Annals of Jinnah Sindh Medical University

Transition in Medical Education: Student Support Matters

Zarrin Zarrin — 2024-07-03

Transition to higher education is a well-researched topic with a focus on first years’ experience. In medical education, every year brings an entirely new experience, and transition never ceases. Additionally, medical education in Pakistan is an undergraduate degree and the entrants are young high school leavers. The learning environment is different to what they have experienced earlier irrespective of which high school they have attended. This is a huge learning curve and requires adaptation at personal level. The changes that incoming students go through are called transitions and require consistent support. Hussey and Smith (2010) have identified the process of transition in terms of various domains.

Oral Clefts and Consanguinity: A Report from Karachi, Pakistan

Summera Kanwal — 2024-07-03

Objective: To evaluate the occurrence of the risk of offspring having cleft lip and palate in consanguineous
marriages
Methodology: This is a cross sectional study which was done for a period of six months from March 2022
to November 2022 at Al-Mustafa Hospital, Karachi. All patients without any syndromes and medically fit
were included and respondents were interviewed using a questionnaire.
Results: A total of 278 patients with 129 (46.4%) females and 149 (53.6%) males were included. Fifty one
(18.3%) patients had isolated cleft lip, 162 (58.3%) patients had complete cleft, and 65 (23.4%) patients had
isolated cleft palate. Total 158 (56.8%) parents of children had consanguineous marriages, of which 83 (29.9%)
were married to paternal side and 76 (27.3%) were married to the maternal side. History of parental cleft was
seen in 9 (3.2%) patients. Among risk factors, 8 (2.9%) mothers had radiation exposure during pregnancy and
8 (2.9%) and 2 (0.7%) had habits of huqqa and smoking respectively. Seven (2.5 %) patients were
twins and one was born with cleft either isolated or complete and other without any anomaly.
Conclusion: Nearly half of the study population in this study had consanguineous marriages. Strategies should
be developed to educate people about association of orofacial clefts with consanguinity along with risk factors.
Key Words: Consanguinity, cleft lip, cleft palate, non-syndromic

Ethnicity based Anatomical Variations in Malleus on Computerized Tomographic Scan

Mariya Azam Khattak — 2024-07-03

Objective: To determine the anatomical variations in malleus among different ethnic groups
Methodology: An observational investigation was conducted within the Otorhinolaryngology and Radiology
department of a public hospital in Karachi, (PNS) Shifa. In this study, 100 participants were included from
January-July 2021 with ages ranging from 10-51 years. After obtaining consent and complete history from
each participant, a detailed examination of ear was done. Subjects were arranged for petrous temporal bone
(PTB) computed tomographic scans based on the inclusion criteria of no deformity concerning ear ossicles.
The parameters considered for potential anatomical differences were width of malleus head, manubrium
length, and complete malleus length.
Results: In 100 subjects, the mean ±S.D (mm) for width of malleus head was 3.02±0.31, for manubrium
length 4.39±0.46 and complete malleus length was found to be 7.59±0.57. The value for length of manubrium
among ethnic groups was found to be significant (p= 0.05).
Conclusion: Identification of these variations in such small bones is difficult but it is not impossible to
comprehend, considering the availability of advance technologies. As, morphological variants can disrupt the
prosthesis procedures, therefore, CT-PTB are suggested to acknowledge these modifications in size and shape.
This study showed variations among groups.
Key Words: Ear ossicles, ethnicity, malleus, morphological variations, petrous temporal bone

A Periodontal Health and its Impact on Oral Health-Related Quality of Life Among Diabetes Mellitus Patients

Nosheen sarwar — 2024-07-03

Objectives: This study aimed to investigate the relationship between periodontal health and oral health-related
quality of life (OHRQoL) in people with diabetes mellitus. The secondary objective was to compare the
OHRQoL between diabetic and non-diabetic individuals.
Methodology: This study was performed at the Department of Operative Dentistry, Pakistan Institute of
Medical Sciences (PIMS), Islamabad from April 2023 to June 2023. The study comprised 80 participants:
40 individuals with diabetes in case group and 40 individuals without the condition taken as control. Clinical
periodontal disease examination was performed at six sites per tooth, to determine clinical attachment loss.
After the examination, the patient was asked to complete self-administered questionnaires covering the OHIP14 domains. To compare the clinical attachment loss between the two cohorts, a chi-square test was employed.
An independent t-test was used to evaluate disparities in OHIP-14 domain scores between the diabetes and
non-diabetes groups.
Results: There were 80 patients, with a mean age of 39.07± 5.96. Among those, 40 had diabetes and the
remaining 40 did not. The majority of participants were women. In contrast to individuals without diabetes,
a significantly higher proportion of those with diabetes exhibited a CAL (Clinical Attachment Loss) of =3mm.
Significant associations between the two groups were observed in OHIP-14 domains such as Impaired
functionality, physical impairment, psychological disability, and social disability, while the remaining domains
showed no significant associations (p>0.001).
Conclusion: This research provided valuable insights into the intricate correlation among diabetes mellitus,
periodontal health, and oral health-related quality of life, underscoring the multifaceted nature of their
interrelation.
Key Words: Clinical attachment, diabetes mellitus, OHIP -14 domain, OHRQoL, periodontal disease

Triple-Negative Breast Cancer (TNBC): Uncommon in Pakistan?

Hiba Siddiqui — 2024-07-03

Objectives: To evaluate the incidence of triple-negative breast cancer (TNBC) and elucidate the factors
associated with triple-negative breast carcinoma.
Methodology: It is a retrospective study, that includes breast cancer patients presenting to the outpatient
department (OPD) for three years from January 2020 to January 2023.
Results: A total of 946 biopsy-proven breast carcinoma cases were included, out of which, 220 (23.2%) were
identified as triple-negative breast cancer. The predominant age range among TNBC patients was 40 to 60
years at the time of diagnosis. A total of 58.2% were postmenopausal, while 41.8% were pre-menopausal.
Histopathologically, TNBC cases primarily exhibited ductal carcinoma (91.4%), metaplastic carcinoma (7.7%),
and lobular carcinoma (0.9%). Tumor grading within the TNBC group revealed that the majority (71.4%)
were poorly differentiated (Grade 3), while 26.8% were moderately differentiated (Grade 2), and 1.8% were
well differentiated (Grade 1). Concerning family history, 12.7% of TNBC patients had a positive first-degree
relative with breast cancer, 5.9% had a positive 2nd-degree family member, and 81.4% had no family history
of breast cancer, indicating a significant association with TNBC. This study also revealed the ethnicity of
TNBC patients that the majority (85%) identified as Urdu-speaking, Sindhi (6.4%), Pakhtoon (4.1%), Punjabi
(3.6%), and Balochi (0.9%) backgrounds.
Conclusion: Our results showed, that TNBC primarily affected individuals aged 40 to 60 with high-grade
tumors, showing associations with menopausal status and histopathology. Family history displayed no
significant correlation while Urdu-speaking ethnicity was prominent. As TNBC is an aggressive neoplastic
entity. By determining the incidence of TNBC, we can adapt interventions and allocate resources more
effectively, thereby enhancing patient care and ultimately advancing survival rates.
Key Words: Age, grade, TNBC, postmenopausal

Clinical Course, Behaviour and Staging of Breast Cancer at the Time of Presentation During the Era of COVID-19 Pandemic

Muhammad Ahmad Mukhtar — 2024-07-03

Objective: To explore the repercussions of COVID-19 pandemic on clinical course, behaviour, and staging
of breast cancer
Methodology: This observational study, during the span of COVID-19, included all patients reported as breast
cancer on histopathology in breast care clinic of MINAR Cancer Hospital, Pakistan. Clinical behaviour, details
of histopathology including tumor type, Estrogen Receptors (ER), HER 2 Neu, and stage of disease at the
time of presentation were recorded and analyzed for frequency and percentages.
Results: Mean age of diagnosis was 45.6 years with STD of ±10.75 with parity range of 0 to 8. Lesion was
most frequent on left side. Only 37% patients were diagnosed at early stage. Total 63% patients presented
with advanced disease with 13% patients having distant metastasis with bones being the commonest site. As
many as 79% patients reported positive for ER and 74% for HER 2 Neu, while 84% patients breastfed children.
Hormone intake history was positive in 32% patients.
Conclusion: COVID 19 pandemic has had a drastic effect on the outcome of breast cancer by hindering early
diagnosis in our population. Adding to the preexisting paucity of screening programmes and deficit in
infrastructure for early diagnosis, COVID 19 pandemic led to an increase in the preexisting high mortality
rate.

Biochemical and Other Mechanisms Associated With Olfaction and Taste Abnormalities in Covid-19

Loung V Umedani — 2024-07-03

Coronavirus (SARS-CoV-2) spreads from its initial nasal reservoir to produce respiratory problems and
neurological manifestations. Viral spike protein-S binds with host receptor angiotensin-converting enzyme
2 with the assistance of membrane fusion protease. Average smell and taste disorders prevalence was 18.8%
and 14.1% respectively.
The objective of this narrative retrospective study was to explore mechanisms underlying olfactory and
gustatory manifestations. For obtaining novel information, we selected articles from January 2021 to January
2023. We searched terms like neurological manifestations, anosmia, loss of taste in COVID-19, and SARSCoV-2 as keywords using PubMed. After scrutiny, we excluded articles with accessory and non-relevant
information and finally selected 23 articles.
Various immune mechanisms like cytokine storm and direct neuroinvasions result in neurological manifestations.
Role of various micro RNAs in molecular pathology point towards future research to explore epigenetic
neuropathological mechanisms to help in designing novel therapeutic remedies. Global awareness and
vaccination protocols had greatly reduced occurrence of disease.
Key Words: Ageusia, anosmia, biochemical, COVID-19, mechanisms

Complete Excision of Rare Esophageal Tumor; Leiomyosarcoma

Shifa Naz — 2024-07-03

Leiomyosarcoma are rare malignant esophageal tumors that remain asymptomatic unless size exceeds 5 cm. They grow at a slow rate and in very few cases have metastasized by the time of their presentation. Here we present a case of a 65 year old male with progressive dysphagia and occasional dull chest pain for one and half years. Clinical examination was unremarkable. Computed tomography showed an 8 cm mass of the upper and middle thoracic esophagus with lateral wall thickness of 1.5 cm. Fat planes were intact with enlarged subcarinal nodes. Biopsy was suggestive of leiomyosarcoma and Mckeown esophagectomy was performed. Intraoperatively mass was consistent with radiological findings , however was adherent to surrounding structure with enlarged carinal nodes . Patient had an uneventful recovery period with histopathological evidence of complete recession of tumor