Journal of Islamabad Medical & Dental College
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Comparison of Vitamin B12 Deficiency Among Diabetics with Peripheral Neuropathy Taking Metformin Versus Non-Metformin Therapies
Full text linkObjectives: 1). To assess the frequency of low vitamin B12 levels in diabetics having peripheral neuropathy 2). To compare frequency of vitamin B12 deficiency among diabetics with peripheral neuropathy who are taking metformin Vs non-metformin therapies.
Methodology: This descriptive, cross-sectional study was conducted in the Medicine department POF hospital Wah, Pakistan from 1st march 2023 to 31st August 2023. A total number of 215 patients with diabetes mellitus aged 12-70 years of either gender who fulfilled the selection criteria were selected. The data was filled on the Proforma. Serum vitamin B12 was calculated by chemiluminescence immunoassay in the POF hospital laboratory
Results: Frequency of vitamin B-12 deficiency among diabetics presenting with peripheral neuropathy was 11.63%(n=25). Vitamin B-12 deficiency among diabetics on metformin was n=18(13.95%) and among diabetics on non-metformin therapy was n=07(8.14%). The p value was calculated that was 0.193, therefore statistically insignificant.
Conclusion: No significant difference in vitamin B12 levels was observed between diabetics on metformin and those on non-metformin therapies, suggesting that diabetic neuropathy itself is the primary contributor to peripheral neuropathy in these patients.
Keywords: Diabetes mellitus, Metformin, Vitamin B12 deficienc
Laproscopic Deroofing with Segmental Liver Resection for Hepatic Cyst. A Case Report
Full text linkBackground: Non-parasitic hepatic cysts are commonly benign lesions that are usually asymptomatic and discovered incidentally. However, large cysts or those causing symptoms may require surgical intervention. While laparoscopic deroofing is the standard minimally invasive approach, combining it with segmental liver resection offers a more definitive treatment in selected cases to reduce recurrence risk. Case Presentation: A 21 years-old female who presented with right upper quadrant discomfort and abdominal distension. Imaging revealed a large simple hepatic cyst occupying segments of the liver, without evidence of infection or malignancy. The patient underwent laparoscopic deroofing with segmental liver resection, performed under general anesthesia. The postoperative course was uneventful, and the patient was discharged on postoperative day 3 with complete symptom resolution. Histopathological analysis confirmed hyadit cyst Discussion: Laparoscopic management of hepatic cysts has become the preferred method due to reduced postoperative pain, shorter hospital stay and faster recovery. However, in cases where cysts occupy a significant portion of hepatic parenchyma or have a high recurrence potential, segmental resection along with deroofing provides a curative outcome. This approach ensures removal of the cyst wall adjoining hepatic tissue and prevents recurrence, while maintaining the benefits of minimally invasive surgery. Conclusion: Laparoscopic deroofing combined with segmental liver resection is a safe and effective treatment for large or recurrent hepatic cysts. It offers excellent postoperative outcomes, minimal complications, and a significantly reduced recurrence rate compared to deroofing alone.Keywords: Hepatic cyst, Laparoscopic deroofing, Minimally invasive surgery, Segmental liver resection
Early Diagnosis of Cesarean Site Ectopic Pregnancy: The Critical Role of Ultrasound in Preventing Complication
Full text linkCesarean scar ectopic pregnancy (CSP) is a rare type of ectopic pregnancy where the embryo implants on the cesarean scar from a prior surgery. We present a case of a 34-year-old woman, gravida 6, para 5, with history of five previous cesarean sections and uncontrolled type 2 diabetes. She presented with 8 weeks and 3 days of amenorrhea. Transabdominal and transvaginal ultrasound confirmed a viable gestation implanted in the anterior part of the lower uterine segment, within the cesarean scar region. Subsequently, laparotomy for excision of ectopic pregnancy was done. Gestational sac adherent to previous uterine scar was removed with all its membranes. Histopathology report confirmed the product of conception. Early diagnosis of cesarean scar ectopic pregnancy (CSP) via ultrasound is vital. Recognizing a gestational sac in the lower uterine segment helps guide timely treatment and prevent serious complications.
Key Words: Cesarean scar ectopic pregnancy (CSP), ultrasound diagnosis, laparotomy
Association of Unexplained Feeding Intolerance with Congenital Hypothyroidism in Preterm Neonates: A Missing Link
Full text linkObjective: This study investigates the association between unexplained feeding intolerance (FI) and congenitalhypothyroidism (CH) in otherwise healthy preterm neonates.Methodology: This descriptive study was conducted in the Neonatology Department, Fatima Memorial Hospital,Lahore to assess the association between thyroid function and feeding intolerance in 102 preterm neonates.Maternal, neonatal, and feeding variables were recorded, and data were analyzed using SPSS version 16.0. Categorical variables were expressed as frequencies and percentages, while continuous variables were summarized as mean ± SD or median (IQR) based on distribution. Fisher’s exact test, Student’s t-test, and Mann–Whitney U test were applied as appropriate.Results: Of the 102 preterm neonates with FI, 37.3% had CH. FI characteristics such as type of feed, time to establishfull feeding, and abdominal distention (isolated or combined with increased gastric residue or reflux) weresignificantly associated with hypothyroidism (p < 0.005). Significant risk factors for CH including APGAR score at 5minutes (p < 0.001), jaundice (p < 0.001), patent ductus arteriosus (p = 0.006), duration of hospital stay (p = 0.002),parity (p < 0.001), chorioamnionitis (p = 0.024) and antepartum hemorrhage (p = 0.002).Conclusion: Approximately one-third of preterm neonates with FI were diagnosed with hypothyroidism. Abdominaldistention, whether isolated or associated with increased gastric residue or reflux, was the most prominent featureof FI linked to CH. Parity, antepartum hemorrhage, chorioamnionitis, low APGAR scores, jaundice, and hsPDA, weresignificantly associated with CH.Key words: Abdominal Distention; Feeding Intolerance; Hypothyroidism; NICU; Prematurity; Reflux, vomitin
Comparison of Functional Outcome of Austin Moore Hemiarthroplasty VS Bipolar Hemiarthroplasty in Transcervical Femoral Neck Fractures in Elderly Population
Full text linkIntroduction: The most popular treatment for misplaced femoral neck fracture in the elderly is hemiarthroplasty.Unipolar and bipolar implants are the two types used in hemiarthroplasty. Different prostheses, such as Austin Moore, Thompson, and Bipolar prostheses, are employed based on the patient's mobility, neck, and bone stock in the medial buttress. Theoretically, bipolar prostheses prevent acetabular erosion by shifting weight to the inner bearing of the prosthesis, which in turn lessens the interaction between the prosthesis and acetabulum.Methodology: This cohort study was conducted by the orthopedic surgery department of Allied Hospital Faisalabadbetween January and June of 2025. Patients of both sexes with femur neck fractures of Garden Type III and GardenType IV who were between the ages of 50 and 70 were included. Patients with pathological fractures, those medicallyineligible for surgery, those with bilateral femur neck fractures, those who had undergone surgery on both the sameand opposite sides, and nonambulators were excluded. Patients were divided into two groups, Austin Moorehemiarthroplasty was done on patients in group A, while bipolar hemiarthroplasty was performed on patients ingroup B. The Haris Hip Score was used to determine the functional outcome both before and after surgery. It wasdetermined weekly for the first four weeks, then every two weeks for three months, and finally every month for sixmonths. An HHS of 90 or higher was considered exceptional, 80 to 89 good, 70 to 79 fair, and less than 70 bad.Results: The Harris hip scores for groups A and B in my study were 62.34 ± 7.32 and 63.42 ± 6.98 at baseline,respectively, and 89.43 ± 6.13 and 82.15 ± 7.45 at six months. 51.66% of patients in this study had outstandingtreatment outcomes from Austin Moore Hemiarthroplasty, 32.23% had good outcomes, 10.43% had acceptableoutcomes, and 5.69% had bad outcomes. 33.65% of patients who underwent bipolar hemiarthroplasty experiencedoutstanding results, 37.91% had good outcomes, 19.43% had fair outcomes, and 9.00% had bad outcomes.Conclusion: This study found that treating transcervical femoral neck fractures in elderly population withAustin Moore Hemiarthroplasty results in a better functional outcome than with Bipolar hemiarthroplasty.Keywords: Austin Moore Hemiarthroplasty; Bipolar Hemiarthroplasty; Femoral Neck Fractures; Harris HipScore; Outcome
Preoperative Thrombophilia Profile in Living Liver Donors from Pakistan
Full text linkObjective: To determine the frequency of thrombophilia disorders among healthy Pakistani liver transplant donors through extended thrombophilia screening.
Methodology: Descriptive, cross- sectional study was conducted at department of hematology, Shifa International Hospital, Islamabad from January 2020 to July 2024. A total of 362 living liver donors were selected who met the inclusion criteria. Blood samples were collected in sodium citrate tubes for extended thrombophilia screening which includes quantitative measurements of Protein C, Protein S, Antithrombin and Lupus anticoagulant. Data was analyzed using the Statistical Package for Social Sciences version 25.0.
Results: The frequency of thrombophilia markers was as follow: Protein C deficiency 5.2%, AT deficiency 13.8%, Protein S deficiency 18.8%. Lupus anticoagulant was positive in 1.4% of donors
Conclusion: Pre-operative thrombophilia profile in living liver donors from Pakistan revealed significant prevalence of hereditary thrombophilia markers within the donor population. Extended thrombophilia screening protocol for LLDs is essential for identifying at risk individuals guiding appropriate perioperative thromboprophylaxis and ultimately improving the safety of both donors and recipients undergoing LLDT
Key words: Living liver donors, Living Liver Donor Transplantation, Protein C, Protein S, Antithrombi
Long Term Outcomes of Cerebrospinal Fluid Leak Management in Paediatric Posterior Fossa Surgery
No full textObjective: To evaluate the long-term outcomes of CSF leak management in paediatric posterior fossa surgeries and to identify the effectiveness of various management strategies and their relationship with surgery types.
Methodology: A retrospective study was conducted from January 2023 to December 2023, involving 150 paediatric patients who underwent posterior fossa surgeries. Data on patient demographics, surgery type, CSF leak management strategies, and postoperative outcomes were collected from medical records. Statistical analysis included descriptive statistics and chi-square tests.
Results: The mean age of the patients was 10.2 ± 5.1 years, with 51% males and 49% females. The most common management strategies were lumbar drainage (37%) and duraplasty (28%). Tumour resections more frequently required revision surgery (24%) compared to Chiari malformation decompressions. A significant statistical association (p = 0.0286) was observed between surgery type and CSF leak management strategy. Outcomes showed that lumbar drainage had a higher incidence of recurrence (15%) and pseudomeningoceles (5%) compared to duraplasty, which had a 90% success rate in resolving CSF leaks.
Conclusion: Lumbar drainage and duraplasty are effective methods for managing CSF leaks in paediatric posterior fossa surgeries. Tailored management strategies based on surgery type are crucial for improving outcomes. The study provides local insights into CSF leak management in Pakistan and highlights the need for further research, including prospective and multicentre studies.
Keywords: Cerebrospinal fluid leak, Cranial fossa, Foass postrea CSF leak, Posterior fossa, Paediatric posterior, Paediatric
Comparison of Pleural Fluid Gene Xpert MTB/RIF Assay with Pleural Biopsy for The Evaluation of Pleural Tuberculosis
Full text linkObjective: To assess the efficacy of gene Xpert assay in comparison of Pleural biopsy to diagnose of pleural tuberculosis.Methodology: This study was conducted at PIMS/SZABMU, Islamabad, Adult population, both genders, aged between 14-70 years presented to hospital with complaints of fever, cough and exudative lymphocytic pleural effusion who were requested to enroll in the study. Included groups of positive and negative for Pleural tuberculosis underwent near neural biopsy using ABRAM's needle approach. SPSS (Statistical Package for Social Sciences) version 23, was used to analyze all of the data. For categorical variables such as gender, frequency and percentage were calculated. For continuous variables such as age, the mean +/- standard deviation was calculated.Results: A total of 190 patients were included in the study with mean age of 27.4 ± 4.8 years; The frequency of Pleural effusion site reported right sided effusion in 108 (56.8%) and left sided effusion in 82 (43.2%) of patients. The Gene xpert results were reported as positive in 55 (28.9%) and negative in 135 (71.1%) of patients; pleural biopsy was reported as positive in 77 (40.5%) and negative in 113 (59.5%) of patients. Correlation of pleural biopsy with gene Xpert results indicated 47 gene xpert patients with Pleural biopsy as positive and 8 as negative while gene xpert negative results were reported in 30 patients with pleural biopsy positive results and 105 negative results, p-value was estimated at 0.0007. Sensitivity was reported as 71.2%, specificity at 92.4%, PPV was 88.2%, NPV at 81.9% and Accuracy was 84.2% respectively.Conclusion: Mycobacterium TB can be accurately detected in patients with exudative pleural effusions using gene xpert analysis.Keywords: Myobacterium TB, Gene Xpert assay, Pleural effusion, Pleural Biops
Sonography and Magnetic Resonance Imaging for the Diagnosis of Adenomyosis: Comparison with Histopathology
Full text linkABSTRACT
Introduction: Modern magnetic resonance imaging (MRI) and transvaginal ultrasound techniques have significantly improved the ability to diagnose adenomyosis with a high level of accuracy. This enables healthcare professionals to administer customized treatments that target this specific disease condition.
Objectives: To assess the accuracy of sonography and MRI in identifying adenomyosis, with histopathology serving as the reference standard for comparison i.e. the gold standard.
Study Design: a cross-sectional validation design
Setting: The Department of Diagnostic Radiology/ Pathology, POF Hospital / Wah Medical College, Wah Cantt.
Duration of Study: From August, 2018, to August, 2019.
Subjects and Methods: The patients who underwent surgical treatment in the relevant department were included in the study. Tissue samples obtained from these patients were subjected to histopathological analysis, which was interpreted by a consultant pathologist. The sonographic and MRI findings were subsequently compared to the histopathology report for each patient.
Results: The mean age of the enrolled patients in the study was 38.3±5.5 years. Specificity, Sensitivity, negative predictive value, positive predictive value, and diagnostic accuracy of sonography and MRI was calculated by taking histopathology as gold standard and found to be 92.1%, 88.0%, 95.8%, 78.5%, and 91.0% respectively for sonography and 96.0%, 84.0%, 94.8%, 87.5%, and 93.0% respectively for MRI.
Conclusion: Sensitivity of sonography remained to be high as compared to MRI in present study while specificity and accuracy of MRI remained to be high from sonography. It is necessary to observe the unusual and usual characteristics of adenomyosis for further improvements in diagnostic outcomes
Comparison of Iron Bisglycinate to Iron Polymaltose for the Treatment of Iron Deficiency Anemia in Children
Full text linkAbstract:
Introduction: Different iron formulations are prescribed to correct iron deficiency anemia, however, there is a lack of head to head trials locally. Objective: To compare the efficacy of Iron Bisglycinate with Iron Polymaltose in treating iron deficiency anemia in children. Methodology: A parallel group randomized double blind study was carried out at Benazir Bhutto hospital from 1st July 2022 to 31st December 2022. A total of 132 children were enrolled. Participants were allocated 1:1 to either Group A or Group B. Group A was given iron bisglycinate and Group B received iron polymaltose. Patients were assessed at baseline and were followed up at 1 month and 3 months. At all these intervals hemoglobin levels, MCV, MCH, Serum ferritin and adverse effects were noted and outcomes were assessed. Results: The mean age of the patients in Group A versus B was 7±2.31 versus 6±2.33. The mean hemoglobin levels at baseline in Group A versus B was 9±0.48 versus 8.9±0.49 g/dl and at 3 months in Group A versus B was 10±0.43 versus 9.4±0.48 g/dl, respectively with p value of 0.000. The mean serum ferritin levels at baseline in Group A versus B was 9.1±1.31 versus 8.8±1.19 ng/ml and at 3 months was 29±5.65 ng/ml and in Group B was 23±1.87 ng/ml, respectively with p value of 0.000. Conclusion: In children with iron deficiency anemia, iron bisglycinate significantly increased hemoglobin, MCV, MCH and serum ferritin levels compared to iron polymaltose. Keywords: Anemia, Ferritin, Hemoglobin, Iron Bisglycinate, Iron Polymaltose, Iron Deficiency