TOF patients are often operated on after age 1 year in LMICs. Unlike in developed countries, older age is not a risk factor for death. Nutritional and hypoxemic status were associated with higher mortality and infection. This information fills a critical knowledge gap for surgery in LMIC.

Purpose The purpose of this paper is to access the present situation of the Pakistani population that suffers from vitamin D deficiency. Design/methodology/approach A review-based study was conducted based on publications from Pakistan between the years 2008 and 2018. The publications were archived from Pub Med and Google Scholar databases. A total of 18 publications were shortlisted, based on the cutoff values of vitamin D sufficiency, insufficiency and deficiency. Findings As per the data, 38.5 per cent of the participants were males, 48.7 per cent were females and 12.8 per cent of the studies have not mentioned the genders of the participants. The cumulative results show that 58.17 per cent (95 per cent CI: 52.17, 64.16) of the population is vitamin D-deficient and 26.65 per cent (95 per cent CI: 21.63, 31.66) is insufficient in vitamin D. The highest level of vitamin D deficiency was reported from Sindh (62.15 per cent), followed by Khyber Pakhtunkhwa (60.57 per cent), Punjab (51.75 per cent) and the Federal Capital (49.25 per cent). Moreover, Cochran’s Q test indicated considerable heterogeneity (p = >0.001) with regard to Vitamin D deficiency (VDD) prevalence found among samples from the selected studies. Originality/value The present analysis suggests that more than half of the Pakistani population suffers from VDD, which, thus, should be considered as an epidemic and treated likewise.

Introduction: Peritoneal mesothelioma is a rare tumor with diagnostic and therapeutic problems. The peritoneum is the second most common site for development of mesothelioma, which in 30-45% of cases is associated with a synchronous pleural mesothelioma. Clinical symptoms and findings may be confusing and diagnosis can be easily overlooked especially in cases where there is no previous asbestos exposure.

The collagen-inducing effects of topical tretinoin do not appear to enhance the healing of high-tension excisional surgery wounds in a porcine model. Tretinoin does not appear to improve the survival of full-thickness skin grafts and, in fact, a detrimental effect was apparent in our model.

IntroductionMyocardial abscess is a rare and potentially fatal condition. Metastatic myocardial abscess in the setting of infective endocarditis has been infrequently reported in the medical literature. To the best of the authors' knowledge no case of myocardial abscess affecting the free wall of the left ventricle secondary to infective endocarditis of a right-sided heart valve has been reported previously.Case presentationWe report a case of tricuspid valve endocarditis caused by Staphylococcus aureus and resulting in a myocardial abscess on the posterior wall of the left ventricle, far from the active valvular infection. We also briefly discuss the role of different investigation modalities including cardiac magnetic resonance imaging in diagnosing myocardial abscess.ConclusionMyocardial abscess is a life-threatening illness. A high index of clinical suspicion is required to make a prompt diagnosis. Final diagnosis may need multi-modality imaging. An early diagnosis, aggressive medical therapy, multidisciplinary care and timely surgical intervention may save life in this otherwise fatal condition.