Frequency of early post operative complications of modified radical mastectomy within period of four weeks

Background: Most of the complications are developed after modified radical mastectomy in breast cancer patients, hence to avoid and reduces the postoperative complications, this study is performed to identify the frequency of early post-operative complications of modified Radical Mastectomy within the period of four weeks.Methods: Cross-sectional case series using non-probability convenient sampling technique was conducted in surgical unit I of Tertiary care hospital, for 1 year from 15 January 2018 to 14 January 2019. 89 patients FNAC proved breast cancer were included, patients that received neoadjuvant chemo or radiotherapy or with inflammatory breast cancer, metastasis and with co-morbid were excluded. After taking consent patients were operated by senior consultant. Follow up was taken daily 7th post-operative day and then followed in OPD on weekly basis fourth week and final outcome was noted. SPSS version 23 was used for data analysis. Quantitative data was reported as frequency in percentages.Results: Total 31 patients developed complications during the study, accounts 34% of total patients. The most common complication was breast seroma in 12(13.48%) of cases with an increased risk in cases of age >50 yr, size of tumor >8 cm, weight >70 kg and increased number of lymph nodes [3 or above] palpable after wards hematoma in 6(6.74%), lymphedema in 5(5.62%), wound infection 4(4.49%) and shoulder dysfunction in 4(4.49%) patients, no patient was found scar hypertrophy.Conclusions: Seroma formation, hematoma were found most common early complications after modified radical mastectomy, lymphedema, wound infection and shoulder dysfunction were observed in small number of patients.

Efficacy and safety of yellow light diode laser 577nm for treatment of melasma patients in Sulaymaniyah city

Background: Recent evidence suggests that angiogenetic factor involved in the pathogenesis of melasma. Yellow light laser which emits 577 nm may has effect on dermal vasculature and may be of benefit in the treatment of melasma

Objective: To evaluate the efficacy and safety of yellow light laser 577 nm for the treatment of melasma in Fitzpatrick skin types II-IV in both male and female patients

Methods: Thirty three patients with melasma were enrolled, from which 30 patients completed the study [5 males, 25 females], age range of [20-40] years, duration of melasma between [2-10] years. They all are either dermal or mixed according to Wood's light examination, Each patient received 2 sessions of yellow light laser 577 nm treatments to the face at 4 weeks interval. The treatment fluency ranged from 10-15 J/cm2, with the pulse duration of 100 ms for skin type II, III, and 120 ms for skin type IV. Clinical parameters included patient self assessment of changes in the pigmentations after each treatment session and 8 weeks after the last session and two investigators independently evaluated Melasma Area and Severity Index [MASI] score before each session and 8 weeks after the last session

Result: Mean MASI score decreased dramatically after treatment from 18.6 +/- 7.5 before treatment to 7.6 +/- 4.5; eight weeks after the last treatment, with a P-value < 0.001 which is statistically significant. Patient´s self assessment revealed that 14 of the patients were experienced excellent improved, 10 of the patients moderately improved, 4 of the patients mildly improved, no patients had no changes and 2 of the patients develop post inflammatory hyperpigmentation

Conclusion: The use of yellow light diode laser 577nm is an effective and safe treatment option for the demal and mixed type of melasma in both males and female patients with Fitzpatrick skin types II-IV

Frequency of negative autopsy and their demographic evaluation at Khyber medical college, Peshawar

This study was planned to see the frequency of negative autopsy against the total autopsies performed during the period. This descriptive study was conducted at the Department of Forensic Medicine and Toxicology, Khyber Medical College, Peshawar and was based upon autopsy data of 10 years with effect from January 1997 to December 2006. In this study fresh or minimally decomposed bodies with no external or internal injury were included. In cases where gross examinations, microscopic examination, toxicological analysis failed to detect the cause of death were labeled as negative autopsies. In a total of 7082 autopsies, 103 [1.45%] autopsies were found to be negative. Out of these negative autopsies, 89 [86.40%] were males and 14 [13.60%] were females. The age of deceased ranged from 6-75 years with mean age of 43.81 +/- 16.95 years. Majority i.e. 17 [16.5%] were in the age range of 31-35 years, followed by 15 [14.5%] in the age range of 51-55 years. Ten [9.7%] were in the age range of 46-50 years and 21-25 years each. Among these negative autopsies, 66 [64.1%] were from urban and 37 [35.9%] were from rural areas of district Peshawar. Majority of negative autopsies were of young male persons from urban areas. Negative autopsies need further studies to look for possible reasons like inadequate training of doctors performing the autopsy or limited resources like availability of histopathalogical or analytical services etc

Rectal malakoplakia presenting as a mass ad fistulous tract in and renal transplant patient

Malakoplakia [MK] is a rare, chronic inflammatory disorder with characteristic morphologic features. It most commonly involves urogenital organs but can affect any organ system in the body. Gastrointestinal tract is the second common site of involvement. It commonly occurs in nontransplant patients but transplant patients are also vulnerable to it. We present a case report of a forty year old male renal transplant patient, who received a kidney from his brother with 1 haplotype and 4 antigen match. He was on regular post transplant follow up with stable graft function. Fifteen months post transplant he presented with the complaint of painful defecation, a swelling in the perianal region and inability to sit down properly. Biopsy examination showed malakoplakia with characteristic Michaelis-Gutmann bodies. Culture of the tissue grew E Coli. Immunosuppression therapy was curtailed and patient was started on ciprofloxacin 500mg OD for 6 months. The lesions regressed completely after six months of the above therapy and the patient became completely symptoms free