Objective: To determine the prevalence and types of cancer among urban-rural populations and their relation to socioeconomic status.Methodology: A cross sectional study was carried out in three hospitals in Punjab named Mayo Hospital, Lahore, Nishtar hospital and civil hospital in Multan, Pakistan. All new cases of cancers were recorded during the months of August 2013 through February 2014. Details of age, sex, socioeconomic status, address whether rural or urban, stage, type of cancer and hemoglobin levels at the time of presentation were recorded after verbal consent from the patients and attendees. For data analysis, Statistical Package of Social Sciences (SPSS v. 21) software was used.Results: A total of 305 patients were investigated in the three health facilities during the six months (August 2013 -February 2014), after taking verbal consent the data of 305 patients were gathered and analyzed. 150 (49.2%) participants of the study were females and 155 (50.8%) were male out of 305 participants. Out Of 305 cancer patients, 176 were from rural areas (57.7%) and 129 from urban areas (42.3%). The 305 patients coming from different socioeconomic backgrounds; 201 subjects (65.9%) were found to be poor, whereas 104 subjects (34.1%) were rich. Of all the types of cancers mainly patients seek medical attention for Breast carcinoma with 67 cases (22%) out of which 37 (55.2%) were poor and 30 (44.8%), 33 (49.25%) were rural patients and 34 (50.75%) were urban. Non-Hodgkin Lymphoma with 40 cases (13.1%) out of which 26 (65%) were poor and 14 (35%) were rich, 21 (52.5%) were rural patients and 19 (47.5%) urban. Squamous cell carcinoma with 29 cases (9.5%): 23 (79.3%) were poor and 6 (20.7%) were rich, 22 (75.86%) were rural patients and 7 (24.16%) urban. Carcinoma of cervix with 22 cases (7.2%); 16 (72.72%) were poor and 6 (27.3%) were rich, 13 (59.1%) patients were from rural areas 9 (40.9%) were from urban areas. Several other rare carcinomas resembling Wilms tumor, with as few cases as 1 case in the time period of 6 months are also discussed. Conclusion:The study shows that in general, cancer is prevalent in poor socioeconomic population and those patients that live in rural areas. Further studies should be carried out to observe the effects of other variables reminiscent of screening, knowledge to pursue medical attention, the time to search for medical attention, and implementation of preventive methods. Justification of environmental factors and increased geographical area should definitely be considered so that the study can be carried on a larger scale.
Objective: To compare the recurrence rate in patients undergoing fistulectomy using tight setons with those using videoassisted anal fistula treatment (VAAFT). Study Design: Comparative prospective study. Place and Duration of Study: Department of General Surgery, MH Rawalpindi, Pakistan from May 2018 to Dec 2021. Methodology: We included 200 patients with high trans-sphincteric anal fistula (simple or complex) of age 18 to 60 years, having ASA I or II. Group- A comprised patients undergoing treatment with VAAFT, while Group- B included patients undergoing treatment with Tight Seton in conventional surgery. Patients were followed for three months after the procedure. Patients having a history of discharge around or in the vicinity of the previous external opening of the anal fistula were labelled as having a recurrence. Recurrence was confirmed on MRI Fistulogram. Results: The mean age of patients in Group-A was 42.10±8.26 years, and in Group-B was 42.17±7.91 years (p=0.95). There were 58 male patients in Group-A and 55 male patients in Group-B (p=0.67). The mean duration of the fistula was 5.30±1.64 months in Group-A and 5.22±1.61 months in Group-B (p=0.72). Recurrence was diagnosed in 24 patients in Group-B and only 06 patients in Group-A (p<0.001). Conclusion: Video-assisted anal fistula treatment (VAAFT) has a lower recurrence rate than Tight Setons in conventional surgery in treating high trans-sphinteric anal fistula.
Objective: To identify the prevalence, contributing factors and coping mechanisms for burnout in clinical residents of a tertiary care centre. Study Design: Cross Sectional Survey. Setting: Islamic International Medical College, Railway Hospital, Rawalpindi. Period: April 2019 to August 2020. Material & Methods: A survey questionnaire consisting of the abbreviated Maslach burnout inventory along with questions on contributing factors and coping mechanisms for burnout was distributed among clinical residents at Pakistan Railway Hospital, Rawalpindi. Data was collected and analyzed using SPSS. Burnout score was calculated for each resident along with the subscale analysis. Chi square was used to identify significant contributing factors to the burnout (P ≤ 0.05). Percentages were calculated for the coping mechanisms used by the residents. Results: Seventy seven residents participated in the survey. Mean Maslach score was 31.79, SD=7.22 for the whole group. 47(61%) residents were categorized as having significant burnout. No risk factor was found to be associated significantly with burnout (p-value ≤ 0.05). Work hours (Mean=2.43, SD=1.56), working conditions (Mean=2.82, SD=1.62) and senior consultant bullying (Mean=2.98, SD=1.96) were considered to be the most important factors contributing to the burnout. The main coping mechanisms identified were staying optimistic (58%), sleeping more (49.4%) and spending time with family (49.4%). Only 5.2% residents had any departmental support. Conclusion: Burn out is commonly present in clinical residents. No significant association with specific factors contributing to burnout was found however residents rate work hours, working conditions and senior consultant bullying as contributing the most.
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