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Objective: To determine the efficacy of alpha blockers in successful management of lower and mid ureteral stones by ureterorenoscopy. Study Design: Comparative prospective study. Place and Duration of Study: Department of Urology, Combined Military Hospital Quetta Pakistan, from Jul 2018 to Dec 2019. Methodology: Total of 150 patients having mid and lower ureteric calculi requiring ureterorenoscopy were divided into two groups. Group A included patients without pre-treatment with alpha blocker was administered before they were subjected to ureterorenoscopy. Study group B included patients who received daily oral dose of alpha blocker, Tamsulosin 0.4 mg twice daily, for 1 week before ureterorenoscopy. Per-operative findings in both the groups were recorded. Results were analyzed by comparing the outcome between both groups in terms of ease of performing procedure, duration of procedure, complications, duration of hospital stay and need for stent placement. Results: Mean operative time was significantly shorter in group B as compared to group A, (15.9 ± 3.81 min vs. 21.9 ± 3.63 min; p≤0.001). Demographic and stone characteristics were comparable between the both groups. Success rate was 74 (98.7%), in group B as compared to 68 (90.7%) in group A, with statistically significant difference (p=0.020). Complications in group B were less frequent 1 (1.3%) vs 7 (9.3%) in group A (p-value=0.027). Conclusion: Use of alpha blockers for one week before performing ureterorenoscopy resulted in fewer complications and made the procedure easier to perform as well. [ABSTRACT FROM AUTHOR]

A considerable number of Pakistani youth wants to leave the country and settle in Western countries for better education and job opportunities as revealed in the current study. Stress due to socio-economic, geo-political and various yet unknown factors emerged as the major cause for brain drain. Present study was conducted in a public sector university of Lahore and primary data is based on personal views and perceptions of individuals collected through semi-structured focused group interviews. The population of the study was 1800 students enrolled in different degree programs and the purposive sample consisted of 90 students. The stress levels of students were checked through questionnaire developed by International Stress Management Association. Mild, moderate and high levels of stress were found to be existent among the sample population with majority 79% suffering from high levels of stress and at a risk of physical and socio-academic failure. It was revealed that majority 91% of the participants were not satisfied with the current socio-economic and political situation and that they wanted to leave the country for good either through student visa or through permanent immigration. Hence stress is impacting their social, emotional and personal lives. [ABSTRACT FROM AUTHOR]

Aims This retrospective study aimed at determining the prevalence of biliary atresia in children presenting with persistent neonatal jaundice by technetium-99m labelled hepatoimino diacetic acid (99mTc-HIDA) scintigraphy. The results were compared with those from similar studies conducted in Pakistan, South East Asia & internationally. Methods The study was conducted at Nuclear Medicine Centre, Armed Forces Institute of Pathology, Rawalpindi, from June 2010 to December 2012. A total of 80 patients with persistent neonatal jaundice were included in the study with 54 males & 26 females in a ratio of about 2 to 1. Main outcome measure was demonstration of biliary atresia on technetium-99m labelled hepatoiminodiacetic acid (99mTc-HIDA) scan. Results Patients with a clinical diagnosis of persistent neonatal jaundice were included in the study. The mean age for males and females at presentation was 224 & 122 days respectively. Biliary atresia was diagnosed in 45 patients with 28 being male and 17 female patients respectively. Conclusion A significant percentage of patients (56.25%) presenting with persistent neonatal jaundice are found to have biliary atresia on scintigraphic evaluation. [ABSTRACT FROM AUTHOR]

Objective: To compare polypropylene suture and skin staples for securing mesh in Lichtenstein inguinal hernioplasty in terms of mean operating time and postoperative pain., Study Design: Randomized clinical trial., Place and Duration of Study: Surgical Ward, Combined Military Hospital, Kharian, from August 2011 to February 2012., Methodology: All individuals fulfilling inclusion criteria underwent elective Lichtenstein inguinal hernioplasty as admitted patients, under spinal anaesthesia and with aseptic measures. In group 1, during the operation, mesh fixation was done with 2/0 polypropylene suture and skin was closed with subcuticular 2/0 polypropylene suture whereas in group 2, the anchorage of mesh was done with skin staples and skin was closed with staples from the same stapler. Mean operative time and postoperative pain, assessed on a visual analog score, were compared between the groups., Results: The overall postoperative pain was lower (p = 0.026) when staples were used to anchor mesh. Moreover, operative time was also lower (37.42 ± 2.69 minutes) in staple group versus (42.44 ± 2.55 minutes in polypropylene group)., Conclusion: Mean operating time and postoperative pain is less in securing mesh with skin staples as compared to polypropylene suture in Lichtenstein inguinal hernioplasty.

Objective: To derive the ethnic factor and validate the modified estimated Glomerular Filtration Rate (eGFR) by Modification of Diet in Renal Disease (MDRD) equation for Chronic Kidney Disease (CKD) patients of Rawalpindi., Study Design: Cross- sectional study., Place and Duration of Study: Armed Forces Institute of Pathology (AFIP), Rawalpindi, from July 2011 to July 2012., Methodology: A total of 140 patients with CKD reporting to AFIP for GFR measurement by 99mTechnetium diethylenethiaminepenta-acetic acid (99mTc-DTPA) renal scan were consecutively inducted. Serum creatinine was measured by the Jaffe's assay on Beckman DxC 600 Analyzer prior to the renal scan. Ethnic factor for population of Rawalpindi with CKD was derived for the MDRD eGFR equation using 99mTc-DTPA renal scan by Gates method as the reference method. MDRD equation was modified by inclusion of the ethnic factor in it. Agreement between the reference GFR (rGFR) and the modified MDRD eGFR (mGFR) was assessed by applying paired samples t-test., Results: Out of 140 patients of CKD, 99 (71%) were males and 41 (29%) females, with mean age of 55 ± 13.42 years. The mean values were 32.91 ± 14.96, 34.89 ± 16.45, 0.971 ± 0.20 and 33.87 ± 15.97 for rGFR, original eGFR, ethnic factor and mGFR respectively. The mGFR with new ethnic factor of 0.971 showed improved performance as compared to original eGFR and showed a significant level of correlation with rGFR (r2 = 0.817), at a p-value of 0.000., Conclusion: This study validates the mGFR equation by inclusion of newly derived ethnic factor of 0.971 in the population of Rawalpindi with CKD and it was found to be not significantly different from the rGFR.