Journal of Bahria University Medical and Dental College

The Relationship between Aesthetics and Self-Esteem

Sannia Perwaiz Iqbal — 2024-04-25

The aesthetic industry encompasses many products and services dedicated to beauty, cosmetics, and personal appearance. As the demand for minimally invasive cosmetic procedures, such as Botox, fillers, peels, and lasers, rapidly increases, Aesthetic Medicine is gaining recognition as a separate specialty within Pakistan and globally.1 The prevalence of skin disorders worldwide has increased, leading to many patients seeking skin therapy that utilizes light, ultrasound, and laser-based solutions

Abdominal Pregnancy at Term a Rare Case Report from Jinnah Post Graduate Medical Centre Karachi, Pakistan

Farah Hassan Khan — 2024-04-25

Abdominal pregnancy is an extreme rare situation and the quoted incidence is 1.4% of all ectopic pregnancies. The diagnosis and management is challenging and requires multidisciplinary input, if not managed in good hands can lead to serious consequences leading to maternal and neonatal mortality. We present a case of 32 years old abdominal pregnancy which presented to us at 31 weeks pregnancy with severe vomiting and mild abdominal pain. The site of pregnancy went unrecognized till 35 weeks pregnancy until she was operated in suspection of placenta Previa. The patient recovered smoothly after surgery and went home in stable condition. Abdominal pregnancy is challenging to diagnose and manage. It requires not only clinical expertise but also strong radiological guidance to advice management. A rare presentation of persistent nausea and vomiting due to compression of underlying intestines may lead to consider the diagnosis of abdominal pregnancy in later gestation

Trachea-o-esophageal Fistula following Button Battery Ingestion, Presenting One Month after the Event- A Rare Presentation

Rutaba Tariq — 2024-04-25

Trachea-o-oesophageal fistula (TEF) formation after battery ingestion is a fatal complication with severe consequences. Urgent removal of battery is necessary within few hours. Persistent oral intolerance, respiratory difficulty or clinical deterioration after removal of battery should raise a suspicion of oesophageal rupture/leak or TEF. We present case of a 3-year-old who ingested button battery, which was diagnosed immediately but due to delay in referral to the concerned specialty the battery was removed on the 2nd day followed by large oesophageal rupture. However initially the child improved after the repair, the development of TEF was presented much later which was a rare presentation. A large fistula which was not closed by conservative approach was successfully closed surgically. The child was recovered after the repair, and the confirmation of adequate repair by esophagoscopy was done. Button battery ingestion (BBI) should be considered a surgical emergency, requiring urgent removal and vigilant monitoring.

Unusual Presentation of Extra Pulmonary Tuberculosis in Middle aged Female: A Unique Case Report

Madeeha Shahid — 2024-04-25

Pulmonary tuberculosis (TB) is a leading cause of morbidity and mortality among all infectious diseases especially in Pakistan where TB is endemic while extra pulmonary TB often encountered. However, primary salivary gland specifically unilateral parotid gland involvement is exceedingly uncommon. We present a case of 38-year old woman with six months duration of right parotid lump. The lump was firm and non-tender with bilateral cervical lymphadenopathy. No other constitutional symptoms of TB in our patient except weight loss. We presumed it a parotid neoplasm but after workup it reveals parotid TB which responds to first line anti-tuberculous therapy (ATT). So, careful exclusion of parotid neoplasm prevented unwanted surgery in our patient and patient recovered without any residual disease. We proposed that the differential diagnosis of a parotid gland swelling should include the infrequent possibility of parotid gland tuberculosis.

Effect of Maternal Literacy on Immunization Completeness in Children Under 2 Years of Age – Karachi, Pakistan

Usman Saeed — 2024-04-25

Objective: To assess the association of different levels of education with complete immunization in children under 2 years of age.

Study Design and Setting: The study was cross sectional analytical and was carried by online survey of mothers living in Karachi. The study was conducted through a period of 4 months from May 2021 to August 2021.

Methodology: The sample size of 270 mothers was calculated using a 95% Confidence Level and using the Epi Info Application. The data was collected using a closed-ended online questionnaire via Google Forms. Due to the COVID – 19 pandemic, the questionnaires had to be distributed online. The data was analyzed using SPSS V23. The statistical test used was Fisher Exact Test to determine whether or not the relationship between maternal education and immunization rate was significant. .

Results: A total of 270 responses were recorded from mothers of various socio-economic statuses. It was observed that as the level of education increased from no formal education to a higher level of education, the percentage of children completely vaccinated increased from 76.9% to 92.7%. Upon statistical testing using Fisher Exact Test, the p-value was found to be 0.017 which is less than the alpha value of 0.05 showing that the relationship between the 2 variables is significant.

Conclusion: The study had shown that the children of mothers with a higher level of education were associated with a higher likelihood of being fully vaccinated than children of mothers with a lower level of education.

Comparison of SOFA and qSOFA Scores in Predicting Infection and Mortality in HDU and ICU Patients at a Tertiary Care Center

Sarah Khan — 2024-04-25

Objective: The objective of this study is to compare the sensitivity and specificity of the SOFA (Sequential Organ Failure Assessment) and qSOFA (Quick Sequential Organ Failure Assessment) in predicting infection and mortality in ICU (intensive care unit) and HDU (high dependency unit) patients admitted at a tertiary care center of excellence.

Study Design and Setting: Prospective observational non-interventional study. Anesthesia Department of Combined Military Hospital, Rawalpindi from Jan 2023-Jun 2023.

Methodology: Patients in both ICU (n=220) and HDU (n=220) setups admitted with a suspicion of sepsis were evaluated for onset of sepsis and mortality. Primary variables studied were the sensitivity and specificity for both scores for predicting infection and mortality in the ICU and HDU. Positive predictive value for both scores were calculated as secondary variable. Results: While assessing the primary variables, the sensitivity of SOFA for predicting infection in the ICU was 25.6% with a specificity of 85.3% versus a sensitivity of 76.8% and specificity of 59.0% for qSOFA. In the HDU, It showed sensitivity and specificity with PPV for SOFA being 64.7%, 95.1% and 64.7% versus 79.3%, 85.3% and 46.9% for qSOFA respectively.

While assessing for mortality, SOFA values in the ICU for sensitivity, specificity and PPV were 81.8%, 93.5% and 69.2% versus 88.8%, 58.3% and 90.9% for qSOFA respectively.

Conclusion: We conclude that qSOFA to be good predictor of mortality in the HDU and SOFA with good specificity for infection and mortality in the ICU

Experiences and Challenges faced by Orthodontists while Treating Epileptic Orthodontic Patients: A Qualitative Study

Sadia Naureen — 2024-04-25

Objective: This study aimed to explore the experiences and challenges faced by orthodontists in treating patients with epilepsy.

Study Design and Setting: This was a qualitative study conducted in the Orthodontic Department at Rawal Institute of Health Sciences, Islamabad.

Methodology: The study period was almost three months from 4th August 2023 to 30th October 2023. Purposive sampling was done and 11 orthodontists with a minimum of 10 years of clinical experience, who had treated at least one patient with epilepsy in the past 5 years, were selected for an interview. Interviews were conducted in person or virtually, and a topic guide was used. Verbatim transcripts were analyzed using framework methodology, with triangulation techniques to minimize bias.

Results: All orthodontists were aware of their patients' epilepsy diagnoses, but none knew the specific type. The implementation of the orthodontic treatment strategy was less than optimal. Ceramic brackets were not used in any case. Limited single-arch treatments were preferred by orthodontists in some cases. Seizure and medicine intake history were not taken at every appointment. The emergency anti-epileptic drug was not available in the dental office. The primary challenges reported were patient motivation, poor oral hygiene, gingival hyperplasia, and bracket breakage.

Conclusion: Orthodontic treatment of epileptic patients is highly challenging. Modified treatment strategies should be adopted to ensure optimal care for such patients.

Red Cell Parameters in Beta Thalassemia Trait; Comparison between Iron Deficient and Non-Deficient Carriers

Nazish Tahir — 2024-04-25

Objective: To compare hematological parameters in iron-deficient and non-deficient carriers of beta thalassemia trait. Study Design And Setting: Comparative cross-sectional study. This study was conducted at the Department of Hematology at PNS SHIFA Hospital, Karachi for six months (February 2023 to July 2023).

Methodology: This comparative cross-sectional study included a total of 304 cases with beta thalassemia trait and was divided into two groups; the Iron-deficient (ID+) and iron-deficient (ID-) group. The study focused on red cell parameters i.e, Hemoglobin (Hb), TRBC, MCV, MCH and RDW. Haemoglobin Electrophoresis results of both groups were also compared. Descriptive statistics were expressed as mean ± SD and the Chi-square test was assigned. A p-value = 0.05 was considered statistically significant.

Results: Out of the total 304 subjects, 76 (25.0%) had iron deficiency, and 228 (75.0) had sufficient iron stores. Mean age of patients was 18 (Range: 3 – 35) years. HbA levels were similar in both the groups with p-value > 0.05. While all other parameters compared showed marked differences among the two groups and were found to be statistically significant. Hb, TRBC, MCV MCH showed lower values in the ID+ group while RDW was lower in the ID- group.

Conclusion: Red Cell parameters and HBA2 levels in beta thalassemia trait vary significantly among the iron deficient vs non-deficient group. Hence due consideration is needed in screening of beta thalassemia trait in patients with iron deficiency anemia.

Gingival Health Status of Abutment Teeth in Acrylic Removable Partial Denture

Sajjad Hussain — 2024-04-25

Objective: To determine the change in gingival health status of removable partial dentures abutment tooth/teeth after 1month post-insertion

Study design and setting : Quasi-Experimental Study, Department of Prosthodontics, Armed Forces Institute of Dentistry Rawalpindi, from October 2021 to April 2022

Methodology: The patients underwent a thorough history and clinical examination after formal consent. Prior to recording the impression for provision of acrylic removable partial denture, the baseline scores for gingival index, plaque index and abutment teeth’s periodontal pocket depth were noted. After 30-days of placement of the acrylic removable partial denture, the patient was recalled for follow up and reassessment of score.

Results: Out of 90, there were 64 (71.1%) males and 26 (28.8%) females with average age of 31.1±5.8 years. The average value of plaque index at baseline was observed to be 0.39±0.03, while mean value of gingival index at baseline was found to be 0.19±0.01. At 30 days follow up, the mean value of plaque index significantly increased to 1.21±0.07 (p=0.001). Similarly, the mean value of gingival index after 30 days insertion of the acrylic removable partial denture significantly increased to 1.50±0.09 (p=0.001). No significant difference was observed between 30 days post-insertion indices between smokers and non-smokers, males and females, and <30 and >30 years age groups.

Conclusion: It is concluded that the gingival health of abutment teeth significantly gets affected due to removable partial denture. The plague and gingival index significantly worsen due to use of removable partial denture within a month’s time.

Prevalence of Cognitive Impairment and Risk Factors among Elderly in Rawalpindi, Pakistan: A cross-Sectional study

Hafsah Gul Khattak — 2024-04-25

Objective: The study aimed to find out the prevalence of cognitive impairment and risk factors among elderly. Study Design and setting: Descriptive cross-sectional study was conducted in elderly population of Rawalpindi. Methodology: The study was conducted from October 2020 to February 2021. After getting approval from the ethical committee, data was collected using a semi structured questionnaire. The sample of 446 participants, raised through nonprobability convenient sampling technique. Participants aged above 60 years, both genders were included however individuals who had severe head injury, depression, severe hearing and visual impairment, delirium and not willing to participate were excluded from study. Informed consent was obtained from all participants. Data was analyzed by using SPSS v24.

Results: Overall mean age of sample was 69±4.6 years. Overall prevalence of cognitive impairment was 35.4 %. Among them 134 (30%) had mild cognitive impairment and 24 (5.4%) had dementia. The prevalence of cognitive impairment increases with age being higher (64.2%) at 70 years and above than at 60-69 years of age. Females 82 (61%) had high prevalence of MCI than males 52 (39%). Age, gender, hypertension, diabetes, and physical activity were significantly associated with cognitive impairment. Data was analyzed using SPSS version 24. Descriptive statistics were applied. Pearson chi square of independence was used to find the association of various factors. The p value less than 0.05 was considered significant.

Conclusion: Cognitive impairment increases with the increasing age and was more prevalent among females. Hypertension, Diabetes, physical activity were modifiable risk factors for cognitive impairment

Current Status of Neurorehabilitation Services in the OIC Countries: Results of an International Online Survey

Zuhaib Hassan — 2024-04-25

Objectives: Neurorehabilitation services are not widely available to most persons with disability (PWD) in the Organization of Islamic Cooperation countries. This study aimed to document status of neurorehabilitation services in OIC countries. Study Design and Setting: Cross-sectional online survey.

Methods: Self-administered online survey conducted using Google Forms. Key resource persons for each OIC country working in field of neurorehabilitation were identified from various databases. The questionnaire was emailed to 20 identified resource persons. The response rate was 60% (12/20).

Results: Neurorehabilitation services were available in 9 out of 12 surveyed countries. Only 2 countries reported providing access to neurorehabilitation services to 76-100% of their population. Five countries reported less than 25% of population had access to these services. Most commonly available neurorehabilitation services included services for stroke, spinal cord injury, pediatric neurorehabilitation, brain injury, and neuromuscular rehabilitation. Three countries had none of these specialized services. Five countries had neurorehabilitation training programs for physicians and other rehabilitation professionals. Patients had to pay out of pocket for these services in most of surveyed countries, followed by public funding and private insurance. Tele-neurorehabilitation and local disease-specific neurorehabilitation guidelines were not available in most of surveyed countries.

Conclusion: Neurorehabilitation services in OIC region are not widely available, with significant variability in availability and quality. There is a need to develop and improve these services. Sharing knowledge and expertise through various forms, such as exchange visits and online sessions, can help improve neurorehabilitation services in these countries

Assessment of level of Burnout among Health Professionals in Lahore, Pakistan

Shehnaz Khan — 2024-04-25

Objectives: The prime objective of this study is to access the level of burnout among healthcare professionals using BAT tool. Also, the association of job satisfaction and workload factors is tested with burnout.

Study Design and setting: A cross-sectional multi-centered study in Lahore during the month of August 2022 to Jan 2023. The data was collected from healthcare professionals in three tertiary care hospitals in Lahore. Methodology: The data was collected from clinicians and staff nurses. The required sample size was calculated as 172. Data was collected using Burnout Assessment Tool (BAT) proposed by Schaufeli (2020). BAT was initially proposed with 33 items. BAT-S was the proposed 33-item version with four core dimensions and two secondary dimensions. The average score for each dimension was calculated and interpreted as given by Schaufeli in user manual for BAT-S. Results: Exhaustion was high among 55.8% of the participants. Mental distance was high among 34.3% of the participants whereas it was normal among 46.5%. Nearly 90% of the participants were satisfied from their jobs, committed to their jobs and accept responsibilities. Job satisfaction was significantly associated with burnout level. Lack of organizational influence and poor internal communication were statistically significantly related with level of burnout. Conclusion: The study was conducted to highlight the level of burnout among healthcare professionals. We found that very high level of burnout was observed in cognitive impairment followed by emotional impairment. The average level of burnout was more common among participants with job satisfaction and good internal communication.

Clinical Characteristics, Prognostic Factors and Outcomes of Paediatric Patients with Haemophagocytic Lymphohistiocytosis

Sehar Aslam — 2024-04-25

Objective: Haemophagocytic lymphohistiocytosis (HLH) is a multi-system autoimmune disorder. The objective of this study was to find out the clinical characteristics and prognosis of paediatric patients with Haemophagocytic Lymphohistiocytosis. Study Design and setting: Cross sectional study conducted at Pak Emirates Military Hospital, Rawalpindi from July 2021 to June 2023.

Methodology: Children with diagnosis of HLH were assessed by including patients who were aged = 13 years during hospitalization. All the patients who had not been diagnosed by using the HLH-2004 criteria were disqualified. Relevant findings were noted by evaluating records pertinent to physical examination, radiology and laboratory markers. Prognosis was assessed by determining the underlying clinical aetiology and whether patient-related factors modulated the overall life expectancy.

Results: A total of 32 patient records were evaluated. Mean age at diagnosis was 44.3 ± 39.1 months (Range: 1-132 months) with majority being males [n=23 (71.9%)]. The common clinical characteristics included fever [n=29 (90.6%)], lymphadenopathy [n=27 (84.4%)], splenomegaly [n=23 (71.9%)] and hepatomegaly [n=23 (71.9%)]. Serum ferritin, bilirubin, ALT, AST, and LDH were also raised. All patients were followed for a mean period of 12 months and 18 (56.3%) children failed to survive. Negative prognostic indicators included severe anaemia (p=0.001), neutropenia (p=0.007), thrombocytopenia (p=0.033), and hyperferritinemia (p<0.001). Elevation of liver enzymes (ALT: p<0.001; AST: p=0.031), serum bilirubin (p=0.037), and LDH (p<0.001) also indicated worse disease prognosis.

Conclusion: HLH in childhood is a potentially life-threatening disease and carries a significant association with deranged liver function

The Association between Estrogen Levels and Prostate Volume in Obese and NonObese Benign Prostatic Hyperplasia (BPH) Patients

Afsheen Khan — 2024-04-25

Objective: To investigate the association between prostate volume and estrogen levels in obese and non-obese individuals suffering from Benign Prostatic Hyperplasia (BPH).

Study Design and Setting: Cross-sectional, analytical study

Methodology: The International Prostatic Symptom Score (IPSS) was used in the study to recognize sixty participants with BPH. The study examined patients' height, weight, waist circumference (WC), and body mass index (BMI). An IPSS score of less than 7 was seen as healthy. Using standardized BMI (25) and waist circumference (90cm), patients were split into two groups, with obese patients being placed in group A and non-obese patients being placed in group B. Using trans-rectal ultrasonography(TRUS), prostate gland's dimensions were measured, and blood samples were taken to determine serum estrogen levels.

Results: In comparison to the non-obesity group, which had a mean prostate volume (PV) of 31.21±6.771 ml, the obese group's PV was 36.13±3.673ml. It was statistically significant that there was a difference between the two groups (p=0.001). In the non-obese group, average level of estrogen was 309.72±73.62pmol/l, compared to 328.21±115.05pmol/l in the obese group (p=0.462). Correlation study (r=0.279,p=0.031) revealed a significantly ideal relationship between participants' blood estrogen levels and PV. Among patients who were obese, there was a significant positive correlation among blood estrogen levels and prostate size(r=0.638, p=0.0001).

Conclusion: When compared to the non-obese group, obesity significantly raises prostate volume in study participants, leading to benign prostatic hypertrophy. In addition, prostate volume and blood estrogen levels in obese males showed a significant positive association.

JN.1 Variant Alert: Pakistan's Precarious Healthcare System under Intense Scrutiny

Kanza Mehmood — 2024-04-25

The recent COVID-19 variant, JN 1, identified by the World Health Organization, is considered a notable strain stemming from the OMICRON subvariant BA.2.86. Despite its unique spike protein mutation (S:L455S), JN.1 is anticipated to have minimal impact on global public health. The singular modification in the virus's spike protein, distinguishing JN.1 from BA.2.86, suggests that existing vaccines should effectively counter both variants. The World Health Organization emphasizes the continued efficacy of current vaccines in protecting against diseases and deaths caused by JN.1, urging individuals, especially those at high risk, to maintain updated vaccinations

Challenges of Implementing Gamification in Medical Education: A Scoping Review

Afifa Tabassum — 2024-04-25

The objective of this scoping review was to identify the challenges in implementing gamification in undergraduate and postgraduate medical education. Three electronic databases, including Google Scholar, PubMed and Pakmedinet were searched for articles published between 2010 and 2021. Eleven articles fulfilled the inclusion criteria. Included articles comprised of 3 original articles, 5 reviews, 1 each of commentary, case study and letter. Majority of the studies (9, 81.8%), addressed administrative and logistic issues. 6 (54.5%) studies analyzed the issues related to learners and 5(45.5%) studies each analyzed the issues due to game design and faculty factors.

In conclusion, the trend of using gamification in medical education is increasing owing to their potential of improvement in learning outcomes and increase in student engagement. But the challenges and barriers to successful gamification implementation need to be analyzed in advance at the institutional level so that strategies to combat these issues may be developed