Journal of Islamic International Medical College (JIIMC)

EDITORIAL: Essential Pain Medicine A Clinical and Ethical Imperative for Healthcare Professionals

Amjad Iqbal — 2026-01-06

Pain is not just a symptom; it is a signal, a story, and often, a silent cry for help and is one of the most common reasons patients seek medical care, yet its management remains one of the most neglected areas in clinical practice. Millions suffer unnecessarily due to under-recognition and under-treatment of pain. The ability to recognize, assess, and effectively manage pain is not merely a clinical skill — it is a moral imperative. Whether acute or chronic, its management directly impacts recovery, quality of life, and trust in the healthcare system. For healthcare professionals, especially in South-East Asia and Pakistan, the integration of essential pain medicine into routine care is not just a clinical necessity — it is a moral obligation.

The Scope of the Problem

Chronic pain affects more people than diabetes, heart disease, and cancer combined. In Pakistan, the burden of chronic pain is substantial, with studies indicating that it surpasses the prevalence of commonly encountered disorders such as diabetes mellitus and hypertension. Despite this, pain management services are limited, and access to essential medications — particularly opioids for severe pain — remains restricted due to regulatory, logistical, and educational barriers.

Gaps in Access and Education

Essential Medicine Lists:
While Pakistan has a National Essential Medicine List, the availability of essential pain medicines, especially opioids for severe pain and palliative care is inconsistent across healthcare facilities due to regulatory, economic, or educational barriers.
Training Deficits.
Medical curricula at the undergraduate as well as post graduate level in the country lacks even basic training in pain assessment and management, leaving doctors ill-equipped to address this critical aspect of patient care.
Regulatory Challenges:
WHO reports highlight that access to essential opioids in South-East Asia is hindered by overly restrictive drug policies, despite their necessity for palliative and cancer care.

The Role of Healthcare Professionals

Doctors are uniquely positioned in health care system and they must lead the transformation in pain care by:
Advocating for Policy Reform: Supporting balanced regulations that ensure access and affordability of essential pain medicines while preventing misuse.
Integrating Pain Education: Encouraging medical institutions to include pain medicine as a core component of undergraduate and postgraduate training.
Expanding Services: Promoting multidisciplinary pain clinics and rehabilitation services, as exemplified by emerging interventional pain management practices in Pakistan.........................................................................................

Risk of Premature Atherosclerosis in Patients with Transfusion Dependent Beta- Thalassemia Major

2026-01-06

Objective: To assess the risk of premature atherosclerosis in transfusion-dependent beta thalassemia major patients using Atherogenic Index of plasma.
Study Design: Comparative Cross-sectional study.
Place and Duration of the Study: Pathology Department, Fauji Foundation Hospital Rawalpindi, from 1st March 2024 to 31st August 2024.
Materials and Methods: Total 120 participants were included in our study comprising of 64 β-Thalassemia major patients and 56 healthy subjects. Patients with poor compliance for blood transfusions or iron-chelating therapy; individuals with age <3 years, having history of familial hyperlipidaemia, diabetes mellitus, hypothyroidism, liver or renal disease were excluded. Consent was obtained and anthropometric along with clinical details were recorded. Fasting blood samples were analyzed for serum lipid profile, serum Ferritin and
plasma hemoglobin. Atherogenic index of plasma was calculated by the formula: log TG/HDL-C. Data was analyzed on SPSS 23.
Results: Sixty-four β-Thalassemia major patients with mean age 13.2±4 years and 56 healthy subjects with mean age 12.6±5 years participated in our study. Elevated serum triglyceride level while reduced serum total cholesterol, low density lipoprotein and high-density lipoprotein cholesterol levels were found among β- Thalassemia major patients than healthy individuals (p <0.001). Atherogenic Index of Plasma was markedly elevated among β-Thalassemia patients than their healthy counterparts; 0.27(0.08-0.38) vs. 0.06(0.03-0.08) (p
<0.001), indicating high propensity of premature atherosclerosis in them. Plasma Atherogenic Index exhibited positive correlation with serum Ferritin (r= 0.41, p = 0.001) and negative correlation with plasma Hemoglobin (r= -0.65, p < 0.001).
Conclusion: β-Thalassemia major patients have elevated Plasma Atherogenic Index value than age-matched healthy subjects, implying high risk of premature atherosclerosis and future cardiovascular events in this vulnerable group.

The Relationship of Islamic Lifestyle and Mental Health in Pregnancy: A Cross- Sectional Analysis

2026-01-06

Objective: This study aimed to examine the association between adherence to Islamic lifestyle practices and mental health outcomes among pregnant women attending a tertiary care center in Karachi.
Study Design: A cross-sectional analytical study.
Place and Duration of Study: The Obstetrics and Gynecology outpatient department of Jinnah Postgraduate Medical Centre, Karachi, from April 15th to June 15th 2025.
Materials and Methods: The study included 300 pregnant Muslim women aged 15 to 49 years with gestational age over 28 weeks, selected via purposive sampling. Data were gathered using a demographic questionnaire, the 75-item Islamic Lifestyle Questionnaire (covering ten domains), and the DASS-21. Descriptive statistics were calculated, and associations were analyzed using Pearson correlation and linear regression.
Results: The mean age of participants was 30.8 ± 8.2 years, with a mean Islamic lifestyle score of 241.6 ± 51.7. Average depression, anxiety, and stress scores were 4.7, 5.1, and 3.8, respectively. Islamic lifestyle was significantly and inversely correlated with total DASS score (r = –0.350, p < 0.001). Regression analysis identified Islamic lifestyle as the sole significant predictor of mental health (β = –0.350, p < 0.001), while demographic variables were not significant.
Conclusion: Stronger adherence to an Islamic lifestyle is linked to lower depression, anxiety, and stress during pregnancy. Integrating culturally and spiritually tailored interventions into antenatal care could improve maternal psychological well-being.

Comparison of Hedstrom and Protaper Universal Retreatment Files for Root Canal Retreatment Using Two Different Solvent

Hassan Rasheed Khan, Saima Azam, Kiran Saba, Beenish Qureshi — 2026-01-06

Objective: To compare the efficacy of Hedstrom files and ProTaper Universal Retreatment files in guttapercha/sealer removal during root canal retreatment using chloroform and orange solvent.
Study Design: In-vitro Randomized Experimental Study.
Place and Duration of Study: Islamabad Dental Hospital in the department of Operative Dentistry and at the National University of Science and Technology Islamabad over a period of 8 months from 3 Jan 2022 to 31 Aug 2022.
Materials and Methods: Sixty mandibular premolars were prepared and then obturated. Specimens were randomly divided in four groups and the gutta percha was removed with Hedstorm files with chloroform (Group A), Hedstorm files with orange solvent (Group B), ProTaper Universal system with chloroform (Group C), ProTaper Universal system with orange solvent (Group D). Residual GP/sealer were outlined on digital radiographs using an AutoCAD software and recorded in millimeter square for coronal, middle and apical 1/3rd of root. Time taken for complete removal was recorded using a stop watch. The data was analyzed using SPSS version 22.0. One-way ANOVA with post-hoc analysis was used to compare the amount of residual GP/ sealer among the four groups and for the comparison of time taken to remove the root filling. Post-hoc Tukey's test was further applied for comparison amongst the groups. A p value of ≤ 0.05 was considered statistically significant.
Results: The mean endodontic retreatment time in groups A, B, C and D were 7.15 min, 7.44 min, 5.46 min and 5.38 min respectively. One-way ANOVA and post hoc analysis showed significant difference of group A and group B with group C and group D (p value<0.001). Comparison of the mean GP/sealer remnants using One-way ANOVA and post hoc analysis showed no significant difference between all the groups (p value=0.778).
Conclusion: ProTaper Universal retreatment files demonstrated faster results as compared to the hand instruments (Hedstrom files) in removing GP/sealer. All the techniques left some residual GP/sealer as seen on radiographs.

Outcomes Following Lichtenstein Mesh Repair: Single Center Study

Wasif Khan, Muhammad Shah, Daim Ali, Adeel Zaib Khan, Zarab Jan, Abdullah — 2026-01-06

Objective: The aim of this study was to evaluate postoperative early and late complications of primary inguinal hernia repair by Lichtenstein Mesh Technique.
Study Design: A Cross-Sectional Study.
Place and Duration of Study: Department of General Surgery, MTI/Hayatabad Medical Complex, Peshawar, from 14 June 2024 to 14 December 2024.
Materials and Methods: A total of 69 patients with primary inguinal hernia, aged 18–70 years, were enrolled via non-probability consecutive sampling. All patients underwent Lichtenstein tension-free mesh repair performed by a consultant surgeon. Early (≤30 days) complications, including hematoma and wound infection, and late (6 months) complications, including chronic groin pain and recurrence, were recorded. The clinicodemographic data were documented, and statistical analysis was performed using SPSS 23. Chi Square and
Fisher's Exact test was used and the p value ≤ 0.05 was considered statistically significant.
Results: Among the 69 patients, the recurrence rate was 10.1%. The significant associations were found between hernia recurrence and the following variables: hernia duration ≥5 years (p < 0.001), low socioeconomic status (p < 0.001), illiteracy (p < 0.001), and presence of comorbidities (p = 0.001), postoperative hematoma (p < 0.001), and chronic groin pain (p < 0.001). No statistically significant association was observed with age, hernia type or side, residence, or surgical site infection.
Conclusion: Lichtenstein mesh repair proved safe with acceptable postoperative outcomes. The recurrence rate was 10.1%, significantly linked to prolonged hernia duration, low socioeconomic and educational status, comorbidities, hematoma, and chronic groin pain.

Comparison of Mean Duration of Postoperative Analgesia in Patients Undergoing Cesarean Section Under Spinal Anesthesia with Bupivacaine Vs. Bupivacaine Plus Buprenorphine

Adil Ashraf, Kainat, Ahsan Ali Ghuari, Muhammad Salman Maqbol — 2026-01-06

Objective: To compare the effect of intrathecal bupivacaine alone vs intrathecal buprenorphine as an adjuvant to bupivacaine on postoperative analgesia in cesarean section patients receiving spinal anesthesia.
Study Design: The Quasi experimental study.
Place and Duration of Study: “Department of Anesthesia”, Lahore General Hospital, Lahore, from 1st May 2022 to 29th May 2023.
Materials and Methods: Sixty pregnant women (ASA I-II, aged between 20-35 years) scheduled for elective cesarean section were enrolled through non-probability consecutive sampling. “Group B” received 1.8ml of 0.5 % hyperbaric bupivacaine with 0.5ml normal saline, while “Group BB” was administered 1.8ml of 0.5% hyperbaric bupivacaine combined with 60μg buprenorphine. All participants were informed of study objectives and provided written consent. Postoperative pain was evaluated using the visual analog scale (VAS). The duration of analgesia, total rescue analgesic use, onset of sensory block, and adverse effects were recorded 24 h after surgery.
Results: Group BB showed significant longer duration of postoperative analgesia and reduced need for rescue analgesics. Maximum VAS scores were also significantly lower in Group BB, with 73.3% of patients reporting a score of 4. Mild sedation (16.7%) and nausea/vomiting (10%) were noted in Group BB, but no respiratory depression was observed. All neonates had Apgar scores > 7 at 1 and 5 minutes.
Conclusion: Intrathecal buprenorphine combined with bupivacaine in cesarean section significantly improves pain control and prolongs the analgesic effect. Given its favorable benefit-risk profile, it can be considered a safe and effective adjunct to spinal anesthesia.

Antibiotic Susceptibility Pattern of Carbapenem Resistant Acinetobacter Baumannii Isolated from Clinical Specimen

2026-01-06

Objective: To determine the antibiotic susceptibility pattern of Carbapenem-resistant Acinetobacter baumannii isolated from the different clinical samples.
Study Design: It was a cross-sectional study.
Place and Duration of Study: Department of Microbiology, Khyber Medical University, and the Department of Microbiology, Armed Forces Institute of Pathology (AFIP) from January 2024 to December 2024.
Materials and Methods: After obtaining ethical approval, Various samples from the intensive care units and wards were collected. It included pus, tissue, non-directed bronchial lavage, blood, bronchoalveolar lavage, sputum, fluid, urine, nasopharyngeal swab, drain, bone, and Cerebrospinal fluid, which were processed in the laboratory. All the samples were inoculated on appropriate culture media, and the bacteria were identified by using Gram stain, motility, colony morphology, and biochemical tests. Antibiotic susceptibility was performed by using the Kirby disc diffusion method according to the Clinical and Laboratory Standards Institute (CLSI 2024). Isolates showing resistance or intermediate sensitivity to meropenem and imipenem were considered resistant. Susceptibility pattern of the rest of the antibiotics was noted according to CLSI 2024. SPSS version 26 was used for the data analysis.
Result: Out of 57 Carbapenem-resistant Acinetobacter baumannii 52 (91.2%) were sensitive to minocycline, 39(68.4%) were sensitive to tigecycline, 4(7%) to gentamicin, 3(5.2%) were sensitive to cefepime, 2(3.5%) to ceftazidime, 1(1.8%) to levofloxacin, tazo-pipracillin and ceftriaxone and showed no sensitivity to amikacin, ciprofloxacin and ampicillin-sulbactam. Tetracycline was tested in urine samples, and Carbapenem-resistant Acinetobacter baumannii showed 100% sensitivity towards it.
Conclusion: Carbapenem-resistant Acinetobacter baumannii showed very low susceptibility to maximum antibiotics. The highest was towards minocycline.

Role of MRI in Epilepsy: A Retrospective Study at POF Hospital, Wah Cantt

2026-01-06

Objective: To establish the role of magnetic resonance imaging (MRI) in the management of epilepsy and to determine the proportion of MRI brain findings in young patients with epilepsy.
Study Design: Retrospective cross-sectional descriptive study.
Place and Duration of Study: Department of Diagnostic Radiology, POF Hospital Wah Cantt, from January 1, 2025 to February 28, 2025.
Materials and Methods: A total of 172 patients were selected by non-probability consecutive sampling. MRI brain images, obtained using the epilepsy protocol, from patients aged 1 to 30 years with a clinical history of epilepsy were retrospectively retrieved from the hospital Picture Archiving and Communication System (PACS) between June 1, 2018, and May 31, 2024. Patient age, gender, and MRI findings were recorded on a predesigned proforma. Data were analyzed using SPSS version 23.0. Age was expressed as mean ± standard deviation, while gender and MRI findings were presented as frequency and percentage. For abnormal MRI findings and the two most common abnormalities 95% confidence interval (CIs) were calculated.
Results: Out of 172 patients, 51.2% were males and 48.8% females, with a mean age of 18 ± 7.29 years. Structural brain abnormalities were detected in 94 patients (54.7%, 95% CI: 47.2%–61.9%), most commonly white matter hyperintensities (15.1%, 95% CI: 10.5%–21.2%) and mesial temporal sclerosis (14.5%, 95% CI:10.0%–20.6%).
Conclusion: Dedicated MRI brain epilepsy protocol serves as a first-line neuroimaging modality in epilepsy management, as it allows accurate detection of structural lesions that can influence treatment decisions.

Comparison of Dynamic Compression Plate Versus Titanium Elastic Nailing System in the Management of Pediatric Femoral Diaphyseal Fractures

2026-01-06

Objective: To compare the clinical outcomes of Dynamic Compression plate (DCP) versus Titanium Elastic Nailing System (TENS) in the surgical management of pediatric femoral diaphyseal fractures in a tertiary care hospital in Pakistan.
Study Design: Prospective non-randomized comparative study.
Place and Duration of Study: Imran Idrees teaching hospital Sialkot, 8 months.
Materials and Methods: This prospective non-randomized comparative study was conducted at Imran Idrees Teaching Hospital, Sialkot from April–December 2023. A total of 60 children (aged 7–12 years) with isolated femoral shaft fractures were enrolled and divided into DCP (n=30) and TENS (n=30) groups. Outcomes measured included fracture union time, operative duration, and postoperative complications. Statistical analysis was performed using SPSS v26, with p value <0.05 taken as significant.
Results: The mean time for fracture union was substantially lower in DCP group. (11.53 ± 0.571 weeks) compared to the TENS group (14.10 ± 2.524 weeks, p=0.001). Conversely, TENS showed a significantly lower operative time (30.83 ± 0.986 minutes) than DCP (53.20 ± 1.243 minutes, p=0.001). A moderate inverse correlation was found between BMI and fracture union time in the TENS group (ρ = -0.455, p=0.013).
Conclusion: Both DCP and TENS are effective surgical options for pediatric femoral shaft fractures. DCP enables faster fracture healing, while TENS reduces operative time. Treatment decisions should be individualized based on patient profile and surgical context.

White Cell Indices and NLR Across CKD Stages: Indicators of Subclinical Inflammation

Sadia Rehman, Santosh Kumar, Anila Bibi, Asma Naveed, Hina Moazzam, Aakash Kamur — 2026-01-06

Objective: To investigate the distribution of neutrophil, lymphocyte, and other white blood cell (WBC) indices across various stages of chronic kidney disease (CKD) and assess their potential role as indicators of subclinical inflammation.
Study Design: It was Cross sectional study.
Place and Duration of Study: A cross-sectional study was conducted at the Nephrology Department, JPMC Karachi, in collaboration with Bahria University, from October 13, 2023, to May 15, 2024.
Materials and Methods: A total of 114 predialysis CKD patients were stratified into stages I–IV based on clinical and laboratory criteria. Complete blood counts, including total WBC count (×10⁹/L), neutrophil (%), lymphocyte (%), eosinophil (%), and monocyte (%), were recorded. The neutrophil-to-lymphocyte ratio (NLR) was calculated. WBC indices were compared across CKD stages using the Kruskal–Wallis test, and correlations with serum creatinine (mg/dL) were analyzed. All statistical analyses were performed using SPSS version 27.
Results: Of the 114 patients, 58.8% were female and 41.2% were male. Although median WBC counts and individual leukocyte subsets did not show statistically significant differences across CKD stages (p > 0.05), a progressive rise in NLR was observed with advancing CKD. This trend, while statistically insignificant, may still hold clinical value as it suggests underlying low-grade inflammation. Correlation analysis showed weak associations between WBC indices and serum creatinine, but the observed patterns indicate biological plausibility, supporting the potential role of these markers in disease monitoring.
Conclusion: Although not statistically significant, the rising NLR trend suggests possible subclinical inflammation. In low-resource settings, routine CBC parameters remain a practical and economical tool for early detection and monitoring in CKD.

The Incidence of Oral Pressure Ulcers Related to Endotracheal Tubes: A Prospective Cohort Study

Cane Lukisari, Kurnia Hayati, Dyah Ayu R, Meircurius, Sri Utami, Sifira — 2026-01-06

Objective: To examine the incidence and implications of oral pressure ulcers (OPUs) associated with prolonged intubation and mechanical ventilation, particularly in patients in Intensive Care Units (ICUs). The purpose of the study was to determine the incidence of OPUs in ICU patients with endotracheal tube (ETT) placement.
Study Design: A prospective cohort study was conducted over six months, from 2 February 2024 to 25 July 2024.
Place and Duration of Study: Dr Ramelan Naval Hospital Surabaya Indonesia, during six months 2/02/2024-25/07/2024
Materials and Methods: A total of 372 ICU patients at Dr Ramelan Naval Hospital were included in this study. The participants were limited to ICU patients with ETT placement who presented with OPUs, without any age restriction. The exclusion criteria were patients without ETT and OPU, as well as patients who died before the observation period ended.
Results: The overall incidence of OPUs related to ETT placement was 16.13%, peaking 3–5 days after installation. Males exhibited a higher rate (55%) than females, with the age group 61–75 years and those with underlying pneumonia being the most affected. Mortality among patients was 55.38%, with 1.94% of these cases involving OPUs, while 44.62% survived, of which 33.73% developed OPUs. The higher incidence of OPUs resulted from prolonged pressure exerted by ETT placement, with a peak occurrence between 4–6 days post-ETT installation.
Conclusion: The incidence of OPUs related to ETT placement is relatively low at 16.13%. However, it is associated with a high mortality rate of 55.38%, underscoring the significant clinical impact of this complication. OPUs predominantly develop between 3–6 days post-ETT placement, highlighting the critical need for early identification and preventive measures during this period to improve patient outcomes.