Annals of Punjab Medical College

Developing Local Cancer Guidelines in Pakistan: A Critical Need for Improved Healthcare

Muhammad Tahir Bashir — 2025-03-31

Early Serum Lipid Profile Changes after Laparoscopic Sleeve Gastrectomy at a Tertiary Care Hospital

Afifa Saadia — 2025-03-31

Objective: This research aims to ascertain how frequently dyslipidemia resolves in patients having laparoscopic sleeve gastrectomy in tertiary care hospitals. Study Design: Quasi-experimental study. Settings: Department of Surgery, Allied Hospital, Faisalabad Pakistan. Duration: September 2021 to March 2022. Methods: 95 patients, aged between 20 and 50 years, who had dyslipidemia and a BMI of more than 30 kg/m2 were selected for the study. Following informed consent, patients were recruited for the study using non-probability consecutive sampling, preoperative venous blood samples taken while fasting for lipid levels and they subsequently had sleeve gastrectomy. The fasting lipid profile test was conducted after three months of surgery. The frequency at which dyslipidemia resolved was recorded. SPSS 22 was used for data entry and analysis. Using stratification, effect modifiers such as age, gender, diabetes, and BMI were managed. The post-stratification chi-square test was used to determine their impact on the result. The significance level is chosen where the P-value is equal to or less than 0.05. Results: A total of 95 patients with a mean age of 33.87± 8.6 years were registered in this research. 53.7% of the participants were women and 46.3% of men. BMI averaged 38.5±2.9 kg/m2. 83.2% of the patients had diabetes. Eighty-two percent of the patients had hypertension. 37.9% of the patients were smokers. A decrease in dyslipidemia was observed in 57.9% of the individuals. Conclusion: Most patients experience reduced hyperlipidemia load following a laparoscopic sleeve gastrectomy.

Assessment of Hematological Profile and Blood Group Patterns in Pregnant Women

Humeera Naz — 2025-03-31

Background: Hematological changes are crucial for meeting the increased requirements of the developing fetus and placenta, leading to significant changes in blood volume and composition. Monitoring these hematological variations helps identify potential maternal-fetal complications and assess overall pregnancy outcomes. Objective: To evaluate the hematological parameters among pregnant women and assess the correlation with different blood groups. Study Design: Cross-sectional study. Settings: Hayatabad Medical Complex, Peshawar Pakistan. Duration: Eight months, from January to August 2024. Methods: The study involved 374 pregnant women. Participants aged 18 and older were selected using non-probability sampling and included if they provided informed consent. Data was collected through a structured questionnaire, and blood samples were assayed for Complete Blood Count and blood group determination by forward agglutination. SPSS version 26 was used for statistical analysis, with a p-value <0.05 deemed significant. Results: Among the 374 participants, blood type B was the most prevalent (32.9%). The mean hemoglobin (Hb) level was 11.32 g/dL (±1.86), while the mean TLC was 9,666 cells/µL (±4,668). The average platelet (PLT) count was 274,360 cells/µL (±77,754). No significant correlation was found between blood groups and Hb (p=0.162), and WBC (p=0.316), while significant association with PLT levels (p=0.007). Conclusion: The present study investigation revealed a notable association was observed between blood groups and platelet counts. These findings contribute to our comprehension of the interrelationship between blood group polymorphisms and hematological parameters, underscoring the necessity for further research in genetically diverse populations.

Diagnostic Challenges in Mucormycosis: Advances in Imaging and Molecular Technique

Muhammad Arif — 2025-03-31

Objective: To assess the diagnostic challenges of mucormycosis, focusing on the role of advanced imaging techniques and molecular diagnostics in a tertiary care hospital setting in Pakistan. Study Design: Prospective, observational study. Settings: Department of ENT, Hayatabad Medical Complex, Peshawar Pakistan. Duration: April 2023 to April 2024. Methods: A total of 170 patients suspected of having mucormycosis were included. Diagnostic methods included computed tomography (CT), magnetic resonance imaging (MRI), and polymerase chain reaction (PCR) for Mucorales DNA. The study evaluated the sensitivity and specificity of these diagnostic tools and analyzed patient outcomes based on early diagnosis and intervention. Results: MRI demonstrated a sensitivity of 82%, while PCR showed an overall sensitivity of 85%. CT scans revealed bone involvement in 65% of cases. Patients diagnosed earlier had significantly better survival outcomes, with a mean time to diagnosis of 7.8 days. A weak positive correlation (r = 0.16) was found between PCR results and patient outcomes. Early diagnosis and the use of molecular techniques were associated with improved survival rates. Conclusion: The combination of advanced imaging and molecular diagnostics significantly improves the accuracy of mucormycosis diagnosis. Early detection through these methods is critical for better patient management and outcomes, especially in resource-limited settings like Pakistan.

Evaluation of Papillary Deficit Between Dental Implant-Supported Crown and Adjacent Natural Tooth

Aqsa Akhtar Khan — 2025-03-31

Objective: To evaluate the mean peri-implant papilla height adjacent to a natural tooth and assess any association of peri-implant papillary deficit with implant location. Study Design: Cross-sectional descriptive study. Settings: Prosthodontics Department, Armed Forces Institute of Dentistry, Rawalpindi Pakistan. Duration: Six months, from January 2023 to July 2023. Methods: 100 patients with dental implants replacing central incisors or first premolars, adjacent to natural teeth, were included. After crown placement (T0), the distance between the interproximal papilla tip and contact point was measured using the CPITN periodontal probe. After 3 months (T1), the measurement was repeated to assess papillary deficit. Data were analyzed using SPSS version 24. Descriptive statistics were calculated, and the paired sample t-test was used to compare papillary deficit at T0 and T1. Stratification and independent sample t-test were employed for effect modifiers (p<0.05). Results: The mean papilla height between the implant and tooth was 2.92±0.72 mm. The mean papillary deficit at T0 was 2.73±0.44 mm, while at T1, it was 0.85±0.52 mm. The difference in papillary deficit at T0 and T1 was statistically significant (p=0.001). No significant difference was found in papillary deficit based on implant location (p=0.14). Conclusion: A statistically significant improvement in papillary height was observed from crown placement to 3 months, indicating progressive papilla growth. However, the implant location did not affect the papillary deficit.

Diagnostic Accuracy of Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) in Differentiating Benign and Malignant Thyroid Nodule

Nosheen Ahmad — 2025-03-31

Objective: To determine the diagnostic accuracy of diffusion-weighted magnetic resonance imaging (DW-MRI) in differentiating benign and malignant thyroid nodules, keeping histopathology as the gold standard. Study Design: Cross-sectional study. Settings: Radiology Department, Allied Hospital, Faisalabad, Pakistan. Duration: 24th June 2021 to 23rd December 2021. Methods: From a total of 145 patients with palpable thyroid nodules on clinical examination of size >5mm and duration >3 months of age 25-65 years of either gender were included. DW-MRI was performed on all patients and correlated with histopathology reports. Results: From 145 patients, 55.86% were from 25 to 45 years. The majority (57.93%) are females. Overall sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of DW-MRI were 94.29%, 90.61%, 90.41%, 94.44%, and 92.41%, respectively. Conclusion: The findings of this study indicate that DW-MRI is a non-invasive modality that exhibits high accuracy in distinguishing malignant from benign thyroid lesions.

Perception and Practices of Parents regarding Milk Consumption and its Association with Oral Health among School going Children of Lahore- a Questionnaire-based Survey

Saira Khalid — 2025-03-31

Objective: To assess the perception and practice of parents regarding milk consumption and its benefits as well as its association with oral health among school-going children of Lahore. Study Design: Questionnaire-based descriptive cross-sectional survey. Duration: 1st January 2022 to 10th May 2022. Methods: With the approval of the Institutional Review Board (IRB) Committee of de 'Montmorency College of Dentistry and the participating schools. Data was collected using in-hand questionnaires administered during scheduled parent-teacher meetings. The chi-Square test was used to compare milk consumption and other variables. Results: In the present study, 89.1% children had regular milk drinking habits. The most preferred source of milk was buffalo (45.4%), followed by cow (42.3%) and goat (7.9%). There was no statistically significant difference between male and female students regarding habit and amount of milk consumption. Parents of government school-going children are keener regarding oral cavity cleaning after milk consumption. Two-thirds of the participants were aware of the term lactose intolerance. There was a statistically significant difference between the views of parents of private and public-school-going children regarding the association of milk with dental caries. Conclusion: The majority of children consume milk regularly. Awareness of parents about milk nutrition and lactose intolerance was adequate. Parents should be educated about the different sources of milk and their benefits. Regular oral cavity cleansing should be recommended after drinking sweetened or unsweetened dairy.

Enhanced Management of TMJ Internal Derangement: A Focus on Sodium Hyaluronate in Arthrocentesis

Aneela Amjad — 2025-03-31

Background: Internal derangement (ID) of the temporomandibular joint (TMJ), often leading to pain and impaired jaw function. Traditional non-surgical treatments include diet modification, splint therapy, physiotherapy, and medications, while invasive surgical options are considered when this fails. Arthrocentesis is a minimally invasive procedure, and adding sodium hyaluronate (SH) has shown the potential to enhance outcomes. Objective: This study explores the impact of adding sodium hyaluronate to arthrocentesis to enhance pain relief and joint function in TMJ internal derangement. Study Design: Randomized controlled experiment. Settings: This research was performed at the Departments of Oral Medicine and Oral & Maxillofacial Surgery at Lahore Medical & Dental College, Lahore Pakistan. Duration: The study lasted for one year and eight months. Methods: Fifty patients with Wilkes stage III, TMJ ID, unresponsive to conservative treatment, were enrolled and randomized into two groups. Group A received arthrocentesis with regular saline, while Group B received arthrocentesis followed by an intra-articular injection of SH. Pain and maximum mouth opening (MMO) were evaluated preoperatively and during the six months postoperatively. Results: Group B exhibited significantly greater pain reduction (VAS score: 1.95 vs. 6.85) and improved MMO (16.75 mm vs. 10.65 mm) compared to Group A. SH showed superior outcomes in both pain relief and MMO. Conclusion: Arthrocentesis combined with sodium hyaluronate significantly enhances pain reduction and joint function in TMJ internal derangement compared to arthrocentesis alone.

Knowledge, Attitude, and Practice regarding Contraception among Women Coming to Tertiary Care Hospital

Farva Shaukat — 2025-03-31

Background: Family planning is defined as planning birth timing, number of children, and spacing between successive births with family planning methods. Two main functions of Family planning are the proper spacing between two pregnancies and birth control of further pregnancies. Knowledge, attitude, and practices are the main components that are used to achieve these functions, and any imbalance between any of these components will affect family planning results. Objective: To assess the knowledge, attitude, and practice of family planning methods among married women. Study Design: This was a quantitative study using a cross-sectional design. Settings: Tertiary care hospital in Faisalabad (Hospital Name?) Duration: January to July 2019. Methods: The sample size was 200 married women. Data was collected through a predesigned questionnaire and analysed using SPSS version 23. Questions were asked regarding knowledge, attitudes, and practices regarding contraception. Results: This study comprised 200 married females with a mean age of 31.29±6.039. 156 (78%) knew about contraceptives, predominantly condoms, with a percentage of 43.5%, and 66 (33%) got information from doctors. 118 (59%) did not know the correct use of contraceptives. 115 (57.5%) are using contraceptives for spacing of birth. 97 (48.5%) are self-motivated for using contraceptives. 64 (32%) were intended to use condoms as contraceptives. But only 58 (29%) are using contraceptives. Conclusion: This study's findings, which reveal a significant gap between knowledge, attitudes, and practices regarding contraceptive methods, have the potential to influence future healthcare strategies significantly. While most women demonstrate good knowledge and positive attitudes, the low practice of contraceptive methods is a clear area for improvement and intervention.

Evaluation of Alveolar Bone Loss under Immediate Dentures Fabricated with Spatial Modelling Technique - A Descriptive Study

Maryam Mumtaz — 2025-03-31

Objective: The objective of this study was to assess the height and width of alveolar bone, before and after insertion of immediate dentures fabricated via the Spatial Modeling Technique, for patients destined for implant prostheses. Study Design: Prospective observational study with a pre-post intervention analysis. Settings: Department of Prosthodontics, Institute of Dentistry, CMH Lahore Medical College, Lahore Pakistan. Duration: Six months from January 01, 2021 to June 30, 2021. Methods: On a sample of 240 subjects, alveolar bone height and width were evaluated via CBCTs as per specified landmarks. Immediate dentures were fabricated via the Spatial Modeling cast modification technique, teeth were extracted, and dentures were inserted in subjects. 3 months post extraction, alveolar bone height, and width were evaluated via CBCT on the same landmarks. Mean loss of alveolar bone was noted. Results: The mean change in height pre and post-extraction was 0.13 ± 0.14. The mean change in width was 2.95 ±1.24. Conclusion: Functional stimulation and protection provided by immediate dentures may result in improved preservation of alveolar bone as compared to bone healing without immediate dentures. Conservative cast modification technique for fabrication of immediate dentures may lead to decreased post-extraction alveolar bone loss in height and width. Increased conservation in labial and lingual reduction in the Spatial Modelling technique may further reduce alveolar bone loss. The selection of a flangeless design of immediate dentures may further preserve alveolar bone width. Clinical Relevance: This study may help in the treatment planning of patients who desire future implants. It may also help in the objective selection of cast modification techniques for patients desiring immediate replacement of teeth.

The Double-Edged Sword of Social Media: Medical Students’ Usage in Learning and Opinions

Noori-Kiran Neem — 2025-03-31

Objective: This cross-sectional study explores the usage patterns, perceived benefits, and adverse effects of social media among MBBS students across different academic years. Study Design: Cross-sectional study. Settings: ABWA Medical College, Faisalabad Pakistan. Duration: January 2024 to June 2024. Methods: The study involved 255 MBBS students from 1st, 3rd, and 4th MBBS years who were invited to fill out an online survey containing demographics, usage patterns, and perceptions of social media's impact on learning. Quantitative data were analyzed using descriptive statistics, and qualitative responses were evaluated through thematic analysis. Results: The average duration of social media use increased with academic progression, from 2.74 years in 1st-year students to 3.27 years in 4th-year students. Daily social media use also rose, from 3.93 hours in the 1st year to 4.73 hours in the 4th year, while time dedicated to educational purposes declined. Benefits included enhanced understanding and stress management, while adverse effects like distraction, health issues, misinformation, and time wastage were consistently reported across all years. Concerns about cyberbullying and privacy issues intensified in later years. Conclusion: Despite its educational potential, social media's growing usage presents significant challenges like distractions, burnout and time wastage. Addressing these issues is essential to optimize its role in medical education and ensure student well-being.

The Burden of Liver Cirrhosis in Patients with Upper GI Hemorrhage

Nafees Ahmad — 2025-03-31

Background: Upper GI bleeding significantly impacts patients with liver cirrhosis, increasing morbidity and mortality. While variceal bleeding is the most common cause, nonvariceal bleeding presents a higher risk of severe endoscopic stigmata, potentially leading to greater complications. Objective: To assess the prevalence of liver cirrhosis in acute upper GI bleeding patients and its correlation with other factors. Study Design: Descriptive cross-sectional study. Settings: Department of General Medicine, Medical Teaching Institute, Khyber Teaching Hospital, Peshawar Pakistan. Duration: 25 Jul 2021 to 25 Jan 2022. Methods: This study included 195 acute upper GI bleeding patients, selected via nonprobability sampling. Patients aged 18–70 years were analyzed through clinical history, lab tests, ultrasounds, and endoscopies by specialists. Data was processed using SPSS 20, with numerical and categorical variables evaluated. Results: The study included 195 patients, 53.8% of whom had liver cirrhosis. The mean age was 44.38±15.23 years, with 54.4% male. Hepatitis C was more prevalent (55.4%) than Hepatitis B (44.6%). Smoking was common (67.2%), while 9.2% reported IV drug abuse. No significant associations were found between liver cirrhosis and age (P=0.178), gender (P=0.080), viral hepatitis type (P=0.739), smoking (P=0.279), IV drug abuse (P=0.879), or BMI (P=0.841). Conclusion: This study found a high incidence of liver cirrhosis in acute upper GI bleeding patients. A multidisciplinary strategy emphasizing early diagnosis and timely intervention is crucial for better outcomes.

Clinical Results of Trigger Finger Release with Percutaneous Needle Technique Under Local Anesthesia

Subhan Shahid — 2025-03-31

Background: Trigger Finger (or trigger thumb) is because of mechanical impingement at the level of the A1 pulley and affects 2-3% of the general population and 10% of the diabetic population. It causes progressive pain and locking of the digit which often requires surgical release when conservative treatment fails. Objective: To assess the outcomes of trigger finger release using percutaneous needle technique. Study Design: Prospective interventional study. Settings: Orthopedic Department of King Edward Medical University/ Mayo Hospital Lahore, Pakistan. Duration: Six months from July 2023 to December 2023. Methods: A total of 32 patients with 19 women and 13 men were included in the study. Biodata and basic information were recorded and disease was graded according to Green Classification. Patients were called to the operation theatre on an outdoor basis and percutaneous release of the A1 pulley was performed using an 18-gauge needle under local anesthesia after obtaining informed written consent. Immediately After the procedure, the finger was assessed functionally using Quinell’s criteria and for pain using Visual Analogue Scoring (VAS). All patients were followed for three months after the release. Results: The Technique was successful in all the 32 patients (100%). No patient was found with recurrence during the initial three months of follow-up. One-third of the patients had excellent outcomes while two-thirds had good outcomes according to Quinell’s grading system. No patient had a poor outcome. Conclusion: Percutaneous release of the trigger finger with the needling technique is an easy, time-saving, resource-saving technique and minimally invasive approach. It also reduces the risk of post-operative wound infection in the diabetic population.

Effectiveness of Calcium and Vitamin D, With and Without Collagen Peptide, in Enhancing Bone Mineral Density on Postmenopausal Women with Osteopenia: A Randomized Controlled Trial

Sara Jamil Khan — 2025-03-31

Background: Osteopenia is the precursor stage to osteoporosis and is a significant problem for women. The interaction of collagen peptide supplementation with calcium and vitamin D supplementation may give some ways through which bone health could be enhanced. Objective: To determine the efficacy of calcium, Vitamin D3, and collagen peptide supplementation in enhancing bone health. Study Design: Randomized controlled trial. Settings: King Abdullah Hospital, Mansehra and Shaheena Jamil Hospital, Abbottabad Pakistan. Duration: Study duration was between March 2024 to May 2024. Methods: Thirty postmenopausal women over the age of 60 years volunteered in this single-blinded randomized controlled trial and were divided into two groups by simple random sampling technique. Group A (n=15) received bioactive collagen peptide along with calcium lactate, and vitamin D3. Group B ((n=15) served as a control group and received Calcium and Vitamin D3 only. Serum procollagen type I N-propeptide was assessed at baseline and after 3 months. Results: The results showed a decrease in procollagen type I N-propeptide level from baseline 61.3±14.7 to 53.0±14.1 (p<0.001) post 3 months in group A. Group B showed the mean rise from 58.8±23.2 to 56.2±23.1 to (p=0.310). Conclusion: These findings reflected decreased PINP level after 3 months using calcium, vitamin D, and collagen peptide medication. Adding collagen peptides to calcium and vitamin D supplements may increase their beneficial effects on bone metabolism.