General practitioners' awareness and management of common psychiatric disorders: a community-based survey from Karachi, Pakistan

This study assessed the knowledge and management of common psychiatric disorders by general practitioners [GPs] in Karachi, Pakistan, Structured interviews were carried out in 2009 with 360 GPs selected by cluster random sampling. Patients with psychiatric disorders were estimated to be up to 10% of the daily caseload according to 71.8% of doctors. Two-thirds of GPs were unaware of the ICD-10 diagnostic criteria for depression and anxiety disorders. Benzodiazepines were the most recognized category of medication [75.3%] and were the most commonly used medication for all mental health conditions. Fewer GPs were familiar with selective serotonin reuptake inhibitors [35.1%] or tricyclic antidepressants [20.2%]. Lack of time and patients financial constraints were reported to be barriers to care. Most GPs [69.2%] had not received any recent medical education about mental health problems. Gaps in GPs' knowledge about the management of mental disorders have implications for the rational use of psychotropic medications in primary care

Port site metastasis by exfoliated cells from occult cholangiocarcinoma a case report

A forty year old man underwent laparoscopic cholecystectomy for symptomatic gall stones. The histological report of removed gall bladder was benign. The patient presented with a nodule at port site one year after the cholecystectomy. The nodule was removed and histopathology revealed adenocarcinoma. Histopathological review of the removed gallbladder again revealed a benign result. All investigations for diagnosis of primary remained equivocal. The patient again presented with obstructive jaundice three months after removal of the nodule. Investigations [CT Scan and ERCP] revealed a nodule at hilum of biliary ducts causing obstruction at that level with dilatation of intrahepatic Nary ducts. Brush cytology revealed hilar cholangiocarcinoma. This case illustrates that exfoliated cells of bile duct tumour metastasized by transluminal route and caused port site metastasis after laparoscopic cholecystectomy. The patient is referred to hepatobiliary surgeon for further treatment