In 1934 Lemmel was the first to report the presence of juxtapapillary diverticula and hepatocholangiopancreatic disease, excluding cholelithiasis. Obstructive jaundice caused by periampullary duodenal diverticulum (PAD) in absence of choledocholithiasis or tumor is known as Lemmel syndrome. A patient with an extraluminal duodenal diverticulum presenting with obstructive jaundice and pancreatitis is presented in this case. Although initially managed conservatively, the patient had recurrence of symptoms after 2 months but then had successful surgical resection of the duodenal diverticulum. LEARNING POINTS Lemmel’s syndrome should be considered in patients with pancreaticobiliary disease in the absence of tumors, stricture, or cholelithiasis. Non-invasive imaging studies should be considered first but endoscopic retrograde cholangiopancreatography (ERCP) remains the diagnostic method of choice. Surgical resection (diverticulectomy), endoscopic sphincterotomy, and papillary balloon dilatation are treatment options when conservative management fails.

Objective To determine the frequency of needle stick injury in dental practice and to evaluate the level of knowledge, attitude and practices of the dental students and dentists regarding needle stick injuries prevention. Materials and methods This descriptive cross-sectional study was undertaken at eight different institutes of Karachi from July 2014 to March 2015. Data were collected in 800-sample questionnaire forms that comprised of ten questions in English language. Questionnaire was designed to obtain information regarding frequency, awareness and prevention of needle stick injury. Data were entered and analyzed in Statistical Package for the Social Sciences (SPSS) Version 20. Result A total of 800 samples were returned with a 100% response rate. About 73% participants gave a history of needle stick injury during practice. Of these 42% were the house officers. It was reported that knowledge regarding vaccination against hepatitis B was prevalent among participants. Most of the participants agreed that they have received guidelines regarding prevention and protection from needle stick injury. Conclusion It was concluded from this study that hepatitis B vaccination is necessary to prevent needle stick injury and proper instruments/guidelines should be given to all health related professionals in order to minimize the risk of bloodborne infections through needle stick injury. How to cite this article Ikram K, Siddiqui HK, Maqbool S, Altaf M, Khan S. Frequency of Needle Stick Injury among Dental Students and Dentists of Karachi. World J Dent 2015;6(4): 213-216.

Objectives: Adequate knowledge and positive attitudes of health care professionals regarding deceased-donor organ transplants lead to higher donation consent rates. This study assessed the knowledge and attitudes of health care professionals toward this issue in the light of recent organ transplant legislation in Pakistan. Materials and Methods: Health care professionals in critical care areas of 2 hospitals in Karachi were selected (n=243) and asked to complete a questionnaire regarding their knowledge and attitudes toward deceased-donor organ transplants. Results: In all, 58.8% of the participants were physicians and 41.2% were nurses; 91.4% correctly identified brain death; 51.5% expressed support for deceased-donor organ transplants; 56.8% had concerns of religious rulings against deceased organ donation; 67.5% felt that a government body could not run such a system fairly; 56.4% of the respondents would consider receiving a deceaseddonor organ if needed, but only 35.3% would donate after their own death. Only 42.7% and 37% were willing to approach patients and families for consent for a deceased-donor organ transplant, respectively. Most of those unwilling felt that the patient could refuse, become upset and aggressive, and lose trust in the health care professionals. Conclusions: Before implementing a deceaseddonor organ transplant system in hospitals, health care professionals should attend a training program regarding their concerns. This would increase motivation when approaching patients/patients' families for consent, thus increasing deceased-donor consent rates.

A 66 year old man was diagnosed with CNS diffuse large B-cell lymphoma, and underwent treatment with Temozolomide, Dexamethasone, Rituximab, and radiation therapy, and prolonged steroid taper with Dexamethasone. Approximately one month after this, he presented with severe acute hypoxemic respiratory failure, and was admitted to the Medical Intensive Care Unit. Imaging showed diffuse ground glass opacities. Patient underwent diagnostic bronchoalveolar lavage which was positive for Pneumocystis jiroveci. He did not respond well to appropriate therapy and was transitioned to comfort care per his family's wishes, and expired. Pneumocystis jiroveci should always be included in the differential diagnosis of pneumonia in patients treated with Temozolomide, especially when this agent is used in combination with long term, high dose corticosteroids and radiation therapy.

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