Letter to the Editor

Transumbilical hernial laparotomy for a cystic abdominal mas

Use of simulation based technology in pre-clinical years improves confidence and satisfaction among medical students

Objective: To determine perception of medical students about learning from integrated simulated clinical skill sessions as part of the undergraduate curriculum.Methods: The cross-sectional study was conducted at the Centre for Innovation in Medical Education, Aga Khan University (AKU), Karachi, from July 2018 to February 2019, and comprised first year medical students undertaking the Respiration and Circulation module of the curriculum. Quantitative data was collected using a questionnaire and the responses were assessed on a five-point Likert scale. Data was analysed using SPSS 21. Qualitative data was gathered through focused group discussion with students and an in-depth interview with the facilitator conducting the sessions. The data was subjected to thematic analyses.Results: Of the 161 subjects, 71(44%) participated in the session I and 90(56%) in the session II. Altogether 68(96%) students in session I and 81(90%) in session II believed integrated sessions to be effective in achieving learning objectives, and 65(92%) in session I and 79(88 %) in session II found them motivating, while 61(86%) in session I and 76(84%) in session II expressed the confidence that they had accomplished learning objectives and felt they had learned practical clinical skills; session I, 59(84%), session II, 73(81%). Qualitative analysis revealed that these sessions enhanced understanding of the subject matter and student engagement.Conclusions: Integrated clinical skills sessions improved students\u27 interest, engagement and confidence. It should be implemented in undergraduate medical teaching curriculum

Frequency of Raised Intraocular Pressure and its Correlations to the energy used following Neodymium YAG Laser Posterior Capsulotomy in Pseudophakes

Objective: To determine the frequency of raised intraocular pressure in pseudophakic undergoing Nd YAG laser posterior capsulotomy. To compare the frequency of raised intraocular pressure in pseudophakic undergoing high and low energy Nd YAG laser posterior capsulotomy Methods: This Descriptive case series included 140 patients with pseudophakic posterior capsular opacity. After dilating the pupils with tropicamide Nd YAG laser posterior capsulotomy was performed and the total amount of energy used was noted. The frequency of raised IOP in post-laser patients and comparison of frequencies of raised IOP undergoing high and low energy Nd YAG laser posterior capsulotomies (≤ 50 MJ labeled as low energy and > 50 MJ labeled as high energy) were calculated Results: The mean age was 57.37 ±8.74. Mean pre laser IOP was 15.15 and post-laser IOP was 17.50. The rise in IOP was normal in 82.9% and raised in 17.1%. In lower energy group normal IOP was found in 35.7% and raised in 2.9%. In a higher energy group, normal IOP was found in 47.1%, and raised IOP was found to be 14.3%. Conclusion: Higher the energy used during the Nd YAG laser posterior capsulotomy procedure, more is the chance of a rise in post-laser intraocular pressure as compared to those in which lesser energy was being used

Ultrasound Evaluation of Liver in Patients Who Had History of Hepatitis C

Background: Hepatitis is an infection of liver. The disorder can be self-limiting or lead to fibrosis(scarring), cirrhosis, or liver cancer. Both acute infection and chronic sequelae, such as hepatitis C, cause significance morbidity and mortality in the hum of population. Hepatitis can be very high in general population. Our study evaluate the liver parenchyma in patients with history of Hepatitis C and provide descriptive to prevent future liver pathologies.The primary goal of our research is to delay or perhaps stop the progression of liver fibrosis, as well as to prevent liver disease.Grey scale ultrasonography has been reported to detect Ultrasonographic features of chronic disease resulting in decreased liver function and ultimately, liver failure and to help the patients with cured hepatitis C to check out the parenchymal damage and to give healthy lifestyle. Objective: To evaluate the ultrasonographic features of the liver in the patients who had history of hepatitis C. Study design: ur study design was retro prospective. Material and method: The retro prospective study was conducted in which data of 56 patients were taken. The data was collected from the radiology department of al-Razi health care and Jinnah hospital. After informed consent, data was collected through ultrasound machine. Out of 56 patients 27 were females and 29 were males. study duration was 4 months. Inclusion criteria includes patients with history of liver hepatitis C. Exclusion criteria was patients with other causes of liver disease, primary biliary cirrhosis, metabolic liver disease and liver transplant recipients except hepatitis C. Result: 56 patients were included in our study out of which 27 were females and 29 were males. The ultrasonographic findings of the patients having liver hepatitis C shows the cirrhosis in 44.6%, change in liver contour in 37.5%, nodularity in 42.9% and vascular changes in 58.9%. Conclusion: Some extent of hepatitis C diseases cannot be seen on CT or MRI but can be seen on grey scale ultrasonography due to its high resolution .so, it can be concluded that the grey scale ultrasonography is more efficient and authentic diagnostic equipment in assessing the liver hepatitis C as compared to the CT. Keywords: hepatitis C, cirrhosis, liver abnormalities, ultrasound. DOI: 10.7176/JHMN/91-08 Publication date:July 31st 202

In-vitro Susceptibility of FMD Virus Serotype A Endemic in KPK, Pakistan

Foot and Mouth Disease virus (FMDV) serotype A is considered to be antigenic ally diverse among various geographical locations leading to diverse patterns of resistance and sensitivity. This phenomenon is posing high risks to global trade. This is the first study to quantify the effects of different physical factors (temperature, pH, UV and gamma irradiation) affecting the infectivity of FMDV serotype A.The infectivity of virus was calculated in term of tissue culture infectivity dose-50 (TCID-50) and plaque forming units (PFU). Virus in suspension (6×106 particles/ml) was treated using Cobalt-60 source in BHK-21 cell line grown in 96 well plates. The virus showed complete inactivation on 3, 5, 9 and 11 pH and 10kGy dose of gamma irradiations.The results revealed that increase in temperature (both moist and dry heat) and UV light as well as increase in time of exposure with same dose of UV irradiations significantly decreased the infectivity of virus (p<0.05). These physical factors are a better alternate for virus inactivation than chemicals, which are toxic for the health and accumulate in the animal products. It is recommended that viral strains should be analyzed for their susceptibility to these physical methods. They could also be combined with thermal inactivation to further improve virus inactivity to obtain virus free products.

Insect Pest Complex of Wheat Crop

Wheat Triticum aestivum L. is grown on broad range of climatic conditions because of edible grains, cereal crop and stable food of about 2 Billion peoples worldwide. Additionally, it is the rich source of carbohydrates (55–60%), vegetable proteins and contributed 50–60% daily dietary requirement in Pakistan. Globally, wheat crops is grown over 90% area of total cultivated area; facing devastating biotic and abiotic factors. The estimated economic losses in wheat quantity and quality are about 4 thousands per tonne per year including physical crop losses and handling. Economic losses of about 80–90 million USD in Pakistan are recorded due to inadequate production and handling losses. Wheat agro-ecosystem of the world colonizes many herbivore insects which are abundant and causing significant losses. The feeding style of the insects made them dispersive from one habitat to another imposing significant crop loss. Areas of maximum wheat production are encountered with either insect which chew the vegetative as well as reproductive part or stem and root feeders. This chapter provides the pest’s taxonomic rank, distribution across the globe, biology and damage of chewing and sucking insect pest of wheat. It is very important to study biology of the pest in accordance with crop cycle to forecast which insect stage is economically important, what the proper time to manage pest is and what type of control is necessary to manage crop pest. The chapter will provide management strategies well suited to pest stage and environment

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research