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Background Bochdalek hernia is the most common type of congenital diaphragmatic hernia (CDH) resulting from postero-lateral diaphragmatic defect. Hepatic heterotopia is very rarely associated with CDH, and hepatic herniation favors the worst prognosis. Case presentation We present a case of a neonate diagnosed with right Bochdalek hernia (BH) with anomalous hepatic lobe heterotopia. Intra operatively, mal-rotated loops were also found to be herniating in the right hemithorax. The mal-rotated loops were reduced back into abdomen after performing Ladd’s procedure and diaphragmatic defect was repaired over the anomalous liver lobe. Baby was discharged on 7th postoperative day and follow-ups showed good recovery. Conclusion This case report discusses the presentation, classification, and significance of this association. Our case report is noteworthy as Bochdalek hernia is very rarely associated with anomalous hepatic lobe.

Introduction: The RIPASA scoring system was established specifically for Asians. Chong CF in his study consisting of 312 patients who had an emergency appendectomy concluded that optimal cut-off threshold score for negative appendectomy was 7.5. Objective: To determine the diagnostic accuracy of RIPASA scoring system in presumptive accurate diagnosis of acute appendicitis by taking histopathology as the gold standard. Materials and methods: This Cross Sectional Study was carried out at Surgery department at a tertiary care hospital, Karachi over a period of 6 months, from 15th December 2019 to 15th June 2020. A total of 141 patients of both gender of suspected cases of acute appendicitis presenting with sign and symptoms were included in the study. Patients underwent detailed history, general and physical examination and scoring of patients according to RIPASA scoring scale and then decision of appendectomy was taken on the basis of RIPASA score. Removed appendix samples were sent for histopathology. Results: Age range in this study was from 15 to 50 years with mean age of 30.191±6.09 years and mean RIPASA score was 5.375±1.77. Majority of patients were males (58.9%). RIPASA score diagnosed 28(19.9%) and histopathology diagnosed 27(19.1%) patients with acute appendicitis. RIPASA score showed sensitivity of 85.2%, specificity 95.6%, diagnostic accuracy 94%, PPV 82.1% and NPV was 96.4%. Conclusion: We conclude that RIPASA scoring system is the scoring system of choice in diagnosis of the acute appendicitis with good sensitivity albeit a hit high and specificity albeit a bit low profile.

Background (SARS-COV-2) infection, led to a pandemic affecting many countries, resulting in hospitals diverting most of their resources to fight the pandemic. Breast cancer, already a healthcare dilemma, is also affected in this scenario. Our aim was to find out the impact of COVID-19 on presentation of breast cancer stage and its effects on overall onco-surgical management. Methods This cohort single-centered retrospective review was carried out at our hospital, over a period of 18 months. Females with known breast cancer were included in the study. Data was collected on performas by a single researcher. Effect of COVID pandemic on presentation stage and its impact on overall management was studied. SPSS 23.0 used for data analysis. A 95% CI was used. Descriptive statistics were presented as range/means. Categorical data was analyzed by Fisher exact test, t-test was applied to numerical data, p value ≤ 0.05 was considered significant. Results Out of 87 patients presenting with suspicious lump, 69 who had malignancy on histo-pathology were included in study. Twelve out of 69 were COVID positive. Sixty patients presented with advanced stage (≥stage 2b) out of which 21 underwent upstaging of disease due to delay in presentation/management. We found that 9 out of 12 (majority) Covid positive patients had disease upstaging. Overall main reason for delay in presentation was found to be unawareness of disease. Conclusion We concluded that COVID-19 pandemic had no impact on presentation delay, breast cancer management/treatment and disease upstaging as compared to figures available for our population before the pandemic. However, our study showed significant correlation between disease upstaging and COVID status. This led us to reconsider our preformed protocols for COVID positive breast cancer patients. Our results can be used by future researchers to investigate if COVID itself can contributes in patho-physiology of upstaging in breast cancer or not.

Background: Diabetic foot ulcers (DFU’s) are chronic wounds in diabetics resulting from ischemia, angiogenesis defects and impaired immunity. Vacuum assisted closure (VAC) provides a new paradigm for diabetic wound dressing. This study compares the mean healing time of wound after VAC versus conventional dressing (CD) in DFU patients.Methods: This randomized controlled trial carried out at surgery department, at tertiary teaching hospital over a period from 28th February-27th August 2020. Total 60 patients of age (25-75 years), both genders having DFU were included. Patients were placed randomly into two groups i.e., group A (VAC therapy) and group B (CD), by using lottery method. Mean healing time noted in both groups. For statistical analysis, SPSS version 20.0 was used. Independent ‘t’ test used to compare the mean healing time of both groups and p≤0.05 considered significant. Effect modifiers were controlled through stratification and post-stratification independent ‘t’ test, to see their effect on healing time. P≤0.05 was considered significant.Results: The mean age of patients in group A was 53.13±9.09 years and in group B was 53.53±9.09 years. Out of 60 patients 41 (68.33%) were males and 19 (31.67%) were females. The mean healing time of wound in DFU patients after VAC closure (group A) was 12.07±2.15 days and after CD (group B) was 17.50±3.16 days with p=0.0001.Conclusions: Study concluded that mean healing time after VAC is less in DFU patients as compared to CD.