Surgical Service Utilization and In-Patient Satisfaction in Surgical Service.

BACKGROUND: The patient satisfaction study is an important and commonly used valid indicator for service quality improvement in healthcare institutions. The aim of this study was to assess the service utilization and patient satisfaction in patients admitted under surgical service in Bir Hospital. METHODS: A prospective cross sectional analytical study was conducted in Bir Hospital, National Academy of Medical Sciences from February 2021 till June 2023. The patient satisfaction data was collected using the SAPS scale after obtaining ethical clearance from the Institutional Review Board. Data were entered and analyzed in Statistical Package for the Social Sciences version 20.0. RESULTS: There were 152 patients included in the study categorized into conservative treatment group, elective surgery group and emergency surgery group. 32.9%(50) patients were "very satisfied", 62.5%(95) patients were "satisfied", 2.6%(4) were "neither satisfied nor dissatisfied" and 2%(3) were "dissatisfied" with the effect of their treatment/care. The mean satisfaction score in conservative treatment group was 22.13 ±2.53 as compared to the mean satisfaction in elective surgery group which was 21.11± 2.55 (P=0.036) and the mean satisfaction score in emergency surgery group which was 21.66 ±2.68 (P=0.64). CONCLUSIONS: The mean score and proportion of patient satisfaction regarding service utilization in patients admitted under surgical service were high with satisfaction score higher in emergency surgery group among the operative groups in Bir Hospital, National Academy of Medical Sciences.

Autoimmune pulmonary alveolar proteinosis and sarcoidosis in the same patient: Case report and systematic review.

Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disorder characterized by surfactant accumulation in the alveolar spaces while sarcoidosis is a multisystem granulomatous disease of unknown etiology. The occurrence of PAP and sarcoidosis in the same patient is rare. A 37-year-old woman presented with cough and breathlessness and was diagnosed to have autoimmune PAP. She responded well to subcutaneous injections of recombinant granulocyte macrophage colony stimulating factor. Three years later, she developed fever, chest pain, cough, and facial palsy. The evaluation revealed a diagnosis of sarcoidosis that responded to immunosuppressive treatment. We discuss the link between PAP and sarcoidosis and review the literature on this association.

Extensive-disease small cell lung cancer, multiple relapses, five lines of therapy and more than 10-year survival.

Small cell lung cancer (SCLC) accounts for nearly 18% of lung cancer cases. Most of the patients of SCLC are not surgical candidates, due to advanced stage at presentation hence only viable options are chemotherapy and radiotherapy. Long-term survival in SCLC is extremely rare due to relapses and comorbidities. Ten-year survival has never been reported in cases with extensive disease at presentation and history of relapses. Here we are describing a case of extensive disease SCLC who has survived multiple relapses and has received five lines of systemic therapy apart from radiation and palliative care. This case emphasises on the need of active and strict disease surveillance at each follow-up.

IMFT of the sigmoid colon: a case report.

Inflammatory myofibroblastic tumor (IMFT) of the colon is a very rare entity, characterized by proliferation of myofibroblast cells admixed with inflammatory infiltrates. The entity was first described in the late 1990s, and since then less than 30 cases have been described. It frequently mimics other neoplasm of the colon, such as adenocarcinoma, lymphoma and stromal tumor, and is very difficult to clinch the diagnosis preoperatively based on the clinical and radiological findings. Here, we discuss an uncommon case of sigmoid IMFT in a 35-year old male, presenting with bleeding per rectum and managed successfully by colectomy.

Implantation cutaneous tuberculosis after ultrasound-guided fine needle aspiration cytology.

A 45-year-old female presented with recurrent biliary pain, fever, anorexia and weight loss of 3 months duration. She was on highly active antiretroviral therapy for underlying human immunodeficiency virus infection for the past 5 months. Clinical examination revealed a 3-cm firm hepatomegaly. Investigations suggested mild anaemia, elevated erythrocyte sedimentation rate, deranged liver function tests, Mantoux test of 25 mm and CD4 count of 417 cells µl-1. Ultrasonography revealed mild central intrahepatic biliary radical dilatation with a dilated common bile duct and multiple periportal and peripancreatic lymph nodes. Ultrasound-guided fine needle aspiration cytology (FNAC) from the periportal lymph node was performed twice. Both were reported as only bloody aspirate. The patient developed an erythematous tender skin nodule at the site of insertion of the FNAC needle 15 days after the second FNAC procedure. An excision biopsy of the nodule showed ill-formed epithelioid cell granulomas with acid-fast bacilli, indicating tuberculosis. The patient was started on antitubercular therapy with complete response.

Down-regulation of replication factor C-40 (RFC40) causes chromosomal missegregation in neonatal and hypertrophic adult rat cardiac myocytes.

BACKGROUND: Adult mammalian cardiac myocytes are generally assumed to be terminally differentiated; nonetheless, a small fraction of cardiac myocytes have been shown to replicate during ventricular remodeling. However, the expression of Replication Factor C (RFC; RFC140/40/38/37/36) and DNA polymerase δ (Pol δ) proteins, which are required for DNA synthesis and cell proliferation, in the adult normal and hypertrophied hearts has been rarely studied. METHODS: We performed qRT-PCR and Western blot analysis to determine the levels of RFC and Pol δ message and proteins in the adult normal cardiac myocytes and cardiac fibroblasts, as well as in adult normal and pulmonary arterial hypertension induced right ventricular hypertrophied hearts. Immunohistochemical analyses were performed to determine the localization of the re-expressed DNA replication and cell cycle proteins in adult normal (control) and hypertrophied right ventricle. We determined right ventricular cardiac myocyte polyploidy and chromosomal missegregation/aneuploidy using Fluorescent in situ hybridization (FISH) for rat chromosome 12. RESULTS: RFC40-mRNA and protein was undetectable, whereas Pol δ message was detectable in the cardiac myocytes isolated from control adult hearts. Although RFC40 and Pol δ message and protein significantly increased in hypertrophied hearts as compared to the control hearts; however, this increase was marginal as compared to the fetal hearts. Immunohistochemical analyses revealed that in addition to RFC40, proliferative and mitotic markers such as cyclin A, phospho-Aurora A/B/C kinase and phospho-histone 3 were also re-expressed/up-regulated simultaneously in the cardiac myocytes. Interestingly, FISH analyses demonstrated cardiac myocytes polyploidy and chromosomal missegregation/aneuploidy in these hearts. Knock-down of endogenous RFC40 caused chromosomal missegregation/aneuploidy and decrease in the rat neonatal cardiac myocyte numbers. CONCLUSION: Our novel findings suggest that transcription of RFC40 is suppressed in the normal adult cardiac myocytes and its insufficient re-expression may be responsible for causing chromosomal missegregation/aneuploidy and in cardiac myocytes during right ventricular hypertrophy.