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Background: The surgical management of patients with peritonitis is complex and demanding. The patients are prone to have high morbidity and mortality. The surgical procedure under general anesthesia may worse the outcome. Objective: To determine the efficacy of two drains placement under local anaesthesia in patients with the diagnosis of peritonitis requiring exploratory laparotomy. Methodology: This was study on 84 patients from January 2013 to July 2019 with generalized peritonitis. The patients required surgical intervention but were unfit having ASA 4. After making the diagnosis, two drains were placed in abdominal cavity under local anaesthesia. First drain was placed in the lumbar area anteriorly while second drain placed in between the umbilicus and the symphisis pubis. Other treatment measures were done as per standard protocol. Post procedure outcome included cure of the patients, improvement and fitness for general anesthesia, deterioration of the condition or death. Results: Out of all patients, 55(65.47%) were male while 29(34.53%) were female. In all patients, there was remarkable decrease in abdominal distension immediately after drain placement. The 69 (82.14%) patients showed improvement in clinical and biochemical parameters within 24 hours. Nineteen (22.62 %) patients were cured and did not require laparotomy .Fifty one (60.71%) improved and underwent laparotomy. The mortality occurred in 14 (16.66%) patients. Conclusion: Peritoneal drainage and lavage by using two drains under local anesthesia and lavage is safe and effective in unfit patients with peritonitis. [ABSTRACT FROM AUTHOR]

Objective: To assess psychological impact of COVID-19 pandemic among healthcare workers (HCWs) in a University Teaching Hospital, the main referral center for COVID-19 in Lahore Pakistan, by quantifying symptoms of acute stress disorder, depression, anxiety, insomnia and to explore their potential risk factors. Study Design: Descriptive Analytical study. Place and Duration of the Study: King Edward Medical University from March 30th-April 15th 2020. Methods: Following Institutional Review Board approval and informed consent, Demographic form, Patient Health Questionnaire, Generalized Anxiety Disorder scale, Insomnia Severity Index, and the stress reactions questionnaire were used for data collection. Descriptive statistics were computed. Binary logistic regression was done to determine potential risk factors for mental health outcomes. Results: Three hundred and thirty-seven healthcare workers participated with 79% physicians and 20% were nurses and paramedical staff. The prevalence of anxiety, depressive symptoms, acute stress disorder and insomnia was 36.2%, 30%, 27.9% &1.5% respectively. Women, frontline HCWs and junior staff had more anxiety, depression and insomnia symptoms with physicians reporting more acute stress symptoms compared to nurses. Binary logistic regression showed that being a junior staff member and a frontline worker appeared to be an independent risk factors for depression and anxiety (but not insomnia). Conclusion: High psychological distress among healthcare workers during COVID-19 reported in Pakistan. Failure to provide adequate psychosocial support can significantly impair their functioning and compromise patient care. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of malignancy and its types in patients presenting with surgical jaundice in a tertiary care setting., Methods: The cross-sectional study was conducted at the North Surgical Ward, Mayo Hospital, Lahore, Pakistan, from May 8 to November 8, 2020, and comprised patients of either gender with a diagnosis of surgical jaundice made on the basis of history, clinical examination, haematological and biochemical reports and radiological investigations. All patients were managed as per the guidelines for surgical jaundice with injection vitamin K intramuscular, hydration with intravenous fluids, avoidance of constipation by lactulose or neomycin, vitals and urine output monitoring and prophylactic antibiotics. Demographic data as well frequency of malignancy were noted using a predesigned proforma. Data was analysed using SPSS 21., Results: Of the 95 patients, 51(53.7%) were male and 44(46.3%) were female. The overall mean age was 49.96±16.54 years (range: 18-80 years). A total of 19(20%) cases had body mass index <30. Malignancy was identified in 50(52.6%) cases; 14(28%) gallbladder, 4(8%) head of pancreas, 9(18%) peri-ampullary carcinoma, 7(14%) cholangiocarcinoma, 6(12%) Klastkin tumour, 5(10%) hepatocellular carcinoma, and 5(10%) metastatic tumour., Conclusions: More than half of the surgical jaundice cases had malignancy, gallbladder being the most affected site.

Objective: The aim of this study was to determine the outcomes of transhiatal esophagectomy for dysphagia for esophageal malignancy in terms of short and long-term morbidity and mortality and to determine the survival series., Study Design: Case series study., Place and Duration of Study: South and West Surgical Ward, Mayo Hospital, Lahore, from January 2001 to December 2007., Methodology: All patients referred electively or admitted through OPD presenting with features of progressive dysphagia due to malignancy were included in the study. The patients were investigated for site of stricture and extent of growth into the surrounding structures. All underwent transhiatal esophagectomy and gastric tube or colon was used as the conduit to restore continuity. Patients with squamous cell variety were referred to oncology department for chemoradiotherapy postoperatively. Morbidity and in-hospital mortality were recorded., Results: A total of 42 patients were operated electively for malignant stricture esophagus through transhiatal approach. Site of lesion were 5 (11.9%) upper, 13 (31%) middle and 24 (58%) at lower end of esophagus. The TNM staging were stage I, IIa, IIb, III and IV in zero (0), 5 (11%), 10 (22%), 24 (57.8%) and 3 (7.1%) respectively. Mean operating time was 154 minutes and average blood loss of 371 ml. Postoperative complications included pneumothorax 16.7%, pulmonary complication (16.7%), anastomotic leakage (9.5%), wound infection (3.4%), recurrent laryngeal nerve injury (4.8%) and stricture formation (4.8%). Only 3 (7.1%) 30-day in-hospital mortality was recorded., Conclusion: Transhiatal esophagectomy is the surgical treatment of choice for resection of carcinoma esophagus specifically at the lower and mid-esophageal levels. The frequency of complications is lower as compared to transthoracic approach and the early stage of presentation can lead to high 5-year survival ratios.

Objective: To determine the accuracy of Fine Needle Aspiration Cytology (FNAC) in cases of gallbladder mass., Study Design: Comparative study., Place and Duration of Study: Surgical Units of Mayo Hospital, Lahore and Lahore General Hospital, Lahore in collaboration with the Department of Radiology, Sir Ganga Ram Hospital, Lahore and Department of Pathology of PGMI, Lahore, from September 2006 to September 2007., Methodology: Ultrasound guided fine needle aspiration cytology was done in all cases and histopathological findings were confirmed with open/laparoscopic biopsies. The results of these two modalities were compared., Results: Fifty cases with mean age 60.71+11.073 years presented with mass gallbladder underwent FNAC. Smears showed adenocarcinoma 23, undifferentiated carcinoma in 7, dysplasia and suspicion of malignancy in 5, hemorrhagic background without malignant cells in 12 and inflammatory cells with no malignancy in 3 cases. Results compared with open/ laparoscopic biopsy showed a sensitivity, specificity and Positive Predictive Value (PPV) of 72.91%, 100% and 100% respectively., Conclusion: Ultrasound guided FNAC is a safe and less invasive diagnostic modality for diagnosing carcinoma gall bladder preventing the patient to undergo major surgery and helps in better quality of life.