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>It is recognized by the Pakistan Medical and Dental Council (PMDC</strong>) and the<strong>&nbsp;Higher Education Commission of Pakistan</strong>. It includes original research papers, reviews, case reports<strong>,</strong> 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.&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> TUMOR BOARD - Historical Perspective and Functionality at Dr. Akbar Niazi Teaching Hospital, Islamabad <p>.</p> Rizwan Aziz Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-17 2024-01-17 12 4 232 233 10.35787/jimdc.v12i4.1098 Burns First Aid: The Forgotten Public Health Challenge <p>.</p> Qurrat ul Ain Muhammad Rehan Tariq Iqbal Copyright (c) 2023 Journal of Islamabad Medical & Dental College 2023-12-30 2023-12-30 12 4 234 236 10.35787/jimdc.v12i4.1077 Accuracy of Haematology Analyzer in the Diagnosis of Malaria in Comparison with Gold Standard Microscopy <p><strong>Objective:</strong> To assess the accuracy of Haematology analyzer in the diagnosis of malaria in comparison with gold standard microscopy.</p> <p><strong>Methodology: </strong>A cross-sectional study was conducted at the Pakistan Institute of Medical Sciences and the Pakistan Atomic Energy Commission in Islamabad, Pakistan. The study was conducted for around six months, from May 2023 to October 2023. The Mindray BC-6200 haematology analyzer was utilised to evaluate a total of 191 samples, comprising 127 samples from that were infected with malaria and 64 samples from healthy controls. When the presence of malaria parasites, identified as Plasmodium vivax and Plasmodium falciparum, was detected in dyed thick blood film, a microscopy examination was carried out as a reference. Analyse-it v4.92.3 was used to create the receiver operating characteristic (ROC) curve analysis. The agreement between BC-6200 and light microscopy was assessed using the Kappa value.</p> <p><strong>Results:</strong> The InR by BC-6200's sensitivity and specificity for P. falciparum and P. vivax infections. The sensitivity of the InR by BC-600 for P. falciparum and P. vivax was 27.9% and 85.5%, respectively. The specificity of the InR by BC-6200 for P. vivax and P. falciparum was 82.7% and 86.5%, respectively.&nbsp; The infection densities in microscopy varied statistically significantly between the various InR groups (χ2 = 14.50, P &lt; 0.005).An analysis was conducted on the correlation between the cell blood count and the count of InR in both the P. vivax and P. falciparum-infected patient groups. The results showed a clear correlation between InR (P. vivax group R2 = 0.87) and ΔWBC (WBCDIFF–WBCBASO). In the Mindray BC-6200 haematology analyzer, WBCBASO represents the number of WBC counting in the BASO channel with severe membrane degradation, while WBCDIFF represents the number of WBC counting in the DIFF channel with mild lyse.&nbsp; The volume distribution widths of RBC, HGB, and red blood cells did not differ substantially. The reticulocyte characteristics of the P. vivax/P. falciparum patient group and control group differed significantly (P&lt;0.02), although RBC, HGB, and red blood cell volume distribution width (RDW) did not differ significantly (P &gt; 0.05). There was a significant difference (P&lt;0.02) in the PLT count between the P. vivax/P. falciparum patient groups and the control group.</p> <p><strong>Conclusion: </strong>The results imply that malaria might be screened for in a clinical setting using the BC-6200 haematology analyzer's "InR" flag and "InR#/InR‰" parameters.</p> Amna Imtiaz Noshina Noreen Syed Mudassar Ali Raza Sundas Ali Farah Hanif Rafay Ali Khan Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 237 243 10.35787/jimdc.v12i4.1055 Frequency of Positive Anti-CCP Antibodies in Rheumatoid Arthritis Patients with Negative Rheumatoid Factor <p><strong>Background: </strong>Rheumatoid arthritis (RA) is a polyarticular autoimmune disease that affects about 1% of the adult population. The disease is characterized by synoviocyte hyperplasia, mainly synovial fibroblasts, resulting in bone and joint destruction. Recent studies have shown that cytokines and other systemic inflammation mediators have a key role in the development ofrheumatoid arthritis. Recently, Anti-Citrullinated Protein Antibodies (anti-CCP) have come into use for the diagnosis of rheumatoid arthritis (RA). It has been reported that anti-CCP has quite a high specificity for RA (98%), together with sensitivity similar to that for rheumatoid factor (RF). The study aimed to determine the frequency of positive anti-CCP antibodies in rheumatoid arthritis patients with negative rheumatoid factor.</p> <p><strong>Methods</strong>: 91 patients (both male and females) aged 40-70years with negative RF were clinically diagnosed with rheumatoid arthritis. Patients with positive rheumatoid factor and joint injuries were disclaimed. The consultant pathologist used a second-generation enzyme-linked immunosorbent assay (ELISA) to assess the serum levels of anti-CCP antibodies, &gt;20IU/ ml is considered positive p-value of 0.05 were considered statistically significant.</p> <p><strong>Results</strong>: In the study, the age range was 40 to 70 years, averaging 53.44 ± 7.16 years. 59 (64.84%) of the patients were between the ages of 40 and 55. Of 91 patients, 56 (61.54%) were women, and 35 (38.46%) were men with aratio of 1.6:1 man to women. In patients with negative rheumatoid factors, 27 (40.66%) patients were found to have the levels of positive anti-CCP antibodies.</p> <p><strong>Conclusion</strong>: Patients with negative rheumatoid factor showed the high frequency of positive anti-CCP.</p> Fahad Qaisar Ammad Masood Sana Ujala Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 244 249 10.35787/jimdc.v12i4.665 High and Low Level Mupirocin Resistance among Clinical Isolates of Methicillin Resistant Staphylococcus Aureus (MRSA) <p><strong>Background: </strong>Staphylococcus aureus is a significant source of nosocomial infections, causing illnesses ranging from minor to life-threatening septic shock. Routine culturing and specific testing can confirm the presence of the bacteria. Antibiotic resistance is a major concern, and methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) is particularly dangerous as it has mutations in the mecA gene, making it resistant to beta-lactam antibiotics. Mupirocin is an effective antibiotic against MRSA, binding to isoleucyl transfer-RNA synthetase to inhibit protein and RNA synthesis.</p> <p><strong>Objective: </strong>In this study, two different concentrations of mupirocin were tested against MRSA.</p> <p><strong>Material &amp; Method: </strong>This study aimed to determine the antimicrobial susceptibility of methicillin-resistant <em>Staphylococcus aureus</em> (MRSA) against two different doses of mupirocin. Clinical samples were collected in the duration of one year from different wards of Jinnah Hospital Lahore and processed in microbiology laboratory of Allama Iqbal medical college and after confirmation of <em>Staphylococcus aureus</em>, the modified Kirby Bauer method was used to test antimicrobial susceptibility. MRSA was confirmed by resistance to cefoxitin. High and low-level doses of mupirocin were applied, and zone sizes were measured.</p> <p><strong>Results: </strong>Total 172 isolated methicillin resistant <em>Staphylocuccus aureus </em>(MRSA) from all age and genders were tested against two doses of mupirocin. Both (mupriocin 5 µg and 200µg) were highly effective and MRSA were around 97% sensitive to mupirocin.</p> <p><strong>Conclusion: </strong>After the resistance of all beta lactam drugs, mupirocin can be very helpful in the treatment of MRSA infections.</p> <p><strong>Key Words:</strong>MRSA, Mupriocin</p> Zainab Yousaf Farhan Rasheed Muhammad Touqeer Hanif Copyright (c) 2023 Journal of Islamabad Medical & Dental College 2023-12-30 2023-12-30 12 4 250 254 10.35787/jimdc.v12i4.983 Association of High Sensitivity C-reactive Protein with Type II Diabetic Retinopathy <p><strong>Objective: </strong>The objective of this study is to find out the association of diabetic retinopathy with serum homocysteine and high sensitivity (hs) CRP levels.</p> <p><strong>Methods: </strong>The research was conducted out at the Army Medical College's Department of Physiology and Centre for Research in Experimental and Applied Medicine (CREAM), Rawalpindi, in partnership with the Armed Forces Institute of Ophthalmology, Rawalpindi for a tenure of 12 months. Ninety subjects, were included in the study, thirty in each group: controls, diabetic subjects, and the patients suffering from diabetic retinopathy (DR).</p> <p><strong>Results: </strong>Healthy controls, diabetic subjects, and patients with DR were found to have mean Fasting Blood Glucose (FBG) values of 5.51 0.34 (mmol/l), 8.11 0.67 (mmol/l), and 8.73 0.90 (mmol/l), respectively (p=0.001). The mean HbA1c level in normal subjects was noted as 5.08 ± 0.27 in healthy controls as compared to 7.70 <u>+ </u>0.89 (mmol/l)) in diabetic subjects and 9.02 <u>+</u> 1.76 (mmol/l) in patients with DR &nbsp;(p=0.001 by ANOVA).&nbsp;</p> <p>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; In normal subjects, the mean hs CRP levels were noted to be 3.74 <u>+</u> 1.97 (mg/l) in healthy controls as compared to 15.32 <u>+</u> 2.93 (mg/l) in diabetic subjects and 26.71 <u>+</u> 4.88 (mg/l) in patients with diabetic retinopathy (p=0.001 by ANOVA).</p> <p><strong>Conclusion: </strong>During the study, it was found that elevated levels of these inflammatory biomarkers can accurately predict the onset of diabetic retinopathy and that hs CRP levels are strongly related with the development of diabetic retinopathy. Monitoring these inflammatory signs in the serum can therefore help prevent diabetic microangiopathic consequences, including DR.</p> Shazia Junaid Lubna Gohar Hina Moazzam Sana Ahmad Sadia Rehman Khubaib Ahmad Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 255 261 10.35787/jimdc.v12i4.1001 A Comparison of Functional Outcome of Open Reduction Internal Fixation Versus Ilizarov External Fixation in Complex Proximal Tibial Fractures: Randomized Controlled Trial <p><strong>Objective:</strong> Proximal tibia fractures can be treated with open reduction and internal fixation (ORIF), hybrid fixation, or external fixation; however, it is still unknown which method is better than the others. The purpose of the study was to compare the clinical and functional outcomes handled by Ilizarov and ORIF in order to determine the gold standard treatment choice for proximal tibia fractures. This study aimed to compare the functional outcomes of open reduction internal fixation and Ilizarov external fixation in the treatment of complicated proximal tibial fractures.</p> <p><strong>M</strong><strong>ethodology:</strong>&nbsp;An RCT was carried out in the Orthopaedic Department at PIMS Islamabad. It was carried out during a 12-month period after the synopsis was approved.This study included 104 patients with Schatzker's grade IV–VI fractures who presented to the orthopaedic department at PIMS, Islamabad. Using the lottery approach, the patients were split into two treatment groups at random. Group B uses the Ilizarov External Fixation procedure, while Group A uses the Open Reduction and Internal Fixation (ORIF) technique. Every three weeks, post-operative follow-ups were conducted. Up until the fracture healed, post-operative radiographs were taken every three weeks. Every patient had a 24-week clinical follow-up. At the follow-up appointment, each patient's outcomes were documented in accordance with the operational definition. SPSS was used to enter and process all of the data.</p> <p>Using SPSS v25.0, all of the data were input and processed. The surgery time, VAS score, and length of hospital stay were compared between the two groups using an independent sample t-test. The functional outcome at six months was compared between the two groups using the Chi-square test. A significant p-value was defined as ≤0.05.</p> <p><strong>R</strong><strong>esults:</strong><strong>&nbsp;</strong>There were 31 (59.6%) men and 21 (40.4%) women in group A, and 36 (69.2%) men and 16 (30.8%) women in group B.In group A, the mean age was 44.87±14.15 years, while in group B, it was 44.25±15.68 years. In terms of functional outcome, 22 (42.3%) of the ORIF technique group had excellent outcomes, while 10 (19.2%), 16 (30.8%), and 4 (7.7%) had good, fair, and poor outcomes, respectively. In contrast, 35 (67.3%) of the Ilizarov technique group had excellent outcomes, while 10 (19.2%), 5 (9.6%), and 2 (3.8%) had good, fair, and poor outcomes, respectively. These results have a statistically significant p-value of 0.024.</p> <p><strong>C</strong><strong>onclusion:</strong><strong>&nbsp;</strong>Compared to open reduction and internal fixation, Ilizarov external fixation is a more reliable method for fixing complicated proximal tibial fractures. For patients with complicated proximal tibial fractures, the Ilizarov external fixation approach yields superior functional outcomes than the open reduction internal fixation technique.</p> <p><strong>KEY WORDS:</strong>&nbsp;Proximal Tibia Fracture, Open Reduction ,&nbsp;Internal Fixation, Ilizarov External Fixation.</p> Muhammad Farhan Farhat Zeeshan Khan Nazim Mohammad Osama Hassaan Ahmad Bilal Razzaq Muhammad Khan Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 262 270 10.35787/jimdc.v12i4.1050 Treatment Non-Compliance due to Glyceryl Trinitrate Side Effects in Anal Fissure <p><strong>Objective:</strong> Anal fissures generally respond very well to the glyceryl trinitrate (GTN) ointment. However, it is associated with side effects like headache and hypotension<strong>.&nbsp; </strong>The objective was to evaluate the noncompliance of patients with topical glyceryl trinitrate due to its side effect in the management of anal fissure.&nbsp;</p> <p><strong>Methodology:</strong>&nbsp; After taking ethical approval, a prospective case series was conducted at IIMCT-Pakistan Railway Hospital over a period from 1<sup>st</sup> March, 2023 to 31<sup>st</sup> August 2023. A sample size of 112 was calculated using WHO calculator 1.1 and these many patients were subsequently studied for side-effects of GTN and their compliance to the therapeutic regime.</p> <p><strong>Results: </strong>Of 122 patients studied: 62 (55.4%) were males, mean age was 35.35±10.22 years and mean daily doses of GTN was 2.31±0.56. Sixty-five (53%) of the patients using topical GTN reported side effects. Headache and postural hypotension were the most commonly reported side effects: 29.5% and 21.4% reported these side effects, respectively. Non-compliance was noted in only 14 patients (12.5%). Headache contributed 78.6% whereas postural hypotension &amp; palpations contributed 21.4% towards the non-compliant cases. Thus, these two side effects were the only ones contributing towards non-compliance and had statistically highly significant association with non-compliance at a p value of 0.001. 94% of the compliant patient completely healed completely whereas only 2% of non-compliant patients achieved healing till 3-month follow-up: these results were significant at<strong> p&lt;0.001. </strong></p> <p><strong>Conclusion: </strong>Headache postural hypotension are significant side-effects of GTN; and they lead to non-compliance and thus subsequent failure to achieve healing.</p> Bilal Ahmed Khalid Farooq Danish Rehan Ahmed Khan Muhammad Asad Muhammad Ismail Seerat Muhammad Umar Nisar Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 271 276 10.35787/jimdc.v12i4.1051 Phenotypic Profile of Kidd Blood Group System in Northern Pakistani Population <p>OBJECTIVE<br>To investigate the phenotypic profile of Kidd blood group system in Northern Pakistani population.<br>STUDY DESIGN: Descriptive cross-sectional PLACE AND DURATION OF STUDY: The research was conducted at department of immunohaematology, Armed Forces Institute of Transfusion (AFIT) Rawalpindi, Pakistan, from Dec 2022 to Jun 2023.<br>METHODOLOGY: The study included 280 donors of all ages and both genders fulfilling the WHO Healthy Volunteer Donor criteria for blood donation. Individuals were included in this study while individuals not fulfilling the criteria were excluded from this study.. Blood grouping was performed by tube agglutination method and for data analysis version 23.0 of Statistical Package for Social Sciences (SPSS) was used.</p> <p>RESULTS: The frequencies of A, B, AB, and O antigens were (23.9%), (33.6%), (10.0%), and (32.5%), respectively among all the 280 participants while the frequencies of Kidd Jka and Jkb were 73.2% and 75.4% respectively. The expression of phenotypic profile was Jk ( a+b+) in 49.6%, Jk (a-b+) in 25.7%, Jk (a+b-) in 23.6%, and Jk (a-b-) in 1.1%.</p> <p>CONCLUSION: Kidd antigen was found in a significant proportion of our donor population which arises the need for undertaking extended antigen typing for this minor blood group as a routine in our blood banks to be able to provide antigen free blood units to chronically transfused, pregnant and anaemic individuals for prevention of delayed haemolytic transfusion reactions.</p> Kehkashan Hassan Asad Mahmood Ayesha Khursheed Zara Tasneem Samia Shafaat Fauzia Khan Kashaf ad Duja Awais Copyright (c) 2023 Journal of Islamabad Medical & Dental College 2023-12-30 2023-12-30 12 4 277 282 10.35787/jimdc.v12i4.1056 Association of Microalbuminuria with Glycemic Status Among Patients with Diabetes Mellitus <p><strong>Objectives:</strong> To evaluate the association between micro-albuminuria and glycemic status among type 2 diabetic patients in Hyderabad, Sindh.</p> <p><strong>Methods:</strong> Cross Sectional study was conducted at the Medical unit of Isra University, Hyderabad from January 2019 to June 2020. All the patients aged between 30 and 50 years, of either genders, with both good controlled as well as uncontrolled diabetes mellitus type II admitted in the medicine ward were included. All the participants were divided into two groups according to their glycemic level. The Group I comprised of patients with poor glycemic control that is HbA1c &gt;7% while Group II comprises of patients with good glycemic control that is HbA1c&lt;7%.</p> <p><strong>Results:</strong> Majority (56.4%) of participants in the study were Male while most (31.0%) them belongs to age group 41-45 years. The mean age of all patients was 42.3 ± 4.1 years. The mean HbA1c level in group 1(poorly controlled) and 2 (good control) participants was 8.04± 0.97% and 5.87 ± 0.44%. There was a statistically significant association (p&lt;0.05) between poorly controlled glycemic status and micro-albuminuria.</p> <p><strong>Conclusion:</strong> Micro-albuminuria is significantly associated with the poor glycemic status among type 2 diabetic patients.</p> Parkash Kumar Chandra Essar Mal Muhammad Aslam Rind Harender Kumar Tanveer Ahmed Talpur Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 283 287 10.35787/jimdc.v12i4.862 First Report of Phenotype Prevalence of Five Major Rh Blood Group Antigens in the Blood Donor Population of Peshawar, Pakistan <p><strong>Objective:</strong> The current study investigated the prevalence of five major Rh blood group antigens in the Peshawar region of Khyber Pakhtunkhwa province, Pakistan.</p> <p><strong>Methodology:</strong> This was a cross-sectional study, conducted at the Peshawar Regional Blood Centre from February to April 2023. A total of 13,148 blood donor samples were analyzed for Rh D, C, c, E, and e antigens using monoclonal reagents. The frequencies were calculated by direct counting on a spreadsheet programme and the Statistical Package for Social Sciences (SPSS for Windows version 25.0. Armonk, NY, USA) was used to conduct a meta-analysis for comparison of results with national and international studies.</p> <p><strong>Results:</strong> The findings of the current study revealed that 92.17% of donors were RhD positive. The e antigen showed the highest frequency of 98.31%, followed by D antigen and the C antigen (92.17% and 78.37%, respectively). Comparative analyses with earlier Pakistani studies and international data indicated significant variations in antigen frequencies, potentially attributed to the diverse ethnic population and geography of the region.</p> <p><strong>Conclusion:</strong> The findings emphasize the importance of local antigen frequency data for efficient blood transfusion strategies, especially for thalassaemia patients requiring frequent transfusions.</p> <p><strong>Key words:</strong> Rhesus, Blood Group, Phenotype</p> Noore Saba Usman Waheed Muhammad Nisar Khan Muhammad Saeed Tariq Hayat Khan Akhlaaq Wazeer Saeed Ahmed Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-12 2024-01-12 12 4 288 293 10.35787/jimdc.v12i4.1093 Esophagogastroduodenoscopy at a Tertiary Care Hospital: Common Indications, Endoscopic Findings and Interventional Approach <p><strong>Objective:</strong> Esophagogastroduodenoscopy (EGD) is frequently performed as a screening, diagnostic and therapeutic procedure in patients presenting to gastroenterology department. No data documentation of EGD with demographics, indications, findings and intervention performed is available for our tertiary care setup in recent years. The aim of this study is to assess the common indications, esophagogastroduodenoscopy (EGD) findings and therapeutic procedures performed in patients undergoing EGD for various gastrointestinal (GI) symptoms.</p> <p><strong>Methodology: </strong>A cross sectional study was conducted on 127 patients in department of Gastroenterology, Pakistan Institute of Medical Sciences Hospital. Duration of study was six months. Collected data included name, age, gender, indications for EGD, mode of presentation, EGD findings and therapeutic procedures that were performed. Statistical package for social sciences version 23 was used to analyze the data.</p> <p><strong>Results: </strong>Mean age was 47.85 ± 6.74 years with male to female ratio of 1.04. Most common indications for EGD included upper GI bleed 25.19% and dyspepsia 22.83%. The three most common EGD findings were esophageal varices (34.64%), portal gastropathy (24.4%) and mild gastritis (14.96%). Variceal banding was the most common procedure performed.</p> <p><strong>Conclusion: </strong>In our tertiary care hospital, upper GI bleed is the most common indication for EGD. Esophageal varices is the most common EGD finding encountered and variceal banding is the commonest procedure performed.</p> <p><strong>Key words: </strong>Esophagogastroduodenoscopy; EGD; Upper gastrointestinal endoscopy; Upper gastrointestinal bleed; Varices; Gastritis; Gastropathy; variceal banding</p> Awais Saeed Abbasi Zain Sharif Muneeb Ullah Muaz Mubashir Haider Wajid Abbasi Mashhood Ali Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-09 2024-01-09 12 4 294 299 10.35787/jimdc.v12i4.874 Safety and Efficacy of Early Cholecystectomy in Acute Biliary Pancreatitis <p><strong>Objective:</strong> This study was done to assess the safety and efficacy of early Cholecystectomy in mild to moderate Acute Biliary pancreatitis in own surgical setup.</p> <p><strong>Methodology: </strong>This descriptive study was done in surgical unit 1, Fauji Foundation Hospital Rawalpindi from 1st January 2019 to 31st December 2022. Total 70 patients diagnosed as having mild or moderate acute biliary pancreatitis were included in study. Patients having severe acute biliary pancreatis, multi-organ dysfunction syndrome and pre-existing severe medical co-morbidity were excluded from study. After informed consent early cholecystectomy either laparoscopic or open was performed by senior consultant surgeon within 2-4 days of admission. Post-operatively patient subjective feeling of pain, intravenous analgesia and hospital stay were recorded. Post-operative complications were documented. Data were analyzed on SPSS version 26.</p> <p><strong>Results:</strong> The age range was from 28 to 72 years with a mean of 45.2 ± 11.86 years. Majority of patients were of mild severity 44(62.9%), while 26(37.1%) cases were of moderate severity. Laparoscopic cholecystectomy was performed 28(40%) cases and open cholecystectomy was done in 38(54.28%) cases. Post-operative pain numerical scale mean was 4.31 ± 1.55. The duration of requirement of post-operative intravenous analgesia was mean 37.02 ± 18.12 hrs. Mean hospital stay of patients was 5.95 ± 1.39 days. Among post-operative complications, the most frequent was post prandial dyspepsia 10(14.3%) cases followed by surgical site infection 6(8.6%) cases, recurrent pancreatitis 4(5.7%) cases, pseudocyst formation 2(2.9%) cases, lobar pneumonia 1(1.4%) case and recurrent biliary sepsis in 1(1.4%) case.</p> <p><strong>Conclusion:</strong> Early cholecystectomy is a safe surgical procedure in mild to moderate biliary pancreatitis. It shortens the course of illness, prevents complications and reduces hospital stay.</p> <p><strong>KEYWORDS</strong>: Cholelithiasis, Acute biliary pancreatitis, cholecystectomy, safety, Efficacy.</p> ABRAR HUSSAIN ZAIDI Muhammad Taimur SHAZIA NAQVI DR. SAMIULLAH Manzoor Ahmed Faridi Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-15 2024-01-15 12 4 300 306 10.35787/jimdc.v12i4.982 Diagnostic Efficacy of SOFA Score in Predicting Outcome and Mortality: An ICU Experience from Pakistan <p><strong>Objective:</strong> To determine the cut-off value of Sequential Organ Failure Assessment score at the time of admission in Intensive Care Unit to predict mortality and outcome in critically ill patients.</p> <p><strong>Materials and Methods: </strong>This cross-sectional, descriptive study was undertaken at Intensive Care Unit of Rawalpindi Teaching Hospital, Rawalpindi, Pakistan between April and August 2023. SOFA score of all critically ill patients at the time of admission in ICU and their outcome (expired or discharged) was recorded. Receiver Operator Characteristics Curve (ROC) was drawn for SOFA score and mortality. Cut off value for SOFA score was calculated. Outcome of patients above and below the cut off value for SOFA score was studied using Chi-square test.</p> <p><strong>Results: </strong>A total of 100 patients (54% females and 46% males) were included in the study with mean patient age of 68.93±11.09 years. Out of 100&nbsp; patients,&nbsp; 48 (48%)&nbsp; improved&nbsp; and&nbsp; 52&nbsp; (52%)&nbsp; expired. The Mean&nbsp; initial&nbsp; SOFA&nbsp; score&nbsp; was&nbsp; 5.44±3.99 in patients who improved and 9.91±4.20 in patients who expired.&nbsp; Coordinates&nbsp; of&nbsp; the&nbsp; ROC curve&nbsp; showed&nbsp; that&nbsp; SOFA score&nbsp; cut&nbsp; off&nbsp; value&nbsp; 7.5&nbsp; had&nbsp; best&nbsp; corresponding&nbsp; sensitivity&nbsp; (0.777)&nbsp; and&nbsp; specificity&nbsp; (0.740). The patients were categorized to Group&nbsp; I&nbsp; (SOFA&nbsp; score ≤7),&nbsp; and&nbsp; Group&nbsp; II (SOFA&nbsp; score ≥8). 34.04% of the Group I and 75.47% of the Group II patients expired (p-value 0.0000001)</p> <p><strong>Conclusions:</strong> Mortality was higher in&nbsp; patients who had higher SOFA score at the time of admission in Intensive Care Unit. At admission SOFA scores (≤7 and &gt;8) are best predictor of outcome in critically ill patients.</p> Muhammad Ali Abbas Malik Shamaila Mumtaz Faran Maqbool Javaria Malik Saima Mir Muhammad Imran Saeed Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-15 2024-01-15 12 4 307 311 10.35787/jimdc.v12i4.1064 A Comparison of Hysterosalpingographic Results in Individuals Experiencing Primary and Secondary Infertility: A Prospective Approach <p>Introduction: In order to examine the uterine and fallopian tubes in women suffering from infertility, Hysterosalpingography (HSG) technique is commonly used in process of different investigations. The technique is used to assess any blockages in the tubes or normal morphology of the uterus. This study aims to compare the HSG results in a study population having primary and secondary infertility.</p> <p>Materials and Methods: We conceded a one-year prospective study at Islamabad Diagnostic Center in Islamabad, Pakistan after getting institutional review board approval. The study duration was from July 1, 2022 to June 30, 2023. Sample size was calculated using online software “Raosoft” which estimated it to 242. All the patients who gave informed consent and having primary and secondary infertility were enrolled. Demographics of the patients including age, duration of infertility, and the presence of tubal and uterine abnormalities, were collected by reviewing clinical notes and X-ray findings.</p> <p>Results: Among 242 enrolled patients with infertility, the ratio of primary infertility was 70.27% (n=170) and that of secondary infertility was 29.75% (n=72). In both the groups, fallopian tube blockage was observed as a major abnormality that affected 20.00% (n=34/170) of patients with primary infertility and 30.55% (n=22/72) of patients with secondary infertility. Unilateral tube blockage was observed in 26.47% (n=9/34) whereas, bilateral blockage was observed in 29.41% (n=10/34) patients with primary infertility. 23.52% (n=8/34) of patients got affected with Bilateral hydrosalpinx, whereas unilateral loculated spill was perceived in 8.82% (n=3/34) of. In patients with uterine congenital abnormalities, 5.88% (n=2/34) had a bicornuate uterus, 2.94% (n=1/34) had a unicornuate uterus, and 2.94% (n=1/34) had uterine didelphys.</p> <p>Conclusion: In order to examine the uterine and fallopian tubes in women suffering from infertility, Hysterosalpingography (HSG) technique is commonly used. The technique is used to assess any blockages in the tubes or normal morphology of the uterus. In this study, fallopian tube abnormalities were most predominant among barren women. So, taking deterrent actions and efficiently management of pelvic infections are indispensable in plummeting the manifestation of infertility resultant of the tubal issues.</p> <p>Keywords: Hysterosalpingography, Infertility, Subfertility, Tubal blockage</p> <p>&nbsp;</p> <p>&nbsp;</p> Naushaba Malik Hinna Hanif Mughal Hassan Mumtaz Shahbakht Aftab Minaal Ahmed Khan Saima Bibi Rida Noor Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-15 2024-01-15 12 4 312 318 10.35787/jimdc.v12i4.1053 Expression of JAK2 V617F Mutation in BCR - ABL Negative Myeloproliferative Neoplasms <p>OBJECTIVE: To detect the presence of JAK2V617F mutation in BCR - ABL negative myeloproliferative neoplasms and to stratify high risk patients for targeted therapy.<br>PLACE AND DURATION OF STUDY: Department of Haematology, Armed forces institute of Pathology (AFIP), Rawalpindi, from Dec 2023 to Oct 2023.<br>STUDY DESIGN: Descriptive cross sectional study<br>METHODOLOGY: A total of 40 consecutive patients of BCR - ABL 1 negative myeloproliferative disorders were included in the study after being diagnosed according to WHO defined haematological criteria for each disorder and performing bone marrow examination under aseptic measures. Informed consent and ethical approval were obtained from each individual. All patients had their blood samples examined for the G-T point mutation (V617F) in the JAK2 gene located on chromosome 9, utilizing allele-specific real-time qualitative polymerase chain reaction (RT-qPCR). Results were analyzed by using SPSS version 22.<br>RESULTS: Out of total 40 patients included in our study 21(52.5%) had Polycythemia Vera (PV), 15 (37.5%) had Primary myelofibrosis (PMF) and 4 (10%) had Essential thrombocythemia (ET). JAK2 mutation was found in 20 (95.2%) patients of PV, 9 (60%) patients of PMF and 2 (50%) patients of ET with a significant p-value of ˂ 0.001.<br>CONCLUSIONS: JAK2 V617F is a useful clinical marker for establishing diagnosis and separating high risk patients for specific targeted therapy.</p> Kehkashan Hassan Ayesha Khursheed Hamid Saeed Malik Manzar Bozdar Rafia Mahmood Zara Tasneem Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-17 2024-01-17 12 4 319 326 10.35787/jimdc.v12i4.1057 Clinicopathological Features and Prognosis of Primary Breast Sarcoma: A Single Centre Retrospective Study <p><strong>Objective:</strong> This study aims to describe clinicopathological characteristics and outcomes of primary breast sarcoma (PBS) and the relevance of clinical and pathological characteristics with the outcomes.</p> <p><strong>Methodology: </strong></p> <p>Study Design: Retrospective longitudinal study</p> <p>Place and duration of study: Department of Medical Oncology Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore from January 1995 to August 2021.</p> <p>Patients aged 18 years and older were included in the study. Individuals with primary or secondary angiosarcoma or cystosarcoma phyllodes were not included. The hospital information system was used for collecting data, and data was collected for 27 patients meeting inclusion study criteria.</p> <p><strong>Results:</strong> Twenty-seven patients were treated with surgery, seven out of 27 patients (25.90%) received adjuvant chemotherapy and 2 patients (7.40%) received chemotherapy on a palliative intent. The remaining (66.70%, n=18) did not receive chemotherapy. Twenty-four out of 27 patients (88.90%) received radiation therapy; intent was adjuvant in the entire cohort. Median PFS was 18 months with 74.01% of patients having no progression at their last follow-up. The median OS was 23 months. Adjuvant radiotherapy was associated with a significant overall survival benefit (P-value: 0.05). Adjuvant chemotherapy was not associated with a significant survival benefit (P-value: 0.5). Age, tumor size, and disease status (localized disease) conferred a non-significant trend towards a better outcome.</p> <p><strong>Conclusion</strong>: Adjuvant radiotherapy is the only factor that affects the outcomes of this disease. Further multicentred and preferably prospective studies with a larger number of patients are required to define disease characteristics and patient outcomes of primary breast sarcoma in Pakistan.</p> <p><strong>Keywords:</strong> clinical characteristics, outcomes, prognosis, primary breast sarcoma (PBS)</p> Naqib Ullah Sameen Bin Naeem Mussadique Ali Jhatial Abdul Wahab Rabeea Shahid Manzoor Khan Shazia Asim Neelam Siddiqui Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-22 2024-01-22 12 4 327 333 10.35787/jimdc.v12i4.1087 Efficacy of Intralesion Injection of Combined 5-Flourouracil and Triamcinolone versus Triamcinalone alone in Keloids and Hypertrophic Scars: A Comparative Analysis <p><strong>Objective:</strong> The treatment of keloids and hypertrophic scars is challenging and controversial. The therapeutic agents found in the literature include silicone sheets, compression garments, corticosteroid injections, 5-fluorouracil (5-FU), bleomycin and interferon, topical imiquimod, cryotherapy, radiation, and laser or light-based therapies. Triamcinolone acetonide (TCA), a corticosteroid, considered first line treatment for the prevention and treatment of keloids and hypertrophic scars. To compare the efficacy of triamcinolone acetonide alone and triamcinolone acetonide plus 5-florouracil for treating keloids and hypertrophic scars in burn patients.</p> <p><strong>Methodology</strong>: In this study, the patients were divided into two groups A and B on the basis of treatment regimen, i.e. Group A (TCA alone) and Group B (5FU+TCA). The efficacy of both treatments was compared for improvement in Vancouver scar scale (VSS) and pruritus scale.</p> <p><strong>Results:</strong> The mean VSS score pretreatment was calculated as 10.74±2.36 in Group A and 10.27±3.14 in Group B.&nbsp; Post-treatment, it was reduced to 5.58±1.04 in Group-A and 3.41±2.11 in Group-B. The comparison of efficacy shows an improvement of 65.80% in Group A and 75.07% in Group B; the p value was 0.047, showing a significant difference.</p> <p><strong>Conclusion:</strong> Combination therapy of intra-lesion injection of triamcinolone acetonide and 5-florouracil has significantly higher efficacy as compared to triamcinolone acetonide alone for the treatment of keloids and hypertrophic scars, but necessary precautions have to be taken.</p> Samia Rizwan Ahmed Ali Ayesha Aslam Sameena Aman Nousheen Saleem Malaika Nasir Anum Ikram Shanzay Hummayoun Amina Hasan Butt Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-31 2024-01-31 12 4 334 338 10.35787/jimdc.v12i4.1104 Effects of Decompression Therapy in Leg Pain and Straight Leg Rise in Patient with Lumbar Radiculopathy Due to Disc Protrusion <p>One among many disc problems is disc protrusion, which has more prevalence in outpatient department physical therapy management Centre globally. The purpose of this study was to compare the effect of lumbar spine decompression therapy and standard physical therapy treatment in patients with lumbar radiculopathy due to disc protrusion. The single-blind randomized control trial of 71 patients was conducted at Max Rehab &amp; Physical Therapy Centre Islamabad, Pakistan. After setting inclusion criteria all the patients were randomly allocated into treatment and control group. Both group received standard physical therapy treatment including, Moist Hot pack, Lumbar Mobilization, Stretching &amp; strengthening exercises. The only difference was that Decompression Group received additional Decompression therapy. The data included demographics and Numeric Pain Rating Scale score in supine lying position for the painful leg and Straight Leg Raise Range for the painful side. The values for leg pain for control group decreased from 6 to 3 and the value for straight leg raise increased from 15° to 49°. The values for leg pain for the Decompression Group decreased from 6 to 2 and the value for the straight leg raise increased from 10° to 48°, the p value for both the variables was &lt;.001 showing statistically significant difference between pre and post values in treating patients leg pain and straight leg raise range of motion. It is concluded that decompression therapy is more effective in managing lumbar radiculopathy.</p> Abdul Ghafoor Sajjad Muhammad Shahid Javed Iqra Hamid Syed Ali Hussain Muhammad Ali Raja Benish Shahzadi Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-31 2024-01-31 12 4 339 347 10.35787/jimdc.v12i4.1058 C-Reactive Protein as a Prognostic Indicator: Navigating the Challenge of Predicting Severity and Mortality in Acute Pancreatitis <p><strong>Objective: </strong>The main goal was to evaluate the effectiveness of C-reactive protein (CRP) in assessing acute pancreatitis severity 48 hours after onset by contrasting its results with CT scans.</p> <p><strong>Methodology: </strong>This cross-sectional study, which lasted six months from May to December 2019 at the Department of General Surgery, Pakistan Institute of Medical Sciences, comprised 150 suspected cases. CT scans and serum samples were taken 48 hours after the onset of symptoms. A postgraduate trainee created reports using a standard proforma to record CT scan results and CRP levels.</p> <p><strong>Results: </strong>The average age of the patients was 45.03±10.86 years, with severe acute pancreatitis confirmed in 28.7% of cases by CT scans. CRP demonstrated notable diagnostic values: sensitivity 81.4%, specificity 92.52%, PPV 81.4%, NPV 92.52%, and an overall accuracy of 89.33%.</p> <p><strong>Conclusion: </strong>C-reactive protein (CRP), a product of interleukin-1 and interleukin-6 responses by the liver, emerges as a valuable and cost-effective biomarker. Its consistent elevation in correlation with pancreatitis severity, especially within the critical 48-hour window, suggests its potential as a reliable predictor. This study underscores CRP's diagnostic utility and accessibility, emphasizing its role in assessing acute pancreatitis severity.</p> <p>&nbsp;</p> <p><strong>Key Words: </strong>C-reactive protein, CT scan, Acute pancreatitis</p> Ibadur Rahman Hira Saleem Muhammad Burhan ul Haq Muhammad Adnan Khokhar Arif Khurshid Zulfiqar Khan Tanoli Shaharyar Ahsan Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-02-13 2024-02-13 12 4 348 355 10.35787/jimdc.v12i4.1142 Epidemiological Review on JN-1 Variant of COVID-19: An Emerging Global Threat <p>The emergence of the Omicron variant, also known as the JN 1 COVID-19 variant, has raised concerns worldwide. This review aims to comprehensively assess the influence, prevalence, and characteristics of the JN-1 variant. It includes a wide range of studies that investigate the effectiveness of vaccines, genetic factors, hospitalizations, and clinical outcomes associated with this variant. The pathophysiology of the JN 1 variant, which could have implications for clinical management and public health, is also discussed. The review addresses the recent increase in cases of the JN-1 variant in Asia and other heavily impacted regions, providing epidemiological evidence. The findings of this review article contribute to a better understanding of the JN-1 variant and its implications for global health.</p> Muhammad Kamran Muhammad Noman Afreenish Amir Faheem Ullah Asma Balqees Hira Tariq Maryam Aftab Naseer Ali Shah Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-17 2024-01-17 12 4 356 362 10.35787/jimdc.v12i4.1095 A Unique Case of Heterotopic Pregnancy <p>Heterotopic pregnancy, characterized by simultaneous intrauterine and extrauterine pregnancies, is a rare but potentially life-threatening condition. Its incidence has increased, attributed to factors such as pelvic inflammatory disease and assisted reproductive technologies. We present a case of spontaneous heterotopic pregnancy in a 28-year-old woman with lower abdominal pain. Initial examination revealed a ruptured left tubal ectopic pregnancy alongside a live intrauterine pregnancy. Prompt diagnosis via transvaginal ultrasonography led to emergency laparotomy, confirming sonographic findings. The ruptured ectopic pregnancy was successfully removed, preserving intrauterine gestation. Follow-up ultrasounds demonstrated a progressing intrauterine pregnancy. This case underscores the diagnostic challenges and emphasizes the importance of early recognition and intervention in heterotopic pregnancies, especially in the absence of predisposing risk factors. Increased awareness, thorough pelvic examination, and close follow-up are crucial for optimal outcomes in both pregnancies.</p> Saba Khilji Dr Wajeeha Anam Dr Mehwish Tabassum Dr Aleena Tahir Dr Manal Niazi Naaemah Saleem Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-17 2024-01-17 12 4 363 366 10.35787/jimdc.v12i4.1069 Pyknodysostosis: A Challenging Diagnosis <p>We report a case of a 7-year-old boy presented to us with short stature, born at full term by SVD with an immediate cry and a birth weight of 03 kg, breast-fed for 2 years. There are no apparent signs of development delay. By the age of two, the mother was concerned about physical and developmental delays.</p> <p>The patient had a male sibling with a history of repeated fractures and sensorineural hearing loss, labelled osteopetrosis.</p> <p><strong>EXAMINATION:</strong></p> <ul> <li>An active male child of 95cm and 12 kg falls below the 3rd centile.</li> <li>He had frontal bossing, mildly hypoplastic maxillae, a wide open fontanelle, and sutural diastasis.</li> </ul> <p><strong>INVESTIGATIONS:</strong></p> <ul> <li>Complete Blood Count, Thyroid profile, Serum Calcium, Phosphorus and Alkaline Phosphatase. All normal.</li> <li>A skeletal survey showed an increase in bone density. Sutural diastasis, multiple Wormian bones, thickening of the Calvaria, thickening of long bones with medullary sparing, and spool deformity of vertebral bodies.</li> </ul> <p><strong>DIFFERENTIAL</strong> <strong>DIAGNOSIS</strong></p> <ul> <li>Pyknodysostosis</li> <li>Hypothyroidism</li> <li>Osteopetrosis</li> </ul> <p><strong>CONCLUSION:</strong></p> <p>Additional X-rays, including the mandible, showed an obtuse angle, the clavicle was laterally deficient, and the hand showed acro osteolysis. The patient was diagnosed with a rare case of pyknodysostosis.</p> Hamna Shakil Manal Niazi Gulandam Shahid Saad Shakil Copyright (c) 2024 Journal of Islamabad Medical & Dental College 2024-01-17 2024-01-17 12 4 367 370 10.35787/jimdc.v12i4.1070