Journal of Bahria University Medical and Dental College

Laser L ight I nduced R etinopathy in a Young Boy: A Case Report from Eye Care Hospital, Karachi

Mazhar Awan — 2024-10-08

A case report of a 14 year-old-boy who came with a history of direct gazing to laser pointer at Khairun'nisa Eye Hospital, Karachi. A comprehensive eye examination including Slit lamp biomicroscopy, Fundoscopy, optical coherence tomography and Fundus photography was done. Main outcome measure were right eye foveal scarring with normal periphery. Fundoscopy showed right Eye old scar at fovea, exactly like solar retinopathy. Solar retinopathy is a type of retinopathy which is caused by directly looking at sunlight. In this report we are presenting the classical case of retinopathy exactly like solar retinopathy due to gazing directly at laser light for a long period of time.

Dental Decay Dilemma: Addressing Caries in Pakistan's Population

Mehwash Kashif — 2024-10-08

Maintaining good oral health is essential for general wellbeing since it affects a person's comfort level when speaking, eating, and interacting with others. It affects systemic health as well as the condition of the teeth, gums, and oral tissues. Maintaining good oral hygiene reduces the risk of systemic illnesses like diabetes and cardiovascular disease in addition to common dental problems like cavities and gum disease.

Next-Gen Rehab: VR & AI Revolutionize Physiotherapy

Alishba Eman — 2024-10-08

The integration of Virtual Reality (VR) and Artificial Intelligence (AI) in healthcare can significantly improve patient outcomes, particularly in physiotherapy. Combining VR and AI enhances accuracy and personalization in physiotherapy, ushering in a new era of patient centered rehabilitation. VR and AR use input devices to gather data on body position, movement, and the environment, and output devices to deliver sensory feedback, including visuals, vibrations, and sounds.1

Immunohistochemical Expression of ROS1 in invasive ductal carcinoma of breast in association with hormonal receptor status and Her2Neu expression

Muhammad Umair — 2024-10-08

Objective: To determine the frequency of immunohistochemical expression of ROS1 in invasive ductal carcinoma of the breast in relation to hormonal receptor status and HER2 expression.

Study Design and Setting: Descriptive cross-sectional study. Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi from May 2022 to Dec 2022.

Methodology: This study was conducted on a sample size comprising 137 patients diagnosed with invasive breast carcinoma (ductal carcinoma) on histopathological biopsy specimen. Immunohistochemistry was performed using ROS1, estrogen receptor, progesterone receptor and HER2 antibodies on patients’ tissue samples. Results were interpreted by two independent histopathologists. Finally data was analyzed using SPSS version 25.

Results: The mean age of sample population was 50.85 ± 12.17 years. 131 patients were women and 6 were men. ROS1 was positive in 54 cases. ROS1 shows weak staining in 41 cases and moderate to strong staining in 13 cases. ER and PR showed no significant statistical correlation with ROS1 expression. HER2 was positive in 37 cases, equivocal in 11 cases and negative in 89 cases. A significant statistical correlation was seen between ROS1 and HER2 as 23 of HER2 positive cases showed ROS1 expression (p=<0.001).

Conclusion: Significant number of ROS1 expressing cases in invasive breast carcinoma can be more revealing in the understanding of pathogenesis of breast carcinoma. In addition, it can also lead to use of certain recent tyrosine kinase inhibitors for treatment of this most common carcinoma in females.

Long Term Outcomes of Pain, Disability and Quality of Life in Open vs Minimally Invasive Surgery of Transforaminal Lumbar Interbody Fusion

Aman Ullah Khan — 2024-10-08

Objective: This study aims to evaluate the short- and long-term outcomes—specifically in terms of pain, disability, and quality of life—between minimally invasive surgery (MIS) and open transforaminal lumbar interbody fusion (TLIF) for treating lumbar spondylolisthesis.

Study Design and Setting: A prospective cohort study was carried out at Liaquat National Hospital & Medical College, Karachi, and a teaching institution in South Asia. The study included patients with chronic back pain for over three months, unresponsive to medical treatment or accompanied by radicular symptoms, with MRI-confirmed grade I and II degenerative lumbar spondylolisthesis, lateral recess stenosis, and unilateral disc herniation. Patients with spinal metastasis, previous surgeries, inflammatory arthritis, or metabolic bone diseases were excluded.

Methodology: The outcomes of MIS-TLIF and open-TLIF were assessed using the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and SF-36 quality of life scores at 1, 6, and 24 months postoperatively.

Results: Among 93 patients, 35 underwent open-TLIF and 58 received MIS-TLIF. MIS-TLIF resulted in significantly less blood loss and faster recovery. At four weeks, the MIS group had lower VAS and ODI scores, and higher SF-36 scores. Similar trends continued at six months, with improvements in ODI and SF-36. By 24 months, the MIS group maintained lower ODI scores, though VAS and SF-36 scores were comparable.

Conclusion: MIS-TLIF shows superior outcomes, especially in the early postoperative phase, with reduced morbidity and improved quality of life, making it a preferable option in resource-limited settings.

Association of pre-op TSH levels with Thyroid Carcinoma in a Tertiary Care Setup in Karachi, Pakistan

Tehmina Junaid — 2024-10-08

Objectives: This study aimed to explore the relationship between pre-operative TSH levels and the presence of thyroid cancer in patients with nodular thyroid disease in the Pakistani population, using data gathered from patients treated at Dr. Ruth K. M. Pfau Civil Hospital Karachi.

Study Design & Setting: A cross-sectional study was conducted at the Dow University of Health Sciences and Dr. Ruth K. M. Pfau Civil Hospital Karachi from January 2022 to December 2022.

Methodology: Patients with thyroid swellings (presenting with either solitary nodules or with multinodular goiter), both benign as well as suspected/confirmed malignancy based on FNAC results were recruited in the study. Preoperative TSH levels, along with other clinical data, were collected. Thyroidectomy was carried out in patients fulfilling the criteria for surgery, with specimens sent for histopathology. An independent t-test was used to compare TSH levels between malignant and benign nodules.

Results: A total of 82 patients were enrolled. Malignancy was confirmed in 41.5% (25 papillary carcinoma, 9 follicular carcinoma). Significantly higher mean TSH levels were observed in patients with malignant nodules (4.76 IU/mL) compared to those with benign nodules (2.48 IU/mL) (p < 0.001).

Conclusion: This study suggests a potential association between elevated pre-operative TSH levels and thyroid cancer in the Pakistani population. These findings warrant further investigation to explore causality and potential underlying mechanisms. The study highlights the value of TSH monitoring, particularly in resource-constrained settings.

Efficacy of Laparoscopic-Assisted Subcostal Transversus Abdominis Plane (TAP) Block: A Double-Blind, Randomized Controlled Trial

Sadaf Ishaque — 2024-10-08

Objective: To analyze efficacy of laparoscopic administered Transversus Abdominis Plane (TAP) block on pain scores and opioid consumption in the first 24 hours in patients undergoing laparoscopic cholecystectomy. Study design and setting: The randomized, double-blinded trial was conducted in surgical unit, Shalamar Medical & Dental College Lahore from September 2019 to March 2020. Methodology: 100 patients of either gender scheduled for elective laparoscopic cholecystectomy were included using consecutive probability sampling method. After informed consent, patients were randomized into Intervention TAP GroupA and Control Group-B. Intervention TAP Group-A received laparoscopic aided TAP block with 20ml 0.5% Ropivacaine in subcostal region while Control Group-B received 20ml saline solution which was used as placebo. Both groups received paracetamol 1gm intravenous eight-hourly and Ketorolac 30mg intravenous 12-hourly. Nalbuphine 5mg intravenous was administered as “rescue analgesic” in patients having pain score of four or above. Postoperative pain scores at rest and on coughing were documented using numerical rating scores (VAS) at 2, 4, 6, 12, and 24 hours. Results: There was a significant difference (p-value=0.038, 0.000, 0.025, 0.000, 0.000) in pain scores over the first 24 hours postoperatively in laparoscopically assisted Intervention TAP Group-A. The total nalbuphine consumption was significantly reduced in Intervention TAP Group-A as compared to Control Group-B. Conclusions: Laparoscopic administered TAP block significantly reduced postoperative pain and total opioid consumption following laparoscopic cholecystectomy

Analysis of Cesarean Section Rates Using Robson Ten Group Classification System in A Tertiary Care Hospital of Peshawar: A Cross-Sectional Study

Maimoona Qadir — 2024-10-08

Objective: To observe CS rates and assess them using Robson's Ten Groups Categorization System in a government tertiary medical facility in Peshawar, Pakistan

Study Design and Setting: From 1st March to 31st August 2023, a cross-sectional study was carried out at the Khyber Teaching Hospital’s department of obstetrics and gynecology in Peshawar, Pakistan

Methodology:. The research cohort consisted of 1250 women with CS who were hospitalized throughout the specified study period. Information on maternal features and pregnancy-related details was collected for every patient.

Results: 4227 women sought labor and delivery services during the course of the research. It was discovered that the CS rate was 29.5%. Most common were Groups 1 (7.57%), 3 (8.65%), and 5 (54.66%), which together accounted for around 69% of all CS occurrences. Group 5's CS rate was 80.7%, but subgroup 5.1's (previous CS) women experienced repeat CS at a rate of 65.14%. 95% babies were alive and 5% were stillborns.

Conclusion: Noticeable raise in the caesarean deliveries rate, leading to substantial worse influence in terms of health, finances, and society. Previous CS is the most prevalent sign of CS.CS if performed on primigravidae with a valid indication, the rate of CS may be managed.

Immunohistochemical Expression of Cyclin D1 in Invasive Breast Carcinoma

Tabish Hassan — 2024-10-08

Objective: This study was conducted to determine the immunohistochemical expression of cyclin D1 in invasive breast carcinoma and its association with already established prognostic parameters like estrogen receptor (ER), progesterone receptor (PR), HER2/Neu, and Ki67 status.

Study Design & Setting: Cross sectional Observational. Department of Pathology, Armed Forces Institute of Pathology, Rawalpindi

Methodology: The study included 350 cases of invasive breast cancer diagnosed between January 2023 and December 2023. Data collected included patient age, histological subtype, molecular subtypes, tumor size, and the presence of estrogen (ER) and progesterone (PR) receptors, as well as HER2/Neu and Ki67 status. Patients who had undergone chemotherapy, received radiation to the breasts, or experienced relapse were excluded from the study. Immunohistochemistry was conducted using a Cyclin D1 antibody to assess Cyclin D1 expression in tissue samples. The expression levels were categorized as negative, weak, moderate, strong staining in tumor cells. Data analysis was performed using SPSS 29.0, and statistical comparisons were made between Cyclin D1 staining and ER, PR, HER2/Neu, and Ki67 status.

Results: Cyclin D1 moderate to strong staining was seen in 173/352 (49.14%) cases of invasive BC. Cyclin D1 expression was slightly statistically significantly associated with ER (x2 = 7.78, P value <0.051) and Ki67 positivity (÷2 = 7.27, P value <0.064).

Conclusion: Cyclin D1 has the potential to serve as a prognostic marker. Incorporating it into the routine IHC workup for breast cancer could enhance patient management, especially with the development of new targeted therapies that inhibit the Cyclin D-CDK4/6 axis.

Prevalence of Dentine Hypersensitivity in Vital Abutment Teeth being prepared for Fixed Partial Dentures or Crowns

Maria Komil Ghuuman — 2024-10-08

Objective: To determine the prevalence of dentine hypersensitivity during the preparation of vital abutment teeth for Fixed Partial Dentures or Crowns and its association with patient’s gender, age, and location of tooth.

Study Design & Setting: This is a descriptive cross-sectional study of patients with 150 abutments of either crown or fixed partial dentures, carried out in the department of Prosthodontics at Armed Forces Institute of Dentistry (AFID) Rawalpindi from June to December 2021.

Methodology: The Dentine Hypersensitivity was recorded on a VAS (Visual Analogue Scale) of 0-10 after the patient reported pain during exposure to thermal stimulus i.e. cold water from a 5cc syringe at 1cm distance during or just after the tooth preparation.

Results: In this study, the prevalence of Dentine Hypersensitivity was 13.3% with a mean dentine hypersensitivity score (VAS) for cold water test (Mean ± SD) of 0.61±1.756. Independent samples t-tests were used to determine the difference in hypersensitivity between genders, two age groups, and type of tooth (anterior/ posterior). It showed significant results with p-values of 0.002, 0.002, and 0.003 respectively.

Conclusion: Within the limitations of this study, it was highlighted that the preparation of vital teeth for conventional porcelain fused to metal (PFM) crown or fixed dental prosthesis results in dentine hypersensitivity in a considerable number of cases, with a higher incidence in women, younger patients, and vital anterior abutments.

Efficacy and safety of Dapagliflozin and Glimepiride in combination with Metformin: Randomized clinical trial

Muhammad Kamran Yousuf — 2024-10-08

Objective: To identify the effective treatment option between dapagliflozin-metformin and glimepiride-metformin combination in patients with type 2 diabetes who were inadequately controlled with metformin monotherapy.

Study design and setting: The present study is randomized, conducted for 12 weeks at the National Medical center, Karachi, Pakistan.

Methodology: The patients were divided into 2 treatment groups; group A was given dapagliflozin-metformin combination, while group B was given glimepiride-metformin combination. The efficacy endpoint of groups was estimated by hemoglobin A1c and fasting blood glucose levels at 0-, 6- and 12-week. While, safety endpoints were identified by analyzing liver function tests, lipid profile tests, renal function test, and urine analysis. The significant difference of data was analyzed by using statistical package of social sciences (SPSS) version 25. The parametric t-test and paired t-test were performed and considered p-value = 0.05 as statistical significant.

Results: Baseline demographics, clinical features of diabetes, levels of liver enzymes, liver function test, renal function test, lipid profile, and urinalysis of randomized patients were similar in both treatment groups by showing p = 0.05. Followed by the initiation of the respective treatment, the baseline change of mean FBG and hemoglobin A1c levels with dapagliflozinmetformin combination was shown significantly reduce more compared to glimepiride-metformin combination (p = 0.05). Conclusion: Dapagliflozin-metformin combination therapy was superior and well-tolerated to regulate glycemic control as compare to glimepiride-metformin combination