Journal of Islamabad Medical & Dental College
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Evaluation of Anterior Ethmoidal Artery on Coronal CT Scan Paranasal Sinus
Full text linkObjective: To determine the frequency of different anatomical landmarks seen for identifying the course of anteriorethmoidal artery, in patients presenting at Fauji Foundation hospital, Rawalpindi for CT paranasal sinus.Methodology: A total of 140 patients in this prospective cross-sectional study were included on coronal computedtomography of paranasal sinuses. The duration of the study was six months. All the examinations were done onAquilion 64 slice Toshiba CT scan. Only the coronal image was used for study and analysis.Results: Patients had an average age of 40.77±15.62. Supra orbital pneumatization was 52.14 percent. The anteriorethmoidal sulcus and foramen were visible in 96.43% and 98.57% of scans. No age group had age-related changes inanterior ethmoidal foramen or sulcus (p-values = 0.52 and 0.95). Age did not affect supraorbital pneumatization(p=0.70). Women (98.6%) had the Anterior Ethmoidal Sulcus more than men (94%), although the difference was notsignificant (p-value 0.19). Gendered supraorbital pneumatization was similar (p=0.73).Conclusion: This study found that key anatomical landmarks for identifying the AEA—the anterior ethmoidal foramen,sulcus, and supraorbital pneumatization—are consistently present across age and gender groups, with no significantdifferences. These results confirm the reliability of these landmarks in guiding surgical approaches to the AEA.Keywords: Anterior ethmoidal artery; CT scan paranasal sinus; Supraorbitary pneumatizatio
Voriconazole in Dermatophytic Infections: An In-depth Examination of Its Role in Tinea Treatment
Full text linkObjective: To evaluate the efficacy of voriconazole in treating dermatophytosis, specifically tinea corporis and tinea cruris, in patients resistant to conventional antifungal treatments. The primary objective was to assess the clinical and mycological cure rates, safety, and potential impact of comorbidities on treatment outcomes.
Methodology: A retrospective analysis was conducted at Khyber Teaching Hospital, Peshawar, from June 2021 to June 2022, involving 150 patients with dermatophytosis who had failed previous treatments. Data were collected from medical records, and patients were treated with voriconazole 200 mg twice daily for a duration of 12 weeks. Follow-up visits were conducted at 2, 4, and 12 weeks.
Results: The clinical cure rate was 70%, with 50% of patients achieving mycological cure. Male patients showed a higher rate of complete resolution (45%) compared to females (40%), with a p-value of 0.003. Comorbidities such as diabetes and hypertension significantly impacted treatment outcomes, with patients without comorbidities achieving 50% complete resolution, compared to 30% and 35% in diabetic and hypertensive patients, respectively, with a p-value of 0.042. Adverse effects were reported in 25% of patients, including visual disturbances (10%), headaches (8%), and skin rashes (7%).
Conclusion: Voriconazole is an effective treatment for dermatophytosis, especially in patients resistant to conventional antifungals. The study highlights the influence of gender and comorbidity status on treatment outcomes and suggests further research to optimize treatment regimens.
Prevalence of Atrial Fibrillation among Individuals with Obstructive Sleep Apnea and Impact of Sleep Apnea on Incidence and Outcomes of Atrial Fibrillation: Systematic Review
Full text linkObjective: 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
Full text linkRenal 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
Full text linkDeeper 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 imagin
The Rising Epidemic of Dental Caries in Pakistan: What Clinicians Need to Know
Full text linkDental Caries is a non-communicable disease which is causing disturbance globally. It is a multifactorial disease, whose prevalence in Pakistan is more than 60%. Understanding these factors can lead to the development of policies and practices in mitigating the prevalence of dental caries. This review aims to explore different factors which leads to the rise of prevalence of dental caries and helps clinicians of Pakistan to mitigate it. Factors which lead to the development of dental caries are dietary habits, oral hygiene practices, socioeconomic factors, and cultural practices. Keeping in mind such factors, clinicians should provide tailored oral hygiene instructions. This is to ensure comprehensive and effective outcomes for all patients. So apart from addressing the chief complaint of a patient, clinician should focus on preventive dentistry as well. By doing this, rising epidemic of dental caries can be controlled.Key Words: Dental Caries, Dental Clinicians, Epidemic, Pakista
Clinicopathological Parameters Affecting Hospital Stay in Dengue Fever
Full text linkObjective: To identify clinical and laboratory parameters that can predict prolonged hospital stay and potentially severe disease in dengue patients, allowing for early triaging and appropriate resource allocation during epidemics when healthcare facilities in developing countries are often overburdened.
Methodology: This study was conducted at a Teaching hospital of Islamabad during the epidemic of Dengue fever 2023. After prior ethical approval, hospitalized dengue patients’ demographic details, clinicopathological parameters and hospital stay were followed till patients were discharged. Data were analysed for association with hospital stay.
Results: A total of 182 hospitalized dengue patients were included in the study. Patients who developed a mean arterial pressure of <65 mmHg, pulse pressure of ≤ 20 mmHg, ALT ≥ 5 times upper limit of normal or advanced age were found to have a longer hospital stay. Patients who were vaccinated for COVID-19 were less likely to have a longer hospital stay; however, this association was close but not significant.
Conclusions: Advanced aged or those who developed hypotension, narrow pulse pressure or hepatic derangement need to be aggressively monitored in Dengue hospitalized patients as they are more likely to have to longer hospital stay.
Keywords: Alanine Transaminase, COVID-19, Dengue, Length of Stay, Severe Dengue
Techniques Applied in Performing a Painless Thyroid FNA; Tips and Tricks
Full text linkThyroid nodules are frequently encountered clinically and the prevalence has surged to 68% as cited (1). Many guidelines in the literature recommend USG guided FNAC in differentiating malignant from benign thyroid nodules (2). Fine needle aspiration (FNA) biopsy of thyroid nodules is one of the minimally invasive, safe and frequently performed procedure on outpatient basis. FNA can be performed under palpation guidance or ultrasound guidance. In addition to knowing the optimum technical skills, one must know the limitations of procedure, its indication and factors affecting the adequacy. Local site pain and ecchymosis are two main commonly seen complications by the IR operators however serious events are rarely reported till date (3). FNA is a well-tolerated procedure but pain is one of the few drawbacks of FNA, however pain score may vary in different people. Some reports have suggested that FNA can be done without local anesthesia when single puncture is used, however multiple punctures are required for adequacy of the sample and in this case, pain is the limitation. Literature review suggest use of 22 to 27 G needles for FNA but blood contamination is frequently seen with the use of larger needles (4).
In our setting, oral paracetamol is administered pre-procedurally to alleviate any discomfort caused by minor bruising and the needling process. Techniques used to minimize the pain felt during the procedure include the following: 1) of the smallest needle size available. We use the needle from a 1 cc syringe which has a detachable 26 gauge needle (commonly used for Insulin injectons). For patients with increased skin to gland distance a longer needle in 23 gauge is used in addition. 2) Mixing of the local anesthesia with bicarbonate to neutralize the stinging effect of the acidic local anaesthetic. We perform infiltration of the skin and in addition the thyroid capsule so that all subsequent needle entries are painless. In our setup, almost 10 mL of local anesthesia is used comprising of 9 mL of 2% xylocaine and 1 mL of sodium bicarbonate (8.4% w/v) in a ratio of 9:1. Since adopting this protocol and technique in our setup at Shifa International Hospital the patients have given excellent feedback especially those who had a FNA performed in the past
Ethical Dilemma of Ghost, Guest, and Gift Authorship in Biomedical Research
Full text linkBiomedical literature serves as the foundation of scientific progress, facilitating the dissemination of research findings to clinicians, researchers, and policymakers, promoting innovation, and guiding medical practices. However, the credibility of this knowledge depends on the transparency and ethical rigor maintained during its production. The authorship in biomedical research is more than a marker of contribution; it signifies accountability and intellectual ownership.
With the increasing complexity of collaborative research and the pressure to "publish or perish," authorship has evolved into a highly sought credential, influencing academic promotions, funding opportunities, and professional recognition. This emphasis on publishing has created a competitive environment in which ethical lapses frequently occur, including the omission of contributors (ghost authorship), the inclusion of unqualified authors (guest authorship), and the attribution of authorship as a favor (gift authorship). These practices distort the academic record, misrepresent contributions, and threaten the integrity of the scientific record
