Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2022-09-24T11:41:48+03:00 Editorial Board Open Journal Systems <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> Relationship of Diabetes Mellitus Among The Patients Reporting With Facial Space Infection 2022-06-01T13:12:01+03:00 Mor khan Shar Sana Ali Muhammad Umar Farooq Hanum Sadiq Muhammad Junaid Junaid Zahoor Ahmed Rana <p>Objective: To determine the frequency of diabetic patients having Odontogenic Maxillofacial space infections in local population.</p> <p>Methodology: This cross sectional study was carried out from 1-3-2020 to August 2020 in the Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, to assess the frequency and association of diabetics with facial space infection. A total of 70 patients of both genders with Odontogenic maxillofacial infection were included in the study. Patients were stratified into three age groups; Age group 1 was from 18-30, Age group 2 from 31-45 years and Age group 3 from 46-60 years. This form includes demographic data (age, gender, contact information, address), medical history (diabetic or non-diabetic) along with sign and symptoms were noted in the Performa. The SPSS version 20.0 was used to analyze the data. Mean and standard deviation was calculated for age. Frequency and percentages were used for the gender and diabetes mellitus.</p> <p>Results: A total of 70 patients having Odontogenic maxillofacial space infection. Of these 70 study cases, 42 (60%) were females and 28 (40%) were males with mean age of 40.97±10.32 years. Out of 70 patients, 55 (78.57%) were diabetic and 15 (21.43%) patients were non-diabetic patients.</p> <p>Conclusion: Diabetic patients are more prone to Odontogenic maxillofacial space infections and due to poor diabetic control multispace infection along with severe complications may occur.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Diagnostic Accuracy and Imaging Appearance Glioblastoma Multiforme on MRI and MRS 2022-09-17T19:03:43+03:00 Nasreen Naz Arti Chandani Areej Fatima Nida Rafique Javerya Sattar <p><strong>Objective: </strong>To determine the diagnostic accuracy of contrast-enhanced MRI with conventional sequences and MR Spectroscopy in the diagnosis of Glioblastoma Multiforme, taking histopathology as the gold standard. We also determined the MR imaging appearance of GBM on conventional sequences.</p> <p><strong>Methodology: </strong>This descriptive cross-sectional study was conducted at a tertiary care hospital from 19<sup>th</sup> August 2019 to 18<sup>th</sup> August 2020 on 165 adult patients suspected of having an intracranial space-occupying lesion. Informed consent was sought and a questionnaire was filled out for patient data, MRI imaging findings, and MRS results.</p> <p>Histopathology results were subsequently followed and recorded. The diagnostic accuracy of contrast enhanced MRI brain as well as MRS was determined in terms of sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy, taking histopathology as gold standard.</p> <p><strong>Results: </strong>In a total of 165 patients selected for the study, the mean age was 56.34±10.04 years with a male to female ratio of 1:1 and the frontal lobe being the most common location (34.5%). In histopathological positive GBM cases, margins of the mass were ill-defined in 55.1%, intralesional low ADC values were observed in 63.3%, signal drop out on susceptibility imaging in 42.8%, and MRS with raised choline and reduced NAA in 75.5%. MRI had a sensitivity of 81.6% and&nbsp; specificity of 94.8%, and MRS has a sensitivity of 75.5% and a specificity of 100%.</p> <p><strong>Conclusion: </strong>Ill-defined margins, necrosis, and hemorrhage are important MRI features suggesting GBM. MRS combined with conventional MR sequences has high sensitivity and specificity in its diagnosis.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Modified Kenalog Protocol for Perianal Fissures- A Quasi Experimental Trial 2022-04-21T18:30:27+03:00 Vishal Farid Raza Qaiser Mahmood Iqra Waris Muhammad Shahwaiz Malik Khalid Javeed Khan <h1>Objective: To ascertain the role of triamcinolone injection at the base of an anal fissure and its effect on healing and pain relief.</h1> <h1>Methodology: A quasi-experimental study was conducted from November 2021 to February 2022. Under aseptic measures, a 1ml Triamcinolone 40mg/ml injection was administered at the base of the anal fissure using a 1cc insulin syringe. This was injected in four positions around the base of the fissure. Patients were followed for one week to assess pain relief and improvement in quality of life. Patients were assessed for quality of life improvement and satisfaction with treatment. Patients were offered lateral internal sphincterotomy at the end of one week and again on follow up after two weeks given they were not satisfied with pain relief or symptom recurrence occurred.</h1> <h1>Results: Twenty five patients were enrolled and analysed. All fissures were seen to have a red inflamed base at enrollment. At one week after treatment, a paler base with less signs of inflammation was observed. Patients reported a mean 70% improvement in their symptoms. A mean change of 16.45 points was seen in Brief Pain Inventory scores at one-week follow up. 25% underwent a lateral internal sphincterotomy. The number needed to treat was 2.5. 5 patients were lost to follow-up after the initial one week follow-up.</h1> <h1>Conclusion: Injection of Triamcinolone at the base of an anal fissure may have a role as an adjunct to standard management in treatment. It has been shown to decrease pain and enhance healing of the fissure thus decreasing the need for surgical intervention.</h1> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Functional Echocardiography (FNECHO): Experience in NICU of A Tertiary Care Hospital 2022-09-24T11:41:48+03:00 Fahim Ahmed Subhani Awais ul Hassan Ammara Ayub Asad Maqbool Ahmed Asma Razzaq <p>Objective: To describe the observational findings of functional echocardiography (FnEcho) in neonatal intensive care unit of a tertiary care hospital by evaluating its frequency of use, characteristics of patients and distribution of heart diseases.</p> <p>Methodology: This Prospective descriptive observational study was done in a tertiary neonatal intensive care unit (NICU) in Rawalpindi, from July 2017 to June 2018. A total of two hundred and twelve neonates admitted to the NICU undergoing echocardiographic assessment were included in the study. Qualitative variables like gender, mode of delivery, and diagnostic findings were represented in terms of frequency and percentages. Quantitative data like age, birth weight and gestational age were highlighted as mean and standard deviation.</p> <p>Results: Out of a total of 212 neonates, 111 (52.4%) were male. The mode of delivery was noted to be lower segment cesarean section among 126 (60.0%) neonates. The mean gestational age was found to be 36.47+2.3 weeks, ranging from 28 to 41 weeks, whereas the mean birth weight was 2.56+0.68 kg, ranging from 1.1 to 4.2 kg. A total of 75 neonates were found to have functional heart disease in the form of pulmonary hypertension 37 (17.4%), hemodynamically significant patent ductus arteriosus 24(11.3%), hypoxic ischemic cardiomyopathy 4(1.9%), and systemic hypotension 10 (17.4%).</p> <p>Conclusion: FnEcho was found to be an effective tool for identifying different kinds of functional and structural heart defects. VSD was found to be the most common type of congenital heart disease, followed by PDA. Timely intervention in PPHN was also rewarding with good outcome.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Comparison the Clinical Effect of 2% Chlorhexidine and MTAD as Final Rinse in Controlling Post Operative Pain in Single Visit Root Canal Treatment 2022-03-27T13:39:46+03:00 Rajesh Kumar Naresh Kumar Hareem Qazi Priya Rani Harjani Sarang Suresh Hotchandani Muhammad Muzamil Alvi <p>Objectives: To compare the mean postoperative pain associated with the use of 2% chlorhexidine or MTAD as final rinse in cases of Symptomatic Apical Periodontitis presenting to the LUMHS operative dentistry department for single visit root canal treatment.</p> <p>Methodology: This single blind randomized controlled trial was conducted at the Department of Conservative Dentistry LUMHS, Jamshoro from February to June 2018. We included 60 patients' teeth with symptomatic apical periodontics. Thirty patients in group A received 2% chlorhexidine solution, while thirty patients in group B received MTAD. Preoperative and postoperative pain levels were assessed using a visual analogue scale.</p> <p>For qualitative variables such as gender, tooth type, and pre and postoperative pain, frequency and percentages were calculated. The chi-square test with a p value of 0.05 was used to compare the two groups.</p> <p>Results: The mean age in both groups were 30 years. Most of the teeth involved in both groups were on the anterior side. Patients in group A had an average age of 30.97±7.29 years. There was no statistically significant difference in the mean pain score between groups at p=0.86 after 7 days, with a score of 0.97 for group A and 0.93 for group B, respectively.</p> <p>Conclusion: Chlorhexidine and MTAD groups have been equally effective in reducing postoperative pain in a single visit as a final rinse.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Relationship of Nucleated Red Blood Cells with Severity of Perinatal Asphyxia and Its Short-Term Outcome 2022-07-07T10:23:23+03:00 Mehwish Iqbal <p><strong>Background:</strong> Globally, perinatal hypoxia is a severe issue that frequently results in infant mortality and long-term morbidity. The premature erythrocytes known as erythroblast, or nucleated red blood cells (NRBCs), are frequently observed in newborns' blood. Their presence in peripheral blood is connected to the hypoxic growing environment of the foetus, therefor NRBCs may the convenient marker for determining the severity and early development of neonatal birth asphyxia.</p> <p><strong>Objective:</strong> To compare the nucleated red blood cell (NRBC) counts of healthy and asphyxiated newborns as a key clinical indicator of the severity of birth asphyxia and short-term outcome.</p> <p><strong>Setting: </strong>Current study was conducted at paediatric department of</p> <p><strong>Study design:</strong> Case control study</p> <p><strong>Study duration:</strong> Six months from June 2020 to November 2020</p> <p><strong>Methods: </strong>&nbsp;Total 112 term newborns including 56 as cases (with birth asphyxia) and 56 as controls (normal babies) aged <u>&lt;</u>24 hours were included. After taking informed consent blood samples were taken immediately after birth for the measurement of NRBC count. All the enrolled cases were admitted in NICU and observed for the severity of birth asphyxia and mortality. The correlation of cord blood NRBC count with severity of birth asphyxia. NRBC count and outcome were analyzed statistically.</p> <p><strong>Results:</strong> The overall average age of the neonates was 14.18<u>+</u>2.66 hours. Boys were more compared to girls. Mean NRBC count was (14.0<u>+</u>18.22) in cases, which was significantly higher compared to controls (2.10<u>+</u>3.93) <em>p-0.002</em>. less than 2 fits/day were observed in 8 cases and &gt;2 fits/days were observed in 6 cases of birth asphyxia. There was a positive coloration of NRBC count with haemoglobin, creatinine level, ALT, and AST. Average NRBC count was significantly high in cases of cardiomegaly, those having ventilation need and respiratory distress syndrome (RDS) (<em>p-&lt;0.05</em>).</p> <p><strong>Conclusions:</strong> The NRBC was observed to be a non-invasive, simple prognostic marker for neonatal asphyxia, may indicate substantial infant mortality and asphyxia-related complications. Mean NRBC was observed significantly higher in cases compared to controls.</p> <p><strong>Keywords: </strong>Birth asphyxia, NRBCs, correlation, mortality.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Outcome of Kangaroo Mother Care in Preterm , Low birth weight neonates ; a randomized control trial 2022-06-21T09:46:27+03:00 Nadeem Ahmad Syeda Shireen Gull MUHAMMAD HAYAT KHAN FASIH HASHMI AZKA BATOOL AMBREEN FATIMA <p><strong>Abstract</strong></p> <p><strong>Objective:</strong> To compare the mean weight gain, duration of hospital stay and mortality rate in preterm/low birth weight neonates given Kangaroo Mother Care as compared to neonates not given KMC admitted in Neonatology Dept.</p> <p><strong>Study design:</strong>Randomized Control Trial (RCT)</p> <p><strong>Place and duration of study:</strong>The study was conducted in department of Neonatology, Children hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad from July to December, 2021. <strong>Methodology:</strong> The neonates who were admitted in Neonatology department due to prematurityor have low birth weight with no hemodynamically instability were included in the study. The selected neonates were divided into two groups. Group A neonates were given Kangaroo Mother Care whereas the neonates of group B were given conventional care.</p> <p><strong>Results:</strong>Overall 60 neonates were included in the study. The both groups were unbiased with respect to base line characteristics i.e. gestational age, Age at start of the study, birth weight, length and OFC. The result showed that the both groups were not significantly different with respect to duration of hospital stay, proportion of early discharge from hospital with p value 0.171 and 0.152 respectively. There was no significant improvement found in neonatal length and OFC at any time till the last follow-up after 2 week between two groups, whereas neonatal weight was significantly increased in KMC group at second follow-up with p value 0.036.</p> <p><strong>Conclusion:</strong> KMC was found to be affective for weight gain in neonates as compared to the conventional care.</p> <p><strong>Key words: </strong>Kangaroo Mother Care, Low birth weight, Neonate hospital stay, Preterm</p> <p><strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Diagnostic Accuracy of Positron Emission Tomography-Computed Tomography (PET-CTScan) In Detecting Bone Marrow Involvement in Patients with Diffuse Large B cell Lymphoma 2022-05-19T07:07:41+03:00 Mohammad Usman Shaikh Danish Shakeel Muhammad Hassan Nayab Afzal Natasha Ali Salman Adil <p><strong><em>Objective</em></strong>: To evaluate the diagnostic accuracy of Positron Emission Tomography combined with CT scan (PET-CT Scan) in detecting bone marrow involvement in patients with Diffuse Large B-cell lymphoma keeping bone marrow biopsy as gold standard.</p> <p><strong><em>Methodology</em></strong><strong>: </strong>Descriptive cross sectional study was conducted at Section of Clinical Hematology, Department of Oncology at Aga Khan University, Karachi, from November 2017 to May 2018.A total of 112 patients who were diagnosed as Diffuse Large B Cell Lymphoma upon histopathological examination of involved lymph node were included in the study. As a part of staging work up all patients underwent PET-CT scan and bone marrow biopsy procedure. Diagnostic accuracy of PET-CT scan for detection of bone marrow involvement was evaluated keeping bone marrow biopsy as gold standard.</p> <p> <strong><em>Results</em>:</strong> Of 112 patients, there were 71(63%) males and 41(37%) females. The mean age was 45.09±17.36years. Mean duration of diagnosis was 17.19±6.02 days. Bone marrow involvement through biopsy was seen in 40(35.7%) cases. Bone marrow involvement through PET- CT scan was found in 47(41.9%) cases. The PET- CT Scan in comparison with bone marrow biopsy for detecting bone marrow involvement in patients with DLBCL had a sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of 95%, 87.7%, 80.85%, 96.92% and 90.18% respectively.</p> <p><strong><em>Conclusion</em></strong><strong>:</strong> PET-CT scan can accurately detect bone marrow involvement in patients with DLBCL so it can be used in most patients instead of invasive bone marrow biopsy procedure for staging of DLBCL patients.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Comparison of Early Outcome of the Close and Open Technique for the Treatment of Distal Femur Fractures 2022-07-01T10:08:51+03:00 Ali Shami <p><strong>Objective:</strong> To compare the effects of closed and open techniques with its associated complications used for the management of distal femoral fracture in younger to older populations.</p> <p><strong>Methodology: </strong>This was a case series study conducted in the Department of Orthopaedic Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad from Sept 2018- March 2019. A total of 66 adult patients were stratified according to treatment technique; closed technique group and open technique group with 33 patients in each group between age 18 - 65 years with fractured close distal 1/3rd shaft of femur distal femur fractures based on AO/OTA classification were included in the study. The Chi-square test was applied to contrast outcomes of closed and open technique and HSS score categories in both procedures.</p> <p><strong>Results: </strong>The study findings showed that the mean age of the patient was slightly greater in the open technique group (41.5 + 23.5 years) compared to the closed technique (29.8 + 11.8 years). Most of the patients had type A femur fracture. The postoperative mean HSS knee score was 70.1 + 15.1 in the open technique group compared to 74.5 + 12.5 in the closed technique group with an insignificant difference between the two means (p&lt;0.949). An insignificant difference was observed in postoperative infection, non-union, and implant failure between both groups.</p> <p><strong>Conclusion: </strong>This study concluded that superior outcomes such as bony union without infection were achieved in patients with femur fractures treated with closed technique as compared to open technique, although the findings were statistically insignificant. Moreover, the functional outcome of the knee joint was also distinctly improved in the closed technique.</p> <p><strong>Keywords: </strong> Distal femur fracture, retrograde intramedullary femoral nail, locking compression plate, complications</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Effectiveness of Laparoscopic Sleeve Gastrectomy for Weight Loss in Morbid Obese Patients 2022-09-12T10:09:21+03:00 Muhammad Naeem Taj Israr Ahmed Yasmin Iqbal Zaki Akbar Muhammad Aamir Saeed Muhammad Adnan <p><strong>Objective: </strong>To determine the effectiveness of laparoscopic sleeve gastrectomy for weight loss in morbidly obese patients at Capital Hospital, Islamabad.</p> <p><strong>Methodology: </strong>This descriptive case series study was done at Capital Hospital, CDA, Islamabad during a period of one-year from February 2019 to January 2020. All the patients with a body mass index of 35 or greater, with or without comorbidities, aged 18 to 65 years of either gender were included. All the patients underwent laparoscopic sleeve gastrectomy for weight loss. The procedure was performed under general anaesthesia by an experienced consultant surgeon after taking informed consent. At the 1<sup>st</sup>, third, and 6<sup>th</sup> month’s follow-up, postoperative weight loss was noted. Effectiveness was taken in terms of &gt; 10% weight loss maintained at 6 months.&nbsp; The study proforma was used to gather all the data, and SPSS version 26 was used to analyse it.</p> <p><strong>Results: </strong>The overall study participants' average age was 57± 9.77 years, and females were in the majority (62%). Overall, laparoscopic sleeve gastrectomy was effective in 85% of patients and was not effective in 15% of patients. The average BMI was 37.31 kg/m<sup>2</sup>. Laparoscopic sleeve gastrectomy showed effectiveness in 57 (85%) patients, while 10 (15%) of the patients' weight was not lost. Effectiveness was statistically insignificant according to age, gender, and comorbidities, p-values were quite insignificant (&gt;0.05).</p> <p><strong>Conclusion: </strong>Laparoscopic sleeve gastrectomy was observed to be an effective technique for weight loss in morbid obese patients. It did decrease the morbidities and improve the quality of life.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Outcome of non-invasive ventilation in severe COVID patients, A prospective cohort study 2022-06-20T07:57:52+03:00 Roshaan Tahir <p><strong>Background:</strong>COVID-19 patients who experience severe SARS-CoV-2 infection develop pneumonia, requiring hospital admissions, oxygen and even ventilator support. Acute respiratory distress can lead to respiratory failure, hypercoagulability, septic shock &amp; multi-organ involvement, all of which can increase mortality in severe cases.</p> <p><strong>Objective:</strong>To determine the Outcome of non-invasive ventilation in severe COVID patients.</p> <p><strong>Study Design</strong>: Prospective Cohort study</p> <p><strong>Methodology:</strong>Eighty seven patients of age 45 to 75 years, admitted in PEMH due to severe SARS-COV2 infection were included in this study. These patients were COVID PCR positive as well as had signs ,symptoms and radiological evidence consistent with COVID19 pneumonia. These patients were put on NIV trial. The primary outcomes were intubation success and failure, as well as the mortality rate. SPSS 2021 was used to enter and analyze the data.</p> <p><strong>Results:</strong>The mean age was 62.89 ±7.55 years. There were 65(74.7%) males and 22(25.3%) females. NIV was successful in 33patients (37.9%) while in 54(62.1%) patients required endotracheal intubation and 24 (27.8%)patients died during follow-up. The mean duration of NIV support was observed as 6.2 ± 3.9 days.</p> <p><strong>Conclusion:</strong> NIV can prevent intubation in nearly half of the patients, according to our findings.</p> <p><strong>Key words:</strong> Outcome, non-invasive ventilation, severe COVID-19, SARS-CoV-2, respiratory rate, intubation</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University BCR ABL gene mutation in acute lymphoblastic leukemia 2022-03-01T13:38:13+02:00 Shabih Haider Asad Mahmood Fahim AKhtar Rafia Mahmood Saadia Muzafar Maliha Batool <p><em>Objective</em>: To determine the frequency of BCR-ABL gene mutation in Acute Lymphoblastic Leukemia.</p> <p><em>Methods</em>: It is a cross sectional study carried out at the Department of Molecular Haematology, Armed Forces Institute of Pathology between January 2018 to March 2021. All newly diagnosed patients of Acute Lymphoblastic Leukemia were included in the study while patients already on treatment and with secondary leukemia were excluded from the study.</p> <p><em>Results</em>: A total of 623 patients were included in the study. BCR-ABL gene was positive in 105 (16.8%) patients. A total of 96 (92%) were positive for BCR ABL p190 rearrangement and 9 (8%) were positive for BCR ABL p210 rearrangement. &nbsp;Mean age of patients was 21 years. The frequency of BCR ABL gene was positive in 72% males and 28% females. BCR-ABL positive ALL was associated with higher TLC count. CNS involvement was more commonly seen in BCR -ABL positive&nbsp; Acute&nbsp; Lymphoblastic Leukemia. With increase in age, the chances of post induction remission decreased.</p> <p><em>Conclusion</em>: In our study population a frequency of 16.8% patients were BCR ABL1 positive in acute lymphoblastic leukemia. BCR- ABL gene mutation in ALL is more prevalent in young adults. Frequency of p190 rearrangement is more common than p210 BCR-ABL rearrangement. BCR-ABL positive ALL is more prevalent in males than in females.</p> <p><em>Key words</em>: Acute lymphoblastic leukemia, BCR- ABL gene rearrangmet</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Determinants of Anxiety in amputees owed to traumatic & non-traumatic causes 2022-07-23T16:32:20+03:00 ABDUL BAQI Qasim Zia SHAHID PERVEZ SHAIKH Muhammad Shoaib Muhammad Mohsin Javaid M. SHAHARYAR MALIK <p><strong>Introduction:</strong></p> <p>Nowadays, number of individuals living with depression and anxiety, are rapidly increasing. Depression and anxiety may develop at any time during the period surrounding the amputation and are serious psychological problems that may affect recovery and independence of amputees. Therefore, there is need of having an understanding on the level of anxiety in amputees.</p> <p><strong>Objective</strong>: The aim and objective of this study was to find out Causes/ factors of anxiety among amputees suffering from traumatic and non-traumatic causes.</p> <p><strong>Methodology:</strong> This descriptive cross-sectional study was conducted in Quetta from the month of May 2018 to July 2018. Data was collected through structured adopted questionnaire according to the inclusion &amp; exclusion criteria &amp; then tabularized and analyzed by applying Chi square test.</p> <p><strong>Results:</strong> This study involved a total of 54 participants of whom 7(13%) were females and 47(87%) males. Among amputees 36(66.7 %) amputations were due to Traumatic injuries and 18(33.3%) were due to non-Traumatic amputation. In Traumatic, majority was due to RTA with 25(46.3 %) and in non-traumatic causes diabetes stood first with 13(24.1%) amputation. Traumatic are more anxious than non-traumatic. There is a significant relationship of marital status with level of Anxiety (p-value 0.047). Statistically significant relationships of amputation with depression &amp; anxiety level were noticed, p value=0.039 &amp; 0.049 respectively.</p> <p><strong>Conclusion:</strong> Amputation has a significant association with anxiety level. This study provides an insight to Healthcare Providers that anxiety do exist at any time surrounding amputation and many factors can significantly influence the various levels of anxiety in amputees particularly due to traumatic causes. It is recommended to do regular or annual screening of depression and anxiety following amputation.</p> <p><strong>Keywords:</strong> Amputees, Anxiety, Depression, Trauma</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Diabetes and Inflammation: Association between C-reactive protein and diabetic Nephropathy 2022-01-14T05:09:32+02:00 Hassan Salim Shahida Perveen Mahwish Niaz Omar Ahsan Umm-e- Farwa Rehana Ramzan Hassan Mumtaz <p><strong>Objective: </strong>To determine the frequency of elevated C-reactive protein in type 2 diabetics and to compare the levels of C-reactive protein between people with diabetes and non-diabetics Nephropathy</p> <p><strong>Study Design:</strong> Cross-Sectional Comparative study</p> <p><strong>Settings:</strong> Diabetic and Medical OPD of Fauji Foundation Hospital, Rawalpindi</p> <p><strong>Duration:</strong> Jan 2019 to July 2019</p> <p><strong>MATERIAL AND METHODS:</strong> A total of 150 patients, who met the inclusion criteria, were studied. Blood samples were collected for blood sugar random, fasting, renal function test, WBC count, and C-reactive protein. Urine samples were collected for the measurement of 24-hour urinary proteins. The presence or absence of proteinuria was used to categorize patients into two groups. <strong>Group A </strong>included 58 patients with type 2 diabetes without Nephropathy, and<strong> Group B</strong> included 92 patients with type 2 diabetes with Nephropathy (proteinuria &gt; 30 mg/dl in 24 hrs).</p> <p><strong>RESULTS: </strong>Mean age in our study was 49.41<u>+</u>7.66. Ninety-two patients (61.3%) presented with diabetic Nephropathy. CRP levels (&gt; 8200 ng/ml) were raised in 50 (54.3%) patients of group B and 19 (32.8%) patients of group A. The difference was statistically significant (p-value 0.010).</p> <p><strong>CONCLUSION: </strong>This study showed a higher prevalence of raised CRP in type 2 diabetics with Nephropathy. This reinforces the idea that low-grade inflammation has an essential role in the inception and evolution of the diabetic renal disease.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Assessment of the Predictors and Mortality in Patients of Acute-On-Chronic Liver Failure; A Prospective Study 2022-06-18T06:05:07+03:00 Rehmatullah Bhatti Ubedullah Bughio Adil Hassan Abdul Hafeez Soomro Jawaid Iqbal Mashooque Ali <p><strong>Objective: </strong>To evaluate the Predictors and Mortality in Patients of Acute-On-Chronic Liver Failure (ACLF); in term of its grades at different time points to define disease resolution, enhancement, worsening, or steady or fluctuating course.</p> <p><strong>Methodology: </strong>This prospective study was conducted at gastroenterology department of Asian Institute of Medical Sciences Sindh Pakistan from January 2018 to December 2018. All the patients of acute-on-chronic liver failure (ACLF) age more then 25 years and of either gender were included. In order to determine the etiology of chronic liver disease as well as the acute triggering event, a complete history was obtained including demographic profile and specifics on clinical characteristics (jaundice, ascites, gastro-intestinal bleed, grade of encephalopathy, records of vital parameters etc.). Serum electrolytes, viral serology, autoimmune profile, liver function tests, serum creatinine, prothrombin time, and INR were among the laboratory tests performed on each patient. The patients were monitored for one month or until any in-hospital deaths occurred.</p> <p><strong>Results: </strong>A total 117 patients were studied; their average age was 40.90<u>+</u>2.26 years and males’ predominance (73.5%). HCV and HBV+HDV were the commonest etiological factors. Overall, 30 days mortality rate was 61.5%. Multiorgan failure, spontaneous bacterial peritonitis, renal failure, high grade hepatic encephalopathy, SIRS were significantly associated with in hospital 30 days mortality (p-0.001). In hospital mortality was also significantly higher in CTP score &gt;18, MELD score &gt;25, CTP classification &lt;13 and presence of hepato-renal syndrome and need for ventilation was associated with poor outcome (p-0.001).</p> <p><strong>Conclusion: </strong>Multiorgan failure, spontaneous bacterial peritonitis, renal failure, high grade hepatic encephalopathy, SIRS and presence of hepato-renal syndrome and need for ventilation were associated with poor outcome. CTP score &gt;18, MELD score &gt;25, CTP classification &lt;13 and presence of hepato-renal syndrome were observed to the significant predictors of the in-Hospital mortality in acute decompensation (AD) of cirrhosis patients.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Comparison of MRI versus Arthroscopy in Assessment of Anterior Cruciate Ligament Injuries of The Knee Keeping Arthroscopy as Gold Standard 2022-01-01T05:54:27+02:00 Auon Shabbir Khan Niazi Muhammad Uzair Khan Niazi Irta Zainab Hassan Mumtaz Midhat Zahra Adnan Anwer <p><strong>Aims &amp; Objectives: </strong>To co-relate Magnetic Resonance Imaging findings with Arthroscopy through Sensitivity and Specificity, keeping Arthroscopy as a gold standard.</p> <p><strong>Design:</strong> Prospective cross-sectional study</p> <p><strong>Materials and Methods: </strong>The study was conducted from February to August 2019 in the Department of Orthopedic Surgery, Combined Military Hospital, Rawalpindi, after receiving approval from the Ethical Committee. MRI of 127 patients was done who had clinical signs of ACL injury and then were booked for Arthroscopy.</p> <p><strong>Results: </strong>There was a male preponderance, with 85.8 % being male. The majority of the patients were of 2<sup>nd</sup> and 3<sup>rd</sup> decade of life. The specificity, sensitivity, NPV, PPV, and Accuracy of MRI in assessing anterior cruciate ligament injuries were calculated in percentages of 64.28%, 89.89 %, 64.28%, 89.89%, and 84.25%, respectively.</p> <p><strong>Conclusion: </strong>MRI is accurate and a non-invasive modality for assessing anterior cruciate ligament tears with good accuracy and better sensitivity. However, diagnostic Arthroscopy remains the gold standard for diagnosing anterior cruciate ligament injuries.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University P53 Over Expression in Bladder Carcinoma 2021-12-30T15:49:56+02:00 Sabeen Afshan Laila Zaib Sumera Sharif Javeria Faridi Farzana Habib Aisha Akbar <p> </p> <p>Objective: The goal of this study was to find out how common p53 overexpression is in bladder urothelial carcinoma.</p> <p><strong>Material &amp; Methods: </strong>This Descriptive, Cross-Sectional Study has been done during April 10th to October 9th, 2018 at the KRL Hospital Islamabad. A total of 74 patients with biopsy-proven urinary bladder carcinoma, ranging in age from 15 to 70 years old and regardless of gender, were included in the study. Patients undergoing radiotherapy, immunotherapy, or who had previously received an immunohistochemistry report were excluded. Following that, the immunohistochemical processing was completed, and the results for p53 expression (positive/negative) were interpreted by the consultant pathologist.</p> <p><strong>Results: </strong>The participants in this study ranged in age from 15 to 70 years old, with a mean age of 47.39 10.26 years. The male to female ratio was 1.6:1 among these 74 patients, with 45 (60.81 percent) being male and 29 (39.19 percent) being female. Overexpression of p53 was found in 31 (41.89 percent) of bladder urothelial carcinoma cases.</p> <p><strong>Conclusion: </strong>This study concluded that the frequency of p53 overexpression in bladder urothelial carcinoma is very high<strong>.</strong></p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Comparison of the Mesio-Distal Widths of the Maxillary and Mandibular Central Incisors between Cleft Lip And Palate Individuals 2022-09-11T21:29:57+03:00 Ali Ayub Umar Hussain Falahat Nasir Ausaf Ali Rizvi <p><strong>Objective</strong>: To compare the mesiodistal widths of the maxillary and mandibular central incisors of the cleft lip and palate individuals with non cleft individuals, in a local population</p> <p><strong>Methodology</strong>: A total of 80 casts (50 of cleft patients and 50 normal) were selected from department of orthodontics. Mesiodistal width of maxillary and mandibular central incisors was measured with vernier caliper. Independent t test was applied to compare mesiodistal width of maxillary and mandibular central incisors between normal and cleft patients.</p> <p><strong>Results</strong> : The mean MD width for the maxillary central incisors was 6.58 ± 1.16mm and 7.67 ±1.18mm for the CLP and control group respectively. The mean MD width for the mandibular central incisors was 4.22± 0.91 mm and 4.67 ± 0.9 mm for the CLP and control group respectively. student t test showed a significant difference in the MD width of both the maxillary and mandibular central incisors between the CLP and control group.</p> <p><strong>Conclusion</strong>: The patients suffering from cleft lip and palate are associated with diminutive central incisors in both jaws.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Association of Anterior Alveolar Dimensions with Different Sagittal Jaw Relationships 2022-09-11T22:33:49+03:00 Abdul Jabbar Muhammad Nazir Maryam Mushtaq <p>Objective: To determine the association between anterior alveolar dimensions and sagittal jaw relationship.</p> <p>Methodology: This Cross-sectional study took place in Orthodontic Department, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro from August 2018 to January 2019. All the subjects, as per ANB angle, were grouped into three categories as (Class I = value between 1° and 4° for ANB angle), (Class II = value &gt; 5° for ANB angle) and (Class III= value &lt;1° for ANB angle). All the data was recorded in the Performa for the purpose of analysis.</p> <p><strong>Results: </strong>Total 90 patients were studied; their average age was 21.12<u>+</u>3.47 years and 52.2% were females. Mean upper posterior alveolus width was significantly higher in sagittal class II as 12.69 ± 5.52 than the sagittal class I and III p-value 0.058. Mean upper anterior alveolus height was found to be significantly greater in class I and III in contrast to class II p-value 0.028. Mean lower anterior alveolus width was insignificantly related with sagittal classification, p-value 0.343. Mean upper anterior alveolus width and lower posterior alveolus width were insignificantly related to sagittal classification, p-value were quite insignificant. Sagittal class II and III were significantly associated with female gender 0.021, while class I was linked to male gender p-value 0.021.</p> <p><strong>Conclusion</strong>:&nbsp; There was a significant association between dimensions of anterior alveolar among different vertical and sagittal jaw association.</p> 2022-09-11T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University Case Report: Ulcerated Adenomyoma presenting as CA Endometrium 2022-01-30T16:31:44+02:00 Zeenat Usman Majida Zafar Syeda Batool Mazhar <p>During this COVID pandemic cancer surgeries are still being carried out via necessary precautions.Endomertial carcinoma is one of the easiest carcinoma to pick and early surgical treatment can completely cure it. Adenomyosis on the other hand is the presence of ectopic <a href="">endometrial tissue</a>&nbsp; with in myometrium if it involves the uterus focally it is known as adenomyoma. Radiological findings of adenomyoma can be mistaken for endometrial carcinoma. We present such a case in which radiologically diagnosed endometrial carcinoma turned out to be adenomyoma on histopathology.</p> 2022-09-15T00:00:00+03:00 Copyright (c) 2022 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University