Search

To evaluate the role of manual therapy with exercise regime versus exercise regime alone in the management of non-specific chronic neck pain. In this 62 subjects randomized controlled trial 31 subjects in group A received manual therapy (manipulation) with supervised exercise regime whilst 31 subjects in group B performed only supervised exercise regime for the period of 3 weeks. Both groups had a home exercise program consisted of strengthening exercises for neck/scapuluar stability, stretching and general range o f motion exercises for neck with advice regarding posture awareness and correction for 3 months. The results suggested significant reduction in pain intensity level in both groups; over 3 weeks and 12 weeks' time period in relation to baseline on visual analog scale (p=0.001). Similarly, statistically significant improvements noticed in Neck Disability Index (NDI) (p=0.0001) in both groups while looking at baseline data with reference to 12 weeks' time period. On closer inspection, the manual therapy (manipulation) with exercise regime appeared as a favorable treatment preference compared with exercise regime alone. [ABSTRACT FROM AUTHOR]

To evaluate the effectiveness of Cognitive Behavioural Therapy (CBT) along with General exercises and General exercises alone in chronic low back pain. Total 54 patients with chronic low back pain who fulfilled inclusion criteria were recruited from Physiotherapy, Department of Alain Poly Clinic Karachi and Institute of Physical Medicine & Rehabilitation Dow University of Health Sciences Karachi. Selected patients were equally divided and randomly assigned into two groups with simple randomisation method. The Cognitive Behavioural Therapy (CBT) and General exercises group received Operant model of CBT and General Exercises whereas General exercises group received General exercises only. Both groups received a home exercise program as well. Patients in both groups received 3 treatment sessions per week for 12 consecutive weeks. Clinical assessment was performed using Visual Analogue Scale (VAS) and Ronald Morris Disability Questionnaire at baseline and after 12 weeks. Both study groups showed statistically significant improvements in both outcomes measures p =0.000. However, mean improvements in post intervention VAS score and Ronald Morris score was better in CBT and exercises group as compared to General exercise group. In conclusion, both interventions are effective in treating chronic low back pain however; CBT & General exercises are clinically more effective than General exercises alone. [ABSTRACT FROM AUTHOR]

Background and objective Pediatric dentists face a serious challenge when encountering cases of primary teeth lost too soon due to systemic disorders such as diabetes mellitus, congenital heart disease, and chronic kidney disease. Prompt identification and treatment are necessary to minimize problems in these patients. This study aimed to better understand and enhance clinical outcomes in pediatric dentistry treatment by investigating diagnostic modalities and early therapy methods for kids who lose their primary teeth too soon because of systemic disorders. Methodology We conducted a retrospective observational study to examine the early loss of primary teeth in children aged 6-10 years with a history of systemic diseases at Naseer Teaching & MMC-General Hospital, Peshawar; Hayatabad Medical Complex, Peshawar; DHQ Teaching Hospital, Kohat; and Fauji Foundation Hospital, Multan from January to December 2022. After carefully gathering data from medical records, a sample of 360 patients meeting the inclusion criteria was examined. SPSS Statistics version 27 (IBM Corp., Armonk, NY) was used for the statistical analysis. Demographic characteristics, clinical manifestations, and management approaches were compiled using descriptive statistics. For categorical data, frequency distributions and percentages were determined, and for continuous variables, means and standard deviations (SD) were calculated. Regression analysis was conducted to analyze relationships between related variables and treatment outcomes. A p-value <0.05 was considered statistically significant. Results The majority of patients were aged between six and eight years, and the cohort had an equal gender distribution. Dental problems including malocclusion (n=175, 48.61%) and early tooth loss (n=245, 68.06%) were common, as were systemic illnesses like genetic disorders (n=45, 12.50%) and endocrine abnormalities (n=67, 18.61%). Diagnostic procedures were often carried out, such as radiographic exams (n=256, 71.11%) and blood tests (n=123, 34.17%). Dietary supplements (n=60, 16.67%) and dental procedures (n=75, 20.83%) constituted the bulk of the treatment. Significant treatment outcomes that demonstrated the efficacy of the therapies were as follows: high patient satisfaction (n=213, 59.17%), improved oral health (n=255, 70.83%), and symptom relief (n=187, 51.94%). Conclusion Our findings highlight the significant impact of certain practical methods for identifying and treating early tooth loss in pediatric patients with systemic illnesses, leading to patient satisfaction in terms of symptom relief and enhanced dental health., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. The Ethics Review Committees of Naseer Teaching and MMC-General Hospital, Peshawar issued approval N/A. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Rajput et al.)

Objective: To find out the possibilities and usefulness of introducing cinemeducation in medical institutions, and to formulate suggestive inserts for faculty and policy-makers., Methods: The quantitative study was conducted in Lahore from January to June 2021 after approval from the ethics review committee of King Edward Medical University, Lahore, and comprised fourth and final year medical students. Relevant short clips from seven movies of different genres were selected and shown to the students who were then divided into eight equal groups. Every session lasted 30 minutes, and was followed by an interactive discussion between the students and faculty members. The critical aspects of the sessions were discussed and analysed. Data was collected using a 7-item questionnaire that was scored on a 5-point Likert scale. Data was analysed using SPSS 21., Results: Of the 240 participants, the questionnaire was returned duly filled by 219(91.25%). Among them, 176(80.4%) said they found the experience worthwhile and that they would like to have such an experience again, while 184(84%) said such sessions should be made a part of regular curriculum. Also, 166(75.8%) participants felt that the session had helped them learn about crucial features of medicine, and 169(77%) thought that the session facilitated the understanding towards patient management., Conclusions: Cinemeducation was found to be an excellent tool of pedagogy that should be incorporated in all the relevant disciplines of medicine and allied sciences.

Objective: To evaluate the intrarater reliability of the cervical range of motion device among adults with and without chronic non-specific neck pain., Methods: The analytical, cross-sectional study was conducted from January to March 2019 at the Sindh Institute of Physical Medicine and Rehabilitation, Karachi, and comprised healthy adults with no neck pain in the preceding 6 months in Group A, and adults of either gender with chronic non-specific neck pain for >3 months in Group B. The two groups were further divided into age groups 21-30 years, 31-40 years and 41-50 years. A cervical range of motion device was used to measure the range of flexion, extension, right and left lateral flexion and right and left rotation of all the subjects. The measurements were taken by a single tester on day-1 and day-3 to assess the intrarater reliability. Data was analysed using SPSS 26., Results: Of the 60 subjects, there were 30(50%) in each of the two groups. Within the groups, there were 10(33.3%) subjects in each of the 3 age subgroups. Overall, there were 27(45%) males and 33(55%) females. In Group A, the intraclass correlation coefficient values for all cervical ranges were between 0.81 and 0.99, whereas in Group B, the values ranged from 0.64 to 0.88. The intraclass correlation coefficient values yielded good to excellent agreement in both groups (>0.75) except for left lateral flexion in Group B (p=0.64), and all the values were statistically significant (p<0.05)., Conclusion: There was good to excellent intrarater reliability of cervical range of motion device in adults with and without chronic non-specific neck pain.

Helicobacter pylori infection is seropositive in ~50% of people globally. Therefore, this study was conducted to evaluate its prevalence in dyspepsia patients., Methods: A cross-sectional study was conducted at Jinnah Postgraduate Medical Centre (JPMC) from January to June 2022 to find out the prevalence and risk factors of H. pylori in dyspepsia patients. A prevalidated questionnaire was used to collect the data from 180 patients. This study adheres to the principles outlined in the Helsinki Declaration. The χ 2 -test was applied, and the odds ratio and 95% CI were calculated to find the association of H. pylori with the risk factors., Results: A total of 180 patients were enrolled in this study, of whom, 73 (40.6%) patients were male and 107 (59.4%) were female. In seropositive H. pylori patients, 80 (60.6%) patients had nausea or vomiting, 110 (83.3%) patients were found to have flatulence, 128 (97.7%) patients were experiencing frequent burping, and 114 (86.4%) patients were having epigastric pain. The household member greater than 4, smoking, rural area residence, NSAIDs consumption, BMI greater than 25, O+ blood group, and Rhesus positive status were significantly associated with H. pylori with a P value of less than 0.05., Conclusion: This study concludes that the prevalence of H. pylori in our population is high, and the risk factors identified are lower class, BMI greater than 25, smoking, O+ blood group, NSAID consumption, rural area residence, household member greater than 4, Rhesus positive status, and the symptoms of nausea or vomiting, frequent burping, epigastric pain, and flatulence. Patients with an increased number of risk factors should be taken into consideration for an appropriate checkup., Competing Interests: No conflicts of interest declared.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Percutaneous nephrolithotomy (PCNL) has evolved as a standard procedure to treat large-sized renal stones. A nephrostomy tube is used frequently in this procedure; however, data regarding tubeless PCNL procedures in elder patients is scarce., Aim: The aim of this study was to review the results and outcomes associated with tubeless PCNL procedures in the elderly population., Materials and Methods: A retrospective review of patients aged ≥60 years at our hospital that was treated for renal stones by PCNL procedure. The patients were separated into two groups: Group 1 underwent tubed PCNL procedures and Group 2 received tubeless PCNL procedures. Information regarding variables were recorded in specified pro forma and then processed in Statistical Package for the Social Sciences statistics analyses. Statistical tests were utilized for continuous and categorical variables and a P <0.05 was considered statistically significant., Results: 121 patients with a mean age of 65±5 years were included in the analysis. Mean stone size and body mass index were 3.4±1.5 cm and 26.2±4.3 kg/m 2 , respectively. Mean operative time was longer in tubed PCNL as compared to the tubeless group. Mean hospital stay was similar among the tubed and tubeless PCNL treated groups. Mean analgesic doses were significantly lower in the tubeless group. The overall stone-free rate was 89/121 patients (74%)., Conclusion: Tubeless PCNL can be safely undertaken in geriatric patients and has potential advantages associated with shorter operative times and reduced necessity for analgesia., Relevance for Patients: Tubeless PCNL is considered advantageous as it can reduce post-operative pain and analgesia necessity; shorten hospitalization and lower cost in young patients. However, there is no clear evidence with reference to virtue of tubeless PCNL in the elderly age groups. This study will analyze and review results and outcomes associated with tubeless PCNL in a cohort of elderly patients., Competing Interests: The authors have no conflict of interest to declare., (Copyright: © 2022 Whioce Publishing Pte. Ltd.)

Background/objectives In patients receiving concomitant chemoradiotherapy (CCRT) as a treatment for oral squamous cell carcinoma (OSCC), cytological changes were seen not only in neoplastic epithelial cells but the non-neoplastic epithelial cells are also affected, resulting in cytopathological atypical changes. The present study was designed to observe oral epithelial atypical cytopathologic changes induced in contralateral normal buccal mucosa in OSCC patients receiving CCRT. Methods The study included 150 patients with OSCC treated by CCRT whose details were collected from the Institute of Nuclear Medicine and Oncology Lahore (INMOL) Hospital Lahore. Cytological smears were obtained from the contralateral normal buccal mucosa of OSCC patients. The serial scrape smears were taken before, immediately after, on the 17th day (mid of treatment), and at the end of CCRT, whereas 20 patients were taken as normal healthy controls and were not exposed to CCRT. The smears were stained with hematoxylin and eosin and Papanicolaou stain. SPSS version 20 (Armonk, NY: IBM Corp.) was used for statistical analysis and p > 0.05 was considered to be significant. Results CCRT-induced oral epithelial atypical cytological changes were predominantly noted at end of therapy (19.7%) in the contralateral normal buccal mucosa. Nuclear atypia features were higher on the 17th day and end of treatment; whereas, epithelial atypia was mainly observed on the 17th day of CCRT (40%). A highly significant association was observed between epithelial atypia and radio-chemotherapy dose (p = 0.045), between CCRT-induced epithelial atypical cytological changes and days of treatment (p = 0.001), and between days of CCRT and nuclear atypia (0.000) accordingly. Atypia was not observed in any control group. Conclusion Varying degrees of oral epithelial atypical cytological changes may occur in otherwise normal contralateral mucosa of the patients receiving CCRT., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Minhas et al.)

Introduction: Various stone factors can affect the outcome of shock wave lithotripsy (SWL). A novel factor called the stone heterogeneity index (SHI) may have an impact on stone free rates. The objective of this study was to assess the role of SHI in SWL outcomes., Methods: Patients' medical records were reviewed for the collection of data variables. They were subjected to SWL, using an electromagnetic lithotripter machine (Storz Modulith SLX-MX). Computation of mean stone density (mean value of the Hounsfield units) and SHI was accomplished by generating elliptical regions of interest on the computed tomography (CT) scan images. Grouping was performed on the basis of stone free and failure outcomes. Relevant statistical tests were applied for continuous and categorical variables. P ≤ 0.05 was considered statistically significant., Results: Overall, 385 subjects were included having a mean age of 38.4 ± 14.7 years. The cohort comprised 276 (71.7%) males and 109 (28.3%) female patients. A total of 234 (60.8%) patients were rendered successful (stone free after one session) while 151 (39.2%) of the patients were declared to have failed the SWL procedure. Stone length, stone density, and SHI values were 13.7 ± 7.6 mm, 935 ± 404, and 201 ± 107, respectively. The stone density, SHI, and stone length were significantly different between the two groups (p-values of 0.001, 0.02, and 0.04, respectively)., Conclusions: SHI can be a helpful CT scan-based parameter to assess stone fragility. It can help clinicians in the judicious selection of patients before implementing SWL procedure., Relevance for Patients: Non-contrast CT-based stone parameters have been found to be effective for predictions of outcomes. SHI can be a helping tool to better predict SWL success rates when treating the renal stones., Competing Interests: We declare that there are no conflicts of interest regarding the study., (Copyright: © Whioce Publishing Pte. Ltd.)

Background/Aims Novel coronavirus disease 2019 (COVID-19) is a global challenge due to little available knowledge and treatment protocols. Thus, there is a great need for collecting data related to COVID-19 from all around the world. Hence, we conducted this study, collecting daily data on COVID-19, to map the epidemiology outbreak and forecast its trajectory for May 2020. Methodology The data was collected from the officially released reports of the National Institute of Health (NIH), Pakistan, and the World Health Organization (WHO). The analysis was done using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY), and forecasting was done using a simple moving average in time series modeler/expert modeler. Results The purpose of this study is to draw the attention of international, as well as national, governing bodies to the rapidly rising number of COVID-19 cases in Pakistan, and the urgency of evaluating the efficacy of the currently implemented strategy against COVID-19. According to this study, there is now an alarming increase in the number of COVID-19 patients in Pakistan, despite a contained spread in the beginning. The predicted number of COVID-19 cases can go over 35,000 by the end of May 2020. Conclusion It is crucial for governing bodies, administrators, and researchers to re-evaluate the current situation, designed policies, and implemented strategies., Competing Interests: https://www.authorea.com/users/312682/articles/443245-covid-19-forecast-of-an-emerging-urgency-in-pakistan?commit=c49436c66a762de0efd67dffcd11d7c69319efe9, (Copyright © 2020, Chaudhry et al.)

Background: Efficacy of percutaneous nephrolithotomy in adults has been studied well in past. However, such studies are sparse within paediatric age group. As this procedure is being adopted in smaller and older children alike, we wanted to determine its safety and efficacy in two different age groups of children (preschool age and school age)., Methods: The records of 59 children undergoing PCNL at our department from December 2009 to May 2017 were reviewed retrospectively. Patients were placed into 2 age groups including children ≤7 years old (group 1) and those ≥7 years (group 2). Twenty-seven patients were put in preschool group with mean age of 4.8±2.1 years while 32 patients in school age group having mean age of 11.8±4.6 years., Results: Stone size was calculated showing mean 309±55 mm2 in preschool and 324±63 mm2 in school age group respectively (p=0.1). The mean operative time was 150.1±38.7 minutes and 166.3±39.6 minutes in the preschool and school age children respectively (p=0.1). The mean length of hospital stay was 3.1±1.4 days and 2.9±1.3 days in preschool and school going children (p=0.5). The stone clearance with PCNL was seen in 96.3% (pre-school group) and 93.75% (school age group) as monotherapy (p=0.1), which increased to 100% after combining it with extracorporeal shock wave lithotripsy., Conclusions: PCNL is equally effective in both pre-school and school age groups in terms of stone free rates. Complication rates were not different between the two groups.

[This retracts the article DOI: 10.7759/cureus.3129.]., Competing Interests: No competing interests declared.

Highly Human Leukocyte antigen sensitized patients have relatively fewer chances of being transplanted successfully and may remain dialysis dependent for a long time. In the last few years with the development of immunomodulatory therapies and advancements in immunological investigations, the chance s of transplantation in these sensitized patients have improved. Desensitization therapies in these patients include plasma exchange, intravenous immune globulins and immunomodulatory agents such as rituximab and bortezomib. These agents used together in desensitization protocols across the world have shown encouraging results in highly Human Leukocyte Antigen sensitized recipients awaiting renal transplant. We used a desensitization protocol using rituximab followed by bortezomib with concurrent plasma exchange sessions and Intravenous Immune Globulins. Our aim was to assess improvement in renal function and quality of life in these patients after desensitization and renal transplantation. To the best of our knowledge, this is the first account of desensitization prior to renal transplantation from Pakistan.

Objective: Mitrofanoff procedure has been employed commonly as bladder draining tool in patients unable to do clean intermittent self catheterization through native urethera. Single centre experience of pediatric age group patients undergoing Mitrofanoff procedure has been presented here., Material and Methods: It was a retrospective study of 29 children who underwent continent catheterizable conduit (CCC), from January 2009 till March 2017. Charts were reviewed for age, gender, presenting complaints, need for augmentation cystoplasty, Mitrofanoff channel source such as appendix or ileal patch, duration of surgery in minutes, hospital stay in days, per operative and postoperative complications. Preoperative evaluation of the children was done by doing complete blood picture, serum electrolytes, and renal function tests. Radiological evaluation included ultrasound kidney,ureter and bladder, voiding cystourethrography, urodynamic analysis and a nuclear renal scan with 99m Technetium dimercapto-succinic acid or MAG-3 scan. The abdominal end of the conduit was brought through the abdominal wall, and a stoma was fashioned by the V-quadrilateral-Z technique., Results: Twenty nine children having mean age of 9.54±4.88 years underwent CCC. There were 19 males (65.51%) and 10 females (34.48%). Children who underwent CCC included 18 children having neurogenic bladder, 2 cases of urethral trauma/stricture 3 patients with history of posterior uretheral valve and 6 patients with exstrophy bladder. Augmentation cystoplasty plus mitrofanoff was done in 18 children while only mitrofanoff in 11 children. Stuck catheter was seen in one patient which was removed successfully via normal urethral route under general anesthesia. Stomal stenosis in first year was noted in 4 patients (13.79%)., Conclusion: Continent catheterizable conduit based on Mitrofanoff principle have durable outcome over long term follow up in terms of urinary continence and complications.

Objective: To assess the effectiveness of clarithromycin based standard triple therapy verses levofloxacin based first line therapy against Helicobacter pylori infection., Methods: This prospective observational study was performed at Akhter Saeed Trust Teaching Hospital, Lahore, from May 2016 to 31st May 2017 and comprised of all patients with positive H. pylori, confirmed by gastroscopic biopsy; fulfill the inclusion criteria of this study. Patients were divided into two groups (Group A and Group B). Group A received clarithromycin 500mg, amoxicillin 1g and omeprazole 20mg twice a day for two weeks. In group B levofloxacin 250mg was replaced by clarithromycin whereas rests of medicines remain the same. Patients were followed up at end of first week, second week and at end of treatment to record any adverse effects and cure rate. Data was analyzed by using SPSS version 24.0 and MINITAB V.16.., Results: Out of 300 enrolled patients (150 patients in each group), 123 (87.85%) patients cured in group A whereas 134 (92.4%) patients cured in group B. Both treatment regimens were almost equally effective in our population with no statistically significant difference in outcome. Significantly less adverse effects were observed in patients having levofloxacin as compared to standard triple therapy., Conclusions: Effectiveness of both standard triple therapy and alternate triple therapy were found satisfactory to be used for treatment in our region. Levofloxacin based alternate therapy is safer to the patients. It can be used in conditions where adverse effects caused by standard therapy are unbearable.

Neurogenic stunned myocardium (NSM) is defined as the occurrence of cardiac abnormalities due to neurological events such as stroke, seizures, etc. These events lead to dysfunction of the autonomic nervous system (ANS) and ultimately cause injury to the myocardium. The clinical features seen in NSM include elevated troponin level, left ventricular dysfunction, and changes on the electrocardiogram (ECG). However, these features are also seen in Takotsubo cardiomyopathy as well as in an acute coronary syndrome (ACS). Hence, diagnosing the condition by clinical presentation alone is difficult. Thus, a patient of NSM who is at increased risk of developing coronary heart disease may require invasive procedures such as cardiac catheterization to rule out ACS. This review aims at raising awareness about NSM among physicians so that management of patients can be individualized., Competing Interests: The authors have declared that no competing interests exist.

Background: This study was conducted to determine the outcome of trans-rectal ultrasound (TRUS) guided biopsy of prostate for the detection of prostatic carcinoma in a single tertiary care hospital in Pakistan., Methods: This is a retrospective study including three hundred and eightythree patients who underwent trans rectal ultrasound guided biopsy of prostate in a single tertiary care hospital. Indications for biopsy were raised prostate specific antigen (PSA), abnormal digital rectal examination (DRE) and/or both. Twelve core biopsy of prostate was done.., Results: The overall detection rate of prostate cancer was 59%. Prostate cancer detection in various PSA ranges of 0-3.99, 4-9.99, 10-19.99 and >20 ng/ml are 22.22%, 37.88%, 50.0% and 89.9%. PSA density >0.15ng/ml2 can diagnose 74.5% of patients with cancer. Prostate cancer detection rate based on abnormal DRE is 64.6% compared to 60.8% detected by PSA>4 ng/ml., Conclusions: In conclusion raised PSA, smaller prostate volume, abnormal DRE and raised PSA density are associated with greater chances of detection of prostate carcinoma.

Background: Posterior urethral valve (PUV) is life-threatening congenital anomaly of the urinary tract that results in vesicoureteric reflux, recurrent UTI, voiding dysfunction and renal insufficiency if not treat timely. Endoscopic ablation of posterior urethral valves using cold knife or laser is the current gold standard therapy. Many urologists go for repeat cystoscopy to see residual valve or stricture while others repeat VCUG to measure the posterior to anterior urethral ratio for residual obstruction. In this study, we have standardized by regularly doing re-look cystoscopy at 3 months whether the child is symptomatic or not to see justification for re-look cystoscopy after PUV ablation., Methods: In this prospective study, first 50 cases that underwent posterior urethral valve fulguration were included. Diagnosis of posterior urethral valve was made by voiding symptoms, ultrasonography and confirmed by voiding cysto-urethrogram (VCUG). All children were treated by endoscopic fulguration of posterior urethral valves (PUV) using cold knife as urethral valvotome and were followed clinically for voiding symptoms and with ultrasonography and laboratory test at 3 and 6 months. All patients underwent re-look cystoscopy at three months to see residual valves irrespective of their clinical improvement., Results: Mean age at presentation was 4.9±3.2 years. The most common symptoms were poor stream (76%), straining at voiding (72%), dribbling of urine (54%), fever (42%) and urinary retention (14%). Residual valves on re-look cystoscopy were seen in 78%. Four (8%) patients had urethral stricture on re-look cystoscopy., Conclusions: We suggest routine re-look cystoscopy after primary fulguration of PUV to pick more residual obstructive valves.

Background: Combining cognitive skills teaching related to the techniques leads to better understanding in a skill training course; but still there a substantial disagreement in curriculum on such combinations. This study aims to help guide the designers in making the outline of instructional plan for a Clinical Skills Module (CSM) for the undergraduates. Objectives were to assess performance of students on a clinical skill after training by two different models of (hands-on only or with cognitive skills) instructions and explore their perception on the employment of educational strategies through Focus Group Discussions (FGD) through a Sequential mixed method study design: (1) Quantitative (Pre- and post-assessments and comparing their results (2) Qualitative (Exploration of perspectives through constructivist approach using qualitative phenomenological design) The study was conducted during the month of September, 2015 at Rabigh Medical College, King Abdul Aziz University, Jeddah., Methods: Students entering fourth year were randomized to two groups to participate in pre-post OSCE using global rating scale and their scores were compared. The examiners were kept blinded to the randomization of students undergoing two separate training methods. The test group (group A) was trained for both procedural as well as cognitive skills whereas the control group (Group-B) was trained only with hands-on practice. Later their perception about the addition of cognitive skills to improve of procedural skills was explored through focus group discussions. The recorded audio tapes of FGDs were transcribed and analysed thematically. Triangulation of themes and trends was achieved by relating the content analysis to the relevant frequency of quotes. Auditing of the data verification was done by all the authors separately.., Results: A total of 42 students completed both pre- and post-tests. As a result, student performance in OSCE significantly increased from pre- to post-test (p<0.001) in both the groups; on the other hand no statistically significant difference was found in the pre- and posttest scores between groups A and B (p=0.108). Five themes (1) advantages, (2) disadvantages of combining theory with practice, (3) time balance in teaching a skill, (4) training on skills, (5) skillsassessment, were found prevalent on thematic analysis of the FGDs., Conclusions: Students' ability to grasp the procedural skills was not significantly different when they acquire the cognitive skills in addition to the practical sessions. Students were more convinced to adopt combination of the two in the learning of procedural skills.

Background: Vesicoureteral reflux (VUR) is a common anomaly affecting 1-3% of all children and 30-50% of those with urinary tract infection (UTI). In the past febrile vesicoureteric reflux on chronic antibiotic prophylaxis were treated by open surgery. Now a day's endoscopic injection of a bulking material has replaced open surgical procedure in cases of primary VUR. Our objective was to assess the efficacy of endoscopic treatment for primary vesico-ureteric reflux in children., Methods: This was a descriptive case series. One hundred and five patients with either unilateral or bilateral VUR (181 ureters) underwent endoscopic treatment for primary VUR between January 2011 and January 2014. Children from 1 to 12 years of age with grade-II to IV reflux on preoperative voiding cystourethrogram (VCUG) were enrolled through consecutive non-probability sampling. Efficacy of treatment was evaluated at three months post injection by a standard VCUG. Ureters with no or grade-I reflux were considered successful treatment., Results: Out of 105 patients 76 had bilateral while 29 had unilateral reflux. Mean age was 5.7 years (SD ± .7). Among 181 refluxing ureters, 116 (64%) were free of reflux, while 49 (27%) showed down gradation and 16 (8.8%) showed no response to treatment on postoperative VCUG., Conclusion: Endoscopic treatment for VUR is a viable option for patients with primary VUR and may be considered in management of such cases.

A 63-year-old lady, presented to us with nonspecific abdominal pain. Ultrasonography (USG) and CT scan abdomen and pelvis, showed right moderate hydronephrosis, with no evidence of mass at pelvi-ureteric junction (PUJ) obstruction. Per-operatively mass upper ureter was found obstructing PUJ. Mass was excised and pyeloplasty done, with Double J (DJ) Stenting. Stent was removed after a week. Histopathology of specimen showed upper ureteric Angiomyolipoma.

Isolated female epispadias without bladder exstrophy is a rare congenital anomaly. Patients present with total or partial urinary incontinence. The diagnosis can only be made on careful genitalia examination by separating the labia majora. That is why it is often missed by most physicians even after being extensively investigated. The physical findings include patulous urethra, flattened mons pubis, and bifid clitoris with lack of anterior labial commissure. In most of the cases, single stage reconstruction of urethra, labia minora and clitoris is enough to achieve urinary continence with cosmetically acceptable genitalia.

Objective: To assess the effectiveness of recombinant human (rh) IL-11 to increase platelets count in patients suffering from Dengue fever (DF)., Study Design: Randomized double blind placebo control study., Place and Duration of Study: Farooq Hospital, Lahore, from July to October 2011., Methodology: Forty hospitalized patients suffering from Dengue fever having platelets count ² 30000 per micro liter were randomly categorized into two groups, rhIL-11 (test) and distilled water (placebo) groups. The efficacy outcomes (as indicated by step up in platelets count at 48 hours) for the treatment group were compared with the outcomes for the placebo group., Results: The data revealed that the increase in platelet response with recombinant human interleukin 11, 1.5 mg subcutaneously is significantly more brisk than the placebo group. The platelets response in patients with severe thrombocytopenia was greater in the treatment group (50%) at 48 hours as compared to the placebo group (20%) (p=0.047). Response rate was slightly greater among males (6/10, 60%) than females (8/16, 50%); moreover, three-fourth (75%) female responders were in the placebo group, compared to half (50%) male responders in the treatment group., Conclusion: Results of the study suggest that treatment of severe thrombocytopenia accompanying DF with recombinant human interleukin11 may be a useful therapeutic option.

The objectives of the study was to determine the causes and outcome of endoscopic repair of cerebrospinal fluid (CSF) leak in a developing country. A total of five patients were recruited in the study. The age of patients ranged from 8 to 65 years. Four patients were male and one was female. In two cases of iatrogenic injury, the first was in the sphenoid sinus. The second was following functional endoscopic sinus surgery (FESS). Fascia lata was used to repair all cases. Beriplast was used as sealing agent in four cases and clotted blood was used in remaining case. Despite the small number, CSF rhinor rhoea was resolved in all cases. The patients were followed up for 2.5 to 6.5 years. Endoscopic repair is a viable option even in developing countries. It is cost effective and has a very low morbidity rate with no mortality at all.

Background: Uromastyx hardwickii, a local lacertilian species, is widely distributed in the Indo-Pak subcontinent and inhabits mostly the arid regions of the country. This study was carried out to assess the seasonal variations on glucose, cholesterol and triacylglycerol (TAG) levels in a poikilotherm vertebrate species and to develop an experimental model for the study of lipid metabolism in higher vertebrates including mammals., Methods: This cross-sectional study was carried out on male Uromastyx hardwickii. Sixty animals were bled and sacrificed within 48 hrs of their arrival in the laboratory. Blood samples were collected by anterior abdominal venepuncture from conscious animals using a heparinised syringe., Results: Mean serum TAG levels were significantly higher in summer, while no significant changes were seen in cholesterol level during different parts of the year. Mean serum glucose levels were significantly higher in summer., Conclusion: Lipid metabolism in Uromastyx hardwickii undergoes significant seasonal alteration. There is significant (p < 0.05) increase in serum triglycerides during summer. Similarly, serum glucose also exhibits seasonal variation.