Search

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]

The technique of in vitro fertilization is the cornerstone of all assisted reproductive techniques. Other sophisticated procedures springing from it can differ in the method of assisted fertilization; for example, the site of deposition of gametes or embryos in the uterus or Fallopian tube, the use of fresh or frozen gametes and embryos, assistance from donor sperms or oocytes, and whether gestation is carried out in the same woman or another woman. IVF itself depends on the retrieval of ova from a woman's ovaries. This pivotal stage of IVF has not been deliberated upon by Muslim jurists, who largely focus on the overall legal status of IVF, whereas the legal position of this particular step in IVF impacts the whole procedure. This research paper focuses specifically on the retrieval of ova for IVF in the light of Islamic Sharī'ah. [ABSTRACT FROM AUTHOR]

Bouveret’s syndrome causes gastric outlet obstruction when a gallstone is impacted in the duodenum or stomach via a bilioenteric fistula. We present case of a 40-year-old female presented with epigastric pain and intractable vomiting for 2 days. Her physical examination and laboratory workup including blood analysis, amylase test and lipase test were normal. Plain abdominal X-ray did not show any signs of small bowel obstruction. A nasogastric tube was placed and drained 2.5 L of gastric contents immediately. Esophagogastroduodenoscopy showed a dilated stomach with excessive secretions and a large blackish-brown hard stone in the duodenal bulb. After failed attempt at endoscopic extraction, patient underwent laparotomy and removal of stone via duodenal incision. Subsequently, the patient exhibited a good postoperative recovery. The condition of the patient has remained stable after being followed up for one year. [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 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]

Massive discharge of wastes produced by the processing of leather so far confers the most important environmental challenge facing the tanneries worldwide. Waste material from tanneries mostly consists of skin remnants and proteinaceous substances as by-products of leather processing. In these conditions, protease-producing bacteria play a vital role in degrading wastes in this sludge. Therefore, an investigation was made to study the effect of long-term tannery sludge contamination on the diversity of both protease-producing microbes and of bacterial extracellular proteases near tanneries of Sambrial and Sialkot. The high amount of carbon and nitrogen in the soil samples reflected their effect on the diversity of the microbial communities in these areas. Phylogenetic analysis based on 16S rRNA gene sequences suggest that the isolated proteolytic bacteria belonged to 9 different genera including Pseudomonas (26.19%), Proteus (19.04%), Serratia (16.66%), Klebsiella (14.28%), Providencia (9.52%), Achromobacter (7.14%), Enterobacter (2.38%), Myroides (2.38%), and Acinetobacter (2.38%). Enzyme activity showed that among all Pseudomonas and Proteus showed relatively high protease production, and inhibition studies revealed that proteases produced by all isolates were strongly inhibited by serine and/or metalloprotease inhibitors, and a smaller proportion was inhibited by inhibitors of cysteine and/or aspartic proteases. Furthermore, isolated bacteria revealed promising degradation activities against casein and/or gelatin with only a few that could hydrolyze elastin, suggesting proteases produced by these isolated bacteria belong to different classes of proteases, i.e., serine and metalloproteases. This study provided new insights on the community structure of cultivable protease-producing bacteria near tannery sludge of Sambrial and Sialkot. This study would be beneficial not only for establishing the way for effective degradation of tannery slugs but also for questing the novel properties of proteases for a future technological application., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)