Thyroid-like follicular carcinoma of kidney: Case presentation and literature review

Thyroid follicular carcinoma like renal tumour (TFCLRT) is a rare variant of primary renal epithelial tumour and was first reported in 2006. Up till now, 40 cases have been identified worldwide and alarmingly, 17 cases have been identified from China only. The condition has been included in the WHO Renal Tumours Classification 2016. We present here the first case of thyroid follicular carcinoma like renal tumour from Pakistan that was managed in our surgical unit and a literature review. Left-sided radical nephrectomy was performed through a midline incision. The left kidney was removed along with intact Gerota fascia, left adrenal gland and lymph nodes alongwith aorta.

An Experience Of Percutaneous Peritoneal Drainage In High-Risk Perforated Peritonitis In General Surgical Ward Of Tertiary Care Hospital Lahore, Pakistan

BACKGROUND

Although conservative treatment has shown a good reduction in mortality and morbidity the majority of patients still need definitive surgery to get rid of the disease completely. It is of note that immediate laparotomy in high-risk patients who have a prolonged history or have multiple comorbidities or in organ failure is not advisable as it is associated with higher morbidity and mortality, besides improved postoperative intensive care.

METHODS

We categorized these high-risk patients based on their comorbidities and then performed percutaneous peritoneal lavage to reduce the septic load from the peritoneal cavity before performing the definite procedure.

RESULTS

Out of the high-risk patients who survived after the PPD and underwent definitive surgery, 61% survived (n=8/13) while the rest of these, 38.5% expired (n=5).

CONCLUSION

Percutaneous peritoneal drainage initially instituted in high-risk patients to optimize their pre-op condition significantly, improves the outcome and has better results than to operate on such patients straightaway.

Promoting green behavior through ethical leadership: a model of green human resource management and environmental knowledge

Purpose

This paper aims to investigate the influence of supervisor's ethical leadership style on subordinates' green or pro-environmental work behavior in the presence of green human resource management (GHRM) as a mediator and environmental knowledge as a moderator.

Design/methodology/approach

A questionnaire-based was distributed to 427 supervisor–subordinate dyads working in various Pakistani organizations. Structural equation modeling was used to determine the mechanisms and boundary conditions in the relationship between supervisor's ethical leadership style and subordinates' green behavior.

Findings

Structural equation modeling supported a partial mediating role of GHRM in the influence of ethical leadership on green work behavior. Further, the findings revealed that employee's environmental knowledge can magnify the indirect impact of ethical leadership, via GHRM, on green behavior.

Research limitations/implications

Cross-sectional survey data are typically associated with common method bias. To counter this bias, we collected data from dual sources, namely, supervisors and their subordinates. The research findings have implications in deepening the understanding of the impact of ethical leadership in improving environmental performance of the organization.

Originality/value

This is the first study that utilizes multi-sourced data to examine the mediating role of GHRM and the moderating role of environmental knowledge in the relationship between ethical leadership and green behavior at work.

Transmigration of an intrauterine device into sigmoid colon-surgical management: A case report

We present the case of a 30 years old woman who had an Interauterine Device placed in a fragile uterus (puerperal period) 5 years ago and presented with dull abdominal pain and disturbed bowel habits. Failure to pull out IUD strings on gynecological examination made us suspicious of translocated IUD and its ectopic placement in sigmoid colon was confirmed on colonoscopy and a CT abdomen with contrast. The transmigrated IUD was removed following laparotomy.

How ethical leadership stimulates academics’ retention in universities

Purpose

The purpose of this paper is to investigate the relationship between ethical leadership and academics’ retention in universities. It draws on the conservation of resources theory to deepen the understanding of a process underlying this relationship whereby academics are more likely to stay in universities through the practice of ethical leadership. Specifically, it advances academics’ job-related affective well-being as a potential mediating mechanism, fostered by ethical leadership, which lowers their intention to leave.

Design/methodology/approach

This study is conducted through a cross-sectional survey of 303 academics in Australian universities. Univariate, bivariate and multivariate analysis procedures are deployed to analyse academics’ data. The research hypotheses are tested through a bootstrapped regression analysis of academics’ perceived ethical leadership, affective well-being and intention to leave.

Findings

The findings lend support to the hypothesised relations, indicating a significant role of ethical leadership on enhanced intentions of academics to stay in universities by directly conserving their job-related affective well-being.

Research limitations/implications

This paper contributes to knowledge of the relationship between ethical leadership and academics’ retention by identifying job-related affective well-being as an underlying mechanism in the university sector.

Practical implications

This paper has practical implications for higher educational institutes seeking to retain their academic staff. Its findings show that the practice of ethical leadership in universities matters, because it lowers academics’ intentions to leave by nurturing their well-being at work.

Originality/value

This is the first study to examine the impact of ethical leadership on academics’ well-being and intentions to leave in the context of universities in Australia. It is one of the first studies to explore the mediating role of affective well-being in the ethical leadership and leadership and intention to leave relationship.

What a Trainee Surgeon Should Know About Refeeding Syndrome: A Literature Review

Refeeding syndrome (RFS) is potentially fatal, yet there is limited understanding regarding its management among general surgeons due in part to a lack of universally accepted guidelines for RFS diagnosis. The aim of this review is to equip general surgery trainees with the essentials of RFS including a review of the National Institute for Health and Care Excellence (NICE) best practice guidelines for RFS. We used the keywords "refeeding", "syndrome", and "hypophosphatemia" to search PubMed, Embase, and Medline databases. We reviewed approximately 130 indexed papers for relevance. Having profound knowledge of nutritional needs in critically ill patients will help trainee surgeons prevent illnesses in the spectrum of RFS, and, over time, this would immensely contribute to reducing the morbidity and mortality associated with RFS.

Academics’ perceptions of bullying at work: insights from Pakistan

Purpose

Despite an extensive history of research into workplace bullying and the psychosomatic harm associated with it in western contexts, research into the occurrence and manifestation of bullying behavior in the academic workplaces of non-western countries is sparse. In response to this gap, the purpose of this paper is to start a research conversation by reporting an empirical enquiry into the occurrence, forms and perceptions of workplace bullying among academics in Pakistan.

Design/methodology/approach

This study was conducted with a representative sample of academics in a large Pakistani province through a cross-sectional survey.

Findings

This study reveals that workplace bullying is prevalent among academics in the Pakistani context, with up to half of them regularly exposed to practices such as excessive work monitoring, undermining of professional competence, lack of recognition of work contributions and obstruction of important work-related matters.

Research limitations/implications

The findings underscore the need for developing broader institutional actions, clear policies and grievance procedures to discourage bullying at work in Pakistan. Higher educational managers will find the results useful for development of anti-bullying policies and codes of conduct.

Originality/value

This is the first study to examine the perceptions, occurrence and demographic risk factors associated with workplace bullying among academics in the Pakistani context.

Paraspinal Extraosseous Ewing's Sarcoma With Disseminated Metastases Masquerading As Pott's Spine

A 16 years old girl presented with low back pain, fever and weakness in both lower limbs for 3 months. Plain radiograph shows lytic lesion in first sacral vertebra and multiple lung nodules. In suspicion of tuberculosis, antitubercular drugs were advised. But magnetic resonance imaging revealed right paraspinal soft tissue mass with multiple lesions in several vertebrae causing spinal canal compression alongwith lesions in iliac bones, sacrum, lung parenchyma and scalp tissue. Fine needle aspiration cytology and biopsy revealed Ewing’s sarcoma. Patient was referred to higher centre for chemotherapy/radiotherapy. Herein we report this rare case of extraosseous Ewing’s sarcoma with disseminated metastases masquerading as Pott’s spine. Bangladesh Journal of Medical Science Vol. 12 No. 03 July ’13 Page 334-338 DOI: http://dx.doi.org/10.3329/bjms.v12i3.15447

Factors contributing to lack of interest in research among medical students

BACKGROUND

Research experiences early in the medical student's education are an important factor for attracting a greater number of doctors to careers with a research component.

OBJECTIVE

To determine the factors contributing to a lack of enthusiasm about research activities among medical students, and to suggest ways to help students develop an interest in research.

DESIGN

A medical institution-based, case-control study was conducted. A case was defined as any fourth year medical student who believed that undertaking research was not interesting; controls were matched for age and sex. A pretested, structured, and self-administered questionnaire was used; the data were analyzed using statistical methods.

RESULTS

In all, 122 students (54% male, 46% female) were recruited to the study. Factors found to be significant were lack of Internet facilities (odds ratio 0.218) and considering research useless (odds ratio 4.570).

CONCLUSION

Measures should be taken at undergraduate level to involve students in research activities. Ensuring easy access to Internet facilities could be one positive step. Further research should be done to explore the reasons why some medical students consider research useless.

The effects of renal transplantation on circulating precursor dendritic cells

BACKGROUND

Dendritic cells (DCs) are potent antigen-presenting cells that induce and regulate immune responses. Recent advances allow accurate quantification of peripheral blood (PB) myeloid and plasmacytoid DC populations (mDC and pDC, respectively), although the response to renal transplantation (RT) remains unknown.

METHODS

Using flow cytometry, PBDC levels were quantified in patients with end-stage renal disease (ESRD) undergoing renal transplantation.

RESULTS

PBDC levels were significantly reduced in ESRD patients pretransplantation compared to healthy controls, with further reduction noted immediately following a hemodialysis session. RT resulted in a dramatic decrease in both subsets, with a greater reduction of pDC levels. Both subset levels were significantly lower than in control patients undergoing abdominal surgery without RT. Subgroup analysis revealed significantly greater mDC reduction in RT recipients receiving antilymphocyte therapy, with preferential binding of antibody preparation to this subset. Samples from later time points revealed a gradual return of PBDC levels back to pretransplant values concurrent with overall reduction of immunosuppression. Finally, PBDC levels were significantly reduced in patients with BK virus nephropathy compared to recipients with stable graft function, despite lower overall immunosuppression.

CONCLUSIONS

Our findings suggest that PBDC levels may reflect the degree of immunosuppression in renal allograft recipients. Furthermore, PBDC monitoring may represent a novel strategy to predict important outcomes such as acute rejection, long-term graft loss, and infectious complications.