Journal of Islamic International Medical College (JIIMC)

EDITORIAL: Holistic Care of Women: Mind, Body, and Hormones

Prof. Dr. Syeda Batool Mazhar — Mon, 07 Jul 2025 00:00:00 +0000

Doctors today practice allopathic medicine, an evidence-based system of care, where effective treatments are based on trials and studies. A scientific alternative system is osteopathic medicine, focusing on holistic approach by including mind and spirit in addition to the body. Homeopathic and Ayurvedic medicine are included in alternative therapeutic options with less support from the global scientific community. Currently, in the developed countries, modern medicine is transitioning to client centered care and shared decision making in clinical practice. This is driven by the educated, well aware and discerning clients presenting in their clinics and hospitals.

The biopsychosocial model, proposes that health and illness are consequences of complex interplay of biological, psychological, and social factors.¹ Engel, a lead proponent of this model suggests that a physician’s “basic professional knowledge and skills must span the social, psychological, and biological, for his decisions and actions on the patient’s behalf to involve all three.” ²Mind & Body medicine can therefore provide a unique approach to health promotion in the community...........................................................................................

Short-Term Outcomes of Immediate Postpartum Intrauterine Device Insertion

Sana Hafeez, Hafsa Irshad, Fareeha Usman, Aiman Yousuf, Joveria Sadaf, Sana Aara — Mon, 07 Jul 2025 00:00:00 +0000

Objective: To determine the short-term outcomes of intrauterine contraceptive device insertion performed immediately after childbirth.
Study Design: Descriptive case series.
Place and Duration of Study: The department of Obstetrics & Gynaecology, Shahida Islam Medical and Dental College (SIMDC), Lodhran, from April 23, 2021 to October 22, 2021.
Materials and Methods: One hundred and fifty women were selected by non-probability consecutive sampling. The patients requiring post-partum contraception and fulfilling selection criteria were included in the study after informed consent. Follow up was done for 3 months after insertion of IUCD and complications such as expulsion, vaginal discharge, menstrual irregularities and lost string, were recorded on a pre-designed proforma. The SPSS version 27.0 was used for data analysis. Women's age, BMI and parity were analysed as
mean and standard deviation. Complications of insertion of IUCD were recorded as frequency and percentage. Chi-square test was applied to check post stratification statistical significance. The p value ≤ 0.05 was considered statistically significant.
Results: The mean age of the women was 26.79 ± 4.48 years. Thirty-nine (26%) women delivered vaginally and 111 (74%) women by caesarean section. The mean body mass index of women was 26.16 ± 5.44 kg/m2. Seventeen (11.3%) females had menstrual disturbance, 24 (14.7%) had vaginal discharge, 47 (31.3%) reported with lost string and 10 (6.7%) with IUCD expulsion. Out of these reported complications, only vaginal discharge demonstrated a statistically significant association (p = 0.013).
Conclusion: The postpartum IUCD insertion is safe and effective method of contraception, with minimal complications such as expulsion, vaginal discharge, menstrual irregularities and lost string, none of which are life threatening.

Interobserver Variability in HER2 Breast Biomarker Reporting: Implications for Diagnostic Consistency and Treatment Precision

Mon, 07 Jul 2025 00:00:00 +0000

Objective: To assess the interobserver variability in HER2 immunohistochemical stain interpretation by pathologists of different strata of experience.
Study Design: Cross-sectional observational study.
Place and Duration of Study: Chughtai Institute of Pathology at Lahore, during a three-month interval from 01/6/2024 to 31/8/2024.
Materials and Methods: Fifty cases (n=50) of invasive breast cancer were included by random probability sampling and blocks were retrieved through respective biopsy reports by the laboratory information system. All the cases of ductal carcinoma in situ (DCIS) and salivary gland-like tumors of the breast were excluded. HER2 antibody was applied to these cases and interpreted by four histopathologists with varying years of reporting experience. Interobserver variability was observed by using the Cohen's and Fleiss kappa tests. A p-value of ≤0.05 was considered statistically significant.
Results: All patients were female, with a mean age of 46.3 years ± 12.87. The highest concordance was observed at a score of 3, while the greatest discordance occurred at a score of 2, with kappa values of 0.81 and 0.35, respectively, and a p-value of <0.01.
Conclusion: The highest interobserver variability was observed in the assessment of HER2 score 2, highlighting the challenges in interpreting equivocal cases.

Evaluation of Cross Match to Transfusion Ratio as a Tool of Quality Working In Tertiary Care Transfusion Services

Rabiah Asghar, Ayesha Junaid — Mon, 07 Jul 2025 00:00:00 +0000

Objective: To evaluate the cross match to transfusion (CT) ratio, transfusion probability (%TP), and transfusion index (Ti) of packed red cells as a tool of quality working in the blood bank.
Study Design: Descriptive observational study.
Place and Duration of Study: This study was carried out from all indoor patient departments and blood bank over a 06 month period, from April 2024 to October 2024 at Shifa International Hospital.
Materials and Methods: After receiving Institutional Review Board approval,
the sample size was calculated using the WHO Calculator 2.0, data was collected through blood bank (HMIS) and department wise CT ratio, TP% and TI were calculated, entered and analysed using SPSS version 26.
Results: 527 packed red cell products (RCC) were prepared after cross-matching, 198 (38%) were transfused, leaving 329(62%) unused with an overall cross CT of 2.6. These results showed that overall CT of blood bank was very close to target CT ratio . Departmental variations were observed, with surgery having a CT ratio of 2.1 indicating significant blood usage while Gynecology/Obstetrics and Liver transplant having 6.6, indicating overrequesting
of blood products.
Conclusion:The study found that blood usage is generally acceptable, with a CT ratio of 2.6. However, significant variation was seen across departments: the surgical department had an efficient CT ratio of 2.1, while Gynecology/Obstetrics and Liver Transplant showed higher ratios (6.6), pointing to possible over-ordering and wastage. The results emphasize the need for targeted approaches, including department-specific protocols and regular audits, to optimize blood utilization.

Computer Vision Syndrome Among Computer Users in Muzaffarabad, Azad Jammu and Kashmir (AJK)

Mon, 07 Jul 2025 00:00:00 +0000

OBJECTIVE: To determine the prevalence of computer vision syndrome among the computer users in Muzaffarabad, AJK.

STUDY DESIGN: Cross-sectional observational study

SETTING: Department of ophthalmology, Abbas institute of medical sciences (AIMS)

SAMPLING TECHNIQUE: non-probability purposive sampling technique

DURATION OF STUDY: Six months (April 2022 to September 2022)

MATERIAL AND METHOD: This institution based cross sectional study was carried out on 346 computer users of district Muzaffarabad AJK. All the participants within age group 18-40 years and who have used computer in 1 month preceding the date of the study were included in the study. Participants more than 40 years and less than 18 years and those who do not give inform written consent were excluded from study. SPSS version 26.0 was used to get results.

RESULTS: A total of 346 participants (45.4% males and 48.6% females) were included in study in the age range between 18 to 40 years. In the study group, 63.5% claimed that they have experienced at least one symptom related to Computer vision syndrome with eye fatigue (37.8%) and headaches (42.7%) being the most common.

CONCLUSION: Computer vision syndrome is a highly prevalent condition among computer users in Muzaffarabad AJK.

Inflammatory Markers and Their Significance in Glycemic Control among Type 2 Diabetes Patients

Mon, 07 Jul 2025 00:00:00 +0000

Objective: To compare serum C-reactive protein and Ferritin levels between type 2 diabetes mellitus patients and healthy individuals and also to assess their association with HbA1c levels.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: This study was carried out from March 2024 to October 2024 at the Department of Pathology, Fauji Foundation Hospital, Rawalpindi.
Materials and Methods: Total 300 participants were divided into diabetic and non-diabetic groups. Diabetic group included 195 known type 2 diabetes patients having diabetes for at least 5 years. Non-diabetic group included 105 apparently healthy subjects. Patients having type-1 Diabetes, hemochromatosis, acute or chronic infection/inflammation, hypertension, pregnancy, anaemia, hemoglobinopathy, recent blood loss, blood transfusion/donation or those taking iron supplements were excluded. All demographic and clinical details
were noted followed by blood sample collection and Laboratory analysis for serum Ferritin, CRP, fasting plasma glucose and plasma HbA1c. Results were statistically analyzed on SPSS 22.
Results: The study comprised of 300 participants who were stratified into diabetic and non-diabetic groups. Elevated levels of serum Ferritin and CRP were observed in diabetic patients compared to healthy subjects; serum Ferritin level 165(98.50-190.00) ng/ml vs. 85.00(55.20-105.25) ng/ml (p = 0.036) and serum CRP level 8.50(5.70-11.10) mg/l vs. 2.80(2.30-4.00) mg/l (p <0.001) respectively. Significant positive correlation was also noted between these inflammatory markers and plasma HbA c; for serum CRP, r=0.464, p <0.001 and for serum 1
Ferritin, r=0.231, p =0.001.
Conclusion: Our study revealed significantly elevated levels of serum CRP and Ferritin in type 2 Diabetes patients as compared to healthy subjects. Serum CRP and Ferritin are positively correlated with HbA1c in patients with type 2 diabetes. These findings support the hypothesis that inflammatory markers may reflect glycemic control status in type 2 diabetes patients.

Evaluating Activity and Chronicity Indices in Lupus Nephritis Using the Recent NIHModified Activity Index Scores: A Comprehensive Correlation Analysis with Renal Function

Mon, 07 Jul 2025 00:00:00 +0000

Objective: To study the correlation between activity and chronicity indices in renal biopsies and renal functions among lupus nephritis patients.
Study Design: Prospective cross-sectional study.
Place and Duration of Study: This study was carried out from October 2021 to 2022 at Department of Histopathology, Shifa International Hospital Islamabad.
Materials and Methods: Clinical data, including history, age, serum creatinine, serum and urine albumin levels, ANA and Anti Ds DNA status, were obtained from the hospital's medical electronic records. Renal biopsies for light microscopy were assessed and scored for activity index and chronicity index using the recent (2018) NIHmodified activity and chronicity index scores (Table I). Immunofluorescence slides were viewed for full house deposits of IgG, IgA, IgM, C3 and C1q as seen in lupus nephritis. Data was incorporated into data management
software, and statistical analysis was conducted using IBM SPSS version 23.0.
Results: Among the 91 renal biopsies, 12 (13.2%) were male patients and 79 (86.8%) were female patients. The mean activity index score was 6.42±3.9 (ranging from 0 to 16 out of 24), while the mean chronicity score was 2.25±2.0 (ranging from 0 to 8 out of 12). Comparisons of activity and chronicity index scores with lupus classes revealed a significant association. Mean activity scores for lupus Class 1 to 5 were 2.07±1.6, 3.40±2.3, 8.21±3.3, 3.00±2.3, and 5.00±0.5 respectively, similarly mean chronicity scores for lupus grade 1 to 5 were 0.50±0.5, 0.80±0.8, 2.75±1.9, 3.00±2.7, and 7.00±0.5 respectively. These scores were compared with lupus classes,
revealing significantly higher mean activity and chronicity index scores for higher lupus classes. A positive correlation between index scores and elevated creatinine levels (p<0.001) was observed.
Conclusion: The study concludes that NIH-modified activity index and chronicity index scores are positively associated with lupus classes and clinical parameters, including serum creatinine, albumin, and urine protein.

Postpartum Depression in Females Presenting with Poor Sleep Quality During Third Trimester of Pregnancy

Mon, 07 Jul 2025 00:00:00 +0000

Objective: To assess the frequency of postpartum depression in females presenting with suboptimal sleep quality in the third trimester of pregnancy.
Study Design: It was an Analytical Prospective study.
Place and Duration of Study: Department of Obstetrics & Gynecology, Imran Idrees Teaching Hospital, Sialkot. Duration of study was 10 months from 28th February 2024 to 15th December 2024.
Materials and Methods: A total of 200 females meeting the inclusion criteria were enrolled through nonprobability consecutive sampling. Women aged 18–40 years with gestational age ≥34 weeks and poor sleep quality were included, while those with multiple fetuses, systemic diseases (e.g., pre-eclampsia, gestational diabetes, renal or liver disease, and anemia) were excluded. After delivery, participants were followed for one month and evaluated for postpartum depression with the Edinburgh Postnatal Depression Scale (EPDS) by a consultant psychiatrist at Imran Idrees Teaching Hospital, Sialkot. Data were recorded and analyzed using SPSS version 23, with Chi-square applied for stratified analysis.
Results: Mean maternal age was 28.7 ± 6.7 years, mean gestation age 37.8 ± 1.8 weeks. Sleep disturbance was pervasive (PSQI 13.3 ± 4.4 > cut-off 5), and 56 of 200 mothers (28 %) screened positive for postpartum depression (PPD). PPD prevalence did not differ by age group (<30 vs >30 y, p = 0.653), parity (p = 0.271), or delivery mode (p = 0.280) thus, poor sleep quality, rather than obstetric factors, was the key correlate of PPD.
Conclusion: The frequency of postpartum depression was high in females presenting with poor sleep quality during third trimester of pregnancy.

Aromatase Activity and Its Association with Coronary Artery Disease in Males

Mon, 07 Jul 2025 00:00:00 +0000

Objective: To determine the association among aromatase activity, testosterone-to-estradiol (T/E2) ratio, body mass index (BMI), and coronary artery disease in males.
Study Design: Comparative cross- sectional study.
Place and Duration of Study: Department of Chemical Pathology, from Feb2023 –Jan2024.
Materials and Methods: This cross-sectional study used the T/E2 ratio as a marker for aromatase activity and assessed the levels of plasma testosterone, estradiol, and T/E2 in 300 males. In order to evaluate the evolution of CAD, T/E2 was compared across serum quartiles and cardiac calcium score groups using ANOVA. It also showed correlations with atherosclerotic plaque, CRP, cholesterol, and BMI.
Results: T/E2 ratio and plaque calcification score were found to be negatively correlated in atherosclerotic plaques. These effects were observed to be greater in men with elevated body mass indexes (BMI). BMI, CRP, and Calcium Score show statistically significant differences across the three T/E2 ratio groups.

Conclusion: Males with low T/E2 ratio had higher levels of calcified plaque, systemic inflammation and evident atherosclerosis. These effects were strongest in men with higher BMI, which increased risk of future major acute coronary event.

Comparison of Lower Incisor Gingival Recession in Nonextraction Orthodontic Patients with Class I Crowding and Class II Malocclusion

Sadia Naureen, Huma Ghazanfar Kiani — Mon, 07 Jul 2025 00:00:00 +0000

Objective: To compare lower incisor gingival recession (GR) in non extraction orthodontic patients with Class I crowding and Class II malocclusion treated using Class II elastics.
Study Design: A cross sectional comparative study.
Place and Duration of Study: Orthodontic Department, Rawal Institute of Health Sciences (RIHS), from February 10, 2024 to August 10, 2024.
Materials and Methods: Pre and post-treatment casts of 42 orthodontic patients were divided into two groups: Class I crowding (C1) and Class II elastic treatment (E2). Clinical crown height (CCH) of the lower left central incisor was measured. GR was determined as the difference in CCH before and after treatment. The data was analyzed by SPSS v.20.0. Descriptive statistics like frequency of gender and mean age in C1 and E2 group were calculated. Paired sample t-test for intra group GR (pre and post treatment) and independent sample t-test for inter group GR were applied to analyze GR between two groups. The p value ≤ 0.05 was considered statistically significant.
Results: Both groups showed an increase in GR after treatment. The mean GR1 value was slightly higher (.5214mm) than GR2 (.4262mm) depicting that the C1 group had slightly more GR than the E2 group, though this difference was not statistically significant.
Conclusion: Both treatment modalities in non extraction cases resulted in increased GR, emphasizing the need to consider periodontal implications during orthodontic planning.

REVIEW ARTICLE: Psychiatric and Psychological Perspectives on the Treatment of Obsessive- Compulsive Personality Disorder: A Narrative Review

Tania Qamar — Mon, 07 Jul 2025 00:00:00 +0000

Background: Obsessive-Compulsive Personality Disorder (OCPD) is known as excessive control, a rigid commitment to norms, and an overarching commitment to perfectionism. Despite its prevalence, OCPD often goes undiagnosed or unnoticed, which leads to considerable impairments in quality of life and psychological functioning.
Objective: The objective of this narrative review is to examine the perspective of psychiatric and psychological treatment approaches for OCPD.
Method: This narrative review focused on literature published between 2000 and 2024, covering adult populations with OCPD across North America, Europe, and Asia. This narrative paper reviewed the different pharmacological and psychological treatment options that used to help individuals with OCPD.
Results/Review: Findings shown that psychiatric or pharmacological treatments are found beneficial, and SSRIs reduce the emotional rigidity or anxiety associated with OCPD. On the other hand, Cognitive-Behavioural Therapy (CBT), psychodynamic therapy, and other new psychological therapies were also found effective. Despite numerous treatment claims, a limited empirical literature has not proven the effectiveness of any treatment for OCPD.
Conclusions: Although CBT seems to have the most empirical support as a treatment, it is promising for improving the conditions of patients with OCPD. Future studies could focus on developing standardized treatment guidelines and intervention models to enhance the quality of care for patients with OCPD. It includes an examination of relevant predictors of treatment response that could provide beneficial clinical care for patients with OCPD.