Journal of Islamabad Medical & Dental College

Climate Change and Respiratory Infections: Pakistan’s Public Health Crisis

2025-05-05T21:11:27+05:00

Evaluation of Distal Humerus Intercondylar Fractures Using Mayo Elbow Performance Score Following Elbow Reconstruction with Two Plates in Inverted Y Configuration

2025-05-03T18:26:32+05:00

Objective: Distal humerus fractures are common in elbow injuries. The objective of this study was to evaluate the clinical result following elbow reconstruction for distal humeral intercondylar fractures utilizing two plates applied in an inverted Y configuration using the Mayo Elbow Performance Score (MEPS)

Methodology: This descriptive case series was conducted from June 2019 to July 2023 in the department of Orthopedics at Akbar Medical Center, Peshawar and Maqsood Medical Center Peshawar. Patients were chosen using a non-probability, sequential sampling procedure. The study included all patients between the age of 20 and 50 years with distal humeral intercondylar fractures, regardless of gender, and whose fractures lasted less than a week. Data was analyzed using SPSS version 20.

Results: Out of 88 patients 53 (60.23%) were males and 35 (39.22%) females. The mean fracture duration was 4.19 ± 1.44 days. The clinical prognosis was excellent in 27 cases (30.68%), good in 37 cases (42.05%), fair in 16 cases (18.18%), and bad in 8 cases (9.09%) following elbow reconstruction utilizing two plates in an inverted Y configuration for distal humeral intercondylar fracture based on the MEPS.

Conclusion: A considerable percentage of patients had a satisfactory clinical outcome following elbow reconstruction with two plates arranged in an inverted Y configuration for distal humeral intercondylar fractures

Keywords: Elbow, Fracture, Humerus, Performance Score, Supracondylar

Seroprevalence of Rubella Antibodies among Women in Rawalpindi and Islamabad

2025-05-05T21:17:30+05:00

Objective: This study aimed to determine the seroprevalence of Rubella immunoglobulin G (IgG) antibodies and associated risk factors among women in the twin cities of Pakistan.

Methodology: This retrospective study involved the collection of 838 blood samples from women at Medicare Hospital Rawalpindi, Holy Family Hospital (HFH) Rawalpindi, and Pakistan Institute of Medical Sciences (PIMS) Islamabad and was conducted from May 2020 to April 2021. Rubella IgG antibodies were detected in the samples using the Chemiluminescent Microparticle Immunoassay (CMIA) method, and statistical analysis was performed using SPSS version 24.

Results: Of the 838 blood samples tested for Rubella IgG antibodies, seroreactivity and seropositivity was highest in the age group of 21-31 years. The prevalence of positive cases reached 96.82%, peaking in November, while negative cases were at 15.38%, peaking in May. These results indicate that many women possess antibodies against the Rubella virus.

Conclusion: The frequency of seropositivity and seroreactivity was elevated during winter. Socioeconomic factors may have contributed to the high prevalence of Rubella cases. Serosurveys should be conducted nationwide. Pakistan should include the MMR vaccine in its national Expanded Program of Immunization (EPI) as it is both effective and affordable.

Keywords: Chemiluminescent Microparticle Immunoassay (CMIA), Extended Program of Immunization (EPI), Measles Mumps Rubella (MMR), Prevalence, Rubella.

Effects of Oral Retinoids on Ocular Surface, Assessment through Ocular Surface Disease Index (OSDI) Questionnaire

2025-05-03T18:32:34+05:00

Objective: Oral retinoids commonly prescribed for acne vulgaris have many side effects. The objective of this study was to determine effect of oral retinoids on ocular surface.

Methodology: This quasi-experimental study, conducted at department of ophthalmology and dermatology HBS Medical & Dental College from August 2023 to July 2024, a total of 109 acne patients who were prescribed oral retinoids were included. Tear film break up time (TBUT) and ocular surface disease index (OSDI) scores were calculated at baseline and three months after therapy to determine effect of oral retinoids on ocular surface and presence of dry eyes. Data were analyzed using SPSS 22.

Results: Mean age of patients was 28.40 ± 9.81 years. There were 23 (21.10%) males and 86 (78.90%) females. Mean baseline and three months follow up TBUT were 24.13 ± 6.31 and 10.33 ± 6.04 seconds, respectively (p < 0.001). Mean baseline and three months follow up OSDI scores were 3.03 ± 2.13 and 22.80 ± 10.32, respectively (p < 0.001). Frequency of dry eyes in acne patients treated with oral retinoids after three months of therapy was 82 (75.23%). The most common ocular complaint of the patients was gritty sensation in the eyes 33 (30.28%) followed by itching in the eyes 22 (20.18%) and burning sensation in the eyes 17 (15.61%).

Conclusion: Dry eyes occurred in 75.23% users of oral retinoids showing a major effect of these agents on ocular surface.

Key words: Acne vulgaris, Dry eye, Retinoids.

Long-term Outcomes and Recurrence Rates in Mahaim Tachycardia Post-Ablation

2025-05-03T18:39:02+05:00

Objective: To evaluate the long-term outcomes and recurrence rates of Mahaim tachycardia post-radiofrequency catheter ablation in patients treated at the Cardiology Department of Hayatabad Medical Complex, Peshawar.

Methodology: This retrospective study was conducted involving 170 patients with Mahaim tachycardia who underwent radiofrequency catheter ablation between June 2017 and July 2024. Patient demographics, procedural details, complications, and long-term follow-up data were analyzed. The primary outcome was the recurrence rate of Mahaim tachycardia, while secondary outcomes included procedural success, complications, and overall survival.

Results: The mean age of the patient population was 44.1 years, with 55.3% of patients being male. Hypertension and diabetes were present in 22.9% and 21.8% of patients, respectively. The mean fluoroscopy and ablation times were 19.8 and 9.9 minutes, respectively. Procedural success was achieved in 78.2% of patients, with a complication rate of 12.9%. Over a median follow-up of 40.6 months, the recurrence rate was 21.8%, and the survival rate was 79.4%. The Kaplan-Meier survival analysis showed a high survival probability, with 95.8% at 12 months and 88.6% at 36 months.

Conclusion: Radiofrequency catheter ablation is a very successful and safe therapy for Mahaim tachycardia, offering substantial long-term advantages while maintaining tolerable rates of complications. Despite a recurrence rate of 21.8%, the procedure offers favorable long-term outcomes, reinforcing its use as a preferred treatment modality. Future studies should focus on advanced techniques to further improve success and reduce recurrence rates.

Keywords: Catheter ablation, Long-term outcomes, Mahaim tachycardia, Recurrence rates, Survival analysis

Effects of Dietary Counseling Strategies to Improve Nutritional Status of Hemodialysis Patients: A Quasi-Experimental Study

2025-05-05T21:43:00+05:00

Objective: Malnutrition is a major concern for CKD patients. Patients on dialysis with severe malnutrition have a higher risk of mortality. The objective of this study was to explore the impact of two different nutritional strategies for improving nutritional status and dietary knowledge of hemodialysis patients.

Methodology: This quasi-experimental study was conducted at Shifa International Hospital Islamabad from Jan 2022 to July 2022. A total of 54 participants were enrolled and divided into two groups and received counseling for 2 months fortnightly. Measurement was taken on three occasions, namely, at baseline, after 2 months, and after 4 months.

Results: Moreover, this study has established there was an improvement in nutritional knowledge post-intervention, with 67% of Group A and 66% of Group B showing a good understanding of dietary restrictions. There was a rise in albumin and reduction in the levels of potassium in the two groups after counseling.

Conclusion: Dietary counseling therefore enhanced nutritional knowledge and improved nutritional status in hemodialysis patients. These findings underscore the importance of nutrition education in the management of CKD and have implications for the development of tailored nutrition counseling programs.

Keywords: Hemodialysis, Nutritional Knowledge, Restrictions

Clinical Spectrum of Black Stone Poisoning in Paediatrics; An Experience in a Tertiary Care Hospital

2025-05-03T18:49:57+05:00

Objective: This study was designed to document the clinical presentation, laboratory findings, complications, and outcomes of black stone poisoning in pediatric patients.

Methodology: This retrospective study was conducted on 58 children under 15 years of age, with moderate to severe black stone poisoning, having moderate to severe symptoms, requiring ICU care, and thus admitted in Pediatric Intensive Care Unit of Children’s Hospital Lahore. The study duration was between May 2019 to September 2023. Data included demographics, clinical features, lab results, and treatment strategies.

Results: Among total of 58 children, 38 % were female and 62 % were male, with most frequent age 1 to 5 years. Symptoms appeared within 1 to 2 hours of ingestion, with most patients seeking care within 3 to 6 hours. Common symptoms included facial swelling (100%), neck swelling (96.6%) and difficulty in breathing (79.3%). Complications included angioedema (97%), cola-colored urine (100%), metabolic acidosis (86%), ARDS (5.2%), hepatitis (10.3%), and shock (62.15%). The mortality rate was 7%.

Conclusion: Black stone poisoning in children is severe, requiring supportive care, early airway intervention, and renal replacement therapy. Public education on the dangers of Paraphenylenediamine and improved management strategies are essential.

Keywords: Acute Kidney Injury, Angiodema, Black Stone, Paraphenylenediamine, Pediatric Poisoning, Respiratory Distress

The Protective Effect of Different Doses of Zinc Sulfate and Silymarin Combination against Anti-Tuberculosis Drug Induced Toxicity

2025-05-03T18:52:32+05:00

Objective: To induce hepatotoxicity with Rifampin and INH in albino rats, to estimate histoprotective effect of combination of ZnSO4 and Silymarin.

Methodology: The 'Animal Experimental Study' was carried out of 14 days’ duration (starting from day 0-13). A sample size of 28 healthy albino wistar rats were taken and divided into four equal groups (A, B, C and D). Group A was normal control and was given water once a day orally for 14 days. Group B was toxic control and was given INH+ RIF combination (50 and 100 mg/kg/day respectively). Liver protection of combination of ZnSO4 + Silymarin was evaluated at different doses against combination of Isoniazid and Rifampicin induced damage in group C and D. INH+ RIF combination (50 and 100 mg/kg/day respectively) was used to induce liver toxicity in Group B, C and D. Combination effect of regenerative agents (Silymarin + ZnSO4 (100 + 3.5mg /kg/day respectively) and (200 + 7mg /kg/day respectively) was analyzed in Group C + D respectively by measuring liver function profile (ALT, ALK PO4, AST, Total bilirubin).

Results: There was significant elevation of all parameters in Group B, showing liver damage. The level of liver enzymes and total bilirubin was significantly decreased on 13^th day (p-value ***< 0.0001) in Group C and D. Comparing Group C, Group D values of only ALT parameter showed significant difference while rest of the parameters did not show any significant difference. A mathematical decrease in AST, ALK PO4, and total bilirubin is evident between Group C and Group D.

Conclusion: The present study has shown the hepatoprotective effect of ZnSO4, SM and their combination in half and full doses as evidenced by improvement in liver function profile (ALT, ALK PO4, AST, Total bilirubin).

Keywords: Albion rats, Hepato-protection, Isoniazid (INH), Liver profile, Liver toxicity Rifampin (RIF), Zinc sulfate

The Impact of Syrinx on Clinical Outcomes in Arnold-Chiari Malformation: A Retrospective Study

2025-05-03T18:54:14+05:00

Objective: Arnold-Chiari malformation is congenital or acquired anomaly of the hindbrain that leads to crowding of the cerebellum and brainstem in the posterior cranial fossa. There is an interplay between syringomyelia and Arnold-Chiari malformation. The objective of this study was to analyse the incidence trends, morphological patterns, and clinical outcomes of Arnold-Chiari malformation with and without syringomyelia, focusing on patients treated at Hayatabad Medical Complex, Peshawar.

Methodology: This retrospective study was conducted on 150 patients from January 2023 to December 2023. Patients were divided into two groups: 75 with syringomyelia and 75 without syringomyelia. Key variables included tonsillar herniation, syrinx length, and surgical outcomes. Statistical analyses were done using t-test and chi-square test to assess relationship between variables, with a significance threshold of p<0.05.

Results: Patients with syringomyelia exhibited significantly higher tonsillar herniation (mean: 10.8 ± 2.3 mm) compared to those without syringomyelia (mean: 7.4 ± 1.9 mm) with p<0.001. Syrinx presence was significantly associated with surgical outcomes (p<0.05). Among patients with syrinx, those with improved surgical outcomes had a mean syrinx length of 18.6 ± 7.5 mm, while stable or unimproved cases exhibited larger syrinx lengths. A significant difference in surgical outcomes was noted between the groups, emphasizing the clinical impact of syrinx presence.

Conclusion: A strong association was found between syrinx presence and clinical outcomes in Arnold-Chiari malformation. Early diagnosis and timely intervention are critical for improved patient outcomes.

Keywords: Arnold-Chiari malformation, Surgical outcomes, Syringomyelia, Tonsillar herniation

Primary Percutaneous Coronary Intervention and Left Ventricular Function Recovery in Acute Myocardial Infarction

2025-05-03T18:56:25+05:00

Keywords: Arnold-Chiari malformation, Surgical outcomes, Syringomyelia, Tonsillar herniation

Frequency of High Total Cholesterol to HDL Ratio with Acute Myocardial Infarction

2025-05-03T18:57:55+05:00

Objective: To evaluate the frequency of high total cholesterol/HDL ratio in patients with acute coronary syndrome who present with acute myocardial infarction.

Methodology: This Cross Sectional Study was conducted at POF Hospital wah cantt and a total of 100 patients who fulfilled the inclusion criteria and presented with acute myocardial infarction to the POF Hospital in Medicine department Wah cantt participated via non probability consecutive sampling. All patients underwent electrocardiography and the high sensitivity Troponin I levels were checked for confirmation of acute myocardial infarction. Once the diagnosis was confirmed, all patients underwent testing for serum total cholesterol, serum HDL levels and total cholesterol levels. The data were collected in a specially designed proforma.

Results: A total of 100 patients were included in our study and their mean age was 46.89±9.04 years. Forty-five patients out of total had high total cholesterol/HDL ratio. The stratification further revealed that high total cholesterol/HDL was more prevalent in females and those suffering from STEMI as compared to NSTEMI.

Conclusion: High total cholesterol/HDL ratio is common among patients presenting with acute MI and hence its utilization can be done as an important diagnostic tool for screening dyslipidemia, a major risk factor for atherosclerosis.

Keywords: Cholesterol, HDL, Lipoprotein, Myocardial infarction

Clinical Significance of Microvascular Obstruction Following Primary Percutaneous Coronary Intervention

2025-05-03T18:59:41+05:00

Objective: To evaluate the clinical significance of Microvascular obstruction following primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) and to assess its impact on myocardial recovery and long-term outcomes.

Methodology: This retrospective study was conducted at Department of Cardiology, Hayatabad Medical Complex, Peshawar, from September 2023 to September 2024. A total of 250 STEMI patients undergoing primary PCI were enrolled. Data on demographics, clinical presentation, angiographic characteristics, and procedural details were collected. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging (CMR) 48 hours post-PCI. Statistical analysis included chi-square tests, t-tests, and logistic regression models.

Results: Among 250 patients, 150 (60%) were males and 100 (40%) were females, with a median age of 58 years (range 25-85). MVO was detected in 35% of patients. Myocardial Blush Grade (MBG) was Grade 3 in 30%, Grade 2 in 50%, and Grade 1 in 20% of patients. Infarct size ≤30% was seen in 50% of patients, 30-50% in 40%, and >50% in 10%. Adjunctive therapies significantly reduced MVO incidence (p=0.02). Logistic regression identified age ≥60 (OR=2.1, p=0.015), infarct size >30% (OR=3.2, p=0.008), and MBG 1 (OR=3.4, p=0.003) as significant predictors of MVO.

Conclusion: MVO significantly impacts myocardial recovery post-PCI, increasing infarct size and reducing left ventricular function. Early detection and adjunctive therapies improve outcome. Future research should explore long-term prognostic implications.

Keywords: Microvascular obstruction, primary PCI, STEMI, myocardial blush grade, cardiac MRI.

Prevalence of Atrial Fibrillation among Individuals with Obstructive Sleep Apnea and Impact of Sleep Apnea on Incidence and Outcomes of Atrial Fibrillation: Systematic Review

2025-05-03T19:06:51+05:00

Objective: This systematic review aims to evaluate the prevalence of AF in individuals with OSA and examine the impact of OSA on AF occurrence and outcomes.

Methodology: A systematic literature search was conducted using PubMed, Web of Science, and Google Scholar, following PRISMA 2020 guidelines and The Cochrane Handbook. Studies were selected based on predefined inclusion and exclusion criteria, focusing on human observational studies examining the relationship between OSA and AF. The risk of bias was assessed independently by two reviewers, with a third reviewer resolving discrepancies.

Results: Out of 200 initially identified studies, 37 met the relevance criteria, and 8 were ultimately included in the final analysis. The findings revealed a significant association between OSA and AF prevalence, with AF rates ranging from 7.2% to 49% in OSA patients, depending on the study population and OSA severity. Studies also indicated that OSA might contribute to AF development through mechanisms such as hypoxia, inflammation, and autonomic dysfunction. Furthermore, OSA was linked to a higher risk of AF recurrence post-treatment and increased hospitalization rates.

Conclusions: The evidence suggests that OSA is an independent risk factor for AF, contributing to its development, recurrence, and worse clinical outcomes. Early identification and management of OSA, including continuous positive airway pressure (CPAP) therapy, may help mitigate AF-related risks. However, further large-scale prospective studies are needed to establish causal relationships and optimize treatment strategies.

Key words: Atrial Fibrillation, Arrhythmia, Breathing, Cardiovascular, Obstructive Sleep Apnea, Sleep-disordered,

Rare Case of Giant Bilateral Renal Angiomyolipoma

2025-05-03T19:08:31+05:00

Renal hamartoma, commonly known as renal angiomyolipoma (AML), is an uncommon solid tumor that does not exhibit malignant traits. Renal AML is inherited via an autosomal dominant pattern. We present a case of 25 years old female who had bilateral renal giant AML’s. Bleeding is a major risk if they are big enough and this requires urgent embolization if needed. Conservative treatment is not recommended in such cases and mostly nephrectomy (partial or total) is treatment of choice considering high bleeding risk in such giant AML’s. Giant AML’s with size more than 20 cm are rarely reported till date in Pakistan.

Key-words: Angiomyolipoma, Renal AML, Tuberous Sclerosis, Radiology, Pakistan.

Bilateral Four-Rooted Maxillary Second Molars: A Case Report with Cone-Beam Computed Tomography Analysis

2025-05-03T19:10:02+05:00

Deeper understanding of root canal anatomy is fundamental for successful endodontic treatment. Two palatal roots in maxillary second molars, although uncommon, can be encountered in clinical practice. Advanced diagnostic tools like cone beam computed tomography (CBCT) plays a pivotal role in identification and management of this type of complex anatomy. This case report presents endodontic management of maxillary second molar with two palatal canals using CBCT and magnification.
Keywords: Dental Pulp Cavity, Maxillary Molar, Palatal Canals, Tooth Root, 3D imaging

Spontaneous Hepatic Hemorrhage Following Whipple’s Procedure: A Report of Two Cases.

2025-05-03T19:12:14+05:00

Whipple procedure, also known as pancreaticoduodenectomy, is a complex surgical operation performed for various pancreatic and periampullary pathologies. While the procedure has undergone significant refinements, it remains associated with significant morbidity and mortality.Spontaneous hepatic hemorrhage/ rupture is a rare but potentially life-threatening complication that has been reported in the literature.

We present two rare cases of spontaneous hepatic rupture following Whipple procedure. A 79-year-old male underwent Whipple procedure for periampullary carcinoma. On postoperative day 19, he suddenly developed epigastric pain, nausea and vomiting. Imaging revealed a spontaneous hepatic rupture. Similarly a 67 years old female for suspected periampullary underwent Whipple’s procedure. On postoperative day 14, she presented to emergency department with complaint of right hypochondrial pain, continuous in nature and severe in intensity and was also diagnosed with spontaneous hepatic rupture. Surprisingly, the early postoperative CT of both patients did not reveal any evidence of hepatic injury or hematoma and there was no history of trauma. Both the patients were managed conservatively and were vitally stable on discharge and follow up.

Keywords: Preiampullary Carcinoma, Spontaneous Hepatic Rupture, Subcapsular Hematoma, Whipple’s Procedure.