Pathological Hip Dislocation in a Neurofibromatosis Patient Secondary to Capsular Hemangioma.

Neurofibromatosis is an autosomal-dominant multi-system disease affecting the nervous, integumentary, ocular, and musculoskeletal systems. In the small number of reported cases, the cause was either atraumatic or an intra-articular neurofibroma. Only a couple of articles in medical literature have reported synovial and capsular hemangioma originating within the hip joint. In this article, we present a rare case of pathological hip dislocation in a neurofibromatosis patient secondary to capsular hemangioma that would be reported for the first time in medical literature. We present the case of a 20-year-old female, resident of Karachi, who presented to the outpatient clinic with pain in the left hip join and inability to bear weight on left leg for 1 week. Diagnosed as a case of posterior hip dislocation after physical examination and imaging, her dislocation was reduced by the Allis method. This maneuver, however, was unsuccessful. Ultimately, the joint was reduced with open reduction via Steinmann pin because post-reduction hip joint was unstable to be contained into the acetabulum; therefore, Steinmann pin was used. The biopsy specimen taken from joint capsule and femoral neck during the surgery revealed cavernous hemangioma within the capsule. Hence, the etiology of posterior hip dislocation was attributed to the presence of capsular hemangioma within the hip joint. The surgery proved successful. The patient had remarkable recovery. The Steinmann pin was removed at 6 weeks, full weight-bearing started at 3 months, and range of motion extended from 0 to 90 degrees at 1 year with imaging studies showing a normally placed hip joint. The presented case reports an unusual etiology of a rare pathology occurring in association with a common genetic disease. It focuses on the importance of thorough examination and extensive relevant investigations in patients presenting with rare pathologies. These practices not only expedite the diagnosis and treatment of such patients, but can also reveal unusual etiologies responsible for uncommon pathologies. This case would help widen the differential diagnosis and treatment strategies of the physicians while dealing with neurofibromatosis patients with pathological hip dislocation. Level of Evidence This is a case report having Level of Evidence 4 in accordance with the levels developed by the Centre of Evidence Based Medicine (CEBM) for treatment.

Cognition improvement strategies, study behaviours and stress among medical students of Dow University of Health Sciences: A cross-sectional study.

OBJECTIVE: To determine the effects of cognition improvement strategies on academic performance, stress and sleep quality of medical students. METHODS: The cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, from March 2019 to March 2020, and comprised medical students regardless of gender and academic year. Academic performance was assessed through grade point average, while stress and sleep were assessed using the Perceived Stress Scale and Pittsburgh Sleep Quality Index. Data was analysed using SPSS 25. RESULTS: Of the 770 subjects, 748(97%) formed the final sample with mean age 20.32±1.49 years; 619(82.7%) females and 129(17.2%) males. Overall, there were 655(87.6%) consumers of cognitive enhancers and 93(12.4%) non-cunsumers. The mean Pittsburgh Sleep Quality Index score of consumers was 6.05±3.306, while that of non-consumers was 5.80±3.701. The respective mean Perceived Stress Scale scores were 21.18±6.09 and 20.5±6.8. There was no significant association of consumption of cognitive enhancers with academic performance and stress levels (p>0.05), but it was significant with sleep quality (p<0.05). CONCLUSIONS: Majority of the students were found to be consuming cognitive enhancers, but no significant association of the stimulants was found with either academic performance or stress.

The effects of bariatric surgery on male and female fertility: A systematic review and meta-analysis.

•Currently natural lifestyle modification is recommended over bariatric surgery in the management of infertility in obese men and women, despite natural weight loss often being an ineffective method to both lose and maintain weight loss in these individuals.•Through this meta-analysis and systematic review, we provide evidence that bariatric surgery effectively improves fertility outcomes for men and women by measurements of hormone levels and improvements in sexual function index scores.•This study demonstrates the importance and even cruciality of bariatric surgery in obese men and women who struggle with reproductive health, especially when finding it difficult to lose and maintain weight. It also proves that it is vital to continue to create and expand our knowledge with evidence-based medicine to help this cohort of patients.