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Man is the best of all the creatures created by Allah Al-Mighty and He looks after all the affairs directly or indirectly related to human being. The holy Quran is the last of all the revelations revealed to the last Prophet and is enriched in all types of sciences. The miraculous nature of the Qur‟ān is evident from its marvelous descriptions of the biological phenomena of human life, especially reproduction, pregnancy, and embryo development. It appeals to its readers with the consistency between the details of the biological processes it provides in the seventh century and the scientific knowledge that man has attained in this era of embryological research and technology. This research article seeks to interpret relevant Qur‟ānic verses with a dimension of anatomical and physiological explanations. It tries to synchronize exegetical references with current information about reproduction and pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To analyze the post-operative benefits of nasogastric tubes among patients undergoing gut resection and anastomosis at our surgical unit. Study Design: Prospective comparative study. Place and Duration of Study: Surgical Department, Combined Military Hospital, Rawalpindi Pakistan, from Jun 2019 to Mar 2020. Methodology: This study was conducted on 80 patients who underwent gut resection and anastomosis due to localized cause at surgical unit of our hospital. With block randomization method half of the patients received nasogastric (NG) tube after the surgery while half did not. Presence of nausea or vomiting, pain abdomen, return of bowel sounds and electrolyte imbalance were compared in both the groups. Results: Out of 80 patients included in the final analysis 50(62.5%) were male and 30(37.5%) were female. Mean age of patients put who underwent the gut resection and anastomosis procedure in our study was 41.34±5.147 years. Chi-square test revealed that all parameters included in the study did not differ significantly among patients with and without nasogastric tube after the surgery. Conclusion: Administration of nasogastric tube did not prove any better in reducing the post-operative abdominal pain, nausea and vomiting. It also did not prove to be effective in preventing the electrolyte imbalance and helping in returning the bowel sounds early. Patients with and without nasogastric tube had equal chance of having any of the complications. [ABSTRACT FROM AUTHOR]

Objective: To compare rubber band ligation (RBL) vs standard hemorrhoidectomy for the treatment of haemorrhoids. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pak Emirates Military Hospital Rawalpindi, from Feb 2020 to Jan 2021. Methodology: A total of 200 patients with 2nd and 3rd-degree haemorrhoids who met the inclusion and exclusion criteria were included in the study. Group-A patients underwent rubber band ligation, while in Group-B, Milligan Morgan hemorrhoid-dectomy was done. Results: There were 200 patients (100 in each Group). There were 135 males (67.5%) and 65 females (32.5%). The female to male ratio was 1:2.01. Mean age was 44.73±8.36 years in Group-A and 43.48±8.98 years in Group-B. Mean duration of complaints was 8.72±4.32 months in Group-A and 10.89±3.80 in Group-B. Post-procedure patients were called for follow up in a third and eighth week. The most common complication seen in Group-A was recurrence which was 18% (p-value 0.001), and pain in Group-B, 82% (p-value 0.001), which was statistically significant. Conclusion: We concluded that Rubber band ligation is a quick, safe and cost-effective procedure for the outpatient department for Grade II and III haemorrhoids. The recurrence rate is high compared to standard hemorrhoid-dectomy, but its advantages make it a first-line procedure for Grade II and III haemorrhoids in the outpatient departments. [ABSTRACT FROM AUTHOR]

Objective: To compare the efficacy of intravenous Paracetamol versus intravenous Tramadol in terms of post-operative analgesia in patients undergoing laparoscopic cholecystectomy. Study Design: Quasi-experimental study. Place and Duration of Study: Department of General Surgery, Pak-Emirates Military Hospital (PEMH), Rawalpindi Pakistan, Jan 2020 to Feb 2021. Methodology: A total of 88 patients admitted for planned laparoscopic cholecystectomy were screened as per the selection criteria and were included in the study. They were further divided into two Groups. Each Group received 44 patients. Group-A received intravenous Paracetamol 1 g, while Group-B received intravenous Tramadol 100 mg, both given 6 hourly over 24 hours. Both Groups were evaluated for pain at regular interval via a Visual Analog Scale for pain, for the first 24 hours post-operatively. Results: Mean Visual Analog Scale score post-recovery at 0 minutes was 6.57±1.47 with Paracetamol and 6.84±1.39 with Tramadol, (p=0.38). The difference in both Groups remained non-significant when checked at regular intervals till 18 hours post-recovery where intravenous Paracetamol showed a clearly superior Visual Analog Scale score of 1.00±0.94 versus 1.66±1.06 with Tramadol, (p= 0.007). Thereafter, the difference disappeared again at 24 hours post-recovery. Conclusion: Paracetamol provides analgesia effectively when compared to Tramadol in the first 24-hour post-operative period. Moreover, it seems to be devoid of the adverse effect profile seen with opioid analgesics. Considering the results obtained, the routine use of Paracetamol as first-line analgesic post-operatively is highly recommended. [ABSTRACT FROM AUTHOR]

Objective: To compare the postoperative infective complications like wound infections and anastomotic leakage, of mechanical bowel preparation with non-mechanical bowel preparation in patients undergoing elective colorectal surgeries. Study Design: Comparative - cross sectional study. Place and Duration of Study: We conducted our study in surgical department of Surgery, Pak Emirates Military Hospital and Combined Military Hospital Rawalpindi, from Feb 2015 to Aug 2015. Methodology: One hundreds and sixty patients were included in this study, which were further divided into groups A and B of 80 patients in each group. Group A was subjected to mechanical bowel preparation before surgery and group B was subjected to non-mechanical bowel preparation. Results: Our study showed that anastomotic leakage was seen in 11 patients (13.8%) of group A and 14 patients (17.5%) in-group B. While surgical site infection was developed in 8 patients (10.0%) in-group A and 12 patients (15.0%) of group B. There was no statistically significant difference between two groups. Conclusion: We concluded in our study that infective complications like sepsis, due to anastomosis leakage after elective colorectal surgery were not severe in patients without bowel preparation done before operation, when compared to patients with bowel cleaning. [ABSTRACT FROM AUTHOR]

Objective: To correlate the operative findings of patients undergoing laparoscopic cholecystectomy, either acute or elective, with surgical complications and conversion to open cholecystectomy. Study Design: Comparative cross-sectional study. Place and Duration of Study: Combined Military Hospital and Pak-Emirates Military Hospital, Rawalpindi Pakistan, from Jul 2021 to Mar 2022. Methodology: Data from patients who underwent laparoscopic cholecystectomy was collected after gaining consent. Patients were evaluated for the correlation of operative findings of acute and nonacute gallbladder cases with the development of complications and conversion to open cholecystectomy. Results: Out of 250 patients, 205 were non-acute cases, whereas 45 were acute. The most common intraoperative complication was iatrogenic perforation of gallbladder 73(29.2%); more common in elective cases 49(19.6%) than in acute cases 24(9.6%). Post-operative complications included sub-hepatic collections 3(1.2%) and port site infections 2(0.8%). There were six overall conversions (2.4%), of which 3(1.2%) occurred in acute gallbladder cases and 3 in elective gallbladder. Acute cases were significantly more likely to be converted to open operations (p=0.039). They were found to have a significant association with gallstone spillage (p<0.001), iatrogenic perforation of the gallbladder (p<0.001), bile leakage (p=0.018), and subhepatic collection (p=0.024). Conclusion: The likelihood of surgical complications and conversion to open procedure can be accurately predicted by the acute gallbladder status pre-operatively. It is thus important to consider these outcomes when commencing post-operative care. [ABSTRACT FROM AUTHOR]

Objective: To compare fissure healing and complications in chronic anal fissure with use of lateral anal sphicterotomy and 0.2% GTN. Study Design: Randomized controlled trial. Place and Duration of Study: Combined Military Hospital Rawalpindi & Combined Military Hospital Kohat over a period of 15 months. Material and Methods: Chronic anal fissure was treated with use of lateral anal sphicterotomy after admission to surgical ward and by application of 0.2% glyceryltrinatrate as an outdoor case on 202 patients over a period of 15 months. Sample size was calculated by sample size calculator. Pain was measured using visual analog scale and incontinence to flatus and faeces was inquired from the patients. All cases were called for regular follow up visits but 10 patients failed to report back. Informed written consent was taken from each patient. Inclusion and exclusion criteria were followed. Analysis was done by SPSS version 13 and Chi Square test was applied. Results: Total 202 patients were included in the study and randomly divided into two groups of 101 patients each using random numbers table. Both GTN and sphincterotomy groups revealed significant, but comparable results. Pain relief, fissure healing and incontinence were significantly higher in group B (Lateral anal sphincterotomy) as compared to group A (0.2% GTN). At the end of 8th week pain relief and incontinence became comparable between both the groups but fissure healing remain significantly higher in group B as compared to group A. Conclusion: GTN when applied to patients produces comparable results if used in long term i.e. eight weeks. It produces adequate symptomatic control and healing of the anal fissures and can be considered equivalent to and one of the recommended treatment options along with lateral anal sphincterotomy in treatment of chronic anal fissure if use for more than 8 weeks. Lateral anal sphincterotomy gives early resolution of symptoms and healing. [ABSTRACT FROM AUTHOR]

Madrasa is the living form of an educational system which thrived in the past. It remained unaware of the swiftness of progress and development which came about in other walks of life and the education that was being imparted through it was also kept away from any change and innovation. As a result, the madrasa, to some extent, fell prey to marginalization, fundamentalism, and a sense of deprivation and its education could not maintain its cherished traditions. The educational system of the madrasa can be analysed in view of a number of aspects. Some of these aspects might be questionable, but a number of them are worthwhile. One of these aspects is the atmosphere of mutual cooperation that a madrasa can provide. Teachers and students belonging to different cultures and traditions come together in a madrasa and develop an intercultural communication pattern. They form cultural groups that work together to rectify their deprivation and remove misunderstanding between them. Their education in a madrasa allows them to take part in joint activities, improve their knowledge, and get an access to some service. In this way, the madrasa education initiates a social mobilization which encourages social groups that are knit together with the fabric of culture to take part in the religious, political, and revolutionary movements of the country. [ABSTRACT FROM AUTHOR]

Objective: To study the morbidity and mortality of early laparoscopic cholecystectomy in acute cholecystitis by comparing its results with laparoscopic cholecystectomy in chronic cholecystitis and simple cholelithiasis. Study Design: Quasi-experimental study. Place and Duration of Study: Pakistan Naval Ship (PNS) Shifa Hospital Karachi and Combined Military Hospital (CMH) Lahore Pakistan, from Nov 2009 to Jan 2013. Material and Methods: Total 398 patients with symptomatic gall stone disease were included in the study after exclusion of patients with upper abdominal surgery, perforated gallbladder with abscess formation, cardiopulmonary disease, equipment failure and those with choledocholithiasis. Cholecystectomy was performed using a three port technique in most of the cases. On the basis of per-operative findings regarding degree of inflammation of gallbladder, all patients were divided into three groups irrespective of duration of symptoms i.e. acute cholecystitis group, chronic cholecystitis group and no inflammation group. The collected data included age, sex, diagnosis, history of previous surgery, co-morbidities, conversion to open surgery and its reasons, operative time, post-operative hospital stay and complications. Statistical comparison was performed using the chi square test. Statistical significance with value of p was less than 0.05 was considered significant. Result: Out of 398 patients, 31.2% had acute cholecystitis, 10.1% had chronic cholecystitis and 58.8% had no inflammation of gall bladder. Complication rates and conversion rates were higher in chronic cholecystitis group as compared to acute cholecystitis group and no inflammation group. Similarly, mean hospital stay was also highest in chronic cholecystitis group. Conclusion: Early laparoscopic cholecystectomy was found safe in acute cholecystitis in expert hands and should be performed in all cases of acute cholecystitis rather than delayed interval cholecystectomy. [ABSTRACT FROM AUTHOR]

Objective: To investigate the safety of hernia repair operation by quantifying the postoperative mortality, postoperative hepatic functional deterioration, and early wound complication among patients in different Child- Turcotte-Pugh (CTP) class groups. Study Design: Retrospective study. Place and Duration of Study: CMH Multan from July 2013 to July 2015. Material and Methods: This is a retrospective review of 277 patients with documented liver cirrhosis who underwent hernia repair (including inguinal, para-umblical and ventral wall hernia) at the combined Military Hospital Multan between July 2013 and July 2015. Morbidity and mortality was compared in three sub-groups based on Child's classification. Results: The present study consisted of 219 males and 58 females with an average age of 46.18±12.76. Mean child score was 7.66 (125, 101 and 51 patients in CTP Class A, B and C respectively). Of the present cohort, 173 patients required inguinal hernia repair with a mean Child score was 7.52 (92, 53 and 28 patients in CTP Class A, B and C respectively). Para-umblical hernia repair was done in 68 patients with a mean Child score of 7.84 (20, 31 and 17 patients in CTP Class A, B and C respectively). Thirty six patients were operated for ventral wall hernias. Their mean Child score was 7.99 (13, 17, 6 patients in CTP Class A, B and C respectively). In the 30 day post-operative period, two patients in CTP class A changed to class B. One patient in CTP class B progressed to class C. Complications occurred in 37 patients (13.36%) but all of these complications resolved by conservative management. Three patients died during the 30-day postoperative period. Conclusion: We conclude that hernia repair in cirrhotic patients is not associated with an increased risk of postoperative complications and recommend elective surgery. [ABSTRACT FROM AUTHOR]

History of great men owes a handsome part of it to the memoir of the Arabian Prophet (...). He scaled the heights of mercy in benefitting mankind and addressed almost all difficulties that beset man. One of these difficulties is a communicable disease. Owing to its characteristic nature of spreading to others in no time a communicable disease can pose threat to man. Hence, it must be prevented as soon as possible. The Holy Prophet (...) was not unaware of this fact. He responded with great strength and much effectiveness to the subject of such communicability. His instructions on plague and treatment with lepers can be presented in favour of this claim. He also offered a scale of measures regarding cleanliness and purity that can prevent us from dengue fever, hepatitis and AIDS. His ways of personal hygiene can be effective in dispelling off the causative factors of many infections. [ABSTRACT FROM AUTHOR]

Objective: To analyse pre-analytical errors which account for the major contribution towards laboratory errors. Study Design: Cross-sectional descriptive study. Place and Duration of Study: Combined Military Hospital Kohat, Pakistan from 1st January to 30th June 2012. Material and Methods: For six months laboratory staff was asked to register rejections and causes for rejection of all samples; including in-patient samples from wards as well as out-patient samples collected in the laboratory. In addition all samples where disparity was noted by the clinicians in the laboratory results were also included for analysis. Suspected samples were reanalyzed, tests were also repeated on fresh samples of the patients and a critical appraisal was made. Results: Among a total of 328418 analyses, clinicians/laboratory staff notified 350 questionable findings, 270 of which were confirmed errors. Out of total 270 errors, 77% were pre-analytical, 8% were analytical, 15% were post analytical errors. Out of total pre-analytical errors 8% were incorrect samples, 21% were misidentifications, 51% were faulty sampling techniques and 20% were incomplete/illegible laboratory request forms. Conclusion: The pre-analytical phase in the total testing process currently appears to be more vulnerable to errors than the other phases. Consequently, the pre-analytical phase should be the main target for further quality improvement. Therefore identifying the critical steps in the pre-analytical phase is a prerequisite for continuous quality improvement, further error reduction and thus for improving patient safety. [ABSTRACT FROM AUTHOR]

Objective: To validate the paediatric appendicitis score for the diagnosis of acute appendicitis in children using histopathology as a gold standard. Design: Validation study. Place and Duration of Study: Military Hospital (MH) and Combined Military Hospital (CMH) Rawalpindi, Pakistan from Dec 2009 to Jul 2010 Patients and Methods: Eighty five children 1-17 year old who came to our tertiary surgical department with the chief complaint of abdominal pain of less than 7 days duration were included in the study. Paediatric appendicitis score (PAS) components including fever > 38°C, anorexia, nausea/vomiting, cough/percussion/hopping tenderness, right-lower-quadrant tenderness, migration of pain, leukocytosis > 10,000 (109/l) and polymorphonuclear - neutrophilia > 7500 (109/l) were assessed and recorded on admission, but the sum was not calculated until later and the score did not play any role in the management of the patient. The diagnosis of appendicitis was made by the trainees and consultants clinically and with the aid of routine sonography of abdomen. After appendicectomies, resected specimens were sent for histopathological examination. Pre-operative PAS, and histopathology report of resected appendix were endorsed on patient's performa. A two by two table was used to determine sensitivity, specificity, positive and negative predictive values and diagnostic efficacy of PAS. Result: Sensitivity of PAS was 92.16%, specificity 88.23%, positive predictive value 92.16%, negative predictive value 88.23% and the diagnostic efficacy 90.59%. Conclusion: PAS is a highly sensitive test with fair degree of specificity in diagnosing acute appendicitis in children and its routine usage may improve the diagnostic accuracy. [ABSTRACT FROM AUTHOR]

Objective: To assess the effectiveness of different modes of treatment of chronic anal fissure as regards improvement of symptoms and complications. Methods: This prospective study included 129 consecutive patients with chronic anal fissures presented to the Surgical Outpatients' Department of Islam Teaching Hospital Sialkot, Pakistan; from September 2010 to November 2012. Patients were distributed in three groups. In "OBG group", patients had attended Gynae/Obs OPD and got treated and were then referred to surgical OPD for failure of treatment or recurrence. Patients who presented with history of treatment by GPs were included in "GP Group"."SGR Group" included those who directly reported to surgical OPD for treatment. Patients were managed both pharmacologically as OPD patients and surgically as admitted patients. Patients were instructed to apply small amounts of 0.2% GTN paste in soft white paraffin, to the anoderm with finger tips three times a day. Patients were evaluated at two-week intervals and at each visit the symptoms control, adverse effects and fissure status were recorded. If there was symptomatic relief or the fissure healing was in progress, the treatment was continued for a total duration of eight weeks. Operated patients were nursed in wards after surgery i.e Internal Anal Sphicterotomy. They were advised to report to OPD weekly for one month or earlier if they experienced any symptoms suggestive of complications. Patients were declared cured in case of complete symptomatic relief with fissure healing. Success, failure and associated problems were recorded and analysed to get results. Results:This study included 129 patients who could be followed up for a minimum of three months. These patients were referred by gynaecologist i.e. 22 (17%) for treatment failure while 5 patients with wrong diagnosis were not included in statistical analysis; similarly 41 (32%) patients were referred by general practitioners and 9 patients with wrong diagnosis were excluded. Sixty six patients i.e. 51% were those who directly reported to surgical OPD and had no previous treatment. With surgical treatment, pain, bleeding per rectum and constipation showed significant improvement as compared to GTN ointment application. Fissure healing was 100% in surgical group as compared to 74% in medical group. Complications were recorded and were found to be headache with medical treatment; while the most feared complication with surgical treatment i.e. permanent incontinence was not encountered in our study. Conclusion: Topical glyceryl trinitrate is economical, has a good healing rate, and faecal incontinence has not been reported. Its effectiveness, however, depends on patients' compliance which may be poor in view of associated headaches and a local burning sensation. It is first line of treatment for anal fissure but lateral internal sphincterotomy is superior, more effective and curative than the chemical sphincterotomy. Surgery is reserved for people with anal fissure who have tried medical therapy for at least one to three months but failed. [ABSTRACT FROM AUTHOR]

Gallstone ileus is a rare disease and accounts for 1-4% of all cases of mechanical intestinal obstruction. It usually occurs in the elderly with a female predominance and may result in a high mortality rate. Its diagnosis is difficult and early diagnosis could reduce the mortality. Surgery remains the mainstay of treatment. We present a case report of a 55 year old lady diagnosed as having gall stone ileus and was treated with emergent laparotomy and enterolithotomy with fistula repair at a later stage. [ABSTRACT FROM AUTHOR]

Objective: To evaluate and determine the effectiveness of surgical excision, aspiration and injection in the treatment of symptomatic ganglions., Methods: The prospective randomized control trial based on non-probability convenience sampling was conducted at the Department of Surgery, Combined Military Hospital, Sialkot, from June 2007 to August 2010, and at the Department of Surgery, Islam Teaching Hospital, Sialkot, from September 2010 to December 2012. The last patient was included in June 2012. Adult patients referred by general practitioners with ganglia of wrist, ankle and knee were included. All the patients were offered treatment options of intralesional steroid injection or excision of ganglion.The study population was distributed in two groups: Group I opted for aspiration and injection treatment, while Group II went for surgical treatment. A minimum follow-up of six months was mandatory for inclusion in the study. Data was compared and analyzed using SPSS version 22., Results: The study had 173 patients with 187 ganglia. Group I had 143(76.4%) patients, while Group II had 44(23.3%). In the short term, 82(57.3%) of the patients achieved complete resolution after one episode of aspiration and injection, and success rate after second injection repeated after 3 weeks was 116(81%). Overall success rate of aspiration and injection of Triamcinolone acetonide six months after the treatment was 116(81%). On the surgical side the success rate was 41(93%). Complications like pain, joint stiffness and ugly scar were few and not significant. Comparison of failure rates of the two groups (19% vs 7%) showed significant difference (p<0.028)., Conclusion: In symptomatic ganglia, surgical excision was a better treatment option as the failure rate was less compared to injection-aspiration. The injection treatment should be offered to those who are not willing for surgery, but they should be properly counselled about the chances of failure.