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Open access Letter to the Editor | March 30, 2022
Developing a culture towards medical journalism

Sarah Ghafoor

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A letter to Editor Biomedica has been written to congratulate and highlight the importance of programs on journalistic writing among health professional. A disconnect between public and health delivery system and healthcare providers can be avoided if medical professionals become involved in writing for community and masses. 

Open access Review Article | March 30, 2022
Glymphatics and brain fog – the post-COVID-19 phenomenon

Mulazim Hussain Bukhari, Shumaila Liaqat, Nadia Naseem

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Since the COVID-19 pandemic and now since the vaccination has emerged as a success, many new signs and symptoms are being observed. Although most people with COVID-19 get better within weeks of illness, there is a wide range of new, relapsing, or ongoing health problems that many people may experience for weeks or more after being infected with the virus that causes COVID-19. Even people who did not have symptoms when they were infected can have post-COVID conditions. The most commonly reported of these symptoms are related to the neurological system, including brain fog, fatigue, anxiety, anosmia, and depression. The role of glymphatics in post-COVID brain fog is a widely studied phenomenon. This review will also explore the possible etio-pathogenesis of brain fog in post-COVID-19 patients.

Open access Case Report | March 30, 2022
Appendico-cutaneous fistula - a case report with a review of the literature

Haseeb Mehmood Qadri, Aroosa Zia, Fahad Qayyum, Muhammad Imran, Muhammad Kareem Ullah, Saeed Mahmood

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Acute appendicitis is one of the most common surgical emergencies. The clinical diagnosis augmented with the laboratory and radiology reports qualifies the patient for appendectomy. Mistreated patients in emergency, during the acute episode, sometimes present with a mass in the right iliac fossa with adhesions of the omentum and associated peritonitis. Appendico-cutaneous fistula is an uncommon presentation of appendicitis. It may present as a sinus with discharge. We report a case of a young female who presented with appendicocutaneous fistula.

Open access Original Article | March 30, 2022
Diagnostic Accuracy of Combining Sonoelastography with Mammography in Solid Breast Lesions Keeping Histopathology as Gold Standard

Mariam Saeed Kalim, Arslan Ahmed, Waseem Sadiq Awan, Saulat Sarfraz

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Background and objective: Breast cancer is the most common malignancy in females. Early diagnosis can help in reducing the morbidity and mortality associated with this disease. Sonoelastography has shown to be a valuable tool in early detection of breast cancer. The aim of the study was to evaluate the diagnostic accuracy of combining sonoelastography with mammography in diagnosing malignant solid breast lesions taking histopathology as a gold standard.
Methods: A descriptive cross-sectional study was carried out at the Department of Radiology, Shaikh Zayed Medical Complex/Federal Post-Gradaute Medical Institute (FPGMI), Lahore, Pakistan during six months period from 1st September, 2018 to 31st March, 2019. Female patients > 35 years of age and presenting with suspected malignant breast masses were included. Mammography and sonoelastography of the lesions were done. Finally, the patients were referred for tru cut biopsy. Diagnostic accuracy was calculated for mammography, sonoelastography and their combination.
Results: A total of 200 female patients were enrolled with a mean age of 50.8 (± 8.6) years. Mammographic findings suggestive of malignancy (BI-RADS category IV and V) were present in 96 (48%) cases. Elastography showed finding of malignancy (Score 4 and 5) in 96 (48%) cases. Combined sonoelastography and mammography diagnosed malignancy in 112 (56%) cases. Histopathologically confirmed malignancy was seen in 110 (55%) cases. The sensitivity and specificity of mammography (76.3 % and 77.7%) and sonoelastography (77.3% and 87.7%), were comparable. The combination of mammography and sonoelastography showed a higher sensitivity (90.9%) and specificity (86.6%). The combination showed a diagnostic accuracy of 89% followed by sonoelastography (82%) and mammography (77%) alone.
Conclusion: Combination of sonoelastography and mammography can significantly enhance the diagnostic accuracy of breast carcinoma. Females may be offered mammography or ultrasonography in combination with sonoelastography for routine testing.

Open access Original Article | March 30, 2022
Root resorption in ameloblastoma: a radiographic analysis of 35 cases

Ruqqia Jehan, Hasan Mujtaba, Noman Noor, Muhammad Shoaib, Asif Noor, Javeria Afzal, Mustafa Sajid, Muhammad Mohsin Javaid

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Background and Objective: Odontogenic tumors are heterogenous lesions with diverse clinical manifestations and histopathological features. Ameloblastoma is a slow growing, sizeable benign tumor with an increased recurrence potential. Radiographically, ameloblastoma mimics other odontogenic tumors occurring in the same region but can be differentiated based on certain features. The objective of the study was to evaluate the radiographic features and presence of root resorption in ameloblastoma as a diagnostic feature in the local population.

Methods: This retrospective hospital-based study was conducted at the Oral and Maxillofacial Surgery Department of Multan Medical and Dental College Multan, Pakistan from 1st Oct 2019 to 31st March 2020. Radiographs of 35 histopathologically confirmed cases of ameloblastoma were included in the study. These radiographs were assessed for site, locularity, and root resorption. Data were processed and analyzed by using SPSS version 23.0

Results: Mean age of the patients was 35.35±18.2 years with male predominance (66% vs. 34%). A total of 55% cases presented below 35 years age group showing increased prevalence in young adults. Multilocular appearance was seen in 24 (68.5%) cases while uni-locular pattern was seen in 12 (31.5%) cases. Root resorption was detected in 19 (54.3%) cases. Statistically, root resorption was not significantly associated with the gender or age of the patients (p > 0.05).

Conclusion: Multi-locular appearance and root resorption are the key radiographical features of ameloblastoma presenting in our population.

Open access Original Article | March 30, 2022
Uterine conservation surgery by using autologous rectus sheath for patients presenting with uterovaginal prolapse - an experience from Southern Punjab

Arif Siddiq, Shazia Jang Sher, Rabia Nafees, Zahra Safdar, Tanvir Jahan, Javed Mirdad Tarar

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Background and Objective: The use of autologous rectus sheath as a sling to correct uterovaginal prolapse in the younger age group has promising results. As this is an infrequently performed procedure in our country, hence this study aimed to assess the effectiveness of using autologous rectus sheath in young patients presenting with uterovaginal prolapse.
Methods: A prospective study was conducted at Bakhtawar Amin Trust Teaching Hospital in Multan, Pakistan in which 21 female patients who underwent uterine conservation surgery by using autologous rectus sheath during a period of 2 years were included. All these patients were followed up at 1 week and 6 months after surgery for any recurrence or other complications.

Results: The mean age of the patients was 47.09 ± 10.17 years. According to the pelvic organ prolapse quantification classification, 38.1% of patients had first degree, while 61.9% of patients had second-degree prolapse. After surgical correction, only one patient presented with first-degree uterine prolapse during follow-up while no post-surgical complication was reported in the rest of the patients with success rate of the procedure being 97.5%.
Conclusion: Uterine conservation surgery using an autologous rectus sheath as a sling for uterovaginal prolapse is an effective method of surgery and cost-effective technique in women seeking uterine conservation in developing countries.

Open access Original Article | March 30, 2022
Assessment of professionalism among undergraduate medical students in Faisalabad: where do we stand?

Zafar Ali Choudry, Sumera Badar Ehsan, Ayesha Ayub, Muhammad Munaim Tahir

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Background and Objective: Teaching medical professionalism is considered important for identity formation of healthcare professionals and must be a part of the curriculum at the undergraduate as well as postgraduate levels. Undergraduate students are often ignored in our culture when the question of professionalism comes under discussion and all the importance is usually given to postgraduate students. This study was designed to compare the professionalism among undergraduate medical students of the public and private medical institutes of Faisalabad city, Pakistan.
Methods: It was a cross-sectional comparative study conducted in a public and a private medical institute in Faisalabad from September 2021 to November 2021. A total of 462 undergraduate students were included from both colleges. The modified version of Penn State College of Medicine Professionalism Questionnaire for medical students was used to assess seven domains of professionalism among the students. SPSS 23.0 was used for statistical analysis.

Results: Response rates of 89.7% and 59.2% were achieved from the public and private medical college respectively. Respect was the highest scored domain among students of the public sector institutes, while equity was the highest scored domain by the private sector medical college (mean = 4.34 ± 0.81 and 3.91 ± 0.99, respectively). The enrichment domain was scored lowest by the students with public and private sector institute (mean = 3.9 ± 0.041 and 3.7 ± 0.055, respectively). There was a significant difference in the domains of professionalism among students based on their years of education (p > 0.05).
Conclusion: The undergraduate medical students at public as well as private sector colleges have positive professional attitudes, especially at the stage of first and the final years of training. The reasons for a declining trend of professionalism during mid-years of medical education among students are yet to be explored.

Open access Original Article | March 30, 2022
Perceived health status of geriatric population living in old age homes and their access to health care facilities

Najam Ul Sabha, Mansoor Ghani, Samina Kausar, Firdos Kausar, Mahpara Qamar

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Background and Objective: The elderly face various health challenges in later life as their immune defenses deteriorate leaving them quite vulnerable and frail. The situation becomes all the more desperate when the basic health support system is compromised or simply unavailable. This study has been conducted to assess the perceived health status of residents of local old-age homes and their access to available health services.
Methods: This cross-sectional study was carried out on 119 elderly subjects living in old age homes (OAHs) in Lahore city of Pakistan. Using the Short Form 36 Health Survey Questionnaire, health-related outcomes of the geriatric population were assessed under eight domains while a self-structured questionnaire was used to determine the level of available health care facilities.
Results: The mean age of the study population was 69.88 ± 5.08 years The lowest mean score is observed in the pain domain i.e., 19.20 ± 12.12, whereas a little better score has been seen for emotional well-being i.e., (58.28 ± 26.58). Insufficient health care services have been regarded as a major issue for the elderly face in OAHs.
Conclusion: The elderly population living in OAHs suffer from poor health status and face multiple barriers to accessing basic health care facilities.

Open access Original Article | March 30, 2022
Rectal diclofenac; an effective modality for pain relief after vaginal birth

Rabia Nafees, Zahra Safdar, Faiqa Saleem Baig, Sumera Zaib, Aisha Iftikhar

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Background and Objective: Vaginal delivery (VD) is the safest delivery option for the mother and is associated with quick recovery and minimal maternal morbidity and mortality. However, one of the commonest fears among women about VD is pain. This study aims to assess the effectiveness of diclofenac suppositories (per rectum) compared to the intramuscular diclofenac for the pain relief in females after VD.
Methods: This prospective comparative was study conducted at the Emergency Section (labor room) of Obstetrics & Gynecology Department in one of the tertiary care teaching hospitals of Lahore, Pakistan. A total of 182 female patients undergoing VD were selected and further divided into group A and group B. Group A was administered rectal analgesia in the form of rectal suppositories (100 mg) immediately after perineal tear (first and second degree only) repair and repeated after 6 hours. While group B received one injection of intramuscular diclofenac, immediately after perineal tear repair. The pain score was measured on a graphical score using Graphic Rating Scale, immediately at rest, during movement, and during urination. The pain score was reassessed after 6 hours with the same parameters and compared between both groups.
Results: The overall pain score was significantly lower immediately (p = 0.004) and 6 hours (p = 0.002) after VD in group A at rest, during movement, and during urination as compared to group B.
Conclusion: The use of rectal diclofenac suppositories is a simpler and more effective and acceptable method of reducing the pain experienced by the women following perineal trauma after vaginal childbirth.

Open access Original Article | March 30, 2022
Impact of education and monthly income on caries index of community living in the rural area of Multan - a cross-sectional survey

Muhammad Ali, Muhammad Ahmed, Hasan Mujtaba, Muhammad Farooq Umer, Muhammad Awais Khan, Javeria Afzal

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Background and Objective: Dental decays and periodontal diseases are among the most common ailments of the oral cavity. The decayed, missing, and filled teeth (DMFT) index defines the number of the decayed teeth, no of the treated teeth, and the number of teeth missing in oral cavity owing to decay. People’s monthly income and level of education influence their behavior toward oral health. The objective of this survey was to assess the impact of education and monthly income on the caries index of the community of Jahangirabad Multan, Pakistan.
Methods: This 3 months survey-based study was conducted among 380 participants from the community of Jahangirabad Multan city. The oral health status of all participants was assessed by using the DMFT index. All individuals with permanent dentition were included in this study.
Results: There were 209 (55%) males and 171 (45) females. Age range of the participants was from 15 to 40 years. The mean and standard deviation of the DMFT index were 1.5 ± 0.156, the range of DMFT score was from 0 to 8. The significant association between the mean DMFT score and level of education was observed (p-value = 0.036).
Conclusion: The population of the rural area of Jahangirabad has an average of 1.5 teeth affected with dental caries. The level of dental caries is found to be inversely proportional to the level of education implying that improving education level of the communities may be one of the factors that can contribute to the reduction in the burden of caries in the rural communities of the country.