Journal of Bahria University Medical and Dental College

Liraglutide - A Promising Approach Against Obesity

Nabila Rafi — 2025-01-07

Obesity has emerged as a global chronic condition that poses a significant public health issue. The World Health Organisation (WHO) has reported a significant increase in obesity rates, which have nearly quadrupled since 1975.1 Thus, it is crucial to consider the significant health risks associated with this issue, including the potential for developing type 2 diabetes, cardiovascular diseases, endocrinal malignancies, and musculoskeletal difficulties. Furthermore, obesity incurs substantial expenses for healthcare systems and populations at large.

Limitations of Artificial Intelligence in Orthodontics. Literature Review

Sadia Naureen — 2025-01-07

In the 21st century, advances in computer technology and data science have brought significant innovation to orthodontics, especially through Artificial Intelligence (AI) and Machine Learning (ML). This study, conducted from July 2 to August 15, 2024, in the Orthodontic Department at Rawal Institute of Health Sciences Islamabad, reviews AI’s transformative role in dentistry, focusing on its applications, benefits, and challenges. A comprehensive literature search across PubMed and Google Scholar yielded 260 peer-reviewed articles from 2001 to 2024. After applying stringent selection criteria, the review focused on AI's historical development, applications, and limitations in orthodontics. While AI enhances diagnostic imaging and patient care, it cannot replace clinical expertise. Key challenges include patient privacy, data security, and ethical considerations. AI systems rely heavily on high-quality data, necessitating rigorous training. Therefore, AI should be viewed as an adjunct in orthodontics, providing a “second opinion” to support clinical decisions.

Noise-Induced Hearing Loss and Tinnitus in the Digital Era: An Alarming Rise in the Younger Generation

Iqbal Hussain Udaipurwala — 2025-01-07

The digital era has fundamentally transformed how we interact with sound, making music, entertainment, and communication more accessible than ever before. However, with this revolution comes an escalating public health concern: noise-induced hearing loss (NIHL) and tinnitus, particularly among the younger generation.

The Evolving Role of Genetic Counseling in Genomic Medicine

Ghulam Hassam U Din Tarrar — 2025-01-07

Genetic counseling involves educating at-risk patients or their close relatives about the occurrence of genetic diseases, their likelihood, and treatment, including ways to prevent or cure them. Counsellors will discuss the genetics and treatment of the disease, as well as the personal, familial, social and insurance implications. Additional diagnostic procedures, such as genetic testing, may be recommended to better understand risks or confirm the diagnosis

“Who am I?” The HiddenAspects of Dissociative Identity Disorder

Alishba Eman — 2025-01-07

Dissociative identity disorder (DID) is a persistent posttraumatic condition marked by impaired memory and selfidentity functions resulting from childhood trauma. It is a severe chronic psychiatric illness characterized by neurobiological, cognitive, and interpersonal disintegration in reaction to intolerable stress. Dissociative Identity Disorder (DID) remains inadequately researched; nevertheless, more investigation may elucidate neurobiological and cognitive characteristics, as well as the interplay between individuals and environmental stressors

Aesthetic Management of Coronal Dilacerations with Enamel Hypoplasia of Permanent Maxillary Central Incisors:

Nehal Amir — 2025-01-07

Dilaceration is a peculiar developmental dental anomaly. It is associated with traumatic events of deciduous teeth affecting the permanent tooth buds. It is chiefly a precipitous change in the axial inclination between the crown and the root of a tooth. Dilacerated crown, a rare clinical presentation, is a result of the non-axial displacement of pre-formed hard tissues of a developing crown at an angle to its longitudinal axis. It conspicuously impacts the appearance of patient. Enamel hypoplasia is primarily due to the trauma or infection of primary predecessor tooth resulting in a quantitative defect in enamel of permanent successors. Occasionally, both conditions; dilacerated crown and enamel hypoplasia can occur concomitantly producing many unpropitious outcomes. This particular case is about a 14-year-old boy presenting to the Department of Operative dentistry and Endodontics for the esthetic management of anomalous maxillary central incisors. These anomalous teeth were conservatively managed using direct composite veneers.

Development, Implementation and Initial Evaluation of the Blueprint for MBBS Theory Exams in a Private Medical College of Pakistan

Yusra Nasir — 2025-01-07

Objective: This study aimed to enhance the validity of the exam bank at Liaquat National Medical College (LNMC), Karachi, through the development and evaluation of the exam blueprinting process as part of an ongoing quality assurance initiative.

Study design and setting: This study was conducted at Liaquat National Medical College (LNMC), Karachi. Participants included key stakeholders i. faculty members, ii-officials from the examination department (involved in the development of the fourth-year MBBS neuroscience exam blueprint), and iii-students.

Methodology: Ethical approval for this study was taken by the LNMC Ethics Review Committee. For the ease of understanding, this article was divided into two sections: In first section, the stepwise approach of blueprint development was discussed whereas the second section dealt with feedback from 105 Year 4 MBBS students, feedback from faculty involved in this process and lastly, the experiences of examination unit personnel were explored.

Results: Following the Calgary model by Coderre et al., blueprint for undergraduate MBBS theory exam was developed. Students (85%) agreed that the exam accurately assessed the taught content. Faculty expressed satisfaction with the blueprinting process, noting improvements in exam quality, topic representation, and the elimination of redundant questions. Examination unit personnel reported better time management and improved alignment with curricular objectives. Initial challenges, such as faculty’s lack of training and resistance were also identified.

Conclusion: The blueprinting process significantly enhanced alignment of theory exam with educational objectives thereby ensuring the content validity. Continued training and institutional support are vital to overcoming initial challenges

Anticancer Activity of n-Hexane and Acetone Leaf Extracts from Delonix regia (Gul Mohar) on HeLa (Cervical) and Prostate Cell Lines

Saeed Ahmed Sheikh — 2025-01-07

Objective: The purpose of this study was evaluation of the anticancer activity of n-hexane and acetone leaf extracts obtained from Delonix regia on BJ, cervical (HeLa), and prostate cell lines.

Study Design and Setting: This in vitro study was designed to assess the cytotoxic effects of leaf extracts from D. regia. The leaves were harvested, dried, and then subjected to extraction using hexane and acetone. The resulting extracts were concentrated and prepared for analysis. The effects of these extracts were evaluated on HeLa and prostate cell lines under standard laboratory conditions.

Methodology: MTT colorimetric assay was used to evaluate the cytotoxic activity of leaf extracts. Cell cultures were prepared and introduced into the plates. Different concentrations of extracts were added, and reduction of MTT to formazan within cells was measured. The cytotoxicity was monitored as the concentration causing 50% growth inhibition (IC50) for cell lines.

Results: Results show that the acetone extract exhibits moderate inhibition (36.29%) on cervical cell lines, while the nhexane extract demonstrates higher inhibition (55.84%) on the same cell line. However, both extracts are inactive on prostate cell lines. On BJ cell lines, both extract showing significant inhibition (69.68% & 61.32%) respectively.

Conclusion: In conclusion n-hexane extracts of D. regia exhibited more cytotoxic activity than acetone leaf extract. Although, D. regia possessed some anticancer activity potential however its efficacy is not comparable to doxorubicin. The study suggests further exploration of acetone and n-hexane extracts from D. regia as potential anticancer agents

Frequency and Association of Perforated Appendix with Patient’s Characteristics in Acute Appendicitis

Muhammad Zeb — 2025-01-07

Objective: To determine the frequency of perforated acute appendicitis in patients with acute appendicitis and its association with patients clinic demographic characteristics.

Study design and setting: This cross sectional study was conducted in general surgery unit from 1st January 2022 to 31st December 2022.

Methodology: 171 patients were included. Patients who were provisionally diagnosed as acute appendicitis were included in the study. Sampling technique was nonprobability consecutive sampling. Statistical analysis was done through SPSS Version 23.

Results: The study included 171 patients, with 58.5% male and 41.5% female. The majority of patients were aged between 25-35 years and had a normal weight. Grossly inflamed appendix was the most common finding (69.6%), followed by perforated appendix (19.3%), normal appendix (8.2%), and gangrenous appendicitis (2.9%). There was no statistically significant difference between gender and intraoperative findings. Age categories and duration of symptoms were significantly associated with intraoperative findings.

Conclusion: In conclusion, 19.3% of patients with acute appendicitis presented with perforation. Age and duration of symptoms were found to be significantly associated with intraoperative findings, highlighting the importance of early diagnosis and timely surgical intervention

Sensitivity and Specificity of the Neutrophil Lymphocyte Ratio (NLR) in Diagnosing Late Onset Neonatal Sepsis in NICU Patients

Zunaira Zulfiqar — 2025-01-07

Objective: To compare the sensitivity and specificity of the neutrophil lymphocyte ratio in diagnosing late onset neonatal sepsis in NICU patients at a tertiary care center

Study Design and Setting: Prospective observational study at Department of Pediatrics, Combined Military Hospital, Lahore from February 2024-July 2024

Methodology: After admission into the NICU for suspected late onset neonatal sepsis, complete blood count, C-reactive protein and blood cultures were sent before changing or starting broad spectrum anti-biotic therapy for 350 patients included in the study. Primary variables observed were sensitivity and specificity of the neutrophil lymphocyte ratio in diagnosing late onset sepsis once co-related with the culture results.

Results: Blood panel parameters showed mean absolute neutrophil count to be 5928.19796.05/mm3versus 7032.80166.02/mm3 between the suspected and confirmed patients’ groups (p<0.001). Similarly, mean absolute lymphocyte count was 2745.32394.53/mm3 versus 3223.60278.90/mm3 between both groups (p<0.001). Median value for NLR was 1.70 (1.00) versus 2.20 (1.00) between the suspected and confirmed culture groups (p<0.001). Assessment of receiver operating characteristics (ROC) for NLR when compared with suspected and confirmed sepsis showed area under the curve being 0.644 (CI=95%) with sensitivity of 74.6%, specificity of 55.6%, positive predictive value being 57.3% and negative predictive value being 73.3% with a cut-off value for NLR being 2.05.

Conclusion: We conclude that neutrophil lymphocyte ratio with a cut-off value of 2.05 is a reliable method to diagnose late onset neonatal sepsis with good sensitivity

Analyzing trends in Cesarean Section by Action Oriented Classification (Robson Criteria) at Creek General Hospital, Karachi

Saba Pario — 2025-01-07

Objectives: The objective of this study is to analyze Cesarean section trends using the Robson classification system and identify the cause of cesarean section in each group, in a tertiary care hospital Karachi.

Study Design and Settings: This cross-sectional study was conducted in the obstetric department of Creek General Hospital Karachi, from 1 Jan 2021 to 31 Dec 2022.

Methodology: Data collection utilized a non-probability consecutive sampling method. This study examined the sociodemographic characteristics, indications for cesarean section, and the Robson classification system in the women who underwent cesarean section in the hospital during specified duration.

Inclusion criteria of study were all women who underwent for C-section procedure during the study timeline. Data was analyzed using IBM SPSS Statistics version 26. The study adhered to the Helsinki Declaration and ethical approval. Results: The Robson classification system was analyzed in this study, and group 5 was shown to be the primary contributor followed by group 2 and then group 1. Most frequently noted indication was previous CS (43.2%), followed by non-progress of labor (15.1%), and fetal distress (11.6%).

Conclusion: Cesarean section rate can be reduced by encouraging vaginal birth after cesarean section in multiparous women who had one cesarean section, under supervision of senior obstetrician. Meanwhile, the Non-progress of labor can be targeted by improving antenatal and intrapartum care, birth preparation classes and presence of companion during labor. Through CTG interpretation and their standardized management protocols will be effective in preventing and curbing the rising cesarean rate due to fetal distress

Mason Radial Head Fractures: Surgical Management

Nisar Ahmed — 2025-01-07

Objective: To evaluate the efficacy of radial head replacement in Mason Type III and IV radial head fracture. To evaluate the clinical outcomes of patients who received radial head replacement implant.

Study design & setting: This is a cross-sectional, analytical study, conducted in the orthopedic department of Doctor’s Hospital Kharian.

Methodology: Study was conducted from 15th April 2023 to 15th February 2024, Stability was assessed, radial head replacement was performed, and bone fragments were extracted during surgery. Radiographic evaluations were carried out to confirm the diagnosis at presentation, to determine the surgical outcome post-procedure, and during follow-up. SPSS- 22 was used for data entry and statistical analysis, Cross-tabulation and chi-square test was performed, P-value of < 0.05 was considered significant.

Results: The research comprised 70 patients, whose average age was 38.5 ± 9.4 years. Upon presentation, their mean hemoglobin level was 12.1 ± 1.5 mg/d. The mean time of the operation was recorded as 68.5 ± 18.9 minutes, with a minimum of 45 minutes and a maximum of 100 minutes. The frequency of the Mayo elbow performance score was determined using pre-validated categories: >90 for outstanding performance, 89–75 for good performance, 74–60 for fair performance, and <60 for bad performance, the study participants were divided into 38 (54.2%), 18 (25.7%), 10 (14.2%), and 4 (5.7%) groups, respectively.

Conclusion: Redo surgery and rate of infection are greater in patients who underwent surgery after 24 hours of injury as compared to patients who were operated within 24 hours.

Prevalence of Hypocalcemia in Infants of Mothers with Gestational Diabetes

Nida Sarwar — 2025-01-07

Objective: To evaluate the prevalence of newborn hypocalcemia among infants of mothers with gestational diabetes. Study Design & Setting: This cross-sectional study was conducted at PNS Shifa Hospital, Karachi, from November 2023 to March 2024

Methodology: Each mother's fasting blood sugar level was evaluated by drawing 5 ml of blood. At 24 hours after delivery, sterile blood samples (2 cc) were taken to determine the neonate's calcium level; a serum calcium level below 7 mg/dl was regarded as hypocalcemia. All information was gathered using a research template that was created in-house. Serum calcium was measured using the Arsenazo III method, and serum albumin was assessed using the bromocresol green (BCG) method.

Results: The mean ± S.D. of the maternal age of the study participants was 26.83 ± 3.87 years. The mean ± S.D. of the gestational age of the study participants was 37.35 ± 0.86 weeks. The mean ± S.D. of fasting glucose levels of the study participants was 104.5 ± 15.1 mg/dl. A total of 27.5% of infants born to mothers with gestational diabetes had hypocalcemia. Infants' median Apgar scores at 1 and 5 minutes were 6 and 9, respectively. The prevalence of hypocalcemia in newborns was highest among mothers aged 21–30, though this difference was not statistically significant (p = 0.139).

Conclusion: The results showed that 27.5% of infants born to mothers with gestational diabetes had hypocalcemia. Maternal age did not have a statistically significant association with hypocalcemia in newborns.

Diagnostic Efficacy of grey-zone Serum Prostate Specific Antigen level in patients with Benign Prostatic Hyperplasia and Prostate Carcinoma

Syed Atif Hussain — 2025-01-07

Objective: Evaluation of diagnostic role of grey zone serum prostate specific antigen level(4-10ng/ml) in patients with benign prostatic hyperplasia (BPH) and prostate carcinoma keeping histopathology as gold standard. Study design and setting: Cross-sectional study conducted in department of urology and chemical pathology, sheikh Zayed hospital Rahim yar khan.

Methodology: Patients with grey zone serum prostate specific antigen level (4-10ng/ml), lower urinary tract symptoms or abnormal DRE (digital rectal examination) were included and diagnosis was confirmed on the basis of histopathology. Chi square test used to see the statistically significant difference between subgroups. P value <0.05 was deemed as significant. Diagnostic role evaluated by ROC curve analysis.

Results: Mean age of study subjects was 60.21±10.046 years and 155 (81.2%) subjects were having serum prostate specific antigen level in grey zone (4-10ng/ml). Of the total 191 study subjects, 59(30.9%) were histopathologically confirmed cases of benign prostatic hyperplasia and 34(17.8%) were confirmed cases of prostate carcinoma. 41 (26.45%) cases of benign prostatic hyperplasia were having serum PSA level in grey zone (4-10ng/ml) and 16(10.32%) cases with prostate carcinoma were having PSA level in grey zone (4-10ng /ml). ROC curve analysis shows AUC=0.584 in case of BPH and AUC=0.707 in case of CA prostate.

Conclusion: On the basis of our study, it is concluded that grey zone serum PSA level in symptomatic individuals should be used in conjunction with other non-invasive diagnostic and clinical parameters to improve diagnosis and to avoid unnecessary biopsy in every symptomatic individual