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Objective: To identify the risk factors predisposing to the Morbidly Adherent Placenta and to evaluate maternal outcomes in those patients. Study Design: Cross-sectional study. Place and Duration of Study: Department of Obstetrics & Gynaecology, Combined Military Hospital, Lahore Pakistan, from Jan to Dec 2021. Methodology: A total of 18 females with a clinical diagnosis of the morbidly adherent placenta, irrespective of age and several previous scars, having singleton foetuses with more than 26 weeks gestational age, were included in the study. Patients’ particulars including demographic data, gestational age, number of previous uterine scars, type of placenta, treatment option and the outcome, were collected. Results: The frequency of morbidly adherent placenta was 4.06 per 1000 deliveries. The mean age of patients was 31.06±2.48 years, whereas the mean gestational age was 35.5±1.15 weeks. The mean parity was 3.5±0.71. Out of 18 patients with morbidly adherent placenta, 3(16.7%) had four caesarean scars, 8(44.4%) had three previous caesarean scars, and 7(38.9%) had two previous caesarean scars. Associated placenta previa was present in 14(77.8%) patients. Hysterectomy was done in 15(83.3%) patients, while in 3(16.6%) patients uterus was preserved. The bladder was repaired in 12(66.6%) patients with post-op catheterisation for three weeks. There was no maternal mortality. Conclusion: Previous caesarean scar and placenta previa are major risk factors for the morbidly adherent placenta. Wellestablished antenatal diagnosis with timely surgical intervention can prevent long-term complications. Keywords: Caesarean section, Placenta previa, Placenta accreta, Placenta increta, Placenta percreta.

Objective: To assess the outcome in patients with diabetic foot osteomyelitis being treated with antibiotics alone with those being treated with antibiotics coupled with conservative surgery. Study Design: Quasi-experimental study. Place and Duration of Study: Combined Military Hospital, Rawalpindi from Feb to Aug 2016. Methodology: Sixty patients with diabetic foot osteomyelitis, fulfilling inclusion criteria, were included in this study. They were divided into two groups of 30 each. The "Antibiotic-Group” received only antibiotics while, the "Surgical-Group" underwent surgery in addition to antibiotics. Results: There were 37 males (61.66%) and 23 females (38.33%). The average age of patients was 59.72±9.79 years. 20 patients (66.67%) had full recovery in the Surgical-Group, and in the Antibiotics-Group, 18 patients (60%) had healed wounds (pvalue=0.599) Conclusion: The outcome of antibiotics only and conservative surgery plus antibiotics is similar.

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.

Objective: Central venous catheterization is an important skill for doctors working in the departments of medicine, surgery, critical care, anesthesiology, and emergency. The Agency for Healthcare Research and Quality, USA named ultrasound guidance of central venous catheter placement as one of 11 most underutilized practices that can enhance patient safety with greatest strength of evidence to provide clear opportunities for safety improvement. In this study, we compare the success of ultrasound-guided insertion of central venous catheter versus landmark technique. Study Design: Randomized controlled clinical trial. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi, from Jul to Dec 2016. Methodology: One hundred twenty patients admitted in its wards and undergone CVC were included. Patients were divided into group A & group B containing 60 patients each. In ‘group A’ CVC was done with ultrasound assistance while in ‘group B’ CVC was done with landmark technique. The primary study outcome was No. of attempts at which CVC was done. Results: In this study, 120 patients were enrolled. There was no difference in demographic data comparison. Success rate was found to be 28 (46.67%) in-group A while 16 (26.67%) in-group B with the p-value of 0.042 which is significant. Conclusion: We concluded that CVC with ultrasound guidance is more successful than landmark technique.