Carcinoma breast; late presentation facts and factors

To evaluate the factors responsible for the late presentation of carcinoma of breast in Pakistani women. Prospective, Cross sectional, Interventional. Women Medical Complex Sialkot and Surgical Unit II. Aziz Bhatti Shaheed [Teaching] Hospital. Nawaz Sharif medical College, University of the Gujrat. Study. January 2009 to June 2012. A total of 87 patients of all age groups with carcinoma of breast were enrolled in this study. Mean age of presentation with breast cancer was 43 years. Stage III carcinoma breast was the most common presenting stage seen in 56 [64.36%] women. Socio economic status, delay in presentation and diagnosis, fear of mastectomy and its social consequences found to be major factors in the late presentation of carcinoma of breast. There is need to launch cancer public health campaign mechanisms, should include teaching of Breast Self Examination [BSE] to patients, Clinical Breast Examination [CBE] to health workers. Strenuous efforts should be made to break the vicious cycle of late presentation, poor treatment outcome and reluctance of patients to present to health facilities because of social mindset

Non-traumatic lower extremity amputations in diabetics

The purpose of this study was to estimate the prevalence of non -traumatic lower extremity amputations in diabetic in peripheral teaching hospital catchment area. Prospective, Cross sectional, Interventional. Surgical Unit II. Aziz Bhatti Shaheed [Teaching] Hospital. Nawaz Sharif medical College, University of the Gujrat. February 1, 2011 to January 31, 2012. A total of 132 patient were subjected to non traumatic lower extremity amputation were enrolled in this study out of which 89 [67.42%] were diabetic, followed by non specific infections n=39 [23.48] Out of 89 total diabetic patients 53 [40.15%] patients were female whereas 36 [27.27%] were male. Both major and minor non traumatic lower extremity amputation rate was more in female diabetic patients than male diabetics. The prevalence of non -traumatic below knee amputations at an early age is high in our diabetic patients, especially in female population. By improving primary health care service regarding foot care awareness in diabetics appears to be the main way to reduce the amputation rate

Hemorrhoidectomy VS rubber band; comparison of post operative complications

To compare open hemorrhoidectomy and Rubber Band Ligation [RBL] in the management of 2nd and 3rd degree hemorrhoids in terms post operative and hospital stay. Experiential Randomized Control Trial. Department of surgery, Allied Hospital and Independent University Hospital Faisalabad. Dec 2008 to May 2009. 100 consecutive patients with second and third degree hemorrhoids were randomly divided into two groups. Group A [50 patients] were operated by open hemorrhoidectomy [Milligan morgan technique] while in group B [50 patients] rubber band ligations was performed. Open hemorrhoidectomy was performed under spinal anesthesia while rubber bands were applied with local xylocaine gel using Barron's rubber band ligator. All the three hemorrhoids were ligated in single session. Average hospital stay was 24 hours in patient operated by open hemorrhoidectomy as compared to one hour in rubber band ligation. 60% patients in group A developed moderate to severe pain requiring I/V morphine derivatives while 40% developed mild pain and treated with NSAIDS. In group B only 20% patients developed moderate pain and were dealt with I/M diclofenac sodium. Eightyeight percent patients in group A and 60% patients in group B developed mild to moderate bleeding in first postoperative week, which was self limiting. 6 patients developed severe bleeding after hemorrhoidectomy requiring blood transfusion. During six month follow up, two patients [4%] of open hemorrhoidectomy and 3 patients [6%] of RBL presented with recurrence and respective procedures were repeated. Rubber band ligation is safe, quick, economical and effective method for the treatment of 2nd and 3rd degree hemorrhoids

Optimal timing for surgery in acute gall stone disease

Laparoscopic cholecystectomy is the gold standard treatment for patients presenting with acute gall stone disease necessitating hospital admission. To assess the impact of timing of laparoscopic cholecystectomy on conversion rate, hospital stay and morbidity. Jan 2008-2010. Department of Surgery, Independent University Hospital, Faisalabad. Experimental study. The subjects were included by consecutive sampling technique. 81 cases were divided into 3 groups. Group A [Surgery within 72 hrs of onset symptoms]. Group B [surgery between 72hrs to 96 hours of onset of symptoms]. Group C [surgery after 96 hours of onset of symptoms]. The mean age was 41-95 years. Female to male ratio was 4.5:1. The overall complication rate was 12.69%. Mean hospital stay was 2.85 days. The open conversion rate was 8.64%. In group A the complication rate was 6%, group B 11.5% and group C 12.8 and. The mean hospital stay and conversion rate had no significant difference. The timing of laparoscopic cholecystectomy has no significant impact on the conversion rate and length of hospital stay in cases with acute cholecystitis. However the complication rate was higher when surgery performed after 72 hours of onset of symptoms

Problem based learning: are our entry level medical students ready

Objectives: To assess the self-directed learning readiness of entry level medical students in public and private medical colleges of Faisalabad

Study Design: Cross sectional study

Place and Duration of Study: All three Medical colleges of Faisalabad [One public and two private] during March, 2010

Methodology: A questionnaire based on 58 items Guglielmino scale for self-directed learning readiness was distributed to Year I students of Medical Colleges in Faisalabad. The forms contained a demographic data portion at the end. The questionnaires were distributed at the end of regular lecture and completed by students in 30 minutes. Incomplete questionnaires were excluded from the analysis

Data Analysis: Analyzed by using statistical software SPSS version 15

Results: Out of received 307 questionnaires 220 contained complete fields. These included 150[50% of the class] students from Punjab Medical College [PMC], 43 [43% of the class] from University Medical College [UMC] and 27[54% of the class] from Independent Medical College [IMC]. The mean score at Guglielmino scale was 203. While there was no statistical difference in the mean scores of the colleges [PMC=205, UMC=208, IMC=196] the score was in Category -Average? for PMC and UMC and -Below Average? for IMC as described in -Guglielmino scale?. There were 16 out of 58 items which showed significant statistical difference among colleges

Conclusion: The self-directed learning readiness of entry level medical students as assessed by Guglielmino scale is shown to be borderline. This factor needs consideration before adoption of the problem based learning. Addition of a component for enhancement of this skill appears to be required in the reformed curriculum of undergraduate medical education for maximizing learning

Hydrocele; surgery vs. sclerotherapy

A hydrocele is an abnormal collection of serous fluid within the tunica or processes vaginalis. It is treated by surgery and sclerotherapy. To compare the results of surgery and sclerotherapy in the treatment of scrotal hydrocele. Randomized control trial. Department of Surgery, Allied Hospital, Faisalabad; Period: April 2001 to March 2002. 50 consecutive male patients with provisional diagnosis of hydrocele. Patients stratified into three age groups and each stratum equally and randomly divided into two groups for sclerotherapy [A] or surgery [B]. 1% Sodium tetradecyle sulphate [STD] was used as sclerosant after aspiration of hydrocele. Surgical procedures used were Jaboulay's, Lord's and subtotal excision. Follow up done for three months. Age range was from 15 to 75 years. Hydrocele was right, left and bilateral in 56%, 42% and 2% patients. Postoperative complications included pain [24% and 20%], hematoma [8% and 12%], infection [8% and 12%], recurrence [40% and 12%] and complications related to anesthesia [0% and 36%] in group A and B respectively. Results of sclerotherapy and surgery for hydrocele are comparable with advantage of economy and convenience for sclerotherapy. However, larger study is recommended with comparison between different sclerosants to find the best one with high success rate and minimum complications

Optical internal urethrotomy for the treatment of urethral strictures

Aims and Objectives: To study the outcome of optical internal urethrotomy in the treatment of urethral strictures. Study Design: Prospective. Setting: Allied Hospital, Faisalabad. Period: April 1996 to Dec. 1998

Patients and Methods: A total of 70 consecutive male patients ranging from 5-80 years treated with optical internal urethrotomy for stricture urethra were included in the study. Follow up ranged from 12 to 30 months

Results: Trauma was the most common cause of urethral stricture. Fracture pelvis alone was responsible for 43% of the strictures while straddle injury accounted for another 23%. The incidence of iatrogenic and infective stricture was found to be 26% and 8% respectively. The results of optical internal urethrotomy were excellent in 61% patients who were treated with single internal urethrotomy. Internal urethrotomy was to be repeated in 21% patients and urethroplasty was performed in 9% patients. Clean Intermittent Self Catheterization and active urethral dilatation was applied as adjuvant treatment to prevent the recurrence of stricture

Conclusions: Internal Urethrotomy is safe and reliable procedure for simple urethral strictures while urethroplasty should be considered for complex strictures. Active urethral dilatation at repeated intervals still has a role in preventing recurrence of stricture after initial treatment with internal urethrotomy or urethroplasty