Journal of Islamabad Medical & Dental College
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Association between Nonalcoholic Fatty Liver Disease Severity Assessed by Fibroscan and Atherosclerotic Cardiovascular Disease Risk Score
Full text linkObjective: The purpose of this study was to investigate the association between the 10-year atherosclerotic cardiovascular disease (ASCVD) risk score and the severity of nonalcoholic fatty liver disease (NAFLD), as determined by Fibroscan.Methodology: Patients with NAFLD who had Fibroscan to measure liver stiffness and steatosis presenting at the cardiology department of Liaquat National Hospital in Karachi, Pakistan were included in this cross-sectional investigation. Lipid profiles, waist circumference, liver enzyme levels, and 10-year ASCVD risk scores were among the demographic, clinical, and biochemical data gathered.Results: Of the 217 patients in the study, 62.2% had steatosis, and 99.1% were obese, indicating significant prevalence of liver disease and metabolic disorders. Most were older than 45 (75.1%) and female (62.2%). Low risk for ASCVD was 42.9%, moderate risk was 30.4%, intermediate risk was 11.5%, and high risk was 15.2%. Significant risk variables for ASCVD included advanced liver fibrosis (p<0.05), higher blood cholesterol (p<0.01), older age (p<0.01), and the LDL to HDL ratio (p<0.01). Males dominated higher ASCVD risk categories (p<0.001), and the high-risk group had the highest prevalence of dyslipidemia, especially with metabolic syndrome (p<0.001). There was a significant correlation between ASCVD risk and NAFLD severity as determined by fibroscopy (p=0.035).Conclusion: In conclusion, the study demonstrates a strong association between advanced NAFLD and increased ASCVD risk. Key risk factors, including age, serum cholesterol, LDL to HDL ratio, and liver fibrosis severity, were significantly linked to higher ASCVD risk (p<0.05). Males and individuals with dyslipidemia, particularly those with metabolic syndrome, were more likely to be at higher risk.Keywords: Atherosclerosis, Cardiovascular Risk, Liver Fibrosis, Metabolic Syndrome, Nonalcoholic Fatty Liver Disease (NAFLD)
A Need for More Clinical Trials to Study the Emerging Effect of Herbal Nano-Drugs in Treatment of Ulcerative Colitis.
No full textDear Editor,
Ulcerative colitis (UC) is a chronic inflammatory condition of the colon, marked by recurring flare-ups and remission. It can lead to complications such as bleeding, colon perforation, and a higher risk of colorectal cancer (CRC). A Scandinavian cohort study found that individuals with UC had a 1.66 times greater risk of developing CRC, and those with both UC and CRC faced a 1.59 times higher mortality risk than CRC patients without UC. Ulcerative colitis (UC) arises from complex interactions among genetic factors, immune dysfunction, environmental triggers, and gut microbiota changes. Treatments include 5-aminosalicylic acids, corticosteroids, immunosuppressants, and biologics. Despite these options, 10–20% of patients eventually require proctocolectomy due to treatment resistance, with ongoing risks of side effects. Recent studies using mouse models have shown encouraging results with probiotics and herbal treatments such as curcumin, saffron, and Lactobacillus. Chao Wu et al. demonstrated that dextran sulfate-coated curcumin nanocrystals enhance drug solubility and efficacy, while reducing inflammation and oxidative stress in ulcerative colitis. Similarly, research by Demin Cai et al. found that the probiotic Lactobacillus johnsonii alleviates intestinal inflammation and restores the Treg/Th17 balance in a dextran sulfate sodium-induced colitis model. Saffron, known as the "Golden Spice," has shown promising effects in treating ulcerative colitis without reported side effects. It has high bioavailability, anti-inflammatory, and anti-carcinogenic properties. Studies indicate it reduces inflammation by modulating immune responses and acts through Ahr/Nrf2 pathways in experimental models.
There’s a clear need for more clinical research into probiotic and herbal treatments using nanocrystal technology for ulcerative colitis. So far, only one human trial has looked at saffron, six at curcumin, and three at Lactobacillus in UC patients. Given their strong bioavailability and promising early results, these nanoformulations could offer a safer and faster-acting alternative to current treatments, but larger-scale studies are essential to fully understand their potential
Effectiveness of Functional Endoscopic Sinus Surgery (FESS) in Improving Nasal Symptoms in Patients having Chronic Rhinosinusitis with Nasal Polyps (CRSWNP)
Full text linkObjective: To evaluate the effectiveness of FESS in ameliorating preoperative nasal symptoms attributable to CRS when compared with the postoperative period, particularly within a 30-day timeframe.Methodology: A prospective observational study was conducted at the Department of Otorhinolaryngology, Dow University of Health Sciences/Civil Hospital Karachi, from January 1st, 2022, to June 30th, 2022. A cohort of 149 eligible patients participated in the study, completing the SNOT-22 questionnaire 48 hours preoperatively and 30 days postoperatively. Efficacy was assessed through improvements in postoperative nasal symptoms, quantified using SNOT-22 scores.Results: Of the 149 patients enrolled, 121 were male and 28 were female. Significant associations were observed between preoperative and postoperative SNOT-22 scores (p-value 0.036), with notable correlations found regarding unemployment, positive family history of allergy, and patients aged 15-35 years, all demonstrating significant reduction in nasal symptoms postoperatively.Conclusion: FESS emerged as highly efficacious in managing CRSwNP symptoms, with notable enhancements in postoperative nasal symptoms and overall quality of life. Furthermore, positive outcomes were particularly pronounced among patients with a family history of nasal allergy, individuals within the younger age group, and those unemployed.Key words: Chronic rhinosinusitis, Functional endoscopic sinus surgery, Nasal polyps, Nasal symptoms, Rhinosinusitis
Association of Calcium and Vitamin D Supplementation with Dental Fluorosis among Adults in Peshawar, Pakistan
Full text linkObjective: To evaluate the association between calcium and vitamin D supplementation and the prevalence of dental fluorosis among adults in Peshawar, Pakistan.Methodology: This cross-sectional study was conducted over two months in Peshawar, Pakistan. Based on its prevalence in the area, a total of 370 participants, recruited from Hayatabad Medical Complex, Peshawar, were evaluated. Detailed history was taken from them according to a preformed history Performa. Participants were examined to check the presence of dental fluorosis. Subsequently, they were divided into two equal groups: Group A (calcium and vitamin D supplement user), and Group B, (not taking any calcium and vitamin D supplements). Data collected was analyzed by IBM SPSS Statistics software, version 22.Results: Out of the total 370 patients, 195 (52.7%) indicated signs of fluorosis which included white opaque spots, yellow to brown discoloration, and chalky enamel appearance. 65 patients in group A and 130 patients in group B were found to be exhibiting dental fluorosis. The association between supplement use and fluorosis prevalence was statistically significant (p < 0.001). A relative risk reduction of 50% was observed among supplement users compared to non-users.Conclusion: The findings indicate a significant association between calcium and vitamin D supplementation and a lower prevalence of dental fluorosis in adults. However, the cross-sectional design of the study limits us in establishing the causal relationships. Further longitudinal or interventional studies are recommended to explore this association in greater depth.Keywords: Adults, Calcium, Cross-sectional studies, Dental fluorosis, Vitamin
Long-term Outcomes and Recurrence Rates in Mahaim Tachycardia Post-Ablation
Full text linkObjective: To evaluate the long-term outcomes and recurrence rates of Mahaim tachycardia post-radiofrequency catheter ablation in patients treated at the Cardiology Department of Hayatabad Medical Complex, Peshawar.
Methodology: This retrospective study was conducted involving 170 patients with Mahaim tachycardia who underwent radiofrequency catheter ablation between June 2017 and July 2024. Patient demographics, procedural details, complications, and long-term follow-up data were analyzed. The primary outcome was the recurrence rate of Mahaim tachycardia, while secondary outcomes included procedural success, complications, and overall survival.
Results: The mean age of the patient population was 44.1 years, with 55.3% of patients being male. Hypertension and diabetes were present in 22.9% and 21.8% of patients, respectively. The mean fluoroscopy and ablation times were 19.8 and 9.9 minutes, respectively. Procedural success was achieved in 78.2% of patients, with a complication rate of 12.9%. Over a median follow-up of 40.6 months, the recurrence rate was 21.8%, and the survival rate was 79.4%. The Kaplan-Meier survival analysis showed a high survival probability, with 95.8% at 12 months and 88.6% at 36 months.
Conclusion: Radiofrequency catheter ablation is a very successful and safe therapy for Mahaim tachycardia, offering substantial long-term advantages while maintaining tolerable rates of complications. Despite a recurrence rate of 21.8%, the procedure offers favorable long-term outcomes, reinforcing its use as a preferred treatment modality. Future studies should focus on advanced techniques to further improve success and reduce recurrence rates.
Keywords: Catheter ablation, Long-term outcomes, Mahaim tachycardia, Recurrence rates, Survival analysi
Clinical Spectrum of Black Stone Poisoning in Paediatrics; An Experience in a Tertiary Care Hospital
Full text linkObjective: This study was designed to document the clinical presentation, laboratory findings, complications, and outcomes of black stone poisoning in pediatric patients.
Methodology: This retrospective study was conducted on 58 children under 15 years of age, with moderate to severe black stone poisoning, having moderate to severe symptoms, requiring ICU care, and thus admitted in Pediatric Intensive Care Unit of Children’s Hospital Lahore. The study duration was between May 2019 to September 2023. Data included demographics, clinical features, lab results, and treatment strategies.
Results: Among total of 58 children, 38 % were female and 62 % were male, with most frequent age 1 to 5 years. Symptoms appeared within 1 to 2 hours of ingestion, with most patients seeking care within 3 to 6 hours. Common symptoms included facial swelling (100%), neck swelling (96.6%) and difficulty in breathing (79.3%). Complications included angioedema (97%), cola-colored urine (100%), metabolic acidosis (86%), ARDS (5.2%), hepatitis (10.3%), and shock (62.15%). The mortality rate was 7%.
Conclusion: Black stone poisoning in children is severe, requiring supportive care, early airway intervention, and renal replacement therapy. Public education on the dangers of Paraphenylenediamine and improved management strategies are essential.
Keywords: Acute Kidney Injury, Angiodema, Black Stone, Paraphenylenediamine, Pediatric Poisoning, Respiratory Distres
The Protective Effect of Different Doses of Zinc Sulfate and Silymarin Combination against Anti-Tuberculosis Drug Induced Toxicity
No full textObjective: To induce hepatotoxicity with Rifampin and INH in albino rats, to estimate histoprotective effect of combination of ZnSO4 and Silymarin.
Methodology: The 'Animal Experimental Study' was carried out of 14 days’ duration (starting from day 0-13). A sample size of 28 healthy albino wistar rats were taken and divided into four equal groups (A, B, C and D). Group A was normal control and was given water once a day orally for 14 days. Group B was toxic control and was given INH+ RIF combination (50 and 100 mg/kg/day respectively). Liver protection of combination of ZnSO4 + Silymarin was evaluated at different doses against combination of Isoniazid and Rifampicin induced damage in group C and D. INH+ RIF combination (50 and 100 mg/kg/day respectively) was used to induce liver toxicity in Group B, C and D. Combination effect of regenerative agents (Silymarin + ZnSO4 (100 + 3.5mg /kg/day respectively) and (200 + 7mg /kg/day respectively) was analyzed in Group C + D respectively by measuring liver function profile (ALT, ALK PO4, AST, Total bilirubin).
Results: There was significant elevation of all parameters in Group B, showing liver damage. The level of liver enzymes and total bilirubin was significantly decreased on 13th day (p-value ***< 0.0001) in Group C and D. Comparing Group C, Group D values of only ALT parameter showed significant difference while rest of the parameters did not show any significant difference. A mathematical decrease in AST, ALK PO4, and total bilirubin is evident between Group C and Group D.
Conclusion: The present study has shown the hepatoprotective effect of ZnSO4, SM and their combination in half and full doses as evidenced by improvement in liver function profile (ALT, ALK PO4, AST, Total bilirubin).
Keywords: Albion rats, Hepato-protection, Isoniazid (INH), Liver profile, Liver toxicity Rifampin (RIF), Zinc sulfat
Demographics and Dynamics of Burn Surgeries: A Comprehensive Five-Year Review
Full text linkObjective: To evaluate the epidemiology and outcomes of surgical interventions for burn patients at a major tertiary care center in Karachi, Pakistan, to identify trends, demographic patterns, and clinical practices in burn management.Methodology: The study was conducted at the Burn Center of Dr. Ruth K.M. Pfau Civil Hospital Karachi from January 2019 to December 2023. Data from 13,803 surgical procedures performed over five years were analyzed to assess procedural trends, patient demographics, and treatment outcomes.Results: A total of 13,803 procedures were performed over five years, demonstrating a general upward trend in surgical activity. The most common procedures included Change of Dressing (29.1–40.2%), Debridement (34.3–43.7%), and Split Skin Grafts (up to 15.5%). Specialized procedures like Release of Contracture and Flap Coverage increased significantly, reflecting evolving clinical practices. Gender analysis revealed higher rates of complex surgeries in males, while females underwent more wound care procedures.The findings highlight key demographic patterns, with young adults (18–30 years) and children being the most affected groups. Seasonal trends and annual variations in procedural volume were also observed. Compared to high-income countries, the Karachi Burn Center focuses on cost-effective wound management, emphasizing early interventions to mitigate complications like amputations and contractures.Conclusion: The findings highlight key patterns in burn care within a resource-limited setting, providing valuable insights for improving clinical protocols and resource allocation. Further research is needed to enhance burn epidemiology data and expand access to specialized surgical care in Pakistan.Keywords: Burns, Epidemiology, Outcomes, Surgery, Treatmen
Evaluation of Physical Properties of Moringa Oleifera-Based Root Canal Sealer- An In Vitro Comparative Study
No full textObjective: To evaluate physical properties of a mixture made by using Moringa Oleifera extract and compare it with Endomethasone N for its use as an endodontic sealer.
Methodology: A total of 60 samples of (Moringa Oleifera mixture) ME mixture and Endomethasone N were used and divided into six groups in order to investigate flow, working time, setting time, pH and solubility. These physical properties were tested according to International Standards Organization 6876/2001. T-test was applied and p-value was set at 0.05 in this in vitro analysis.
Results: The ME mixture displayed higher pH values for fresh (9.56 + 0.04) and set (8.87 + 0.10) samples at all time intervals (p < 0.05). It also showed better flow (21.15 + 1.21mm) and solubility (0.73 % + 0.5) when compared with Endomethasone N.
Conclusion: The results indicated better physical properties of ME mixture when compared with Endomethasone N so, ME mixture can serve as a better alternative to other endodontic sealers.
Keywords: Endodontics, Moringa oleifera, Physical properties, Root canal seale
Vitamin D Supplements as a Valuable Adjunctive Treatment Option for Irritable Bowel Syndrome
Full text linkObjective: To assess the efficacy of vitamin D supplementation on IBS severity.Methodology: This study was conducted at the Department of Medicine, Pakistan Institute of Medical Sciences (PIMS), Islamabad, from August 2022 to August 2024. A total of 152 participants aged 18–65 years diagnosed with irritable bowel syndrome (Rome IV criteria) and vitamin D deficiency (<20 ng/ml) were enrolled. Participants were allocated into two groups: Group A (cases, n= 76) received vitamin D supplementation for 1 month alongside standard care, while Group B (controls, n = 76) received standard care alone. The Irritable Bowel Symptom Severity Score (IBS) and serum vitamin D levels were measured at baseline, 4 weeks, and 12 weeks. Statistical analysis was performed using SPSS v23, with a p-value ≤0.05 considered significant.Results: Total 152 patients were included in the study with mean age of 32.7 ± 5.8 years; gender distribution indicated 61(40.1%) male participants and 91(59.8%) female participants. Comparative analysis of pre and post treatment was reported for IBSSSS mean value and Vitamin D values, the pre-treatment IBSSS in group A was 245.8 ± 21.8 while post treatment was 152.1 ± 16.2 with p-value of 0.015, Vitamin D was reported as 15.9 ± 1.23 in pre-treatment while 38.2 ± 1.24 as post treatment in group A, with p-value of 0.007. The elevated vitamin D after Treatment and declined IBSSSS was reported in group A. Conclusion: Vitamin D supplementation is a valuable adjunctive treatment option for IBS patients, especially with vitamin D deficiency.Keywords: GI disorders, Irritable bowel syndrome, Supplementation, Vitamin D deficienc