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.

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Background: Acute pancreatitis is one of the most common causes of acute abdominal pain in patients presenting to tertiary care hospital. The prevalence of acute pancreatitis in Pakistan is 0.03%. Assessment of prognosis is important in management of patients with acute pancreatitis. A simple and clinical oriented scoring system to predict the severity of acute pancreatitis at the time of presentation is required. Objectives: To determine the agreement between BISAP score and CRP in assessing severe acute pancreatitis. Methodology: A cross-sectional study was conducted at a tertiary care centre on 15 patients diagnosed as acute pancreatitis who fulfilled the inclusion criteria. Demographic data was noted and their BISAP Score and CRP values were calculated and statistical analysis was done using SPSS 20.0 Software. Results: Mean + SD age of the study participants was 46.73 + 8.29 years. Nine (60%) were males and six (40%) patients were females. The agreement of BISAP score and CRP level in assessing the severity of acute pancreatitis was 66.7%. Conclusion: There is a substantial agreement in favor of both CRP criteria and BISAP scoring in diagnosing acute severe pancreatitis.

The study of breast diseases and their epidemiology deserves special attention. Another reason that grants special value to the breast diseases is the way it affects women health both physically and mentally. The commonest breast symptom is breast lump. Breast lumps are the most common symptom bringing patient to a breast clinic. They are also the most common cause of serious trouble for the patients keeping in view the increased incidence of breast cancer. This is partially due to increased awareness among females. In this study we detected the frequency of clinically palpable breast lumps and their causes and treatment presenting to the breast clinic of a busy private sector hospital. Methods: Study design: Descriptive case series Place of study: Department of Surgery, Holy family Hospital Karachi Duration of study: 1 year (from July 2020 till June 2021) Study population: All females presenting to the breast clinic within the mentioned period Data collection procedure: All the information was taken by the patient through history. Informed consent was taken for examination. Further investigations according to the triple assessment protocol were done in patients who presented with a lump to ascertain the exact nature and etiology of lump. All the data was then entered in a predesigned proforma. Results: A total of 126 patients presented to the breast clinic in Holy family Hospital. The number of patients presenting with breast lump was just above half of the total patients i.e 66 patients (52%).Out of these 66 patients, majority was benign i.e 53 patients(80%) with malignant lumps accounting for 13 patients,20 % of the total patients with breast lump.60(48%) patients presented with symptoms other than breast lump. The most common symptom other than lump was pain followed by nipple discharge, skin diseases etc. Conclusion: Breast lump was the most common symptom in patients presenting to our breast clinic and majority were benign and did not require surgery. Keywords: Clinically Palpable, Breast Lump, Triple Assessment