Journal of Ayub Medical College Abbottabad
J Ayub Med Coll Abbottabad, the printed and online Journal of Ayub Medical College Abbottabad Pakistan, is an indexed journal, recognised by Pakistan Medical and Dental Council (PM&DC) as a Standard Medical Journal and by Higher Education Commission (HEC) of Pakistan. It is registered with Serial Data System of France (pISSN 1025-9589 and eISSN 1819-2718) and indexed with PubMed, Medline, PakMediNet, and Tehqeeqat. It is the second journal from Pakistan to achieve this status, and the first journal of any medical college of Pakistan to be internationally indexed and the first Pakistani Medical Journal available Full Text with Illustrations FREE online. JAMC is also indexed in the Master List of Index Copernicus. The journal is published quarterly and contains articles of medical research interest having basic, applied or clinical research content.
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board. USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access. AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
PERIOSTEAL OSTEOSARCOMA PRESENTING IN JAW BONE; UNUSUAL SITE OF AN UNUSUAL ENTITY
Periosteal osteosarcoma (PO) is a rare surface based bone tumor of intermediate grade, comprising mostly of chondroblastic tumor cells and accounts for 1-2% of all osteosarcoma cases. PO is almost often located in the long bones and affects patients mostly in their second and third decades of life. Mandible is a rare site. We report a rare case of mandibular periosteal osteosarcoma in a 26 year old female patient. She presented with fracture and swelling left side of mandible. Segmental mandibulectomy was performed. No pre surgical treatment was received. The radiological findings and histologic features led to the diagnosis of Periosteal osteosarcoma. There is no evidence of local recurrence after 05 months of follow up. This treatise highlights importance of radiological and histological identification of such an unusual entity at such unique primary site of occurrence.
Copyright (c) 2025 Anam Ghauri, Afifa Ghauri https://creativecommons.org/licenses/by-nd/4.0
TAKAYASU ARTERITIS IN A YOUNG FEMALE PRESENTING WITH PYREXIA OF UNKNOWN ORIGIN IN THE PRE-PULSELESS PHASE
Takayasu arteritis is a rare chronic large vessel vasculitis that mainly occurs in young females with a higher prevalence in Asian population. This disease, in its early stages, often goes undiagnosed because of its non-specific and vague symptoms. This poses great difficulty for doctors to accurately make the diagnosis. One of its initial presentations is 'pyrexia of unknown origin (PUO). PUO precedes the pulseless stage of Takayasu arteritis. Here we're going to do a case report on a 26-year-old female patient presenting with PUO as the pre-pulseless stage of Takayasu arteritis. The presentation as PUO in the absence of pulse deficits is very uncommon and has been very underwhelmingly reported.
Copyright (c) 2025 abeera, fatima, dr tehzeeb zehra, dr hayida ali, dr muhammad jahangir, sheema, Romana Irshad https://creativecommons.org/licenses/by-nd/4.0
A CASE REPORT OF BARDET-BIEDL SYNDROME: EMPHASIZING GENETIC COMPLEXITY AND MULTIDISCIPLINARY MANAGEMENT
Bardet-Biedl Syndrome (BBS) is a rare autosomal recessive ciliopathy presenting with multisystemic manifestations. We report a case of a 17-year-old female with BBS who presented with life-threatening kidney disease. The patient exhibited classic BBS features, including retinal dystrophy, polydactyly, obesity, and cognitive impairment. Genetic analysis revealed consanguinity, underscoring the link between familial history and increased disease likelihood. This case highlights the importance of early genetic studies, comprehensive multidisciplinary care, and genetic counseling for affected families to improve patient outcomes and guide subsequent pregnancies.
Copyright (c) 2025 Dua.B. Zaidi, Daayl Naim Mirza, Romesa Jamshed, Inshal Jawed https://creativecommons.org/licenses/by-nd/4.0
SCORPION STING AND UNILATERAL PULMONARY EDEMA: A CASE REPORT
A man inflicted with scorpion sting on his left big toe developed dyspnea and hypotension 6 hours later. The chest X-ray showed alveolar infiltrates only on right side with elevated Troponin-T and B-type natriuretic peptide levels. Toxic myocarditis is a rare and under-recognized but potentially fatal complication of scorpion envenomation; development of pulmonary edema only on one side is even more uncommon and can cause delay in the diagnosis. Awareness of the condition is important to guide the treatment and avert complications.
Copyright (c) 2025 Akhwand Shakeel Ahmad https://creativecommons.org/licenses/by-nd/4.0
MAGGOT INFESTATION IN CIRCUMCISION WOUND: A CASE REPORT AND REVIEW OF LITERATURE
Back Ground: Male circumcision is an obligated practice in Muslims and Jews and it is one of the oldest operations performed all over the world. The safety of male circumcision depends on various factors including the who circumcised the boy, the type of anesthesia used and associated complications. Circumcision in Pakistan is mainly done by traditional circumcisers and less by medically trained professionals. The various complications associated with circumcision include bleeding, excessive or inadequate removal of fore skin, injury to the glans and infection. Myasis of circumcision wound is an extremely rare event.
Copyright (c) 2025 Ishrat Mahtam, Sirajuddin Soomro, Roshan Ali Siyal, Baqa Muhammad Abbasi https://creativecommons.org/licenses/by-nd/4.0
AN ANOMALOUS VENA CAVAL RETURN TO LEFT ATRIUM PRESENTING AS RECURRENT ABORTIONS: A CASE REPORT
Opening of inferior vena cava into the left atrium with atrial septal defect is an extremely rare congenital abnormality. We report a case of 28-years-old female presented with repeated respiratory tract infections and repeated abortions 19 years after the repair of atrial septal defect and partial anomalous pulmonary venous return. Investigations showed that she was also having abnormal drainage of inferior vena cava into the left atrium. This drainage was causing hypoxemia leading to repeated abortions. Second surgery was performed which confirmed the drainage of inferior vena cava into the left atrium. The repair was carried out with subsequent correction of hypoxemia and successful pregnancy.
Copyright (c) 2025 Mohsin Masud, Dr. Shafi, Prof. Sajid https://creativecommons.org/licenses/by-nd/4.0
EXPLORING THE LEARNING EXPERIENCE OF POSTGRADUATE MEDICAL RESIDENTS IN BEDSIDE CLINICAL SKILLS: A QUALITATIVE ANALYSIS.
Background: Sir William Osler, a renowned physician, once said, “Medicine is learned by the bedside and not in the classroom. Let not your conceptions of disease come from the words heard in the lecture room or read from the book. See and then reason and compare and control. But see first”. Objective was to explore the learning experience of Postgraduate Medical Residents in Bedside Clinical Skills and identify the hurdles in good learning experience. Methods: This study was conducted in the Department of Medicine, medical teaching institute of Khyber Pakhtunkhwa in March 2025. The duration was till the saturation of data. The participants were inducted after taking informed consent and proper explanation of the objectives of the study. Induction was through purposive sampling for a focus group comprised of eight postgraduate medical residents from different years of residency. The data analysis was from the audio recordings of the focus group and were transcribed verbatim. From the transcribed data codes were identified to look for themes, sub-themes and individual quotes with in the data. Results: A focus group of eight postgraduate medical students, four male and four female along with a male PGR was part of the study. PGRs were from different years of training and were from the medical department. All participants appreciated the effectiveness of bedside clinical skill teaching. They unanimously agreed on the beneficial role of the supervisor in improving the learning experience. Our participants identified different barriers and suggested ways to overcome them. Overcrowded, hectic, and underequipped medical units are clear barriers to learning, and hospital administration has been identified as a mechanism for addressing this issue. Our participants were unsure regarding the impact of CPSP and PGMI in improving the overall learning experience for bedside clinical skills. Conclusion: Bedside clinical skills teaching by their supervisors as an effective tool to enhance their learning as well as decision making while interacting with the patients. Barriers of fear, overcrowding and poor medical resources are well accepted but with time they eased out by adaptation with the environment
Copyright (c) 2025 Syed Yasir Hussain Gilani, Saima bibi, Ayesha Junaid, Junaid Sarfaraz Khan https://creativecommons.org/licenses/by-nd/4.0
EFFECTIVENESS OF ORAL ISOTRETINOIN VERSUS TOPICAL TRETINOIN 0.05% IN THE MANAGEMENT OF FACIAL PLANE WARTS
Background: Facial plane warts present a therapeutic challenge due to limited treatment options. Electrocautery and cryotherapy, though effective, carry risks of scarring and pigmentation. LASER therapy is often inaccessible in resource-limited settings. While both topical tretinoin and oral isotretinoin have shown satisfactory outcomes, no standard treatment exists. Dermatologists are cautious with oral isotretinoin due to the absence of clear guidelines. This trial aimed to compare the efficacy of oral isotretinoin versus topical tretinoin 0.05% in treating facial plane warts. Methods: Approved by the hospital’s ethics board, the study began in January 2023 at Khyber Teaching Hospital. Clinically diagnosed patients with facial and neck plane warts were enrolled. A total of 106 participants were randomized into two groups. Group A received topical tretinoin 0.05%, while Group B was administered oral isotretinoin at 0.5 mg/kg. Treatment response was assessed at 1 and 3 months. Complete lesion clearance marked treatment success, with monthly follow-up for 3 months to assess recurrence. Results: Among 106 patients (61 males, 45 females), 30 (56.6%) in Group A and 42 (79.2%) in Group B achieved complete clearance (p=0.0125). Recurrence occurred in 4 participants per group (13.3% in A; 9.3% in B, p=0.612). Conclusion: Oral isotretinoin proved significantly more effective than topical tretinoin 0.05% in treating facial plane warts, with a comparable recurrence rate.
Copyright (c) 2025 Huma Gul, Jahangir Khan, Zarar Bin Jamil https://creativecommons.org/licenses/by-nd/4.0
PROCEDURAL SUCCESS AND IN HOSPITAL COMPLICATIONS OF CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTION
Background: Chronic total occlusion (CTO) recanalization had been considered as technically challenging procedure with low chances of successful recanalization. The aim this study is to find out the rate of procedural success and complications associated with revascularization of CTO. Methods: This is a retrospective observational study. Records of 243 patients presenting to Peshawar Institute of Cardiology were analyzed form 1st April 2021 till 31st March 2024, who had PCI for CTO lesions. Results: Among 243 patients analyzed 70.4% were male and 29.6% were females. J-CTO score was used to assess the complexity of the lesion. Mean J-CTO score was 2.4±0.97. LAD was the commonest CTO vessel requiring revascularization. Highest success rate (95%) was seen with “easy” lesions (J-CTO <1) and shows a significant association at p value >0.05. Overall complication rate was very low. Two patients (0.82%) had mortality. Coronary perforation was the gravest complication. Conclusion: CTO recanalization is a complex procedure which requires different skillset. Our success rate is lower than international figures which emphasizes on the necessity of advanced training in this domain of coronary intervention. Fortunately, our complication rate closely resembles to global data ensuring safety of our procedures.
Copyright (c) 2025 Mohammad Waleed, Rafi Ullah Jan, Ali Raza, Shahzeb, Syed Alishan, Abidullah, Fazal Akbar, Maryum Masoud https://creativecommons.org/licenses/by-nd/4.0
EFFECT OF AWARENESS ON KNOWLEDGE OF NON-ALCOHOLIC FATTY LIVER DISEASE AMONG NON-GI PHYSICIANS
Objective: To measure the base line level of knowledge among non-gastroenterology physicians and compare knowledge after sharing of reading material about NAFLD upon reassessment. Study design: Quasi-experimental. Place and duration of study: POF Hospital Wah Cantt Methodology: Proforma containing various NAFLD related questions covering three domains including risk factors, diagnostics and treatment were included. The Proformas were handed over to all participants involved in the study. The first part of the questionnaire comprised demographic information of the participants. The second part of the questionnaire was about the knowledge of the doctors regarding NAFLD. The questionnaire comprised of 12 questions including multiple choice questions & questions with yes or no with a total 25 parameters. The maximum achievable score was 25. The primary outcome was the frequency of distinct categories of score before and after creating awareness. Results: Nine non-gastroenterology (22.5%) physicians had good knowledge, 17(42.5%) had fair knowledge and 12(30.0%) had poor knowledge. After the awareness campaign, 10(25.0%) participants had excellent knowledge, 9(22.0%) had very good knowledge, 18(45.0) had fair knowledge and only one participant (2.5%) had poor knowledge with p value less than 0.05. Conclusion: We concluded that primary care physicians underestimate the frequency of NAFLD and fail to recognize its risk factors, diagnostics and treatment. The adequate use of awareness campaigns improved their knowledge effectively. Keywords: Awareness, Liver, Non-alcoholic fatty liver disease (NAFLD), prevalence
Copyright (c) 2025 Noreen Adil, Adil Mehraj, Mehwish Gilani, Ammad Akram https://creativecommons.org/licenses/by-nd/4.0
POST-OPERATIVE SENSITIVITY IN COMPOSITES USING BULK-FILL VS. OBLIQUE INCREMENTAL PLACEMENT TECHNIQUE: A DOUBLE-BLIND, RANDOMIZED TRIAL
Background Post-operative sensitivity is a potential drawback of composite restorations. Placement strategies have a profound impact on sensitivity. This trial is aimed to compare the occurrence and severity of sensitivity in composites using bulk-fill technique and oblique incremental technique. Methods This double-blind, randomized clinical trial was conducted at the Department of Operative Dentistry and Endodontics, School of Dentistry, Islamabad from December 20, 2022, to July 24, 2023. A total of 90 participants with moderate-sized Class II carious lesions were recruited and randomly distributed into two groups A and B (n=45). After informed consent, restorative intervention was accomplished using an etch-and-rinse adhesive strategy. In group A, a nanohybrid composite resin was placed using an oblique incremental strategy with a thickness of 2 mm while in group B, bulk-fill strategy was employed with a thickness of 4 mm. Participants were instructed to rate their sensitivity status at evaluation periods using Visual analogue scale. Data was analyzed using the Independent Sample T-test. The level of significance was calibrated at ≤0.05. Results According to results of this trial, a significant difference was discerned between two groups after one day (p=0.00) and one week (p=0.01). Nonetheless, the statistical contrast between two groups was not as significant (p=0.05) after two weeks period. Conclusion In conclusion, post-operative sensitivity at all three-time intervals using Bulk-fill technique was reported to be less than Oblique incremental approach. This corroborates the claim that utilizing the bulk-fill strategy for composite restoration mitigates post-operative discomfort.
Copyright (c) 2025 Nehal Amir, Hashim Bin Mansoor, Haider Rizwan, Ayman Ijaz, Khadim Hussain https://creativecommons.org/licenses/by-nd/4.0
A COMPARISON OF SERUM NUCLEAR FACTOR ERYTHROID 2-RELATED FACTOR 2 IN DIABETIC AND NON-DIABETIC PATIENTS WITH OSTEOARTHRITIS
Background: Osteoarthritis (OA) or inflammation of joints is a chronic degenerative and irreversible joint disorder. Oxidative stress in chronic inflammation contributes to osteoarthritis. Nuclear factor erythroid 2-related factor 2 (Nrf2) signaling pathway have an inhibitory role in oxidative stress and inflammation, as significant interaction exists between transcriptional pathways involving Nrf2 and NF-κB which is related to immune response in body. Diabetes mellitus being a pro inflammatory condition, has more oxidative damage due to the effects of hyperglycaemia. This study evaluated serum Nrf2 expression levels in osteoarthritis patients in the presence and absence of hyperglycaemia in order to find out the magnitude of anti-oxidative response, whether Nrf2 expression levels increases or decreases in oxidative stress environment comparatively. Objectives of this study were to evaluate Nrf2 serum expression levels in osteoarthritis patients by ELISA and to compare Nrf2 serum circulatory levels between diabetic osteoarthritis patients’ group and non-diabetic osteoarthritis patients’ group. Method: The comparative cross-sectional study was conducted from February 01, 2023 to 31 January, 2024 at department of Biochemistry, Nowshera medical college (NMC), Nowshera and Medicine/Orthopaedic OPD of Qazi Husain Ahmad Medical complex (QHAMC), Nowshera. This comparative cross-sectional study included 44 male and female osteoarthritis patients of ≥50 years old that were further divided into a diabetic and non-diabetic group on the basis of hyperglycaemia. NRF2 levels were measured using ELISA. Results: Blood circulatory levels of NRF2 were significantly higher in non-diabetic patients of osteoarthritis Conclusion: Nrf2 levels are lower in diabetic patients of osteoarthritis as compared to non-diabetic patients of osteoarthritis.
Copyright (c) 2025 Zahid Irfan Marwat, Alamzeb Jadoon, Shah Nawaz, Aamir Sheharyar, Saifoor Ahmad Khan, Muhammad Israr https://creativecommons.org/licenses/by-nd/4.0
TOOL DEVELOPMENT FOR EVALUATING ADHERENCE TO THE MANAGEMENT IN PATIENTS WITH TYPE 1 DIABETES MELLITUS (T1DM)
Background: Type 1 Diabetes Mellitus (T1DM) is a chronic disease that needs strict adherence to maintain the glycaemic control and prevent complications. However, there is currently a lack of tools specifically designed for low- and middle-income country (LMIC) contexts to monitor adherence to T1DM management. The purpose of this study is to construct a self-administered tool to assess adherence to management protocols in T1DM patients. Methods: The adherence tool was developed in three phases: item pool construction, content validation, and pilot testing. The item pool construction phase consisted of a scoping review, focus group discussions (FGDs) and in-depth interviews (IDIs). In the second phase, expert validation and cognitive interviews were carried out to refine the questionnaire. Then, a pilot study on 25 T1DM patients was conducted to evaluate the tool’s internal consistency and reliability. Thematic and statistical analysis was employed to analyse qualitative and quantitative findings, respectively. Results: The developed tool consists of 43 questions, which covers different aspects of diabetes care including insulin dosage and administration 16 items), diet (12 items), and exercise (15 items). The tool was contextualised to cater for the needs of local patients and is delivered in the local language i.e. Urdu. The pilot study demonstrated good reliability (Cronbach alpha=0.78), test-retest reliability (Cronbach alpha=0.67) showing high internal consistency, and construct validity (Cronbach alpha=0.67) for the developed adherence assessment tool. Also, a strong correlation was found between adherence to overall T1DM management and HbA1C levels. Conclusion: The developed self-administered tool reliably assesses adherence to T1DM management in LMIC contexts. This tool offers a practical resource to monitor and improve glycaemic control in T1DM patients, tailored to local needs.
Copyright (c) 2025 Mohammad Jawad, Saima Afaq, Zia Ul Haq, Sana Hussain, Fatima Sarfaraz, Arshad Hussain, Moosa Ali https://creativecommons.org/licenses/by-nd/4.0
A COMPARATIVE STUDY OF DIGITAL LATERAL CEPHALOGRAM AND VIRTUAL CONE-BEAM COMPUTED ASSISTED CEPHALOGRAM IN CEPHALOMETRIC ANALYSIS
Background: The Advent of innovative technologies like Cone Beam Computed Tomography (CBCT) scans presents itself as an alternative to traditional lateral cephalometric radiography. However, it is imperative to validate images generated using this technology for meaningful comparisons. Moreover emphasizing the necessity to justify the amount of radiation exposure is crucial. Through this investigation, we seek to determine the comparability of angular and linear measurements derived from Digital lateral cephalometry and CBCT derived lateral cephalograms. Methods: 40 lateral cephalometric radiographs and 40 virtual cephalograms from cone-beam computed tomography were analyzed, involving forty patients from the Orthodontic Department at Fauji Foundation Hospital Islamabad. After the prior calibration, two sets of measurements within a fifteen-day interval using Down's analysis and WebCeph software. The discrepancies between these measurements were assessed to determine their significance Results: There was strong correlation between the measurements of 2D and 3D cephalometric angles among FA, AOC, MPA, YA, COP, IIA, IOPA, IMPA and UIAP Linear . The most notable variance was observed in the Cant of occlusal plane (COP) reaching a statistical significance (P < 0.05). Conversely, Y-axis exhibited the least variance. Conclusions: The absence of statistically significant differences suggests that, in our study, choice of radiograph used for analysis had minimal impact on the cephalometric measurements. These findings highlight the reliability and comparability between CBCAC and DLC.
Copyright (c) 2025 Dr.Momna Qadeer, Prof. Dr. Rozina Nazir, Dr. Ruhamaa Arshad https://creativecommons.org/licenses/by-nd/4.0
EVALUATING THE IMPACT OF A TRAINING WORKSHOP ON PRESCRIPTION WRITING SKILLS: A PRE AND POST INTERVENTIONAL STUDY
Evaluating the Impact of a Training Workshop on Prescription Writing Skills: A Pre and Post Interventional Study
Copyright (c) 2025 Ubaidullah, Usman Mehboob, Humera Adeeb, Samreen Raiz https://creativecommons.org/licenses/by-nd/4.0
DENTAL REHABILITATION UNDER GENERAL ANESTHESIA: A QUALITATIVE ANALYSIS OF ITS IMPACT ON CHILDREN’S ORAL HEALTH-RELATED QUALITY OF LIFE.
Background: Early childhood caries is a widespread condition in the developing world, considerably affecting children’s oral health-related quality of life by causing pain, discomfort, and functional impairments. Dental rehabilitation under general anesthesia is a beneficial intervention for severe early childhood caries, offering substantial relief and marked improvements in oral health-related quality of life. This study explores the impact of dental rehabilitation under general anesthesia on the emotional and social well-being of affected children and their families. Methods: A qualitative study was conducted at the Department of Pediatric Dentistry, Children's Hospital, Pakistan Institute of Medical Sciences, Islamabad. Out of 40 children who underwent comprehensive dental treatment under general anesthesia, the parents of 15 children agreed to participate in focus group discussions and in-depth interviews. Two focal group discussions (with five parents each) and five in-depth interviews were conducted and thematic analysis synthesized data into a comprehensive picture of the participants’ experiences. Results: Before dental rehabilitation under general anesthesia, children experienced pain, sleep issues, behavioral problems, poor academics, and social withdrawal, causing emotional and financial stress for families. After treatment, children showed improved behavior, school performance, and well-being. Parents reported enhanced family dynamics and reduced financial burdens, significantly improving overall quality of life. Conclusion: Dental Rehabilitation treatment under general anesthesia, substantially improves children’s oral and functional health, emotional stability, and social interaction, while positively influencing family well-being. Parents expressed high levels of satisfaction, highlighting it as a valuable intervention for managing extensive forms of early childhood caries and enhancing overall quality of life.
Copyright (c) 2025 Halima Sadia Qazi, Naila Amir, Palwasha Babar, Fayyaz Alam, Asma Munir Khan, Sajjad Ahmad https://creativecommons.org/licenses/by-nd/4.0
EXAMINING CORRELATES OF FIVE FACTOR MODEL PERSONALITY TRAITS OF FUTURE SPECIALISTS AND THEIR SPECIALTY PREFERENCES: A CROSS-SECTIONAL ANALYTICAL STUDY
Background: Personality traits significantly influence medical students' and physicians' specialty choices. The Five Factor Model assesses extraversion, conscientiousness, openness, agreeableness, and neuroticism. Certain specialties attract individuals with specific traits, and recognizing these correlations enhances medical education and career planning. Objectives were to assess personality traits of medical students and house officers using Factor Five Model, identify their future specialty preferences and determine any correlation. Methods: This cross-sectional analytical study (n=230) was conducted among medical students from a private medical college and house officers at a tertiary care hospital in Rawalpindi, Pakistan, after ethical approval from March to August 2023. A self-administered questionnaire collected demographic data, specialty preferences, and personality traits assessed using the Big Five Inventory–2 Extra-Short Form with Cronbach’s α = 0.74. Data were analyzed on SPSS v-23 (p≤0.05). Results: Out of 230 respondents, 64.8% were females, mean age 23±1.5 years. Agreeableness had highest mean score (10.97±2.26), Neuroticism was lowest (8.70±2.49), with females scoring higher in both. Significant higher Agreeableness was linked to post-graduate study plans (p=0.028). Surgery (n=75) and Internal Medicine (n=50) were most preferred. Extraversion was significantly higher in Surgery (p=0.014) and lower in Radiology (p=0.027). Pediatrics correlated with higher neuroticism (p=0.028), family medicine with lower neuroticism (p=0.05). Emergency Medicine (p=0.018) and Ophthalmology (p=0.05) were associated with higher agreeableness. Conclusion: These findings highlight personality patterns influencing specialty choices in medical professionals. Recognizing these associations aids medical training, career counselling, and workforce planning, ensuring balanced physician distribution. Tailored guidance may enhance job satisfaction, fulfilment, and healthcare efficiency.
Copyright (c) 2025 Fizza Nouman, Tahira Amjad, Malaika Nasir, Abdur Rahim, Maimoona Yousaf, Malaika Abid, Abdullah Inayat Gondal, Abdullah Waheed Chaudhry https://creativecommons.org/licenses/by-nd/4.0
RADIOGRAPHIC FINDINGS OF TEMPOROMANDIBULAR JOINT OSSEOUS CHANGES USING CONE-BEAM COMPUTED TOMOGRAPHY IN A SAUDI POPULATION: A RETROSPECTIVE STUDY
Background: The temporomandibular joint (TMJ) is a complex synovial articulation that plays a critical role in mastication, speech, and mandibular movements. Pathologies affecting the TMJ, such as internal derangement, osteoarthritis, and degenerative bone changes, can significantly impair function and quality of life. Objectives were to evaluate the prevalence and pattern of osseous changes in the temporomandibular joint (TMJ) using cone-beam computed tomography (CBCT) in a Saudi population, with emphasis on diagnostic and surgical relevance. Methods: This retrospective study was conducted in the Department of Diagnostic Sciences, Qassim University, Saudi Arabia, and included 414 bilateral CBCT scans obtained between January 2020 and December 2024. Scans were evaluated for degenerative bony changes such as condylar flattening, erosion, osteophytes, subchondral sclerosis, and cysts. Two experienced radiologists performed independent assessments, and inter-examiner reliability was calculated. Demographic associations were analyzed using Chi-square and ANOVA tests, with significance set at p<0.05. Results: Of the 414 subjects, 260 (62.8%) were male and 154 (37.2%) were female. Condylar flattening was the most frequent pathology, observed in 10.63% of right and 9.90% of left TMJs, followed by erosion and subchondral cysts. A total of 73.7% of cases exhibited radiographic abnormalities. Age was significantly associated with the presence of TMJ pathologies (p<0.01), particularly in individuals aged 40–60 years. No statistically significant association was found between gender and TMJ degeneration. Conclusions: cone-beam computed tomography effectively detects subtle and early-stage TMJ osseous changes, with flattening, erosion, and cystic degeneration being the most prevalent findings. The strong age-related pattern of TMJ degeneration supports the need for early radiographic screening, especially in middle-aged adults. From a surgical perspective, CBCT imaging plays a vital role in preoperative planning, aiding in the decision-making process for conservative versus surgical interventions.
Copyright (c) 2025 Waleed Abdulhadi Alalawi, Shaul Hameed Kolarkodi, Khalid Alotaibi, Abdulrahman Altwaijri, Faraj Alotaiby https://creativecommons.org/licenses/by-nd/4.0
BRONCHIECTASIS IN CHILDREN WITH PCD: MPA (MAIN PULMONARY ARTERY) AND MPA-TO-AA RATIO AS MARKERS OF DISEASE SEVERITY
Objective Lung function in primary ciliary dyskinesia becomes abnormal from an early age and doing any lung function test in the first few years of life requires a child's cooperation which can be difficult. HRCT is done every few years to monitor lung structure. We aimed to look at the relationship of bronchiectasis with the size of MPA (main pulmonary artery) and MPA-to-AA (ascending aorta) ratio. This can be used as an additional disease marker when assessing CT chest. Methods This was a retrospective analysis of CT chest measurements in children with confirmed PCD, followed up at our centre between 2008-2020. Diameters of the main pulmonary artery, ascending and descending aorta were measured at predetermined reference points. The scans were independently analysed by two radiologists. CT chest contrast images were obtained on a 64 slice- Discovery CT750 HD, GE Healthcare medical system. Bronchiectasis was graded using the Modified Reiff scoring method. Results 38 measurements from 26 patients were taken into consideration to assess the relationship between MPA diameter, MPA: Ascending aorta and bronchiectasis. There was a positive correlation between the age-adjusted MPA-to-AA ratio and severe bronchiectasis (r=0.59, p=0.47). Children without bronchiectasis had an inverse correlation with MPA-to-AA ratio (r= -0.28, p=0.16). MPA diameter was positively related to both severe (r=0.59, p=0.06) and no bronchiectasis (r=0.91, p=0.01). There was a disproportionate age-dependent increase in the size of MPA in children who had multiple scans once bronchiectasis progressed from mild to severe. Conclusions This is a pioneer study looking at CT chest markers like MPA (diameter) and MPA-to-AA ratio in children with PCD and their relevance to the severity of bronchiectasis. An elevated MPA-to-AA ratio can be used as a marker of severe bronchiectasis however MPA diameter on its own has limited value in differentiating mild from severe bronchiectasis.
Copyright (c) 2025 Adnan Zafar, Mohammed Salman Qureshi , Saba Ayub https://creativecommons.org/licenses/by-nd/4.0
ASSESSING GESTATIONAL DIABETES RISK: THE ASSOCIATION OF ABDOMINAL SUBCUTANEOUS FAT THICKNESS IN FIRST TRIMESTER AND GLUCOSE CHALLENGE TEST AT 24-28 WEEKS
Background: Gestational diabetes mellitus (GDM) is a common complication during pregnancy, affecting approximately 3–4% of expectant mothers. This condition increases the risk of postpartum diabetes in mothers and obesity in their children. Moreover, GDM is linked to a higher incidence of infections, pre-eclampsia, eclampsia, and large-for-gestational-age infants, all contributing to perinatal morbidity. This study aimed to examine the association between GDM and abdominal subcutaneous fat thickness (ASFT), with the specific objective of determining a predictive ASFT cut-off value for GDM. Methods: This study was conducted at the Obstetrics and Gynaecology Departments of Pakistan Air Force Hospital, Kamra, and Pakistan Air Force Hospital, Islamabad, between December 2023 and May 2024. The cohort included 288 pregnant women aged 21–35 years, none of whom had diabetes, a history of smoking, hypertension, or metabolic syndrome. Pre-pregnancy body mass index (BMI) and weight gain were recorded, and ASFT was measured via ultrasound. Between 24 and 28 weeks of gestation, participants underwent a 75 g oral glucose tolerance test (OGTT). Data analysis was performed using ROC curve analysis and logistic regression via IBM SPSS version 23.0. Results: Of the 288 participants, 52 (18.05%) were diagnosed with GDM. The mean maternal ASFT was 2.2±0.4 cm, with statistically significant differences observed between the GDM and non-GDM groups (p<0.05). An ASFT threshold of 2.1 cm demonstrated a sensitivity of 76.25% and specificity of 92.57% in predicting GDM. Conclusion: Maternal ASFT measured by ultrasound in the first trimester is a reliable predictor of GDM risk in the second trimester. This parameter may serve as a useful supplementary diagnostic tool for assessing early risk of GDM.
Copyright (c) 2025 Adila Anwar, Amina Akbar, Sadaf Afroze, Shakra Tabasam, Shahnaz Sheeba, Ghana Shahid https://creativecommons.org/licenses/by-nd/4.0
OPEN LABEL STUDY COMPARING THE EFFICACY OF CONTINUOUS LOW DOSE ISOTRETINOIN VERSUS INTERMITTENT LOW DOSE ISOTRETINOIN REGIMENS IN MODERATE TO SEVERE ACNE VULGARIS
Background: Acne vulgaris, recognized as the eighth most prevalent disease globally, affects approximately 9.4% of the world population. It can manifest in a spectrum ranging from mild physiologic acne to severe presentations such as nodules, cysts, and abscesses. This open-label comparative study was conducted at the Dermatology OPD of Akbar Niazi Teaching Hospital, Islamabad, from September 1, 2021, to March 1, 2022, with the objective of evaluating the efficacy of low-dose continuous versus low-dose intermittent oral isotretinoin in patients with moderate-to-severe acne vulgaris. Acne was defined by the presence of lesions—including papules, pustules, comedones, or cysts—with a Global Acne Grading System (GAGS) score of 19–30 indicating moderate and 31–38 indicating severe cases. Efficacy was defined as a greater than 80% reduction in the GAGS score after three months of treatment, calculated as: percentage decrease = total decrease in score / baseline score ×100. The hypothesis stated that a difference exists in efficacy between the two isotretinoin regimens. Methods: A total of 60 patients of both gender with Acne vulgaris were included in the study. Patients were divided in two groups, A and B. Each group had 30 patients. The initial assessment of acne was done by using GAGS score (global acne scoring system). In group A, patients were prescribed 20 mg oral isotretinoin once daily for 6 months and in Group B patients were prescribed intermittent regimen - 20 mg oral isotretinoin on alternate day for 6 months. Efficacy was noted by lesion counts from both groups, on monthly basis for 3 months and a follow up visit at 6 months. Results: Age range in this study was 18 to 40 years with mean age of 24.866±3.29 years and mean GAGS score was 28.266±2.79 in Group A and mean age of 25.266±3.67 years and mean GAGS score was 28.533±3.12 in Group B. Efficacy was observed in 27 (90%) patients in group A as compared to 25 (83.3%) patients in group B (p=0.447). Conclusion: In conclusion, the present study demonstrates that the low-dose continuous and low-dose intermittent oral isotretinoin regimens have comparable efficacy at the end of treatment.
Copyright (c) 2025 Farhat Rehman, Durreshehwar Arshad Pirzada, Sumaira Abdullah, Mahvish Aftab Khan https://creativecommons.org/licenses/by-nd/4.0
RELATION OF RADIOGRAPHIC BI-RADS (4 AND 5) SCORE AND TRIPLE NEGATIVITY IN PATIENTS WITH BREAST CANCER
Background: Breast cancer is a disease in which cells in the breast grow out of control and form tumors. Lesion that has radiological features suggesting likelihood of cancer 2-10% is 4a, 10-50% is 4b, and 50-95% is 4c and more than 95% is BIRAD 5. Methods: This cross-sectional study was done at department of radiology, SKBZH CMH Muzaffarabad from Nov 2023 to March 2024. Our study included 100 patients having BI-RADS 4 and 5 confirmed by the sonomammography. Then all those patients underwent biopsy to check the triple negative status and the samples were sent for histopatholoical analysis. Data was analyzed using SPSS 21 version. Chi-square test was used to find the association between parameters. Results: A total of 100 patients were included in this study. The mean age of the patients was 48.45±14.663 years. A significant association of radiological grading (BIRADS 4 and 4) with triple negativity status and LN metastasis with p values 0.00 were found. A significant association of triple negativity with grades, LN metastasis, Necrosis, scars with p value 0.008, 0.016, 0.001, and 0.006 respectively were found. No significant association of size of tumor with radiological grading and triple negative status were found. Conclusion: Although, traditionally lesions with BI-RADS 5 score are considered more malignant than lesions with BI-RADS 4 score by clinicians in the daily practice, as pointed out in recent reports, TN have more frequent radiological BI-RADS 4 score.
Copyright (c) 2025 Farah Afzal, Iffat Ara, Azmat Ali, Ayesha Jabeen, Sadia Tahir, Sadaf Aziz https://creativecommons.org/licenses/by-nd/4.0