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Objective: To evaluate correlation of fasting serum cholesterol level with severity of chronic liver disease (CLD). Study Design: Cross-sectional Survey. Setting: North Medical Ward, Mayo Hospital Lahore. Period: June 2020 to December 2020. Material & Methods: Patients having chronic liver disease with age 25-85 years and of either gender, were included. After 12 hours of fasting, 5ml of blood was drawn from patients under all aseptic precautions into sterile disposable syringes and blood samples were sent to laboratory for measurement of total cholesterol. Total cholesterol (TC) in mg/dl was noted from their reports. CLD severity patients was defined by using Modified Child Pugh classifications. Data was entered in SPSS version 20 and analyzed by same software. Results: Total 100 cases diagnosed with chronic liver disease (CLD) were studied, with an average age of 53.8±10.76 years. The majority of participants, constituting 72%, were male. Overall average TC was 119.85±31.51mg/dl. Out of all 27% patients belonged to CPT class A, 28% had CPT class B and 45% had CPT class C. Spearman correlation between Child Pugh score and total cholesterol level was calculated. A negative spearman correlation was found as r= -.672. It was significant at the level of 0.01. Conclusion: As per the study conclusion, total serum cholesterol level was observed to be the significantly corelated with degree of liver damage. The significance of this correlation highlights the potential clinical utility of serum total cholesterol as a prognostic tool for evaluating the degree of liver damage. [ABSTRACT FROM AUTHOR]

Objective: To see the pattern of bone involvement in metastatic breast carcinoma. To study the distribution of bone metastasis, central skeleton vs. peripheral skeleton, in metastatic breast carcinoma. Study Design: Retrospective study. Setting: Department of Surgery, Nishtar Medical University, Multan, in accordance with Breast Clinic MINAR. Period: March, 2021 to August, 2022. Material & Methods: The study was done in breast clinic MINAR, Multan. It was retrospective, non-randomized and single institution based study. The female patients who presented with breast carcinoma from March 2021 to August 2022, aged 25 to 70 years were scrutinized. Among these, the patients with metastatic breast carcinoma having metastasis in bones, confirmed on bone scan, were included in the study. 90 cases were collected in this research. The tumours which primarily arise from bone, lymphoid tumours, soft tissue tumours and bone marrow tumours and bone metastasis due to malignancies arising from other visceral organs were excluded. All the data was entered and analyzed using computer programme SPSS version 25.0. Results: The highest range of patients were between ages of 46-65 years. 87.8% were married, 2.2% were unmarried and 10% were divorced or widow. 43.3% were from rural area and 56.7% were from urban area. 93.3% previously had not any history of breast carcinoma. Only 6.7% had family history of breast carcinoma. 64.4% had menarche during the age of 12 to 14 years. And 42.2% had menopause between 50 to 55 years. While in all these cases 46.7% were those who had no menopause at all when they presented with metastatic breast carcinoma. Among these 13.3% had solitary bone metastasis and 86.7% had metastasis to multiple bones. 46.7% had central or axial skeletal involvement, 13.3% had peripheral skeletal involvement and 40% had both, including central and peripheral skeleton. Conclusion: This study has shown that among all the patients there were 46.7% patients had central skeletal involvement and 13.3% had peripheral skeleton involvement and 40% had both. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of breast carcinoma among females above 30 years of age presenting with palpable breast lumps in south Punjab. Study Design: Cross Sectional study. Setting: Department of Surgery, Ward No.4, Nishtar Medical University/Hospital, Multan. Period: 1st July, 2021 to 31st December 2021. Material & Methods: One hundred and thirty six patients with palpable breast lumps were included in the study. History, clinical examination, mammography, fine needle aspiration cytology (FNAC) and Tru cut biopsy was done in all the patients. Finally the report of Tru cut biopsy was used to find out the frequency of breast carcinoma in all these patients. Results: Carcinoma was present in 43 (31.6%) patients and benign diseases were present in 93 (68.4%) patients. Conclusion: Carcinoma was present in higher frequency (31.6%) among patients above 30 years of age who presented with palpable breast lumps. [ABSTRACT FROM AUTHOR]

Objectives: To determine the frequency of spontaneous closure of postoperative enterocutaneous fistula at a tertiary care hospital. Study Design: Descriptive Case Series. Setting: Department of General Surgery Unit-I, Nishtar Medical University/ Hospital, Multan. Period: Nine months 1/4/2018 to 31/12/2018. Material & Methods: Non-probability consecutive sampling. Results: From 80 patients, 34 (42.5%) were male and 46 (57.5%) were female. Mean age of our patients was 40.31 ± 10.58 years. Most of our patients i.e. 55 (68.8%) belonged to poor families. Mean body mass index of our patients was 24.67 ± 3.39 kg/m2 and obesity was present in only 14 (17.5%) patients. Initial surgery was elective in 53 (66.2%) and emergency surgery in 27 (33.8%) patients. Site of origin of ECFs was gastric in 17 (21.3%), duodenum in 22 (27.5%), Jejunum in 14 (17.4%), Ilium was involved in 17(21.3%) and colorectal in 10(12.5%). Mean disease duration was 3.21 ± 2.09 weeks and mean duration of surgery was noted to be 4.71 ± 2.13 hours and 73.8% underwent surgical procedure for up to 5 hours. Mean hospital stay was noted to be 13.58 ± 7.41 days while 73.8% stayed in hospital for more than 7 days. Spontaneous closure of post-operative enterocutaneous fistula was noted in 25 (31.3%) of our patients. Conclusion: Spontaneous closure of post-operative enterocutaneous fistula without any surgical intervention is quite common. [ABSTRACT FROM AUTHOR]

Background: Herniorrhaphy and hernioplasty are the two most common modalities used with different degree of success and complication rates in the treatment of inguinal hernia. Several studies show that use of mesh is superior to the non-mesh operations in inguinal hernia surgery. It is generally believed that the use of biomaterials should be limited to non-infected surgical fields. Now the concept regarding use of mesh in complicated hernias is changing as shown by many studies. Current study is being planned to observe the outcomes of the mesh hernioplasty in treatment of complicated inguinal hernias in emergency so that in future appropriate and safe technique may be suggested for repair of complicated hernias in emergency setting. Objectives: To compare the outcome of hernioplasty and herniorrhaphy in emergency for the treatment of complicated (Irreducible/obstructed) inguinal hernias regarding wound infection and hospital stay. Material & Methods: Randomized control trial. Setting: Surgical ward, Sheikh Zayed Hospital, Rahim yar khan. Period: 09 months from 01-01-2016 to 30-09-2016. Sample Size: A total of 64 patients with 32 patients were included in each group, with confidence level of 95% and power of 80% and anticipated mean level of hospital stay in group 1 of 5±3.4 days versus 3±2.1 days in group 2. Sampling Technique: Nonprobability, consecutive sampling. Results: In this study there were total 64 cases with 32 in each group. The mean age was 41.69±11.06 years and the mean duration of hernia obstruction was 12.83±4.97 hours. There was no significant difference in terms of age, duration of hernia and hernial obstruction between both groups. Seroma was seen in 5 (7.81%) out of 64 cases while wound infection was seen in 8 (12.50%) of cases. Seroma was seen in 2 (6.25%) out of 30 cases in herniorrhaphy as compared to 3 (9.38%) out of 32 cases with hernioplasty with p value of 0.64. Wound infection was seen in equally 4 (12.50%) out of 32 cases in both groups with p value of 1.0. Duration of hospital stay was 4.66±1.36 in patients with herniorrhaphy as compared to 4.53±1.37 days with hernioplasty with p value= 0.82. There was no significant difference in terms of age groups, duration of hernia and its obstruction between both groups regarding seroma. There was also no significant association among any of the confounding factors regarding the wound infection and length of the hospital stay between the both groups. Conclusion; We can perform hernioplasty as compared to herniorrhaphy for complicated inguinal hernia with similar complications and better success rates in the same emergency setting. [ABSTRACT FROM AUTHOR]

Introduction: "Mycotic aneurysms are defined as a localized, irreversible dilation of an artery due to destruction of the vessel wall by infection." Intravenous (IV) drug abuse is an increasing social and health problem. Repeated punctures under septic conditions along with needle sharing habits among IV drug abusers result in various vascular complications. In addition, patients who present with these complications frequently have viral infections, which are hazardous to healthcare workers. Objectives: With these existing controversies of optimal surgical management of infected femoral artery pseudo aneurysm, we reviewed our surgical technique used for their treatment and their clinical outcome, in a population of IV drug abusers of Rahim Yar Khan. Study Design: Retrospective, descriptive study. Setting: Sheikh Zayed Medical College/Hospital Rahim Yar Khan. Period: 2 years from 1-1-2015 to 31-12-2016. Material & Methods: Total 10 patients were included in this study. All patients were managed and operated in emergency ward. In all the patients we performed first external iliac ligation and then excision of the sac and debridement of the wound. The protocol of this study has been approved by the ethical committee of the hospital. Results: In this 2 years study, 10 patients were managed. Mean age was 22.5 years and age range from 18-28 years. All patients were young males and belong to low socioeconomic status. The duration of IV drug abuse was 2-3 years. A self-injection was the commonest mode of injection. All the infected femoral pseudo aneurysms were on the right side. 5 patients were hepatitis C virus (HCV) +ve and 4 patients were hepatitis B surface antigen (HbsAg) positive. Only one patient was human immunodeficiency virus (HIV) positive. Five patients presented with oozing pulsating mass and 5 patients with infected pulsatile mass. Right leg was survived in all the patients. There was no amputation. Conclusion: Ligation of the external iliac artery first then excision and debridement of the infected femoral artery pseudo aneurysms seems to be a safe procedure in IV drug abusers with low morbidity and no mortality. There was no amputation of the limb. [ABSTRACT FROM AUTHOR]

Aims & Objectives: To evaluate the effects of Serum Calcium and Urinary Calcium excretion on upper urinary tract stone diseases in the Peshawar (a high stone incidence belt). Subjects & Methods: One hundred patients (age 20-60years) who were suffering severely from upper urinary tract stone disease were selected from LRH and Hayatabad Medical Complex Hospitals of Peshawar, same numbers of healthy controls from the same region were also selected for the study. Results: When results were summed up and test Parameters were compared, it was seen that mean Serum Calcium in stone formers was greater than that of non-stone formers (P<0.001). Same pattern was also observed (P< 0.001) in both groups regarding mean urinary calcium excretion. Conclusions: We concluded that calcium is a definitive risk factor in upper urinary tract stone disease. However we suggest further work and research on wide scale population in order to evaluate this relation. [ABSTRACT FROM AUTHOR]

Aims & Objectives: Geographical variation in the rates of kidney stones has been observed for many years. Pakistan is situated in stone belt. Calculus diseases is endemic in Pakistan, perhaps the incidence in Pakistan is highest in the world. Purpose: To evaluate etiology and biochemical risk factors (inorganic phosphate) in the Peshawar. Subjects & Methods: Study was conducted at LHR and Hayatabad Hospitals of Peshawar for the period of nine months. Two hundred patients and same number of controls were selected. Results: The mean value of mean inorganic phosphate in non stone formers were less than that of stone formers. The mean of urinary inorganic phosphate excretion in stone formers was greater than that of non-stone formers. Conclusions: We conclude that inorganic phosphate is an independent risk factor for renal stone formation. [ABSTRACT FROM AUTHOR]

Background: Despite advances in the prevention and treatment of hypertension over the past decade, hypertension remains an important public health challenge. Recent efforts to reduce the prevalence of hypertension have been focused on non-pharmacologic means, specifically diet. An increased intake of magnesium has been shown in some but not all studies to reduce blood pressure in patients with hypertension. Decreased Serum magnesium levels are associated with development of hypertension. Aims: This study was planned to investigate relation of serum magnesium with blood pressure in patients with mild uncomplicated hypertension. Subjects & Methods: Study was conducted at LUMHS hospital Jamshoro and DHQ hospital charsadda for the period of six months. Fifty known cases of uncomplicated mild hypertensive patients were selected, same number of healthy controls were also examined. Results: When results were summed up and test parameters were compared, it was seen that no significant differences were found in serum magnesium levels among both groups, when compared statistically. Conclusion: Finally we conclude that no relation of magnesium with hypertension was observed. Suggestions: Much more work on wide scale population may be needed to clarify the idea. [ABSTRACT FROM AUTHOR]