Journal of Islamabad Medical & Dental College
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Primary Percutaneous Coronary Intervention and Left Ventricular Function Recovery in Acute Myocardial Infarction
Full text linkObjective: Arnold-Chiari malformation is congenital or acquired anomaly of the hindbrain that leads to crowding of the cerebellum and brainstem in the posterior cranial fossa. There is an interplay between syringomyelia and Arnold-Chiari malformation. The objective of this study was to analyse the incidence trends, morphological patterns, and clinical outcomes of Arnold-Chiari malformation with and without syringomyelia, focusing on patients treated at Hayatabad Medical Complex, Peshawar.
Methodology: This retrospective study was conducted on 150 patients from January 2023 to December 2023. Patients were divided into two groups: 75 with syringomyelia and 75 without syringomyelia. Key variables included tonsillar herniation, syrinx length, and surgical outcomes. Statistical analyses were done using t-test and chi-square test to assess relationship between variables, with a significance threshold of p<0.05.
Results: Patients with syringomyelia exhibited significantly higher tonsillar herniation (mean: 10.8 ± 2.3 mm) compared to those without syringomyelia (mean: 7.4 ± 1.9 mm) with p<0.001. Syrinx presence was significantly associated with surgical outcomes (p<0.05). Among patients with syrinx, those with improved surgical outcomes had a mean syrinx length of 18.6 ± 7.5 mm, while stable or unimproved cases exhibited larger syrinx lengths. A significant difference in surgical outcomes was noted between the groups, emphasizing the clinical impact of syrinx presence.
Conclusion: A strong association was found between syrinx presence and clinical outcomes in Arnold-Chiari malformation. Early diagnosis and timely intervention are critical for improved patient outcomes.
Keywords: Arnold-Chiari malformation, Surgical outcomes, Syringomyelia, Tonsillar herniatio
Affective Response of Parents of Newly Diagnosed Type-1 Diabetes Patients: An Experience from a Developing Country
Full text linkObjective: To analyze the affective response of parents of type 1diabetes children in a developing country like Pakistan.Methodology: One-year cross-sectional study, utilizing questionnaires, analyzed the economic and psychosocial aspects of newly diagnosed type 1 diabetes (T1D) parents, presenting in a tertiary care unit.Results: Seventy-nine parents were part of the study. The monthly family income of 82% parents was less than 50,000/- rupees. 78% parents felt shocked and depressed, 14% experienced guilt and 8% were in denial after diagnosis. 93% did not accept injectable insulin as first line of treatment and wanted to try other treatments like homeopathic medicine because of financial constraints, pen prick fear for monitoring blood glucose and insulin injections for treatment. 83% parents concern was affordability of glucose strips and insulin pens and asked for complete financial support for management of their type 1 daibetes child.Parents showed grave apprehensions about life expectancy and long-term medical complications. 81% were apprehensive about schooling, 8% about their marriage and 3% about future career and jobs. 69% parents asked about inheritance of the disease and chances in siblings.Conclusion: Parents are prone to psychosocial affects with depression being the most prevalent followed by guilt and denial. The most stressing aspects were injections and regular monitoring pricks fear. Affordability of monitoring strips and insulin pens was also a stressor along with schooling and physical activities.Key words: Affective response, Chronic illness, Insulin pens, Stress, T1D
Cerebral Diffusion Restriction Beyond Neoplasia: Radiological Patterns, Pitfalls, and Pearls. A Pictorial Review
No full textObjective: To highlight various non-proliferative causes and associated diffusion restriction patterns.Methodology: A collection of cases has been assembled depicting diffusion restriction on MR Brain imaging stemming from non-neoplastic intracranial pathologies.Results: Various causes were encountered including vascular (infarcts), infectious (abscess, empyema, viral infections), traumatic (hematoma), metabolic (inborn error of metabolism), toxic (carbon-monoxide toxicity) and demyelinating (tumefactive demyelinating disease).Conclusion: This detailed pictorial helps the radiologist in narrowing the differentials improving diagnostic precision.Keywords: Cerebral, MRI, Non-neoplastic, Restricted Diffusion
Repeated Malfunction of Shunt Contains Plethora of Surgical Procedures: The Institutional Based Study
Full text linkObjective: To highlight the course of management that patient went through with multiple episodes of shunt failure and its associated morbidity or mortalityMethodology: The patients were included who have repeated shunt failure by highlighting some arbitrary predictors. Patient was not followed but admitted again and again with active hydrocephalus in neurosurgical ward. The exclusion of patients, who have shunt exposed through natural orifices.Results: Total number of 31 patients were included and mostly 35.5% were less than 1 year & 35.5% were the age >10 and as the age increases, number of procedures also increases and outcome decreases (0.006). The cause of shunt placement was mainly hydrocephalus (61.3%) and 80.6% patients have right sided placement. 51.6% of shunts was performed in 2020 and mostly Indian shunt 83.9%. Surgical procedures include immediate removal of shunt (32.3%), revision of lower end (19.4%), revision of upper end (32.3%), external ventricular drainage (22.6%), endoscopic third ventriculostomy (41.9%), complete shunt revision (35.5%), externalization at lower end (22.6%), externalization at neck (22.6%) and placement of same shunt (25.8%).Conclusion: The problems that shunt holds not only include over-drainage or under drainage but it also creates ripples of events. Once the malfunction occurs; the sequence continuous to occur besides changing of hardware.Keywords: Hydrocephalus, Morbidity, Mortality, Shunt revision, Shunt malfunction
Asymmetric Tracheostomy Cuff Inflation Causing Air Leak and Inadequate Tidal Volume Delivery: A Case Report
Full text linkWe report a rare case of tracheostomy tube malfunction due to asymmetric cuff inflation, a complication scarcely discussed in medical literature and distinct from more commonly reported tracheostomy cuff herniation. This case highlights a less recognized cause of air leak and inadequate ventilation, contributing to the understanding of rare tracheostomy complications.A 71-year-old male, recovering from Ivor Lewis esophagectomy and requiring surgical tracheostomy for prolonged ventilatory support, presented with a persistent air leak and reduced tidal volume soon after tube placement. This occurred despite an adequate cuff pressure (28 cm H₂O) and confirmed correct tube positioning. Direct laryngoscopy revealed air escaping through the glottis with each delivered breath, with the tracheostomy cuff visibly intact and no herniation.The findings led to the diagnosis of asymmetric tracheostomy cuff inflation. The therapeutic intervention involved the replacement of the problematic tracheostomy tube with a new non-fenestrated tube. This intervention immediately and completely resolved the air leak and restored normal ventilation.This case underscores the importance of prompt recognition and considering asymmetric cuff inflation in the differential diagnosis of tracheostomy tube malfunction. Differentiating between tracheostomy cuff herniation and a merely asymmetric cuff is crucial for healthcare professionals to manage these situations effectively and in an evidence-based manner.Keywords: Airway Management, Critical Care, Tracheostomy
Evaluation of Frequency of Beta Thalassemia Trait Among Pregnant Females
No full textABSTRACT:
Objective: To determine the frequency of Beta thalassemia trait in pregnant females
Results: A total of 200 pregnant females, who presented for the first time in antenatal clinics of Shifa International Hospital were included in the study. 11% women were diagnosed as beta thalassemia trait, 29% had normal hemoglobin studies with concomitant iron deficiency anemia. 1.5% were diagnosed as cases of Hemoglobin-D trait, 1% as Hemoglobin-S trait and 0.5% as Hemoglobin-E trait. Among females, who were diagnosed with beta thalassemia trait,17.6% had cousin marriage and 12.5% had positive family history of thalassemia.
Conclusion: This study establishes, that the frequency of β-thalassemia trait amongst pregnant females was alarming (11%), highlighting the importance of routine screening in antenatal clinics.
A robust protocol for early identification of thalassemia carriers and to implement appropriate genetic counselling and management strategies is the need of the hour in a country like Pakistan showing highest birth rate.
 
Correlation of Various Anatomical Facial Landmarks with Inter-Canine Distance in Population of Northern Punjab
Full text linkBackground &amp; Objective: The optimal alignment of teeth and face proportion significantlycontributes to a balanced face appearance. Significant ethnic variations in anatomy have beenobserved, and incorporating these standard measurements in prosthodontic intervention cangreatly enhance outcomes. The study objective was to correlate various anatomical faciallandmarks, including intercanthal distance (ICD), interpupillary distance (IPD), and inter-alarwidth, with inter-canine distance (ICaD) in young adults from the northern Punjab population inPakistan, to assess the mesiodistal width of anterior maxillary teeth in edentulous patients.Methods: This prospective observational cross-section study was conducted at the Departmentof Anatomy and Prosthodontics of General Hospital, HBS Medical and Dental College,Islamabad, and Farooq Teaching Hospital, Akhtar Saeed Medical College, Rawalpindi, fromDecember 2022 to December 2023. A total of 600 healthy individuals aged between 18 and 26years were included. ICD, IPD, and inter-alar width were measured with a digital caliper havinga precision of 0.01 mm. A flat metal plate shaped like a &quot;T,&quot; known as the &quot;canine tip marker,&quot;was used to identify the tips of maxillary canines, which were then measured using a digitalcaliper. Data was analyzed using SPSS v 25, employing independent t-tests and ANOVA forstatistical evaluation.Results: The age of individuals was 24.98±4.5 years, with an equal male-to-female ratio of 1:1.The correlation was significant (p &lt; 0.001) between these anatomical landmarks and ICaD, withinter-alar width showing the strongest correlation (r = 0.640). The ANOVA test revealed thatmost individuals had less than 5% variability between actual and calculated ICaD values for allextraoral anatomical facial landmarks measurements, except for ICD.Conclusion: When selecting artificial teeth, it is important to consider a combination of variousfacial and oral factors. The regression equation can be effectively applied in selecting teeth toattain significant results.Keywords: Anatomy; Alar; Face; Intercanthal; Interpupillary; Inter-canine distance
The Impact of Dietary Nutrients and Antioxidants in Boosting Male Fertility: A comprehensive review
Full text linkVarious nutrients play a crucial role in enhancing reproductive health and have shown promise in mitigating and treating male infertility. Omega 3 fatty acids present in diets have been noted for their ability to boost sperm quality by maintaining the integrity of sperm membranes and the stability of mitochondria. Phytochemicals have also displayed a potential to improve sperm function and reduce damage caused by oxygen free radicals. Certain dietary phytochemicals uniquely influence sperm movement, mitochondrial function and seminal fluid quality with effects varying based on concentration levels.
Furthermore, nutrients and minerals play a role in minimising oxidative damage and enhancing sperm health by improving mitochondrial function. This review delves into how various dietary nutrients enhance mitochondrial function resulting in improved reproductive health and sperm function. Understanding how nutritional nutrients support sperm mitochondria and modulate epigenetic variables linked to sperm quality could pave the way for effective treatments, for male fertility issues by targeting mitochondrial function. It elucidates how different dietary nutrients promote functions to enhance sperm functionality and overall fertility.
Keywords: Dietary nutrients, Antioxidants, Male infertility, Sperm mitochondria
 
Association between Hemoglobin Levels and Severity of Coronary Artery Disease among Patients Presenting with ST- Segment Elevation Myocardial Infarction
Full text linkObjective: This study aimed to elucidate the association between hemoglobin levels (anemia) and the severity of coronary artery disease (CAD) among patients experiencing ST-segment elevation myocardial infarction (STEMI).
Methods: This prospective cohort study included patients aged 20 to 80 years presenting with STEMI to Liaquat National Hospital and Medicare General and Cardiac Hospitals between September 2023 and February 2024. Anemia was categorized as per the criteria defined by the World Health Organization based on hemoglobin levels. The severity of CAD was assessed based on the number of vessels affected and the Syntax Score system derived from coronary angiography.
Results: Results: Of the 228 patients, 122 were anemic based on hemoglobin levels. The Syntax Score was significantly higher in the anemic group compared to the non-anemic group (27.97±7.15 vs. 24.62±7.04, p<0.01). One-way ANOVA showed significant differences in mean Syntax Scores across anemia severity levels, with the severely anemic group having the highest scores (F(3, 224) = 4.310, p = 0.006). Logistic regression indicated that lower hemoglobin levels were significantly associated with higher CAD severity (β = -0.556, t = -2.284, p = 0.023), and male gender also correlated with higher Syntax Scores (β = 2.294, t = 2.165, p = 0.031). The ROC curve analysis revealed an area under the curve (AUC) of 0.537, indicating that hemoglobin alone is not a strong predictor of multivessel disease in this population.
Conclusion: Lower hemoglobin levels are significantly associated with increased severity of CAD in patients with STEMI, emphasizing the need for careful anemia management in CAD patients
Fabrication and Evaluation of Anti-Microbial Efficacy of Root Canal Sealer Using Moringa Oleifera Extract
Full text linkof different root canal sealers, new alternative agents are required. These new root canal sealers should ideally be easy to formulate as well as cost-efficient as well. In developing countries, healthcare products derived from natural/herbal sources are of common use. Moringa oleifera is a plant with reported antimicrobial properties. The extract of this plant can be easily formulated, within an economical range. Our study investigated the use of Moringa oleifera extract as a root canal sealer material by fabricating it and assessing its antimicrobial activity.
Objective: To fabricate a root canal sealer by using extract of Moringa Oleifera, evaluate and compare the antimicrobial activity with Endomethasone N.
Methodology: A new Moringa Oleifera extract (ME) mixture was made and characterization was done using SEM, FT-IR and UV-vis spectrophotometry. In order to evaluate antimicrobial activity, agar well diffusion method was used. The antimicrobial activity was measured by their zone of inhibition against Staphylococcus aureus (ATCC 6538) and Escherichia coli.
Results: The ME mixture exhibited a non-homogenous mixture with a range of particle size distribution. Further, it showed highest zone of inhibition (36.36 + 3.74 mm) against S.aureus in comparison to Endomethasone N.
Conclusion: The results of ME mixture were better than Endomethasone N in terms antimicrobial efficacy. It can be concluded that ME mixture would serve as a better replacement in place of other root canal sealers