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> en-US <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> (Prof. Dr. Naila Irum Hadi) (Zikrat Jamil) Mon, 23 Dec 2019 00:00:00 -0500 OJS 60 Dengue Fever: A Challenge to Health System Ghulam Murtaza Gondal Copyright (c) Mon, 23 Dec 2019 10:30:37 -0500 Diagnostic Value of Immature-to-Total Neutrophil Ratio in Neonatal Sepsis <p>Background: Neonatal sepsis is the third most common reason of neonatal mortality in Pakistan. Blood culture, the gold standard test for diagnosis of neonatal sepsis, is time consuming. Therefore, rapid diagnostic tests with good specificity and sensitivity is needed for accurate and early diagnosis of this condition. The objective of this study was to determine the diagnostic value of abnormal (≥ 0.2) immature-to-total-neutrophil ratio in neonatal sepsis.<br>Material and Methods: This cross-sectional study was carried out on 288 neonates, aged 0-28 days, admitted with suspected sepsis. Detailed history of the neonates was recorded including gender, age, birth weight, maternal age, gestational age and clinical features. Blood culture and Peripheral blood films were done in each case. Differential leucocyte counts, total Polymorphoneutrophil count (PMN), immature neutrophil count, mature neutrophil count and calculation of I/T ratio was carried out in the Pathology Department of PIMS, Islamabad. The study outcome was divided into three groups on the basis of positive or negative blood culture and I/T ratio as normal, probable sepsis and proven sepsis group. Data was analyzed by SPSS version 21.0. Diagnostic value of I/T ratio was determined in NS by calculating values of sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) by considering the blood culture as the gold standard test of NS.<br>Results: The mean age and weight of the neonates at the time of admission was 1.1 (± 0.6) days and 2.51 (± 0.40) kg, respectively. About 60% of the neonates were males and 118(41%) neonates had I/T ratio of ≥ 0.2. On the basis of positive or negative blood culture and I/T ratio, 82 (28.5%) neonates were diagnosed as proven sepsis, 43 (14.9%) neonates had probable sepsis and remaining 163 (56.6%) neonates were declared as normal. Out of 82 neonates with positive blood cultures, 75 (91.5%) had I/T ratio ≥ 0.2, while 7 (8.5%) had I/T ratio ≤ 0.2. The sensitivity, specificity, positive and negative predictive value and diagnostic accuracy of abnormal I/T ratio to diagnose neonatal sepsis was 91%, 79%, 64%, 96% and 83%, respectively.<br>Conclusions: Due to substantially high diagnostic accuracy of I/T ratio ≥ 0.2, we recommend it as a useful, rapid and cost-effective tool in accurate diagnosis of neonatal sepsis.</p> Husnain Ali, Ejaz Hussain, Imran Mahmood Khan, Iqtada Haider Shirazi, Muhammad Imran, Bilal Ahmad Copyright (c) Mon, 23 Dec 2019 10:35:06 -0500 Superficial Parotidectomy by Retrograde approach through Marginal Mandibular Nerve Dissection <p>Background: Parotid gland is most commonly involved in tumors, comprising about 80% of the salivary gland neoplasms. Majority of parotid tumors are benign in nature, the most common being pleomorphic adenoma. Superficial Parotidectomy is the preferred treatment option, using either anterograde or retrograde approach. The objective of this study was to determine the post-operative facial nerve status and other complications following superficial Parotidectomy by retrograde dissection for benign lesions of parotid gland.<br>Material and Methods: This prospective clinical study included a total of 22 patients who had superficial Parotidectomy by retrograde technique involving marginal mandibular nerve dissection. These patients were studied post-operatively for facial nerve status, Frey’s Syndrome, wound infection and salivary fistula.<br>Results: Out of a total of 22 patients, 54.54% developed temporary facial palsy on ipsilateral angle of mouth and all of them recovered by the end of 3 months post-surgery. Two patients (9.09%) developed salivary gland fistula and both of them healed spontaneously within two weeks. Frey’s Syndrome and wound infection were not seen in any of the patients included in the study. Histopathology of these lesions revealed pleomorphic adenoma (n=20) and Warthin’s tumor (n=2), respectively.<br>Conclusion: The use of marginal mandibular nerve as a landmark for retrograde dissection of facial nerve in superficial Parotidectomy is a reliable method to ensure lower percentage of facial nerve injury and associated complications.</p> Altaf Hussain , Alveena Farid, Waqar Uddin Copyright (c) Mon, 23 Dec 2019 10:40:25 -0500 Psychological Stress among Parents of Hearing Impaired versus Intellectually Disabled Pakistani Children <p>Background: Parents of special children face physical, psychological and social impact of their child’s disability, including hopelessness and depression. This study is important as it will help professionals plan and provide effective coping strategies so parents could have a positive perception and behavior for disabilities (like hearing impaired and intellectual disability) in their children. The objective of this study was to analyze level of psychological stress among parents of children with hearing impaired (HI) versus intellectual disability (ID) and relationship between disability and psychological stress.<br>Material and Methods: This cross-sectional study comprised of parents (n = 200) of 100 HI and 100 ID children, of both genders, aged 1 to 16 years. These were recruited by non-probability convenience sampling after taking consent from special education centers of Punjab (Pakistan), over a period of six months from May 2017 to October 2017. After collecting demographic details, quantitative assessment of parental stress was done using Parental Stress Scale (PSS). Statistical analysis was carried out using SPSS v21.<br>Results: The sample population (n=200) consisted of 32.5% male and 67.5% female respondents, with a mean age of 41.23 ± 6.7 years. The mean of total parental psychological stress score was 61.85 ± 17.1 with significant association between disabilities (HI and ID) and psychological stress (p&lt;0.01). In HI group, moderate psychological stress was seen (n=53, 26.5%), while in ID group, profound level of psychological stress was noted in majority (n=70, 35%) of participants.<br>Conclusions: Parents of both HI and ID children showed psychological stress, however, parents of ID children suffered higher level of stress.</p> Nazia Firdous, Nazia Mumtaz, Ghulam Saqulain Copyright (c) Mon, 23 Dec 2019 10:44:36 -0500 Frequency of Noise Induced Hearing Loss Among Traffic Wardens of Lahore <p>Background: Noise-induced hearing loss (NIHL) is a major cause of disability throughout the world. It is the most common irreversible job-related hazard in the world with a higher burden in the developing regions of the world. Certain occupations are at high risk for NIHL. Traffic wardens could be considered highly vulnerable group as they are exposed to long hours of traffic noise. The objective of this study was to determine the frequency of noise induced hearing loss among traffic wardens of Lahore city.<br>Material and Methods: It was a cross-sectional, descriptive study, carried out from 1st December 2018 to 31st May 2019, in which 329 traffic wardens appointed in 34 beats/sectors of Lahore city were included. Data was collected through a structured questionnaire, followed by Pure Tone Audiometry (PTA) of all the subjects.<br>Results: A total of 329 traffic wardens were selected for this study. Mean age of the traffic wardens was 35.35 ± 1.21 years. NIHL was present in 174 (52.9%) traffic wardens, out of which, 138 (79.3%) had mild, 32 (18.4%) moderate, and 4 (2.3%) had moderately severe degree of hearing loss. Among the 329 traffic wardens, 165 (50.2%) had exposure to noise between 7am to 3pm (morning shift) and 42 (12.8%) had some problem with their hearing. Only 12 (3.6%) had ringing in the ears or tinnitus, 140 (42.6%) wore any hearing protection during duty hours and 42 (12.8%) said they had difficulty in hearing and frequently asked people to repeat themselves.<br>Conclusion: In this study a high frequency of noise induced hearing loss was reported among traffic wardens of Lahore city with most of them having mild to moderate degree of hearing loss.</p> Salman Shahid, Hina Majid, Khalid Ismail, Sohail Safdar, Syed Bilal Hassan Copyright (c) Mon, 23 Dec 2019 10:47:49 -0500 Antimicrobial Sensitivity Pattern for Urine Isolates in Urinary Tract Infection <p>Background: The increased frequency and management of antibiotic resistance pattern in urinary tract infection (UTI) is a challenging task for the clinicians. Therefore, the current study was planned to identify the microbial etiology of UTI and the most suitable antibiotics used. The objective of the study was to assess the frequency of antimicrobial sensitivity pattern in patients with urinary tract infection.<br>Material and Methods: This cross-sectional study was carried out at Al Sayed Hospital, Kidney Centre, Rawalpindi over a period of seven months i.e. June 30, 2018 to January 30, 2019. A total of 152 patients were enrolled according to the inclusion and exclusion criteria of the study. Urine culture proceedings were done as per latest recommended guidelines of Clinical and Laboratory Standard Institute (CLSI) for UTI.<br>Results: Regarding overall sensitivity of antibiotics for the pathogens of urine culture, highest sensitivity was observed for carbapenems (83.5%), followed by polymyxin B (72.3%), phosphonic acid derivatives (65.8%), aminoglycoside group (65.7%), extended spectrum penicillin (63.1%), imidazolidinedione (59.9%) and tetracycline (59.9%) groups. The least sensitivity was observed for Oxazolidinone (linezolid) (14.5%), teicoplanin (13.8%), tigecycline (10.5%) and first-generation cephalosporins (1.3%).<br>Conclusions: Carbapenems showed maximum sensitivity for all urine isolates. The second and third options were polymyxin B and phosphonic acid derivatives, respectively.</p> Kiran Tauseef Bukhari, Haseeb Tauseef Bukhari, Humaira Zafar, Mudassira Zahid Copyright (c) Mon, 23 Dec 2019 10:55:42 -0500 Clinicopathological Characteristics of Breast Carcinoma in Premenopausal Women <p>Background: Breast cancer is one of the leading causes of mortality world-wide. The objective of this study was to see the pattern and characteristics of carcinoma breast in premenopausal women reporting at a tertiary care hospital.<br>Material and Methods: This cross-sectional study was conducted at surgical unit of Pakistan Institute of Medical Sciences (PIMS), Islamabad from May 2012 to April 2015. A total of 144 female patients were admitted during this period as diagnosed cases of carcinoma breast. Of these patients, all cases of breast carcinoma diagnosed in premenopausal women were selected and assessed for tumor type, TNM classification and involved breast quadrants.<br>Results: Out of 144 patients 70 (48.6%) cases of carcinoma breast were reported in premenopausal women. The ages ranged from 14 to 48 years with a mean age of 33 ± 7.95 years. According to TNM classification, 2.9% patients were in T1, 25.7% were in T2, 32.9% were in T3 and 38.6% were in T4. Similarly, 37.1% patients presented with a nodal status of N0, 38.1% with N1, 21.4% with N2 and 2.9% with N3. Out of 70 patients, 11 (15.7%) presented with distant metastasis (M1) at the time of diagnosis. The upper outer quadrant of breast (32.9%) was most commonly involved site, followed by upper inner, lower outer and lower inner quadrants, respectively. Most common tumor type was invasive ductal carcinoma (85.7%), followed by invasive lobular carcinoma (7.1%), papillary carcinoma (4.3%), medullary carcinoma (1.4%) and malignant phylloides (1.4%). Regarding exposure to risk factors of breast cancer in these patients, 35.7% women did not breast feed and 27.1% were nulliparous. There was no history of use of oral contraceptive pills in 82.8% and positive family history was reported in 27.1% patients.<br>Conclusions: Late presentation with advanced disease in premenopausal women is more common in our part of the world as compared to international literature. More studies on larger sample sizes should be carried out to validate these findings.</p> Nazia Ishaque, Muhammad Asad Copyright (c) Mon, 23 Dec 2019 11:26:46 -0500 Mandibular Reconstruction with Free Fibula Flap: Experience at Hayatabad Medical Complex, Peshawar <p>Background: Mandibular defects may result from trauma, infections, cancer ablation or radiation necrosis. These defects may vary according to the content and nature of the tissues that require reconstruction. The objective of this study was to evaluate the outcome of vascularised free fibula flap for mandibular reconstruction in terms of flap success rate and complications.<br>Material and Methods: This prospective clinical study was carried out at Department of Plastic Surgery, Hayatabad Medical Complex, Peshawar from January 2014 to December 2018. The study included patients of either gender who underwent mandibular reconstruction with free fibula oseteocutaneous flap during the study period. Diabetic patients with underlying vascular pathologies and cachectic patients were excluded from the study.<br>Results: There were 56 patients with 38 males and 18 females. Their age ranged from 24-66 years with a mean age of 36 years. The mandibular defects resulted from various etiologies and included: Squamous cell carcinoma (n=27, 48.21%), Giant cell granuloma (n=3; 5.35%), Ameloblastoma (n=2; 3.57%), Road traffic accidents (n=10; 17.85%), Firearm injury (n=9; 16%), Bomb blast injury (n=3; 5.35%) and osteoradionecrosis (n=2; 3.57%). Primary reconstruction of the mandibular defects was performed in 44 patients, whereas delayed reconstruction was performed in 12 patients. Out of the 56 flaps, 49 flaps survived completely. Our share of complications was as follows: Wound infections (n=13; 23.21%), Skin graft loss at donor site (n=5; 8.95%), Complete flap loss (n=4; 7.14%), Orocutaneous fistulae (n=3; 5.35%), Ankle instability (n=2; 3.57%), Skin paddle necrosis (n=1; 1.78%) and sensory deficit distal to donor site (n=1; 1.78%).<br>Conclusions: Microvascular free fibula is a reliable tool for mandibular reconstruction following tumor resection or trauma. The flap has a high success rate and relatively fewer complications.</p> Syed Asif Shah, Irfan Ullah, Muhammad Bilal, Mohammad Hamayun Shinwari, Adeeba Ahmad, Ehsan Ullah Copyright (c) Mon, 23 Dec 2019 11:30:40 -0500 Breast Feeding Remains a Strong Protection against Infant Infections. <p>Background: Breast feeding prevents infections in infants. Those who are partially or never breast-fed and receiving bottle feeds are at higher risk of infections as compared to exclusive breast-fed infants. The objectives of this study were to record the effect of exclusive breast feeding versus partial and never breast feeding on infections in infants and also to find an association of infection with type of feed, gestation and vaccination status in infants till six months of age.<br>Material and Methods: A total of 500 Infants were included in this cross-sectional study. Information regarding pattern of feeding and infections was obtained by verbal interview of mother and the questionnaire was filled by the study physician. The outcome evaluated was infections in infants till one year of age. Categorical comparisons were made using chi square test. A ‘p’ value &lt; 0.05 was considered statistically significant.<br>Results: Out of 500 infants, 59.4% were males. About 59.6% were exclusively breast-fed till 6 months of age, 31.2% were partially breast-fed and 9.2% were never breast-fed. In exclusively breast-fed group, 29.5% infants reported infections as compared to 40.4% in partial breast-fed group and 65.2% in never breast-fed infants (P &lt; 0.000). Similarly, 40.6% of infants in exclusively breast-fed group, 55.1% in partial breast feed and 58.7% in the never breast-fed reported infections in 4-6 months of age, which was statistically significant (P = 0.003). There was no significant difference in infection rates among the three study groups in 7-9 (P=0.192) and 10 -12 months (P=0.42) of age.<br>Conclusions: Exclusive breast feeding till six months of age significantly reduces the risk of infections in infancy.</p> Shagufta Sohail, Kaneez Fatima, Noshina Riaz Copyright (c) Mon, 23 Dec 2019 11:35:42 -0500 Marsupialization Followed by Enucleation and Chemical Cauterization for Treatment of Odontogenic Keratocyst Involving Maxillary Sinus: A Case Report <p>Odontogenic keratocysts are odontogenic cysts which have locally infiltrative behavior. They mostly occur in second and fourth decades but can occur at any age throughout life. In majority of cases, they are located in the posterior region of mandible, but can also be found in the maxilla especially in the canine region. In this article, we have discussed the diagnosis and management of a large odontogenic keratocyst cyst involving the maxillary sinus. A 22 years old male patient presented with pain and swelling on right side of the face since last one year. There was history of pus discharge and gradual increase in size of the swelling since last 3-4 months. Patient took antibiotics but there was no improvement. Odontogenic keratocyst is a developmental pathology which arises from additional remnants of dental lamina of oral epithelium. They present with swelling, pain and pus formation/discharge as signs of infection. Often, when the lesion is large there can be paresthesia of the lower lip. These lesions can also be clinically asymptomatic. Mostly they appear as well-demarcated unilocular radiolucency having a thin, sclerotic well-defined margin. There are many treatment options like enucleation, marsupialization, decompression, curettage, use of chemical agents like Carnoy's solution, cryotherapy with liquid nitrogen or peripheral osteotomy and surgical resection of lesion.</p> Muhammad Jamal, Muhammad Zeeshan Baig, Laiba Saher, Muhammad Asim Copyright (c) Mon, 23 Dec 2019 11:51:29 -0500 Ovarian Mucinous Carcinoma Saeed Alam, Huma Mushtaq, Naima Tariq Copyright (c) Mon, 23 Dec 2019 00:00:00 -0500