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Background & Objectives: Generally, the blockage of upper respiratory tract in children is seen with the hypertrophy of adenoids and tonsils. Normally for patients with adenoid hypertrophy (AH), Adenoidectomy with or without Tonsillectomy is carried out, however it has its own complications like haemorrhage and recurrence of adenoid tissue. Consequently, therapeutic approach has increased extraordinary consideration rather than surgical procedure. The inflammatory process proposed for AH has prompted the utilization of anti-inflammatory drugs to treat this issue. The objective of this study was to assess the impacts of Montelukast sodium in children with enlarged adenoids. Methods: A randomized controlled trail was performed from April 2018 to March 2019 in the Otorhinolaryngology clinic of Dr. Akbar Niazi Teaching Hospital, Islamabad. In this randomized, placebo treatment-controlled trial, 60 children aged 4-12 years meeting inclusion criteria were isolated into two groups. The study group was treated with Montelukast sodium 5mg consistently for three months while the control group got placebo treatment for a similar timeframe. A questionnaire was filled by parents/ guardians of every child before and after the intervention to evaluate the severity of sleep discomfort, snoring and mouth breathing. Results: Following 3 months of treatment, significant reduction in size of the adenoids was seen in 76% of study group compared with just 3% of control group getting placebo treatment. Conclusion: Montelukast sodium seems to be effective in the reduction of the size of adenoids and improvement in clinical manifestations. It can be viewed as a viable option in contrast to surgical treatment in children with hypertrophy of adenoids. doi: https://doi.org/10.12669/pjms.37.2.2670 How to cite this:Naqi SA, Ashfaq AH, Umar MA, Karmani JK, Arshad N. Clinical outcome of Montelukast Sodium in Children with Adenoid Hypertrophy. Pak J Med Sci. 2021;37(2):362-366. doi: https://doi.org/10.12669/pjms.37.2.2670 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Hearing is decreased in later age is due to aging and is normally seen in most of the elderly people all over the world. Objectives: To ascertain the degree of hearing in elders in relation to age, pattern and extent of hearing weakness in old age so that interventional strategies can be planned to improve their wellbeing. Study Design: Cross Sectional Study. Setting: ENT Outdoor Clinic of Akbar Niazi Teaching Hospital of Islamabad Medical and Dental College, Bhara Kahu, Islamabad. Period: December 2017 to October 2018. Material & Methods: 200 patients were part of the study with age > 50 years and no past history of drug therapy. Data was gathered by detailed clinical history, clinical examination and audiometric findings. Result: 57% patients were found with normal hearing and 43% had variable degree of hearing deterioration. Highest number of hearing weakness was found in 9th decade. Most of hearing deterioration was found in both the ears and that of sensorineural in type. Conclusion: Sensorineural type of hearing impairment is very frequently occurring problem seen in the latter part of life in our community. The frequency and severity of decreased hearing is directly proportional to age.

Background: Chronic suppurative otitis media (CSMO) is an important cause of preventable hearing loss, particularly in developing world. The objective of this trial was to compare efficacy of 2% acetic acid versus 0.3% ciprofloxacin ear drops in achieving dry ears in CSMO in adult population of Islamabad, Pakistan. Materials & Methods: This trial was conducted at Department of ENT, HBS Medical College, Islamabad, Pakistan from March 2018 to February 2019. With alpha 5%, beta 20% and power of study 80%, sample size was calculated 47 for each group. All adult patients of CSOM, having ear discharge for more than three months were eligible. Patients with aural poly, external auditory canal pathology, ear malignancy, having mastoid surgery in preceding 12 months or having used antibiotics in last one week were excluded. Experimental group received 2% acetic acid, twice daily while control group received 0.3% ciprofloxacin eardrops twice daily. At two weeks, achievement of dry ears was noted. Sex and age in years were matching variables. Primary end point was achieving dry ears, which was compared between the two groups using McNemar chi-square test. Results: Experimental group included 30 (63.8%) men and 17 (36.2%) women and control group included 32 (68%) men and 15 (32%) women. Mean age of experimental group 36±2.14 years was matching to the control group 36±2.59 years. Dry ears were achieved in 35 (74.47%) patients in experimental group and in 11 (23.40%) patients in control group. The efficacy of 2% acetic acid was significantly higher than 0.3% ciprofloxacin eardrops in achieving dry ears (p

A review of novel coronavirus transmission from China to globally is a serious illness or just a thread to world population In the beginning cases of novel coronavirus (COVID-19), were found with infected pneumonia (NCIP) in Wuhan city, China, during December 2019 and January 2020 An outbreak of 2019 novel coronavirus diseases (COVID-19) in Wuhan, China has spread quickly national and international wide through transportation and travelling of people Covid-19 outbreak was idiopathic, and it got attention not only nationally but internationally Health authorities got activated and they took immediate actions for prevention, diagnosis, and treatment of the condition They use precaution by isolating the people infected with it even who were suspected, did close monitoring of the patients and discovered different treatment procedures and diagnostic tests to combat the disease Electronic articles search and data collected were done through PubMed, Google Scholar and Medline, using the following keywords: coronavirus, coronavirus transmission and outbreak, and coronavirus review All types of articles were included to discuss Covid-19 transmission national as well as international included Pakistan [ABSTRACT FROM AUTHOR] Copyright of Professional Medical Journal is the property of Professional Medical Journal and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission However, users may print, download, or email articles for individual use This abstract may be abridged No warranty is given about the accuracy of the copy Users should refer to the original published version of the material for the full abstract (Copyright applies to all Abstracts )

The DNA repair capacity of human cells declines with age, in a process that is not clearly understood. Mutation of the nuclear envelope protein barrier-to-autointegration factor 1 (Banf1) has previously been shown to cause a human progeroid disorder, Néstor–Guillermo progeria syndrome (NGPS). The underlying links between Banf1, DNA repair and the ageing process are unknown. Here, we report that Banf1 controls the DNA damage response to oxidative stress via regulation of poly [ADP-ribose] polymerase 1 (PARP1). Specifically, oxidative lesions promote direct binding of Banf1 to PARP1, a critical NAD+-dependent DNA repair protein, leading to inhibition of PARP1 auto-ADP-ribosylation and defective repair of oxidative lesions, in cells with increased Banf1. Consistent with this, cells from patients with NGPS have defective PARP1 activity and impaired repair of oxidative lesions. These data support a model whereby Banf1 is crucial to reset oxidative-stress-induced PARP1 activity. Together, these data offer insight into Banf1-regulated, PARP1-directed repair of oxidative lesions., Mutation of the nuclear envelope protein, barrier-to-autointegration factor 1 (Banf1), has previously been associated with the development of ageing associated diseases in a human progeria syndrome. Here, the authors reveal the functional link between Banf1-regulated, PARP1-directed repair of oxidative lesions.

Physical examination is a critical component of medical practice yet the focus on efficient patient turnover has impacted the availability of patients with clinical findings willing to be examined by students and skills' teaching is not consistent across clinical rotations. This work evaluates simulation methodologies for teaching of the peripheral arterial examination and evaluates whether skills learnt are transferable to clinical practice.Second-year medical students were taught peripheral arterial examination on a SimMan 3G or with simulated patients (SPs). Both groups were assessed by Objective Structured Clinical Examination (OSCE) with outpatients who have been diagnosed with peripheral arterial disease.There was no difference in the pass rate at OSCE between the two groups. SimMan better facilitated repeated practice, group learning, peer teaching and discussion, which were highly valued by the students. Students felt that the SImMan tutorial did not facilitate development of spatial cognition or pattern recognition. They also felt less well prepared to deal with real patients in terms of having practised appropriate language, issuing instructions and attempting to reassure patients.Both methods of simulation teaching have distinct merits and the ideal approach maybe to use the SimMan in combination with SPs.

ATM is the most significant molecule involved in monitoring the genomic integrity of the cell. Any damage done to DNA relentlessly challenges the cellular machinery involved in recognition, processing and repair of these insults. ATM kinase is activated early to detect and signal lesions in DNA, arrest the cell cycle, establish DNA repair signaling and faithfully restore the damaged chromatin. ATM activation plays an important role as a barrier to tumorigenesis, metabolic syndrome and neurodegeneration. Therefore, studies of ATM-dependent DNA damage signaling pathways hold promise for treatment of a variety of debilitating diseases through the development of new therapeutics capable of modulating cellular responses to stress. In this review, we have tried to untangle the complex web of ATM signaling pathways with the purpose of pinpointing multiple roles of ATM underlying the complex phenotypes observed in AT patients.

Background Physical examination is a critical component of medical practice yet skills are falling into disuse resulting in unfamiliarity with signs and an increased reliance on laboratory and imaging tests. 1,2 The focus on safety and quality of care and efficient patient turnover has significantly impacted on the availability of patients with clinical findings willing to be examined by students. It is our experience and reported by others that skills’ teaching is not consistent across clinical rotations. 2 The need for standardisation and a shortage of training capacity have contributed to the increasing use simulation techniques. Methodology 2nd year students were divided into two groups, one taught peripheral arterial examination on a SimMan 3G and the second group on simulated patients (SPs) and assessed by OSCE with patients presenting with peripheral arterial disease. Feedback was obtained from students in focus group discussions. Results (Tables with results to be presented in the poster) There was no difference in the pass rate at OSCE between the two groups. SimMan better facilitated repeated practice, group learning, peer teaching and discussion which were highly valued by the students. Students felt that their spatial cognition, pattern recognition and development of mental spatial signs were not best facilitated during the SimMan tutorial. They also felt unprepared to deal with real patients in terms of having practiced appropriate language to issue commands, to put patients at ease or to reassure patients and felt embarrassed when faced with an intimate examination of a real patient for the first time. Conclusion Both methods of simulation teaching have distinct merits and the ideal approach maybe to use the SimMan in combination with SP tutorials. References Schwind CJ, Boehler ML, Folse R, Dunnington G, Markwell SJ. Development of physical examination skills in a third-year surgical clerkship. Am J Surg. 2001;181:338–40 Mangione S, Burdick WP, Peitzman SJ. Physical diagnosis skills of physicians in training: a focused assessment. Acad Emerg Med.1995;2:622–9 Ramani S. Twelve tips for excellent physical examination teaching. Med Teach. 2008;30:851–856

Aim Minimally invasive approaches for stoma closure offer considerable benefits for patients. Single port access via an end ileostomy site after stoma take-down in patients with prior total colectomy and a rectal stump remnant could allow restoration of ileorectal continuity by anastomosis but has not been detailed previously. Methods After mobilisation of the end ileostomy, the anvil of a circular stapler is secured into the open end of the distal ileum and the intestine returned into the abdominal cavity. A single port access device (in this description, a ‘surgical glove port’) is placed then into the stoma site and full laparoscopy performed. Once the rectal stump is identified and prepared, an intracorporeal anastomosis can be constructed in a tension-free manner using a Knight-Griffin technique. Leak-testing can also be performed and the operation concluded with closure of the solitary incision. Results In selected cases, adhesiolysis and anastomosis can be safely performed in toto. If the peritoneal environment is challenging, access can be escalated to multiport laparoscopy or even laparotomy. Conclusion Initiation of ileorectal anastomosis construction by single port laparoscopy at least allows peritoneal assessment but can provide for the operation's completion. This can confer maximum patient benefit for the most minimally invasive option.

Research on prostate cancer progression has focused extensively on the concept of miRNA, which can operate either as promoters or as suppressors of carcinogenesis. Moreover, recent genetic studies and emerging functional work show that strikingly similar and overlapping pathways are involved in prostate carcinogenesis. Unswervingly, these elements constitute a recently explored ‘network of networks’ that dynamically reorganizes during DNA damage and is responsible for positively or negatively regulating genome organization and integrity. We consider these facets of convergence and discuss how insights from diametrically opposed interactions of ataxia–telangiectasia mutated and mitrons can inform us about, and possibly help us to get a step closer to personalized medicine. Copyright © 2012 John Wiley & Sons, Ltd.

A 64-year-old man presented with right-sided abdominal pain. CT demonstrated an inflamed Meckel’s diverticulum (MD) (figure 1). Single-incision laparoscopy (SILS) was performed (figure 2) and MD was identified and exteriorised. Extracorporeal resection and anastomosis of small bowel containing MD was performed. The patient recovered well and was discharged home 2 days later. Figure 1 CT images demonstrating inflamed Meckel's diverticulum (MD) (red arrow). Figure 2 Intraoperative image demonstrating (A) the glove port technique which uses a sterile glove for the insertion of three standard …

We present a case of a 68-year-old female who presented to the emergency department with shortness of breath and right shoulder pain after falling down a flight of stairs. Chest x-ray revealed multiple rib fractures and a large haemothorax on the right side (figure 1A). x-Ray of the humerus showed a complex fracture of the surgical neck of the humerus with …