Introduction  Squamous cell carcinoma is the most common malignancy of the head and neck, with the buccal mucosa being the most common site involved. Early locoregional metastasis is a hallmark of this disease, and early stage tumors may harbor metastatic nodes that are occult. Certain parameters can help identify high-risk patients for whom the pattern of occult nodal metastasis can be predicted. Tumor thickness is one such objective parameter. Objective  To determine the relationship of tumor thickness with neck node metastasis in squamous cell carcinoma of the buccal mucosa. Methods  A retrospective chart review of 102 patients with biopsy-proven squamous cell carcinoma of the buccal mucosa with N 0 Necks was performed. All patients underwent tumor resection with neck dissection, and the tumor thickness was measured. Univariate and multivariate analyses were performed. Results  A total of 102 patients, of which 73.53% were males and 26.47% were females. The mean age of the patients was 49.3 ± 11.1 years. It was found that the risk of neck node metastasis in buccal squamous cell carcinoma increases 35.5 times for a tumor thickness ≥ 2 mm, and the risk of neck node metastasis in buccal squamous cell carcinoma decreases by 0.58 times for each centimeter decrease in tumor size, while the rate of occult neck lymph node metastasis was found to be 37%. Conclusion  We conclude that tumor thickness is significantly related with neck nodal metastasis in buccal squamous cell carcinoma, considering the age of the patient and the size of the tumor.

Background: The issues pertaining to postgraduate medical education have been debated for long but there has been little contribution to this literature from developing countries. Therefore, a need to make an accurate assessment regarding current status of postgraduate training in Pakistan was felt and feedback from residents is the cornerstone of such an assessment. The objective of our study was to document perceptions of FCPS trainees of medical and surgical disciplines in private and public tertiary care hospitals of Karachi, Pakistan.Material and Methods: This was a cross sectional survey of the medical and surgical FCPS trainees in three hospitals (1 public and 2 private) of Karachi Pakistan, conducted over a period of two months (1st November 2018 to 31st December 2018). A total of 325 participants selected by convenient sampling technique were included in the study. Data was collected through structured self-developed questionnaire and analyzed by SPSS version 16.0.Results: The percentage of postgraduate trainees in private hospitals working for more than 80hours/week is higher than those working in public sector hospitals (59.4% versus 42.4%). Topic presentation and Academic meetings (Conferences, Workshops and CMEs) were the most preferred teaching strategies in Postgraduate training (77.4% and 77.5%). About 62.7% of the residents believed that their program was in line with CPSP guidelines. Public sector hospitals were better in terms of medical benefits giving partial cover (62.8%) than private sector (P-value <0.001). Majority of trainees at private sector hospitals seemed satisfied with their working environment than at public hospital (77.5% versus 12.5%) (P-value <0.001). Trainees perceived that the security arrangements at both public and private hospitals were not adequate, but in case of emergency private hospitals seemed to have better security response as compared to public hospitals (89% versus 23%) with a significant difference of <0.001.Conclusions: Perception of most of the postgraduate trainees is that they are being adequately trained for the challenges of an independent physician or surgeon.Key words: Postgraduate training programs, Medical education, Trainees perception

Background Inhaled medications are the main therapeutic treatment of chronic obstructive pulmonary disease (COPD) and inhaler technique remained important that can increase medication efficacy, reducing dose and side effects. Poor inhaler technique is multi-factorial and the quality of inhaler technique has not previously assessed in Pakistan. We conducted a study to examine a range of competing factors that impact COPD patient willingness, practices, and preference in using their inhalers. Methods A cross-sectional of 765 patients with COPD were interviewed and assessed by qualitative questionnaires. Objective inhalation technique and steps assessment was performed; satisfaction, preferences, perception, and practice of different types of inhaler devices were evaluated at a single crosssectional visit at the study enrolment. Results The study included 765 participants of mean age 58.7 years (SD ±7.8); 32% males and 68% females. Almost all of the females were exposed to biomass fuel smoke exposure (99%) and pipe (Huka) smokers 53%, while most male participants were cigarette smokers (92%). Only 6.3% of participants were able to perform correct steps of inhaler use, and few educated patients completed 7-steps. 66% of patients were using dry powder inhalers (DPI) inhaler devices and mostly performed the steps 1, 2, and 4 (98%) correctly, while 44% who were using metered-dose inhalers (MDI) completed only steps 2 and 4 correctly (88%). The majority of participants reported the particular inhaler devices was prescribed by the visiting consultants (54%). Interestingly, they were using two inhalers together (47%) relieving symptoms of dyspnea (83%) and cough (73%). The inhaler use technique was demonstrated to most of the patients by the pharmacy salesman (38.4%), while 15.8% reported that their doctors taught them the inhaler technique. 54.2% reported reason for poor adherence to inhaler use as they understand it might not work lately and 75.2% were not aware of any side effects associated with the regular use of an inhaler. Conclusions Poor inhaler technique is highly prevalent and the associated errors did not appear to be dependent on device type. Most of the participants had not receive proper training about the correct use and were not involved in decision making about the choice of inhaler device.