Journal of Islamabad Medical & Dental College
The Journal of Islamabad Medical & Dental College (JIMDC) is a new quarterly Journal of Islamabad Medical & Dental College. It is recognized by the Pakistan Medical and Dental Council (PMDC) and the Higher Education Commission of Pakistan. It includes original research papers, reviews, case reports, and short communications related to health, medicine, and dentistry. Submitted manuscripts must be original, written in English, and will be accepted for publication with the understanding that they have not been submitted simultaneously to any other journal, have not been published or are under consideration elsewhere, and have not been published previously. The manuscripts will be reviewed through a double-blind peer review process.
This is an Open Access article distributed under the terms of the Creative Commons Attribution-Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Frequency of Febrile Fits in Children with Iron Deficiency Anemia
Objective: To identify the frequency of febrile seizures in children having iron deficiency anemia. Methodology: This cross-sectional study was conducted at the Department of Paediatrics, Ayub Teaching Hospital, Abbottabad, over a period of six months from 20th January 2022 to 20th July 2022. A total of 147 children of both genders diagnosed with iron deficiency anemia were enrolled in the study. Blood samples were collected from all participants and analyzed for hemoglobin (Hb) levels, mean corpuscular volume (MCV), and plasma ferritin to confirm the diagnosis of iron deficiency anemia. Data regarding the occurrence of febrile fits were recorded as per the operational definition. Results: The children from 6 months to 5 years with a mean age of 3.074±1.12 years were there, and mean duration of complaint was 5.544±1.90 months. Male patients were 46.9% and females were 53.1%. Febrile fits were observed in 40.1% patients. Conclusion: In conclusion, our data indicates that the presence of anemia and low blood iron levels might aggravate febrile fits in children. Keywords: Febrile seizures, Iron deficiency anemia, Risk Factors
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The Levels of Glucagon Like Peptide-1 in Gestational Diabetes Mellitus and Normal Pregnancy
Objectives: Gestational diabetes mellitus (GDM) is a chronic hyperglycaemic condition occurring in pregnancy. The increased blood glucose level is due to dysfunction of beta cells of the pancreas associated with chronic insulin resistance. Glucagon-like peptide-1 (GLP-1), an incretin hormone, is involved in the process of insulin secretion from beta cells. It is proposed that defects in GLP-1 are related to both Type 2 diabetes mellitus and probably GDM. Thus, a study was planned to measure and compare fasting blood GLP-1 levels between GDM and normal pregnant females along with other anthropometric and blood parameters. Methodology: Eighty-four pregnant females were divided into 3 groups (n=28 in each group), pregnant females with normal glucose tolerance (NGT), GDM for the first time (GDM-1), and GDM for the 2nd time (GDM-2). Anthropometric parameters, fasting blood glucose level, GLP-1, serum insulin level and HOMA-IR were assessed in all study subjects. Analysis was done by SPSS-20. One-way ANOVA was applied for comparison of variables among study groups. Results: There was a significant difference (p ˂0.05) regarding waist-to-hip ratio, fasting blood glucose level and HOMA-IR among groups, with an increase in both GDM-1 and GDM-2. There was a non-significant difference in fasting GLP-1 levels among the study groups (p = 0.688). Conclusion: GLP-1 levels are not altered with deranged fasting blood glucose levels and HOMA-IR in GDM patients. Keywords: Gestational diabetes mellitus, Glucagon Like Peptide-1, insulin resistance (HOMA-IR).
Open Vs Laparoscopic Heller Myotomy in Management of Achalasia Cardia, Retrospective Analysis of 75 Cases
Objective: To compare open transabdominal heller myotomy and Laparoscopic heller myotomy in terms of symptom control, safety and quality of life. Methodology: Patients with a diagnosis of achalasia cardia who underwent open as well as laparoscopic Heller myotomy were included in the study. A record of all these patients, including age, sex, symptoms, diagnosis and details of surgery, postoperative results and follow-up, was made. Patients were divided into two groups and compared in terms of symptomatic control and quality of life. Results Out of 75 patients, 33 were included in Group A (Open approach) and 42 in Group B (laparoscopic approach). The mean age of the patients was 33.82 + 5.37 years with age ranging from 25 to 47 years. Most common symptom was dysphagia which was present in 100% of patients followed by weight loss which occurred in 83.58% of patients. Mean operative time in Group A was 60.00 + 6.08 minutes, while in Group B it was 45.43 + 7.07 minutes (p=.000). Overall, 8 (12.30%) complications occurred in the study population, which was intraoperative mucosal injury. Over a follow-up period of 6 months, 30 (92.90%) in Group A were satisfied with the results, having no dysphagia or regurgitation, while in Group B, 39 (92.85%) had satisfactory results. Conclusion: Laparoscopic Heller myotomy is a safe alternative approach used for the treatment of achalasia cardia as compared to the open approach in terms of symptomatic control and better quality of life. Keywords: Achalasia Cardia, Fundoplication, Heller Myotomy, Motility disorder
Fetomaternal Outcomes in Pregnant Women with Intrahepatic Cholestasis of Pregnancy in Third Trimester
Objective: To determine the fetal outcome in pregnant women with intrahepatic cholestasis in the third trimester. Methodology: Patients aged 18 to 45, with a gestational age of at least 24 weeks and a diagnosis of intrahepatic cholestasis of pregnancy, were included. Exclusion criteria included having cholelithiasis or choledocholithiasis on ultrasonography, having a shrunken or echogenic liver on ultrasonography, having a platelet count of less than 100,000/microlitre at study enrollment, having a diagnosis of PIH or pre-eclampsia, or not knowing their LMP. Under the guidance of a specialist gynaecologist with at least three years of post-fellowship experience, the researcher herself evaluated each participant every two weeks and monitored them till birth. Results: Preterm delivery in 38 (25.33%), NICU admission in 23 (15.33%), meconium-stained liquor in 13 (8.67%), cesarean delivery in 85 (56.67%), postpartum hemorrhage in 53 (35.33%), and perinatal death in 11 (7.33%) were the fetomaternal outcomes in this study among pregnant women with intrahepatic cholestasis of pregnancy in the third trimester. Conclusion: IHCP is linked to negative outcomes for both the mother and the fetus (preterm, NICU admission, and perinatal death). Keywords: Intrahepatic cholestasis, NICU, Outcome, Perinatal death, Preterm Outcome
Micro-Organisms and Antibiotic Susceptibility in Children with Severe Acute Malnutrition
Objective: To determine the frequency of positive blood culture, micro-organisms and antibiotic resistance in children having severe acute malnutrition with positive blood cultures. Methodology: A total of 285 children with severe acute malnutrition of both genders and ranging in age from 6 months to five years were included. Children who had congenital syndrome, cancer, heart problems, chronic liver illness, or chronic renal disease or had taken antibiotics within the week before presentation were not included. Two blood culture bottles with 20 millilitres of Brain-Heart Infusion (BHI) broth were used to inoculate the blood. The microorganisms were evaluated. Positive blood cultures were subjected to antibiotic susceptibility testing (AST) using the E-test and the Kirby-Bauer disk diffusion technique in compliance with the European Committee on Antimicrobial Susceptibility Testing's standards. Antibiotic resistance was assessed. Results: Seventy-five (26.32%) of the children in our research with severe acute malnutrition had positive blood cultures. Staphylococcus aureus was found in 11 (14.67%), pneumococcus streptococcus in 08 (10.67%), enterobacterales in 29 (38.67%), non-fermented GNB in 23 (30.67%), and enterococcus in 04 (5.33%) of the children with severe acute malnutrition who had positive blood cultures. Resistance was documented to ciprofloxacin (38.67%), erythromycin (45.33%), amikacin (29.33%), ceftriaxone (64.0%), gentamycin (33.33%), and penicillin (74.67%). Conclusion: In order to guarantee prompt and effective care, these results highlight the vital necessity of routine blood culture testing, locally customized antibiograms, and evidence-based treatment procedures. Keywords: Antibacterial Agents, Bacteraemia, Drug Resistance, Bacterial, Infant, Severe Acute Malnutrition
Epidemiology, Clinical Features, Outcomes, and Antimicrobial Resistance Patterns of Enterobacteriaceae Bacteremia in a Tertiary Care Hospital of Peshawar
Objective: To determine the frequency, antimicrobial resistance patterns, clinical outcomes, and predictors of in-hospital mortality with Enterobacteriaceae bacteraemia. Methodology: This retrospective study was conducted at Rehman Medical Institute, Peshawar, over one year. Patients from all age groups with Enterobacteriaceae (excluding Salmonella spp.) bacteraemia presenting to hospital from March 2024 to March 2025 were included. Bacterial identification and antibiotic susceptibility testing followed CLSI guidelines. Clinical and demographic data were collected and analyzed by SPSS 27. Results: Of 569 positive blood cultures, 154 (27.1%) yielded Enterobacteriaceae growth. Of 154 patients, 91 (59.1%) were male. The median (IQR) age of participants was 43 (55) years. The most common focus of infection was the respiratory tract (75, 48.7%). Around 57 (37.0%) cases required ICU admission, while 49 (31.8%) were mechanically ventilated and 55 (35.7%) received inotropic support. Meropenem was the most frequently prescribed empirical antibiotic (37.8%). Klebsiella pneumoniae (52.6%) was the commonest isolated pathogen. High resistance was observed for amoxicillin (97.8%), ceftriaxone (78.8%), and ciprofloxacin (76.9%). While 35.7% of pathogens were resistant to amikacin and 43.5% were resistant to meropenem. Mortality (26.90%) was significantly associated with age >60 years, malignancy, chronic kidney disease, altered consciousness, use of inotrope, and mechanical ventilation. Independent predictors of death included Age >60 years (OR 10.6), altered consciousness (OR 19.2), inotrope support (OR 35.7), mechanical ventilation (OR 142.9), extended-spectrum beta-lactamase (ESBL) strains (OR 8.3), and coagulation abnormality (OR 7.3). Conclusion: Multidrug resistance among Enterobacteriaceae bacteremia isolates is alarmingly high. Advanced age, altered consciousness, haemodynamic instability, ventilator support, and ESBL strains were strongly associated with in-hospital mortality. Keywords: Antibacterial Agents, Bacteremia, Drug Resistance, Enterobacteriaceae Infections, Hospital Mortality
Role of Periarticular Multimodal Drug Injection Administered Intraoperatively in Pain Management and Opioid Consumption in Elderly Patients with Femoral Neck Fractures Undergoing Hemiarthroplasty
Objective: To determine the effect of intraoperative periarticular multimodal drug injection (PMDI) on postoperative pain scores and opioid consumption compared with conventional systemic analgesia in elderly patients with femoral neck fractures undergoing hemiarthroplasty. Methodology: Quasi-experimental study conducted in the Department of Orthopaedics, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from 2nd October 2025 to 1st January 2026. A total of 136 patients aged 60–80 years with Garden type III or IV femoral neck fractures were enrolled using non-probability consecutive sampling and allocated equally into two groups (n = 68 each). The intervention group received intraoperative PMDI (0.25% bupivacaine 20 mL, ketorolac 30 mg, epinephrine 0.3 mg, with normal saline to a total volume of 40 mL), while the control group received standard systemic analgesia. Pain was assessed using the Visual Analog Scale (VAS) at 24 and 72 hours, and total tramadol consumption (mg per patient) was recorded over the first three postoperative days. Comparisons were made using the Mann–Whitney U test; p ≤ 0.05 was considered significant. Results: The median age was 65 years (IQR 6) and median BMI was 24.0 kg/m² (IQR 2.41). Baseline characteristics were comparable between groups. Postoperative VAS scores were significantly lower in the PMDI group than controls (median 2.0 [1.0–2.88] vs 4.5 [3.5–5.38]; U = 525.5, Z = −7.807, p < 0.001). Total opioid consumption was also significantly reduced in the PMDI group (median 100 mg [50–150] vs 250 mg [150–300]; U = 390.0, Z = −8.465, p < 0.001). No significant association was found between VAS scores or opioid consumption and gender, age category, or Garden classification (all p > 0.05). Conclusion: Intraoperative PMDI significantly reduces postoperative pain and opioid consumption in elderly patients undergoing hemiarthroplasty for femoral neck fracture. Keywords: Analgesia, Hemiarthroplasty, Multimodal, Opioid, Pain management, Periarticular injection.
Accuracy of Surgical APGAR Score in Predicting the Severity of Postoperative Complications Following Emergency Abdominal Surgery
Objective: The objective of this study was to determine the accuracy of the Surgical Apgar Score in predicting the severity of postoperative complications following emergency abdominal surgery, using actual postoperative events as the gold standard. Methodology: A total of 231 patients aged 14–75 years undergoing emergency abdominal surgery under general anesthesia were enrolled using consecutive sampling. Variables such as intra-operative lowest heart rate, least MAP (mean arterial pressure) as well as estimated blood loss were recorded in order to calculate the SAS. Complications following surgery were classified in accordance with the Clavien–Dindo Classification over a 30-day follow-up. Diagnostic accuracy of SAS was calculated by specificity, sensitivity, PPV (positive predictive value) , NPP (negative predictive value), as well as the ROC (receiver operating characteristic) curve analysis. Data were stratified by demographic and clinical factors to evaluate the consistency of SAS performance. Results: The mean SAS was 5.8 ± 2.9. High-grade complications (Clavien–Dindo III–V) occurred in 47.2% of patients. SAS shown with sensitivity = 74.3%, specificity = 67.2%, PPV = 58.3%, NPV = 80.4%, and diagnostic accuracy = 69.7%. The area under curve was 0.75 (95% CI: 0.69–0.81, p < 0.001). Stratified analyses confirmed stable performance across subgroups. Conclusion: The Surgical Apgar Score is a reliable, simple tool that can predict the severity of postoperative complications after emergency abdominal surgery, facilitating early risk stratification and guiding perioperative care. Keywords: Clavien–Dindo Classification, Diagnostic Accuracy, Emergency Abdominal Surgery, Postoperative Complications, Surgical Apgar Score
Effect of a Structured Decision Aid on Decisional Conflict and Decision Regret in Breast Cancer Surgery: Experience from Pakistan
Objective: The most prevalent cancer among Pakistani women is breast cancer. Even though mastectomy and breast-conserving surgery (BCS) have similar oncologic results in early stages, patient decisions are influenced by socioeconomic status, family involvement, knowledge of health issues, and radiotherapy availability. Decisional conflict and regret are caused by systematic impediments and inadequate consulting time in public-sector hospitals. Although available data indicates that decision aids increase patient participation and satisfaction with the treatment plan, little is known about their utility in low- and middle-income countries (LMICs). Methods: From April to October 2025, a prospective cohort research was conducted at Mayo Hospital Lahore. A total of 126 women (63 in each group) with stage I–II breast cancer who qualified for either BCS or mastectomy were recruited. Counseling combined with a structured decision aid was compared to regular counseling. The Decisional Conflict Scale (DCS) was used to measure outcomes prior to surgery, and the Decision Regret Scale (DRS) was used six weeks and six months after surgery. Results: Patients who received the decision assistance exhibited better understanding of available treatments, increased involvement in the decision-making, and lower DCS scores, indicating lesser uncertainty. Additionally, less remorse at both follow-up intervals was reported through lower DRS ratings. Conclusion: This study demonstrates the efficacy of low-cost decision aids in LMICs such as Pakistan. Decision aids reduce decisional conflict and regret in breast cancer surgery by overcoming challenges such low literacy, limited consultation time, and family dominance by simplifying complex knowledge and by clarifying patient values Keywords: Decision making, Decision aids, Patient Participation, Patient Satisfaction
Depression and Anxiety among Patients with Acute Coronary Syndrome
Objective: To determine the prevalence of depression and anxiety among patients with Acute Coronary Syndrome (ACS) at the Saidu Group of Teaching Hospitals, Swat, Pakistan, and to identify the associated sociodemographic and clinical factors. Methodology: A cross-sectional study was conducted between April and October 12, 2025, with an enrollment of 190 ACS patients enrolled. Depression was assessed using the Beck Depression Inventory (BDI), with a score greater than 17 indicating depression. Anxiety was assessed using the Beck Anxiety Inventory (BAI), with a score greater than 0 indicating anxiety. Statistical analysis was performed using the chi-square test to examine associations between psychological conditions and sociodemographic factors. Results: The study revealed that 44% of ACS patients had depression, and 42% exhibited anxiety among these 63% were mean age of patients was 51.7 years ± SD = 12.3), and 63% of the participants were male. Significant associations were found between depression and older age (p-value = 0.03), 58% of patients in the 46-60 age group showing depression. Diabetes and smoking were also linked to higher rates of depression and anxiety. The chi-square test revealed a significant relationship between age and depression (chi2 = 6.74, p-value = 0.03). Conclusion: The study highlights the high prevalence of depression and anxiety among ACS patients in Pakistan, underscoring the need for integrated mental health care in cardiovascular treatment. Early screening and intervention for psychological distress in ACS patients are essential to improve patient outcomes. Future studies should explore the effectiveness of combined physical and mental health interventions. Keywords: Acute Coronary Syndrome, Anxiety, Comorbidities, Depression, Mental Health
Correlation of Modified CT Severity Index with Complications of Acute Pancreatitis
Objective: To determine the correlation between the Modified CT Severity Index (MCTSI) and complications of acute pancreatitis and to evaluate its predictive ability for clinical outcomes. Methodology: An analytical cross-sectional study was conducted at Pakistan Aeronautical Complex (PAC) Hospital, Kamra, and Pakistan Air Force (PAF) Hospital, Islamabad, between October 2024 and September 2025. Non-probability consecutive sampling of patients with acute pancreatitis yielded a sample of 50. All patients underwent a contrast-enhanced computed tomography scan of the abdomen (CECT) and were classified by MCTSI. An assessment for local and systemic complications, ICU admission, requirement for intervention, and length of hospital stay were all assessed of each patient. Fisher’s exact test, Spearman correlation coefficient, and ROC curve analysis were used to analyze statistical data. Results: The patient’s mean age was 35.7±10.5 years. The percentage of patients receiving admission to the ICU increased progressively by severity of acute pancreatitis: 33% for mild severity and 100% for severe cases. Local complications were observed in 24% (pseudocyst) and 2.6% (abscess) of patients and were predominantly identified among grade 3 and 4 MCTSI. Systemic complications occurred in 6% of patients and were significantly associated with severe acute pancreatitis (p<0.001). MCTSI was found to have a strong correlation with the total number of complications (r=0.68, p=0.001). ROC analysis showed a good predictive accuracy of the MCTSI for complications (AUC 0.83, 95% CI 0.72-0.94) with sensitivity of 81% and specificity of 78% at MCTSI cut-off value of ≥6. Conclusion: MCTSI is associated with complications of acute pancreatitis and provides a reliable prediction of adverse clinical outcomes, supporting its use in early identification of risk and clinical decision-making. Keywords: Intensive Care Units, Length of Stay, Pancreatitis Acute Necrotizing, Prognosis, ROC Curve, Severity of Illness Index, Tomography, X-Ray Computed.
Comparison of Vaccinated Versus Unvaccinated Children Among Measles Cases Presenting to A Tertiary Care Hospital
Objective: To determine the frequency of vaccinated and unvaccinated children among measles cases and to compare age, gender, and nutritional status between the two groups. Methodology: This cross-sectional study was conducted in the Department of Pediatrics at Combined Military Hospital Sialkot from 2nd February 2026 to 31st March 2026, vide letter No. CPSP/REU/PED-2022-149-7509 dated 2nd February 2026. A total of 323 children aged 15 months to 5 years with confirmed measles were included using non-probability consecutive sampling. Vaccination status was verified through immunization records. Results: There were 128 (39.6%) vaccinated and 195 (60.4%) unvaccinated. The mean age was significantly higher in vaccinated children (3.12±1.05 years) compared to unvaccinated children (2.66±1.14 years) (p = 0.021). Gender distribution showed no significant difference (p = 0.332). A significantly higher proportion of unvaccinated children had moderate and severe acute malnutrition compared to vaccinated children (p<0.001). Conclusion: A higher proportion of measles cases were unvaccinated, and unvaccinated children were more likely to have poor nutritional status. Strengthening immunization coverage is essential to reduce measles burden. Keywords: Measles, Malnutrition, Pediatrics, Vaccination, Z-scores
Efficacy of Potassium Citrate as a Preventive Treatment for Double-J Stent Encrustations
Objectives: To evaluate the association between potassium citrate in Double-J (DJ) stent encrustment prevention and compare the incidence of related urinary tract infections (UTI) and crystalluria between patients who use potassium citrate and those who don't use potassium citrate. Methodology: This prospective cohort study was carried out at the Sindh Institute of Urology and Transplantation. A total of 94 patients requiring DJ stent placement in case of stone disease were enrolled and followed prospectively for 6 weeks. The patients were categorized into two groups. The one group was receiving potassium citrate (60 mEq/day) as prescribed by their respective physicians, and the other group were not receiving potassium citrate. All stents were standardized towards 6 weeks of indwelling. Macroscopic stent encrustation was the major product. Secondary outcomes were crystalluria and UTI incidence. SPSS version 26 was used in the analysis of data (p < 0.05 was taken as significant). Results: Both potassium citrate and non-potassium citrate patients were having baseline demographics (p<0.05). The macroscopic DJ stent encrustation was much lower in the potassium citrate taking patients than in the non-potassium citrate taking patients (12.8% vs. 36.2; OR 0.26; 95% CI 0.0930.74; p = 0.008). The potassium citrate group demonstrated a significantly lower incidence of crystalluria (17.0% vs. 42.6%; p = 0.007) and UTIs (6.4% vs. 23.4%; p = 0.021). Stratification indicated that the association was significant irrespective of the BMI or diabetic state. Conclusion: Oral potassium citrate use was associated with a reduced risk of DJ stent encrustation, crystalluria, and UTI. Its regular application ought to be reviewed among the patients who need indwelling ureteral stents for over 6 weeks to limit the morbidity of the stent. Keywords: Double-J Stent, Encrustation, Potassium Citrate, Urolithiasis, Urinary Tract Infection.
Diagnostic Accuracy of Intraoperative Void Score in Predicting Catheter Free Status in Patients Undergoing Transurethral Resection of the Prostate (TURP)
Objective: To analyze the accuracy of diagnosis and inter-observer reliability of the intraoperative void score in predicting the catheter-free status after TURP. Methodology: The prospective study on diagnostic accuracy was a diagnostic accuracy study that was carried out in the Department of Urology, Sindh Institute of Urology and Transplantation, during a period of six months. One hundred and seventeen men aged ≥50 years with benign prostatic hyperplasia who received TURP were recruited through consecutive sampling. The intraoperative void score was measured right after the resection through the application of standardized suprapubic pressure (50 N) and the rating of the urinary stream. The scoring was done by two independent assessors. Success in the study was a trial without a catheter (TWOC) on days 3-5 post-operation and a post-void urine of less than 100 mL and no re-catheterization. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, 95% confidence intervals, and Cohen's kappa were determined. Results: Among 117 patients, 71 (60.7%) patients managed to have their catheter-free voiding, and 46 (39.3%) patients failed TWOC. The intraoperative void score was able to point out 58 true positives, 46 true negatives, 13 false negatives, and no false positives. The sensitivity was 81.7%; specificity, 100%; PPV, 100%; NPV, 78.0, and general diagnostic accuracy, 88.9%. Inter-rater reliability was high (0.81), which means that there was near-perfection. Conclusion: Intraoperative void score is a very specific, reliable, and practical predictor of catheter-free voiding after TURP. Its simplicity to use and its good diagnostic capability justify its application in the routine perioperative assessment to inform the early postoperative management. Keywords: Benign Prostatic Hyperplasia (BPH), Catheter-Free Voiding, Intraoperative Void Score, Transurethral Resection of the Prostate (TURP), Trial Without Catheter (TWOC)
Severity of Failure of Conventional Tooth-Supported Fixed Dental Prostheses at a Tertiary Care Dental Hospital
Objective: To determine the severity of failure of conventional tooth supported fixed dental prostheses (FPD) in patients reporting to a tertiary care dental hospital. Methodology: A cross-sectional study was conducted at the Department of Prosthodontics, Foundation University College of Dentistry, Foundation University, Islamabad, Pakistan, from July 2025 to January 2026 using a non-probability consecutive sampling technique. A sample of 150 participants that fulfilled the inclusion and exclusion criteria was included. Demographic and prostheses related information including location of prostheses, type of prostheses, material of prostheses, duration of time the prostheses were employed and class of severity of failure were transferred to the proformas. The data was entered and analyzed in SPSS Statistics version 21. Results: The mean age of the participants was 47.82 ± 15.188 years; 123 participants were females and 27 were males. 14% of the participants displayed class I level of failures, 4% class II, 7% class III, 33% class IV, 15% class V and 27% class VI. Most commonly involved site was the maxillary posterior region; the most commonly failed prostheses were long-span PFM FDPs that exceeded 5 years of employment. Conclusion: Tooth supported-FPD provide one of the most durable treatment approaches for missing teeth. However, with the duration of their service, the tooth-supported FPD get vulnerable to biological as well as mechanical complications. Appropriate case selection, meticulous treatment planning, and regular follow-up are essential to minimize complications and enhance prosthesis longevity. Keywords: Crown, Dental abutment, Dental prosthesis failure, Metal-ceramic restorations, Prosthesis removal
Vericiguat in Decompensated Cardiac Failure: Clinical Insights on Addition to Guidelines-Derived Medical Therapy
Objective: To assess the efficacy of vericiguat compared to placebo in patients with decompensated heart failure, focusing on key outcomes such as hospitalisation rates, cardiovascular death, and side effects like gastrointestinal disturbances and hypotension. Methodology: A total of 130 patients were enrolled in a randomised controlled trial conducted at the Armed Forces Institute of Cardiology, Rawalpindi, from January 2026 to April 2026. Participants were randomly assigned to receive either vericiguat (n = 64) or placebo (n = 66). The primary outcomes were hospitalisation, cardiovascular death, and side effects, which were assessed through chi-square tests, t-tests, and descriptive statistics. Results: The study demonstrated no statistically significant differences between the vericiguat and placebo groups. Heart failure hospitalisation occurred in 60.94% (n = 39) of the vericiguat group compared with 45.45% (n = 30) in the placebo group (p = 0.111). Cardiovascular death was observed in 46.88% (n = 30) of patients receiving vericiguat versus 59.09% (n = 39) in the placebo group (p = 0.223). Gastrointestinal disturbances were reported in 59.38% (n = 38) of the vericiguat group and 56.06% (n = 37) of the placebo group (p = 0.838), while hypotension occurred in 51.56% (n = 33) and 56.06% (n = 37), respectively (p = 0.735). Conclusion: This randomised controlled trial compared vericiguat with placebo in heart failure with reduced ejection fraction, assessing hospitalisation, cardiovascular mortality, and safety outcomes. Vericiguat showed a numerical reduction in heart failure hospitalisation and a favourable trend in the composite outcome and cardiovascular death, but none of these differences were statistically significant. Keywords: Cardiovascular Death, Heart Failure, Hospitalisation, Side Effects, Vericiguat
Role of p53 in Oral Cancer-A Systematic Review
Objective: Oral squamous cell carcinoma (OSCC) is a common tumor that develops in the mucosa of the oral cavity. Various factors such as tobacco, betel quid and alcohol are the most common causes of oral cancer. Changes at the genetic level, such as p53 mutations, have also led to cancer cell proliferation and progression. It has also been discovered that early detection and prognosis can improve if p53 is being used as a diagnostic as well as a therapeutic tool for oral cancer. In this study, a review has been done over the recent advancements of p53 as a diagnostic tool for oral cancer detection. Methodology: This review followed the PRISMA guidelines for systematic reviews and meta-analyses. We retrieved relevant literature from 2014 to 2024 using six search engines: HEC Digital Library, PubMed/Medline, Elsevier, Wiley Online Library, Google Scholar, and Wolter Kluwer. For this review, we selected studies based on the following criteria: abstracts that included p53 and oral cancer; the 50 most cited articles; and articles investigating the role of p53 in the detection and treatment of oral cancer. Results: In order to carry out this study, thirty studies were searched and assessed which discussed the role of p53 in tumor progression and recent advancements describing the application of these as a diagnostic tool in oral cancer detection and treatment. Conclusion: This systematic review describes the role p53 plays in the pathophysiology of oral cancer and that it can be used as a diagnostic parameter as well as a treatment for oral cancer. This research may have missed some studies written in language other than English. Keywords: Apoptosis, DNA repair proteins, Mutation, Oral Cancer, p53.
Beyond Infection: The Global Health and Economic Burden of Antimicrobial Resistance
Anti-microbial Resistance (AMR) has become one of the major contributors to mortality and disability globally. After the discovery of antimicrobials, it was believed by the medical industry that the battle against microbes would be conquered. However, the rise in resistance of microbes changed the dynamics of the battle. The numbers of morbidity and mortality are staggering due to AMR in 2021 about 21.36 Million people died due sepsis and 4.71 people died due to drug-resistant infections. If this trend continues, it is estimated that 39 million people will be expected to die by 2050. AMR has grown from a clinical issue to a systemic threat that is challenging global health security and economic stability. AMR, if overlooked, can cause critical economic losses according to WHO AMR can cause an additional 1 trillion dollars in healthcare costs by 2050 and GPD loss of about 3.4 trillion per year by 2030. The high-burden pathogens, especially those belonging to the ESKAPE group, are at the centre of HAIs as well as treatment failures. The health burden caused by AMR is not limited to increased mortality rates but also includes increased durations of hospitalization, increased risks of complications during critical medical procedures such as cancer chemotherapy, organ transplantation, and neonatal care, as well as compromised surgical safety. Based on projections by global institutions, unless effective control measures are put in place, AMR is expected to significantly impact global GDP in the coming decades. The global response to AMR, such as antimicrobial stewardship programmes and surveillance, as well as the One Health approach, is critical but needs to be more effectively implemented. The issue of AMR requires urgent, sustained, and multidisciplinary action to reduce its growing health burden as well as economic consequences. Keywords: Antimicrobial resistance, AMR Health Burden, AMR Economic burden, Antimicrobial Stewardship
The Silent Exodus: Brain Drain of Pakistan’s Health Workforce
Multifocal Skeletal Tuberculosis Without Pulmonary Involvement: A Diagnostic Conundrum
A high level of clinical suspicion is necessary for the diagnosis of multifocal skeletal tuberculosis, while more recent studies can aid in radiological confirmation of the diagnosis. They could, however, occasionally be inaccurate, conflating the diagnosis with metastasis. The most reliable method of diagnosis is still a biopsy. Even in nations where TB is widespread, immunocompetent patients seldom experience multifocal skeletal involvement. Fortunately, it can be treated with successful outcomes. A rare case of Multifocal TB of lumbar vertebrae 3,4, ribs, sternum, and hip bones is reported in the case report. The patient had unusual radiological imaging results that were more indicative of multiple myeloma. Keywords: Granulomatous inflammation, Immunocompetent, Lytic bone lesions, Malignancy, Multifocal skeletal tuberculosis
Twin Neonates with Harlequin Ichthyosis in a Rare Monochorionic Dizygotic Pregnancy: A Medical Enigma
The condition Harlequin ichthyosis (HI) is a severe but rare form of congenital ichthyosis. It is due to mutation in the ABCA12 gene. Harlequin ichthyosis is an inherited, autosomal recessive disorder. Our case study reports the first-ever birth of twins affected by Harlequin ichthyosis to parents with a strong family history in Pakistan. Family history played a major role in our case, as there was a strong history of HI in the relatives. There are around 200 case reports published worldwide about HI, but to our knowledge, this is the first case ever reported of twin birth of Harlequin ichthyosis in Mansehra, Pakistan Keywords: Autosomal recessive, Congenital, Harlequin ichthyosis, Mutation, Twin Pregnancy.