JAIMC: Journal of Allama Iqbal Medical College
Journal of Allama Iqbal Medical college is the official Journal of Allama Iqbal Medical college Lahore. It is a peer reviewed and open access medical journal. Since its inception in 2003, it is being published quarterly as print and now available online as well. It includes original research articles, review articles, case reports and Letter to Editor. It accepts manuscripts by national and international medical professionals. Postgraduate trainees and undergraduate students are also encouraged to get their original work published in JAIMC. We operate and process publications in accordance with ICMJE’s (International Committee of Medical Journal Editors) recommendations. AIMS & Scope JAIMC aims to strengthen evidence based medicine by publishing high quality manuscripts with inferential analysis. Every issue comprises of innovative and interesting topics encompassing Basic medical, clinical and Public Health domains. We accept scientific manuscripts from clinical and public health disciplines, systematic reviews and meta-analyses, case reports, case series, letter to editor, short communication from biomedical researchers, academicians, health professionals. We plan to introduce a separate page “student’s corner” for undergraduate and postgraduate students to provide opportunity to future researchers to publish their work. Prof. Dr. Kokab Jabeen, PhD Editor-in-Chief
You are free to: Share — copy and redistribute the material in any medium or format The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. Non-Commercial — You may not use the material for commercial purposes . No-Derivatives — If you remix, transform, or build upon the material, you may not distribute the modified material. No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. Notices: You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation . No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
Mixed Neuroendocrine and Non-Neuroendocrine Neoplasm of the Gallbladder: Adenosquamous Carcinoma with Small Cell Neuroendocrine Differentiation – A Case Report
Background & Objectives: Gallbladder carcinoma is an aggressive malignancy, with adenocarcinoma being the most common histological subtype. Adenosquamous carcinoma is a recognized but uncommon variant, while the presence of small cell neuroendocrine differentiation within adenosquamous carcinoma of the gallbladder is exceedingly rare and associated with poor prognosis. Case Presentation: We report the case of a 66-year-old female who presented with right hypochondrial pain and jaundice. Histopathological examination of a simple cholecystectomy specimen revealed an infiltrating neoplasm exhibiting glandular architecture, squamoid differentiation, and sheets of small round cells predominantly on the serosal aspect. Immunohistochemistry showed p63 and CK positivity in squamoid nests and neoplastic glands respectively, and synaptophysin positivity in the small cell component, confirming neuroendocrine differentiation. The tumor perforated the serosa (pT3), with perineural invasion present and serosal margin involvement. Conclusion: Adenosquamous carcinoma of the gallbladder with small cell neuroendocrine differentiation is a rare and aggressive entity. Accurate histopathological evaluation with immunohistochemistry is essential for correct diagnosis and prognostication.
KEY WORDS: Gallbladder carcinoma, Adenosquamous carcinoma, Neuroendocrine differentiation, Small cell carcinoma, Histopathology, Case report
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc-nd/4.0 https://creativecommons.org/licenses/by-nc-nd/4.0
Modified Stoppa’s Approach Versus Ilio Inguinal Appraoch For Anterior Column Fractures of Acetebulum in a Tertiary Care Hospital
BACKGROUND AND OBJECTIVE: Acetabular fractures are complex injuries that present a surgical challenge due to the deep location and complex anatomy of pelvis. Modified Stoppa approach has emerged as an alternative approach to the traditional ilio-inguinal technique, offering improved exposure of the fracture site, reduced intraoperative blood loss, shorter operative duration, and potentially fewer complications. This study aims to compare Modified Stoppa's approach with Ilioinguinal approaches for blood loss during the surgery, operative time, postoperative complications, and functional outcomes in patients undergoing surgical fixation for anterior acetabular fractures. METHODOLOGY: This cross sectional analytical study was conducted in department of Orthopaedic surgery Lahore General Hospital, Lahore from 1st Nov. 2022 to 30th Nov. 2023. RESULTS: Mean operative time in Stoppa,s group was 92±10 as compared to 110±12 in Ilioinguinal group which was statistically significant (P < 0.001). Hemoglobin drop was 1.5 , compared to Ilioinguinal group which was also statistically significant (P = 0.04). Harris Hip score was in excellent in Stoppa group and was 17 (51.5) , compared to 16 (48.5) in Ilioinguinal group (p > 0.05). CONCLUSION: Modified Stoppa,s approach can be used as alternative approach for surgical management of anterior acetabulum fractures due to visualization of fracture site, less blood loss, short operative duration, better fracture reduction and less complication rate.
KEY WORDS: Anterior Acetabulum, Modified Stoppa Approach, Ilioinguinal Approach, Intraoperative blood loss
Diagnostic Accuracy of Diffusion Weighted MRI in Differentiating Malignant from Benign Liver Lesions Taking Histopathology as Gold Standard
Background & Objective: Liver lesions are common, and distinguishing between malignant and benign types is crucial. Histopathology, the gold standard, is invasive and costly. DW MRI, a promising non-invasive alternative, requires further research to confirm its diagnostic accuracy in liverlesion differentiation.Objective was to determine the diagnostic accuracy of diffusion weighted MRI in differentiating malignant from benign liver lesions taking histopathology as gold standard. Methodology: A total of 150 patients meeting inclusion criteria were enrolled from the Department of Diagnostic Radiology, Sir Ganga Ram Hospital, Lahore. Written consent and medical history were obtained, and all underwent diffusion-weighted MRI on a 1.5-T scanner. MRI findings were compared with histopathology for assessing diagnostic accuracy of DW MRI in differentiating liver lesions from benign lesions. Data was analyzed using SPSS 26.0. Sensitivity, specificity, and predictive values were calculated, and results were stratified by age and gender. Results: The patients had a mean age of 46.77±14.63 years and males were dominant with n=86 (57.3%). Participants aged 18–40 years were 45.3%, while 54.7% were older than 40 years. DW MRI classified 61.3% of lesions as malignant, confirmed as 64.7% by histopathology. Sensitivity, specificity, PPV, NPV, and accuracy were 90.72%, 92.45%, 95.66%, 84.46%, and 98.70%, respectively. Conclusion: Diffusion-weighted MRI demonstrated higher diagnostic accuracy in differentiating malignant from benign liver lesions while taking histopathology as the gold standard, showing high sensitivity, specificity, and consistent performance across age and gender, supporting its clinical utility
KEY WORDS: Diagnostic Accuracy, Histopathology, Liver Lesions, Sensitivity, Specificity, PPV, NPV
Evaluation of Troponin I Values in Acute Coronary Syndrome Patients with and without Impaired Renal Function
Background & Objective: Elevated cardiac troponin levels are common in chronic kidney disease (CKD) which make it challenging to diagnose acute coronary syndrome in these patients. It is difficult to interpret the cardiac troponin levels in CKD patients due to persistent increase of troponin levels in these patients which limit their diagnostic value. Our study aims to evaluate troponin-I levels in patients with acute coronary syndrome with and without impaired renal function Methodology: Retrospective Cross-sectional study conducted in Pathology department, Shalamar Hospital Laboratory, Lahore from February 2025 to August 2025. A total of 202 Patients aged between 25 to 65 years both genders diagnosed as acute coronary syndrome with evaluated renal function were included. Data was divided in two groups i.e., Group A (Preserved renalfunction, eGFR≥60ml/min/1.73m2) Group B (Impaired renalfunction, eGFR<60ml/min/1.73m2). Troponin I levels were compared between patients with and without impaired renal function and p value <0.05 taken as statistically significant. Results: Median age was 42 years in patients with preserved renal function and 53 years in patients with impaired renal function. Troponin I levels were significantly higher in patients with impaired renal function (6.80ng/ml) than in patients with preserved renal function (3.80ng/ml). Weak negative, statistically insignificant correlation found between eGFR and troponin I (r, p value: -0.18, 0.09) in patients with preserved renal function (Group A). Moderate to strong, significant negative correlation between eGFR and troponin I (r, p value: -0.56, <0.001) in patients with impaired renal function (Group B). Statistically significant difference in troponin I levels between patients with preserved and impaired renal function with higher levels in impaired group with P value 0.012. Conclusion: It has been concluded that serum troponin I levels are significantly higher in patients with acute coronary syndrome with impaired renal function. These findings highlight the importance of interpreting troponin I values with caution in acute coronary syndrome patients with renal impairment to avoid overdiagnosis of myocardial infarction. Further studies are recommended to establish adjusted diagnostic cutoff for troponin I in patients with impaired renal function to improve the clinical decision making.
KEY WORDS: Troponin I, Acute coronary syndrome, Myocardial infarction, renal impairment, cardiac biomarker, chronic kidney disease
Association of Body Mass Index with Anemia among Pregnant Women Visiting a University Hospital of Lahore
Background & Objective: Anemia is among the most common nutritional disorders seen in pregnancy worldwide. The issue is commoner in women of reproductive age, contributing to maternal morbidity and mortality. We aimed to determine association of body mass Index (BMI) with anemia among pregnant women visiting a University Hospital of Lahore. Methodology: This was a descriptive, cross-sectional study conducted at department of Obstetrics & Gynecology, Lahore General Hospital, Lahore from September 2024 to December 2024. A total of 186 women falling into the inclusion criteria were kept in the study. In all women, a blood sample was sent to the hospital laboratory after collecting all the sociodemographic details on a pre-designed proforma. Iron deficiency anemia and Body Mass Index were noted as per operational definition. Data was analyzed using SPSS version 20.0. Patient age, gestational age, parity, BMI, hemoglobin levels were represented by mean and standard deviation. Effect modifiers were controlled by stratification and chi square test was applied post-stratification and p-value ≤0.05 was considered as significant. Results: The study analyzed 186 pregnant women, revealing a significant association between Body Mass Index (BMI) and anemia. Among participants, those categorized as obese (BMI ≥30) exhibited a higher prevalence of anemia (72%) as compared to those with BMI ≤29 (10.53%). Multivariable logistic regression indicated that underweight women had an adjusted odds ratio (AOR) of 3.00 (95% CI: 1.40-6.40; p=0.005), while overweight (AOR: 1.80; p=0.017) and obese women (AOR: 2.20; p=0.011) also showed increased odds of anemia. Additionally, educational level and monthly income were significantly linked to anemia, with illiterate women having a higher risk (AOR: 2.10; p=0.010) and those earning less than 20,000 Rupees having an AOR of 1.95 (p=0.001). Conclusion: The frequency of iron deficiency anemia is quite high in obese pregnant females. Public awareness regarding maintenance of healthy body weight is very important.
KEY WORDS: iron deficiency anemia, pregnancy, prevalence, sociodemographic factors.
Outcome of Simultaneous Bilateral Total Knee Replacement in Patients Compared to Unilateral Knee Replacement: A Comparative Study
Background & Objectives: Joint replacement for the treatment of large joint arthritis has proven very successful. Total Knee Replacement (TKR) improve mobility, reduces pain and overall positive effect on quality of life. With changing trends in current orthopedics and a balance between patient satisfactions with cost effective procedures, simultaneous bilateral TKR is gaining popularity. We aim to look at the outcome of simultaneous bilateral TKR in our study Methodology: We looked at TKAs performed at a private institution during a period of 3 years by one surgeon. Total 140 joints were replaced by Dr Muhammad Bilal during April 2021 to April 2024. Primary outcome measures were any need for re-admission to hospital within 2 months and secondary complications such as infection, manipulation for stiffness, revision, or any other procedure performed. Results: Out of total 135 joint replaced, 61% (n=51/84) patients had Simultaneous Bilateral Knee Replacement while 39% (n=33/84) patients had one side knee replacement. Out of 84 patients, 64% (n=54) were females and 36% (n=30) were male patients. Our primary outcome measures show none of the patients in either group needed re-admission within 2 months after surgery. None of the patients developed stiffness or need for manipulation under anesthesia. One patient in unilateral knee replacement group developed painful patella which was replaced, one patient developed delayed infection and one patient developed peri prosthetic fracture. Conclusion: Our study has clearly shown that simultaneous bilateral TKR group has better Patient reported Outcome Measures (PROMs), low rate of infection, stiffness and anesthetic complications. Economically it has only one hospital episode and lower overall costs. Patient selection criteria are not well defined yet but we recruited patients of 75 years or younger, and fewer or at least well controlled associated medical conditions for simultaneous bilateral TKR. Meticulous surgical technique, strict adherence to protocols and involvement of multi disciplinary team are of utmost importance for higher success rates.
KEY WORDS: Knee Replacement, Joint Arthroplasty, Simultaneous Bilateral Knee Replacement
Comparison of Screws Alone Versus Screws Plus Bone Graft for Garden Type III Femur Fractures
Background & Objectives: Femoral neck fractures (FNF) are common injuries and are associated with complications such as non-union and osteonecrosis. The management of these fractures is a subject of ongoing debate, particularly concerning deciding whether to save or replace femoral head. In younger patients, surgical interventions that prioritize the preservation of hip anatomy and function are essential. This study evaluated the functional outcomes and union rates of Garden type III FNFs treated with cannulated screws alone versus cannulated screws with bone grafting. Methodology: A prospective comparative cross-sectional study was conducted at the Department of Orthopaedic Surgery, Mayo Hospital, Lahore. Seventy patients with Garden type III FNFs were randomly allocated into two groups. Group A underwent fixation with cannulated screws only, while Group B received cannulated screws with bone grafting. Functional outcomes were assessed using the Harris Hip Score (HHS), and radiological healing was evaluated with Radiographic Union Score for Hip (RUSH). Results: Group B demonstrated significantly better outcomes compared to Group A. The mean HHS was 88.86 ± 3.16 in Group B versus 84.57 ± 4.46 in Group A (p < 0.001). Bone healing was also superior in Group B, with mean RUSH bridging scores of 9.89 ± 0.86 compared to 8.63 ± 1.14 in Group A (p < 0.001). The fracture line reduction score was higher in Group B (9.83 ± 0.66 vs 8.71 ± 0.95, p < 0.001). Conclusion: Cannulated screw fixation supplemented with bone grafting significantly improves functional recovery and bone healing compared with screw fixation alone.
KEY WORDS: Femoral neck fracture, Garden type III fracture, Cannulated screws, Bone graft, Functional outcome
Vaccine Hesitancy — Threat to global immunization gains
Vaccination stands among the most significant achievements of modern medicine, credited with saving millions of lives by preventing infectious disease. However, in recent years, the full potential of vaccines has been undermined by a phenomenon known as vaccine hesitancy. In 2019, vaccine hesitancy was recognized by the World Health Organization (WHO) as one of the top ten threats to global health. The WHO’s Strategic Advisory Group of Experts (SAGE) defines “vaccine hesitancy” as a delay in acceptance or refusal of vaccination despite availability of vaccination disease prevention, and ensuring resilient health systems for future generations. 1. REFERENCES MacDonald NE; SAGE Working Group on Vaccine Hesitancy. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161-4. doi: 10.1016/j.vaccine.2015.04.036. 2. 3. 1 services
Copyright (c) 2026 Muhammad Faheem Afzal (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Role of Artificial Intelligence (AI) in improving Diagnostic Accuracy of Histopathology
Histopathology is an essential diagnostic technique for a number of diseases including cancer. It has been accepted worldwide as the gold standard forthe diagnosis of neoplas1 tic disorders. Since the middle of 20th century, the histopathology reports have been increased significantly in both the length and context and are becoming more complex. With the advancements in pathology, updated and more complex criteria are in practice for grading and staging systems, along with the comments on status of resection margins. There is an urge that the histopathologists should develop new methodologies for the documentation of this information.
Artificial Intelligence, Histopathology, Immunohistochemistry, Machine learning
Copyright (c) 2026 https://creativecommons.org/licenses/by-nc-nd/4.0
Triple Co-Infection with Influenza A, SARS-CoV-2, and Streptococcus Pneumoniae: A Case Report
Background: Viral respiratory infections can predispose patients to secondary bacterial pneumonia. It is rare for an infection to occur concurrently with Influenza and SARS-CoV-2; adding Streptococcus pneumoniae is a rare but serious clinical entity that is associated with significant morbidity and mortality. Case Presentation: A 58-year-old male patient, without significant comorbidities, presented with high-grade fever, productive cough, dyspnea, and altered sensorium in emergency department of Jinnah hospital, Lahore. RT-PCR performed on nasopharyngeal swabs showed positivity for Influenza A and SARS-CoV-2. Blood culture revealed the growth of Streptococcus pneumoniae. Chest imaging showed features of bilateral multilobar pneumonia. He received a therapeutic course of antivirals, broad-spectrum antibiotics, corticosteroids, and supportive care, culminating in clinical improvement. Conclusion: This case highlights the consideration of bacterial co-infection in patients with dual viral respiratory infections and the need for early microbiological testing and appropriate, timely antimicrobial therapy. COVID-19, Influenza, Streptococcus pneumoniae, co-infection,
KEY WORDS: COVID-19, Influenza, Streptococcus pneumoniae, co-infection, pneumonia
Relationship between Mothers' Education Level and Age-Appropriate EPI Vaccination of Children Attending Pediatric OPD at Lahore General Hospital
Background & Objectives: The Expanded Program on Immunization (EPI) prevents vaccine-preventable diseases and reduces childhood morbidity and mortality. Maternal education is often cited as a determinant of vaccination uptake, but its local role is unclear. This study was conducted to see the association between mothers' education level and knowledge about EPI with EPI vaccination uptake amongst children attending the Pediatric OPD at Lahore General Hospital. Methodology: A cross-sectional study was conducted over six months at the pediatric OPD, Lahore General Hospital. A total of 186 mothers with children under two years were recruited using convenience sampling. Data were collected through a structured questionnaire and vaccination cards. Variables included maternal education, knowledge about EPI, and vaccination status. Data was analyzed using SPSS v23. Chi-square test was applied; p <0.05 was considered statistically significant. Results: Mean maternal age was 27.5 years (range: 19–45). More than half (54.8%) had matric education or higher, and 90.9% reported EPI knowledge. Overall, 79.6% of children had up-to-date vaccination. Maternal education level was not significantly associated with vaccination status (p = 0.05), whereas maternal knowledge of EPI was strongly associated (p <0.001). Conclusion: Maternal education level alone was not linked to vaccination status, whereas EPI knowledge showed a strong association. Strengthening maternal awareness may improve vaccination coverage more effectively than focusing solely on formal education.
KEY WORDS: EPI, immunization, maternal education, vaccination coverage, child health
Treatment Outcomes of Adolescent AO 22A Diaphyseal Radius and Ulna Fractures Treated with Dynamic Compression Plate and Intramedullary Elastic Nail
Background & Objective: Diaphyseal fractures of the forearm are a prevalent orthopedic injury that necessitate surgical intervention to reestablish functional range of motion, alignment, and stability. Complications, including malunion, nonunion, and long-term functional impairment, may result from these fractures if not properly managed. Main Objective was to compare treatment outcome of Adolescent AO 22ADiaphyseal Radius and Ulna Fractures Treated with Dynamic Compression Plate and Intramedullary Elastic Nail. Methodology: It was a prospective comparative study that included 70 patients, all of whom had diaphyseal fractures of the radius and/or ulna that necessitated surgical treatment. The patients were aged between 12 and 18 years. Group A consisted of 35 patients who were treated with DCP fixation, while Group B consisted of 35 patients who were treated with IMEN fixation. The patients were randomly assigned to these two categories. Clinical evaluations were conducted at 2 weeks, 6 weeks, and 12 to 16 weeks following surgery to evaluate pain levels, functional improvement, range of motion, and any complications. Results: At 6 weeks, Group B (IMEN) showed better outcomes with lower Quick DASH (15.49 ± 2.94 vs. 20.45 ± 2.99) and higher MEPS (81.6 ± 4.8 vs. 75.3 ± 5.2), with faster union (10.8 ± 1.9 vs. 12.5 ± 2.3 weeks, p<0.05). By 12–16 weeks, functional recovery remained superior (MEPS 91.2 ± 3.9 vs. 85.7 ± 4.3; Quick DASH 8.5 ± 1.4 vs. 12.6 ± 1.9, p<0.05). Complications were fewer in Group B (infection 2.9% vs. 8.6%, malunion 0% vs. 5.7%). Conclusion: This study shows that Intramedullary Elastic Nailing (IMEN) provides superior outcomes over Dynamic Compression Plate (DCP) fixation in diaphyseal forearm fractures, with faster healing, improved function, less pain, and fewer complications. Both methods remain effective, but IMEN may be preferred in adolescents, while larger studies with longer follow-up are needed for confirmation.
KEY WORDS: Intramedullary Elastic Nailing, Dynamic Compression Plate, forearm fractures, functional outcomes, bone healing, complications \
Diagnostic Accuracy of Diffusion Weighted Magnetic Resonance Imaging in differentiation between Bbenign and Malignant Soft Tissue Tumors keeping Histopathology as Gold Standard
Background & Objective: To determine diagnostic accuracy of Diffusion Weighted Magnetic Resonance Imaging in differentiation between benign and malignant soft tissue tumors keeping histopathology as gold standard. Methodology: Atotal of 176 patients meeting inclusion criteria underwent MRI, including DWI sequences at b-values of 0, 50, and 1000 s/mm² and ADC values were calculated from corresponding maps. ROI was placed on the solid tumor component of mass. Post-contrast imaging was also performed. All MRIs were interpreted by blinded, qualified radiologists to ensure unbiased results. Definitive diagnoses were confirmed through histopathological analysis by certified pathologists. Results: 98 (55.69%) were aged 13–40 years and 78 (44.1%) were 41–75 years, with a mean age of 40.62±10.13 years. There were 94 males (53.5%) and 82 females (46.5%). Tumor sizes ranged from 3.1 cm to 11.5 cm, with a mean size of 6.3 cm. The average ADC value of benign masses (1.50 × 10⁻³ mm²/s) was higher than that of malignant masses (0.83 × 10⁻³ mm²/s). A cutoff ADC value of 1.1 × 10⁻³ mm²/s provided sensitivity of 85.51%, specificity of 86.84%, PPV of 88.89%, NPV of 82.50%, and diagnostic accuracy of 85.88%. Histopathology showed 97 masses (55.3%) were malignant and 79 (44.7%) were benign. Conclusion: Diffusion-weighted MRI (DWI) is a non-invasive, cost-effective imaging tool with 85.5% sensitivity and 86.8% specificity for evaluating soft tissue masses. It can aid early detection of malignant tumors, improving patient outcomes through timely diagnosis.
KEY WORDS: Diffusion Weighted Imaging (DWI), Magnetic Resonance Imaging (MRI), soft tissue tumor, Restricted Diffusion.
Pre and Post Mentoring Comparative Analysis of Academic Performance of MBBS Students in the Subject of Biochemistry
Background & Objective: Mentorship plays a significant role for successful academic development and work fulfillment. The objective of the study was to evaluate the role of one-on-one mentoring sessions in their biochemistry exam performance compared to their initial term results. Methodology: Acomparative cross-sectional study was conducted at Rashid Latif Medical College, Lahore, after taking approval from Institutional Review Board (IRB), to compare the impact of mentoring sessions on the academic performance of students. Students from 1st year and 2nd year MBBS participated in the study after an informed consent. Eleven faculty members from biochemistry department, who were trained and had been made aware of the regulations and protocols of the mentorship program prior to its initiation were involved in the study. An equal number of students were assigned to each mentor. In addition, the students received training regarding their role as mentees before conducting the study. Results: The comparison of pre and post mentoring academic performance of students revealed a significantimprovement in performance for both below-average and above-average students (p<0.001). Effect of mentoring was also evaluated class-wise. Mean results of both classes were estimated before and after mentoring. Comparison of means by t-test revealed a significant rise the score of students after mentoring sessions. A significant association was found between mentoring and performance of students (p<0.001, χ2=64.490). Conclusion: Mentoring helps students to improve their academic performance significantly.
KEY WORDS: Biochemistry, Mentoring, Academic Performance, Medical Students.
Association of Human Epidermal Growth Factor Receptor-2 (HER2) Over Expression with Subtype and Grade of Gastric Adenocarcinoma
Background & Objective: Gastric cancer is associated with substantial morbidity and mortality worldwide. It is the fourth most commonly diagnosed cancer and the second most common cause of cancer related deaths globally. With increasing understanding of the molecular biology of HER2, and the availability of genomics and proteomics analysis, it has now been recognized that HER2 is implicated in other severe forms of cancers, notably gastric cancers. The objective of the study was to evaluate the frequency of over-expression of HER2 in patients of gastric adenocarcinoma. Methodology: A retrospective cross sectional study was carried out in Head Office Chughtai Lab, Lahore from 1st July 2024 to 31st December 2024. Atotal of 65 diagnosed cases of gastric adenocarcinoma of both genders were included in the study. All autolyzed/poorly fixed specimens and metastatic gastric adenocarcinomas were excluded. The histological preparation was performed by classic method for inclusion in paraffin followed by hematoxylin and eosin staining. The immunohistochemical analysis was performed on serial sections using immune-enzymatic soluble complex method. The antibody used was HER2 polyclonal antibodies from DAKO. HER2 scoring was conducted as 0, +1, +2 and +3. Results: Age range in this study was from 30 to 70 years with mean age of 56.492±11.91 years. Male gender was dominant (61.5%) as compare to females (38.5%). Over-expression of Her 2 was seen in 24.6% patients with gastric adenocarcinoma. Moreover, HER2 overexpression was found to be an independent prognostic factor in well to moderately differentiated adenocarcinomas with intestinal sub-type. Conclusion: HER2 overexpression is a poor prognostic indicator in well to moderately differentiated, intestinal subtype-, early stage gastric adenocarcinomas. Therefore, IHC 3+ and 2+ cases should be further analyzed by FISH to assess HER2/neu gene status.
KEY WORDS: HER2, Adenocarcinoma, Gastric carcinoma, Immunohistochemistry
A CASE OF SALMONELLA MENINGITIS IN AN IMMUNOCOMPETENT INFANT
Salmonella species represent a documented, though rare, etiology of bacterial meningitis, predominantly impacting infants, elderly individuals, and those who are immunocompromised. The condition is associated with considerable morbidity and mortality, in addition to substantial neurological complications. A3-monthold male infant with no prior health issues was admitted to the emergency department at Jinnah Hospital, Lahore, presenting with a 48-hour history of fever, lethargy, poor feeding, and irritability. There was no significant travel history or known sick contacts, but the family had a pet bearded dragon at home. On examination, the infant was having fever (39.2°C), tachycardia, and had a bulging anterior fontanelle. Kernig's sign was negative. Initial laboratory investigations revealed leukocytosis with a left shift. Lumbar puncture revealed CSF pleocytosis, high protein, and low glucose. Blood and CSF cultures were sent. The infant was empirically started on intravenous ceftriaxone and vancomycin. After 48 hours, both blood and CSF cultures grew Salmonella Enteritidis. Antibiotics were de-escalated to high-dose intravenous ceftriaxone for a total course of 4 weeks. The patient showed gradual clinical improvement. This case highlights the importance of considering non-typhoidal Salmonella as a causative agent of meningitis in infants, even those who are apparently immunocompetent. Athorough history, including exposure to reptiles, is crucial. Salmonella meningitis requires prolonged antibiotic therapy and close monitoring for complications. This case had a positive outcome due to prompt diagnosis and appropriate management.
Keywords: Salmonella meningitis, bacterial meningitis, infant, complications, ceftriaxone
Copyright (c) 2025 https://creativecommons.org/licenses/by-nc-nd/4.0
PATTERN OF UPPER AND LOWER LIMB AMPUTATIONS AMONG PATIENTS PRESENTING TO EMERGENCY DEPARTMENT OF MAYO HOSPITAL, LAHORE
Background &Objective: Limb amputation is a surgery performed for the removal of a limb. It is indicated when the recovery of limb is impossible due to certain conditions. There are different types of amputations, and their causes, pattern, and levels can vary from one area to the other. The objective of this study was to assess the pattern of upper and lower limb amputations among patients presenting to Emergency Department of Mayo Hospital, Lahore. Methods: This retrospective study was executed at the Mayo Hospital, Lahore, from 2018 to 2020. Atotal of 100 patients were included in the study. These individuals had undergone upper or lower limb amputations due to trauma or mechanical injuries. Data was taken from hospital records and entered in SPSS version 25. Descriptive statistics were used to assess the pattern of amputations. Chi-square test was used to see the association between gender and limb involvement, and p≤0.05 was considered significant. Results: The mean age of participants was 42.7 ± 9.5 years. 75% patients were male and 25% female. 78% cases of amputations were performed because of road traffic accidents, whereas, 22% were due to mechanical injuries. Lower limb amputations were more common (60%) than upper limb amputations (40%). The most frequent levels of amputations were below-knee (58.3%) and below-elbow (62.5%). The mean Mangled Extremity Severity Score (MESS) was 7.8 ± 0.57. There was no statistically significant association between gender and type of limb amputated (p = 0.34). Conclusion: Trauma remains the leading cause of limb amputation in emergency settings in Pakistan, with young to middle-aged males most affected. Lower limb amputations are more prevalent, and below-joint amputations are more common due to efforts to preserve limb function. These findings highlight the need for improved trauma prevention, early intervention, and development of a national amputation registry to inform healthcare planning and rehabilitation services.
Keywords: Limb amputation, trauma, emergency department, upper limb, lower limb, road traffic accident, Mangled Extremity Severity Score, Pakistan
IDENTIFICATION OF CANDIDA SPECIES ISOLATED FROM DIFFERENT CLINICAL SAMPLES AND THEIR SUSCEPTIBILITY AGAINST COMMONLY USED ANTIFUNGAL DRUGS
Background & Objectives: Antifungal resistance is becoming prevalent in Candida species globally and threating the human health. Aim of this study was to identify Candida to species levels isolated from different clinical samples and analyze their antifungal susceptibility patterns. Methods: 70 Candida species isolated from 120 different clinical samples were identified and their antifungal susceptibility testing was carried out against azoles, polyenes, echinocandins and pyrimidine by using Vitek 2 Compact System. Results: Candida species were identified in 58.3% of clinical isolates from different samples of patients. The most frequent strains found in female patients were of C. albicans, followed by C. glabrata, whereas in male patients C. krusei was the commonest. All of the isolated Candida species showed resistance to Fluconazole (100%), whereas 46% showed resistance to Itraconazole and 28% were resistant to Voriconazole. However, the majority of isolates were sensitive to polyenes (Amphotericin B 91%), echinocandins (Caspofungin 84%) and pyrimidine (Flucytosine 80%) respectively. Conclusion: Identification of Candida species and antifungal susceptibility testing is necessary to help the physician in deciding on the suitable antifungal drug.
Keywords: Antifungal susceptibility, Candida species, Fluconazole resistance
COMPARISON OF CONVENTIONAL CROSS-K WIRES VERSUS DORGAN'S TECHNIQUE FOR SUPRACONDYLAR FRACTURES IN CHILDREN
Background & Objectives: Supracondylar humerus fractures are one of the most common fractures in childhood. The traditional treatment utilizing cross-K-wire fixation is biomechanically stable, it poses a considerable risk of ulnar nerve injury. Dorgan's technique, employing lateral cross K-wires, presents a viable alternative by reducing the complication rate. This study assessed the outcomes of standard cross-Kwire fixation compared to Dorgan's technique in paediatric patients for treatment of type III supracondylar fractures. Methods: A comparative cross-sectional study was conducted at the Department of Orthopaedics, Mayo Hospital, Lahore. A total of 72 paediatric patients with Gartland type III supracondylar fractures were randomly distributed to two groups: Group A(n=36) received traditional cross K-wire fixation, while Group B (n=36) received Dorgan's technique. Patients were monitored for six weeks, and outcomes were evaluated based on operative time, ulnar nerve injury, union rate, pin track infection, as well as cosmetic and functional outcomes as per Flynn's criteria. Results: The incidence of ulnar nerve palsy was less in Group B (p = 0.013). Fracture healing rate was higher in Group B (88.9% vs 77.8%) (p = 0.206). Based on Flynn's criteria, Group B demonstrated significantly superior cosmetic (58.3% vs 47.2% excellent, p < 0.001) and functional results (52.8% vs 44.4% excellent, p < 0.001) than Group A. Conclusion: Dorgan's technique had less incidence of ulnar nerve injury and better cosmetic and functional results than traditional cross K-wire fixation. Furthermore, it provides a safer and similarly effective option for addressing type III supracondylar humeral fractures in children.
Keywords: Gartland type III fracture, K-wire fixation, Supracondylar humerus fracture, Dorgan's technique, ulnar nerve injury
PATIENT SATISFACTION WITH DIAGNOSTIC SERVICES OF A PUBLIC SECTOR TERTIARY CARE HOSPITAL IN A DEVELOPING COUNTRY: A CROSS-SECTIONAL STUDY USING SERVQUAL® QUESTIONNAIRE
Background & Objectives: Patient satisfaction is a multidimensional concept that consists of client's perceived needs, their expectations and experience of a health care system. This study aimed to assess patient satisfaction with pathology and radiology services at a public tertiary care hospital in a Pakistani metropolitan city. Methods: From August to December 2023, we conducted exit interviews with 434 randomly selected adult patients at a 1700-bed teaching hospital in Lahore. Using the SERVQUAL® questionnaire, we assessed client satisfaction and service quality across accessibility, affordability, reliability, responsiveness, and assurance.Analysisinvolved descriptive statistics, patientsatisfaction scoring, and examining socio-demographic factors with multiple logistic regression. Results: Out of 248 pathology clients, 74 (29.8%) were aged 35-44 years and 127 (51.2%) were female. Of 186 radiology clients, 63 (33.8%) were aged 45 or older and 137 (73.7%) were male. Overall, 59% clients using pathology and 53% clients using radiology services were satisfied with more females (75%;p=<0.001) were satisfied from radiology service. Only one-third of clients were satisfied with problem resolution and the availability of a helpline. Higher likelihood of satisfaction from radiology services was found for affordability (OR: 1.53; 95% CI: 1.12-2.87, p=0.001) and accessibility (OR: 1.81; 95% CI: 1.05-2.13, p=0.01) service domains, whereas for pathology service, accessibility and level of education were significant domains of satisfaction. Conclusions: Asignificant proportion of clients at a teaching hospital in a developing country were dissatisfied with pathology and radiology services. Key predictors of satisfaction included education level, area of residence, responsiveness, accessibility, and affordability.
Keywords:DiagnosticServices, health service delivery,SERVQUAL®questionnaire.HealthCareUtilization, Healthcare Service, pathology service.
ANATOMICAL LANDMARKS FOR SAFE SURGICAL PRACTICE: A STUDY OF NUTRIENT FORAMINA OF DRIED CADAVERIC LONG BONES OF UPPER LIMB
Background and objectives: The vascular supply of long bones through nutrient arteries entering via nutrient foramina, plays a crucial role in bone health and remodeling. Understanding the morphometric characteristics of nutrient foramina is essential in orthopedic, plastic, and reconstructive procedures for preventing complications such as delayed union, nonunion or avascular necrosis. The aim of the study was to evaluate the number, direction, location, position of nutrient foramina in long bones of the upper limb to provide anatomical data relevant to local surgical practices. Methods: This descriptive, cross sectional study was conducted in the Department of Anatomy, King Edward Medical University, Lahore, from October 2024 to December 2024. A total of 150 dried cadaveric long bones of the upper limb were taken, including 50 humeri, 50 radii, and 50 ulnae. Nutrient foramina were examined for number, location, size, direction, and position. Bone length and distance of foramina from the proximal end were measured, and the Foramen Index (FI) was calculated. Data were analyzed using SPSS version 26.0. Results: A single nutrient foramen was most common: 76% in humeri, 72% in radii, and 94% in ulnae. Double foramina were rare, and absence of foramina was observed in 20% of humeri, 24% of radii, and 4% of ulnae. In humeri, nutrient foramina were predominantly located on the anteromedial surface and classified as Type II (middle third) in 95% of cases. In radii and ulnae, most foramina were in the proximal third (Type I). Conclusion: This study provided population-specific data on the morphology and topography of nutrient foramina, critical for optimizing surgical outcomes in orthopedic and reconstructive procedures by aiding in the identification of safe zones and preserving vascular integrity. Key words: Nutrient foramen, foramen index, nutrient artery, long bones.
Nutrient foramen, foramen index, nutrient artery, long bones.
All That Glitters is Not Gold: Can We Trust International Scientific Journals?
Scientific journals are the cornerstone of evidencebased practice,shaping clinical decisions, policy development, and future research directions. The integrity of published research heavily relies on robust editorial oversight and a rigorous peer-review process. These systems are intended to act as quality filters, ensuring methodologicalrigor, ethical compliance, and scientific accuracy before findings reach a global audience. When these standards are not met, flawed studies can mislead practitioners, misinform public health initiatives, and erode trust in academic publishing.
Copyright (c) 2025 Fatima Imran, Urvah Shafique (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
CHOLECYSTOCUTANEOUS FISTULA: A RARE COMPLICATION OF GALLBLADDER DISEASE - A CASE REPORT
Spontaneous cholecystocutaneous abscess or fistula is an exceptionally rare consequence of gallbladder disease, with fewer than 100 cases reported in the literature. The condition was first described by Thelisus in 1 1670, and later, Courvoisier documented 169 occurrences of biliary fistulas in the 19th century . Biliary 2 fistulas, which can be internal or external, often arise as a complication of acute calculus cholecystitis. From suppurative cholecystitis with spontaneous rupture to surgical external drainage of an abscess, the disease's 3 natural course has changed due to medical and surgical interventions have significantly altered its course . The primary underlying mechanism involves obstruction of bile outflow due to gallstones, which increases intra gallbladder pressure, disrupts lymphatic drainage, and compromises gallbladder wall circulation. These pathophysiological changes contribute to necrosis and subsequent fistula formation. If perforation occurs, bile leakage may lead to a localized peritoneal abscess or extend externally through the abdominal wall .Early and effective management of biliary tract disease is critical to preventing this uncommon but severe complication.
Cholecystocutaneous fistula, Gallbladder disease, Cholecystitis, Surgery
Copyright (c) 2025 Mohsin Gillani, Ghazia Qasmi, Imran Abbas, Rida Fatima (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
KNOWLEDGE AND PERCEPTION OF PRACTICING DOCTORS ON ARTIFICIAL INTELLIGENCE APPLICATION IN MEDICINE
Background and Objectives: Artificial Intelligence (AI) is gaining importance in every field, including medicine. The aim of this study was to determine the knowledge and perception of practicing doctors on artificial intelligence application in medicine. Methods: This study was conducted among doctors of Bahawal Victoria Hospital, Bahawalpur using a nonprobability convenience sampling strategy. The tool included questions on socio-demographics and to assess the knowledge and perception of doctors about the application of artificial intelligence in medicine and medical practices. Data were entered and analyzed in SPSS. Results: Most of the respondents were postgraduate residents (45.7%). There were 73.3% participants who already knew about the applications of AI in medicine but only a few (13.3%) had read any academic literature about it. There were 42.9% participants who think that the AI will 'moderately affect' the field of medicine and around 33% of participants reported that Radiology will be the specialty to be 'most affected' by AI. There were 9.5% of the respondents strongly agreed and 31.5% agreed that AI will replace the future medical practitioners. Still, the majority of the respondents agreed that the medical curriculum should incorporate the component of AI for the students. Conclusion: Most of the doctors lack formal education in artificial intelligence. However, they hold a favorable opinion of AI in healthcare and open to incorporating it. Because the AI is the future of healthcare, so it is essential to integrate AI training into medical education.
Artificial Intelligence, Doctors, Knowledge and Perception, Medicine
Copyright (c) 2025 Shahla Naeem, Huda Abbas, Sundas Hamna (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
DIAGNOSTIC ACCURACY OF TIRADS (THYROID IMAGING REPORTING AND DATA SYSTEM) IN IDENTIFYING THYROID NODULES ON ULTRASOUND, USING BETHESDA CYTOLOGICAL CATEGORIES FROM FINE NEEDLE ASPIRATION CYTOLOGY AS THE GOLD STANDARD
Background & Objectives: To determine the diagnostic accuracy of TIRADS (Thyroid Imaging Reporting and Data System) in identifying thyroid nodules on ultrasound, using Bethesda Cytological categories from Fine Needle Aspiration Cytology as the gold standard. Methods: 130 patients, diagnosed with both; solitary nodules and muti-nodular goiters were included. TIRADS scoring by using ultrasound was done. “Fine needle aspiration cytology (FNAC) was done and the Bethesda category was recorded. All the data was analyzed in SPSS v.25. Results: The mean age of patients was 38.6 ± 15.6 years. There were 51.5% males and 48.5% females. The average nodule size was 2.52 ± 1.10 cm, with 52.3% having solitary nodules and 47.7% multi-nodularity. FNAC Bethesda showed high sensitivity (85.7%–100%) and diagnostic accuracy (86.6%–98.4%), with better performance in larger nodules, females, and nodules present for over eight months. Positive TIRADS and Bethesda scores were found in 35.4% and 38.5% of patients, respectively. Conclusion: FNAC Bethesda and TIRADS demonstrated high diagnostic sensitivity and accuracy, especially in larger nodules, solitary nodularity, females, and prolonged swelling
Thyroid nodules, Ultrasonography, Diagnostic accuracy, Cytology
Copyright (c) 2025 Rafia Irum, Hira Bushra, Riffat Kamal, Mariyam Rehman (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Evaluating the Cytotoxic and Apoptotic Potential of Terpinen-4-OLAgainst SF767 Glioblastoma Cells Via P53 Modulation: An In-Vitro Study
Background and Objectives: Terpinen-4-ol (T4-ol) is a monoterpene derivative of essential oil which has many anti- inflammatory, bactericidal and antifungal activities and is safe as compared to other treatment options available. Our study's objectives were to analyze the effects of different concentrations of Terpinen4-ol on apoptosis of cell lines. Methods: This in vitro experimental study was conducted at the IMBB Department, University of Lahore, Lahore Pakistan, from October 2022 to March 2023. Study treatment was divided into four groups: negative control (normal cell line), positive control (cisplatin) Terpinen-4-ol (experimental group) and vehicle control (DMSO). In order to culture cells cryovials were thawed and then cells were cultured in T75 flasks. To assess the cell viability MTT assay was used. Bioassay technology laboratory ELISA kit was used to evaluate inflammation and apoptosis. Graph Pad prism was used to perform statistical analysis. The data was analyzed using one- way analysis of variance (ANOVA) with bonferroni comparison within groups. P ≤ 0.05 was considered statistically significant. Results: When compared to the control group, the treated lines showed more apoptotic changes. P-value was ≤ 0.05. Conclusion: In this study we have observed anticancer effects of T4-ol against GBM cell line by observing p53 induced apoptosis. Key Words: Terpinen-4-ol (T-4-ol), Glioblastoma (GBM), apoptosis, MTTand Crystal Voilet assay.
Terpinen-4-ol (T-4-ol), Glioblastoma (GBM), apoptosis, MTTand Crystal Voilet assay
Copyright (c) 2025 Neelam Bilal, Shazia Ramzan, Kanwar Sajjad Ali, Hina Sadaf, Zoja Muzaffar, Sehar Shamshad Ali, Zoraiz Chaudhry, Tahir Maqbool (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Clinical and Hematological Features of Acute Leukemia in Pediatric and Adult Patients at a Tertiary Care Hospital Lahore
Acute Leukemia, Acute Lymphoblastic Leukemia, Acute Myeloid Leukemia, Hematological Malignancy, Sudan Black-B, FAB Classification
Copyright (c) 2025 Asma Akhtar, Rabia Ahmad, Masuma Ghazanfar, Shizra Kaleemi, Sabeen Fatima (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Correlation of Glycated Hemoglobin and Fating Lipid Profile Among Type 2 Diabetes Patients
Background and Objectives: Patients with T2DM are at an increased risk of developing dyslipidemia, which is associated with cardiovascular diseases. This study aimed to assess the relationship between HbA1c levels and the fasting lipid profile in individuals with T2DM within our community. Methods: This cross-sectional study was performed from November 2024 to April 2025 at Farooq Hospital, Lahore. One hundred sixty T2DM patients were included, whereas people without T2DM were excluded. The sample was collected in EDTA and clotted vaccutainers separately for analysis of HbA1c and fasting lipid profile. The data was evaluated using IBM SPSS version 27.0 software. The Chi-square test and Pearson correlation were applied to determine the relationship between variables. Results: Of the 160 T2DM patients, 48.75% were male and 51.25% were female. The average age was 54.16 ± 12.978. Out of the total, 25% T2DM patients exhibited adequate glycemic control, whereas 75% T2DM patients did not achieve adequate glycemic control. The average HBA1c, cholesterol, TG, HDL, and LDL levels were 8.159 ± 2.064, 195.83 ± 67.32, 195.63 ± 226.51, 44.5 ± 15.57, and 110.04 ± 40.72, respectively. Cholesterol, TG, and HDL had a positive correlation with HbA1c; however LDL showed a negative correlation. Conclusion: The elevated HBA1c is a good predicator of dyslipidemia so the patients must to be instructed to consistently monitor and regulate fasting lipid profile and HBA1c levels.
Type 2 diabetes mellitus, fasting lipid profile, glycated hemoglobin
Copyright (c) 2025 Omar Shahid, Rizwan Akhtar, Masooma Jaffer, Rabia Sadaf, Zainab Yousaf, Faiz Rafiq (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
BATTLING BEYOND THE FRONTLINE: WAR'S TOLL ON MEDICAL CARE AND PUBLIC HEALTH
Health and well-being are fundamental rights of humanity that cannot be achieved 1 without peace and security. In recent times, wars and conflicts have been imposing detrimental effects on not only those directly involved in combat but also civilians, families, communities, institutions, and the environment, leading to large scale destruction of infrastructure and loss of human 2 life. According to Small Arms Survey, armed conflicts cause 133,750 deaths each year. However, this estimate does not include indirect attributable 3 mortality due to conflicts.
Copyright (c) 2025 Ammara Riaz (Author) https://creativecommons.org/licenses/by-nc-nd/4.0
Umbilical Discharge due to an Intrauterine Contraceptive Device (IUCD): A Case Report of a Rare Cause in an Adult Woman
A 38-year-old female presented to the outpatient department for spontaneous umbilical discharge for the past 1 year. She reported mild periumbilical pain but there were no other abdominal or urinary symptoms. Patient was afebrile. Abdominal examination was unremarkable. A sinogram was attempted but we were unable to cannulate the sinus. After surgical exploration of the umbilicus, a T shaped copper device was discovered which was removed followed by an unremarkable recovery.