BackgroundColorectal carcinoma is ranked as the second most common cancer diagnosis in females and third in males. It is the third leading cause of cancer-related deaths worldwide. Disease burden has been attributed to a myriad of factors comprising genetic, environmental, and dietary factors. Rectal cancer has been shown to demonstrate variance according to the geographical location.MethodsA retrospective review of 477 rectal cancer patients treated at Shaukat Khanum Memorial Cancer Hospital & Research Centre from 2006 to 2014 was performed. Demographic and clinicopathological features were compared between the two age groups (≤40 or >40 years). These included sex, ethnicity, family history of cancer, the location of tumor, clinical staging, histopathological type, and response to chemoradiation. Chi-square was used to compare the frequencies between the two age groups. p-value < 0.05 was taken as significant.ResultsMean age of the study group was 44.62 ± 16.11 years. 43.8% were ≤40 years of age, and 70.2% were male. 50.3% patients belong to Punjab province, 287 (60.2%) had lower rectal cancer, family history of cancer was present in 82 (17.2%) patients. 432 (90.5%) patients had T1/T2 disease and 296 (62.1%) had N2 disease. Metastatic disease at presentation was observed in 37 (7.8%). Progressive disease was found in 90 (18%) patients.ConclusionHigh frequency of young onset rectal cancers and the lack of family history emphasize the need of indigenous strategies and national awareness of this disease for an early identification of these patients.
Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries.
Purpose: Head and neck cancers (HNC) are among the most common cancers in developing countries, especially in the Southeast Asia. Oral cavity is the most commonly affected site. The risk factors are tobacco, betel nut and alcohol. The dimensions of the disease are quite different in developing countries than the western world. Poor socioeconomic status, poverty, lack of healthcare facilities and illiteracy are the factors that pose a major challenge to the management of the disease. The aim of this study is to analyse the database that has been collected over a period of 10 years showing the trends of the disease and the management outcome of these individuals.Methods: Men and women diagnosed with HNC from 2004 to 2014 from Cancer Registry Database of Shaukat Khanum Memorial Cancer Hospital and Research Centre have been retrospectively analysed.Results: In the 10 year period a total of 5027 patients presented to the head and neck clinic at our institution with a mean age + standard deviation of patients of 58.33 + 20.54. Oral cavity (42.6%) and larynx (13%) were the two mostcommon sites followed by the less frequent ones. Squamous cell carcinoma ranked as the most common histological type presented to our institute (69.2%), followed by basal cell carcinoma (6.6%), mucoepidermoid carcinoma (4%), adenoid cystic carcinoma (3.6%) and 1.9% adenocarcinoma.Conclusions: Being a third world country, the burden of the disease on the healthcare system is enormous. With limited resources and funding, there is a need to train people in the speciality and develop the National Cancer ControlProgram (NCCP) for better monitoring and disease control.Key words: Developing country, head and neck cancer, health infrastructure
BackgroundGallstone disease is a common surgical entity worldwide and accounts for a major portion of hospital admissions and surgeries. Metabolic syndrome is diagnosed when three of the following medical conditions are positive: central obesity, high blood pressure, increased fasting glucose levels, low high-density lipoprotein (HDL) levels and high serum triglycerides.ObjectiveTo compare the frequency of metabolic syndrome in patients with uncomplicated gallstone disease and complicated gallstone disease.Study designObservational, cross-sectional study.MethodologyA total of 104 patients, above age 18 years, visiting the outpatient department (OPD) or the emergency department, diagnosed as having gallstone disease. The study was conducted in surgical unit VI, civil hospital Karachi from June 2014 to June 2015. Patients’ demographics, abdominal waist circumference, blood pressure, serum fasting blood sugar, triglyceride level and HDL levels were recorded. Final outcome was labeled as presence or absence of metabolic syndrome. Presence of metabolic syndrome was compared in patients with complicated gallstone disease as well as in patients with uncomplicated gallstone disease. Chi square test was used to detect statistical significance and a p-value of <0.05 was taken as significant.ResultsThe ages were comparable between the two groups, that is, the complicated and uncomplicated gallstone disease at 42.42 +/- 12.15 years in the former and 39.24 +/- 10.41 years in the latter group. Metabolic syndrome was more predominant in the complicated arm 40.38% when compared to uncomplicated arm 25% but it was not significant statistically with a p-value of 0.2.ConclusionMetabolic syndrome is associated with complicated gallstone disease though this study failed to reach statistical significance due to small sample size, it re-enforces the findings of previous studies. It is an easily assessable and useful measure to predict complications associated with gall stone disease.
Non-muscle-invasive bladder cancer (NMIBC) is categorized into high-risk and low-risk groups. Although, bacillus Calmette-Guerin (BCG) is the recommended adjuvant therapy of high-risk bladder tumor, optimal schedule (induction versus maintenance) of this therapy is a subject of debate. The objective was to evaluate outcomes of induction BCG in high-risk NMIBC patients at Shaukat Khanum Memorial Cancer Hospital & Research Centre, Pakistan and retrospective cohort study conducted in the department of urology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Pakistan. Three-year disease-free survival and progression-free survival was the main outcome measure. Data of 68 high-risk (Ta and T1 with G3 or high-grade subtype) bladder cancer patients who underwent transurethral resection followed by six-weekly intravesical BCG instillation was included in the study. Recurrence was described as biopsy-proven bladder cancer; whereas the presence of muscle invasion was considered as progression. Disease-free survival and progression-free survival were defined as time intervals elapsed between the starting date of BCG instillation and recurrence or progression, respectively. Kaplan-Meier curve was employed to estimate the three-year study end-points. Disease-free survival at three years was observed to be 66.2% and progression-free survival at 86.8%. The use of induction BCG alone for high-risk patients of NMIBC is a viable option both in terms of effective disease-free and progression-free survival rates.
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