Association Of Liver Fatty Acid Binding Protein With Acute Kidney Injury In Paediatric Patients After Cardiac Surgery.

Background: Acute kidney injury (AKI) is a common complication after cardiac surgery. Like Creatinine level, the role of L-FABP in renal injury and its recovery had been shown by studies, so by using/measuring urinary Liver fatty acid-binding protein (uL-FABP) levels it can be a valuable biomarker for monitoring and diagnosis of various renal diseases. The study aimed to determine L-FABP as a biomarker for early diagnosis of AKI acute kidney injury in paediatric patients after cardiac surgery so that early treatment interventions can prevent AKI morbidity. Methods: This descriptive study was conducted in the Pathology laboratory of Sheikh Zayed Hospital, Lahore from 2015 to 2016. Selected through convenience sampling, patients' blood and urine were analysed for desired markers. Results: Out of 88, 10 (11.4%) patients developed AKI after cardiac surgery. In patients with AKI, serum creatinine levels started to rise at 24-48 h after surgery whereas uL-FABP was to be high at 4h. The optimal cut-off value of uLFABP was found 269 ng/l, with this cut-off value sensitivity of marker at four hours to recognize AKI was found to be 80% and specificity was 83.3%, the positive and negative predictive values were 38.1% and 97.0% respectively with an accuracy level 83.0%. Conclusion: It may be concluded from this study that uL-FABP may be considered as an early predictor of the development of AKI in paediatric patients undergoing cardiac surgery.

Effect of lumbar traction on discogenic low back pain using variable forces.

OBJECTIVE: To determine the effect of variable traction forces on discogenic low back pain. METHODS: The experimental study was conducted at the Department of Physical Medicine and Rehabilitation at the Combined Military Hospital, Okara, Pakistan, from July to December 2018, and comprised patients of low back pain who were randomised into group 1 treated with high-force lumbar traction, hot pack and lumbar stabilisation exercises, and group 2 treated with low-force lumbar traction, hot pack and lumbar stabilisation exercises. There were a 3 sessions per week for 3 weeks for a total of 9 sessions. Modified Oswestry disability index and visual analogue scale were used to measure outcomes. Data was analysed using SPSS 20. RESULTS: Of the 30 patients, there were 15(50%) in each of the two groups. There were 18(60%) females and 12(40%) males, with an overall mean age of 30±5.5 years. Also 18(60%) subjects were obese on the basis of body mass index.There was significant improvement in pain in both groups (p<0.05), while disability scores in group 1 showed more improvement compared to group 2 (p<0.05). Young age was significantly associated with better results (p<0.05). CONCLUSIONS: Use of variable force lumbar traction improved pain in discogenic low back pain, while high-force lumbar traction also reduced functional disability.

Impact of strengthening exercises with and without blood flow restriction on quadriceps of knee osteoarthritis patients.

OBJECTIVE: To determine the effect of blood flow restriction with strengthening exercises on knee osteoarthritis patients. METHOD: The case-control study was conducted at the Department of Physical Medicine and Rehabilitation, Combined Military Hospital, Okara, Pakistan, from June to December 2018, and comprised knee osteoarthritis patients who were assigned to two equal groups. The cases in Group A received strengthening exercises with blood flow restriction, while the controls in Group B received strengthening exercises without blood flow restriction. Both groups were given 4 sessions of treatment per week with 5-minute warm-up on a stationary bike for 4 weeks. Outcome was measured using visual analogue scale, Kujala scoring questionnaire and muscle girth measurement. Data was analysed using SPSS 20. RESULTS: Of the 30 patients, 15(50%) were in each of the two groups. There were 20(66.7%) females and 10(33.3%) men with an overall mean age of 66.5}6.5 years. Also, 18(60%) subjects were overweight on the basis of body mass index. There were significant improvement in terms of pain and disability in both the groups (p<0.05)), but only Group A showed significant improvement in muscle girth (p<0.05). Overall there was no significant difference between the groups (p>0.05). CONCLUSIONS: Strengthening exercises reduced pain and disability, but the addition of blood flow restriction had no significant impact except in terms of muscle size.

Motor impairment and skeletal mineralization in children with cerebral palsy.

OBJECTIVE: To evaluate the bone mineral density and the effect of motor impairment on bone mineral density in children with cerebral palsy. METHODS: The cross-sectional study was conducted at the Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan, from January 2013 to January 2015. Children diagnosed with cerebral palsy were sampled by non-probability purposive sampling from the Cerebral Palsy clinic. On the basis of Gross Motor Function Classification level of motor impairment, the children were divided into mild Cerebral Palsy (level 1 & 2) and moderate to severe Cerebral Palsy (level 3-5) groups. Bone mineral density z-score was measured at lumbar spine with Dual Energy X-Ray Absorptiometry at L1-L4 lumbar vertebra. Data was analysed using SPSS 20. RESULTS: Of the total 108 children selected, 18(16.6%) had to be excluded due to poor nutrition status or deranged serum chemistry, while in 4(3.7%) children Dual Energy X-ray Absorptiometry scan was not done on technical grounds. Of the remaining 86(79.6%) children, 39(45.3%) were males and 47(54.7%) were females. The overall mean age was 6.08±2.89 years and mean bone mineral density z-score was -2.16±0.62. Statistically significant difference was found in bone mineral density z-scores of moderate to severe compared to mild Cerebral Palsy group (p<0.05). Significant difference in bone mineral density z-scores was also found among different levels of Gross Motor Function Classification system of motor impairment (p<0.05). CONCLUSIONS: Cerebral Palsy children had low bone mineral density z-score, especially those who were non-ambulatory.

Effectiveness of Test-Enhanced Learning (TEL) in lectures for undergraduate medical students.

OBJECTIVE: To determine the effectiveness of Test-Enhanced learning as a learning tool in lectures for undergraduate medical students. METHOD: This quantitative, randomized controlled trial included eighty-four students of 4th year MBBS from Yusra Medical & Dental College, Islamabad. The duration of study was from March 2016 to August 2016. After obtaining the informed consent; participants were equally assigned to interventional and non-interventional study groups through stratified randomization. Single best answer MCQs of special pathology were used as data collection instrument after validation. A pre- and post-test was taken from both groups, before and after the intervention, respectively and their results were compared using SPSS version 21. RESULTS: There were 13 male (31%) and 29 female (69%) participants in each study group who showed an equivalent baseline performance on pre-test (p=0.95). Statistically significant difference was found among mean scores of interventional and non-interventional study groups at exit exam (p=0.00). Interventional group also showed a significant improvement in their post-test scores (mean: 17.17±1.59) as compared to pre-test scores (mean: 6.19±1.81). CONCLUSIONS: Test-enhanced learning has significant effect on improving the learning of course content delivered to undergraduate medical students through lectures.

Higher stress scores for female medical students measured by the Kessler Psychological Distress Scale (K10) in Pakistan.

The aim of this study was to determine the stress level of medical students and the relationship between stress and academic year. A cross-sectional, descriptive study was conducted at an undergraduate medical school with a five-year curriculum, in Pakistan, from January 2014 to April 2014. Medical students in the first four years were included in the study. The Kessler Psychological Distress Scale (K10), a self-administered questionnaire, was distributed to the students. A total of 445 medical students completed the questionnaire. The average stress score was 19.61 (SD=6.76) with a range from 10 to 43. Stress was experienced by 169 students (41.7%). The scores of female students were higher than scores of males, indicating a higher stress level (P=0.011). The relationship between stress and academic year was insignificant (P=0.392).