± </span></span>0.90 . In the split dose <span data-startindex="272" data-endindex="278" data-paragraphid="21"><span class="red-underline">group, </span></span>mean age of patients was 49.85<span data-startindex="309" data-endindex="311" data-paragraphid="21"><span class="red-underline"> ± </span></span>11.38 years, 56 (40.9%) patients were male, 81 (59.1%) patients were female, efficacy of the procedure was achieved in 137 (100%) <span data-startindex="442" data-endindex="449" data-paragraphid="21"><span class="red-underline">patients</span></span> and the mean BBPS score was 7.61<span data-startindex="483" data-endindex="485" data-paragraphid="21"><span class="red-underline"> ± </span></span>0.49 . The difference in both groups was highly significant (p-value<span data-startindex="558" data-endindex="560" data-paragraphid="21"><span class="red-underline"> &lt; </span></span>0.0001).</p> <p class="root-block-node" data-changed="false" data-paragraphid="23"><span class="red-underline"><strong><span data-startindex="0" data-endindex="11" data-paragraphid="23">Conclusion: </span></strong></span>A split dose is thus more efficacious and acceptable <span data-startindex="65" data-endindex="69" data-paragraphid="23"><span class="red-underline">than </span></span>single dose of polyethylene glycol electrolyte solution given for bowel preparation.</p> Salman Javed Najam Us Sehar Sarah Samreen Mohsin Raza Qamar Sajad Amber Saleemi Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.599 Early Versus Interval Cholecystectomy in Mild Acute Biliary Pancreatitis. A Retrospective Study in Tertiary Care Hospital <p><strong>Objective:</strong> The objective is to determine the adequacy of early cholecystectomy (EC) versus interval cholecystectomy (IC) in terms of recurrence, duration of hospital admission, and perioperative complications after mild acute biliary pancreatitis (MABP).</p> <p><strong>Methodology:</strong> After endorsement from the ethical committee, clinical data and files of all the admitted patients having MABP in the general surgery department of Holy Family Hospital, Rawalpindi, was collected retrospectively from August 2017 to July 2020. The patients’ demographic profile, clinical findings, diagnostic investigations, timing of cholecystectomy, operating surgeons, operative time, biliary complications, intraoperative bleeding, conversion rate, duration of admission, and recurrence were reviewed. Patients presented with abdominal pain, vomiting, jaundice, or fever. The diagnosis was confirmed on the basis of a CT scan of the abdomen showing an inflamed pancreas and stones in the gallbladder. Outcomes were compared and reviewed between the two groups.</p> <p><strong>Results:</strong> In this research proposal, 263 patients admitted were analyzed. EC was performed were discharged after conservative management and followed up after 12 weeks for interval laparoscopic cholecystectomy (IC). It was observed in patients of IC (EC 2 [1.2%] vs IC 7[7%]; p value &lt;0.01) while duration of hospitalization was prolonged as compared to patients of EC (EC 5.53+0.58days vs IC 5.82+0.78days; p value &lt;0.001). lar in both EC and IC.</p> <p><strong>Conclusion: </strong>EC performed after MABP is associated with shorter duration of hospitalization and reduced recurrence with similar rate of perioperative complications.</p> Sidra Mehmood Dar Anam Saeed Jamal Nasir Malik Sadaf Batool Jahangir Sarwar Khan Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.567 Outcome of Acute Peritonitis Related To Cause and Duration Of Presentation <p class="root-block-node" data-changed="false" data-paragraphid="14"><strong><span class="blue-complex-underline error-hovered" data-startindex="0" data-endindex="174" data-paragraphid="14">Objective: </span></strong><span class="blue-complex-underline error-hovered" data-startindex="0" data-endindex="174" data-paragraphid="14">To determine the outcome of acute cause-related peritonitis correlated with the duration of inflammation within 24, 24-48, and after 48 hours of hospital admission.</span></p> <p class="root-block-node" data-changed="false" data-paragraphid="15"><strong><span class="red-underline" data-startindex="0" data-endindex="12" data-paragraphid="15">Methodology: </span></strong>This quasi experimental study was conducted at Surgical Ward <span class="red-underline" data-startindex="74" data-endindex="74" data-paragraphid="15">#</span>3, Jinnah Postgraduate Medical <span class="red-underline" data-startindex="106" data-endindex="111" data-paragraphid="15">Centre</span> from September 2019 to March 2021. Patients over 12 years old were included in this study. The duration, cause, and <span class="red-underline" data-startindex="81" data-endindex="88" data-paragraphid="16">outcomes</span> of peritonitis were noted. All complications were recorded and treated accordingly.</p> <p class="root-block-node" data-changed="false" data-paragraphid="17"><strong>Results</strong>: 136 patients between the ages of 13 <span class="red-underline" data-startindex="45" data-endindex="46" data-paragraphid="17">to</span> 80 years old were included<span class="red-underline" data-startindex="74" data-endindex="74" data-paragraphid="17">,</span> 104 were males (76.8%) and <span class="red-underline" data-startindex="103" data-endindex="105" data-paragraphid="17">32 </span>females (23.18%). 37 patients (28.2%) were aged 13–20 years, 61 (44.2%) were aged 21–40, 33 (23.91%) were aged 41–60, and 5 (3.6%) were aged over 60 years. Mortality showed 2 patients (1.47%) expired in 24–48 hours<span class="red-underline" data-startindex="320" data-endindex="320" data-paragraphid="17">,</span> and 6 (4.4%) in 48 hours.<span class="red-underline" data-startindex="347" data-endindex="348" data-paragraphid="17"> </span>The <span class="red-underline" data-startindex="353" data-endindex="357" data-paragraphid="17">cause</span> of peritonitis included typhoid ileal perforation (41%), duodenal perforation (33%), ruptured appendix (28%), intestinal tuberculous (14%), gangrenous gut (7%), tumour perforation (6%), liver abscess (3%), and gastric perforation and rectal tear (1%). Notably, 2.4% of patients with typhoid peritonitis, 3.0% with duodenal perforation, 3.5% with ruptured appendix, 14.2% with tuberculous intestine, 33.3% with tumour perforation, and 100% with liver abscess perforation passed. Paralytic ileus (8%) and burst abdomen (8%), were the most common complications.</p> <p class="root-block-node" data-changed="true" data-paragraphid="18"><strong><span class="blue-complex-underline" data-startindex="0" data-endindex="181" data-paragraphid="18">Conclusion: </span></strong><span class="blue-complex-underline" data-startindex="0" data-endindex="181" data-paragraphid="18">Typhoid ileal perforation was the major cause of peritonitis, and paralytic ileus and burst abdomen were the most common complications contributing to the mortality rate.</span></p> Ayesha Mehboob Sughra Parveen Mazhar Iqbal Kehkashan Anwar Jehangir Ali Kulsoom Moulabux Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.529 The severity of acute respiratory infections by using Pediatric Respiratory Severity Score <p>Objective:&nbsp;To determine the severity of acute respiratory infections by using Pediatric Respiratory Severity Score (PRESS) in children.</p> <p>Methodology:&nbsp; This&nbsp;descriptive cross sectional study conducted at outpatient and emergency paediatric department of the Federal Govt. Polyclinic hospital, Islamabad, from October 2017 to December 2019.&nbsp;One hundred and seventeen&nbsp;children with acute respiratory infections were enrolled in the study by a non-probability sampling technique. Epidemiologic variables of interest included age, sex, and breastfed or not. Clinical variables of interest included respiratory rate, use of accessory respiratory muscle, wheeze on auscultation, and oxygen saturation at room air. &nbsp;PRESS assessed tachypnea, wheezing, accessory muscle use, SpO2 and feeding difficulties with each component given a score of 0 or 1, and total score were categorized as a mild(0-1), moderate (2-3) or severe(4-5).</p> <p>Result: Out of 117 children mostly 98(83.8%) were belong to age &gt;2 months-&lt;12 months as compared to 19(16.2%) belong to age group of &gt;12months-&lt;24 months. Among them 17 (14.5%) were mild, 53 (45.3%) were moderate, and 47 (40.2%) were severe according to their severity of respiratory distress. None of mild case (p</p> Naveed Ashraf Naveed Butt Kaneez Fatima Atiqa Minhas Rabia Tabasum Shahzad Munir Amna Gul Maham Zahid Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.641 Comparison of injectable phenytoin and leveracetam in control of neonatal seizure due to birth asphyxia related hypoxic ischemic encephalopathy (HIE) grade II <p class="root-block-node" data-changed="false" data-paragraphid="70"><strong>Objectives:</strong><span class="red-underline" data-startindex="11" data-endindex="12" data-paragraphid="70"> </span>To record and <span class="red-underline" data-startindex="27" data-endindex="33" data-paragraphid="70">analyze</span> the demographic data of enrolled <span class="red-underline" data-startindex="68" data-endindex="77" data-paragraphid="70">neonates, </span>type of clinically observed <span class="red-underline" data-startindex="106" data-endindex="113" data-paragraphid="70">seizures</span> and risk factors for birth <span class="red-underline" data-startindex="142" data-endindex="149" data-paragraphid="70">asphyxia</span> and to compare the efficacy of leveracetam and phenytoin as <span class="red-underline" data-startindex="211" data-endindex="212" data-paragraphid="70">a </span>sole <span class="red-underline" data-startindex="218" data-endindex="222" data-paragraphid="70">agent</span> <span class="red-underline" data-startindex="224" data-endindex="226" data-paragraphid="70">in </span>control of neonatal <span class="red-underline" data-startindex="247" data-endindex="253" data-paragraphid="70">seizure</span> due to grade II HIE.</p> <p class="root-block-node" data-changed="false" data-paragraphid="71"><strong><span class="red-underline" data-startindex="0" data-endindex="12" data-paragraphid="71">Methodology: </span>A prospective </strong>comparative study was conducted in the nursery of the Combined Military Hospital Malir Cantt for 7 months from June 2020 to <span class="red-underline" data-startindex="143" data-endindex="145" data-paragraphid="71">Dec</span> 2020. A total of 60 cases of grade II HIE (based on Sarnet staging) due to birth asphyxia (labeled on a predefined criterion) were reported during the study period and were enrolled using a consecutive sampling technique. Their demographic data, clinical features, and frequencies of the selected known risk factors for birth asphyxia were recorded. <span class="red-underline" data-startindex="484" data-endindex="494" data-paragraphid="71">Sample was </span><span class="red-underline" data-startindex="495" data-endindex="504" data-paragraphid="71">randomized</span> into two groups <span class="red-underline" data-startindex="522" data-endindex="527" data-paragraphid="71">using </span>alternate sampling technique. I/V Phenytoin was given to group A, while I/V Leveracetam was given to group B. The response was measured in terms of seizure control with a single drug.</p> <p class="root-block-node" data-changed="false" data-paragraphid="72"><strong>Results:<span class="red-underline" data-startindex="8" data-endindex="9" data-paragraphid="72"> </span></strong>Out of 60 neonates, <span class="red-underline" data-startindex="29" data-endindex="30" data-paragraphid="72">35</span>(58.33 %) were preterm.<span class="red-underline" data-startindex="54" data-endindex="55" data-paragraphid="72"> </span>Observed risk factors for birth asphyxia included gestational diabetes <span class="red-underline" data-startindex="127" data-endindex="128" data-paragraphid="72">14</span>(23.3%), pregnancy induced hypertension <span class="red-underline" data-startindex="169" data-endindex="170" data-paragraphid="72">10</span>(16.7%), meconium stained liquor <span class="red-underline" data-startindex="204" data-endindex="204" data-paragraphid="72">9</span>(15%), <span class="red-underline" data-startindex="212" data-endindex="216" data-paragraphid="72">fetal</span> bradycardia <span class="red-underline" data-startindex="230" data-endindex="237" data-paragraphid="72">8(13.3%)</span> and maternal infections <span class="red-underline" data-startindex="263" data-endindex="263" data-paragraphid="72">2</span>(3.3%).<span class="red-underline" data-startindex="271" data-endindex="272" data-paragraphid="72"> </span>Phenytoin alone controlled seizures in 22 (73.3%) cases and was found significantly better than <span class="red-underline" data-startindex="369" data-endindex="379" data-paragraphid="72">Leveracetam</span> which alone controlled seizures in <span class="red-underline" data-startindex="416" data-endindex="417" data-paragraphid="72">19</span>(63.3%) cases . <span class="blue-underline" data-startindex="434" data-endindex="450" data-paragraphid="72">(P-value &lt; 0.001)</span></p> <p class="root-block-node" data-changed="false" data-paragraphid="73"><strong><span class="red-underline" data-startindex="0" data-endindex="11" data-paragraphid="73">Conclusion: </span></strong>Perinatal asphyxia is more common in preterm neonates. Gestational diabetes is the most common risk factor for birth asphyxia. Phenytoin <span class="red-underline" data-startindex="149" data-endindex="151" data-paragraphid="73">is </span>significantly better first line sole antiepileptic<span class="red-underline" data-startindex="202" data-endindex="203" data-paragraphid="73"> </span>agent than Leveracetam.</p> Ameena Saba Meha Zahid Taqi Hasan Zaidi Itrat Fatima Sohail Shehzad Wajeeha Amber Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.625 Correlation of Body Mass index with Disease Activity in Rheumatoid Arthritis <p><strong>Objective: </strong>To evaluate correlation between body mass index and disease activity in rheumatoid arthritis patients.</p> <p><strong>Methodology: </strong>This comparative case-control observational study was conducted at Pakistan Institute of Medical Sciences, on rheumatoid arthritis patients visiting the (Out Patient Departments) OPDs between July, 2021 and December, 2021.The study subjects were selected by non-probability convenient sampling from outpatient department. Body mass index and disease activity score were calculated for rheumatoid arthritis patients in OPD. Statistical Package for Social Sciences (SPSS) version 26 was used for data analysis. Mean ± S.D was calculated for age, body mass index and disease activity. Pearson’s correlation coefficient was used for establishing an association between variables. P value less than 0.05 was considered significant. Simple scatter with fit line was plotted to show graphical association between body mass index and disease activity.</p> <p><strong> </strong><strong>Results: </strong>A total 60 patients with 35 (58.3%) female and 25(41.7%) were male. The mean age was 47.21 years. The mean DAS-28 for normal weight group was 2.74 and for overweight group was 4.17. There was positive correlation between body mass index and DAS-28 with r was 0.584 (p&lt;0.05). When correlation on gender basis was calculated, for female patients r was 0.653 and for males 0.529, respectively. </p> <p><strong>Conclusion: </strong>In Rheumatoid Arthritis patients, body mass index is positively correlated with disease activity. Evaluation of this requires trial on large scale, thus, helping in tailoring new management plan, including, weight reduction rather than escalating drug treatment for disease control and improving quality of life in rheumatoid arthritis patients.</p> Fatima Khan Wajahat Aziz Saleha Farrukh Uzma Rasheed Shazia Zammarrud Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.610 Early Bubble Continuous Positive Airway Pressure Therapy for Premature Neonates with Respiratory Distress Syndrome <p><strong>Objective</strong>: To determine the improved outcomes by early introduction of bubble continuous positive airway pressure (CPAP) in preterm neonates.</p> <p><strong>Methodology: </strong>This descriptive case series wasconducted in NICU of Shifa International Hospital, Islamabad, Pakistan for a period of six month from 12<sup>th</sup>Sep 2016 to 12<sup>th</sup>March 2017 after ethical approval. Around 90 preterm infants were enrolledwith gestational age of 28 to 37 weeks and with the clinical features of Respiratory Distress Syndrome (RDS). In the group failing CPAP the severity of RDS and fio2 requirement greater than 50% was noted.</p> <p><strong>Results:</strong> The mean gestational age was32.39±2.69and the mean birth weight was1827±532.97g.The median age to start CPAP was 5.27h of life and 10 babies had failed CPAP.Male preponderancewas likely to fail CPAP in present research. More than 80% of the group that failed CPAP had a Fio2 requirement greater than 50%,and 89% of the infants failing CPAP had severe RDS proven radiologically as well as clinically.</p> <p><strong>Conclusion: </strong>CPAP is of valuable importance in low resource countries with lack of ventilators and provides adequate and conservative method of treatment of mild to moderate RDS for preterm neonates, however in cases of severe RDS intubation and mechanical ventilation is often necessary.</p> Nahdia Zaman Jawaria Zia Anam Zafar Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.582 Comparison of Dexmedetomidine with Midazolam during Monitored Care Anesthesia (MAC) in Patients Undergoing Septoplasty <p class="root-block-node" data-changed="false" data-paragraphid="3"><strong>Objective: </strong>To compare the sedative and analgesic outcomes of dexmedetomidine with midazolam for monitored <span class="red-underline" data-startindex="106" data-endindex="115" data-paragraphid="3">anesthesia</span> care (MAC) in patients undergoing <span class="red-underline" data-startindex="151" data-endindex="161" data-paragraphid="3">Septoplasty</span>.</p> <p class="root-block-node" data-changed="false" data-paragraphid="4"><strong><span class="red-underline" data-startindex="0" data-endindex="13" data-paragraphid="4">Methodology: </span></strong>This comparative study was conducted at Shalamar Medical and Dental <span class="red-underline" data-startindex="77" data-endindex="84" data-paragraphid="4">College </span>Lahore from March 2019 to August 2020. <span class="blue-underline blue-complex-underline" data-startindex="124" data-endindex="281" data-paragraphid="4">A total of 150 patients who were planned for Septoplasty under MAC having age 18-45 years, and ASA status I-II in Shalamar Medical and Dental College Lahore. </span>Patients were randomly divided into two equal groups<span class="red-underline" data-startindex="334" data-endindex="335" data-paragraphid="4">; </span>In group D<span class="red-underline" data-startindex="346" data-endindex="346" data-paragraphid="4">;</span> IV <span class="red-underline" data-startindex="351" data-endindex="366" data-paragraphid="4">dexmedetomidine </span>1 <span class="red-underline" data-startindex="369" data-endindex="375" data-paragraphid="4">µg.Kg-1</span> was given over five <span class="red-underline" data-startindex="397" data-endindex="412" data-paragraphid="4">mins after that </span>IV infusion at the rate of 0.5 <span class="red-underline" data-startindex="444" data-endindex="448" data-paragraphid="4">µg.Kg</span><sup>-1</sup>.hour<sup>-1</sup> was started. In group M<span class="red-underline" data-startindex="482" data-endindex="482" data-paragraphid="4">;</span> midazolam 0.06 mg.<span class="red-underline" data-startindex="502" data-endindex="503" data-paragraphid="4">Kg</span><sup>-1</sup> was given <span class="red-underline" data-startindex="517" data-endindex="519" data-paragraphid="4">as </span>slow <span class="red-underline" data-startindex="525" data-endindex="529" data-paragraphid="4">bolus</span> <span class="red-underline" data-startindex="531" data-endindex="535" data-paragraphid="4">after</span> <span class="red-underline" data-startindex="537" data-endindex="540" data-paragraphid="4">that</span> continuous infusion at the rate of 0.01 mg.<span class="red-underline" data-startindex="585" data-endindex="586" data-paragraphid="4">Kg</span><sup>-1</sup>.hour<sup>-1</sup> was started. Sedation was monitored according <span class="red-underline" data-startindex="643" data-endindex="645" data-paragraphid="4">to </span>Ramsay sedation scale <span class="red-underline" data-startindex="668" data-endindex="671" data-paragraphid="4">and </span>VAS scale was used to measure the intensity of pain.</p> <p class="root-block-node" data-changed="false" data-paragraphid="5"><strong><span class="red-underline" data-startindex="0" data-endindex="8" data-paragraphid="5">Results: </span></strong>The <span class="red-underline" data-startindex="13" data-endindex="16" data-paragraphid="5">Mean</span> age was 34.<span class="red-underline" data-startindex="29" data-endindex="31" data-paragraphid="5">3±5</span>.7 years in group D <span class="red-underline" data-startindex="52" data-endindex="57" data-paragraphid="5">versus</span> 35.<span class="red-underline" data-startindex="62" data-endindex="64" data-paragraphid="5">7±6</span>.1 years in group M. There were 49 (65.3%) male patients in group D and 47 (62.7%) in group M. <span class="red-underline" data-startindex="160" data-endindex="164" data-paragraphid="5">Mean </span>sedation and pain <span class="red-underline" data-startindex="183" data-endindex="191" data-paragraphid="5">score was</span> significantly <span class="red-underline" data-startindex="207" data-endindex="210" data-paragraphid="5">less</span> in group D as compared to group M (p-value 0.001 &amp; 0.002 respectively). There were 12 (16.0%) patients in group D who required rescue <span class="red-underline" data-startindex="346" data-endindex="353" data-paragraphid="5">sedation</span> and 32 (42.7%) in group M required rescue sedation (p-value 0.003). <span class="blue-complex-underline" data-startindex="423" data-endindex="539" data-paragraphid="5">There were 14 (18.7%) patients in group D who required rescue analgesia versus 29 (38.7%) in group M (p-value 0.006).</span></p> <p class="root-block-node" data-changed="false" data-paragraphid="6"><strong><span class="red-underline" data-startindex="0" data-endindex="11" data-paragraphid="6">Conclusion: </span></strong>Use of dexmedetomidine for MAC is advantageous as compared to midazolam in<span class="red-underline" data-startindex="86" data-endindex="86" data-paragraphid="6">-</span>terms of better sedation and analgesia and reduced requirements <span class="red-underline" data-startindex="151" data-endindex="152" data-paragraphid="6">of</span> rescue doses of sedatives and analgesics.</p> Nusrullah Khan Ahmed Shakeel Ahsan Rizvi Muhammad Sarfraz Asif Mahmood Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.509 Comparison of Endodontic Pain observed with Sodium Hypochloride, Hydrogen peroxide and Norman Saline based Root canal irrigants <p><strong>Objective: </strong>To compare frequency and intensity of endodontic pain with sodium hypochlorite, hydrogen peroxide and normal saline groups.</p> <p><strong>Method:</strong>105 subjects were randomly allocated to 3 study arms. Group A (Sodium Hypochlorite), Group B (Hydrogen Peroxide) &amp; Group C (Normal saline).Data regarding endodontic pain was recorded by asking the patient to mark on the Visual Analogue Scale (VAS) according to the severity of pain on the proforma provided.</p> <p><strong>Results:</strong>The minimum Intensity of pain was 0 and maximum was 10 with mean and standard deviation were 3.43 3.576 VAS. Endodontic pain was present in 12/35 (34.3%), 24/35 (68.6%), 30/35 (85%) patients of Group’s A, B, C respectively. Significant difference between groups with respect to Intensity of pain (VAS) was shown by one-way ANOVA. For Group A the Intensity of pain (VAS) was 82.38 4.34 and for Group B, C the Intensity of pain (VAS) were 4.37 3.456 and 6.11 3.197 respectively.</p> <p><strong>Conclusions:</strong>Sodium Hypochlorite was much better than Hydrogen peroxide and normal saline in the management of endodontic pain in terms of incidence and intensity.</p> Nouman Noor Hassan Mujtaba Sadaf Humayoun Muhammad Farooq Umer Muhammad Mohsin Javid Arfa Rehman Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.634 Comparative Bony Union Time Analysis of Dynamic Hip Screw and Proximal Femoral Plate Implants <p class="root-block-node" data-changed="false" data-paragraphid="3">Objective: To examine the comparative and effective applicability <span class="red-underline" data-startindex="62" data-endindex="64" data-paragraphid="3">of </span>Dynamic Hip Screw (DHS)<span class="red-underline" data-startindex="88" data-endindex="88" data-paragraphid="3">,</span> and <span class="red-underline" data-startindex="94" data-endindex="101" data-paragraphid="3">Proximal</span> femoral plate (PFP) to establish a rapid bony union with the least complications for the treatment of unstable pertrochanteric <span class="red-underline" data-startindex="230" data-endindex="238" data-paragraphid="3">fractures</span></p> <p class="root-block-node" data-changed="false" data-paragraphid="4">Methodology: The effectiveness of both techniques was assessed by implanting DHS or PFP as an intervention in 84 healthy participants divided into two groups (DHS and PFP; 42 participants each). implantation, the bony union was clinically and radiographically screened at follow-ups after 6 weeks of operation, and later on, 2 weekly for up to 3 months.</p> <p class="root-block-node" data-changed="false" data-paragraphid="5">Results: A total of 84 participants with a mean age of 68.36 years (65.5% females and 34.5 % males) were provided with DHS or PFP interventions. Corresponding outcomes involved bony union at 2.7 months<span class="red-underline" data-startindex="201" data-endindex="203" data-paragraphid="5"> ± </span>0.2 in DHS implants and 2.9 months<span class="red-underline" data-startindex="238" data-endindex="240" data-paragraphid="5"> ± </span>0.1 in the PFP fixation group. Complications involved superficial (6%) and deep wound infections (3.6%) in both groups. However, varus collapse (13.1%) was exclusively detected in DHS surgeries.</p> <p class="root-block-node" data-changed="true" data-paragraphid="6"><span class="red-underline" data-startindex="0" data-endindex="0" data-paragraphid="6"> </span>Conclusion<span class="red-underline" data-startindex="11" data-endindex="11" data-paragraphid="6">: </span>Implications from the study have unveiled the efficiency of PFP as a treatment of unstable pertrochanteric fractures for the achievement of rapid bony union with minimum complications. </p> Ali Shami Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-03-31 2022-03-31 18 1 Chronic Lymphocytic Leukemia: Autoimmune Presentations in A tertiary Care Hospital of Lahore <p><strong>Objective: </strong>To determine the frequency of presenting features and complication in chronic lymphocytic leukaemia</p> <p data-changed="true" data-paragraphid="63"><strong><span data-startindex="0" data-endindex="12" data-paragraphid="63">Methodology: </span></strong>This descriptive study was conducted at the Hematology department, King Edward Medical University and affiliated hospitals, from January 20th to June 20th, 2016. For every patient, a <span data-startindex="193" data-endindex="199" data-paragraphid="63">through</span> clinical and dermatological examination, abdominal ultrasound<span data-startindex="262" data-endindex="264" data-paragraphid="63"> , </span>bone marrow examination <span data-startindex="289" data-endindex="291" data-paragraphid="63">was</span> done. <span data-startindex="299" data-endindex="305" data-paragraphid="63">Afresh </span>3 <span data-startindex="308" data-endindex="309" data-paragraphid="63">ml</span> blood sample for CBC, immune profile, and serum testing was collected by a syringe using aseptic technique. A complete blood count was carried out <span data-startindex="457" data-endindex="462" data-paragraphid="63">using </span>Automated Haematology Analyzer (<em>Sysmex KX-21)</em> <span data-startindex="509" data-endindex="512" data-paragraphid="63">and </span>chemical examination was done on Beckman Coulter<span data-startindex="561" data-endindex="576" data-paragraphid="63"> Beckman coulter</span>. <span data-startindex="579" data-endindex="591" data-paragraphid="63">Reticulocyte </span>count was <span data-startindex="602" data-endindex="605" data-paragraphid="63">done</span> <span data-startindex="607" data-endindex="610" data-paragraphid="63">and </span>direct antiglobulin test using <span data-startindex="642" data-endindex="646" data-paragraphid="63">coomb</span>’s reagent was done. Every patient was evaluated for the creteia of SLE and was <span data-startindex="727" data-endindex="737" data-paragraphid="63">categorized</span> accordingly.</p> <p data-changed="false" data-paragraphid="68"><strong>Results: </strong>Out of the 150 patients enrolled in the study, <span data-startindex="56" data-endindex="58" data-paragraphid="68">122</span>(81.3%) were male and <span data-startindex="81" data-endindex="82" data-paragraphid="68">28</span>(18.7%) <span data-startindex="91" data-endindex="99" data-paragraphid="68">patients </span>were female. The mean age was 65.8<span data-startindex="130" data-endindex="132" data-paragraphid="68"> ± </span>1.33 <span data-startindex="138" data-endindex="142" data-paragraphid="68">years</span> with the majority of patients falling <span data-startindex="181" data-endindex="182" data-paragraphid="68">in</span> the group of 71<span data-startindex="199" data-endindex="200" data-paragraphid="68">- </span>80 years. Out of 150 patients, 40 (26.7%) had coombs positive. Most of the patients who had coombs positive were in stage 4. The patients who presented with complications such as paraneoplastic pemphigus were 1 out of 150 patients. Splenomegaly was found in 87.3 % of all CLL <span data-startindex="475" data-endindex="482" data-paragraphid="68">patients</span> with 13.33% <span data-startindex="496" data-endindex="505" data-paragraphid="68">presented </span>with massive <span data-startindex="519" data-endindex="530" data-paragraphid="68">splenomegaly</span> <span data-startindex="532" data-endindex="532" data-paragraphid="68">.</span>Angioedema was found in 2 out of 150 patients. No case of SLE, Sjogren s <span data-startindex="606" data-endindex="613" data-paragraphid="68">syndrome</span> Churg strauss <span data-startindex="629" data-endindex="636" data-paragraphid="68">Syndrome</span>, <span data-startindex="639" data-endindex="648" data-paragraphid="68">Vasculitis</span> or Richters Trasnformation was found.</p> <p data-changed="false" data-paragraphid="69"><strong><span data-startindex="0" data-endindex="11" data-paragraphid="69">Conclusion: </span></strong>Detection of complications in a significant number of CLL patients is related to disease progression and overall survival. The treatment modalities are different <span data-startindex="173" data-endindex="174" data-paragraphid="69">in</span> different causes of <span data-startindex="196" data-endindex="202" data-paragraphid="69">anaemia</span> and complications due to CLL. It will help <span data-startindex="247" data-endindex="250" data-paragraphid="69">the </span>clinicians <span data-startindex="262" data-endindex="274" data-paragraphid="69">in modifying </span>the treatment and <span data-startindex="293" data-endindex="302" data-paragraphid="69">decreasing</span> the misery of patients due to<span data-startindex="333" data-endindex="337" data-paragraphid="69"> co </span>morbidities.</p> Arsala Rashid Mukarrama Rashid Nabila Aslam Huma Sheikh Ambareen Kashif Aysha Khanum Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.613 Churg Strauss Syndrome – Case Report <p>We report a 49 year old male patient who presented with swelling in both thighs without pain and dyspnea. Platelet count was low (13,000/mm<sup>3</sup>) with increased eosinophils (48.9%). Patient developed pulmonary embolism. His ADAMTS 13 level was low and was therefore diagnosed as TTP. Treatment given was corticosteroid and plasma exchange. After a year he developed a lump in the skull. Histopathology report revealed vasculitis. Due to presence of vasculitis (TTP) along with eosinophilia, patient was finally diagnosed as a case of Churg Strauss Syndrome (CSS).</p> Noshina Noreen Samina T. Amanat Syeda Wajeeha Jalil Rabeea Irfan Ahmed Farooq Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-04-28 2022-04-28 18 1 10.48036/apims.v18i1.561