Penetrating chest trauma can be used as an indicator of violence in the country. We aimed to look at the changes in its incidence and management at a major trauma centre in the country. We also wanted to look at any effect of prehospital time on surgical intervention and outcome of the victim. In this retrospective descriptive study, we observed the presentation and management of 191 penetrating chest injury patients at a level II trauma hospital in Pakistan in the last 20 years. The study sample was divided into two groups: Group 1, 1988-1998 and Group 2, 1999-2009. No significant change in incidence of trauma was observed between the two groups. The delay in the time between event and arrival showed an increase in the number of surgical procedures performed. Also the number of thoracotomies performed went up significantly in the second decade from 5.7 to 16.5% with a P<0.05. Six (3.1%) mortality cases were observed in 20 years. It was seen that the greater the prehospital time, the greater the chances of surgery. Also seen was the increase in mortality as critical cases could make it to the hospital alive in recent times due to improved transportation services.

Aims: The COVID-19 is most recently discovered of the corona viruses which caused respiratory infections consisting of two large scale pandemics MERS & SARS and found to be zoonotic in origin. The disease started from Wuhan local seafood market in China and infected 2,761 people. The 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of critically ill patients and has shown it 96% identical to bat coronavirus and bearing same cell entry receptor angiotensin converting enzyme II (ACE2). Corona means crown in Latin and it look like a crown under a microscope. Corona virus disease is an infectious disease where most infected people suffered from mild to moderate respiratory illness and recover without requiring special treatment however older people and those with underlying medical problems develop serious illness and can be prevented by washing the hands or using an alcohol based rub and not touching the face. Outbreak is small but unusual; the epidemic is outbreak over a larger geographic area while pandemic spreads to multiple countries. Methodology: The duration of review for spread of COVID-19 was between 31st December 2019 to 11th March 2020. The 31st December 2019 was the reporting of first case of Corona Virus (COVID-19) by the China while 11th March was declaration date of Pandemic by the World Health Organization (WHO).A total of 70 papers consisting of research article, review papers and news reports has been studied and evaluated. Results: China on 31 December 2019 first informed about COVID-19 and WHO declared on 11 March 2020 that COVID-19 can be characterized as a pandemic. Scientists suspected that corona virus originated in a bat and before passing to human hopped to another animal. Thailand, Japan, USA, France, Australia, Germany, Italy and Spain reported their first case on 13, 16, 19, 24, 25, 27, 31 and 31 January 2020. In February the cases reported by Belgium, Egypt, Iran, Brazil, Pakistan, Netherland, England and Ireland on 4,14,19,25,26,27,28,29 while in March cases seen in Saudi Arabia, South Africa, Peru and Turkey on 2, 5, 6 and 10 respectively. WHO on 11 March 2020 assessed the outbreak as a pandemic with 114 affected countries. Conclusions: The spread of disease as a pandemic occurred due to movement of carriers outside China. Strict quarantine needed to prevent spread of disease. The code of ethics for social distancing should be defined and strictly implemented. Selling, buying and eating of wildlife animals should be internationally banned.

No abstract

Choledochal cysts are congenital bile duct anomalies. These cystic dilatations of the biliary tree can involve the extrahepatic biliary radicles, the intrahepatic biliary radicles, or both. The etiology remains unknown, but choledochal cysts are likely to be congenital in nature. Cyst excision is the definitive treatment of choice for choledochal cyst because of the high morbidity and high risk of carcinoma after internal drainage, a commonly used treatment in the past. CDC is a congenital anomaly involving cystic dilatation of various ducts of biliary tree. The precise etiology of extrahepatic cysts continues to remain unclear. The most commonly accepted theory is an anomalous pancreatobiliary duct junction (APBDJ) and abnormal function of the sphincter of Oddi. Proper imaging plays an essential role in preoperative planning. Proper diagnosis evaluation and management is essential for optimal management. Type I cysts are the most frequently encountered. Choledochal cysts can have variable presentations. Hepatobiliary ultrasound and MRCP are the present day standards for imaging; early diagnosis should be the norm to avoid possible late complications of cholangitis, cirrhosis, hepaticolithiasis and spontaneous perforation. Excision of the cyst with hepaticojejunostomy is the best approach.

Delayed presentation of Developmental Dysplasia of Hip (DDH) comes with challenges in treatment as well as high surgical cost. Therefore the objective of this study is to quantify the economic impact of management of late presentation of DDH during a last 3-year period. We conducted a retrospective study with analysis of DDH cases managed between years 2012 to 2014. Early and late presentations of DDH were identified and cost management for both was estimated. Out of twenty-four DDH cases, thirteen cases fulfilled the inclusion criteria. All were female with majority of them presenting with unilateral DDH predominantly of the left hip. Most patients presented after age of six months and the principal complaint was abnormal or limping gait. The grand total cost for managing DDH during the three years period was USD 12,385.51, with 86% of the amount having been used to manage late presentation of DDH that was mostly contributed by the cost of surgery. We concluded that delayed presentation of DDH contributes heavily to high national expenditure. Early detection of DDH cases with systematic neonatal screening may help to minimize the incidence of the late presenting DDH and subsequently reduce the economic burden to the government.