Annals of Jinnah Sindh Medical University

First Cousin Marriages in Pakistan--- Are We Suicidal??

2026-06-27T10:11:50+05:00

First cousin (consanguineous) marriages are very common in Pakistan. As per published data (Emery's Genetics) it is about 50 percent. In reality it is over 70percent. An honest country wide survey is required. Cousin marriages are almost 100percent in rural areas. In a short survey in rural Sindh, when they were told that children of both paternal and maternal uncles and aunties are your first cousins and should not be married with, the answer was amazing. Most of them said, " then what is left?". It is said that marrying outside first cousin may lead to label them "Kari"

Assessment of Thyroid Gland Enlargement Through Clinical Grading and its Correlation with Ultrasonographic Thyroid Volume among Pregnant and Non-Pregnant Women in Local Population in Karachi

2026-06-27T10:11:50+05:00

Objectives: The aims of this study were to evaluate thyroid gland enlargement using clinical grading methods
in both groups, measure thyroid volume through ultrasonography, and determine the correlation between
clinical grading and ultrasonographic thyroid volume.
Methodology: This cross sectional study was conducted at the Gynea OPD, Ojha campus, DIMC, DUHS,
Karachi from Oct 2016-Dec 2018) through consecutive sampling and separated into two groups, Pregnant
and Non Pregnant women. The gross examination of thyroid gland was performed and this examination
purpose to evaluate the size of thyroid lobes through standard methods of inspection and palpation. The
Thyroid volume was measured by ultrasound and then calculated by WHO co-factor V (ml) =0.479*L*W*D
by applying inclusion / exclusion standard.
Results: The examination were made on thyroid grading with correlation of total thyroid volume (TTV)
among pregnant and non-pregnant women. Thyroid gland was examined by inspection and palpation. The
grading (from 0-2) of enlargement of gland was done. 50 pregnant women were examined among which 34
(68%) were found to have Grade 1 while 16 (32%) had no thyroid enlargement (means neither visible nor
palpable). On the other hand, in the non-pregnant group, not even a single enlargement was observed. The
mean difference was considered significant in pregnant women with p-value (< 0.01). In non-pregnant women,
mean TTV was 5.58±2.41, where as in pregnant women, it was 7.02±3.21, which was significantly increased
in pregnant women with p-value 0.01*.
Conclusion: The study proposed that physical clinical examination of thyroid gland is a valuable method, and
it also finds that even pregnant women who looks healthy in this population may still have some degree of iodine deficiency. The volume of the thyroid gland is enhanced during pregnancy, suggesting an iodine deficiency. A combined approach (clinical + imaging) is recommended for accurate diagnosis in antenatal care

Weekly Assessment of Acute Oral Mucositis on Concurrent Chemo Radiotherapy in Oral Cavity Cancers

2026-06-27T10:11:51+05:00

Objective: This study aimed to assess the weekly progression of acute oral mucositis in patients with oral cavity cancer undergoing concurrent chemoradiotherapy.

Methodology: A descriptive study was conducted at the Department of Oncology, Dr Ziauddin University Hospital from September 2020 to December 2021. Patients with SCC of oral cavity with ages between 18 and 70 years, planned for radiation therapy as adjuvant (after surgery) with chemotherapy were recruited. The severity of mucositis was evaluated weekly during the treatment according to RTOG/EORTC criteria of adverse events. The severity of mucositis was compared between patients aged below and above 45 years and between genders.

Results: Total 126 patients were included in the study. At Week 07, Grade 3 radiation induced oral mucositis constituted the highest proportion in patients aged <45 years, i.e. 74.4%, followed by Grade 4 (23.3%), and Grade 2 (2.3%) oral mucositis, which seemed similar to the oral mucositis grades in patients who are >45 years of age. The p-value (0.783) indicated that the observed differences in grade distribution between the age groups were not statistically significant. At Week 07, the percentage of Grade 3 XRT induced oral mucositis was higher than Grade 4 and Grade 2 oral mucositis in both female and male patients. The p-value (0.979) indicated that the observed differences in grade distribution between genders were not statistically significant.

Conclusion: Acute oral mucositis is a common and severe toxicity in oral cavity cancer patients undergoing concurrent chemoradiotherapy, typically peaking at Grade 3 by Week 7, with no significant differences observed across age or gender, highlighting the need for uniform supportive care strategies.

The Frequency and Clinical Association of Anti-CCP Positivity in Patients with Psoriatic Arthritis (PsA) and its Significance in Skeletal Involvement

2026-06-27T10:11:51+05:00

Objectives: To determine the prevalence of anti-CCP antibodies in patients with PsA and evaluate their
association with clinical features.
Methodology: A cross-sectional study was conducted in the Department of Rheumatology, Liaquat National
Hospital, Karachi. Sixty-one (61) PsA patients fulfilling CASPAR criteria were enrolled. Clinical assessments
included joint distribution, axial/peripheral involvement, and skin manifestations. Anti CCP measured using
ELISA Kits (cut-off value: <17 U/mL), X-rays, MRI, or CT scans were utilized where available, as part of
routine clinical evaluation to characterize the pattern of skeletal involvement and were considered in conjunction with clinical findings to support the overall diagnosis. Associations between anti-CCP positivity and clinical features were analyzed using chi-square tests and logistic regression.
Results: Anti-CCP antibodies were detected in 31.1% of PsA patients. Anti-CCP positivity was significantly
associated with the absence of skin involvement (p 0.008) and older age (p=0.025). No significant associations
were observed between anti-CCP status and patterns of joint involvement, axial or peripheral disease. Logistic
regression demonstrated significantly lower odds of anti-CCP positivity in patients with skin involvement
(OR = 0.06, 95% CI: 0.006–0.582, p = 0.015).
Conclusion: A substantial proportion of PsA patients in this cohort tested positive for anti-CCP antibodies.
Anti-CCP positivity may represent a distinct clinical subset in PsA and was associated with older age and an
inverse relationship with skin involvement. It may also be associated with a distinct clinical pattern of
musculoskeletal involvement. These findings highlight the potential role of anti-CCP antibodies in the clinical
assessment of PsA and support their use in guiding diagnostic and therapeutic considerations.

Clinical Efficacy of Azithromycin Versus Doxycycline in Patients of Acne Vulgaris

2026-06-27T10:11:52+05:00

Objective: To determine the clinical efficacy of azithromycin versus doxycycline in patients of acne vulgaris.
Methodology: A quasi-experimental study Was conducted at the Department of Dermatology, Dow University
of Health Sciences (DUHS), Karachi, from 09-07-2025 to 10-10-2025. The patients diagnosed with acne
vulgaris were randomly distributed into Group A (Azithromycin Group) and Group B (Doxycycline Group).
Group A patients were treated with oral azithromycin in a dose of 500 mg once a day and three times a week,
whereas patients in group B received oral doxycycline in a dose of 100 mg once a day. All patients were
additionally given 0.1% topical adapalene. Follow-up of each patient was performed after 6 weeks and 12
weeks, and improvement was measured after 12 weeks of therapy.
Results: Of the 122 patients with acne vulgaris, males were 36.1% (n=22) and 31.1% (n=19), and females
were 63.9% (n=39) and 68.9% (n=42) in the Azithromycin and Doxycycline groups, respectively. There was
no discernible difference between the two groups' levels of severity before treatment (p-value=0.917) and
after six weeks of treatment (p-value=0.994), while a significant difference is seen after twelve weeks of
treatment (p-value=0.018). Improvement in terms of clinical efficacy was significantly (p-value=0.006) higher
in the Doxycycline group than in the Azithromycin group.
Conclusion: The clinical efficacy of azithromycin and doxycycline was similar after six-weeks of treatment,
while doxycycline showed significantly higher clinical efficacy than azithromycin after twelve weeks of
treatment in the management of acne vulgaris.

Comparative Study to Assess the Practices Regarding Fad Diets Among Medical and Non-Medical Students of Lahore

2026-06-27T10:11:52+05:00

Objectives: To compare the practices and assess the experiences regarding fad diets among medical
and non-medical students
Methodology: A cross-sectional study was conducted on 378 students (189 from medical and 189 from
non-medical institutions) from different universities of Lahore, through an online survey.
Result: Majority of the medical (47%) and non-medical (56%) students were satisfied with their
weights. The majority of respondents did not follow fad diets. Among those who did, medical students
were 17.5% and non-medical students were 21.69% but p-value (>0.05) showed insignificant
difference between them. Both medical (24.87%) and non-medical (19.58%) students reported no
changes in their weights resulting from the fad diets. However, the majority of medical (31.75%)
and non-medical (21.6%) students also did not experience any side effects. A total of 25.93% medical
and 28.04% non-medical students recommended these diets to others.
Conclusion: This study states that majority of the students of both medical and non-medical domains
did not follow any fad diet, while those who tried fad diets, experienced few health consequences
and therefore their majority will recommend it to others. This study demonstrates that there is no
significant difference between medical and non-medical students in terms of practices and experiences
regarding fad diets.

Epigenetic Regulation of Antibiotic Resistance in Bacteria

2026-06-27T10:11:53+05:00

Objective: The objective is to understand how epigenetic mechanisms, such as DNA methylation and nucleoid
associated protein modifications, which regulate gene expression without altering the underlying DNA
sequence, are associated with persistence and antibiotic resistance phenotypes in bacteria, which enable them
to evade host immune responses and resist antimicrobial agents. The study aims to understand how epigenetic
processes that control bacterial gene activity without changing DNA, help bacteria survive antibiotics and
avoid immune system attacks.
Methodology: Peer-reviewed research articles, systematic reviews, and meta-analyses published between
1996 and 2024 were prioritized for inclusion, along with earlier foundational studies where necessary. Global
health reports from organizations such as WHO and CDC were also consulted for epidemiological context.
The keywords, “bacterial epigenetics,” “DNA methylation,” “histone-like protein modification,” “nucleoid
associated proteins,” “RNA regulation,” “epigenetic inheritance,” “antibiotic resistance,” and “antimicrobial
tolerance” were used to search literature.
Results: This review finds that while the well-researched genetic factors are major influencers of bacterial
resistance, genetic factors alone do not fully determine virulence due to the growing number of resistant
strains. Epigenetic mechanisms also contribute by regulating gene expression without introducing permanent
mutations. Rapid bacterial adaptations to antibiotic environments, and the transmission of resistance-associated phenotypes to daughter cells, have been shown to persist in some bacterial species across multiple generations under sustained selective pressure. These findings suggest that incorporating epigenetic targets into existing antimicrobial treatment strategies may improve therapeutic outcomes against resistant bacterial infections. They highlight that this dual-targeting approach may reduce the likelihood of pathogen adaptation, as it simultaneously disrupts multiple resistance-associated mechanisms available for the cell to defend itself. The practical implications of these systems could potentially lead to a decrease in the global recurrence of resistance cases.
Conclusion: Targeting bacterial epigenetic mechanisms, either through inhibitors of methyltransferases and
other regulatory enzyme, or through epigenome editing tools in combination with existing antibiotics, represents a promising way to enhance antibiotic efficacy and reduce the emergence of resistance.

Complete Surgical Excision of A Challenging Giant Intrathoracic Mass—Solitary Fibrous Tumor

2026-06-27T10:11:53+05:00

Background: Solitary fibrous tumors are rare mesenchymal tumors that remain asymptomatic and are
diagnosed incidentally. They grow at a slow rate and expand to giant size by the time of their presentation.
Introduction: This is a case of a female who presented with exertional dyspnea, orthopnea and dull chest
pain for 4-5 years. Clinical examination showed reduced movement over the left chest along with dull
percussion note and absent breath sounds. Computed tomography showed a large 20*11*12cm heterogeneous opacity occupying the left hemi thorax. Biopsy was inconclusive. A complete excision of the mass was achieved. Intraoperatively, mass was consistent with radiological findings, however, was adherent to surrounding structure with atelectasis. Patient had an uneventful recovery period with histopathological evidence of solitary fibrous tumor.
Conclusion: Complete surgical excision remains the mainstay of treatment for solitary fibrous tumors and
can achieve favorable outcomes.

Atypical Presentation of Dermatofibroma: A Rare Case

2026-06-27T10:11:54+05:00

Background: Dermatofibroma, also termed benign fibrous histiocytoma, is a common benign fibrohistiocytic
tumor that typically presents as a firm reddish-brown nodule on the extremities. Atypical variants—particularly
atrophic and giant plaque-like forms occurring on the face—are exceedingly rare and may be mistaken for
inflammatory or malignant dermatoses. We report a 47-year-old woman who presented with a four-month
history of an 8 × 4 cm hyperpigmented, indurated, atrophic plaque on the right side of her face, without
antecedent trauma. Clinical differentials included morphea, lupus panniculitis, lichen sclerosus et atrophicus,
and subcutaneous sarcoidosis. Histopathology revealed dermal spindle cells in a storiform pattern with collagen
entrapment, and immunohistochemistry was positive for CD68 and ASMA and negative for CD34 and S100,
confirming dermatofibroma. The lesion was completely excised with cervicofacial flap reconstruction.
Recognition of such atypical facial variants is essential to guide accurate histopathological diagnosis.

Modified Twin Occlusion Prosthesis—Case Series

2026-06-27T10:11:54+05:00

The use of twin occlusion is commonly associated with maxillofacial prosthesis incorporating double row
of teeth in posterior region where the inside or palatal row of teeth provide occlusal contact and hence helps
in mastication and the outside or buccal row towards the cheeks provide support and improves the appearance.
This clinical case series reports the treatment of patients with modified twin occlusion acrylic removable
prosthesis to improve the patient’s facial profile and achieve satisfactory aesthetics and function.

Design, Translational, and Regulatory Barriers in Advancing Nanocrystal-Based Therapeutics

2026-06-27T10:11:54+05:00

Poor aqueous solubility is one of the major critical issues that hinder the clinical integration of nearly 90% of the drug candidates in the discovery pipeline (1, 2). Addressing that biopharmaceutical problem, nanocrystal-based drug formulations have emerged as a promising solution, particularly for BCS Class II and IV drugs, where oral absorption is comprised mainly due to inadequate solubility or permeability (1, 2). Nanocrystals consist of crystalline particles of the pure drug, stabilized by minimal concentration of excipients and do not contain any carrier system (1, 2). By engineering these crystalline active ingredients into the nanometer range, dissolution velocity is significantly increased, resulting in better aqueous solubility, improved bioavailability and potential dose reduction (1-3). However, several translational, design, and regulatory barriers continue to limit the seamless transition of nanocrystal therapeutics into clinical use (1-4).