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Based on the Government Regulation in Lieu of Law, it has reduced and changed the nomenclature for the imposition of administrative sanctions against environmental pollution and damage. As regulated in the Implementation of administrative sanctions from the instrument, five points are regulated by the government sanctions instrument. This article uses normative research methods with statutory and analytical approaches. Using primary and secondary data types using deductive logic analysis methods. The results of this study indicate that there is a change in administrative sanction arrangements, especially in administrative fines, where there is no specific indicator in providing the amount of fines. The revocation of business licenses is certainly in line with Good Governance, which lies in legal certainty, effectiveness, and efficiency. This is because the government has full responsibility for the legal position that is made to be implemented as fairly as possible. In addition, the government plays an active role in maximizing administrative law instruments wisely and responsibly. How to cite item: Ismail, Muhammad Rizky Akbar, and Lego Karjoko. “Ideality of Implementation Administrative Sanctions Against Environmental Damage in Indonesia.” Jurnal Cakrawala Hukum 14 no. 2 (2023): 200-211. DOI: 10.26905/idjch.v14i2.10420.

Background: Surgeons specifically junior ones in our setup of third world country face the issue of diagnosing Acute Appendicitis (AA) as presentation usually is not typical. Cases presenting at odd hours may put residents & house officers in trouble, when sophisticated investigations are either un-available or expansive. Need for a structured diagnostic criterion is thus always there. Various scores have been designed to help out surgeon e.g. Alvarado score which got more popular & is practiced randomly. Aim of this study was to revisit Alvarado score for its efficacy in current era at Ayub Teaching Hospital (ATH) Abbottabad, i.e., by calculating negative appendicectomy rate. Methods: This descriptive study was conducted at Surgical "B" Unit (ATH) from 1st September 2021 to 31st May 2022. 160 patients with pain RIF were included & evaluated by Alvarado score & consequently placed in 03 groups. Those having score 1-4 (Group-1) at presentation were discharged while the ones with score 5-6 (Group-2) were observed, re-evaluated at interval for re-grouping as Group-1 or 3 based on their final score. Patients with score 7-10 (Group-3), having score confirmed Acute Appendicitis were operated. Findings were recorded on a proforma. SPSS-version 26 was utilized for statistical analysis. Results: Total patients were 160, males were 118 & female patients were 42. Discharged (Group-1) patients were 22. Group-2 patients (41 in number), were observed for 24-48 hour when score of 16 declined to ≤4 level & were discharged. 25 patients whose score increased to ≥7 levels were operated like other 97 patients of Group-3. Histopathology confirmed 109 of 122 patients as acute appendicitis while 13 turned out negative appendicectomies. Negative appendicectomy rate was therefore 10.65%, i.e., 13 out of 122, it was 06.17% in males (i.e., 05 of 81) & 19.51% (i.e., 08 of 41) in females. Conclusion: Alvarado score again proved helpful even today in reducing the negative appendicectomy rate at surgery department of ATH, it should therefore be routinely adopted in diagnosis of suspected appendicitis cases in the third world countries (e.g. Pakistan) setup (facing scarcity of sophisticated resources). [ABSTRACT FROM AUTHOR]

Studying the Quran is an integral act of worship in Islam, necessitating a nuanced comprehension of its verses to ease learning and referencing. Recognizing the diverse thematic elements within each verse, this research pioneers in applying Deep Learning techniques, specifically Long Short-Term Memory (LSTM) and Bidirectional LSTM (Bi-LSTM), coupled with Word Embedding methods like Word2Vec and FastText, to refine the multi-label classification of the Quran's translations into Indonesian. Targeting core thematic categories such as Tawheed, Worship, Akhlaq, and History, the study aims to elevate classification accuracy, thereby enhancing the textual understanding and educational utility of the Quran's teachings. The employment of Bi-LSTM in conjunction with FastText and meticulous hyperparameter optimization has yielded promising results, achieving an accuracy of 71.63%, precision of 64.06%, recall of 63.60%, and a hamming loss of 36.17%. These outcomes represent a significant advancement in the computational analysis of religious texts, offering novel insights into the complex domain of Quranic studies. Furthermore, the research accentuates the critical role of selecting suitable word embedding techniques and the necessity of precise parameter adjustments to amplify model performance, thereby contributing to the broader field of religious text analysis and understanding. Through such computational approaches, this study not only fosters a deeper appreciation of the Quran's multifaceted teachings but also sets a new precedent for the interdisciplinary integration of Islamic studies and artificial intelligence. [ABSTRACT FROM AUTHOR]

Background: Laparoscopy has become the highest quality level way to deal with cholecystectomy since its inception 30 years preceding, and is perhaps the most normally performed general surgeries. Pain being a significant issue after laparoscopic cholecystectomy bringing about extended admissions or readmissions. With significant varieties in pain relieving conventions an integrated approach is important to diminish pain. The aim of this study is to assess the effectiveness of Bupivacaine as local anesthetic agent at port sites after laparoscopic cholecystectomy. Methods: Study population of 84 patients was divided into control group (receiving no local anesthetic) and study group (receiving Bupivacaine as local anesthetic). Visual analogue scale was used to quantify and compare pain perceived by each group; at fixed intervals of 6, 12 and 24 hours after shifting of the patients back to the ward. Results: Each group comprised 42 patients. At 6 hours post operative pain score in study group, 4.5±0.32 was significantly lower than in control group, 7.6±0.41 (p<0.05). Though pain assessments at 12 and 24 hours didn't reveal any significant differences among the two groups; postoperative requirement of Tramadol was significantly (p<0.05) lower in study group (92±0.064mg) in comparison to control group (158±0.21mg). Conclusion: Use of long-acting local anesthetic injections at port sites after laparoscopic cholecystectomy significantly lowers pain during first 6 hours post operatively and also lowers narcotic analgesics requirements during post operative period. [ABSTRACT FROM AUTHOR]

Gall bladder ascariasis is a rare entity accounting for only 2.1% of biliary ascariasis features due to anatomical features of the cystic duct. It usually presents with vague abdominal features. Ultrasonography is the most sensitive and useful investigation for its diagnosis. We present a case of gall bladder ascariasis in an antenatal young female patient showing features of cholecystitis. She was diagnosed by ultrasonography and managed by laparoscopic cholecystectomy followed by oral anti-helminthic drugs. She made an uneventful recovery and is doing great in follow-up visits. [ABSTRACT FROM AUTHOR]

Background: Acute appendicitis is one of the most common acute surgical emergencies on emergency room floor and timely diagnosis of the condition is of utmost importance. Multiple diagnostic Score exist to help in the clinical diagnosis; among Which RIPASA is a recent introduction. Methods: The study was carried out Ayub Teaching hospital of Abbottabad from Sept-2017 to Feb-2018, Department of General Surgery. The ultimate decision to perform surgery was not guided by the scores and the surgeon’s decision was the final word, and specimens were sent afterward for histopathology. The results compiled and entered into SPSS 20. Results: Out of the 308, 288 patients underwent surgery for AP, 165 (57.3%) were male and 123 (42.7%) were female, 252 (87.5%) had positive histopathology report and 36 (12.5%) had a negative report, with resultant negative appendectomy rate of 12.5% well below the average. 26 (9.02%) had a perforated appendix and 8 (2.8%) had post-op wound infection. The sensitivity of RIPASA score at a cut-off value of 7.5 was 98.02%, with specificity of 75%, and Positive Predictive Value of 96.48%, and Negative Predictive Value of 84.7%. Compared to Alvarado’s Score Sensitivity and Specificity of 53% and 75% respectively. Conclusion: On the balance the RIPASA Score detects early preventing from dreadful complication and in turn have low specificity giving way to a slightly higher negative appendectomy rate with the consequent morbidity and mortality of unnecessary surgery. Still RIPASA Score outperforms the Alvarado and Modified Alvarado Score. [ABSTRACT FROM AUTHOR]

Introduction Bezoars, masses of indigestible foreign bodies formed in the gastrointestinal tract, pose challenges in their management. Phytobezoars are particularly problematic due to their difficult diagnosis and resilience towards treatment. Recently, Coca-Cola has emerged as a potential solution due to its acidic composition and mucolytic properties. However, existing evidence is limited, highlighting the need for comprehensive studies. This research explores the efficacy of Coca-Cola in dissolving persimmon-related phytobezoars, aiming to contribute valuable insights to non-invasive treatment options. Material and methods Conducted as a descriptive case series, this study employed gastric cola lavage using non-probability purposive sampling. Patients aged 18-70 with persimmon-related phytobezoars were included. Two nasogastric tubes were inserted for cola lavage over 12 hours, utilizing three liters of cola until the disappearance of symptoms. When the bezoar disappeared, it was considered as complete success to the treatment. Results Out of 31 patients, 45.2% were male and 54.8% were female, with a mean age of 56.77 ± 9.01 years. Efficacy was noted in 54.8% of cases. Age less than 50 and no history of diabetes mellitus were associated with higher chances of treatment success (p-value ≤0.05). Conclusion Ingestion of Coca-Cola was highly effective, safe, and reliable for the dissolution of persimmon-related phytobezoars, as the frequency of efficacy was high in our study. Coca-Cola ingestion is a non-invasive and cost-effective mode of phytobezoar dissolution that should be taken as a first-line initial treatment option to attain desired outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Riaz et al.)

Objective: To compare the efficacy of primary versus secondary closure of stoma reversal skin wound in terms of wound infection., Methods: The study was conducted at Surgical B Unit of Ayub Teaching Hospital, Abbottabad, Pakistan, from January 1 to December 31, 2020, and comprised adult patients of either gender undergoing stoma reversal. The patients were randomised into primary closure group A and secondary closure group B. Surgical procedure was similar in both the groups except the skin closure technique. In group A, skin was closed with interrupted polypropylene sutures, while in group B, wound was dressed with saline-soaked gauze daily using aseptic technique and was allowed to heal by secondary intention or delayed primary closure later on. Postoperatively, the wound was assessed for infection till 30th postoperative day or complete wound healing. Data was analysed using SPSS 16., Results: Of the 50 patients, 35(70%) were males and 15(30%) were females. The overall mean age was 28±1.65years. There were 25(50%) patients in each of the two groups. There were 19(76%) males and 6(24%) females in group A with a mean age of 32±2.8years. There were 16(64%) males and 9(36%) females in group B with a mean age of 23±3.5years. Overall, 10(20%) patients had wound-site infections; 9(36%) in group A versus 1(4%) in group B (p=0.005). Frequency of wound infection with respect to gender, type of stoma and length of hospital stay was not significant (p>0.05)., Conclusions: Secondary skin closure was found to be associated with significantly reduced wound infection rate after stoma reversal., Cclinical Trial Number: https://clinicaltrials.gov/ct2/show/NCT04785404.

Background: Anal fissure is a linear tear in the distal anal canal resulting from persistent hypertonia and spasm of the internal sphincter which results in mucosal ischemia. We have conducted a study in order to compare the outcome of 0.2% glyceryl trinitrate cream versus 2% diltiazem cream in the treatment of chronic anal fissure., Methods: This randomized controlled trial (RCT) was carried out in the Department of Surgical "B" unit, at Ayub Teaching Hospital, Abbottabad, Pakistan from 15th June 2012 to 15th May 2015. One hundred and eighty-four patients who visited the outpatient department for the treatment of chronic anal fissure were included in the study. They were divided into two groups with 92 patients in each group. Patients in group "A" included those patients receiving topical glyceryl trinitrate and group "B" patients were those receiving topical diltiazem cream., Results: Out of 184 patients 66.3% were males, 33.7% were females. Mean age of the patients was 43.84±7.976 and mean duration of symptoms was 10.55±2.524. Overall outcome in terms of healing was 71.2%, among which 80.4% were from diltiazem group while 62% in glyceryl trinitrate group. Complete relief of pain was observed in 67.9%, 26.1% complained of mild pain and 5.4% complained of moderate pain. Only one patient in glyceryl trinitrate group complained with severe pain with no healing after one month of follow up. No statistical association was found between healing outcome and gender as well as age of the patients (p>0.05) although an association was found between healing outcome and duration of symptoms (p<0.05)., Conclusions: This study shows that diltiazem has better outcome in terms of healing of chronic anal fissure and reductions in symptoms, i.e., pain compared with glyceryl trinitrate.

Background: Acute intestinal obstruction due to tuberculosis is a common surgical problem in our community. Emergency surgery is usually required and surgical procedure depends upon the location and extent of the disease. The aim of this study was to determine the commonly involved region of intestine and different surgical procedures tailored., Methods: Thirty patients operated upon for acute intestinal obstruction in emergency with operative and histopathological findings suggestive of tuberculosis were included in the study. Demographic profile, operative findings, details of surgical procedure, complications and post-op hospital stay were recorded. The patients were followed for 6 months., Results: Intestinal tuberculosis is more common in young female, with male to female ratio of 1:1.5. Stricture of the small bowel was found in 50% of the cases. The next common finding was ileocaecal tuberculosis found in 40% of patients. Strictruplasty was performed in 11 (36.33%). The right hemicolectomy, limited ileocaecal resection and segmental bowel resection with end to end anastomosis were performed in four patients each. Other procedures were release of adhesions and bands in 4 patients, ileotransverse bypass in 1 patient and loop ileiostomy in 2 patients. Major complication in 10 patient and mortality rate was 10%., Conclusion: Because of non-specific clinical features, ignorance and malpractice intestinal tuberculosis presents late. Ileocecal tuberculosis is becoming less common as compared to small bowel strictures. Less radical surgery gives better results. Post operative complications and mortality are related to the perforation of the intestine at the time of surgery.

Background: Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional cost to individuals but also is a significant financial burden to society at large. The Objective was to study the outcome of spinal fixation with fixateur interne in cases of thoracolumbar spinal injuries in terms of neurological recovery and complications., Methods: This Descriptive study was conducted at Department of Neurosurgery, Hayatabad Medical Complex and Postgraduate Medical Institute, Peshawar, from March, 2006 to December, 2007 Study included patients admitted in Neurosurgery Ward HMC, with acute traumatic spinal injuries during the above mentioned period who underwent thoracolumbar spinal fixation with fixateur interne. Name, age, sex, other relevant data, history, examination findings and investigation results were recorded. Postoperative outcome was evaluated taking neurological status, and complications like infection, implant failure and other complications into consideration. Follow-up of 6 months was carried out., Results: There were 31 patients, (18 male and 13 female). Fall from height (48%), road traffic accidents (26%) and crush injuries (26%) caused the trauma. Most common age group was from 21-30 years age. Fractured vertebrae included 2 D11 fractures, 12 D12 fractures, 13 L1 fractures, 3 L2 fractures and 1 L3 fracture. Mean operative time 80 minutes, mean blood loss 200 ml, mean hospital stay 6 days and mortality rate was 0%. Number of patients with Frankel grade A reduced from 27 to 19 and in Frankel grade E increased from 0 to 4 patients. Only one patient had infection and one patient had implant removal., Conclusion: Fixateur interne is a useful and low-cost implant for fixation of thoracolumbar junction injuries with very easy availability and easy operative insertion and little blood loss. It has excellent post-operative outcome in terms of neurological improvement and a very low complication rate. Mortality rate is minimal.

Background: To determine incidence of renal stone disease in patients with urinary tract infection, this cross sectional study was conducted at Surgical Unit of District Head Quarters Hospital, Charsadda over a period of one year from January to December 2005., Methods: One hundred consecutive patients were enrolled in this study. All those patients who presented with urinary symptoms were included. While patients with lower urinary tract stones, upper urinary tract stones with renal failure, renal tumours and previous history of renal stones disease were excluded. The data was obtained and analyzed by filling a specially designed proforma for each patient., Results: All 100 patients were between age ranges of 15-60 years (Mean age 37.5 years). Infection was present in 79% of cases. The commonest organisms isolated according to culture report were E. Coli (30%), Proteus (19%), Klebsiella (11%), Pseudomonas (7%), Staphylococcus aureus (3%) etc. The frequency of renal stone disease in patients with urinary tract infection was 18.98%. (12.6% in male and 6.3% in female). Mean age of patients with renal stones was 31.26 years and male to female ratio was 1.5:1., Conclusion: Renal stone disease makes an important group among urinary stone diseases. Urinary tract infection with certain bacteria plays an important role in the synthesis of renal stones. A high incidence can be prevented by adopting a variety of simple conservative measures.

Background: Mesh Hernioplasty is the preferred surgical procedure for abdominal wall hernias and infection remains one of the most common complications of this technique. In some patients the mesh may need removal to overcome infection, where as others may be salvaged by conservative treatment. This study was conducted to assess the outcome of conservative management for mesh site infection in abdominal wall hernia repairs., Methods: This study was carried out in Ayub Teaching Hospital Abbottabad Pakistan from Jan 2006 to Dec 2007. Thirteen consecutive cases were included, who developed mesh site infection after abdominal wall hernia repair. Pus or purulent fluid was sent for culture and sensitivity. All patients were treated by intravenous antibiotics and local wound care. Treatment was taken as successful when there was complete resolution of infection and healing of the wound., Results: There were 7 inguinal (53.84%), 4 para-umbilical (30.76%) and 2 incisional hernias (15.38%). Eight patients were males (61.53%) and 5 females (38.46%). Median age of the patients was 40 years (range 28 to 52 years). Staphylococcus aureus was the most commonly found organism causing infection in 8 patients, (76.9%). Mean hospital stay was 22 days (range 18-26 days). All cases were effectively treated conservatively without removing the mesh. Polypropylene mesh was used in all of these cases., Conclusion: Conservative management is likely to be successful in mesh site infection in abdominal wall hernia repairs.

Background: This study was carried out to estimate the prevalence, severity and mode of splenic trauma and management technique from amongst the abdominal trauma cases admitted in Ayub Teaching Hospital., Methods: The study was carried out at Surgery units of Ayub Teaching Hospital, Abbottabad, the only referral hospital for major trauma cases, from July 2001 to Dec. 2002. One hundred consecutive abdominal trauma patients admitted to all surgical units which were followed up through complete documentation were included in the study. Their injuries were classified, treatment strategies outlined and complications were documented., Results: Out of the 100 patients presenting in emergency, 25% presented with blunt and 75% with penetrating trauma. 97 patients underwent laparotomy and 03 treated conservatively. Mean age was 27.26 (range 19-49) years. Out of these cases 19 patients had splenic injury, 6 (31.57%) with Type-I & II while 13 (68.42%) with Type-III & IV. 11(57.89%) of the splenic injuries were due to blunt abdominal trauma and 8 (42.10%) due to penetrating abdominal injuries. 14 (83.6%) of the patients with splenic injury underwent splenectomy and 5(26.3%) splenorrhaphy., Conclusion: The commonest cause of splenic injury was blunt abdominal trauma; Assessment of the severity of splenic injuries at the time of laparotomy resulted in splenic salvage procedures in some cases. Splenorraphy was associated with fewer complications.