Resident Journal of Rawalpindi Medical University

Empowering the Next Generation of Researchers: RJRMU's Commitment to Strengthening Future Faculty

2025-07-12T07:38:43+00:00

Research plays a crucial role in academia, particularly within medical universities, as it underpins the advancement of knowledge and the development of future healthcare professionals. It fosters a culture of inquiry, critical thinking, and problem-solving, which are essential for addressing complex health challenges. The integration of research into medical education not only enhances the learning experience but also contributes to the overall improvement of healthcare practices and outcomes[i]. Research is fundamental for generating new insights and innovations in medical science, which directly impact patient care and treatment methodologies[ii]. Engaging medical students in research is crucial for inspiring academic careers and reversing the decline of medically trained researchers[iii],[iv]

Correlation between the Neutrophil-to-Lymphocyte Ratio and the Severity of Acute Pancreatitis

2025-07-12T08:00:01+00:00

Background: Acute pancreatitis (AP) is a potentially lethal condition triggered by various factors, with a poor prognosis if it escalates to severe acute pancreatitis. Traditional methods for evaluating the severity of AP such as the Ranson criteria, the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and the Bedside Index of Severity in Acute Pancreatitis (BISAP) scores, are cumbersome and resource-intensive, requiring costly investigations. To overcome this limitation, this study investigated the relationship between the neutrophil-to-lymphocyte ratio (NLR) and AP severity, exploring the potential of NLR as a simple and more affordable predictive indicator of AP severity.

Methods: This cross-sectional study was conducted at Benazir Bhutto Hospital (BBH) in Rawalpindi, Pakistan, from January 2022 to January 2024, among 210 diagnosed patients of AP. Consecutive sampling and a set of inclusion and exclusion criteria were used to recruit patients. Informed consent was acquired prior to data collection. A self-created form was used to gather data. The severity of AP was assessed using the Ranson criterion score. Based on the severity of their AP (Ranson score), the patients were split into two groups. Descriptive and inferential statistics were used in the Statistical Package for the Social Sciences (SPSS) to analyse the data. P-values below 0.05 were regarded as significant.

Results: From 210 patients, n=136 (64.76%) had non-severe AP while n=74 (35.24%) had severe AP. Significant variations were found in the age, gender, WBC count, serum AST level, blood glucose level, serum LDH level, serum amylase level, serum lipase level, Ranson score, lymphocyte count, neutrophil count, and neutrophil-to-lymphocyte ratio with p < 0.05. Pearson’s correlation showed that NLR was positively and significantly correlated with the Ranson scores (r = 0.82 p < 0.002). Linear regression analysis also indicated NLR as a significant predictor of AP severity (β = 3.20, 95% CI: 1.80-4.70, p < 0.002).

Conclusion: In the present study, NLR was found as an efficient indicator of AP severity in patients as a positive and significant association was noted between the NLR and the severity of AP. Higher NLR was correlated with higher Ranson scores, suggesting the increase in severity of AP. This current study findings endorse the use of NLR as a supplementary, cost-effective tool for prompt identification of high-risk AP patients, facilitating timely interventions and improved outcomes, particularly in resource-constrained setting

Integration of ALBI Score into Barcelona Clinic Liver Cancer (BCLC) Staging System

2025-07-14T04:36:47+00:00

Background: Hepatocellular carcinoma (HCC) is a major world health concern with a high mortality rate. liver function assessment is important for appropriate staging and treatment strategy. The Albumin-Bilirubin (ALBI) score offers a simpler, more objective alternative to the Child-Turcotte-Pugh (CTP) score for assessing liver function in hepatocellular carcinoma (HCC) patients within the Barcelona Clinic Liver Cancer (BCLC) staging system. The study aims to evaluate the concordance between ALBI- and CTP based BCLC staging in HCC patients.

Material and Methods: A prospective study was conducted from September 2021 to February 2022 at the Centre for Liver and Digestive Diseases, Holy Family Hospital, Rawalpindi, Pakistan. 93 HCC patients, diagnosed via triphasic CT per EASL guidelines, were enrolled using convenience sampling. ALBI and CTP scores were calculated, and their integration into BCLC staging was compared using Cohen’s kappa (κ). Data were analyzed with IBM SPSS Statistics v22.0.

Results: Among 93 patients (72% male, mean age 60.16 ± 8.47 years), 61% had multifocal lesions, and 88% had chronic hepatitis C. Cohen’s κ showed near-perfect agreement between ALBI-based and CTP-based BCLC staging (κ = 0.97, p < 0.001), with disagreement in only two patients. ALBI’s objectivity and simplicity enhanced its clinical utility.

Conclusion: This study concludes that ALBI score is a reliable, objective alternative to the CTP score in BCLC staging regarding liver function., offering comparable prognostic performance with greater ease of use. Larger, multicenter studies are needed to validate these findings and assess survival outcomes. The medical community, researchers, and research organizations might all benefit from these findings.

Comparison of Acetic Acid Verses Topical Antibiotics for Otorrhea Resolution in Active CSOM-A Randomized Control Trial

2025-07-14T04:43:33+00:00

Introduction: Chronic Suppurative Otitis Media (CSOM) is a long -standing middle ear infection causing hearing loss, often in developing countries. Treatment includes aural toilet, topical antibiotics, and antiseptics. Drug resistance and ototoxicity are concerns, with acetic acid as a potential alternative.

Study design: Randomized control trials.

Material and methods: Study was conducted in ENT Department of Rawalpindi Teaching hospital.

Results: A total of 186 patients with tubotympanic type of CSOM were randomly divided into two groups. In group A patients were treated with topical acetic acid while in group B patients were treated with topical Gentamycin ear drops.

Conclusion: This study concluded that both acetic acid and topical gentamicin are effective in resoling otorrhea but acetic acid presented as viable alternative especially for those with concerns about ototoxicity or antibiotics resistance.

Impact of dysnatremia on Mortality in Patients with Acute Kidney Injury at Holy Family Hospital, Rawalpindi: A Cross-Sectional Study

2025-07-14T04:45:24+00:00

Objective: To determine the frequency of dysnatremia among acute kidney injury (AKI) patients and assess the associated in-hospital mortality during the first 10 days of admission.

Methods: A descriptive cross-sectional study was conducted over six months at Holy Family Hospital, Rawalpindi. Data were collected from 120 AKI patients. Sodium levels were categorized as normal, hyponatremic, or hypernatremic, and mortality rates were tracked. Descriptive statistics were applied using SPSS.

Results: Among 120 patients, 31.7% (n=38) had dysnatremia. In-hospital mortality was 12.5% (n=15), with dysnatremia significantly associated with increased mortality.

Conclusion: Dysnatremia is common in AKI patients and is associated with increased short-term mortality, highlighting the need for careful monitoring of sodium levels in such patients.

Estimation of risk of stroke in middle aged and elderly indoor patients of a medical unit in tertiary care hospital of Rawalpindi

2025-07-14T04:49:27+00:00

Background: Stroke is a major cause of disability and mortality worldwide, with South Asian countries, including Pakistan, disproportionately affected. Identifying high-risk patients is critical to enable early intervention and reduce the stroke burden.

Methods: A cross-sectional study was conducted over five months at Medical Unit-II, Holy Family Hospital, Rawalpindi. Seventy-five inpatients aged 45-80 years with stroke risk factors, such as hypertension, diabetes, smoking, atrial fibrillation, dyslipidemia, and a family history of cardiovascular disease, were included. Data collection utilized the American Stroke Association (ASA) Stroke Risk Assessment Tool. Patients were categorized into low (score 1–5), moderate (score 6–9), and high-risk groups (score = 10). Data were analyzed using SPSS version 25.0, with t-tests and Chi-square tests applied to determine significant associations.

Results: The mean age of the study population was 62.8 ± 9.6 years, with nearly equals representation of males (49.3%) and females (50.7%). A sedentary lifestyle (68%) and hypertension (56%) were the most prevalent risk factors. Of the participants, 45.3% were classified as high-risk, with a significant association between age and high-risk score (p < 0.05). Older age groups (65–80 years) showed higher frequencies of high stroke risk scores.

Conclusions: This study indicates that a significant proportion of middle-aged and elderly patients with established risk factors are at high risk for stroke. Implementing routine use of the ASA Stroke Risk Assessment Tool in clinical settings may facilitate early risk identification and targeted prevention, potentially reducing stroke incidence.

Your Voice Matters: Resident Feedback Survey for Quality Improvement of RJRMU

2025-07-14T04:52:09+00:00

To enhance the quality and relevance of the Resident Journal of Rawalpindi Medical University (RJRMU), we conducted an online survey involving all medical residents at RMU. This initiative aimed to gather valuable feedback on the journal’s content, structure, accessibility, and its role in academic and professional development. Resident feedback is crucial in shaping a journal that effectively meets their scholarly needs, promotes research engagement, and reflects the evolving landscape of medical education and practice. By incorporating their insights, we strive to improve the journal’s impact, ensuring it serves as a robust platform for knowledge dissemination and academic growth

Comparison of Two Dimensional Shear Wave Elastography Versus Fibrosis-4 Index for Evaluation of Liver Fibrosis in Chronic Hepatitis B Patients

2025-07-14T04:54:47+00:00

Introduction: In countries like Pakistan, chronic hepatitis B infection is a major public health issue. Accurate assessment of liver fibrosis is crucial for proper medical care. Promising techniques include 2D-SWE and serum-based models like FIB-4. CHB infection contributes to liver fibrosis, cirrhosis, and liver cancer. Accurate assessment of liver fibrosis is crucial for proper care, using non-invasive techniques like 2D-SWE and serum-based fibrosis models like FIB-4.

Objective: To evaluate liver fibrosis among patients with CHB infection, we aim to compare the diagnostic performance of 2D-SWE and FIB-4.

Study Design: This research was a Quasi Experimental study.

Patients and Methods: The study involved a sample of 100 individuals with chronic Hepatitis B infection, selected using a sequential non-probability sampling method. Eligibility for the study requires patients to demonstrate laboratory indications of chronic hepatitis B infection and provide either hepatic biopsy or fibro-scan results. Exclusion criteria involved patients with congestive heart failure, hepatic focal lesions, portal vein thrombosis, history of hepatic interventional procedures, or fibrosis due to other causes. Written informed consent were obtained from participants. The process involved in data collection included performing 2D-SWE and calculating fibrosis-4 scores using age, platelet count, and serum liver enzyme levels. This information was then documented on a specific proforma.

Results: The research comprised of a sample of 100 patients diagnosed with chronic hepatitis B, yielding diverse findings. The analysis of gender distribution indicated the presence of 67 male and 33 female participants. Descriptive statistics were provided for several variables, encompassing age (with a mean of 37.46, ranging from 30 to 49 years), alanine aminotransferase (ALT) level (with a mean of 76.10, ranging from 25 to 312 IU/L), and aspartate aminotransferase (AST) level (with a mean of 136.98, ranging from 55 to 456 IU/L), platelet count (ranging from 70 to 200 with a mean of 114.43), Fibrosis 4 Index score (ranging from 0.93 to 7.83 with a mean of 2.28), and duration of disease (ranging from 1 to 10 years with a mean of 3.93). The crosstabulation table showed the distribution of Ishak levels based on elastography results. The statistical analysis revealed significant differences in Fibrosis-4 Index across different elastography groups. Post hoc analyses further supported these findings, indicating significant mean differences between specific elastography groups. These results emphasize the importance of elastography in assessing liver fibrosis in chronic hepatitis B patients.

Conclusion: Evaluating liver fibrosis in chronic hepatitis B patients can be done effectively using non-invasive methods like 2D-SWE and FIB-4. However, Standardized protocols and guidelines are needed to integrate non-invasive techniques like 2D-SWE and FIB-4 into clinical care for chronic hepatitis B patients.

Microbial Profile and Resistance Pattern in Infected Orthopedic Implants Cases of a Tertiary Care Teaching Hospital

2025-07-14T04:57:56+00:00

Background. The infected orthopedic implant and their antibiotics susceptibility pattern vary regionally and has changed over the time. The detailed knowledge of the frequency of the causative microorganisms and their antibiotics susceptibility are necessary for better therapeutic outcome. The of this study was to identify the antibiotic resistance and sensitivity pattern in various orthopedic infectious cases.

This study was a cross sectional prospective study that took place over a period of 6 months from August 2022 to March 2023 at a tertiary care hospital. The recommended methods of bacteria culture were performed. The data was analyzed by descriptive statics.

Results. A total of 34 patients (25 males and 09 females) with positive cultures of postoperative orthopedic infected implant were included. The most common causative organism of infection was Staphylococcus aureus, 16 patients (47.05%); Methicillin resistant Staphylococcus Aureus, 02 patients (5.88%); Klebsiella species, 03 patients (8.82%); and Enterococcus species,01 patient(2.94%); Escherichia coli, 07 patients(20.58) and Pseudomonas aeruginosa in 05 patients (14.70%). Data also revealed that gram-positive bacteria were isolated in 19 patients (55.888%), while gram-negative microorganisms were found in 15 patients (44.11%). Among gram positive bacteria the antibiotics with the greatest sensitivity were Fucidic acid, Linezolid, Doxycycline, Cefepime, and Meropenem, while for gram-negative bacteria the antibiotics with greater sensitivity were Amikacin, Ertapenem, Imipenem, Linezolid and Doxycycline

Identifying leadership skill gaps in obstetrics and gynecology residents: Mixed-method study

2025-07-14T05:01:34+00:00

Introduction: Leadership development is a critical aspect of residency training, particularly for physicians working in high-pressure environments. This study aims to assess residents' leadership competencies, identify gaps in training, and explore barriers to leadership skill development.

Methods and material: A cross-sectional survey was conducted among 30 gynecology and obstetrics residents at Benazir Bhutto Hospital. Data collection included a structured questionnaire with Likert-scale, multiple-choice, and open-ended questions, as well as semi-structured interviews with a resident and a program director.

Results: Participants reported low-to-moderate confidence in leadership abilities, with 70% rating their skills as "average." Key gaps included the lack of structured workshops (70%) and mentorship programs (63.3%). Time constraints (80%) and insufficient resources (63.3%) were the main barriers. Residents favored workshops (86.7%) and simulation exercises (70%) for leadership training.

Conclusion: The findings highlight significant gaps and barriers in leadership development during residency. Improved training methods, such as structured workshops and mentorship programs, are recommended to enhance leadership competencies among medical residents.

Joint Collaborative Academic Program for Gaza Medical Students at Rawalpindi Medical University

2025-07-14T05:06:27+00:00

The ongoing conflict in Gaza disrupted the education of Al-Azhar University medical students, necessitating an academic collaboration between Rawalpindi Medical University (RMU) and Al-Azhar University to ensure their continued medical training. RMU provided a structured one-year academic integration program to facilitate their adaptation and academic progress. Medical examination psychological examination and previous academic assessment was carried out upon integration into RMU. One-week foundation module of basics sciences was conducted after initial assessments of basic sciences.

The Challenges Beyond Calot’s triangle: Post Cholecystectomy Right Hepatic Artery Aneurysm

2025-07-14T05:28:20+00:00

Cholecystectomy is a very common surgical procedure with approximately increase from 55,31,860 to 71,61,339 cholecystectomies in South Asian region per year (from 2019 to 2022)¹. Given this, despite development of rules to address safety of this frequented procedure, there are outliers where difficulties maybe faced both intra and post operatively. We present such a case of open cholecystectomy with intraoperative variant anatomy followed by the development of right hepatic artery aneurysm post operatively. Intrahepatic pseudo-aneurysm is a rare but potentially life-threatening complication following cholecystectomy. It is crucial for both surgeons and radiologists to recognize its symptoms promptly. Currently, the preferred treatment approach is minimally invasive, radiology-guided procedures, with trans-arterial embolization being the most effective therapeutic option

Peripheral Ulcerative Keratitis (PUK) in a Post-Cataract Surgery Patient

2025-07-14T05:29:51+00:00

Background: Peripheral Ulcerative Keratitis (PUK) is a serious ocular manifestation of systemic inflammatory diseases, particularly rheumatoid arthritis (RA). This case report presents a rare instance of corneal thinning secondary to RA following cataract surgery.

Case Presentation: A 50-year-old patient with a history of hepatitis C and RA underwent cataract surgery on the left eye in 2021. Three years later, the patient developed sudden-onset foreign body sensation, photophobia, and blurry vision. Examination revealed corneal thinning at the phacoemulsification incision site, with associated scleritis and hypopyon. Laboratory investigations confirmed elevated inflammatory markers and a positive rheumatoid factor, leading to a diagnosis of rheumatoid vasculitis with secondary PUK.

Management and Outcome: The patient received topical antibiotics, lubricants, oral steroids, and systemic immunosuppression with methotrexate. Surgical interventions, including conjunctival resection and peripheral tectonic keratoplasty, were performed to stabilize corneal thinning. Regular follow-ups showed improvement, with no further progression of corneal ulceration.

Conclusion: This case highlights the importance of early diagnosis and multidisciplinary management in PUK associated with RA. Systemic immunosuppressive therapy, combined with surgical interventions, plays a crucial role in preventing severe ocular morbidity and preserving vision.

A Rare Case of Acral Lentiginous Melanoma: A Rare Variant with Unique Diagnostic Challenges and Management

2025-07-14T05:33:56+00:00

Acral lentiginous melanoma (ALM) is so called because of the location and histological orientation of the tumor. It can develop on the sole, palm or subungal surface. Lesions on the palms, soles or nails typically accompany this rare type of melanoma. Although it is uncommon, it is the most frequently found subtype of melanoma in people who are not Caucasian, such as Latinos, Africans, Chinese, and Koreans. The diagnosis is most commonly made in the 60s or 70s of life.

Eyes as Windows: Ocular Manifestations Paving the Path to Sarcoidosis Diagnosis

2025-07-14T05:35:48+00:00

A 32-year-old male presented with sudden, painless vision loss in both eyes. Examination revealed impaired visual acuity, vitreous inflammation, and macular edema. Systemic investigations showed elevated inflammatory markers and angiotensin-converting enzyme (ACE) levels, suggesting granulomatous disease. Tuberculosis was excluded, and a diagnosis of ocular sarcoidosis was established. Treatment with corticosteroids led to significant improvement in visual acuity. Ocular sarcoidosis is a common manifestation of systemic sarcoidosis, a multisystem disease characterized by noncaseating granulomas. Ocular involvement occurs in 12-76% of systemic sarcoidosis cases, with uveitis and conjunctival nodules being common findings. High suspicion and adherence to IWOS criteria are crucial for diagnosis.

Picture of the Issue

2025-07-14T05:40:20+00:00

Tape Worm in Duodenum found Incidentally During ERCP Procedure

Resident Research Forum at the 7th International Scientific Conference of Rawalpindi Medical University

2025-07-19T08:32:32+00:00

The Resident Research Forum (RRF), a synergy for nurturing research and academic acumen among residents, played a central role in the 7th International Scientific Conference of Rawalpindi Medical University (RMU). Conducted on December 20, 2024, Friday, this session exhibited four topic centered symposia and a comprehensive poster presentation session, seamlessly aligning with the conference's theme, “Reshaping the Medical Education Landscape: The RMU Model.”
Innovative Leadership: The central theme and framework of the conference were formulated and directed by Vice Chancellor Rawalpindi Medical University, Professor Dr. Muhammad Umer, whose relentless dedication and unyielding commitment built a strong foundation for the success of the event. His ideation of revolutionizing healthcare education by merging innovation with medical expertise, was reverberated across the whole conference, inspiring residents and faculty alike