Journal of Islamic International Medical College (JIIMC)

EDITORIAL: The Triad of Modern Healthcare: Unifying Accreditation, Technology, and Safety Culture

Abdul Basit Baig — 2025-10-06

For healthcare institutions in Pakistan, the journey toward world-class patient care often hinges on a critical ambition: achieving international accreditation. Organizations like the Joint Commission International (JCI) or Accreditation Canada offer more than just a symbolic certification; they're a powerful force for a complete overhaul of how patient care is delivered. But to truly unlock this potential, we need to go beyond simply ticking boxes. The real transformation happens when we blend three essential elements: the strict discipline of accreditation, the game-changing power of technology, and the fundamental shift to a proactive safety culture. It's a triad, and each part is crucial.

At its heart, accreditation gives us a solid framework for constant improvement. It forces a deep dive into every corner of our operations, from making sure we've got the right patient to managing medications and keeping infections at bay. But here’s the thing: that framework today is totally tied to technology. The digital shift is not an optional extra; it's a critical part of a successful accreditation strategy. Think about it. Manual, paper-based processes aren't just slow, they are a huge source of errors that can put patients at risk. The meticulous record-keeping and streamlined workflows that accreditation demands are a perfect match for what modern technology can do.

Electronic Health Records (EHRs), for instance, create a single source of truth for patient data. Clinical decision support systems, many of them now with some AI-enabled clinical decision support (CDS), act as a safety net. They can flag a bad drug interaction, alert a doctor to a patient's declining condition, and make sure everyone on the care team has the most up-to-date information. In a way, accreditation pushes us to adopt the very tools that make our systems stronger, more reliable, and ultimately safer.

While systems and tech provide the skeleton of quality healthcare, a robust culture of patient safety is the lifeblood. The best tech and the toughest standards will crumble if staff are too scared to report mistakes or near-misses. This is where clinical governance becomes so incredibly vital: in building a just culture. This is a huge shift away from a blame-game model where errors are met with punishment. Instead, it creates an environment where staff feel safe to speak up, learn from what happened, and help fix the system...........................................................................................................................

The Incidence of Measles with Disease Manifestations in Infants: Do Infants Need Measles Vaccine Earlier than 9 Months?

Sidra Tul Muntaha, Afrah Tariq, Jawad Ahmad khan, Arslan Farooq, Farhan Hassan — 2025-10-06

Objective: To find out the incidence of measles with disease manifestations in infants equal to and less than 9 months of age.
Study Design: It was a descriptive cross-sectional study based on secondary data analysis.
Place and Duration of Study: It was carried out at Cantonment General Hospital Department of Paediatrics from 1st January 2023 to 30th September 2023 (9 months).
Materials and Methods: It was a secondary data analysis of all records collected of expanded programme of immunization from Rawalpindi District, Punjab from 1st January 2023 to 30th September 2023. Data included all infants equal to and less than 9 months of age of both genders presenting with signs and symptoms of measles. Infants with positive measles serum IgM antibodies were labelled as confirmed measles cases. Data was analyzed using windows SPSS version 24.0. Results described in both in frequencies and percentages.
Results: In our study total of 470 infants were enrolled. Out of which 294(62.6%) were measles IgM positive. Of the total cases, 182 (61.9%) were male and 112 (38.1%) were female. Among them, 20 (6.8%) were vaccinated, whereas 274 (93.2%) were unvaccinated. Age wise distribution showed that IgM positive cases at 1,2,3,4,5,6,7,8,9 months were 3(1%), 4(1.4%), 16(5.4%), 19(6.%%), 33(11.2%), 52(17.7%), 52(17.7%), 81(27.6%), 34(11.6%) respectively. Common symptoms seen were fever 294(100%), cough 287(97.6%), coryza 95((32.3%), conjunctivitis 41(13.9%), rash 294(100%). Complications were seen in 41(13.9%) with mortality of 5(1.7 %).
Conclusion: We conclude that a significant number of infants are being infected with measle virus before reaching the age of first recommended vaccine inoculation against measles. It is affecting children as young as one month old.

Diagnostic Utility of P57 Immunomarker in Differentiating Complete and Partial Hydatidiform Mole

2025-10-06

Objective: To assess diagnostic utility of p57 in differentiating complete and partial hydatidiform mole.
Study Design: Cross-sectional descriptive study.
Place and Duration of Study: Histopathology department at Chugtai's Institute of Pathology, Lahore, Pakistan for a period of six months starting from 1st January 2022 to 30th June 2022.
Materials and Methods: A total of 50 cases of molar pregnancies were included in this study. Age, gross findings, and histomorphological features were noted. p57KIP2 immunostain was applied on diagnostic histology slide for definitive subtyping into complete and partial mole. The Chi-squared test and Fisher Exact test were used to assess associations between different variables, with statistical analysis conducted using SPSS version 26.
Results: The preliminary diagnosis based on morphology alone revealed 29 (58%) cases of complete mole while 21 (42%) cases of partial mole. However, when p57 antibody was interpreted in conjugation with histology the final diagnosis revealed 37 (74%) cases turned out to be complete mole and 13 (26%) cases were categorized as partial mole.
Conclusion: p57KIP2 immunostain is a useful and reliable ancillary test to reach final diagnosis which helps in accurate diagnosis in the best interest of patients.

Serum Uric Acid as A Biomarker in Bipolar Disorder Type I, Current Episode Manic- Hospital Based Cross-Sectional Study

2025-10-06

Objective: To compare serum uric acid in bipolar disorder (BD) type I patients, current episode manic with healthy matched controls.
Study Design: Our study had a cross-sectional, case-control design.
Place and Duration of Study: This research was done at Rawal General & Dental Hospital which is the tertiary care teaching hospital of Rawal Medical & Dental College, Islamabad. The period of study was from 1/10/2023 to 31/03/2024 for a period of 6 months.
Materials and Methods: Thirty patients with BD suffering from manic episode according to DSM-5 criteria, along with 30 matched healthy controls were enlisted in the study. Young Mania Rating Scale (YMRS) was administered to the patients to determine the severity of mania and serum uric acid was determined for both cases and healthy controls (HC). The data was analyzed with Statistical Package for Social Sciences version 22 (SPSS).
Results: Compared to HC (4.4 ± 0.9mg/dl) bipolar patients had elevated plasma uric acid levels (6.06 ± 1.48 ml/dl) [p = 0.018]. Age and gender were the two factors that could introduce bias, but after controlling for these, the results were still significant. In the cases YMRS was used to measure the severity of the manic episode, and serum uric acid levels did not have a correlation with this variable (P >0.683).
Conclusion: The level of serum uric acid was significantly higher in cases versus controls in the local population. These results were in line with international studies and pointed to aberrant purine nucleotide turnover in BD.

Analysis of Factors Affecting Implant Placement in Posterior Maxilla With Lateral Window Sinus Lift Technique; A CBCT Study

2025-10-06

Objective: To identify and analyse factors influencing lateral sinus augmentation for implant placement in the posterior maxillary region.
Study Design: Retrospective cross-sectional study.
Place and Duration of Study: The study was conducted in the Periodontology department at University College of Dentistry, The University of Lahore between January 2024 to June 2024.
Materials and Methods: The study was conducted at the Department of Periodontology, University College of Dentistry. Using CBCT (Cone Beam Computed Tomography) scans from 278 cases with missing posterior maxillary teeth, the study analysed factors like sinus angle, sinus septa presence, angle of sinus, posterior superior alveolar artery (PSAA) visibility and distance of PSAA from the superior and inferior border of the potential window.
Results: Key findings include a predominance of PSAA within the intra-osseous region (92.6%) and variations in distances from the PSAA to the superior and inferior borders of the planned lateral window. Additionally, the study highlighted a low incidence of maxillary sinus septa (5%). Schneiderian membrane thickness was less than 3mm in 79% of the cases, and variations in maxillary sinus shape were noted to be an angle greater than 30 degrees in 90.1% of the cases. The location of PSAA was intraosseous in 75 (92.6%) cases whereas in the
remaining 6 (7.4%) cases it was not evident intraosseously.
Conclusion: In conclusion, CBCT proved crucial for treatment planning, and thorough evaluation of PSAA's relationship with sub-antral bone height was emphasized for safe lateral sinus augmentation procedures in posterior maxillary implant placements. The study contributes valuable insights for dental practitioners involved in implant planning and sinus surgeries.

Predictive Role of Skull Fracture Type and Location in Intracranial Hemorrhage Among Road Traffic Accident Victims: A CT-Based Observational Study

Rukhsana Aziz, Nosheen Noor, Ghazala Naz — 2025-10-06

Objective: To evaluate the predictive relationship between skull fracture types and the presence of Intra cranial Hemorrhage (ICH) in patients with head trauma due to Road Traffic Accidents (RTAs).
Study Design: Retrospective observational cross-sectional study
Place and Duration of Study: The study was carried out during the month of May 2025 at the Radiology Department of Lady Reading Hospital Peshawar
Materials and Methods: Following institutional review board approval, the retrospective study was carried out in May 2025 at the Radiology Department of Lady Reading Hospital Peshawar using data gathered in the Radiology Department's Health Management Information System (HMIS) between January and December 2022. The study analyzed CT brain scans of 300 RTA patients. Data included age, gender, fracture type and site, and presence and type of Intracranial hemorrhage (ICH). Chi-square and logistic regression were used to assess associations.
Results: Out of 300 RTA patients, 246 (82%) were male, with the majority aged 11–30 years. ICH was observed in 126 patients (42%), most commonly extradural hematoma (58.7%). Skull fractures were seen in 154 patients (51%), with parietal bone being the most frequently affected (30.7%). A significant association was found between skull fractures and ICH (p < 0.001). Logistic regression confirmed that fracture type independently predicted ICH (p < 0.001), with linear fractures showing the highest odds (OR = 5.34), followed by depressed (OR
= 4.51) and comminuted fractures (OR = 2.13). Fracture site was also significantly associated with hemorrhage type (p < 0.001).
Conclusion: Skull fracture type and location are significant predictors of ICH in RTA patients. Linear and depressed fractures, in particular, are strongly associated with ICH. These findings highlight the importance of detailed CT evaluation for early identification and risk stratification in head trauma cases.

Personality Profiles of Alcohol and Amphetamine Addicts Admitted at Tertiary Care Mental Health Facility

Asif Azeem, Hassan Iqbal, Sikandar Ali, Tashfin Bin Nazar, Abdullah Asif — 2025-10-06

Objective: To determine the personality profiles of alcohol and amphetamine (Ice) users admitted at Armed Forces Institute of Mental Health, (AFIMH) Rawalpindi.
Study Design: A cross-sectional study.
Place and Duration of Study: Armed Forces Institute of Mental Health (AFIMH), Rawalpindi from Nov 1, 2021, till April 30, 2022.
Materials and Methods: We consecutively sampled 222 subjects. Basic demographic data including age, gender, ethnicity and socioeconomic status were recorded. Patients were divided into two groups. Patients with primary alcohol addiction were labeled as Group A, while patients with primary amphetamine (ice) addiction were labeled as Group B. Personality profiles of the patients were assessed using the Urdu version of the Minnesota Multiphasic Personality Inventory- 2 (MMP- 2) and data was analyzed by using SPSS 26.
Results: Out of the total cases, 75 individuals (33.78%) were primarily addicted to alcohol, while 29 individuals (13.06%) had a primary addiction to amphetamines. Among those with alcohol addiction, 26 (34.6%) exhibited hypochondriasis, 54 (72%) showed signs of depression, and 56 (74.6%) scored high on hysteria. Psychopathic deviation was observed in 36 individuals (48%), and 40 (53.3%) had elevated masculinity scores. Additionally,
38 (50.6%) displayed paranoia, 31 (41.3%) had psychasthenia, and 40 (53.3%) showed signs of schizophrenia. Hypomanic traits were present in 10 individuals (13.3%), and 21 (28%) scored high in social introversion. In the amphetamine addiction group, 10 individuals (34.4%) out of 29 showed hypochondriasis, while 20 (68.9%) experienced depression and an equal number scored high on hysteria. Psychopathic deviation andr elevated masculinity were each noted in 14 individuals (48.2%). Paranoia was found in 13 individuals (44.8%), psychasthenia in 15 (51.7%), and schizophrenia in 16 (55.1%). Additionally, hypomania was seen in 8 individuals (27.5%), and 9 (31.0%) scored high in social introversion.
Conclusion: Depression and hysteria are the most common psychiatric disorders among alcohol and amphetamine addicts

Antimicrobial Efficacy of Commercial Dentifrices Containing Triclosan, Chlorhexidine, and Herbal Extracts Against Caries-Associated Pathogens

2025-10-06

Objective: To evaluate the antimicrobial potential of four commercial dentifrices against caries-associated microbes and to compare the effectiveness of active ingredients within these dentifrices in preventing the onset and progression of dental caries.
Study Design: In vitro Experimental Study
Place and Duration of Study: Army Medical College from 20th January 2023 to 18th August 2023.
Materials and Methods: The study was performed to compare the antimicrobial potential of four commercial dentifrices against microbes responsible for causing Dental Caries i.e. Streptococcus mutans (ATCC 25175) and Lactobacillus casei (ATCC 393) using agar well diffusion assay. Incubations of S. mutans were accomplished in aerobic and anaerobic conditions, whereas L.casei was incubated in microaerophilic and anaerobic environments. After incubation, the zones of inhibition (ZOI) around the tested dilutions were measured and the mean values of ZOI ± SD were calculated. The plate with no visible growth was considered as MIC. The independent t-test was applied to compare the effectiveness of dentifrice against cariogenic microbes. Inter-group comparisons between dentifrices were conducted through
one-way analysis of variance (ANOVA) with significant differences further evaluated by Tukey HSD tests. A pvalue of ≤ 0.05 was considered statistically significant.
Results: Each dentifrice exhibited antibacterial activity against S. mutans and L. casei. Chlorhexidine was the most effective agent against both S. mutans and L. casei, while herbal dentifrices exhibited the least efficacy. In addition, for each formulation, S. mutans showed significantly higher susceptibility.
Conclusion: All four dentifrices showed antimicrobial effectiveness against key cariogenic
pathogens. Chlorhexidine emerged as the most potent in preventing both the initiation and advancement of dental caries due to its strong antibacterial efficacy against S. mutans and L. casei.

Prevalence of Urinary Tract Infection (UTI) In Malnourished Children Aged 1 Month to 5 Years: A Study from The Children's Hospital and Institute of Child Health, Multan

2025-10-06

Objective: To identify the prevalence of urinary tract infections in malnourished children and the predominant pathogens and assess their antibiotic sensitivity pattern.
Study Design: A retrospective observational study.
Place and Duration of Study: Conducted at Nutritional Stabilization Centre of The Children's Hospital and The Institute of Child Health Multan, from 01.01.2023-31.12.2023.
Materials and Methods: Children aged 1 month to 5 years with severe acute malnutrition (weight-for-height < –3 SD with or without complications or bilateral pedal edema) based on WHO criteria were included. Urine samples were collected by age-appropriate methods; midstream clean-catch for children >3 years and pediatric urine collection bags for younger children, after proper perineal hygiene and analyzed by the hospital's pathology department through routine examination and culture. Results were analysed by using SPSS version 23.0. with frequency distributions and paired t-tests applied; significance was set at p < 0.05. Results: A total of 247 patients were included in study. Of these, 62 children (33%) had culture positive UTI. Escherichia coli was the most frequently isolated pathogen (64.5%), followed by Klebsiella species (19.3%). Antibiotic sensitivity varied by organism, indicating the need for pathogen-specific treatment protocols.
Conclusion: Urinary tract infections (UTIs) are highly prevalent among children with severe acute malnutrition, with Escherichia coli identified as the predominant pathogen, followed by Klebsiella. Routine screening for UTIs in malnourished children admitted to nutritional stabilization centers is recommended to facilitate timely interventions, improve clinical outcomes, and reduce morbidity.

REVIEW ARTICLE: Bibliometric Evaluation of Dental Research Productivity and Assessment of Influencing Factors in Pakistan

2025-10-06

Objective: This study aimed to evaluate the dental research productivity of Pakistan-based authors and assess the factors that can influence their performances.

Methods: The bibliometric analysis was carried out to examine dental research contributed by Pakistani authors from 1993 to 2022. The bibliographic details of all the relevant published articles on dentistry were extracted from the Scopus database. The search strategy was built using pertinent keywords connected with different Boolean Operators. After applying the inclusion/exclusion criteria, 2859 articles were included in the final analysis. Micro-soft Excel and VOSviewer software were used to analyze the data.

Results: Overall, Pakistan contributed 0.72 percent of the global dental research, however in the last five years, this ratio reached 1.56 percent. A slow research progress was recorded in the first 15 years, whereas exceptional growth was found in the last five years of study. The research impact analysis showed that the selected articles were cited with an average of 7.68 citations per article. Moreover, dental research co-authored with international authors had a higher citation impact than nationally collaborated or single-authored articles. The highest number of articles were found on Dental Education, followed by Oral Pathology/Medicine and Dental Public Health, however, the articles on Periodontics gained the highest citation impact. Most of the articles were published in locally published journals, and Saudi Arabia was found to be a vital partner in dental research.

Conclusion: The research activities increased over time, and dental research with international collaboration had a better impact.

CASE REPORT: Beyond Acute Appendicitis: A Rare Case of Preoperative Diagnosis of Appendiceal Intussusception on Ultrasound Imaging

Maria Niaz Khan, Saman Afraz, Momina Waqar, Ayesha Imran — 2025-10-06

Appendiceal intussusception is an uncommon and often misdiagnosed condition due to its nonspecific clinical presentation. We document the case of a 40-year-old female presenting with right iliac fossa pain, in whom ultrasonography revealed doughnut sign suggestive of appendiceal intussusception—a rare finding on this imaging modality. This case underscores the significance of considering a broad spectrum of differential diagnosis in abdominal pain and reinforces the diagnostic value of ultrasonography in identifying rare surgical pathologies.