RESUMO
OBJECTIVE: To see the frequency of newly diagnosed Hepatitis-B and Hepatitis-C cases during pre-operative surgical assessment of patients from lower socioeconomic class and to study the possible risk factors
STUDY DESIGN: Descriptive Cross Sectional study
SETTING: Department of Surgery, Sir Syed College of Medical Sciences and Hospital, Karachi
STUDY DURATION: From July 2012 to July2013
MATERIAL AND METHODS: Total 107 patients [>18 years] of both genders from lower socioeconomic class planned for elective surgical procedure were included after ethical approval. Previously diagnosed cases of Hepatitis-B and C were excluded. After history and clinical examination, Hepatitis-B and Hepatitis-C serology was performed [ELIZA technique]. History of blood transfusion, previous dental or surgical procedures, intravenous injections, intravenous drug abuse, tattooing, piercing, circumcision, shaving by barbers, unprotected sex and Hepatitis-B vaccination status obtained. Data was analyzed by SPSS version 17
RESULTS: Among 107 cases [42% males and 58% females] with mean age 39+14 years, Hepatitis-B infection was present in 6[6%] cases, Hepatitis-C in 11[10%] and Hepatitis-B and C serology was negative in 90 [84%] cases. Frequency of Hepatitis-B was 3% [in males] versus 9% [in females]; Hepatitis-C 6.4% [in males] versus 15.5% [in females]. Among those with Hepatitis-B or C, history of previous surgical procedure present in 47% cases [vs. 21% in Hepatitis-B and C negative cases], dental procedure in 29.4% [vs. 7.7 %], intravenous injections in 94% [vs. 43%], intravenous drug abuse in 5.8% [vs. 0 %], blood transfusion in 35% [vs. 12%], tattooing in 0% [vs. 2%], unprotected sex in 5.8% [vs. 1%], piercing in 64.7% [vs. 39%], circumcision by barbers in 83.3%of males [vs. 80%], shaving by barbers in 66.6% of males [vs. 27%]. Hepatitis-B and C was found to be associated with history of blood transfusion, intravenous injections, dental procedures, shaving by barbers, piercing and intravenous drug abuse [p< 0.05]. Clinical stigmata of liver disease were present in 3% cases. Among all cases 9% were previously vaccinated for Hepatitis-B
CONCLUSION: Preoperative determination of Hepatitis viral markers is a good clinical practice to limit transmission from asymptomatic carriers and to diagnose new cases. Pakistan has high prevalence of Hepatitis-B and C and poverty and low literacy rate are the main determinants of its spread. Those who are negative for Hepatitis-B should be encouraged to get vaccinated
There is need for measures to create awareness about preventive measures and affective control of transmission of Hepatitis-B and C in community as well as at health care facilities
RESUMO
About 99% of testicular tumors are malignant though they only constitute about 1-2% of malignant tumors in male. They are more readily accessible to examining fingers than a tumour of any other organ in the body, however too often they escape detection until it has metastasised. Worst error is to plunge a trocar and cannula into the enlarge testis or operating from scrotal approach in the belief that it is a hydrocele. Proper pre-operative assessment and diagnosis has the key role in the life expectancy of patient. Hydrocele and testicular tumor both have different operative approaches. For hydrocele scrotal approach and for tumor inguinal approach is recommended. For tumor, if scrotal approach has been adapted it may result in disaster. Two cases of testicular carcinoma initially diagnosed and operated as cases of hydrocele are reported