The study of frequency of malignancy and its types in surgical jaundice; a tertiary care experience.

OBJECTIVE: To determine the frequency of malignancy and its types in patients presenting with surgical jaundice in a tertiary care setting. METHODS: The cross-sectional study was conducted at the North Surgical Ward, Mayo Hospital, Lahore, Pakistan, from May 8 to November 8, 2020, and comprised patients of either gender with a diagnosis of surgical jaundice made on the basis of history, clinical examination, haematological and biochemical reports and radiological investigations. All patients were managed as per the guidelines for surgical jaundice with injection vitamin K intramuscular, hydration with intravenous fluids, avoidance of constipation by lactulose or neomycin, vitals and urine output monitoring and prophylactic antibiotics. Demographic data as well frequency of malignancy were noted using a predesigned proforma. Data was analysed using SPSS 21. RESULTS: Of the 95 patients, 51(53.7%) were male and 44(46.3%) were female. The overall mean age was 49.96±16.54 years (range: 18-80 years). A total of 19(20%) cases had body mass index <30. Malignancy was identified in 50(52.6%) cases; 14(28%) gallbladder, 4(8%) head of pancreas, 9(18%) peri-ampullary carcinoma, 7(14%) cholangiocarcinoma, 6(12%) Klastkin tumour, 5(10%) hepatocellular carcinoma, and 5(10%) metastatic tumour. CONCLUSIONS: More than half of the surgical jaundice cases had malignancy, gallbladder being the most affected site.

Adverse Effects of Sinopharm COVID-19 Vaccine among Vaccinated Medical Students and Health Care Workers.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease caused a highly problematic situation worldwide. Various vaccines were launched to combat the COVID-19 pandemic. This study aims to investigate the adverse effects of first and second doses of the Sinopharm vaccine among vaccinated medical and dental students and healthcare workers. A well-established questionnaire was distributed online, and 414 medical and dental students and healthcare workers (HCW) comprising 355 females (85.7%) and 59 males (14.3%) participated; all were vaccinated with two doses of Sinopharm. The most common side effect was pain at the injection site after dose one in 253 respondents (61.3%) and after dose two in 161 respondents (38.9%). Other symptoms included general lethargy in 168 (40.6%), myalgia/body pain in 99 (23.9%), low-grade fever in 93 (22.4%), and headache in 87 (21%) respondents. Common side effects reported after the second dose of the vaccine following pain at the injection site included general lethargy in 21.3% (88), headache in 10.4% (43), myalgia/body pain in 9.9% (41), and low-grade fever in 6.1% (25) of the respondents. In conclusion, common adverse effects of the Sinopharm vaccine were pain at the injection site, general lethargy, myalgia, body pain, low-grade fever, and headache. These adverse effects were mild in intensity for both doses but slightly more frequent and severe for the first dose than the second dose.

Sexual Dysfunction in Female Patients Undergoing Hemodialysis and Its Relationship With Anxiety and Depression.

Introduction Hemodialysis is renal replacement therapy. However, it is associated with various complications. Sexual dysfunction is one of them. It is estimated that 25%-64% of female patients on hemodialysis have sexual dysfunction worldwide. This impaired quality of life further leads to anxiety and depression. Around 22.8%-39.3% of patients on hemodialysis are depressed while 27% have a major anxiety disorder. In Pakistan, the incidence of end-stage renal disease (ESRD) is 100 per million people. As far as we know, this is the first study conducted in Multan to assess sexual dysfunction in female patients undergoing hemodialysis. The objective of this study was to find out the prevalence of sexual dysfunction in female patients on hemodialysis and its relationship with anxiety and depression. Material and methods A cross-sectional study was conducted in Nishtar Medical University Hospital, Multan, Pakistan, from February 2021 to May 2021. Data were collected from 55 female patients in the form of an interview after having met inclusion and exclusion criteria. The questionnaire had some sociodemographic questions. The female sexual function index (FSFI) was used to evaluate sexual dysfunction in hemodialysis patients while anxiety and depression were assessed using the hospital anxiety and depression (HADS) scale. SPSS version 25.0 (IBM Corp., Armonk, NY) was used for data analysis. Pearson's correlation was used to find the association of sexual dysfunction with anxiety and depression. A p-value of <0.05 was considered statistically significant. Results Hypertension (56.4%) was the leading cause of chronic kidney disease (CKD). The most serious problem of the patients was sexual arousal suggested by the low mean score (1.77 ± 2.27) as compared to other sexual domains. Anxiety and depression were found in 20% and 30.9% of patients, respectively. There was a significant negative correlation between age ((arousal: r= -0.297, p= 0.028), (lubrication: r= -0.274, p= 0.043), (orgasm: r= -0.298, p= 0.027), and (pain: r= -0.271, p= 0.045)) and depression ((desire: r= -0.465, p= <0.001), (satisfaction: r= -0.366, p= 0.006)) with sexual function. While anxiety was not significantly associated with sexual function ((desire: r= -0.347, p= 0.069), (arousal: r= 0.053, p= 0.700), (lubrication: r= 0.061, p= 0.658), (orgasm: r= 0.047, p= 0.736), (satisfaction: r= -0.113, p= 0.410) and (pain: r= 0.045, p= 0.746)). Conclusion Sexual dysfunction is not uncommon in female hemodialysis patients. There was a significant negative correlation of different sexual domains with age and depression, respectively. The correlation of anxiety with sexual dysfunction was found to be statistically insignificant.

Seroprevalence of Hepatitis B Virus and Hepatitis C Virus in Patients Undergoing Maintenance Hemodialysis.

Background Underdeveloped countries suffer a huge burden of infectious diseases, among which hepatitis B virus (HBV) and hepatitis C virus (HCV) are of major concern. Our study sought to determine the seroconversion rate for HBV via hepatitis B antigen (HBsAg) and HCV via anti-hepatitis C virus antibodies (anti-HCV) among patients on maintenance hemodialysis in the dialysis unit of a tertiary care hospital in Pakistan. Methodology This study was carried out from October 2020 to January 2022 at the hemodialysis unit and the urology department of a tertiary care hospital in Multan. A total of 172 patients of both genders were screened for HBV and HCV seropositivity. Data analysis was done through IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States). Conclusions were drawn accordingly. Results At the one-year follow-up, screening revealed that 20 (11.7%) patients were positive for HBsAg and 39 (23%) were positive for anti-HCV. Five patients had dual seropositivity for HBsAg and anti-HCV, while three were positive for both HBsAg and anti-HDV. Four out of 20 patients who screened positive for HBsAg and 11 out of 39 patients screened for anti-HCV had a history of one more blood transfusion. Though the correlation between the duration of hemodialysis and viral markers was significant (p<0.05) for the patients screened positive for anti-HCV, a similar correlation was not observed in the patients with seropositivity for HBsAg. Conclusion Our study concludes that seroconversion is statistically significant for HCV infection compared to HBV infection. Tight adherence to standard preventive measures to minimize the transmission of these pathogens can lead to a decline in the incidence of these infections. Screening should be done widely to control and optimally manage these infections.

A Rare Case of Hypohidrotic Ectodermal Dysplasia in a Seven-Year-Old Child.

Ectodermal dysplasias (EDs) encompass a large group of inherited disorders that affects two or more ectodermally derived structures. Hair, sweat glands, teeth, and nails are the most common ectodermal derivates affected. Other ectodermal structures that may be affected are ears, eyes, lips, and mucous membranes of the mouth or nose. During embryonic development, the ectoderm forms the outermost layer of the primary germ layers that give rise to the several structures that are commonly affected in ED. Therefore, ED manifests differently among patients, depending on the abnormality's combination and severity. Out of 150 distinctive syndromes, the most common syndromes within this group are hypohidrotic (defective sweat glands) and hidrotic (normal sweat glands). In addition, different types of inheritance patterns are found in ED; X-linked inheritance is by far the most common mode of inheritance. We present here the clinical case of hypohidrotic (anhidrotic) ED in a seven-year-old boy.

A ruptured seventeen weeks' ectopic pregnancy: A case report.

Ectopic pregnancy is a common condition with a prevalence of 2% in all pregnancies. Implantation of the developing blastocyst outside the uterine cavity leads to ectopic pregnancy. About 95% of ectopic pregnancies occur in the different segments of the fallopian tubes. Usually, an ectopic pregnancy grows up to 1.5-3.5 cm and any size greater than this leads to rupture. We present a case of ruptured ectopic pregnancy in which the foetus had a crown-rump length(CRL) of 12 cm was retrieved. To our knowledge, this is the largest foetus recovered from a ruptured ectopic pregnancy at the ampulla of fallopian tube reported in the literature. Timely diagnosis and proper management is the key to reduce morbidity associated with it.