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Objective: To study the etiology, diagnosis, treatment and complications of acute pancreatitis in a tertiary care hospital. Methodology: Study Design: It was a descriptive study. The study was conducted at Surgical Unit of Benazir Bhutto Hospital (BBH) Rawalpindi from 1st January 2014 to 31 July 2017. All the patients who presented in emergency with abdominal symptoms and diagnosed as a case of acute pancreatitis were included in the study. All the data of gender, age, serum amylase & lipase, etiology, CT severity index, Ranson's criteria, complications, mortality and management were noted on a predesigned proforma. Percentages and frequencies were calculated for all the data by SPSS 21 version. Results: Total 161 patients were included in the study, with 60.9% females and 39.1% males. Maximum patients 31% were from age group of 26 to 40 years of age and minimum 1.2% from 71 to 85 years. Gall stones were the major cause of the disease contributing 67% of cases. At admission Ranson's score of the maximum patients 32.2% had total score of 1, While only 1.2% had moderate pancreatitis. After 48 hours of admission 24.2% had 2 score while only 1.2%had severe pancreatitis. The radiological CT severity index 82.6% patients had mild pancreatitis while1.2% patients had severe disease. 93.1% patients were managed conservatively, 1.9% patients went Cystogastrostomy, 1.2% patients needed Exploratory laparotomy and 1.2% patients went for Pancreatic Necrosectomy. On calculating the morbidity 67.7% patients had no significant morbidity. 32.3% had complications including pleural effusion, ascites, pancreatic necrosis, pseudo cyst formation, shock, acute renal failure and multi organ failure. Overall mortality rate was 3.7%. Conclusion: Acute pancreatitis in our set up is mainly due to gall stones. A multidisciplinary approach, measurement of severity of disease with computerized tomography scan and Ranson's scoring system is always helpful in disease management and its complications. [ABSTRACT FROM AUTHOR]

Background and Objectives: Milligan Morgan Hemorrhoidectomy is one of the most commonly performed surgeries. Post-operative pain is the major cause of morbidity in post hemorrhoidectomy patients. Metronidazole has an established role in relieving post hemorrhoidectomy pain. The objective was to evaluate the pain score by using topical and oral metronidazole in post Milligan Morgan hemorrhoidectomy patients., Methods: A prospective randomized controlled trail was done in surgical departments of Akbar Niazi Teaching Hospital, Islamabad. A total of 166 consecutive patients with 3 rd and 4 th degree hemorrhoids were presenting in surgical OPD and who underwent Milligan Morgan hemorrhoidectomy between July 2018 and December 2018 were included in the study. Patients allocated in two groups, Group-A received topical metronidazole 10% post hemorrhoidectomy for seven days and Group-B were given oral metronidazole 400mg for 07 days. Analgesics were given on patient's requirement. Patients post hemorrhoidectomy pain was recorded by using VSA scale at baseline (1 st day) and on 7 th post-operative day. Data analysis was done by using SPSS 21. Pain calculated by compared in terms of mean, standard deviation between groups and independent sample T test was used. Association between demographic details like gender and ages of the patients with pain scale on 7 th day was measured and chi-square distribution was used., Results: Total 166 patients were included in this study. The mean ages of the patients were 44.07±10.62 years with minimum 20 and maximum 60 years. Out of 166 patients, female were 55 (33.1%) and male were 111 (66.9%). Results showed significantly lower pain in patients using topical metronidazole as compared to oral metronidazole ( p=0.001 ). Association of pain with respect to ages was insignificant ( p=0.202 ) whereas between genders inside the groups showed significant difference ( p=0.028 )., Conclusion: These results showed that topical metronidazole significantly reduces pain in post hemorrhoidectomy patients as compared to oral metronidazole overall and even when data stratified among age, gender and type of hemorrhoids., (Copyright: © Pakistan Journal of Medical Sciences.)