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.
Beyond the Virus: Tracheal Stenosis as a Sequela of Severe COVID-19 – A Case Report
INTRODUCTION: The COVID-19 pandemic has haunted the globe with its wide array of presentations, for over 2 years now. We present a case of tracheal narrowing – a presentation that may have an association with the pathology of the causative virus. CASE REPORT: A 57 year old female, known case of congestive heart failure and hypertension, presented with increasing shortness of breath. She had a history of recent hospital admission for congestive heart failure exacerbation, which included several days of intubation. Diagnosed with COVID-19 pneumonia, the patient was admitted and a CT scan ordered, which revealed bilateral ground glass opacities – a finding characteristic of the disease. In addition, the trachea was found to be narrowed. This was confirmed and treated with rigid bronchoscopy, which greatly improved the patient’s condition. CONCLUSION: Diagnostic testing modalities are limited in their abilities to identify COVID-19. This may affect management protocols. We propose establishing a scoring system, using a combination of symptoms and laboratory investigations as scoring criteria, to help not only identify patients in need of therapy but also to stratify disease severity. Our case represents a unique and rather rare finding, which may possibly hint towards COVID-19.
Copyright (c) 2026 Muhammad Abdullah, Muhammad Osama Muslim MD, Aiman Balouch, Abdurrahman Mir Khan, Alina Tariq, Syeda Gul E Zahra, Sania Muslim https://creativecommons.org/licenses/by-nc/4.0
Role of Structured Infection Prevention and Control Training Program in Reducing Surface Contamination and hospital acquired infections: A Single Centre Study
Objective: To assess the impact of a structured IPC training program on reducing surface contamination and the frequency of HAIs. The findings aim to support effective infection control strategies and improved outcomes in healthcare settings. Methodology: Retrospective interpreted time series (ITS) analysis of monthly environmental cultures from six critical areas of Tertiary care teaching hospital (June 2022 to Dec 2023) was conducted. Surface culture reports and HAI records were analyzed before and after IPC training implementation. Descriptive statistics and chi-square tests assessed the changes in surface contamination and HAI rates. Results: Among 619 environmental samples from six critical areas, 32 (5.1%) showed microbial growth. Positive cultures rates declined significantly across study period from 11.9% to 3.1% and 1.7% following IPC program implementation (df = 2, p < 0.001). ICUs had highest contamination, predominantly Gram-positive cocci, including coagulase-negative Staphylococci. Hospital-acquired infections decreased in critical areas, with a significant shift after IPC implementation ( df = 3, p = 0.019). Conclusion: There is a significant impact of implementation of infection prevention and control policies followed by regular and structured training sessions of healthcare professionals on surface bacterial contamination of critical areas and hospital associated infections in a tertiary care hospital.
Copyright (c) 2026 Aliya Batool https://creativecommons.org/licenses/by-nc/4.0
Prevalence of Hyponatremia in Patients With Moderate to Severe Bronchiolitis
Objective: 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. An admission sodium check is recommended 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
Assessment of the Anti-hyperglycemic effects of Rosemary (Salvia Rosmarinus) compared to Glimepiride in Alloxan induced Diabetic Rabbits
Objectives: To observe the antihyperglycemic effects effect of Rosemary (Salvia rosmarinus) in alloxan induced diabetic rabbits. Methods: The experimental study was conducted at the Department of Pharmacology and Therapeutics in collaboration with the Animal House of Agriculture University, Tando Jam, involved 24 adult healthy male rabbits weighing between 1.5 to 2.5 kg. The rabbits were divided into four groups: Group A (normal control) and Group B (diabetic induced control) both received 0.9% NaCl, while Group C (diabetic induced) received Rosmarinus officinalis 250 mg/kg, and Group D (diabetic induced) received glimepiride 2.5 mg/kg. Clinical parameters such as blood glucose, and body weight were measured on day 0 and day 28. Rosmarinus officinalis leaves were dried, powdered, and prepared into an ethanolic extract. Blood samples were collected from the femoral vein, centrifuged, and analyzed for serum blood glucose level. Hyperglycemia was confirmed with blood glucose levels above 200 mg/dl. Data was entered and analyzed by SPSS version 26. Results: Fasting blood sugar (FBS) levels showed a significant reduction in Groups C and D compared to Group B by Day 28. Specifically, in Group C' FBS dropped from 252.8±2.5 to 181.3±2.3, and in Group D from 255±1.8 to 197.16±2.5, indicationg Rosmarinus officinalis demonstrated significant efficacy in improving FBS levels in diabetic rabbits. Conclusion: Rosmarinus officinalis effectively reduced glycemic concentrations in alloxan-induced diabetic rabbits..
Copyright (c) 2026 Soobia Pathan, Mujtaba shah, Aziz, Madiha Niamat, Amjad Mahmood Khan, Shujaullah https://creativecommons.org/licenses/by-nc/4.0
The Diagnostic Significance of Cytokeratin 13 & 17 Expression in Oral Mucosal Biopsies by Immunohistochemical Technique
Objective: To find out immunohistochemical (IHC) profile of cytokeratin 13 and 17 expression in oral premalignant and malignant epithelial lesions. Methodology: This descriptive cross-sectional study was conducted at, pathology department of Liaquat University of medical and health science Jamshoro from January 2017 to June 2019. Excisional biopsy samples of patients of all age groups, both gender with complain of oral mucosal epithelial lesions were enrolled. Oral mucosal biopsies were fixed in 10% formalin, routinely processed, and stained with H&E for histopathological diagnosis. Immunohistochemistry for Cytokeratin 13 and 17 was performed on paraffin sections after deparaffinization and blocking of endogenous peroxidase activity. Tissue sections were kept moist throughout the procedure and mounted on FLEX IHC slides. All the relevant pathological and clinical data were recorded using study proforma and analyzed by SPSS version 20. Results: Patient’s mean age was 40.45+11.94 years and males were in majority 63.4%. Buccal mucosa, cheek and tongue were most common sites of biopsy, 32.8%, 21.6% and 31.3% respectively. CK13 was positive among 73 cases. CK17 was positive among 96 cases. Leukoplakia, sub mucous fibrosis, ulcers were significantly associated with CK13 p=0.003, while leukoplakia and squamous cell carcinoma were significantly associated with CK 17 p=0.001. Results: A total of 139 cases were included. The mean age of patients was 40.45 ± 11.94 years. Males constituted the majority (63.4%). The most common biopsy sites were buccal mucosa (32.8%), cheek (21.6%), and tongue (31.3%). Most patients (78.4%) reported symptoms for 1 to 3 months. Leukoplakia was the most frequent oral lesion, observed in 22.3% of cases. CK13 positivity was observed in 73 cases, while CK17 was positive in 96 cases. CK13 expression was significantly associated with leukoplakia, submucous fibrosis, and ulcers (p = 0.003). CK17 expression showed significant association with leukoplakia and squamous cell carcinoma (SCC) (p = 0.001). Histologically, dysplasia was significantly associated with positive CK13 expression, whereas SCC was significantly associated with CK17 expression, both with statistically significant p-values. Conclusion: CK13 is a useful immunohistochemical marker for epithelial dysplasia, while CK17 serves as a reliable diagnostic marker for squamous cell carcinoma. CK13 expression was significantly higher in cases of leukoplakia, submucous fibrosis, ulcers, and epithelial dysplasia. CK17 was more frequently expressed in cases of leukoplakia and SCC.
Copyright (c) 2025 Kiran Aqeel, Ferzana Memon, Tanveer Shaikh https://creativecommons.org/licenses/by-nc/4.0
Resolution of Type 2 Diabetes After Sleeve Gastrectomy
Objective: To determine the resolution of type-II diabetes mellitus (DM) after sleeve gastrectomy (SG) among patients by evaluating glycemic control, medication use, and weight loss. Methodology: A prospective observational study was done at the Nescom hospital, Islamabad, from August 2022 to September 2023. Both male and female individuals aged 18 years old or above, morbidly obese with BMI greater than35 kg/m and with diagnosis of type –II DM undergoing laparoscopic sleeve gastrectomy were included. Laparoscopic sleeve gastrectomy was done using a standardized four-port technique. A possible large curvature of the stomach was resected, starting 6 cm proximal to the pylorus up to the angle of His. The 36-Fr bougie was used to calibrate the sleeve. Postoperative care started with a liquid diet and structured follow-up at POD3, 2 weeks, and 6 months. At each visit, BMI, fasting glucose, and HbA1c were recorded. Data were documented on a study proforma and analyzed using SPSS version 26. Results: Overall mean age of the individuals was 47 ± 8 years with 63.3% being female and 36.7% males. Before the surgeries, 66.7% required hypoglycemic drugs and 53.3% were on insulin. Average HbA1c decreased significantly from 8.9% preoperatively to 8.2% on POD3, 7.1% at 2 weeks, and 5.9% at 6 months (p < 0.001). The plasma glucose levels declined from 202.7 mg/dL (POD3) to 138.4 mg/dL at 2 weeks and 100.8 mg/dL at 6 months (p < 0.001). Additionally, the excess weight loss was improved steadily, from 4.1% at POD3 to 11.7% at 2 weeks and 35.1% at 6 months (p < 0.001). However, there were no significant gender-based differences were observed in HbA1c, plasma glucose, excess weight loss, or BMI (all p > 0.05). Conclusion: LSG is an effective intervention for achieving significant weight loss, improving glycemic control, and reducing plasma glucose levels in Pakistani patients with T2D. These findings support the use of LSG as a valuable tool for managing obesity-related T2D in diverse populations. Further research with larger sample sizes and longer follow-up periods is recommended to validate these results and elucidate the underlying mechanisms.
Copyright (c) 2024 Natasha Maryam, Summera ambreen https://creativecommons.org/licenses/by-nc/4.0
Enhanced post total knee replacement recovery by using intraarticular intraoperative cocktail injections
Objective: To assess the advantages of a specific cocktail combination in TKR patients, focusing on postoperative pain relief and enhanced recovery of knee mobility. Methodology: This prospective, double-blinded, placebo-controlled study was conducted at Akbar Niazi Teaching Hospital, Islamabad, from January 2022 to December 2024. Sixty consecutive patients underwent unilateral TKR were enrolled, with 30 receiving an intraoperative intraarticular cocktail injection (intervention) and 30 receiving normal saline (control). Postoperative pain for each knee was assessed using visual analog scale (VAS), and time required to attain 90° of knee flexion was recorded for both groups. The collected data were analyzed utilizing SPSS v 23. Changes in pain scores within the groups across follow-up periods were analyzed using repeated measures ANOVA Results: The patients were between 55 and 85 years old (mean was 63.2±9.2 years), and males were 66.7%. Patients who received the cocktail injection experienced significantly less pain than the control group during the first 48 hours and achieved 90° of knee flexion in a significantly shorter time. Conclusion: Intraoperative intraarticular cocktail injection significantly alleviates early postoperative pain and enhances early knee mobility.
Copyright (c) 2026 Muhammad Hanif, Obaid ur Rehman, Naveed Gul, Junaid Hassan, Muhammad Rehman, Naveed Arshad https://creativecommons.org/licenses/by-nc/4.0
Efficacy of Dexamethasone in preventing post spinal hypotension in elderly patients undergoing orthopedic surgery; A Randomized Control Trial at a tertiary care hospital
Introduction: Lower limb orthopedic surgeries under spinal anesthesia are associated with hypotension due to sympathetic blockade. Dexamethasone has been shown to improve hemodynamic stability by increasing systemic vascular resistance. Objective: To compare the efficacy of single pre-operative dose of intravenous Dexamethasone vs placebo in elderly patients undergoing orthopedic surgeries in spinal anesthesia in terms of number of hypotensive episodes. Methodology: After ethical approval and clinical trial registration (NCT07052864), study was carried out at Department of Anesthesiology and Critical Care Medicine, PIMS Hospital, Islamabad from 30th June 2025 to 30th August 2025. A total of 134 patients were enrolled who were 50 years to 100 years belonging to ASA I & II. Group A patients were given single preoperative dose of dexamethasone 8?mg IV in 100?ml normal saline 1 hour before induction of spinal anesthesia in the pre-operative area while group B patients were given placebo. Results: The incidence of intra operative hypotension was significantly higher in group B than group A. The incidence in group B was 70% and in group A it was 45% with p value being 0.003. Similarly intraoperative phenylephrine consumption was 0.00 (50.00) in group A while in group B it was 50.00 (200.00) with p value being 0.02. Conclusion: Prophylactic administration of Intravenous Dexamethasone is effective in preventing post spinal hypotension and reducing intraoperative vasopressor requirements among elderly patients undergoing lower limb orthopedic surgeries.
Copyright (c) 2026 Sadia Saleem https://creativecommons.org/licenses/by-nc/4.0
Popliteal Artery Injuries in Motorcycle Accidents Following Posterior Knee Dislocation: Surgical Outcomes of Saphenous Vein Graft Repair — A Single-Center Case Series from Nishtar Hospital, Multan
Objective: To assess the surgical outcomes and early functional recovery of patients undergoing great saphenous vein graft repair for popliteal artery injuries following posterior knee dislocations caused by motorcycle accidents. Study Design: Descriptive case series. Place and Duration of Study: Plastic Surgery and General Surgery Departments, Nishtar Hospital, Multan, from January 2021 to December 2024. Methodology: This study included 21 male patients aged 12 years and older who sustained posterior knee dislocations due to motorcycle-related trauma. All patients had intraoperatively confirmed injuries to the popliteal artery and underwent arterial reconstruction using reversed autologous great saphenous vein grafts. Fasciotomy and orthopedic stabilization were performed as required. Patients who presented more than 12 hours after trauma with non-viable limbs or incomplete follow-up data were excluded. Graft patency was evaluated with Doppler ultrasonography on days 2 and 7, and with CT angiography at six months. Functional outcomes were assessed at 12 weeks using the Lower Extremity Functional Scale (LEFS). Results: All patients achieved limb salvage, with no amputations recorded. Graft patency at six months was confirmed in all cases. The mean LEFS score was 65.0 ± 4.1, with 18 patients (85.7%) achieving scores of 60 or higher, reflecting satisfactory recovery. Postoperative complications occurred in 5 patients (23.8%) and included wound infection, early graft thrombosis, seroma, and wound dehiscence—all managed conservatively. Conclusion: Timely revascularization using reversed saphenous vein grafts offers excellent outcomes in terms of limb salvage, graft durability, and early functional recovery in patients with motorcycle-related popliteal artery injuries.
Copyright (c) 2026 Muhammad Naveed Shahzad, Muhammad Jamil Zahid, Ahsan ur Rehman Khan 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
Efficacy of Ligasure use in Total Thyroidectomy at a tertiary care Hospital
Abstract Objective To evaluate the effectiveness of the ligasure small jaw (LSW) device in achieving hemostasis during total thyroidectomy. Materials and Methods This study is conducted as a retrospective observational study at Akbar Niazi Teaching Hospital.86 Patients underwent thyroidectomy using LSJ between April 2021 till April 2024 were studied. Parameters including peroperative findings of intraoperative bleeding and operative time and postoperative findings of voice change and hospital stay were assessed. After approval from the ethical board, data was collected as a qualitative research study and entered on standard SPSS sheet version 26. Results A total of 86 patients were observed during the study period. Per operative findings of intraoperative bleeding measured by the visual gauze method showed 6ml gauze blood in 39.5% and more than 6ml gauze blood in 26.8% and rest of the patients were having 3ml-6ml gauze blood. The mean surgery time noted was 92.07±6.34 minutes.64% of the patients had hospital stay of 1-2 days. Only 1 patient had voice hoarseness which was relieved spontaneously after giving stat dose of steroid. Conclusion The results demonstrated that LSJ effectively minimized intraoperative bleeding, reduced operative time, and preserved recurrent laryngeal nerve function, with minimal complications. Comparative analysis with traditional ligation techniques, diathermy or bipolar devices confirmed the efficiency and safety of LSJ.
Copyright (c) 2026 Dr Ahmad Raza, Hira Saleem, Dr Sabah Ali Chaudhary, Dr Nausheen Nawaz, Dr Sidra Ahmad, Dr Misbah Arif, Dr Kaynat Mustafa, Dr Muhammad Hassan Farooq https://creativecommons.org/licenses/by-nc/4.0
Altered Sleep Pattern in Patients of Acute Myocardial Infarction at Cardiology Ward of Liaquat University of Medical & Health Sciences
Objective: To determine the frequency of altered sleep patterns among patients with acute myocardial infarction admitted to the cardiology ward of Liaquat University of Medical & Health Sciences. Methodology: This prospective observational study was conducted in the Department of Cardiology, Liaquat University Hospital (LUMHS), from September 2023 to March 2024. Patients of both genders, aged 20–65 years, presenting with acute myocardial infarction were included. Sleep patterns were assessed using both open- and close-ended questions, and any deviation from the normal sleep pattern was considered abnormal. Associations between altered sleep patterns and baseline as well as clinical parameters were evaluated, with a p-value < 0.05 considered statistically significant. Results: The overall mean age of the patients was 54.04 ± 8.82 years. Male patients constituted a higher proportion compared with females (62.82% vs. 37.28%). The overall frequency of altered sleep patterns among patients admitted with acute myocardial infarction was 40.69%. A higher prevalence of altered sleep patterns was observed among males, married individuals, urban residents, housewives, patients belonging to the middle socioeconomic class, those with normal body mass index, non-smokers, patients presenting with typical chest pain, and those diagnosed with non–ST-elevation myocardial infarction (NSTEMI); however, these associations were not statistically significant (p > 0.05). Depression was the only variable that showed a statistically significant association with altered sleep patterns among patients with acute myocardial infarction (p = 0.04). Conclusion: The prevalence of altered sleep patterns was notably high among patients admitted with acute myocardial infarction. However, depression was the only factor significantly associated with sleep deviation in this population.
Copyright (c) 2026 Shahim Ali Bhurgri, Shahbaz Ali Shaikh, Jaweria Amjad, Faraz Farooq Memon, Shahid Hussain Memon, Shadab Sahato https://creativecommons.org/licenses/by-nc/4.0
Comparison of diode laser tonsillectomy and bipolar cauterization tonsillectomy
Background: Tonsillectomy is routinely done in recurrent tonsillitis, obstructive sleep apnea and in case of tonsillar hypertrophy. Several methods such as diode laser tonsillectomy and bipolar electrocautery have been done to enhance parameters such as bleeding, recovery period, and postoperative events. Objectives: To compare the outcomes of diode laser tonsillectomy and bipolar cauterization tonsillectomy in terms of intraoperative efficiency, postoperative recovery, and complications. Methods: The present study is a prospective comparative study carried out at Rawal Institute of Health Sciences (RIHS), Islamabad from January 2023 to December 2023. A total of 100 patients were randomly selected for the diode laser tonsillectomy procedure and bipolar cauterization tonsillectomy. Various details such as intraoperative parameters, postoperative pain, time to start a normal diet, and the complication/s that ensued were documented and compared. Results: The mean age of the patients was 26.5±5.2 years, with gender distribution was 50% male and 50% females. Diode laser tonsillectomy resulted in shorter operating time (25.0±5.0 min), decreased blood loss (5.0±2.0 ml), reduced pain score at day 7 (1.5±0.5 points) and faster postoperative recovery than bipolar cauterization (p < 0.001). The frequency of secondary haemorrhage in the diode laser patients (2%) was also noticeably less. Conclusion: Diode laser tonsillectomy is characterized by fewer post-operative complications, shorter time of treatment, and faster healing compared to classical methods of tonsillectomy due to high cost it is not popular.
Copyright (c) 2026 Mirza Nasheed Baig, Farhan Ahmed, Mumtaz Ahmad Umar, Muhammad Yasir Khan, Ayesha Jawad, Saira Iftikhar https://creativecommons.org/licenses/by-nc/4.0
Establishing a Prediction Model for Successfully Planned Endotracheal Extubation in Preterm Neonates: An Answer to Many Questions
Objective: To establish the prediction model for successfully planned endotracheal extubation in preterm neonates. Study Design: Prospective cohort study Place and Duration of Study: This study was conducted at Neonatal ICUs of Fatima Memorial Hospital Lahore, from February 2023 to October 2024. Methodology: The study included 255 preterm neonates (28–35 weeks gestation) intubated <7 days and extubated for the first time before 30 days of age. Successful extubation was labeled as no need for reintubation within 72 hours following extubation. Demographics, prenatal, and peri-extubation data were collected analyzed using multivariate logistic regression to identify independent predictors. Receiver operating characteristic (ROC) analysis assessed model discrimination, and a nomogram was constructed for individualized prediction. Results: Of 255 neonates, 174 (68.2%) achieved successful extubation. Independent predictors included multigravida status (OR = 0.026, 95% CI: 0.002–0.356, p = 0.006), higher serum sodium levels (OR = 1.436, 95% CI: 1.108–1.862, p = 0.006), higher pre-extubation pH (OR<0.001, p = 0.001), Keywords: Endotracheal extubation, Endotracheal intubation, Mechanical ventilation, NICU, Preterm neonates
Copyright (c) 2025 Rafia Gul, Aimen Tahir, Samer Fatima, Muhammad Usman, Lubna Asghar, Tahir Mahmood Butt, Irshad Hussain https://creativecommons.org/licenses/by-nc/4.0
Evaluation Of Postoperative Pain With Resin Based Sealer vs Zinc Oxide Eugenol Based Sealer After Single Visit Endodontic.
Objective: The aim of this study is to compare the postoperative pain after single visit endodontics using zinc-oxide eugenol sealer and resin-based sealer. Introduction: Complete root canal system obturation and disinfection, as well as periradicular tissue healing, are the objectives of root canal therapy. One of the key concerns of endodontic practice is pain management both during and after root canal therapy. Methodology: A prospective, randomized, double-blind clinical trial was conducted at school of dentistry from June 2023 to November 2023 on 180 patients. The study included patients aged 18-60, ASA Class 1 or 2, with single-rooted teeth suffering from symptomatic irreversible pulpitis. Exclusions were made for ASA Class 3-5 patients, those with immature apices, severe periodontal issues, recent analgesic use, and those needing root canal treatment on multiple teeth. Single visit RCT was planned in single rooted teeth as per presentation and these patients were divided in to two groups, in Group A patients zinc oxide eugenol-based sealer was used and in group B resin based sealer was used. Per-operative, postoperative at 24H and 48H pain perception was calculated through VAS. Data was analyzed through SPSS software v20.0. Results: The mean age of Group A was 32.38±8.28 and Group B was 32.14±8.58. Around 51% of from Group A were male as compare to 34.4% male patients in group B. Majority (53%) of Group A patients have Mild pain as compare to 42% in Group B patients. P value was significant at post-operative pain after 24H and 48H of treatment in either group. Conclusion: in this investigation found that, between 24 and 48 hours after endodontic therapy, zinc oxide eugenol-based sealers have a slightly higher incidence of discomfort than resin-based sealers. Key words: Sealer, VAS, Pain, Endodontics
Copyright (c) 2025 Ahsen Amin, Nouman Noor, Almas Sarfraz , Sheejia Asif, Abeera Maqbool, Mor khan Shar https://creativecommons.org/licenses/by-nc/4.0
Predictors of Allergic Airway Disease in Children Under Two Years of Age
Objective: To determine the frequency of factors responsible for allergic airway disease in children <2 years of age. Methodology: This descriptive cross-sectional study was conducted at the Department of Pediatrics, LUMHS, Jamshoro, from October 2022 to April 2023. Children under 2 years of age diagnosed with allergic airway disease were included in the study. Both boys and girls with a disease duration of at least 3 months were enrolled. The assessed factors included family history of asthma, cow’s milk protein allergy, allergic rhinitis, low socioeconomic status, maternal education level, respiratory tract infection, and prematurity. All collected data were entered into Microsoft Excel and subsequently analyzed using SPSS version 23. Results: The patients’ ages ranged from 5 to 24 months (mean: 12.28 ± 3.40 months). Of the total participants, 84 (69.4%) were male and 37 (30.6%) were female. The contributing factors identified were family history of asthma in 21 (17.4%) patients, cow’s milk protein allergy in 59 (48.8%), allergic rhinitis in 53 (43.8%), low socioeconomic status in 28 (23.1%), primary-level maternal education in 56 (46.3%), matric-level education in 50 (41.3%), above-matric education in 15 (12.4%), respiratory tract infection in 49 (40.5%), and prematurity in 31 (25.6%). Conclusion: Cow’s milk protein allergy and allergic rhinitis were the most common contributing factors to allergic airway disease in children under 2 years of age, exceeding the contribution of respiratory tract infections and prematurity.
Copyright (c) 2026 Komal, Roomana Qureshi, Muhammad Hanif, Asadullah Memon, Sher Muhammad Nuhrio, Sadaf Ujjan 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
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
Oral Health Care Status and Barriers to Accessing Oral Health Care Services in Geriatric Population
Objective: To evaluate the oral health status and identify major barriers to accessing dental care among the geriatric population. Methodology: This descriptive cross-sectional study was conducted at Institute of Health Management and Research Sciences from November 2024 to May 2025, on elderly individuals aged 60 and above attending the dental OPD of LUMHS. Overall 150 elderly individuals aged >60 years, both genders, who were able to respond the study questionnaires were included. After taking demographic information, oral health status and barriers to accessing dental care were evaluated. SPSS version 26 was used for data analysis. Results: Average age of individuals was 63.9+3.99 years. Males were in majority 56.0%. Oral health was note fair or poor, with half not using any dental prosthetics. Financial barriers (58.7%) and fear of dental visits (56%) were the main barriers. Only 41.3% visited dentists regularly, and preventive services were underutilized (8%). Cost and lack of awareness were key reasons for avoiding dental care. Despite 49.3% considered oral health very important and 82.7% were satisfied with available services. Conclusion: Most of the elderly individuals observed with poor oral health, with limited access due to financial, social, and awareness-related barriers despite high satisfaction among those receiving care.
Copyright (c) 2024 Faizan Sadiq https://creativecommons.org/licenses/by-nc/4.0
Efficacy of PECS Block In Perioperative Period For Pain Management In Patients Undergoing Elective Breast Surgery
Objective: To compare the effectiveness of intraoperatively performed PECS block (without the ultrasound guidance) and no regional blocks in controlling postoperative pain and opioid use among patients undergoing elective modified radical mastectomy (MRM) and Mastectomy. Methodology: Study Design: Randomised controlled trial. Duration and Place of Study: This study was conducted from Oct 2024 to march 2025 in Pakistan Institute of Medical Sciences, Islamabad. A randomized, controlled prospective study will be a study of 60 female (ASA I- II) patients who are to undergo MRM and Mastectomy. The patients were randomized into two groups, Group P (PEC group): Received PECS block intraoperatively under direct view (surgeon assisted) and Group C (Control group): Received standard general anesthesia without block. Primary outcome: Requirement of Analgesia. Secondary outcomes: Total Opioid use in 24 hours, Mean time to first rescue analgesic request,Visual Analogue Scale (VAS). Results : The average time to first rescue analgesia was similar between the PECS block group and control group (70.04 + 44.01 vs. 54.44 + 31.01 minutes; p =0.118). There was no significant difference in the total intraoperative tramadol intake (104.14 ± 15.02 mg vs. 96.82 ± 30.62 mg; p = 0.244). The Tramadol requirement postoperative rescue analgesia and the percentage of the patients rescued by the analgesia remained similar in the groups (p &gt; 0.05). The mean VAS pain scores of the two groups in all the time points assessed (1, 2, 4, 6, 12, and 24 hours after the operations) were significantly lower and no differing VAS pain scores between the two groups were found to be statistically significant. Conclusion: PECS block, when used intraoperatively, is safe and effective as a supplement to general anesthesia among patients that undergo elective modified radical mastectomy. It was proven to be more effective in terms of postoperative pain scores measured with the Visual Analog Scale (VAS) at pre-specified postoperative intervals and cumulative opioid consumption at 24 hours post operation significantly reduced compared to patients who received no block. Safety was measured using the incidences of perioperative and postoperative complications associated with the block and no adverse events associated with the blocks. It was also related to the decreased incidence of opioid-related adverse effects when PECS block was used, which contributes to the effectiveness of multimodal analgesia with PECS block in breast cancer surgery.
Copyright (c) 2026 Hira Bajwa, Erum Majeed, Aatif Inam Shami https://creativecommons.org/licenses/by-nc/4.0