Clinico-pathological Characteristics of Cutaneous Malignant Melanoma in Pakistan.

OBJECTIVE: To analyse epidemiological and clinical characteristics of patients presenting with cutaneous malignant melanoma (CMM) in Pakistan; and to compare the results with other studies. STUDY DESIGN: Case series. PLACE AND DURATION OF STUDY: Shaukat Khaum Memorial Cancer Hospital (SKMCH) from January 1997 to December 2017. METHODOLOGY: All patients presenting to the study centre with a diagnosis of CMM were included in the study. Non-cutaneous melanoma cases were excluded. Patient demographics, tumor type, and tumor stage were recorded retrospectively. All data were analysed in SPSS and descriptive statistics were determined. RESULTS: A total of 169 CMM patients were registered during a 20-year period. The highest incidence of melanoma was seen in the age group 40-59 years (n=69, 40.8%). Most common clinical subtype was unspecified melanoma (n=154, 91%). The most frequently observed T-stage at presentation was Tx (n=124, 73.4%), followed by T4 (n=23, 13.6%). With regard to body distribution, CM was seen most commonly in the lower limb including hip. CONCLUSION: CMM is a rare disease in Pakistan. However, patients tend to present at a more advanced stage. Identification of risk factors and tumor characteristics is, therefore, of paramount importance in managing these patients. Key Words: Cutaneous malignant melanoma (CMM), Pakistan, Lower middle income country, Stage.

Lack of awareness among surgeons regarding safe use of electrosurgery. A cross sectional survey of surgeons in Pakistan.

OBJECTIVE: To assess our surgeons perceptive regarding the safe usage of electrosurgical devices. METHOD: ology: This cross sectional survey was carried out at two hospitals, A cancer hospital and a public sector general hospital. Consultants, fellows and senior residents (Resident year 3rd and year 4th) on the surgical floor were requested to fill up the questionnaire. Calculations were performed with Statistical Package for the Social Sciences (SPSS 20) for Windows version 20 statistical software. Data was described using median with minimum and maximum value for quantitative variables. For categorical variables, number of observations and percentages were reported. The study is complied with hospital guidelines on research involving human subjects. RESULTS: Out of 80 questionnaires 52 were filled and returned. 12 consultants, 16 fellows/Senior registrars and 24 senior residents filled their questionnaires. For the sake of anonymity no information was obtained regarding the level of training and experience. Total 12 questions were asked. An expert level was set for a score above 10/12. A moderate level was set at 8/12. A score of less than 8 was considered unsafe for using electrosurgical devices. Only 6 (11.5%) participants had an expert level of understanding. 16 (30.7%) had moderate understanding. 30 (57.7%) were considered unsafe regarding use of electrosurgical devices. 85% participants were not aware of the correct mode of current to use for coagulating vessels. 69% of surgeons would use electrocautery to control staple line bleeds. 67% participants weren't aware of the correct placement of dispersive electrode. 60% couldn't identify a safe device for use in patients with a pacemaker. 46% of surgeons would cut a dispersive electrode to fit it on a child. 69% believed that harmonic scalpel was a bipolar cautery. 61% couldn't differentiate between RFA and Microwave Ablation. 63% didn't know how to handle an operating room fire. CONCLUSION: In these two hospitals, high level of ignorance noticed regarding the procedure and indications of basic electrosurgical equipment which needs raising awareness and further training.

Burnout among surgical residents in a lower-middle income country - Are we any different?

OBJECTIVE: To assess the presence of burnout among surgical residents working at various public sector hospitals in Pakistan. DESIGN: A survey based on MBI was used to assess the presence of burnout. Residents were grouped into Group A (Burn out) or Group B (No burn out). Pearson Test was used to see any correlation between different variables and burn out. A p value of <0.05 was taken as significant. SETTING/PARTICIPANTS: A cross sectional survey of all the surgical residents at various public sector hospitals in Lahore was done. RESULTS: A total of 133 residents responded to our questionnaire. 74% respondents were male and 26% were female. All residents showed a very high level of burnout. 50.4% residents had high levels of burn out on the EE category, 49.6% in the DP category and 53.4% residents had low levels on the PA scale. When assessed for overall burn out 57.9% residents had overall burnout. Males were more prone to develop burnout. Job dissatisfaction was the most prevalent reason for burn out. Owning a smartphone was significantly associated with development of burnout. Awareness regarding the burnout syndrome and having children were two factors which had a protective effect against burnout syndrome. Marriage, working hours, financial conditions, smoking and consumption of coffee/tea had no effect on development of burnout syndrome. CONCLUSION: There is high prevalence of burnout among the surgical residents in our hospitals. Unsatisfactory training is the number one reason for development of this syndrome.

The health seeking behaviour of elderly population in a poor-urban community of Karachi, Pakistan.

OBJECTIVES: To presents socio-demographic characteristics and health seeking behaviour of elderly and to determine frequency of Diabetes Mellitus and Hypertension in elderly population of a poor peri-urban community in Karachi, Pakistan. METHODS: A cross-sectional study was conducted, targeting population aged 65 or above. A total of 438 respondents were interviewed after taking informed consent, between November 2005 and December 2005. Frequencies and Chi square values were calculated for different variables using SPSS 13.0. RESULTS: Total population surveyed comprised of 438 elderly, 158 (36%) women and 280 (63.9%) men. Mean age for the population was 71.44 +/- 7.74. A total of 238 (54.3%) elderly were found to be economically active. More than half (n = 269, 61.4%) of the elderly were found to be illiterate. Only 72 (16.4%) of the elderly population were Diabetic and 132 (30.1%) were Hypertensive. Common symptoms that prompted elderly of Azam Basti to seek health care were fever (61.2%), generalized body aches (43.4%) and cough (40.4%). Over half of the (n = 269, 61.4%) responders reported factors which deterred them from seeking health care, out of which 62% reported financial constraint as the commonest factor. Deterrence from seeking health care was associated with illiteracy (p = 0.001) and living alone (p = 0.06). CONCLUSION: The elderly population of this peri-urban community has financial constraints in seeking health care. Hypertension was found to be more prevalent among women as compared to men, ratio being 1:2. Less number of people knew they were diabetics; this might be attributed to ignorance and non-availability of investigations and screening.