Tuberculosis of male breast: A rare benign entity.

Granulomatous mastitis is a rare benign condition often seen in young lactating females of reproductive age group. Prepubescent males or elderly women may also be the victim of this infectious disease. Primary infection of the breast may occur through skin abrasions, open wounds or through the lactiferous ducts while secondary spread occurs from an infective focus elsewhere in the body via lymphatic or hematogenous routes. We present a case of breast tuberculosis diagnosed in a 62-year-old man at our institution. The patient presented with a palpable painful mass in the left breast with chronic sinus formation and pus discharge for a month with loss of appetite and weight loss. The etiology was unknown. The imaging features were suggestive of tuberculosis. Histopathology was concordant with imaging and showed chronic granulomatous inflammation with necrosis. The patient received oral anti-tuberculosis therapy for six months with no side effects or any further complications. Breast tuberculosis is a rare entity especially in male breast mimicking carcinoma. The mainstay of treatment is antitubercular therapy if imaging and histopathology confirms the diagnosis. Clinical awareness is necessary during diagnostic workup for establishing the correct diagnosis and treatment

To identify the features differentiating peritoneal tuberculosis from carcinomatosis on CT scan abdomen taking omental biopsy as a gold standard

OBJECTIVE: To differentiate peritoneal tuberculosis from carcinomatosis on computed tomography scan of abdomen, taking omental biopsy as the gold standard.. METHODS: This retrospective diagnostic accuracy review of cases was conducted at Aga Khan University Hospital, Karachi, and comprised patient\u27s medical record files from February 2007 to February 2016. Computed tomography scan findings were compared with diagnosis made on the basis of histopathology. Multiple logistics regression analysis was done and sensitivity and specificity were tested through Pearson chi square test. RESULTS: Of the 98 patients identified, 62(63.2%)were found to be cases of disseminated tuberculosis and 36(36.7%) were diagnosed as malignant on histopathology. Computed tomography features were significantly specific to differentiate abdominal tuberculosis from carcinomatosis (p=0.004). On computed tomography,4 findings showed statistical significance: Smooth thickening of the peritoneum (p\u3c0.001), abdominal mass (p=0.03), lymph node necrosis (p=0.024) and high-density ascitic fluid (p\u3c0.001). Out of these, smooth thickening of the peritoneum (sensitivity=77%; specificity=86.1%) and high-density ascitic fluid (sensitivity=68.9%; specificity=72.2%) were more specific findings. Overall, the sensitivity and specificity of computed tomography was found to be 88.5% and 83.3%, respectively. CONCLUSIONS: Although no single finding on a computed tomography scan was diagnostic proof of peritoneal tuberculosis, a combination of findings could reliably distinguish between peritoneal tuberculosis and carcinomatosis

Large mediastinal mass in a 15-year-old boy

Hyperimmunoglobulin E syndrome is a rare multisystem inherited disorder characterised by high serum IgE levels, skin disorder causing eczema, dermatitis, recurrent staphylococcal infections and pulmonary infections and various skeletal and connective tissue abnormalities. Common presentation is with recurrent skin and sinopulmonary infections. Several features unrelated to immune system such as characteristic facial features, hyperextensibility of joints, multiple bone fractures and craniosynostosis have been described in the literature. We describe a rare presentation of this disease with invasive aspergillosis presenting as mediastinal mass with extension to mediastinalstructures and pulmonary vasculature

Psychosocial experiences of women with vesicovaginal fistula: a qualitative approach.

Abstract Vesicovaginal fistula (VVF) is a condition associated with a number of physical and psychological consequences. In order to gain a deeper understanding of the issues faced by women diagnosed with VVF, a qualitative exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 8 women hospitalized with the diagnosis of vesicovaginal fistula at Kohi Goth Women\u27s Hospital, Karachi, Pakistan. Semi structured interviews of each participant were conducted, recorded, and transcribed. Five major themes were identified, among which all of the participants experienced physical discomforts, psychological disturbances, issues with social and interpersonal relationships and financial constraints. However, concerns with religious practices were experienced by 87.5% of the participants. Pakistani women who are suffering through VVF face many challenges. Combined efforts should be made to offer supportive services to women suffering from this condition

Difficulties in laparoscopic cholecystectomy: Conversion versus surgeon\u27s failure

Background: Laparoscopic cholecystectomy is considered to be gold standard treatment for symptomatic gall stones. Despite several benefits there are still disadvantages of laparoscopic cholecystectomy in difficult cases where anatomy is disturbed even in experienced hand. Aim of this study is to identify advantages of early conversion to open cholecystectomy in difficult cases and how it should not be associated with surgeon\u27s failure.Methods: Observational study was conducted at tertiary care hospital of Karachi, Pakistan from January 2012 till June 2015. All patients who presented to general surgery department with symptomatic gall stones and planned for laparoscopic cholecystectomy was included in the study. Demographic data was collected. Preoperative workup includes baselines investigations with liver profile test and imaging study (ultrasound scan). All patient underwent laparoscopic cholecystectomy at first. Operative difficulties, incidence of conversion, reason for conversion and complication intra-operative or postoperative were recorded. Data was analyzed using SPSS 20.Results: Out of 1026 patients, 78.26% (803) were female. Mean age of patients were 41.30±8.43 years (range 26-68 years). Common presenting symptoms were pain at upper abdomen and dyspepsia. Most of the patients had multiple gall stones (93.85%). Nine hundred and ninety-two patients (96.68%) of patients underwent successful laparoscopic cholecystectomy. This includes patients in whom dissections were difficult because of disturbed anatomy of calots triangle. Only 3.13% of patients were converted to open cholecystectomy. There was a significant difference (\u3c0.05) in complications observed between completed and converted cholecystectomies.Conclusions: Conversion from laparoscopic to open procedure should be done in cases of technically difficult situations to avoid significant mortality and morbidity. Surgeons experience had a pivotal role in determining its need and justification

Oral sildenafil use in neonates with persistent pulmonary hypertension of newborn

Background: The prevalence of PPHN has been estimated at 1.9 per 1000 live births. After the discovery of iNO\u27s, its efficacy and benefit in PPHN is well established. Even in the best of centers equipped with iNo and ECMO the mortality is around 20%. Also, iNO is expensive and difficult to administer and monitor which makes it difficult choice in our part of the world. Furthermore About 40% of patients do not respond or have rebound pulmonary hypertension after discontinuation. Owing to these reasons, other treatment modalities like phosphodiesterase inhibitors such as Sildenafil need to be evaluated.Methods: We report a retrospective case series of eighteen patients with PPHN admitted in NICU and treated with oral sildenafil.Results: Three (17%) babies had mild, 5 (28%) moderate and 10 (55%) severe PPHN based on echocardiography. Sildenafil was started on all patients on a mean of 1.67 days and stopped on mean 12.6 days. Initial fio2 was 100%, which after starting sildenafil decreased gradually to 40% on mean 10 days. Average length of stay in NICU was 13 days. Twelve (67%) patients survived whereas 6 (33%) expired (Figure 2). No improvement in oxygen Index after 36 hours (p\u3c0.05) was the independent predicting risk factor for PPHN related mortality in the expired patients.Conclusions: Oral sildenafil can be a used in conjunction with other treatment modalities for PPHN especially in resource limited settings. However further studies regarding its comparative efficacy need to be done

Surgically resected gall bladder: Is histopathology needed for all?

Background. Laparoscopic cholecystectomy is considered to be gold standard for symptomatic gall stones. As a routine every specimen is sent for histopathological examination postoperatively. Incidentally finding gall bladder cancers in those specimens is around 0.5–1.1%. The aim of this study is to identify those preoperative and intraoperative factors in patients with incidental gall bladder cancer to reduce unnecessary work load on pathologist and cost of investigation particularly in a developing world. Methods. Retrospective records were analyzed from January 2005 to February 2015 in a surgical unit. Demographic data, preoperative imaging, peroperative findings, macroscopic appearance, and histopathological findings were noted. Gall bladder wall was considered to be thickened if ≥3 mm on preoperative imaging or surgeons comment (on operative findings) and histopathology report. AJCC TNM system was used to stage gall bladder cancer. Results. 973 patients underwent cholecystectomy for symptomatic gallstone disease. Gallbladder carcinoma was incidentally found in 11 cases. Macroscopic abnormalities of the gallbladder were found in all those 11 patients. In patients with a macroscopically normal gallbladder, there were no cases of gallbladder carcinoma. Conclusion. Preoperative and operative findings play a pivotal role in determining incidental chances of gall bladder malignancy

Trail without catheter after transurethral resection of prostate: clamp It or not?

Abstract Background. There has been argument between clinical practitioners about clamping catheter or not prior to its removal after transurethral resection of prostate (TURP). We conducted a clinical trial to assess whether clamping has any role in early bladder tone recovery particularly in patients who undergo TURP. Methods. Randomized clinical trial was conducted at a tertiary care hospital, Karachi from January 2014 to July 2015. Eighty-six study participants who underwent TURP were randomly allocated into two groups of 43 participants each. In Group I, patient\u27s Foley catheter was not clamped prior to its removal and in Group II Foley catheter was clamped. Data of all subjects were analyzed using SPSS version 20. Results. There was no significant difference in age and weight of resected tissues between two groups. Among 4 patients in Group I who required recatheterization, 1 patient was discharged with catheter as compared to Group II in which 2 patients were discharged with catheter (P = 0.99). Only 1 patient (2.3%) in Group II had bleeding which required recatheterization. Length of stay was significantly affected by early and free removal of Foley catheter (P \u3c 0.001). Conclusion. The results of current study identified that clamping whether done or not had no significant impact on urinary retention

Factors affecting compliance with standard precautions among nursing and allied health staff at a tertiary care hospital in Karachi

Standard precautions have been promoted widely to protect patients and health care workers from health care associated infections. Partially followed standard precautions, increases the risk of infection transmission. The aim of this study was to measure the level of Compliance with Standard Precautions (CWSP) and to explore the factors associated with CWSP among nursing and allied health staff at a tertiary care hospital in Karachi. Methods: Following a gross-sectional study design, 279 nursing and allied health staff, including nurses, midwives, technicians, and nursing assistants from the Aga Khan University Hospital (AKUH), Karachi, participated in this study\u27 The data were collected using the Health care worker\u27s Questionnaire (Gershon et al., 1995; Kermode et a1., 2005). Results: The overall compliance rate with standard precautions at AKUH was 44.1%\u27. However, variations were found from unit to unit; the Coronary Care Unit had the highest (90%) and Surgical Units had the lowest rate (30.8%). Variations were also found among different components of the standard precautions as well as for various items within specific components. With regard to the factors affecting CWSP, safety climate, co-workers\u27 support, knowledge about blood borne virus transmission and standard precautions were positively associated with the staff’s compliance; whereas, workplace stress and risk taking behavior were negatively associated with the staff s compliance. Implications These findings imply that decreased workplace stressors, a supportive work environment, promoting a safety climate, enhanced knowledge, and increased commitment of staff towards standard precautions are the key factors to improve individuals\u27 CWSP