Early optimal management of biliary perforations remarkably improved the very high mortality and morbidity that characterised this condition in the past.

In the absence of a quality assurance regulatory body to monitor and overlook the professional competence of practicing surgical pathologists, a mandatory review and second opinion should be undertaken whenever a major therapeutic endeavor is to be undertaken, regardless of the cost for the ultimate benefit of the patient.

Background Nurses and paramedics by being the frontline workers of the healthcare profession need to be equipped with the relevant knowledge, skills and protective gears against different forms of infection, including COVID-19. Though the governments and concerned stakeholders have provided P.P.E.s, training and information to protect the healthcare professionals, however until now the scientific literature has virtually not reported the impact of P.P.Es availability, training and practices on the COVID-19 sero-prevalence among the nurses and paramedics. Objective This study aimed to assess the Impact of P.P.Es availability, training and practices on COVID-19 sero-prevalence among nurses and paramedics in teaching hospitals of Peshawar, Pakistan. Methods A cross-sectional survey was conducted with a total of 133 nurses and paramedics as subjects of the study. Results A univariate analysis was done for four variables. The findings indicate that the healthcare professionals (nurses & paramedics) who have received P.P.Es on time at the start of COVID-19 emergence has fewer chances of contracting the COVID-19 infection (O.R = 0.96); while the odds for P.P.Es supplies was 0.73, and the odds of hand hygiene training was 0.95. Conclusion The study concluded that the availability of the P.P.E.s, COVID-19 related training and compliance with W.H.O recommended practices against COVID-19 were instrumental in protection against the infection and its spread.

Background With the growth of global terrorism and rapid advancements in the field of science, the threat of a nuclear, biological, and chemical (NBC) attack remains imminent. This study assesses perceptions of preparedness of health care professionals in case of an NBC attack/incident in a tertiary care hospital. Patients and methods We conducted a descriptive, cross-sectional study of 200 health care workers (including nurses and doctors) in a tertiary care hospital, from October 2018 through December 2018. Participants answered 17 yes/no questions and five 5-point Likert scale questions. We analyzed the data using chi-square tests and one-way analysis of variance. Results Most participants (73.6%) reported availability to an isolation facility, and a majority of participants (72%) reported they had access to ventilators. Approximately 60% of participants reported they had access to beds, and 44.6% reported access to a laundry facility. Most participants (65.3%) knew of an employee assistance program while 31.1% did not know about such a program at their institution. More than 50% of the respondents think they can deal with an emergency involving an NBC attack while 60% of the respondents did not think that their institution would be able to protect them in the event of an NBC attack/incident. Overall, the participants were not adequately prepared for a mass scale NBC incident. The level of preparation was linked to the number of courses and training programs completed by the participants, with postgraduate medical personnel having the maximum level of preparedness, followed by medical graduates and nursing personnel. Conclusion Given the inadequate level of preparedness for an NBC incident as indicated by our findings, drills and seminars on large-scale emergencies such as an NBC attack should be included in the curriculum of undergraduate medical and nursing students in order to impart them the necessary training and confidence in dealing with an NBC incident.

Background and objective Tubularized incised plate (TIP) urethroplasty is an easy and popular technique for repairing hypospadias, however urethrocutaneous fistula (UCF) is a frequently reported complication. Different techniques are used to reduce this complication. We aimed to compare the rate of UCF after single dartos and double dartos TIP urethroplasty in children with distal and mid penile hypospadias. Methods A randomized controlled trial (NCT 04699318) was conducted in the Department of Pediatric Surgery, Mayo Hospital, Pakistan from August 2017 to February 2018, after ethical approval. After informed consent, a total of 60 patients with distal and mid penile hypospadias who were uncircumcised, had no chordee, and/or previous surgery, were randomly allocated in two groups using computer generated table numbers. Group A underwent single dartos TIP urethroplasty and Group B underwent double dartos TIP urethroplasty. Catheter was removed on day 10 post-operatively in both groups and primary outcome (UCF) was noted after a week of catheter removal. Rate of UCF was compared using chi square and p-value of <0.05 was taken as significant. Data was stratified to check for effect modifiers. Results Out of 60 children, eight (13.3%) developed UCF. In Group A, seven (23.3%) developed UCF and in Group B, one (3.3%) developed UCF (p-value 0.02). In both groups, no patient (0%) had urethral disruption, penile torsion, skin necrosis or meatal stenosis. Conclusion Additional covering of neo-urethra by a double dartos layer significantly reduces fistula rate after tubularized incised plate urethroplasty in both primary distal and mid penile hypospadias.