Neurobiological mechanisms invoking the release of endogenous opioids and depression of stress hormone release are believed to be the basis of acupuncture analgesia. This study compared plasma beta-endorphin and cortisol levels with self assessment scores of intensity of pain, before and after 10 days of electro-acupuncture treatment in patients suffering from chronic pain as a result of osteoarthritis knees. Forty patients of either sex over 40 years with primary osteoarthritis knee were recruited into a single-blinded, sham-controlled study. For electro-acupuncture group the points were selected according to the Traditional Chinese Medicine Meridian Theory. In the sham group needles were inserted at random points away from true acupoints and no current was passed. Both groups were treated for 10 days with one session every day lasting for 20-25min. Pre- and post-treatment Western Ontario and McMaster Universities (WOMAC) index of osteoarthritis knee and Visual Analogue Scale (VAS) for pain were recorded and blood samples were taken for the measurement of plasma cortisol and beta-endorphin levels. Following electro-acupuncture treatment there was a significant improvement in WOMAC index and VAS (p=0.001), a significant rise in plasma beta-endorphin (p=0.001), and a significant fall in plasma cortisol (p=0.016). In conclusion electro-acupuncture resulted in an improvement in pain, stiffness and disability. Of clinical importance is that an improvement in objective measures of pain and stress/pain associated biomarkers was shown above that of a sham treatment; hence demonstrating acupuncture associated physiological changes beyond that of the placebo effects.

Vagal paraganglioma is a rare finding that develops from paraganglionic tissue found around the vagus nerve; it has a prevalence of 0.012% of all tumors. It is the third most common paraganglioma of the head and neck but still accounts for less than 5% of these tumors, and it has a well-established female prevalence. It is a difficult tumor to identify early based on its symptoms alone and only a thorough investigation can help solidify its diagnosis. In this report, we discuss a presentation of this phenomenon that is not only unique in its manifestation but also a very difficult diagnosis due to its deceptive presentation and multiple extensions. These masses need a good surgical regime to be removed properly and postoperative complications are very frequent in most of these cases.

Introduction: Since the outbreak of the Ebola virus, its design has constantly been evolving to serve the purpose of protection without hampering the efficiency. In a study conducted in 2019, before the advent of COVID 19, it was found that performing precarious laboratory or clinical works while wearing PPE involved various restrictions compared to the same work without PPE.  The objective of this study is to identify the influence of personal protective equipment on physiological parameters and the individual wellbeing of healthy workers. Methods: This Pilot Quasi-experimental study was performed on 12 volunteers fitting the inclusion criteria. Candidates were seated comfortably and their baseline resting pulse rate, respiratory rate, oxygen saturation via pulse oximeter, blood pressure, and End-tidal CO2 were recorded via a portable monitor. All candidates were asked to wear a KN95 mask along with a 3 ply mask over it and wear anti-fog goggles. All the above-mentioned parameters were recorded again after five minutes of comfortable sitting and ten minutes of brisk walk. Result:   Significant difference is found between resting EtCO2 and after wearing of PPE (P = 0 .044). After a brief exercise, the further rise in EtCO2 is also significant (P = 0.002).  There is no significant rise in pulse after wearing PPE (P = 0.092) but on exertion after wearing PPE, the rise in pulse is statistically significant (P = 0.002). The rest of the variables, such as the rise in respiratory rate, blood pressure, and fall in oxygen saturation rise has no statistical significance. Conclusion: Personal protective equipment has proven to rise in end-tidal carbon dioxide and tachycardia, which can lead to headache, dizziness, and respiratory discomfort. All of the factors can hamper the health care workers' performance and can adversely affect their efficiency.Keywords: covid-19, end tidal CO2, personal protective equipment, physiological

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Objective: To explore the feasibility of assessment of operative skills of FCPS vascular surgery trainees based on video recordings of the surgical procedures with a view to introduce it in the curriculum. Methods: This qualitative study was carried out from 9th April 2021 – 15th July 2021 at Shifa Tameer e Millat University, Islamabad, Pakistan. It is a qualitative study based on constructivist grounded theory. Semi structured interviews of 16 participants, including five vascular surgical trainees, six vascular surgical consultants/supervisors/examiners, and five medical educationists were conducted, recorded and transcribed. Open and axial coding method was employed to identify recurring themes. Results: Six themes could be identified. (1) There was consensus among participants on deficiency in current assessment of surgical skills. (2) Most participants believed that this is a useful method, although four out of 16 participants believed that current methods were sufficient. (3) There was a unanimous opinion that its purpose should be initially formative assessment and later for summative assessment. (4) It was suggested that it is practical with logistic support; it can be made part of trainee’s record to be reviewed later; maybe by independent observers. (5) Participants believed that the logistic issue in term of equipment and trained manpower will be a challenge in implementing this mode of assessment. Other barriers included medicolegal and ethical issue and acceptability by the stake holders. (6) Participants also suggested remedies for the barriers. Conclusion: Video review of surgical procedures can improve assessment of operative skills of trainees provided it is used as formative tool initially with a need to overcome logistics, medicolegal and cultural barriers. doi: https://doi.org/10.12669/pjms.39.1.6737 How to cite this: Bhatti AM, Ahsin S, Mansoor S. Feasibility of video assessment of operative skills in FCPS vascular surgery. Pak J Med Sci. 2023;39(1):---------. doi: https://doi.org/10.12669/pjms.39.1.6737 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.

OBJECTIVE The aim of the study was to  measure the relationship between the type of vascular access and HRQOL in patients undergoing dialysis in a tertiary care hospital STUDY DESIGN Cross-sectional study PLACE AND DURATION OF STUDY Department of Vascular Surgery and Nephrology from January 2021 till June 2021 PATIENTS AND METHODS Data was collected by dialysis center nurse and duty doctors  on patients meeting the inclusion criteria . It was a short form survey 36 ( SF -36 )  questionnaire which included health related quality if life in terms of physical symptoms, social functions and access related complications in last 4 weeks  on a score of 0 to 3 .Higher scores means poorer quality of life. RESULTS A total of 80 patients were recruited in the study. A total of 80 patients participated in the study. Male predominance was observed ( n = 59, 73.8 % ). Mean age was   53 +/−  13.9 . 2. Mean  HRQOL score  in AVF  3.8  +/− 4.8 which was the lowest followed by  tunnelled dialysis catheter ( TDC)  9.7   +/−4.5     and non tunnelled double lumen catheter( NTDC )   11.8  +/−9.1    . CONCLUSION The HRQOL assessment in ESRD patients can inform the medical personnel of the effectiveness of treatment interventions, it also plays an important role in improving patient's care, assessing patient's needs, setting treatment goals and monitoring disease progression.

Objective: to evaluate the knowledge and practice of diabetic patients in terms of the diabetic foot and correlate it with the severity of diabetic foot and limb loss. Study Design: Cross-sectional study Place and Duration of Study: Department of Vascular Surgery, Combined military hospital, Lahore Pakistan, from Jan 2020 to Jan 2021. Methodology: Data was recorded in terms of demographics, knowledge and practice of control of blood sugars and foot care of the patients. SINDBAD scoring was used to assess the severity of diabetic foot and compare it with their knowledge and practice and ultimately as an outcome of their limb salvage. Results: Most patients 171(88.6%) already had a diabetic foot ulcer. Hypertension alone 72(37.3%) was the most common comorbid condition. A large percentage of patients, 108(63%), ultimately ended up with a limb amputation. A higher age and longer duration of diabetes were associated with an adverse outcome of diabetic foot disease. According to the SINDBAD scoring, the assessment of the foot showed the majority 142(73.6%), had lost protective sensation, with the ulcer being greater than 1cm2 in a large number 147(76.2%) of feet. Conclusion: While steps are made for patient awareness related to diabetes and its complications, there is a need to address the decreased applicability of this knowledge by the patients, especially with regard to diabetic foot disease.

Objective : To assess the outcomes in managing patients with chronic kidney disease (CKD) requiring vascular access before and after, a formal vascular surgery fellowship program (VSFP) was introduced in a tertiary care hospital in Punjab. Study Design : Pilot quasi-experimental study. Place and Duration of Study: Department of Vascular Surgery and Nephrology at Combined Military Hospital (CMH) ,Lahore Pakistan, from Feb to Oct 2020. Methodology: Patients meeting the inclusion criteria of ages between 20 to 70 years, either gender and undergoing dialysis due to chronic renal failure were recruited in the study. Data was collected at the initial phase when a VSFP was absent and later when it was present. Outcome variables were current dialysis access, waiting time for permanent dialysis access and failure rate about the duration of chronic renal failure. Results: A total of 226 patients were recruited in the study. In both pre-vascular surgery fellowship program time (pre-VSFPT) and post-vascular surgery fellowship program time (post-VSFPT), the predominant functional dialysis access at the time of the interview was arterio-venous fistula (AVF). However, they were much higher in the post-VSFPT, i.e., 46(54.1%) as compared to 96 (68.1%) (p= 0.069). In addition, in pre-VSFPT, 24 (28.2%) patients had a “Never Created” AVF status at the time of the interview as compared to 21(14.9%) in post-VSFPT, which was statistically significant. Conclusion: The establishment of a fellowship program not only benefits the trainee but it improves patient care significantly. This study highlights the improvement in all the benchmarks of the formation