Journal of Islamabad Medical & Dental College <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> Islamabad Medical and Dental College en-US Journal of Islamabad Medical & Dental College 2227-3875 <p><img style="border-width: 0;" src="" alt="Creative Commons License"><br>This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (<a href=""></a>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> Premature Ovarian Insufficiency: An important yet neglected health condition Syeda Batool Mazhar Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 315 317 10.35787/jimdc.v10i1.664 Seasonal trends of Influenza in Islamabad, Pakistan <p><strong>Background: </strong>Viral outbreaks have always been a challenging task for clinicians and Influenza virus has been on top of the list. The history of influenza epidemic reveals its devastating effects in the form of multiple deaths and economic burden. Hence this study was planned to recognize the peak activity time span of Influenza infection and its frequency in our set-up at Shifa International Hospital, Islamabad Pakistan.</p> <p><strong>Material and Methods:</strong> A cross sectional study was performed in Pathology Laboratory, Shifa international hospital Islamabad from April 2016 to March 2019. Nasopharyngeal swabs were collected from patients of all age groups, with clinically suspected influenza infection throughout the year, irrespective of gender, according to hospital’s standard policy. Samples were analysed on GeneXpert kit (Xpert Flu Assay). Data collected was entered and then analysed in SPSS version 17.</p> <p><strong>Results:</strong> Of the total 591 samples included in study, 233 (39.4%) were positive for influenza (Flu A or Flu B), while 358 (60.6%) showed negative results. Total 172 (73.8%) were positive for Flu A while 61 (26.1%) were positive for Flu B. Among Flu A cases, 107 (62.2%) were positive for H1N1. Most of the positive cases (n=206; 88.4%) were reported in the months of January and February during the three-year period (2016-2019) of this study.</p> <p><strong>Conclusions:</strong> Influenza virus has peak activity in the months of January and February. Both Influenza A and B are circulating in the environment but Flu A is predominant and H1N1 is more prevalent.</p> Sania Raza Muhammad Usman Imran Ahmad Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 318 322 10.35787/jimdc.v10i1.549 Auricular Cartilage Interposition Arthroplasty in Recurrent Temporomandibular Joint Ankylosis in Pediatric Patients <p><strong>Background: </strong>Temporomandibular joint (TMJ) ankylosis in early childhood can lead to disturbances in growth, facial asymmetry and difficulties in eating as well as in breathing.&nbsp; The objective of the study was to evaluate the effectiveness of auricular cartilage as an interpositional material after gap arthroplasty in pediatric patients with temporomandibular joint ankylosis in maintaining the achieved postoperative mouth opening.</p> <p><strong>Material and Methods:</strong> This prospective study was conducted at the Oral and Maxillofacial Surgery Department of King Edward Medical University, Lahore, from 1st January 2019 to 30th November 2019. Thirty patients, aged 5 to 15 years with clinical and radiological diagnosis of TMJ ankylosis were included in the study. TMJ ankylotic mass was removed, the gap was created and interposition of auricular cartilage graft was done in these patients. Mouth opening was measured as a distance between the incisal edges of mandibular central incisors to maxillary central incisors using the scale. Preoperative and postoperative mouth opening was noted and compared using the paired t-test.</p> <p><strong>Results:</strong> Among the thirty patients, 19 were male and 11 were female. The mean (±SD) age of patients was 9.23±3.23 years (age range 5 to 15 years). The mean preoperative mouth opening (T1) was 7.3±3.1 mm, while the mean postoperative mouth opening (T2) was 29.2±3.3 mm. The mean interincisal distance was 29.0 mm (range 21 mm to 35 mm). The mean difference in pre- and postoperative mouth opening (T2-T1) was 21.6 ± 5 mm.</p> <p><strong>Conclusions:</strong> Autogenous auricular cartilage graft is an efficient and reliable interpositional material for achieving early postoperative mouth opening in TMJ ankylosis patients.</p> Ahmad Liaquat Arun Kumar Shah Nabeela Riaz Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 323 328 10.35787/jimdc.v10i1.545 Immunohistochemical Expression of BCL-2 in Malignant Salivary Gland Tumors <p><strong>Background: </strong>Malignant salivary gland tumors (MSGTs) consist of a heterogeneous group of neoplasms with complex clinicopathological features and biological behaviors. The purpose of this study was to determine the expression of Bcl-2 antiapoptotic protein in mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (ADCC), acinic cell carcinoma (ACC) and polymorphous low-grade adenocarcinoma (PLGA) of salivary glands and to find out its association with different grades of these tumors.</p> <p><strong>Material and Methods:</strong> This descriptive study included 55 cases of MSGTs. Tissue sections were stained with routine hematoxylin and eosin stain as well as Bcl-2 immunostain. MSGTs were graded as low grade (Low grade MEC, ACC, PLGA, and tubular pattern of ADCC), intermediate grade (cribriform pattern of ADCC, and intermediate grade of MEC) and high grade (high grade of MEC and solid pattern of ADCC) tumors on H&amp;E sections. Bcl-2 expression was scored as ‘negative’ (&lt;5% of neoplastic cells), ‘1’ (5-19% of neoplastic cells), ‘2’ (20-49% of neoplastic cells), and ‘3’ (&gt;50% of neoplastic cells), respectively.</p> <p><strong>Results:</strong> MSGTs most commonly involved the parotid gland (52.7%), while ADCC (40%) and MEC (38.2%) were the most common tumors. Expression of Bcl-2 was strongly positive in 56.4% cases of MSGTs which included ADCC (71%), MEC (19.4%) and ACC (9.7%), respectively. A significant association was found between Bcl-2 staining and types of MSGTs i.e., MEC, ADCC, ACC (P = .001) as well as between Bcl-2 staining and grades of MSGTs (P = .013).</p> <p><strong>Conclusions:</strong> Bcl-2 protein is expressed in malignant salivary gland tumors. Its expression maybe helpful in grading small biopsies, predicting behavior, and planning targeted therapy of MSGTs.</p> <p>&nbsp;</p> <p>&nbsp;</p> Faiz Rasul Sultan Muhammad Wahid Iman Imran Zainab Rizvi Rozina Jaffar Ambereen Anwar Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 329 336 10.35787/jimdc.v10i1.542 Benefits of Near-Peer Tutoring in Small Group Discussions: A Pilot Study <p><strong>Background: </strong>A year senior medical students can prove to be a useful teaching resource with added benefits for the tutors. The objective of this study was to explore the perceptions of near-peer tutors after facilitating small group discussions while delivering an integrated curriculum in preclinical years.</p> <p><strong>Material and Methods:</strong> This qualitative exploratory pilot study was conducted in Rawal Institute of Health Sciences Islamabad, Pakistan from July 2017 to November 2017. Students of First year MBBS class (n=100), were divided into six small groups. Seven Second year MBBS students who had secured more than 60% marks throughout year one assessments and in Professional examination were selected as Near-Peer tutors after informed verbal consent. In the first discussion, three groups were taught by three tutors and three by junior faculty. In the second discussion, the groups were swapped and exposed to the same strategy as above, with new learning objectives, but the remaining three tutors now took batches. One tutor acted as a substitute. Qualitative data was collected after interviewing the tutors individually and responses were audio recorded. The collected data, both notes and audio recordings of the interviews, was transcribed into text to generate codes, theme and sub themes.</p> <p><strong>Results:</strong> Transcription of data revealed that the tutors enjoyed teaching and were of the opinion that Near-Peer tutoring is more effective in small groups, for both tutors and the learners. The tutors felt a boost in self-confidence and improvement in communication skills, after facilitating a small group. Tutoring also helped in developing their higher order cognitive thinking, learning skills and time management.</p> <p><strong>Conclusions:</strong> Near-Peer tutoring helped the tutors develop learning and communications skills while facilitating small group sessions, thus helping them in their future medical roles.</p> <p><strong>Key words: </strong>Integrated curriculum, Near-Peer tutoring, Peer Assisted Learning, Small group discussions.</p> Shazia Muazam Farzana Majeed Saima Mumtaz Khattak Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 337 344 10.35787/jimdc.v10i1.577 Ameliorative effects of Withania coagulans and Metformin on Ovarian morphology in Polycystic ovarian disease induced rats <p><strong>Background: </strong>Various medicinal herb plants are being used in place of metformin for treatment of polycystic ovarian disease for their less harmful effects. Withania coagulans (WC) is a herb known for its insulin sensitizing and weight reducing properties. The present study was done to determine the influence of aqueous extract of Withania coagulans (aqWC) and metformin on ovarian weight and ovarian folliculogenesis in polycystic ovarian disease-induced rats.</p> <p><strong>Material and Methods:</strong> An experimental animal study was carried out at the Physiology Department of Islamic International Medical College, Rawalpindi from April 2016 to March 2017. Forty female Sprague Dawley rats were divided initially into two groups. Group A (Normal Control) and Disease induced group. Standardized laboratory diet was fed to Group A while the disease induced group was given standardized laboratory diet and letrozole solution orally (1mg/kg) for 21 days to induce Polycystic ovary syndrome, which was established by observing estrous cycle of rats. Disease induced group was then split into group B (PCOS control), C (Aqueous Withania coagulans treated) and D (Metformin treated) and observed after 14 days. Groups A and B underwent ovarian dissection after 21 days and groups C and D underwent dissection at the end of experiment (after 35 days). Independent sample t-test was used for the comparison between the control and disease induced group.</p> <p><strong>Results:</strong> Group B showed a significant increase in ovarian weight in comparison to group A rats (P &lt; .05). Treatment with Withania coagulans and metformin significantly decreased ovarian weight (P &lt; .05) and increased primary, Graafian, antral follicular count and corpus luteum along with reduction in cystic follicular count in letrozole-induced polycystic ovarian disease rats. Improved folliculogenesis was also observed in the same groups (groups C &amp; D).</p> <p><strong>Conclusions:</strong> Withania coagulans can be a substitute for improvement of ovarian follicular development in polycystic ovarian disease.</p> Hira Ayaz Abdul Samad Aiman Farogh Anjum Nasar Abbas Shamsi Sidra Arshad Mahvash Khan Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 345 350 10.35787/jimdc.v10i1.457 Knowledge of otic barotrauma among air travelers in Sialkot, Pakistan <p><strong>Background: </strong>Otic barotrauma (OBT) is defined as traumatic inflammation in human middle ear that occurs at the time of avian drop. However, it can be avoided using its adequate knowledge. The objective of present study was to evaluate the knowledge of the trauma among air travelers in Sialkot city of Punjab, Pakistan.</p> <p><strong>Material and Methods:</strong> This cross-sectional study enlisted male adult International air travelers (n=50) from Sialkot city, Pakistan between November 2018 and April 2019 using purposive sampling technique. A specially developed questionnaire (Cronbach’s alpha = .82) having 12 close-ended items on barotrauma (total possible score 12) was administered to the participants at their home. Level of knowledge was categorized as inadequate (score 0-6), moderate (7-9) and adequate (10-12). Pearson’s chi-squared test was used to see the association between adequate knowledge on the OBT and sociodemographic variables using a P-value &lt; .05 as statistically significant.</p> <p><strong>Results:</strong> Mean age of the participants was 47.60±9.9 years. Most of them (n=36; 72%) travelled for work reason. Almost all i.e. 46 (92%) gave correct response against item 1 (information provider about air trauma) and 12 (treatment of otic barotrauma) of the administered questionnaire. The rate of adequate knowledge on OBT was found to be higher among those having more than two-time travelling experience (82.9%, <em>P</em> = .02). However, there was no significant difference in knowledge of the barotrauma between people having less than or more than 12 years of science education (<em>P</em> = .59). All the business tourists (n = 5) had adequate knowledge of barotrauma followed by jobbers (n=25) and pilgrims (n=3), respectively.</p> <p><strong>Conclusions:</strong> Business tourists have adequate knowledge on otic barotrauma associated with air travel than jobbers or Hajj/Umrah pilgrims.</p> Muhammad Saeed Razi Saleh Muhammad Asif Javed Javaid Riaz Qureshi Miss Mahnoor Mujahid Hussain Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 351 357 10.35787/jimdc.v10i1.433 Association of Heavy School Bags with Musculoskeletal Discomfort among Primary School Children of Islamabad, Pakistan <p><strong>Background: </strong>Musculoskeletal disorders, an increasing concern among school going children, primarily affect muscles and tendons. They lead to secondary damage to nerves and joints in the neck, upper back, shoulders, arms, and hands, etc. The objective of this study was to determine the association of carrying heavy school bags with musculoskeletal discomfort among primary school children in government schools of Islamabad, Pakistan.</p> <p><strong>Material and Methods:</strong> This cross-sectional survey was conducted in different government schools of Islamabad, Pakistan from June 2018 to November 2018. After an informed consent from parents, 377 healthy school going children aged 6-14 years were included in this study. Data was collected through Backpack Questionnaire. Chi square test was used to compare the frequency of musculoskeletal discomfort with demographic characteristics and backpack-related features. P-value less than .05 was considered statistically significant.</p> <p><strong>Results:</strong> Mean age of the school children was 9.49 ± 1.53 years with 179 (46.9%) male and 203 (53.1%) female students. Majority of students (89.8%) were found with school bags more than 15% of their body weight. Shoulder pain was the most commonly reported complaint (67.3%). There was a significant association between pain and perceived backpack weight (<em>P</em>=.001), and between pain and self-perceived posture (<em>P</em>=.001). Leaning forward (66.2%) was the most commonly adopted posture followed by leaning sideways (15.4%) and stooping (2.9%), respectively. The association between pain and duration of carrying backpack from home to school was insignificant (<em>P</em>=.055) in contrast to pain and duration of carrying bag from school to home (<em>P</em>=.007), respectively.</p> <p><strong>Conclusions:</strong> Musculoskeletal discomfort was found commonly among primary school children with shoulder pain being the most frequent, as maximum students were carrying heavy school bags.</p> Humaira Khan Hadiqa Adnan Sara Qayyaum Hajar Jamshaid Rabiya Tahir Qurat-ul-Ain Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 358 364 10.35787/jimdc.v10i1.492 New Onset Heart Failure after Right Ventricular Pacing in Patients with Normal Left Ventricular Function <p><strong>Background: </strong>Cardiac pacing is the best optional treatment for cardiac rhythm disturbances such as cardiac arrhythmias, high grade atrioventricular (AV) block and heart failure (HF). Right ventricular apical (RVA) pacing in patients with normal left ventricular heart, may stimulate HF and cardiomyopathy. The objective of this study was to determine the frequency of new-onset heart failure after right ventricular apical pacing in patients having normal left ventricular (LV) function.</p> <p><strong>Material and Methods:</strong> This prospective study was conducted from March 2017 to January 2019 in Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology, Multan Pakistan. Adult patients (n=50) who fulfilled the American College of Cardiology (ACC) guidelines for permanent pacemaker (PPM) insertion and with normal LV function were included in this study. Pacemaker was implanted in all patients under local anesthesia. All patients were followed up for six months to determine the occurrence of heart failure. 2-D echocardiography was done to determine heart failure at follow up in pacemaker clinic.</p> <p><strong>Results:</strong> Mean age of the study participants was 50.53 ± 6.75 years with male predominance. Mean pre-implantation ejection fraction (EF%) was 55.4 ± 4.2%. Main reason of PPM insertion was third degree AV block followed by right bundle branch block (RBBB). Incidence of HF was 4% at 06 months’ follow-up. Mortality occurred only in 1 (2%) patient.</p> <p><strong>Conclusions:</strong> Right ventricular pacing is associated with risk of new onset heart failure in long term follow-up. In the present study, HF developed in 4% patients in a follow-up period of six months</p> Fawad Qadir Muhammad Shahid Hadi Yousuf Saeed Muhammad Tahir Mohyudin Abu Bakar Ali Saad Zahid Iqbal Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 365 369 10.35787/jimdc.v10i1.378 Histomorphometric Alterations in Hepatic Tissue from Malathion-Induced Toxicity: An Experimental Animal Study <p><strong>Background: </strong>Malathion, a widely used insecticide readily absorbed through skin and seriously affects different tissues and organs of the body. The main objective of this study was to compare the histomorphometric alterations resulting from hazardous effects of different doses of Malathion on hepatic tissue of male albino Wistar rats.</p> <p><strong>Material and Methods:</strong> This animal experimental study was conducted at the Department of Anatomy and Postgraduate Research Laboratory at the Isra University, Hyderabad, Sindh Pakistan from February to July 2019. Thirty male albino Wistar rats between 250-300 grams weight were distributed equally into group A (control), group B (low-dose Malathion group; 27mg/kg 1/50 of LD50), and group C (high-dose Malathion group; 50mg/kg). Bodyweight of all rats was taken twice, before and after the experiment. The liver was dissected out, washed and weighed. Histopathological examination was done under the light microscope. Grading was done for severity in histopathological changes in each group. Data was analyzed using one-way ANOVA and Post-hoc Tukey test for comparison with the level of significance set at P-value ≤ .05.</p> <p><strong>Results:</strong> Statistically significant (P &lt; .05) decline in body weight was observed in groups B and C in comparison with group A. The relative weight of the liver was increased significantly (P &lt; .05) in the experimental groups, when compared with the control group. Mild-to-moderate histopathological changes were observed in the low-dose Malathion group (Group B) while moderate-to-severe histopathological changes were demonstrated in the high-dose group (Group C).</p> <p><strong>Conclusions:</strong> Malathion is a potent toxic pesticide and its exposure can exhibit damage to the hepatic tissues in a dose-dependent manner.</p> Shazia Parveen Channar Nasreen Qazi Sajjad Ali Almani Sehar Gul Memon Mansoor Mukhtar Qazi Rida Qureshi Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 370 375 10.35787/jimdc.v10i1.534 A Case of Calvarial Tuberculosis in an Elderly Male Patient <p>Tuberculosis (TB) is still endemic in developing countries like Pakistan. Tuberculosis affecting bones account for 1% of all TB infections. Calvarial tuberculosis, a rare manifestation of extra-pulmonary TB, accounts for 0.2%-1.3% of all cases of skeletal TB. Even in developing countries where TB is endemic, cases with this type of TB are not commonly seen. The most commonly involved sites are the frontal and parietal bones, with destruction of both the inner and outer table. Proper diagnosis and timely management help in improving prognosis. Here we describe the case of a 70-year-old male patient with pulmonary and extrapulmonary (calvarial) tuberculosis. The diagnosis was established on histopathological examination with demonstration of Acid-Fast Bacilli (AFB) and typical features seen on computed tomography (CT) scan.</p> Miqdad Haider Aijaz Zeeshan Khan Chachar Nabeel Shafqat Waqar Zaheer Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 376 379 10.35787/jimdc.v10i1.624 Histopathology Images admin jimdc Copyright (c) 2021 Journal of Islamabad Medical & Dental College 2021-03-31 2021-03-31 10 1 i ii 10.35787/jimdc.v10i1.700