Journal of University Medical & Dental College

The Incompetence of Competency? Making CBME Work in Pakistan

2025-06-11T04:45:46+00:00

Assessment of the prevalence and spatial distribution of the posterior superior alveolar artery within the maxillary sinus wall utilizing CBCT imaging

2025-05-31T04:41:19+00:00

BACKGROUND & OBJECTIVE: The posterior superior alveolar (PSAA) artery plays a crucial role in supplying blood to the lateral wall of the maxillary sinus. This artery is of particular significance while performing procedures that involve the maxillary sinus. Our current study aimed to localize this artery and record its distance from a particular landmark: the maxillary sinus floor in patients reporting to a dental teaching hospital.

METHODOLOGY: This cross-sectional study was conducted in the Department of Periodontology at Lahore Medical & Dental College. A total of 85 cone-beam computed tomography (CBCT) images were analyzed to document the presence and precise location of the posterior superior alveolar artery (PSAA).

RESULTS: This study visualized 170 maxillary sinuses of 55 males and 30 females. The PSAA was visualized in 84.1 % of the sinuses. Further analysis revealed that in 54.1% of cases (n = 92), the artery was located intraosseously; in 21.2% (n = 36), it was situated below the sinus membrane; and in 8.8% (n = 15), it was found on the outer surface of the lateral wall of the maxillary sinus. The mean vertical distance from the lowest point of the sinus floor to the PSAA was 6.96 mm, with a range of 1.32 mm to 16.23 mm.

CONCLUSIONS: Our study validates the diverse locations of the PSAA relative to the maxillary sinus's lateral wall, with no notable differences observed between genders. Additionally, it highlights the effectiveness of CBCT as a reliable method for pre-surgical evaluation of the maxillary sinus and its associated blood vessels.

Prevalence of hypomagnesemia and its association with clinical outcomes in patients with acute coronary syndromes

2025-05-31T04:41:28+00:00

BACKGROUND & OBJECTIVE: Acute coronary syndromes (ACS), including unstable angina, NSTEMI, and STEMI, remain the leading causes of morbidity and mortality. Hypomagnesemia (<1.7 mg/dL) occurs in 29–76% of ACS patients and predicts worse outcomes, including arrhythmia's, larger infarction size, and higher in-hospital mortality. Limited studies have explored its prevalence and prognostic value in low- and middle-income countries like Pakistan. This study aimed to assess the prevalence of hypomagnesemia in ACS patients and its impact on early clinical outcomes.

METHODOLOGY: This descriptive cross-sectional study was conducted over one year at Faisalabad Institute of Cardiology, Faisalabad. A total of 185 ACS patients were recruited through consecutive sampling. Serum magnesium was measured within 24 hours of admission. Clinical outcomes, including arrhythmia's, infarction size, and in-hospital mortality, were analyzed using SPSS 25.

RESULTS: Hypomagnesemia was observed in 85(45.9%) of patients. Those with hypomagnesemia had significantly higher rates of arrhythmia's (41.2% vs. 20%, p≤0.001), larger infarction size (52.9% vs. 30%, p≤0.001), and higher in-hospital mortality (23.5% vs. 10%, p=0.012). Logistic regression identified hypomagnesemia (OR: 2.5, p=0.01), advanced age (OR: 1.8, p=0.03), and diabetes (OR: 1.6, p=0.04) as key predictors of mortality.

CONCLUSION: Hypomagnesemia is common in ACS and linked to poor outcomes. Routine screening and management, especially in resource-limited settings, are crucial. Further studies are needed to confirm findings and optimize treatment strategies.

Immunohistochemical expression of hypoxia inducible factor-1 alpha (Hif -1α) in patients of head and neck squamous cell carcinoma

2025-05-31T04:41:37+00:00

BACKGROUND & OBJECTIVE: Hypoxia-inducible factor-1 alpha (HIF-1α) could serve as a molecular target for therapy in head and neck squamous cell carcinoma (HNSCC). Limited research has been conducted on HIF-1α expression in the Pakistani population, and global studies have shown conflicting results. This study aims to measure the expression of Hypoxia-inducible factor-1 alpha (HIF-1α) in patients with HNSCC through immunohistochemistry.

METHODOLOGY: Sixty biopsy specimens from HNSCC patients were analyzed for HIF-1α expression using immunohistochemistry with a standard immunoperoxidase technique. The final immunolabeling score was derived by multiplying the proportion and intensity scores.

RESULTS: The age range in our study sample varied greatly between 25 to 82 years, with the mean age being 55.4±7.4 years. The gender distribution revealed 43 male patients (72%) and 17 female patients (28%). The highest number of cases involved the oral cavity (n=25), followed by the laryngeal region (n=23), the nasopharynx (n=8) and the head and neck skin (n=4). Results revealed that the highest frequency of cases was of intermediate grade (n=28), followed by low-grade tumor (n=17) and high-grade tumors (n=15). A total of 36 tumor showed positive HIF-1α staining (60% of the cases). However, no significant associations were found between HIF-1α expression and other clinicopathological parameters.

CONCLUSION: Our population recorded a significantly elevated expression of HIF-1α in HNSCC patients. Therefore, HIF-1α may be an invaluable marker for early diagnosis and a potential target for molecular therapy against HNSCC.

Non-restorative cavity control on proximal carious lesion of primary maxillary incisors

2025-06-04T09:12:51+00:00

BACKGROUND & OBJECTIVE: Early childhood caries (ECC) is a high-prevalence infectious disease with significant unmet dental care needs globally. This study aimed to compare the clinical success rates of nonrestorative cavity control (NRCC) using disking with a restorative approach (RA) using a resin-modified glass ionomer (RMGI) restoration on the proximal surfaces of the primary maxillary incisors with dental caries.

METHODOLOGY: 108 proximal caries in 42 children aged 3–5 years met the inclusion criteria; caries were limited to the outer-to-middle-third of the dentin with no pulpal or periapical pathology. The study included two experimental groups: the NRCC group was treated with proximal disking and applying 5% sodium fluoride varnish, while the RA group received RMGI Class III restorations. The follow-up period was 20 months. The 20-month cumulative survival rates were estimated using the Kaplan-Meier survival analysis, and the differences between the groups were analyzed using the Log-rank test.

RESULTS: The cumulative survival probability for the NRCC group was 71.4%, while the RA group demonstrated a 71.7% success rate after 20 months. The survival probabilities between the two caries management modalities were similar (p = 0.963).

CONCLUSION: The clinical success rates of NRCC using disking or RA using RMGI on the proximal caries surfaces of the primary maxillary incisors were similar.

The obstructed hernia dilemma: lichtenstein or darn? a comprehensive comparison lichtenstein vs darn repair

2025-06-11T05:50:34+00:00

BACKGROUND& OBJECTIVES: Inguinal hernia, representing approximately 75% of all abdominal wall hernias, poses a substantial surgical burden, affecting millions worldwide. Males bear a significantly higher lifetime risk than females. The primary aim of this study was to compare Lichtenstein repair and Darn repair techniques in managing obstructed inguinal hernias, evaluating the incidence of wound infection, seroma formation, post-operative pain duration, and hernia recurrence for each repair method.

METHODOLOGY:A total of 40 patients (20 in each group) were selected. Group 1 contained the patients undergoing Lichtenstein repair, and Group 2 contained those undergoing Darn repair. Data was analyzed using SPSS version 25. Data for wound infection, seroma, andpost-op pain were described using frequency, and similarity amongst groups was made using chi-square and Fisher exact test

RESULTS: Forty subjects were randomly divided into Lichtenstein repair and Darn repair groups. The mean age in the Lichtenstein repair group was higher than in the Darn repair group. Seroma formation occurred in 15% of patients in both groups. Post-operative wound infection showed variations over time, while recurrence rates remained similar between the groups.

CONCLUSION: This study provides valuable insights into managing obstructed inguinal hernias, suggesting that Lichtenstein mesh repair may be a viable option for this condition. Future studies should further investigate the role of mesh repair in emergency hernia cases, potentially reshaping current surgical paradigms.

Comparison of spontaneous resolution of secundum atrial septal defects in term and preterm neonates

2025-06-16T09:16:51+00:00

BACKGROUND & OBJECTIVE: Atrial septal defects (ASDs) are among the most common congenital heart defects, with secundum ASDs accounting for approximately 70% of cases. These often close spontaneously during infancy or early childhood. However, the timing and likelihood of spontaneous closure may be influenced by gestational age. This study aimed to compare the spontaneous resolution of secundum ASDs in term versus preterm neonates and to identify potential predictors for natural closure to guide optimal early interventions.

METHODOLOGY: This cohort study was conducted at the Pediatric Department of Hilal-e-Ahmar Hospital, Faisalabad, Pakistan, from December 2022 to March 2024. A total of 280 neonates were enrolled—140 preterm and 140 term—each diagnosed with a secundum ASD within one month of birth. Newborns with major congenital heart defects were excluded. Patients were followed until spontaneous resolution, defined as defect closure or reduction in size to less than 3 mm without the need for medical or surgical intervention.

RESULTS: The mean age at baseline and follow-up was 4.44±1.86 days and 13.57±6.56 months for term neonates, and 8.11±5.68 days and 14.16±6.87 months for preterm neonates. Among preterms, 55% were male and 45% female; among terms, 51.4% were male and 48.6% female. While most ASDs resolved spontaneously in both groups, resolution was less frequent among preterm infants.

CONCLUSION: Spontaneous resolution of secundum ASDs is common in both term and preterm neonates, though preterm infants show a lower rate of closure. Early identification and follow-up are essential for optimizing outcomes.

Evaluation of salivary IL-6 and carbonic anhydrase VI as biomarkers in periodontal health and disease

2025-06-13T06:30:07+00:00

BACKGROUND & OBJECTIVE: Saliva contains proteins that may serve as biomarkers for oral diseases. Periodontitis, an inflammatory gum disease linked to poor oral hygiene, alters salivary composition. This study aimed to compare salivary carbonic anhydrase VI (CA VI) and interleukin-6 (IL-6) levels among individuals with healthy gums, mild, and moderate periodontitis.

METHODOLOGY: In this cross-sectional study, ELISA measured CA VI an enzyme involved in pH regulation and IL-6 a pro-inflammatory cytokine in saliva. Periodontal status was assessed via periodontal pocket depth (PPD) and clinical attachment loss (CAL) using a Michigan O probe.

RESULTS: The Kruskal-Wallis test showed no significant differences in CA VI and IL-6 levels across the groups (p = 0.217 and p = 0.579, respectively). However, in healthy individuals, CA VI levels were inversely correlated with PPD (Spearman’s ρ = –0.455) and CAL (ρ = –0.433). In mild periodontitis, CA VI negatively correlated with PPD (ρ = –0.467). In moderate periodontitis, IL-6 levels showed a significant inverse correlation with CAL (Pearson’s r = –0.408).

CONCLUSION: Salivary CA VI and IL-6 levels were not significantly different across periodontal health statuses, suggesting limited use as diagnostic biomarkers. Nonetheless, significant correlations between CA VI and periodontal parameters in healthy and mildly affected individuals and IL-6 and CAL in moderate periodontitis indicate potential roles in disease progression monitoring.

Measurement of food sensitivity with special reference to food properties in children with autism spectrum disorder

2025-05-31T04:40:38+00:00

BACKGROUND & OBJECTIVE: Autism spectrum disorders (ASD) are lifelong neurodevelopmental conditions often associated with atypical dietary behaviors. This study aimed to analyze food sensitivity and its relationship to food acceptance in children with ASD.

METHODOLOGY: Twenty-five children with ASD were selected for the study. Various fruits differing in color, shape, and texture were introduced twice weekly. The Childhood Autism Rating Scale (CARS) was used to assess behavioral responses and food acceptance.

RESULTS: Hard-textured foods were accepted by 72% of the children. Soft and slippery foods were more likely to be rejected—30% and 10% of children split and rejected them, respectively. Mineral analysis revealed varying zinc (11.5–36.5 µg/dl) and iron levels, with the highest iron levels in 5-year-olds and the highest zinc in 8-year-olds. Behavioral assessments highlighted significant patterns in joint attention, play, and sensory processing. Statistical analysis showed no significant difference (p > 0.05) in food acceptance based on color, texture, or frequency of intake.

CONCLUSION: Children with ASD exhibit consistent reactions to specific food textures and colors. The findings emphasize the importance of texture-based interventions in early childhood to improve dietary variety and food acceptance in ASD populations.

Laparoscopic excision of abdominopelvic Ewing’s Sarcoma in a child: A case report

2025-05-31T04:40:30+00:00

Ewing sarcoma is a rare and aggressive neoplasm that primarily affects the bones and soft tissues of pediatric and adolescent patients. When located in the abdominopelvic region, it poses challenges for treatment due to its proximity to vital organs. We present a case of a 16-year-old male diagnosed with abdominopelvic Ewing sarcoma. He presented with abdominal pain and swelling extending from the pelvis to above the umbilical region. CT imaging revealed a large mass with both solid and cystic components originating from the pelvic area, with surrounding displacement. A core needle biopsy confirmed the diagnosis. Neo-adjuvant chemotherapy was initiated to reduce the tumor size. Post-treatment imaging revealed two masses, one in the pelvis and one in the peri-splenic area. Laparoscopic surgery successfully excised abdominopelvic Ewing’s Sarcoma. Histopathology showed clear resection margins and 60% necrosis. Adjuvant radiotherapy was given to minimize recurrence. This case demonstrates successful management using a multidisciplinary approach.

Common prescription errors among dentists in the middle east: A comprehensive literature review

2025-05-31T04:41:03+00:00

BACKGROUND AND OBJECTIVE: Prescription errors in healthcare pose significant risks, leading to adverse patient outcomes and escalating healthcare costs. In dentistry, mistakes like incorrect drug choice or dosage can cause serious complications. Although these risks are well-known, limited research focuses specifically on dental prescription errors in the Middle East. This study aims to investigate common prescription errors within this region’s dental field and identify factors that could help improve patient safety and elevate care standards.

METHODOLOGY: A literature review of existing studies was performed utilizing databases such as Google Scholar, Scopus, and PubMed, zeroing in on dental prescription errors related to the Middle East.

RESULTS: The data reveals common errors include wrong drug choice, prescribing unsafe drugs, inappropriate treatment length, incomplete patient information, wrong dosage, and poor communication with patients.

CONCLUSION: As highlighted in the study, immediate targeted measures are required to create safer dental prescribing in the Middle East. Recommendations encompass providing ongoing training, performing regular audits, and using electronic prescribing systems. Teamwork between healthcare providers is crucial to creating hypervigilance of prescribing in dental care and improving medication safety.