Annals of Jinnah Sindh Medical University

Medically Unexplained Somatic Symptoms: A Dilemma for all

Muhammad Iqbal Afridi — 2024-12-31

Medically unexplained symptoms (MUS) are genuine, frequent clinical presentations and related to substantial amount of distress, functionality loss and great healthcare expenses. These symptoms are ‘persistent bodily complaints for which adequate examination and investigation does not reveal sufficient explanatory structural or other specified pathology.

Comparison of Two and Three Stage Esophagectomies for Esophageal Carcinoma: Early Results in A High Output Center

Ambreen Abid — 2025-01-06

Objective: Despite the advancements inmanagement and surgical expertise, esophageal cancer continues to
be the sixth most common cause of cancer related deaths. The aim of study was to compare various variables
of Two-stage and Three-stage esophagectomies leading to the morbidity and mortality.
Methodology: A retrospective cross-sectional study was conducted in Thoracic Surgery Department, JPMC,
Karachi from 2019-2021. All resectable and operatable tumors were included. Data was retrieved from a preformed data sheet and was analyzed using SPSS-22.
Result: A total of 114 patients were included in this study, with 66(57.9%) males. Mean age of presentation
was 45.25±15.32 years. Squamous cell carcinoma was encountered in 75 patients (65.8%). The most common
location of tumor was lower thoracic esophagus (LTE) seen in 66 patients (57.9%) Ivor Lewis esophagectomy
(2 stage) was performed in 69(60.5%) patients, whereas McKeown (three stage) was conducted in 45(39.5%).
Tumor free margins were seen in 111(97.4%). Longer duration (5hrs) of surgery was 62.7% found in McKeown
esophagectomy. Total 30-day mortality was 7.9% (9/114), with respiratory failure as the most common cause.
Overall mortality was 7% (8/114), predominant in two stage esophagectomy. However, major complications
such as anastomotic leak 5.26% (6/114) and early stenosis 29.8% (34/114) were noted in Three stage surgery.
Conclusion: Despite smaller duration of surgery, technical feasibility and low morbidity, two staged
esophagectomy bears comparable mortality as compared to the three staged esophagectomy. However, both
procedures are relatively safe and effective provided accurate indications, patient selection and technical expertise.
Key Words: Anastomotic leak, esophageal carcinoma, ivor lewis esophagectomy, McKeown esophagectomy,
squamous cell, stricture

Effectiveness of Diode Laser Powered Adenoid Gland Ablation in patients with Adenoid Hyperplasia

Beenish Nisar Ahmed — 2025-01-06

Objective: To evaluate the surgical efficacy of diode laser ablation of adenoid gland hyperplasia in terms of
improvement in surgical technique, clinical symptoms and quality of life.
Methodology: In this study, we found out the results of diode laser ablation in the adult population who
present with adenoid hyperplasia with grade 2 enlargement from the grading system of Parikh et al., Diode
laser ablation was done under general anesthesia. Patients with grade 2 hypertrophy were diagnosed with
endoscope and after informed consent laser ablation was done under general anesthesia .Postoperatively
patients were followed ,examined and pro forma were filled.
Results: Results were analyzed on preoperative and postoperative endoscopic findings, improvement in
symptoms of nasal obstruction, intraoperative blood loss, duration of surgery and postoperative complications.
Results showed that diode laser effectively ablated adenoid tissues with less complications better surgical
technique and improving symptoms and quality of life. Please mentions specif resuts in stats
Conclusion: It was observed that endoscopic laser ablation was better in terms of minimal blood loss, can
be performed in less surgical time, and improves obstructive symptoms. There was no significant postoperative
complication.
Key Words: Adenoid hyperplasia, diode laser ablation, endoscopic grading system, OSA obstructive sleep
apnoea

The Socioeconomic and Training Influences on Medical Students’ Psychiatry Career Choices

Irfan Ali Syed — 2025-01-06

Objective: This study investigates the impact of socioeconomic status and training factors on medical students'
preference for psychiatry as a career.
Methodology: Conducted at a tertiary care hospital, the cross-sectional study targeted final and fourth-year
undergraduate medical students. Exclusions comprised students without psychiatry ward exposure, or attendance
at non-specified universities. Data collection involved a self-structured questionnaire distributed both online
and manually, preceded by a pilot study for questionnaire standardization. Independent variables included
age, gender, medical college, and study year, with dependent variables focusing on career preferences and
psychiatry-related knowledge.
Results: Psychiatry ranked as the third most chosen specialty. Demographic analysis revealed that there was
no significance of gender in students’ interest in psychiatry, with a nearly equal ratio of male and female
participants. Among age groups, 23-year-olds showed the highest preference for psychiatry. Factors significantly
influencing psychiatry choice included satisfaction level (p<0.001), exposure to mental illness(p=0.013),
clinical exposure through ward rotations (p=0.026), and lectures (p=0.012).
Conclusion: The study highlights a positive attitude towards psychiatry, ranking it third among career choices.
Notable associations were found between interest in psychiatry and exposure to mental illness, as well as
clinical and educational experiences. These findings underscore the importance of addressing socioeconomic
and training factors in shaping medical students' career preferences in psychiatry

Association Between Haemoglobin Levels and HbA1c in Diabetic Patients: Insights from a Tertiary Care Hospital in Lahore

Rukhsana Tumrani — 2025-01-06

Objective: To determine the correlation between haemoglobin and HbA1c level in diabetic patients in Lahore
Methodology: Cross sectional study conducted in Pathology Department, Shalamar Hospital, Lahore from
July to November 2023. Participants above 14 years of age, of all genders having both haemoglobin and
HbA1c level analyzed, were included in this study. Patients below 14 years of age, those with history of
haemoglobinopathies, acute or chronic blood loss, acute and chronic renal failure, alcoholism, and pregnant
females were excluded. Data was entered and analyzed using SPSS version 25. The inferential statistics were
used to correlate the significance of Haemoglobin and HbA1c.
Results: Of the total 312 study subjects, the mean age was 48.14±13.42 years, with 154(49%) males and
158(51%) females. Mean Hb level in males was 14.17±2.02g/dl while in females, mean haemoglobin level
was 12.73±1.50g/dl with statistically significant difference of mean Hb level with respect to gender (p value
<0.001). Mean HbA1c level in males was 9.09±2.12%. While in females mean HbA1c level was 8.60±2.21%
with statistically significant difference of mean HbA1c % with respect to gender (P value 0.047). Positive
correlation has been found between haemoglobin and HbA1c levels in diabetic patients in this study.
Conclusion: Significant positive correlation has been found between haemoglobin and HbA1c levels among
female diabetic patients. The effect of low haemoglobin should be kept in mind while evaluating the HbA1c
results in diabetic patients to monitor glycemic status, as misinterpretation leads to mismanagement of diabetic
patients.
Key Words: Diabetes mellitus, glycosylated haemoglobin (HbA1c), haemoglobin

The Exploring the Risk Factors and Practices of Self-medication for Oral Problems Among Dental Patients

Javeria Jabeen — 2025-01-06

Objective: The present study aims to identify common types of medications used
for self-treatment by individuals aged 18-35 years and to explore the influence of socio-demographic factor on
self-medication practices among patients visiting Dow International Dental College, Karachi
Methodology: The study was conducted at the diagnostic Department of Dow International Dental College DIDC, DUHS. A closed-ended, self-administrated, structured questionnaire was given to study participants in diagnostic OPD. Data Analysis: This was done by using IBM-SPSS ver. 2.1. Mean and SD were calculated
for variables whereas frequency and percentage were calculated by descriptive analysis.
Results: The participants in the study were between the age range of 25 – 34 years old. Females were in majority taking self-medication. Regarding the education level, the secondary education level comprised the largest group on self-medication (n=250). The majority of the participants lived nearest to the health Centre i.e. less than 1km away. The usage of oral analgesics was found in most i.e. 35.3% and these medications were purchased mostly from pharmacy shops by 122 participants (73.5%). The reason for taking self-medication was after triggering factors of pain i.e. 254 (75.6%) only for a few days.
Conclusion: This research concluded that the use of self-medication was found in most of the young adult population and dental pain is the most common reason for self-medication. Analgesics were the most frequent medication used as self-medication.
Key Words: Oral health problem, risk, self-medication,

Comparison of Incidence of Superficial Surgical Site Infection in Primary Closure over Drain versus Delayed Primary Closure in Patients Undergoing Exploratory Laparotomy for Peritonitis

Amin Mazhar Chaudhary — 2025-01-06

Objective: To document difference in incidence of superficial surgical site infection (SSSI) following primary
wound closure over a drain versus delayed wound closure after exploratory laparotomy for generalized
peritonitis. Surgical Site infection (SSI) is a common complication after surgery. Exploratory laparotomy for
perforation is one of the common cases faced by surgeons in the emergency. Post-surgery infection after such
cases is expected. Wound infection leads to increased patient morbidity and cost. Various attempts have been
done to limit surgical site infection
Methodology: A prospective cross-sectional observational study was carried out at Surgical Unit-II, Services
Hospital, Lahore, from January 2016 to December 2020. Patients between the ages of 12 and 65 years who
had presented in the surgical emergency with peritonitis requiring exploratory laparotomy were enrolled.
Approval from Institutional Review Board and written informed consent from all the patients were obtained.
Midline laparotomy was made in all cases. In group A, primary closure of wound over a corrugated rubber
drain (CRD) was done. In group B, each patient’s wound was left open for twice a day dressing with saline soaked gauze with delayed closure on 5th post-operative day. After surgery, patients were shifted to ward and were followed-up there for seven days. Then patients were discharged and were followed up in OPD weekly up to the 30th day after surgery. Wounds were examined at follow up for SSSI. The data was entered and analyzed through SPSS version 20. Comparison of frequency of SSI in both groups by using chi-square test
was done using p-value =0.05 as significant.
Results: Mean age of the participants was 35.51±14.11 years with 118 (60.20%) males and 78 (39.80%)
females. Total of 23 (11.73%) patients had SSI and 173 (88.26%) patients had no SSI. No statistical difference
of SSSI was seen between both groups.
Conclusion: No significant difference was found in the incidence of SSSIs between primary closure over a
drain and delayed wound closure following exploratory laparotomy for generalized peritonitis.
Key Words: Delayed primary closure, drain, primary closure, superficial surgical site infection

Exploring the Concept of Health-Related Quality of Life Among People with Heart Failure in Karachi, Pakistan

Anny Ashiq Ali — 2025-01-06

Objective: This study aimed to explore and understand the in-depth meaning of HRQoL among HF patients in a
tertiary care hospital, Aga Khan University Hospital, Karachi, Pakistan. By conducting in-depth interviews and
engaging with the patients, this research aimed to uncover the shades of their daily struggles, aspirations, and
adaptations.
Methodolgy: A qualitative interpretive design was used to study heart failure patients’ perceptions of their HRQoL. Through the Purposive sampling technique, 14 Heart Failure patients were selected from the outpatient department of AKUH. In-depth semi-structured interviews were conducted until meaningful information was achieved. A manual content analysis technique followed to analyze the data.

Results: The study's findings revealed two major themes. Theme one, "Heart Failure Patients' Perception about
Health," highlighted participants valuing good health, the role of good health for maintenance, and the prioritization of well-being. Participants underscored the significance of health as a precious asset, emphasizing how HF had transformed their perception of good health and motivated them to take active measures to maintain it. The second theme identified, "Attributes of HRQoL in Heart Failure," participants described how HF had redefined their roles: It required dietary adaptation, intervened in their social and family relations, and took them on a path toward acceptance. This is the theme that showed the variation of impact of HF in changing the daily responsibilities by meeting their dietary restrictions and social and family changes that came into their lives.

Conclusion: This study highlights the perceptions and experiences of HRQoL among HF patients in Karachi. If
a better quality of life in relation to health is to be promoted in Pakistan among heart failure patients, the findings bring out the need to address the physical, emotional, social, and cognitive constituents of HRQoL. Such information can help to enrich person-centered care and therapies, enhancing the quality of life for patients suffering from heart failure in Pakistan.

Beta Thalassemia: A Family Affair - Exploring the Interplay Between Disease Awareness, Parental Stress, Child Well-being and Quality of Life in Karachi, Pakistan

Fareeha Shahid — 2025-01-06

Objective: To assess the general public's level of disease awareness and understanding, as well as its impact
on various elements of life.
Methodology: This is a cross-sectional study. Total sample size was 275. Study duration was September 2020
–February 2021. Inclusion criteria was all men and women, either married or unmarried, above the age of
18 years, who did not work in healthcare sector and lived in Karachi, Pakistan. A standardized questionnaire
was created using Google Forms, and data was collected online. In addition, a consent form was appended
to the questionnaire. The study was given approval by the institute'sÊethicalÊreview committee. The data was
analyzed using SPSS version 25. Chi square test was used for data comparison. A p-value of <0.05 was
considered statistically significant.
Results: Out of the total study population, 81.7% were married and 17.3% were unmarried. The majority
(51.4%) were aged 18 to 22 years. A significant association was found between knowledge and quality of life
(p-value; 0.018), between the role of consanguineous marriages and disease etiology (p-value; 0.014), between
the number of units of blood transfused to the thalassemic patient in one sitting and its effect on quality of life
(p-value; 0.006), and between knowledge and the number of hospital visits for blood transfusion (p-value; 0.031).
Conclusion: The study indicated that our sample group lacked sufficient awareness regarding thalassemia
and its impact on quality of life for both the patient and the family.
Key Words: Beta-thalassemia major, consanguineous marriages, disease awareness, quality of life

Prosthodontic Management of a Patient with Ectodermal Dysplasia— A Clinical Report

Rumaisa Shahid — 2025-01-06

Ectodermal Dysplasia is a congenital, diffuse and non-progressive disorder characterized by hypoplasia or
aplasia of structures derived from the ectoderm germ layer. Ectodermal dysplasia has three different inheriting
patterns with X-linked inheritance being the most common. It is classified into Hypohydrotic and hydrotic
based on the condition of sweat glands. Clinical manifestations of this disorder include hypodontia, anodontia,
soft and thin enamel, delayed eruption, xerostomia, alveolar ridge atrophy, flat nasal bridge, decreased or no
sweat glands, frontal bossing, sunken cheeks, loss of hair, and thin and abnormally shaped nails. Globally,
the cases of ectodermal dysplasia are rare, having a prevalence of 1:100,000 with only a few documented and
reported in Pakistan. This report presents a female patient, aged 16 years, who came to the OPD with the main
complaint of missing teeth. Provisional diagnosis of Ectodermal Dysplasia was made based on examination
and history. It aims to contribute to the improvement of treatment planning, promoting documentation and
early diagnosis in Pakistan.

Key Words: Complete denture, congenital, ectodermal dysplasia, ectoderm germ layer, hypodontia, prosthetic
rehabilitation,