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> Next Generation Sequencing as an Emerging Technology in Rare Disease Genetics Memoona Rasheed Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 1 3 10.35787/jimdc.v9i1.521 COVID-19 Pandemic: Impact on Countries with Weak Health Systems Muhammad Ahmed Abdullah Farah Rashid Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-29 2020-03-29 9 1 4 5 10.35787/jimdc.v9i1.523 Accuracy of Multi-Detector Computed Tomography in Detection of Esophageal Varices in Chronic Liver Disease <p><strong>Background:</strong> Patients with chronic liver disease should undergo screening endoscopy, but this approach places a heavy burden upon endoscopy units along with other limitations. The aim of this study was to determine the diagnostic accuracy of multi-detector computed tomography scan in detecting esophageal varices taking endoscopy as gold standard.<br><strong>Material and Methods:</strong> This cross-sectional study was done from 1st Jan 2018 to 31st Dec 2018 at Department of Radiology, PIMS Hospital Islamabad. A total of 180 patients of both gender with chronic liver disease for at least 12 months were included in this study with an age range of 25-65 years. Patients with active gastrointestinal hemorrhage, hypersensitivity to iodinated contrast agent, chronic renal failure, claustrophobic and pregnant females were excluded. All the patients underwent endoscopy and computed tomography of lower chest and the upper abdomen before and after intravenous contrast administration. Multi detector computed tomography (MDCT) scan findings for esophageal varices were compared with endoscopy findings.<br><strong>Results:</strong> In MDCT positive patients (n=102), 98 were true positive and 04 were false positive. Among 78 MDCT negative patients, 07 were false negative, whereas 71 were true negative. Overall sensitivity and specificity were 93.33%, and 94.67% respectively. The positive and negative predictive values were 96.08% and 91.03% respectively, while diagnostic accuracy of MDCT in detecting esophageal varices in chronic liver disease patients was 93.89%, taking endoscopy as gold standard.<br><strong>Conclusions:</strong> Multi-detector computed tomography scan is a highly sensitive and accurate non-invasive modality for detecting esophageal varices in chronic liver disease patients.<br><strong>Key words:</strong> Accuracy, Chronic liver disease, Esophageal varices, Multi-detector computed tomography</p> Syeda Zakia Shah Umair Ajmal Shahabuddin Siddiqui Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 6 11 10.35787/jimdc.v9i1.346 Assessment of Complete Coverage of Expanded Program on Immunization in Children at Mayo Hospital Lahore, Pakistan <p><strong>Background:</strong> Goal of the expanded program on immunization (EPI) is to ensure full immunization of children under one year of age to globally eradicate poliomyelitis, tetanus, measles-related deaths and to extend all new vaccines and preventive health interventions to children in all parts of the world. Demographic and health survey 2012-13 showed that in Pakistan complete immunization coverage is very low (54%) to achieve this goal. The objective of this study was to assess any improvement in terms of vaccination coverage in Pakistan in the last 3-4 years.<br><strong>Material and Methods:</strong> This descriptive cross-sectional study was carried out at outpatient department of Pediatric Medicine of Mayo Hospital Lahore from May, 2016 till November, 2016. The non-probability purposive sampling technique was used to include patients after taking informed consent. Demographic details were collected and parents were questioned about different vaccinations received and confirmed through vaccination card. Data analysis was done through SPSS version 20 and results were presented as frequencies and percentages. Chi-square test was applied for association among categorical variables.<br><strong>Results:</strong> Complete coverage of expanded program on immunization was achieved in 86% children. A statistically significant difference was noted between mother’s education and immunization coverage of children (P-value 0.013).<br><strong>Conclusions:</strong> Education of mother and socioeconomic status were two significant factors affecting immunization coverage. In order to meet target of 95% immunization coverage rate set by WHO, more awareness should be created among people with low socioeconomic status along with improvement of immunization facilities in these areas.<br><strong>Key words:</strong> Children, Expanded Program on Immunization, Immunization Coverage</p> Qurat ul Ain Khalid Imran Mahmood Khan Wajeeha Amber Aqmal Laeeq Chishti Khawaja Amjad Hassan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 12 16 10.35787/jimdc.v9i1.501 Clinical Risk Factors and Angiographic Pattern of Coronary Artery Disease in Young Females <p><strong>Background:</strong> Coronary artery disease (CAD) is associated with the highest mortality in women around the world. The objective of this study was to compare the clinical risk factors and angiographic pattern of coronary artery disease in young versus old age females having CAD.<br><strong>Material and Methods:</strong> This cross-sectional study was conducted at the Department of Cardiology, Chaudhry Pervaiz Elahi (CPE) Institute of Cardiology Multan, Pakistan from April 2018 to December 2018. All females with diagnosis of angina and consistent ischemic changes on ECG were enrolled in the study. A total of 230 females were included with 123 patients aged &lt;45 years and 107 patients aged &gt;45 years. Comparison of patient characteristics, clinical risk factors and angiographic pattern in young and old age females was done by using SPSS version 21 statistical software.<br><strong>Results:</strong> Prevalence of hypertension (<em>P</em>=0.001), dyslipidemia (<em>P</em>=0.06) and diabetes mellitus (<em>P</em>=0.007) was significantly higher in females of older age group (&gt;45 years). Similarly, a larger number of older age females (32; 29.9%) presented with ST-Elevation Myocardial Infarction (STEMI) as compared to young female patients (22; 17.88%) (<em>P</em>=0.03). Regarding angiographic patterns of CAD, there was no difference in the prevalence of single vessel disease (SVD), double vessel disease (DVD) and triple vessel disease (TVD) between the groups. Normal angiogram was found in 13 (12.3%) old age females versus 35 (28.8%) young females, respectively (<em>P</em>=0.002).<br><strong>Conclusions:</strong> The risk factors profile and clinical presentation of CAD is different in young female patients with CAD. There is an essential need to determine the coronary atherosclerosis factors in young females and these women should be treated more aggressively to prevent adverse cardio-vascular outcomes.<br><strong>Key words:</strong> Angiographic Pattern, Coronary Artery Disease, Clinical Pattern, Young Females</p> Hadi Yousuf Saeed Fawad Qadir Muhammad Shahid Muhammad Tahir Mohyudin Abu Bakar Ali Saad Zahid Iqbal Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 17 22 10.35787/jimdc.v9i1.377 Antimicrobial Susceptibility Pattern among Patients Presenting with Acute Exacerbation of COPD <p><strong>Background:</strong> The irrational use of antibiotics in outpatient as well as indoor patients without studying the culture and sensitivity patterns may have led to resistance in common organisms causing acute exacerbation of chronic obstructive pulmonary disease. The objective of this study was to determine the culture and sensitivity patterns of bacteria in the sputum of patients presenting with acute exacerbation of chronic obstructive pulmonary disease (COPD) in our population.<br><strong>Material and Methods:</strong> This cross-sectional study was conducted in the Medicine Department, Jinnah Hospital Lahore from 1st January 2018 to 25th June 2018. A total of 215 patients with acute exacerbation of COPD were collected through non-probability consecutive sampling technique. COPD was diagnosed on the basis of history, examination, chest X-ray and spirometry. Acute exacerbation was taken as an acute rise in one or more of the following; sputum volume and/or purulence, frequency and severity of cough and dyspnea. Two sputum samples were collected from each patient. Antimicrobial susceptibility testing was done as per CLSI guidelines. Data was analyzed by SPSS version 21.0. with p-value ≤ 0.05 considered as statistically significant.<br><strong>Results:</strong> Among 215 selected cases, 118 (54.88%) were males and 97 (45.12%) were females. A total of 110 (51.16%) cultures were positive and 105 (48.84%) were negative for bacterial growth. Klebsiella pneumoniae (n=69; 62.72%) was the most frequent microorganism in patient’s sputum followed by Pseudomonas aeruginosa (n=21; 19.1%) and Staphylococcus aureus (n=20; 18.2%). Regarding sensitivity pattern, amikacin was found to be the most sensitive antibiotic against these organisms followed by gentamicin and ciprofloxacin.<br><strong>Conclusions:</strong> Klebsiella pneumoniae was the most common microorganism in the sputum of patients presenting with acute exacerbation of COPD, while amikacin was reported to be most sensitive antibiotic against the microorganism.<br><strong>Key words:</strong> Acute exacerbation, Antimicrobial susceptibility pattern, COPD</p> Amer Zohaib Fahad Aman Khan Imran Khan Mukhtar Ahmad Talha Khalid Tasiha Malik khawar Siddique Sidra Munir Muhammad Saeed Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 23 27 10.35787/jimdc.v9i1.429 Perceptions of Fellowship Trainees in Public and Private Tertiary Care Hospitals of Karachi <p><strong>Background:</strong> The issues pertaining to postgraduate medical education have been debated for long but there has been little contribution to this literature from developing countries. Therefore, a need to make an accurate assessment regarding current status of postgraduate training in Pakistan was felt and feedback from residents is the cornerstone of such an assessment. The objective of our study was to document perceptions of FCPS trainees of medical and surgical disciplines in private and public tertiary care hospitals of Karachi, Pakistan.<br><strong>Material and Methods:</strong> This was a cross sectional survey of the medical and surgical FCPS trainees in three hospitals (1 public and 2 private) of Karachi Pakistan, conducted over a period of two months (1st November 2018 to 31st December 2018). A total of 325 participants selected by convenient sampling technique were included in the study. Data was collected through structured self-developed questionnaire and analyzed by SPSS version 16.0.<br><strong>Results:</strong> The percentage of postgraduate trainees in private hospitals working for more than 80hours/week is higher than those working in public sector hospitals (59.4% versus 42.4%). Topic presentation and Academic meetings (Conferences, Workshops and CMEs) were the most preferred teaching strategies in Postgraduate training (77.4% and 77.5%). About 62.7% of the residents believed that their program was in line with CPSP guidelines. Public sector hospitals were better in terms of medical benefits giving partial cover (62.8%) than private sector (P-value &lt;0.001). Majority of trainees at private sector hospitals seemed satisfied with their working environment than at public hospital (77.5% versus 12.5%) (P-value &lt;0.001). Trainees perceived that the security arrangements at both public and private hospitals were not adequate, but in case of emergency private hospitals seemed to have better security response as compared to public hospitals (89% versus 23%) with a significant difference of &lt;0.001.<br><strong>Conclusions:</strong> Perception of most of the postgraduate trainees is that they are being adequately trained for the challenges of an independent physician or surgeon.<br><strong>Key words:</strong> Postgraduate training programs, Medical education, Trainees perception</p> <p>&nbsp;</p> Sadaf Zia Maisam Abbas Onali Hina Yousuf Aria Masoom Asna Shahab Nabiha Amjad Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 28 34 10.35787/jimdc.v9i1.392 Comparative effects of Alpha Tocopherol and Ascorbic Acid on Chronic Stress Induced Neuropeptide Y Derangements <p><strong>Background:</strong> Chronic stress decreases resilience of the body mainly due to hormonal imbalance. Neuropeptide Y-ergic system is abnormally regulated in chronic stress due to reduction-oxidation imbalance. The antioxidants such as alpha-tocopherol and ascorbic acid reduce this imbalance with positive effect on neuropeptide Y synthesis and release. This study was aimed to compare the protective effects of alpha-tocopherol and ascorbic acid on plasma neuropeptide Y levels in chronic stress.<br><strong>Material and Methods:</strong> This quasi-experimental study was done at Al-Nafees Medical College in collaboration with National Institute of Health Islamabad from January 2015 to January 2016 after taking institutional approval. Sixty male Sprague Dawley rats were obtained and divided equally into four groups; group I (control), group II (restraint stress group - chronic restraint stress six hours daily for 28 days), group III (restraint stress + alpha-tocopherol 50mg/kg body weight /day), and group IV (restraint stress + ascorbic acid 100mg /kg body weight /day). Cardiac puncture was done to obtain blood for biochemical analysis.<br><strong>Results:</strong> A significant decrease in plasma neuropeptide Y levels was seen in group II compared to group I, group III and group IV. However, alpha-tocopherol administration in group III showed positive effects on maintenance of plasma neuropeptide Y concentration with better p trend than that of ascorbic acid supplementation in group IV.<br><strong>Conclusions:</strong> Alpha-tocopherol supplementation has more potent effect than that of ascorbic acid on chronic restraint stress induced derangements in neuropeptide Y levels. It leads to less imbalance in neuropeptide Y levels during chronic stress.<br><strong>Key words:</strong> Ascorbic Acid, Alpha-Tocopherol, Chronic Stress, Neuropeptide Y</p> Saadia Zainab Tahir Ahmad Munir Anjum Ilahi Adnan Saleem Khan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 35 41 10.35787/jimdc.v9i1.332 Disease Pattern and Outcome among Neonates in Pediatric Ward of POF Hospital, Wah <p><strong>Background:</strong> Neonatal period is the duration between 0-28 days of birth and it is the most susceptible period of life because of the large number of problems and diseases which a neonate is likely to face. The objective of the study was to determine the disease pattern and outcome among neonates in Pediatric ward of POF Hospital.<br><strong>Material and Methods:</strong> A descriptive study was carried out at Pediatric ward of POF Hospital Wah Cantt. Retrospective data regarding age, sex, reasons for admission, outcome and mode of delivery (from hospital record) was collected for all neonates admitted during the year 2016 from 1st January to 31st December. The data was analyzed by using SPSS V-19.<br><strong>Results:</strong> Among total neonates (n=887) admitted during the year, 63.2% were males and 36.8% were females. Mean weight of neonates was 2.54 + 0.75 kg while mean age was 2.39 + 5.8 days. Most common diseases were Prematurity, Respiratory Distress Syndrome, Seizures and Sepsis. Overall, 82.64% recovered from their illness while 17.02% expired.<br><strong>Conclusions:</strong> Prematurity, respiratory distress syndrome, seizures and sepsis were the major causes of neonatal admission in this study.<br><strong>Key words:</strong> Diagnostic value, Immature-to-total neutrophil ratio, Neonatal sepsis</p> Robina Mushtaq Musarat Ramzan Anum Jehan Aqsa Mushtaq Areeba Siddiqui Abdul Basit Aroosha Arif Ali Farooq Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 42 47 10.35787/jimdc.v9i1.386 Impact of Endoscopic Retrograde Cholangiopancreatography on Laparoscopic Cholecystectomy <p><strong>Background:</strong> For Common Bile Duct (CBD) stones an Endoscopic Retrograde Cholangiopancreatography (ERCP) is done prior to cholecystectomy. However, the ideal timing of cholecystectomy following ERCP is still a matter of debate. The aim of the present study was to observe the possible impact of ERCP on subsequent laparoscopic cholecystectomy.<br><strong>Material and Methods:</strong> This case control study was carried out in the Department of Surgery Unit 1, Holy Family hospital, Rawalpindi, from January 2018 to March 2019. A total number of 300 patients of symptomatic gallstones presenting to outpatient department were enrolled. Two groups, A (control group) and B (case group) were made on the basis of absence or presence of CBD stones, respectively. Group A underwent laparoscopic cholecystectomy within three working days of admission. In group B, ERCP was performed prior to cholecystectomy. Primary operating surgeon filled structured questionnaires for each patient immediately after surgery to compare operative differences between both groups. The baseline demographic details, clinical characteristics, laboratory investigations and peri-operative findings of both groups were recorded. Means and percentages were calculated with P value &lt;0.05 regarded as statistically significant.<br><strong>Results:</strong> Majority of patients in this study were females (81%) of middle age group (42.5+15 years). Biliary colic was most common presenting complaint in both groups (33%). Dissection in triangle of Calot (P=0.00) and removal of gallbladder from liver bed (P=0.00) was significantly more difficult in group B than A. Intra-abdominal lavage was also done more often in post ERCP group (P=0.00). However procedural time did not vary between the two groups (P=0.19).<br><strong>Conclusions:</strong> Preoperative ERCP increases difficulty in laparoscopic cholecystectomy but does not prolong procedural time.<br><strong>Key words:</strong> Choledocholithiasis, Endoscopic retrograde cholangiopancreatography, Laparoscopic cholecystectomy</p> Ramlah Ghazanfor Sara Malik Maham Tariq Mehwish Changeez Javaria Malik khawaja Rafay Ghazanfor Khadija Ghulam Syed Waqas Hassan Jahangir Sarwar Khan Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 48 53 10.35787/jimdc.v9i1.383 Frequency of Post-Operative Wound Contamination in Bakhtawar General Hospital, Jamshoro <p>Background: Surgical site wound infection (SSI) imposes a great challenge worldwide. It is the third most commonly reported nosocomial infection. The objective of the study was to assess the frequency of postoperative wound infections in a newly developed health organization.<br>Material and Methods: This cross-sectional study was conducted from June 2017 to May 2018 in Bakhtawar General Hospital, Jamshoro. A total of 364 cases of surgery, from Obstetrics and Gynecology and General Surgery department were included. Surgical interventions involving an incision were assessed. Infection (SSI) rate was noticed and data was analyzed by SPSS version 18.<br>Results: Healthy discharge rate was 97%. The overall surgical site wound infection rate was 3.1%. These infections were high in genitourinary surgeries (9.09%). Among Obstetrics &amp; Gynecology surgeries, maximum number of SSIs were reported in cases of emergency Lower Segment Cesarean Section (LSCS).<br>Conclusions: The overall rate of SSI for different types of surgeries performed at Bakhtawar General Hospital, Jamshoro was only 3.1%. Frequency of SSI was highest in genitourinary surgeries followed by gastrointestinal and obstetrics and gynecology surgeries, respectively.<br>Key words: General Surgery, Genitourinary surgery, Obstetrics &amp; Gynecology surgery, Post-operative wound contamination</p> Altaf Hussain Ambreen Amna Saifullah Brohi Farkhunda Nadeem Amin Fahim Muhammad Imran Ahmed Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 54 58 10.35787/jimdc.v9i1.294 Swallowing Difficulties with Tracheostomy: A Neuro-Rehabilitation Perspective <p>Swallowing and breathing are complex and highly coordinated functions. These functions depend on well-coordinated work of many organs with larynx and nervous system playing a critical role. Disturbance in one of these functions negatively affects the other. Surgical airways like tracheostomies are required in a number of situations, including but not limited to major head and neck procedures, cases with decreased lung function, excessive bronchial secretions and cases requiring neuro-rehabilitation when prolonged airway is required for mechanical ventilation. Extensive neuro-rehabilitation is required since patients with surgical airway may develop swallowing difficulties including dysphagia and/or aspiration with a very high prevalence, which can pose a threat to life. This article reviews the current status of the diagnostic and therapeutic modalities for swallowing difficulties with special emphasis on current neuro-rehabilitative strategies. Electronic databases including Medline, Web-of-science, Cochrane Library, and Google scholar were used for literature search. Downloaded articles were subsequently assessed independently by two researchers to determine suitability for inclusion in the study.<br><strong>Key words:</strong> Neurorehabilitation, Tracheostomy, Transcranial direct current stimulation, Transcranial magnetic stimulation, swallowing difficulty</p> <p>&nbsp;</p> Ghulam Saqulain Nazia Mumtaz Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 59 64 10.35787/jimdc.v9i1.290 Transmission Routes and Infection Control of Novel Coronavirus-2019 in Dental Clinics – A Review <p>The novel Coronavirus (nCoV-19) pandemic began in Wuhan, China with Severe Acute Respiratory Syndrome (SARS) in December, 2019. The virus transmitted from China to other countries by traveling of the infected individuals. The number of infected populations with Coronavirus is increasing day by day with an increased mortality rate. The signs and symptoms of the disease include fever, non-productive cough, dyspnea, and fatigue. The transmission routes of the virus include respiratory secretions or droplet infection and direct contact with the infected person. Dentists are a group of professionals that are highly exposed to infectious diseases. The nCoV-19 is transmitted from patient to dentist and dentist to patient mainly through aerosol and splatter produced by the dental procedure and saliva of an infected person. To avoid transmission of the virus from patient to dentist and from dentist to other patients, screening tests should be done at dental setups. The use of gloves, face shields, masks, gowns, and antiseptic handwash are mandatory for the dentist. Awareness programs should be conducted to prevent further transmission of the disease. We searched Google, Google Scholar, WHO website for coronavirus and National Institute of Health website ( for relevant literature by using various MeSH terms including ‘2019-nCoV’, ‘transmission of 2019-nCoV in dental clinics’, ‘dentistry and COVID-19’ and ‘infection control’, etc<br><strong>Key words:</strong> COVID-19, Dental clinics, Infection control, Transmission</p> Sana Ali Uroosa Zeb Mashooq Khan Anees Muhammad Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 65 72 10.35787/jimdc.v9i1.517 Aggressive Central Giant Cell Granuloma: A Case Report <p>Central giant cell granuloma (CGCG) is a benign non odontogenic lesion of jaw that may show aggressive behavior. It is classified as aggressive and non-aggressive lesion on the basis of biological behavior and radiographic features. Central giant cell lesion is more frequent in children and young adult before the age of 30 years with female predilection, with characteristic radiological and histopathological features. Here we present a case of a 35 years old female with clinical and radiological diagnosis of central giant cell lesion in posterior mandible confirmed by histopathology. A surgical approach with regular follow up is the treatment of choice in most of the cases.</p> <p><strong>Key Words:</strong> Calcitonin, Corticosteroid, Curettage, Enucleation, Giant cell lesion</p> Jahangir Hammad Muhammad Ayoub Kashaf-ud-doja Tariq Farhat Gul Babar Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 73 75 10.35787/jimdc.v9i1.428 Lung Pathologies Department of Radiology Copyright (c) 2020 Journal of Islamabad Medical & Dental College 2020-03-26 2020-03-26 9 1 i ii 10.35787/jimdc.v9i1.522