Journal of Islamabad Medical & Dental College
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Assessing the Vitamin-D (Calciferol) Supplementation Impact on Glycemic Levels among Patients with Type-2 Diabetes (DM-2); A Quasi-Experimental Trial
Full text linkBackground: Calciferol has vital role in maintenance of glucose levels by its action on VDR receptors which are located on beta cells of the pancreas after that leading to the surge in insulin secretion as well as improvement of insulin sensitivity offered by an increased expression of insulin receptors
Objective: To determine the effect of Vitamin-D (calciferol) on the control of blood glucose (measured in terms of mean reduction of ≥1 in HbA1c) in calciferol deficient and insufficient diabetics, who have poorly controlled DM-2
Methodology: A Quasi-Experimental trial at the Department of Medicine, Fauji Foundation Hospital, Rawalpindi for 06 months was conducted after, meeting inclusion and exclusion criteria. 115 patients were enrolled and effect of calciferol on levels of blood glucose was assessed by measuring HbA1c levels, and pre-& post calciferol supplementation.
Results: Results showed mean of ages was 57.80 ± 7.64 years, 39(33.91%) patients were male and 76(66.09%) patients were females. On pre-intervention, the mean HbA1C of the patients who participated was 7.99 ± 0.48 while on post-intervention the mean HbA1C of the patients was 7.97 ± 0.48 (p-value=0.7523).
Conclusion: Effect of calciferol on glycemic control (measured in terms of mean reduction of ≥1 in HbA1c) in calciferol-deficient and insufficient diabetics was insignificant. Therefore, vitamin D supplementation appears to have no effect on blood glucose control in diabetes individuals who have low levels of calciferol—both inadequate and deficient—both of which are low.
Keywords: Calciferol (Vitamin-D), Levels of blood sugar, Poorly Controlled Type-2 Diabete
Diabetic Foot: Its Mode of Presentation and its Grades according to WIfI classification at A Tertiary Care Hospital
Full text linkAbstract
Background: Diabetes Mellitus (DM) is a prevalent metabolic disease that has a major impact on public health. One of the major side effects of diabetes is diabetic foot ulcers (DFU). Objective: To ascertain the method of presentation, analyze, and distribute the diabetic foot lesions in accordance with the WIfI classification of diabetic foot ulceration in a tertiary care hospital of Pakistan. Methodology: This cross sectional study was carried out at Department of General Surgery, Pakistan Institute of Medical Sciences Islamabad, from January to December 2022. All adult patients with DFUs were enrolled consecutively. Patients with healed foot ulcerations were excluded. Data regarding age, gender, duration of diabetes, co morbidities, severity of wound, ischemia, severity of infection was noted on a proforma according to WIfI classification. Results: A total of 76 patients presented with DFUs with mean age of 51.03±7.041 years, (range 40 - 70 years). There were 52(68.4%) males and 24(31.6%) females. The duration of diabetes was <5 years in 40(52.6%) followed by 5-10 years in 21(27.6%) patients. According to wound severity, 55(72.4%) patients presented with grade 2 (Deep Ulcer with exposed bone, joints or tendons) followed by 16 (21.1%) with grade 1 (Small Superficial Ulcer without gangrene). According to Ischemia, 44 (57.9%) patients presented with grade 1, 13(17.1%) presented with grade 2 and 19(25.0%) presented with grade 3. There is a significant association of severity of DFUs with age and duration of disease. Conclusion: Diabetic patients commonly present with grade 2 of DFUs followed by grade 1, while presentation with ischaemia were of grade 1.
Keywords: Diabetic Foot Ulcer, Diabetic Mellitus, WIfI classificatio
Persistent QTc Prolongation Due to Hypocalcemia from Hypoparathyroidism in a Heart Failure Patient: A Case Report
Full text linkThe QT interval on an electrocardiogram reflects ventricular depolarization and repolarization, with prolonged QTc indicating a defect in myocardial repolarization. This condition increases the risk of arrhythmias, torsade’s de pointes, and sudden cardiac death. We present the case of a 40-year-old female with heart failure and reduced ejection fraction who exhibited persistent QTc prolongation due to hypocalcemia resulting from hypoparathyroidism secondary to a thyroidectomy performed 15 years prior. Management included standard heart failure treatment alongside active vitamin D and calcium supplementation, leading to clinical improvement. This case underscores the importance of early identification and management of secondary causes of QTc prolongation in heart failure patients
Navigating Additional Canals in Mandibular Teeth: A Case Series
Full text linkMorphological variation exists in mandibular teeth. Thus, the clinician should be mindful of all the possibilities of variation. Following case series exhibit the variation of morphology in mandibular teeth within the Pakistani population reported at Operative and Endodontics Department of Islamabad Dental Hospital
Keywords: Canine teeth, Endodontics, Mandibular incisor, Premolar, Root canal morphology
Spontaneous Hepatic Hemorrhage Following Whipple’s Procedure: A Report of Two Cases.
Full text linkWhipple procedure, also known as pancreaticoduodenectomy, is a complex surgical operation performed for various pancreatic and periampullary pathologies. While the procedure has undergone significant refinements, it remains associated with significant morbidity and mortality.Spontaneous hepatic hemorrhage/ rupture is a rare but potentially life-threatening complication that has been reported in the literature.
We present two rare cases of spontaneous hepatic rupture following Whipple procedure. A 79-year-old male underwent Whipple procedure for periampullary carcinoma. On postoperative day 19, he suddenly developed epigastric pain, nausea and vomiting. Imaging revealed a spontaneous hepatic rupture. Similarly a 67 years old female for suspected periampullary underwent Whipple’s procedure. On postoperative day 14, she presented to emergency department with complaint of right hypochondrial pain, continuous in nature and severe in intensity and was also diagnosed with spontaneous hepatic rupture. Surprisingly, the early postoperative CT of both patients did not reveal any evidence of hepatic injury or hematoma and there was no history of trauma. Both the patients were managed conservatively and were vitally stable on discharge and follow up.
Keywords: Preiampullary Carcinoma, Spontaneous Hepatic Rupture, Subcapsular Hematoma, Whipple’s Procedure
Frequency of High Total Cholesterol to HDL Ratio with Acute Myocardial Infarction
Full text linkObjective: To evaluate the frequency of high total cholesterol/HDL ratio in patients with acute coronary syndrome who present with acute myocardial infarction.
Methodology: This Cross Sectional Study was conducted at POF Hospital wah cantt and a total of 100 patients who fulfilled the inclusion criteria and presented with acute myocardial infarction to the POF Hospital in Medicine department Wah cantt participated via non probability consecutive sampling. All patients underwent electrocardiography and the high sensitivity Troponin I levels were checked for confirmation of acute myocardial infarction. Once the diagnosis was confirmed, all patients underwent testing for serum total cholesterol, serum HDL levels and total cholesterol levels. The data were collected in a specially designed proforma.
Results: A total of 100 patients were included in our study and their mean age was 46.89±9.04 years. Forty-five patients out of total had high total cholesterol/HDL ratio. The stratification further revealed that high total cholesterol/HDL was more prevalent in females and those suffering from STEMI as compared to NSTEMI.
Conclusion: High total cholesterol/HDL ratio is common among patients presenting with acute MI and hence its utilization can be done as an important diagnostic tool for screening dyslipidemia, a major risk factor for atherosclerosis.
Keywords: Cholesterol, HDL, Lipoprotein, Myocardial infarction
 
Long-Term Outcomes of Fusion vs Non-Fusion Surgeries for Lumbar Spondylolisthesis
Full text linkObjectives: 1). To compare the long-term clinical, radiological, and functional outcomes of fusion and non-fusion surgeries for lumbar spondylolisthesis (LS), focusing on pain relief, disability reduction, and overall effectiveness of each approach.Methodology: This retrospective study was conducted at Hayatabad Medical Complex, Peshawar, from January to December 2023. A total of 100 patients (50 in the fusion group and 50 in the non-fusion group) were included. Pre- and post-operative pain (VAS for leg and back pain) and disability (ODI) scores were collected at 1, 6, and 12 months after surgery. Statistical analysis was performed using paired t-tests to assess the significance of differences between pre- and post-operative measures.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: Both fusion and non-fusion surgeries led to significant improvements in pain and disability. These results suggest that non-fusion surgery is a viable alternative to fusion for the treatment of LS, providing substantial benefits in terms of pain relief and functional outcomes.Keywords: Fusion surgery, Lumbar Spondylolisthesis (LS), Non-fusion surgery, Oswestry Disability Index (ODI)Visual Analog Scale (VAS)
Endocrine and Biochemical Dysregulation in Beta-Thalassemia: Pathophysiology and Biomarkers
Full text linkThis study assessed endocrine dysfunction in 34 transfusion-dependent beta-thalassemia patients (mean age 17.35±2 years) from Pakistan, where disease burden is high (5,000–9,000 annual births). All patients had severe iron overload (mean ferritin 12,617±4,959.63 ng/mL). Hormonal/metabolic profiling via CLIA revealed prevalent endocrinopathies, hypogonadism (67%) with male predominance (52% of total cohort), hypothyroidism (19%), and hypocalcemia/vitamin D deficiency (87%) (32.3% severe). Key correlations included strong LH-testosterone (r=0.924, p<0.001) and FSH-testosterone (r=0.634, p=0.004) associations, indicating primary gonadal failure, and an inverse fT4-calcium relationship (r=−0.366, p=0.043). Critically, ferritin showed no correlation with endocrine parameters (p>0.05). Findings highlight multifactorial endocrine complications beyond iron overload alone, underscoring the necessity for routine endocrine screening in thalassemia management
Frequency of In-Hospital Mortality In-Patients Presenting with Acute Heart Failure with Elevated Neutrophil to Lymphocyte Ratio at Tertiary Care Hospital, Karachi
Full text linkBackground: Patients admitted with acute heart failure (AHF) have in-hospital mortality rates of great concern, anda complex cascade of hemodynamic, neurohormonal, and inflammatory responses contribute to this. High NLR inhospital on admission could indicate the aggravated inflammatory state, which could result in poor clinical outcomes, such as increased in-hospital mortality.Methodology: A cross-sectional study targeted 135 patients with their admission causes being acute heart failure and elevated NLR ratio. The variables were collected; the age, gender, residence status, diabetes mellitus type II,hypertension, dyslipidemia, smoking status, obesity status, anemia status, and duration of heart failure. The patientswere monitored and assessed with in-hospital mortality. The control of the effect modifiers was done by stratificationand the post-stratification chi-square test/Fisher test was used with a p-value of 0.05 set as statistically significant.Results: Mean age of the participants was 55.14 ± 12.49 years, and the mean duration of heart failure was 18.72 ±10.24 hours. The mean BMI was 27.41 ± 2.56 kg/m², height was 158 ± 7.28 cm, weight was 78.7 ± 9.87 kg, and theneutrophil-to-lymphocyte ratio (NLR) was 2.21 ± 1.41. Among the participants, 74 (54.81%) were female and 61(45.19%) were male. In-hospital mortality occurred in 43 (31.9%) patients, while 92 (68.1%) survived duringhospitalization.Conclusion: NLR is a low-cost, simple-to-use clinical applicable value that forecasts prognosis in the short-term andclassifies the ri
William Campbell Syndrome as a Cause of Asymmetrical Bronchiectasis In a 10-Year-Old Child: A Case Report
Full text linkBackground: William Campbell Syndrome is a rare congenital disease of the bronchial cartilages involving the 4th to 6th generation of bronchial divisions with involvement of bilateral lungs. There is deficiency of bronchial cartilages resulting in dilated bronchi, with collapse of the distal lung. Diagnosis is by clinical and radiological findings. Case Presentation: A 10-year-old female child presented in OPD with fever, wheezing and productive cough. The patient has been taking treatment for past 1 year for asthma. Chest x-ray showed reduced left lung volume, with multiple infiltrates in the left mid and lower zones. Patient was referred for a CT scan which demonstrated segmental and subsegmental bronchiectasis in the bilateral lungs, asymmetrically. Expiratory / Inspiratory CT demonstrated a significant diminution in size of the involved bronchi. William Campbell Syndrome was proposed as the underlying etiology, after exclusion of common causes of bronchiectasis. Conclusion: Bronchiectasis in children is often underdiagnosed and undertreated. When young patients present with recurrent infections, the underlying cause is important to elucidate for the management of the patient and for improving life quality and expectancy. William Campbell syndrome is a rare cause of congenital bronchiectasis due to deficient bronchial cartilage. Diagnosis in our patient was made by history, imaging and exclusion of other causes of bronchiectasis. Keywords: Bronchiectasis, High Resolution Computed Tomography Chest (HRCT Chest), William Campbell Syndrome (WCS)