Journal of Shalamar Medical & Dental College - JSHMDC

AI in healthcare: Weighing innovation with trust, ethics, and human touch

Talat Waseem, Haseeb Arif — Fri, 27 Jun 2025 00:00:00 +0000

Artificial Intelligence (AI) is a game-changing phenomenon that has the potential to change how we communicate, work, and live completely. This is particularly true for the healthcare industry, where artificial intelligence (AI) has been applied to a wide range of fields, including medical education and training, diagnostic medicine, creating individualized treatment plans, and medical research, which has produced advances in essential fields like pharmacology and genomics.¹ But as AI technology develops and becomes increasingly integrated into our daily lives, it is essential to comprehend how it affects society's socioeconomic elements and the moral and societal conundrums raised by its broad use.

Metoclopramide-induced acute dystonic reaction: A case report

Shafiq Ur Rahman, Rozina Roshan, Faheem Shaikh — Fri, 27 Jun 2025 00:00:00 +0000

Metoclopramide, a common antiemetic, is associated with extrapyramidal side effects. This case report describes a 19-year-old male with dengue fever who developed involuntary muscle contractions and respiratory distress two hours after receiving intravenous metoclopramide for nausea. Despite the rare incidence (0.2% of users), the patient exhibited severe extrapyramidal symptoms, which were managed with procyclidine. The case emphasizes the need for vigilance in monitoring patients receiving metoclopramide, as early recognition and treatment of such reactions are critical to prevent complications. Clinicians should be aware of these potential side effects when prescribing metoclopramide, especially in vulnerable populations.

Exploring burning mouth syndrome: Diagnosis and management of an unusual presentation: A case report

Maarij Zubair, Muhammad Dawood, Nida Zubair — Fri, 27 Jun 2025 00:00:00 +0000

Burning Mouth Syndrome (BMS) is a chronic pain condition of the oral mucosa without visible lesions and may be linked to systemic disorders. A 45-year-old male with anemia, gastroesophageal reflux disease (GERD), and suspected Crohn’s disease presented with a persistent burning sensation, primarily on the tongue. Clinical findings included mucosal atrophy, gingival pigmentation, cobblestoning, and generalized chronic periodontitis. He was diagnosed with BMS Type 1, and systemic symptoms prompted further evaluation, raising suspicion for Crohn’s disease. A multidisciplinary approach was initiated. This case highlights the rare association between BMS and Crohn’s disease and emphasizes the role of oral signs in identifying systemic illness.

Evaluation of serum Cystatin C as a predictor of eGFR in type 2 diabetic patients with nephropathy

Fri, 27 Jun 2025 00:00:00 +0000

Background: Diabetic nephropathy (DN) is the leading cause of chronic kidney disease (CKD) worldwide.

Objective: To evaluate serum Cystatin C as a predictor of eGFR in type 2 diabetic patients with nephropathy.

Methods: A cross-sectional analytical study was conducted at the Department of Nephrology, Liaquat University of Medical & Health Sciences, Jamshoro, Pakistan, from 10^th March to 9^th September 2023. Patients with type 2 diabetes (T2D) for more than five years, both males and females, 30 to 65 years of age, and with nephropathy for the last 2 years were included in the study. Serum creatinine, serum Cystatin C (Cys-C), fasting blood sugar (FBS), glycated hemoglobin A1c (HbA1c), total protein, and albumin were measured. A spot urine sample was collected to analyze total urinary protein, albumin, and creatinine levels. The estimated glomerular filtration rate (eGFR) was calculated using the CKD Epidemiology Collaboration (CKD-EPI) equation. One-way ANOVA, Pearson correlation test, and Linear regression analysis were done to analyze the data.

Results: A total of 113 patients were analyzed, with a mean age of 55.5±6.1 years. The mean duration of T2D was 12.0±5.3 years. The mean HbA1c level was 9.1±1.3%. Based on Cys-C levels, the mean eGFR was 71.33±24.8 mL/min/1.73m². Among the participants, 43(38.1%), were suffering from Stage II, 32(28.3%) from Stage I, 32(28.3%) from Stage III, and 6(5.3%) from Stage IV CKD. A majority of 50(44.2%) of study participants had microalbuminuria. A statistically significant (p<0.001) negative correlation between eGFR and Cys-C level was observed among the study participants. Serum Cystatin C is a significant (<0.05) predictor of eGFR.

Conclusion: Serum Cystatin C was a significant predictor of eGFR in type 2 diabetic patients with nephropathy. The strong negative relationship between Cystatin C and eGFR supports its potential role as a valuable marker for assessing renal function in diabetic patients.

Forensic investigation of electrocution: Examining electrical injury profiles in Hyderabad, Pakistan

Fri, 27 Jun 2025 00:00:00 +0000

Background: Electrocution-related deaths in Pakistan are a significant public health concern, demonstrating the interplay of electrical safety, infrastructural issues, and socioeconomic status.

Objective: To investigate the forensic characteristics of electrical injuries.

Methods: This cross-sectional study examined 175 electrocution death cases that were autopsied at the Civil Hospital, Hyderabad, Pakistan, mortuary in one year from November 2023 to December 2024. We gathered and examined information on burn patterns, anatomical distribution of injuries, voltage levels, wound sites, injury types, cause of mortality, and gender differences. Information was obtained from eyewitness statements, police inquest documents, and autopsy results using a structured information proforma and checklist.

Results: Out of 175 dead bodies examined, the majority were males (90.3%), and 34.8% were between 21 and 30 years of age. The results indicate a predominance of upper limb injuries (37.8%) and a high incidence of low-voltage injuries (78.3%). Cardiac arrest has emerged as the leading cause of mortality (41.7%), underscoring the critical role of infection in post-injury complications. The gender wise differences of injury location, degree of burns, and mortality cause were found statistically significant (p<0.05).

Conclusion: Electrical injuries, particularly those involving low-voltage sources, have a significant impact on specific body areas, notably the upper limbs, and are linked with a high risk of septic complications that can ultimately lead to death.

Correlation between computed tomography findings and liver function parameters in chronic liver disease

Fri, 27 Jun 2025 00:00:00 +0000

Background: Chronic liver disease (CLD) leads to cirrhosis, hepatocellular carcinoma (HCC), and liver failure. Non-invasive assessment tools are crucial for the early detection and management of these complications of CLD.

Objective: To determine the correlation between computed tomography findings and liver function parameters in patients with chronic liver disease.

Methods: This retrospective study was conducted in the Department of Radiology, Lady Reading Hospital, Peshawar, Pakistan from December 2024 to January 2025 after obtaining the Institutional ethical approval (Ref. No. 569 MTI/LRH). Medical records of 276 patients with CLD from 1^st October 2023 to 30^th September 2024 were reviewed. Data were retrieved from the radiology department and laboratory information systems. Data of adult patients were included if they had undergone a contrast-enhanced computed tomography (CT) and liver function tests (LFTs) and hematological tests done within seven days of the CT scan. CT reports were assessed for cirrhosis, ascites, splenomegaly, portal vein thrombosis (PVT), and hepatocellular carcinoma. LFTs and hematological tests included ALT, AST, bilirubin, albumin, INR, and platelet count. Statistical analysis involved Pearson’s correlation and multivariate logistic regression.

Results: Cirrhosis was present in 96.7%, ascites in 64.1%, splenomegaly in 47.8%, PVT in 40.2%, and HCC in 73.9%. There was a significant negative correlation (r= –0.81, p<0.001) between cirrhosis and serum albumin levels. The severity of ascites correlated positively (r=0.70, p=0.008) with serum bilirubin levels and INR (r=0.60, p=0.010), indicating worsening of hepatic function. Splenomegaly was significantly correlated with reduced platelet counts (r = –0.75, p< 0.001).

Conclusion: CT findings in chronic liver disease showed significant correlations with liver function parameters. Cirrhosis correlated with low albumin, ascites severity with elevated bilirubin and INR, and splenomegaly with thrombocytopenia. These findings highlight the complementary role of CT imaging and biochemical markers in assessing disease severity and hepatic dysfunction.

Quality of life of mothers having children with Down syndrome

Saadia Shahzad, Iram Manzoor — Fri, 27 Jun 2025 00:00:00 +0000

Background: A mother's Quality of life (QoL) is essential not only for her own well-being but also for providing better care to her child.

Objective: To assess the QoL of mothers having children with Down syndrome.

Methods: A cross-sectional analytical study was conducted in ten special needs schools catering to intellectual disabilities from September 2023 to March 2024 after Institutional ethical approval (IRB Ref letter # M-22/82/-CM). The study population was mothers of children with Down syndrome. A sample size of 37 was calculated on the WHO sample size calculator, doubled to 74, and the questionnaire was administered to 100 mothers. We included mothers of children diagnosed with DS, willing biological mothers who have one child with Down syndrome, and all other normal children. Whereas, single mothers, mothers having a child with Down syndrome who also suffered from another dual diagnosis, and mothers having another chronically sick or disabled child were excluded. A convenient sampling technique was applied. Data was collected using a standardized, validated WHOQOL-BREF instrument.

Results: The total QoL mean score for mothers was 84.45±14.33. Higher maternal education (p=0.007) and having a child older than 10 years (p<0.001) were significantly associated with increased mean QoL scores. Gender of the child and household income showed no statistically significant (p>0.05) associations.

Conclusion: Mothers with a higher education level, a child with Down syndrome of >10 years, and a better family socio-economic status had a higher quality of Life.

Assessment of metacognition levels: A cross-sectional study among dental professionals in Pakistan

Fri, 27 Jun 2025 00:00:00 +0000

Background: Metacognition plays a pivotal role in learning, particularly in dentistry, enabling individuals to effectively manage their cognitive processes and identify areas for improvement.

Objective: To evaluate the degree of metacognition among dental professionals at various phases of their careers.

Methods: A cross-sectional study was conducted, using a non-probability sampling technique in private dental hospitals of Lahore from April to June 2024. A total of 320 dental professionals consented to participate. Data collection involved a semi-structured questionnaire and the Metacognitive Assessment Inventory (MAI), comprising two overarching domains – knowledge about cognition and regulation of cognition, each with three and five subdomains, respectively. Data were analysed using SPSS version 25. Descriptive statistics were computed, and one-way ANOVA and post hoc analysis were used to evaluate group differences. A p-value of <0.05 was considered statistically significant.

Results: Consultants demonstrated significantly higher total cognitive knowledge scores than house officers (16.4 versus 8.5, respectively). This trend extended across subdomains, including procedural, conditional, and declarative knowledge. Similarly, consultants outperformed other participants in cognitive regulation (32.9 versus 17.6, respectively), particularly in planning and evaluation. Subdomains such as information management, communication, and debugging strategies were significantly higher in consultants than in graduate dentists, house officers, and postgraduates. General dentists had the highest cognition score among all the others (p<0.05).

Conclusion: The metacognition level of consultants and general dentists was highest among dental professionals. It underscores the importance of fostering self-learning among dental professionals, particularly through developing their metacognitive abilities.

Etiology, clinical features, and outcomes in acute-on-chronic liver failure patients in the intensive care unit of a quaternary care center

Fri, 27 Jun 2025 00:00:00 +0000

Background: Multi-organ failure and a sharp decline in liver function are hallmarks of acute-on-chronic liver failure (ACLF), carrying high mortality.

Objective: To determine the etiology, clinical presentations, and the mortality outcome in patients with acute-on-chronic liver disease.

Methods: In this retrospective study, medical records of 109 patients admitted to the Intensive Care Unit (ICU) of Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan, from 1^st January 2022 to 31^stAugust 2023 with ACLF were included after ethical approval (PKLI-IRB/AP/149). Data regarding demographics, clinical features, comorbidities, Child-Turcotte-Pugh (CTP) score, Chronic Liver Failure Consortium (CLIF-C score), Model for End-stage Liver Disease-Na (MELD-Na), and ACLF grades were recorded, and their outcome in terms of mortality was noted.

Results: The mean age was 47.4 ± 10.5. The primary cause of cirrhosis was hepatitis C virus (HCV) infection (52.3%), followed by cryptogenic cirrhosis (14.7%). According to the CTP score, 95.4% of the patients had Child-Pugh class C cirrhosis, and 52.3% were classified as grade 3 ACLF. Out of 109 patients, only 31 survived, with a mortality rate of 71.6%. Acute decompensation was mainly secondary to hepatic encephalopathy precipitated by infections and variceal bleeding. The non-survivors had significantly higher INR=3.4 ± 1.8 vs 2.6 ± 1.1 (p=0.002) and ammonia levels =230.1 ± 241.7 µg/dL vs 125.7 ± 65.7 µg/dL (p=0.002) on ICU admission compared to those who survived. The mean MELD-Na score at hospital admission was 32.9 ± 6.5, and in ICU admission was 34.7 ± 6.7 (p<0.001), but was not significant regarding survival (p=0.195). The CLIF-C score increased from 50.4±10.1 (in ward) to 56.1 ±10.2 (ICU transfer) (p<0.001) and was also higher in non-survivors compared to survivors (p<0.001). It is observed that increasing CLIF-C scores is a sign of poor prognosis.

Conclusion: HCV infection was the most common cause of cirrhosis, and hepatic encephalopathy was the common trigger for ACLF. A high INR, hyperammonia, advanced ACLF grade, and an increase in CLIF-C score lead to poor outcomes in terms of survival, while worsening of CLIF-C scores may additionally predict short-term mortality.

Comparative outcomes of Piperacillin-Tazobactam versus Ceftriaxone in managing spontaneous bacterial peritonitis in cirrhotic patients: An observational study

Fri, 27 Jun 2025 00:00:00 +0000

Background: Spontaneous bacterial peritonitis (SBP), a serious complication of liver cirrhosis, demands prompt antibiotic treatment, but rising resistance to ceftriaxone has spurred interest in alternative therapies.

Objective: To compare the treatment outcomes of Piperacillin-Tazobactam versus ceftriaxone in spontaneous bacterial peritonitis among cirrhotic patients.

Methods: This comparative observational study was conducted from 1^st January to 1^st July 2023 at the Services Institute of Medical Sciences, Lahore, Pakistan. A total of 218 cirrhotic patients, 18-60 years of age, diagnosed with SBP based on an ascitic fluid polymorphonuclear (PMN) count >250/μL, were enrolled using non-probability consecutive sampling. On the physician’s discretion, patients receiving Piperacillin-Tazobactam (4.5 g IV every 8 hours) were allocated to Group A (n=109) and those receiving Ceftriaxone (2 g/day) were allocated to Group B (n=109). Treatment response was observed on day five by assessing clinical improvement and repeat ascitic fluid analysis. A Chi-square test was conducted using SPSS version 22 for statistical analysis.

Results: The mean age of the study population was 35.7 ± 6.5 years, with 61.93% male patients. A higher proportion of patients treated with Piperacillin-Tazobactam (75.2%) showed resolution of SBP by day 5 compared to those receiving Ceftriaxone (62.4%). Although there was a difference in the response to the treatments (χ²=3.61, p=0.0574), it was statistically not significant. Across stratified subgroups, age, gender, symptom duration, Child-Pugh score, and PMN count for the Piperacillin-Tazobactam (group A) showed higher, though statistically insignificant, treatment response rates compared to Ceftriaxone (group B).

Conclusion: Piperacillin-Tazobactam showed a higher, though statistically insignificant, resolution rate of SBP compared to Ceftriaxone. This trend was consistent across age groups, gender, symptom duration, Chil-Pugh score, and PMN count, suggesting a potential clinical advantage.

Frequency and risk factors of restless leg syndrome in pregnant women

Zainab Memon, Nusrat Nisar, Bakhtawar, Rabia, Ghazala, Sidra — Fri, 27 Jun 2025 00:00:00 +0000

Background: Restless leg syndrome (RLS) is a prevalent neurological condition in pregnancy, and is associated with poor maternal and fetal outcomes

Objective: To determine the frequency and the risk factors leading to restless leg syndrome in pregnant women.

Methods: A cross-sectional descriptive study was conducted from 3^rd December 2023 to 2^nd June 2024, at the Obstetrics & Gynecology department of Bilawal Medical College and affiliated Countess of Dufferin Fund Hospital, Jamshoro, Pakistan. Pregnant women from all trimesters, aged 20–40 years, were recruited using non-probability consecutive sampling after obtaining informed consent. Pregnant women having painful legs, peripheral neuropathy, akathisia, nocturnal leg cramps, peripheral vascular disease, pre-gestational diabetes, renal failure, and varicose veins were excluded. RLS was diagnosed based on the 2012 revised International RLS Study Group (IRLSSG) criteria. 5 mL of blood was collected for complete blood count (CBC) and iron studies. Data analysis was performed using SPSS Version 22.

Results: A Total of 204 participants were included. The mean age of the pregnant women was 24.83±4.41 years. RLS was observed in 97 participants (47.5%), with the remaining 107 (52.5%) unaffected. RLS was most prevalent in the third trimester, accounting for 22.5% of cases. Most women were multiparous (152, 74.5%), while 52 (25.5%) were nulliparous. Iron deficiency anemia was identified as a significant risk factor for restless leg syndrome, with an odds ratio of 7.839 (p < 0.001). Additionally, gestational hypertension (OR=2.679, p=0.041) and chronic hypertension (OR=9.418, p=0.003) were significantly associated with an increased risk of RLS.

Conclusion: Restless leg syndrome affected nearly half of the pregnant women studied, with the highest prevalence observed in the third trimester. Iron deficiency anemia, gestational hypertension, and chronic hypertension were found to be significant risk factors for RLS, highlighting the need for early identification and management of these conditions during pregnancy.

Community dental visits as a catalyst for understanding oral health disparities in undergraduate dental students

Fri, 27 Jun 2025 00:00:00 +0000

Background: Oral health disparities remain a critical public health issue, highlighting the need for experiential learning in dental education

Objective: To evaluate the impact of community dental visits on undergraduate dental students’ awareness, understanding, and attitudes toward oral health disparities in underserved populations.

Methods: A descriptive cross-sectional study was conducted on 150 dental students (2^nd to 4^th year at Rehman College of Dentistry, Peshawar, Pakistan, from 1st March to 30th June 2023. Purposive sampling was done, and students participating in community dental visits were included. A newly developed questionnaire based on 04 major themes: awareness of students on oral health inequalities, role of community visits in raising awareness, socioeconomic factors underlying oral health disparities, and recommendations by students for dental curriculum modifications was used. SPSS version 22 was used for data analysis. Chi-square test and t-test were applied to compare responses.

Results: A response rate of 49% (73/150) was obtained with a female-to-male ratio of 45:28. Most of the dental students in 2^nd, 3^rd, and 4th year (82.6%, 83.3% & 95%, respectively) agreed on the lack of oral health prioritization in primary healthcare Undergraduate dental students of the 2^nd year (78-95.6%), 3^rd year (76.7-93.3%) & 4^th year (85-95%) recommended to increase the integration of community-based dental education in BDS. Across all years, 82–90% of the participants reported heightened motivation to address dental health disparities following community visits. There was a significant difference between responses of dental students of different years regarding awareness of oral health disparities concerning socioeconomic status (p<0.05). A greater proportion of fourth-year students (80%) agreed on the relevance of socio-economic status compared to third-year (40%) and second-year (43.4%) dental students.

Conclusion: Community dental visits are an effective educational strategy for enhancing undergraduate dental students’ awareness and understanding of oral health disparities. Increasing their frequency may further strengthen students’ attitudes toward addressing these disparities in underserved communities.