The reduction in clinical and surgical exposure of trainees during COVID-19 and its impact on their training.

OBJECTIVE: To assess the impact of coronavirus disease on surgical training. Methods: The cross-sectional study was conducted at the General Surgery Department of Liaquat National Hospital, Karachi, from August 2019 to May 2020, and comprised surgical trainees from year 1 to 4. The subjects were interviewed and inquired about their opinion regarding the impact of coronavirus disease on their training. Data was prospectively collected in two equal phases of 5 months each, separating the phases on the basis of the application of preventive measures and changes relating to coronavirus disease. Data of cases from log books was divided into major and minor cases. RESULTS: Of the 24 surgical trainees available, 18(75%) participated; 12(66.6%) females and 6(33.3%) males. There was a significant difference between the two phases, with the number of surgical case going down drastically in the second phase (p=0.005), affecting the training process. CONCLUSIONS: Considering the ongoing pandemic, it may be worthwhile to look into the possibility of increasing the duration of training.

Arranging blood for elective thyroid surgeries: dilemma continues in the developing world.

BACKGROUND: Cross matched blood is frequently ordered based on a subjective anticipation of blood loss for a procedure. Excessive blood arrangement and wastage overburdens the blood bank in terms of work load and storage of blood, increases cost of medical care and results in injudicious use of a limited resource. The aim of this short report is to assess the current practice for arranging cross matched blood in elective thyroid surgeries by comparing cross match to blood transfused ratio. FINDINGS: Medical records for all patients from January 2009 to December 2014 undergoing thyroid surgery were retrieved and reviewed through electronic health information management system (HIMS). A total of 91 patients were included in the study, out of which 18 (19.7%) were male and 73 (80.2%) were female. A total of 107 units of blood were arranged and only 9 were transfused. 47 patients underwent a total thyroidectomy, while 44 underwent a hemithyroidectomy. The cross match to transfusion ratio came out to be 11.88. CONCLUSIONS: Routine arrangement of cross matched blood is not required in elective thyroid surgeries. All institutions should have a maximum blood ordering schedule planned for elective procedures, and blood products should be arranged accordingly to avoid unnecessary cross matching.

Discordance of biomarker status in recurrent breast cancer.

OBJECTIVE: To study the pattern of percentage change of biomarker status in recurrent breast cancer and to compare it with its primary biomarker. METHODS: Patients with recurrent breast disease presenting to the Breast Unit of Liaquat National Hospital and Medical College, Karachi, between January 2004 and January 2011 were included in this study. Outcome of interest was any change in the biomarker status of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor 2 (HER2/neu) with respect to their respective primary status. SPSS 18 was used for statistical analysis. RESULTS: The study had a total of 58 female patients with biopsy-proven recurrent breast carcinoma with a mean age of 46 +/- 11.3 years. Time to recurrence varied between 2 to 3 years with a mean of 2.3 +/- 1.9 years. Invasive ductal carcinoma was the most prevalent recurrent tumour (50/58 patients: 86%). There was a change of 25.9% in oestrogen receptor status (p < 0.01); change of 36.2% in progesterone receptor status (p = 0.036); and 22.4% change in Her2/neu status (p = < 0.01). Of the 42 (72.27%) patients who were triple negative at presentation, 30 (71.4%) remained triple negative (p = 0.02). Six of the 16 (37.5%) patients became triple negative upon recurrence (p < 0.01). CONCLUSIONS: The study demonstrated that there was indeed a change in biomarker status in patients presenting with recurrent breast carcinoma. There is need for clinicians to check biomarker status in recurrent breast cancer patients as it may assist a shift in the management plan.