Breast Cancer knowledge and perceived barriers to help seeking among pre-clinical and clinical female medical students of King Edward Medical University, Lahore: a cross-sectional study.

BACKGROUND: Breast cancer is the most common form of cancer in women and second most common cancer after lung cancer. The prognosis of breast cancer depends on early detection and intervention which in turn relies upon awareness. Health workers in all communities are responsible for educating the population at risk. This study evaluates the knowledge regarding breast cancer, personal judgment of confidence, perceived barriers to help seeking and breast self-examination practices among Pakistani female medical students and studies the impact of clinical training on the studied variables. METHODS: Descriptive cross-sectional study design using self-administered validated questionnaires (BCAM-Breast Cancer Awareness Measure designed by Cancer Research UK) was employed. Female medical students enrolled in clinical and pre-clinical classes of King Edward Medical University, Lahore were targeted and questioned regarding symptoms, risk factors and their practices regarding breast cancer. Possible barriers to seeking help were also studied. RESULT: The mean number of symptoms correctly identified was 6.7 ± 3.2 (5.5 ± 3.2 for pre-clinical and 7.8 ± 2.9 for clinical students) and for risk factors it was 4.3 ± 2.1 (3.7 ± 2.1 for pre-clinical and 4.7 ± 2.2 for clinical students). The difference in the level of perception of two groups was found to be significant (p < 0.001 for symptoms and p < 0.001 for risk factors). 38.7% of the subjects responded that they check their breasts rarely, 33.1% were fairly confident while 8.6% were very confident about detecting a change in their breast, 50.0% never noticed a change in their breast, and 77.4% will contact a doctor within a week or less of finding a change in their breast. Confidence about detecting a change significantly improved (p < 0.001) after the start of clinical training. CONCLUSION: This study suggests that clinical training may have improved knowledge of female medical students regarding breast cancer; yet the knowledge related to the symptoms and risk factors of breast cancer and frequency of breast self-examination of female medical students is less than anticipated.

A Profile of Colorectal Tumors Presenting as Emergency.

OBJECTIVE:  To determine the factors, management and outcome of colorectal tumors presenting at Emergency Department, Mayo Hospital, Lahore. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Accident & Emergency Department, Mayo Hospital, Lahore, from August 2017 to July 2019. METHODOLOGY: Conducted on 40 consecutive patients who presented in the Accident and Emergency Department, Mayo Hospital, Lahore; determined to have colon or rectal cancer as the cause of intestinal obstruction or perforation, were studied. Data was abstracted from patient charts. Studied variables included patient's demographic data, indication for admission, surgical procedure done, complications, histopathology and mortality rate. RESULTS: Forty patients underwent operations of colon and rectum during the study period. Mean age at presentation was 37.8 ± 16.7 years. Intestinal obstruction (75%) was the main presenting symptom. Ascending colon was the main site involved (50%), followed by recto-sigmoid mass (15%) and rectal mass (12.5%); 80% patients subjected to the stoma formation. Electrolyte imbalance and wound infection were the most common medical and surgical complications. Adenocarcinoma was the most common tumor on histopathology (92.5%). After surgery 87.5% patients survived and 12.5% patients expired. Factors significantly associated with worse outcome were greater ASA score (p=0.004), absence of screening colonoscopy in the past (p=0.013) and postoperative medical complications (p<0.001). CONCLUSION: Colorectal tumor cases continue to present in emergency in a high number. Male gender, young age and ascending colon cancers were more frequent among such cases. Most patients had to undergo stoma formation in emergency. Mortality is significantly associated with higher ASA score, absence of screening colonoscopy and postoperative medical complications. Key Words: Colorectal carcinoma, Adenocarcinoma, Ascending colon, Wound infection, Emergency, Young males, Screening colonoscopy, ASA score.

Surgical Outcome of Peripheral Vascular Injuries in Adults.

OBJECTIVE: To describe the management and outcome of adult patients after peripheral vascular injuries. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Accident & Emergency Department, Mayo Hospital Lahore, Pakistan, from January 2014 to December 2018. METHODOLOGY: All adult trauma patients (aged ≥13 years), who were admitted following injury to peripheral blood vessels regardless injuries, were included. Variables including patient data, mechanism of injury, vessel involved, injury severity score (ISS), surgical procedure etc. were retrospectively extracted from patient charts. Binary logistic and multinomial regression analyses were performed. The p-value <0.05 was considered significant for mortality and limb outcome. RESULTS: There were 117 patients, with mean age of 28.9±11.6 years. The commonest cause was blunt trauma (55.6%). The popliteal artery was most commonly involved (44.4%). Complete transection of artery was the most common type of injury (58.1%). The mean ISS was 17.2 ± 10. Reverse saphenous vein graft (RSVG) was the most common surgical repair (49.6%) procedure. Wound infection (17.1%) was the main complication. Limb salvage rate was 73.5% and mortality rate was 5.1%. Variables significantly influencing the limb outcome (amputated vs. salvaged) were duration of injury (p <0.001), concomitant body injury (p=0.009), ISS (p <0.001), surgical procedure (p <0.001), hemoglobin on presentation (p<0.001), number of blood transfusion (p=0.05) complications after surgery (p <0.001) and referral or not (p=0.001). Factors significantly associated with mortality were duration of injury (p=0.008), ISS (p = 0.002) and complications after surgery (p=0.011). CONCLUSION: Low hemoglobin on presentation, postoperative increased requirement of blood transfusions and having reverse saphenous graft as procedure were independent risk factors for amputation. ISS score and postoperative complications led to higher amputation and mortality rates after surgery. Key Words: Injury severity score (ISS), Glasgow coma scale (GCS), Reverse saphenous graft (RSVG), Fasciotomy, Popliteal artery, Mortality.