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OBJECTIVE: To compare the radiological healing in elderly patients with hip fractures fixed with intramedullary versus extramedullary implants at 3 months by using Radiological Union Score for Hip (RUSH score). METHODS: This quasi-experimental study was conducted at Lady Reading Hospital, Peshawar from September 2020 to March 2021, in elderly patients (50-80 years) with hip fractures. Out of 238 patients, 119 were non-randomly assigned to Group-A undergoing intra- medullary implants and 119 to Group-B undergoing fixation with an extra-medullary implant. After the surgery, the patients were followed up periodically at 2nd week, 6th week and 12th week after surgery and assessed for radiological healing through RUSH score. The data was analyzed using SPSS version 23. RESULTS: Out of 238 patients, 96 were males and 142 were females. In Group-A, 51 (42.9%) were males and 68 (57.1%) were females. In Group-B, 45 (37.8%) were males and 74 (62.2%) were females. Majority (n=135/238: 56.72%) were aging from 50-60 years. Mean±SD of age was 63.1±8.8 years and 61.7±8.1 years in Group-A & Group-B respectively. Mean±SD of RUSH score in Group-A & Group-B was 19.50±6.92 and 22.51±5.60 respectively. Mean RUSH score for males in Group-A and Group-B was 21.52±6.39 and 22.33±6.99 (p=0.354) and for females in Group-A and Group-B was 19.36±7.33 and 22.18±5.75 (p=0.025) respectively. Median and IQR of RUSH score in Group-A & Group-B was 21±10 and 23±8 respectively (p=0.069). CONCLUSION: There was statistically insignificant difference in median RUSH score with use of either intramedullary or extramedullary implants in the management of hip fractures.

OBJECTIVE: The current meta-analysis was carried out to identify the efficacy and safety of thalidomide in transfusion-dependent β-thalassemia (TDT) patients. METHODS: Six databases: PubMed, EMBASE, Scopus, Cochrane Library, EBSCOhost, and MEDLINE were searched until November 18, 2021, for studies that assessed the efficacy of thalidomide in TDT patients by using the following search terms: “Thalidomide”, “thalidomid”, “thalomid”, “N-phthaloylglutamimide”, and Thalassemia” using Boolean or wildcard operators. Original research publications in English with observational and/or experimental designs having a sample size ≥10, regardless of age and gender, used thalidomide for ≥3 months exploring the impact of thalidomide in ameliorating transfusion needs among TDT patients were included in this meta-analysis. Data were independently extracted by two reviewers using a data extraction form. The National Institutes of Health tool was used for quality assessment. RESULTS: Nine studies collectively involving 407 TDT patients fulfilled eligibility criteria. Thalidomide was associated with complete cessation of blood transfusion requirements with an overall response of 54% (95% CI, 34–75%) to a transfusion-independent state; heterogeneity was considered high with an I2 of 94.7%, p-value

OBJECTIVE: To share our experience of laparoscopic assisted Swenson pull-through for classic Hirschsprung’s disease (HD) with sigmoid colostomy. METHODS: Thirty-one patients with HD and sigmoid colostomy operated in Pediatric Surgery department, Khyber Teaching Hospital, Peshawar, Pakistan, between June 2014 and June 2018 were included. Patients with long segment HD, and those operated elsewhere were excluded from the study. Demographic characteristics, intraoperative findings and post operative course were retrieved from files. Post-operative outcome at 3rd, 6th and 12th month follow ups were taken from follow up charts. RESULTS: Mean age and weight of patients were 13.23±1.76 months and 7.89±1.42 kg, respectively. Male to female ratio was 6.75:1. Mean operative time, duration of urinary catheterization and hospital stay were 171.87±15.76 min, 0.79±1.02 days and 5.91±1.01 days, respectively. After surgery, stool consistency was liquid in 12 (61.29% ) and loose in 12 (38.7 %) patients. However, stool frequency was >3 times/day in 10 (32.25%) cases, 2-3 times/day in 18 (58.06%) patients and 0-1 time/day in 3 (9.67% ) patients. Surgical site infection and perianal excoriation were seen in 2 (6.45%) and 11 (35.48%) patients, respectively. Progressive improvement in stool consistency and frequency was noticed at 12th month follow up. Perianal excoriation was seen 11 (35.48%) patients at 3rd month, 6 (19.35% ) patients at 6th and 1 (3.22%) patient at 12th month follow up. CONCLUSION: Laparoscopic assisted Swenson pull-through is a good treatment option for patient with recto-sigmoid HD and bears a predictable and acceptable stooling pattern, optimum hospital stay and minimal complications.

OBJECTIVE: To compare needle assisted laparoscopic repair (NALR) of inguinal hernia in children with open hernia repair (OHR). METHODS: This randomized controlled trial was conducted at the Paediatric Surgery Unit of Khyber Teaching Hospital, Peshawar, Pakistan from Feburary 2017 to September 2018. Children aged upto 16 years and diagnosed with reducible inguinal hernia were randomized into two-groups; NALR and OHR. Obstructed inguinal hernia and cases which presented with recurrence were excluded from this study. Demographic and clinical data was collected and analysed using SPSS 20. RESULTS: One hundred and fifteen patient were included in the study with NALR (n=50) and OHR group (n=65). NALR group included unilateral (n=35), bilateral hernia (n=5), PPV (n=10). OHR group included unilateral (n=55), bilateral (n=10). The mean age for NALR was 2.96±2.5 years and OHR was 4.17±3.62 years. Mean weight for NALR group was 11±6kg and OHR was 7.6±3.7kg. Operating time for unilateral NALR was 12±2.4 minutes and OHR was 24±3.8 minutes while bilateral NALR was 18.3±3.1 minutes and OHR was 32±6.3 minutes. Hospital stay for NALR group was 40±6.8 hours and OHR was 30±7.7 hours. Analgesia doses for unilateral NALR (4.5±1.2) were less than OHR (6.96±1.8) (p=0.02) and same is the case for bilateral repair (p=0.03). OHR had a high rate of postoperative complications; surgical site edema (14%), wound infection (4%) and recurrence (2.8%). CONCLUSION: NALR is a safe and reliable substitute to OHR in terms of less operating time, minimum hospital stay, less doses of analgesia required and low rate of postoperative complications.

Objective: To determine the outcome of the modified MAGPI procedure for primary repair of distal hypospadias. Methodology: This prospective descriptive study was performed in three hospitals of Bannu and Peshawar. A total of 24 cases with distal hypospedias were included in the study with coronal, subcoronal and glandular hypospadias. Those with chordee and more proximal forms where the MAGPI was not the procedure of choice were excluded from the study. The procedure of modified MAGPI included a modification of the original MAGPI (meatal advancement and glanuloplasty) by excision of a triangular shaped piece of glanular tissue or a vertical incision in the glans distal to the meatus. The patients were followed up for 6 months. Results: The total number of patients who underwent modified MAGPI procedure was 24. The age range was 2- 10 years. The average length of hospitalization was 24 hours. Complications observed in 4 (16.6 %) cases. We observed two (8.3%) patients with meatus retraction and one (4.2%) with glanular dehiscence or total disruption and one (4.2%) with wound infection. No case with fistula was observed. Straightening of penis, good micturating stream and cosmetic outlook as well as parents satisfaction was achieved in 83.3% (n=20/24) cases. Conclusion: Follow up of all the operated cases of the modified MAGPI procedure for primary repair of distal hypospadias showed good functional and cosmetic results. Complication rate was 16.7%. Key words: MAGPI procedure, Hypospadias, Coronal This article may be cited as: Rehman HU, Waheed T, Rehman IU, Imran M. Outcome of the modified Magpi procedure for primary repair of distal hypospadias. Khyber Med Univ J 2012; 4(4): 179-182.

Objective: To find out the efficacy of Bishop Koop procedure in terms of duration of hospital stay, postoperative complications and survival rate for jejunoileal atresias (JIA) in neonates in our setup. Material and Methods: This retrospective study was carried out at Pediatric unit, Khyber Teaching Hospital, Peshawar. Cases of JIA admitted from January 2009 to June 2010 were retrospectively analyzed. Patient’s age, sex, weight, type of delivery; gestational age, clinical presentation, associated anomalies, management and outcome were recorded from ward register. Nineteen neonates with age of 5 days and above , with a weight < 3 kg and cases having lower jejunal and ileal atresias were included in the study. Results: All 19 neonates (10 with jejunal atresia and 9 with ileal atresia) underwent Bishop Koop procedure. Type 3(a) was the most common (68.42%) atresia seen in the series. The mean age was 5.83 days and mean weight was 2.73kg. Postoperative hospital stay was 5-9 days (mean 5.78 days). Two patients (10.5%) died of postoperative leak from anastomotic site with septicemia while 17 (89.5%) patients survived. In 10 (52.6%) patients Bishop Koop chimney closed spontaneously, and in seven (36.8%) patients closure was done at the age of 1 year. Only one (5.3%) patient developed wound infection and one (5.3%) had adhesive intestinal obstruction; both were treated conservatively. Conclusion: Bishop Koop procedure is a safe technique with good outcome in terms of decrease morbidity, mortality and short hospital stay thus helping in improving the survival. However more efforts are recommended to improve our intensive care to achieve better outcome. Key Words: Jejunoileal Atresias, Bishop Koop Procedure, Neonates. This article may be cited as: Imran M, Rehman HU, Rehman IU, Waheed T, Khan I. Outcome of Bishop Koop procedure in neonatal jejunoileal atresias: A retrospective analysis. KUST Med J 2011; 3(2): 52-56.

Intestinal obstruction is common in neonates; however, Intestinal obstruction due to sigmoid atresia is very rare. We present a case of sigmoid atresia, suspected from clinical examination and radiological investigations on day two of life, and subsequently confirmed at surgery and histopathology. Sigmoid atresia Type 3(a) was noticed peroperatively. Resection and primary anastomosis was done with proximal covering stoma. The patient was discharged on 7th post operative day without any complications. Key words: Neonate, Intestinal atresia, Sigmoid colon. This article may be cited as: Imran N, Rehman IU, Waheed T. Sigmoid atresia: A rare cause of neonatal intestinal obstruction. KUST Med J 2009; 1(2): 71-72.