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Background: All patients with chronic renal failure need vascular access for hemodialysis that is possible with CVP line but it shorter life. The most suitable and effective vascular access on long term basis is the creation of arteriovenous fistula (AVF). The objective of this study was to compare the patency rate of Radiocephalic vs. Brachiocephalic AVFs in population of D.I.Khan division, Pakistan. Materials & Methods: This randomized control trail was conducted in Department of Surgery Gomal Medical College, D.I.Khan, Pakistan from January 2017 to December 2019. 266 patients were equally randomly allocated into Brachiocephalic AVF (BCAVF) and Radiocephalic AVF (RCAVF). Sex, age groups and patency of AVT were nominal variables. Data for sample was described by count & percentages and for population as confidence interval at 80% confidence level. McNemar chi-square test was used to test hypothesis to compare patency rate of Brachiocephalic AVF vs. Radiocephalic AVF. Results: Patency was present in 129 (97%, 80% CI 94.45-98.39%) and absent in four (3%, 80% CI 1.61-5.55%) cases in Brachiocephalic, while it was present in 107 (80.5%, 80% CI 76.04-84.86%) cases and absent in 26 (19.5%, 80% CI 15.52-24.32%) cases in Radiocephalic AVF group. McNemar chi-square test showed p <.0001, so the null hypothesis was rejected, showing higher patency rate in BCAVF. Conclusion: Brachiocephalic AVF creation is more ideal in terms of patency and maturation as compare to Radiocephalic AVF because of increased vessel diameter and increased arterial pressure at proximal site below elbow joint. [ABSTRACT FROM AUTHOR]

Background: Inguinal hernia is a common surgical problem. Mesh repair is considered as the best procedure for inguinal hernia repair . There is increased chance of wound infection using mesh. Objective of this study was to determine the frequency of surgical site infection in mesh repair for inguinal hernia in our setup. Material & Methods: This descriptive study was conducted in Surgical Unit, DHQ Teaching Hospital, D.I.Khan, Pakistan from January 2011 to January 2013. A total of 120 male patients above the age of 30 year were included. Patients with co-morbid conditions or those presented as strangulated hernia were excluded. A proforma designed for study, was used for data collection. Antibiotic prophylaxis was given in the form of 1 gram of Ceftriaxone 15 minutes prior to induction of anesthesia. Spinal anesthesia was given in 96 (80%) cases while 24(20%) were operated under general anesthesia. The mesh used was Polypropylene (Prolene). Patients were followed for 6 months to determine the incidence of wound infection. Data was analyzed using the SPSS version 13.0. Results: A total of 120 male patients were included in the study, with mean age of 48.26±8.3 years and range of 30-80 years. The hernias on right side were more common 92(76.66%) and 75(62.5%) were indirect. Out of 120 cases, 85(70.83%) patients were hospitalized for 24 hours, 26(21.66%) patients were retained for 48 hours, while 9(7.5%) patients had prolonged hospital stay due to complications like haematoma, seroma and wound infection. Frequency of wound infection was found in 6(5%) patients. All patients had only superficial wound infection and were treated by giving intravenous antibiotics according to the culture and sensitivity report, drainage and local wound care. No patient needed mesh removal for control of infection. Conclusion: Mesh repair is simple, safe and effective procedure. Frequency of wound infection in mesh repair is acceptably lower with good antibiotic cover. [ABSTRACT FROM AUTHOR]