Levels of Depression and Anxiety Post-Mastectomy in Breast Cancer Patients at a Public Sector Hospital in Karachi.

BACKGROUND: There is a noticeable change in the approach with which women nowadays seek help for diseases like breast cancer, primarily due to awareness campaigns, but what happens after surgical procedures is of great significance too. This study focused on the several psychological connotations attached to mastectomy and how the patients cope. OBJECTIVE: To understand the pattern of anxiety and level of depression among Pakistani patients undergoing mastectomy. MATERIALS AND METHODS: The sample size consisted of 88 patients who had undergone mastectomy at the different surgical units of the Civil Hospital, Karachi, from January 2012- December 2014; The questionnaire was administered before they were discharged i.e. within 3 days of surgical procedures. The patients were asked if they were willing to participate in this study, those who agreed signed the consent form and then we preceded by asking questions with a standardized tool. A self made questionnaire was constructed keeping in mind the nature and specification of the disease, which consisted of 20 questions related to anxiety and depression, focusing on a mixture of psychological and physiological symptoms. RESULTS: There were a total of 88 patients out of which 36 (41%) were aged 51 to 60 years, 24 (27.2%) of the patients were in the age category of 41 to 50 years, 17 aged 61 and above (19.3%) and only 11 (12.5%) 30-40 years of age, the youngest of all the age categories. The pattern of depression and anxiety was found to be similar among all age categories, severe depression and anxiety predominating over moderate level of such symptoms, with only relatively few patients sufering mild or no depression symptoms. CONCLUSIONS: It was concluded that going through mastectomy leads to moderate to severe levels of depression and anxiety, primarily because the females feel incomplete and insecure after losing a part of themselves.

Duodenal tuberculosis.

Duodenal tuberculosis is an uncommon disease. It may be either extrinsic or intrinsic or both. In the extrinsic type there can either be primary duodenal involvement or compression due to enlarged paraduodenal lymph nodes. The clinical presentation can be dyspeptic or obstructive symptoms. The dyspeptic symptoms include epigastric pain, nausea, and occasional vomiting and obstructive symptoms include bilious vomiting frequently after meals, epigastric pain, and generalized abdominal pain. This report describes a young lady presenting with gastric outlet obstruction symptoms due to tuberculous adhesion involving the proximal duodenum.

Mucinous adenocarcinoma of the appendix.

Mucinous neoplasm is a rare malignancy of the gastrointestinal tract, the most common site being the appendix. There are different types of mucin producing tumours that can occur in the appendix, which can be benign as well as malignant. Mucin produced by these tumours results in ascites that makes it palpable as jelly belly.

Spectrum of perforation peritonitis in Pakistan: 300 cases Eastern experience.

BACKGROUND: Perforation peritonitis is the most common surgical emergency encountered by the surgeons all over the world as well in Pakistan. The spectrum of etiology of perforation peritonitis in tropical countries continues to differ from its western counter part. This study was conducted at Dow University of health sciences and Civil Hospital Karachi (DUHS & CHK) Pakistan, designed to highlight the spectrum of perforation peritonitis in the East and to improve its outcome. METHODS: A prospective study includes three hundred consecutive patients of perforation peritonitis studied in terms of clinical presentations, Causes, site of perforation, surgical treatment, post operative complications and mortality, at (DUHS&CHK) Pakistan, from 1st September 2005 - 1st March 2008, over a period of two and half years. All patients were resuscitated underwent emergency exploratory laparotomy. On laparotomy cause of perforation peritonitis was found and controlled. RESULTS: The most common cause of perforation peritonitis noticed in our series was acid peptic disease 45%, perforated duodenal ulcer (43.6%) and gastric ulcer 1.3%. followed by small bowel tuberculosis (21%) and typhoid (17%). large bowel perforation due to tuberculosis 5%, malignancy 2.6% and volvulus 0.3%. Perforation due to acute appendicitis (5%). Highest number of perforations has seen in the duodenum 43.6%, ileum37.6%, and colon 8%, appendix 5%, jejunum 3.3%, and stomach 2.3%. Overall mortality was (10.6%). CONCLUSION: The spectrum of perforation peritonitis in Pakistan continuously differs from western country. Highest number of perforations noticed in the upper part of the gastrointestinal tract as compared to the western countries where the perforations seen mostly in the distal part. Most common cause of perforation peritonitis is perforated duodenal ulcer, followed by small bowel tuberculosis and typhoid perforation. Majority of the large bowel perforations are also tubercular. Malignant perforations are least common in our setup.