AIM: To investigate the changes of retinal vascular parameters and retinal layer thickness in patients with multiple sclerosis(MS).METHODS: This single-centered case-control study was performed on a MS group of 42 patients diagnosed with MS and a control group of 43 healthy hospital staff matched in terms of age and sex at Iran University, department of neurology and ophthalmology from March 2020 to March 2021. The ophthalmic parameters of each patient were recorded, and optical coherence tomography was used to evaluate the retinal thickness in the layers.RESULTS: This study enrolled a total of 85 participants, with a mean age of 40.44±11.52 years, including 61 females(72%). The control group consisted of 43 individuals with a mean age of 39.49±11.07 years, while the MS group comprised 42 participants with a mean age of 41.40±12.01 years. The mean disease duration in the MS group was 8.45±6.04 a. The thickness of the ganglion cell layer in the right eye was significantly lower in the MS group compared to the control group(P=0.034). In addition, except for the left nasal sector(P=0.106), the mean peripapillary neurofibrillation in all examined sectors were significantly lower in the MS group than in the control group(P<0.05). The average vessel density in both the deep and superficial capillary plexuses across all regions of both eyes was lower in the MS group than in the control group, with all comparisons for the superficial capillary plexus showing statistical significance(P<0.05 for all except the left nasal sector).CONCLUSION: The thickness of the retina of patients with MS is significantly reduced. Therefore, optical coherence tomography results can be used as a reliable tool to evaluate disease progression and prognosis in MS patients.

Background/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO. Methods: We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software. Results: Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR, 1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95% CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01). Conclusions Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.

Background/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO. Methods: We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software. Results: Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR, 1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95% CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01). Conclusions Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.

Background/Aims: Evidence suggests comparable outcomes between endoscopic ultrasound (EUS) and endoscopic retrograde cholangiopancreatography (ERCP) in the biliary drainage of malignant distal biliary obstruction (MDBO). We conducted an updated systematic review and meta-analysis comparing the EUS with ERCP in the management of MDBO. Methods: We performed a literature search using the Medline, Embase and Cochrane databases, including randomized controlled trials comparing EUS and ERCP in patients with MDBO. Meta-analysis was performed using the random-effects model using the STATA ver. 17.0 software. Results: Both procedures were comparable in technical (risk ratio [RR], 1.01; 95% confidence interval [CI], 0.78–1.30) and clinical (RR, 1.10; 95% CI, 0.85–1.41) success. No difference was identified in total adverse events (RR, 0.75; 95% CI, 0.42–1.35), acute cholangitis (RR, 0.84; 95% CI, 0.43–1.62), stent patency (RR, 1.13; 95% CI, 0.87–1.46) and mean stent patency time (mean difference, –0.01; 95% CI: –0.21 to 0.19). ERCP was associated with a higher risk of procedure-related pancreatitis (RR, 0.17; 95% CI, 0.04–0.68) and statistically non-significant higher risk for reintervention (RR, 0.61; 95% CI, 0.37–1.01). Conclusions Although EUS and ERCP were comparable in terms of efficacy and safety, ERCP was associated with a higher risk of procedure-related pancreatitis and reintervention, with the latter finding not reaching statistical significance.

Background: The optimal surgical approach for managing multiple renal arteries in living donor kidney transplantation remains unclear. This study compared outcomes between separate anastomoses (SA) and pantaloon anastomosis (PA). Methods: A retrospective cohort study was conducted from November 2018 to August 2024. In total, 117 patients were included (SA, 67; PA, 50). The primary outcome was arterial complications. Secondary outcomes included renal function, graft and patient survival at 1 year, and intraoperative variables. Statistical analyses utilized the t-test, the Mann-Whitney U-test, and Kaplan-Meier survival curves. Results: The mean warm ischemia time was similar between groups (105.48±35.64 vs.103.92±33.51 min; P=0.811). Cold ischemia time was also comparable (75.90±14.36 vs.80.68±17.85 min; P=0.111). However, anastomosis time was significantly longer in the SA group (39.00 [35.00–43.00] min) compared with the PA group (34.00 [28.50–39.50] min; P<0.001). The immediate postoperative creatinine reduction was slightly greater in the SA group (46.83%±20.68% vs. 39.78%±19.04%; P=0.090). Vascular complications requiring re-exploration were infrequent in both groups (1.5% vs. 2.0%). At 1 year posttransplant, creatinine levels were comparable between the SA (1.20 [0.95–1.45] mg/dL) and PA (1.20 [1.05–1.35] mg/dL) groups (P=0.337). Regression analysis confirmed that postoperative creatinine levels were independently associated with SA (P=0.006). Graft survival was similarly high (97% vs. 98%), as was patient survival (100% vs. 96%). Conclusions Both anastomosis techniques are safe and effective for transplanting kidneys with anatomical anomalies. SA offers surgical efficiency and provides superior early renal recovery.

Ovarian cysts are rare in children. Their common presentation is acute abdomen, which can be a life-threatening event that needs emergent investigation and intervention. Herein, we report a gynaecological case of a twisted ovarian cyst in an 11-year-old girl who presented to the emergency department with sudden-onset generalised abdominal pain. Multiple strong analgesics were prescribed, and pain-controlled analgesia was then started. Abdominal ultrasound revealed a left adnexal mass, and abdominal computed tomography showed a non-enhancing soft tissue tumour with multiple cystic components in the pouch of Douglas. The patient underwent emergency laparotomy, which revealed a gangrenous left ovarian mass measuring 9×5 cm that was twisted five times. Histopathology showed extensive haemorrhagic infarction with no remnant of viable tissue, consistent with a twisted ovary. It was challenging to determine the origin of the pain in this patient, as thorough examination could not be performed because she was in severe pain. Abdominal ultrasound helps guide diagnosis, as a gynaecological cause is rare in premenarchal children. A vigilant assessment is important to avoid delays in diagnosis and emergency intervention.
Ovarian Cysts ; Abdomen ; Child

Introduction: Urinary incontinence (UI) is a condition which is common and is closely linked to vaginal delivery. Pelvic floor muscle exercise (PFME) are considered the first line management of UI and regular practice of PFME is a key factor in its effectiveness. This study was designed to investigate the effectiveness of theory-based intervention using social media to reduce UI among postpartum women. Methods: This is a randomized controlled trial with the final number of recruited participants of 104. The participants were assigned randomly either to control or intervention groups and were followed up at three and six months. The primary outcome of this study was severity of UI. Adherence to exercises was the secondary outcome. Results: After the intervention, at three months and six months follow-up, there were significant differences between the two groups regarding the practice of PFMEs (p≤ 0.05). Friedman’s analysis of variance showed that there was a significant difference in respect of the exercise adherence rating scale among the intervention group at baseline, at three months and post six months (p≤ 0.05). In the intervention group at baseline the mean (standard deviation, sd) of the International Consultation on Incontinence Questionnaire Short Form was 3.00 (1.94) whereas at three months it decreased to 1.96 (1.69), which decreased further to 1.04 (0.51) at six months. Conclusion: theory-based education delivered through social media is a feasible and effective way of increasing the practice of PFMEs, and can lead to decrease of severity UI.

BACKGROUND AND OBJECTIVES: In clinical masking, the plateau is a state in which the non-test ear (NTE) is completely masked by the noise and tone is heard only by the test ear (TE). At least 15 to 20 dB of plateau width is needed to obtain valid threshold. In the study, a part of plateau after initial masking level known as the minimum plateau width (mPW) was determined and compared by a new formula and the plateau searching method. SUBJECTS AND METHODS: Minimum plateau widths of air conduction were obtained in 29 participants with unilateral and 30 participants with bilateral conductive hearing loss (CHL) aged 20 to 45 years old by using step by step plateau method and mPW estimation by the formula between two points of masking diagram [mPW=(N2-N1)-(T2-T1)] and then the mPW of two methods was compared for each frequency. RESULTS: There was no significant difference between the minimum plateau width obtained by the plateau and formula methods for two given point of masking diagram in people with unilateral and bilateral CHL at octave frequencies from 500 Hz to 4,000 Hz. CONCLUSIONS: Threshold obtaining of TE by two tones for two noise levels delivered to the NTE is enough to estimate the mPW between these two noise points and it is not necessary that for clinicians to know the actual values of masking diagram components.
Ear ; Hearing Loss, Conductive ; Masks ; Methods ; Noise

PURPOSE: In Pakistan, courses in pharmacy practice, which are an essential component of the PharmD curriculum, were launched with the aim of strengthening pharmacy practice overall and enabling pharmacy students to cope with the challenges involved in meeting real-world healthcare needs. Since very little research has assessed the efficacy of such courses, we aimed to evaluate students' perceptions of pharmacy practice courses and their opinions about whether their current knowledge of the topics covered in pharmacy practice courses is adequate for future practice. METHODS: A cross-sectional study was conducted over two months among the senior pharmacy students of two pharmacy colleges. A content- and face-validated questionnaire was used to collect data, which were then analysed using SPSS version 20. Descriptive analysis and logistic regression were performed. RESULTS: Research in pharmacy practice (30.2%), applied drug information (34.4%), health policy (38.1%), public health and epidemiology (39.5%), pharmacovigilance (45.6%), and pharmacoeconomics (47.9%) were the major courses that were covered to the least extent in the PharmD curriculum. However, hospital pharmacy practice (94.4%), pharmacotherapeutics (88.8%), and community pharmacy practice (82.8%) were covered well. Although 94% of students considered these courses important, only 37.2% considered themselves to be competent in the corresponding topics. Of the participants, 87.9% agreed that the pharmacy courses in the present curriculum should be redesigned. CONCLUSION: Our results showed that the pharmacy practice courses in the current PharmD curriculum do not encompass some important core subjects. A nationwide study is warranted to further establish the necessity for remodelling pharmacy practice courses in Pakistan.
Cross-Sectional Studies ; Curriculum ; Delivery of Health Care ; Economics, Pharmaceutical ; Education, Pharmacy ; Epidemiology ; Health Policy ; Humans ; Logistic Models ; Pakistan* ; Pharmacies ; Pharmacovigilance ; Pharmacy* ; Public Health ; Students, Pharmacy*

PURPOSE: The goal of this study was to compare the knowledge and attitudes of pharmacy and medical students regarding adverse drug reactions (ADRs), as well as their perceptions of barriers to ADR reporting, in a Higher Education Commission-recognised Pakistani university. METHODS: A cross-sectional study was conducted among final-year pharmacy (n=91) and medical (n=108) students in Pakistan from June 1 to July 31, 2014. A self-administered questionnaire was used to collect the data. The responses of pharmacy students were compared to those of medical students. RESULTS: Pharmacy students had a significantly better knowledge of ADRs than medical students (mean+/-SD, 5.61+/-1.78 vs. 3.23+/-1.60; P<0.001). Gender showed a significant relationship to knowledge about ADRs, and male participants were apparently more knowledgeable than their female counterparts (P<0.001). The attitudes of pharmacy students regarding their capability to handle and report ADRs were significantly more positive than those of medical students (P<0.05). In comparison to pharmacy students, a lack of knowledge of where and how to report ADRs was the main barrier that medical students perceived to ADR reporting (P=0.001). CONCLUSION: Final-year pharmacy students exhibited more knowledge about ADRs and showed more positive attitudes regarding their capacity to handle and report ADRs than final-year medical students.
Cross-Sectional Studies ; Drug-Related Side Effects and Adverse Reactions* ; Education ; Female ; Humans ; Male ; Pakistan* ; Pharmacovigilance ; Pharmacy* ; Students, Medical* ; Students, Pharmacy