Clinical presentation and management of adult choledochal cyst: a retrospective review

Objectives: To determine the mode of presentation and commonest surgical procedures done for adult choledochal disease in a tertiary care hospital

Methodology: A retrospective review conducted in Lady Reading Hospital, Peshawar, from January 1995 to January 2005 with one year of follow up. All patients above 13 years of age with choledochal cyst were considered for the study. Mode of clinical presentation and commonest surgical procedures were recorded

Results: Of the total 23 patients collected, 08 [34.78%] were males and 15 [65.22%] were females. Regarding mode of clinical presentation, pain right hypochondrium with raised serum bilirubin and ALT levels was found in 21.73% of patients. Complete cyst excision was possible in 69.56% of the patients. Complete cyst excision followed by Roux-en-Y common hepatico-jejunostomy was performed in 30.43% and common hepatico-dudenostomy in 26.08%

Conclusion: The most common mode of clinical presentation of choledochal cyst was pain right hypochondrium with raised serum bilirubin and ALT levels. The commonest surgical procedure was complete cyst excision with Roux-en-Y common hepatico-jejunostomy

Teaching microscopy effectively through a combined Peyton's fourstep approach and Gagne's instructional model

Objective: To design a lesson plan for teaching microscopy using a combined Peyton's and Gagne's model

Study Design: Qualitative study with scoping review

Place and Duration of Study: Khyber Medical University, Peshawar from April-September 2017

Material and Methods: We searched Pub Med through a variety of search strategies. The purpose of the search was to identify relevant articles [using an inclusion and exclusion criteria] on making a lesson plan for a psychomotor skill. After selection of articles, the evidence was synthesized including author's name, year of publication, country, key findings, model used to make a lesson plan and limitations of the study. From the synthesised evidence, a lesson plan was designed on microscopy. This is a qualitative study with scoping review, therefore, no quantitative analysis or software was used

Results: In total, 130 articles were identified but after screening and assessment for eligibility five articles were selected. The synthesized evidence suggested that four articles had used Gagne's model, while one article had used a combined Gagne's and Peyton's model to design a lesson plan to teach psychomotor skills. We used the combined model to design a lesson plan for pathology students on microscopy. The microscopy skill was broken down into different parts and each learning step was integrated into the nine events of Gagne's model. The Peyton's model was combined to teach the actual microscopy skill for better learning and executing the skill

Conclusion: The model combined Gagne's and Peyton's model, which was used to design an effective lesson plan to teach microscopy. This model could also help in delivering better teaching sessions for other psychomotor skills

Body mass index in medical students and its association with gender and academic year

Background: Students are generally prone to weight related problems due to sedentary lifestyle and disordered eating habits. The objective of current study was to evaluate the body mass index among MBBS and Physiotherapy students of Peshawar and to see its association with gender and academic year

Methods: This was a cross-sectional study conducted among MBBS and Physiotherapy students in Peshawar, from Sep 2016 to Sep 2017. A self-administered questionnaire was distributed among 250 students of different institutes, 213 filled questionnaires were returned. Body mass index [BMI] was used to classify underweight, overweight, and obesity grade I and grade II. Data was analyzed using SPSS-20

Results: Mean age of participants was 21.77+/-1.45. Females were 137 [64.3%] while males were 76 [35.7%]. Unmarried participants were 192 [90.1%], while 21[9.9%] were married. Mean height, weight and BMI of the participants were 1.654 meter, 61.1 Kg, and 22.8 respectively. One hundred and thirty [61.0%] were MBBS, and 83 [39.0%] were Physiotherapy students. Out of 213 respondents, 109 [51.2%] had normal BMI, 21[9.9%] were underweight, 41 [19.2%] were overweight, 31 [14.6%] were grade I obese and 11 [5.2%] were grade II obese. Majority of 1[st] year [68.0%] and 4[th] year [72.7%] students had normal BMI. BMI was not associated with gender or academic year [p>0.05]. Mean BMI in MBBS students was higher than the physiotherapy students [23.3 vs 22.1 Kg/M[2], p=0.03]

Conclusion: The prevalence of obesity appears higher in our students

systematic translation of biomarkers research into clinical practice

Background: The rapid gains in science and technology during the last century resulted in an epidemiological shift from infectious diseases to non-communicable diseases like cancer, diabetes mellitus, and cardiovascular diseases. However, despite the large funding put into the understanding of etiology of cancer, identification of novel diagnostic markers, and advancing cancer treatment, the translation of research findings into clinical practice leaves much to be desired for

Methods and Results: The translation of cancer biomarkers into clinical practice is a great challenge that needs to be promptly addressed for better cancer outcomes. This review discusses the characteristics of clinically useful cancer biomarkers, and how biomarkers identified by research can be used for the improved cancer management and patient outcomes. We also explored the underlying reasons for the less than an optimal translation of biomarkers research into clinical practice, how basic medical sciences can undertake more clinically relevant research, and provide suggestions on how to improve the clinical translation of research findings from such studies. The reason delaying the clinical translation of biomarkers are: lack of systematic analyses on existing cancer biomarkers; inadequate sample size; lack of an optimal scoring system and threshold; limited use of panels of biomarkers; technical differences between laboratories; and the need for well-designed validation studies [biomarker clinical trials]

Conclusion: Clinical translation of biomarkers could potentially be facilitated through a systematic approach taking into account the reasons highlighted in the current study

Evaluation of hepatotoxic and nephrotoxic effects of piroxicam sulfonated derivatives

Background: Pain management requires new pharmacotherapy with good efficacy and less side effects. Piroxicam is used routinely in clinical practice but it is associated with side effects. To minimize the chances of adverse effects, sulfonated piroxicam derivatives [SPD] have been introduced. We sought to find hepatotoxic and nephrotoxic effects of SPD in Albino rats

Methods: An experimental study on SPD was carried out at the Institute of Basic Medical Sciences, Khyber Medical University, Peshawar. Healthy 24 albino rats were divided into 5 groups. One control group and four experimental groups [compound I and II, each with a dose of 10mg/kg and 20mg/kg] received treatment for 7 days. Liver function tests [LFTs], renal function tests [RFTs] and histology of liver and kidney specimens was performed after culling rats. The difference between median values of samples was assessed using Kruskal-Wallis test with post-hoc [for LFTs and RFTs]. SPSS-21 was used for all statistical analysis and p?0.05 was considered statistically significant

Results: The alanine aminotransferase [ALT] values were significantly high in the 20 mg/Kg group than control for both compounds [p=0.03, p=0.001 respectively]. The aspartate aminotransferase [AST] values were significantly high in the 10 mg/Kg and 20 mg/Kg group than control for compounds II [p=0.01, p=0.0001 respectively]. The alkaline phosphatase [ALP] values were significantly high in the 20 mg/Kg group than control for compounds II [p=0.002]. The blood urea values were significantly high in the 20 mg/Kg group than control for compounds II [p=0.008]. The mean final score of liver injury in all experimental groups [mean range 5-7] was less suggesting that the damage in liver was less pronounced. Renal injury was more pronounced in the 20 mg/Kg dose for both compound I and compound II [mean score 7] compared to 10 mg/Kg dose [mean score 4]

Conclusion: Piroxicam sulfonated derivatives can cause focal changes in liver and kidney which might be reversible. The changes are less pronounced for compound I with a low dose

Attributes of a good medical school: faculty perspective in local context

Background: Medical schools and institutions are required to meet the standards of national and international accreditation bodies. These standards guide the attributes of a good medical school. The current study was designed to identify the attributes of a good medical school from a local perspective

Methods: For this qualitative study based upon grounded theory, 25 participants were recruited through purposive sampling who underwent a workshop to get an insight about the attributes of a good medical school. They were asked to provide the faculty perspectives of a good medical school. The participant responses were put in online software 'Worditout' to look for the repetitions of words, followed by open coding technique. Initial coding was followed by a second phase of axial coding of the data in order to identify themes and thematic analyses of all the data were performed

Results: The teaching experience of the participants in medical schools varied from 2 to 20 years. In total, 198 responses/comments from all the participants were recorded. After doing the open and axial coding all the responses were summarized into four themes. The themes highlighted in order of the response frequency were: 1] improved learning strategies and opportunities; 2] modification and improvements in teaching methodologies; 3] standardised and programmatic assessment methods and 4] parameters of quality assurance and management

Conclusion: The attributes of a good medical school are guided by the national and international standards. However, some of the standards are contextual and our study showed these standards as attributes of a good medical school. It includes provision of better learning opportunities, teaching methodologies, standardised assessment and quality assurance

Surgical management of depressed skull fracture

To study the outcome of surgical management of depressed skull fracture.This study was conducted form April 1995 to March 2001, in department of Neurosurgery PGMI/LRH Peshawar. A total of 98 patients with depressed skull fracture, treated surgically were included in the study. It included patients operated for cosmetic reasons or functional outcome. Patients treated conservatively, secondary to fire arm injury and penetrating objects were excluded from the study. Details regarding the causes, duration and clinical conditions were documented. X Rays skull were done in all cases. CT scan was done in 78 cases. After surgery patients were followed up for 9 months. Clinical examination of the wound for sepsis, CSF leak, check up X Rays/CT scan and neurological assessment of patients was done on every visit. A total of 98 patients were operated under general anesthesia in the emergency. There were 63 [61.74%] male and 35 [34.3%] female patients with age ranged from 01-55 years with an average age of 11 years. The causes of depressed skull fracture were, falls from height in 53 [51.94%] cases, road traffic accident in 32 [31.36%] cases sports injury in 2 [1.96%] cases, physical violence in 7 [6.86%] cases and miscellaneous in 8 [7.8%] cases. 30 [29.4%] cases were operated for cosmetic purpose while the rest of 68 [66.64%] cases were operated for functional outcome. Closed depressed skull fracture was noted in 23 [22.54%] cases, while compound depressed skull fracture was in 75 [73.5%] cases. The incidence of depressed skull fracture was 14 [13.7%] in frontal bone, 17 [16.66%] in fronto-parietal, 18 [17.64%] in temporal, 30 [29.4%] in parietal, 11 [10.78%] in occipital, 4 [3.9%] on superior saggital sinus, 3[2.94%] on confluence of sinuses and 1 [0.96%] on transverse sinus. Indications for surgery were depressed skull fracture more than 5 mm in frontal, fronto-parietal area, all opened depressed skull fractures, with focal neurological deficit, leaking CSF and oozing brain matter along with depressed fracture. Postoperatively 66 [64.68%] showed excellent recovery, 13 [12.74%] were hamiparetic, 3 [2.94%] were dysphasic, 11[10.78%] were having seizures, 9 with post traumatic syndrome and 2 [1.96%] remained in vegetative state, and 4 [3.92%] developed meningitis. No CSF leaks were noted. Depressed skull fracture is a common neuro-traumatic disorder. The commonest causes in our society are:- fall from height and Rood traffic accident. In time surgical management gives excellent results and leads to minimize the sequel of this condition. Most of the causes can be prevented just by adopting preventive measures. The condition can be treated in periphery hospital as well, if trained personals are available