Pakistan Institute Of Medical Sciences Research Articles

The Impact of Cognitive Behavioral Therapy on Depressive Symptoms in Patients with Type 2 Diabetes Mellitus

Background: Diabetes and depression are major issues globally, with CBT identified as the most effective treatment for depression. Self-help CBT in Pakistan has shown positive results for depression treatment. A study has found that CBT leads to a higher remission rate for depression in Type 2 diabetes patients, highlighting the need for proper treatment of diabetes-related depression to improve health outcomes.Methods: In a randomized controlled trial a total of 32 patients with diabetes and depression were allocated to CBT therapy (n=16) and controls without CBT therapy (n=16). The study was conducted at the Department of Psychiatry, and diabetic’s clinic of Department of General Medicine, Pakistan Institute of Medical Sciences, Islamabad, in a period of 2 months. Known cases of Type 2 Diabetes fulfilling the diagnostic criteria of Depression and anxiety using DSM –V research criteria, and who lived within the catchment area were approached. Formal approval from hospital ethical committee and written informed consent from participants were obtained. Those persons, who agreed to enter the study, were assessed 2 weeks after the first screening, to fill in the baseline measures when they attended their first appointment. These persons were asked to attend further appointments and were assessed every two weeks till end of the study final assessment were made. Results: The mean age of patients was 50.9 + 7.5 years in group A (CBT) and 45.4 + 10.1 years in group B (without CBT). Male and female cases were equally selected in both groups respectively. The mean HADS was found similar at baseline in both study groups while post intervention phases in group A, greater improvement was observed (8.8 + 2.6) compared to (10.3 + 2.9) in group B. The WHO quality of life scale was almost similar in both groups at baseline, however, greater improvement in quality of life was observed in group A (90.7 + 9.0) compared to group B (82.1 + 13.9) and the difference in mean WHOQOL was found statistically significant (p-value = 0.04). Conclusions: The CBT intervention has a clear role in the management of depression in diabetic patients. In this study it has shown significant improvement in the health and depression scales and also in the overall quality of life according to WHO scale.

Impact of health-related internet use on disease management behavior of chronic patients: Mediating role of perceived credibility of online information

During the last two decades, Internet use has increased in all parts of the world. Although, the trend of actively using the Internet for seeking health-related information was already on the rise, it accelerated soon after the COVID-19 pandemic. Along with the increased use of the Internet for health decisions, serious concerns have been raised due to fake or misinformation. This study aims to determine the impact of Internet use for gathering health-related information on the disease management behavior of patients and to identify the mediating role of perceived credibility of online information. The study surveyed 200 chronic disease patients with diabetes and hypertension from the Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. It is concluded that overall health-related Internet use has a positive impact on the disease management behavior of chronic disease patients. The study further confirms the mediating role of the perceived credibility of online information. Patients who are frequent users of the Internet for health information, who perceive online information more credible, reported better disease management behavior as compared to the less frequent users and those who perceive online information less credible.

Study of metabolic syndrome indicators in newly diagnosed diabetes mellitus type 2 patients in Pakistani population.

Metabolic syndrome (MetS) being a biological abnormality confers the highest risk of type 2 diabetes mellitus (T2DM). To assess MetS indicators in the newly diagnosed T2DM Pakistani population. A cross-sectional study (N = 123) with newly diagnosed T2DM patients (gender: both, MeanAge: 49.24 ± 6.84 years) was selected from Medical OPD, Pakistan Institute of Medical Sciences, Islamabad. Basic profile, family history, and physical activity were recorded through a predesigned questionnaire, dietary intake through seven days Food Diary and Food Frequency Questionnaire. Blood pressure and selected clinical signs and symptoms were recorded. Anthropometric measurements included mid-upper arm circumference (MUAC), body mass index (BMI), waist circumference (WC), waist-and-hip ratio (WHR), waist-to-height ratio (WHtR), and conicity index. Lab parameters included fasting blood glucose, HbA1c, insulin levels, and lipid profile. Homeostatic model assessment of insulin resistance (HOMA-IR) was computed to assess insulin resistance. Almost all parameters related to MetS were higher than normal. The prevalence of MetS was 59.7%. BMI, MUAC, and WHtR were independently associated with HOMA-IR, but WC, WHR, and the conicity index had no relationship MetS indicators. The prevalence rate of MetS was found to be 59.7% in newly diagnosed T2DM patients. MUAC was found to be a better parameter for the diagnosis of central obesity and insulin resistance in the selected population.

Relationship of Hearing Loss and Tympanic Membrane Perforation Characteristics in Chronic Suppurative Otitis Media Patients.

Objective The objective of this study is to assess the relationship between the site of tympanic membrane (TM) perforation and the type and degree of hearing impairment. The secondary objectivewas to compare the duration of the disease and the degree of hearing loss. Study design This is a prospective observational study. Place and duration of the study This study was carried out in the Department of Otolaryngology/Head and Neck Surgery at the Pakistan Institute of Medical Sciences, Islamabad, from May 2021 to April 2022. Patients and methods Of all the screened patients, 77 fulfilled the inclusion criteria. Patients aged 10-40 years with inactive mucosal chronic otitis media and unilateral perforation in one quadrant were included. The site of TM rupture was observed, and audiometric analysis was performed. Results The mean age of participants was 25 ± 8.61 years, with a preponderance of the female gender (57.1%). A total of 32 (41.6%), 19 (24.7%), 19 (24.7%), and seven(9.1%) perforations involved posterosuperior, anterosuperior, anteroinferior, and posteroinferior quadrants respectively. Conductive, mixed, and sensorineural hearing loss was found in 52 (67.5%), 18 (23.4%), and seven (9.1%) cases, respectively. Of all the subjects, 13 (16.9%) had the disease for < one year, 39(50.6%) for one to five years, 17 (22.1%) for five to 10 years, and eight (10.4%) for > 10 years. There was a statistically significant association between the degree of hearing loss and the site of perforation. No significant association was found between the site of perforation and thetype of hearing loss. Duration of disease and degree of hearing loss also had no significant association. Conclusion The extent of hearing loss was found to be directly influenced by the anatomical site of perforation, with the posterosuperior quadrant perforation producing the greatest degree of impairment.

The prevalence of fibromyalgia among doctors in the tertiary care hospital: A cross-sectional study.

Fibromyalgia syndrome (FMS) is an umbrella term for chronic pain syndrome, associated with tenderness, fatigue, reduced pain thresholds, and paresthesia in the limbs. The field of medicine places doctors in constant work-related stress, sleep deprivation, and depression, thus increasing their vulnerability to developing FMS. This study aims to evaluate the prevalence and severity of FM (fibromyalgia) among physicians in a tertiary care hospital setting. The cross-sectional study was performed at the Pakistan Institute of Medical Sciences, Islamabad, Pakistan, from December 2019 to December 2020.243 physicians of either gender, and from all the departments being house officers, medical officers, and post-graduate trainees were included & divided into 3 age groups from 20 to more than 45 years. Widespread Pain Index (WPI) equal to or more than 7 and Symptom Severity Score (SSS) equal to or more than 5 OR WPI=3 to 6 and SSS equal to or more than 9 were required, according to the modified American College of Rheumatology preliminary diagnostic criteria 2016 for fibromyalgia diagnosis. Data was analyzed using SPSS 25. Among a total of 243 participants, FMS was diagnosed in 69 (28.40%) individuals. The predominant FMS population was the youngest age group 20-35 (56=81.16%). Increased BMI, increasing pain score category, gender, and comorbidities are significantly associated with FMS (p≤0.05). Whereas, advancing age is insignificantly linked with FMS (p>0.05). The prevalence of fibromyalgia was found to be high among doctors working in stressful hospital settings, particularly among the youngest ones.

Comparison of PD-L1 Expression in Oral Squamous Cell Carcinoma and Premalignant Lesions of Oral Cavity

Objectives of this study were to compare expression of Programmed Death-Ligand 1(PD-L1) protein in oral squamous cell carcinoma (OSCC) and oral potentially malignant disorder (OPMD) cases; and to compare the PD-L1 protein expression in histological grades of OSCC and also in OPMD's with Dysplasia and without Dysplasia. In this study, 25 cases of Oral squamous cell carcinoms, 25 cases of Oral Potentially Malignant Disorders and 10 cases of non-neoplastic oral mucosa (control) cases were included. FFPE blocks of OSCC and OPMD cases were contributed by Department of Pathology, Histopathology Division,Pakistan Institute of Medical Sciences, Islamabad. Immunohistochemical staining of cases with PD-L1 monoclonal antibody (1:100; Dako) was carried out at Histopathology division , PMC Labs, Peshawar Medical College,Peshawar, Riphah International University, Islamabad . Epithelial cells (membranous and cytoplasmic) positivity was observed for PD-L1 Antibody. Data was analyzed in SPSS version20. For qualitative variables frequencies and percentages were calculated whereas for quantitative variables means and standard deviations were recorded. The Chi-square test was applied to evaluate the significant difference in categorical variables . p-value of ≤0.05 was taken as significant. PD-L1 expression in OSCC cases turned out to be 48% (n=12/25) as compared to 8% of OPMD cases (n=2/25) with a significant p value of 0.002 and all non-neoplastic oral mucosa cases were negative. PD-L1 expression in high grade OSCC cases was quite high (61% n=11/18) as compared to low grade OSCC (14% n=1/7) cases with a significant p value of 0.035. A statistically significant increased PD-L1 expression was noted in OSCC as compared to OPMD. Expression of PD-L1 was more intense in high grade OSCC cases. The relation of PD-L1 expression to age ,gender or location of OSCC and OPMD cases , and presence of dysplasia in OPMD cases was statistically not significant.

Diagnostic Accuracy of Triphasic CT in the Characterization of Incidental Focal Liver Lesions

Objectives: To determine the diagnostic accuracy of triphasic CT in the diagnosis of focal liver lesions as benign or malignant by using histopathology as the gold standard. Methods: This descriptive cross-sectional study was carried out at the diagnostic radiology department of the Pakistan Institute of Medical Sciences (P.I.M.S.) in Islamabad.110 individuals with localized liver lesions between the ages of 15 and 65 years and both genders were included. All of the study subjects were then undergoing triphasic CT scan of the liver. The CT findings were recorded as benign or malignant and correlated with histopathology findings. Data collection was done by using the self-structured proforma. Results: Patient’s mean age was 43.92 ± 12.87 years. Out of all, males were 68 (61.82%) and females were 42 (38.18%), with a female-to-male ratio of 1:1.6. Malignant lesions were 73 (66.36%) and 37 (33.54%) patients had benign lesions as per Triphasic CT diagnosis. Furthermore, in these 73 malignant cases, 67 cases were observed with malignant lesions and 6 cases had benign lesions on histopathology, while among the 37 CT cases of benign lesions, 8 cases had malignant lesions as per the histopathological diagnosis. Although triphasic CT showed 89.33% sensitivity and 82.86% specificity in the diagnosis of focal liver lesions by using histopathology as the gold standard. Conclusion: Triphasic CT was observed to be a non-invasive, accurate, and highly sensitive imaging technique in the diagnosis of focal liver lesions, whether (benign or malignant). Therefore, it can be used frequently to lower the number of pure diagnostic biopsies. Keywords: Malignant hepatic lesions, non-invasive, imaging modality, sensitivity

Diagnostic Accuracy of Doppler Ultrasound in Testicular Torsion Keeping Surgical Findings as the Gold Standard

Objective: To determine the diagnostic accuracy of ultrasound with Doppler analysis in testicular torsion, keeping surgical findings as the gold standard.&#x0D; Study Design: Cross-sectional validation study&#x0D; Place and Duration of study: Radiology Department of Pakistan Institute of Medical Sciences, from Dec 2017 to Dec 2019.&#x0D; Methodology: The study included 58 candidates of acute scrotum who were clinically equivocal with a strong suspicion of testicular torsion and were referred by the concerned surgery department to Radiology, where a senior resident performed the testicular ultrasound. The grey scale features, along with doppler findings, were noted. Only those cases that underwent surgical exploration were included. The clinical, sonological, and per-operative findings were recorded.&#x0D; Results: The mean age of our study was 18.00±6.02 years. The sensitivity, specificity, positive predictive value and negative predictive value of Doppler ultrasound were 98%, 86%, 98% and 86%, respectively. The most consistent Doppler ultrasound feature was absent intra-testicular flow, found among 46 out of 50 surgically confirmed cases of testicular torsion, while four had reduced intra-testicular flow. Similarly, heterogeneous testicular echotexture was the most frequently met grey scale feature. The sonological Whirlpool sign in our study came had 69% sensitivity and 100% specificity.&#x0D; Conclusion: The overall diagnostic accuracy of ultrasound is significantly high, especially when both greyscale and colour Doppler findings are simultaneously interpreted. The sensitivity of ultrasound in diagnosing testicular torsion is far more than its specificity.

Perceived Social Support as a Predictor of General Health in HIV+ Patients: Moderating Role of Gender

Human Immunodeficiency Virus (HIV) affects the functioning of the human immune system (HIS). Objectives: To evaluate the predictive role of social support in general health among HIV+ patients, and the moderating role of gender between social support and general health. Methods: Cross-sectional study was carried out at the Jinnah Hospital Lahore, Pakistan Institute of Medical Sciences (PIMS), Association of people living with HIV and AIDS Islamabad, and New Light AIDS control program (NGO) Rawalpindi from February 2019 to March 2020. Berlin Social Support Scale and General Health Questionnaire were used to assess perceived social support and general health among HIV patients. Results: Social support significantly predicted general health components (p &lt; .001), and significant moderating effect of gender (β= -.32, t = 2.49, p&lt;.05) was found between social support and general health among HIV patients. Conclusions: Social support emerged as a protective factor of general health in HIV+ patients in Pakistan that helped them to manage stress and fight with their illness. The high level of social support system tends to decrease general health problems among HIV + patients; however relationship between perceived social support and general health was stronger among women as compared to men.

Frequency of Urinary Tract Infection in Febrile Children without Any Focus on Infection

Background: In newborns and young children, a urinary tract infection is a frequent hidden cause of fever. Children younger than a year old who appear with fever and symptoms of UTI are usually given treatment for something else. Objectives: The objective of this study was to assess the prevalence of UTI in children presenting to a tertiary care hospital between the ages of 1 month and 36 months with nonspecific fever. Duration and study settings: The Children's Hospital Pakistan Institute of Medical Science, SZABMU, Islamabad, was the site of this trial, which ran from Jan 2018 to June 2018. Study design: Descriptive cross sectional Methodology: After a complete medical history and physical examination, a urine sample was taken for testing and culture using a soft tube in younger children and a clean catch approach in older children or those who are cooperative. Urisys 2400 was used to analyse the urine samples. Larger children's urine samples were grown on CLED agar plates (cysteine lactose, electrolyte deficient). Clinitek Siemens, a haematology analyser, was used to determine the number of white blood cells in the blood. The Pakistan Institute of Medical Sciences in Islamabad is home to a state-of-the-art laboratory where tests including leucocyte count, urine DR, and culture were conducted. A pre-designed proforma was used to record the patient's demographic information, medical history, diagnosis, and laboratory results. Results: In this study, 6.47 percent (n=18) of 278 children aged 1 to 36 who presented to a tertiary care hospital with a fever and no other obvious signs of infection were found to have a urinary tract infection. Conclusion: Children arriving to a tertiary care hospital with a fever and no other signs of infection are not likely to have a urinary tract infection. Keywords: UTI in children with diffuse fever and no obvious source of infection.

Role of Different Oral Anticoagulants Used During Diabetes-Related Complications in Patients with Atrial Fibrillation

Introduction: Globally, cardiovascular disease is the main contributor to mortality, accounting for about 17.5 million deaths, or 46.2% of deaths from non-communicable diseases. Objectives: The main objective of the study is to find the diabetes-related complications and mortality in patients with atrial fibrillation receiving different oral anticoagulants. Material and methods: This cross-sectional study was conducted in Pakistan Institute of Medical Sciences, hospital Islamabad from August 2021 to May 2022. The data were collected from 120 diabetic patients who were diagnosed with AF. After permission from the hospital ethical committee, a total of 120 patients meeting the inclusion and exclusion criteria was enrolled in the study. A detailed history of DM and physical examination were done to meet the inclusion and exclusion criteria. Results: The data were collected from 120 patients. Out of 120 participants, 60 were treated with warfarin while 60 were considered as the control group. The median age was 26 years in group I and 25.3 years in group II (p=0.705). Female cases counted for 41 (86%) and 19 (14%) in the I and II groups, respectively. Conclusion: It is concluded that patients with AF and diabetes have a high overall cardiovascular risk. Non–vitamin K antagonist oral anticoagulants were associated with lower hazards of diabetes complications and mortality than warfarin in patients with AF and DM.

Real World Data about the Characteristics of Adult Diabetes Mellitus Patients Visiting Outpatient Department of a Tertiary Care Hospital

Objective: To find our characteristics of adult diabetes mellitus (DM) patients visiting outpatient department (OPD) of a tertiary care hospital. Study Design: Observational, cross-sectional study. Place and Duration: Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad Pakistan from October 2021 to March 2022. Methodology: We included a total of 200 patients. Inclusion criteria were patients of both genders aged 18 to 70 years having type-1 and type-2 diabetes mellitus with a disease duration history of at least 6 months visiting outpatient department. Socio-demographic data along with DM related characteristics including family history of DM, types of DM, types of medications being used and fasting/postprandial blood glucose levels were recorded. Frequency of various DM related complications at the time of enrollment were also noted. Results: In a total of 200 patients of DM, 129 (64.5%) were male and 71 (35.5%) female. Overall, mean age was 45.03±12.46 years while 91 (45.5%) patients were aged between 31 to 45 years. Mean BMI was 23.33±4.75 kg/m2. Positive family history of diabetes was found in 98 (49.0%) patients. Type-1 diabetes mellitus was reported by 13 (6.5%) patients while remaining 187 (93.5%) patients had type-2 diabetes mellitus. Mean Duration of diabetes was 7.65±7.60 years. There were 91 (45.5%) patients who were using oral plus injectable/insulin medications. Overall, mean fasting blood glucose was 148±49.06 mg/dl while mean 2-hour postprandial blood glucose was 235.07±58.80 mg/dl. Neuropathy was the most common diabetes related complications noted in 91 (45.5%) while gastrointestinal related complications were the 2nd most frequent complications observed in 31 (15.5%). Practical Implications: Vast majority of the DM patients reported hyperglycemia during routine follow ups which arises the need to revisit current management strategies. Conclusion: Majority of the patients with DM were male, middle aged and belonged to urban areas of residence. Nearly half of the DM patients reported neuropathy related complications. Keywords: Diabetes mellitus, neuropathy, hyperglycemia, insulin.

Assessment of quality of life of stroke survivors and their caregivers presenting to a tertiary care hospital in Pakistan.

To determine the quality of life of stroke survivors and their caregivers presenting to a tertiary care setup. The descriptive study was conducted from July to December 2019 at the Neurology Department, Pakistan Institute of Medical Sciences, Islamabad, Pakistan, and comprised patients of either gender with ischaemic or haemorrhagic stroke aged 40-70 years and their caregivers. Data was collected using the stroke-specific quality of life Scale and the caregiver quality of life questionnaire. Data was analysed using SPSS 20. Of the 80 patients, 50(62.5%) were males and 30(37.5%) were females. The overall mean age was 61.46±11.80 years, and 56(70%) were aged >55 years. Among the patients, speaking power, mobility and mood were more affected with mean levels of 15.51±8.63, 22.63±8.33 and 19.08±7.05, respectively. The domains of social role, self-care and upper extremity function were also affected with mean values of 19.022±7.06, 15.71±8.81 and 18.88±7.02, respectively. Among the caregivers, the levels of physical wellbeing and functional wellbeing were high 15.07±5.65 and 15.35±5.76, respectively. There were differences in terms of age and gender but the difference was not significant (p>0.05). The quality of life of stroke survivors was low, and that of caregivers was also quite compromised.

Hyponatremia As A Marker Of Complicated Appendicitis.

The most frequent cause of paediatric acute abdomen is acute appendicitis. If acute appendicitis is not treated promptly, one third of cases progress to complicated appendicitis. Complicated appendicitis is associated with significant morbidity and its management protocol differs significantly from that of uncomplicated appendicitis. In this study, we assessed the relationship between serum sodium levels and complicated appendicitis. We conducted a prospective observational study from July to December 2020 at the Department of Neonatal and Paediatric Surgery, The Children Hospital, Pakistan Institute of Medical Sciences, Islamabad, on a sample size of 140 patients who met inclusion and exclusion criteria. For this study, we divided the patients into two groups. Group 1 had uncomplicated appendicitis and Group 2 had complicated appendicitis. These findings were then compared to preoperative serum sodium (Na) levels. The median serum sodium level in group 1 (uncomplicated appendicitis) was 137.81 mg/dl, while in group 2 it was 131.35 mg/dl (Complicated Appendicitis). The sensitivity and specificity of serum sodium levels at a cut-off point of less than 135 mg/dl were 84.80% and 89.40%, respectively. Hyponatremia is currently thought to be a new marker for differentiating between complicated and uncomplicated appendicitis. It is a low-cost, high efficiency predictive marker for diagnosing and differentiating complicated appendicitis in children.

Lymphocytopenia delays recovery in COVID-19 infected patients.

Objective: To observe the effect of reduced lymphocyte count on the recovery of Covid 19 infected patients. Study Design: Observational study. Setting: Rawal Institute of Health Sciences Islamabad, Pakistan Institute of Medical Sciences, Islamabad. Period: March 2021 till June 2021. Material &amp; Methods: Sample Size: One hundred adult humans suffering from COVID-19 infection. Hundred adult patients with positive PCR test for corona virus were selected. Adult patients belonging to both genders with reduced lymphocyte count and no immunological and blood disorder were included and those below the age of 18 years with any disorder related to immune system or blood were excluded. Adult patients were divided in two groups A and B with 50 patients in each group. Lymphocyte count of all the patients was noted from the record in the laboratory of Rawal institute of health sciences and Pakistan institute of Medical sciences Islamabad. Group A were those whose lymphocyte count was close to reference range and group B were those whose lymphocyte count was very low. Follow up of all the patients was done. Reduction and disappearance of symptoms like fever and cough were considered as recovery symptoms. Statistical Analysis: Data was entered using SPSS version 25. Data was checked for normality by using shapirowilk test. The comparison in the days of recovery with the lymphocyte count showed a significant difference of P value of 0.00. Results: Group A patients had mean lymphocyte count 0.87 x 109 / L and Group B had mean lymphocyte count of 0.45 x 109 / L. The average recovery time for corona virus infected patients with marked reduction in lymphocyte count is 19 days and those with mild reduction in lymphocyte count the average recovery time is 12 days. Conclusion: Patients suffering from COVID-19 infection with less lymphocytopenia showed early recovery and disappearance of symptoms as compared to those with more lymphocytopenia.

Comparison of Intralesional Triamcinolone Acetonide Injection versus Surgical Intervention for Management of Primary Chalazion

Purpose: To compare the effectiveness of intralesional steroid injection versus Incision and curettage in management of primary chalazion. Study Design: Quasi experimental study. Place and Duration of Study: Department of Ophthalmology, Pakistan Institute of Medical Sciences, Islamabad, from August 2020 to January 2021. Methods: Eighty patients were divided into two groups of 40 each through consecutive sampling. Patients with primary chalazion of the size &gt;5mm, age group 18 to 50 years and either gender were included. Patients with recurrent, multiple and infected chalazia were excluded. All patients underwent complete ocular examination. Group A underwent Incision and curettage while in group B a 28 gauge needle with a 1 ml syringe was used to inject 0.25 ml of 40 mg/ml Triamcinolone Acetonide into the chalazion via transcutaneous route. Success was defined as 80% reduction in the size of chalazion after one month. The chi-square test was used for equivalence of treatment efficacy between the groups. Results: Age range in this study was 18 to 50 years. Mean age was 34.10 ± 5.87 years in Group A and 35.975 ± 7.60 years in Group B. The procedure was successful in 31 (77.5%) individuals in group A and 33 (82.5%) individuals in group B (P = 0.576), which was statistically insignificant. Stratification with respect to gender and age also showed no statistically significant difference between the two groups (p &gt; 0.05). Conclusion: Intralesional steroid injection and Incision/curettageare equally effective in management of primary chalazion.

Utility of Cell Block with p53 Immunostain in Diagnosing Urothelial Carcinoma

Background: Urine cytology is an initial noninvasive screening test done in patients with suspected urothelial carcinoma. The objective of this study was to compare the sensitivity of conventional smear cytology with cell block technique for the diagnosis of malignant cells in urine and to assess the efficacy of p53 immuno-marker in the diagnosis and prognosis of urinary bladder cancer.&#x0D; Methodology: The study was carried out in the department of Histopathology, Pakistan Institute of Medical Sciences(PIMS), Islamabad. Cell blocks and cytology smears and were prepared from urine samples of 80 patients of urothelial carcinoma and p53 stain was applied. Data was analyzed using version 21. Sensitivity of conventional smear and cell block techniques were calculated for both low and high grade urothelial carcinomas.&#x0D; Results:The sensitivity of detecting atypical cells using conventional smear was 31% and 70.6% for low grade and high grade urothelial tumors respectively. The sensitivity increased to 41.4% and 84.3% for low and high grade urothelial carcinomas respectively with cell block technique. Positive p53 stain was seen in 13.8% of cases with low grade tumors and 66.7% cases with high grade tumors. Chi-square test was used to find the association of cytology findings with the histologic grade.&#x0D; Conclusion: Sensitivity of urine cell blocks is higher than the conventional smear method for detecting high grade lesions. It can be used as an efficient non-invasive technique and an adjunct tool for the determination of disease relapse and overall survival in patients.&#x0D; Keywords: Carcinoma, Cytology, P53 Protein, Urine

Relationship of Diabetes Mellitus Among The Patients Reporting With Fascial Space Infection

Objective: To determine the frequency of diabetic patients having Odontogenic Maxillofacial space infections in local population. 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. 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. 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.

Diagnostic Accuracy of Ultrasound for Small Bowel Obstruction in Paediatric Population Undergoing Laparotomy Keeping Surgical Findings as the Gold Standard

Objective: To analyze the diagnostic accuracy of ultrasound in small bowel obstruction in the paediatric population and compare it with surgical findings.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Radiology Department, Pakistan Institute of Medical Sciences, Islamabad Pakistan from Jun 2018 to Jun 2019.&#x0D; Methodology: This study enrolled 84 paediatric small bowel obstruction cases who underwent exploratory laparotomy at the Pakistan institute of medical sciences from Jun 2018 to Jun 2019. The clinically suspected cases of small bowel obstruction were referred by paediatric surgery to the Radiology department, where an ultrasound abdomen was performed by a senior resident, exclusively targeting the bowel. The clinical, sonological, and per-operative findings were recorded on a proforma.&#x0D; Results: The mean age in our study was 3.5±2.7 years. A male gender predominance was noted. The most consistent greyscale feature favouring bowel obstruction was dilated bowel loops, found among 98.7% (76 out of 77) of surgically confirmed cases of bowel obstruction. The sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of ultrasound were 98.7%, 71.4%, 97.4%, 83.4% and 94.6% respectively. The sonological cause of obstruction was readily demonstrated among 51 (67%) out of 76 true positive cases. The most common site of obstruction was the distal ileum, with intussusception being the leading cause found among 32% of true positive cases.&#x0D; Conclusion: The overall diagnostic accuracy of ultrasound in revealing small bowel obstruction is high among the paediatric population.

HAEMATOLOGICAL PARAMETERS AND THEIR SIGNIFICANCE IN PREDICTING SEVERITY IN TERMS OF TUMOR GRADE IN PATIENTS WITH ORAL SQUAMOUS CELL CARCINOMA

Objective: The objective of our study was to determine the most reliable haematological parameters for assessing the tumor severity with respect to histological grade in patients with Oral Squamous Cell Carcinoma. Material and Methods: This retrospective cross-sectional study was conducted at Pathology Department, Pakistan Institute of Medical Sciences, Islamabad from January to December 2019. Fifty-eight patients of Oral Squamous Cell Carcinoma were selected by consecutive non-probability sampling. Preoperative hemogram values including total leukocyte count, red cell count, hematocrit, hemoglobin, red cell indices, platelet count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio were recorded and was studied how these parameters differed among the histological grades of tumor. Stratification of patients was done based on gender and histological grade of tumor. Independent-sample t-test for gender and ANOVA-test for histological grade was applied to assess differences in haematological parameter measurements between the groups. P&lt; 0.05 was considered significant. Results: Anemia was observed as a common finding in our patients seen in 24% cases. Mean platelet count was within normal range. We observed that the haematological parameters i.e. total leukocyte count, absolute neutrophil count, absolute lymphocyte count, neutrophil to lymphocyte ratio and platelet to lymphocyte ratio varied significantly with the advancing grades of the tumor from well-differentiated to poorly-differentiated keratinizing oral squamous cell carcinoma. Conclusion: The pre-surgical haematological profile holds many prognostic indicators, useful in predicting tumor severity in terms of histological differentiation of tumor. Key Words: Oral squamous cell carcinoma, Prognosis, Histology