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) Thu, 31 Dec 2020 00:00:00 +0500 OJS 60 Ibn-e-Sina’s “Canon of Medicine” Syed Irfan Ahmad Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 00:36:16 +0500 Symptom Analysis of Confirmed Covid-19 Patients Managed at Allied Hospitals of Rawalpindi Medical University, Pakistan <p><strong>Introduction</strong></p> <p>Coronavirus can cause respiratory disease ranging from mild upper respiratory tract illness to severe pneumonia, severe acute respiratory distress syndrome, and death. The purpose of this research was to study the symptoms of confirmed Coronavirus disease (COVID-19) cases and their relationship with gender and age groups.</p> <p><strong>Materials and Methods</strong></p> <p>This observational cross-sectional study was conducted at Rawalpindi Institute of Urology and Transplantation (RIUT) that is the COVID-19 management center of Rawalpindi Medical University, Rawalpindi during the month of March 2020. Consecutive sampling methodology was used, and all real-time polymerase chain reaction (RT-PCR) confirmed patients of COVID-19 were included. Data regarding age, gender, and symptoms with onset was recorded and analyzed.</p> <p><strong>&nbsp;Results</strong></p> <p>Thirty-five patients, 22 (62.9%) males, and 13 (37.1%) females were included. Seven (20%) patients were ≥60 years old, and 12 (34.8%) ≥40 years old. 21 (60%) were symptomatic and the rest of them were asymptomatic. The mean duration of symptoms was 2.8±1.1 days. Fever (13, 61.9%), persistent cough (12, 57.1%), sputum (6, 28.6%), shortness of breath (4, 19%), anorexia (3, 14.3%), fatigue (3, 14.3%), myalgia (1, 4.8%), were presenting symptoms. Cough, anorexia, and fatigue were significantly more frequent in the patients ≥40 of age. Anorexia and fatigue were common in the age groups ≥40 and ≥60 years. Myalgia was significantly frequent in patients aged ≥60 years.</p> <p><strong>Conclusion</strong></p> <p>Fever, persistent cough and shortness of breath are commonest symptoms of COVID 19 patients. COVID-19 can be asymptomatic in many cases.</p> Javeria Malik, Muhammad Khurram, Arsalan Manzoor Mughal, Noman Ahmed Chaudhary, Qaiser Aziz, Muhammad Mujeeb Khan, Muhammad Shahzad Manzoor Copyright (c) 2020 Journal of Islamabad Medical & Dental College Histomorphometric Variations of the Placenta in Normal and Hypertensive Pregnancies <p><strong>Background</strong>: Pregnancy-induced hypertension is a leading cause of deleterious changes in the placenta resulting in decreased blood supply towards the placenta. The objective of the current study was to analyze the histo-morphometric variations in the placenta of women with or without known pregnancy-induced hypertension.</p> <p><strong>Methods</strong>: Cross-sectional study was carried out in the Gynecology and obstetrics section of Nazeer Hussain Medical Complex, Hyderabad in collaboration with Isra University, Hyderabad from March 2019 to August 2019. A total of <strong>100 </strong>placentae were selected and divided into two groups (control and study groups) based on the presence or absence of hypertension in pregnancy. The observations of the control group placenta were compared with the study group placentas. All placentae were observed for morphometric and histological changes. SPSS ver. 22 was used to analyze the collected data.</p> <p><strong>Results</strong>: There was an increase in the mean weight of placentae among the control group as compared to the group having known hypertension cases and the difference was statistically significant (p-value &lt;0.05). The fetoplacental weight ratio was increased among the hypertension group when compared to the statistically insignificant control group (p-value &lt;0.05). Various gross (infarction, calcification) and histological changes (hyalinised villi, intervillous hemorrhage, decreased villous vascularity) were observed in the placentae of the hypertensive group as compared to the normal group.</p> <p><strong>Conclusion: </strong>The findings of the study concluded that Preeclampsia/PIH poses harmful and serious histo-morphometric variations in the placental tissues that affect fetal outcome.</p> Rizwan Ali Talpur, Samia Siddiqui, Sehar Khowaja, Naila Noor, Muhammad Saqib Baloch, Mansoor Mukhtar Qazi Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 00:47:03 +0500 Nephroprotective Effects of L-Arginine against Chemotherapy Induced Acute Kidney Injury in Wistar Rats <p><strong>Objective </strong>To evaluate the protective role of L-Arginine in cisplatin induced acute renal injury through assessment of renal, oxidative stress and inflammatory markers in albino wistar rats.</p> <p><strong>Methods:</strong> Quasi-experimental study was conducted at the department of physiology and postgraduate research laboratory at Isra University, Hyderabad, Sindh from April 2019 to September 2019. Thirty male Albino wistar rats were selected through non-random purposive sampling and divided equally into three different groups: Group-A (Control group), Group-B (experimental group) received Cisplatin alone and Group-C (experimental group) received Cisplatin along with arginine. After sacrificing the animals, blood samples were collected through cardiac puncture while renal histopathological analysis was under the light microscope. The changes in severity were observed using a graded scale. Data was analysed using SPSS v23.0.</p> <p><strong>Results: </strong>There was a statistically significant (p-value &lt;0.05) decline in the bodyweight and rise in absolute kidney weight of group B in comparison with other two group. Moreover, significant rise (p-value &lt;0.05) in serum renal markers was observed in group B while significant decline (p-value &lt;0.05)&nbsp; in these serum renal markers in group C compared with group B.&nbsp; Furthermore, prominent demage in normal renal histology in group B rats while restoration of renal histology was demonstrated in group C rats.</p> <p><strong>Conclusion:</strong> The present study concludes that L-Arginine exerts an anti-oxidative, anti-inflammatory and nephro-protective effect for renal tissue damage caused by Cisplatin.</p> <p>Keywords: Acute Kidney Injury, Antioxidant, Cisplatin, L-Arginine, Oxidative stress</p> Dr.Kumayl Abbas Meghji, Dr.Tariq Feroz Memon, Dr. Imtiaz Ahmed, Dr. Sehar Gul Memon, Dr. Naila Noor, Dr. Ali Abbas Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:52:21 +0500 Psychological impact of COVID-19 pandemic on mental health of general population of Pakistan <p><strong>Objective:</strong> To ascertain the psychological impact of COVID-19 pandemic on mental health of general population of Pakistan.</p> <p><strong>Study design:</strong> Descriptive Cross-Sectional Study.</p> <p><strong>Place and Duration of study:</strong> The participants in the study were selected from community population of Islamabad in a period of two months from 15<sup>th</sup> May to 15 July 2020.</p> <p><strong>Patients and Methods:</strong> A total of 278 participants were selected for this study. All the participants were given structured questionnaire consisting on demographic information HADS scoring system to calculate depression and anxiety. HADS consists of 14 questions, each of which is scored 0–3. The possible scores for depression and anxiety ranged 0-21. Higher scores indicate increased severity of anxiety or depression. A cut off value of 8 or more was used to identify the anxiety and depression.&nbsp;</p> <p><strong>Results:</strong> The mean age was 33.42 ± 9.67 years and 148 (53.2%) were males. Among these participants 238 (85.6%) were resident of urban area, and 167 (60.1%) were married. Most of the participants were graduate 102 (36.7%). Thirty-six (12.9%) participants had a known patient of Covid-19 in their family or friends. Most of the participants 196 (70.5%) had no any comorbid disease. The mean anxiety score was noted to be 6.47 ± 5.51 and mean depression score was 6.65 ± 4.17. History of any comorbid disease showed a highly significant (p-value &lt; 0.01) association with anxiety and depression score.</p> <p><strong>Conclusion:</strong> To minimize the effect of Covid-19 pandemic on mental health of general population attention should be given to vulnerable groups like males, middle age adults, less educated and unemployed persons especially the people with chronic comorbid disease.</p> <p><strong>Keywords: </strong>Covid-19, Mental health, General population, Anxiety, Depression</p> Muhammad Afzal, Dr. Hameed Mumtaz Durrani, Dr. Muhammad Imran Sohail Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:13:58 +0500 Comparison of Quality of Life in Breast Cancer Survivors with Lymphoma Survivors <p><strong>Objectives: </strong>To compare the Quality of Life of Breast Cancer Survivors and Lymphoma Survivors post treatment.</p> <p><strong>Methodology: </strong>A cross sectional study was performed in the departments of General Surgery and Oncology at Pakistan Institute of Medical Sciences Islamabad from 1<sup>st</sup> June to 31<sup>st</sup> December 2019. Patients who had received treatment for breast cancer and Lymphoma were included using non probability consecutive sampling technique. A standardized questionnaire (QOL-CSV) to assess quality of life in cancer survivors was filled in by the researchers after interviewing the patients and their responses were recorded with the demographic and clinical characteristics of each patient. The data was entered in SPSS version 20 and co-relations were obtained.</p> <p><strong>Results: </strong>A total number of 50 lymphoma survivors (LS) and 166 breast cancer survivors (BCS) participated. Physical parameters revealed a better mean score of 75.86 ±10.53 for LS group than for BCS group (63.45 ±9.64). Psychological well being score was similar with a mean of 42.18 ±8.06 for LS and 43.04 ±7.04 for BCS group. Distress was dealt better by LS than BCS (50% scoring 41-50 in LS versus 46.6% scoring 31-40 in BCS). Fear of recurrence and spread was higher amongst BCS group (≤10 score in 46.4% participants). LS group performed worse in social factors (mean value of 26.88 ±6.67). Spiritual well being was markedly better in BCS (mean value 47.15 ±6.27).</p> <p><strong>Conclusion: </strong>Considerable negative impact on physical, psychological and social well being of carcinoma survivors is noted, especially after mastectomy.</p> <p><strong>Key words: </strong>Carcinoma, Lymphoma, Breast cancer</p> Dr. Mumtaz Ahmad Khan, Dr. Shaista Zaffar, Dr. Namrah Mahmood Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:16:16 +0500 Nosocomial Blood Stream Infections in Pediatric Intensive Care Unit of Fauji Foundation Hospital, Rawalpindi Pakistan <p><strong>OBJECTIVE: </strong>To determine the frequency of most common bacterial organisms in nosocomial blood stream infections</p> <p><strong>STUDY DESIGN: </strong>A Cross-sectional descriptive study</p> <p><strong>PLACE AND DURATION:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </strong>In &nbsp;Department of Paediatric Medicine, Fauji Foundation Hospital, Rawalpindi, Tertiary care hospital over a period of 06 months from 6<sup>th</sup> July 2017 to 6<sup>th</sup> Jan &nbsp;2018</p> <p><strong>METHODOLOGY: </strong>Total 385 patients admitted in PICU were included in the study according to the inclusion criteria. Patients were monitored from the time of admission to their final outcome for development of hospital acquired infections, based on standard definitions.</p> <p>Blood sample for culture were collected aseptically according to the protocol of the microbiology laboratory. The bottles were incubated for 7 days. Patients were monitored from time of the blood culture yielding growth until culture report becomes available. Data was calculated through a structured Performa confidentiality of patient was maintained.</p> <p><strong>RESULTS: </strong>Pseduomonas Aeruginosa and Salmonellia Tpyhi were the most common bacterial organism 83 (21.6) in nosocomial blood stream infection whereas E.Coli and Klebsiella found in 77 (20.0) and 67 (17.4) patients respectively.</p> <p><strong>CONCLUSION: </strong>The study concluded that the frequency of most common bacterial organisms in nosocomial blood stream infections is substantial. Thus, early initiation of appropriate antibiotic therapy help in contributing significantly towards decrease in mortality rates due to blood stream infections.</p> <p><strong>KEYWORDS: </strong>Nosocomial, Bloodstream infection, Intensive care unit</p> Iqra Ayaz, Hira Hameed, Wajeeha Amber, Talal Zafar Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:18:44 +0500 Comparison of Clipless and Clipped Laparoscopic Cholecystectomy at Nishtar Hospital Multan, Pakistan <p><strong><u>Objective:&nbsp;</u></strong></p> <p>To compare the efficacy of clipless cholecystectomy using harmonic scalpel and clipped conventional laparoscopic cholecystectomy.</p> <p><strong><u>Study design:</u> </strong></p> <p>A randomized control trial.</p> <p><strong><u>Place and duration of study:</u> </strong></p> <p>Department of general surgery at Nishtar Hospital Multan, from October 1<sup>st</sup> 2019 to March 31<sup>st</sup> 2020.</p> <p><strong><u>Methodology: </u></strong></p> <p>Total 188 patients of gallstone related cholecystitis were enrolled in the study and were selected using non-probability consecutive sampling technique. All the patients were randomly divided into two equal groups. One group was designated for clipless and the other for conventional clipped laparoscopic cholecystectomy. Age, gender, duration of cholecystitis, duration of Procedure, hospital stay, usefulness in difficult procedures and biliary leakage were recorded for all the patients. Data was entered in SPSS version 23 and analyzed.</p> <p><strong><u>Results:</u></strong></p> <p><u> </u>Operation time was 28.35±7.92 minutes and 21.15±4.47 minutes in clipped and unclipped surgery, respectively (p&lt;0.001). Hospital stay was 2.37±0.60 days in clipped surgery group and 1.71±0.74 days in clipless surgery group (p&lt;0.001). Biliary leakage was reported in 2(2.1 %) patients of the clipped group and 1(1.1%) patients of the unclipped group (p = 0.561). Usefulness of the procedure in difficult cases was documented in 0 (0.0%) of the clipped procedures and in 8 (8.5%) of the clipless procedures (p=0.004).</p> <p><strong><u>Conclusion: </u></strong></p> <p>As witnessed from this study, it can be concluded that clipless surgery is a better option as compared to the clipped conventional laparoscopic Cholecystectomy as former is associated with shorter operation time, shorter hospital stay and better usefulness in difficult cases.</p> Dr Abdul Manan, Dr Ashar Ahmad Khan, Irfan Ahmad , Dr Muhammad Usman , Tariq Jamil, Dr Muhammad Afzal sajid Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:21:07 +0500 Common Radiological Findings in Children with Suspected Foreign Body Inhalation <p><strong>BACKGROUND: </strong>Foreign body inhalation is an emergency situation, affecting children mostly in first decade of life. An aspirated solid or semisolid object may lodge in the larynx or trachea may cause complete obstruction. Lesser degrees of obstruction or passage of the obstructive object beyond the carina can result in less severe signs and symptoms. Chronic debilitating symptoms with recurrent infections might occur with delayed extraction, or the patient may remain asymptomatic. Many aspirated foreign bodies are unexpectedly discovered, go undetected, or are misdiagnosed. In many cases with suspected foreign body radiological findings may reveal other findings e.g. emphysema, atelectasis, air trapping.</p> <p><strong>OBJECTIVE: </strong>To determine the frequency of common radiological findings among children with suspected foreign body inhalation.</p> <p><strong>MATERIAL AND METHODS: </strong>This cross-sectional descriptive study was conducted at Department of ENT, Khyber Teaching Hospital, Peshawar, from April 2017 to October 2017. In this study a total of 141 patients were observed. All patients were subjected to detailed history and clinical examination. X ray chest (AP and lateral views) of all the patients was performed to detect common radiological findings (Radio-opaque Foreign Body (FB), Pneumonia, Emphysema, atelectasis and Air Trapping). The demographic details like name, age, gender, address and contacts were recorded on a pre-designed proforma.</p> <p><strong>RESULTS: </strong>In this study mean age was 8 years with SD ± 3.563.&nbsp; Sixty percent children were male while 40% children were female. Sixteen percent children had Radio opaque FB, 13% children had pneumonia, 28% had emphysema, 18% children had atelectasis while 25% had Air trapping.</p> <p><strong>CONCLUSION: </strong>Our study concludes that the frequency of Radio opaque was 16%, pneumonia 13%, emphysema 28%, atelectasis 18%, Air trapping 25% among children with suspected foreign body inhalation.</p> <p><strong>KEY WORDS: </strong>radiological findings, suspected foreign body inhalation, Pneumonia, Emphysema, atelectasis and Air Trapping</p> Muhammad Junaid, Mansoor Alam, Fawad Sahibzada, Sajid Ali, Khalid Saeed, Hamid Mukhtar Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:23:38 +0500 Mastalgia: Risk Factors and Treatment Strategies Used at Two Breast Clinics in Pakistan <p><strong><u>Introduction</u></strong><strong><u>:</u></strong><strong>&nbsp;&nbsp; </strong>Mastalgia is a common cause of fear and anxiety in patients especially in south east asia due to high prevalence of&nbsp; breast cancer . Mastalgia is one of the commonest symptom with which women consult a breast clinic.</p> <p><strong><u>Objective:&nbsp; </u></strong>Aim of this study is to determine risk factors associated with&nbsp; &nbsp;mastalgia,its association with&nbsp; &nbsp;various breast disorders, and various&nbsp; management strategies used for &nbsp;its treatment.</p> <p><strong><u>Study Design: &nbsp;</u></strong>Prospective Descriptive &nbsp;Study</p> <p><strong><u>Duration and place of study: </u></strong>&nbsp;This study was carried out at CMH Rawalpindi &nbsp;and Thall over a period of six months &nbsp;from January&nbsp; to July 2017.</p> <p><strong><u>Materials and Methods:</u></strong> All &nbsp;women &nbsp;presenting to breast surgery clinic with complaints of breast pain, heaviness, and tenderness were included in the study. Patients were initially evaluated&nbsp; at the time of presentation, treatment initiated&nbsp; and then were evaluated after six months of treatment.</p> <p><strong><u>&nbsp;</u></strong></p> <p><strong><u>Results: </u></strong>A total of 93 women &nbsp;presented to our clinic during this period. Cyclical mastalgia was noted in 39.8% (n=37) women while 60.2% (n=56) had non cyclical mastalgia. In 41.9%(n=39) patients no underlying pathology was noted ,49.5%(n=46) patients &nbsp;had benign disorders while 8.6%(n=8) had malignancy. Increased BMI ,lack of exercise were associated with onset of mastalgia while use of OCP was associated with low risk of mastalgia. Of all 45.1%(n=42) responded to measures like reassurance, dietary and lifestyle modifications while 54.9%(n=51) were treated with&nbsp; pharmacological therapy .Those having malignancy were treated according to the underlying malignancy.</p> <p>&nbsp;</p> <p><strong><u>Conclusion:</u></strong>&nbsp; Careful and thorough evaluation of mastalgia is necessary to rule out any underlying pathology.</p> <p>&nbsp;</p> <p><strong><u>&nbsp;</u></strong></p> sohail saqib Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:25:54 +0500 A Cadaveric Morphometric Study of Lumbar Vertebrae in Zimbabwean Adult Males <p><strong>Background: </strong>The occurrence of vertebral fractures and spinal cord injuries in developing countries in Africa is high with an annual incidence rate of 12.1 to 57.8 per million; 82.8% of these occurring in males and the most common causes being vehicle crushes (41.4%) and falls (34.9%)<sup>1</sup>. Treatment of vertebral fractures is aimed at stabilising a segment and then restoring its mobility thereby preventing nerve damage<sup>2</sup>. Violation of the pedicle walls during transpedicular screw fixation may occur if the screw diameter is too large or there is wrong placement<sup>3</sup>. Prevalence of pedicle wall violation using the “free hand” technique was reported to be 1.4%<sup>4</sup>.</p> <p><strong>Objective: </strong>To document the dimensions of the pedicles of lumbar vertebrae in the Zimbabwean population.</p> <p><strong>Study design</strong>: A descriptive cross-sectional study.</p> <p><strong>Place and duration of study: </strong>The study was conducted in the Gross Anatomy Laboratory of the Department of Anatomy, University of Zimbabwe College of Health Sciences, Harare. The duration of study was 6 months (from June 2019 to December 2019).</p> <p><strong>Material and Methods: </strong>A total of 15 adult male cadaveric specimens were taken from the Department of Anatomy at University of Zimbabwe. The lumbar vertebrae were dissected and their Pedicle Transverse Diameter (PTD), Pedicle Vertical Diameter (PVD) and the chord length were measured using a vernier calliper. Statistical calculations were performed using SPSS version 20.</p> <p><strong>Results: </strong>There was no significant difference between the pedicle dimensions of the right and left sides (P &gt; 0.05). PTD steadily increases from vertebral level L<sub>1</sub> to L<sub>4</sub> followed by an abrupt increase at L<sub>5</sub>. PVD gradually decreases from L<sub>1</sub> to L<sub>5</sub> level. The chord length increases from a minimum at L<sub>1</sub> to reach a maximum at L<sub>3</sub> and then again decreases to L<sub>5</sub> level.</p> <p><strong>Conclusion: </strong>Pedicle dimensions for the Zimbabwean population differ from those reported in previous studies for other population groups.</p> <p><strong>Key words: </strong>Chord length, Lumbar vertebrae, Pedicle dimensions.</p> Maimoona Khan Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:28:08 +0500 Mucoepidermoid Carcinoma: A Demographic and Histopathological Profile <p>Background: To find the frequency and clinico-pathological presentation of mucoepidermoid carcinoma (MEC).<br>Materials and Methods:<br>In this study, we included all the malignant salivary gland tumors. Among these the frequency of mucoepidermoid carcinoma was considered. Age, gender, histopathological grading and anatomical site of tumor were included in data analysis.<br>Results:<br>Out of 60 malignant salivary gland tumors reported to the histopathology department, 30 tumors were diagnosed as mucoepidermoid carcinomas. The patient’s age having mucoepidermoid carcinoma ranged from 6 to 88 years, mean age of 44.9±19.2SD. The male patients were 23 in number while female were 7. Out of 30 cases, 73.3% patients had tumor in parotid gland, while13.3% patients in submandibular gland . Other tumors were in palate, retromolar area, and in posterior 1/3rdof tongue (13.3%). According to histopathological grading 26.6% cases of MEC were of high grade, 26.6 % were intermediate grade and 36.6% were low grade.<br>Conclusions:<br>According to this study, the frequency of MEC was 50% among all salivary gland tumors. MEC was mostly found in parotid gland and histopathologically low grade type was the most common.</p> zainab niazi Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:30:45 +0500 Effect of Novel COVID-19 Infection on Different Organs of Human Body: A Narrative Review <p>The COVID-19 infection creates a drastic effect on vital organs of human body including heart, liver, brain and lungs. This infection can cause mild to severe organ injuries resulting in death of the patient. The novel corona virus damages host cells through ACE-2 receptors. Therefore, proper care should be taken to protect vital organs during diagnosis and treatment of COVID-19 infection.</p> abdul qadir Hayat Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:33:01 +0500 Two Case Reports of Hereditary Sensory Autonomic Neuropathy Type IV <p>Hereditary Sensory Autonomic Neuropathy type IV (HSAN-IV), previously known as congenital insensitivity to pain and anhidrosis (CIPA), is an uncommon condition that presents in infancy with repeated episodes of fever, loss of pain sensations and self-mutilation. We are reporting two patients from two different families. Both patients had history of recurrent fever, anhidrosis, and pain insensitivity and self-mutilation behavior. Both had delayed motor developmental milestones with cognitive impairment. Clinical diagnosis of HSAN type IV was made on the basis of history, clinical examination and excluding other possible causes. Diagnosis of this rare disease is commonly delayed and patients ultimately develop complications. As there is no definitive treatment, these patients and their families should receive proper education and counselling for rehabilitation</p> QURAT-UL-AIN KHALID Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:36:03 +0500 Intraparotid Facial Nerve Schwannoma in a 40-Year-Old Male with Hearing Loss – A Case Report <p>Schwannoma is a benign tumor of axonal nerve sheath. Head and neck area, particularly parotid gland is an uncommon site for Schwannoma, however it can rarely arise from the intraparotid part of facial nerve and present as either a symptomless mass or facial paresis. Its diagnosis before surgical intervention is important for the conservation of parotid gland and facial nerve. On clinical examination and imaging studies, it can be misdiagnosed easily. FNAC is a helpful tool for its diagnosis. This entity should not be ignored while dealing with parotid masses. We present a case of a patient who came with the complaint of a parotid mass. Magnetic imaging resonance (MRI) scan suggested a parotid tumor which proved to be a spindle cell neoplasm on Fine Needle Aspiration Cytology (FNAC). A definite diagnosis of schwannoma of intraparotid facial nerve was made on histopathological examination of the excision sample.</p> Nosheen Nabi Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:38:06 +0500 Histopathology Images Department of Pathology Copyright (c) 2020 Journal of Islamabad Medical & Dental College Thu, 31 Dec 2020 01:41:55 +0500