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Objective: To determine the diagnostic accuracy of Barium contrast enema for diagnosis of Hirsch-sprung disease, taking histopathology as the gold standard. Study Design: Cross-sectional validation study. Place and Duration of Study: Department of Paediatric Surgery, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2019 to May 2021. Methodology: A total of 251 patients with symptoms of Hirsch-sprung disease were included. All patients were assessed with a Barium enema and full-thickness rectal biopsy. Barium enema was reported for the presence of contrast in the rectum after 24 hours, the presence or absence of transitional zone and a Recto Sigmoid Index less than 1. Full-thickness rectal biopsy was taken 2 cm above the dentate line, and histopathology was performed to see the ganglion cells in Meissner`s and Myenteric plexus. Results: Histo-pathologically confirmed cases were 120(true positive), where 12(false positive) had no Hirsch-sprung disease on histopathology. In Barium enema negative patients, 113 were true negatives while 06 were false negatives. Overall sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Barium contrast enema for diagnosis of Hirsch-sprung disease were 95.24%, 90.40%, 90.91%, 94.96% and 92.83%, respectively. Conclusion: We concluded that the diagnostic accuracy of Barium contrast enema for diagnosis of Hirsch-sprung disease is quite high, taking histopathology as the gold standard.

Objective: To assess the safety of the Mitchelle bank technique for herniotomy in children by comparing its recurrence rate with conventional Ferguson's technique. Study Design: Quasi-experimental study. Place and Duration of Study: Paediatric Surgery Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Sep 2018 to Sep 2019. Methodology: Children below the age of 6 years coming to Paediatric Surgery Outpatient Department with inguinal hernia were included in the study. The patients were divided into two groups. Group-I underwent herniotomy by Mitchelle bank technique (MBT-group) while Group-II by Ferguson's technique (FT-group). The demographic characteristics of the studied population, operative time, and intra-operative and post-operative complications were recorded. Results: The mean age of the patients was 25.94 ± 17.06 months in Ferguson's technique-group and 24.76 ± 16.63 months in the Mitchelle bank technique-group. The mean operative time was less in the Mitchelle bank technique-group (13.17 ± 1.47 minutes) as compared to Ferguson's technique-group (16.23 ± 1.51 minutes) (p0.05). Conclusion: Mitchelle bank technique is safe for herniotomy in children with less operative time and no increase in...

Objective: To compare the effectiveness of Bupivacaine local wound infiltration with Bupivacaine caudal block on postoperative pain in children undergoing open inguinal hernia repair. Study Design: Quasi-experimental study. Place and Duration: Department of Paediatric Surgery, Pak Emirates Military Hospital Rawalpindi, from Jan to Sep 2019. Methodology: 60 patients (30 each in two groups) fulfilling the inclusion criteria who underwent open inguinal herniotomy were included in this study. Patients in group-A received caudal block with 0.25% Bupivacaine 1 ml/kg body weight, while Group-B received local wound infiltration of 0.5% Bupivacaine 2 mg/kg body weight after the completion of surgery. The post-operative pain score was calculated using Hannallah's objective pain scale at 30 minutes, one, two, four, six and eight hours following the procedure. A total pain score of 3 requiring the rescue analgesia in the form of oral Paracetamol (10 mg/kg body weight) was considered the endpoint. Results: Mean post-operative pain score was 8.20 ± 1.54 in group-A compared to 7.20 ± 1.88 in Group-B with the p-value of 0.02, which showed a statistically significant difference between the two groups. Conclusion: We concluded that local infiltration with Bupivacaine after open herniotomy in children is safe, highly effective and easy to perform the procedure, which results in excellent post-operative analgesia compared to caudal Bupivacaine block.

Background: Pyelonephritis is a renal inflammatory condition diagnosed with patient’s history, physical examination and imaging studies. Although laboratory finding, clinical sign and symptoms are considered for the diagnosis and treatment. Aim: To compare the sonographic findings of pyelonephritis with urine complete examination Methodology: A Cross sectional analytical study was conduct at Gilani Ultrasound Center, Ferozepur Road, Lahore and routine urine examination was performed in the Sanabil Health Services Hospital, Khayaban-e-Quaid, Lahore. Entirely comprised patients were queried concerning variables such as gender, age, clinical history, grey scale ultrasound findings, Doppler ultrasound findings and lab findings. Patients were enquired to lie down as well as depiction Abdomen. Results: Out of 138 patients, 77 were males and 61 were females, maximum age of patients was 77 years and minimum was 18 years, 75 (54.3%) patients with clinical history of pyelonephritis, 67 patients were with lab findings that support pyelonephritis and 71 patients had no lab findings. Out of 138 patients, 67(48.6%) patients had right kidney acute pyelonephritis and 65(47.1%) had left kidney acute pyelonephritis. Conclusion: The study concluded that there was an important association among the Urine complete examination as well as sonographic findings in the evaluation of acute pyelonephritis. However, the clinical and ultrasound findings in acute Pyelonephritis do not play a significant role but these findings can be helpful in chronic cases of Pyelonephritis. Key words: Acute pyelonephritis, Ultrasonography, Urine complete analysis, Routine urine examination

Chordee is a condition in which the penile head has a curvature. It can be towards ventral or dorsal aspect. Dorsal chordee is very rare. In many normal males mild degrees of curvature can exist. Causes of dorsal chordee can be diverse but urethral duplication as its etiology is even rarer. We report a case of six year old boy who presented with severe dorsal chordee with associated double urethra and cleft of the glans dorsally without hypospadia.

Background: Diabetes during pregnancy is very common that increase the complications in pregnancy. This study aimed to compare the EFW in Daibetic and non-diabtic mothers. during 3rd trimester. Objective: To compare sonographically the Estimated fetal weight (EFW) in diabetic and non-diabetic mothers during 3rd trimester. Methods: The study will be conducted in 35 diabetic and 35 non diabetic mothers during 3rd Trimester. To assess EFW the BPD, AC, and FL will be recorded on USG. In Diabetic mothers, the diabetes will be confirmed by Gluccometer. Results: The group statistics showed that mean estimated fetal weight among offsprings of 35 diabetic and 35 non-diabetic mothers were 2.3 and 2.0, respectively. The calculated fetal weight estimation among fetuses was as low as 1042g and as high as 4090g. Mean difference of estimated fetal weight in Diabetic & Non-Diabetic pregnant women that calculated as 2085.8285 for non-diabetic and 2334.5142 for diabetic mothers. Conclusions: It is concluded that there were no such prominent differences among the Estimated fetal weight in diabetic and non-diabetic mothers.

Despite the fact that traffic engineering techniques have been comprehensively utilized in the past to enhance the performance of communication networks, the distinctive characteristics of Software Defined Networking (SDN) demand new traffic engineering techniques for better traffic control and management. Considering the behavior of traffic, large flows normally carry out transfers of large blocks of data and are naturally packet latency insensitive. However, small flows are often latency-sensitive. Without intelligent traffic engineering, these small flows may be blocked in the same queue behind megabytes of file transfer traffic. So it is very important to identify large flows for different applications. In the scope of this paper, we present an approach to detect large flows in real-time without even a short delay. After the detection of large flows, the next problem is how to control these large flows effectively and prevent network jam. In order to address this issue, we propose an approach in which when the controller is enabled, the large flow is mitigated the moment it hits the predefined threshold value in the control application. This real-time detection, marking, and controlling of large flows will assure an optimize usage of an overall network.

To assess the safety of direct trocar insertion (DTI) before creating pneumoperitoneum in laparoscopic procedures.An observational study.Combined Military Hospital (CMH) Kohat, Pakistan from November 2013 to January 2015.All the cases undergoing laparoscopy at the study centre in the above duration were included in the study after approval from the Hospital Ethical Committee and informed written consent. Out of the 200 cases, DTI was successfully used to establish peritoneal access in 190 cases, while open Hassen's technique (OL) was used in ten cases. Body mass index (BMI) of all the patients was calculated before surgery. All the cases were performed under general anaesthesia with adequate relaxation. A 10 mm permanent re-useable sharp metallic trocar was inserted through umbilical scar after lifting the abdominal wall using towel clamps. Studied variables included age, gender, BMI, operations, history of previous surgery, number of attempts for DTI and complications.Mean age of the patients in DTI group was 46.58 ±13.94 years, while 48.70 ±10.08 years in OL group. Female to male ratio in DTI group was 1.43:1; and 2.33:1 in OL group. Increase in BMI had a relation with number of unsuccessful attempts of DTI, so obesity was the main reason of failure of DTI.DTI is a safe and effective method of peritoneal access for laparoscopy with very low failure rate related to BMI and minimal complications.

This paper designs and measures the performance of a message scheduling scheme for the mobile sensor network employing two sinks. For the purpose of enhancing the successful delivery ratio for time-sensitive sensor messages and also avoiding congestion around the sinks, the proposed scheme keeps their loads different, and makes each sensor node send the urgent message to the low-load sink. For a neutral node, the urgency of a message is estimated by comparing the slack value of the message and slack distribution of overall messages observed at the node. With this information, each node decides the destination of each message. The simulation performed via ns-2 reveals that the proposed scheme, called chop partition, can improve the deadline meet ratio of real-time messages by up to 7.2% for AODV case and 8.2% for DSDV case, compared with the random selection scheme, or even partition, for the given experiment parameters.