Purpose: Laparoscopic approach to colonic tumor requires skill set and resources to be established as routine standard of care in most centers around the world. It presents particular challenge in country like Pakistan due to economic constrain and lack of teaching and training opportunities available for surgeons to be trained to deliver such service. The aim of this study is to look into changing practice of our institution from conventional approach of open to laparoscopic surgery for right colon cancer. Methods: Consecutive patients between January 2010 to December 2018 who presented to Shaukat Khanum Memorial Cancer Hospital and Research Centre with diagnosis of right colon (cecum, ascending and transverse colon) adenocarcinoma and underwent surgical resections were included in this study. Results: A total of 230 patients with adenocarcinoma of the right colon underwent curative resections during the study period. Of these, 141 patients (61.3%) underwent laparoscopic surgery while open resection was performed in 89 patients (38.7%). Five-year disease-free survival (DFS) of patients with American Joint Committee on Cancer (AJCC) stage III (80.9% vs. 54.8%, P = 0.021) was significantly better if these patients underwent laparoscopic surgery while a trend toward better DFS (96.7% vs. 84.1%, P = 0.111) was also observed in AJCC stage II patients, although this difference was not significant. Conclusion: This study demonstrates the adoption of a laparoscopic approach for right colon cancer over 10 years. With a standardized approach and using the principle of oncological surgery, we incorporated this in our minimally invasive surgery practice at our institution.
Background and objective The incidence of synchronous primary endometrial and ovarian cancer is uncommon and poses a diagnostic challenge to the treating physician about their origin as either primary or metastasis. The purpose of this study was to evaluate the clinicopathological behavior, treatment modality-related outcomes, and prognosis related to primary endometrial and ovarian cancers at a tertiary care referral center in South Asia. Methods We retrospectively analyzed 30 patients with synchronous ovarian and endometrial cancers treated at Shaukat Khanum Memorial Cancer Hospital and Research Centre in Lahore, Pakistan from January 2005 to August 2017. Results The median age of the patients at the time of diagnosis was 51 years (range: 25-72 years). The common presenting symptoms were irregular uterine bleeding (30%), post-menopausal bleeding (26.7%), abdominal mass (16.7%), and abdominal pain (26.7%). Endometrial adenocarcinoma type was the most common histological variant found among the participants: 90% (n=27) of uterine and 56.7% (n=17) of ovarian cancers. All patients underwent surgical intervention. Among them, 25 patients received platinum-based adjuvant chemotherapy, four received neoadjuvant chemotherapy, and 18 received adjuvant radiotherapy. The early-stage group [International Federation of Gynecology and Obstetrics (FIGO) stage I and II] had a more favorable prognosis than the advanced stage group (FIGO stages III and IV).
The curing of patient is the top most priority of health associated professionals. Complete and proper information of medicine is always the willing of the patients and their close ones. The primary source of information for patients' regarding the medicine is patients' information leaflet (PIL). The main aim of the present study is to evaluate the errors and incomplete information in leaf inserts sold with marketed medicines in Pakistan. For the present study, 11 different classes of oral medicines of different multinational and national pharmaceutical industries were purchased from different community and hospitals pharmacies in Karachi. The present study has been revealed incomplete information related to medicines in PILs. 9 out of 11 PILs have 48.84% (n= 63) major while minor errors were 51.16% (n= 66). The major errors were included incomplete information of indications, adverse drug effects, drug mechanism, dosage errors, drug-drug and drug-food interactions, precautions and warning, pharmacokinetic profile and pregnancy and lactation. Whereas, omission of structural formula, molecular formula, molecular weight, chemical names, laboratory tests, clinical trials data, font size, paper quality, and use of national language (Urdu) have been observed as minor errors. It has been concluded that majority of PILs sold with marketed medicines were not up to the mark and met the regulatory requirements. In countries like Pakistan, with high illiteracy rate and low financial status, patients' were unaware about the importance of PILs. Mainly pharmaceutical industries have not called attention on information of marketed drugs medicines in Pakistan which has been proven a shocking situation regarding the negligence of healthcare matter in Pakistan.
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