Knowledge, Attitude and Practices among Undergraduate Medical Students Regarding Surgical Correction of Refractive Errors; a Cross-sectional Study

Aim: This study was aimed to assess the knowledge, attitude and practices regarding refractive error correction surgeries among undergraduate medical students.Study Design: In this study cross-sectional study design was used.Duration and Place of Study: The study was conducted amongst the undergraduate MBBS students studying at Dow Medical College, Karachi. The duration of study was seven months (August, 2019 till February, 2020).Methods: A sample size of 189 was calculated for the study with confidence level 95% and confidence limit 5%. Data was collected through a validated self-administered questionnaire which was divided in five subsections used to gain information regarding participant抯 demographics, knowledge, attitude and practices regarding refractive error surgeries. Data was analyzed using IBM SPSS V.22.Results: In our study 189 students with a mean age of 21�8 years were included. Among the participants 112 (59.3%) had refractive errors. Glasses were used by majority 76 (67.9%) of participants for visual correction. Use of refractive error correction methods at all times was reported by 72 (66.7%) participants. Majority of respondents 142 (75.5%) had heard about surgery being used for correction of refractive errors. A large number of students 117 (66%) refused for surgery and fear of the outcomes was one of the reason for this refusal.Conclusion: We found that majority of the participants were aware about refractive error correction surgeries yet most of them showed unwillingness for these procedures. This negative attitude must be changed to positive in order to enhance the practice for these procedures.

Determinants of Breast Self-Examination Practice amongst Iraqi/ Sulaimani Women using Champion Health Belief Model and Breast CAM

Breast cancer (BC) is one of the major threat to females health in Iraq which can be easily prevented through Breast self-examination (BSE). This study aims to find out the level of awareness and practice of BSE among women and investigates the relation of socio-demographic factors, other comorbid conditions, knowledge, and belief with the BSE practices. This cross-sectional study conducted on 750 women using predesigned questionnaires and two scales, Breast cancer awareness measure (BCAM) and Champion health belief model (CHBM). The findings indicate that 75.2% of women were aware regarding BSE and 49.7% knew that BSE should be done monthly. 31.7% of participants never practiced BSE, 51.8% and 18.0% of participants practiced BSE rarely and regularly respectively. Education, employment status, family history, past breast disorders, knowledge, lactation status, perceived seriousness, health motivation, confidence, perceived benefits and barriers for BSE were significantly associated with the regular practice of BSE. Increase in women’s health motivation and sensitization of women about the benefits of BSE is suggested to increase the adoption and practice of BSE.

Enhancing value of quality assurance rounds in improving radiotherapy management: a retrospective analysis from King Hussein Cancer Center in Jordan

PURPOSE: The quality assurance (QA) chart rounds are multidisciplinary meetings to review radiation therapy (RT) treatment plans. This study focus on describing the changes in RT management based on QA round reviews in a single institution. MATERIALS AND METHODS: After 9 full years of implementation, a retrospective review of all patients whose charts passed through departmental QA chart rounds from 2007 to 2015. The reviewed cases were presented for RT plan review; subcategorized based on decision in QA rounds into: approved, minor modifications or major modifications. Major modification defined as any substantial change which required patient re-simulation orre-planning prior to commencement of RT. Minor modification included treatment plan changes which didn’t necessarily require RT re-planning. RESULTS: Overall 7,149 RT treatment plans for different anatomical sites were reviewed at QA rounds. From these treatment plans, 6,654 (93%) were approved, 144 (2%) required minor modifications, while 351 (5%) required major modifications. Major modification included changes in: selected RT dose (96/351, 27%), target volume definition (127/351, 36%), organs-at-risk contouring (10/351, 3%), dose volume objectives/constraints criteria (90/351, 26%), and intent of treatment (28/351, 8%). The RT plans which required major modification according to the tumor subtype were as follows: head and neck (104/904, 12%), thoracic (12/199, 6%), gastrointestinal (33/687,5%), skin (5/106, 5%), genitourinary (16/359, 4%), breast (104/2387, 4%), central nervous system (36/846, 4%), sarcoma (11/277, 4%), pediatric (7/251, 3%), lymphoma (10/423, 2%), gynecological tumors (2/359, 1%), and others (11/351, 3%). CONCLUSION: Multi-disciplinary standardized QA chart rounds provide a comprehensive and an influential method on RT plans and/ or treatment decisions.

Assessment of breast cancer early detection program in Iraq-Sulaimania: Measuring the cancer detection rate

Background: Low- and middle-income countries require to specify early detection programs and intervention models for breast cancer. The aim of this study was to assess the performance efficacy of an Iraqi early detection model in terms of cancer detection rate (CDR) and the method of participation in this program. Materials and Methods: Data from June 2007 to August 2016 was collected from the Breast Disease Treatment Center in the Sulaimani province in Iraq. A total of 40,491 women had registered at the center during that period for breast cancer screening, and cancer was detected in 793 women. Results: The CDR of the Iraqi program was 8.2 per 1000 screened women, and that of the mammograms was 42.02 per 1000 mammograms. Women mostly participated in the program by the self-referral method (77.54%). Conclusion: The performance of the Iraqi early detection model was effective with a high CDR, and most women participated by self-referral. This program could, therefore, be effective in low- and middle-income countries

Histologic profiles of reduction mammaplasty specimens among jordanian females

Reduction mammaplasty is a common surgical procedure that yields a variable amount of tissue for pathologic examination. The purpose of this study was to evaluate the histological diagnoses of the reduction mammaplasty specimens and to determine the incidence of breast lesions in otherwise asymptomatic and healthy Jordanian females. All reduction mammaplasty specimens of 73 patients over a 10-year period [September 1999-September 2009] at Jordan University Hospital were retrospectively examined. The average number of blocks submitted per breast was 4 [range 3-5]. Variables such as age and preoperative mammograms were examined. A total of 143 specimens were evaluated. Normal mammary tissue was present in 36 patients [49%]. The most common benign lesion was fibrocystic disease [21%] Precancerous breast lesions were identified in 7 patients [9.6%]. No case of carcinoma in situ or invasive carcinoma was encountered in our study. Most of the histopathological lesions were found in patients younger than 35 years of age. Preoperative mammograms were done for 26 patients and all were normal. This study demonstrates the importance of systemic analysis of breast reduction specimens to help identify and guide the management of patients with increased risk of breast cancer following reduction mammaplasty. Consequently, thorough sampling and handling of breast reduction specimens should be emphasized

Risk factors for hematoma development post reduction mammaplasty: novel associations and implications

The aim of this retrospective study was to analyze various preoperative and intraoperative factors that may contribute to the development of wound hematoma after reduction mammaplasty. This will help us to estimate a prospective patient's individualized risk based on selected identifiable factors, facilitating patient selection and preoperative counseling. Sixty six patients, who underwent Wise-pattern, Inferior pedicle reduction mammaplasty over a 10- year period [1999-2008] performed by a single surgeon were studied. The following factors were addressed: age, medical history, medications, smoking habits, Body Mass Index [BMI], phase of menstrual cycle, mass of resection, prophylactic heparin, operation time, intraoperative blood loss, preoperative and postoperative Hemoglobin [Hb] and Hematocrit [Hct] levels, various blood pressure measurements and hematoma formation. The operative time was divided into two periods and in our experience, hemostasis was achieved in the second period. In our series, six patients developed a postoperative wound hematoma; only two patients required operative evacuation [3%]. Body Mass Index [BMI], mass of resection and subcutaneous prophylactic heparin significantly affected the likelihood of wound hematoma [P values: 0.018, 0.002 and 0.031, respectively]. Smoking, age, medical illnesses and phase of menstrual cycle had no statistical significance on the development of wound hematoma. Logistic regression analysis showed that the peak systolic blood pressure during the period of hemostasis was significantly lower in patients who developed hematoma [P=0.019]. Our data indicate that there was a significant correlation between post-operative hematoma and Body Mass Index [BMI], mass of resection, prophylactic heparin and intraoperative hypotention during the period of hemostasis

Carcinoma of breast co-existing with non-Hodgkin's lymphoma of axillary lymph nodes

The co-existence of breast carcinoma and lymphoma in the axillary lymph nodes, without a history of previous chemotherapy or radiotherapy is rarely described. We present a case of a 50-year-old female with right breast mass, proved by pathological examination to be invasive mucinous carcinoma. Examination of the axillary lymph nodes as axillary clearance showed concomitant small lymphocytic lymphoma and chronic lymphocytic leukemia, with no evidence of metastatic mammary carcinoma deposits

Breast reconstruction in conserving breast cancer surgery

Breast conserving treatment [BCT] combined with radiotherapy have proved the test of time as a sound oncological operation regarding survival and local recurrence. Successful BCT is a balance between adequate surgery and maintaining the breast's appearance. Unsatisfactory outcome reaches 20-30% in standard techniques of BCT. Concepts described to widen the spectrum of BCT, have made an improvement of cosmetic outcome, and facilitated a liberal safety margin. Volume displacement techniques, such as glandular flap, mammoplasty, donut mastopexy, and batwing mastopexy proved useful in large breasts and volume replacement, such as latissimus dorsi flap and local flaps are of great advantage to replace defects in small and medium sized breasts. Some of these techniques are simple, but comprehensive knowledge and training are required for sophisticated ones. The objectives of this article are to shed light on different techniques adopted by surgeons to perform BCT in conjunction with various oncoplastic techniques and to discuss the factors that influence their applications to achieve best oncological and aesthetic outcome

Food Consumption Patterns: Findings from the Malaysian Adult Nutrition Survey (MANS)

This study reports the food consumption patterns of adults aged 18 to 59 years in the Malaysian Adults Nutrition Survey (MANS) carried out between October 2002 and December 2003. A total of 6,742 subjects comprising 3,274 men and 3,468 women representing the northern, central , southern and east coast of Peninsular Malaysia as well as Sabah and Sarawak were interviewed. A semiquantitative food frequency questionnaire (FFQ) which consisted of 126 food items was used to evaluate the food consumption pattern (habitual food intake) of the respondents during the previous one- year period. The results demonstrate that nasi putih (cooked rice) was consumed by 97% of the population twice daily (average 2½ plates per day). Other food items consumed daily were marine fish, (one medium fish per day), green leafy vegetables (one cup per day) and sweetened condensed milk (three teaspoons per day. The mean frequencies for daily intake of rice, leafy vegetables, marine fish, local kuih, anchovy(ikan bilis) and biscuits were significantly higher among the rural compared to the urban adults. In contrast, more urban dwellers consumed chicken and eggs more frequently than their rural counterparts. More men than women consumed chicken and eggs more frequently. Malaysian adults showed a satisfactory habit of drinking plain water, with 99% drinking at least six glasses of plain water daily. Other beverages such as tea (47%), coffee (28%), chocolate-based drinks (23%) and cordial syrup (11%) were also consumed on daily basis, however, in a smaller proportion of the population. There were differences in the prevalence of daily consumption of foods when comparing urban and rural population, and also between men and women. The prevalence of daily consumption of marine fish among rural and urban adults was 51% and 34% respectively. For sweetened condensed milk, men and women consumed 43% and 28% respectively; however, more women drank full cream milk than men. Between the age groups, 21% of adults below 20 years old consumed chicken at least once a day, while this pattern of intake was not shown in the older age groups. Our findings show that adults, aged 50 to 59 years old, had the highest prevalence of daily consumption of full cream milk with 24% while those aged 18 to 19 years old had the lowest prevalence of daily consumption at 15%. The food consumption pattern of Malaysian adults appears to be satisfactory. However, some changes in food habits are recommended especially in substituting the less wholesome sweetened condensed milk with the more nutritious full cream or skimmed milk.

Mammary duct ectasia and periductal mastitis in males

Mammary duct ectasia/periductal mastitis is exceedingly rare in males. Ten cases have been reported in the literature, the last 2 cases were associated with Human immunodeficiency virus. The previously reported cases presented in females with blood stained discharge or subareolar inflammatory process. All cases required surgical treatment, 7 out of 10 cases underwent a form of mastectomy. To the best of our knowledge this disease entity was not reported in patients suffering from Behcets disease. This article described 2 new cases, one of them is a young man who had associated Behcets disease. An immune mechanism may be responsible for such association, which was not reported before. The clinical presentation, pathological findings and management of these 2 new cases were outlined followed by literature review

Epidemiological study of injured people in road traffic accidents in Baghdad city

Two hundred and ninety-four people with road traffic injuries were admitted to hospitals within the period from 1st. June 1989 to 30 July 1989.47.3% of the injuries were due to collision. 56.5% of injured people were students and labourers, and 27.2% of the injured were below the age of nine years. The most frequent injuries were fractures and wounds [58.9%]. Head injuries were 39. 1% of the total. The average length of stay in the hospital for the people who were required to stay ten or less days was five days per injured person, while the average for those who required a stay for more than ten days [mainly due to fracture] was fifteen days per person. 43.8% of the injured were discharged after complete care was received while 6.5% died. It is recommended that an efficient emergency units in the hospitals should be set to receive road traffic injuries in order to avoid the complications and to deliver better care to the injured