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Splenectomy was successfully performed soon after and the child is now healthy with no remissions of previous symptoms.Adenoid cystic carcinoma of the Bartholin gland is a rare vulval cancer. Available literature suggests an aggressive nature with protracted clinical symptoms and local recurrence despite adequate surgical excision with or without adjuvant radiotherapy. This case demonstrates the role of neoadjuvant chemotherapy and interstitial brachytherapy with less radical surgery, in the treatment of adenoid cystic carcinoma of the Bartholin gland. A 63-year-old woman presented in the clinic four months after the removal of vulvar mass with histopathology report showing adenoid cystic carcinoma of the Bartholin gland with positive margins. Clinical examination and imaging showed local disease extension up to the levator ani and abutting anal margin. She was given four cycles of neoadjuvant chemotherapy followed by ipsilateral hemivulvectomy with inguino-femoral lymphadenectomy followed by 25 cycles of external beam radiation and three cycles of interstitial brachytherapy. The patient has been disease free for more than 30 months. The use of neoadjuvant chemotherapy in treatment of Bartholin carcinoma along with conser vative surgery and radiotherapy can be a good treatment strategy as it reduces the morbidity associated with radical surgery without recurrence to date.Cerebral Palsy (CP), a non-progressive motor disorder, which arises due to lesions of the brain during pregnancy, labour or shortly after birth effects 1-1.5/1000 live births. Altogether 658 CP cases were acquitted from 14 health organizations that permitted access to the data. Data was assembled with respect to topography, muscle tone, severity level and Gross Motor Function Classification System (GMFCS) is accompanied by the comorbidities and co-mitigating factors from 2010-2016. Data represented topographically showed a greater percentage of quadriplegic cases i.e.186 (39.9%). Spastic tone was the most commonly presented muscle tone i.e. 352 (53.4%) and 235 (57.7%) cases were in the mild severity zone. Level II was the most prevalent GMFCS i.e. 189 (34.4%). The most prevalent comorbidity was epilepsy i.e. 96 (14.58%) and co-mitigating factor was Attention Deficit/Hyperactivity Disorder i.e. 18 (2.73%). A dominant male to female ratio was seen as 1.41. The prevalence of males was exhibiting an increase of 80.3% in contrast to females.The objective of this study was to determine the prevalence of preventable risk factors of acute kidney injury in a tertiary care hospital in Pakistan. All patients admitted at Aga Khan University Hospital, Karachi with diagnosis of acute kidney injury were included out of which 134 were selected via random sampling. Patients with existing CKD were excluded. Data was then collected retrospectively from medical records of these patients. LXS-196 clinical trial Mean age was 60±11.7 years while mean serum creatinine on admission was 2.4±1.3 (mg/dl). Sepsis played a role in almost half of the patients [60 (45%)]. Other factors included diarrhoea [23 (17%)], nephrotoxic drug use [25 (19%)] and cardiac pathology [24 (18%)]. It was found that most cases of AKI were due to preventable factors (infections, diarrhoea, and drug toxicity) and concerted efforts to eliminate them would be vital in reducing mortality caused by AKI in developing countries.Team objectively structured bed side assessment (TOSBA) is one of the tools used by medical students to assess teamwork. The aim of this study was to measure the team scores and to correlate team performance scores with individual performance in final year medical students using TOSBA. It was a quasi-experimental study including 100 students, divided into 22 teams comprising of 4-6 members. TOSBA sessions were setup for module assessment of teams. Their individual and team performance scores were measured. Correlation between individual and team scores was calculated using Pearson correlatio n test. Results of the study showed seven (7) high scoring, eight (8) medium scoring and seven (7) low scoring teams. Team scores had a statistically significant correlation with individual scores (p less then 0.05). Reliability of the tool was 0.58 with a high convergent validity. TOSBA is a tool that can be used for individual and team assessment during clerkships.A study was conducted to determine the frequency of allergic rhinitis among healthcare professionals and its impact on their work at the Aga Khan University Hospital Karachi Pakistan. Healthcare workers including doctors, nurses, technicians and pharmacists were included. Participants were asked to fill a questionnaire consisting of score for allergic rhinitis (SFAR), and work productivity and activity impairment questionnaires. link2 Out of 167 workers, 101 were males. Mean age of the participants was 29.0 ± 5.9 years. Overall prevalence of allergic rhinitis among healthcare workers was found to be frequency (19.2%). We noted that 13 individuals reported to have missed their work in the past week accounting to 4.3% of their work. When calculated with the actual work hours 35.9% of their work was reported to have been impaired due to this condition.Cell-adhesion complex within a tissue is important for its stability, structural integrity, functioning, cellular migration and morphogenesis. Disruption of desmosomal cell-adhesions complex results in epithelial conditions such as epidermolysis bullosa and bullous pemphigoid. link3 Desmosome assembly and disassembly is regulated post-translationally by calcium, kinase/phosphatase activity, proteolytic processing, and also through adhesive junctions. Altered functions of desmosomal proteins desmocollin and desmoglein can cause blistering disorders, such as pemphigus foliaceus and pemphigus vulgaris, and non-Hodgkin Lymphoma while defective desmoplakin can cause supra-basal clefting in epithelium and conditions such as Carvajal syndrome, palmo-plantar keratoderma etc. This review summarises major functions of demosomal complex family and how mis-regulation of demosomal structural proteins occur in pathogenesis of non-, pre- and malignant oral lesions with disrupted epithelium.Metabesity refers to metabolic aberrations associated with obesity. These include low- grade inflammation, mitochondrial dysfunction, and changes in gut microbiome. Along with a genetic component, the phenotypes in metabesity are largely the result of sedentary lifestyle and unhealthy eating habits. Metabesity is associated with several co-morbidities including an increased risk for cardiovascular conditions like hypertension, heart failure, myocardial infarction, stroke, and sudden death. Insulin resistance, high blood pressure and glucose levels, visceral adiposity, progressive atherosclerosis, dyslipidaemia and fatty liver are common in obese individuals. Obesity increases the risk for and overall mortality due to cancer. Metabesity adversely impacts endocrine balances in the body and increases the risk of degenerative conditions like dementia. Metabesity is an impending epidemic of huge public health implications with enormous clinical, socioeconomic, and humanistic burden. Interventions to combat sedentary lifestyle and unhealthy eating should be introduced early in life to prevent the onset and progression of metabesity. This review also summarizes the experts' recommendation from Pakistan to manage the rising metabesity concern in their geography based on the literature evidences.

To evaluate the direct and interactive role of personal and work-related factors in psychological burnout among doctors.

The cross-sectional study was conducted in September, 2018, at three hospitals of the twin cities of Rawalpindi/Islamabad, Pakistan, and comprised doctors aged 24-49 years. Data was collected using a demographic questionnaire and the self-reporting Copenhagen Burnout Inventory. Data was analysed using SPSS 23.

Of the 161 doctors, 66(41%) were males and 96(59%) were female. The overall mean age of the sample was 26.44 4.80 years (range 24-49 years). There was significant direct effect of work setting and indirect effect of gender and work setting on psychological burnout (p<0.05). Doctors experienced more burnout in emergency room settings compared to wards and outpatient departments (p<0.05). Further, young and low-salaried doctors were more prone to psychological burnout, and continuous working hours added to the adversity of burnout (p<0.05)..

Personal and workplace related factors were found to play a significant role in psychological burnout which may possibly affect the overall efficiency of doctors.

Personal and workplace related factors were found to play a significant role in psychological burnout which may possibly affect the overall efficiency of doctors.

To investigate whether measuring pancreas volume with abdominal tomography in patients with severe abdominal pain can predict acute pancreatitis.

The case-control study was conducted at Adnan Menderes University from January 1, 2015, to January 1, 2017, and comprised patients who were diagnosed with acute pancreatitis. Pancreas volume measurements of patients and control group were made with Telemed Ekinoks software using freehand technique. Presence of a correlation between pancreas volume and pancreatitis was found in patients aged <57 years and a cut-off value was calculated for pancreatitis in this particular patient group.

Of the 183 subjects, 132(72%) were patients with a mean age of 59.6±16.5 years, and 51(28%) were controls with a mean age of 55.8±18.6 years (p=0.170). The difference between the groups in terms of pancreas volume was significant (p<0.001). There was a negative correlation between age and pancreas volume among the patients (p<0.001), the correlation was not significant among the controls (p=0.898). Among the subjects aged <57 years, the cut-off value was calculated at 95.055, and sensitivity to pancreas volume was 70.91% while specificity was 82.14%. Positive predictive value was 88.6%.

High pancreas volume with pancreatitis was observed in patients aged <57 years.

High pancreas volume with pancreatitis was observed in patients aged less then 57 years.

To determine the frequency of retinal re-detachment (reRD) following silicone oil removal (SOR) in patients who had undergone pars planavitrectomy for treatment of Proliferative vitreoretinopathy (PVR) detachment.

A total of fifty (50) patients with diagnosis of PVR in LRBT hospital Lahore were selected within a duration of 12 months from April-2018 to April-2019 for this prospective observational study. Patients of rhegmatogenous retinal detachment (RD) who underwent vitrectomy using temporary SO tamponade and had completely attached retina at the time of SOR, were included. SOR was done via 3 ports pars plana vitrectomy (PPV) using EVA DORC machine. In 20 patients, scleral buckling (SB) was also done alongwith vitrectomy procedure. After SOR all patients were followed up for 6 months to determine the frequency of retinal re-detachment.

There was male pre-dominance with 30 (60%) of total proportion. There were 26 (52%) patients who had a grade C PVR (C1), 18 (32%) had grade B PVR. The retinal re detachment was found in 2 (4.