Surgery Outpatient Department Research Articles

Mediation and Dose-Response Relationship Among Physical Activity, Daylight Exposure, and Rest-Activity Circadian Rhythm in Patients With Esophageal and Gastric Cancer.

Physical activity and daylight exposure predict rest-activity circadian rhythm (RACR) in patients with cancer. However, whether daylight exposure mediates the relationship between physical activity and RACR and the optimal amounts of physical activity and daylight that benefit RACR remain unclear. This study investigated the mediating role of daylight exposure and determined the dose-response relationship among daylight exposure, physical activity, and RACR in patients with cancer. This cross-sectional exploratory study recruited 319 patients with esophageal and gastric cancer from 2 surgery outpatient departments in Taiwan. Daylight exposure (>500 lux), physical activity (up activity mean), and RACR (midline estimating statistic of rhythm) were measured through actigraphy. Regression was performed, and the receiver operating characteristic curve was plotted. Daylight exposure (>500 lux) partially mediated the relationship between physical activity (up activity mean) and RACR (midline estimating statistic of rhythm). The optimal cutoffs for discriminating between satisfactory and poor RACR were 187.43 counts/min for physical activity (sensitivity, 90.3%; specificity, 84.4%) and 35.71 min/d for daylight exposure (sensitivity, 55.9%; specificity, 78.2%). Participants who engaged in physical activity were more likely to receive daylight exposure and experience improved RACR. The optimal level of daylight exposure and frequency of physical activity that can improve RACR in patients with esophageal and gastric cancer are 36 min/d and 187 counts/min, respectively. Healthcare professionals should encourage patients to engage in exercise or physical activity during the daytime to improve their circadian rhythm.

Psychological Assessment and Treatment Effectiveness in Mastalgia: Developing a Treatment Algorithm.

Background Mastalgia often impairs the physical, social, and sexual lives of women. It may manifest in both cyclical or acyclical patterns. The psychoneurotic association of mastalgia has been claimed for a long time in various available literature. Several treatment options have been used and are available in the market for mastalgia, but no specific guidelines are currently in place at the global or local levels. This study aims to evaluate the psychological status and effectiveness of various treatment options in women presenting with mastalgia. Methods This study was conducted in the General Surgery outpatient department from February 1 to November 30, 2021,at King George's Medical University, Lucknow, India. Females of all age groups presenting to the General Surgery outpatient department with unilateral/bilateral breast pain and/or chest wall pain were considered for this study. Pregnant patients, those with a history of allergy to drugs, or those who were lost to follow-upwere excluded from the study. The psychological status of patients was assessed using the Depression Anxiety and Stress Scale(DASS-42) scale. Pain assessment was performed using a visual analog scale (VAS). Patients were divided into five categories: (i) isolated chest wall pain, (ii) isolated breast pain, (iii) both chest wall and breast pain, (iv) pain with an associated lump(s), and (v) pain and tenderness isolated over the lump, and two groups: Group-A: VAS≤4, and Group-B: VAS>4. Group B patients in Category iv were randomized into two groups: topical non-steroidal anti-inflammatory drugs (NSAIDs) or evening primrose oil+vitamin E. The next line of treatment was tamoxifen 10mg followed by danazol 100mg followed by ormeloxifene 30mg. Results The mean age of 106 participants enrolled was 31.59±10.52 years. The mean scores,using the DASS-42 scale, for depression, anxiety, and stress were 7.31±8.53, 7.08±6.57, and 11.15±8.07, respectively. The depression, anxiety, and stress scores had no significant correlation with pain scores (p =0.84, 0.99, and 0.97 for depression, anxiety, and stress, respectively), or duration (p=0.69, 0.66, and 0.85 for depression, anxiety, and stress, respectively). Twenty-nine of 43 patients (67.44%) responded to topical NSAIDs as first-line treatment, and out of the remaining, 6.98% responded to evening primrose oil + vitamin E, 18.60% to tamoxifen, and 4.65% to danazol. Twenty-nine of 32 patients (90.63%) responded to evening primrose oil+vitamin E as first-line treatment, while 6.25% and 3.12% responded to tamoxifen and danazol, respectively. Conclusions Both topical NSAIDs and evening primrose oil + vitamin E were found effective first-line treatment options in the majority of patients. Hence, it is always advisable to start such patients on topical NSAIDs, or evening primrose oil + vitamin E, before switching over (if no resolution of pain is reported with these drugs) to higher and more severe treatment options. The duration or severity of pain did not correlate with the psychological condition of the patient.

Factors affecting patient satisfaction at a plastic surgery outpatient department at a tertiary centre in South Africa

BackgroundThe main purpose of a medical facility is to improve the welfare of patients, and user satisfaction is one of its primary goals. This study aimed to identify variables influencing patient satisfaction at the Plastic Surgery Outpatient Department of Chris Hani Baragwanath Academic Hospital, Gauteng, South Africa. By identifying factors affecting patient satisfaction, the services provided to patients may be improved.MethodsA questionnaire was compiled focusing on patients over 18 years of age and using a Likert scale to measure factors influencing patients’ satisfaction with the services received. Descriptive statistics were applied.ResultsA total of 142 participants, 69% of whom were under age 40 and 52.8% were male, were recruited using a systematic sampling technique. In 78% of cases, this was the patient’s first visit to the clinic. The results revealed that the patients were not satisfied with the ease of appointment scheduling and waiting times. A high level of satisfaction was reported for both nursing staff and doctors, aside from a lack of clear and prominent display of name badges. Overall satisfaction was at the “satisfied” level, and no participants reported lower than neutral feelings. The CSAT score was 79.5%, which is considered “good” for healthcare. The participant’s level of education was significant in multiple items; those with the lowest education reported higher overall satisfaction. A model produced by regression analysis was found to be strongly significant statistically.DiscussionBatho Pele principles in South Africa provide a framework for consulting with service consumers, ascertaining their happiness, and identifying methods to enhance their experience. According to this survey, people are happy with the human part of the services received, although areas such as scheduling appointments and the physical surroundings still need much work.ConclusionThese aspects of treatment are occasionally disregarded in a medical organisation with insufficient finances. Developing these areas can help turn patients into devoted patrons of a healthcare facility. An effective strategy to boost customer satisfaction has been suggested to enhance service quality and, especially in South Africa, conform to Batho Pele service standards.

Case Report: Tuberculosis in hydrocele of the spermatic cord in an older adult

Background: Antibioma is a loculated collection in the spermatic cord, which is generally a transparent sterile fluid located above the testis in the inguinal region. It is an acquired congenital anomaly that is commonly observed in infants and children. Infected spermatic cord hydrocele has been reported on previously, but to the best of our knowledge, antibioma of spermatic cord hydrocele in adults has not yet been reported. In specific cases of long-standing abscesses, cartridge-based nucleic acid amplification test (CBNAAT) is used as the final diagnostic tool and can determine whether they are of tubercular pathology. Case: Here we are presenting a case of a 72-year-old male patient reporting to the surgery Outpatient Department, with complaints of swelling in the left inguinal region since birth, along with intermittent pain in the swelling for one year. It was diagnosed as antibioma and was confirmed to be of tubercular origin by CBNAAT following surgical exploration. The patient was started on anti-tubercular management as per the National Tuberculosis Elimination Programme protocol. Conclusions: Long standing abscesses are mostly tuberculous. We must look into whether they need urgent attention or can be managed conservatively as a routine procedure.

A study to assess the efficacy of local applicants to prevent complications of diabetic foot

Background: Diabetes is one of the most common comorbid illnesses in our community. Diabetes is associated with numerous complications related to microvascular, macrovascular, and metabolic etiologies. One of its complications in long course is diabetic foot ulcer and the associated morbidity and mortality is a major health issue. Aims and Objectives: This study was conducted to describe the lesions we treat, study and compare outcomes and to identify measures to decrease morbidity and mortality due to diabetic foot disease. Materials and Methods: All patients who attended general surgery outpatient department at M.Y. Hospital (M.P.) India between July 1st 2021 and June 30th, 2022 were included in this study with nonhealing Diabetic foot Ulcer Wagners Stage 3 for more than 2 weeks without any other comorbidities. Results: Majority of the patients presented with higher grade and with poor glycemic control at the time of presentation. Conservative management with antibiotics was useful in a small subset of the patients. Majority of the patients needed surgical treatment in the form of debridement to amputations. Conclusion: Diabetic limb disease is more prevalent in male sex commonly in 51–60 years of age group. 74% of patients presented with foot ulcer and Staphylococcus aureus was found the most common microorganism in pus culture from wounds. Local applicants are effective in controlling ulcers. In our study, hydrogel with colloidal silver was most effective followed by silver nitrate. Early and aggressive treatment of these ulcers can prevent the rate of amputation.

Demographic Diseases Pattern in the ENT and Head and Neck Surgery Outpatient Department of A Tertiary Care Hospital

Background: The distribution of diseases in society varies across communities and geographical places. Diseases of the ear, nose, and throat (ENT) pose severe public health issues in both rural and urban populations.Objective: To determine the demographic disease pattern in the ENT and Head and Neck Surgery (HNS) Out Patient Department(OPD).Materials and Methods: This retrospective study is based on patient’s medical records who attended the Out Patient Department of Otorhinolaryngology, Khwaja Yunus Ali Medical College and Hospital (KYAMCH). The study records covered 2312 patients who visited the Out Patient Department from September 2019 to August 2020 were included in this study.Results: Study of patients in light of their diagnoses of chronic tonsillitis in 367 (15.87%), followed by chronic pharyngitis affected 347 (15.01%) patients, allergic rhinitis in 135 (5.74%), acute/chronic adenotonsillitis with otitis media with effusion in 133 (5.75%), and otitis externa in 123 (5.32%) individuals. In a broad heading, if the tonsils are mainly affected, it’s called tonsillitis; if the throat is mainly affected, it’s called pharyngitis.Conclusion: High prevalence of chronic tonsillitis and pharyngitis among ENT illnesses. The most prevalent ENT conditions include chronic suppurative otitis media (CSOM/COM) 11.63%, allergic rhinitis, acute and chronic adenotonsillitis, otitis media with effusion (OME), otitis externa and acute tonsillitis. KYAMC Journal Vol. 14, No. 01, April 2023: 43-47

A CLINICAL PROSPECTIVE STUDY OF CHRONIC PANCREATITIS

Introduction: Chronic pancreatitis (CP) is a relentlessly progressive fibroinflammatory process, resulting in the destruction of endocrine and exocrine elements, which may eventually lead to pancreatic insufficiency. Although previous reports on the treatment of CP have yielded considerable data, our study hopes to give validation on managing CP patients conservatively with confidence. Aim: A prospective study of CP. Methods: This study was conducted in the Department of General Surgery, SVRRGGH, affiliated with Sri Venkateswara Medical College Tirupati. The materials for the study were collected from patients presenting to the surgery outpatient department and emergency room with the features of CP during the period of March 2020–April 2021 were included in the study. Results: The incidence is high in patients of age group 44.46±9.16, of which 63.3% were males and 36.7% were females. The most common presenting symptom was pain abdomen. All the data were statistically analyzed using software, namely SPSS 21.0 and Instat. Microsoft Word and Excel have been used to generate tables and graphs. Results on continuous measurements are presented on Mean±SD, and results on categorical measurements are presented in number (%). Conclusion: Conservative management shows 100% pain relief, 33.3% had steatorrhea, while surgical management shows 80% pain relief and 80% steatorrhea. Hence patients with CP can be treated effectively with conservative management.

CLINICAL STUDY OF DIABETIC FOOT, ITS RISK FACTORS, CLINICOPATHOGENESIS, INVESTIGATIONS AND MANAGEMENT

Objectives: The objectives of the study are to study epidemiology and clinicopathogenesis of diabetic foot ulcers and (2) to study investigations that correlate with diabetic foot recurrence and its management. Methods: This study was done among diabetic patients came to surgery outpatient department with complaints of ulcer, swelling, gangrene, over foot, toes/leg+foot/ankle and admitted in surgery ward of C.R. Gardi Hospital, Ujjain, Madhya Pradesh, in time period between October 2017 and November 2018. Detailed history and thorough clinical examination were done in all cases. A total of 85 cases of diabetic foot ulcers were analyzed. Results: Out of 85 patients involved in study, peak incidence of diabetic foot ulcer is seen in age group of 51–60 years and the lowest, i.e., 3.5% of incidence seen in age group of <40 years. The most common cause of ulcer formation was trauma, i.e., 61.2% and rest 38.8% were spontaneous as patients were unaware of any injury that might have caused it. In this study, it is seen that patients with duration of diabetes 11–15 years were most consisting 40% of all patients and more than 15 years being the least with 7.2%. Conclusion: On the basis of our study findings, we found out that most common mode of ulcer formation was due to injury rather than spontaneous. It can be due to the fact that majority of population is from rural areas and less educated and mostly involved and open-field work such as farming and laborer.

Management of a giant lymphocele following varicose vein surgery: a case report

BackgroundA lymphocele or lymphocyst is formed when lymphatic fluid accumulates in a space, following disruption of lymphatic channels. Here, we report a case of a giant lymphocele in a middle-aged female, who underwent Trendelenburg operation (saphenofemoral junction ligation) for varicose veins of her right lower limb.Case presentationA 48-year-old Pakistani Punjabi female presented to the plastic surgery outpatient department with a history of painful, progressive swelling of the right groin and medial aspect of the right thigh for 4 months. After investigation, it was diagnosed as a giant lymphocele. A pedicled gracilis muscle flap was used to reconstruct and obliterate the cavity. There was no recurrence of the swelling.ConclusionLymphocele is a common complication after extensive vascular surgeries. In the unfortunate case of its development, prompt intervention must be done to prevent its growth and ensuing complications.

Clinicopathological Evaluation of Breast Lump in Different Age Groups

Background: Breast masses have a variety of etiologies, benign and malignant. Fibroadenoma is the most common benign breast mass; invasive ductal carcinoma is the most common malignancy. Most masses are benign, but breast cancer is the most common cancer and the leading cause of cancer deaths in women. Although most breast cancers occur in women older than 50, a significant number of women are diagnosed with breast cancer younger than 50. An efficient and accurate evaluation can maximize cancer detection and minimize unnecessary testing and procedures. Objectives: Our study aimed to explore the frequency & pattern of different types of breast lumps in various age groups. Materials & method: This cross-sectional observational study was carried out in the inpatient and outpatient department of surgery at Shaheed Ziaur Rahman Medical College Hospital, Bogra, from July 2008 to Dec 2008. A total of 130 patients with palpable breast lumps were included in the study. The age of the patients was between 11 to 70 years. Fine Needle Aspiration Cytology and biopsy were done for most of the patients with a breast lump. Sometimes ultrasonography, mammography, and other routine investigations were also done. Result: In this study, the most common age was 11 to 20. The three most common diseases presented with lumps were Fibroadenoma, Carcinoma of the breast, and fibroadenosis. Peak age incidence of fibroadenoma was observed in the 11 to 20 age group (66%), while fibroadenosis was common in the third decade (46%), and peak age incidence was between the late twenties and early thirties. Carcinoma of the breast was common in 31 to 40 years age group (40%). No carcinoma was found below the age of 22 years. Most of the patients with carcinoma presented in an advanced stage. This reflects on illiteracy, poverty, lack of awareness, and medical facilities screening procedure in our population. Conclusion: The diversity of clinical presentation of breast lumps in different age groups was observed in our hospital practice, and a correlation between clinical manifestations, FNAC findings, and histological diagnosis of breast lumps was made. Fibroadenoma was common in the second and third decades, while breast carcinoma was common in third and fourth decades. Here we attempted to find out the age incidence of the breast lump and its correlation with clinical features, FNAC findings, and histopathological reports to improve the accuracy of diagnosis and management of breast disease. J Dhaka Med Coll. 2022; 31(1) : 107-113

Experience of Breast Clinic in a Tertiary Level Hospital

Background: Breast cancer is the second leading cancer worldwide (2089 million new cases per year, 11.6%) after lung cancer and 5th most leading cause of death (6.6%). The breast clinic concept is to set up a center of a cohesive group of dedicated breast cancer specialists working together as a multidisciplinary team with access to all the facilities required to deliver highquality care throughout the breast cancer pathway.2 The guidelines note that these professionals do not necessarily have to be based in one location but do need to be in the same geographical area and able to carry out close multidisciplinary work. To provide uniform management of breast diseases, hospital-based breast cancer screening, and properly manage breast cancer patients, we restarted this breast clinic weekly on Thursday in the Outpatient Department of Surgery in Dhaka Medical College Hospital, 2018. Method and Materials: A 1year observational study was done from 1st August 2018 to 31st July 2019. All female patients having breast problems are included in this study by purposive sampling technique. The total number of patients was 620. A database kept using a registrar book, Microsoft Excel, and documents. Results: Out of 620 patients, 26% presented with mastalgia, 50% with a breast lump, 15% with Fibrocystic changes, 4% with nipple discharge, 2 cases with duct papilloma, 2% duct ectasia, and 4% with others. Among the breast lumps, 42% presented with different stages of Carcinoma Breast, 32.4% with Fibroadenoma, 4% with galactocele, 8% breast abscess, 2% with breast TB, 9% with Chronic breast abscess including Granulomatous mastitis. Conclusions: Females are half of the total population, but attention to their problems is not given to that much extent. Therefore, they often presented their symptoms lately. Though mastalgia is a rare symptom of breast cancer, patients are over-conscious regarding breast pain. In contrast, a painless malignant lump grows in its pattern and advances to the T3-4 stage at the presentation time. So providing comprehensive breast care as well as screening with multidisciplinary experts and equipment is a burning need for every tertiary-level hospital. J Dhaka Med Coll. 2022; 31(1) : 93-97

A RETROSPECTIVE STUDY BETWEEN CLINICAL EXAMINATION, FOCUSSED ABDOMINAL SONOGRAM IN TRAUMA AND CT SCAN IN BLUNT INJURY ABDOMEN IN A TERTIARY CARE CENTRE

Aims and Objectives: Blunt abdominal trauma (BAT) accounts for the majority (80 percent) of abdominal injuries seen in the Emergency Department and is responsible for substantial morbidity and mortality in developing countries. It requires high degree of suspicion, investigation and management. The most commonly injured abdominal organs are liver and spleen. The aim of this study was to nd etiology, early diagnosis and management of patients with blunt abdominal trauma based on clinical examination, FAST and CT scan. A retrospective study of 60 cases of blunt Abdominal trauma patients Methods: presenting to emergency and outpatient department of Surgery of Silchar Medical College and Hospital from September 2020 to September 2021 was done. Amongst the studied cases most Results: common age group involved was (21–30) years (28 cases). Liver was found to be the most common injured organ (22 cases) followed by bowel and spleen. FAST was the most commonly used investigation after blunt abdominal trauma. CT was used only in hemodynamically stable patients (19 cases). The most common intra-operative nding was Intestinal perforation and the most common surgery performed was the repair or resection and anastomosis of intestinal perforation. Most common mode of injury wa Conclusions: s road trafc accidents and predominantly, men were affected. Clinical examination alone is inadequate because patients may have altered mental status. Initial resuscitation followed by physical examination and monitoring of clinical parameters and FAST and computed tomography (CT) abdomen are very important to detect patients with minimal and clinically untraceable sign of abdominal injury. Rapid diagnosis, early timed referral, adequate and trained staff, careful monitoring, early decision to go for operative or nonoperative management can help save many lives.

Carcinoma stomach in Eastern India-An audit from a tertiary health care center.

In spite of declining incidence and fatality over the past decade, stomach cancer still remains a global health issue due to its aggressiveness and heterogeneity. There is wide variation in the epidemiology of stomach cancer, not only worldwide but also among different regions of India. However, there is very limited data available for the Indian population. This study was aimed at establishing the incidence and role of risk factors, analyzing the symptoms, stage of disease, and mode of various surgical treatments of patients in the eastern region of India, and comparing them with the results of other studies in India and regions outside India. An audit of the database of carcinoma stomach patients attending the radiotherapy and surgery outpatient department (OPD) between January 2020 and June 2021 was performed. Demographic, clinical, and treatment-related data were collected and analyzed with respect to other regions of India and the worldwide pattern of carcinoma stomach. The mean age of the study population was 58 years with male dominance (70%). The antrum was the most common (60%) primary site, and stage III was the most common (47.6%) stage at presentation. Around 73.4% of patients underwent radical surgery. Most patients (50%) had an eventless post-operative period, and 76% received peri-operative chemotherapy. Also, 20% of patients received adjuvant chemoradiation. Our analysis suggests that there are certain differences (like dietary habits), as well as similarities (like socio-demographic factors), among the risk factors of carcinoma in this part of the country than other parts. Further studies into the risk factors and different clinical presentations are required for prevention and early detection.

Benign breast cyst in a young male patient diagnosed on cytopathology: Report of a rare case

Abstract Fine needle aspiration cytology (FNAC) is a widely accepted procedure for evaluating breast masses. Cystic lesions in female breasts are common. However, they are incredibly uncommon in male breasts, especially in cytology. Here, we report a rare benign breast cyst diagnosis on FNAC in a 26-year-old male patient without associated gynecomastia. A 26-year-old male patient presented to surgery outpatient department with left breast swelling for 3 months. He had no history of pain, nipple discharge, or fever. The patient, however, was on antitubercular treatment for pulmonary tuberculosis. On physical examination, a small diffuse 5–6 mm lump was palpable in the left breast. Ultrasound revealed a soft small tissue lesion in the superior aspect of the left areola with the suspicious flow on color flow Doppler following which FNAC was advised. Aspiration yielded scanty fluid. On microscopy, smears showed low cellularity comprising few monolayered sheets and small aggregates of benign ductal epithelial cells admixed with a fair number of cystic macrophages in a fluid background. There was no evidence of malignancy. Thus, a cytologic diagnosis of a benign breast cyst was rendered. This is the first case report describing the cytology of a benign breast cyst diagnosed in a male patient as young as 26 without associated gynecomastia. We report this case because of the rarity of this condition and to create awareness that breast cysts should also be kept in mind when dealing with male breast masses, thus avoiding unnecessary surgery, especially in a young men.

Primary Breast Carcinoma in Accessory Axillary Breast Tissue: A Case Report

Accessory axillary breast carcinoma is unusual, with an incidence of 0.2 to 0.6%. It is commonly located in the axilla; however, it may be seen anywhere along the milk line. Development is hormone-dependent, similar to normal breast tissue. Here, a 65-year-old postmenopausal multiparous woman presented at the Surgery Outpatient Department (OPD) with a complaint of a lump in her left axilla with multiple overlying skin ulcers for the past four months. A routine bilateral mammogram was performed, which showed a well-defined hypoechoic area measuring 1.2×1.0 cm with no lymph nodes and calcification over the left accessory breast tissue. A wedge biopsy of the lesion revealed Invasive Ductal Carcinoma (IDC). She underwent a left modified radical mastectomy with an extended incision to the left axilla. She also received neoadjuvant chemotherapy with close follow-up. Recent studies suggest that there is no additional advantage with mastectomy over total excision of accessory breast tissue. Axillary clearance is performed if preoperative lymph node biopsy is positive. Early diagnosis and differentiation of accessory breast cancer are the keys to the effective management of the cancer.

Ntestinal Metaplasia in Barrett’s Oesophagus: A Clinicopathological Study

Introduction: The incidence of Oesophageal Adenocarcinoma (EAC) has increased at a faster rate than any other cancer in the developed nations. Despite advances in treatment, five year survival rate for EAC is <15%. Till date, Barrett’s Oesophagus (BE) is the only known precursor of EAC increasing its risk by greater than 30 to 60 fold. Most important risk factor for development of dysplasia and EAC is specialised Intestinal Metaplasia (IM) in BE. Aim: To find the association between clinical, endoscopic and histopathological features and presence of IM in patients with endoscopically suspected BE. Materials and Methods: This was an institution based descriptive study with a cross-sectional design conducted in the Departments of Pathology and Surgery, in a tertiary care centre of North Bengal for four years (2017-2021), among patients attending surgery and medicine Outpatient Department (OPDs) or Inpatient Department (IPDs), suspected on clinical basis and subsequent endoscopic detection of BE utilising Prague criteria. Periodic Acid-Schiff (PAS) and Alcian Blue (pH 2.5) stains were used to detect complete or incomplete IM and results were analysed using appropriate statistical software. Results: Among 120 cases included in the study, 72 (60%) had Short Segment Barrett’s Oesophagus (SSBE) and 48 (40%) Long Segment Barrett’s Oesophagus (LSBE). Hiatal hernia was significantly more frequent in LSBE patients (32 out of 48) compared to patients with SSBE (24 out of 72). The associations of tobacco and alcohol abuse with microscopically proven BE were statistically significant with p-values of 0.005 and 0.004, respectively. The association of IM with the increasing length of Columnar Lined Oesophagus (CLE) was statistically significant (p-value=0.004). Conclusion: Tobacco and alcohol abuse, presence of hiatal hernia (particularly in LSBE patients) were significantly associated with BE. Increasing length of CLE is more commonly associated with IM. Incomplete IM was observed more commonly in LSBE cases whereas complete IM was detected more frequently in cases diagnosed as SSBE by endoscopy

The Diagnostic Value of BRAF V600E Gene Detection Combined with DNA Ploidy Analysis in Thyroid Cancer.

The thyroid cancer incidence has been experimenting an accelerated growth all over the world. The serine/threonine-protein kinase (BRAF) V600E gene detection or the DNA ploidy analysis has been employed in the identification of thyroid cancer type. This study aimed to evaluate the diagnostic value of the BRAF V600E gene integrated with DNA ploidy analysis in thyroid cancer. From August 2022 to May 2023, 400 individuals from the thyroid surgery outpatient department of our hospital were enrolled in this study. The participants were divided into low-risk groups (Ⅰ+Ⅱ+Ⅲ group; n = 200) and high-risk groups (Ⅳ+Ⅴ group; n = 200) based on the Thyroid Imaging Reporting and Data System (TI-RADS). A total of the patients were subjected to the DNA ploidy analysis, the BRAF V600E gene detection, or the combination of both techniques. We evaluated the diagnostic value of the above techniques and considered the postoperative pathology results as gold standard for cancer diagnosis. The negative predictive value (NPV), accuracy, specificity, sensitivity, and positive predictive value (PPV) of TI-RADS, BRAF V600E gene detection, DNA ploidy analysis, and BRAF V600E gene detection joined with DNA ploidy analysis were calculated. Among 400 subjects, 238 presented thyroid cancer and 162 had benign lesions, according to the postoperative pathology results. The obtained sensitivity, specificity, accuracy, PPV, and NPV values of TI-RADS were 55.88%, 58.64%, 57.00%, 66.50%, 47.50%, respectively; of BRAF V600E gene detection were 81.93%, 69.75%, 77.00%, 79.92%, 72.44%, respectively; of DNA ploidy analysis were 83.19%, 72.84%, 79.00%, 81.82%, 74.68%, respectively; of BRAF V600E gene combined with DNA ploidy analysis were 90.34%, 76.54%, 84.75%, 84.98%, 84.35%, respectively. Compared with TI-RADS, the sensitivity, specificity, accuracy, PPV, and NPV values of DNA ploidy analysis, BRAF V600E gene detection, and the conjunction of these last two methods were increased (p < 0.05). The combination of DNA ploidy analysis and BRAF V600E gene detection had the highest values among them all. BRAF V600E gene detection in conjunction with DNA ploidy analysis showed a better diagnostic value than both methods separately or TI-RADS.

Our Experience with Tension-Free Urethral Reconstruction with Urethral Plate Dorsal Slit Technique

Background Hypospadias is among the most common urogenital anomaly which is usually corrected by various surgical techniques. The global burden of hypospadias is shared among adult and pediatric urologists and plastic surgeons as well. Potential complications of the repair include meatal stenosis, urethrocutaneous fistula, urethral stricture, and urethral diverticulum. Fistula rates in large hypospadias series have been reported to range from 2% to 14% in Snodgrass repairs. Objective Our aim of this study is to identify the effectiveness of the dorsal urethral plate slit technique for tension-free hypospadias repair. Material and Methods A retrospective review was performed. A total of 53 patients presented to the plastic surgery outpatient department of Liaquat National Hospital within 2 years from January 2019 – December 2020 with congenital hypospadias, out of these 14 patients were included in the study who met the inclusion criteria. None of the patients had any prior hypospadias correction. The surgical technique involved the dorsal slit technique for tension-free repair. The patients were followed post-operatively for a total duration of 2 years to assess for any post-operative complications. Result The mean age of patients was 11 years, with the most common preoperative complaints of abnormal urinary stream. In all operated cases we observed a 7.1% rate of fistula formation. None of the subject patients developed meatal stenosis and only 1 patient developed a fistula during the study period. All other patients reported a good urinary stream and had an acceptable cosmesis postoperatively. Conclusions The urethral plate dorsal slit technique for tension-free hypospadias repair has a good outcome with relatively fewer complications and a high success rate. This modification along with careful preoperative planning during patient selection plays a key role in the outcome of the repairs.

A Study to Assess the Level of Knowledge Regarding Menstrual Cup Among Women of Reproductive Age Group in a View to Develop an Information Pamphlet in a Selected Hospital, Bangalore

Background: Menstruation is a phenomenon unique to the females. The onset of menstruation is one of the most important changes occurring among the girls during the adolescent years. Hygiene-related practices of women during menstruation are of considerable importance, as it has a health impact in terms of increased vulnerability to reproductive tract infections. A method for menstrual hygiene management, alternative to sanitary pads and tampons, is the menstrual cup. The menstrual cup is a bell-shaped device made of high- grade medical silicon, which is inserted into the vagina during menstruation. The device should be boiled once per month and can be used for 5–10 years. It collects more blood than the standard sanitary pads and is environmentally friendly with few known side. The knowledge about menstrual cup will motivate the women to start using them as it is an ecofriendly, cost effective and sustainable method and will thereby promote menstrual hygiene. The present study was aimed to assess the level of knowledge regarding menstrual cup among the women of reproductive age group. Objectives: To assess the level of knowledge regarding menstrual cup among women of reproductive age group. To determine the association between the levels of knowledge among women of reproductive age group and selected demographic variables. Methods: The research design selected for the study was descriptive design. The study was conducted among the women of reproductive age group from 18 to 45 years who visited the female medicine and female surgery out-patient department of a selected hospital, Bangalore. A structured questionnaire was used to assess the level of knowledge regarding menstrual cup. The data was analyzed using descriptive and inferential statistics. Results: The mean knowledge score was 9.04.With regards to the knowledge score in specific domains, 77% of the subjects knew what a menstrual cup is, 42% had knowledge about the action of menstrual cup, 40% of them knew how to use a menstrual cup, 37% had knowledge about the advantages of menstrual cup and 51% of them knew some facts on menstrual cup. This study result shows that 88.09% of the subjects had poor knowledge regarding 11.9% of them had average knowledge and none of them had good knowledge regarding menstrual cup. As per the statistical analysis there was no significant association between the level of knowledge and baseline variables at 0.05level of significance. The result of the study emphasizes need for

Effectiveness of Foam Sclerotherapy in Treatment of Symptomatic Haemorrhoidal Diseases at a Tertiary Care Hospital, Agra, Uttar Pradesh, India: A Prospective Interventional Study

Introduction: Haemorrhoids is a very common condition in patients presenting to surgery Outpatient Department (OPD) with complaints of bleeding per rectum. Injection Foam Sclerotherapy has been established as a safe, simple and effective non surgical modality in treatment of symptomatic grade 1 and 2 haemorrhoids. Aim: To evaluate the effectiveness of foam sclerotherapy as a treatment modality in patients suffering with symptomatic Grade I and II Haemorrhoidal diseases. Materials and Methods: This prospective interventional study was conducted in General Surgery department of FH Medical College and Hospital, Agra, Uttar Pradesh, India between April 2021 to September 2021. A total of 42 patients with complaints of bleeding per rectum, and who were diagnosed as a case of Grade I or II internal haemorrhoids were included. 3% Polidocanol was used as the sclerosing agent for sclerotherapy. Effectiveness of sclerotherapy was evaluated, parameters assessed were bleeding per rectum, pain and pruritis with regular follow-ups of the patients at specific intervals. Results: Among 42 patients 29 (69.05%) patients had grade I haemorrhoids while 13 (30.95%) presented as a case of grade II haemorrhoidal disease. Among the patients with grade I haemorrhoids, 82.76% (24/29) were treated successfully after a single session of foam sclerotherapy while 53.85% (7/13) of the patients with grade II haemorrhoids were symptomatically relieved after a single session. The success rate after 2nd session of sclerotherapy was 100% (29/29) in patients diagnosed as a case of grade I haemorrhoids comparing it to 69.23% (9/13) in those with grade II haemorrhoids. The overall cure rate for either grade of haemorrhoid after three sessions of therapy was 95.24% (40/42). Conclusion: This study reflects that 3% polidocanol when used as a sclerosant agent was found to be cheap, safe and effective, and first line treatment modality in grade I and II haemorrhoids that can be done on outpatient basis with minimal complication.