Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University
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 in 1990 and the Journal of Surgery in 1991. They were officially merged into one journal, APIMS, in 2005. The Annals of PIMS is recognized by the Pakistan Medical and Dental Council (PMDC), the Higher Education Commission of Pakistan ( Y category), and the CPSP (https://www.cpsp.edu.pk/files/news_notifications/cpsp-sec-2020-338.pdf) It is indexed in WHO-IMEMR, & Base from Germany.
Shaheed Zulfiqar Ali Bhutto Medical University
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons. org/licenses/by-nc/4.0/.) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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.
Objective: 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.
Copyright (c) 2025 Omer Ehsan, Talha Kareem, Haran Innocent Bhatti, Faizan Nihal, Muhammad Iqbal Khan, Umair Ahmed Khan https://creativecommons.org/licenses/by-nc/4.0
Association of Acne Vulgaris with mental health and quality of life among Acne Vulgaris patients
Objectives: To determine the level of anxiety (HADS-A) and depression (HADS-D) and to find out association of mental health and Quality of life among acne vulgaris patients. Methodology: It was a comparative cross-sectional study conducted in Dermatology OPD of PIMS Islamabad from January to June 2025, in which age and gender matched cases and controls were enrolled from through non-probability purposive sampling. Those who were diagnosed with acne vulgaris were considered as cases (Group A), while those who were not diagnosed with acne vulgaris or any skin disease (e.g. patient attendants accompanying the patients) were considered as healthy controls (Group B). Study participants filled the anxiety (HADS-A), depression (HADS-D). Quality of Life (DLQI) questionnaires and Global Acne Grading System (GAGS) score were measured for cases. Descriptive and inferential statistics was applied using SPSS v26. Results: This study included a total of 153 male participants (cases=70; controls=83) with the mean age of 20.6±3.9 years. Mean GAGS score amongst cases was 21.3±7.3 and mean total DLQI score of cases was 6.15±4.9. Correspondingly, mean HADS-A and HADS-D score among all the participants was 4.36±4.4 and 4.45±3.9 respectively. HADS-A and HADS-D mean scores are slightly higher in cases (i.e. 4.7 and 4.9 respectively) (p>0.05). DLQI showed positive correlation (r=0.50) with HADS-D and HADS-A (p<0.001). Mostly moderate to severe acne patient had higher DLQI but very severe acne had relatively milder effect on DLQI. Consecutively, highest GAGS score was observed in patients with higher duration of acne. Conclusions: Our study concluded that acne does not cause any significant mental health issue including anxiety and depression. No association of acne vulgaris with mental health issues and QoL is reported in our study. Furthermore, advance longitudinal studies are required which should include female population and larger sample size.
Copyright (c) 2025 amberwaqar https://creativecommons.org/licenses/by-nc/4.0
Factors Causing for Recurrence of Chronic Sub Dural Hematoma after Burr Hole Craniotomy and Evacuation
Objective: To determine the incidence of recurrence of Chronic Sub Dural Hematoma (CSDH) and its associated factors at a tertiary care Hospital. Methodology: This cross-sectional observational study was conducted at Neurosurgery department at Pakistan Institute of Medical Sciences (PIMS), Islamabad, from February 2024 to October 2024. Patients aged 18 years and above, both genders, underwent diagnosed with CSDH confirmed by imaging (CT or MRI) and drained with burr hole craniotomy and evacuation were included. All patients undergoing burr hole craniotomy and evacuation for the drainage of chronic subdural hematoma (CSDH), (a neurosurgical technique involves creating two or more burr holes in the cranium, through which the dura mater is carefully elevated to access the subdural space. Following this, all the patients were followed during the post-operative period till discharge for recurrent CSDH. All the demographic information, including recurrences and risk factors was entered and analyzed using SPSS version 26. Results: The study included 145 patients, with an overall mean age of 62.59 years, the majority being male (83.4%). The primary underlying cause was trauma, affecting 69.7% of the patients. The overall recurrence rate of hematoma was 12.4%, with approximately half of the cases occurring within two weeks postoperatively. Male gender was a significant risk factor, with 12 of 18 recurrent cases occurring in males compared to 6 in females (p = 0.041). Bilateral hematomas were also significantly associated with recurrence, as 6 of 7 patients with bilateral involvement experienced recurrence (p = 0.001). Hematoma thickness and midline shift were statistically significant predictors, as all 18 recurrent cases had a thickness >15 mm and a midline shift >10 mm (p = 0.001). Regarding drain tube management, 13 of 18 patients whose drains were removed within 24 hours experienced recurrence. Conclusion: Recurrences of chronic subdural hematoma observed to be the 12.40%. Male gender, bilateral hematoma, mixed density hematoma, thickness and midline shift were found to be the causative factors for recurrences.
Copyright (c) 2025 Khudeja, Lal Rehman, Anees https://creativecommons.org/licenses/by-nc/4.0
Enhancing Diagnostic Accuracy in Symptomatic Breast Diseases: The Role of Ultrasound with Mammography
Objectives: To evaluate the diagnostic performance of mammography and ultrasound, individually and in combination, in patients presenting with symptomatic breast disease. Methodology: A cross-sectional validation study was conducted in the Department of Surgery at a PAF hospital in Islamabad, affiliated with Air University, from January 2025 to August 2025. A total of 120 female patients with breast symptoms underwent standard two-view mammography and targeted breast ultrasound. Imaging findings were categorized using the BI-RADS classification and correlated with histopathology, which served as the gold standard. Diagnostic parameters, including sensitivity, specificity, predictive values, and overall accuracy, were calculated. Results: The mean age of the patients was 44.2 ± 10.8 years, with the majority belonging to the 41–50-year age group. Mammography demonstrated a sensitivity of 76.2% and a specificity of 79.5%, while ultrasound showed a sensitivity of 90.5% and a specificity of 85.9%. When both modalities were combined, sensitivity increased to 95.2%, specificity to 91.0%, and overall diagnostic accuracy to 92.5%. The negative predictive value was highest for the combined approach (97.3%), thereby minimizing false-negative results. Conclusion: The combination of ultrasound with mammography significantly improves diagnostic accuracy in symptomatic breast disease compared with either modality alone and should be incorporated into routine clinical practice.
Copyright (c) 2025 Sidra Shabbir,, Atia khatoon, Ayesha Shahid, Fatima Tuz Zahra Shakir, Muhammad Nazim khan, Muhammad Farooq Dar https://creativecommons.org/licenses/by-nc/4.0
Comparison of Success Rate between Two Different Surface Treated Miniscrews with Conventional Miniscrews during Fixed Orthodontic Treatment
Objective: To determine the success rate between two different surface treated miniscrews and conventional miniscrews during fixed orthodontic treatment. Methodology: This prospective, split-mouth, comparative clinical study was conducted at Orthodontics Department of Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) Dow university Hospital karachi, from October 2024 to March 2025. Patient with fixed orthodontic therapy with requirement of absolute anchorage, patients with good oral hygiene and healthy periodontal status, aged 15 to 30 years of either gender were included. Individuals assigned to two groups, with Group A receiving sandblasted miniscrews on the right side and conventional miniscrews on the left, whereas Group B received acid-etched miniscrews on the right side and conventional miniscrews on the left side. The success was defined as the ability to maintain anchorage throughout orthodontic treatment without clinically detectable mobility. SPPS-26 version was used for data analysis. Results: The success rate was significantly higher in Sandblasted miniscrew 80% as compared to 56.6% in conventional group (0.047). The success rate of Acid-Etched miniscrew was also found significantly higher 86.6% compared to conventional group 53.3% (p=0.010). However, the success rate was compared between Acid-Etched miniscrew and Sandblasted miniscrew, no significant difference was observed as p-value < 0.05. Conclusion: Success rate of acid-etched surface miniscrews and Sandblasted miniscrews differed significantly. However, significant difference has been found in success rate between surface treated miniscrews with conventional miniscrews.
Copyright (c) 2025 Anum Mahmood, Imtiaz Ahmed, Sadia Rizwan, Nadia Parveen, Bushra Anees, Muhammad Saleem Qureshi https://creativecommons.org/licenses/by-nc/4.0
Serum Zinc Deficiency among Patients having Viral Cirrhosis
Objective: To determine the frequency of serum zinc deficiency in patients with viral cirrhosis. Methodology: Present descriptive cross-sectional study was done at Department of Gastroenterology Isra University Hospital, from January 2020 to July 2020. Patients aged 18 to 60 years, both genders who were presented with viral cirrhosis (Hepatitis B and C) were enrolled. Around 3 to 5 mL of venous blood was collected aseptically from cirrhotic patients for the measurement of serum zinc levels. Blood collection was centrifuged at 3,000 rpm for 10 minutes. Plasma sample analysis for zinc determination was performed on an automated Perkin-Elmer Analyst 300 atomic absorption spectrophotometer in biochemistry department to assess the zinc deficiency. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: Mean of age of the patients was 49.3±13.4 years. Out of 162 patients, 88 (54.3%) were male while 74 (45.7%) were female. Diabetes mellitus was documented in 61 (37.7%) patients. Serum zinc deficiency was found in 103 (63.6%) patients. Additionally, the zinc deficiency was statistically insignificant according to age and gender of the patients (p=>0.05), while it was significantly higher among diabetes and hypertensive patients (p=<0.05). Conclusion: Serum zinc deficiency was observed highly prevalent among viral cirrhosis patients, affecting nearly two-thirds of the study population.
Copyright (c) 2025 Wali Mohammad, Prem Kumar, Akram Munir, Sunil Dat Maheshwari, Moomal Bhutto, Marvi Soomro https://creativecommons.org/licenses/by-nc/4.0
Incidence, Risk Factors, and Outcome of AKI in Preterm Neonates Admitted to the NICU
Objective:To determine the incidence, potential risk factors, and outcomes of acute kidney injury (AKI) among preterm neonates. Methodology: This prospective cohort study was conducted in the neonatal intensive care units (NICUs) of Fatima Memorial Hospital, Lahore, from April 2024 to October 2024. Preterm neonates born between 28 and 36 weeks of gestation were eligible for inclusion. A total of 432 preterm neonates admitted to the NICU of this tertiary care hospital during the study period were enrolled. Neonates with major congenital anomalies or chromosomal abnormalities were excluded. AKI was diagnosed using the modified Kidney Disease: Improving Global Outcomes (KDIGO) criteria. The primary outcomes assessed were in-hospital mortality and duration of hospitalization. Results: AKI was diagnosed in 178 preterm neonates (41.2%). Maternal anemia emerged as the most significant risk factor, increasing the risk of neonatal AKI by 5.8 times (487%), followed by hemodynamically significant patent ductus arteriosus (hsPDA) (2.89 times; 189%) and mechanical ventilation (1.7 times; 76.8%). In contrast, exposure to antenatal steroids was nephroprotective, reducing the risk of AKI by 63.6%. The mortality rate among neonates with AKI was 16.3% (p < 0.001), with stage 3 AKI demonstrating the highest mortality rate (30%). Kaplan–Meier survival analysis showed a significant reduction in survival duration among neonates with stage 3 AKI, with a mean survival time of 16.51 days. Conclusion: Approximately two-fifths of preterm neonates in this cohort developed AKI, affecting 178 (41.2%) of the 432 enrolled neonates. Key risk factors included maternal anemia, hsPDA, and mechanical ventilation, while antenatal steroid exposure had a protective effect. Preterm neonates with stage 3 AKI experienced hospital stays that were twice as long and demonstrated a 50% reduction in mean survival (p < 0.001).
Copyright (c) 2025 Rafia Gul, Lubna Asghar, Samer Fatima, Muhammad Usman, Furqan Saleem, Irshad Hussain, Sidra Hamayoon https://creativecommons.org/licenses/by-nc/4.0
Examining the Relationship between Parental Smoking and Asthma Severity in Children with Bronchial Asthma
Objectives: 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 through standard 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. Among children 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 &lt; 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.
Copyright (c) 2025 Hammad Ajhmad, Nuzhat Yasmeen, Muhammad Abdullah https://creativecommons.org/licenses/by-nc/4.0
Routine Histopathology of Gallbladder After Elective Surgery for Gallstones is Waste of Resources or Justified
Objective: To determine the need for routine histopathological analysis of gallbladder specimens post-cholecystectomy in Pakistan, focusing on detecting unexpected pathologies. Methodology: This descriptive cross-sectional study was conducted at Islamabad Medical Complex, NESCOM, 1st august 2022 to 31st October 2023, involving 534 patients who were diagnosed with gallstones-induced acute or chronic cholecystitis, while excluding those with clinical or radiological indications of gallbladder carcinoma. All surgical specimens were carefully submitted for histopathological analysis, and the collected data were systematically evaluated using SPSS 26 version. Results: Overall 534 mean age of patients was 49.03 +15.02 years. The chronic cholecystitis was the most frequent histopathological finding (85.0%), followed by acute on chronic cholecystitis (13.5%), while rare lesions included gallbladder polyps (0.7%) and mucinous adenocarcinoma (0.7%). Additionally, the distribution of histopathological outcomes across different age groups (p = 0.527) and between genders (p = 0.988) showed no statistically significant differences. Conclusion: Study revealed that most gallbladder specimens following elective cholecystectomy for gallstones showed benign pathology, predominantly chronic cholecystitis, with only rare lesions such as gallbladder polyps or mucinous adenocarcinoma, and although incidental malignancy was uncommon, which indicating that the routine histopathological examination remains essential and justified to ensure early detection of unexpected neoplastic changes that could be missed on gross examination.
Copyright (c) 2024 Natasha Maryam, Summera ambreen, Amna batool https://creativecommons.org/licenses/by-nc/4.0
Subcutaneous Suction Drain to Reduce Surgical Site Infection in Contaminated Cases of Emergency Laparotomy: A Randomized Controlled Trial
Objective: To compare the frequency of surgical site infections (SSIs) in contaminated emergency laparotomy cases between two groups: with and without subcutaneous suction drains. Methodology: This randomized controlled trial was conducted from December 2024 to February 2025 at the Department of General Surgery, Pakistan Institute of Medical Sciences, Islamabad. A total of 150 patients aged 18 to 75 years who underwent midline exploratory laparotomy with contamination were included. Patients were randomly assigned to either the subcutaneous suction drain group (n = 75) or the control group without drains (n = 75). Data on demographic characteristics, comorbidities (diabetes mellitus and hypertension), and surgical site infections were collected. Surgical site infections were assessed using standard clinical criteria, including redness, swelling, pain, warmth, and wound discharge. Results: The incidence of surgical site infections was significantly lower in the subcutaneous suction drain group (13.3%) compared to the control group (46.7%) (p < 0.001). Stratified analyses revealed that age, gender, comorbidities, and body mass index (BMI) were significant predictors of SSI risk. Among patients in the control group, younger patients (<40 years) had an infection rate of 44.1%, whereas older patients (>40 years) had an infection rate of 48.8% (p = 0.015). Conclusion: The use of subcutaneous suction drains significantly reduces the incidence of surgical site infections in contaminated emergency laparotomy cases.
Copyright (c) 2025 Haris Farooq, Aatif Inam Shami, Burhan Ul Haq https://creativecommons.org/licenses/by-nc/4.0
Comparative Evaluation of the Efficacy of Green Tea vs Normal Saline on Post-Operative Swelling and Pain in Third Molar Surgery
Background: Common problems following mandibular third molar extraction include edema, pain, and trismus. Pain is commonly treated with paracetamol, diclofenac sodium, and NSAIDs, while NSAIDs can induce gastrointestinal and renal problems. Synthetic corticosteroids are also utilized for their anti-inflammatory properties, which minimize postoperative inflammation and consequences. Methods: The study was conducted at Nishtar Institute of Dentistry in Multan from June 30, 2021 to January 31, 2023, and comprised 56 individuals (28 each group) aged 18-30 with impacted third molars. The ethical approval and informed consent were obtained. Panoramic radiography evaluated surgery sites. The sample size was calculated using the WHO Sample Size Calculator. 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 include the full facts. Conclusion: Rinsing with mouth wash made from green tea on a daily basis 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.
Copyright (c) 2025 Sehrish Liaqat, Ahsan ullah, Shahzad Nasir, Muhammad Abi Waqas, Shaheen Anjum, namal pervez https://creativecommons.org/licenses/by-nc/4.0
The Outcome of Intra-Articular Injections of Platelets Rich Plasma with Hyaluronic Acid in Osteoarthritis of Knee
Introduction: Knee osteoarthritis (KOA) is a degenerative joint disorder characterized by pain, stiffness, and reduced function. Intra-articular injections of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) (Cellular MatrixTM PRP-HA) have emerged as promising nonsurgical treatment options aimed at improving symptoms and delaying disease progression. Objective: To evaluate the clinical outcomes and safety profile of intra-articular PRP combined with HA in patients with KOA. Methods: This longitudinal, single-centre study was conducted at the Department of Rheumatology, Fatima Memorial Hospital, over a six-month period. A total of 20 patients aged 40–75 years with radiographically confirmed KOA (Kellgren–Lawrence grades I–IV) were enrolled via purposive sampling. Each patient received two intra-articular injections of PRP combined with HA prepared with cellular matrix tube in a specialized centrifuge machine on days 1 and 90. Functional and pain outcomes and difficulty scores were asssessed via the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), visual analogue scale (VAS), and other clinical parameters at three time points: baseline and 90 and 90 days post after the final injection (Day 180). Repeated measures ANOVA was used for statistical analysis.Adverse effects were minimal, with only 3 patients (15%) reporting mild, transient symptoms. Results: Statistically significant improvements were observed in most functional activities and clinical scores. The difficulty scores assessed by WOMAC and VAS decreased from 49.30 ± 5.89 to 29.95 ± 15.40 (F = 13.12, p < 0.0001), the pain scores decreased from 14.05 ± 2.56 to 8.50 ± 4.47 (F = 10.85, p = 0.0001), and the VAS scores decreased from 7.40 ± 1.23 to 4.10 ± 1.52 (F = 29.55, p < 0.0001). The WOMAC score improved from 69.10 ± 7.60 to 41.90 ± 20.38 (F = 14.32, p < 0.0001). The radiological grade remained unchanged (p = 0.135). Adverse effects were minimal, with only 3 patients (15%) reporting mild, transient symptoms. Conclusion: PRP combined with HA significantly reduces pain and improves functional outcomes in patients with KOA, with an excellent safety profile, making it a viable alternative to surgical intervention in selected cases. Keywords: Knee osteoarthritis, Platelet-rich plasma, Hyaluronic acid, Intra-articular injection, Functional outcomes
Copyright (c) 2025 Naveed Aslam Lashari, Sumaira Farman , Muhammad Ahmed Saeed, Nadia Irum, Laraib Moeed, Nighat Mir Ahmed, Sanabil Naveed, Muhammad Hamza https://creativecommons.org/licenses/by-nc/4.0
Spectrum of Duodenal & Small Intestinal Diseases in Quetta: A Hospital-Based Study
Objective: To determine the spectrum of inflammatory and neoplastic diseases affecting the duodenum and small intestine in patients presenting to a tertiary care hospital in Quetta. Methodology: This retrospective observational study was conducted at a tertiary care hospital in Quetta from April 2021 to January 2025. A total of 152 patients of all ages and both genders who underwent duodenal or small intestinal biopsy were included. Only cases with complete clinical, endoscopic, and histopathological data were analyzed. Histological assessment was performed on endoscopic biopsies, incisional biopsies, and excision specimens. Celiac disease was classified using the Marsh classification. Data analysis was carried out using SPSS version 20. Associations between variables were assessed using Chi-square and Fisher’s exact tests, with statistical significance set at p<0.05. Results: The mean age of patients was 31.53 ± 13.81 years, with a male predominance (70.4%). Anemia (39.5%) and chronic diarrhea (19.1%) were the most common presenting symptoms. Inflammatory and benign conditions accounted for 95.4% of cases, while malignant lesions comprised 4.6%. Chronic non-specific inflammation was the most frequent histopathological finding (61.2%). Celiac disease was diagnosed in 19.7% of cases, predominantly in males, with Marsh stage 1 and stage 3b being the most common subtypes. Giardiasis and Meckel’s diverticulum were each identified in 1.3% of cases. Among malignant lesions, adenocarcinoma was the most common (2%), followed by intestinal lymphomas and gastrointestinal stromal tumors. Conclusion: Inflammatory conditions, particularly chronic non-specific inflammation and celiac disease, represent the majority of duodenal and small intestinal pathologies in this region. Although uncommon, malignant lesions remain clinically significant. Histopathological evaluation of biopsies plays a crucial role in accurate diagnosis and appropriate management.
Copyright (c) 2025 Muhammad Zubair, Faiqa Mubeen, Muhammad Asif Farooq, Aaminah Hanif, Muhammad Zeeshan Rana, Sania Khan https://creativecommons.org/licenses/by-nc/4.0
Comparative Analysis Between Paracetamol vs Placebo During Labour in Primigravida in Terms of Cervical Dilatation and Adequate Analgesia
Objective: To evaluate a comparative analysis of paracetamol versus placebo during labour in primigravida women in terms of cervical dilatation and adequacy of analgesia. Methodology: This randomized controlled trial was carried out in the Obstetrics and Gynaecology Department of Patel Hospital, Karachi, from June 2023 to December 2023. All primiparous women with singleton pregnancies, cephalic presentation, active labour, and gestational age greater than 37 weeks were included. The women were randomly categorized into two groups: the intervention group 1000 mg 1 g paracetamol with oxytocin augmentation) and the control group (oxytocin augmentation alone. Cervical dilatation was measured in centimeters from the onset of active labour greater than 4 cm) to full dilatation 10 cm. Pain scores were measured using the Visual Analogue Scale VAS, where participants rated their pain. Changes in pain scores over time were analyzed to determine the analgesic efficacy of paracetamol compared to placebo. Pain scores were assessed at regular hourly intervals until full cervical dilatation or delivery. Data were entered and analyzed using SPSS version 26. Results: A total of 80 women with term pregnancies were studied, with an overall mean age of 24.22 years. Conclusion: Paracetamol administration as an adjunct to oxytocin augmentation was found to be significantly effective in promoting faster cervical dilatation and significantly reducing labour pain.
Copyright (c) 2025 Shumaila, Samina Saleem, Asiya kazi, Hafsa Tarique, Afshan Abbas https://creativecommons.org/licenses/by-nc/4.0
Role of Probiotics in the Prevention of Recurrent Upper Respiratory Tract Infections in the Pediatric Age Group
Objectives: To determine the role of probiotics in prevention of recurrent upper respiratory tract infection in children. Methodology: This quasi-experimental study was conducted at Pediatrics department of Combined Military Hospital, Quetta, Pakistan from October-2024 to April-2025. A total of 64 children with recurrent upper respiratory tract infection were included who were divided into Group-P (probiotic) and Group-S (no probiotics). Children were followed up after three months to assess for recurrence. Analysis of data was performed through Statistical Package for Social Sciences (SPSS) software version 22. Results: Median age was 5.00 (3.00) years. There were 45 (70.30%) male and 19 (29.70%) female patients. Median number of episodes of URTI in three months at the end of study in Group-P was 1.00 (2.00) while in Group-S it was 2.00 (3.00), (p = 0.136). Frequency of recurrence of URTI in Group-P (n = 32) at three months follow up was 9 (28.13%) while in Group-S (n = 32), it was 17 (53.13%), (p = 0.042). Conclusion: Probiotics are highly useful in prevention of recurrent upper respiratory tract infection in children. Keywords: Infections, Probiotics, Recurrence, Respiratory Tract.
Copyright (c) 2025 Nidda Arshad Waraich, lt Col Muhammad omer tufail, Zainab Akmal Abbasi, Muhammad Umer Farooq https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Hyponatremia in Patients With Moderate to Severe Bronchiolitis
Objective We aimed to estimate the frequency and severity of hyponatremia in infants hospitalized with moderate–severe bronchiolitis and to assess its association with the severity of disease and length of stay (LOS). Methodology It was a single-centre cross-sectional study of consecutive infants with moderate–severe bronchiolitis conducted at Pediatric Medicine Department, Federal Government Polyclinic (FGPC) Hospital, Islamabad, from 01-11-2023 to 30-04-2024. Patients were selected by clinical diagnosis using Pediatric Respiratory Severity Score (PRESS) at presentation. Serum sodium was measured and hyponatremia categorized by standard thresholds. Associations with clinical severity and LOS were tested with chi-square and correlation analyses. Multivariable logistic regression was applied to adjust for confounding variables like age and gender. SPSS version 27 was used for analysis and a P<0.05 was considered significant. Results Data of total of n=135 eligible infants were analysed. Hyponatremia was found in 62.2% of cases (mild 63.1%, moderate 36.9%, severe 0%) and was significantly associated with bronchiolitis severity (P<0.001) and longer durations of hospital stay (P<0.001). Serum sodium showed a strong negative correlation with PRESS (r=-0.712; P<0.001) and LOS (r=-0.594); P<0.001). In multivariable adjusted models, severe (vs moderate) bronchiolitis carried markedly greater odds of a higher hyponatremia category (aOR 6.27; 95% CI 2.25–17.45; P<0.001). Conclusions In infants with bronchiolitis, a low admission serum sodium levels track with higher PRESS and longer LOS. We recommend an admission sodium check along with PRESS-based triage. This will help in identifying children who need closer observation.
Copyright (c) 2025 Dr. Tayyeba Rasheed Malik, Dr Sidra Nisar, Dr Shahzad Munir, Dr Shehreen Iqbal, Dr Naveed Ashraf https://creativecommons.org/licenses/by-nc/4.0
Relapse of Plasmodium Vivax Malaria and Use of Primaquine in Pediatric Population at Tertiary Care Hospital
Objective: 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.
Copyright (c) 2025 Anum Ahmed, Arshad Ali, Ghulam Jelani, Farah Saeed, Mobassir Ali Akbar https://creativecommons.org/licenses/by-nc/4.0
Evaluation of the Gag Reflex in Patients Wearing Partial Dentures During Impression Taking
Objective: To determine the frequency of the gag reflex in patient of partial dentures wearer while taking impression. Methods: a Cross Sectional descriptive study was done at department of Prosthodontics, Institute of Dentistry, LUMHS, Jamshoro, on 97 prosthodontics patients (removable partial denture, fixed restoration such as crown, bridge) aged 20 to 60 years and of either genders. Data regarding demographic characteristics and gag reflex were collected using the Gagging Problem Assessment Questionnaire (GPA–Patient Short Form). The scores were categorized as mild, moderate, or severe. After all the relevant data collection the analysis was done using IBM SPSS version 26. Results: Overall mean age of the individuals was 36.93±7.66 years and females were in majority 63(64.9%). Out of all partial denture wearers, 92.8% reported experiencing a gag reflex. Additionally the majority of participants (62.9%) had a mild gag reflex, 6(26.8%) had a moderate response, 3(3.1%) reported a severe gag reflex, while 7(7.2%) showed no gag reflex. However the severity of the gag reflex did not show a statistically significant association with age and gender (p-&gt;0.05). Conclusion: This study revealed that a mild to moderate gag reflex was observed the most common among partial denture wearers, particularly during impression procedures involving the upper jaw and posterior oral regions, without its significant association with age or gender. Key words: Partial denture, Gag reflex, Impressions
Copyright (c) 2025 SANAM https://creativecommons.org/licenses/by-nc/4.0
Efficacy and Safety of Dapagliflozin in Type 2 Diabetics With Stage 3A Chronic Kidney Disease
Objective: The objective of this study was to evaluate the efficacy and safety of Dapagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, in patients with chronic kidney disease stage 3A (CKD 3A) and inadequately controlled Type 2 Diabetes Mellitus (T2DM). Methodology: This randomized controlled trial was conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad, and included 196 patients with T2DM and CKD 3A (estimated glomerular filtration rate [eGFR] 45–60 ml/min/m²) with inadequate glycemic control (HbA1c 7.0%–11.0%). Patients were randomly assigned to either Dapagliflozin 10 mg/day plus standard care (Group A) or placebo plus standard care (Group B). After 24 weeks of treatment, HbA1c, eGFR, and hypoglycemic events were assessed. Efficacy was measured by changes in HbA1c, while safety was evaluated based on changes in eGFR and the occurrence of hypoglycemic episodes. Results: After 24 weeks, Group A demonstrated a significant reduction in HbA1c levels, with a mean decrease from 8.2% (± 0.71) to 7.7% (± 0.68) (p = 0.002). In contrast, Group B showed no significant change, with a mean HbA1c reduction from 7.58% (± 0.72) to 7.52% (± 0.38). The eGFR in Group A declined slightly from 52.14 ml/min/m² (± 4.8) to 51.27 ml/min/m² (± 5.8), whereas in Group B, a more pronounced decline was observed from 50.8 ml/min/m² (± 6.7) to 47.6 ml/min/m² (± 6.0) (p < 0.000). Hypoglycemic episodes occurred in 5% of patients in Group A and 6% in Group B, with no significant difference between the groups. Conclusion: Dapagliflozin effectively reduced HbA1c levels in patients with T2DM and CKD 3A without significantly affecting eGFR or increasing the risk of hypoglycemic events. It can be considered a safe and effective therapeutic option for this patient population. Keywords: Type 2 Diabetes Mellitus, SGLT2 Inhibitor, Dapagliflozin, Chronic Kidney Disease Stage 3A, HbA1c, eGFR, Hypoglycemia
Copyright (c) 2025 Malik Abdul Rehman, Badar U Din Shah, Adnan Akhter https://creativecommons.org/licenses/by-nc/4.0
Early Versus Late Laparoscopic Cholecystectomy for Acute Cholecystitis
Objective: To compare outcomes between early and late laparoscopic cholecystectomy (LC) in patients presenting with acute cholecystitis (AC). Material and methods: This randomized controlled trial was conducted in the Surgical Department of Capital Development Authority Hospital, Islamabad, from 29 October 2019 to 29 April 2020. Patients aged 18–60 years of either gender diagnosed with acute cholecystitis—confirmed on ultrasonography by the presence of gallstones, a positive sonographic Murphy’s sign, gallbladder wall thickening >3 mm, or pericholecystic fluid—were included. Participants were randomly allocated into two groups: Group A (early LC) and Group B (late LC). All patients received standard preoperative and anesthetic management. Surgeries were performed by a single experienced laparoscopic surgeon. Outcomes were assessed in terms of conversion to open surgery, bile leak, and mean hospital stay. Results: The mean age in the early LC group was 44 ± 10.7 years, compared to 40 ± 11.9 years in the late LC group. In Group A, 40% of patients were male and 60% were female, whereas in Group B, 35% were male and 65% were female. None of the patients in the early LC group required conversion to open surgery, while 9% of patients in the late LC group were converted. Bile leak occurred in 2% (1 patient) of the early LC group compared to 12% (5 patients) in the late LC group. The mean hospital stay was shorter in the early LC group (2 ± 1.29 days) compared to the late LC group (3 ± 2.84 days). Conclusion: Early laparoscopic cholecystectomy was associated with fewer complications and a shorter hospital stay and appears to be a better treatment option compared to late laparoscopic cholecystectomy in patients with acute cholecystitis.
Copyright (c) 2025 Israr Ahmed, Muhammad Naeem Taj, Aasma Waleed, Waleed Munir, Zakia Akbar https://creativecommons.org/licenses/by-nc/4.0
Vitamin D Deficiency in General Paediatric Population Presented in Combined Military Hospital, Malir
Objective: To determine the frequency of vitamin D deficiency in paediatric population presented at combined military Hospital, Malir. Methodology: This descriptive cross-sectional designed study was conducted at the Pediatric Outpatient Department (OPD) at combined military Hospital, Malir, from July to November 2021. Children aged 6 months to 12 years, both boys and girls presented to the pediatric department for routine care, nutritional concerns, or nonspecific symptoms potentially related to micronutrient deficiency were included. A 3–5 mL sample of venous blood was collected aseptically from each participant for biochemical assessment of the vitamin D and vitamin D (25-hydroxyvitamin D) level <20 ng/mL was considered deficient. All the relevant information was entered and analyzed using SPSS version 26. Results: Out of all 54.5% were female and 45.5% were male. Most children (47.7%) were 1–5 years old. Around half (50%) children were found to have vitamin D deficiency, while 31.8% had insufficient levels, and only 18.2% had sufficient. Sunlight exposure, type of dairy product intake, fish and meat intake, and socioeconomic status had significant associations with serum vitamin D levels p <0.05. Conclusion: A higher prevalence observed of vitamin D deficiency among children, and found to be strongly linked to inadequate sunlight exposure, poor dietary intake, and low socioeconomic status.
Copyright (c) 2025 Ayesha Asif, Syed Taqi Hassan Zaidi, Wasif Shujaat Ali, Muhammad Hanif, Komil, Tasneem Kousar https://creativecommons.org/licenses/by-nc/4.0
Knowledge, attitude and practices of healthcare professionals regarding disaster management
Objective: To assess the level of knowledge, attitude, and readiness to practice disaster medicine among healthcare professionals. Methodology: Across-sectional observational study was conducted from November 2024 to January 2025, at the Pakistan Institute of Medical Sciences (PIMS) in Islamabad. A self-administered, validated questionnaire was used to collect the information from the doctors regarding knowledge, attitude and practices about disaster management. Data was analyzed using SPSS version 25. Results: A total of 170 doctors participated in the study, 55.3% (n = 94) were males and 44.7% (n = 76) were females. House officers were the largest percentage of responders (56.5%, n = 96), followed by postgraduates (30%, n= 51). Most of the participants (95.3%, n=162) knew the disaster meaning. However, only 27.1% (n = 46) were aware of their hospital's disaster preparedness plan. 52.4% (n=89) were unclear about the disaster drills. Majority (97.1%, n = 165) agreed that disaster preparedness training should be required for the doctors. Conclusion: There are gaps in disaster preparedness among doctors at PIMS, as many reported lacking formal training, awareness of hospital disaster plans, or participation in drills. A strong consensus among participants supported making disaster preparedness training mandatory, with a high willingness to engage in such programs. Keywords: Disaster, Disaster preparedness, Disaster management,Healthcare professionals
Copyright (c) 2025 S H Waqar, Muhammad Atif, Laiba Ejaz, Samia Sajid, Mirza Khan, Zain ul Abidin,, Fatima Shahzad, Shahzad Rasheed https://creativecommons.org/licenses/by-nc/4.0
Frequency of Spinal Tuberculosis in Diabetics With Highly Suspected Clinical Features of Tuberculous Spine
Objective: Spinal tuberculosis is a health condition that cause neurological issue & impacts quality of life. This becomes more challenging when occurred in the diabetic patients. Frequency of spinal tuberculosis among the diabetic cases presenting with the highly suspected clinical features of the tuberculosis spine. Methodology: This was cross sectional study conducted on 300 patients in department of interventional radiology of Ittefaq Trust Hospital situated in Lahore, Pakistan. The inclusion criteria was either gender with age of 30-70 years &amp; strong clinical suspicion of spinal TB. Patients’ blood sugar level of fasting greater then 126mg/dl. Patients were subjected to the MRI for identification of clinical features of the strongly suspected cases. Data entry and analysis was done by using SPSS 25inc. descriptive statistics was calculated along with the application of the chi square test to find out the impact of other variables on of the spinal TB. A p-value 0.05 as significant, Results: 300 patients when evaluated, it was noted that mean age of the patients was 53.47±9.93 years at the time of presentation. Majority of the patients with tuberculosis was male 178(59.7%). Mean duration of the disease was found to be 14.7±9.4 months. Radiological scan was done, and it was clarified that lumbar spine was involved in 240(80%) cases and 2 vertebrae was involved in 170(56.7%) cases. 159(53.4%) patients were having spinal tuberculosis along with diabetes mellitus. Conclusion: It is important to check the diabetic cases with back pain for spinal tuberculosis for early management accordingly.
Copyright (c) 2025 Afaf Arif, Muhammad Aqeel Babri, Hassan Riaz, Rana Shakil Ahmad https://creativecommons.org/licenses/by-nc/4.0
Maternal and fetal outcomes in pregnant women Presenting with burn injuries at PIMS Islamabad
Objective: To document the clinical presentation of burn injuries among pregnant women and determine the fetomaternal outcomes. Design Retrospective cohort study Methodology All the pregnant ladies that presented to MCH and the ones for which call of consultation was sent from burn center of Pakistan Institute of Medical Sciences, Islamabad were recruited after informed consent. The study was conducted from May 2008 to October 2024 that is 15years 5 months. Non probability simple random technique was employed .Ethical approval was taken. Data was collected retrospectively .A structured questionnaire was filled. The particulars like total burn surface areas, type of burn, mode of burn was documented. The obstetrical management of the patients that is no intervention, supportive or delivery of fetus trimester wise was recorded. The primary outcome measures included the clinical presentation and trimester-wise distribution of the patients. The secondary outcome measures included feto-maternal outcomes. Results: A total of 33 pregnant burn patients were managed at PIMS between 2008 and 2023, with ages ranging from 20 to 45 years (63.6%, n = 21, aged 21–30 years). Patients presented equally across trimesters: first (n = 11), second (n = 10), and third (n = 12). Flame burns predominated (75.8%, n = 25), followed by electric (n = 4), scald (n = 3), and chemical burns (n = 1). Nearly all cases were accidental (97.0%, n = 32), with one suicidal instance (3.0%). Burn severity varied: <30% TBSA (n = 10), 30–50% (n = 5), 50–70% (n = 7), and >70% (n = 11). Maternal mortality correlated strongly with TBSA (p < 0.001*), declining from 90% survival at <30% TBSA (n = 9/10 alive) to 9.1% at >70% (n = 1/11 alive). Fetal mortality followed a similar pattern (p = 0.008*), with 100% demise at >70% TBSA (n = 6/6 expired). Patient admissions increased over time, peaking in 2020–2023 (n = 15) compared to 2008–2011 (n = 4), while maternal mortality decreased significantly (p = 0.007*) under multidisciplinary care. Active management strategies improved outcomes: maternal survival was highest with supportive therapy (55.6%, n = 5/9) and fetomaternal surveillance (57.1%, n = 4/7), while fetal survival reached 100% with delivery (n = 5/5 alive). In contrast, no intervention led to 9.1% maternal survival (n = 1/11 alive) and universal fetal mortality (n = 0/9 alive), and termination of pregnancy resulted in 0% survival for both mother (n = 0/1*) and fetus (n = 0/1*; p < 0.001*). Younger maternal age showed a non-significant trend toward better fetal survival (p = 0.527*). Overall, 39.4% of mothers (n = 13) and 30.3% of fetuses (n = 10) survived, with improved outcomes observed in recent years. Conclusion Among the various patients managed it was found that supportive therapy is better for good maternal outcomes in first and second trimester. In third trimester it is best to deliver fetus as soon as reasonably possible for better pregnancy outcome in pregnant patients inflicted with burn injuries. Over the years the patients were better managed by having multidisciplinary care. PIMS is about to become a center of excellence of care for pregnant women presenting with burns. Key Words Maternal mortality, TBSA, Fetus
Copyright (c) 2025 Sara Usman, Zeenat usman, Ahaifa Khan, Ashir Khalid, Faryal Ali, Nosheela Javed https://creativecommons.org/licenses/by-nc/4.0
Annals of PIMS: A Profile of Progress and Vision
Copyright (c) 2025 Tanwir Khaliq https://creativecommons.org/licenses/by-nc/4.0