Huge Multinodular Goiter with occult carcinoma: A case report

Enlarged nodular goiters are becoming increasingly infrequent. They are still common in certain geographical areas and can present with compressive symptoms to the trachea, oesophagus and recurrent laryngeal nerve. Surgical treatment of enlarge goiter involves a high degree of skill which can lead to serious complications. We present a case 73 year old female patient who had huge enlarged multinodular goiter for more than 15 years. Surgery was planned and thyroidectomy was done. Surgical excision resolved the local symptoms. Histopathological examination revealed papillary carcinoma with multiple cysts and areas of haemorrhage and necrosis

Surgical Audit of Patients at a Tertiary Care Hospital

Objective: Analysis of various cases admitted to surgical unit of Pakistan Institute of Medical Sciences (PIMS), Islamabad. Patients and Methods: This cross-sectional study was conducted from Jan 2016 – Dec 2016 at Department of General Surgery, PIMS Islamabad. The record of all the cases admitted in Surgical Unit II during the year 2016 was reviewed. All data was collected on a specially designed performa that included basic information of patients like demographics characters, mode of admission i.e. emergency, outpatient department, referred or transferred from another unit, management i.e. operation or conservative treatment, the outcome of management i.e. discharge, referred or death, and the presence of co-morbidities. Data was recorded and analyzed by using SPSS version 20. Results: Total number of admissions during the study period was 822, out of these 54.3% (n=447) were males and 45.60% (n=375) were females. The mean age of the patients was 35.9. The Record showed that 33.09% procedures were performed in an emergency while 66.91% were elective. Among these appendicectomy was the commonest emergency procedure while cholecystectomy was the commonest elective procedure. Majority of patients (94.89%) were discharged with full recovery and there were 19 (2.31%) deaths. Conclusion: Most patients were managed by surgery elective. Cholecystectomy being the most common elective procedure followed by breast surgeries and Appendicectomy was the most common operation performed in emergency. In Pakistan, there is a need for Surgical Audit in our hospitals for proper planning and betterment of health care system of the country. It is recommended to start computerized audit and sharing of patient’s database

The modified Adomian decomposition method for solving Chaotic Lü system

In this paper, a numerical scheme based on adaption of standard adomian decomposition method (ADM) is applied to thechaotic Lü system. Then, the standard ADM is converted into a hybrid numeric-analytic method called the modified ADM (MADM). Numerical comparisons with the standard ADM and the fourth-order Runge-Kutta method (RK4) is made in order to prove that MADM is the reliable method for nonlinear problems

Patients’ Satisfaction About Health Care Services in Outpatient Department of General Surgery at PIMS, Islamabad

Objective: To assess the Patients’ satisfaction about health care services in the outpatient department of General Surgery at PIMS, Islamabad. Methodology: This is a prospective cross sectional study done for six months at General Surgery OPD, PIMS, Islamabad. All patients who attended the outpatient department of GSU-III were included. After consent patients answered a specially designed 30-item cross-sectional questionnaire regarding general convenience and satisfaction aspects regarding the OPD. Questions depicting the interpersonal relationships and the role of Doctors and the paramedic staff at the hospital are also included. All data was collected, recorded and analyzed using SPSS 17 and excel 2013. Results: A total of 410 patients were included with the mean age of 41 years and male to female ratio was≈ 1:3. 57.4% patients had completed their secondary or higher secondary education. 12.1% were labourers, 19.5% were students, 19.5% were unemployed and 34.1% were housewives. Most of the population was already registered at the general surgery department PIMS. Response to various questions regarding general convenience and satisfaction aspects regarding the OPD were averagely rated ‘agree’ or ‘strongly agree’ by 96.3% patients, while 14.6% had their reservations. Answers depicting the interpersonal relationships and the role of Doctors and the paramedic staff at the hospital were appreciable in 71.95% and 64.6% of the cases respectively. 16.2% and 19.5% negated respectively. Interviews from all patients were taken into account in data analysis and conclusion. In sum, the patient’s satisfaction (58.5%) with the overall care (62.1%) were satisfactory. 59.7% patients wished to recommend this service to others. Conclusion: Most of the patients who visited the Outpatient department of General Surgery Unit III were satisfied regarding the overall care and the behavior of doctors and paramedical staff interacting with them

Patient satisfaction with regards to health care services provided in general surgery ward at PIMS, Islamabad

Objective: To assess the patient’s satisfaction about health care services in the general surgery ward at PIMS, Islamabad.Methodology: This is a cross-sectional study done for three months at General Surgery ward PIMS, Islamabad. All patients admitted and discharged from General Surgery Unit-III from March to May 2018 were included in the study. After formal permission from the patients, a specially designed 30-item cross-sectional questionnaire pertaining to general patient satisfaction and convenience aspects, interpersonal relationships and the role of doctors and paramedic staff of the general surgery ward were noted. All data was collected, recorded and analyzed using SPSS 17 and Excel 2013.Results: A total of 251 patients were incorporated in the study with an average age of 45 years with Male to Female ratio of 1:2. General convenience and satisfaction aspects pertaining to the general surgical ward were averagely rated by the patients. They agreed or strongly agreed by 82.8% patients, while 17.2% had uncertainties. Interpersonal relationships and the role of Doctors and the paramedic staff at the hospital were appreciated by 77.1% and 68.9% respectively, while 22.9% and 31.1% negated respectively. Patient’s interviews were incorporated in data examination and deductions. Patient’s satisfaction was evaluated to be 56.3% while overall care was 59.7%. 65.2% patients wished to recommend these services, to others in need.Conclusion: Most of the patients admitted at General Surgery Ward were satisfied with overall care and behavior. Areas that need more attention are cleanliness, privacy, seeking patient views in their illness discussion, explaining them the prescription drugs and lab investigations

Perceptions of COVID-19 Disease Among Patients in Isolation Ward

Objective: To explore the perceptions about COVID – 19 disease among patients admitted in Isolation ward and to improve management ideas. Methodology: This qualitative cross sectional interview based study was conducted at Isolation ward, Pakistan Institute of Medical Sciences Islamabad from April to June 2020. Patients who were reported positive for SARS COV-2 through nasopharyngeal or oropharyngeal swabs and were admitted for at least one day in isolation ward, were included in the study. Patients who were too ill to talk for the interview and those who could not survive the disease were excluded. After taking informed consent and following the standard operating procedures (SOPs) of Corona Isolation ward; data was obtained by conducting in depth interviews arranged as per patients’ convenience on mobile calls. Data was analyzed using Narrative Analysis. Themes were delineated and organized to groups for understanding. Results: Twenty two patients participated with the mean age of 34.64±7.26 years. Majority of the patients had anxiety and fear for the COVID-19 disease however also were hopeful to face it. The delineated themes were anxiety & depression, fear, hopefulness & moving forward, health facilities & related issues, living in isolation and physiological disturbances like sleep, appetite, smoking or addiction, exercise. Conclusion: Covid-19 patients depict mixed perceptions while admitted in Isolation ward and this provide us an insight to this catastrophic illness. Their experiences help the health authorities to address this issue. &nbsp

Surgical Management of Soft Tissue Sarcoma

Background: To study the management patternof soft tissue sarcomas in a tertiary care settingMethods: In this descriptive study patients whowere operated for soft tissue masses were included.Intra-operative findings, procedure details andpostoperative orders were recorded. Postoperativechemo-radiotherapy records were reviewed andrecorded. Depth of the tumour was grouped asdeeper or superficial than 5 cm. The follow uprecords were accessed from the outpatientdepartment and any surgical complications wererecorded up to three years.Staging was done usingclinical and radiological criteria taking into accountthe histological grade,tumour size , depth, locallymph node invasion and metastasis.Surgicalprocedure for removal of STS are wide local excision(WLE), intralesional excision (IE) or tumordebulking, marginal excision (ME) and radicalexcision (RE).Results: Sixty eight patients with mean age of 43.0± 17.258 SD were diagnosed as cases of soft tissuesarcomas. Male to female ratio was 3.25:1.The mostcommon histopathological variety was malignantfibrous histiocytoma (35.3%) , followed byRhabdomyosarcoma(30%). Most common involvedsite was lower limbs (35.3%).Wide local excision wasperformed in majority (82.4%) . Most commonpostop complication was wound infection (10.3%)Conclusion: Clinicians must be agile about thenature of these tumours and their referral to aspecialist surgeon for further management. Promptdiagnosis, accurate investigations and earlyintervention will benefit the patients and help usunderstand this disease entity