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 License (, 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) Sun, 29 Sep 2019 00:00:00 -0400 OJS 60 Maternal Health in Pakistan: Where do we stand? Farah Rashid, Sara Makhdoom Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 07:11:37 -0400 Antibiotic Sensitivity Patterns of Uropathogens in Children: The Current Trend <p><strong>Background:</strong> The emergence of antibiotic-resistant infections has led to increased health care costs and mortality among children. The purpose of this study was to determine the causative organisms responsible for urinary tract infection and their antibiotic sensitivity pattern among pediatric patients of Rawalpindi/Islamabad.</p> <p><strong>Material and Methods:</strong> This cross-sectional study was carried out from June 2014 to June 2015, in the Department of Microbiology, Army Medical College, Rawalpindi, affiliated with the Military Hospital, Rawalpindi. About 270 urine samples of children with UTI were analyzed through Analytical Profile Index (API) 20E and biochemical test strips system. Their antibiotic susceptibility was determined by using standard techniques. Data were assessed and analyzed by SPSS version 17.</p> <p><strong>Results:</strong> Most common uropathogen was <em>Escherichia coli</em> (61.48%), followed by <em>Proteus</em> (15.5), <em>Klebsiella</em> (12.3%), <em>Pseudomonas</em> (4.5%), <em>Enterococcus</em> (3.7%) and <em>Enterobacter</em> (2.5%). Gram-negative rods, were most sensitive to imipenem (100%), Gentamycin (86%) and Amikacin (78.3%). They were least sensitive to Ampicillin (4.2%) and Norfloxacin (5.5%). Gram-positive cocci showed highest sensitivity for Vancomycin (100%) while displayed relatively less sensitivity for Nitrofurantoin (61.2%) and Gentamycin (48.7%). Cephalosporins also showed increased resistance with only 14% of gram-negative rods showing sensitivity to Cefotaxime. These organisms were highly resistant to Penicillin, showing a sensitivity of only 12.4%.</p> <p><strong>Conclusion: </strong>Decreased sensitivity against penicillin and cephalosporins is seen in uropathogens causing UTI in children. High sensitivity towards Nitrofurantoin makes this drug an empirical treatment in UTI.&nbsp; Regular surveillance of the developing resistance in uropathogens due to inappropriate use of antibiotic is necessary to reduce complication in children with urinary tract infection.</p> Sara Najeeb , Naima Tariq, Muniba Kanwal, Gul-e-Rehan , M. Usman Sadiq , M. Irfan Sadiq Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 07:08:47 -0400 Accuracy, Sensitivity and Specificity of Oral Brush Cytology in the Diagnosis of Oral Epithelial Lesions <p><strong>Background:</strong> Oral Squamous cell carcinoma (SCC) is highly prevalent in Pakistan than the rest of the world. Five-year survival rate is 80% if SCC is diagnosed at an early stage. The survival rate declines to 20% if diagnosed at a later stage. The objective of the present study was to find out the usefulness of oral brush cytology in detecting oral lesions.</p> <p><strong>Material and Methods:</strong> In the present prospective observational study, 88 samples were collected from Maxillofacial Surgery Out-Patient Department (OPD), Liaquat University Hospital and ISRA University Hospital from July 2015 to December 2015. After taking written informed consent, oral brush cytology was performed and stained with standard Papanicolaou (PAP) staining protocol. The biopsy of the patients was performed by standard protocols of oral biopsy and specimen preserved in 10% buffered formalin. Cross tabulation between diagnosis of brush cytology and biopsy of same patients was done and accuracy, sensitivity and specificity were calculated.</p> <p><strong>Results:</strong> According to the distribution of patients on brush cytology, 59.1% patients were diagnosed with malignant tumors, whereas 17.1% had benign tumors. On biopsy of the same patients, squamous cell carcinoma was confirmed in 72.7% and benign tumors were found in 17% of the patients. Comparison of brush cytology with biopsy of same patients revealed no significant difference. Accuracy, sensitivity and specificity of brush cytology of the oral cavity for detection of malignant tumor were calculated as 86.36%, 81.25% and 100% respectively. Whereas accuracy, sensitivity and specificity of brush cytology of the oral cavity for detection of benign and inflammatory conditions were 100%.</p> <p><strong>Conclusion: </strong>Oral brush cytology has good accuracy, sensitivity and specificity for detection of oral epithelial lesions and can be useful in early detection of oral cancer as well as other lesions. Moreover, as an easy-to-do, painless and non-invasive procedure, it can be a good screening method for detection of oral lesions.</p> Abdul Majid, Bushra Sajid, Kiran Shaikh, Amin Fahim, Farkhunda Nadeem, Ghulam Shah Nizamani Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 07:23:30 -0400 Frequency of Surgical Impactions of Mandibular Third Molar in Orthodontic Patients with Different Antegonial Notching <p><strong>Background:</strong> Few studies have been reported so far on the frequency of lower third molar impactions in patients with different morphological characteristics. Our aim in this study was to find out the frequency of impacted lower third molars in orthodontic patients with different antegonial notch depths.</p> <p><strong>Material and Methods:</strong> This cross-sectional research was conducted at Orthodontics Department of Dental Section, Faisalabad Medical University, Faisalabad, and de’Montmorency College of Dentistry, Lahore, Pakistan from June 2017 to June 2019. A total of 60 orthopantomograms (OPGs) of patients with impacted lower third molars were included. The depth of antegonial notch was calculated on all the selected OPGs by measuring distance between the deepest area of the notch cavity and the tangent on the inferior border of the mandible. The patients with depth of antegonial notch of 1 mm or less were labeled as having shallow antegonial notch, while those with 3 mm or more were considered as having deep antegonial notch. Percentages and mean <u>+</u> SD were calculated for different variables. Depth of antegonial notching was compared between genders using ANOVA with P-value &lt;0.5 considered as significant.</p> <p><strong>Results:</strong> Of 60 orthodontic patients, there was an equal number of male and female patients (n=30). The average age of the patients was 25.5±4 years. Overall frequency of impactions was similar in both the genders and frequency of impacted lower third molars was found to be greater in patients with deeper antegonial notches.</p> <p><strong>Conclusion: </strong>Mandibular third molar impactions were most frequent in orthodontic patients with deep antegonial notches</p> Muhammad Azeem, Muhammad Mudassar Saleem, Zubair Hassan Awaisi, Muhammad Imran Saleh, Naeem Murtaza, Syeda Rabbab Hasan Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 07:34:17 -0400 Association of Clinicopathological features of Cholecystitis with Helicobacter Pylori Infection in Gall bladders <p>Background: Helicobacter pylori (H. pylori) have been associated with gastritis, but its presence in other parts of the gastrointestinal system has not been studied much. Few previous studies have identified “H. pylori” in gallbladder and found its association in causing cholecystitis and gallstones, but there is limited data showing a significant association in Pakistan. This study was designed to identify H. pylori microorganism in cholecystitis patients and find its association with the morphological changes seen in the affected gall bladders. <br><br>Material and Methods: All patients with acute and chronic cholecystitis admitted in Akbar Niazi Teaching Hospital (ANTH) between the ages of 18 and 80 years from January 2017 till March 2019, who underwent cholecystectomy, were included in the study. Gall bladder specimens were sent to Pathology department, ANTH after surgery and were analyzed for the presence of H pylori bacteria using Hematoxylin and Eosin and Giemsa staining. Signs of inflammation, hyperplasia, metaplasia, mucosal atrophy or erosion, lymphoid infiltration, fibrosis, cholesterolosis or any other morphological changes were also noted. Association of H. pylori with cholecystitis and other morphological changes were assessed by Chi Square analysis. P value less than 0.05 was considered statistically significant.<br><br>Results: Chronic cholecystitis was present in 91% cases and acute cholecystitis in 9%. Other histological findings were Hyperplasia (10%), Metaplasia (15%), Fibrosis (79%), Cholesterolosis (19%) and ulcerations (36%). H pylori was found in 17% of gall bladders and all the cases were of chronic cholecystitis, with 11.7% males and 88% females. Gallstones were present in 76.4% cases and were more common in 41-60 years’ age group (64.7%). Other histological findings seen in H. pylori positive cases were; Hyperplasia in 11.7% cases, Metaplasia in 17.6%, Fibrosis in 94.1%, cholesterolosis in 23.5% and ulcerations in 17.6% cases. Association of H. pylori with gender, cholecystitis, gall stones, histological features and age distribution was non-significant.<br><br>Conclusion: Although H. pylori infection has been found in cases of chronic cholecystitis and gall stone formation, its association with cholecystitis and other morphological changes could not be proved. Hence, it is uncertain whether H. pylori eradication in patients with gastritis can prevent cholecystitis or gall stones formation.</p> Saleha Anjum Khan, Huma Mushtaq, Ahmad Raza, Mohammad Nauman Mustafa, Saeed Alam Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 07:39:28 -0400 Prevalence of Cerebrospinal Fluid Leak in Traumatic Head Injury at a Tertiary Care Center <p><strong>Background:</strong> Cerebrospinal fluid circulates around the surface of brain and spinal cord and through the brain’s ventricles. CSF leak is a condition that occurs when the CSF leaks through a defect in the dura or skull and out through the ear or nose. The most common causes of CSF leak include head injury, brain and sinus surgery. The objective of this study was to determine the frequencies of post-traumatic cerebrospinal fluid leak in traumatic head injury.</p> <p><strong>Material and Methods:</strong> A descriptive case series was carried out in the Department of Neurosurgery, Hayatabad Medical Complex, Peshawar for a period of 1 year, from 1<sup>st</sup> February 2016 to 31<sup>st</sup> January 2017. A total of 422 patients presenting within 48 hours of acute trauma to the head were included in a consecutive manner and followed up till 7<sup>th</sup> day to determine the CSF leak.</p> <p><strong>Results:</strong> The mean age group of our sample was 37.37 <u>+</u> 12.3 years of which 79.6% were male patients and 20.4% female patients. Most of the patients (55.5%) were ≤ 40 years of age. CSF leak was observed in 5.2% of patients, with otorrhea seen in 2.1% patients and rhinorrhea in 3.1% patients, respectively.</p> <p><strong>Conclusion: </strong>CSF leak is quite common in our population after acute trauma to the head. The high prevalence may be due to high frequency of accidents in our society with high velocity impact and more commonly seen in the younger age group (≤ 40 years).</p> Muhammad Junaid, Asad Nabi, Muhammad Aslam Khan, Muhammad Umair Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 07:54:51 -0400 Role of Magnetic Resonance Imaging and Spinal Tap in Early Diagnosis of Tuberculous Meningitis <p><strong>Background:</strong> Tuberculous meningitis (TBM) is difficult to diagnose in early stages due to nonspecific symptoms. There should be high index of suspicion to diagnose TBM at an early stage. The objective of the study was to find out the role of magnetic resonance imaging (MRI) and spinal tap in early diagnosis of tuberculous meningitis.</p> <p><strong>Material and Methods:</strong> A cross sectional study was conducted from July 2015 till July 2018 at Neuromedicine ward, Jinnah Postgraduate Medical Centre (JPMC), Karachi. All patients above 12 year of age, both male and female with nonspecific symptoms like headache, malaise and drowsiness or suspicion of TBM (stage I, II, and III according to British Medical Research Council TBM staging criteria) were included in the study. Patients diagnosed with other CNS disease like encephalitis, malaria and acute bacterial meningitis were excluded. Magnetic Resonance Imaging (MRI) of the brain and early spinal tap for cerebrospinal fluid (CSF) analysis were used to diagnose TBM and findings were noted. Results of MRI and CSF analysis were analyzed by SPSS version 24.</p> <p><strong>Results:</strong> A total of 110 patients of TBM, with 60 (54.5%) male and 50 (45.5%) female patients were included in the study. Most of the patients belonged to a younger age group of 12-40 years (81.8%), while 18.2% were above 40 years of age. About 90% patients were diagnosed in stage I TBM and 10% in stage II and III. MRI brain findings included meningeal enhancement (60%), hydrocephalus (41.81%) cerebral edema (82.73%), tuberculoma (19%) and infarct (14.5%), respectively. CSF analysis showed low protein in 80%, low glucose in 91.8% and lymphocytic pleocytosis in 97.2%, respectively.</p> <p><strong>Conclusion: </strong>Both MRI brain and spinal tap with CSF analysis played a role in the early diagnosis of TBM, which is important to prevent the lethal complications associated with late diagnosis of this disease.</p> Salma Haji Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 08:09:42 -0400 Comparison of Safety and Efficacy of Potassium Hydroxide versus Combination of Salicylic and Lactic Acid for Molluscum Contagiosum <p><strong>Background:</strong> Molluscum contagiosum (MC) is a contagious cutaneous infection caused by MC virus, affecting mainly the pediatric population. It is characterized by flesh-colored umbilicated papules occurring on the skin surface. Potassium hydroxide (KOH) and salicylic acid plus lactic acid combination being keratolytic agents, are effective treatment options. The objective of the study was to compare the efficacy and safety of 10% KOH solution versus salicylic acid/ lactic acid combination in treating Molluscum contagiosum in pediatric population.</p> <p><strong>Material and Methods:</strong> A total of 80 children (age range 1-13 years) with Molluscum contagiosum lesions were selected from the Dermatology Out-Patient Department, and were randomly allocated into two groups by lottery method. Group A was given topical 10% KOH solution and group B was given Salicylic plus Lactic acid preparations for topical application. Patients were followed after two weeks to see regression in size of the lesion, and development of any side-effects. Final visit was scheduled at 6 weeks. Statistical analysis was carried out using SPSS (version 16) with p value less than 0.05 considered as statistically significant.</p> <p><strong>Results:</strong> Patients with MC (n = 80) were equally divided into group A (treated with 10% KOH) and group B (treated with combination of Salicylic acid and Lactic acid). After 6 weeks, complete remission from Molluscum contagiosum virus was seen in 29 (72.5%) patients of group A and 34 (85%) patients of group B. There were 12 (30%) patients in group A who developed local irritation and 4 (10%) developed local erythema after 6 weeks. None of the patients of group B had any such side effects.</p> <p><strong>Conclusion: </strong>10% KOH solution is as effective as the combination of Salicylic and Lactic acids for treatment of Molluscum contagiosum in pediatric population, however it is associated with side effects of local irritation and erythema.</p> Durre-Shehwar Arshad Pirzada, Sumaira Abdullah, Qurat-ul Ain Zia, Syed Afaq Ahmed, Hamid Ali Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 08:18:31 -0400 Use of Zinc and ORS in Home Management of Diarrhea: Knowledge of Mothers attending a Tertiary Care Hospital <p>Background: Diarrhea is the second leading cause of mortality in children below 5 years of age in Pakistan. Use of Zinc and ORS has been proven in clinical trials to be beneficial in reducing morbidity and mortality. Poor knowledge regarding home management of diarrhea leads to mortality due to severe dehydration. The objective of this study was to assess the level of knowledge of mothers of under five-year-old children regarding, diarrheal home management in Cantonment General Hospital, Rawalpindi.<br>Material and Methods: This was an observational cross-sectional study carried out at Department of Pediatrics, Cantonment General Hospital, Rawalpindi, from 1st August, 2017 to 31st January, 2018. About 400 mothers of under five-year-old children, coming to the outpatient department of the hospital were enrolled in this study. A self-designed structured and validated questionnaire was used to assess the level of knowledge of mothers regarding home management of diarrhea using Oral Rehydration Solution (ORS) and Zinc. Data was analyzed using SPSS version 23 with a p value &lt; 0.05 considered statistically significant.<br>Results: About 91% (n=364) of mothers had awareness regarding use of ORS as a means of diarrheal home management. Regarding level of knowledge variable results were found. A good percentage of mothers had knowledge of the purpose of ORS use (78.3%), administration (60%) and initiation of ORS (68%), but only 20.8% mothers rightly answered the timing of ORS administration. Mothers knowledge about the use of zinc, daily administration and duration of administration (10-14 days) was 38.8% ,20.5% and 17.3% respectively. Mothers who were more educated especially secondary and above and of the age group 22-31, had better awareness of ORS than others, as P value is less than 0.05. Among mothers who were aware of the use of ORS, only 41.8% of them were also aware of the use of zinc.<br>Conclusion: A high awareness level regarding ORS use in mothers was reflected fairly in terms of purpose, administration and initiation of ORS but the kno</p> Noshina Riaz, Sidra Tul Muntaha, Maria Qibtia, Shugufta Sohail Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 08:23:54 -0400 Earthquake Preparedness in Schools of Islamabad <p><strong>Background:</strong> Pakistan is located in the Himalayan region, which has the highest vulnerability to earthquakes. The Islamabad-Rawalpindi area lies in a tectonically active zone, where earthquakes have been frequent in the recent geological past. Earthquake preparedness in schools is relatively under studied area in Pakistan. The objective of this study was to determine the level of preparedness of schools for earthquakes and to compare it between urban and rural, government and private schools in Islamabad Capital Territory.</p> <p><strong>Material and Methods:</strong> It was a cross-sectional comparative study. The study population was schools of Islamabad Capital Territory. The total sample size was 74 and non-probability purposive sampling technique was used.&nbsp; Data was collected through a structured questionnaire pretested on 5% of the sample size and respondents were administrative staff of schools. Data was analyzed using SPSS version 21. Data of the categorical variables was presented in the form of frequencies (percentages). Statistical significance of association between school profile and level of preparedness was determined by using bivariate tabular association analysis (Chi square).</p> <p><strong>Results:</strong> Out of 74 schools, 61 were private and 14 were government schools. 46 schools were located in urban areas while 28 were in rural area of Islamabad Capital Territory. Out of the total schools, 66.2% had written preparedness plan for earthquake and 73% of the schools had a safety committee to lead disaster response planning.&nbsp; Most of the schools (82.4%) had minimum of two exits in high occupancy rooms. There was significant association of location of school with preparedness plan for earthquake (p=0.009), and type of school with two evacuation drills annually (p=0.03).</p> <p><strong>Conclusion: </strong>Private schools and those located in urban areas are better prepared for earthquakes as compared to government schools and the ones located in rural areas.</p> Nadia Tariq, Tamkeen Nishat Jaffry, Sadaf khalid Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 08:34:34 -0400 Airway Clearance in Bronchiectasis: A Randomized Control Trial of N-Acetylcysteine with 3% hypertonic saline <p><strong>Background:</strong> N-Acetylcysteine and 3% hypertonic saline are being used effectively for sputum clearance in chronic cases of bronchiectasis for quite some time. However, their use in acute condition of the disease seems to be underexplored. The objective of our study is to compare the role of nebulized N-acetylcysteine and 3% hypertonic saline in clearing the airway in patients with acute exacerbation of bronchiectasis.</p> <p><strong>Material and Methods:</strong> A total of 136 confirmed cases of bronchiectasis were enrolled in this study. This randomized controlled trial was done in chest ward of Nishtar Hospital Multan from January 2015 to March 2017. Sampling was done by non-probability consecutive sampling and patients were divided into two groups A and B by lottery method. Verbal informed consent was taken from all participants. Group A participants received nebulization of N acetylcysteine mixed in normal saline for ten minutes, while group B participants were nebulized with 10ml of 3% hypertonic saline for ten minutes. Group B was active control group in the study. Data was collected on pre-designed Proforma, and analyzed by SPSS version 22. Numerical variables such as saturation, weight of sputum, age and blood pressure was analyzed by using t test. These were considered significant if the p value was equal or less than 0 .05. For qualitative variables chi square test was applied.</p> <p><strong>Results:</strong> The mean O2 saturation of Group A, before and after treatment, was 92.11±3.07% and 94.47±2.18%, respectively. The difference was statistically significant (p value =0.001). The sputum weight of Group A, before and after treatment, was 2.63±2.39 g and 7.41±1.38 g, respectively. The difference was statistically significant (p value =0.001). The frequency of rhonchi of Group A, before and after treatment, was 52% and 76%, respectively. The difference was statistically significant (p value =0.003). While, for Group B, the mean O2 saturation, before and after treatment, was 92.36±3.13% and 93.49±2.27%, respectively. The difference was statistically significant (p value =0.012). The sputum weight, before and after treatment, was 3.11±2.01 g and 5.56±1.02 g, respectively. The frequency of rhonchi, before and after treatment, was 45% and 74% respectively. Again, the difference was statistically significant.</p> <p><strong>Conclusion: </strong>Both nebulized N-acetylcysteine and 3% hypertonic saline cause airway clearance by enhancing sputum expectoration in patients with acute exacerbation of bronchiectasis equally. Both these agents also improve oxygen saturation in acute exacerbation of bronchiectasis significantly.</p> Muhammad Imran Shehzad, Muhammad Atiq Ul Mannan, Masood Alam, Abdul Rauf, Muhammad Imran Sharif Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 09:09:06 -0400 Comparison of Efficacy of Laryngeal Mask Airway and Intersurgical-Gel Supraglottic Airway Device During General Anesthesia in a Tertiary Care Hospital <p><strong>Background:</strong> Upper airways collapse during anesthesia is a common issue faced by anesthetists. Air way maintenance is an essential component of general anesthesia. Laryngeal mask airway and Intersurgical-gel (i-gel) air way devices are new advances in general anesthesia. Present study aims to compare the ease of insertion and hemodynamic response of i-gel supraglottic and laryngeal mask airway (LMA).</p> <p><strong>Material and Methods:</strong> A Randomized Clinical trial was conducted at the Department of Anesthesia, Shaikh Zayed Hospital, Lahore. Study duration was 6 months (June 2014- December 2014). A total of 60 patients were selected through non-probability consecutive sampling. Ethical approval was taken from ethical review board of Sheikh Zayed Hospital and informed written consents were taken from all the participants. Patients were randomly divided into two groups using lottery method. Group A was given laryngeal mask airway device while group B patients were provided with i-gel supraglottic device during anesthesia. Patients were compared for ease of insertion and hemodynamic parameters. Data was analyzed using SPSS version 24. Chi-square and t-test were applied and p-value ≤0.05 was considered statistically significant.</p> <p><strong>Results:</strong> A total of 60 patients were included in study. Mean age of patients was 35.2±11.7 years in LMA group and 36.7±13 years in i-gel group. Group B had lower number of insertion attempts (p=0.01) and high insertion satisfaction (p=0.4) as compared to group A. However, process failure and bleeding rate was found to be slightly higher in group B (16% and 13% respectively) as compared to group A (p&gt;0.05).</p> <p><strong>Conclusion: </strong>i-gel supraglottic device is a successful alternative option in terms of ease of insertion and less hemodynamic response as compared to laryngeal mask airway during general anesthesia.</p> <p><strong>Key words:</strong> , ,&nbsp;</p> Muhammad Saqib Butt, Noor Un Nisa, Ghulam Mustafa, Hasham Khan Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 00:00:00 -0400 Peutz-Jeghers Syndrome presenting as Intussusception in a young female: A Case Report <p>Peutz-jeghers syndrome is rare condition with autosomal dominant inheritance. It is due to the mutation in a tumor suppressor gene SK 11 at chromosome no 9. It has a very characteristic presentation. Patient usually presents at a young age with intestinal obstruction due to polyps leading to intussusception. Also there is melanosis at perioral, digits and perineal regions. There is very strong association of cervical and breast carcinoma in females and testicular tumors in males. GIT, pancreatic and lung malignancies occur in both sexes. Regular follow up and screening are necessary for early detection of malignancies. We present a case of young girl who presented with intestinal obstruction along with other signs and symptoms of peutz-jeghers syndrome. Exploratory laparotomy revealed jejunoileal intussusception and hamartomatous polyps. Patient and other family members were advised screening studies of associated malignancies and regular follow up.</p> Junaid Zia Hashmi, Muhammad Masood ur Rauf Khan, Waqas Arshad, Zeeshan Haider Pirzada, Arifa Zia Hashmi Copyright (c) 2019 Journal of Islamabad Medical & Dental College Sun, 29 Sep 2019 09:30:07 -0400 An Unusual Case of Gallbladder Carcinoma with Pseudopancreatic Cyst <p>Generally, carcinoma of the gallbladder is an extremely unusual neoplasm, however, high incidence rates have been reported in certain parts of the world. The role of certain factors such as genetic susceptibility, lifestyle and infections of gallbladder in causing carcinogenesis is still not clearly understood. Due to its early vague symptoms and lack of serosa in the gallbladder to slow its spread, gallbladder carcinoma typically presents at an advanced stage with a five-year survival rate of less than 5%. Pseudopancreatic cyst is an uncommon but not a rare complication of acute pancreatitis and injury to the pancreas. However, it rarely presents with carcinoma of gallbladder. We present here an unusual case of gallbladder carcinoma with pseudopancreatic cyst in a 58-year old male.</p> Nahin Akhtar, Huma Mushtaq, Ahmed Raza Copyright (c) 2019 Journal of Islamabad Medical & Dental College Tue, 01 Oct 2019 00:05:08 -0400 Miscellaneous radiology images Manal Niazi Copyright (c) Tue, 01 Oct 2019 00:11:36 -0400