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Breast Cancer Stem Cells (BCSCs), unlike normal breast cells, exhibit the potential for self-regeneration and tumour formation and express unique markers. Studies have highlighted their role in tumour progression, recurrence, and treatment resistance. BCSCs can be one of the reasons that resistance is encountered despite recent advances in the treatment of breast cancer (BC). This review underlines the clinical implications at the molecular level of different cellular pathways, cellular level interactions in Tumour Micro Environment (TME), and types of markers and receptors involved in tumorigenesis. It accentuates the importance of comprehensive targeted treatment options available for BCSCs so that targeted modalities can be introduced to deal with treatment resistance. Stem cells (SCs) are a developing field, and limited data is available from our country to use stem cell-targeted treatment plans as a therapeutic option. Therefore, this literature review will provide insight for future research in this domain. Continued...

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.

Breast cancer, a leading cause of mortality among females, has been the center of research for many decades. Work is in progress to advance the research worldwide and in our region. This study is conducted to look into regional ethical predilection/age, clinical presentation/stage, pathological subtypes and risk factors of BC among patients of Karachi, with the aim of proposing a ground in our policy making regarding protocol setting for screening and management of BC patients.A prospective cohort study started at public Hospital, Karachi from 2010 to 2020.500 females with histo-pathologically proven BC selected. History, clinical examination, radiological and histo-pathological data retrieved; data regarding age, ethnicity, family history, parity, marriage/menopause, stage/lump size/symptoms were filled on pro-forma. Primary outcomes were age, ethnicity, family history, stage/histological type and menopausal status of our cohort while secondary outcomes were parity, marriage, symptoms and lump size/site. Data analyzed using SPSS in ranges and percentages.Among different ethnicities, Makrani were the most affected(34%). Majority were premenopausal females ≤50yrs (78%). Infiltrating ductal carcinoma (88.8%) was the commonest subtype. Family history was positive in few (5.8%). Parity and marital status had no effect on our population. Breast lump (88%) was the commonest presenting symptom and 51% of our patients had the right side involved. Upper outer quadrant (51%) was the most involved quadrant and the majority (46%) were stage II.Age of presentation is around a decade earlier in our region, with women of Makrani descent more prone to develop BC. 2/3rd of patients were premenopausal, with lump breast as primary complaint. Majority of patients presented in stage-II. Results of age and racial predilection in our population suggest us to concentrate future research more on genetic profiling so we incorporate the results to devise population specific protocols with reference to age, presentation, BC type, ethnicityrisk factors.Record submitted retrospectively at ClinicalTrials.govt on 09-07-2022

Critically ill COVID-19 patients have to undergo positive pressure ventilation, a non-physiological and invasive intervention that can be lifesaving in severe ARDS. Similar to any other intervention, it has its pros and cons. Despite following Lung Protective Ventilation (LPV), some of the complications are frequently reported in these critically ill patients and significantly impact overall mortality. The complications related to invasive mechanical ventilation (IMV) in critically ill COVID-19 patients can be broadly divided into pulmonary and non-pulmonary. Among pulmonary complications, the most frequent is ventilator-associated pneumonia. Others are barotrauma, including subcutaneous emphysema, pneumomediastinum, pneumothorax, bullous lesions, cardiopulmonary effects of right ventricular dysfunction, and pulmonary complications mimicking cardiac failure, including pulmonary edema. Tracheal complications, including full-thickness tracheal lesions (FTTLs) and tracheoesophageal fistulas (TEFs) are serious but rare complications. Non-Pulmonary complications include neurological, nephrological, ocular, and oral complications.

Meckel's diverticulum (MD)1, the most common congenital anomaly of the gastrointestinal tract, occurs in 2% of the population with males being more symptomatic than females. In this case, a 32-year-old male presented with sudden onset colicky abdominal pain, bilious vomiting, and absolute constipation. Emergency laparotomy was done on his virgin abdomen, as a result MD and vitelline cyst along with a fibrous cord connecting the two were identified. Knotting of an ileal loop around this cord had resulted in intestinal obstruction. Meckel’s diverticulectomy, along with cord resection, was carried out. The patient made smooth recovery and was discharged on the fifth postoperative day with no complications. The importance of this study is to highlight the case of symptomatic MD in an adult male as it can be a cause of intestinal obstruction and should always be considered in a patient presenting with symptoms of intestinal obstruction.

Yusra Iqbal,1 Wajiha Khan,1 Mehwish Mooghal2,3 1Department of Surgery and Medicine, Dow University of Health and Sciences, Karachi, Sindh, Pakistan; 2Department of Surgery, PNS Shifa Hospital, Karachi, Sindh, Pakistan; 3Department of Surgery, Bahria University Medical and Dental College, Karachi, Sindh, PakistanCorrespondence: Yusra Iqbal, Tel +923343627273, Email yusraiqbal001@gmail.comAbstract: Gender disparity, that is the unequal attitude and treatment of people due to their gender, is found in many fields including the medical profession. Not only it is present in developed countries but is also a major concern in developing countries like Pakistan. According to data, Pakistani female doctors face gender discrimination that negatively impacts their workplace performance and has proven to be a hindrance to them taking up leadership roles. The patriarchal mindset of society, workplace harassment, and lack of basic facilities in the hospital for working mothers are just a few of the factors that compel women to leave their careers. Even if they continue to work, women have to perform the duties of a mother and homemaker along with their jobs, and that negatively impacts their skills as doctors and as leaders. Efforts need to be taken to encounter all the problems that are negatively affecting leadership roles of female doctors such as providing equal opportunities, arranging awareness campaigns about creating a workplace environment that is favorable to all genders, and creating policies that will help working mothers by forming daycare centers and giving paid maternity leaves. This will help in alleviating the gender disparity in the healthcare system and will increase the chances of female doctors proving themselves good doctors and leaders.Keywords: gender inequality, authoritative position, healthcare system

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.