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Necrotizing Enterocolitis (NEC) contributes significantly to a high neonatal death rate in Pakistan and other developing countries. A number of elements related to its development are modifiable and can be addressed. Objectives: To evaluate the frequency of NEC, its associated factors and outcome in preterm babies. Methods: This retrospective, cross-sectional study was conducted at Ziauddin University Hospital, Karachi. Medical records of admitted preterm newborns from 1st December 2020 till 1st December 2022 were reviewed and neonates meeting the modified Bell’s diagnostic criteria ,with NEC stage II and III were included. Data pertaining to antenatal period, delivery and postnatal course of the disease were recorded . Data analysis were done using SPSS version-20 and results expressed as frequencies and percentages. Chi square test was applied with p-value statistical significance set at

Hydrodissection, a technique used to treat nerve entrapments, involves injecting an anaesthetic, saline, or 5% dextrose in water to separate the nerve from the surrounding tissue. Objectives: To assess the efficacy of this technique in all patients undergoing difficult laparoscopic cholecystectomy in terms of operative time, haemorrhage, and intra-operative complications. Methods: A multicenter observational study was conducted at the department of surgery, PAF Faisal Hospital and Anis Bantva Trust Hospital Karachi. A total of 219 patients were included in this study who underwent laparoscopic cholecystectomy for symptomatic gall stones, with age ranging from 18-70 years, with intra-operative Cuschieri classification >1, using a non-probability sampling method. Results: This study included 219 patients from hospital records categorized as per intra-operative difficulty grading of Cuschieri from grade II-IV. The mean age of patients was 40.46 ±12.50 years, with an average duration of symptoms of 16.95 ± 8.73 days. There were 160 (73.1%) males and 59 (26.9%) females. About two-thirds of patients were admitted through the emergency department. The pre-operative and intraoperative diagnosis of patients was symptomatic cholelithiasis 76 (34.7%), acute on chronic cholecystitis (27.9%), chronic cholecystitis 57 (26.0%), empyema and mucocele gallbladder 11 (5%) each, and Gangrenous gallbladder 3 (1.4%) were recorded. Conclusion: This study showed a clear association of intra-operative complicated anatomy during laparoscopic cholecystectomy to its conversion to open cholecystectomy. Techniques of dissection are of significant importance to minimize injuries to vital structures

Background: Acute appendicitis is an inflammation of the vermiform appendix. Usually, the diagnosis is made on clinical evaluation and elevated leukocyte count (TLC). But in cases when the clinical diagnosis is indeterminate, additional assessment needs imaging. Despite the increased use of modern diagnostic modalities such as Sonography, computed tomography (CT), and diagnostic laparoscopy, the frequency of misdiagnosis of appendicitis has remained constant (15%) as has the rate of appendiceal rupture. Presently, some serum markers such as C-reactive protein (CRP), lactate, and bilirubin have been proposed as a diagnostic tools for appendicitis. When compared CRP, TLC and lactate are found less explicit than bilirubin as predictive markers for acute appendicitis and its complications. Objective: To determine the diagnostic accuracy of hyperbilirubinemia in diagnosing perforated appendix by taking per-operative findings as the gold standard. Material & methods: It is a cross-sectional survey conducted at the Surgery department at PAF Hospital Mushaf, Sargodha. The duration of the study was from 1st June 2018 to 1st December 2018. A total of 160 patients of both gender with acute appendicitis with Alvarado Score ≥ 7 were included. Patients with age less than 12 years, HBsAg & anti-HCV positive, history of jaundice, history of liver disease (e.g.: Crigler-Najjar, Gilbert syndrome, cirrhosis, hepatitis), the patient is alcoholic, history of hemolytic disorders (e.g.: thalassemia, spherocytosis), history of the biliary disease (e.g.: biliary stones, worm infestation, atresia, etc), history of gastrointestinal& hepato-pancreato biliary malignancy, patient with appendicular mass per-operatively and appendectomy performed incidentally or for other indications were excluded. All patients were tested by routine laboratory investigations including LFTs hyperbilirubinemia was recorded. All cases underwent appendectomy by the same surgical team& peri-operative findings were recorded & compared with pre-operative total bilirubin levels. Patients were categorized as true positive, true negative, false positive & false negative. Results: The age range in this study was from 12 to 60 years with a mean age of 35.231± 8.63 years and mean Pre-Op Bilirubin Levels was 0.812±0.72 mg/dl. Laboratory Findings (Bilirubin levels ≥ 1mg/dl) diagnosed 44(27.5%) patients and Per Operative Findings diagnosed 60(37.5%) patients with Perforated Appendix. Laboratory Findings (Bilirubin levels ≥ 1mg/dl) have shown a sensitivity of 50%, specificity of 86%, the diagnostic accuracy of 73%, PPV 68.18%, NPV 74.4%, (p=0.000) in the diagnosis of Perforated Appendix. Conclusion: It is concluded that serum bilirubin level was higher in patients with appendiceal perforation, it s a definite predictive potential in these cases. Therefore, acquiring SB values upon admission can be used in combination with more recent diagnostic tests such as CT scans n, ultrasonography to help determine the presence of perforation and thus assist in timely clinical management. Keywords: Perforated appendix, Hyperbilirubinemia, Diagnostic accuracy

Objective: To compare the efficacy of fistulotomy with marsupialization vs fistulotomy alone in the treatment of simple low lying anal fistula in terms of wound healing and postoperative pain. Study Design: Randomized control trial Place and Duration: Department of General Surgery, JPMC Karachi, duration of Study was 6 months from 23rd Aug 2020 to 23rd Feb 2021. Methodology: Sixty patients of either gender having ages 25-60 years presented with low anal fistula were included in this study. Detailed demographics were recorded after taking informed written consent from all the patients. Patients were divided in to two groups. Fistulotomy was performed on 30 patients in group A and fistulotomy with marsupialization was performed on 30 patients in group B. Patients were asked to choose envelop labelled treatment A and treatment B for the randomization. All patients were followed up on 24 hours after surgery and on weekly interval up to 4 weeks to determine the outcomes in terms of wound healing and pain score. Data was analyzed by SPSS 23.0. Results: In group A mean age of patients was 43.633+8.568 years while in group B mean age was 41.800+9.813 years. The mean Pain score after 24 hours in group A was 6.100+0.922 while in group B it was 5.033+0.718 with overall mean Pain score after 24 hours of 5.566+0.980. The mean Pain score after 5th day in group A was 4.266+0.639 while in group B it was 2.833+0.698 with overall mean Pain score after 5th day of 3.550+0.981. In Group A efficacy was achieved in 4 patients (6.7%) while in Group B efficacy was achieved in 14 (23.3%) patients. Conclusion: Marsupialization of the wound after fistulotomy for low anal fistula results in faster wound healing and less mean post operative pain as compare to fistulotomy alone. Keywords: Low Anal Fistula, Marsupialization, Fistulotomy, Pain, Wound Healing

Objective: To find out the exactfrequency of fungal nasal polyposis and its associated risk factors. Methods: A descriptive cross-sectional study was conducted atENT department of Jinnah Postgraduate medical center (JPMC) from August 2020 to March 2021. The demographic data, detailed history and clinical examination of all the participants were noted. Specimen was sent in formalin solution for histopathological examination while another was sent in normal saline for culture and sensitivity of fungal infection. Gomorri Methylamine Silver stain and Periodic Acid Schiff stain were used to confirm the fungal hyphae. Statistical Package for the Social Sciences (SPSS) version 20 was used to analyze the data. p-value of less than 0.05 was considered as significant. Results: The mean age of the study participants was 30.29 ± 11.42. On histopathological findings, the Fungal nasal polyposis was reported among 43% of the individual while remaining were having allergic type of polyps. Out of 84 positive fungal cases, about 65.7% were aspergillus while remaining 34.3% of mucormycosis. About 17.2% of the cases were having BMI less than 30 and have no significant association. It had been found that majority of patients (43%) were farmers while about 39.9% were immunocompromised. Very few of them (22.6%) were having personal history of allergy. Conclusion: There is a high frequency of fungal nasal polyposis that is 43% in current setup. The disease is multifactorial and is predominant in farmers and in immunocompromised individuals. Keywords: Nasal polyps, Fungal rhino-sinusitis, Chronic rhino-sinusitis, Fungal nasal polyposis

Objective This study aimed to determine the association of Apgar score with meconium staining of amniotic fluid in labor. Methodology A retrospective observational study was carried out through the non-probability convenient sampling technique at the Department of Obstetrics and Gynecology for a duration of six months. Only those women were selected who had more than 24 weeks of gestation period. The women were excluded on the basis of risk factors for fetal distress and breech in late labor. Results A total of 216 pregnant women were selected from the labor room in this study. The mean age of the women was 26.57±4.28 years. The gestational age of the women was 36.09±4.11 weeks. Moreover, the mean parity of pregnant women was 1.68±2.53. It has been observed that the women who had meconium staining, the neonates of 144(77.4%) women showed the Apgar score of less than six at one minute. However, for the women without meconium staining, the neonates of only 15(50%) women showed the Apgar score of less than six at the one-minute interval with a significant association (p=0.02). With respect to age groups, a significant association of meconium staining with Apgar score was noted in the 21-30 years age group, whereas, no significant association was seen in other age groups. Similarly, a significant association of meconium staining and Apgar score was noted in primiparous women, whereas, no significant association was noted in multiparous women. No significant association of Apgar score and meconium staining was seen with respect to the mode of delivery. Conclusion The study has found a relation between the Apgar score and meconium staining of amniotic fluid and reported that the Apgar score of less than six at one minute was significantly associated with meconium staining of amniotic fluid.

Paediatric heart transplantation recipients suffer an increased incidence of infectious, autoimmune and allergic problems. The relative roles of thymus excision and immunosuppressive treatments in contributing to these sequelae are not clear. We compared the immunological phenotypes of 25 heart transplant recipients (Tx), 10 children who underwent thymus excision during non-transplantation cardiac surgery (TE) and 25 age range-matched controls, in two age bands: 1-9 and 10-16 years. Significant differences from controls were seen mainly in the younger age band with Tx showing lower CD3 and CD4 cell counts whilst TE showed lower CD8 cell counts. Naïve T cell and recent thymic emigrant proportions and counts were significantly lower than controls in both groups in the lower age band. T cell recombination excision circle (TREC) levels were lower than controls in both groups in both age bands. There were no differences in regulatory T cells, but in those undergoing thymus excision in infancy, their proportions were higher in TE than Tx, a possible direct effect of immunosuppression. T cell receptor V beta spectratyping showed fewer peaks in both groups than in controls (predominantly in the older age band). Thymus excision in infancy was associated with lower CD8 cell counts and higher proportions of Tregs in TE compared to Tx. These data are consistent with thymus excision, particularly in infancy, being the most important influence on immunological phenotype after heart transplantation.

Introduction: The current practice standards demand achievement of cure along with preservation of voice and laryngeal anatomy. The recommended approaches for early stage glottic carcinoma are both laser surgery (LS) as well as radiotherapy (RT). Both modalities having some merits as well as demerits. So the objective of the study is to compare the outcome of early glottic cancer patients having laser resection with the patients who received radiation therapy. Study Design: Cross sectional study. Setting: Ziauddin Hospital. Period: January 2013 up to July 2017. Material and Methods: Patients aged 18 years and above with a history of constant hoarseness of voice from 2 months to 4 months were taken. Only the patients with stage 1 that is T1a or T1b squamous cell carcinoma of vocal cords with no nodal or distant metastasis (T1N0M0) were included. Results: A total of 25 patients were diagnosed with glottic cancer of stage T1N0M0. The mean age was 50.56 ± 11.8. Most of them were male with high prevalence of aggravating factors. Majority of patients had left sided vocal cord involvement. When comparing the both modalities, the results showed that Radiotherapy had more complications than Laser surgery. On follow-up visits, the complication with Radiotherapy subsides and larynx anatomy restored but there was no voice restoration in Laser surgery. Conclusion: It can be concluded that both treatment modalities including Laser Surgery and Radiotherapy had excellent outcome with good prognosis for voice. However, considering the survival rates, Radiotherapy showed bit superiority over Laser Surgery, despite its complications. Radiotherapy should be the first choice after diagnosing early stage of glottic carcinoma.

To assess the perceptions regarding basal bolus insulin injections and the changes in blood glucose levels and glycosylated hemoglobin (HbA1c) before and after 3 months of such treatment in diabetic patients.Quasi-experimental study.Department of Endocrinology, Liaquat National Hospital, Karachi, from December 2014 to March 2015.A total of 222 diabetic patients started on basal bolus insulin injection were enrolled and asked to answer 17 questions. Those with complications of diabetes were excluded. Fasting blood glucose (FBS), random blood glucose (RBS) and HbA1c levels were checked initially, and after 3 months of getting basal bolus insulin. Paired t-test and chi-square test were used for determining p-value with significance at p0.05.Majority (n=217, 97.7%) of the patients were previously taking other insulins. Before starting this treatment, the mean FBS was 260.5 ±52.2 mg/dl, RBS was 385.5 ±47.61 mg/dl and HbA1c was 12.76 ±1.92%. After 3 months of treatment, FBS improved to 117.9 ±14.2 mg/dl, RBS was 156.7 ±17.09 mg/dl and HbA1c was 7.72 ±4.41% (p0.001). Two hundred and sixteen (97.3%) patients believed that basal bolus insulin was started as their diabetes worsened; 157 (70.70%) thought that their blood glucose control would improve with the use of this form of insulin. One hundred and ninety four (87.4%) had fear of needle injections. Perceptions regarding hypoglycemia with this form of insulin were observed in 157 (70.7%). One hundred and twenty seven (84.1%) of the females and 51 (71.8%) of the males thought that the basal bolus insulin regimen was too expensive (p=0.032).There were many misconceptions in patients who were started on basal bolus insulin. Marked improvement in blood glucose levels and HbA1c were observed after the use of this regimen.

To assess the clinical presentations and short-term outcomes of patients with thyroiditis presenting to a tertiary care hospital in Karachi, Pakistan.Case series.Department of Endocrinology, Liaquat National Hospital, Karachi, from June 2014 to February 2015.Patients between 18 and 70 years of age with acute onset of thyroiditis confirmed on thyroid scan or clinical judgment presenting to the outpatient services were included in the study. Pregnant females, psychiatric patients and patients having other chronic illnesses were excluded from the study.A total of 26 patients with thyroiditis attended the endocrine clinic. Mean age of patients was 41.2 ± 11.12 years. There were 18 (69.2%) females. Clinical presentations were fever (65.4%), tender neck (23.1%), goiter (19.2%), localized tenderness in neck and palpable lymph nodes (26.9%). Major symptoms reported were: sore throat (69.2%), weight loss (38.5%), upper respiratory tract infection, thyroid pain, tremor, sweating and fever of unknown origin in 26.9% cases. All the patients had raised Erythrocyte Sedimentation Rate (ESR). Low Thyroid Stimulating Hormone (TSH)0.4 mlU/L was seen in 88.5% and 57.7% had raised Free T41.8 ng/dL. Complete recovery was seen in 88.5% patients while 11.5% had early hypothyroidism.Fever and sore throat were the main presenting features of thyroiditis patients. ESR was raised in all patients. A majority of patients had complete recovery with appropriate management; however, few cases developed hypothyroidism.