Summary Background 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov , NCT03471494 . Findings Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding National Institute for Health Research Global Health Research Unit.

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Facial bones injuries results in functional disturbances. Patients may presents with flattening of normal malar prominence, lid drop, eye movement limited or with double vision, numbness of cheek area and unilateral epitasis. Emphasizing upon incision type, fixation method and occasionally reconstruction, surgeons suggest different methods for repairing complex fractures of Zygoma.

ABSTRACT… Objectives: To asses and manage medical emergencies in the dental setups of Hyderabad city. Methodology: Study Design: Descriptive Cross Sectional study. Setting: General and Specialist dentists of Hyderabad city. Period: June 2015 to January 2016. In this study population of 187 dentists were enlisted practicing either in public or private setup of Hyderabad, Sindh. Questionnaire designed to obtain information about their experience. Results: (59.89%) of the graduate dentists having less than 5 years clinical experience and (40%) have clinical experience of more than 5 years, qualification, 114 (60.63%) of the practitioner had fundamental dental aptitude and 73 (39.0 %) were specialists with different postgraduate aptitude. Medical emergency workshops attended, (60.96%) General dentists and Specialist had undertaken BLS course, commonly occurring emergency was vasovagal syncope with the prevalence of 103(55.0%) and availability of drugs and equipment's were Oral Glucose (90%), Aspirin (86%) and Sprit Ammonia (78%) usually available drugs kept by the Clinical Setup to handle the emergency procedures. Conclusion: Dental practitioners of city Hyderabad are able to identify and handle medical crisis, however most of the doctors either not properly trained to contract with these circumstances or they have poor assets to deal with medical emergencies. Improvement in knowledge of dentists through speculative and demonstrable educational courses, availability of emergency drugs, equipment's and advance groundwork for the emergency management of the patients is required. Key words:Basic Life Support, Clinical Setups, Medical Emergencies.

Objective: Comparative outcome of one versus two drains insertion for in the term of seroma formation following modified radical mastectomy in breast carcinoma. Methodology: This Prospective Interventional trial was conducted at Department of General Surgery, Liaquat University Hospital Hyderabad from February 2018 to January 2019.  Females with breast carcinoma admitted for modified radical mastectomy were included. Patients were divided into two groups.  Groups I underwent one drain placement and group II underwent two drains placement. All patients were observed to measure and record the volume of the fluid. Patients were discharged from Hospital in stable condition and after removal of drains, and followed up weekly for one month. Data was recorded on self-made proforma and analyzed by using SPSS-20. Results: Total of 80 patients were selected, 38 in group A and 42 in group B. Mean age of patients of group A was 49.08 ± 9.89 years and group B was 51.40 ± 13.59 years. , Excised Mass weight was lesser in group A as compared to group B. Mean volume of drain discharge was significantly higher in Group B 323.43 ± 158.88 ml, while it was in group A 230.29± 200.98, findings were statistically significant 0.013. Seroma formation was statistically insignificant among both groups as 8(21.1%) in group A and   10(23.8%) in group B, p-value 0.768. Conclusion: One-drain and two-drain insertion are equally effective to reduce the seroma formation after modified radical mastectomy; however, one drain insertion leads to more patient compliance and comfort with probably less morbidity and cost.