Two testicles in left inguinal region: An unusual presentation of Polyorchidism.

We present a case of 1-year old boy who presented with left undescended testis and hernia. The testis on right side was normally placed. During surgery 2 testicle each with separate epididymis and vasa deferentia.   Keywords: Undescended double testes, Orchidopexy, Herniotomy

Post-operative surgical site infection in Inguinal Hernia.

Introduction: Surgical site infection is defined as microbial contamination of surgical wound within 30 days of operation; most common complication occurs after surgery and increase the mortality and morbidity rate. Objective: To find prevalence of post-operative surgical site infection and it’s causing organism. Methodology: This descriptive study was conducted between Feb 2014 to July 2017, 100 cases operated in Bhurgri Hospital Matli, were included after taking informed consent. The surgical site when found infected, swab sensitivity was sent. Result: The age range was from one month to 70 years. A Total number of 100 patients with primary and recurrent inguinal hernia were subjected to hernia repair with proven mesh and anatomically repair. Conclusion: Escherichia Coli is the most common pathogens involved in post-surgical infection. Keywords:  Inguinal hernia, mesh repair, wound infection, microorganism infection rate

Complications of Laparoscopic cholecystectomy at Muhammad Medical College Mirpurkhas: Audit of 100 cases.

Introduction: The main objective was to determine the complications of laparoscopic cholecystectomy (LC) and its cause at Muhammad Medical College Mirpurkhas.Methodology: This is prospective study carried out from February 2008 to January 2016. Data of all patients undergoing elective laparoscopic cholecystectomy during the study period and fulfilling the selection criteria was collected and entered in standard proforma and analyzed on SPSS 10.Result: A total number of ten patients underwent laparoscopic cholecystectomy with an overwhelming majority of females (87 out of 100). The age ranges from 22-60 years mean age being 38 years. The overall complication rate was 9%. The complication included bleeding (4/100, 4%) from cystic artery and gall bladder bed, port site infection (4/100 4%) One patient developed collection in pouch Morrison and one patient was developed stitch granuloma. There was no bile duct injury and colonic injury. The most common cause of these complications was accidental injury to cystic artery and gross spillage of infected bile.Conclusion: Bleeding and port site infections were common post-operative complication; the most common cause of bleeding was cystic artery injury whereas the commonest cause port site infection was gross spillage of infected bile.Key Words: Laparoscopic endoscopy, cholelithiasis, complication

Orbital Embryonal Rhabdomyosarcomain Karachi (1998-2002)

Objective: To study the epidemiology of ocular Rhabdomyosarcoma (ORMS) in Karachi. Methods: Incident ORMS cases resident of Karachi, registered at Karachi Cancer Registry (KCR) during 1st January 1998 to 31st December 2002 were included in the study. The data were classified using ICD-O2; computerized with Canreg-3, and analyzed using SPSS 10.0. Results: Ten cases of ORMS were reported to KCR during 1998-2002. RMS originated in the orbit in eight cases, conjunctiva in one and eyelid in one. Nine cases presented with proptosis, associated with conjunctivitis in four cases. One case presented with eyelid swelling. The crude annual incidence rate was 0.13/100,000, the age standardized rate was 0.3/100,000. The mean age of childhood cases was 10.4 years (95% CI 4.0; 16.7); and adult cases was 24.8 years (95% CI 12.8; 36.7). At presentation, eight patients were older than 10 years and three were older than 20 years. Five cases were categorized as childhood malignancies. Tumors were a TNM stage III disease at presentation in eight cases; survival at the end of one year was 70%, and at the end of two years 20%. There were no survivors at the end of three years. Conclusion: ORMS in Karachi is a disease with a dismal survival. It may reflect a late presentation, or shorter adult ORMS survival or a manifestation of a different genetic pattern, associated with rapid evolution and poor prognosis. Health education for the population, especially parents and health providers is essential for early ORMS diagnosis. Pediatricians, ophthalmologists and health professionals, can play a vital role. Healthcare planning should focus on capacity building for ophthalmologic screening. Cytogenetic studies are advised to determine the genetic pattern

Awareness of the process of informed consent among family practice patients in Karachi

Objective: To study the awareness of \u27Informed Consent\u27, among patients presenting to Family Physicians. Methods: A cross-sectional study was carried out at the Community Health Centre, Aga Khan University Hospital, Karachi in July 2002. Written Consent was taken and confidentially was assured Results: Out of the 100 patients interviewed, 80 agreed to participate in the study, forty-four men and thirty-six women. Approximately half the participants (45%) were graduates and 40% had less than five years of school education. The awareness of the process of \u27informed consent\u27 was observed in only 20% of the respondents, all in the educational category of graduates. Conclusion: A lack of awareness of informed consent was observed in patients attending the Community Health Centre, Aga Khan University, despite stringent institutional policies, which are adequately followed. To improve awareness, \u27Health Education Programs\u27 for the population are required with media support. Readability of written consent forms should be of class V level or less to give advantage to the less educated classes in the society. Local languages should be utilized for written and verbal consent. Public health programs should also be aimed at educating physicians, nurses and paramedics. Provisions should be made to legalise the process of taking consent (JPMA 54:398;2004)

Ductal carcinoma in situ (DCIS) in Karachi

Objective: To study the frequency of ductal carcinoma in situ (DCIS) in a large pathology series. DCIS is a proliferation of non-invasive, malignant epithelial cells within the ductolobular system of the breast. It is a heterogeneous entity with several morphologic variants that differ in gross appearance, growth pattern, cytologic features, mammography, and malignant potential. Methods: The data of The Aga Khan University\u27 Pathology Department, diagnosed on the basis of histopathology, during a 6-year period (1st January 1998 to 31st December 2003) was reviewed, all cases of DCIS studied, and data was analyzed with the help of analytical software SPSS. Results: Thirty-eight cases of DCIS were reported to the Aga Khan University Pathology Department, during a 6-year period (1998 to 2003), comprising approximately 1% of all breast cancers reported to the unit in the same period. The mean age of the patients at diagnosis was 48.95 years (CI 95% 44.6; 53.3). Approximately half the cases occurred in the 45-54 year age group (figure 1). Two cases (5.3%) were recurrences with previous lumpectomy scars. Comedo necrosis was observed in five (13.2%) cases, whereas 33 (86.8%) cases were non-comedo type. The clinical presentation was a palpable mass (92.1%), nipple discharge (5.3%) or clinically occult lesions diagnosed on mammography (2.6%). Approximately half the patients presented with a grade 2 disease. Atypical ductal hyperplasia was observed in a third of the cases, predominantly associated with a grade 1 and 2 disease. The estrogen and, progesterone receptor status was studied in 12 (31.6%) cases. Estrogen positivity was observed in 11 (91.7%) cases and progesterone positivity in 7 (58.3%) cases. Microcalcification was observed in four (10.6%) cases. Conclusion: The cases reported in this study are the indolent grade 1 or 2 cases with a non-comedo pattern, and a positive estrogen and progesterone receptor status. If untreated, only 40% of these innocuous forms of DCIS become invasive over a time span of approximately 25-30 years. In Pakistan we are missing the more aggressive forms of DCIS which have a shorter transition to invasive carcinoma

Cancer Esophagus Karachi 1995-2002:Epidemiology, Risk Factors and Trends

Objective: To study the trends of cancer esophagus in Karachi South during 1995-2002 and identify risk factors. Methods: Incident esophageal cancer cases recorded at the Karachi Cancer Registry for Karachi South, during 1st January 1995 to 31st December 2003 were reviewed. For maximum completion of data, incident cases registered from 1st January 1995 to 31st December 2002 were included for final analyses. Results: The Age Standardized Incidence Rates (ASIRs) of cancer esophagus in Karachi South for males were 6.5/100,000 (1995-1997) and 6.4/100,000 (1998-2002). In females the observed rates were 7.0/100,000 (1995-1997) and 8.6/100,000 (1998-2002). Conclusion: In the moderately high incidence, cancer esophagus zone of Karachi, the ASIRs in males remained stable during the last decade, but in females, an upward trend was observed suggesting a progressively higher exposure to risk factors in the latter. The potential risk factors in Karachi are use of all forms of tobacco, areca nut, infrequent consumption of raw fruits and vegetables and diet deficiencies. There is a necessity to actively control the proven risk factors and address the existence of other risk factors. The primary recommended strategy for the control of cancer esophagus would therefore be legislation against tobacco and areca nut in Pakistan and public health education. The risk factors of cancer esophagus identified in this article need to be further confirmed

Risk Factors of Blood Transfusion during Caesarean Delivery in Rural Area of Sindh

Introduction: Hemorrhage is a leading cause of maternal deaths; particularly in developing countries. Bleeding in pregnant ladies is an indication of blood transfusion with all its attended risk. Objective: This study was conducted to identify the factors necessitate blood transfusion during cesarean section. Methodology: A total number of 2855 of pregnant women scheduled for emergency cesarean section or elective cesarean section at Bhurgri Hospital, rural area of Sindh, between July 2014 and December 2017. Participant were followed from the date of admission to the date of discharge and then for two weeks. Preoperative Hb level and the need for blood transfusion, clinical experience of obstetrician, indication for caesarean section, primary or repeat caesarean section and status of HBsAg/HCV were assessed. Results: A total of the numbers of 4823 patients had deliveries from July-2014 to Dec-2017.Among them, 2855 patients underwent cesarean delivery, the ratio of cesarean section was recorded as 59.19%. All pregnant women who underwent cesarean delivery selected for our study. The mean age of the women who had surgery was 26 years. Conclusion: Preoperative anemia, increasing parity, severe blood loss at surgery and status of HBs/HCV significantly contributes to require for blood transfusion in pregnant women undergoing a surgery (cesarean section). Keywords: Caesarean section, Blood product transfusion, Risk factors, Anemia, HBs, HCV

Small B Cell Non-Hodgkins Lymphoma in Pakistan

Objective: To study the pattern of small B cell lymphomas in Pakistan. Methods: This descriptive study was carried out at the Aga Khan University Hospital pathology department including 1721 cases of Non-Hodgkins Lymphoma (NHL) diagnosed during a period of five years (1998-2002) and classified according to REAL/WHO classification. The antibodies used included Leukocyte Common Antigen (LCA), Pan B (CD20, CD79a), Pan T (UCHL-1), Bcl 2, Mib 1(Ki 67) and Cyclin D1 (Dako, Denmark). Results: Out of the 1721 NHL cases, only 140 (8.1%) could be categorized as small B-cell NHL. The study group comprised small lymphocytic lymphoma/chronic lymphocytic leukemia (58 cases; 41.4%) followed by follicular lymphoma (46 cases; 32.9%), mantle cell lymphoma (15 cases; 10.7%), extra nodal marginal zone B cell lymphoma of MALT type (15 cases; 10.7%), lymphoplasmacytic lymphoma (5 cases; 3.6%) and splenic marginal zone B-cell lymphoma (1 case; 0.7%). No case of nodal marginal zone lymphoma was diagnosed. The age ranged from 18 to 98 years with a mean and median of 54.64 and 58.50 years respectively. Small B-cell NHL was more common in males; with male to female ratio of 2.1. Majority of the small B-cell NHL were nodal at presentation with a nodal to extranodal ratio of 3.4. Conclusion: It is concluded that the frequency of these small B-cell NHL is very low in our population in contrast to the western literature. Further studies based on epidemiologic and etiological factors are required to look into this marked difference of occurrence of these indolent lymphomas