Association between vitamin D deficiency and breast Cancer

Objective: To determine the association between vitamin D deficiency and breast cancer

Methods: This case control study included 94 female patients aged 20-75 years of any marital status and parity. Newly diagnosed 42 breast cancer patients who presented to surgical OPD of Dow University Hospital from Jan 2016 to June 2016 were included into the study as "cases" after informed consent. Age matched 52 females who presented to OPD for complain other than breast pathology were included as the "control group". The sociodemographic of both cases and controls and histopathological characteristics of cases were recorded. Serum 25-[OH]2D levels were studied by the ELISA technique and recorded in ng/ml. Vitamin D deficiency was considered at serum level less than 20ng/ml

Results: Mean age was 40.1 Years for controls and 47.6 Years for cases. Mean height, weight and BMI did not differ between cases and controls. Serum Vitamin D levels were significantly lower in cases [85.7%] than controls [55.8%]. The unadjusted and adjusted ORs for breast cancer in cases and controls showed a statistically significantly increased risk of breast cancer with low vitamin D concentration [p value0.003]. After adjustment for age, parity, BMI, sun exposure, economic status and education status the ORs [95% CIs] for breast cancer risk was 7.8 [1.99 - 30.58] for women with vitamin D concentrations <20ng/mL

Conclusion: Findings of our study conclude that vitamin D deficiency is associated with risk of breast cancer

Sentinel lymph node identification by blue dye in patients with breast carcinoma

Objective: To determine the diagnostic accuracy of methylene blue dye to detect axillary lymph node metastases in patients with breast carcinoma by taking histopathology as gold standard

Methods: This quasi experimental study was done at Department of Surgery of Dow University Hospital Karachi during January 2013 to September 2015 after the approval of Hospital Ethical Committee. A total number of 85 patients with biopsy proven carcinoma were included in the study. 1% methylene blue dye was infiltrated in the peri tumoural area of the diseased breast. The blue stained node called sentinel lymph node [SLN] was recognized and carefully dissected out. SLN and mastectomy with axillary clearance specimen was sent for histopathology in two separate bottles and the report of the histopathology was compared

Results: The axillary lymph nodes were positive for carcinoma in 61 cases out of 85[71.7%].Two of the patients had negative sentinel lymph node but positive non sentinel lymph node [false negative], and in three cases sentinel lymph node were involved only but not the rest of the axilla [False positive]. The sensitivity, specificity and accuracy were 96.8%, 86.36% and 94.1% respectively

Conclusion: Methylene blue dye technique is a reliable and safe diagnostic modality for detection of Sentinel lymph node in breast cancer patient because of its high accuracy

Comparison of hemorrhoidectomy by ligasure with conventional Milligan Morgan's hemorrhoidectomy

Objective: To compare the efficacy of haemorrhoidectomy done by using LigaSure with conventional Milligan Morgan haemorrhoidectomy

Methods: This randomized controlled trial was done at Department of Surgery Dow University Hospital Karachi during January 2013 to September 2015. A total of 55 patients were included in the study. Patients were randomly allocated to group A [Haemorrhoidectomy by Ligasure] and group B [Milligan Morgan Haemorrhoiectomy]. Efficacies of both procedures were compared by operative time, Blood loss, wound healing, and pain score on immediate, 1st and 7th post operative day

Results: Out of total 55 patients 23 were male and 32 were females. The most common group of age involved was between 40 - 60 years. Third degree Heamorrhoids were present in 37 [67.3%] of patients while remaining 18 [32.7%] had fourth degree Heamorrhoids. Group A included 29 cases while Group B included 26 cases. The mean operating time of Group A was 52.5 with standard deviation of 11.9 while it was 36.6 +/- 9.8 in the other group. The mean blood loss in group A was 51.92 with standard deviation of 15.68 while it was 70.34 +/- 25.59 in group B. Overall pain score was less in those patients who underwent Heamorrhoidectomy by Ligasure method

Conclusion: The efficacy of Heamorrhoidectomy by Ligasure is better than the traditional Milligan Morgan Heamorrhoidectomy but we need more clinical trials with large sample size and long term follow ups

Operations; cancellation on the intended day of surgery

To find out reasons for cancellation of operation on the day of surgery in the Surgical Department of Civil Hospital Karachi. Observational study. All operation theatre bookings of the Civil Hospital Surgical Department from July 2010 to October 2010 have been studied by using the 'daily operating theatre lists'. Frequency of cancellation, type of surgeries cancelled and their reasons studied. Out of total 455 cases, 97 [21%] surgical operations were cancelled on the day of surgery, highlighting patients' non-compliance as a major contributing reason, followed by the lack of operating room time and other causes. Among the less contributing factors were patient expiry on table, failure to administer anesthesia and delay in operation due to exams [engagement of patients in undergraduate exam in the college]. Patients non-compliance is a major challenging factor that causes a large number of cancellations of operations in the Civil Hospital Karachi

Computer based assessment [CBA]: perception of residents at dow university of health sciences

During the past few years, Computer-based assessment [CBA] has gained popularity as a testing modality. This assessment offers several advantages over paper based assessment [PBA] testing. The objective of this study was to find out residents' perception of this method of assessment. The post graduate residents of Dow University of Health Sciences in the field of Surgery, Medicine, Gynecology and Obstetrics experienced their first formative Computer-based assessment [CBA] in year 2013.Immediately after formative CBA, an anonymous paper based questionnaire was distributed amongst the residents and response was sought for their self-perceived computer usage competence before starting residency, perceptions regarding CBA method and to determine their preference for PBA or CBA in future assessment preferences. Total 173 residents completed the questionnaire. More than half of residents, 56.1% had no prior experience of CBA. Three fourth, 76.4% of the residents were less than confident before sitting in CBA, while after completing CBA, 64.8% were either confident or extremely confident for CBA. Most common problem encountered by students was logging in 28.9%. More students [53.2%] believed that paper assessment took longer to complete than CBA. Majority of the students [61.8%] rated CBA as better than PBA despite experiencing it for the first time. Resident's perception for CBA is good and they recommend its use in future assessment as well. However, to take maximal advantage of this technology, faculty should be trained to develop questions not only with text and pictures but with audio and video support

Altered lipid profile in patients with gallstones admitted for cholecystectomy

The cholesterol content is important in classifying gallstones as either cholesterol or pigment stones. Most of the gallstones are cholesterol stones. There is a multifactorial and complex relationship between blood cholesterol, Low Density Lipoprotein, and High Density Lipoprotein levels and cholesterol gallstone formation. Evidence showed that more than half of patients with gallstones have altered serum lipids which are a risk factor for ischemic heart diseases. This study was done to find out frequency of altered lipid profile in patients with gallstones admitted for cholecystectomy at Dow University Hospital Karachi Pakistan. case series study. This study was conducted at the Surgical Unit-2, Dow University Hospital, OJHA Campus, Karachi for a period of 14 months from January 2012 to March 2013. All diagnosed patients of cholelithiasis were included in this case series study. Lipid profile was performed for all patients before performing cholecystectomy. Post operatively gallbladder specimens were sent for histopathology and stones for chemical analysis. A total number of 45 patients were included in this study, out of which 40 were female. The mean age of patients was 47.7 +/- 13.3 years. On chemical analysis, Cholesterol was found in all of the stones. The histopathology of all patients showed chronic cholecystitis. The total mean serum cholesterol level was 199.3 +/- 36.8 , HDL cholesterol was 43.5 +/- 7.7, LDL +/- 23.9 cholesterol was 127.2 +/- 23.9, and triglycerides were 139.1 +/- 37.5. Serum total cholesterol was elevated in 28/45 patients [62.2%], LDL cholesterol was elevated in 26/45 [57.7%], triglycerides elevated in 18/45[40.0 %,] whereas HDL cholesterol was below normal in 16/45 [35.5%] of patients. Most of the patients operated for Lap Cholecystectomy had altered lipid profile. Patients presenting with Cholelithiasis should be investigated for altered lipid profile, which is a major risk factor for developing cardiovascular disease if left untreated

Role of diagnostic laparoscopy in recurrent vague abdominal pain

To determine the role of laparoscopy in the management of recurrent vague abdominal pain. Descriptive case series. Surgical Unit 1, Civil Hospital Karachi, from January 2005 to June 2007. All patients who presented with vague recurrent abdominal pain and underwent laparoscopic surgery to make a definitive diagnosis were included in the study. A total of 60 patients were managed. There were 36 [60%] females and 24 [40%] males. The mean age was 26 year [range 18-58 year]. The common mode of admission was out patient department [73.3%]. Fourteen [23.3%] patients presented with vague abdominal pain in lower Abdomen, followed by 12 [20%] with right lower abdominal pain and 12 [20%] with central pain radiating to right lower abdomen. Diagnosis was established in 56 [93.3%] patients. In 4 [6.6%] patients no pathology was found. The most common diagnosis was inflamed appendix in 18 [30%] patients followed by abdominal tuberculosis in 16 [26.6%] patients. Most [36.6%] of the patients stayed in hospital for 24 hours. There was no readmission and no major postoperative complications. Diagnostic laparoscopy in vague abdominal pain provided a higher diagnostic accuracy and improved treatment. It may be considered as first line operative investigation for undiagnosed vague abdominal pain

quality of surgical case notes using crabel score at Dow university hospital

To find out the quality of medical records in the department of surgery at Dow University Hospital, a tertiary care teaching hospital. Medical records of all patients admitted in surgery department of surgery at Dow University Hospital from February 2012 to April 2012 were reviewed. By analyzing two sets of medical notes, a numerical score out of total 100 was calculated which is used as a representative value of quality; 100 being most accurate. For each omission of any of the criteria of CRABEL score, one point was deducted and the total scores was presented as percentage. The overall CRABEL score was 72.1 in all surgical case notes. Most frequents points were deducted in subsequent entry section with total deduction of 30.3% while least deduction was seen in discharge section with total deduction of 4.4%. Quality of Record keeping in surgical department of surgery is 71% in relation to CRABEL score. Subsequent entry section is the major factor in decrease in the quality of notes

Prevalence of malignancy in resected specimen of patients operated for benign nodular goitre

To determine the frequency of malignancy on histopathology amongst resected specimen of thyroid gland in patients, who had no evidence of malignancy pre-operatively on clinical grounds and investigations. A retrospective descriptive study carried out from Jan. 2000 to Dec. 2005. Surgical Unit one, Civil Hospital, Karachi. A total of 190 patients who were operated for benign nodular thyroid disease during the study period; 100 cases had multinodular goitre and 90 solitary nodules. Biodata, clinical features, investigations, diagnosis, details of surgery, complications and histopathology reports of all the patients were reviewed and analyzed. Amongst the 190 patients the mean age was 33.42 +/- 12.4 years [range l7-45 years], while the male: female ratio was 1:6.6. Seven [3.6%] cases were found to be malignant on histopathology, with a frequency of 3% [3/100] amongst multinodular cases and 4.4% [4/90] amongst solitary nodules. Prevalence of malignancy in multinodular goiter does not differ significantly from solitary nodules. Hence, multinodularity should no longer be considered as an indicator of benign disease. Both varieties of nodular goitres should be considered for surgery even if there is no suspicion of malignancy

Incidence of abdominal tuberculosis presenting with intestinal obstruction

A retrospective study of 27 patients presenting with intestinal obstruction, with a strong suspicion of abdominal tuberculosis on admission was carried out at the surgical unit-3, Civil Hospital, Karachi, during the period of 15 months, from October '99 to December '2000. 20 patients [74 percent] were admitted through the emergency department. Among them 16 [59.2 percent] were females mostly in the 20- 40 age group and 11 [40.7 percent] were males in the 30 to 50 age group. Of the 27 cases 9 were known cases of abdominal tuberculosis on admission. 4 cases [14.8 percent] responded well on conservative management on anti-tuberculous therapy, all of the remaining 23 cases [85.1 percent] underwent surgical intervention. Of these 22 cases were provisionally diagnosed as Abdominal Koch's; the criteria of which were based on clinical presentation, laboratory investigations, and radiology and per-operative findings. The most common operative finding was of the multiple strictures of the small bowel. Out of 23 patients operated for acute intestinal obstruction, 17 cases [73.9 percent] were finally diagnosed as abdominal tuberculosis on histopathology. Segmental resection, bypass procedures, and right hemi-colectomy were the common operative procedures, performed on these patients. Abdominal tuberculosis can be difficult to diagnose pre operatively and thus a delay can affect the proper management and increase the morbidity. So an early diagnosis can make a difference in the prognostic outcome

Incidence of helicobacter pylori associated chronic antral gastritis in patients presenting with dyspeptic symptoms at Sindh Govt. Lyari general hospital

Recent Studies have proved that H. Pylori, found in gastric Antrum of patients with peptic ulcer disease, is now believed to have a pathophysiologic role in Gastritis. Aim of the study was to observe and detect during routine upper G.I. Endoscopic carried out at the S.GLyari Gen. Hospital, in patients presenting with dyspepsia, the incidence of H. Pylori, confirmed by Antral Biopsy method for Urease test or histopathology.diagnostic Upper G.I. Endoscopics were performed on 61 patients presenting with Dyspepsia in the period of 18 months from February '98 to August'99. Routine Antral Biopsies were taken in all patients, in all patients, in which gastritis was seen and urease test done all of them, and biopsy was also sent for Histopathology. Out of the 61 Endoscopies done on patients presenting with symptoms of Dyspepsial Epigastric pain, 30 patients had Antral gastritis [17 were H.Pylori+ve and 13 were H.Pylori-ve], 19 were essentially normal, 02 had duodenal ulcer. Triple Regime Treatment, comprising Omeprazole, Clarithromycin and Amoxicillin was given to H.Pylori+ve patients for two weeks and of these 73.3% responded very well. Incidence of aprox. 56.6% H.Pylori associated chronic Gastritis was observed. The diagnostic methods of upper G.I.Endoscopies plus antral biopsies for HelicoUrease test/Histopathology have high specificity and sensitivity

Incidence of carcinoma of gallbladder discovered on routine histopathology after cholecystectomy for cholelithiasis

This is a retrospective study of 148 patients, seeking for incidence of carcinoma of gallbladder in patients admitted with cholelithiasis in Surgical unit-3, Civil Hospital Karachi, form January 1999 to 2001, all of whom underwent cholecystecomy. Out of 148 patients, 120 [81%] were females [mean age 40 years], 14 [9.4%] were males [mean age 56 years]. The commonest clinical presentation was of upper abdominal pain [93%], followed by flatulent dyspepsia [65%], nausea and vomiting [25%], and palpable gallbladder [17%], jaundice [14%]. Live function tests were altered in 21% of cases, with raised alkaline phospatase in 17%. Utraonography of abdomen was done in all the patients, which showed choleithiasis in 100% of cases, increased wall thickness [7%], irregularity in the wall [4%], CBD dilatation with or without stones in 16% of cases. Laparoscopic Cholecystectomy was done in 72 patients and open cholecystectomy was done in 65 patients. 16 patients had CBD exploration. 08 patients were suspected of carcinoma gallbladder per-operatively. Cholecystectomy plus wedge resection of liver was done in 05 patients and the other 03 suspected cases had simple cholecystectomy. Histopathology of all the above patients revealed inflammatory changes in 138 patients [93%], 10 patients [7%] were diagnosed as stage-I carcinoma of gallbladder on histopathology. Of these 06 came bock for follow up, and no further surgical intervention was offered and treatment was expectant and symptomatic. The incidence of carcinoma discovered on routine histopathology after cholecystectomy for choleithiasis with chollecystitis was 7%