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Objective: To evaluate the efficacy of intravenous dexamethasone in comparison with control group for the prevention of po3stoperative nausea and vomiting in patients undergoing laparoscopic cholecystectomy. Study Design: Randomized controlled study. Setting: Department of Surgery, Dr. Akbar Niazi Teaching Hospital, Islamabad, Pakistan. Period: 1st November 2022 to 31st April 2023. Material & Methods: A total of 120 patients of prospective laparoscopic cholecystectomy from both genders in ages between 18-60 years were randomized into two equal groups A and B. Group A subjects were administered with 4 mg IV dexamethasone preoperatively while group B patients were control subjects. The primary outcome was set as the reduced PONV after surgery. It was assessed through VAS scores and recorded at different time intervals. The final outcome was measured at 24th hour. Rescue antiemetic was administered whenever VAS score became > 5. Results: At 24 hours after surgery, VAS score was 0.57 ± 1.42 SD in group A and in group B it was 1.67 ± 2.10 SD (p=0.001). Efficacy of treatment (no PONV up to 24 hours) was present in 81.7% patients in group A (dexamethasone) and in 56.7% of patients in group B (control). The difference was statistically significant (P=0.003). Conclusion: Preoperative intravenous administration of dexamethasone was found effective in controlling PONV in patients undergoing laparoscopic cholecystectomy. Moreover, prophylactic dexamethasone administration also resulted in lesser consumption of rescue antiemetics when compared with controlled group. [ABSTRACT FROM AUTHOR]

Groundwater is a primary source of freshwater provisions all around the world. Due to its limited availability, water has become a precious entity nowadays. The future accessibility of groundwater is endangered due to its massive exploitation, particularly in the irrigation sector. Therefore, the current study was conducted to assess the declining groundwater levels in Rechna Doab, Punjab, Pakistan, where the aquifer has been reported to be highly stressed. A groundwater flow model was developed using the MODFLOW code of the USGS, and the steady-state model was calibrated for the year 2006, followed by a transient calibration for the years 2006–2010. Finally, the model was validated for 2011–2013, and a new scenario-based approach was used. Multiple future scenarios were developed to simulate the future response of the aquifer under changed recharge and pumping. The hydrodynamics of the groundwater flow was studied for two decades, i.e., up to 2033. The results under the business-as-usual scenario revealed a net gain in water levels in the upper parts of the study area. In contrast, a lowering of water levels was predicted in the central and lower parts. A maximum drop in the water level was anticipated to be 5.17 m, with a maximum gain of 5 m. For Scenario II, which followed the historical trend of pumping, an overall decline in water levels was observed, with a maximum expected drawdown of 15.68 m. However, the proposed water management Scenario III showed a general decrease in the upper study region, with the highest drop being 10.7 m, whereas an overall recovery of 6.87 m in the lower regions was observed. The simulations also suggested that the unconfined aquifer actively responded to the different scenario-based interventions. It was concluded that the region's aquifer needs immediate action regarding pumping and recharge patterns to avoid a potential increase in pumping costs and to preserve the sustainability of endangered groundwater resources. Moreover, proper groundwater pumping and its policy legislation for its management should be implemented in order to protect this precious resource. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the number of patients admitted to hospitals as emergency cases under general surgery with regards to variations with seasons and case load of commonest surgical emergencies. Study Design: Observational Descriptive study. Place and Duration: At York NHS Foundation Teaching Hospital and Scarborough District Hospitals, United Kingdom from 1st January 2013 to 31st December 2016. Methodology: The Network Services York NHS Foundation Trust was requested to provide the data-base which included the data of the patients admitted to York Teaching and Scarborough District Hospitals. The data retrieved included all elective as well as emergency admissions among which the elective admissions were excluded from the analysis. Four major surgical diagnoses, which include acute appendicitis, cholecystitis, pancreatitis and diverticulitis were reviewed. Spring, summer, autumn and winter were defined as seasons. Patient admissions were categorized into 12 months and in 4 seasons. Edward's test was performed for 12-month seasonal statistical analysis and goodness of fit test was applied to verify four seasonal variations. Results: A Total of 74,529 patients were admitted in both the hospitals, which include elective and emergency patients. Out of them 30,029 (40.29%) were admitted as acute surgical patients including all surgical sub-specialties with a significant monthly variation as p<0.001. Acute surgical admission trend in summer was 26.34% while it was 24.02% in winter. There was 2.32 % higher admission in summer as compared to winter. Among four major surgical diagnoses, acute appendicitis was 28.10% p<0.001, acute cholecystitis was 26.71% p<0.001, acute pancreatitis was 24.44% with p<0.001 and acute diverticulitis was 20.75% with p<0.001. Conclusion: A steady cyclical trend in acute surgical admissions, with more admissions during summer months were observed. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine the diagnostic accuracy of C - Reactive Protein (CRP) and White Cell Count (WCC) in non-traumatic acute abdomen pathologies by taking CT scan findings as gold standard. STUDY DESIGN: A retrospective analytic cross sectional study PLACE AND DURATION: At Pinder fields Hospital Mid Yorkshire NHS Trust, over a period of 6 months from 1st January 2014 to 31st June 2014. METHODOLOGY: All patients reporting to Emergency Department due to non-traumatic acute abdomen were included. Other than all basic demographic information, C- Reactive Proteins and White Cell Count within 24 hour of admission were recorded and its diagnostic value compared to the final diagnosis of all patients with CT scan. CRP > 5 mg/l and WCC <4 and >11 were taken as abnormal. RESULTS: A total of 396 patients were studied, with mean age 59 years and male to female ratio was 1:1.5. Positive CT showing acute abdomen pathologies were 74.24% and 25.86% were negative. Abnormal WCC and Positive CT scan were found in 154 patients with Specificity of WCC 72% and Sensitivity of WCC 52%. The Pearson Chi-Square showing p-value < 0.001, which is highly significant i.e. there is a trend that abnormal WCC is associated with positive CT scan. The specificity and sensitivity of positive CT scan findings were 84% and 89-91% when CRP levels were more than 50 with normal or abnormal WCC. This reaches up to 97% with raised WCC and 100% with normal WCC. CONCLUSION: C -reactive proteins more than 100 U/L has high diagnostic value and indication for CT scan or Surgery in diagnosing the exact cause of acute abdomen. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate the role of Pre-operative computed tomography in the assessment of acute abdomen. STUDY DESIGN: A retrospective observational study. Place and Duration: At District Hospital of NSHS Trust United Kingdom from 1st January, 2013 to 31st December, 2013. METHODOLOGY: Patients who underwent emergency, with pre-operative CT scans on the same admission, were incorporated into the review. The CT scan report was contrasted with the operative and histology findings and where an inconsistency existed, the CT images were checked on by the consultant radiologist, blinded to the first report and the operative findings. Accuracy of CT findings were compared with operative and histological findings of the pathology. RESULTS: among the total of 91 patients, 74 CT scans reports were checked with the laparotomy findings, giving a diagnostic precision of 81%. These entire CT were reported by the on-call radiology. On reviewing of the CT by a consultant radiologist, the accuracy is expanded up to 93%. Delay amongst CT scan and the operation did not fundamentally modify analytic precision, nor was there any factually noteworthy lessening in exactness in reports issued. CONCLUSIONS: The CT scan is valuable modality helping in assessment or diagnosis in acute abdomen and a senior (consultant) radiologist review considerably enhances the diagnostic precision in diagnosis. [ABSTRACT FROM AUTHOR]

Minimally Access Surgery (MIS) is intended to minimize the trauma of access without compromising the exposure of operative field. With the rapid invention the approaches used in MIS are laparoscopic, endluminal pelvivisecral, with or without the help of robotic system. In this review we have given a critical brief overview of all these emerging techniques. For preparation of this article the literature was searched on internet using Pub Med, Medline, Med Scope, Google, Pakmedinet, different international website. [ABSTRACT FROM AUTHOR]

A 25-year-old lady presented with a small pea-sized lesion on left side of her neck, anteriorly. There was no history of any other lesion on her body. She was medically fit otherwise. An excision was planned, after taking consent from her, which was performed under local anaesthesia as a day procedure. Her postoperative recovery was uneventful. Histopathology showed dermatofibrosarcoma protuberance which is an extremely rare skin tumour. She was further investigated for metastasis. Her CT scan of chest, abdomen and pelvis was performed which showed prominent thymus. Other than this finding, no other abnormality was found in CT scan. [ABSTRACT FROM AUTHOR]

Objective: To evaluate patient experience (fear of getting Covid-19) from elective surgery and challenges of elective surgical practice and ways to overcome during this pandemic era. Materials & Methods: This study was an observational cross-sectional survey and it has been conducted in the General Surgery Department of Dr. Akbar Niazi Teaching Hospital, Islamabad, from May to August 2021 after approval by the Institutional Review Board (IRB). Fear of Covid-19 infection was measured through the "fear of Covid-19 scale" by Ahorsu et al and analyzed. All findings were entered in a structured Proforma. Data was entered in SPSS version 26 and analyzed. Effect modifier chi-square was used to find out the patient's dropout due to getting Covid-19 infection from surgery. Results: A total of 200 patients were included; 62% of patients were male and 38% were females. The mean age of the patients was 38.64±12.08 years. The statistical analysis showed that there was a very significant association between the FCV-19 scale and getting Covid-19 infection from elective surgeries (p ≤ 0.05). When stratified the FCV-19 scale with the education status of all patients there was a very significant association between them (p=0.001). In the patient's observations regarding the FCV-19 questionnaire, most of the patients disagreed (46.3%) with getting Covid-19 infection from their elective surgeries or any fear of Covid-19 infection. Conclusion: Fear of getting Covid-19 is still present in some of the patients who visit hospitals for elective surgeries. Discussing the various steps taken by the institute to improve patient safety and minimize the risk of Covid-19, greatly enhanced their confidence in elective surgery and improved satisfaction level. [ABSTRACT FROM AUTHOR]

A 43-years-old male patient presented through general practitioner with a complaint of right scrotal mass and was operated through inguinal approach. A 4 cm mass was excised and was found to be a liposarcoma of the spermatic cord upon histopathology, which is a diagnostic dilemma and very rare entity. [ABSTRACT FROM AUTHOR]

Background: Continuous ambulatory peritoneal dialysis (CAPD) has become a popular and established form of renal replacement therapy in patients with end-stage renal disease (ESRD). The objective of this study was to analyse the outcome of open Tenckhoff catheter insertions in patients with ESRD in term of catheter related complications., Methods: From December 2006 to November 2011, 337 Tenckhoff catheters were placed in 305 patients with ESRD for CAPD, by general surgeons in King Saud Medical City, Riyadh, Saudi Arabia. Medical record of all these patients was reviewed retrospectively regarding the demography, causes of ESRD, catheter related complications, and their management., Results: Mean age of the patients was 51.2 +/- 14.5 (range, 16-87 years). Majority of the patients were female 164 (53.7%). Forty three patients (14.1%) had previous abdominal surgery. Diabetic nephropathy was the commonest (51.4%) primary cause of ESRD. Ninety three insertions (27.5%) were associated with complications. Post insertion peritonitis was the commonest complication (9.2%) in our series, followed by mechanical dysfunction (8.6%). Fifty two catheters (15.4%) were removed because of different complications. Follow up ranged between 4-47 months with a mean of 21.4 +/- 11.2 months., Conclusions: Open surgical approach is simple, safe, and effective method of Tenckhoff catheter insertion with an acceptable complication rate, provided patients are adequately optimized and prepared for surgery.

Background: Pulmonary tuberculosis (PTB) may be easily confused with other chest diseases during its initial presentation. This study was carried out to identify presenting clinical and laboratory features that differentiate PTB from other diseases and to correlate clinical features and laboratory findings., Methods: This study was carried out at the Department of Pulmonology, Ayub Teaching Hospital Abbottabad, from September 1999 to December 2000. A total of 46 patients were included in the study after being clinically diagnosed as pulmonary tuberculosis. These patients were subjected to detailed history taking recording age, sex, weight, socioeconomic status and smoking habits. They were clinically evaluated and laboratory tests including Hemoglobin, ESR, TLC, DLC and sputum for AFB were done. They were put on standard antituberculous therapy and followed from 2 to 5 months to monitor treatment effect. Statistical analysis was performed by SPSS 8 computer program., Results: A bimodal presentation (below age 30 years and above age 50 years), fever, productive cough, weight loss, night sweats and raised ESR were the most common findings in PTB patients. Sputum AFB smears were positive in 50% of diagnosed cases. No correlation was found between clinical and laboratory parameters in establishing a confident diagnosis of the disease., Conclusions: The study highlights the importance of further research to pinpoint stronger and more reliable criteria for diagnosis.