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> Mitochondrial DNA Inheritance Mystery Irfan Afzal Mughal Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 153 154 10.35787/jimdc.v9i3.606 Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Karachi, Pakistan: On a Road to Minimize ESRD Burden <p>End Stage Renal Disease (ESRD) is clinically defined as the progressive and irrevocable impairment of kidneys to perform life-sustaining functions and represents the final stage of Chronic Kidney Disease (CKD). With bulging morbidity and mortality and rampant rise in economic burden globally, ESRD is now recognized as a major public health issue. Certainly, it goes without saying that coming decades will observe a high prevalence of ESRD, and chronic non-communicable diseases such as hypertension and diabetes mellitus, with accumulating aging population as the driving force. This prognosticated upsurge in ESRD pool has been gauged to occur mainly in the developing countries.</p> Rashid bin Hamid Muhammad Tassaduq Khan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 155 157 10.35787/jimdc.v9i3.465 Diagnostic value of Transthoracic Ultrasonography for COVID-19 Pneumonia: A Prospective Study <p><strong>Background</strong>: Corona virus infection requires early detection and precise diagnosis for an effective control in community. COVID-19 PCR is the gold standard diagnostic test having low sensitivity and adequate availability constraints. Because of high false negative rate, a large number of undetected patients remain a constant source of inadvertent disease dissemination in the community. This study was conducted to explore the diagnostic usefulness of transthoracic ultrasonography for COVID-19 pneumonia during the current pandemic.</p> <p><strong>Material and Methods</strong>: This cross-sectional study was conducted in the Pulmonology OPD of Gulab Devi Teaching Hospital, Lahore-Pakistan from April 1, 2020 to July 30, 2020. A total of 237 patients with dry cough, fever and shortness of breath of sudden onset, clinically diagnosed as COVID-19 pulmonary infection, were included in the study. Patients were investigated with chest x-ray/HRCT, transthoracic ultrasonography, COVID-19 RT-PCR on nasopharyngeal samples and hematological tests. Sensitivity, Specificity, PPV (positive predictive value), NPV (negative predictive value) and diagnostic accuracy of transthoracic ultrasonography was calculated with <em>P</em>-value &lt;0.05 considered as statistically significant. SPSS-26 software was used for statistical analysis.</p> <p><strong>Results: </strong>Of the total 237 patients (mean age 41.23±17.5 years) presenting with complaints of a pulmonary infection, 228 were diagnosed as COVID-19 pulmonary infection by transthoracic ultrasonography and PCR. &nbsp;Bilateral lesions and B-lines were the most frequent characteristic features on ultrasonography (n=237 patients; 100%). Transthoracic ultrasound diagnosed 228 patients as cases of COVID-19 pneumonia with 100% sensitivity, 66.67% specificity, 98.7% PPV, 100% NPV, and 98.73% diagnostic accuracy. Only 135 /228 (59.21%<strong>) </strong>patients were diagnosed by RT-PCR. The <em>P</em>-value by Fisher exact test was highly significant at 0.001 (cut-off <em>P</em>- value &lt; 0.05).</p> <p><strong>Conclusion: </strong>Transthoracic ultrasonography is a useful diagnostic tool with a high sensitivity, is free- from radiation exposure and capable of providing foundations for evidence based, early detection of corona virus pneumonia in a pandemic situation.&nbsp;</p> Abdul Rasheed Qureshi Huma Bilal Muhammad Sajid Zeeshan Ashraf Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 158 167 10.35787/jimdc.v9i3.581 Health Capacity and Vulnerability in Context of COVID-19 Outbreak: An Analysis of 185 Countries <p><strong>Background: </strong>The coronavirus disease 2019 (COVID-19) pandemic has affected most countries, afflicting severe damage. Mitigation measures to control the pandemic rely heavily on existing health capacity and vulnerability of each country. The health capacity and vulnerability with respect to COVID-19 outbreak for 185 countries was assessed in this study to identify those where capacity-building needs to be prioritized.</p> <p><strong>Material and methods: </strong>The State Parties Annual Reporting data based on WHO International Health Regulations monitoring and evaluation framework was used to extract an indicator for national health capacity. Another indicator for vulnerability was extracted from INFORM epidemic risk index. These metrics were selected after evaluating their complementarity and availability.</p> <p><strong>Results: </strong>Among 185 countries, 111 (60%) had health capacities at level 4 and 5 with most of them having vulnerability at level 3 and 4. Twenty-two (11.89%) countries had level 2 health capacity in place coupled with moderate to high vulnerability. Among continents, Europe had best while Africa had worst mean functional capacity and vulnerability scores.</p> <p><strong>Conclusions: </strong>The results showed that most countries had sufficient response and reaction capacities to handle the pandemic. However, resources, intensified surveillance, and capacity building should be prioritized in vulnerable countries with ill-equipped national health capacities.</p> Usama Waqar Shaheer Ahmed Daniyal Ali Khan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 168 174 10.35787/jimdc.v9i3.567 Protective Effect of Morus Nigra Leaf Extract on Diazinon-Induced Hepatotoxicity in Rats <p><strong>Background:</strong> Diazinon is a globally used pesticide. Morus nigra (Black Mulberry) possesses flavonoids and phenols, which act as antioxidants. The objective of this study was to determine the possible protective effects of Morus nigra leaf extract on Diazinon-induced hepatotoxicity in rats.</p> <p><strong>Material and Method: </strong>It was an experimental study conducted in the Department of Anatomy, Postgraduate Medical Institute, Lahore. A total of 36 healthy male Wistar albino rats were divided into three groups with 12 rats in each group. Group I was the control group. Group II was treated with 60 mg/kg body weight (bw) Diazinon daily for 4 weeks through orogastric intubation. Group III was treated with Diazinon 60 mg/kg bw daily along with 350 mg/kg bw of Morus nigra extract daily for 4 weeks through orogastric intubation. Blood samples were collected through cardiac puncture, for estimation of alanine transaminase (ALT) and aspartate transaminase (AST) levels. Liver dissection was done, slides of the hepatic tissue were prepared and studied under light microscope. The histology of hepatocytes, portal lobule, portal vein and sinuosoids was observed. SPSS 20 was used for data analysis. One-way ANOVA followed by Tukey’s test was applied to establish difference among groups with <em>P</em>-value ≤0.05 considered as statistically significant.</p> <p><strong>Results: </strong>Histology of Liver tissue in group I showed normal morphology while group II revealed hypertrophy and vacuolization of hepatocytes, congested central vein and sinusoids and presence of necrotic foci. These toxic effects were reversed by the co-administration of Diazinon with Morus nigra in group III which showed normal histology of the hepatic tissue. Similarly, Diazinon administration resulted in significant elevation of ALT and AST levels (<em>P</em>-value&lt;0.05), while, Morus nigra resulted in a considerable decline in the levels of these enzymes (P-value &lt;0.05).</p> <p><strong>Conclusion:</strong> Morus nigra extract has hepatoprotective effects against liver toxicity induced by Diazinon.</p> Hina Majid Salman Shahid Sadia Shakeel Mariam Ashraf Muhammad Yasoob Ali Amna Ahsan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 175 181 10.35787/jimdc.v9i3.483 Issues in Clinical Learning Environment among Undergraduate Nursing Students in Khyber Pakhtunkhwa, Pakistan <p><strong>Background: </strong>Nursing students apply theoretical and evidence-based knowledge on real patients in clinical placements, thus poor clinical education may affect their performance along with patient care. The perceptions of nursing internees may serve as a solid evidence of issues in clinical learning. The objective of this study was to identify issues regarding clinical learning among undergraduate nursing students.</p> <p><strong>Material and Methods: </strong>A descriptive cross-sectional design was employed to collect data from a sample of 72 graduated Nursing Internees from Nursing Colleges in the Khyber Pakhtunkhwa (KPK) province of Pakistan. This study was conducted from April 2019 to August 2019. A Questionnaire in the form of Likert scale was developed for data collection regarding past experiences of their undergraduate studies. SPSS 22 was used for analysis. Chi-squared test was used to compare between male/female, public/private clinical placements and public/private colleges, respectively.&nbsp;&nbsp;&nbsp;</p> <p><strong>Results: </strong>Of the participants 79% (n=57) were male and 21% (n=15) were female. Mean age of participants was 24.29±1.72 years. Four barriers in clinical education due to deficiencies in educational institutions included: shortage of clinical teachers (76.4%), clinical teachers rarely visited students (75%), too many students were supervised by a single teacher (81.9%) and students are overloaded with too many written assignments (75%). The <em>P</em>-value for shortage of clinical teachers was statistically significant (<em>P</em>=.016). The main barriers in clinical education attributed to clinical settings or the hospitals were behavior of the hospital staff resulting in the loss of students’ confidence (73.6%) and anxiety of students to perform wrong procedures (73.6%). &nbsp;However, none of these barriers in clinical education were statistically significant (<em>P</em>&gt;0.05).</p> <p><strong>Conclusion: </strong>Findings of the study illustrated dissatisfaction of graduate nursing internees regarding the clinical education as almost all the issues received more than 50% responses.</p> <p><strong>Key words:</strong> Clinical placement, Clinical Nursing teacher, Nursing internees, Student nurses</p> Asghar Khan Hamida Begum Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 182 189 10.35787/jimdc.v9i3.467 Comparison of Auramine Phenol and ZN Staining in Diagnosis of Pulmonary Tuberculosis with GeneXpert MTB/RIF as Gold Standard <p><strong>Background:</strong> Pakistan faces an immense burden of pulmonary tuberculosis (TB) due to large number of cases and limited resources. Despite the recent advancement in the diagnostic techniques for pulmonary TB, smear microscopy is still a useful technique for the diagnosis of this disease. This study was conducted in order to compare the diagnostic value of Auramine stain with the conventional Ziehl-Neelsen (ZN) stain on the sputum smear for the diagnosis of pulmonary TB, keeping GeneXpert MTB/RIF as the gold standard.</p> <p><strong>Method: </strong>This cross-sectional study was conducted on 356 suspected patients of pulmonary TB referred to the Pathology laboratory from TB ward and OPD of District Head Quarter (DHQ) teaching hospital Rawalpindi, Pakistan. Sputum specimen were collected and two smears were prepared from each sputum sample on which Auramine phenol and Ziehl-Neelsen staining were carried out as per WHO recommendations. All these samples were further tested using Gene Xpert MTB/RIF technique. The sensitivity, specificity, Positive predictive value (PPV) and Negative predictive values (NPV) of ZN and Auramine stain were calculated and compared with GeneXpert MTB/RIF technique.</p> <p><strong>Results</strong>: Out of the total 356 samples, 64(18%) were positive and 291(82%) were negative by GeneXpert which was taken as the gold standard. On comparison with GeneXpert, percentage of true positive was greater in case of Auramine than ZN stained samples (16.29% versus 12.92%), while the percentage of false positive was same for both staining techniques (0.28%). There were lesser false negative cases observed in samples stained by Auramine as compared to the ones stained by ZN (1.68% versus 5.05%). The sensitivity, specificity, positive predictive value and negative predictive values were 97.87%, 94.17%, 71.88 and 99.66%, respectively for the ZN staining and 98.31%, 97.98%, 90.63% and 99.66% respectively, for the Auramine phenol staining.</p> <p><strong>Conclusion</strong>: Smear microscopy using Auramine phenol stain is a useful technique for the diagnosis of pulmonary TB. The Auramine phenol staining with fluorescent microscopy is found to be superior to ZN staining because of higher sensitivity and specificity.</p> <p><strong>Keywords</strong>: Auramine phenol, Fluorescence microscopy, GeneXpert, Mycobacterium tuberculosis, Ziehl-Neelsen</p> Naureen Saeed Fatima-tuz-zuhra Nadeem Ikram Farhana Shaukat Fareeha Sardar Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 190 194 10.35787/jimdc.v9i3.435 Prevalence of Speech Sound Disorders among Primary School Children <p><strong>Background:</strong> Communication Disorders are common and affect individual’s abilities to comprehend, detect and use language and speech, with speech sound disorders (SSD) being the most common communication issue of the youth. SSD is a disorder of development with difficulty in articulation and phonology affecting understanding and intelligibility of speech of a child. It affects the scholarly accomplishment in school as well. The objective of this study was to determine the prevalence of speech sound disorders among primary school going children.</p> <p><strong>Material and Methods: </strong>This was a cross-sectional study, recruiting a sample of 377 children through probability sampling technique from May 2018 to December 2018. Students of both genders, aged 4 to 8 years, were enrolled from Government Primary Schools of Mandi Bahauddin District, Punjab Pakistan. Students from private and special schools were excluded. Tool for Assessment of Articulation and Phonology in Urdu (TAAPU) was used to collect data, followed by data analysis using SPSS version 20.</p> <p><strong>Results: </strong>Of 377 primary school children, 167(44.3%) were males and 210 (55.7%) were females with a male to female ratio of 1:1.26. Speech Sound Disorder was detected in 5 (1.3%) children, 4 males and only 1 female. Of these 5 cases with SSD, 3 (60%) males suffered from substitution and 1(20%) from omission, while 1 (20%) female child suffered from substitution disorder.</p> <p><strong>Conclusion: </strong>The prevalence of Speech Sound Disorders in primary school children is very low being 1.3%, with significantly higher prevalence in males aged 61-72 months. “Substitution” of sounds is more common compared to “omission”.</p> Iqra Aslam Nazia Mumtaz Ghulam Saqulain Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 195 200 10.35787/jimdc.v9i3.283 An Experience of Surgical Management of Peripheral Vascular Injuries at Pakistan Institute of Medical Sciences, Islamabad <p><strong>Background:</strong> Peripheral vascular trauma is fairly common and its repercussions lead to need for urgent management and multidisciplinary approach. We hereby evaluate the presentation, management and outcomes of peripheral vascular injuries presenting in a tertiary care hospital in Islamabad, Pakistan.</p> <p><strong>Material and Methods:</strong> This was a prospective clinical study conducted in the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS) Hospital, Islamabad Pakistan from January 2016 to June 2018. A total of 60 patients with vascular extremity trauma were included in the study. Initial assessment and resuscitation were done and patients with vascular injury were directly shifted to operating room for primary vascular repair (if defect size &lt; 2 cm) or vein graft (great saphenous). Fractures and nerve injuries were also treated. Fasciotomies were performed where indicated. Post-operative monitoring of limb was done for palpable pulses, temperature and color changes. Collected data included age, gender, duration of injury, nature of injury, operative findings, other associated injuries, type of definitive repair, involvement of artery, complications including amputations, infections, re-exploration, ligation or death. Statistical Package for Social Sciences (SPSS) version 23 was used to analyze data.</p> <p><strong>Results:</strong> Out of total 60 patients, 53 (88.3%) were males and 7 (11.7%) were females, with a mean age of 27.8±14.1 years. Most of the patients presented after 6 hours of trauma (n=36; 60%). Blunt trauma accounted for 37 (61.7%) while penetrating trauma was seen in 23 (38.3%) patients. Per operatively, 33 (55%) patients had intimal injury, 7 (11.7%) had partial tear and 20 (33.3%) had complete transection of artery. Primary repair was performed in 9 (15%) patients and reverse vein graft in 51 (85%) patients. Most commonly injured arteries were femoral (n=21; 35%), brachial (n=18; 30%) and popliteal (n=12; 20%) arteries, respectively. Amputations were significantly related to presentation of patients later than 6 hours (<em>P</em>=0.035).</p> <p><strong>Conclusion: </strong>Patients who present with vascular trauma need an early diagnosis, referral and timely management in order to save both limb and life of patients with special concern for good quality of life and cost-effective management.</p> Muneeb Ullah Seemab Niaz Aabid Ali Arsalan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 201 206 10.35787/jimdc.v9i3.411 Frequency of Neck and Upper Extremity Musculoskeletal Disorders in Dentists <p><strong>Background: </strong>Musculoskeletal disorders are not only becoming prevalent among health care professionals in our country but are affecting their health and performance adversely. They are caused by poor ergonomics and awkward posture during work activities. The purpose of this study was to determine the frequency of neck and upper limb musculoskeletal disorders in dentists of Lahore, Pakistan.</p> <p><strong>Material and Methods:</strong> This cross-sectional study was conducted during October 2017 to March 2018. The data was collected using convenient sampling technique from 162 Dentists including 52 males and 110 females of Children hospital Lahore, Punjab Dental hospital and Fatima Memorial Hospital, Lahore. Data was collected by using Mangalore Questionnaire for identification of musculoskeletal disorders. Descriptive analysis of the data was done using SPSS version 22.0.</p> <p><strong>Results:</strong> Of 162 dentists, 115 (71%) suffered from musculoskeletal disorders. Shoulder was the most commonly affected region (30.9%) followed by neck (25.9%), arm (6.2%), wrist (4.3%), elbow (3.1%) and forearm (0.6%). Pain (45.7%) was found to be the most common complaint followed by muscle weakness (20.4%), paraesthesia (3.7%) and swelling (1.2%).</p> <p><strong>Conclusions:</strong> It was concluded that majority of the dentists were suffering from musculoskeletal disorders with shoulder as the most affected region and pain as the most frequent complaint.</p> <p><strong>Key words: </strong>Dentists, Musculoskeletal disorders, Neck pain, Upper extremity</p> Sidra Sarwar Sara Khalid Tahir Mahmood Hadeeqa Jabeen Shahid Imran Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 207 211 10.35787/jimdc.v9i3.404 A Review of Child Sexual Abuse in Pakistan Based on Data from “Sahil” Organization <p>Child sexual abuse (CSA) is an unrevealed but an alarming issue in every civilized society. This paper examines the reported incidents of child sexual abuse in Pakistan. Its primary goal is to assess the currently available data on incidents of CSA in Pakistan from 2010 to 2016, while the specific objective is to understand the magnitude, as well as nature and context of the problem. Data on CSA from 2010 to 2016 were collected from the "annual cruel numbers" of the "Sahil" organization, which revealed that incidents of CSA have increased in Pakistan since 2010. The data show that 2,252 incidents of CSA (Boys 606 and Girls 1,646) occurred in 2010 and a larger number, 4,139 incidents (Boys 1,729 and Girls 2,410), occurred in 2016. Most of the survivors belonged to the Punjab province of Pakistan (1,723 out of 2,252 in 2010 and 2,676 out of 4,139 in 2016). Most abusers were acquaintances of their victims (3,964 in 2010 and 1,829 in 2016). The majority of incest cases were observed in 2012 (144 cases).&nbsp; The victim's home was a place of abuse in most incidents (306 incidents in 2010 and 594 in 2016). Government, as well as non-governmental organizations, should raise awareness of CSA. Furthermore, religious leaders must play their role to curb occurrence of CSA by preaching about its religious implications.</p> Muhammad Abdullah Avais Hamida Narijo Mike Parker Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 212 218 10.35787/jimdc.v9i3.412 Giant Pulmonary Chondroid Hamartoma in Welder’s Lung: A Unique Case Report <p>Pulmonary Hamartomas are benign lung tumors, containing cartilage, connective tissue, fat and usually appear as peripheral lesions. They are 2-4 cm in size, frequently asymptomatic, comprising of 5–8% of all solitary pulmonary nodules. The peak incidence occurs in 40-70 years of age with a male preponderance. We describe a unique case of centrally located, giant chondroid hamartoma, in the background of pulmonary hemosiderosis. Patient presented with cough, shortness of breath and left sided chest pain, masquerading as pleural effusion, lung cancer and left sided chest pain mimicking myocardial disease. Chest x-ray raised the suspicion of pleural effusion but ultrasound and CT-scan indicated a benign calcified central mass. A presumptive diagnosis of cartilage-containing benign mass was made on ultrasound-guided percutaneous biopsy, while surgical resection followed by histopathology revealed a chondroid hamartoma. No recurrence was noted on follow-up. Chondroid hamartoma can be large, symptomatic and requires modern modalities for diagnosis while its association with pulmonary hemosiderosis, still requires to be investigated.</p> Abdul Rasheed Qureshi Huma Bilal Muhammad Sajid Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 219 224 10.35787/jimdc.v9i3.584 Saliva as a Diagnostic Tool for Detection of Coronavirus: A Review <p>We aimed in this literature review to demonstrate the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non-invasive diagnostic modality. The specimen can be easily obtained and tested from suspected individuals. Review of available literature in PubMed, Google Scholar, EBSCO, and Semantic Scholar was carried out using keywords and combination of “Coronavirus”, “saliva” and “diagnosis”. Of 1846 articles found, 110 were screened and included in this literature review. Currently, nasopharyngeal swab is the standard diagnostic tool as it has been reported to be accurate and sensitive towards detection of coronavirus. Testing of saliva specimens is now being considered to aid rapid detection, because saliva collection and its testing are relatively simple, cheap, and safe for both patients as well as healthcare professionals. Further research on this will be beneficial to control and contain the virus.</p> Abhishek Lal Mahnoor Khawaja M. Saleem Naseer Ahmed Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 225 232 10.35787/jimdc.v9i3.570 COVID-19 Pneumonia: Bilateral Peripheral Consolidations with Basal Predominance Manal Niazi Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-09-29 2020-09-29 9 3 i iii 10.35787/jimdc.v9i3.609