Journal of Islamic International Medical College (JIIMC)

EDITORIAL: Teaching the 8-Second Brain: Rethinking Pedagogy for Generation Z in Health Professions Education

2026-03-28T09:55:44+00:00

The education of health professionals is at a critical pedagogical crossroads that requires urgent attention. The student population of most current medical, dental, nursing, and allied health schools is made up of Generation Z: students born from 1997 to 2012. They demonstrate radically different thinking patterns, the way they engage, and what they learn compared to previous generations. The so-called 8-second brain generation, often referred to in literature, is a manifestation of short attention spans among Gen Z, likely conditioned by their digital upbringing, being mesmerized by streams of information and multimedia flowing rapidly. Although this tag begs to be oversimplified and generalized, it is true to a significant pedagogical fact: students today do not receive, process, and prioritize information in the same way as past generations did.

The traditional pedagogical practices, which are based on didactic lectures, passive learning, and delayed feedback, constitute a significant part of the curriculum delivered. Such approaches are becoming less in harmony with the changing learning environment that modern learners are taking. It is not the lack of attention span or discipline, but rather the learned adaptive cognitive strategies used in the information saturated environment in Gen Z. Instead of viewing generational traits as an obstacle to interdisciplinary teaching and learning, the educators can exploit normalizing behaviour as the chance to establish new forms of exploration, motivate more personal investment in the learning process, promote clinical reasoning and promote adaptive expertise..................

EDITORIAL: Analytical Challenges in Drugs of Abuse Testing

2026-03-28T09:59:34+00:00

Drugs of Abuse (DOA) group includes drugs ranging from therapeutic drugs e.g., benzodiazepines, opioids to illegal drugs e.g., Phencyclidine, lysergic acid diethylamide etc. Prevalence of DOA is on the rise in our society.¹ According to United Nations Office of Drugs and Crime(UNODC) there are 6.7million drug users in Pakistan which also happens to be the largest consumer of heroin in south east Asia.² Besides addiction, drug abuse is linked to a variety of health problems, including HIV/AIDS, cancer, heart disease, and many more. It is also linked to homelessness, crime, and violence. In essence, DOA addiction is costly to both individuals and society. Keeping in view the increasing use of DOA in our society, its testing has become an indispensable service in modern laboratories and many large or medium sized medical laboratories in Pakistan are involved in DOA testing. From emergency departments and workplace compliance programs to pain management clinics and forensic investigations, laboratories play a central role in detecting these drugs that can impair judgement, threaten safety or contribute to morbidity and mortality. However, as new patterns of substance of abuse evolve and analytical technologies advance, laboratories face mounting scientific, operational, ethical and regulatory challenges in delivering accurate and clinically meaningful results. One of the most pressing challenges is the rapid proliferation of new psychoactive substances leading to shifting in patterns of drug abuse.³ Synthetic cannabinoids, designer stimulants, novel benzodiazepines and synthetic opioids like fentanyl analogues have complicated traditional testing paradigms. Standard immunoassay screening panels that are designed to detect common drugs like opiates, cannabinoids, cocaine, amphetamines, benzodiazepines and barbiturates often fail to identify newer compounds or cross react unpredictably. This puts the laboratories under pressure to develop and validate methods for the new drugs that have joined the DOA menu.........................

Molecular Subtypes of Breast Cancer in Quetta - A Hospital-Based Study

2025-11-04T05:24:06+00:00

Objective: This study aimed to determine the molecular subtypes of breast cancer using
immunohistochemistry and to assess their distribution in the study population.
Study Design: It was a retrospective observational study.
Place and Duration of Study: The study was done at Combined Military Hospital, Quetta, from January 2022 to May 2025.
Materials and Methods: The study included 105 patients with complete histopathological data. The data was analysed using SPSS version 20, and employing chi-square tests to evaluate their associations. Statistical significance was determined at p-value < 0.05.
Results: Among the 105 cases, Invasive Ductal Carcinoma (IDC) was most common (89.5%, n=94), followed by Invasive Lobular Carcinoma (ILC) (4.8%, n=5) and Mucinous Carcinoma (3.8%, n=4). Rarer types included Metaplastic carcinoma and Medullary carcinomas. IHC-based molecular subtyping revealed Luminal A as the predominant subtype (40%, n=42), followed by Luminal B (24%, n=26), Triple-Negative Breast Cancers, TNBCs (19%, n=20), and HER2-enriched (16.2%, n=17). These subtypes were correlated with the patient's age,
histological grade, and proliferation index.
Conclusion: Luminal A emerged as the most common molecular subtype, typically presenting with a lower histological grade than Luminal B, HER2-enriched, and TNBCs. Most lobular carcinomas were Luminal A type. TNBCs were high-grade, more frequent in younger patients, while other subtypes were common in older age groups. Utilizing IHC markers for molecular subtyping can enhance prognosis and facilitate targeted therapies for improved patient outcomes.

Pattern of Coronary Artery Disease in Patients Under 50 Years of Age with Acute Coronary Syndrome

2025-12-09T07:37:05+00:00

Objective: To determine the angiographic patterns and severity of coronary artery disease (CAD) in patients aged ≤50 years presenting with acute coronary syndrome (ACS) at a tertiary care hospital.
Study Design: Hospital based cross sectional analytical study.
Place and Duration of Study: Department of Cardiology, PAEC General Hospital, Islamabad, from January 1 and June 30, 2025.
Materials and Methods: Consecutive patients aged 30–50 years presenting with STEMI, NSTEMI, or unstable angina who underwent coronary angiography were enrolled. Demographic characteristics, cardiovascular risk factors, and angiographic findings were recorded. Data were analyzed using SPSS version 26.0. Associations between risk factors and CAD severity were assessed using the chi-square test, with p <0.05 considered statistically significant.
Results: Ninety patients were included (mean age 44.94 ± 3.94 years), with 67.8% males. STEMI was the most frequent presentation (74.4%), followed by unstable angina (16.7%) and NSTEMI (8.9%). After angiography single-vessel disease was observed in 37.8% of patients, double-vessel disease in 22.2%, triple-vessel disease in 11.1%, 28.9% had normal coronary arteries. Hypertension (55.6%) and smoking (40%) were the most prevalent risk factors.
Conclusion: Among young adults presenting with ACS, STEMI is the predominant clinical presentation, and single-vessel CAD is the most frequent angiographic pattern. A considerable proportion had normal coronary arteries, highlighting the need for further evaluation of non-obstructive mechanisms in young ACS patients.

Pseudothrombocytopenia Unveiled: Navigating Frequency and Causes in a Tertiary Care Hospital

2026-02-12T07:49:09+00:00

Objective: To determine the proportion and laboratory-identified mechanisms of pseudothrombocytopenia among patients with automated platelet counts <100 × 10⁹/L in a tertiary care hospital.
Study Design: Descriptive Cross-sectional study
Place and Duration of Study: This study was conducted in the Department of Pathology, Fauji Foundation Hospital Rawalpindi, from January 01, 2025, to June 30, 2025.
Materials and Methods: All patients undergoing complete blood count analysis during the study period with an automated platelet count below 100 × 10⁹/L were included. Peripheral blood smears were examined to classify the subtypes of thrombocytopenia into true thrombocytopenia and pseudothrombocytopenia, including platelet clumping, giant platelets, and abnormal platelet distribution. Data was analyzed using SPSS Statistics version 29.0. Chi-square test was applied for categorical variables, and p-value < 0.05 which is considered
statistically significant.
Results: Out of total 755 blood samples, morphologically consistent with true thrombocytopenia (absence of smear artefacts) accounted for the majority of cases (70.7%). Among the 221 cases of pseudothrombocytopenia (29.3%), platelet clumping was the most frequent cause (19.7%), followed by giant platelets (7.9%) and abnormal platelet distribution (1.6%).
Conclusion: Pseudothrombocytopenia remains a frequent laboratory artefact in patients with low automated platelet counts. Accurate classification through systematic peripheral blood smear evaluation is essential to differentiate pseudothrombocytopenia from true thrombocytopenia. Implementation of standardized laboratory verification practices supports reliable platelet count reporting and enhances patient safety.

Comparison of Surgical Site Infections in Emergency Laparotomy and Elective Laparotomy

2026-02-03T16:20:38+00:00

Objective: This study aimed to find out the frequency, microbiological profile, pattern and predictors of wound site infections comparing emergency and elective midline laparotomy.
Study Design: Prospective comparative observational study.
Place and Duration of Study: was conducted in Department of General Surgery Hayatabad Medical Complex, Peshawar from 1 February 2024 to 30 September 2025.
Materials and Methods: The complete data was collected on a standardized proforma. Patients were operated and post-operative data was collected during follow-up for one months.
Results: Among 328 patients, 200 (60.9%) underwent emergency and 128 (39.1%) elective laparotomies. Baseline demographics, ASA class, and comorbidities were comparable between groups. Emergency surgeries had longer operative duration (p < 0.001), higher peritoneal contamination (63% vs. 3.1%) (p < 0.001), more contaminated/dirty wounds (p < 0.001), and greater ICU admission (37.5% vs. 17.1%) (p < 0.001). Surgical site infection (SSI) was significantly higher after emergency surgery (17.0% vs. 7.8%), with more superficial and
deeper or organ-space infections (p < 0.001). Emergency cases also showed higher rates of reoperation, readmission, 30-day mortality (5.5%), and longer hospital stay (8.7 ± 4.7 vs. 6.9 ± 1.9 days).
Conclusion: Surgical site infections were frequently higher in emergency laparotomy than in elective laparotomy, driven by contamination, wound class, and operative complexity. Several risk factors in emergency signify risk of SSI, like contamination, prolonged operative duration and intra-abdominal sepsis.

Hospital-Based Descriptive Analysis of Surgically Treated Malignancies: A Single Center Four-Year Experience

2026-02-02T04:51:22+00:00

Objective: To describe the institutional pattern of histologically confirmed malignancies managed surgically at a tertiary care hospital in Gilgit-Baltistan (GB), Pakistan, and to identify the need for structured cancer surveillance in the region.
Study Design: Retrospective record-based descriptive analysis.
Place and Duration of Study: Department of General Surgery, Shaheed Saif ur Rehman Government Teaching Hospital, Gilgit, 1st January 2021 – 31st December 2024.
Materials and Methods: Records of patients with confirmed malignant tumors treated surgically during the study period were reviewed. Tumor sites were classified using ICD-10 codes and histological diagnoses verified from pathology reports. Descriptive statistics were applied to summarize demographic and tumor characteristics. Association between gender and tumor site was analyzed using the Chi-square test.
Results: One hundred twenty-one surgically managed malignancies were included (mean age 52.4 ± 14.8 years; male-to-female ratio 1.05:1). The most frequent tumor sites were stomach (18.1%), skin (15.7%), retroperitoneum/peritoneum (15.7%), colorectal (9%), breast (9%), and ovary (8.2%). Gastrointestinal malignancies collectively constituted 35.3% of cases. Adenocarcinoma was the predominant histological subtype in gastrointestinal cancers. The annual number of cases treated increased over the four-year period, reflecting expanding surgical capacity.
Conclusion: These findings represent hospital-based case distribution rather than population-level incidence. Establishment of a regional cancer registry is essential to generate reliable epidemiological data for health planning in Gilgit-Baltistan.

Prevalence and Multi-Faceted Effects of Unintended Pregnancy on Women's Psychology, Physical Health, and Socioeconomic Status in Saudi Arabia

2026-02-18T06:05:33+00:00

Objective: To determine the prevalence of unintended pregnancy among women in Saudi Arabia and assess its psychological, physical, and socioeconomic impact.
Study Design: Descriptive cross-sectional.
Place and Duration of Study: The study data were retrieved from all the provinces of Saudi Arabia from October 2024 to April 2025.
Materials and Methods: A cross-sectional study was conducted on women aged 18-49 who had experienced an unintended pregnancy in the last five years across all provinces of Saudi Arabia. Most of the participants of
the study were recruited via social media platforms using online structured questionnaires.
Results: This study included 587 women from across Saudi Arabia who had experienced an unintended pregnancy. Most of the participants were Saudi nationals (93.9%) with a bachelor's degree (61.7%). Unintended pregnancies were predominantly reported once in the past five years (83.6%), with singleton pregnancies being most common (94.2%). Over half of the pregnancies were not protected by any contraception (54.7%). Financial strain was reported by 23.7% of participants and was significantly associated with nationality (p=0.027) and age (p=0.016), with greater impact among non-Saudis and less financial disruption in women aged ≥36 years. Mental health was notably affected post-pregnancy, especially in those with multiple unintended pregnancies (p=0.020). Educational impacts were significant among those with only elementary to middle education (p<0.001).
Conclusion: Unintended pregnancies significantly impact Saudi women's financial, mental, and educational domains. Notably, the lack of contraceptive use is widespread, contributing to high rates of unintended pregnancies. Targeted educational programs and improved access to family planning services are critical for alleviating significant societal consequences

Evaluation of Thrombophilia Profile in Northern Pakistan: Frequency and Presentation

2026-02-23T08:03:11+00:00

Objective: This study aims to ascertain the prevalence of thrombotic disorders and thrombophilia profile among patients in Northern Pakistan.
Study Design: Cross sectional descriptive study.
Place and Duration of Study: This study was conducted at the department of hematology, Shifa International Hospital, Islamabad, Pakistan from 1st June 2024 to 31st July 2025.
Materials and Methods: Ethical approval was obtained from the Institutional Review Board (IRB) prior to commencement of the study. The sample size was calculated using the WHO sample size calculator, considering a confidence level of 95% and anticipated prevalence of 2.5%. Non- probability consecutive sampling technique was employed. Data were collected using a structured proforma and analysed using SPSS version.
Results: Out of the 926 patients, there were 256 patients with portal vein thrombosis (PVT) (27.6%), 192 with stroke (20.7%), 160 with Deep vein thrombosis (DVT) (17.2%), mesenteric thrombosis 124 (13.3%) and 94 with Pulmonary embolism (PE) (10.1%) remaining 100 were presented with minor thrombotic episodes. Thrombophilia profiles revealed that 368 patients had protein S deficiency, 298 had anti-thrombin deficiency, 146 had protein C deficiency, and 114 patients had an activated protein C resistance. A total of 50 thrombotic disorders patients underwent molecular testing, out of which 10% were heterozygous for the Factor V Leiden
mutation. 2% were homozygous for the Prothrombin (Factor II) mutation, and 88% did not exhibit any mutation.
Conclusion: According to this study, Protein S and anti-thrombin deficiencies are the most common deficiencies among thrombotic disorders patients in northern Pakistan. The prevalence of undetected site thrombosis, such as PVT, was higher than reported globally.

A Comparative Assessment of Clinical and Pathological Staging in Patients Undergoing Surgery for Oral Squamous Cell Carcinoma in Pakistan

2025-08-26T06:08:22+00:00

Objective: To compare the radiological and histopathological staging of Oral Squamous cell carcinoma and to measure the concordance between clinical and histopathological staging in patients visiting a tertiary care hospital in Pakistan.
Study Design: Retrospective cross-sectional study.
Place and Duration of Study: Foundation University College of Dentistry, September 2019-November 2023.
Materials and Methods: Thirty-two histopathologically confirmed cases of OSCC who underwent tumor resection with neck dissection were included. Clinical and radiological records were reviewed for clinical staging (cT, cN), and histopathological reports for pathological staging (pT, pN). Concordance was assessed using Chisquare, Kendall's tau-b, Cohen's Kappa, and Cramer's V, with p < 0.05 considered significant.
Results: Concordance between clinical tumor size (cT) and pathological tumor size (pT) was 46.9%, The Chisquare test was not significant (p = .232), but Kendall's tau-b showed a significant positive correlation, Cramer's V indicated a moderate effect size (V = 0.349), and Cohen's Kappa demonstrated fair agreement (κ = 0.271, p = .005). Nodal staging showed marked discordance (84.4%) between cN and pN, with no significant association (p > 0.05), weak correlation (τb = 0.124, p = .433), moderate but non-significant effect size (V = 0.408, p = .192), and negligible agreement (κ = 0.002, p = .968).
Conclusion: Assessment of OSCC staging showed fair agreement for tumor size but negligible correlation for nodal status. These findings highlight the limitations of clinical staging and stress the role of pathological confirmation in guiding treatment.

MEDICAL EDUCATION: Adapting to Change: Undergraduate Dental Students' Learning Experiences and Perceived Enablers and Barriers During the Post-COVID-19 Transition From Online to Onsite Education

2025-08-11T11:45:53+00:00

Objective: The present study aimed to explore final-year undergraduate dental students' learning experiences and their perceived enablers and barriers during the post-COVID-19 transitional phase from online to onsite education.
Study Design: A qualitative case study design using focus group discussions was employed in accordance with the Consolidated Guidelines for Reporting Qualitative Research (COREQ) checklist.
Place and Duration of Study: Faculty of Dentistry, Asian Institute of Medicine, Science and Technology (AIMST) University, from April 2022 to June 2023.
Materials and Methods: Homogeneous convenience sampling was used to identify final-year undergraduate dental students currently enrolled at AIMST University Malaysia. Eighteen dental students were recruited and randomly assigned to three groups. They were invited for an online discussion through the recorded Zoom platform. The focus group discussions were audio-recorded and transcribed verbatim. Thematic analysis was performed using an inductive approach.
Results: Three major themes were discovered: (1) Perception of learning facilitating experiences, (2) Perceptions of learning impeding experiences, and (3) Factors influencing learning during transition. The first major theme is divided into five sub-themes: clinical hands-on, treating 'real' patients, knowledge acquisition and understanding, teaching quality, and social interaction. Meanwhile, two sub-themes emerged from the second major theme: expectation and challenging schedule. Finally, the third major theme is divided into six
sub-themes: adaptability, confidence and readiness; changes in availability of support; lifestyle; communication; and technical.
Conclusion: Undergraduate final-year dental students reported both facilitating and impeding learning experiences during the COVID-19 transitional period. Dental educators should tailor the current dental education and pedagogical structures to suit the needs and demands of dental students when the country has fully entered the endemic phase.

CASE REPORT: Anaesthetic Management of An Adult Patient with Homocystinuria and Dystonia Undergoing Orthopaedic Surgery: A Case Report

2026-01-22T02:36:29+00:00

hypercoagulability and metabolic stress. Anaesthetic management in adult patients undergoing non-ocular surgery has rarely been reported. We describe the anaesthetic management of a 29-year-old man with homocystinuria, marfanoid features, and dystonia who underwent elective orthopaedic foot surgery.
Perioperative care focused on minimizing thromboembolic and metabolic risks through reduced fasting duration, maintenance of normothermia and adequate hydration, avoidance of nitrous oxide, and use of mechanical thromboprophylaxis. General anaesthesia was administered using a laryngeal mask airway with sevoflurane and atracurium. The intraoperative and postoperative courses were uneventful, and the patient was discharged on the same day of the surgery. This case highlights that with careful, physiologically guided planning, safe anaesthesia can be achieved in adult patients with homocystinuria, even in resource-limited settings.