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>It is recognized by the Pakistan Medical and Dental Council (PMDC</strong>) and the<strong>&nbsp;Higher Education Commission of Pakistan</strong>. It includes original research papers, reviews, case reports<strong>,</strong> and short communications related to health, medicine, and dentistry. Submitted manuscripts must be original, written in English, and will be accepted for publication with the understanding that they have not been submitted simultaneously to any other journal, have not been published or are under consideration elsewhere, and have not been published previously. The manuscripts will be reviewed through a 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> (Dr. Usman Waheed (Ph.D.)) (Waleed Hassan (MS Biotechnology)) Sun, 07 Jul 2024 22:19:45 +0500 OJS 60 Frequency of Hypocalcemic Seizures in Children with Afebrile Seizure: From 2 months - 2 years in a Tertiary Care Hospital <h2>Objective: To determine the frequency of hypocalcemic seizures in children with afebrile seizure from age 2 months - 2 years. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</h2> <h2>Methodology: This Descriptive Cross-Sectional study was conducted in Pediatric Department of Ayub Teaching Hospital Abbottabad for a period of six months (15th April, 2017 to 15th October, 2017). Total 130 cases fulfilling the inclusion criteria were enrolled in the study after approval from ethical committee of hospital and informed consent from the parents of children. A detailed history and examination were done and blood samples for serum calcium level were sent to the hospital laboratory along with other routine investigation to rule out the cause. All data was analyzed using SPSS version 21.</h2> <h2>Results: Out of 130 cases 48(36.9%) children had hypocalcemia while 82(63.1%) were normocalcemic. 79 (60.8%) were males and 51 (39.2%) were females. The mean age of children was 13.03 ± 6.81 months. The average calcium level was 8.23±1.51mg/dl.</h2> <h2>Conclusion: It has been concluded that afebrile seizures occur frequently in children with hypocalcemia. Thus, we got the local evidence regarding this association and recommend to screen all new afebrile seizure cases for hypocalcemia.</h2> <p>Key words: Hypocalcemic fits, children, afebrile seizures, hypocalcemia</p> Shafaq Sultana, Isma Waheed, Sadia mahmood Ahmad, Muhammad Nadeem Qureshi, Tahir Saeed Siddique Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:25:33 +0500 Regional Disparities in Maternal Blood Parameters during Pregnancy: A Comparative Analysis across Four Provinces of Pakistan <p><strong>&nbsp;Objective</strong>: A comparative analysis of hemoglobin (HB), mean corpuscular volume (MCV), and ferritin levels among pregnant women from all four provinces in Pakistan: Punjab, Sindh, Khyber Pakhtunkhwa, and Balochistan.</p> <p><strong>Methods: </strong>It was a Cross-sectional Observational study. The study was conducted at four centers in Karachi, Quetta, Kharian and Mardan Pakistan for 1 year from 1<sup>St</sup> Feb 2022 to 31st Jan 2023. Maternal blood parameters were measured and compared across different regions of Pakistan to identify potential regional differences due to factors such as ethnicity, socio-economic status, and other factors.</p> <p><strong>Results</strong>: The mean hemoglobin levels were 10.95 g/dL in Balochistan, 11.04 g/dL in KPK, 10.82 g/dL in Punjab, and 10.36 g/dL in Sindh. The mean MCV values was 80.56 FL in Balochistan, 79.70 FL in KPK, 77.94 FL in Punjab, and 80.89 FL in Sindh. The mean serum ferritin levels were 16.00 ng/mL in Balochistan, 23.84 ng/mL in KPK, 33.92 ng/mL in Punjab, and 20.93 ng/mL in Sindh.</p> <p><strong>Conclusions: </strong>Overall, the results showed significant variation in the mean values for the different variables across the four provinces. We also noticed that gestational anemia is very common health issue all over Pakistan. This study provides valuable insights into regional differences in maternal blood parameters during pregnancy in Pakistan and may help in the development of regionally targeted interventions to address maternal anaemia.</p> <p><strong>Keywords</strong>: Gestational Anaemia, Pregnancy, Iron Deficiency Anemia, Maternal Health</p> <p>&nbsp;</p> Samina Rehan, Samina Naseem Khattak, Muhammad Irfan Khattak, Shumaila Hadi, Sadia Rehman, Zara Sami, Khubaib Ahmad Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:30:45 +0500 Comparison of Dexamethasone-Denenhydraminate and Dexamethasone-Ondansetron in Preventing Post-Operative Nausea and Vomiting after Laparoscopic Cholecystectomy <p><strong>I</strong><strong>ntroduction:</strong> Postoperative nausea and vomiting (PONV) is one of the most common problems after implementation of general anesthesia. Laparoscopic cholecystectomy for the treatment of cholelithiasis is popular amongst surgeons as well as patients due to its associated advantages, which includes a short hospital stay. However high incidences of PONV have been reported after laparoscopic cholecystectomy.</p> <p><strong>Objective:</strong> To compare the efficacy of combination dexamethasone-dimtenhydrinate with dexa-methasone-ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy.</p> <p><strong>Study design:</strong> Randomized controlled trial</p> <p><strong>Settings:</strong> Department of Anaesthesia, Holy Family Hospital, Rawalpindi Medical University and Allied Hospital.</p> <p><strong>Duration of study:</strong> Study was carried out over a period of six months from 01-01-2022 to 30-06-2022.</p> <p><strong>Methodology:</strong> A total of 160 patients were enrolled, 80 patients each to either group D for Dexamethasone-Dimenhydrinate group or group-O for Dexamethasone-Ondansetron.</p> <p>Results: Mean age of the patients was 42.3±13.2 and 42.4±14.0 in group-D and Group-O, respectively. There were 40 (50%) males and females in group-D while 29 males (36.3%) and 51 females (63.7%) in group-O. Efficacy of combination dexamethasone+ dimtenhydrinate with dexamethasone+ondansetron in preventing PONV showed at 30 minutes (5.0% vs 12.5%; p=0.093), at 60 minutes (7.5% vs 20.0%; p=0.022), at 120 minutes (6.3% vs 17.5%; p=0.028) and at 24 hours (5.0% vs 18.8%; p=0.007).</p> <p><strong>Conclusion:</strong> In conclusion, our study demonstrated that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron combination&nbsp; in prevention of nausea and vomiting after laparoscopic cholecystectomy.</p> Rabia Ashraf, Ammar Shah, Umer Naseem, Muhammad Nazir Awan, Farah Naz Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:34:16 +0500 Comparison of Outcomes of Intravenous Dexamethasone Versus Placebo as Adjunct to Local Anaesthetic Brachial Plexus Block for Upper Limb Surgery <p><strong>Introduction:</strong> Dexamethasone has been tested in combination with different local anesthetics with varying degree of results including increase in intensity and duration of block.</p> <p><strong>Objectives: </strong>To compare the outcomes of intravenous dexamethasone versus placebo as adjunct to local anesthetic brachial plexus block for upper limb surgery.</p> <p><strong>Study design: </strong>Randomized controlled trial</p> <p><strong>Setting: </strong>Department of Anesthesia, pain management and intensive care Holy Family Hospital, Rawalpindi.</p> <p><strong>Study duration:</strong> 7<sup>th</sup> November 2019 till 6<sup>th</sup> May 2020.</p> <p><strong>Materials &amp; Methods:</strong> A total of 10 0 patients of either gender aged 18 to 60 years admitted for upper limb surgery were included. Patients with pregnancy, DM, block failure and contraindication to brachial plexus block were excluded. Patients in group A received a block injection with 30ml of 0.5% bupivacaine along with 2ml of intravenous dexamethasone. Group B patients received 30ml of 0.5% bupivacaine for block injection and 2ml of normal saline intravenously. Block success was confirmed using the sensory and motor examination of the upper limb. Block duration was recorded in hours, opioid consumption was recorded in intravenous morphine equivalents in first 24 hours, visual analogue scores for pain on scale of 0-10 at upper limb at rest was recorded at 8 and 24 hours.</p> <p><strong>Results: </strong>In our study, duration of local anesthetic brachial plexus block in dexamethasone and placebo group were 16.12 ± 1.33 hrs and 9.77 ± 1.26 hrs respectively with p-value = 0.0001. Opioid consumption in Morphine Equivalents&nbsp; at 24 hrs in local anesthetic brachial plexus block and placebo group were 16.48 ± 2.60 vs 22.68 ± 3.78 with p-value &lt; 0.0001 respectively.</p> <p><strong>Conclusion: </strong>This study concluded that intravenous dexamethasone has better outcomes as compared to intravenous saline as adjunct to local anesthetic brachial plexus block for upper limb surgery.</p> Naila Mughal, Ammar Shah, Sana Latif, Umer Naseem, Farah Naz, M. Nazir Awan Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:36:19 +0500 Vaccination Status Against the Hepatitis B Virus of the Patients Visiting a Tertiary Care Dental Hospital <p><strong>Abstract:</strong></p> <p><strong>Objective</strong></p> <p>To assess the vaccination status for Hepatitis B virus among patients attending a tertiary care dental hospital in Multan, aiming to identify gaps and opportunities for improvement in vaccination coverage.</p> <p><strong>Methods</strong></p> <p>This cross-sectional questionnaire study conducted at Multan Dental College from June 2023 to Feb 2023 included patients attending the dental OPD. 181 participants completed the questionnaire regarding vaccination status. Ethical approval and informed consent were obtained from Multan Dental Hospital.</p> <p><strong>Results</strong></p> <p>Among 181 participants, 98 (54.14%) were males and 83 (45.86%) were females. Regarding age groups, 36 (19.9%) were 16-20 years old, 69 (38.12%) were 21-25 years old, 54 (29.83%) were 26-30 years old, and 22 (12.15%) were 31 years old or above. Out of 181 participants, 51 (28.17%) were non-vaccinated, while 130 (71.83%) were vaccinated. Among the vaccinated, 47 (26%) received the 1st dose, 36 (19.9%) received the 2nd and 3rd doses each, and 11 (6.07%) received the Booster dose. The majority (58.82%) of non-vaccinated individuals cited multiple reasons for not receiving immunization, including vaccine unavailability and busy schedules. Additionally, 9.8% lacked awareness of the vaccination, while others mentioned injection phobia and lack of motivation</p> <p><strong>Conclusion</strong></p> <p>The study emphasizes the challenge of incomplete vaccination among patients, which necessitates coordinated efforts by public health officials. Implementing AI-powered reminder systems could effectively address this issue, improving vaccination rates and public health outcomes.</p> Muhammad Shoaib , Rizwan Zafar Langrial , Mariam Khalid Mahmood , Basil Khalid , Hina Nasim, Anoosha Mujtaba Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:38:03 +0500 Frequency and MIC-based Antimicrobial Resistance Profile of MDR and XDR Gram Negative Isolates of Blood Culture Specimens in a Tertiary Care Setting <p>The escalation of antimicrobial resistance (AMR) among Gram-negative bacteria, particularly multidrug-resistant (MDR) and extensively drug-resistant (XDR) pathogens, posed a significant challenge in tertiary care settings. This paper comprehensively analyzed the antimicrobial resistance profile of MDR and XDR Gram-negative isolates from blood culture specimens at Jinnah Hospital, Lahore, a leading tertiary care facility. Over a period of one year, 9600 blood culture specimens were processed, revealing a high incidence of resistance to a wide array of antibiotics, with notable findings including 100% susceptibility to Colistin and over 90% resistance to several commonly used antibiotics such as Ciprofloxacin and Piperacillin/Tazobactam. Among the positive isolates, 33.8% were classified as MDR and 66.2% as XDR. The study emphasized the critical role of Minimum Inhibitory Concentrations (MICs) in guiding therapeutic decisions, highlighting the wide variability in resistance patterns and the necessity for personalized antimicrobial therapy. The prevalence of MDR and XDR isolates underscored the urgent need for advanced treatment modalities, comprehensive surveillance, and robust antimicrobial stewardship initiatives. Additionally, the study pointed to the emergence of colistin resistance as a critical challenge in managing infections caused by these pathogens. Through detailed analysis and discussion, this study illuminated the grave challenge posed by AMR in tertiary care settings. It emphasized the importance of innovative approaches to antimicrobial stewardship, developing new antimicrobial agents, and ongoing surveillance to effectively combat this public health crisis.</p> Asma Ejaz, Farhan Rasheed, Muhammad Bilal, Gul Fraz, Saadia Chaudhary, Mian Zahid Sarfraz Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:41:04 +0500 Effect of Early Mobilization and Bed Positioning on Mobility among Patients with Traumatic Brain Injury <p><strong>Background: </strong>Traumatic brain injury is defined as the disturbance in the function of the brain , or&nbsp; indication of pathology of brain,&nbsp; by the application of&nbsp; an exterior bodily force. Early mobilization exercises are explained as physiotherapy exercises of altering degree that are clinically safe and accurate developmentally started within 2 to 3 days of admission in neurological ICU. This early mobilization exercises helps in improving TBI patients recovery.</p> <p><strong>Objective:</strong> The purpose of this study is to validate and evaluate the effect of early mobilization and bed positioning on mobility among patients with traumatic brain injury.</p> <p><strong>Methods:</strong> This quasi-experimental study included 28 TBI patients. This study was conducted at general hospital, Lahore, and Jinnah hospital Lahore. Early mobilization and bed positioning therapies protocol were performed for 6 weeks. There were three sessions per week. Each session was 30 minutes. Mobilization scale and Norton scale were used as evaluation parameters before and after 6 weeks.</p> <p><strong>Results:</strong> The data’s regularity was assessed by the Shapiro-Wilks test. Following statistical analysis, the regimen for early mobilization and bed positioning therapy’s efficacy for all examined variables was confirmed. The scores on early mobilization and Norton scales differ significantly.</p> <p><strong>Conclusion:</strong> The results suggested that early mobilization and bed positioning therapies has improved mobility in TBI patients. This therapy protocol has also improved the TBI patients’ quality of life.</p> <p><strong>Keywords:</strong> Bed positioning, Mobility and Traumatic brain injury.</p> Maria Siddique, Nazeer Mehrvi, Rehana Niazi, Qurat-ul-Ain, Mauzzen Nasir Copyright (c) 2024 Journal of Islamabad Medical & Dental College Sun, 07 Jul 2024 22:44:36 +0500 Role of zinc supplementation in the treatment of children with culture-proven febrile urinary tract infection <p><strong>Objectives: </strong>To compare the efficacy of zinc plus antibiotics versus antibiotics alone in the treatment of culture-proven febrile urinary tract infection in children</p> <p><strong>Patients and methods: </strong>This randomized control trial was conducted at FFH, Rawalpindi. Children with culture proven UTI requiring IV antibiotics were enrolled in the study (n=70) divided in two groups. Group A was given zinc in addition to the antibiotic while group B received antibiotic only. The results of two groups were then compared or the difference in the clinical response.</p> <p><strong>Results:</strong> In our study total 70 patients were enrolled, 35 patients in each group. Mean age was 7.69±2.5 years in group A and 8.3±2.2 years in group B. There were 62.9% males group A and 60% in group B, females were 37.1% in group A and 40% in group B. Mean duration of illness was 6.9±2.4 days in group A and 8±4.1 days in group B. Efficacy was 82.9% in group A and 57.1% in group B, p-value 0.019.&nbsp;</p> <p><strong>Conclusion:</strong></p> <p>There was early clinical recovery and significant reduction in the time of hospital stay in patients given zinc along with the antibiotic treatment.</p> <p><strong>Keywords:</strong> Zinc, urinary tract infection, febrile UTI</p> Amna Saleh, Kiran Mushtaq Toor, Huma Saleem Khan, Sumaira Khalil, Awais Tahir Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:28:44 +0500 Frequency of Atypical AVNRT in Patients Presenting with Narrow Complex Tachycardia <p><strong>ABSTRACT</strong></p> <p><strong><em>Objective:</em></strong> To determine the frequency of atypical AVNRT in patients presenting with Narrow Complex Tachycardia.</p> <p><strong><em>Study Design:</em></strong> Descriptive Cross Sectional</p> <p><strong><em>Place and Duration of Study:</em></strong> Department of Cardiology, MTI-Hayatabad Medical Complex, Peshawar, from March, 2021 to March, 2022.</p> <p><strong><em>Methodology:</em></strong> Ninety-three patients of either aged 30 to 80 years diagnosed with narrow complex tachycardia by consultant cardiac electrophysiologist on ECG showing QRS duration of less than 120 milliseconds were included in this study. Patients were managed as per standard protocol which included comprehensive clinical evaluation such as patient history, physical examination and invasive electrophysiological study for the diagnosis and characterization of atypical Atrioventricular Nodal Reentrant Tachycardia (AVNRT).</p> <p><strong><em>Results:</em></strong> A total of ninety-three patients were studied with mean age of 43.08 years (SD = 9.07). Among the participants, 58.1% were male, while 41.9% were female. Majority of patients had Slow-Fast AVNRT (7.5%) followed by Fast-Slow AVNRT (3.2%), and Slow-Slow AVNRT in 2.2% patients.</p> <p><strong><em>Conclusion:</em></strong> &nbsp;This study underscored the importance of gender-specific variations in the prevalence of different AVNRT types and highlighted the impact of gender as a potential influencing factor in the manifestation of specific types of AVNRT within the study population.</p> Hameed Ullah, Nasir Ali, Romana, Talia Mansoor, Muhammad Idrees Khan, Zahoor Ahmad Khan Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:29:53 +0500 Unmasking Acne: Azithromycin Edges Out Doxycycline in Randomized Trial at Tertiary Care Centre <p><strong>Background:</strong> Acne vulgaris, a prevalent global condition, often necessitates antibiotic therapy. Doxycycline has been a mainstay treatment; however, recent research suggests azithromycin might be superior. Conflicting data and a lack of local studies regarding their comparative efficacy warrant further investigation.</p> <p><strong>Objectives:</strong> This study aimed to compare the efficacy of oral azithromycin with oral doxycycline in treating acne vulgaris at a tertiary care hospital in Islamabad.</p> <p><strong>Methods:</strong> A randomized controlled trial was conducted. Patients aged 14-30 years (n=190) were enrolled and randomly assigned to either azithromycin or doxycycline treatment groups. Baseline and post-treatment (12 weeks) Global Acne Grading System (GAGS) scores were assessed. Percent reductions in GAGS score were categorized into four groups (&lt;25%, 25-50%, 51-75%, and &gt;75%) for intergroup comparison. Written informed consent was obtained from all participants.</p> <p><strong>Results:</strong> The mean patient age was 21.30±4.93 years, with a female predominance (male:female ratio 1:1.2). Most patients had Fitz-Patrick Skin Type-V (64.7%) compared to Type-IV (35.3%). Baseline GAGS scores were comparable between groups (p=0.612). Notably, post-treatment GAGS scores were significantly lower in the azithromycin group (p&lt;0.001), demonstrated by a greater mean change (19.33±3.03 vs. 17.70±2.99; p&lt;0.001) and percent reduction (81.87±8.74 vs. 75.97±11.12%; p&lt;0.001) compared to doxycycline. Additionally, 75.3% of patients achieved an excellent reduction in GAGS score, with a significantly higher proportion observed in the azithromycin group (87.4% vs. 63.2%; p&lt;0.001). Similar significant differences were observed across subgroups based on age, gender, and skin type.</p> <p><strong>Conclusion:</strong> This study suggests that azithromycin demonstrates superior efficacy to doxycycline for acne vulgaris management, regardless of patient demographics or skin type. Its established better safety profile further supports its potential as a preferred therapeutic option in future dermatological practice.</p> <p><strong>Keywords: </strong>Acne Vulgaris, Azithromycin, Doxycycline, Percent Reduction in GAGS Score</p> Tania Raees, Amanat Ali, Sameer Ahmed, Mehwish Tayyab, Attiya Munir, Sadia Lodhi Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:32:15 +0500 Sex Determination through Pelvic Bone Using Anteroposterior Radiographs <p><strong>Background: </strong>Forensic anthropology uses digital radiography to identify victims' gender, despite the population-specific nature of determining gender from bones, offering a cost-effective and straightforward method. The objective of the study was to evaluate the accuracy of the digital radiography technology for sex recognition of the selected participant group in Hyderabad, Sindh</p> <p><strong>Time and location:</strong> Cross-sectional study conducted by department of Forensic medicine Liaquat University of medical and Health Sciences Jamshoro and Isra University Hyderabad at the outpatient of Liaquat University hospital, Hyderabad from February to May 2023.</p> <p><strong>Methods:</strong> The study included male and female patients aged 18-50 years and was authorized by the Research and Ethics Committee LUMHS. Study participants were divided into two groups; male and female. &nbsp;Differences in pelvis bone fragments parameters like iliac height, inter-acetabular distance, pelvic inlet (breadth), acetabulum diameter, pubic length, Ischial length and ischio-pubic index on digital x-ray radiographs of both groups were examined and compared.&nbsp;</p> <p><strong>Results:</strong> A statistically significant difference (p&lt;0.05) in bony prominence parameters including inter-acetabular distance, acetabular diameter, breadth of the pelvic inlet, pubic length, ischial length and ischio-pubic index was observed between group A and group B. The study revealed that the accuracy in recognizing male individuals through ileum height (68.8%), inter-acetabular distance (64.7%), and the pelvic inlet breadth (61.0 %)</p> <p><strong>Conclusion:</strong></p> <p>The iliac height, inter-acetabular distance, pelvic inlet (breadth), inter-acetabular diameter, pubic length, Ischial length and ischio-pubic index on radiographs (x-rays) of pelvic bones are a reliable bone fragments parameters in sex determination with high precision.</p> Haya Afzal Memon, Jamshed Ul Qadir Memon, Naveed Ali Qadri, Salman Ahmed Farsi Kazi, Sadia Abdul Qayyum, Waheed Ali Nahyoon Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:33:24 +0500 Correlation of Low Back Pain with Pathological Changes of Lumbar Spinal Segment in Young Adults: A Cross-Sectional Study <p><strong>Abstract:</strong></p> <p><strong>Objectives:</strong> The objective of this study was to determine the association of low back pain in young adults with most likely involved spinal level by MRI findings of their lumbar spinal segment.</p> <p><strong>Methods</strong><strong>:</strong> The current study was conducted on 120 adults aged 25 to 40 years with low back pain. Lumbar spinal Magnetic Resonance Imaging (MRI) of these subjects was collected from Capital Diagnostic Center, Islamabad. Patients with any trauma, spinal surgery or fracture, active malignancy, metabolic bone disease, rheumatoid arthritis or pregnancy were excluded from the study. Disc and non-disc related parameters were evaluated from L1- L5 spinal levels. Further, gender based difference in magnetic resonance imaging findings was also assessed. <strong>Results: </strong>All the adults with low back pain showed some degree of disc degeneration on Pfirrmann grading system. The disc related MRI findings were more prevalent at lower lumbar spine levels L4-5 &amp; L5-S1. On gender comparison, no significant difference of spinal level was found in males and females. However, it was revealed that males mostly had asymmetrical disc bulge (p = 0.03) and females were having facet joint involvement (p = 0.005).&nbsp; <strong>Conclusion: </strong>In young adults with low back pain, lower lumbar spinal levels were involved. Disc degeneration was mostly found in lower lumbar spinal levels without any gender difference. However, other underlying factors of low back pain may differ in males and females.</p> <p><strong>Key words:</strong> Disc Degeneration, Intervertebral Disc, Lumbar spine, Low back pain, MRI, Young adults</p> Mamoona Shoukat , Shamaila Ejaz; Nausheen Raza; Fariha Ahmad ; Ammara Ghafoor , Nadia Ahmad Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:35:14 +0500 Radiological Evaluation of Various Complications of Dengue Hemorrhagic Fever <p><strong>Abstract:</strong></p> <p><strong>Objective:</strong> This retrospective study aimed to investigate the spectrum of imaging findings in patients with Dengue Hemorrhagic Fever (DHF) and explore the associated clinical parameters.</p> <p><strong>Methods:</strong> A total of 237 patients diagnosed with DHF confirmed via ELISA were included in the study. Imaging modalities including abdominal and chest ultrasound in every patient, HRCT (n=19), and CT brain scans (n=3)in patients having symptoms related to chest or brain were performed as part of the diagnostic workup. Demographic data, platelet counts, DHF grading, and imaging findings were recorded. Descriptive analysis was conducted using SPSS v26.</p> <p><strong>Results:</strong> The mean age of the patients was 34.50 ± 16.4, with a male preponderance (58.2%). Grade I DHF was observed in 69.2% of patients, followed by Grade II (23.6%) and Grade III (7.1%). Abdominal ultrasound revealed hepatomegaly (19.4%) and splenomegaly (19.6%). Thick-walled gall bladder (34.7%), pericholecystic fluid (7.1%), and gall bladder sludge (5.06%) were also noted. Ascites was present in 19% of cases. Chest ultrasound detected pleural effusion in 11.8% of patients, predominantly mild. HRCT scans showed pleural effusion (89.5%), ground glass opacities and consolidations (36.8%), alveolar shadowing (26.3%), and signs of non-cardiogenic edema (10.5%). CT brain scans revealed intracerebral bleed in 2 out of 3 patients with neurological manifestations.</p> <p><strong>Conclusion:</strong> This study provides insights into the spectrum of imaging findings in DHF. Abdominal ultrasound demonstrated hepatomegaly, splenomegaly, and gall bladder abnormalities, while chest ultrasound and HRCT revealed pleural effusion and pulmonary manifestations. CT brain scans identified intracerebral bleeding in some cases. These findings highlight the importance of imaging modalities in evaluating DHF complications and guiding appropriate management. Prospective studies with larger sample sizes are warranted to validate these findings and further enhance our understanding of imaging features in DHF.</p> Samina Akhtar, Shafat Khatoon, Mujahid Raz, Ayesha Isani Majeed, Syeda Zakia Shah, Ayesha Qazi, Ramish Riaz Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:36:27 +0500 Totally Extra Peritoneal Management of Inguinal Hernia Repair: Our Experience in a Public Sector Hospital <p><strong>Objective:</strong></p> <p>The study objective is to analyze the clinical effectiveness and efficiency of laparoscopic TEP in our set up and to determine its surgical outcomes regarding incidence of early and late post-operative complications.</p> <p>&nbsp;<strong>Materials and Methods: </strong>A retrospective descriptive study was conducted at Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University for 5 years and 6 months from January 2018 to June 2023. After approval from the ethical board, data was collected as a qualitative research study through focus group interviews. Adult patients aged between 20 to 70 years, selected by retrospective consecutive sampling who were presented in surgical OPD with unilateral, bilateral, or recurrent inguinal hernia, underwent laparoscopic TEP hernia repair. Patients were reviewed on 1<sup>st</sup> post-operative day, during 1<sup>st</sup> week, and at 6 months to 1 year post-surgery. Data was entered into a standard SPSS sheet version 26.</p> <p>&nbsp;<strong>Results:</strong> The primary outcomes were evaluated based on early postoperative complications including wound infection, seromas or hematoma, urinary retention and abscess formation or mesh infection, and late complications including recurrence and chronic pain. Clear advantages were observed for the laparoscopic TEP technique regarding early return to normal daily activities due to reduced postoperative complications.</p> <p><strong>Conclusions:</strong> The newer advanced concepts in hernia surgeries have proven to have good control over early complications, and postoperative pain, with minimal recurrence. Surgeons should acquire adequate experience and anatomical knowledge before performing this advanced inguinal repair surgery.</p> Hira Saleem, Aurangzeb Khan, Huma Sabir Khan, Nazan Hassan, Naveed Akhtar Malik, Muhammad Hanif Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 13:40:43 +0500 Prevalence of Ischemic Versus Hemorrhagic Stroke in Patients Taking Anti-Coagulation Therapy <p><strong>OBJECTIVE: </strong>To evaluate the prevalence of ischemic versus hemorrhagic stroke in patients taking anti-coagulation therapy.</p> <p><strong>PATIENTS AND METHODS: </strong>This cross-sectional prospective study was conducted at medicine Departments of Peoples University of Medical &amp; Health Sciences (PUMHS), for a period of 18 months from September 2021 to January 2023. All the patients taking anti-thrombotic therapy (warfarin, rivaroxaban, dabigatran, or apixaban) were included in this study and their baseline and clinical data were collected. Statistical package for the social sciences version (SPSS v. 26) was used for data entry and data analysis. Chi-square test/fisher’s exact and independent <em>t-</em>test test was used for determination of risk factors associated with hemorrhagic or ischemic strokes. A p value of &lt;0.05 was considered as statistically significant.</p> <p><strong>RESULTS:</strong> A total of 296 patients were enrolled for final analysis. The overall mean age, BMI, and duration of anticoagulation therapy was 62.14±8.44 years, 25.38±3.19 kg/m<sup>2</sup>, and 8.34±12.51 months. Among all study participants, 57.43% (n = 170) were taking NOACs while 42.56% (n = 126) were taking warfarin. The overall prevalence of stroke was 14.18% (n = 42) and among them hemorrhagic stroke was more common (57.14%, n = 27) than ischemic stroke (35.71%, n = 15). Patients taking NOACs were more likely to have hemorrhagic stroke as compared to ischemic stroke, 74.07% (n = 20/27) and 40.0% (n = 7), respectively, p value &lt;0.001.</p> <p><strong>CONCLUSION: </strong>The risk of stroke is quite high in patients receiving anti-thrombotic therapies. Hemorrhagic stroke is higher in patients receiving NOACs</p> <p><strong>KEYWORDS: </strong>Anti-thrombotic therapy, ischemic stroke, hemorrhagic stroke, Pakistan</p> Nasrullah Aamer, Muhammad Nouman , Shahid Hussain Memon , Zaheer Hussain Memon , Shazia Ahmed, Hira Saeed Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 22:04:05 +0500 Efficacy of Reticulocyte Hemoglobin Content and Immature Reticulocyte Fraction in Early Diagnosis of Latent Iron Deficiency in Blood Donors <p><strong>Abstract</strong></p> <p><strong>Objective: </strong>To assess the utilization of Reticulocyte Hemoglobin content and Immature Reticulocyte Fraction in detecting of Latent Iron deficiency in Blood donors.</p> <p><strong>Methodology: </strong>A prospective Cross sectional study was conducted at Pakistan Atomic Energy Commission Hospital in collaboration with Pakistan Institute of Medical sciences, Islamabad Pakistan. The study was conducted over a period of 6months from July 2023 to December 2023. A total of 191 donors were included in study and evaluated by using Mindray BC-6200 hematology analyzer. Serum Ferritin was correlated with Reticulocyte parameters. The agreement between Ferritin and Mindray BC-6200 was assessed by applying P- test.</p> <p><strong>Results: </strong>The mean age of donor group was 36.35 years with predominatly male donors (82%). About 65% were repeated donors. The sensitivity of <strong>RHE</strong> in correlation with serum ferritin was 87.5% and Specificity of this test was 93.7% and the sensitivity of <strong>IRF</strong> in correlation with serum ferritin was 68.7% and Specificity of this test was 86.75%.The P-value is significant in both parameters &lt;0.01.</p> <p><strong>Conclusion</strong>: RHE can be used as a first line test in detecting Latent Iron deficiency in donors and can replace serum Ferritin, IRF is less sensitive and specific as compared to RHE.</p> <p><strong>Key words</strong>: blood donors, latent iron deficiency, reticulocyte haemoglobin expression (RHE), immature reticulocyte fraction (IRF), serum ferritin</p> Farah Hanif, Noshina Noreen, Maha Tariq Kiani, Farwa Sijjeel, Amna Imtiaz, Sundas Ali Copyright (c) 2024 Journal of Islamabad Medical & Dental College Thu, 11 Jul 2024 00:00:00 +0500 Applanation Ultrasound versus Optical Biometry in the measurement of Axial Length in a Normal Eye <p>Objectives</p> <p>Accurate measurement of the axial length (AL) of the eye is important to make sure that the patient is emmetropic postoperatively. Multiple studies conducted around the globe compare AL using optical and ultrasound biometry. However, results are still inconclusive, as some studies stated that there is no difference in both modalities, whereas other studies considered optical biometry to be more superior. We aim to compare AL measurements using applanation ultrasound and optical biometry AL Scan, in Islamabad, in order to find out which modality is more superior.</p> <p>Methods</p> <p>This was a prospective cross-sectional study that was conducted at the department of Ophthalmology, PAF Hospital, E9 Islamabad. The study was conducted over a period of eight months, from April to November 2023. Participants were enrolled using non-probability, consecutive sampling. The axial length of each eye was measured by both optical and ultrasound biometer.</p> <p>Results</p> <p>There were 80 eyes of 40 participants including both males (77.5%) and females (22.5%) aged between 16-58 years. The axial length using the optical biometer showed a greater value ranging from 22.01 to 30.18mm with a mean value of 23.89 ± 1.31mm whereas the axial length measured using applanation ultrasound was 21.62 to 30.00mm with a mean of 23.53 ± 1.29mm. The mean difference between both was 0.36 ± 0.21mm which was statistically significant (P &lt;0.005).</p> <p>Conclusion</p> <p>There is a statistically significant difference between the mean readings of the AL measured by the IOL master and ultrasound biometer, so both the devices cannot be used interchangeably.</p> Arsh Zahoor, M. Azam Khan, Irfan Aslam Khattak, Ayisha Shakeel, Maria Saleem, Shaista Haider Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 22:17:56 +0500 Identification and Susceptibility Pattern of Various Candida Species Isolated from Different Clinical Samples in Rahim Yar Khan <p><strong>Objective: </strong>To isolate distinct Candida species from various clinical samples and examine their patterns of antifungal susceptibility.</p> <p><strong>Methodology</strong>: This prospective, cross-sectional study was carried out from January 2023 to December 2023 on 210 clinical samples positive for Candida, conducted in Pathology Laboratory of Sheikh Zayed Hospital, Rahim Yar Khan. The VITEK 2 compact system was utilized to identify the isolates and determine their antifungal susceptibility pattern.</p> <p><strong>Results:</strong> Candida isolates were analyzed, with Candida albicans being the most prevalent species at 64.8%. Antifungal sensitivity was highest for amphotericin, followed by caspofungin, fluconazole, flucytosine, and micafungin. Voriconazole was the least sensitive drug.</p> <p><strong>Conclusion:</strong> The study found that Candida albicans as most prevalent, followed by Candida Guilliermondii. Rare non-albicans included Candida Glabrata, Candida Krusei, Candida Tropicalis, Candida Sake and Candida Intermedia. Amphotericin has a strong antifungal sensitivity.</p> <p>&nbsp;</p> Muhammad Imran Shoukat, Kokab Jabeen, Muhammad Shahbaz Hussain, Muhammad Bilal Ghafoor, Muhammad Waseem Abbas Copyright (c) 2024 Journal of Islamabad Medical & Dental College Thu, 11 Jul 2024 00:00:00 +0500 The Evaluation of the protective roles of canagliflozin and zinc sulphate on body weight and hepatic histology in diabetic dyslipidemia <p>The significant increase in diabetes prevalence in the past decade has placed a considerable strain on the global healthcare system, especially in developing nations such as Pakistan. Although current therapy options effectively manage blood glucose levels, their accompanying adverse effects can hinder patient adherence. This study investigates the therapeutic properties of Canagliflozin, a SGLT-2 inhibitor, recognized for its tolerance and supplementary advantages on body weight and blood pressure, when used in combination with Zinc Sulphate. Zinc is acknowledged for its function in the regulation of hyperglycemia and dyslipidemia. The study involved the use of a type-2 diabetic rat model, induced by a high-fat diet and streptozotocin to examine the separate and combined impacts of Canagliflozin and Zinc Sulphate on the liver's histology. A total of forty-eight male Sprague-Dawley rats were separated into six groups and the treatments were delivered for eight weeks. Body weights were observed and histological evaluations of the liver were performed with the NASH-CRN scoring system. The findings exhibited a notable decrease in body weight among the diabetic-induced groups in comparison to the normal control. The combined utilization of Canagliflozin and Zinc Sulphate showed a heightened efficacy in managing diabetes related weight loss and steatosis of liver in the rat model having type-2 diabetes. This indicates a possible combined treatment strategy that should be further investigated to enhance the management of hepatic steatosis in individuals with diabetes. The study also proposes the potential for using a reduced dosage of Canagliflozin in combination with Zinc, so limiting adverse effects.</p> Ayela Eman Zia, Neelofar Yousaf, Muhammad Umar Talha, Wardah Siddiqui, Zoobia Irum, Waqar Ahmed Siddiqui Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 22:23:02 +0500 Myths regarding dental health and hygiene among the employees of a tertiary care hospital: single centred study <p><strong>Objective: </strong>To identify various myths and misconceptions regarding dental health and hygiene among the non-medical employees of a tertiary care hospital.</p> <p><strong>Methods:</strong> This cross-sectional descriptive study was conducted among 200 non-medical regular employees of a public tertiary care hospital of Islamabad. Simple random sampling was used to collect data using self-constructed mixed questionnaire. Doctors, nurses and paramedics were excluded from the study. Ethical approval from Institute of Review board was taken before commencing the study.</p> <p><strong>Results: </strong>Study population comprised of 200 respondents with majority (n=190) males, above the age of 40 years (n=118). Majority were married (n=185) and had education of Maters level (n=124). Dental problem was experienced by 94.5% participants. Majority (58.5%) used tooth brush to clean their tooth compared to 5% using miswak and 2.5% danadasa. More than half (54%) of participants believed that gap between upper incisors is symbol of good fortune whereas 41.5% believed that eye sight can be affected following dental extraction. One-fourth (24.5%) participants believed that wisdom tooth has some link with the wisdom and 78% responded that dental problems can be inherited. Majority (63.5%) believed that the procedure of scaling weakens the teeth.</p> <p><strong>Conclusion:</strong> Non-medical employees believe in outdated false stories and myths regarding dental health and hygiene. We recommend educational and counselling sessions for our population specially the ones working in a healthcare facility regarding dental health. There is strong need to discourage various myths prevailing in the community by endorsing health promotion.</p> <p><strong>Key words:</strong> Myths, brushing, extraction, pain, scaling</p> Mansoor Habib Fida Shah, Muhammad Mohsin Javaid, Umme Kulsoom Khattak, Farhan Javed, Basil Khalid Waheed, Anoosha Mujtaba Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 22:25:58 +0500 Systemic Lupus Erythematosus Presenting As Mixed Sensori-motor Axonal Polyneuropathy <p>Systemic Lupus Erythematosus (SLE) is an autoimmune disease that has multisystem manifestations. However, axonal polyneuropathy is rare in SLE. We report the case of a 41-years old lady who presented with gradual onset, progressively worsening bilateral lower limb weakness for 1 month along with tingling, prickling and burning sensation. There was history of dry eyes, oral ulcers, dry mouth, dental caries, lethargy and fatigue. On examination, poor oral hygiene, coarse dry tongue, oral ulcers, dental caries and conjunctival pallor were noted. Neurological examination of lower limbs revealed flaccid LMNL paralysis with paresthesia of both feet extending up to the mid-shin level. She had normochromic normocytic anemia with hemoglobin 10.8 g/dl and raised ESR 40 mm/hour. NCS revealed mixed sensori-motor axonal polyneuropathy. ANA, anti-DsDNA (138 IU/ml), Anti-Sm (&gt;200 U/ml) and anti-Ro/SSA antibodies (146 U/ml) were positive with low serum C3 (29.3 mg/dl) and low serum C4 (07 mg/dl). She was diagnosed as SLE and started on plasmapheresis, steroids, hydroxycholoroquine and azathioprine with marked improvement at follow-up.</p> Mutahra Khaliq, Nauman Ismat Butt, Muhammad Sohail Ajmal Ghoauri, Fahad Qaisar, Tayyaba Hashmi, Sabir Ali Copyright (c) 2024 Journal of Islamabad Medical & Dental College Thu, 11 Jul 2024 11:37:09 +0500 Gallbladder Perforation as a Complication of Enteric Fever: An Intriguing Case of Acute Abdomen <p>If not identified and treated right once, gallbladder perforation—a uncommon but dangerous<br>consequence of acute cholecystitis—can result in significant morbidity and mortality. We describe the<br>example of a female patient, having 19 years of age, who had a history of constipation. The patient was diagnosed with typhoid fever and underwent imaging studies that revealed gallbladder wall perforation along its postero-inferior aspect with adjacent contained right subhepatic collection. The patient underwent diagnostic laparoscopy and subtotal cholecystectomy. This instance emphasizes how crucial it is to rule out gallbladder perforation while diagnosing acute abdomen in typhoid fever patients. Prompt surgical intervention and early diagnosis can avert major problems and enhance results.</p> Aleena Tahir, Mehwish Tabassum, Wajeeha Anum, Saba Khilji, Manal Niazi, Dr Mashaal Shabrani Copyright (c) 2024 Journal of Islamabad Medical & Dental College Wed, 17 Jul 2024 22:29:09 +0500