Journal of Islamabad Medical & Dental College
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A Systematic Review on Epidemiology of Burns in Pakistan
No full textBurns are graded as the fourth most common trauma type globally, followed by other traumas including accidents, interpersonal violence and falls. South Asian regions account for 187–243 incidences of burns per hundred thousand annually. Whereas Pakistan lacks national data and cannot measure the burn burden annually. Due to the dearth of clinical and epidemiological studies on burns in Pakistan, we performed this study. This systemic review study aimed at summarizing available Pakistan’s epidemiological data, based on national studies in the past 32 years. The data of our systemic review were collected from five search engines, i.e. PubMed, Google Scholar, PakMediNet, Scopus, and DOAJ. The studies which were reviewed for the article were from 1990 to 2022. The articles of nonhuman participants, duplication and lacking in primary focus were excluded. The PRISMA guidelines were used. A total of 10 articles were included, out of which 4 are from Islamabad ICT, Sindh and 2 from Punjab. The overall gender ratio shows male dominance of 56.07 %. Flame burns were recorded at a higher percentage of 58.32%. The mean TBSA recorded in this research was 29.6%. The mean mortality rate of all the studies shows a percentage of 26.1%. More research studies are needed in areas lacking information about the victims of burn injuries so that policymakers know the actual number of injuries with whom they have to deal.Keywords: Burns, Prevalence, Pakistan, Epidemiolog
Optimizing Dental Waste Practices: A Comprehensive Review of Waste Management in Hospital and Private Dental Practice across Pakistan
No full textObjective: To analyze and document the management of biomedical waste, assessing potential health and environmental risks, over a period of six months throughout the dental hospitals of Pakistan.
Materials and methods: In this cross-sectional questionnaire-based study, the questionnaire was distributed to final-year students, house officers, postgraduate trainees, practicing dentists, and dental assistants in both private and public healthcare settings across Pakistan through electronic media. A convenient sampling technique was used, and the study was completed in six months, from April to September 2023, with a sample size of 356, actively practicing dental professionals, students, trainees, and dental assistants with a minimum of 6 months of experience included in this study. Non-practicing dentists and assistants within the last 6 months were excluded from the study. The study assessed criteria and dental practitioners' knowledge regarding waste disposal in dental setups and hospitals.
Result: In biomedical waste disposal practices across hospitals and clinics, incorrect methods were observed in amalgam disposal (77.2% vs. 75.8%), fixer disposal (92.2% vs. 87.1%), bloody gauze disposal (52.1% vs. 68.5%), tooth disposal (73.2% vs. 60.4%), sharps disposal (75.1% vs. 29.4%), and solid waste disposal (24.8% vs. 24.4%) in hospitals and clinics, respectively. Proper methods, such as separators, silver recovery, yellow bags, and incineration, were variably used/adopted.
Conclusion: According to the current study, most private dental facilities and hospitals are unaware of the various types of biomedical waste and do not use proper disposal methods. There is an immediate need for practitioners to receive ongoing dental education on waste management in dental care
Comparison of Dexamethasone-Diphenhydramine and Dexamethasone-Ondansetron in Preventing Post-Operative Nausea and Vomiting after Laparoscopic Cholecystectomy
Get PDFIntroduction: Postoperative nausea and vomiting (PONV) is one of the most common problems after implementation of general anesthesia. Laparoscopic cholecystectomy for the treatment of cholelithiasis is popular amongst surgeons as well as patients due to its associated advantages, which includes a short hospital stay. However high incidences of PONV have been reported after laparoscopic cholecystectomy.
Objective: To compare the efficacy of combination dexamethasone-dimtenhydrinate with dexa-methasone-ondansetron in preventing postoperative nausea and vomiting after laparoscopic cholecystectomy.
Study design: Randomized controlled trial
Settings: Department of Anaesthesia, Holy Family Hospital, Rawalpindi Medical University and Allied Hospital.
Duration of study: Study was carried out over a period of six months from 01-01-2022 to 30-06-2022.
Methodology: A total of 160 patients were enrolled, 80 patients each to either group D for Dexamethasone-Dimenhydrinate group or group-O for Dexamethasone-Ondansetron.
Results: Mean age of the patients was 42.3±13.2 and 42.4±14.0 in group-D and Group-O, respectively. There were 40 (50%) males and females in group-D while 29 males (36.3%) and 51 females (63.7%) in group-O. Efficacy of combination dexamethasone+ dimtenhydrinate with dexamethasone+ondansetron in preventing PONV showed at 30 minutes (5.0% vs 12.5%; p=0.093), at 60 minutes (7.5% vs 20.0%; p=0.022), at 120 minutes (6.3% vs 17.5%; p=0.028) and at 24 hours (5.0% vs 18.8%; p=0.007).
Conclusion: In conclusion, our study demonstrated that dexamethasone–dimenhydrinate combination was more effective than dexamethasone–ondansetron combination in prevention of nausea and vomiting after laparoscopic cholecystectomy
Investigating Machine Learning Models in Acute Myocardial Infarction to Predict Mortality
Get PDFObjective: Pakistan and the rest of the world suffer from a high rate of acute myocardial infarctions (AMIs). In this study, we employed a machine learning model to predict mortality in patients with Acute Myocardial Infarction (AMI). By analyzing various variables, they assessed the impact of these factors on the predictive models, highlighting the potential of machine learning in improving mortality prediction and informing clinical decision-making in AMI cases.
Methodology: This study conducted three experiments using a Kaggle dataset to predict mortality in Acute Myocardial Infarction (AMI) patients with machine learning. Relevant input features were selected, and three models (SVM, DT, KNN) classified mortality status. Model performance was rigorously evaluated with metrics like Accuracy, AUC, Precision, Recall, and F1-score. Data preprocessing, including handling missing values and normalization, preceded model training.
Results: Among the evaluated models, the Support Vector Machine (SVM) exhibited the highest accuracy of approximately 87.66% and demonstrated robust discrimination capabilities, with an AUC score of 0.796. Precision, recall, and F1 scores indicated a balanced trade-off between correctly identifying negative outcomes and effectively capturing positive cases.
Conclusion: The SVM model emerged as the most promising classifier, showcasing strong potential for predicting patient mortality in the context of AMI. However, further refinements and optimizations may be necessary to enhance model performance, ensuring its clinical relevance and utility in real-world medical scenarios.
 
Vaccination Status Against the Hepatitis B Virus of the Patients Visiting a Tertiary Care Dental Hospital
Get PDFAbstract:
Objective
To assess the vaccination status for Hepatitis B virus among patients attending a tertiary care dental hospital in Multan, aiming to identify gaps and opportunities for improvement in vaccination coverage.
Methods
This cross-sectional questionnaire study conducted at Multan Dental College from June 2023 to Feb 2023 included patients attending the dental OPD. 181 participants completed the questionnaire regarding vaccination status. Ethical approval and informed consent were obtained from Multan Dental Hospital.
Results
Among 181 participants, 98 (54.14%) were males and 83 (45.86%) were females. Regarding age groups, 36 (19.9%) were 16-20 years old, 69 (38.12%) were 21-25 years old, 54 (29.83%) were 26-30 years old, and 22 (12.15%) were 31 years old or above. Out of 181 participants, 51 (28.17%) were non-vaccinated, while 130 (71.83%) were vaccinated. Among the vaccinated, 47 (26%) received the 1st dose, 36 (19.9%) received the 2nd and 3rd doses each, and 11 (6.07%) received the Booster dose. The majority (58.82%) of non-vaccinated individuals cited multiple reasons for not receiving immunization, including vaccine unavailability and busy schedules. Additionally, 9.8% lacked awareness of the vaccination, while others mentioned injection phobia and lack of motivation
Conclusion
The study emphasizes the challenge of incomplete vaccination among patients, which necessitates coordinated efforts by public health officials. Implementing AI-powered reminder systems could effectively address this issue, improving vaccination rates and public health outcomes
Left Main Stem Disease on Coronary Angiography in Patients with Unstable Angina Presenting to Emergency Department of Hayatabad Medical Complex Peshawar
Get PDFABSTRACT
Objective: This study aimed to establish the prevalence of left main stem (LMS) disease during coronary angiography among patients arriving at the emergency department of Hayatabad Medical Complex, Peshawar, with unstable angina.
Methodology: An observational study was carried out at the Cardiology Department, MTI-HMC Peshawar, spanning from December 2022 to January 2024. A total of 150 individuals diagnosed with unstable angina were enrolled. Coronary angiography was conducted on all participants, with an LMS disease diagnosis based on stenosis in the LMS artery exceeding half the left main coronary artery's diameter.
Results: The patient cohort comprised 70.0% males and 30.0% females, with an average age of 52.1 years (±6.5). Among them, 23.3% exhibited left main stem disease during coronary angiography. No significant links were identified between LMS disease and age group (p=0.24), gender (p=0.28), smoking habits (p=0.49), or diabetes (p=0.84).
Conclusion: The research points out the substantial occurrence of LMS disease in individuals with unstable angina, signalling the necessity of prompt revascularization in this subgroup. Nonetheless, no noteworthy correlations were discerned between LMS disease and the assessed clinical parameters and risk factors. These discoveries underscore the imperative for further investigations into additional factors influencing LMS disease progression in those with unstable angina for improved coronary artery disease screening and management strategies
Health Impacts of Climate Change: Secondary School Teachers’ Beliefs and Their Understanding and Teaching Practices in Karachi, Pakistan
Get PDFObjective:
The objective of this cross-sectional study was to investigate the understanding, attitudes, and teaching practices of secondary school teachers in Karachi, Pakistan, regarding global climate change.
Methods:
A representative sample of 603 teachers was selected using a multistage sampling strategy. Data were collected through a standardized questionnaire administered by trained enumerators. The questionnaire assessed teachers' understanding of climate change, perceptions of its impacts, and engagement in environmentally sustainable practices. Demographic information such as age, gender, educational qualifications, marital status, and teaching experience was also collected.
Results:
The majority of respondents were female teachers from private schools, below the age of 35, and with less than five years of teaching experience. 89% of the teachers characterized their knowledge of climate change as limited or moderate. Only 11.3% considered their understanding sufficient or comprehensive. Over 80% of the teachers could identify the primary causes of climate change. The study also found a significant awareness of climate change impacts among the teachers, including extreme weather patterns, water scarcity, increased diseases, and elevated sea levels.
Conclusion:
The findings of this study indicate a lack of comprehensive knowledge among secondary school teachers in Karachi regarding global climate change. However, there is a high level of awareness about its impacts. These results highlight the need for improved climate literacy and education among teachers, particularly in integrating climate change topics into the curriculum. Effective adaptation and mitigation strategies require a better understanding of context-specific climate challenges.
 
A Unique Case of Heterotopic Pregnancy
No full textHeterotopic pregnancy, characterized by simultaneous intrauterine and extrauterine pregnancies, is a rare but potentially life-threatening condition. Its incidence has increased, attributed to factors such as pelvic inflammatory disease and assisted reproductive technologies. We present a case of spontaneous heterotopic pregnancy in a 28-year-old woman with lower abdominal pain. Initial examination revealed a ruptured left tubal ectopic pregnancy alongside a live intrauterine pregnancy. Prompt diagnosis via transvaginal ultrasonography led to emergency laparotomy, confirming sonographic findings. The ruptured ectopic pregnancy was successfully removed, preserving intrauterine gestation. Follow-up ultrasounds demonstrated a progressing intrauterine pregnancy. This case underscores the diagnostic challenges and emphasizes the importance of early recognition and intervention in heterotopic pregnancies, especially in the absence of predisposing risk factors. Increased awareness, thorough pelvic examination, and close follow-up are crucial for optimal outcomes in both pregnancies
Pyknodysostosis: A Challenging Diagnosis
No full textWe report a case of a 7-year-old boy presented to us with short stature, born at full term by SVD with an immediate cry and a birth weight of 03 kg, breast-fed for 2 years. There are no apparent signs of development delay. By the age of two, the mother was concerned about physical and developmental delays.
The patient had a male sibling with a history of repeated fractures and sensorineural hearing loss, labelled osteopetrosis.
EXAMINATION:
An active male child of 95cm and 12 kg falls below the 3rd centile.
He had frontal bossing, mildly hypoplastic maxillae, a wide open fontanelle, and sutural diastasis.
INVESTIGATIONS:
Complete Blood Count, Thyroid profile, Serum Calcium, Phosphorus and Alkaline Phosphatase. All normal.
A skeletal survey showed an increase in bone density. Sutural diastasis, multiple Wormian bones, thickening of the Calvaria, thickening of long bones with medullary sparing, and spool deformity of vertebral bodies.
DIFFERENTIAL DIAGNOSIS
Pyknodysostosis
Hypothyroidism
Osteopetrosis
CONCLUSION:
Additional X-rays, including the mandible, showed an obtuse angle, the clavicle was laterally deficient, and the hand showed acro osteolysis. The patient was diagnosed with a rare case of pyknodysostosis
Epidemiological Review on JN-1 Variant of COVID-19: An Emerging Global Threat
Get PDFThe emergence of the Omicron variant, also known as the JN 1 COVID-19 variant, has raised concerns worldwide. This review aims to comprehensively assess the influence, prevalence, and characteristics of the JN-1 variant. It includes a wide range of studies that investigate the effectiveness of vaccines, genetic factors, hospitalizations, and clinical outcomes associated with this variant. The pathophysiology of the JN 1 variant, which could have implications for clinical management and public health, is also discussed. The review addresses the recent increase in cases of the JN-1 variant in Asia and other heavily impacted regions, providing epidemiological evidence. The findings of this review article contribute to a better understanding of the JN-1 variant and its implications for global health