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cisions. Through participating in PREP, significant positive increases were found in students' perception of RO in the areas of Flexibility, Patient Population, Competitiveness of the Specialty, Quality of the Working Environment, and Levels of Stress. This study highlights which information sources students value the most when forming their perception of RO and the impact a single elective experience has on improving student perception of the field. RO-based programs and lectures can be better designed using this information to introduce students to this specialty.The neurological complications of coronavirus disease 2019 (COVID-19) are being better understood as the pandemic progresses. We report a second case of a patient who presented with COVID-19 infection and encephalopathy to our institution. In addition, we report MRI brain and cerebrospinal fluid data. COVID-19 does not seem to cross the blood-brain barrier. The exact mechanisms of encephalopathy and pathological response of COVID-19 are unknown.Colonic Dieulafoy's lesions are an exceptionally rare cause of lower gastrointestinal (GI) bleeding. These lesions are almost exclusively found in the upper GI tract based on previous reviews. ZLN005 PGC-1α activator We present a case of an 81-year-old man who presented with melena progressing to hematochezia and was found to have a cecal Dieulafoy's lesion on colonoscopy. Hemostasis with clipping was achieved and allowed for the resumption of anticoagulation. This case demonstrates the importance of considering this diagnosis in lower GI bleeding when evidence of more common causes may not be present, especially considering these lesions amenability to endoscopic therapy.Introduction Otosclerosis is a disorder in which the footplate of the stapes is replaced by an abnormal bone, thereby affecting sound transmission to the inner ear at the level of the oval window. The solution to this condition is to reestablish this mechanism back to normal via the ossicular chain to the inner ear. The aim of stapes surgery is to improve the hearing level to thresholds appropriate enough to obviate the need for hearing aid. The hearing improvement achieved after surgery often lasts for many years. The purpose of the current study was to review our experience and find out the rate of success related to hearing outcomes after stapedotomy. Methods The patients who were operated for otosclerosis between January 2000 and December 2010 at Aga Khan University Hospital, Karachi, Pakistan were included in the study. The charts were reviewed to collect clinical data regarding stapes surgery. The values of speech reception threshold (SRT) were recorded, and the preoperative and postoperative means weres were compared with a t-test, and a p-value of less then 0.05 was considred significant. Postoperatively, 34 ears had AB-gap of 10 dB (70.8%), 11 (22.9%) had within 20 dB, and three (6.3%) had within 30 dB. Conclusions The success rate related to hearing outcomes in patients operated for otosclerosis was excellent and comparable to that found in the current literature. The wide AB-gap noticed in the majority of our patients may represent a delayed presentation to otolaryngologists, which requires further evaluation.Hemiconvulsion-hemiplegia-epilepsy (HHE) syndrome is a rare condition, characterized by sudden onset of unilateral seizures leading to cerebral hemisphere atrophy and hemiplegia which might persist for lifetime. It is believed to be outcome of prolonged or unmanaged status epilepticus in pediatric age group. HHE is diagnosed during childhood but we report an undiagnosed case of 30-year-old male who was dealing with uncontrolled seizure, phenytoin toxicity and hemiparesis. He was diagnosed with HHE based on characteristic imaging findings leading to complete alteration of management and opened wide array of surgical options to manage this debilitating condition.Background The outbreak of Coronavirus (COVID-19) in Wuhan, China, which began in December 2019, evolved to become a global pandemic. The pandemic, along with the obvious health-related impact, also poses a serious threat to the psychological well-being of individuals and has resulted in significant behavioral changes. We aimed to describe the psycho-behavioral response to this crisis among the population of Karachi, Pakistan, in the month of March 2020. Methods A structured, self-administered questionnaire was constructed, based on previously conducted surveys, assessing the psychological impact and behavioral changes pertaining to COVID-19. Questionnaires were made available online, and were administered to any individual who was a resident of Karachi, during March 2020. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0 (IBM Corp., Armonk, NY) to identify possible risk factors for psychological and behavioral changes. The responses were compared based on gender, age, and lncorporated changes in their behavior to ensure their safety i.e. reduced physical contact (86.5%) and visits to healthcare facilities (74.5%), canceled plans (84.5%), and washing hands more often (87%). Conclusion Our study highlighted the increased anxiety levels that an individual experienced on a regular basis regarding their health, the health of their peers, certain avoidance behaviors as a result of the disease, and behavioral changes of the concerned population. Besides calling attention to this worrisome situation, we also tried to list possible solutions to avert any future distress that may ensue as a result. Hopefully, our study will help the concerned authorities to take measures in order to alleviate the psychological and behavioral impact of COVID-19.Ovarian granulosa cell tumors are rare gynecological cancers with favorable clinical evolution and survival outcomes. We report a new case of this presentation in a patient that was initially diagnosed as a bilateral primary melanoma of the ovary. The patient is a 51-year-old woman with a history of abdominal swelling and deterioration of her general conditions. Physical examination revealed abdominal distension and diffuse dullness with initially highly elevated cancer antigen 125. Contrast-enhanced thoracoabdominal-pelvic computed tomography showed a left-sided ovarian mass and abundant ascites and pleurisy. Ex-lap surgery found two large bilateral ovarian masses associated with peritoneal carcinomatosis and highly abundant ascites. The histopathological examination of the omental biopsy revealed an undifferentiated tumor proliferation of cells with highly positive Human Melanoma Black 45 marker in favor of an achromic malignant melanoma according to the pathologist. Because of her advanced disease, the patient received a combination of six cycles of neoadjuvant dacarbazine, cisplatin, and paclitaxel and showed partial response based on the response evaluation criteria in solid tumors, followed by total abdominal hysterectomy and bilateral salpingo-oophorectomy with cytoreductive surgery.