Majority of the population disregards obesity as a health risk: obesity among different socioeconomic strata in Karachi - a hospital case study

Background: Obesity is a chronic disease which requires aggressive management. Obesity, although not a direct cause of most diseases, unfavorably alters the risk factor profile. It may lead to high blood pressures and high cholesterol levels, which can result in cardiovascular diseases or strokes. In addition to these diseases, the quality of life is also severely impaired. Successful treatment of obesity not only alleviates the associated medical problems, but also improves the quality of life dramatically

Objectives: To observe and compare obesity, its perception and complications among different socioeconomic classes in Karachi

Methods: A predesigned questionnaire was filled out at two hospitals of Karachi for a sample representing patients from lower and higher socioeconomic strata. BMI of these patients was calculated and assessed with respect to their income, education level and occupation, eating patterns, frequency of exercise. The presence of associated non-communicable diseases like hypertension and diabetes mellitus was also recorded. Data was analyzed using SPSS software

Results: The patients' population comprised 31 males and 19 females. The mean age was 45.56 [SD +/- 12.08]. Minimum age was 15 years, while maximum was 75 years. Pathological analysis revealed that majority of SCC cases were moderately differentiated, SCC with clinical stage T2 or T3, NO,MO/N1,M0. Most common oral sites came out to be buccal mucosa of cheeks followed by lateral borders of tongue and lips. All patients underwent primary resection +/- neck dissection and reconstruction when necessary

Conclusion: Obesity was observed in all classes irrespective of the education, income and occupation of the respondents with sedentary lifestyle being the main causal factor. There exists lack of awareness of the harmful consequences of obesity

Laparoscopic colonic surgery: early experience

The paper reports early experience with laparoscopic colonic surgery in relation to indications, tumour size, operative time, duration of analgesic requirement postopera-tively, return of bowel activity, postoperative complications and mortality. A multicentre case series study at Jinnah Postgraduate Medical Centre, Orthopedic and Medial Institute, SIUT and South City Hospital between February 2007 and February 2010. Clinical and operative records of all laparoscopic-assisted colonic procedures performed between February 2007 and February 2010 were studied. 80 laparoscopic-assisted colonic surgeries were performed during this period. There were 74 cases of carcinoma, 5 cases of tuberculosis and 1 case of polyp. Laparoscopic-assisted procedures included right hemicolectomy in 54 cases, left hemicolectomy in 15 cases, sigmoid colectomy in 6 cases, segmental resection of splenic flexure in 2 cases, transverse colostomy in 3 cases. Eight cases were converted to open surgery; six because of locally advanced disease, one because of bleeding and one because of failure to localize the tumour. Mean operative time was 150 minutes. The mean tumour size was 6cm. Mean duration for analgesic requirement was 2.5 days. Mean time to return of bowel activity was 2.7 days with a mean hospital stay of 5 days. Intraoperative traction injury to the small bowel was encountered in 1 patient. Postoperatively 2 patients had local wound infection and 2 patients developed pulmonary infection. Laparoscopic-assisted colonic procedures are associated with a smaller wound, quicker return of bowel activity, reduced consumption of analgesics, a shorter hospital stay and low rates of pulmonary infection. Laparoscopic colonic surgery is feasible and a logical progression towards acquisition of advanced laparoscopic skills with good results

Inverted Meckel 's diverticulum as a cause of obscure lower gastrointestinal bleeding

A 52-year-old postmenopausal female, with no co-morbidity presented with peri-umbilical colicky abdominal pain for one week. Similar episodes of pain without any associated vomiting, anorexia or any weight loss had been experienced in the last one year. There was no history of per vaginal blood loss. Stool examination revealed occult blood. She was on regular hematinics. Complete blood count showed a hematocrit of 28% at the time of admission despite receiving multiple blood transfusions and iron supplements. Esophagogastroduodenoscopy and colonoscopy were non-contributory. A small bowel enema was then performed which revealed an intraluminal polypoidal filling defect in the terminal ileum. The patient underwent laparotomy through a midline incision and an inverted Meckel's diverticulum resulting in intussus-ception was identified. About 8 cms of the small bowel was resected and intestinal continuity was restored. Inspection of the specimen demonstrated a 6.5 cm inverted diverticulum which had served as a lead point for an intussusception. She had a smooth postoperative recovery and maintained her hematocrit postoperatively without any hematinics when reviewed in the outpatient clinic after two weeks. Histology of the resected specimen showed ectopic gastric mucosa with ulceration of the adjacent ileum