Introduction The receptor activator NF-κB ligand (RANKL) and Osteoprotegrin (OPG) single nucleotide polymorphisms (SNPs) have been associated with the risk of breast cancer to bone metastasis. This study was designed to investigate the association of RANKL and OPG gene polymorphisms with breast to bone metastasis in Pashtun population of Khyber Pakhtunkhwa, Pakistan. Materials and methods A total of 215 participants were enrolled containing 106 breast cancer patients, 58 breast to bone metastasis and 51 age and gender matched healthy controls. RANKL (rs9533156) and OPG (rs2073618, rs3102735) polymorphisms were genotyped in genomic DNA, using Tetra-ARMS PCR protocol. The results were analyzed among the three groups and P-value less then 0.05 were considered statistically significant. Results Our results displayed significant association of OPG (rs3102735) risk allele and corresponding genotypes in breast cancer vs healthy controls, bone metastasis vs healthy controls and breast cancer vs breast to bone metastasis as a disease risk. However, there was no association observed for OPG (rs2073618) risk allele and corresponding genotypes with the diseases risk. Similarly, RANKL (rs9533156) risk allele and corresponding genotypes in breast cancer vs healthy controls, bone metastasis vs healthy controls and breast cancer vs breast to bone metastasis exhibited significant association except for the risk allele carrying genotypes in breast to bone metastasis. Conclusion OPG (rs3102735) and RANKL (rs9533156) exhibited significant association with breast to bone metastasis while OPG (rs2073618) didn’t show significant association with breast to bone metastasis in Pashtun population of Pakistan. However, this study unlocks more questions to investigate the exact scenario of genetic predisposition of breast to bone metastasis.
Introduction: One of the most habitually utilized appraisal instruments that action the learners' presentation in work environment is the mini-Clinical Evaluation Exercise (mini-CEX), in which a specialist notices and rates the genuine exhibition of residents. A few essential examinations have assessed the adequacy of mini-CEX by evaluating its educational and psychometric properties. Purpose: The main aim of this study was to discuss the attributes, MINI-CEX scores, its parameters, issues and suggestions through perception of the respondents. Methodology: This was a prospective observational study from January 2019 to November 2020. Thirty faculty and 30 residents from Department of Urology Institute of Kidney Diseases HMC Hayatabad medical Complex Peshawar 2000 had relations with tertiary consideration community partook in this exercise. The data was collected through interview. Findings: The analysis has been done through SPSS version 22, Sample Size Software correlation and t-test on parameters, comparison on instruments etc. Conclusion: faculty scores higher in all aspects of the variables such as interview, physical examination, professionalism, clinical judgement, counselling, organization, and overall competence. It was tracked down that the senior faculty gave higher capability scores and better by and large satisfaction scores in contrast with their residents.
Aim: The goal of this study is to characterise the appearance of posterior urethral valves and evaluate the effectiveness of their treatment in settings with limited medical resources. Methods: The Department of Urology at lrh Peshawar performed a retrospective, descriptive research between Jan 2019 and Jan 2021. The presentation, duration of symptoms, complications, and treatment outcome were all considered. Results: There were 460 patients in total. Approximately three years old was the midpoint [02 days–10 years]. The average time from the onset of symptoms to diagnosis was [2.4 years]. 400 (90%) individuals reported urosepsis; 160 (34%) patients showed unilateral or bilateral reflux; 70 (16%) patients presented with big decompensated bladder, and 80 (18%) patients presented with substantial renal insufficiency. The radiological results verified the presumptive diagnosis of the posterior urethral valve. All patients underwent a cystoscopy and valve fulguration; some underwent further vesicostomy or ureterostomy procedures. Conclusion: According to the study, late presentation is common in our setting. High rates of illness and death are linked to this. The medical community must work toward greater awareness and earlier diagnosis to slow the epidemic.
Introduction: Renal cell carcinoma accounts for 90% of all cases of kidney cancer. The major treatment option available is radical Nephrectomy with 93% survival rate. In the literature, partial nephrectomy, nephron sparing surgery and cryoablation all have been mentioned with similar effects. The unavailability of cryoablation in a third-world country like Pakistan has forced urologists to undergo Nephron Sparing Surgery. Objective: To assess the nephrological and oncological outcomes of nephron sparing procedures in individuals with single functioning kidney and renal tumor. Methodology: This retrospective study was piloted at the Department of Urology & Transplantation, Institute of Kidney Diseases Peshawar for duration of eight years from 2012 to 2020. There were 45 patients enrolled in our study. All the required information was collected on a predesigned Performa. Data analysis was carried out by using IBM SPSS version 24. Results: In the current study, 45 patients with a solitary functioning kidney and renal tumor were selected. There were 39 (86.67%) males and 6 (13.33%) female patients in our study. The serum urea and creatinine levels in 44 (97.78%) patients were normal, while one patient had a preoperative creatinine level of 3.1mg/dl. Oncocytoma was the only tumor in which creatinine levels were improved after surgery. Only one patient with T3 disease developed liver metastasis and died after 38 months of surgery with normal urea and creatinine levels. There had been no recurrence, progression, or metastasis in 44 patients (97% percent). Conclusions: Nephron sparing surgery is equally effective in terms of Nephrological and Oncological outcomes in patients having solid renal tumors in solitary functioning kidneys. Keywords: Nephrological, Oncological, Outcome , Renal tumors, Clear cell carcinoma
Background:"I fear the man who has practised one kick 10,000 times." Lee Bruce This aphorism highlights the growing importance of simulation in postgraduate urology training, especially during the COVID 19 pandemic, when all teaching and training activities were stopped, jeopardising postgraduate residents' education. Postgraduate residents must perform hours of surgical training to overcome urological learning curves. According to study, residents educated on simulators boost their summative scores. By introducing simulation to urology training in a way comparable to the well-known Halsted apprenticeship model, the current study emphasises the hybrid model of IKD. Objective: to compare the formative assessment results between residents taught on simulators and residents in the conventional apprenticeship model on factors of communication skills, technical competence, and overall capacity to conduct procedure on OSAT and DOPS. Material & Methods: from 2019 to 2021 this comparative study was conducted in the Department of Urology by Team C at the Institute of Kidney Diseases Peshawar. Group A (10 residents) and Group B (10 residents, 5 from the second and third years) received STEPS method OT instruction in the first phase. These simulators were used to impart knowledge to Group "B" Harvey for counseling and medical examinations Simulator for PCNL The second phase included a six-month training assignment swap between the two groups. A standard QSAT and DOPS proforma was used to evaluate each resident. Data analysis was done using SPSS 24.0. Results: Residents in Group A, who were originally exposed to the conventional technique, considerably outperformed Group B on Harvey (mean: 50.5; standard deviation: 2.21.1) in terms of communication skills, professionalism, and ethical concern during the first phase (p 0.001). However, the Group p0.05 shown considerably higher technical proficiency and overall process performance capacity. The mean technical skill and overall capacity to finish the process had a somewhat positive association in phase 1 in favour of group B (r=0.630, p 0.01). All QSAT and DOPS metrics significantly improved in the second phase. However, both groups did not vary significantly (p> 0.05). According to Pearson coefficient correlation, both groups considerably overcame their gaps in technical proficiency, communication skills, and procedural competence. (P= 0.001) Results are shown in Figures 1 through 06 and Tables 1 through 2. Conclusion: To improve the standard of urology residency in Pakistan, a hybrid paradigm that includes both simulation and actual performance is necessary. Keywords: simulation, education, learning, skills, innovation, urology
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