Journal of Islamabad Medical & Dental College 2022-10-18T10:23:40+05:00 Dr. Khalid Hassan Open Journal Systems <p>The Journal of Islamabad Medical &amp; Dental College (JIMDC) is a new quarterly Journal of Islamabad Medical &amp; Dental College. <strong>Its is recognized By Pakistan Medical and Dental Council (PMDC</strong>) <strong>and Higher Education Commission of Pakistan</strong>. It includes original research papers, reviews, case reports<strong>,</strong> and short communication related to health, medicine and dentistry. Submitted manuscripts must be original, written in English, and will be accepted for publication with the understanding that it has not been submitted simultaneously to any other journal, not published or under consideration elsewhere and has not been published previously. The manuscripts will be reviewed through double-blind peer review process.&nbsp;</p> Universal Health Coverage in Pakistan: A call for Health System Reforms 2022-09-29T07:15:47+05:00 admin jimdc Babar Tasneem Sheikh 2022-09-28T00:00:00+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College A breakthrough in Alzheimer’s Disease 2022-10-11T14:41:16+05:00 Taimoor Hassan <p>Alzheimer's disease is among the most prevalent types of dementia worldwide. Studying mice models, Australian researchers discovered one of the possible origins of Alzheimer's disease. The discovery has been termed a "breakthrough" by some. Scientists have gained a better grasp of why and how Alzheimer's disease arises by researching the blood-brain barrier. Their findings point to possible therapy and preventive strategies for the neurodegenerative disorder.</p> 2022-09-28T00:00:00+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College The Impact of Disease Severity and Treatment on Quality of Life in Patients of Psoriasis 2022-10-12T14:03:12+05:00 Palvisha Qadri Saadia Tabassum Umm-e- Aiman Chhipa <p><strong>Background:</strong> Psoriasis is a common inflammatory dermatosis with significantly challenging clinical needs in patient management. Given its chronicity and social stigmatization, the burden on health-related life quality is substantial. The objective of this study was to assess <em>psychosocial and financial</em>&nbsp;impact of disease severity&nbsp;and treatment modalities on patients’ life quality.</p> <p><strong>Methodology: </strong>A total of 93 clinically diagnosed patients with Psoriasis were included in this cross-sectional study. Quality of life was assessed through Dermatology Life Quality Index (DLQI) scoring system and disease severity by Psoriasis area severity index (PASI) respectively. Treatment modalities were evaluated by filling out a brief questionnaire. Descriptive analyses were presented as mean ± SD for symmetrically distributed variables while median with interquartile range (IQR) were reported for non-symmetrically distributed variables. Association was determined by Chi-square test considering p-value ≤0.05 as significant.</p> <p><strong>Results:</strong> There were 47.3% male and 52.7% female patients. The Median DLQI score was 6.00 with an IQR of 7. Topical treatment was used in the majority of patients currently (60%). Quality of life ( QOL) for 41.9% of cases was mildly affected. Rest of the cases were affected more severely, consisting of 47.3% with moderate and 10.8% with severe impact on quality of life. Significant association of DLQI scores was found with disease severity and current treatment modalities.</p> <p><strong>Conclusion: </strong>Different therapies along with disease severity, remarkably affect QoL among psoriasis patients.</p> <p><strong>KEYWORDS</strong></p> <p>Disease Severity ,Impact, Psoriasis , Quality of Life<strong>, </strong>Treatment</p> 2022-09-28T14:07:45+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College Utility of Cell Block with p53 Immunostain in Diagnosing Urothelial Carcinoma 2022-10-12T13:29:21+05:00 Alina Ali Nosheen Nabi Maryam Fatima Armaghana Qamar Khan Henna Azmat Ashok Kumar Tanwani <p><strong>Background:</strong> 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.</p> <p><strong>Methodology: &nbsp;</strong>&nbsp;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.</p> <p><strong>Results:</strong>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.</p> <p><strong>Conclusion: </strong>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.</p> <p><strong>Keywords: </strong>Carcinoma, Cytology, P53 Protein, Urine</p> 2022-09-28T14:09:14+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College Mitotic Index and Immunohistochemical Expression of Ki-67 in Pleomorphic Adenoma of Salivary Glands 2022-10-12T13:31:17+05:00 Faiz Rasul <p>.</p> <p><strong>Background</strong>: Pleomorphic adenomas (PAs) are the most common type of salivary gland tumors (SGTs) which may undergo malignant transformation to Carcinoma ex PA (CaExPA). The purpose of this study was to determine mitotic index (MI) and expression of Ki-67 in Pleomorphic adenomas of salivary gland tumors.</p> <p><strong>Methodology: </strong>This study was carried out on sixty patients of pleomorphic adenoma. Slides with specimens were stained with Hematoxylin &amp; Eosin to count Mitotic index. Labeling Index (LI) of Ki-67 was determined immunohistochemically. Mitotic figures (MF) were counted in 10 HPF selected in the proliferative area. MI was scored as<strong> 1</strong> (0 to 4 MF per 10 HPF); <strong>2</strong> (5-9 MF per 10 HPF) and <strong>3</strong> (&gt; 9 MF per 10 HPF). Immunoexpression of Ki-67 was scored as ‘0-negative’ when &lt;5% of neoplastic cells stained, ‘1-weak positive’ when 5-19% of neoplastic cells were stained, ‘2-moderate positive’ when 20-49% of neoplastic cells were stained, and ‘3-strong positive’ when &gt;50% of neoplastic cells were stained with Ki-67. Data was, entered in SPSS 21.</p> <p><strong>Results: </strong>Mean age was 38.7 ± 12.86 years. Out of 60 cases, 26 (43.33%) were of males while 34 (56.67%) were of females. Expression of Ki-67 was negative in 50% while remaining weak positive. Only score 01 of MI observed.</p> <p><strong>Conclusion:&nbsp; </strong>Ki-67 is more sensitive marker than mitotic index in pleomorphic adenomas even in small sized tumors and it can help in detection of malignant transformation of PAs.</p> <p><strong>Keywords: </strong>Adenomas, Immunohistochemistry, Ki-67 Antigen, Parotid Neoplasms, Pleomorphic</p> 2022-09-28T14:10:59+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College Outcome of Ultrasound Guided Trucut Biopsy of Adnexal Masses with Suspected Malignancy 2022-10-12T14:09:14+05:00 Syeda Zakia Shah Sara Shahid Syed Murtaza Hussain Hadia Hina Hyder Wajid Abbasi Haseeb Noor <p><strong>Background: </strong>Ultrasound guided sampling techniques are frequently used in the tissue diagnosis of various tumours. Female patients commonly present with adnexal masses and require tissue diagnosis by trucut biopsy for initiation of the treatment. This study was done to determine the outcome of ultrasound guided trucut biopsy in patients presenting with suspected adnexal malignancy.</p> <p><strong>Methodology:</strong> This cross sectional study was done at the Department of Radiology, MCH Centre, PIMS hospital, Islamabad from October 2018 to September 2020. In this study, all female patients aged 18 years and above with suspected adnexal malignancy were included. Trucut biopsy was performed under ultrasound guidance, sample sent for histopathology and various histopathological outcomes were assessed. Patients were kept under observation for 2 hours following biopsy. The data was entered and assessed by using SPSS version 24.0. Frequencies and percentages were calculated for nominal data and mean and standard deviation for numerical data.</p> <p><strong>Results</strong>: Mean age of the subjects was 50.24±10.52 years and mean duration of symptoms was 2.97±1.23 months. Definitive diagnosis made in 59 (95.1%) out of 62 cases and only 3 (0.04%) cases were inconclusive; among which two showed inadequate sample and one showed normal tubo-ovarian tissue. 90% histopathological findings were conclusive and no complication was reported.</p> <p><strong>Conclusion: </strong>Trucut biopsy has high diagnostic yield with no complications and most common malignancy detected was serous cystadenocarcinoma followed by mucinous carcinoma.</p> <p><strong>Key words</strong>: Biopsy, Malignancy, Ultrasound</p> <p><strong>&nbsp;</strong></p> 2022-09-28T14:12:29+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College High Resolution Computed Tomography Chest Findings Among Post-COVID Patients 2022-10-12T13:52:28+05:00 Rabia Shahid Muhammad Saleem Akhter Muhammad Waseem Maryam Rafiq <p>&nbsp;</p> <p><strong>Background:</strong> HRCT chest has proven to be a helpful radiological modality to assess the course of disease. The main objective of the study was to analyze the pattern of lung involvement on HRCT chest among post-Covid patients.</p> <p><strong>Methodology: </strong>This cross-sectional study was carried out in the post Covid patients (30 days after discharge) from Nov 2020 to July 2021 in Sahiwal Teaching Hospital, Pakistan. Total 180 patients were selected through non probability consecutive sampling technique. Whole body Multi Slice CT scan 128 Slices by GE discovery was used to get HRCT of chest and to document various patterns and stages of pulmonary fibrosis in the post-COVID patients. The data was analyzed using the IBM SPSS 28.0.0 2021. Various radiological findings were expressed in percentages.</p> <p><strong>Results:</strong> A total of 77.8% patients had bilateral lung involvement, while 22.2% had unilateral lung involvement after one month of disease.</p> <p>Ground Glass Haze was the commonest radiological pattern, found in 140 (77.8%) cases. Other radiological patterns were Air Space Opacification (47.2%), Septal Thickening (20%) and Fibrotic Bands (26.1%). Traction Bronchiectasis (10%) and Honey Combing (7.8%) were among the lesser ones reported. About 62% patients had mixed findings on HRCT Chest.&nbsp; Diagnosis of Organizing Pneumonia was made in 166 (92.22%) patients while 14 (7.78%) patients were labelled as UIP (Usual Interstitial Pneumonia) with honey-combing in HRCT chest. The involvement of Right Lower Lobe was in 165 (91.7%) of cases. Right Middle Lobe remained fairly spared and was seen in 120 (66.7%) cases.</p> <p><strong>Conclusion</strong>: Patchy ground glass haze seen bilaterally in lower lung lobes are the commonest abnormalities in HRCT chest of post-COVID patients.</p> <p><strong><u>Keywords: Covid-19, Pneumonia, Radiology</u></strong></p> 2022-09-28T14:14:04+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College An Audit of Laparoscopic Cholecystectomy; at a Tertiary Care Hospital in Islamabad 2022-10-18T10:23:40+05:00 Muneeb Ullah <p><strong>Background: </strong>Laparoscopic Cholecystectomy is a commonly performed surgery and is a gold standard for the treatment of cholelithiasis as it has fewer side effects. This study was conducted to determine indications and complications of this surgery at a tertiary care hospital in Islamabad.</p> <p><strong>Methodology: </strong>This retrospective study was conducted in the department of Surgery, Maroof International Hospital from March 2017 to March 2019. A total of 250 patients who underwent laparoscopic cholecystectomy were included through consecutive sampling technique. The data regarding age, gender, mode of presentation, types of presentation, per operative findings, operative complications and duration of hospital stay was collected from patients’ medical record. Statistical Package for Social Sciences SPSS version 23 was used to analyze data.</p> <p><strong>Results: </strong>&nbsp;Mean age of the participants was 46.24 ± 14.13 years. Female to male ratio was 2.73:1. Almost 38.4% patients had chronic cholecystitis, 35.2% had symptomatic gallstone disease, 24.8% had acute cholecystitis and 1.6% had gallbladder polyps. No major vascular or common bile duct injury were noted. 27.2% patients had per operative gallbladder perforation. Stone spillage occurred in 8.8% patients with retrieval in all of them. 75.2% patients were discharged on day 1. Per operatively, 98.4% patients had cholelithiasis, 59.6% had adhesions, 9.6% had mucocele, 1.6% had empyema and 0.8% patients had collections.</p> <p><strong>Conclusion: </strong>Laparoscopic cholecystectomy is a safe procedure in all types of gallstone disease presentations with low complication rate.</p> <p><strong>Key words: </strong>Cholelithiasis, Gallstones, Laparoscopic Cholecystectomy, Per-operative complications</p> 2022-09-28T14:16:15+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College Comparative Benefits of Tissue Marking by Poster Ink in Histopathology 2022-10-12T13:54:08+05:00 Dr. Ayesha Sarwar Prof. Ashok Kumar Tanwni Dr. Anum Usman khalida Moeed <p><strong>Background: </strong>Tissue margin marking with India ink is important in decision making for surgeons. The present study was conducted to examine the reliability of different shades of locally available poster colours in tissue marking and to evaluate the colour perceptibility microscopically in comparison with similar tissues marked by India ink.</p> <p><strong>Methodology:</strong> This experimental study was conducted at Department of Pathology, HBS Medical &amp; Dental College &amp; Hospital, Islamabad from 27<sup>th</sup> February 2021 to 29<sup>th</sup> April 2021<strong>. </strong>Sample size was fifty, collected through convenient sampling technique. Five types of formalin fixed tissue specimens were selected for the study so as to evaluate the effectiveness of poster ink marking on different tissue surfaces. From each specimen, four sections were taken from the margins. Three shades of poster colour (black, blue and green) were used to ink three sections while one section from each tissue type was marked with India ink. After complete tissue processing and routine haematoxylin and eosin (H&amp;E) staining, slides were examined microscopically. Scoring was done on a scale 0 to 3 on the basis of visibility.</p> <p><strong>Results: </strong>The present study showed that poster colours inking of the tissues was quite reliable as compared to India ink. Most consistent results were achieved with black and blue colours as compared to green colour.</p> <p><strong>Conclusion: </strong>Poster colours are reliable tool for tissue marking when India ink is not available. Their availability in a variety of colours provides them an edge over India ink.</p> <p><strong>Key words</strong>: Eosin, India ink, Resection Margins</p> 2022-09-28T14:17:29+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College The Attitude of Physical Therapy Students Towards their Profession and Education in Punjab 2022-10-12T14:23:29+05:00 Tahir Mahmood Abdul Salam Iqra Waseem Aqsa Khalid Umer Maqsood <p><strong>Background: </strong>The quality of medical teaching can be refined based on the attitude of the students towards their clinical and teaching environment. The objective was to determine student attitudes towards their profession and education in Punjab.</p> <p><strong>Methodology: </strong>This cross-sectional survey was conducted from 20<sup>th</sup> July to December 2021 after taking ethical approval. The data was collected through an online google document from physical therapy undergraduates and post graduates from different institutes of Punjab. The outcome was measured using “physical therapy student attitudes questionnaire (PSAQ)”.It had four sections, section A is about the knowledge of the profession, section B includes beliefs about future, section C is about patient exposure in clinical trainings and section D is about level of satisfaction from the learnings. The data was encoded and analyzed using SPPS V.23. The descriptive statistics and mean<u>+ </u>standard deviations were used to present the scores. The independent sample t-test was used to find the difference in mean scores of males and females with p value ≤ 0.05 taken as significant.</p> <p><strong>Results: </strong>The current study comprised of 82(32.15%) males and 173(67.84%) females with mean age of 22.5<u>+</u>6.5 years.&nbsp; &nbsp;The overall satisfaction level regarding knowledge, future beliefs, clinical exposure and learning was good with total mean± SD of 87.62<u>+</u>17.64 for males and 87.97<u>+</u>18.67 for females.<strong> &nbsp;</strong>There was no statistically significant difference of satisfaction among male and female students with P &gt;0.05</p> <p><strong>Conclusion: </strong>The student attitude was quite satisfactory regarding their choice of physical therapy profession, good future, patient exposure and learning skills. There was no statistically significant difference based on the gender.</p> <p><strong>Keywords: </strong>Education, Patients, Physical therapy, Satisfaction, Training.</p> 2022-09-28T14:19:00+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College Endometriotic Stones; Can they exist? A case report 2022-09-29T07:14:39+05:00 Muneeb Ullah <p>Endometriosis is a gynaecological pathology that manifests as pelvic pain, infertility and cyclical issues. The presence of endometriotic tissue outside the uterus is the hallmark of endometriosis and commonest sites are ovaries, fallopian tubes, uterosacral ligaments and lateral pelvic peritoneum. Ovarian endometriotic cyst (EC) is typically a chocolate cyst that is often diagnosed by a combination of clinical history examination and radiological imaging. However, the definitive diagnosis requires histopathological confirmation. The management is complex and requires long term suppression of menstrual cycle and ovarian cystectomy. We hereby illustrate a case of a young female who presented with EC. During a routine daycare laparoscopic cystectomy, a rare finding of endometriotic stones was ascertained per-operatively. It has not been reported previously as per our knowledge. Patient remained well post operatively and was discharged in evening.</p> 2022-09-28T14:20:57+05:00 Copyright (c) 2022 Journal of Islamabad Medical & Dental College