Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University <p>The Annals of Pakistan Institute of Medical Sciences (APIMS) is the Official quarterly and open access journal of Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Pakistan. Previously two separate medical journals of this institute were being published, namely, JPIMS started from 1990 and the Journal of Surgery 1991. They were officially merged into one journal APIMS in 2005. Annals of PIMS is recognized by Pakistan Medical and Dental Council (PMDC), Higher Education Commission of Pakistan ( Y category), CPSP <a href="" target="_blank" rel="noopener">(</a> index in EBSCO Host &amp; Base from Germany. </p> Shaheed Zulfiqar Ali Bhutto Medical University en-US Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 1815-2287 <p>This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<a href="" target="_blank" rel="noopener noreferrer" data-saferedirecturl=";source=gmail&amp;ust=1631333068703000&amp;usg=AFQjCNHZYtuxBPig6twKvyD2CCwaQDd05g"><strong>https://creativecommons.<wbr />org/licenses/by-nc/4.0/</strong></a>.) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> Geographic Accessibility of Burn Care Centres; A Battle of Life in Pakistan Muhammad Rehan Tariq Iqbal Esha Kamran Copyright (c) 2023 Muhammad Rehan, Tariq Iqbal, Esha Kamran 2023-09-07 2023-09-07 19 3 Psychological Problems among School Going Children- A Systematic Review <p>impairments in individuals. Adolescence is the most critical stage for the development of diverse psychological adaptations.</p> <p><strong>Objective:</strong> This research study systematically analyzes the psychological problems affecting school-going children. The aim of this study is to assess the consensus and variations in the spectrum of psychological problems among school-going children, as well as their associated factors, based on previously published literature.</p> <p><strong>Methodology:</strong> The research methodology employed in this study follows the PRISMA diagram. We conducted a search in EndNote Version X9's PubMed collection using specific keywords, such as "psychological issues" and "school-age children." Papers published before 2019 were excluded from the electronic PubMed collection.</p> <p><strong>Results:</strong> Out of a total of 1564 papers, we included 10 articles for systematic analysis. These articles were international research studies conducted in various countries, including China, Europe, Turkey, the Netherlands, Denmark, the USA, and Canada. The research studies utilized cross-sectional correlational research design, longitudinal research studies, and quantitative cross-sectional studies.</p> <p><strong>Conclusion:</strong> Qualitative analysis revealed a spectrum of psychological and physical problems in school-going children, including behavioral changes, ignorance, arrogance, irritation, social withdrawal, social isolation, lack of confidence, low self-esteem, anxiety, depression, stress, and post-traumatic stress disorder. These psychological issues are strongly associated with factors such as mobile phone addiction, social media addiction, parental psychological disorders, child sexual abuse, school bullying, and criticism. It is recommended to consider moderate to vigorous physical activities as non-pharmacological treatments for these psychological problems.</p> Asima Mehaboob Khan Rizwan Taj Aamir Naveed Aamir Naveed Copyright (c) 2023 Asima Mehaboob Khan, Rizwan Taj, Aamir Naveed, Aamir Naveed 2023-09-07 2023-09-07 19 3 194 200 10.48036/apims.v19i3.866 Effectiveness of Scalp Nerves Block in Reducing the Immediate Postoperative Pain in Patients Undergoing Craniotomy in Elective Neurosurgical Procedures <p>Objective: To determine the usefulness of regional scalp block in controlling pain after craniotomy.</p> <p>Methodology: This prospective, randomized, double-blind, placebo-controlled study was conducted at the Pakistan Institute of Health Sciences, Islamabad from November 2021 to April 2022. Adult patients aged 18 to 65 years, scheduled for elective craniotomy for neurosurgical procedures with an American Society of Anesthesiologists (ASA) physical status of I or II, of either gender, were included. Patients underwent craniotomy for their respective lesions. Patients were randomized into two groups: one receiving a regional scalp nerve block of 0.5% bupivacaine with 1:100,000 epinephrine after general anesthesia, and the other undergoing general anesthesia as a placebo. Pain intensity was assessed using the Visual Analog Scale (VAS) pain score at baseline (preoperatively), at 1 hour postoperatively, and at 6 hours postoperatively.</p> <p>Results: The mean age of patients in the treatment group was 43.14 years, while in the control group, it was 42.55 years. The treatment group had 26 males (54.2%) and 22 females (45.8%), while the control group had 25 males (52.1%) and 23 females (47.9%). There was no significant difference in the VAS score preoperatively (p &gt; 0.05). Patients undergoing surgeries lasting less than 3 hours showed that the treatment group had a significantly lower mean VAS score of 3.08 at 1 hour compared to the control group's score of 5.11 (p = 0.027), while at the 6-hour post-surgery it was insignificant (p = 0.844). For surgeries lasting more than 3 hours, the treatment group had a significantly lower mean VAS score at 1 hour and at 6 hours post-surgery compared to the control group (p &lt; 0.05). There were no overall complications associated with the subcutaneous injection of epinephrine and bupivacaine in blocking the scalp nerves.</p> <p>Conclusion: The administration of scalp nerve blocks using bupivacaine and epinephrine prior to surgical incisions has demonstrated notable advantages in terms of postoperative pain management. Such nerve blocks can offer superior postoperative analgesia compared to the control group.</p> Muhammad Mujahid Sharif Musadique latif Memon Mubshar Nawaz Waseem Ahmed Zia ur Rahman Muhammad Ameeq Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 201 205 10.48036/apims.v19i3.794 A Cephalometric Study of Pharyngeal Dimensions Following Twin Block Treatment <p><strong>Objective:</strong> To assess and compare changes in pharyngeal airway widths (PAW) using lateral cephalograms before and after treatment with a removable twin block appliance.</p> <p><strong>Methodology:</strong> Lateral cephalogram records were taken before (T0) and after (T1) the treatment of 50 Class II subjects (ANB&gt;40; 28 males, 22 females; mean age 12.6 years) using the removable twin block appliance. The study period spanned 12 months. Airway volumes, including upper airway width (UAW), middle airway width (MAW), and lower airway width (LAW), were compared between T0 and T1. The data were analyzed using SPSS statistical software via paired t-test. A p-value of ?0.05 was considered statistically significant.</p> <p><strong>Results:</strong> A total of 50 patients were included in the study, and airway changes were analyzed at two different times prospectively (T0 and T1). The male-to-female ratio was 1:0.8 (44% females, 56% males). The mean upper airway width (UAW) at T0 and T1 was 14.04 mm and 15.3 mm, respectively. The mean middle airway width (MAW) at T0 and T1 was 8.8 mm and 11.8 mm, respectively, while the mean lower airway width (LAW) at T0 and T1 was 7.5 mm and 10.2 mm, respectively. The mean age was 12.6 years, and the mean BMI was 21. The mean SN-Md angle was 31.8 degrees. At T1, a significant increase in airway volume was observed in upper airway width (UAW), middle airway width (MAW), and lower airway width (LAW) (P=0.000).</p> <p><strong>Conclusion:</strong> Treatment with the Twin Block Appliance in growing subjects resulted in an increase in the overall posterior pharyngeal airway volumes.</p> Asma Najibullah Khan Omar Arshad Amra Minhas Abid Shahzonia Tariq Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 206 209 10.48036/apims.v19i3.815 Comparison of Bubble CPAP Versus Conventional Ventilation in Neonates Having Respiratory Distress <p><strong>Objective:</strong> To compare the outcomes of bubble continuous positive airway pressure (B-CPAP) versus ventilator continuous positive airway pressure (V-CPAP) in neonates experiencing respiratory distress.</p> <p><strong>Methodology:</strong> This randomized controlled trial was conducted at the Department of Neonatology, Children's Hospital, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from March 1, 2021, to August 31, 2021. A total of 150 neonates of both genders who presented with respiratory distress and were delivered at &gt;32 weeks of gestation, weighing &gt;1500 grams. The neonates were then randomly allocated to two groups using a lottery method. Treatment failure was defined as a neonate's inability to maintain a SpO2 greater than 90% or an arterial partial pressure (PaO2) greater than 50 mmHg with a maximal CPAP of &gt;7 cm of water and a FiO2 greater than 0.6 or the necessity of mechanical ventilation.</p> <p><strong>Results:</strong> Of these, 82 (54.7%) were male, and 68 (45.3%) were female, resulting in a male-to-female ratio of 1.2:1. The mean gestational age was 36±2.49 weeks in the B-CPAP group and 35.52±1.36 weeks in the V-CPAP group. The mean birth weight was 2381±506.4 grams in the B-CPAP group and 2187.3±427.49 grams in the V-CPAP group. Out of the 75 neonates in the B-CPAP group, 10 (13.3%) were classified as treatment failures, while 19 (25.3%) out of 75 neonates in the V-CPAP group met the criteria for treatment failure, according to our operational definition. Although the failure rate was slightly higher in patients receiving V-CPAP for the management of respiratory distress, these differences were not statistically significant (p-value= 0.052).</p> <p><strong>Conclusion:</strong> In the treatment of neonatal respiratory distress, there was no significant difference in the failure rate between bubble CPAP and ventilatory CPAP. Regardless of the neonate's gender, birth weight, gestational age, or Silverman score, bubble CPAP may be considered as the primary mode of respiratory support for neonates with respiratory distress.</p> Kinza Imran Haider Sherazi Sadia Riaz Yasir Abbas Muneera Ali Mustansir Ali Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 210 214 10.48036/apims.v19i3.785 Socio-Demographic and Clinical Factors Associated with Poor Glycemic Control Among Patients of Type-2 Diabetes Mellitus Presenting at a Tertiary Healthcare Facility <p><strong>Objective:</strong> To identify socio-demographic and clinical factors associated with poor glycemic control in type-2 diabetes mellitus patients at a tertiary healthcare facility.</p> <p><strong>Methodology:</strong> This cross-sectional study was conducted at Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from February 2022 to July 2022, included 246 known type-2 diabetes patients of both genders, aged 18 to 75, with at least three consecutive days of fasting blood glucose (FBG) measurements. We assessed socio-demographic and clinical characteristics and classified glycemic control according to ADA guidelines: FBG between 80-130 mg/dl as good control and FBG above 130 mg/dl as poor control. We recorded the prevalence of good and poor glycemic control and compared them based on various socio-demographic and clinical factors.</p> <p><strong>Results:</strong> Among 246 patients, 152 (61.8%) were male, with a mean age of 46.47±11.55 years and a mean BMI of 23.13±5.01 kg/m². The mean diabetes duration was 9.18±7.50 years, and 132 (53.7%) patients had a disease duration &gt; 5 years. Diabetes-related complications were present in 156 (63.4%) patients. Poor glycemic control was found in 137 (55.7%) patients. Significant associations with poor glycemic control were observed for age (p&lt;0.001), educational status (p&lt;0.001), BMI (p=0.002), residential status (p=0.013), family history of diabetes (p&lt;0.001), diabetes duration (p&lt;0.001), and current diabetes medications (p=0.001).</p> <p><strong>Conclusion:</strong> A majority (55.7%) of type-2 diabetes patients in our study had poor glycemic control. Factors such as increasing age, BMI, education level, residential status, family history of diabetes, longer disease duration, and current diabetes medications were significantly associated with poor glycemic control.</p> Shafat Khatoon Hareem Bin Saleem Shajee Ahmed Siddique Copyright (c) 2023 Shafat Khatoon, Hareem Bin Saleem, Shajee Ahmed Siddique 2023-09-07 2023-09-07 19 3 215 219 10.48036/apims.v19i3.867 Severity of Post Obturation Pain in Single Versus Multiple Sittings Endodontic Treatment Using Rotary Nickle Titanium Instruments <p><strong>Objective: </strong>To evaluate the significant difference in the incidence and severity of post-obturation pain following single-visit and multiple-visit root canal treatments.</p> <p><strong>Methodology:</strong> This study was conducted in the Operative Dentistry Department of Rawal Dental Hospital in Islamabad. A total of 156 patients were randomly assigned to two groups, with 78 participants in each group. Prior to treatment, all participants were asked to mark a horizontal scale to indicate the intensity of their pain. After 24 hours of treatment, participants were questioned about their pain using a Visual-Analogue Scale. SPSS- 20 was used &amp; Independent T-test was done for an analysis. P&lt;0.05 was well-thought-out as statistically significant.</p> <p><strong>Results:</strong> The study comprised 93 male participants (59.6%) and 63 female participants (40%). Among the treated teeth, 80 (51%) were anterior teeth, and 76 (48%) were posterior teeth. The mean Visual-Analogue Scale (VAS) and standard deviation (SD) for Group 1 before treatment were 9.12 and 1.98, respectively, while for Group 2, they were 8.76 and 1.03, respectively. After 24 hours post-operatively, the mean VAS and S.D for Group 1 were 5.58 and 1.92, and for Group 2, they were 4.86 and 1.18, respectively. An independent sample t-test revealed a statistically insignificant variation in pre- and post-operative pain levels in both groups.</p> <p><strong>Conclusion:</strong> The incidence of pain was lower in the multi-visit group compared to the single-visit group, but this difference was not statistically significant.</p> Nouman Noor Rahima Azhar Rafia Sartaj Hasan Mujtaba Sadaf Humayoun Muhammad Mohsin Javaid Muhammad Athar Copyright (c) 2023 Nouman Noor, Rahima Azhar, Rafia Sartaj, Hasan Mujtaba, Sadaf Humayoun, Muhammad Mohsin Javaid 2023-09-07 2023-09-07 19 3 220 224 10.48036/apims.v19i3.764 Diagnostic Accuracy of Ultrasonography in Diagnosis of Parotid Gland Lesions Using Fine-Needle Aspiration Cytology as The Gold Standard <p><strong>Objective:</strong> To determine the diagnostic accuracy of ultrasound by using ultrasound-guided FNAC as the gold standard for diagnosing parotid salivary gland conditions.</p> <p><strong>Methods:</strong> A prospective observational study was conducted at the Radiology department of Islamabad Diagnostic Centre from January 2022 to December 2022. Patients of all ages and genders with suspected major salivary gland conditions were included. All patients underwent ultrasonography and FNAC after providing informed consent and receiving an explanation of the procedure. Following local anesthesia, a needle was inserted under ultrasound guidance to aspirate tissue samples. The aspirated material was labeled, handled, and transported for laboratory analysis. Data were collected using a self-designed form, and data analysis was carried out using SPSS version 20.</p> <p><strong>Results:</strong> A total of 47 cases were evaluated, with a mean participant age of 47.31 years. Of all participants, 57.4% were males, and 42.6% were females. Among the cases with benign FNAC results, 19 were correctly identified as benign in histopathology (True Positives, TP), while 2 were incorrectly classified as malignant (False Positives, FP). Conversely, for the cases with malignant FNAC results, 6 were falsely identified as benign (False Negatives, FN), and 20 were correctly classified as malignant (True Negatives, TN). Sensitivity was found to be 76%, and specificity was 95%. The positive predictive value (PPV) was 90%, and the negative predictive value (NPV) was 76%. The overall accuracy of ultrasound-guided FNAC was calculated to be 82%.</p> <p><strong>Conclusion:</strong> Ultrasonography has proven to be an effective, non-invasive, and reliable diagnostic tool for assessing parotid gland pathology. It demonstrated a strong capability in accurately distinguishing between benign and malignant cases, with high sensitivity and specificity.</p> Naushaba Malik Hina Hanif Mughal Mujahid Raza Altaf Hussain Copyright (c) 2023 Naushaba Malik, Hina Hanif Mughal , Mujahid Raza, Altaf Hussain 2023-09-07 2023-09-07 19 3 225 229 10.48036/apims.v19i3.888 Histopathological Changes in the Gall Bladder Mucosa Associated with Helicobacter Pylori Gastritis <p><strong>Objective:</strong> To identify Helicobacter Pylori (HP) gastritis-associated histopathological changes in Gall Bladder (GB) mucosa in patients undergoing cholecystectomy.</p> <p><strong>Methodology</strong> This prospective comparative cross-sectional study was conducted in the Gastroenterology department of Liaquat National Hospital, Karachi, Pakistan, from December 2021 to December 2022. The study included all patients admitted with a diagnosis of any Gall Bladder pathology and those who were electively scheduled for cholecystectomy. Participants were categorized into two groups based on the presence of HP: group A (HP positive) and group B (HP negative) in gastric mucosa before cholecystectomy. HP detection was performed using various methods, including HP stool antigen (HPSA), Urea breath test (UBT), HP antibodies, and biopsy confirmation through gastroscopy.</p> <p><strong>Results:</strong> The mean age of patients in group A was 42.88 ± 8.28 years, and in group B, it was 43.35 ± 8.74 years (p=0.458). According to the GB histological findings, Chronic cholecystitis with focal Cholesterolosis was significantly more common in group A (75.4%), while Chronic cholecystitis alone was significantly higher in group B (66.2%) (p=0.001). Dysplasia was observed more frequently in group B compared to group A. Erosion was more prevalent in group A, patients than in group B (p=0.001). Although symptom improvement in the HP positive group with persistent symptoms post-eradication was not statistically significant, it did show some improvement (p=0.527).</p> <p><strong>Conclusion:</strong> The histological findings of chronic cholecystitis with focal Cholesterolosis were significantly higher in the HP positive group compared to the HP negative group, while chronic cholecystitis alone was significantly more common in the HP gastritis negative group. Some HP gastritis group patients experienced symptom improvement after HP eradication.</p> Mehreen Akmal Jamal Lubna Kamani Rabia Ali Faisal Siddiqui Copyright (c) 2023 Mehreen Akmal Jamal, Lubna Kamani, Rabia Ali, Faisal Siddiqui 2023-09-07 2023-09-07 19 3 230 234 10.48036/apims.v19i3.882 Intra Ocular Pressure Change After Low Energy And High Energy Nd:Yag Laer Posterior Capsulotomy <p>&nbsp;</p> <p>OBJECTIVE</p> <p>To determine the frequency of change in Intraocular Pressure (IOP) among patients undergoing YAG Laser Posterior Capsulotomy and to compare IOP change based on the level of YAG laser energy and number of shots applied.</p> <p>METHODOLOGY</p> <p>A descriptive cross-sectional study was conducted at the Department of Ophthalmology, Fauji Foundation Hospital Rawalpindi, from December 2021 to November 2022. A total of 200 pseudophakic eyes with posterior capsular opacification were included in the study. Preliminary baseline intra-ocular pressure (IOP) was measured by Goldman Applanation Tonometry (GAT). Patients were divided into groups according to the laser energy utilized and the number of shots. IOP was measured after 1 and 4 hours post-procedure and results compared.</p> <p>RESULTS</p> <p>In the low energy group (mean energy 2.73 mJ), average IOP calculated was 14.86 and 12.97 mmHg after 1 and 4 hours of procedure respectively. While in the high energy group (mean energy 4.11mJ), it was 19.42 and 17.51 mmHg respectively. In group 1 (less than 20 shots), mean IOP 1 and 4 hours procedure was 13.88 and 12.97 mmHg respectively. In group 2 (greater than 20 shots) the mean IOP was 21.63 and 18.31 mmHg respectively. The rise in IOP was significantly higher for the higher laser energy and in the group with greater number of shots at both 1 and 4 hours (p=0.000).</p> <p>CONCLUSION</p> <p>In conclusion, we found that significant rise of IOP is noted when more energy and greater number of shots are utilized in YAG laser capsulotomy.</p> <p>&nbsp;</p> Urwa Ghafoor Asfandyar Asghar Rana Intisarul Haq Maham Fazal Tehmina Nazeer Naila obaid Copyright (c) 2023 Urwa Ghafoor 2023-09-08 2023-09-08 19 3 235 239 Assessment of Mean American Knee Society Scorefor Complex Plateau Fractures with Llizarov External Fixation <p><strong>Objective:</strong> To determine clinical outcomes based on the AKSS (American Knee Society Score) in patients with complex tibial plateau fractures treated using Ilizarov external fixation.</p> <p><strong>Methodology:</strong> This descriptive case series study was conducted at the Department of Orthopaedics, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from November 2020 to November 2021. The study included patients aged 20 to 55 of both genders with Schatzker type V or VI tibial plateau fractures who underwent Ilizarov external fixation and surgery within one week of the injury. Informed consent was obtained from all patients before undergoing Ilizarov external fixation. Pin tract infections were monitored weekly, and radiological assessments were performed monthly. The decision to remove the fixator was based on evidence of bone healing from two different angles, along with a successful stress test after removing the rods between the first two rings. After the fixator was removed, patients wore a removable brace for 3 to 5 weeks to protect their limbs during weight-bearing. Six weeks after external fixation, patients were assessed for pain levels, knee and ankle range of motion, limb alignment, and functional status according to the AKSS. Data were collected and analyzed using SPSS version 20.</p> <p><strong>Results</strong>: The mean age of the patients was 32.4±8.7 years. Out of all the patients, 66.5% were male, and 33.5% were female. The AKSS score averaged 82.5±11.2, the mean duration of surgery was 41.5±9.3, and the mean range of motion (ROM) was 22.1±4.8. Clinical outcomes were classified as excellent in 47 (27.2%) patients, good in 57 (32.9%), while 48 (27.8%) and 21 (12.1%) had fair and poor clinical outcomes, respectively.</p> <p><strong>Conclusion:</strong> The Ilizarov external fixation technique appears to be a reasonably effective method for treating complex tibial plateau fractures.</p> Fahad Hassan Abdul Qadeer Khan Wazir Ahmed Nadeem Ahmed Suresh Kumar Copyright (c) 2023 Fahad Hassan, Abdul Qadeer Khan, Wazir Ahmed, Nadeem Ahmed, Suresh Kumar 2023-09-07 2023-09-07 19 3 245 249 10.48036/apims.v19i3.893 Investigation of the Monocyte to High Density Lipoprotein Ratio as an Inflammatory Marker in Schizophrenia <p><strong>Objective:</strong> The purpose of this study is to investigate the potential relationship between MHR and schizophrenia.</p> <p><strong>Methodology:</strong> This case control study was conducted at the psychiatry department of a tertiary care hospital of a private medical college from 1/11/2022 to 31/04/2023, involving 60 subjects, with thirty diagnosed with schizophrenia according to DSM-5 criteria and thirty healthy controls. The Positive and Negative Syndrome Scale (PANSS) was employed in the patient group to gauge the severity of schizophrenia. Peripheral venous blood was collected from all participants for the analysis of complete blood count parameters, including MHR, and the lipid profile (HDL cholesterol). Pearson’s correlation co-efficient was used for correlation analysis, P values of &lt; 0.05 were considered as statistically significant.</p> <p><strong>Results:</strong> Patients with schizophrenia exhibited higher MHR values (15.25±3.16 in schizophrenia patients and 11.50±2.65 in controls; P = 0.001). Both monocyte counts and MHR in schizophrenia patients were significantly elevated compared to the control group. A noteworthy positive correlation was observed between age, body mass index, severity of disease, and MHR. Statistical analyses, including independent sample t-tests, chi-square tests, and Pearson’s correlation coefficient, were employed to explore relationships between study variables and calculate P values.</p> <p><strong>Conclusion:</strong> The utilization of the novel parameter MHR enabled the demonstration of an association between low-grade systemic inflammation and schizophrenia. This study underscores the validation of MHR as a valuable marker in psychiatric patients with schizophrenia, warranting further research to explore the utility of this simple and cost-effective instrument.</p> Ather Muneer Hina Saghir Ambreen Zahoor Mariam Tariq Hafiz ud din Seemab Abid Copyright (c) 2023 Ather Muneer, Hina Saghir, Ambreen Zahoor, Mariam Tariq, Hafiz ud din 2023-09-07 2023-09-07 19 3 251 255 10.48036/apims.v19i3.839 An Assessment of the Current Trends of Antibiotic Resistance of Salmonella Typhi Against 1st Line Antimicrobial Agents in Metropolitan City of Karachi <p><strong>Objectives:</strong> To assess current trends of antibiotic resistance against S. typhi in Pakistani population.</p> <p><strong>Methodology:</strong> This was a cross-sectional, observational descriptive research conducted in various diagnostic facilities in Karachi-Pakistan from January 2019 to November 2020. A data of 1223 patients, who were reported positive for typhoid fever, was collected from various diagnostic facilities with in the area. Clinical isolates were examined for culture sensitivity by using BACTEC™ and Versa TREK™. Isolates of the Salmonella typhi and para typhi were recovered from blood of the patients. The collected data was analyzed using SPSS version 22.0.</p> <p><strong>Results:</strong> Among all isolates, 92.7% (n=1134) isolates were identified as S. typhi and the remaining 7.3% (n=89) as S. paratyphi. Study population suffering from typhoid fever were 58.5% (n=716) male trailed by 41.5% (n=507) female. Similarly, among 1223 clinical isolates, 14.2% (n=174) were non-resistant, 5.4% (n=66) were multi-drug resistant (MDR), 56.4% (n=690) were extensive drug resistant (XDR), 12.7% (n=155) were moving towards multi-drug resistant species trend and 5.7% (n=70) were heading towards XDR. A further 5.6% (n=68) were moving towards ESBL positive typhoid fever. Moreover, 49.1% of the S. typhi isolates were found to be resistant to all the first line antibiotics agents (ampicillin, chloramphenicol and co-trimoxazole) with only 15.2% found to be sensitive to all first line antibiotics drugs.</p> <p><strong>Conclusion:</strong> Strains of Salmonella typhi in Karachi are resistant to most of the drugs recommended by local infectious disease society for treatment of typhoid. This is alarming for healthcare policy makers because of lack of newer drugs discovered for treatment of typhoid fever and pathogens isolated for this highly infectious disease being resistant to most of the recommended anti-microbial agents.</p> <p><strong>Keywords:</strong> Typhoid fever, Drug resistance, XDR, Salmonella typhi</p> Maria Haider Sobia Jamil Sakina Fatima Aylia Mazhar Hussain Abidi Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 256 261 10.48036/apims.v19i3.828 Correlation Between Perceived Stress and BMI Among Obstructive Sleep Apnea Individuals <p><strong>Objective:</strong> To investigate the potential association between higher perceived stress levels and elevated Body Mass Index (BMI) in patients with obstructive sleep apnea (OSA).</p> <p><strong>Methodology:</strong> This prospective study was conducted at the Pulmonology Department of Dow University Hospital, Dow University of Health Sciences, from July to October 2020. The study included adults aged 18 and above, of both genders, diagnosed with OSA through clinical evaluation and sleep studies. BMI was calculated using the formula BMI = kg/m², and the Perceived Stress Scale (PSS) was utilized to assess participants' perceived stress levels. The PSS questionnaire, comprising 10 items, was completed by participants, with each item rated on a 5-point Likert scale (ranging from 0 to 4). Higher scores indicated higher perceived stress. Relevant clinical data were recorded, and the Pearson correlation coefficient was calculated to determine the direction of the relationship.</p> <p><strong>Results:</strong> The study included 160 OSA cases, with an average age of approximately 50.29 years. The majority of participants were male (59.4%), while females constituted 40.6% of the sample. BMI categories revealed that 13.8% were overweight, 85.0% were obese, and only two individuals had a normal BMI. Concerning stress levels, 41.3% experienced low stress, 45.6% reported moderate stress, and 13.1% reported high perceived stress. Importantly, the study found an insignificant association between BMI and perceived stress (p-value &lt; 0.278).</p> <p><strong>Conclusion:</strong> The study identified a predominant occurrence of obesity among OSA patients. A positive correlation between elevated BMI and perceived stress was observed. The limited number of similar studies and the acknowledged limitations of the current study underscore the necessity for further research and interventions to explore the impact of BMI on stress in OSA.</p> Faisal Asad Fasih-Ur-Rahman Madiha Moin Saif-Ur-Rahman Ubedullah Safa Fatima Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 262 265 10.48036/apims.v19i3.892 Comparison of Laryngoscopic Glottic Views Obtained via Macintosh vs Miller Blade in Adults Undergoing General Anesthesia with Endotracheal Intubation <p><strong>Objective:</strong> To compare the glottic views obtained through Miller and Macintosh blade laryngoscopy in adults undergoing general anesthesia with endotracheal intubation.</p> <p><strong>Methodology:</strong> This quasi-experimental study was conducted at Holy Family Hospital, Rawalpindi, from June 2022 to September 2022. Sixty patients scheduled for elective surgery under general anesthesia with endotracheal intubation were enrolled. Patients were randomly assigned to two groups: Miller blade group (n=30) and Macintosh blade group (n=30). The anesthesiologist conducting the intubation recorded the Cormack Lehane grade obtained. Data analysis utilized SPSS version 27.0, employing independent-sample t-tests, Mann-Whitney U tests, chi-square, or Fisher's exact tests as appropriate. A p-value &lt;0.05 was considered statistically significant.</p> <p><strong>Results:</strong> In the Miller blade group, comprising 30 patients, the mean age was 44.60+13.310 years, and 53.3% were male. Cormack-Lehane grades were distributed as follows: 76.7% grade I, 20.0% grade II, and 3.3% grade III. In the Macintosh blade group, with 30 patients, the mean age was 40.93+12.798 years, and 46.7% were male. Cormack-Lehane grades were distributed as follows: 30.0% grade I, 50.0% grade II, 13.3% grade III, and 6.7% grade IV.</p> <p><strong>Conclusion:</strong> The study concluded that Miller blade laryngoscopy provides superior glottic views compared to Macintosh blade laryngoscopy. However, the ease of intubation and the time taken for intubation were not investigated, suggesting areas for exploration in future studies.</p> Hassam Zulfiqar Hashaam Ghafoor Muhammad Haroon Anwar Jawad Zahir Farzana Mazhar Bokhari Inam Ul Haq Copyright (c) 2023 Hassam Zulfiqar 2023-09-07 2023-09-07 19 3 266 271 10.48036/apims.v19i3.830 Comparison of Tramadol Versus Bupivacaine as Local Anesthetic in Pain Control in Inguinal Hernia Surgery <p><strong>Objective:</strong> To compare the outcomes of local infiltration of tramadol versus bupivacaine for postoperative pain control and time to mobilize patients out of bed with less intravenous analgesia consumption in inguinal hernia surgery.</p> <p><strong>Methodology:</strong> This randomized controlled trial was conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Islamabad September 2018 to August 2019. A total of 122 patients who were randomly allocated to either Group A (tramadol) or Group B (bupivacaine).</p> <p>Data on postoperative pain scores (VAS at 3, 6, 12, 24 hours), time to first analgesia, and time to mobilization were collected using a structured proforma and analyzed with SPSS version 26.</p> <p><strong>Results:</strong> In the bupivacaine group, mean age was 34 ± 9 years; in the tramadol group, 31 ± 8 years. At 24 hours post-surgery, mean pain score was 5.2 ± 1 in bupivacaine and 2.7 ± 0.5 in tramadol. Tramadol showed significantly lower mean pain at 3rd, 6th, 12th, and 24th hours (p &lt; 0.001). Time to first analgesia was 10 ± 7 hours in bupivacaine and 13.5 ± 5.6 hours in tramadol, indicating a statistically longer duration for tramadol (p &lt; 0.05). Mobilization time was 9 ± 4 hours in bupivacaine and 6 ± 4.5 hours in tramadol, with tramadol showing significantly lower time to mobilize (p &lt; 0.001).</p> <p><strong>Conclusion:</strong> Tramadol local infiltration is effective in reducing pain, delaying analgesia need, and promoting earlier mobilization compared to bupivacaine. Consideration of tramadol at wound closure for inguinal hernia repair may enhance outcomes and patient satisfaction</p> Muhammad Sheraz Manzer Mehmood Hannan Sajid Basit Mukhtar Burhan Ul haq Aatif Inam Copyright (c) 2023 Muhammad Sheraz, Manzer Mehmood, Hannan Sajid, Basit Mukhtar , Burhan Ul haq , Aatif Inam 2023-09-07 2023-09-07 19 3 272 276 10.48036/apims.v19i3.885 Effect of Continuous Ultrasonic Irrigation on Postoperative Pain in Cases in Symptomatic Apical Periodontitis After Single Visit Endodontic Treatment <p><strong>Objective: </strong>To examine and evaluate the efficacy of Continuous Ultrasonic Irrigation (CUI) in comparison to Syringe Irrigation (SI) with regards to the reduction of postoperative pain.</p> <p><strong>: </strong> The clinical investigation was carried out at the Department of Operative Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro, for a period of six months, starting from January 2021 and ending in June 2021. The study involved a total of 90 patients, and its objective was to assess pain levels experienced by the participants 24 hours and seven days after the surgical procedure. The Heft Parker Visual-Analogue Scale was utilized as the tool for pain measurement.</p> <p><strong>Results: </strong>CUI yielded superior outcomes in terms of statistically significant postoperative pain reduction at the 24-hour when compared to syringe irrigation. Nevertheless, it was shown that syringe irrigation demonstrated more efficacy in mitigating postoperative discomfort on the seventh day. The findings also revealed statistically significant disparities in pain intensity between the two cohorts at the 24-hour mark and on the seventh day, with notable variations in pain levels based on gender.<br /><strong>Conclusion:</strong> The efficacy of continuous ultrasonic irrigation in lowering postoperative pain was shown to be higher at the 24-hour mark, whereas syringe irrigation demonstrated greater effectiveness at the 7-day postoperative period.</p> <p> </p> Bharat Kumar Feroze Ali Pooja Kumari Imran Ali Rajesh Kumar Sarang Suresh Copyright (c) 2023 Bharat Kumar, Feroze Ali, Pooja Kumari, Imran Ali, Rajesh Kumar, Sarang Suresh 2023-09-07 2023-09-07 19 3 277 283 10.48036/apims.v19i3.777 Approaches to Different Learning Styles in Undergraduate Medical Students of Al-Tibri Medical College Karachi <p><strong>Objectives:</strong> The purpose of this study was to evaluate the different styles of learning preferred by undergraduate medical students from 1st to 5th year of Al-Tibri Medical College Karachi</p> <p><strong>Methodology:</strong> This was a cross sectional observational study carried out on the undergraduate medical students of Al-Tibri Medical College Karachi from 1st year to 5th year for a period of six months. The sample consisted of 498 participants, distributed across the various academic years: 101 from the first year, 96 from the second year, 101 from the third year, 104 from the fourth year, and 96 from the fifth year. For collecting data, a self-administered and pre-tested questionnaire of VARK learning styles was distributed amongst students. The analysis of data was done using SPSS version 23.</p> <p><strong>Results:</strong> From 498 undergraduate medical students included, mean age was 20.93 ± 2.27 years. Mean score for visual learning style was 2.75 ± 2.5, auditory was 3.4 ± 2.1, reading / writing was 3.9 ± 2.8 and kinesthetic was 4.75 ± 3.2. 56 % of 1st year students opted for uni-modal while 44 % multi-modal learning style. 51 % of 2nd year students preferred uni-modal while 49 % multi-modal learning style. 52 % of 3rd year students chose uni-modal while 48 % multi-modal learning style. 50 % of 4th year students picked uni-modal and multi-modal learning style each. 44 % of 5th year students opted for uni-modal while 56 % multi-modal learning style.</p> <p><strong>Conclusion:</strong> Majority of students approached learning using kinesthetic style followed by reading / writing. A multi-modal mode of learning was preferred where a combination of either of VARK’s learning styles were put into practice for attaining and acquiring the best possible knowledge.</p> Anas Bin Tariq Abdul Razaque Shaikh Asad Jiskani Ain Ul Haq Omaimah Tauqir Faizan Ahmed Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 284 288 10.48036/apims.v19i3.884 Do Respiratory Maneuvers Affect Rght Hepatic Vein Waveform and Maximum Velocity in Post LDLT Recipients? <p><strong>AIM:</strong>  To evaluate the effect of respiratory maneuvers on right hepatic vein (RHV) Doppler waveform and its maximum velocity in Living donor liver transplant (LDLT) recipients.</p> <p><strong>METHODS:</strong> This was a prospective cross-sectional study performed at Pakistan Kidney and Liver Institute and Research Centre (PKLI&amp; RC), Lahore Radiology department. The sample size of the study, calculated according to WHO sample size calculator, was 30 patients after applying the inclusion and exclusion criteria. Most of these patients were analyzed during their first post-operative week while staying in the surgical intensive care unit (SICU). The Doppler waveform and maximum velocity of RHV were recorded during normal gentle breathing, following breath-hold after deep inspiration and then after quiet expiration. The waveforms that were recorded were triphasic, biphasic, or monophasic in the pattern. To assess the RHV flow quantitatively, the Damping Index was also calculated during all these three respiratory maneuvers as follows (DI=Minimum velocity/maximum velocity)</p> <p><strong>RESULTS:</strong> The maximum velocities during normal respiration, after quiet expiration and after breath-holding following deep inspiration were 125 cm/sec, 105 cm/sec and 94 cm/sec. The waveforms observed during gentle breathing were triphasic in 77%, biphasic in 10%, and monophasic in 13% of the patients. After quiet expiration, these were triphasic in 80%, biphasic in 6%, and monophasic in 13% of patients. However, after breath-hold following deep inspiration, the waveforms observed were triphasic in 42%, biphasic in 13%, and monophasic in 45% of the patients. (P &lt;0.008)</p> <p><strong>CONCLUSION: </strong>The study showed that not only did the RHV waveforms show significant change from triphasic pattern to monophasic pattern, but also the peak velocities were lower following expiration. Therefore, during the Doppler ultrasound assessment of post-LDLT recipient patients, respiratory variations must be taken into consideration.</p> Muhammad Salman Rafique Bushra Bilal Sana Kundi Tahir Malik Kayenat Khan Huma Hussain Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 289 293 10.48036/apims.v19i3.688 Intraoperative Wound Irrigation for Prevention of Surgical Site Infections After Abdominal Surgery <p><strong>Objectives:</strong> To compare the frequency of surgical site infections after abdominal surgery with and without intraoperative irrigation of the surgical wounds.</p> <p><strong>Methodology:</strong> This randomized controlled trial was performed in general surgery department, PAF Hospital, Islamabad from 10th August 2022 to 9th May 2023. A total of 520 patients undergoing abdominal surgeries of any gender between the ages of 15–70 years were included. Patients were randomly divided in two groups on the basis of non-probability, consecutive sampling. The participants included in the group-A did not receive any intraoperative wound irrigation. The participants in the Group-B received intraoperative wound irrigation with antiseptic solution i.e., povidone-iodine in solution. Each patient was followed up respectively on 7th, 21st and 30th days postoperatively to observe surgical site infection. Chi square test was applied to compare SSI percentage between two groups. P-value of less than 0.05 was taken as significant.</p> <p><strong>Results:</strong> Mean age was 39.87±6.93 years in group-A and 37.67±7.56 years in Group-B. Out of 520 patients, 344 (66.15%) were males and 176 (33.85%) were females. Surgical site infection after abdominal surgery without intraoperative irrigation was found to be 34 (13.08%) and surgical site infection after abdominal surgery with intraoperative irrigation was 12 (4.62%), hence statistically significant (p-value = 0.0007).</p> <p><strong>Conclusion:</strong> This study concluded that intraoperative wound irrigation is effective to prevent the surgical site infections after abdominal surgery.</p> Maryam Hameed Muhammad Nazim Khan Irmaghana Basharat Fahad Mudassar Hameed Umar Fayyaz Ghani Nauman Anwar Rana Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 294 297 10.48036/apims.v19i3.912 Continuous Versus Interrupted Sutures for Repair of Episiotomy or Second-Degree Perineal Tears <p><strong>Objective:</strong> To compare the efficacy in absorbed continuous vs interrupted suture material for repair the episiotomy and 2nd degree perineal tears in terms of time required for repair, number of suture material used and pain relief following childbirth.</p> <p><strong>Methodology:</strong> A comparative randomized controlled trial was performed in Gynae &amp; Obstetrics department of Akbar Niazi Teaching Hospital, Islamabad between May and October 2022. Total 300 patients of term delivered by spontaneous vaginal birth with episiotomy or 2nd degree perineal tear through non probability consecutive sampling were included. In Group A perineal tear was repaired with continuous non locking sutures and in Group B continuous locking sutures was done. Duration of procedures and number of suture material used was noted. Patients were followed for 24 hours for pain.</p> <p><strong>Results:</strong> The patients mean age was 24.85±3.98 years. The gestational mean age at time of delivery of all the cases was 38.79±0.84 weeks. Type of perineal trauma among all the cases was observed as 84 (28.0%) cases had 2nd degree perineal tear while 216 (72.0%) had episiotomy. Mean time required for suture repair in Group A was 9.0±0.86 sec, while in Group B, the mean time required for suture repair was 15.02±2.06 sec (p-value = 0.001). Mean suture material required for suture repair in Group A was 108.38±9.70 cm, while in Group B, the mean suture material required for suture repair was 114.01±7.17 cm (p-value = 0.001). The mean pain score in Group A was calculated as 3.64±0.94 on VAS, while in Group mean pain was 5.46+0.75 on VAS (p-value = 0.001).</p> <p><strong>Conclusion:</strong> Through this study, it was proved that episiotomy and repair of perineal tears with continuous suture is faster, and uses less suture material without increasing complexity compared to interrupted suture. The continuous suture method of perineal repair is associated with less pain than the interrupted method.</p> Uzma Nayyer Maria Tariq Afnan Rizwan Gul Amber Muhammad Nahyan Dar Michelle Ahmad Jaspal Copyright (c) 2023 2023-09-07 2023-09-07 19 3 298 301 10.48036/apims.v19i3.823 Effectiveness of Cataract Uncomplicated Surgery on Retina Thickness <p><strong>Background:</strong> The most common preventable cause is cataract for the loss of vision, and pseudophakic cystoid macular edema, also called Irvine-Gass syndrome, is a well-known complication after cataract surgery.</p> <p><strong>Objective:</strong> To determine changes in total retinal thickness after cataract uncomplicated surgery.</p> <p><strong>Objective:</strong> To determine changes in total retinal thickness after cataract uncomplicated surgery.</p> <p><strong>Methodology:</strong> A prospective quasi experimental study was done at the department of Ophthalmology of Combined Military Hospital (CMH), Rawalakot AJK between September and December 2022. Total 28 patients (28 eyes) who underwent phacoemulsification uncomplicated surgery and grafting of intraocular lens in unilateral eye were included. The effective phacoemulsification time and total energy used during phacoemulsification cataract surgery was noted. The optical coherence tomography (OCT) scan was performed to analyze the retina thickness. Data were collected preoperatively, which serves as a baseline measurement. This baseline measurement was used to compare with measurements taken at postoperative day 1, end of week 1, end of month 1, and follow-up period month 3 to assess changes in various parameters such as total retinal thickness.</p> <p><strong>Results:</strong> The patient’s mean age comprising of 20 (71.4%) males and 8 (28.6%) females was 54.73±7.6 years. Typically, there is a transient decrease in retinal thickness, immediately after surgery (day 1), followed by a gradual increase in thickness over the weeks (first week) and months (1st &amp; 3rd month) following surgery. Overall, a positive correlation was seen between phacoemulsification time, total energy, and changes in the retinal thickness (1mm &amp; 1-3mm grids) (p ? 0.05).</p> <p><strong>Conclusion:</strong> The study concluded that a follow-up period of at least 3 months is generally recommended after surgery of cataract to assess the whether preoperative levels return of total retina.</p> <p><strong>Methods:</strong> A prospective quasi experimental study was done at the department of Ophthalmology of Combined Military Hospital (CMH), Rawalakot AJK between September and December 2022. Total 28 patients (28 eyes) who underwent phacoemulsification uncomplicated surgery and grafting of intraocular lens in unilateral eye were included. The effective phacoemulsification time and total energy used during phacoemulsification cataract surgery was noted. The optical coherence tomography (OCT) scan was performed to analyze the retina thickness. Data were collected preoperatively, which serves as a baseline measurement. This baseline measurement was used to compare with measurements taken at postoperative day 1, end of week 1, end of month 1, and follow-up period month 3 to assess changes in various parameters such as total retinal thickness.</p> <p><strong>Results:</strong> The patient’s mean age comprising of 20 (71.4%) males and 8 (28.6%) females was 54.73±7.6 years. Typically, there is a transient decrease in retinal thickness, immediately after surgery (day 1), followed by a gradual increase in thickness over the weeks (first week) and months (1st &amp; 3rd month) following surgery. Overall, a positive correlation was seen between phacoemulsification time, total energy, and changes in the retinal thickness (1mm &amp; 1-3mm grids) (p ≤ 0.05).</p> <p><strong>Conclusion.</strong> The study concluded that a follow-up period of at least 3 months is generally recommended after surgery of cataract to assess the whether preoperative levels return of total retina.</p> Anum Badar Amena Masrur Sidra Naseem Rabeeah Zafar Sarah Naveed Malik Tahira Afzal Khan Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 302 306 10.48036/apims.v19i3.796 Comparison of Catheter Related Blood Stream Infections in Hemodialysis Patients Treated With Trisodium Citrate as Catheter Locking Solution vs Heparin as Conventional Locking Method <p><strong>Objective:</strong> To compare the frequency of temporary catheter related blood stream infections using sodium citrate as catheter locking solution with heparin as standard in hemodialysis patients.</p> <p><strong>Methodology:</strong> A randomized controlled trial was conducted at a nephrology department's hemodialysis unit in Pakistan Institute of Medical Sciences (PIMS) between August 2022 and February 2023. Total 110 consecutive end-stage renal disease patients, aged above 18 years, undergoing hemodialysis with temporary central venous catheters, were divided into two groups. Group-I received trisodium citrate 46.7% as a lock solution, while Group-II received heparin 2000 U/ml (control).</p> <p><strong>Results:</strong> The average age of patients in both groups was 51.98±13.57 years. The average duration of dialysis in both groups was 4.01±3.1 months and mean catheter time in Group-I was 13.65±8.29 days and in group-II was 13.40±8.33 days with statistically insignificant (p ? 0.05). The rate of CRBSI per 1000 catheter days was 3.12 days for group I and 5.14 days for group II (p = 0.001). The cumulative mean infection-free catheter survival in the trisodium citrate group was lower than the heparin group (log rank = 2.31, p = 0.128). Cox regression survival analysis between two groups; the difference in group I &amp; II was insignificant (HR = 1.6, CI = 0.49–1.17, p = 0.201).</p> <p><strong>Conclusion:</strong> There is insignificant difference between trisodium citrate 46.7% and heparin as a catheter lock solution in the survival rate of tunneled hemodialysis catheters in end-stage renal disease.</p> Jais Kumar Karmani Saima Mir Syed Mohsin Naveed Syed Asim Ali Shah Muhammad Khalid Javaid Fareena Asim Armughan Ahmad Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 307 312 10.48036/apims.v19i3.877 Relationship between mode of delivery and rate of birth asphyxia in a Tertiary Care Hospital, Rawalpindi: A case-control study <p><strong>Abstract:</strong></p> <p><strong>Objective: </strong>To assess the relationship between mode of delivery and rate of birth asphyxia in a Tertiary care Hospital, Rawalpindi.</p> <p><strong>Methodology: </strong>This prospective case control study was conducted in Holyfamily Hospital,Rawalpindi from August 2021 to December 2021.One hundred and seventy two newborns were enrolled after assessing the inclusion criteria and divided equally into cases(neonates with birth asphyxia) and controls(neonates without birth asphyxia).A structured performa was designed to take detailed history of mode of delivery and severity of birth asphyxia by using APGAR score. Data analysis was done using SPSS 24.00.</p> <p><strong>Results: </strong>One hundred and seventy two neonates were included in the study. 110 were males (63.9%) and 62 were females (36%). Term infants were more affected with birth asphyxia rather than preterm infants(53.6%). Meconium stained liquor(61.9%) and non-booked cases(55.1%) were seen more in case group.Spontaneous vaginal delivery was the common mode among all in our study population(91%). Emergency caesarean sections have higher frequency of birth asphyxia as compared to elective caesarean sections (39.3%) but no statistically significant difference found in frequency of birth asphyxia between case and control groups with regards to mode of delivery (p value=0.620) but significant in terms of neonatal mortality(p value=0.000).</p> <p><strong>Conclusion:</strong></p> <p>Birth asphyxia is a common contributor to neonatal mortality and improving perinatal care can help in reducing neonatal morbidity and mortality in developing countries.</p> Anam Zafar Sughra Wahid Dr.Nahdia Zaman Dr.Jawaria Zia Dr.Farah Naz Dr.Anum Abdullah Copyright (c) 2023 Anam Zafar, Sughra Wahid, Dr.Nahdia Zaman, Dr.Jawaria Zia, Dr.Farah Naz, Dr.Anum Abdullah 2023-09-07 2023-09-07 19 3 Tuberculosis in Superficial Lymphadenopathy Based on Fine Needle Aspiration Cytology: A Cross Sectional Study <p>Objective: To investigate the prevalence of tuberculosis in individuals presenting with<br />superficial lymphadenopathy using Fine Needle Aspiration Cytology (FNAC) as a diagnostic<br />criterion.<br />Methodology: This cross-sectional research was carried out at HBS General Hospital in<br />Islamabad for a span of three years, commencing from July 2015 and concluding in June 2018.<br />The study included individuals who presented with superficial lymph node enlargement and met<br />the specified inclusion and exclusion criteria. All patients provided written consent before<br />undergoing fine needle aspiration cytology (FNAC). The diagnosis of tuberculosis was<br />established based on histopathological findings.<br />Results: 632 patients between the ages of 15 to 60 years underwent FNAC after clinical<br />examination and relevant lab investigations. 85.4%(n=540) had cervical lymphadenopathy<br />.57.7%(n=312) had tuberculous lymphadenitis with 58.3%(n=182) females and 41.6% (n=130)<br />males .Axillary lymphadenopathy was observed in 5.53%(n=35) patients.3.64% (n=23) females<br />and2.1% (n=13) males had tuberculous lymphadenopathy.has with3.64% (n=and 2.15<br />23)females females. Generalized lymphadenopathy was seen in 5.1%(n=32) with0.94%males<br />(n=6) and 0.79% (n=5) had histological evidence of TB on FNAC. Inguinal lymph adenopathy<br />was observed in 3.95%(n= 25) of patients 1.26%(n= 8 ) including0.94% (n=5)of males and<br />0.47% (n=3) of females<br />Conclusion: Lymphadenopathy is a prevalent clinical condition, encompassing a spectrum of<br />underlying causes, ranging from manageable tuberculosis to malignant conditions. FNAC<br />represents a safe and expeditious diagnostic technique that diminishes the necessity for<br />excisional biopsies. In our current study, cervical lymph nodes were the most frequently affected<br />site for tuberculous lymphadenopathy, with a higher occurrence among females.<br />Key Words: Lymph Node Disease, Lymphadenopathy, Lymph Node Biopsy, Enlarged Lymph<br />Nodes, Neoplasm</p> Nadeem Islam Mehreen Babar Aleena Rana Shirin Aamir Jahangir Anjum Muhammad Shahid Khan Copyright (c) 2023 Nadeem Islam, Mehreen Babar, Aleena Rana, Jahangir Anjum, Muhammad Shahid Khan 2023-11-08 2023-11-08 19 3 Time to Antibiotic Administration in Pediatric Oncology Patients Presenting to The Emergency Department with Fever and Neutropenia <p><strong>Objective:</strong> To evaluate the time to antibiotic administration (TTA) in febrile neutropenia patients, and their outcomes.</p> <p><strong>Methodology: </strong>Descriptive cross-sectional cohort Study was conducted at The Indus Hospital and Health Network in Karachi, Pakistan from April 2021 to September 2021. All the children with fever and neutropenia secondary to malignancy or oncologic treatment and those who gave consent to being part of the study were included. Clinical measures and laboratory examinations were documented. Patient records was accessed through the Hospital Management Information System to identify pediatric oncology patients presenting to the ED with fever and neutropenia (antibiotic given on clinical assessment and then neutropenia confirmed on laboratory testing). The following information were obtained for every participant: hematologic/ oncologic diagnosis, absolute neutrophil count (ANC), patient triage time, time to antibiotic order by doctor, (TTA), any barrier to TTA if given 60 minutes after triage, patient outcome 24 hours after TTA. Physician and nursing notes were reviewed to identify potential causes of delay in antibiotic administration. Data was analyzed using SPSS version 26.</p> <p><strong>Results: </strong>A total of 357 patients were studied, their mean age was 7.40<u>+</u>4.13 years. Males were in majority 66.7%. Sever neutropenia was in 41.2% of the cases. Overalled of the patients and patients related barrier were most common. 71.40% cases given antibiotics within 60 minutes, while 28.60% were given after 60 minutes. Out of all 9.0% were discharged, 48.7% were followed in daycare, 29.4% were admitted in ward, 8.7% were admitted DHU, 4.2% were admitted in ICU and 2.2% cases were died. Outcomes of the patients were statistically insignificant according to time to antibiotic given after triage (p=&gt;0.05), while ICU admission was significantly high among patients those were given antibiotic within 60 minutes (p=0.012).</p> <p><strong>Conclusion: </strong>The administration of antibiotics in pediatric oncology patients does not seem to have a significant impact on delaying the initiation. Current evidence suggests that such delays are minimal and do not have a significant impact on patient outcomes. Therefore, the use of antibiotics in pediatric oncology patients should continue to be based on clinical judgment and individual patient needs, rather than concerns about delaying initiation.</p> Hira Faheem Sana Naveed Muhammad Shamvil Ashraf Muhammad Rafi Ghulam Qadir Pathan Copyright (c) 2023 Hira Faheem, Sana Naveed, Muhammad Shamvil Ashraf, Muhammad Rafi, Ghulam Qadir Pathan 2023-09-07 2023-09-07 19 3 Barriers to uptake of postpartum Long Acting Reversible Contraception: A cross sectional study <p><strong>OBJECTIVE:&nbsp; </strong>The present research aimed&nbsp;to investigate&nbsp;factors limiting postpartum long-acting reversible contraception from being used in our system.&nbsp;&nbsp;</p> <p>&nbsp;</p> <p><strong>SETTING AND DURATION</strong>: This cross sectional study was carried out in the department of Obstetrics and Gynecology, Nishtar Medical University, Multan, from September 2022 to April 2023. &nbsp;</p> <p><strong>&nbsp;</strong></p> <p><strong>METHODS:&nbsp; </strong>A cross-sectional analysis of institutions was carried out. The study population consisted of all women who gave birth at this hospital during the study period. Data were gathered using a structured questionnaire that had been pretested. The survey asks questions about sociodemographics, reproductive health, healthcare, knowledge and attitudes about LARC, and family planning use. At discharge, a skilled nurse conducted a face-to-face interview with the patient in a quiet private room to gather the data. &nbsp;</p> <p><strong>&nbsp;</strong></p> <p><strong>RESULTS: </strong>In our study most (56.04%) of the women were between age of 26-35 years and (69.97%) belonged to urban area. Main bulk (47.68%) of the women had parity of 3-4 and majority (44.58%) of the women in sample had 0-2 alive children and (21.05%) women presented with history of previous abortion. Most (74.61%) of the women had spontaneous vaginal delivery. The rate of use of LARCs was 69 (21.36%) in our study sample. The comparison of rate of use of LARC’s was found to be significantly (P-value &lt; 0.05) associated with increasing age, increasing women education, occupation and job status. Family income, number of alive children and duration for plan to have next pregnancy were also significant (P-value &lt; 0.05) contributors for uptake of LARCs.</p> <p>&nbsp;</p> <p><strong>CONCLUSION: </strong>The rate of used of postpartum LARC was low (21.36%) in the studied population. Postpartum women from of higher age, having higher education, with formal employment, having higher level of family income, and with higher duration for plan to have next pregnancy were more likely to use LARC. &nbsp;&nbsp;&nbsp;<strong>&nbsp;</strong></p> <p><strong>&nbsp;</strong></p> <p><strong>KEY WORD: </strong>Postpartum Family Planning, Postpartum Long Acting Reversible Contraception, Uptake of LARCs,</p> Imran Sohail Sheikh Ghulam Mujtaba Nasir Hameed Mumtaz Durrani Haroon Rashid Khan Jawairiah Liaqat Copyright (c) 2023 Imran Sohail Sheikh, Ghulam Mujtaba Nasir, Hameed Mumtaz Durrani , Haroon Rashid Khan, Jawairiah Liaqat 2023-09-07 2023-09-07 19 3 Comparison of Ultrasound Biometry with Optical Biometry for Measurement of Axial Length and Calculation of Intraocular Lens Power in Patients Undergoing Routine Cataract Surgery <p><strong>Background</strong></p> <p>The most common cause of visual impairment in adults is Cataract all over the world. Ultrasound biometry and optical biometry are two methods used to calculate the power of intraocular lens by measuring the axial length. To get good refractive results after surgery the exact estimation of intraocular lens power is very important.</p> <p><strong>Objective</strong></p> <p>To compare the axial length and intraocular lens power calculated by using ultrasound biometry and optical biometry in patients with cataract</p> <p><strong>Material &amp; Methods</strong></p> <p>It was prospective, randomized control study comprising of 50 patients undergoing contract surgery in Eye Department of PIMS using non-probability consecutive sampling. Patients having traumatic or juvenile cataract, glaucoma, macular or retinal diseases, high myopes, corneal opacities or diseases, vitreal hemorrhages and uveitis were excluded. After taking informed written consent from patients biometry was performed using optical scan and ultrasound biometry (with appalation probe). Axial length and intraocular power calculated by both methods was recorded. SPSS 22 was used to analyze and enter the data.</p> <p><strong>Results</strong></p> <p>The mean axial length measurement by ultrasound of the patients’ eyes was 22.72±0.85 mm and by optical biometry was 22.67±0.86 mm. Similarly the mean intraocular lens power calculated by ultrasound was 20.60±1.56D and by optical was 20.51±1.51D. Optical and ultrasound method showed strong positive correlation in measurements of intraocular lens power and axial length of eyes, i.e. r=0.965 &amp; 0.939 respectively.</p> <p><strong>Conclusion </strong></p> <p>The findings of this study suggested that optical biometry is good alternate of ultrasound in measurement of axial length and intraocular lens power of patients, as strong correlation exist between both techniques.</p> Sumaira Rahim Nida Fatima Khadija Imran Nida Armoghan Fahmina Nazir M. Arif Khan Copyright (c) 2023 Annals of PIMS-Shaheed Zulfiqar Ali Bhutto Medical University 2023-09-07 2023-09-07 19 3 A Multi-centered study to evaluate causes of amputation amongst patients of depression and anxiety <p><strong>Background: </strong>Trauma is among one of leading causes of amputation followed by vascular disease, while other causes were uncontrolled&nbsp;diabetes, malignancies and infections. RTA was the cause of 58.8% of all traumatic amputations. Traumatic limb amputations could occur because of an occupational, agricultural, environmental, suicidal injuries, assaults, or the domestic accidents.</p> <p><strong>Materials and Methods: </strong>Three Main Rehabilitation Centers from Quetta, were involved in 3 month’s cross-sectional research. 54 subjects were included in this research. Inclusion Criteria was “newly amputees to 10years’ time since an amputation, amputees with nonpsychiatric history &amp; background, “Upper &amp; lower limb uni-lateral amputees. Exclusion Criteria was amputation because of congenital malformation, amputees from an Afghanistan, amputees with bi-lateral Amputation. Adopted structured questionnaire “Hospital Anxiety and Depression Scale” (HADS) was used. Chi-square test was done.</p> <p><strong>Results: </strong>47 were men while women were 7. 66.7% amputations were as a consequence of Traumatic injuries whereas 33.3% were as a result of non-traumatic causes. Regarding traumatic causes, major was RTA’s with 46.3% (25), while among non-traumatic diabetes stood first (1<sup>st</sup>) with 24.1%. Tumor along with fall were least responsible for amputation (4%) contribution each. Chi-square test reveals statistically insignificant relationship between anxiety, depression with different causes of amputation (p value= 0.13, 0.10) respectively.</p> <p><strong>Conclusion:</strong> RTA and diabetes were the main reasons of amputation. Causes of amputation have an impact on anxiety &amp; depression despite the insignificant relationship. Outcomes of this study can also be utilized for prevention planning.</p> <p><strong>Keywords: </strong>Amputation, Anxiety, Causes, Depression, Traumatic</p> Abdul Baqi Khan Qasim Zia Mohammad Osama Shahrukh Khan Sara Bashir Kant Rabia Mahmood Muhammad Athar Copyright (c) 2023 Abdul Baqi Khan, Qasim Zia, Mohammad Osama , Shahrukh Khan, Sara Bashir Kant, Rabia Mahmood, Muhammad Athar 2023-10-18 2023-10-18 19 3 To compare the effectiveness of Chlorhexidine and Povidine iodine in preventing surgical site infections (SSIs) in C-section deliveries <p><strong>Background</strong>: Surgical site infections (SSIs) are a significant concern in healthcare settings,</p> <p>leading to increased morbidity, mortality, and financial burden. Effective skin preparation</p> <p>&nbsp;using suitable antiseptic agents is crucial for preventing SSIs.</p> <p><strong>Objective:</strong> This study aimed to compare the effectiveness of Chlorhexidine and Povidine iodine in preventing SSIs in C-section deliveries.</p> <p>&nbsp;</p> <p><strong>Methods</strong>: The study was conducted at a medical university and hospital in Karachi, Pakistan, over a six-month period. A sample size of 35 participants was calculated, and a non-probability consecutive sampling technique was used to select participants. Two groups were randomly assigned, with Group 1 receiving Chlorhexidine gluconate and Group 2 receiving Povidone-Iodine for skin preparation. Data on various factors were recorded, and the occurrence of SSIs within ten days of cesarean delivery was assessed.</p> <p><strong>Results:</strong> The study included women aged 18 to 45 years. The efficacy of Chlorhexidine and Povidine iodine in preventing SSIs was evaluated. The results showed that Chlorhexidine was effective in preventing SSIs in 94.3% of cases, while Povidine iodine was effective in 91.4% of cases. However, no significant difference was observed between the two groups.The study results were consistent with previous research showing a reduction in SSI rates with the use of Chlorhexidine or Povidine iodine. However, other studies have reported conflicting</p> <p>findings. The overall rate of SSI was lower in the Chlorhexidine group, but contextual factors and adherence to infection control practices may influence outcomes..</p> <p><strong>Conclusion</strong>: This study contributes to the existing body of knowledge on preventing SSIs in C-section deliveries. While Chlorhexidine and Povidine iodine showed comparable efficacy, Chlorhexidine appeared to be slightly more effective in reducing SSIs. However, the limitations of the study and the need for further research in different healthcare settings should be considered.</p> Habiba Sharaf Ali Shaheena Ishtiaq Summiya Yayia Copyright (c) 2023 Habiba Sharaf Ali , Shaheena Ishtiaq , Summiya Yayia 2023-09-07 2023-09-07 19 3 Correlation of Smart Phone Addiction with Poor Sleep Quality and Low Academic Score in Medical Students of Nishtar Medical University, South Punjab <p><strong>Background:</strong> Smart phone addiction can disturb sleep quality in medical students by upsetting internal biological clock (SCN) and melatonin level which in turn adversely affects academic performance of medical students.</p> <p><strong>Objectives: </strong>To correlate smart phone addiction (SPA), poor sleep quality and low academic score in medical students and its association with gender.</p> <p><strong>Methodology</strong>: A Cross- sectional descriptive study was conducted on medical students of 4th and final year MBBS (who were mobile phone addict for more than one year). The percentage of last professional exam was taken as academic score. A proposed SPA diagnostic criterion was used to diagnose smart phone addict students. For SPA severity and sleep quality assessment Problematic Mobile Phone Use Questionnaire (PMPU-Q) and Pittsburgh Sleep Quality Index (PSQI) were used.</p> <p><strong>Results</strong>: A total of 74 subjects having mean (SD) age of 22.24 (1.929) years presented with negative correlation between academic score and PSQI (p&lt; 0.05) were included in the study. There was no significant association between academic score and smart phone addiction. The male students had worse score in dependency and dangerous use on PMUQ scale. The female students were worse in dangerous and problematic use of smart phone on PMUQ scale.</p> <p><strong>Conclusion: </strong>The SP dependency and poor subjective sleep quality of male students were negatively associated with their academic score. The female students with low academic score were worse at PSQI score, their academic score was not significantly correlated with their smart phone addiction.</p> <p><strong>Keywords: </strong>Smartphone addiction, Sleep Quality, Academic Score</p> Dr. Ghulam Mujtaba Nasir Ghulam Dastgeer Muhammad Umar Khan Afshan Batool Ahmad Naseer Khan Aneesa Altaf Copyright (c) 2023 Dr. Ghulam Mujtaba Nasir, Ghulam Dastgeer, Muhammad Umar Khan, Afshan Batool, Ahmad Naseer Khan, Aneesa Altaf 2023-09-07 2023-09-07 19 3 Transmural migration of gossypiboma into stomach: A Case Report <p>Gossypiboma is the term given to retained abdominal sponges. The statistics of its incidence is more likely to be underestimated because most of the time such cases are not reported due to the fear of medicolegal complications. Such cases causes serious morbidity and even mortality if not diagnosed. We present a case report of a rare phenomena that involved transmural migration of gossypiboma into stomach with a brief review of literature. Gossypiboma was left in abdominal cavity during open cholecystectomy and later was removed on exploratory laparotomy from the stomach. Patient recovered well with no morbidity.</p> Sana Sharafat Ali Kanza Farrukh Zakir Jamal S H Waqar Copyright (c) 2023 Sana Sharafat Ali, Kanza Farrukh, Zakir Jamal, S H Waqar 2023-11-08 2023-11-08 19 3 10.48036/apims.v19i3.900