I am a aspiring surgeon. I have done FCPS and MCPS from BCPS and MRCS from RCS England. I am now working in General Surgery in Nottingham University Hospitals NHS Trust.
Introduction The COVID-19 pandemic has had significant consequences on healthcare delivery worldw... more Introduction The COVID-19 pandemic has had significant consequences on healthcare delivery worldwide, with a particular impact on surgical services and training. In preparation for the influx of COVID cases, non-urgent appointments, investigations, and operations were cancelled. As a result of the cancellation of cases, elective and emergency case exposure was inevitably reduced. Over 65 percent of trainees lost all training and only 9% reported that they would meet the essential skills. One in eight trainees in their final year have had their training extended due to failure to meet curricular requirements, while a quarter of trainees reach their final year behind their planned training trajectory. The primary objective was to identify the case with the highest cancellation rate to perceive its impact on surgical training. Method This is a retrospective study of data gathered by Department of eHealth in a tertiary hospital. Data collected from December 2020 to September 2021were an...
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
Aim Identify reasons for discharge delays in a tertiary care hospital and find areas of improveme... more Aim Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement. Method Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS. Results Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days). 27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed dischar...
Introduction Haemorrhagic cholecystitis and cystic artery pseudo-aneurysm (CAP) are two very unco... more Introduction Haemorrhagic cholecystitis and cystic artery pseudo-aneurysm (CAP) are two very uncommon causes of right upper abdominal pain. However, the development of haemorrhagic cholecystitis induced by ruptured cystic artery pseudo-aneurysm and haemobilia are extremely rarely documented with few occurrences documented in the literature. Case presentation A 80year-old frail patient was admitted with RUQ pain, deranged LFTs and melaena. She had known gall stones, hypertension, chronic kidney disease and fibromyalgia. She demonstrated localized tenderness in the right abdomen and bloods showed a significant drop in haemoglobin which required blood transfusion. Abdominal ultrasound showed cholecystitis and MRCP showed CBD dilatation with no choledocholithiasis. She was found to have haemorrhagic cholecystitis and CAP along with a cholecysto-colonic fistula on triple phase liver CT. The patient underwent urgent embolization of the CAP and remained clinically stable. She was discharge...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Aim Identify reasons for discharge delays from hospital and areas of improvement and any scope fo... more Aim Identify reasons for discharge delays from hospital and areas of improvement and any scope for trainees to make a difference – Trainee lead intervention. Method All inpatients including Elective and Emergency admissions were included from all 3 teams over 1 week. Data were collected on Microsoft Excel and analysis done with SPSS. Result Total 102 patients were included (Purple 44, Yellow 40, Red 18). Mean age was 60.5 years. 54 (52.9%) patients were Female. 57.4% data were missed for clinical frailty score (CSF). 46.5%patients had polypharmacy. 61 patients did not have any Expected date of Discharge (EDD). Mean Length of Hospital stay (LOS) is 18.01 days and median 10 (1–161) days. Total 27 patients were delayed. 1 stayed for 161 days awaiting rehab bed. Mean Duration of delay was 4.93 days and Median 1 day (1–42).4 patients were waiting beds outside of hospital for 3, 6,10, >30 days;6 patients were delayed for Stoma nurse review for average 1 day. Delayed discharges do not s...
survival may influence MDT decision making. Methods: This audit reports a single unit experience,... more survival may influence MDT decision making. Methods: This audit reports a single unit experience, over 2 years, in 62 patients who underwent NAC and their radiological and pathological response to treatment. Results: The mean age of this cohort was 46.5 years. Out of 42 symptomatic (67.7%) patients, 28 (45%) presented within 4 weeks. Eight (12.9%) were screen detected. Commonest TNM presentation was T2(33)N1(35)M0(59). Indication for NAC was breast conservation in the majority(54,62%), followed by ER-ve, Her2+vity(10,16.1%), locally advanced tumour(15,24.1%), inflammatory(8,12.9%) and triple negative tumours in <50 years(11,17.7%). 32 (52%) women had ER positive,13 (21%) had HER2 positive and 20 (32%) had triple negative cancers. Excellent radiological (MRI) response was seen in 17 (27.4%) and partial response in 38 (61.2%) patients. 44 (71%) underwent breast conserving surgery (BCS) while 18 (29%) had mastectomy. Fifteen (24.19%) had their decision for mastectomy changed after NAC. Eleven (18%) had a complete pathological response (CpR). All patients had undergone surgery within 8 weeks of final NAC. Four (6.4%) patients were reported to have local recurrence (LR) at the conclusion of the audit period. Conclusion: Patients offered NAC in our unit fit the criteria suggested by NICE guidelines. Our rates of CpR (18%Vs.15-36.6%), improved BCS rates post NAC (24.9%Vs.16-25%), and LR rates (6.4%Vs.6%) are acceptable and comparable to the literature.
Background & aims: International guidance advocates the avoidance of prolonged preoperative fasti... more Background & aims: International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. Methods: This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. Results: Of the 343 surgical patients included within the study, 50% (n ¼ 172) were male, 78% (n ¼ 266) had elective surgery and 22% (n ¼ 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n ¼ 250) for food, and 21% (n ¼ 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001. Conclusions: Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.
Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...
Background: Carcinoma of the breast is the most common malignancy in females. At present carcinom... more Background: Carcinoma of the breast is the most common malignancy in females. At present carcinoma breast is the leading cancer in Bangladesh and is competing cancer cervix in incidence. Epidemiological studies at regional and global levels suggest the occurrence of carcinoma breast at a younger, premenopausal age in Indian and Asian women as compared with western women. Knowledge of this factor emphasizes the need to modify the timing of modalities of detection of early carcinoma and its management. According to literature, majority of carcinoma breast cases in the western countries present in Stages I and II of the disease whereas in Bangladesh majority cases present in Stage III of the disease. The objective of this study is to observe age of occurrence of breast cancer and stage of cancer in SSMC and MH.Methods: A cross sectional observational study was conducted in 34 patients of histopathologically confirmed breast cancer.Results: Mean age of subjects was 46.24±7.4 years. Age ...
Introduction The COVID-19 pandemic has had significant consequences on healthcare delivery worldw... more Introduction The COVID-19 pandemic has had significant consequences on healthcare delivery worldwide, with a particular impact on surgical services and training. In preparation for the influx of COVID cases, non-urgent appointments, investigations, and operations were cancelled. As a result of the cancellation of cases, elective and emergency case exposure was inevitably reduced. Over 65 percent of trainees lost all training and only 9% reported that they would meet the essential skills. One in eight trainees in their final year have had their training extended due to failure to meet curricular requirements, while a quarter of trainees reach their final year behind their planned training trajectory. The primary objective was to identify the case with the highest cancellation rate to perceive its impact on surgical training. Method This is a retrospective study of data gathered by Department of eHealth in a tertiary hospital. Data collected from December 2020 to September 2021were an...
Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practi... more Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89·6 per cent) compared with that in countries with a middle...
Background: End colostomy rates following colorectal resection vary across institutions in high-i... more Background: End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods: This study comprised an analysis of GlobalSurg-1 and-2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle-and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results: In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6⋅9 per cent) from low-HDI, 254 (15⋅5 per cent) from middle-HDI and 1268 (77⋅6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57⋅5, 40⋅9 and 35⋅4 per cent; P < 0⋅001) and subsequent use of end colostomy (52⋅2, 24⋅8 and 18⋅9 per cent; P < 0⋅001) in low-compared with middle-and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3⋅20, 95 per cent c.i. 1⋅35 to 7⋅57; P = 0⋅008) after risk adjustment for malignant disease (OR 2⋅34, 1⋅65 to 3⋅32; P < 0⋅001), emergency surgery (OR 4⋅08, 2⋅73 to 6⋅10; P < 0⋅001), time to operation at least 48 h (OR 1⋅99, 1⋅28 to 3⋅09; P = 0⋅002) and disease perforation (OR 4⋅00, 2⋅81 to 5⋅69; P < 0⋅001). Conclusion: Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone.
Aim Identify reasons for discharge delays in a tertiary care hospital and find areas of improveme... more Aim Identify reasons for discharge delays in a tertiary care hospital and find areas of improvement. Method Data were collected for seven days, and all inpatients (Elective and Emergency) admissions were included. Patient's demographic data, length of hospital stay, and discharge data were entered on Microsoft Excel and analysed using SPSS. Results Out of 102 total patients, 48 (47.1%) were male and 54 (52.9%) females. Mean age was 60.5 years (min 20 max 91). Clinical frailty score (CFS) was not calculated in more than half of the patients (n=55, 57.4%). 47(46.5%) patients had polypharmacy. 61(59.80%) patients did not have a documented Expected date of Discharge (EDD). Median hospital stay was 10 days (1–161 days). 27(26.47%) patients had delayed discharge (mean 4.93 days, median 1 day). Reasons for delay included unavailability of rehab bed (n=5, 4.9%), stoma nurse review (n=6, 5.88%), and awaiting bloods, diabetic control or discharge hub planning (n=3, 2.94%). Delayed dischar...
Introduction Haemorrhagic cholecystitis and cystic artery pseudo-aneurysm (CAP) are two very unco... more Introduction Haemorrhagic cholecystitis and cystic artery pseudo-aneurysm (CAP) are two very uncommon causes of right upper abdominal pain. However, the development of haemorrhagic cholecystitis induced by ruptured cystic artery pseudo-aneurysm and haemobilia are extremely rarely documented with few occurrences documented in the literature. Case presentation A 80year-old frail patient was admitted with RUQ pain, deranged LFTs and melaena. She had known gall stones, hypertension, chronic kidney disease and fibromyalgia. She demonstrated localized tenderness in the right abdomen and bloods showed a significant drop in haemoglobin which required blood transfusion. Abdominal ultrasound showed cholecystitis and MRCP showed CBD dilatation with no choledocholithiasis. She was found to have haemorrhagic cholecystitis and CAP along with a cholecysto-colonic fistula on triple phase liver CT. The patient underwent urgent embolization of the CAP and remained clinically stable. She was discharge...
SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this stu... more SummaryPeri‐operative SARS‐CoV‐2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS‐CoV‐2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre‐operative SARS‐CoV‐2 infection were compared with those without previous SARS‐CoV‐2 infection. The primary outcome measure was 30‐day postoperative mortality. Logistic regression models were used to calculate adjusted 30‐day mortality rates stratified by time from diagnosis of SARS‐CoV‐2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre‐operative SARS‐CoV‐2 diagnosis. Adjusted 30‐day mortality in patients without SARS‐CoV‐2 infection was 1.5% (95%CI 1.4–1.5). In patients with a pre‐operative SARS‐CoV‐2 diagnosis, mortality was increased in patients having surgery wi...
Aim Identify reasons for discharge delays from hospital and areas of improvement and any scope fo... more Aim Identify reasons for discharge delays from hospital and areas of improvement and any scope for trainees to make a difference – Trainee lead intervention. Method All inpatients including Elective and Emergency admissions were included from all 3 teams over 1 week. Data were collected on Microsoft Excel and analysis done with SPSS. Result Total 102 patients were included (Purple 44, Yellow 40, Red 18). Mean age was 60.5 years. 54 (52.9%) patients were Female. 57.4% data were missed for clinical frailty score (CSF). 46.5%patients had polypharmacy. 61 patients did not have any Expected date of Discharge (EDD). Mean Length of Hospital stay (LOS) is 18.01 days and median 10 (1–161) days. Total 27 patients were delayed. 1 stayed for 161 days awaiting rehab bed. Mean Duration of delay was 4.93 days and Median 1 day (1–42).4 patients were waiting beds outside of hospital for 3, 6,10, >30 days;6 patients were delayed for Stoma nurse review for average 1 day. Delayed discharges do not s...
survival may influence MDT decision making. Methods: This audit reports a single unit experience,... more survival may influence MDT decision making. Methods: This audit reports a single unit experience, over 2 years, in 62 patients who underwent NAC and their radiological and pathological response to treatment. Results: The mean age of this cohort was 46.5 years. Out of 42 symptomatic (67.7%) patients, 28 (45%) presented within 4 weeks. Eight (12.9%) were screen detected. Commonest TNM presentation was T2(33)N1(35)M0(59). Indication for NAC was breast conservation in the majority(54,62%), followed by ER-ve, Her2+vity(10,16.1%), locally advanced tumour(15,24.1%), inflammatory(8,12.9%) and triple negative tumours in <50 years(11,17.7%). 32 (52%) women had ER positive,13 (21%) had HER2 positive and 20 (32%) had triple negative cancers. Excellent radiological (MRI) response was seen in 17 (27.4%) and partial response in 38 (61.2%) patients. 44 (71%) underwent breast conserving surgery (BCS) while 18 (29%) had mastectomy. Fifteen (24.19%) had their decision for mastectomy changed after NAC. Eleven (18%) had a complete pathological response (CpR). All patients had undergone surgery within 8 weeks of final NAC. Four (6.4%) patients were reported to have local recurrence (LR) at the conclusion of the audit period. Conclusion: Patients offered NAC in our unit fit the criteria suggested by NICE guidelines. Our rates of CpR (18%Vs.15-36.6%), improved BCS rates post NAC (24.9%Vs.16-25%), and LR rates (6.4%Vs.6%) are acceptable and comparable to the literature.
Background & aims: International guidance advocates the avoidance of prolonged preoperative fasti... more Background & aims: International guidance advocates the avoidance of prolonged preoperative fasting due to its negative impact on perioperative hydration. This study aimed to assess the adherence to these guidelines for fasting in patients undergoing elective and emergency surgery in the East Midlands region of the UK. Methods: This prospective audit was performed over a two-month period at five National Health Service (NHS) Trusts across the East Midlands region of the UK. Demographic data, admission and operative details, and length of preoperative fasting were collected on adult patients listed for emergency and elective surgery. Results: Of the 343 surgical patients included within the study, 50% (n ¼ 172) were male, 78% (n ¼ 266) had elective surgery and 22% (n ¼ 77) underwent emergency surgery. Overall median fasting times (Q1, Q3) were 16.1 (13.0, 19.4) hours for food and 5.8 (3.5, 10.7) hours for clear fluids. Prolonged fasting >12 h was documented in 73% (n ¼ 250) for food, and 21% (n ¼ 71) for clear fluids. Median fasting times from clear fluids and food were longer in the those undergoing emergency surgery when compared with those undergoing elective surgery: 13.0 (6.4, 22.6) vs. 4.9 (3.3, 7.8) hours, and 22.0 (14.0, 37.4) vs. 15.6 (12.9, 17.8) hours respectively, p < 0.0001. Conclusions: Despite international consensus on the duration of preoperative fasting, patients continue to fast from clear fluids and food for prolonged lengths of time. Patients admitted for emergency surgery were more likely to fast for longer than those having elective surgery.
Surgical site infection (SSI) is one of the most common infections associated with health care, b... more Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with e...
Background: Carcinoma of the breast is the most common malignancy in females. At present carcinom... more Background: Carcinoma of the breast is the most common malignancy in females. At present carcinoma breast is the leading cancer in Bangladesh and is competing cancer cervix in incidence. Epidemiological studies at regional and global levels suggest the occurrence of carcinoma breast at a younger, premenopausal age in Indian and Asian women as compared with western women. Knowledge of this factor emphasizes the need to modify the timing of modalities of detection of early carcinoma and its management. According to literature, majority of carcinoma breast cases in the western countries present in Stages I and II of the disease whereas in Bangladesh majority cases present in Stage III of the disease. The objective of this study is to observe age of occurrence of breast cancer and stage of cancer in SSMC and MH.Methods: A cross sectional observational study was conducted in 34 patients of histopathologically confirmed breast cancer.Results: Mean age of subjects was 46.24±7.4 years. Age ...
Uploads
Papers by Ashrafun Nessa