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CURRENT ISSUE
October 2025 – December 2025
VOL. 24, ISSUE NO. 1
EDITORIAL
Vaccine Hesitancy — Threat to global immunization gains
Prof. Muhammad Faheem Afzal
https://doi.org/10.59058/jaimc.2026.24.1.104
ORIGINAL ARTICLES
Comparison of Screws Alone Versus Screws Plus Bone Graft for
Garden Type III Femur Fractures
Ahmad Humayun Sarfraz, Muhammad Akram, Abdul Haq, Saif Ullah,
Waqas Azam, Rana Muhammad Asghar
https://doi.org/10.59058/jaimc.2026.24.1.107
ABSTRACT
Background & Objectives: Femoral neck fractures (FNF) are common injuries and are associated with complications
such as non-union and osteonecrosis. The management of these fractures is a subject of ongoing debate, particularly
concerning deciding whether to save or replace femoral head. In younger patients, surgical interventions that
prioritize the preservation of hip anatomy and function are essential. This study evaluated the functional outcomes
and union rates of Garden type III FNFs treated with cannulated screws alone versus cannulated screws with bone
grafting.
Methodology: A prospective comparative cross-sectional study was conducted at the Department of Orthopaedic
Surgery, Mayo Hospital, Lahore. Seventy patients with Garden type III FNFs were randomly allocated into two groups.
Group A underwent fixation with cannulated screws only, while Group B received cannulated screws with bone
grafting. Functional outcomes were assessed using the Harris Hip Score (HHS), and radiological healing was evaluated
with Radiographic Union Score for Hip (RUSH).
Results: Group B demonstrated significantly better outcomes compared to Group A. The mean HHS was 88.86 ± 3.16 in
Group B versus 84.57 ± 4.46 in Group A (p < 0.001). Bone healing was also superior in Group B, with mean RUSH bridging
scores of 9.89 ± 0.86 compared to 8.63 ± 1.14 in Group A (p < 0.001). The fracture line reduction score was higher in
Group B (9.83 ± 0.66 vs 8.71 ± 0.95, p < 0.001).
Conclusion: Cannulated screw fixation supplemented with bone grafting significantly improves functional recovery
and bone healing compared with screw fixation alone.
KEY WORDS: Femoral neck fracture, Garden type III fracture, Cannulated screws, Bone graft, Functional outcome
Outcome of Simultaneous Bilateral Total Knee Replacement in Patients Compared to Unilateral Knee Replacement: A Comparative Study
Muhammad Bilal, Muhammad Shakeel Basit, Muhammad Adeel Abbas,
Hafiz Abdul Rauf, Adil Kazi
https://doi.org/10.59058/jaimc.2026.24.1.108
ABSTRACT
Background & Objectives: Joint replacement for the treatment of large joint arthritis has proven very successful.
Total Knee Replacement (TKR) improve mobility, reduces pain and overall positive effect on quality of life. With
changing trends in current orthopedics and a balance between patient satisfactions with cost effective procedures,
simultaneous bilateral TKR is gaining popularity. We aim to look at the outcome of simultaneous bilateral TKR in our
study
Methodology: We looked at TKAs performed at a private institution during a period of 3 years by one surgeon. Total 140
joints were replaced by Dr Muhammad Bilal during April 2021 to April 2024. Primary outcome measures were any need
for re-admission to hospital within 2 months and secondary complications such as infection, manipulation for stiffness,
revision, or any other procedure performed.
Results: Out of total 135 joint replaced, 61% (n=51/84) patients had Simultaneous Bilateral Knee Replacement while
39% (n=33/84) patients had one side knee replacement. Out of 84 patients, 64% (n=54) were females and 36% (n=30)
were male patients. Our primary outcome measures show none of the patients in either group needed re-admission
within 2 months after surgery. None of the patients developed stiffness or need for manipulation under anesthesia. One
patient in unilateral knee replacement group developed painful patella which was replaced, one patient developed
delayed infection and one patient developed peri prosthetic fracture.
Conclusion: Our study has clearly shown that simultaneous bilateral TKR group has better Patient reported Outcome
Measures (PROMs), low rate of infection, stiffness and anesthetic complications. Economically it has only one hospital
episode and lower overall costs. Patient selection criteria are not well defined yet but we recruited patients of 75 years
or younger, and fewer or at least well controlled associated medical conditions for simultaneous bilateral TKR.
Meticulous surgical technique, strict adherence to protocols and involvement of multi disciplinary team are of utmost
importance for higher success rates.
KEY WORDS: Knee Replacement, Joint Arthroplasty, Simultaneous Bilateral Knee Replacement
Association of Body Mass Index with Anemia among Pregnant Women Visiting a University Hospital of Lahore
Saira Fayyaz, Rabia Wajid, Sumaira Fatima Sabir, Hina Masood
https://doi.org/10.59058/jaimc.2026.24.1.109
ABSTRACT
Background & Objective: Anemia is among the most common nutritional disorders seen in pregnancy worldwide. The
issue is commoner in women of reproductive age, contributing to maternal morbidity and mortality. We aimed to
determine association of body mass Index (BMI) with anemia among pregnant women visiting a University Hospital of
Lahore.
Methodology: This was a descriptive, cross-sectional study conducted at department of Obstetrics & Gynecology,
Lahore General Hospital, Lahore from September 2024 to December 2024. A total of 186 women falling into the
inclusion criteria were kept in the study. In all women, a blood sample was sent to the hospital laboratory after
collecting all the sociodemographic details on a pre-designed proforma. Iron deficiency anemia and Body Mass Index
were noted as per operational definition. Data was analyzed using SPSS version 20.0. Patient age, gestational age,
parity, BMI, hemoglobin levels were represented by mean and standard deviation. Effect modifiers were controlled by
stratification and chi square test was applied post-stratification and p-value ≤0.05 was considered as significant.
Results: The study analyzed 186 pregnant women, revealing a significant association between Body Mass Index (BMI)
and anemia. Among participants, those categorized as obese (BMI ≥30) exhibited a higher prevalence of anemia (72%)
as compared to those with BMI ≤29 (10.53%). Multivariable logistic regression indicated that underweight women had
an adjusted odds ratio (AOR) of 3.00 (95% CI: 1.40-6.40; p=0.005), while overweight (AOR: 1.80; p=0.017) and obese
women (AOR: 2.20; p=0.011) also showed increased odds of anemia. Additionally, educational level and monthly
income were significantly linked to anemia, with illiterate women having a higher risk (AOR: 2.10; p=0.010) and those
earning less than 20,000 Rupees having an AOR of 1.95 (p=0.001).
Conclusion: The frequency of iron deficiency anemia is quite high in obese pregnant females. Public awareness
regarding maintenance of healthy body weight is very important.
KEY WORDS: iron deficiency anemia, pregnancy, prevalence, sociodemographic factors.
Evaluation of Troponin I Values in Acute Coronary Syndrome Patients with and without Impaired Renal Function
Rukhsana Tumrani, Afsheen Nigar, Muhammad Usman, Madiha Naqvi,
Fahad Liaqat, Zainab Awais
https://doi.org/10.59058/jaimc.2026.24.1.110
ABSTRACT
Background & Objective: Elevated cardiac troponin levels are common in chronic kidney disease (CKD) which make it
challenging to diagnose acute coronary syndrome in these patients. It is difficult to interpret the cardiac troponin
levels in CKD patients due to persistent increase of troponin levels in these patients which limit their diagnostic value.
Our study aims to evaluate troponin-I levels in patients with acute coronary syndrome with and without impaired renal
function
Methodology: Retrospective Cross-sectional study conducted in Pathology department, Shalamar Hospital Laboratory,
Lahore from February 2025 to August 2025. A total of 202 Patients aged between 25 to 65 years both genders diagnosed
as acute coronary syndrome with evaluated renal function were included. Data was divided in two groups i.e., Group A
(Preserved renalfunction, eGFR≥60ml/min/1.73m2) Group B (Impaired renalfunction, eGFR<60ml/min/1.73m2). Troponin I
levels were compared between patients with and without impaired renal function and p value <0.05 taken as
statistically significant.
Results: Median age was 42 years in patients with preserved renal function and 53 years in patients with impaired renal
function. Troponin I levels were significantly higher in patients with impaired renal function (6.80ng/ml) than in patients
with preserved renal function (3.80ng/ml). Weak negative, statistically insignificant correlation found between eGFR
and troponin I (r, p value: -0.18, 0.09) in patients with preserved renal function (Group A). Moderate to strong,
significant negative correlation between eGFR and troponin I (r, p value: -0.56, <0.001) in patients with impaired renal
function (Group B). Statistically significant difference in troponin I levels between patients with preserved and
impaired renal function with higher levels in impaired group with P value 0.012.
Conclusion: It has been concluded that serum troponin I levels are significantly higher in patients with acute coronary
syndrome with impaired renal function. These findings highlight the importance of interpreting troponin I values with
caution in acute coronary syndrome patients with renal impairment to avoid overdiagnosis of myocardial infarction.
Further studies are recommended to establish adjusted diagnostic cutoff for troponin I in patients with impaired renal
function to improve the clinical decision making.
KEY WORDS: Troponin I, Acute coronary syndrome, Myocardial infarction, renal impairment, cardiac biomarker,
chronic kidney disease
Diagnostic Accuracy of Diffusion Weighted MRI in Differentiating Malignant from Benign Liver Lesions Taking Histopathology as Gold Standard
Kiran Sarfraz, Saman Chaudhry, Verda Ashraf, Zunair Maqsood, Hira Ashfaq Butt, Shahzaib Nawaz
https://doi.org/10.59058/jaimc.2026.24.1.111
ABSTRACT
Background & Objective: Liver lesions are common, and distinguishing between malignant and benign types is crucial.
Histopathology, the gold standard, is invasive and costly. DW MRI, a promising non-invasive alternative, requires further
research to confirm its diagnostic accuracy in liverlesion differentiation.Objective was to determine the diagnostic accuracy
of diffusion weighted MRI in differentiating malignant from benign liver lesions taking histopathology as gold standard.
Methodology: A total of 150 patients meeting inclusion criteria were enrolled from the Department of Diagnostic
Radiology, Sir Ganga Ram Hospital, Lahore. Written consent and medical history were obtained, and all underwent
diffusion-weighted MRI on a 1.5-T scanner. MRI findings were compared with histopathology for assessing diagnostic
accuracy of DW MRI in differentiating liver lesions from benign lesions. Data was analyzed using SPSS 26.0. Sensitivity,
specificity, and predictive values were calculated, and results were stratified by age and gender.
Results: The patients had a mean age of 46.77±14.63 years and males were dominant with n=86 (57.3%). Participants
aged 18–40 years were 45.3%, while 54.7% were older than 40 years. DW MRI classified 61.3% of lesions as malignant,
confirmed as 64.7% by histopathology. Sensitivity, specificity, PPV, NPV, and accuracy were 90.72%, 92.45%, 95.66%,
84.46%, and 98.70%, respectively.
Conclusion: Diffusion-weighted MRI demonstrated higher diagnostic accuracy in differentiating malignant from
benign liver lesions while taking histopathology as the gold standard, showing high sensitivity, specificity, and
consistent performance across age and gender, supporting its clinical utility
KEY WORDS: Diagnostic Accuracy, Histopathology, Liver Lesions, Sensitivity, Specificity, PPV, NPV
Modified Stoppa’s Approach Versus Ilio Inguinal Appraoch For Anterior Column Fractures of Acetebulum in a Tertiary Care Hospital
https://doi.org/10.59058/jaimc.2026.24.1.112
Muhammad Khalid Syed, Muhammad Abdul Hanan, Tahir Mehmood,
Muhammad Siddique Hamid, Mubashir Farhan, Waseem Subhan
ABSTRACT
BACKGROUND AND OBJECTIVE: Acetabular fractures are complex injuries that present a surgical challenge due to the
deep location and complex anatomy of pelvis. Modified Stoppa approach has emerged as an alternative approach to
the traditional ilio-inguinal technique, offering improved exposure of the fracture site, reduced intraoperative blood
loss, shorter operative duration, and potentially fewer complications. This study aims to compare Modified Stoppa's
approach with Ilioinguinal approaches for blood loss during the surgery, operative time, postoperative complications,
and functional outcomes in patients undergoing surgical fixation for anterior acetabular fractures.
METHODOLOGY: This cross sectional analytical study was conducted in department of Orthopaedic surgery Lahore
General Hospital, Lahore from 1st Nov. 2022 to 30th Nov. 2023.
RESULTS: Mean operative time in Stoppa,s group was 92±10 as compared to 110±12 in Ilioinguinal group which was
statistically significant (P < 0.001). Hemoglobin drop was 1.5 , compared to Ilioinguinal group which was also
statistically significant (P = 0.04). Harris Hip score was in excellent in Stoppa group and was 17 (51.5) , compared to 16
(48.5) in Ilioinguinal group (p > 0.05).
CONCLUSION: Modified Stoppa,s approach can be used as alternative approach for surgical management of anterior
acetabulum fractures due to visualization of fracture site, less blood loss, short operative duration, better fracture
reduction and less complication rate.
KEY WORDS: Anterior Acetabulum, Modified Stoppa Approach, Ilioinguinal Approach, Intraoperative blood loss
Mixed Neuroendocrine and Non-Neuroendocrine Neoplasm of the Gallbladder: Adenosquamous Carcinoma with Small Cell Neuroendocrine Differentiation – A Case Report
Saba Umar, Sadia Anwar
https://doi.org/10.59058/jaimc.2026.24.1.113
ABSTRACT
Background & Objectives: Gallbladder carcinoma is an aggressive malignancy, with adenocarcinoma being the most
common histological subtype. Adenosquamous carcinoma is a recognized but uncommon variant, while the presence of
small cell neuroendocrine differentiation within adenosquamous carcinoma of the gallbladder is exceedingly rare and
associated with poor prognosis.
Case Presentation: We report the case of a 66-year-old female who presented with right hypochondrial pain and
jaundice. Histopathological examination of a simple cholecystectomy specimen revealed an infiltrating neoplasm
exhibiting glandular architecture, squamoid differentiation, and sheets of small round cells predominantly on the
serosal aspect. Immunohistochemistry showed p63 and CK positivity in squamoid nests and neoplastic glands
respectively, and synaptophysin positivity in the small cell component, confirming neuroendocrine differentiation.
The tumor perforated the serosa (pT3), with perineural invasion present and serosal margin involvement.
Conclusion: Adenosquamous carcinoma of the gallbladder with small cell neuroendocrine differentiation is a rare and
aggressive entity. Accurate histopathological evaluation with immunohistochemistry is essential for correct diagnosis
and prognostication.
KEY WORDS: Gallbladder carcinoma, Adenosquamous carcinoma, Neuroendocrine differentiation, Small cell
carcinoma, Histopathology, Case report
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