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

A Rare Case of Cardiac Angiosarcoma Presenting as Recurrent Atrial Flutter/Fibrillation

Introduction Cardiac angiosarcomas are extremely rare, with an incidence of only 0.056%. They can have various presentations, including arrhythmias. Case A 65-year-old male presented to an outside hospital one year ago with palpitations. Heart rates were 130 bpm, and EKG revealed new-onset atrial flutter with 2-1 block. Apixaban and metoprolol tartrate were started, with plans for a TEE and cardioversion in 4 weeks. He went to the emergency department twice the following month with rapid atrial fibrillation and had TEE and cardioversion twice one week apart. A 2.5 cm mass in the right atrium was noted on the TEE. The atrial mass was concerning for a myxoma. A cardiac MRI was done as an outpatient, showing a large mass (31 x 22 x 35 mm) at the roof of the right atrium consistent with myxoma. A right atrial biopsy was performed, with pathology showing malignant vascular neoplasm favoring angiosarcoma. Primary cardiac angiosarcoma was diagnosed, and chemotherapy was initiated. He was referred to a cardiothoracic surgeon and underwent a right atrial sarcoma resection, left atrial appendage clip, and MAZE procedure. A few weeks later, the patient presented to our hospital with atrial flutter/fibrillation and rapid heart rates. Given multiple recurrences of symptomatic atrial fibrillation and intolerance of rate control medications, it was decided to proceed with an AV nodal ablation, which was successful. Conclusions Cardiac angiosarcoma is a rare malignant tumor. Diagnosis is challenging due to nonspecific presentations based on its location in the heart and can be the etiology for recurrent atrial fibrillation/flutter

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

Trace Out the Improvement Level and Awareness of Polycyctic Ovary Syndrome (Pcos) among General People and Educational Institute of Developed and Developing Countries

One of the most prevalent hormonal problems which affect women is polycystic ovary syndrome (PCOS). It consists of several fundamentals, including reproductive, metabolic, and cardiovascular ones, and has effects on the patient\u27s health throughout the duration of their life. Limited data is available on PCOS in developing countries like Pakistan. The aim of our study is to trace out the prevalence of PCOS in developed countries like America and China as well as developing countries like Pakistan. The study was done in the above mention developed and developing countries through the interviews of people by online questionnaire. This survey research was completed in April 2023 to July 2023. 560 responses were collected during the studied duration. We have seen that the females of 24 year age have maximum effects of PCOS. According to this survey 74.4 % unmarried females are affected by PCOS. According to our finding 71.8 % affected females were reported in developing countries and 28.2 % females are reported in developed countries. Our survey also shows that irregular menstrual cycle, hair loss and hair thinning, weight gain or difficulty in weight loss, acne or oily skin, excessive hair growth are the some common symptoms of PCOS. Hormonal birth control, insulin sensitizing medication, Anti-androgen medication, fertility treatment, life style changes like diet, exercise and surgery are the some treatments that were received for PCOS by affected females. We recommended that more awareness is required in both developed and developing countries through TV, Radio, Newspapers and social media plate forms

Survival disparities in rural versus urban patients with Pancreatic Neuroendocrine Tumor: A multi-institutional study from the US Neuroendocrine Tumor Study Group

BACKGROUND: Pancreatic Neuroendocrine Tumors (PNETs) are indolent malignancies that often have a prolonged clinical course. This study assesses disparities in outcomes between PNET patients who live in urban (UA) and rural areas (RA). METHODS: A retrospective cohort study was performed using the US Neuroendocrine Tumor Study Group database. PNET patients with a home zip code recorded were included and categorized as RA or UA according to the Federal Office of Rural Health Policy. Overall survival (OS) was analyzed by Kaplan-Meier method, log-rank test, and logistical regression. RESULTS: Of the 1176 PNET patients in the database, 1126 (96%) had zip code recorded. While 837 (74%) lived in UA, 289 (26%) lived in RA. RA patients had significantly shorter median OS following primary PNET resection (122 vs 149 months, p ​= ​0.01). After controlling for income, local healthcare access, distance from treatment center, ASA class, BMI, and T/N/M stage, living in a RA remained significantly associated with worse OS (HR 1.60, 95%CI 1.08-2.39, p ​= ​0.02). CONCLUSION: Rural patients have significantly shorter OS following PNET resection compared to their urban counterparts

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