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Objective: To compare the frequency of post-operative infection rate between single dose versus multiple dose antibiotic therapy in patients undergoing laparoscopic cholecystectomy. Study Design: Comparative prospective study. Place and Duration of Study: Surgical Department, Combined Military Hospital, Lahore Pakistan from Oct 2017 to Feb 2020. Methodology: Patients of both genders undergoing laparoscopic cholecystectomy for simple cholelithiasis were included. Group-A patients underwent laparoscopic cholecystectomy using single-dose prophylactic antibiotic therapy with 2-gram 3rd generation cephalosporin at the time of induction of anaesthesia. In contrast, Group-B patients underwent laparoscopic cholecystectomy using 2-grams of 3rd generation Cephalosporin intravenously at the time of induction of anaesthesia followed by intravenous 1-gram Ceftriaxone two doses 12 hours apart. All patients were followed up on the first postoperative day, and then 1-week and 2-week follow up were done for any surgical site infection. Results: Patients in Group-A had a mean age of 37.12±6.53 years, while patients in Group-B had a mean age of 37.74±6.40 years. The post-operative infection rate in Group-A (single dose antibiotic therapy) was seen in 08 (4.28%), while in Group-B (multiple dose antibiotic therapies) was seen in 18 (9.63%) patients (p-value = 0.042). Conclusion: This study concluded that the single-dose prophylactic antibiotic is as good as multiple-dose antibiotic therapy used as prophylaxis for the prevention of post-operative infection rate among patients with cholecystectomy done via the laparoscopic method. [ABSTRACT FROM AUTHOR]

Objective: To highlight the presentation and outcomes of Aortofemoral bypass surgery at a tertiary care hospital. Study Design: Prospective observational study. Place and Duration of Study: Vascular Surgery department, Combined Military Hospital Lahore, from Jan 2015 to Dec 2019. Methodology: A total of 23 patients between 50-80 years of age presenting with critical limb ischemia due to Aortoiliac occlusive arterial disease type C or D of Trans-Atlantic inter Society Consensus (TASC) II classification confirmed on CT Angiogram, were included in the study. The clinical presentation, co-morbid illnesses, history of smoking, obesity, post operative patency of graft, wound infection, amputation rates, and mortality were documented on a structured proforma. All patients were followed up at 1, 6, 12 and 24 months of surgery. Outcomes were assessed in terms of graft patency, wound infection, limb survival, amputations and mortality. Data was analyzed by SPSS version 23.0. Results: The mean age of patients was 71.04 ± 7.29 years. Most patients presented with rest pain (56.5%). The frequency of smokers was 78.3% while 34.8% patients had both diabetes mellitus and ischemic heart disease. Hyperlipidemia was present in 30.4% patients. Two patients (8.7%) developed superficial surgical site infection. The limb salvage rate was 95.7% and the mortality rate was 4.3%. Conclusion: Aortofemoral bypass surgery is a safe and highly effective treatment modality for the management of aortoiliac occlusive arterial disease in experienced hands. Limb salvage can be successfully achieved in more than 95% cases. [ABSTRACT FROM AUTHOR]

Background: Hepatitis C is one of the commonest and fatal diseases in Pakistan as well as around the World. There were around 17 million people all over Pakistan with infected Hepatitis C virus (HCV). Patient's knowledge, attitude and practice are important determinants to combat this fatal disease. In this regard, socioeconomic factors including low income, low educational status and inadequate housing conditions may effect on patient's knowledge, attitude and practice. The main objective of this study was to identify the impact of socio-economic determinants on patient's knowledge, attitude and practice. Methods: The convenient sample technique was used to collect the data of 278 patients of HCV from Hepatitis C Clinic at Social Security Teaching Hospital Multan Road Lahore. Logistic regression was applied to identify the socioeconomic determinants that was crucial important regarding patient's knowledge, attitude and practice Results: The results indicate that those patients who had low educational status, low income, unemployed, and inadequate housing conditions had poor performance regarding knowledge, attitude and practices towards Hepatitis C. There was a significant association between socio-economic determinants and its effects on patient's knowledge, attitude and practice. Conclusion: Poor knowledge, negative attitude and bad practice towards HCV were the main reasons behind poor socioeconomic determinants. Poor knowledge, bad practices, helpless peoples, low income, low status, inadequate housing conditions and educational status effects on patient's health. [ABSTRACT FROM AUTHOR]

Background: Port wine stain (PWS) is a low flow vascular malformation. The gold standard treatment for PWS in childhood is pulsed dye laser (PDL).There is very little evidence in literature regarding comparison of single pass versus double pass pulsed dye laser in achieving clearance of these capillary malformations. We did a randomized controlled trial to compare outcome of single-pass versus double-pass pulsed dye laser for management of PWS. Methodology: This randomized study trial was performed at Jinnah Burn and Reconstructive Surgery Center/AIMC Lahore, from Jan 2019 to Dec 2019. Sample size of 30 patients was divided into 2 groups (15 patients in each group). Group A was given single pass of pulsed dye laser and patients in group B were subjected to double pass of pulsed dye laser (595nm wavelength, 7mm spot size, pulse width from 2-6ms and radiant exposure of 4-12 J/cm2). Total no of 4 sessions were done with period of 3 weeks between each session and the results were analyzed after 3 months of the last session. Results: The mean of the patient's age was 17±8 years and the mean of time since lesion appeared was 16±8 years. Nineteen participants (63%) were females. Most of the patients (83%) had PWS on face and neck. Double pass PDL was effective in 40% of patients and single pass PDL in 20% (p value <0.05). Conclusion: Double pass is more effective in treating port wine stain as compared to single pass pulsed dye laser. [ABSTRACT FROM AUTHOR]

Objective: To validate a clinical scoring system for defining the severity of ailment that will assist in developing strategies for management prioritisation. Study Design: Cross-sectional analytical study. Place and Duration of Study: Paediatric Department, Combined Military Hospital Lahore, Pakistan, form Jan 2020 to Jul 2021. Methodology: The paediatric patients who reported to the Medical Reception Centre and were admitted to an Inpatient Facility were enrolled. Demographic profile, temperature, oxygen saturation, pulse, respiratory rate, seizures, and sensorium labelled as "TOPRS" score was recorded with "0 - Normal" and "1 - Abnormal" and scores calculated for each patient with the incorporation of systemic inflammatory response and advanced paediatric life support criteria. Results: A total of 300 paediatric patients with an age range of 1-18 years (mean: 3.86±5.43) were included. Of 300 patients, 237(79%) were discharged after improvement, and the mortality rate was 63(21%). A significant association with the mortality rate was deciphered with temperature, oxygen saturation, and respiratory rate variables. In contrast, pulse rate, sensorium, and seizures were concluded to have an insignificant association. Score "0" mortality was associated with the 4.4% mortality, whereas score "5" enumerated an 80% death rate. Conclusion: The TOPRS clinical scoring system has significant value in the diagnosis of mortality and morbidity of paediatric patients and, hence, can assist in early recognition and triage of patients, consequently aiding in the provision of prioriti sation protocols and management in a befitting manner. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the impact of adjuvant Granulocyte-Macrophage Colony-Stimulating Factor (GM-CSF) therapy in neonatal sepsis. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Lahore Pakistan, Mar 2019 to Mar 2020. Methodology: Thirty neonates (15 cases and 15 controls) were randomly selected for this study. The Interventional Group was given GM-CSF and standard-of-care treatment; the Control Group only received standard care. Both groups were followed for the primary outcome (i.e., discharge or death). Secondary outcomes included the effects of GM-CSF on haematological parameters of neonatal sepsis. Results: The mean gestational age of the children was 33.46±2.47 weeks. In the Interventional-Group, 56.7% of the neonates were discharged with the resolution of the sepsis. There was no significant difference concerning the secondary outcome, but the mortality was higher in the neonates among the Control-Group (p-value>0.05). Conclusion: Our study showed no difference in mortality between the Interventional and the Control Groups. The GM-CSF therapy could be used as an adjuvant therapy in neonates with neonatal sepsis to increase the total leukocyte and absolute neutrophil counts. Further studies are needed to holistically chart the clinical benefit of GM-CSF adjuvant therapy. [ABSTRACT FROM AUTHOR]