Bilateral wrist drop in a middle age man

Peripheral neuropathy is a common disorder which often causes disability.Among metals lead intoxication leads to bilateral radial neuropathy. Patients with lead neuropathy present with weakness that primarily involves the wrist and finger extensors. Lead intoxication in humans causes axonal degeneration. We report a case of middle age male who presented with bilateral wristsdrop, workup revealed that he had bilateral radial nerve neuropathy which was secondary to his occupational exposure to lead causing lead intoxication. Chronic lead exposure as a risk factor for neuropathy should be identified and treated promptly as its avoidance and treatment can save major disabilities

Cutaneous allodynia in migraine

OBJECTIVE: Objective of this study is to find out the presence and severity of cutaneous allodynia in migraine sufferers. BACKGROUND: Cutaneous allodynia is the perception of pain in response to non noxious stimuli. It occurs due to repeated stimulations that lead to sensitization and abnormal skin response. MATERIALS AND METHODS: It was a descriptive case study and conducted at Neurology department Pakistan Institute of Medical Sciences from June 2017 to May 2018. All patients of both genders above age 13 years of age with migraine diagnosed as having “Migraine without aura” or “Migraine with aura” according to the International Headache society criteria, ICHD-3 beta, were enrolled in this study. Cutaneous allodynia was evaluated by using Allodynia Symptom Checklist that consisted of 12-items. Cutaneous allodynia severity was defined according to score i.e No allodynia if score was 0-2, mild allodynia if score was 3-5, moderate allodynia if score was 6-8 and severe allodynia with a score of 9 or more

MVD as the First Line Therapy after Failed Medical Treatment; for Idiopathic Trigeminal Neuralgia

Objective: To analyze the outcome of MVD as a first choice therapy when medical treatment has failed for the definitive management of Idiopathic Trigeminal Neuralgia.Material and Methods:Study was conducted at the Department of Neurosurgery PGMI / Lahore General Hospital, Lahore. This was a prospective observational case series from January 2007 to December 2008, 50 selected patients of Idiopathic Trigeminal Neuralgia diagnosed after radiological and clinical exclusion of secondary causes of Neuralgia presenting in whom medical management had failed were offered MVD as the first Intervention. All the patients were followed for one year post-operatively.Results: Mean age was 59.2 years and minimum age 47 year and maximum 72 years. There was 16 males (32.0%) and females were 34 (68.0%). Male to female ratio was 1: 2.16. In 15 (30.0%) patients facial pain was on left side and 35 (70.0%) patients had right sided pain. V1 was found in 1 (2.0%) patient, V3 in 2 (4.0%) pati-ents, V1 and V2 in 2 (4.0%) patients, V1-3 in 17 (34.0%) patients, V2,3 in 28 (56.0%) patients. An Arterial loop was found in 37 (74.0%) patients as the compressing agent and a Vein only in 4 (8.0%) patients. Mixed artery and vein in 8 (16.0%) patients. Thick arachnoid was the compressing agent in 1 (2.0%) patient. Out of 50 patients 46 (92.0%) had Excellent outcome, 3 (6.0%) patients had Good outcome, 1 (2.0%) patient was in Fair outcome group. No patients were in Bad and Failure outcome groups.Conclusion: Microvascular Decompression of trigeminal nerve is a safe and first choice therapy when medical treatment has failed for the definitive management of Idiopathic Trigeminal Neuralgia in otherwise medically fit patients provided Surgeon has adequate experience of performing the procedure

Practices of working capital policy and performance assessment financial ratios and their relationship with organization performance

The purpose this study is to highlight the application of working capital policy and the performance assessment financial ratios and to determine their relationship with organization performance. The target respondents were the finance executives/financial analysts of the companies. 64 properly filled questionnaires were processed for analysis. This study concludes that the finance executives consider that the proper practices of working capital and financial ratios are very important for the growth and performance of the organization. This research study also finds that there is positive and significant relationship between these practices and organization performance

Practices of working capital policy and performance assessment financial ratios and their relationship with organization performance

The purpose this study is to highlight the application of working capital policy and the performance assessment financial ratios and to determine their relationship with organization performance. The target respondents were the finance executives/financial analysts of the companies. 64 properly filled questionnaires were processed for analysis. This study concludes that the finance executives consider that the proper practices of working capital and financial ratios are very important for the growth and performance of the organization. This research study also finds that there is positive and significant relationship between these practices and organization performance

Non-technical skills for urological surgeons (NoTSUS) : development and evaluation of curriculum and assessment scale

In the last decade non-technical skills (NTS) have emerged as a vital area for improvement within surgery. This study aims to develop and evaluate a Non-technical Skills for Urological Surgeons (NoTSUS) training curriculum and assessment scale. This international, longitudinal and observational study began with a 3-round Delphi methodology to refine curriculum contents and rating scale. Sessions with up to four participants were delivered where each candidate undertook an independent scenario within the validated full immersion simulation environment. Candidates were assessed using both the NoTSS (Non-technical Skills for Surgeons) and NoTSUS rating scales by NTS-trained and non-trained experts. A post-training evaluation survey was distributed. 62 participants comprising trainees (n = 43) and specialists (n = 19) undertook the NoTSUS course. The NoTSS and NoTSUS scales correlated well, with a mean difference of 3.3 in the overall total (p = 0.10, r = 0.53). However, there was significant differences in scores between the NoTSS-trained and non-trained raters (n = 28, p = 0.03). A one-way ANOVA test revealed significant improvement throughout the four simulation scenarios in each session (p = 0.02). The NoTSUS curriculum received positive feedback from participants and demonstrated educational value and acceptability. The NoTSUS curriculum has demonstrated high educational value for NTS training aimed at urologists, with marked improvement throughout sessions. Correlation of NoTSUS and NoTSS scales proves its suitability for evaluating NTS in future training. Demonstration of inter-rater reliability indicates that the scale is reliable for use in assessment by expert faculty members. Furthermore, qualitative feedback from participants suggests gain of transferrable skills over the course. The online version of this article (10.1007/s00345-020-03406-6) contains supplementary material, which is available to authorized users

Protocol for developing a core outcome set for male infertility research:an international consensus development study

Abstract STUDY QUESTION We aim to develop, disseminate and implement a minimum data set, known as a core outcome set, for future male infertility research. WHAT IS KNOWN ALREADY Research into male infertility can be challenging to design, conduct and report. Evidence from randomized trials can be difficult to interpret and of limited ability to inform clinical practice for numerous reasons. These may include complex issues, such as variation in outcome measures and outcome reporting bias, as well as failure to consider the perspectives of men and their partners with lived experience of fertility problems. Previously, the Core Outcome Measure for Infertility Trials (COMMIT) initiative, an international consortium of researchers, healthcare professionals and people with fertility problems, has developed a core outcome set for general infertility research. Now, a bespoke core outcome set for male infertility is required to address the unique challenges pertinent to male infertility research. STUDY DESIGN, SIZE, DURATION Stakeholders, including healthcare professionals, allied healthcare professionals, scientists, researchers and people with fertility problems, will be invited to participate. Formal consensus science methods will be used, including the modified Delphi method, modified Nominal Group Technique and the National Institutes of Health’s consensus development conference. PARTICIPANTS/MATERIALS, SETTING, METHODS An international steering group, including the relevant stakeholders outlined above, has been established to guide the development of this core outcome set. Possible core outcomes will be identified by undertaking a systematic review of randomized controlled trials evaluating potential treatments for male factor infertility. These outcomes will be entered into a modified Delphi method. Repeated reflection and re-scoring should promote convergence towards consensus outcomes, which will be prioritized during a consensus development meeting to identify a final core outcome set. We will establish standardized definitions and recommend high-quality measurement instruments for individual core outcomes. STUDY FUNDING/COMPETING INTEREST(S) This work has been supported by the Urology Foundation small project award, 2021. C.L.R.B. is the recipient of a BMGF grant and received consultancy fees from Exscentia and Exceed sperm testing, paid to the University of Dundee and speaking fees or honoraria paid personally by Ferring, Copper Surgical and RBMO. S.B. received royalties from Cambridge University Press, Speaker honoraria for Obstetrical and Gynaecological Society of Singapore, Merk SMART Masterclass and Merk FERRING Forum, paid to the University of Aberdeen. Payment for leadership roles within NHS Grampian, previously paid to self, now paid to University of Aberdeen. An Honorarium is received as Editor in Chief of Human Reproduction Open. M.L.E. is an advisor to the companies Hannah and Ro. B.W.M. received an investigator grant from the NHMRC, No: GNT1176437 is a paid consultant for ObsEva and has received research funding from Ferring and Merck. R.R.H. received royalties from Elsevier for a book, consultancy fees from Glyciome, and presentation fees from GryNumber Health and Aytu Bioscience. Aytu Bioscience also funded MiOXYS systems and sensors. Attendance at Fertility 2020 and Roadshow South Africa by Ralf Henkel was funded by LogixX Pharma Ltd. R.R.H. is also Editor in Chief of Andrologia and has been an employee of LogixX Pharma Ltd. since 2020. M.S.K. is an associate editor with Human Reproduction Open. K.Mc.E. received an honoraria for lectures from Bayer and Pharmasure in 2019 and payment for an ESHRE grant review in 2019. His attendance at ESHRE 2019 and AUA 2019 was sponsored by Pharmasure and Bayer, respectively. The remaining authors declare no competing interests. TRIAL REGISTRATION NUMBER Core Outcome Measures in Effectiveness Trials (COMET) initiative registration No: 1586. Available at www.comet-initiative.org/Studies/Details/1586. TRIAL REGISTRATION DATE N/A. DATE OF FIRST PATIENT’S ENROLMENT N/A

The role of purinergic signalling in urological malignancies

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Diagnosis and management of premalignant penile lesions

Diagnosing premalignant penile lesions from benign penile dermatoses presents a unique challenge. The rarity of these conditions and the low incidence of penile cancer mean that the majority of our knowledge is based on small, non-randomized, retrospective studies. The introduction of specialist penile cancer centres in the UK has resulted in the centralization of expertise and resources, and has furthered our understanding of the biological behaviour and management of this rare malignancy. We review the current trends in the approach to diagnosing and treating various premalignant penile conditions