Ectopic pregnancies are an important cause of morbidity and mortality in early pregnancy. This article presents an up-to-date review of the risk factors associated with tubal ectopic pregnancies and how these patients present. This is crucial for midwives who may be conducting booking appointments at earlier gestations and for those working in early pregnancy units. The role of transvaginal ultrasound as the new diagnostic gold standard is also explored. Management strategies are outlined, including the surge in conservative treatment, and the long term implications of ectopic pregnancies are also outlined. A case study is presented to show an example of how these women present in early pregnancy.

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Introduction: Evidence on conducting baseline echocardiogram before starting chemotherapy in pediatric cancer patients is limited from developing countries where malnutrition and infections are common and which may result in cardiac dysfunction. Materials and Methods: A prospective, observational study was conducted from October 2016 to May 2017 at The Indus Hospital, Karachi, Pakistan, among children 1 to 16 years of age suffering from cancer. Echocardiography was performed before starting chemotherapy. Associations between body mass index and cardiac abnormalities were studied. Results: A total of 384 children met the inclusion criteria. The median (interquartile range) age was 8.0 (5.0 to 12.0) years and 62.0% (n=238) were male individuals. Twenty-two of 384 (5.7%) children had systolic dysfunction. Four of 22 had moderate-systolic and one of 22 had mild systolic dysfunction, for whom the therapy was altered, and they were treated without anthracyclines. Four of these 5 patients died, and only 1 of 5 survived through high-risk protocol. Seventeen of 22 children had low–normal systolic dysfunction. We found no evidence of an association between body mass index for age and abnormal left ventricular ejection fraction and abnormal fractional shortening (P-trend=0.587; 0.487, respectively). No associations were found of weight-for-age and height-for-age with these outcomes. Conclusions: In developing countries, echocardiograms should be expeditiously performed and technology made more accessible to rule out cardiac dysfunction and avoid delay in chemotherapy. Malnutrition was not associated with cardiac dysfunction.

Background: Bile duct injury is the most serious complication of laparoscopic cholecystectomy and misidentification is thought to be the most common cause. CVS is a method of exposure of hepatocystic triangle to minimize this injury. Material and methods: This prospective cohort study was conducted in the Surgical Deptt Hayatabad Medical Complex from 1st August 2018 to 31st July 2020. Results: A total of 100 patients were included with 69 females and 31 male patients with age range of 25-70 years and mean age 37 years. The mean procedure time noted was 45 minutes (35-55mins). CVS was achieved in all patients and documented in the form of video or picture as doublet view of hepatocystic triangle. No BDI was noted. Only 01 patient presented with 20ml collection in the gall bladder fossa which was treated conservatively. Conclusion: Achieving CVS during laparoscopic cholecystectomy is a safe way to minimize BDI. Incarporating CVS into our syllabus and guidelines will promote culture of safe laparoscopic cholecystectomy.

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