Journal of Rawalpindi Medical College
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Parental Attitudes About Childhood Vaccination: Factors And Trends In Rawalpindi
No full textObjective: To determine the frequency of complete vaccination of children according to the EPI schedule and to assess the contributing factors for missing vaccines among parents of children under 12 years of age attending the Paediatric OPD of FFH, Rawalpindi.
Methods: This cross-sectional study was conducted at the Paediatric OPD of a tertiary care hospital by investigators from the Department of Community Medicine from March 2022 to May 2022, involving parents of children under 12 years of age. A total of 320 participants took part in the study. After obtaining approval from the institutional ethics review committee, data were collected using non-probability consecutive sampling. Parents' Attitudes towards Childhood Vaccinations, a pre-validated tool, was used as an instrument with permission from the developer. Data was analysed using SPSS version 26.
Results: Among total respondents, 83.8% had fully vaccinated children, and 72.8% never delayed their child’s vaccination. 38.1 % of the parents were concerned about the side effects of the vaccine, while 56.3% had no hesitancy regarding childhood vaccines. 53.7% respondents agreed that the child’s vaccination as per the EPI schedule was good. There was a statistically significant association with the level of education (p= 0.001) and ethnicity (p= 0.001) of the respondent with the delayed vaccination of the child.
Conclusion: Our study found that while most of the respondents’ children were fully vaccinated according to the EPI schedule, several parents had concerns about the safety and efficacy of the vaccines. We also discovered that the education level of the child’s parent or guardian and their ethnicity were significantly associated with delay in vaccinating the child. The public health implications point towards greater health education and health promotion in all areas of the country
Utilising A Silastic Sheet In Endoscopic Sinus Surgery To Prevent The Formation Of Lateral Synechiae
No full textObjective: To compare the formation of lateral nasal synechiae after endoscopic sinus surgery with and without insertion of a silastic sheet between the middle turbinate and lateral nasal wall.
Methods: This study includes 70 patients of either gender, 20-60 years of age, admitted for elective endoscopic sinus surgery for chronic rhinosinusitis. Patients were divided into two groups. In group S, a silicone sheet was placed between the middle turbinate and the lateral nasal wall. While in group-T, no silicone sheet was placed. All patients were evaluated for the development of lateral nasal synechiae up to the 6th post-operative month.
Results: In group-S, 3 (8.6%) patients developed lateral nasal synechiae, while in group-T, 11 (31.4%) patients developed lateral nasal synechiae. Comparison of both groups showed a p-value of 0.017.
Conclusion: Silastic sheet placement in the middle meatus significantly reduces the formation of lateral nasal synechiae after endoscopic sinus surgery
Histopathological Effects Of 4g And 5g Electromagnetic Radiations On Liver Tissue
Full text linkObjective: To compare the effect of EMF at 2100 MHz and 3500 MHz on the histomorphology and functions of a rat’s liver.
Methods: Thirty male Sprague Dawley rats were divided into three groups with 10 rats in each group: a control group with no EMF exposure, a 2100 MHz exposure group, and a 3500 MHz exposure group. The rats in the exposure groups were subjected to EMF for 5h/day for 4 weeks. Histological examinations were performed to observe sinusoidal dilatation, congestion, and hepatocyte vacuolation in the classic hepatic lobule. Serum LFTS were assessed to evaluate liver function.
Results: The control group of rats exhibited no hepatocyte vacuolation, and only 10% showed sinusoidal dilatation and congestion. In contrast, 40% of the rats in Group B displayed moderate sinusoidal dilatation and congestion, whereas Group C had 20% with severe and 60% with moderate sinusoidal dilatation and congestion. Severe hepatocyte vacuolation was observed in 10% of the rats in Group C, while Group B had no rats with severe hepatocyte vacuolation. When comparing serum levels among the groups, ALT levels were 35.5 ± 4.7 in Group A (control), 42.4 ± 3.9 in Group B, and 49.8 ± 4.5 in Group C. Likewise, AST levels were 140.6 ± 4.3 in Group A, 263.5 ± 5.1 in Group B, and 295.3 ± 4.6 in Group C.
Conclusion: Electromagnetic field (EMF) exposure at frequencies of 2100 MHz and 3500 MHz has been found to impair liver structure and function in rats, with the severity of damage increasing with frequency. This indicates that higher frequencies, such as those used in 5G networks, may pose greater risks. This study underscores the potential risks associated with EMF exposure and indicates that further research is necessary to grasp its impact on human health.
Effects Of Ragging On Students Across Multiple Disciplines In A Medical University
No full textObjective: This cross-sectional study aims to assess the perception of ragging and its effects on first-year students across various departments, including MBBS, Dentistry (BDS), Physiotherapy (DPT), and Nursing (BSN).
Methods: A total of 293 students from four departments (MBBS, BDS, DPT, and BSN) participated in this study. Data was collected using a self-structured questionnaire, covering perceptions of ragging, mental health impacts, physical and verbal abuse, academic consequences, and anti-ragging policies. Chi-Square tests were applied to analyse associations between ragging experiences and gender, between physical and verbal abuse, and between reporting of such practices and policies against them. Chi-square analysis between gender and the academic impacts of ragging showed different score distributions among males and females.
Results: The results revealed that 94.5% of students reported experiencing ragging (Figure 1), with 46.7% viewing it as a highly negative experience. Significant impacts on mental health were reported, including upsetting memories (35%) and suicidal thoughts (6.5%). Physical and verbal abuse were prevalent, affecting 16.6% and 43% of students, respectively. Gender analysis showed significant differences in academic impact (p = 0.025), physical and verbal abuse (p = 0.021), and reporting practices (p = 0.034). Departmental analysis also showed significant variation, with Physiotherapy students reporting the highest prevalence of negative experiences (p = 0.00001) (Table 4). Only 17.3% of students lodged formal complaints, and 58.5% found anti-ragging policies ineffective.
Conclusion: This study highlights the pervasive nature of ragging and its detrimental effects on students' mental health and academic performance, emphasising the need for more stringent anti-ragging measures across departments
Use Of Colour Doppler Ultrasonography In Early Assessment Of Dialysis Access Complications In Patients Undergoing Surgery For Hemodialysis Access.
Full text linkObjectives: A majority of patients all over the world with renal failure in the late stage of the disease need regular hemodialysis for maintaining a good quality of life. Making an arterio-venous (AV) fistula is the most common way to have vascular access for doing hemodialysis in these patients. Our study aimed to see the use of colour Doppler ultrasound (CDU) in the early diagnosis of ischemic steal syndrome (ISS) in patients with AV fistula for hemodialysis.
Methods: We conducted this study in the Nephrology and Radiology departments of Fauji Foundation Hospital, Rawalpindi. The study was a prospective, cross-sectional trial conducted on sixty patients of chronic renal failure who were on hemodialysis and advised to have an arterio-venous fistula in the upper extremity. Patients had having age range in age from 20 to 70 years. Colour Doppler ultrasound was done, and assessment of the line and its complications along with PSV (Peak Systolic Velocity) and EDV (End Diastolic Volume) measurement was done by an expert Radiologist.. The proximal, mid, and distal outflow veins were examined for patency, diameters, and mean velocities. The extent of the stenosis was calculated where there was stenosis.
Results: The Majority of the patients had normal vessel calibre, with 13 patients (21.6%) having a BB fistula, 15 patients (25%) having an RC fistula, and 32 patients (53%) having a BC fistula. Our study had shown a mean age of AVF maturation of 3.07 ± 0.389 weeks after its 1st creation. Five patients (8.3%) had an uncomplicated outcome, and 55 patients (91.6%) had a shunt complication of 90%. A significant venous thrombosis was seen in 24 patients(40%), stenosis in 18 patients(30%), aneurysmal dilatation in 12 patients(20%), pseudo-aneurysmal formation in 6 patients(10%) and last but not least steal syndrome in 2 patients(3.3%,).
Conclusion: Early recognition and management of an abnormal fistula in hemodialysis patients can improve the outcome in chronic renal failure patients and reduce the incidence of ischemic steal syndrome and other complications.
Keywords: Colour Doppler Ultrasonography, Hemodialysis, AV fistula, Ischemic steal syndrom
Association Of Vitamin D Deficiency And Urinary Tract Infection At A Tertiary Care Hospital In Karachi
No full textObjective: To determine the association between vitamin D deficiency and urinary tract infections within the local population.
Methods: In this cross-sectional study, urine and blood samples of 174 participants (87 healthy controls and 87 UTI patients) were collected by standard operating procedures. Urine samples were processed for the physical, chemical, microscopic examination and culture & sensitivity. The disinfectant susceptibility examination was skilled by using the Kirby-Bauer disc diffusion test by CLSI recommendations. Vitamin D levels of the participants were determined in blood samples by the ELISA technique.
Results: Out of 87 urine samples of UTI patients, 84 (96.5%) were growth positive; out of these positive cases, Gram-negative bacteria were 75(89.3%) in comparison to Gram-positive bacteria, which were 8(9.5%), and 1(1.2%) was Candida albicans. In all of these isolates, Escherichia coli was the predominant 49(56.3%) uropathogens and a higher frequency was observed in young females. The majority of the UTI patients, 68(78.2%), revealed a vitamin D deficiency, compared to 5(5.7%) in the control group participants. There was a statistically significant difference (p-value .001).
Conclusion: This study highlights the strong correlation between vitamin D deficiency and UTI
Diagnostic Accuracy Of Magnetic Resonance Imaging (MRI) In The Diagnosis Of Meniscal Tears, Keeping Arthroscopy As The Gold Standard
No full textObjective: To evaluate the accuracy of magnetic resonance imaging (MRI) in diagnosing meniscal tears.
Methods: A descriptive, cross-sectional validation study was carried out for 1 year on 71 patients who fulfilled the selection criteria after written informed consent. All patients had MRIS of the affected knee, and then arthroscopy was performed.
Results: On MRI, the diagnosis of meniscal tear was made in 29 (40.8%) patients. Arthroscopy confirmed meniscal injury in 30 (42.3%) cases. The sensitivity, specificity, PPV, NPV and accuracy of MRI for diagnosing meniscal tears were 86.5%, 92.7%, 89.7%, 90.4% and 90.1%, respectively, keeping arthroscopic findings as the gold standard.
Conclusion: In patients with meniscal tears, MRI showed a high sensitivity and specificity and an accuracy of keeping arthroscopy as the gold standard and thus can be used as a non-invasive screening tool for establishing the diagnosis in patients who have a suspicion of meniscal tear
Did You Make Someone Else Better Today? Grit, Leadership, and Being Human
No full textGive your best shot in the fight. I invite you to be the CEO of your success. Warren Buffett once said, “The best investment by far is anything that develops yourself, and it's not taxed at all.” That wisdom still holds. Not all heroes wear capes. As Cleveland celebrates the release of a new Superman movie, the birthplace of the character, let me introduce you to a few real people with superpowers.
Take Dr. Fatima (not her real name). As a child, she was unable to attend school for years. After fleeing war with her family, she sold hand-knit socks and gloves on the freezing streets of Pakistan. On July 1st, 2025, she began her dream fellowship in Haematology-Oncology. Her white coat carries many stripes: post-doctoral training at MD Anderson and the Cleveland Clinic, a master’s degree, multiple publications, and now, a new chapter of service and learning. I salute her.
I’m reflecting on snapshots of extraordinary lives. Dr. Iqbal, originally from Sialkot, could have taken the path of least resistance. His father, a factory worker, earned just enough to survive. His mother, a homemaker, held the family together. But Iqbal chose a different route. He worked hard, broke norms, and this July, he graduated from a prestigious fellowship in Chicago. He begins a new job and a lifetime of service and impact.
Then there’s Dr. Mustafa. Labelled as having low literacy and placed in the lowest academic track in the Netherlands, he was told he’d never go to university. But after losing his baby sister to meningitis in a refugee camp at age ten, he made it his mission to become a doctor. “I studied hard,” he says. “They moved me to the highest level.” He was accepted into one of Europe’s top medical schools and earned a research scholarship at Johns Hopkins. “I’ve been told I’m not a traditional applicant. But I’m grateful for my journey. I speak six languages and am learning Arabic from my wife, my seventh. My experiences have shown me the endless possibilities.” After a medicine residency in Pittsburgh, he is now a fellow at an Ivy League medical centre.
A few weeks ago, I was asked to help write the obituary of a dear friend, Dr. Gohar Dar. Once a house officer at Holy Family Hospital, he served for 25 years at the Cleveland Clinic’s main campus, specialising in critical care and cardiac anaesthesia, and was the founding Program Director of its elite Cardiac Anaesthesia Fellowship. “Gohar,” which means "precious gem," truly captured how he lived and served. I met his childhood friends, who flew in from around the world to honour him. One of them said, “I met Gohar on the first day of medical school and laid him to rest on his last day on Earth. For 40 years, we laughed at the little things until people thought we were high.” Gohar was a brilliant physician, a devoted husband and father, and a beloved friend. Known for his clinical precision, humility, and radiant smile, he brought calm to the most critical moments. A man of deep faith, he embodied the Islamic virtue of ihsan, excellence in action, worship, and character. He recited the Qur’an for guidance, strength and clarity. He welcomed guests with warmth, mentored younger colleagues without fanfare, and brought people together with gentle humour and a love for cricket. His home radiated joy and hospitality. His legacy of excellence, service, and unwavering trust in Allah (SWT) endures. Inna lillahi wa inna ilayhi raji’un.1 As the Prophet Muhammad (PBUH) said, “Shall I not tell you whom the Fire is forbidden to touch? It is forbidden to touch a man who is accessible to others, gentle, soft-hearted, and easy-going.” Gohar taught us how to live a full life, and what is important in life: love, humility, friendship and family.
It all begins with a seed. Consider the towering coastal redwoods of Muir Woods (Sequoia sempervirens), the tallest trees on Earth. They all started small. As Adam Grant writes in Hidden Potential, people often judge your future by your peaks. One ace from Serena Williams is enough to show her potential. Steve Jobs is remembered not for his failures, but for the Mac, the iPhone, and his “connecting the dots” speech to Stanford graduates. Stephen Hawking chose to study time itself after being diagnosed with ALS and told he had two years to live. His curiosity kept his mind alive long after his body failed.
The antidote to decline is curiosity and the internal drive that money can’t buy. Let’s go beyond scores and GPAs. Let’s be intentional. Let’s think long-term, even past the next exam or semester, because the goal is to live fully and serve meaningfully. We may not be Superman, but we all carry an X factor. You, the tired first-year medical student: take a deep breath, and nurture that X factor. Greatness and nearsightedness are incompatible. As Daniel Pink writes in Drive, purpose matters more than pressure. Be ready to say what Bhulay Shah said: Merā rāñjhā hun koī hor.
Let’s build lives worth remembering, not just for what we achieve or earn, but for how we help others grow. Let’s show humility as a tribute to our parents and grandparents. Let’s demonstrate integrity as a sign of the greatness of our teachers. Let’s read and write consistently, because healing humanity requires communication and empathy.
Those who cannot read and those who choose not to read are, in effect, the same. As Admiral McRaven said in his “Make Your Bed” speech: “The only thing that matters is the size of your heart.”
I vividly remember my late mother’s kindness and compassionate smile, and my father’s unwavering conviction in his Creator and his quiet integrity. We owe it to our loved ones to honour their sacrifices through lives of meaning.
What would I change if I could go back a few decades? My mindset. I would dream bigger, adopt an I-can attitude, and be more proactive in seeking mentorship and wisdom. I would spend less time hesitating and more time doing. President Roosevelt said, “Believe you can and you're halfway there.” So don’t stop at the next assignment or exam. Go beyond the bare minimum. The shadows of ignorance and disease are vast, and the need for action is urgent.
I’m here to give my best. I may not know everything now, but I know I can learn. I can ask questions. I can challenge the status quo. “Is this the best way? How can I do it better?” Mastery is a mindset. It requires deliberate effort, deep passion, and often, a thousand mundane repetitions. The incubator of innovation is built on the questions of what and how. From before kindergarten to after the doctorate, let’s pursue greatness by holding tightly to one powerful question: Why?
Faiz Anwer is an academic oncologist, physician-scientist, mentor, and lifelong student. He is a graduate of Rawalpindi Medical University and serves as a Professor of Medicine at the Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, where he specialises in the care of patients with plasma cell disorders
Omega-3 Fatty Acids Ameliorate Sleep Deprivation-Induced Histomorphological Alterations in the Rat Prostate
Full text linkObjective: The primary objective of this study was to observe the impact of chronic sleep deprivation on the histomorphological features of the rat prostate gland and to evaluate the potential protective effects of omega-3 fatty acid supplementation.
Materials & Methods: Thirty male Sprague-Dawley rats (200-300g) were randomly divided into three groups (n=10 per group): Group A (control, maintained on a normal sleep-wake cycle), Group B (sleep deprivation, subjected to 16 hours of sleep deprivation followed by an 8-hour sleep opportunity daily for 60 days), and Group C (sleep deprivation + omega-3, subjected to the same sleep deprivation regimen as Group B, supplemented with 260 mg/kg/day omega-3 fatty acid via oral gavage). Post-euthanasia and after dissection, prostate tissues were processed for histological observation using H&E and Masson's trichrome staining to assess epithelial apoptosis, collagen deposition, and smooth muscle architecture. Statistical analyses were performed using SPSS software version 21, with p<0.05 considered statistically significant.
Results: Group A (control) showed normal histological structure. Group B (sleep deprivation) exhibited a significantly higher frequency of epithelial apoptosis (p<0.05), increased interacting collagen deposition (p<0.001), and marked irregularities in the smooth muscle layer surrounding the acini (p=0.002). Group C (sleep deprivation + omega-3) demonstrated reduced epithelial apoptosis, collagen deposition, and smooth muscle distortion relative to Group B.
Conclusion: The present study observed that sleep deprivation caused significant changes in the histomorphology of the rat prostate gland, including epithelial apoptosis, collagen fibre deposition in the interacting space, and irregular arrangement of the smooth muscle fibres around the acini. Additionally, omega-3 fatty acid supplementation had an ameliorative effect on these histomorphological alterations induced by sleep deprivation
Diagnostic Accuracy Of Tokyo Guidelines 2018, In Acute Cholecystitis, Taking Histopathology As Gold Standard
No full textObjective: To evaluate the diagnostic accuracy of the 2018 Tokyo Guidelines for acute cholecystitis by comparing clinical diagnosis with histopathological findings in patients undergoing cholecystectomy.
Methods: This prospective observational study was conducted on 71 patients undergoing cholecystectomy with a preoperative diagnosis of acute cholecystitis based on TG18. The diagnostic criteria included clinical features (right upper quadrant pain, Murphy’s sign), laboratory parameters (leukocytosis, elevated CRP), and imaging findings on abdominal ultrasonography (gallbladder wall thickening, pericholecystic fluid). Postoperative histopathological examination of the resected gallbladders was used as the gold standard for confirming the diagnosis. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated.
Results: Out of 71 patients, histopathology confirmed acute cholecystitis in 64 cases and ruled it out in 7. The Tokyo Guidelines demonstrated a sensitivity of 93.4%, specificity of 40%, positive predictive value of 90.47%, negative predictive value of 50%, and an overall diagnostic accuracy of 85.91%. Six patients had discordant results, showing false-positive diagnoses according to the Tokyo Guidelines, which were not supported by histopathology.
Conclusion: The 2018 Tokyo Guidelines are highly sensitive and have good diagnostic accuracy for acute cholecystitis, making them valuable in clinical settings. However, the low specificity and modest NPV indicate a potential for overdiagnosis. Refinement of diagnostic criteria is warranted to reduce false-positive rates and improve the detection of true negative cases.
Keywords: Acute Cholecystitis; Tokyo Guidelines; Diagnostic Accuracy; Cholecystectomy; Histopathology; Sensitivity and Specificit