Unilateral Thyroid Lobectomy as Day Care Procedure: A Cross Sectional Study with Literature Review on the Safety and Cost Effectiveness

Abstract Introduction Thyroid nodules are common globally in almost one fifth of the adult population. The gold standard treatment for thyroid nodule is thyroid lobectomy or total thyroidectomy depending upon the diagnosis. Thyroidectomy has a few known complications but, as per the ATA consensus statement, it is a safe surgery to be done as a day care procedure. Objective To access the feasibility and safety of thyroid lobectomy as a day care surgery and its effect on decreasing overall financial burdens. Methods This retrospective chart review was done from 2006 to 2022. A total of 736 patients underwent thyroid lobectomy among which only 56 were done as day care surgery. Data analysis was done using the IBM SPSS Statistics for Windows, Version 23.0 (IBM Corp., Armonk, NY, USA). Results A total of 40% of the population was male. The mean age of the study population was 42 years. Bethesda II was the most encountered diagnosis, with a rate of 69%. The majority of patients were discharged after 6 hours of postoperative observation. The only complication encountered was seroma, which was seen in two patients. Conclusion Thyroid lobectomy appears to be a safe procedure with a drastic difference in overall cost as a day care procedure. We recommend switching the practice of inpatient thyroid lobectomy to a day care procedure in carefully selected candidates. The major hurdle in day care lobectomy can be approval from insurance.

Reliability and validity of floor transfer test in subjects with idiopathic Parkinson’s disease

@#Objective: To determine the validity and reliability of the floor transfer test (FTT) in people with Parkinson’s disease (PD). Methods: The sample was 25 subjects with PD. The concurrent and convergent validity of FTT was determined by correlation with scores of timed up and go test (TUG), movement disorder society- unified Parkinson’s disability rating scale-III [motor component] (MDS-UPDRS), Schwab and England activities of daily living scale (SEADL). The intra rater reliability (ICC 3, 1), SEM, MDC, Bland & Altman limit of agreement (LOA) were determined. Results: FTT scores were positively correlated with TUG (ρ= 0.59, p=0.02), MDS UPDRS III (ρ= 0.69, p=0.001) and negatively correlated with SEADL (ρ= -0.79, p=0.001) showing moderate concurrent and convergent validity. ICC (3,1) was 0.92, SEM and MDC were 1.28 and 3.54 respectively. Conclusion: FTT is a valid and reliable tool to assess functional mobility in people with mild PD.

Synthesis, characterization, and in vitro release of oxytetracycline loaded in pH-responsive CaCO3 nanoparticles

Alternative drug delivery for the treatment of resistant bacterial infections is necessary to bypass existing antibioticresistance mechanism and ensure direct delivery of the drug to the targeted site using locally sourced materialsto minimize cost in the long term. In this study, cockle shell-derived calcium carbonate aragonite nanoparticles(CS-CaCO3NP) was synthesized, loaded with oxytetracycline (OTC), and characterized using Zeta analysis,Transmission electron microscopy (TEM), FESEM, X-ray Diffraction (XRD), Fourier Transform Infrared (FTIR) andBrunauer–Emmett–Teller analysis. The loaded OTC-CS-CaCO3NP was further characterized after which the in vitrorelease of OTC was studied. A homogenously spherical CS-CaCO3NP was observed on TEM with a mean diameter of29.90 nm and −19.9 zeta potential which increased to 62.40 nm and −23.5, respectively, after OTC loading. XRD andFTIR analysis of OTC-CS-CaCO3NP revealed that OTC maintained its functionality and crystallinity. The formulationof OTC:CS-CaCO3NP in ratio 1:4 with drug encapsulating efficiency (71%) was used for in vitro release studies.OTC was sustainably released from OTC-CS-CaCO3NP over a period of 96 hours. Our results suggest that OTC-CSCaCO3NP is a promising nanoparticle antibiotic delivery system with efficient physicochemical and pharmacologicalproperties whose antibiotic properties should be further investigated.

Toxoplasmosis in an immunocompetent patient

Toxoplasmosis is an obligate intracellular, food borne parasite disease with variable clinical presentation. Although the neurological presentation of toxoplasmosis in immunocompetent patients is uncommon, broad differential diagnosis should be kept in consideration when attending to similar patients. Twenty years old man with no known co-morbid conditions presented with fever and unilateral limb weakness for three weeks. It increased gradually, associated with altered level of consciousness for the last five days, diagnosed as acute toxoplasmosis. MRI Brain showed multiple ring enhancing lesions in frontal, parietal and temporal lobes. Serology for toxoplasmosis denoted raised IgM levels 36IU/mL [cut off value > 18IU/ mL]. This case report describes the clinical presentation and management of neurological toxoplasmosis in immunocompetent patient. Early diagnosis and prompt management can resolve the symptoms at an earlier stage

Frequency of depression among patients with Type-I diabetes in a developing country, Pakistan

Objective: To determine the frequency of depressive symptoms among young people with Type-I diabetes

Methods: This cross sectional study was conducted at Baqai Institute of Diabetology and Endocrinology, Karachi, Pakistan from February to December 2015. All People aged between 12-20 years with Type-I diabetes for at least 1 year attending the OPD were included in the study. Information about participants' demographic characteristics, co morbidities and Complications, current treatment and medications were obtained. Acylated hemoglobin [HbA1C] levels were checked in all People. The Center for Epidemiologic Studies Depression [CES-D] scale was used to assess the depressive symptoms in the study participants. A cut off value of >/= 16 was used to screen for depression. SPSS 19 was used to analyze the results

Results: Out of 104 people with Type-I diabetes, depressive symptoms were observed in 44 [42.3%] participants. Depressive symptoms were more frequent in females [28/55, 50.9%]. Depressed people had more episodes of DKA [11/44, 25%], hypoglycemia [12/44, 27.3%] or hospitalization [7/44, 15.9%] in the last six months which were not statistically significant

Conclusion: Depressive symptoms are quite common in people with Type-I diabetes. Health care professionals should consider screening youth with diabetes for depression regularly. Further large scale studies are needed to validate our findings

Bacteriological study of bile in patients with cholelithiasis

Objective: To determine the aerobic microbial flora in bile of patients having cholelithiasis

Methods: Study included seventy patients of cholelithiasis, out of which 56 [80%] underwent open cholecystectomy, while 14 [20%] were operated by laparoscopic cholecystectomy. Bile for culture was taken per operatively in all patients

Results: Mean age of patients was 44.17 +/- 13.20 and majority of patients were in age group 35- 72. Female to male ratio was 3.4: 1. Pain in right hypochondrium was major presenting feature in 65 patients [93%]. Mean pain duration was 26.21 +/- 23.44 months. Bile culture was positive in 25 [36%] patients.13 [62%] culture positive patients were diabetics. Postoperatively 7 patients [10%] developed fever while 4 patients [5.7%] developed wound infection

Conclusion: SThe frequency of positive bile culture in patients of cholelithiasis was 36%, in this series, commnest organisms being E. coli and Klebsiella. Wound infection 5.7% could have been due to endogenous or exogenous contamination. As all patients who developed wound infection were culture positive in this series, peri-operative antibiotic prophylaxis is recommended in patients undergoing biliary surgery

Pakistan's Recommendations for Optimal Management of Diabetes from Primary to Tertiary care level [PROMPT]

Pakistan is a developing country with limited resources and diverse socio-economic standards. Pakistan has high prevalence of diabetes and its complications, which is a great challenge to the existing health care system. National action plans for control of diabetes have been developed and initiatives have been taken but not at an ideal pace. First National Practice Guidelines for Pakistan were published in 1999. It was very helpful in standardizing the management of Type-2 diabetes. In view of important developments in the field of diabetes during the recent years, it was felt that 1999 National Clinical Practice Guidelines edited, should be revised. Also with rapidly increasing number of diabetic patients and the escalating burden on health economy, it is essential to develop a primary to secondary / tertiary care referral system. These guidelines are developed after an extensive research and cover many aspects of diabetes management. This special communication is an extract of a PROMPT document that has already been published as a Supplement in Pakistan Journal of Medical Sciences in 2017. We hope that these guidelines will help in improving the diabetes care in Pakistan

Prevalence and susceptibility patterns of bacteria causing respiratory tract infections in North Waziristan, Pakistan

Respiratory tract infections [RTIs] are the most common infectious diseases in humans and are the major cause of mortality and morbidity in Pakistan. These infections are the leading causes of consultations in primary care in Pakistan. Therefore, this study was aimed at determining bacterial pathogens of respiratory tract infections and the susceptibility patterns of bacterial isolates to antibiotics. The study was conducted between February, 2013 and March, 2014 in North Waziristan region of Pakistan. Sputum specimens were collected aseptically from 227 patients and cultured on the appropriate bacteriological media. Bacterial isolates were identified by biochemical tests and their antibiotics susceptibility patterns were determined by standard methods. Out of 227, various species of bacteria were isolated from 152 [75%] specimens. The prevalence of bacteria species isolated were as follows Pseudomonas aeruginosa [42.8%], Streptococcus pneumoniae [26.7%], Corynebacterium diphtheria [10.6%], Staphylococcus aureus [5.9%], Proteus vulgaris [4.6%], Micrococcus species [3.3%], Klebsiella pneumoniae [2.6%] and Bacillus species [2.6%]. The susceptibility patterns varied among bacterial species depending on the antibiotics. For the susceptibility test 11 commercially available antibiotics against bacterial isolates were used. The results revealed that generally the bacterial isolates were susceptible to gentamicin [80.9%], meropenem [75%], ceftazidime [62.5%], cefotaxime [57.9%] and ceftriazone [57.9%] and resistant to penicillin [84.9%] and doxycycline [78.9%]. The antibiotics gentamicin [100%] meropenem [100%], ceftriaxone [58.5%], ciprofloxacin [60%] trimethoprim [60%], ceftazidime [66.2%] and cefotaxime [64.6%] were observed effective against the P. aeruginosa isolates. The findings of our study provide significant information for empiric therapy of patients with RTIs in North Waziristan region of Pakistan

Effect of angiotensin converting enzyme inhibitoron glomerular hyperfiltration in patients with type 1 diabetes

Objective: To assess the effect of angiotensin converting enzyme inhibition on glomerular filtration rate [GFR] in normotensive patient with type 1 diabetes

Methods: A two year non-placebo control prospective study was conducted after ethical approval at Diabetes Centre of Diabetic Association of Pakistan, a WHO collaborating centre in Karachi, Pakistan. All patients with type 1 diabetes visited the out-patients department from August 2009 till July 2011 and those who fulfilled the inclusion criteria were invited to participate. A total of 121 people aged >/=18 years and >/= 5 years of diabetes were included. Pregnant and lactating woman and those aged <18 years were excluded. GFR was calculated by using CKD-EPI formula [eGFR] at baseline and after two year. On the basis of estimated GFR, patients at baseline were divided according to KDIGO classification of chronic kidney diseases into, hyperfiltration [eGFR >/= 100 ml/min] and normal filtration group [eGFR < 100 ml/min]. All subjects in hyperfiltration group received ACE inhibitor [treatment group] while patients with normal filtration did not receive ACE inhibitor [control group]

Results: Fifty two patients [43%] were in the treatment and sixty nine [57%] were in the control group. At baseline eGFR, systolic and diastolic blood pressures between groups were non-significantly different. After two years, compared to baseline, eGFR of the treatment group declined and the control group increased significantly. No significant difference in systolic while diastolic blood pressure of the treatment group increased significantly after two years compared to baseline. In contrast both systolic and diastolic blood pressure of control group increased significantly after two years compared to their baseline values

Conclusion: Present study demonstrated that initiation of ACEI in hyperfiltration stage declined GFR and keep blood pressure within normal range

Framingham risk score in impaired glucose tolerant population: a sub analysis of diabetes prevention and awareness program of Pakistan

Objective: To assess the 10-year risk of coronary artery disease [CAD] in subjects with impaired glucose tolerance [IGT] using Framingham risk score

Methods:Data for this study was collected from Diabetes Prevention and Awareness Program. Primary prevention team visited different primary health care centers, factories, service organizations and offices within Karachi, Pakistan. IGT was diagnosed according to World Health Organization criteria after taking informed consent. Information regarding social-demography, dietary habits and physical activities were obtained by a designed questionnaire on one-to-one based interview. Framingham risk score [FRS] was used to assess risk of developing CAD

Results:A total of 315 subjects with IGT were recruited for the study. Mean age of subjects was 44.1 +/- 9.8 years and mean BMI was 27.3 +/- 5.0 kg/m[2]. Overall, 31.4% of the participants were at risk of having CAD. Males were 6.4 times and hypertensive subjects were 2.44 times more likely to have CAD in next 10 years

Conclusion:According to the findings of the study, male and hypertensive IGT subjects were more likely to develop CAD in next 10 years. Community based awareness programs are needed to educate people regarding healthy lifestyle in order to reduce the risk of IGT and CAD

1, 25-dihydroxyvitamin D3, a potential role player in the development of thyroid disorders in schizophrenics

Objective: The present study was designed to assess the role of vitamin-D, in the development of autoimmune thyroid dysfunction in newly diagnosed schizophrenics

Methods: For the present study 100 patients and 100 controls were screened out and studied for their thyroid antibodies, GSH, homocysteine, NOS and vitamin D levels by appropriate protocols to assess the underlying mechanism involved in the schizophrenics susceptible to autoimmune thyroid diseases

Results: The results of the present study depicted that in schizophrenics, levels of cytokines like IL-6 [7.98 +/- 0.67 pg/ml], TNF-alpha, [40.76 +/- 6.98 pg/ml], homocysteine [16.98 +/- 1.09 micro mol/L], Tg-Ab [30.93 +/- 3.87 IU/L], TPO-Ab [10.33 +/- 1.78 IU/L] and TSHr-Ab [3.76 +/- 0.055 IU/L] increased whereas, those of Vit-D [12.76 +/- 0.99 pmol/L], NOS [5.99 +/- 0.87 IU/L], GSH [4.48 +/- .965 micro g/dl] and NO [16.87 +/- 3.98 ng/ml] were decreased in the patients as compared to healthy control subjects

Conclusion: Vitamin-D in schizophrenia is involved in augmentation of hyperhomocysteinemia, inflammation, oxidative stress and thyroid antibodies, thereby playing a significant role not only in induction of schizophrenic symptoms but may also result in autoimmune thyroid diseases. Thus, earlier detection and rectification of its levels are helpful to limit the miseries of schizophrenia

Chemotherapy alone or combined chemotherapy and involved field radiotherapy in favorable risk early-stage classical Hodgkin lymphoma - a 10 years experience

Objective: To determine the outcome of patients with early-stage [stage I-II] favorable risk classical Hodgkin lymphoma treated with chemotherapy alone or combined modality treatment [CMT] utilizing chemotherapy and involved field radiotherapy

Methods: This retrospective study was done at Department of Medical oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan from January 2004 to December 2013

Results: There were 101 patients, with male predominance [71.3%]. Mean age was 34 years. Sixty three [62.4%] patients received CMT and 38 [37.6%] patients had chemotherapy alone. Ninety eight percent patients had ABVD chemotherapy. Dose of radiotherapy ranged from 20 to 36 gray. Difference between baseline characteristics and major toxicities among the two groups was insignificant. Patients treated with CMT had better overall survival compared to chemotherapy alone: 100% versus 91% at five years and 96% versus 81% at 10 years, respectively [p=0.03]. Progression free survival was also better with CMT against chemotherapy alone at five years [98% versus 81%] and 10 years [82% versus 71%] [p=0.01]

Conclusion: Favorable risk classical Hodgkin lymphoma patients had better overall survival and progression free survival when treated with CMT against chemotherapy alone

Eye donation: awareness in urban population of Pakistan: an analysis

Objectives: To evaluate the awareness and willingness of an eye donation among urban population of Pakistan

Methodology: A cross sectional study was conducted among urban population of Pakistan to access the awareness and concern about eye donation. For this a convenient sampling technique was used and a self-administrative questionnaire was administered. Participants were selected from 3 provinces and 5 major cities of Pakistan. A total of 1520 responded, 52.6% were males and 47.4% were females

Results: 530[66.2%] out of 800 male and 463[64.3%] out of 720 female participants were aware about eye donation. Willingness to donate eyes after death was only seen in about 54/800 [6.7%] males and 58/720 [8%] females. Mass media, television, radio were the most common source of information for both male 342/800 [42.7%] and female 316/720 [43.8%] regarding eye donation. At the end nobility was treated the most common influencing factor for both male 102/800 [12.7%] and female 145/720 [20%] participants

Conclusion: Awareness of eye donation among urban population was not found to be adequate and the willingness for eye donation is too much low. This may be because of lack of high literacy rate in Pakistan, no government eye banks, very few NGO's eye bank and lack of eye donation awareness campaigns

effective role of provided by puppet theater for children

Problem: Through her work in the field of theater, the present researcher has noticed that there is no interest in Puppet Theater in spite of the significant role it can provide for children, owing to the powerful influence a puppet can have on the child

Importance: The importance of Puppet Theater lies in its ability to make us monitor the role provided for the child by this type of theater through attracting the attention of those responsible for the child's education to the importance of using Puppet Theater in the educational process. It also makes them pay attention to the importance of using Puppet Theater in the learning process. In addition, those who are responsible for the acculturation of the child should pay attention to the importance of using Puppet Theater in the cultural process

Aims: The study aimed to recognize the effective role provided by Puppet Theater for children

Sample: This study focused on Puppet Theater provided for children from age 3 to age 15 years

Methodology: The study employed the documentary survey method. It then defined Puppet Theater, its origin, importance and types. The study also presented the international experiments in the field of Puppet Theater, showing the parties of the communication process in Puppet Theater and referring to some previous studies which were concerned with Puppet Theater and its effective role for children

Results: The present study concluded with a group of findings: Puppet Theater is considered one of the important media that can be used to improve the child's awareness, Puppet Theater can help the child to retain information on the long run, and Puppet Theater is a significant medium for advising and guiding children

Recommendations: The study recommends the following; The need for the coordination between educational, artistic and therapeutic institutions to benefit from Puppet Theater in the development of the child in all fields, the need for adopting this artistic form by institutions and theater bands, and Holding on-going training courses for the those who work in the field of Puppet Theater

Surgical trainees and HIV/AIDS; perception and associated fear

Objective: to access the level of awareness regarding HIV/AIDS among surgical trainees of Pakistan and the fear associated of getting transmitted while working in a healthcare setup

Materials and Methods: a cross sectional study was conducted at 10 hospitals in Sindh. The study was conducted on surgical trainees in those hospitals and a self-administered questionnaire was administered during the period of Jan-August 2015. Chi Square test was applied and P-values were commuted to find the significance. The data was analyzed by SPSS 17

Results: the questionnaire was administered to 400 surgical trainees of whom 310 opted to participate. The level of awareness regarding HIV was significantly high in both male and female surgical trainees, however in comparison females had a greater level of awareness about the treatment [30%], modes of transmission [100%], and knowledge regarding dealing with needle prick injuries [96%] as compared to male trainees. However lack of knowledge about the HAART therapy was seen among both male [26%] and female surgical residents [30%]. Moreover majority of both male [58%] and females [87%] surgical trainees had the point of view that government is not taking affective steps to counter the fight against HIV/AIDS

Conclusion: in spite of significant general knowledge about HIV and its prevention yet lack of knowledge was seen about HIV treatment i.e. HAART therapy in surgical trainees of Pakistan. Furthermore the Pakistani government needs to take proper initiatives to increase the awareness and to counter the fight against this fatal disease

Kidney donation, preference and determinants in Pakistan

Objective: Pakistan has a dual burden of communicable and non-communicable diseases. The major indication of renal transplantation is end stage renal disease due Diabetes and hypertension, which is also a cost effective treatment significantly decreasing mortality and morbidity in these patients

Material and Methods: this cross-sectional study was carried out in Pakistan to determine the level of awareness among the general population regarding kidney donation and their willingness to donate. The total number of participants who completed a questionnaire was three thousand five-hundred and twenty. 56% were male while 44% female. The sample included people of all ages from all educational and ethnic backgrounds

Results: among participants 63.5% were found to be aware regarding kidney donation and 46.6% showed a willingness to donate to a first degree relative [FDR]. Only 11.5% were willing to donate to someone other than a FDR. Females were found to be more willing to donate to both a FDR and a non-FDR with a male to female ratio of 0.7 [95% C.I]. A small percentage [16.7%] albeit important believed organ donation should be declared illegal

Conclusion: awareness regarding kidney donation and educational status were found to be linked, with people educated at a higher level having greater knowledge about the topic. All stakeholders need to develop a comprehensive strategy to decrease the overall health burden of end stage renal disease and promote legal renal transplantation

Association of SNP rs9939609 in FTO gene with metabolic syndrome in type 2 diabetic subjects, rectruited from a tertiary care unit of Karachi, Pakistan

To determine the association of SNP in FTO gene, rs9939609, with Metabolic Syndrome [MS] in type 2 diabetic subjects at a tertiary care unit of Karachi, Pakistan. We genotyped FTO rs9939609 SNP in 296 patients with type 2 diabetes from the Out Patient Department [OPD] of Baqai Institute of Diabetology and Endocrinology [BIDE]. MS was defined on the basis of International Diabetes Federation [IDF] and National Cholesterol Education program [NCEP]criterion. Association between the rs9939609 SNP and MS was tested through chi-square and Z-tests by using odds ratio [OR] with 95% confidence intervals. The frequency of MS as defined by IDF criterion was significantly higher in female subjects as compared to male subjects [p= 0.006]. Carriers of ? 1 copy of the rs9939609 A allele were significantly more likely to had MS [69.6%] than non-carriers [30.4%], corresponding to a carrier odds ratio [OR] of 0.52 [95% confidence interval [CI] [0.29-0.93], with a similar trend for the ATP III-defined MS."A" allele carriers under dominant model, carry all the criterion of MS more significantly as compared to non-carriers. The FTO rs9939609 SNP was associated with an increased risk for Metabolic Syndrome in type 2 diabetic populations at a tertiary care unit of Karachi, Pakistan

Differences in various biochemical and clinical parameters with respect to family history of non communicable diseases in fourth year MBBS students of Karachi, Pakistan

To observe the differences of various biochemical and clinical parameters with respect to Family History [FH] of Non-communicable Diseases [NCDs] in fourth year Bachelor of Medicine, Bachelor of Surgery [MBBS] students. This observational study was conducted at Baqai Institute of Diabetology and Endocrinology from December 2013 to January 2014. Total 50 medical students from Dow University of Health Sciences [DUHS] participated in the study. Statistical Package for Social Sciences [SPSS] version 13 was used to analyze the data. For cross tabulation and mean comparison z-test and t test were applied. Out of 50 subjects, there were 26 [52%] females. Mean age of the study population was 21.56 +/- 0.90 years. Mean serum cholesterol levels with positive FH of NCDs was significantly higher than negative FH of NCDs [p=0.005]. Mean value of low density lipoprotein [LDL] of positive family history of NCDs was found higher than those with negative FH [p=0.006] being statistically significant. The insulin levels in subjects with positive FH of NCDs were higher than subjects with negative FH of NCDs [p=0.685]. However, serum leptin and plasma renin showed no significant difference with the negative FH of NCDs being higher compared to positive FH of NCDs [p=0.068] and [p=0.884] respectively. However, Waist circumference, Body mass index and central obesity in subjects with positive FH of NCDs shows increasing trend but no statistically significant difference [p > 0.05] was observed. In our study of various biochemical and clinical parameters with respect to FH of NCDs, Serum Cholesterol and LDL levels were observed higher and statistically significant

Retinal screening acceptance, laser treatment uptake and follow-up response in diabetics requiring laser therapy in an Urban Diabetes Care Centre

Objective: To determine the acceptance of retinal screening, Laser uptake and subsequent follow-up in diabetic patients attending the Diabetes Centre of Diabetic Association of Pakistan [DAP], Karachi

Study Design: Observational case series

Place and Duration of Study: Diabetic Centre of Diabetic Association of Pakistan [DAP], Karachi, from January 2011 to December 2012

Methodology: All the diabetic patients were screened for Diabetic Retinopathy [DR] with non-Mydriatic Fundus Camera [NMFC]. Patients with DR were examined by the ophthalmologist using fundus lens and slit lamp. DR was graded for severity on the basis of modified Airlie House Classification. Patients with Sight Threatening Diabetic Retinopathy [STDR] were advised Laser treatment. Each patient was followed-up for at least 6 months. The records of patients recommended Laser were retrieved, and called for re-examination

Results: Retinal screening was accepted by all of the 8368 registered diabetics attending DAP Centre. On fundus photography, 21.2% [1777] individuals were found to have DR. Seven hundred and five [39.5%] patients were found to have STDR. Laser was advised to 96.4% [680] of STDR patients; amongst whom 70.5% [480] accepted Laser treatment. Out of 480 patients who had Laser treatment, 21.2% [107] turned out for follow-up after 6 months

Conclusion: Acceptance of retinal screening and Laser application was good; but follow-up was suboptional

Massive retroperitoneal mass - giant schawanoma

Schwannoma are usually solitary, slow growing, and non-aggressive neoplasms usually found in head and neck region. Retroperitoneal Schawanoma especially large sized are rare and difficult to diagnose clinically. We are discussing a 43 years old lady, who presented with huge reteroperitoneal mass of left side, treated successfully