Film as an educational tool in medical pedagogy: A study on cinemeducation and its effectiveness.

OBJECTIVE: To find out the possibilities and usefulness of introducing cinemeducation in medical institutions, and to formulate suggestive inserts for faculty and policy-makers. METHODS: The quantitative study was conducted in Lahore from January to June 2021 after approval from the ethics review committee of King Edward Medical University, Lahore, and comprised fourth and final year medical students. Relevant short clips from seven movies of different genres were selected and shown to the students who were then divided into eight equal groups. Every session lasted 30 minutes, and was followed by an interactive discussion between the students and faculty members. The critical aspects of the sessions were discussed and analysed. Data was collected using a 7-item questionnaire that was scored on a 5-point Likert scale. Data was analysed using SPSS 21. RESULTS: Of the 240 participants, the questionnaire was returned duly filled by 219(91.25%). Among them, 176(80.4%) said they found the experience worthwhile and that they would like to have such an experience again, while 184(84%) said such sessions should be made a part of regular curriculum. Also, 166(75.8%) participants felt that the session had helped them learn about crucial features of medicine, and 169(77%) thought that the session facilitated the understanding towards patient management. CONCLUSIONS: Cinemeducation was found to be an excellent tool of pedagogy that should be incorporated in all the relevant disciplines of medicine and allied sciences.

Comparison of Endonasal and External Septoplasty for Treatment of Buckled Caudal Septal Deviation.

OBJECTIVE: To compare endonasal and external septoplasty for type 2 caudal septal deviations in terms of operative time, aesthetic and functional outcome. STUDY DESIGN: Descriptive Analysis. PLACE AND DURATION OF STUDY: ENT Department, Mayo Hospital/ K.E.M.U, Lahore, from October 2019 to October 2020. METHODOLOGY: Record of patients operated for septal deviations in 2019 were retrospectively reviewed. All patients, diagnosed with type 2 caudal septal deviations, were included; while those with marked inferior turbinate hypertrophy, deviated nasal septum after trauma, and those who could not be followed-up, were excluded. Twenty-eight patients, operated by external approach, were placed in group A; and 32 patients, who had endonasal surgery, were placed in group B. Functional outcome was assessed by nasal obstruction symptom evaluation (NOSE) scale; and cosmetic deformity was assessed by visual analog scale (VAS) pre- and postoperatively at six months. Operative time was measured for both the groups. RESULTS: Sixty patients were included. Mean preoperative NOSE scale score for group A was 67.36 ± 8.07 and postoperative was 15.82 ± 3.62 (p<0.001). Mean preoperative NOSE score for group B was 69.40 ± 5.80 and postoperative it was 18.00 ± 3.75 (p<0.001). Mean VAS score for group A preoperative and postoperative was 18.93 ± 7.86 and 76.07 ± 6.85 (p<0.001), respectively. Mean VAS score for group B preoperative and postoperative was 19.69 ± 7.82 and 71.56 ± 8.84, respectively (p<0.001). Mean operative time for group B was 52.25 ± 3.37 minutes, and for group A 115.00 ± 9.91 minutes (p<0.001). The difference in preoperative and postoperative NOSE and VAS scores compared for both groups revealed p-value of 0.952 and 0.044, respectively. CONCLUSION: Extracorporeal septoplasty resulted in better aesthetic outcome; though endonasal septoplasty had shorter operative time. Both surgical techniques resulted in good functional outcome. Key Words: Nasal septum, Nasal surgical procedures, Deviated nasal septum, Caudal deviation septum, Septoplasty,  Septorhinoplasty, Nasal obstruction symptoms evaluation (NOSE) score, Visual analogue scale (VAS).

Role of placental blood drainage as a part of active management of third stage of labour after spontaneous vaginal delivery.

OBJECTIVE: To compare the duration of 3rd stage of labour and blood-loss in patients with and without placental cord blood drainage following normal vaginal delivery. METHODS: The quasi-experimental study was conducted at the Services Hospital, Lahore, Pakistan, from October4, 2015, to April 4, 2016, and comprised pregnant women aged 18-40 years with any parity having gestation >36 weeks and haemoglobin >7.0gm. The subjects were divided into two groups. In one group, routine active management of third stage of labour was done and placental end of the umbilical cord was left open to drain blood in a kidney tray till flow ceased. In the other group, the placental end of the cord was left clamped and spontaneous expulsion was carried out by controlled cord traction. Data was analysed using SPSS 22. RESULTS: Of the 200 females, 100(50%) were in each of the two groups. The overall mean age was 29.22}6.84 years. The mean baseline haemoglobin in placental cord drainage group was 11.48}0.89 and that in the control group was 11.40 } 0.91 (p>0.05). The mean duration of third stage of labour in placental cord drainage group was 5.67}1.81 hours and in control group it was 8.44}2.50 hours (p<0.001). The mean blood-loss in placental cord drainage group was 174.69}13.69mlcompared to 196.25}15.06ml in the control group (p<0.001). CONCLUSIONS: In the management of the third stage of labour with the cord drainage method, results showed significant reduction in postpartum blood-loss and the duration of the third stage in normal vaginal birth patients.

Concurrent radiotherapy and chemotherapy with erlotinib followed by maintenance erlotinib in patients with Epidermal Growth Factor Receptor mutation- positive adenocarcinoma lung.

OBJECTIVE: To assess the efficacy and tolerability of erlotinib in combination with radiation therapy followed by maintenance therapy in Stage III and IV, epidermal growth factor receptor mutationpositive adenocarcinoma lung patients. METHODS: The single-arm, quasi-experimental study was conducted at the Mayo Hospital, Lahore, Pakistan, from September 2013 to December 2014, and comprised patients with lung adenocarcinoma who were followed up till December 2017. The patients received concurrent radiation therapy (60- 70 Gy in 30-35 fractions) along with erlotinib 150mg/day, followed by erlotinib 150mg/day as maintenance therapy till disease progression. Primary endpoint was overall response rate according to Response Evaluation Criteria in Solid Tumours guideline version 1.0, while secondary endpoint was progression-free survival, overall survival and toxicity assessment with Common Terminology Criteria for Adverse Eventsversion 3.0. Before starting erlotinib, all patients received four cycles of standard chemotherapy with platinum doublets (Pemetrexed, Docetaxel, Paclitaxel, Gemcitabine). Data was analysed using SPSS 16.. RESULTS: of the 62 patients initially enrolled, 49(79%) completed the study. Of them, 37(75.5%) patients were smokers. Mean age of the patients was 57.0±8.51 years (range: 31-73 years) and 40 (81.6%) were male subjects. Objective response rate was 71.4% (n=35). Median progression-free survival for stage III disease was 7.4 months and for stage IV disease 2.8 months. Corresponding median overall survival rates were 12.9 months and 5.5 months. Common adverse events observed were rash n=30(61.2%), fatigue n=21(42.9%) and diarrhoea n=18(36.7%). CONCLUSIONS: Concurrent radiotherapy with erlotinib was effective and well-tolerated in patients with locally advanced adenocarcinoma lung harbouring epidermal growth factor receptor mutation.

Outcome of Management of Vascular Malformations of Lip.

OBJECTIVES: To describe the characteristics and outcome of management of vascular malformations of lip. PLACE AND DURATION OF STUDY: The Department of Plastic Surgery and Burn Unit, King Edward Medical University, Mayo Hospital, Lahore, from January 2009 to December 2013. METHODS: A prospective case series of 38 patients with vascular malformation of lip was performed. Demographic information and clinical features were noted. Treatment employed, complications, functional, and cosmetic outcome were recorded. Surgical debulking was performed as definitive treatment in all patients and nonsurgical techniques were added as adjuvant modalities in 18 patients. Sclerotherapy was performed for venous malformations in 10 patients. LASER was performed in 8 patients with capillary or combined malformations. Arterial malformations were managed surgically without embolization. Postexcision defects were closed primarily in 36 patients with Abbe flap in 1 and nasolabial flap in another patient for reconstruction. RESULTS: Of 38 patients included in the study 20 (53%) were males with mean (SD) age 18 (6) years. Twenty-one percent were high and 79% low-flow malformations (29% venous, 16% capillary, and 34% combined). Lower lip was involved in 70% patients with 95% having difficulty in eating and 87% abnormal speech. Referring diagnosis was incorrect in 35% patients. Postsclerotherapy and postexcision pain scores were mean (SD) 5 (1.26) and 4 (1) respectively. All patients had improvement in eating and speech with restoration of normal muscle function in mean (SD) 5.63 (1.2) weeks. Ninety-five percent patients were satisfied with their outlook. One patient had recurrence at 1 year follow-up. CONCLUSION: Surgical debulking with proper use of adjuvant procedure for vascular malformations of lip produces best functional and aesthetic results with minimal complications.