In total, 513 medical students (66% female) participated. Their mean age was 21 ± 1.6 years. Three hundred seventy-five students (73%) reported having visited a doctor at least once in the past 6 months. Fifty students (9.9%) admitted to having addictions. The overall prevalence of significant hypochondriacal concerns was 11.9% (61 students). The presence of addiction was associated with a greater likelihood of developing significant health-related anxiety (odds ratio = 3.82, p = .003), 95% confidence interval [1.51, 7.11]. Age, gender, medical school, year of medical school, and visits to the doctor in the previous 6 months were not associated with greater likelihood of developing significant health-related anxiety. Second-year medical students experienced a significantly greater degree of worry (MSD-Distress scale) than 5th-year students (M score = 12.6 ± 4.6 vs. 10.7 ± 4.4, p = .04). Insights: The prevalence of substantial hypochondriacal concerns in medical students in Pakistan was low in comparison to similar studies published in literature. Student health physicians should be aware of the true prevalence of hypochondriacal concerns and behavior and not dismiss legitimate complaints. Educational sessions to counteract this phenomenon can be incorporated into the curriculum of undergraduate medicine. By defining heightened awareness of symptoms as a normal process, different coping techniques can be discussed to help medical students reduce their level of stress.

Dengue fever (DF) is an acute febrile illness that follows a self-limiting course. However, some patients suffer from complications, including myocarditis, due to the involvement of other organs. A child presented at the Aga Khan University Hospital in Karachi, Pakistan, in June 2013 with a high-grade fever, malaise and epigastric pain radiating to the chest. Positive DF antigen and immunoglobulin M assays confirmed the diagnosis of DF. Persistent bradycardia with low blood pressure led to further cardiac investigations which showed a decreased ejection fraction and raised serum cardiac enzymes, indicating myocardial damage. With supportive care and use of inotropes, the spontaneous normalisation of cardiac enzyme levels and ejection fraction was observed. The child was discharged five days after admission. This case highlights the importance of identifying myocarditis in DF patients suffering from cardiac symptoms that are not explained by other potential aetiologies. Awareness, early suspicion and supportive care are essential to ensure favourable outcomes.

A 9 year old girl presented to us with complaints of fever and pain in burn wounds with deteriorating health for one month. According to Lund and Broder's chart, burns spanned the posterior trunk (13%), right arm (1.5%), left arm (1.5%), and buttocks (2.5%). The wounds showed improper healing. She had previously underwent split-thickness skin grafting, using skin harvests from thighs and antimicrobial therapy with vancomycin, fluconazole and colomycin with limited clinical improvement. Analgesia was administered. Blood cultures and tissue cultures from the burns indicated polymicrobial wound infection and sepsis, including methicillin resistant Staphylococcus aureus, Klebsiella pneumoniae and Pseudomonas aeruginosa. Despite broad-spectrum antibiotics, fever persisted and condition deteriorated. Antifungals were also administered with no clinical improvement. Eventually another split-thickness skin grafting was done to provide fresh grafts. In due course, ultraviolet light exposure, of wavelength 32-40 nm/W/cm 2 , was considered for treatment. In prone position, the wounds were exposed to ultraviolet phototherapy 6-8 h daily for 8 days. Eventually, wound healing and sepsis improved. Antibiotics were optimized and high protein diet was started. Eventually the wounds showed fresh margins and visible signs of healing. With remarkable clinical improvement and no further fever spikes, the patient was eventually discharged. She was advised to shower regularly, apply bandages with acetic acid. On her last outpatient follow up, 2 weeks after discharge, she was doing well, with no complaints of pain or fever. Examination of burns showed clean wounds, with clear margins and good graft uptake. She did not require any further grafting or surgical procedures thereafter.

Introduction: Obesity has been established as a major risk factor for a number of non-communicable diseases and over the year's multiple strategies have been directed at addressing this issue including minimally invasive procedures like laparoscopic sleeve Gastrectomy, specifically with an end goal of weight reduction for the morbidly obese. This procedure has become the preferred choice for both patients and physicians over the past few years. Laparoscopic sleeve Gastrectomy was introduced at our center recently; we have carried out a retrospective review of charts to evaluate this procedure short-term outcome at our center in our local population. Methods: A retrospective Cohort study, based on a record review for the treatment outcome of laparoscopic sleeve gastrectomy, was carried out at the department of surgery, Aga khan University Hospital, Karachi over a three-year period since its inception and analyzed in June 2015 using SPSS version 20. Results: A total of 17 patients fulfilled the inclusion criteria, out of which 12 were females (70.6%). The mean age of study participants was 41.53 years. Only one patient had undergone liposuction previously for weight loss. The most common comorbidities observed were diabetes mellitus (23.6%), hypertension (23.6%) and polycystic ovarian syndrome (17.7%). A statistically significant mean reduction in excess body weight of 28.9±14.90 Kg, CI 21.27-36.59 was observed along with reduction in BMI at 1 year with a mean difference of 11.1±5.38 Kg/m 2 , CI 21.27-36.60. Results were further analyzed for reduction in percentage excess body weight which showed a mean reduction of 43.6% for the study participants. Co-morbidity improvement was seen as reduction in systolic blood pressures in 9 patients (52%) though these were not found to be significant. Conclusion: Laparoscopic Sleeve Gastrectomy shows great potential for the Indian sub-continent population, especially for patients requiring rapid weight loss for better health outcomes, although long term follow up and out comes will determine the effectiveness of the procedure over extended periods and its role as a first line intervention for obesity.