Journal of Rawalpindi Medical College
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Unveiling Thrombocytopenia Trends In Pediatric Epilepsy: The Valproate Connection
Full text linkObjective: To determine the frequency and association of thrombocytopenia in patients on valproate therapy in the Pediatrics department of Pakistan Atomic Energy Hospital, Islamabad.
Methods: A descriptive cross-sectional study, conducted in the department of Paediatrics, PAEC General Hospital, Islamabad from 06-June-2022 to 05-December-2022. A total of 125 diagnosed cases of epilepsy and valproic acid therapy were included. After written informed consent from parents/guardians, demographic details were noted, and patients underwent testing for platelet count and thrombocytopenia was labelled as a platelet count of <150000/µL.
Results: The mean age of patients included in this study was 8.13±2.80 years. The mean duration of epilepsy was 3.44±1.56 years. Thrombocytopenia was observed in 31 (24.80%) patients on valproic acid therapy and a strong association between higher dosage of valproic acid and thrombocytopenia was observed (p <0.001).
Conclusion: An increased risk of thrombocytopenia is observed when valproic acid is used as a monotherapy or a part of polytherapy. Mostly this thrombocytopenia is not life-threatening but the importance of serial monitoring of platelet count during prolonged valproic acid use cannot be ignored due to the associated risk of bleeding, as children on higher doses of valproate are at greater risk of thrombocytopenia.
Keywords: Epilepsy, Valproic Acid, Thrombocytopenia
Zinc Supplementation Mitigates High Salt Diet-Induced Bone Damage: A Histological Evaluation of Osteocyte Apoptosis: Protective Effects of Zinc Against Salt-Induced Osteocyte Apoptosis: A Histological Study
Full text linkObjective: This study aims to evaluate the protective role of zinc supplementation against bone damage induced by a high-salt diet, with a specific focus on osteocyte apoptosis in rats.
Methods: This was an investigational study conducted at the Army Medical College, Rawalpindi, Pakistan, over eight weeks. Thirty female Sprague-Dawley rats were randomly divided into three groups: control (Group C), high-salt diet (Group A), and high-salt diet with zinc supplementation (Group B). Group C received a standard diet, Group A received a diet with 8% sodium chloride, and Group B received the high-salt diet plus zinc supplementation at 50 mg/kg body weight daily via oral gavage. After eight weeks, femurs were harvested, processed, and stained with hematoxylin and eosin. Osteocyte apoptosis was assessed by counting empty lacunae and apoptotic bodies under light microscopy.
Results: The high-salt diet group (Group A) exhibited a significantly higher density of apoptotic osteocytes compared to the control group (mean ± SD: 2.3166 ± 0.820 vs. 1.3666 ± 0.431 per unit area; p=0.0005). Zinc supplementation in Group B resulted in a significant reduction in osteocyte apoptosis compared to both the high-salt diet group (mean ± SD: 1.7000 ± 0.492 per unit area; p=0.0087) and the control group (p=0.0009). These findings indicate that zinc supplementation effectively reduces osteocyte apoptosis caused by high salt intake.
Conclusion: Zinc supplementation significantly mitigates the harmful effects of a high-salt diet on bone health by reducing osteocyte apoptosis. This suggests its potential as a therapeutic intervention to counteract salt-induced bone damage and prevent related diseases such as osteoporosis.
Keywords: Zinc, salt, osteocytes, apoptosis, osteoporosis
Exploring the Morphometry of Infraorbital and Mental Foramina: Insights from a Local Anatomical Study
No full textObjective: The study aims to determine the dimensions of the IOF and MF, their distances from clinically significant anatomical landmarks, and their potential variations in a local population.
Methods: The study was conducted in the Anatomy Department of Nishtar Medical University, Multan, from June 2024 to November 2024. A descriptive study was performed on 132 dry adult human skulls. The transverse and vertical diameters of the IOF and MF, along with their respective distances to the anterior nasal spine (for IOF) and symphysis menti (for MF), were measured using digital Vernier callipers. Measurements were taken twice by the authors to minimise errors. Data analysis was performed using SPSS version 20.0, with results expressed as mean ± standard deviation.
Results: All skulls exhibited a single IOF and MF bilaterally. The mean transverse diameter of the IOF was 2.858 ± 0.633 mm (right) and 3.112 ± 0.823 mm (left), while its vertical diameter was 4.199 ± 0.732 mm (right) and 4.229 ± 0.887 mm (left). The mean IOF-to-anterior nasal spine distances were 32.22 ± 3.73 mm (right) and 31.48 ± 3.53 mm (left). For the MF, the mean transverse diameter was 2.81 ± 0.65 mm (right) and 2.92 ± 0.71 mm (left), while the vertical diameter was 2.96 ± 0.69 mm (right) and 3.01 ± 0.72 mm (left). The distance of MF from the symphysis menti was 25.43 ± 2.34 mm (right) and 25.16 ± 2.29 mm (left). These findings provide valuable anatomical data for clinicians performing surgical and anaesthetic interventions in the midface and lower face regions.
Conclusion: The findings of this study contribute to a growing body of evidence on IOF and MF morphology, emphasizing population-specific variations. This localised data is essential for clinicians performing surgical and anaesthetic procedures in the midface and lower face, ensuring safer and more effective interventions.
Keywords: Infraorbital foramen, mental foramen, local population, regional anaesthesi
Prevalence Of Allergic Fungal Rhinosinusitis Among Patients Having Nasal Polyposis
No full textObjective: To assess the prevalence of allergic fungal rhinosinusitis among patients with nasal polyps and associate it with risk factors
Methods: This cross-sectional study design was conducted at the ENT department of Combined Military Hospital Quetta, from January to December 2024. One hundred and sixty-three adult patients presenting with bilateral nasal polyps were enrolled in the study. All the patients underwent functional endoscopic sinus surgery, and the histopathology sample reports were evaluated. Patients were assessed according to the Bent and Kuhn diagnostic criteria for allergic fungal rhinosinusitis, which include the presence of nasal polyps with characteristic double-density CT findings, fungal hyphae on fungal microscopy, and the presence of eosinophilic mucin on histopathology samples, and were labelled as having allergic fungal rhinosinusitis.
Results: Out of 163, there were 76 (46.6%) males and 87 (53.4%) females with a mean age of 49.10±9.4 years. Allergic fungal rhinosinusitis was found in 50 (30.7%) of the patients. Females were more commonly found to have allergic fungal rhinosinusitis as compared to males (34.0% vs 66.0%, p=0.032). A higher percentage of patients with allergic fungal rhinosinusitis were found to have a history of allergy (p<0.001), diabetes (p<0.001) and hypertension (p=0.001) as compared to those without allergic fungal rhinosinusitis.
Conclusion: The frequency of allergic fungal rhinosinusitis was reported to be 30.7% among patients presenting with nasal polyps, where the mean nasal score was higher among such patients, along with various risk factors, including gender, history of allergy, diabetes and hypertension.
Keywords: Nasal polyps, allergic fungal sinusitis, risk factors, allergy, fungal infectio
Fatigue Assessment Using FACIT-F Scale In Axial Spondyloarthropathy, Rheumatoid Arthritis And Systemic Lupus Erythematosus Patients Presenting To A Tertiary Care Hospital
Full text linkObjective: To measure fatigue in patients with axial spondyloarthropathy, Rheumatoid Arthritis and Systemic lupus erythematosus and find its correlation with the disease activity measures.
Methods: This Cross-sectional, descriptive study was carried out in the Rheumatology Unit of the Federal Government Polyclinic Hospital from October 2024 to April 2025. This study included a total of 135 patients, with 45 patients meeting the ASAS criteria for spondyloarthropathy. Disease activity in ankylosing spondylitis (AS) patients was assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI). The Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) scale was used to evaluate fatigue in all patients.
Results: A total of 90 (66.6%) female patients and 45 (33.3%) male patients were included. Severe fatigue with a FACIT-F score of <30 was found in 81 (60%) of all included patients. Among the spondylarthritis group, the mean FACIT fatigue score was found to be 26 ±9.37, for RA it was 26.60 ±11.23, while that in the SLE cohort was found to be 28.86 ±12.40.
Demographic profiles suggest that fatigue was most common in AS patients (68.8%), followed by RA (62.2%) and then by SLE (48.89%).
The mean value of the FACIT score varied with the activity of the disease in all three diseases studied in this cohort. An independent sample t-test was used to compare the mean difference in the FACIT score among the ankylosing spondylitis patients, while ANOVA was used to find the difference in means among the RA and SLE patients, respectively.
Conclusion: Patients with active disease and higher disease scores had a lower FACIT-F score, suggesting more fatigue, thus correlating with the disease activity.
Key Words: Fatigue, Ankylosing spondylitis, Systemic lupus erythematosus, Rheumatoid arthritis
Morphometric Assessment of the Mandible and Mandibular Foramen in the Pakistani Population
Full text linkObjective: Mandibular size and foraminal anatomy vary from population to population because they provide passage to important anatomical structures that have great importance during clinical procedures. Through a comprehensive literature review, we found that no existing morphometric data are available for the Pakistani population. This cross-sectional analysis is performed on 86 dry adult mandibles (from Rawalpindi Medical University) to identify key mandibular dimensions and foraminal positions in a Pakistani sample.
Methods: Each mandible was measured twice with digital Vernier calipers (0.01 mm precision). Paired (left vs. right) parameters included mandibular body length, ramus height, and distances from the mandibular foramen to the anterior and posterior borders of the ramus. Unpaired parameters (bicondylar width and bigonial width) were measured across specimens. Morphological variants (e.g., accessory mental foramina) were also observed. Statistical comparison of sides used paired two-tailed t-tests or Wilcoxon signed-rank tests (significance set at p<0.05).
Results: Out of 100 mandibles examined, 86 were suitable for analysis. Significant side-to-side differences were found for mandibular body length, the distance from the anterior border to the mandibular foramen, and mandibular notch distance to angle (p<0.05). No accessory mental foramina were observed. Unpaired measurements such as bicondylar width (114.53 ± 5.44 mm), bigonial width (94.47 ± 6.93 mm), and symphysis menti height (28.57 ± 4.45 mm) were recorded.
Conclusion: The findings offer population-specific morphometric data on the mandible and foramina in Pakistan and may serve as a reference for anatomical and clinical research.
Keywords: Mandible; Mandibular Canal; Population; Anatomy, Cross-Sectional; Pakista
Assessing Bone Mineral Density Among Female Medical Students Of Pakistan: Unveiling The Impact Of Lifestyle Factors On Skeletal Health- An Analytical Cross-Sectional Study
Full text linkObjective: To assess the frequency of low bone mineral density (BMD) and its association with lifestyle factors among female medical students in Pakistan.
Methods: A cross-sectional study was conducted at ---- between January and June 2025. A total of 184 undergraduate female medical students were included using non-probability consecutive sampling. BMD was assessed using Quantitative Ultrasound (QUS) of the calcaneus, with T-scores recorded for each participant. Data on demographic details and lifestyle factors, including physical activity, dietary intake, BMI, and screentime, were collected through a structured questionnaire. Statistical analysis was performed using SPSS 26.0. Pearson correlation and chi-square tests were applied, with p-values less than 0.05 considered statistically significant.
Results: Among 184 female participants, the mean age was 22.00 ± 1.056 years. QUS revealed that only 36 students (19.6%) had normal bone mineral status, 134 (72.8%) had osteopenia, and 14 (7.6%) had osteoporosis. A significant positive correlation was observed between BMI and T-score (r = 0.347, p value of 0.000). Bone status was significantly associated with year of study (p = 0.002), physical activity (p 0.000), carbonated drink intake (p = 0.009), overeating (p = 0.005), and coffee consumption (p = 0.038).
Conclusion: Most young female medical students had low BMD, with modifiable lifestyle factors contributing significantly, highlighting the need for early screening and preventive strategies targeting bone health in this vulnerable population.
Keywords: Bone Density, Osteoporosis, Lifestyle, Students, Medica
Assessment of Ki-67 proliferation index in relation to histological grades of oral squamous cell carcinoma
Full text linkObjective: To evaluate the Ki-67 proliferation index and its correlation with different histological grades of Oral squamous cell carcinoma.
Methods: This retrospective immunohistochemical study was conducted at the Pathology Department of Mayo Hospital, Lahore, from January 2024 to May 2025. A total of 30 histopathologically confirmed cases of OSCC were selected. Hematoxylin and eosin (H&E) stained slides were used for grading tumors, followed by immunohistochemical staining for Ki-67. The staining intensity and percentage of positively stained tumor cells were evaluated and scored.
Results: Among the 30 cases, 6 (20%) showed no immunoreactivity for Ki‑67, 1 case (3%) exhibited mild staining, 13 cases (43.3%) demonstrated moderate staining, and 10 cases (33.3%) displayed intense Ki‑67 expression. A significant positive correlation was found between higher Ki-67 expression and poor tumor differentiation (p < 0.05). High-grade tumors (moderately and poorly differentiated OSCC) exhibited markedly increased Ki-67 labeling index as compared to well-differentiated tumors.
Conclusion: This study reinforces the utility of Ki-67 as a reliable proliferative marker in oral squamous cell carcinoma. Its expression correlates significantly with histological grade, indicating its potential role in prognostication and guiding therapeutic strategies.
Keywords: Carcinoma Squamous Cell; Cell Proliferation; Immunohistochemistry; Ki-67 Antigen; Mouth Neoplasms; Neoplasm Grading; Tumor Cells Malignant
The Role Of Cyberchondria In Mediating Health Anxiety, Fears And Obsessions Among Students Of Private Medical Colleges Sargodha
Full text linkObjective: This study was conducted to examine the role of cyberchondria in mediating health anxiety, fears and obsessions among Students of private medical college.
Methods: This descriptive correlational study was conducted at department of Psychiatry & behavioural sciences and Medical OPD of Rai Medical College, Sargodha. For this purpose data was collected from 150 medical students. The Cyberchondria Severity Scale (CSS‑12) was used to measure cyberchondria severity and Short Health Anxiety Inventory (SHAI) scale was used to measure Anxiety in patients. The Obsessive–Compulsive Inventory – Revised (OCI‑R) scale was used to measure Obsessive Compulsive Disorder (OCD) in patients.
Results: Descriptive statistics (i.e. frequency distribution, percentages, mean, standard deviations, Pearson correlation and Anova) were the analytical methods to test the objectives. Results of correlational analysis showed positive but non- significant correlation between cyberchondria and mobile usage per day. Results of linear regression analysis indicate that cyberchondria has significant impact on health anxiety. Findings also indicate significant gender differences on health anxiety and cyberchondria, Females are more concerned about health and have more cyberchondria tendencies than males. However, non-significant difference on OCD patterns, mobile phone daily usage.
Conclusion: This study shows that feeling constantly worried about your health and obsessively checking the internet for information can make you feel more anxious and stressed, and can also lower your quality of life. It also shows that cyberchondria has a great impact on health anxiety. Gender differences exist in health anxiety and cyberchondria.
Keywords: Cyberchondria, Health Anxiety, Fear, OCD
Outcome Of Diabetic Ketoacidosis And The Factors Affecting It - Experience From Pediatric Intensive Care Unit
No full textObjective: To study the outcome of patients admitted with DKA in the Pediatric Intensive Care Unit (PICU) and the factors affecting it.
Methods: It was a prospective study, conducted in the Pediatric Intensive Care Unit of the University of Child Health Sciences & The Children’s Hospital, Lahore, from June 2019 to July 2022. Data was collected on well well-designed form. Patients who were admitted to the PICU with DKA were enrolled in the study. Data was analyzed using SPSS version 25. Chi-square test was used to find out the p-value.
Results: In this study, 165 patients were enrolled, from June 2019 to July 2022, with a mean age of 7.88±3.97yrs years. Forty-four patients (26.7%) presented in moderate DKA, while 73.3%(n=121) presented in severe DKA. Ninety-five patients (57.6%) had new-onset diabetes. Among already known cases, 50.3%(n=83) had poor glycemic control. Mean hospital stay was 5.0 ±2.4 days. Moderate cases recovered within 24-36 hours of hospital stay, while severe cases took 5-7 days to recover completely. Mortality was seen in 23.6%(n=39) while 76.3%(n=126) recovered. Conscious level, pH at admission, hypernatremia, pulmonary edema, cerebral edema, refractory shock, need for mechanical ventilation, and dialysis were the factors that were strongly associated with the outcome of DKA patients (p <0.001).
Conclusion: The more severe the presentation of DKA, the greater the chances of complications and worse outcomes. Altered conscious level, pH<7 at admission, hypernatremia, pulmonary edema, cerebral edema, refractory shock, need for mechanical ventilation, and peritoneal dialysis were the factors associated with poor outcome.
Keywords: Diabetic Ketoacidosis, Treatment outcome, Risk factors, Pediatric IC