Services Institute of Medical Sciences (Urdu:سروسز انسٹیٹوٹ آف میڈیکل سائنسز), established in 2003, is a public medical school located in Lahore. Services Hospital and Punjab Institute of Mental Health are the affiliated teaching hospitals. It is officially abbreviated as SIMS.The college admits students on open merit and is granted through a centralized Medical College Admission Test conducted annually by the Pakistan Medical Commission. In case of foreign students, the admission is processed through the Higher Education Commission of Pakistan.
Anastomotic leak (AL) is a feared complication of colorectal surgery, associated with high morbidity, mortality and adverse oncologic outcomes. Despite advances in perioperative care, its incidence remains significant, and prevention is a central challenge in modern colorectal practice. This review summarizes the current evidence on AL with a focus on risk factors, diagnostic considerations and preventive strategies. Patient-related risks include malnutrition, comorbidities, lifestyle factors and, more recently, alterations in the gut microbiota. Intraoperative contributors involve technical aspects of anastomosis construction, adequacy of vascular perfusion and procedure complexity, while postoperative risks relate primarily to delayed recognition and insufficient recovery pathways. Preventive measures span the entire perioperative continuum. Nutritional optimization, risk stratification and modulation of the microbiota represent key preoperative interventions. Intraoperatively, strategies emphasize meticulous technique, assessment of perfusion with emerging technologies and selective use of protective measures such as diverting stomas or transanal tubes. Postoperatively, standardized surveillance and adherence to enhanced recovery protocols are critical for early detection and mitigation of complications. Taken together, the evidence underscores that AL is a multifactorial complication requiring a multimodal prevention strategy. This review provides a structured overview of established knowledge and highlights evolving concepts, with the goal of informing both clinical decision-making and future research.
Background: Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are used as hematological markers of systemic inflammation. However, their performance compared with conventional biomarkers i.e., erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) requires further investigation. This study assesses the association and diagnostic performance of NLR and PLR against ESR and CRP-defined systemic inflammation. Methods: In this cross-sectional analytical study, 4,553 eligible individuals were enrolled and their laboratory data was noted. Correlation of NLR and PLR with ESR and CRP was tested by applying Spearman’s rank correlation. After categorizing participants into normal and inflammatory group on basis of their ESR and/or CRP status, differences in their NLR and PLR values were assessed using the independent t-test. The diagnostic ability of NLR and PLR to discriminate ESR and/or CRP defined inflammation was analyzed using receiver operating characteristic (ROC) curve. Multivariable logistic regression was applied to test their independent association with systemic inflammation, after adjustment for confounding factors such as age, gender and hemoglobin. Results: NLR and PLR were significantly correlated with ESR and CRP (p<0.001) Participants in the inflammatory group had higher NLR and PLR as compared to those in the normal group. ROC demonstrated the limited discriminatory ability of NLR (AUC=0.574, 95% CI: 0.557–0.591) and PLR (AUC=0.552, 95% CI: 0.535–0.569). Multivariable binary logistic regression showed NLR as independent predictor of systemic inflammation (OR: 1.230, p<0.001) while PLR did not show predictive utility (OR: 1.001, p=0.228). Conclusion: NLR demonstrated a stronger and independent association with systemic inflammation compared to PLR. However, given their limited diagnostic accuracy, NLR should be used as a supportive marker in screening for inflammation. Neither NLR nor PLR can fully replace ESR and CRP
Retroperitoneal lymph node dissection (RPLND) remains a fundamental pillar in the treatment of selected patients with testicular cancer, particularly nonseminomatous germ cell tumours (NSGCT). While open RPLND has traditionally been regarded as the standard of care, it is linked to substantial perioperative morbidity. Robotic-assisted RPLND (R-RPLND) has been introduced as a minimally invasive option; however, evidence remains largely observational, and its comparative benefits over non-robotic approaches require further clarification. PubMed, Embase, and Google Scholar were searched from inception to August 2025 for comparative studies evaluating R-RPLND versus non-robotic RPLND (open or laparoscopic) in patients with testicular cancer. Randomized trials and cohort studies reporting perioperative or oncologic outcomes were included. Pooled effect estimates were calculated using fixed- or random-effects models based on heterogeneity. Outcomes assessed included estimated blood loss, transfusion rate, length of hospital stay, operative time, lymph node yield, postoperative complications (including ejaculatory dysfunction), and recurrence. Fourteen comparative cohort studies encompassing 7,908 patients were included. Compared with non-robotic RPLND, R-RPLND was associated with significantly reduced estimated blood loss (mean difference − 362.99 mL, p = 0.0035), lower transfusion rates (risk ratio 0.12, p < 0.0001), and shorter hospital stay (mean difference − 5.40 days, p < 0.0001). No statistically significant differences were observed between groups in operative time, lymph node yield, overall postoperative complications, postoperative ejaculatory dysfunction, or recurrence rates. Considerable heterogeneity was observed across several perioperative outcomes, although sensitivity analyses confirmed the robustness of the pooled estimates. Robotic-assisted RPLND offers meaningful perioperative advantages over non-robotic approaches, including reduced blood loss, transfusion requirements, and length of hospitalization, while maintaining comparable oncologic and functional outcomes. These findings support R-RPLND as a safe and effective alternative to conventional techniques in appropriately selected patients. However, further prospective multicenter studies are warranted to address residual heterogeneity and to evaluate long-term outcomes.
Aims: Aggression in psychiatric inpatients is a frequent challenge that threatens staff safety and patient well-being. Although guidelines recommend verbal de-escalation as the first-line approach, restrictive practices such as chemical and physical restraints are often overused. Methods: A retrospective review of patient records was conducted at the Services Hospital Lahore psychiatry ward (January–June 2022). Data were compared against NICE NG10 and Maudsley prescribing guidelines. Results: A total of 30 inpatients were included (66.7% male, mean age 35.4 ± 11.6 years). Diagnoses included substance-related disorders (50%), schizophrenia/psychosis (40%), mood disorders (10%), and dissociative disorders (10%). All patients (100%) were managed with chemical restraints as first-line intervention; 20% also required physical restraints. None received verbal de-escalation first. Reasons included fear of patient violence (40%), rapid availability of medication (40%), and lack of staff training (20%). Conclusion: There is systemic over-reliance on chemical restraints in this setting, with minimal use of evidence-based de-escalation. Staff training and guideline adherence are urgently required.
