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[Use regarding health-related and administrative directories to measure social health inequalities].
[This corrects the article DOI 10.1093/rb/rbaa009.][This corrects the article DOI 10.1093/rb/rbaa009.].Acute type-A aortic dissection is a surgical emergency and has a high rate of short-term mortality. Aortic dissection is highly under-reported in Pakistan. With the technological developments in its management, arterial cannulation technique of direct true lumen cannulation has emerged with improved outcomes. We aimed to compare the mortality and morbidity outcomes between direct true lumen and conventional cannulation techniques for arterial access in patients with acute type- A aortic dissection under a single-centre retrospective review from 2007 to 2017. Mean age of the participants was 43.3±11.6 vs 45±12.4 years with males being dominant in both groups. Frequency of overall morbidity was high in conventional cannulation group (Group-B), though it did not attain statistical significance, (p>0.999). Mortality rate was also high in Group-B (10% vs 30%), (p=0.582). Direct true lumen cannulation is an equally reliable option for establishing cardiopulmonary bypass due to reduced mortality and morbidity and may be given preference when dissection is extending into femoral and innominate arteries.Thrombosis of vein of Labbe is an uncommon finding and usually tends to occur along with extensive dural venous sinus thrombosis. Clinical presentation varies from headache to aphasia, dysarthria and upper motor neuron weakness symptoms. Recognized risk factors for thrombosis should be considered while diagnosis. MR venogram remains investigation of choice for detection and to look for the extent of thrombosis.Dural closure at the end of cranial surgery is considered an extremely important step to maintain anatomical continuity, separate the intradural space with the extradural one, and to prevent possible complications related to cerebrospinal fluid leak. Wherein its usefulness in posterior fossa craniotomy is established, many surgeons do not perform it routinely in supratentorial craniotomies, citing unnecessary delay and lack of evidence supporting it. Herein, we have reviewed the data to find evidence in support of watertight suture based dural closures compared to other dural closure techniques, in supratentorial craniotomies.With rapidly increasing prevalence of obesity worldwide, it has become imperative to generate a comprehensive and easy to use clinical model for its management. We propose a simplified yet systematic approach to an obese patient, for a personalised patient centric obesity management. The SECURE model encompasses three domains in evaluation of the patient (Severity assessment, Etiological evaluation and Comorbidity workup) and the other three pillars for obesity treatment (Urge life style changes, Role of medications and surgery and Expected goal setting). This provides a clinical action checklist that may be useful even in other chronic non communicable disorders.Most practice guidelines recommend the use of longacting or pre-mixed insulin at the initiation of insulin therapy in type 2 diabetes, especially in patients not achieving glycaemic goals. Nonetheless, there are some specific indications where basal bolus insulin is the preferred regimen for insulin initiation. These include the "5S" situations - 'Severe' hyperglycaemia, 'Symptomatic' diabetes, 'Sick' diabetes (acute or chronic comorbidity), 'Special' situations (pregnancy, childhood, adolescence) and 'Secondary' diabetes (pancreatic, drug-induced, endocrine disorders). This review describes a practical approach to initiation and follow up of basal bolus insulin regimens.Dubin-Johnson syndrome presents as asymptomatic recurrent hyperbilirubinemia, while Glucose-6-Phosphate-Dehydrgenase-deficiecy as acute haemolytic anaemia. ETC159 We present a case with coexisting Dubin-Johnson syndrome and Glucose-6-Phosphate Dehydrogenase deficiency unmasked by acute viral hepatitis E.Oesophagocutaneous fistula is a very rare disorder. No case of oesophagocutaneous fistula after blunt trauma has been reported. In this report we present a case of 25-year-old nursing student seen at the Lahore General Hospital, Lahore, with a history of blunt trauma to the neck. She was initially diagnosed with supra-sternal abscess. A few days after the incision and drainage of this abscess, she developed discharge of water and food particles from the wound site. It was investigated and diagnosed as oesophagocutaneous fistula. Her neck exploration was done and fistulous tract was found communicating with the upper mid-esophagus. The tract was excised and sent for biopsy. Histopathology revealed non- caseating granulomas with no evidence of malignancy. A gene X-pert was done to rule out tuberculosis and it came out to be negative. Postoperatively, the patient is living a normal life. This is the first of its kind case of oesophagocutaneous fistula reported from our part of the world.Myxofibrosarcoma belongs to the group of sarcoma tumours, which represent only 1% of the adult tumours worldwide. It is one of the rare, aggressive connective tissue neoplasm of malignant fibrocytes in a myxoid matrix, and mostly occurs in people in their 60s to 80s. Like many other tumours of connective tissue, it reveals high recurrence rates, but rarely metastasise. We present a case of a 50-year-old female who had a large, soft tissue sarcoma over the left leg. Wide surgical excision was done due to its increased size and aggressive clinical behaviour, so as to increase the patient's comfort. On histopathology, the tumour was diagnosed as high-grade myxofibrosarcoma with no evidence of metastasis.Angiolipoleiomyoma (ALLM) is a rare variant of benign neoplasm of the uterus. It has a prevalence of only 0.06% with only a handful of cases. According to our review of the literature, this case study is one of the only two youngest patients of ALLM reported. We present the case of a 26-year-old female with ALLM of the uterus. She presented with a large abdominopelvic mass and underwent myomectomy and plication of the round ligament to preserve fertility. Although renal angiomyolipomas are more prevalent, extrarenal manifestation especially that which is found in the uterus is still a rare entity. Commonly occurring in women in their fifth to sixth decades of their lives, the case presented here is of a woman in her reproductive age. Therefore, by reporting it we are not only acquainting physicians to consider this as a differential, but also for World Health Organisation (WHO) to include this in their classification of tumours of the female genital tract.
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