Laparoscopic Versus Open Surgery for Colorectal Cancers: Clinical and Pathological Outcomes from a Single Institution in Bahrain.

INTRODUCTION: Colorectal carcinoma is commonly diagnosed and accounts for an important cause of cancerrelated mortality worldwide. Despite that literature has shown the superiority of laparoscopic surgery, with improved short-term clinical benefits and equivalent oncological outcomes compared with open surgery for colorectal cancer, most cases are operated by open approach. The purpose of this study was to compare the clinical and pathological outcomes between laparoscopic and open colorectal cancer surgery at our institution. METHODOLOGY: 126 patients who had operations for colorectal cancers were identified. Patients ' clinical data, surgery type and details, postoperative early clinical outcomes and histology reports were retrieved from the database and retrospectively reviewed. Statistical analysis was used to assess the differences between laparoscopy and open approach in terms of clinical and oncological outcomes. RESULTS: Significant advantages were associated with minimally invasive colorectal surgery, with shorter postoperative hospital stay, less incidence of medical complications and improved survival. There were no statistically significant differences between both groups in pathological parameters, namely, number of retrieved lymph nodes and margins. DISCUSSION: In the hands of skilled trained surgeons, laparoscopic surgery for colorectal cancer is oncologically safe as it showed adequate dissection and appropriate number of resected lymph nodes, and is associated with reduction in postoperative morbidity and mortality. Conversion to open surgery is a risk associated with minimally invasive surgery. However, it is reported that conversion and postoperative complications are decreasing with increased surgical experience. CONCLUSION: In accordance with the current worldwide practice, our study indicates that minimally invasive surgery for colorectal cancer has the benefits of laparoscopy in terms of short-term clinical outcomes but show similar pathological outcomes in comparison to open approach. With increased surgical expertise, laparoscopic surgery is becoming the standard approach to treat colorectal cancer in our centre.

Towards health with justice: making the tobacco industry accountable through administrative liability.

For many decades, the transnational tobacco industry has evaded the consequences of harming people and the planet. Despite selling a deadly product, it has continued to remain one of the most profitable industries in the world, now venturing into 'wellness and pharmaceutical' businesses as part of its diversification strategy. Meanwhile, efforts to make the tobacco industry pay through court systems have not progressed due to the inherent challenges within the judicial systems in most countries. This paper explores mechanisms for ensuring accountability through administrative liability, including the use of compensation mechanisms and adjudicatory bodies. Such mechanisms operationalise vital principles and practices derived from international law, such as the imposition of effective, proportionate, and dissuasive non-criminal sanctions, victims' right to compensation, and 'polluter pays' principles. Measures such as taxation, surcharges, penalties, financial guarantees or insurance, along with the establishment of adjudicatory bodies and trust funds, are discussed. In order to hold the tobacco industry to account for the wide range of harms caused by its products and its misconduct; policies on 'liability' must clearly articulate how the industry will compensate for past and future harms in a manner that deters it from causing further damage.

Aortic Root Enlargement in patients with small aortic annulus undergoing double valve replacement. Is it justified? A retrospective Comparative cohort study.

BACKGROUND: Small Aortic Annulus (AA) is big issue during Aortic Valve Replacement (AVR) necessitating replacement of an undersized prosthetic valve especially with Double Valve Replacement (DVR). Despite that small aortic valve prostheses can lead to Prosthesis-Patient Mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures fearing from morbidity and mortality. OBJECTIVE: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus undergoing double valve replacement. METHODS: The study included 100 consecutive patients underwent DVR for combined rheumatic aortic and mitral valve diseases, between Jan. 2016 and Sept. 2020. Only (50) patients had ARE with DVR.  ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick¢s or Manouguian procedures. The estimated postoperative end-points were mortality, effective orifice areas (EOA), mean aortic pressure gradient and valve-related complications. The least postoperative follow-up period was 6 months. RESULTS: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.5 ±0.20 m2, aortic annulus diameter was 20±1.4 mm, aortic orifice area was 0.80±0.50 cm2, and aortic peak gradient (PG) 80±40 mm Hg. During follow-up period, there was a mild to moderate paravalvular leak (1%) with, (1%) heart block, and residual PG on prosthetic aortic valve; that was all in DVR alone. CONCLUSION: Enlargement of aortic root by Nick¢s or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

Diagnostic Accuracy Of Ripasa Score.

BACKGROUND: Acute appendicitis is one of the most common acute surgical emergencies on emergency room floor and timely diagnosis of the condition is of utmost importance. Multiple diagnostic Score exist to help in the clinical diagnosis; among Which RIPASA is a recent introduction. METHODS: The study was carried out Ayub Teaching hospital of Abbottabad from Sept-2017 to Feb-2018, Department of General Surgery. The ultimate decision to perform surgery was not guided by the scores and the surgeon's decision was the final word, and specimens were sent afterward for histopathology. The results compiled and entered into SPSS 20. RESULTS: Out of the 308, 288 patients underwent surgery for AP, 165 (57.3%) were male and 123 (42.7%) were female, 252 (87.5%) had positive histopathology report and 36 (12.5%) had a negative report, with resultant negative appendectomy rate of 12.5% well below the average. 26 (9.02%) had a perforated appendix and 8 (2.8%) had post-op wound infection. The sensitivity of RIPASA score at a cut-off value of 7.5 was 98.02%, with specificity of 75%, and Positive Predictive Value of 96.48%, and Negative Predictive Value of 84.7%. Compared to Alvarado's Score Sensitivity and Specificity of 53% and 75% respectively. CONCLUSIONS: On the balance the RIPASA Score detects early preventing from dreadful complication and in turn have low specificity giving way to a slightly higher negative appendectomy rate with the consequent morbidity and mortality of unnecessary surgery. Still RIPASA Score outperforms the Alvarado and Modified Alvarado Score.

Pill aspiration presenting as an endobronchial tumor.

Tracheobronchial foreign body aspiration is a major cause of morbidity and mortality. The incidence of foreign body aspiration decreases significantly with increasing age, resulting in atypical presentations in adults. A high index of suspicion is required in adults presenting with respiratory symptoms. We present a rare case of a foreign body (pill) aspiration in an elderly female mimicking an obstructing endobronchial lesion.

Prevalence of depression and anxiety in a village in Sindh.

OBJECTIVE: To study the prevalence of Anxiety and Depression and its association in a rural area of Sindh, Pakistan. METHODS: A cross-sectional study was conducted at Ansari Para, in Tehsil Hala, Sindh province in Pakistan, using the Aga Khan University Anxiety and Depression Scale Urdu Version. RESULTS: Out of a total of 260 people interviewed, 112 people (43.1%) were screened to have anxiety and depression. Depression and anxiety were strongly associated with female gender, family dynamics, child environment, unsuccessful love affairs and among those with medical chronic disorders. A gradual decreasing incidence of depression and anxiety was noted with increasing level of education. A significantly strong association was noted between child mortality and maternal depression while no such association was found in males. There is a significant difference in the age of depressed and normal individuals. There was significant correlation between unhappy childhood and unsatisfying family relationships. However, no relationships were found between depression & anxiety and martial status, presence or number of children, absence of male offspring, living in joint family system, financial problems and any deficiencies that the respondents felt that he might have. CONCLUSION: This study suggests that anxiety and depression is a common psychiatric disorder even in remote village areas and contradicts the common belief that people those who live in the remote rural areas lead stress-free lives or have low rates of psychiatric morbidity.

Prevalence of behavioural and psychological problems in working children.

OBJECTIVE: To determine the prevalence and screen the nature and types of behavioural and psychological problems among working children in Karachi. METHODS: A cross sectional study was conducted in three urban squatter settlements of Karachi from May to June 2006, targeting working children aged 11-16 years. Behavioural Problems of these children were estimated by using the self reported Urdu version of the Strengths and Difficulty Questionnaire. The results were cross-tabulated using SPSS 13.0 with the identified risk-factors. RESULTS: Out of a total of 225 respondents, 94.2% (n = 212) males and 5.8% (n = 13) females, the prevalence of Behavioural Problems among working children was found to be 9.8%. Peer problems were most prevalent (16.9%) seconded by Conduct problems (16.7%). Adverse family environment and work environment were closely associated with Behavioural Problems in these children. CONCLUSION: Our study reinforces the need for measures to improve the environment of the children and prevent the psychological and behavioural problems associated with working children. Gradual, long-term policies are required to decrease the need for working children, though sudden abolishment would cause more detrimental effects.