Background: Global regulatory bodies and the PM&DC (Pakistan Medical and Dental Council) share a competency framework that emphasizes the importance of graduates being effective communicators and collaborators in the healthcare system to achieve positive patient outcomes. However, due to unclear roles, conflicting power dynamics, and varying educational qualifications among healthcare professionals, effective interprofessional teamwork is often not realized, leading to suboptimal outcomes. Objective: To evaluate the attitudes and readiness of healthcare students towards inter-professional education. Methods: This comparative cross-sectional study was conducted from March to August 2020 by utilizing a prevalidated inventory called the Readiness of Interprofessional learning scale (RIPLS) to assess the readiness of students in healthcare programs. Data was collected using Google Forms, and the Kruskal-Wallis Test was employed to compare perceptions among the four groups. Results: 157 students completed the questionnaire, resulting in a response rate of 58%. All four groups demonstrated high readiness for mutual learning (mean rank=78.78) although physiotherapy students had higher scores (mean rank=79.36) compared to the other groups, while nursing students had the lowest scores (mean rank=77.92). Conclusion: The positive attitude of students towards interprofessional education and collaboration highlights the need for integration with other healthcare disciplines at both the curricular and co-curricular levels. Clinical case studies, problem-based learning, and simulations can be effective methods for fostering students' understanding of each profession's role.

Objective: To find out statistical significance of wound infection, use of absorbable suture material and obesity in causation of incisional hernia. Design: A case-control comparative study. Place and Duration of Study: Combined Military Hospitals Rawalpindi and Peshawar from 01 Jan 2000 to 31 Dec 2002. Subjects and Methods: In total 93 patients with incisional hernia were reviewed. A control group of 90 patients was also included in the study, which was operated during the same period who did not develop incisional hernia but had similar selection criteria otherwise. Patients of study group having post operative wound infection, in whom absorbable suture material was used and who were obese were cross tabulated with patients of control group having no incisional hernia, to identify statistically significant variables between these groups by calculating P value for these three factors. P value of < 0.01 was considered highly significant, P-value 0.05 as significant and P-value of >0.05 as insignificant or equivocal. Results: Out of 93 patients who developed incisional hernia 35 (37.6%) had postoperative wound infection. In control group 7 (7.8%) patients, out of 90 had post operative wound infection. The P value for post operative wound infection was < 0.01. It was statistically highly significant. In Study group chromic catgut, which is an absorbable suture, was used in 59 (63.4%) cases. Where as in control group chromic catgut was used in 10 (11.1%) patients and prolene was used in 80 (88.9%) patients. The P value for use of non absorbable suture material was < 0.01. It was statistically highly significant. There were 14 (15.05%) patients who were obese (weight more than 20% of the ideal weight) in the study group where as in control group 5 (5.6%) patients were overweight. The P value for obesity was >0.05. Its statistical significance was equivocal. Conclusion: Our study has shown that out of three incisional hernia factors under study, the wound infection and absorbable suture material were statistically most important factors. (P-value <0.01) and obesity was statistically insignificant (P-value >0.05).

The dental profession is an important segment of human health care services all over the world. Dental schools in Europe and United States have evolved their curriculum to keep abreast with advances in dentistry; like connective tissue biophysics and molecular engineering through an objectively structured and clinically oriented curriculum. However, dental education in our country is still mostly traditional. This article examines the new approaches to teaching and learning in dental schools/colleges that are shaping dental curriculum globally. Articles relating to curricular trends in dental education and advancement in the dental profession published between 2010-2020 were searched in medical search engines. However, few relevant articles published before this period were also consulted. The current trends in dental curricula show new teaching, learning, and assessment methods like small group discussions, case-based learning, competency-based learning, Inquiry-based teaching-learning, and peer-assisted learning. The curricular format is integrated and new innovative assessment techniques like the assessment of multiple systematic reviews (AMSTAR) are being employed. Virtual reality, interdisciplinary teaching, and distributed community models in dental education are being implemented. The emergence of COVID-19 has also affected dental education and as a result, e-learning formats and assessment techniques have become increasingly popular. Dental schools abroad have revamped their curriculum with the advances in newer technologies and research related to dentistry. There is a need to immediately update and redesign the present dental curriculum in our country as well.

Objective: To compare the efficacy of topical 0.2% glyceryl trinitrate (GTN) ointment with 2% Nifedipine ointment in healing of anal fissure. Study Design: Quasi experimental study. Place and Duration of Study: Department of Surgery, Combined Military Hospital (CMH) Dera Nawab Sahib, from Oct 2015 to Oct 2016. Methodology: A total of 330 patients were divided into two groups (group A and group B) with 165 patients in each group using lottery method. Patients in group A were treated with topical application of 0.2% glyceryl trinitrate ointment for four weeks while group B patients were treated with topical 0.2% nifedipine. Patients were followed up after four weeks of initiation of treatment and healing of fissure was assessed. Frequency of healing of fissure in both groups was calculated and compared. Results: Healing rate of anal fissure was found significantly higher in group B (79.4%) as compared to group A (63.6%). The p-value was found to be 0.002 which was statistically significant. However, gender had no effect on fissure healing (p-value 0.413). Conclusion: Topical 2% nifedipine ointment therapy was superior to 0.2% glyceryl trinitrate ointment in terms of healing of anal fissure.

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Objective: To study if concept mapping (CM) is a useful learning approach to enhance meaningful learning in final year medical students compared to traditional methods in an undergraduate medical college to improve learning of puberty disorders in Gynaecology. Study Design: Quasi experimental study. Place and Duration of Study: Army Medical College Rawalpindi, from Dec 2016 to Mar 2017. Methodology: The final year MBBS class was randomized into 2 groups of 100 each that were taught disorders of puberty using interactive lectures of 50 students. One was taught “disorders of puberty” by traditional lecture and the second by CM. There was Delphi agreement of the content of lecture and method of interaction by the faculty of Gynaecology. Multiple Choice Questions (MCQs), Extended matching Questions (EMQs) and Short Answer Questions (SAQs) were used to assess deep learning two days after lecture. Scores were compared individually and overall between the two groups to assess student‟s learning in the two groups. Results: Mean score of students in the intervention group was significantly higher than the control group (71.9% vs. 55% of total score, p<0.001). The difference of individual scores was more marked in MCQs, EMQs that dealt with pathophysiology and investigations and in SEQs that dealt more with treatment aspect of puberty disorders. Conclusion: CM method was more successful in learning as compared to lecture-based method. Students in CM group received statistically significant higher scores compared to control group. As a supplement to traditional teaching techniques concept maps promoted meaningful learning.

Objective: To determine the proposed level of sanctions by the students and the staff for professionalism lapses related to academic integrity in two Pakistani medical colleges. Study Design: Cross sectional study. Place and Duration of Study: Private Medical Colleges in the year 2013. Material and Methods: A stratified sample of 520 students, and 60 faculty members were invited to participate in this cross sectional study. A validated and customized version of Dundee Poly-professional Inventory–1 for use in Pakistani medical schools was used. The students were asked to indicate the appropriate level of sanctions (1-10) that should apply for the first time offence without circumstances that lessen the gravity of the offence. Results: The response rate of students and faculty was 92%, and 62% respectively. There was statistically significant difference between the students and the faculty (p<0.05) in recommended severity of punishment for 31 (68%) offences. Students considered that no punishment should be given for completing work for another student; accessing not permitted old exam papers or course work to assist in study; and photographing dissection or pro-section or cadaver material, whereas faculty thought these behaviors were punishable. They were stricter on recommended sanction for drinking alcohol over lunch and interviewing a patient in afternoon, by two levels. The faculty was more severe on punishments by at least one level for rest of the unprofessional behaviors. Conclusion: Pakistani faculty perceived the majority of behaviors more severely as compared to the students. Dundee Poly Professionalism Inventory-I can be used in Pakistan, and other South Asian countries to measure perceptions of severity of unprofessional behaviors related to academic integrity, that can help in forming code of conduct.

Objective: To find out the effect of computer based animations on learning of Physiology.Study Design: Randomized control trial.Place and Duration of Study: Army Medical College Rawalpindi, from Jan to Sep 2016.Material and Methods: Sixty students of first year MBBS class were selected through simple random sampling and then randomly assigned into two groups of 30 each; group I and II. A pre-test was given to both the groups to assess their basal knowledge about the systems to be taught. In 1st teaching session, experimental group was taught with and control without animations. In 2nd teaching session, control group became experimental and previously experimental group became control. After both the teaching sessions MCQ tests of C2, C3 and C4 level were given to the groups and marks obtained were compared.Results: There were 20 (33.3%) male and 40 (66.7%) female students with mean age of 18.92 ± 0.56 years. Comparison of pre-test scores confirmed that basal level of knowledge was equal between the two groups (p-value=0.19). Post-test score comparison showed that experimental group scored significantly higher marks as compared to the controls (p-value=0.001 for post-test I and 0.02 for post-test II).Conclusion: Level of understanding of student increases if they are shown computer based animations during the physiology lectures. Hence, animations have positive effect on student’s academic performance.

Objective: To determine the demotivating factors influencing the teacher’s motivation at Army Medical College from the faculty’s perspective. To identify the possible solutions to the demotivating factors influencing the teacher’s motivation from the faculty’s perspective. Study Design: Exploratory qualitative design. Place and Duration of Study: Army Medical College on 30 Jan 2016. Material and Methods: This study was conducted during the pre and post workshop sessions in order to explore the teacher’s motivation through faculty’s perspective at the Army Medical College. Purposive sampling was done and consisted of twenty teaching faculty members of undergraduate subjects and two qualified medical educationists. Results: This study has observed alleged barriers and supports to involve in the enhancement of motivation. Teachers’ perceptions identified the financial, incentive/promotional, time management, acknowledgement/ appreciation, formal training, multiple jobs and intrinsic motivation with lack of empowerment as the major demotivators. The commonest remedial solutions were suggested such as financial rewards, appreciation from head of department (HOD) and Principal. Certificate (Medal) for dedicated services, good working environment and provision of assurance and support with involvement in decision making. Conclusion: Perceived demotivators and solutions to engage in the improvement of teaching were identified as financial barriers, lack of time management and acknowledgement with no structured training of the faculty. Addressing these de motivators and reinforcing the solutions can lead to improvement in the faculty motivation.

Objective: To determine the postgraduate residents’ perception of their educational environment. Study Design: Descriptive cross-sectional study. Place and Duration of Study: Armed Forces Post Graduate Medical Institute (AFPGMI) Rawalpindi, in October 2014. The postgraduate training (residency) is being imparted in two military teaching hospitals and nine armed forces clinical institutes affiliated with AFPGMI. Material and Methods: Fifty-six residents enrolled with AFPGMI in various postgraduate training programs were included in this study. Twenty-nine residents were from medical and allied (general medicine, psychiatry, dermatology, rehabilitation medicine, military medicine) and twenty-seven from surgical and allied (general surgery, gynecology, ophthalmology, ENT, pathology, radiology) disciplines. An established instrument Dutch Residency Educational Climate Test (D-RECT) was administered to determine residents’ perspective on their learning environment. The survey form of each resident was analyzed to determine overall perception of educational climate addition to detailed analyses of perceptions regarding supervision, coaching and assessment, feedback, teamwork, peer collaboration, professional relation between consultants, adaptation of work to residents’ competence, role of consultants, formal education, role of specialty tutor/supervisor and patient sign-out. Descriptive and inferential statistics were applied on the data to draw interpretations using SPSS Version 20.0. Results: Overall 64% of residents had positive perception of learning environment. Except ‘feedback’ that was perceived more negative (50%) than positive (32%), other elements perceived positively but having notable negative perception (mean score of less than 3.6 on Likert scale) included work adaptation to residents’ competence (25%), coaching and assessment (23%), role of specialty tutor/supervisor (23%) and patients’ sign-out (21%). Educational climate perception by residents in “medical and allied” versus “surgical and allied” disciplines did not reveal any statistically significant difference (p-value > 0.05). Conclusion: The study highlights an overall positive learning climate at Armed Forces Post Graduate Medical Institute, but finds a need to provide regular structured feedback to residents during their training. To accomplish this end, periodic use of workplace based assessment tools is suggested.

BACKGROUND:Both Total and Subtotal Thyroidectomy are correct treatment options for symptomatic Euthyroid Multinodular Goitre. The choice depends upon surgeon's preference due to consideration of disadvantages like permanent hypothyroidism in Total Thyroidectomy and high chances of recurrence in Subtotal Thyroidectomy. Many surgeons believe that there is a higher incidence of Recurrent Laryngeal nerve injury in Total Thyroidectomy which affects their choice of surgery. This study aimed to compare the incidence of recurrent laryngeal nerve injury in total versus subtotal thyroidectomy.METHODS:This non randomized controlled trial was carried out at Department of Surgery and ENT of Ayub Teaching Hospital Abbottabad, and Combined Military Hospital Rawalpindi from 1st September 2013 to 30th August 2014. During the period of study, patients presenting in surgical outpatient department with euthyroid multinodular goitre having pressure symptoms requiring thyroidectomy were divided into two groups by convenience sampling with 87 patients in group 1 and 90 patients in group 2. Group-1 was subjected to total thyroidectomy and Group -2 underwent subtotal thyroidectomy. All the patients had preoperative Indirect Laryngoscopy examination and it was repeated postoperatively to check for injury to the recurrent laryngeal nerve.RESULTS:A total of 177 patients were included in the study. Out of these, 87 patients underwent total thyroidectomy (Group-1). Two of these patients developed recurrent laryngeal nerve injury (2.3%). In group-2 subjected to subtotal thyroidectomy, three of the patients developed recurrent laryngeal nerve injury (3.3%). The p-value was 0.678. The overall risk of injury to this nerve in both surgeries combined was 2.8%.CONCLUSIONS:There is no significant difference in the risk of recurrent laryngeal nerve damage in patients undergoing total versus subtotal thyroidectomy.

Objective: To evaluate the usefulness and safety of early versus late oral intake after appendectomy. Study Design: Randomized clinical trial. Place and Duration of Study: Combined Military Hospital Multan from August 2008 to February 2009. Material and Methods: One hundred patients with uncomplicated acute appendicitis, undergoing appendectomy under general anesthesia were included in the study and randomly divided into two equal groups. Early oral intake group (group A) was allowed fluids, when patients were out of effects of general anesthesia. Delayed fed (group B) was started oral fluids, on appearance of normal bowel sounds or passage of flatus. Low residue solid diet was started, after tolerance of oral fluids, in both groups. Results: Early oral intake resulted in start of solid diet earlier by average 9 hours; these patients had normal bowel sounds, and passed flatus, earlier, after 4 hours and 5 hours as compared to late feeding group. Six (12%) patients had mild ileus in early fed group whereas 4(8%) patients in delayed fed group had mild ileus. Thirty eight (76%) early fed patients were very satisfied, as compared to 29 (58%) delayed fed patients. The hospital stay was prolonged by 2 days in delayed fed group. Conclusion: Early oral feeding implemented after appendectomy is safe and effective, with a shortened hospital stay as the primary benefit in patients after appendectomy.

BACKGROUND:As a front line state in war against terror, Pakistan has been a victim of terrorism, for the last many years & Baluchistan has been the hub of all such terror activities. The objective of this study was to determine the incidence and type of injuries in mass casualties in terrorist activities in Baluchistan.METHODS:The study was done by the review of the record of all patients of terrorist attacks who were admitted in Combined Military Hospital (CMH) Quetta from 27th Aug 2012 to 31st Jul 2015. The final injuries sustained by the victims were documented in the patient charts after repeated examination. The data was collected from these patient charts. Data was analysed using SPSS-21. Frequency & percentages of different injuries was calculated to determine the injury pattern.RESULTS:A total of 3034 patients reported to the hospital (n-3034), 2228 were admitted (73.4%). Out of the injured, 1720 (56.69%) were patients of multi system trauma, whereas 1314 (43.3%) had a single site injury. Out of these 537 patients had fractures of long bones (17.6%), those with head & spinal injuries with neurological deficit were 455 (14.9%), 266 had abdominal injuries requiring surgical intervention (8.7%), 75 (2.47%) had thoracic injuries were whereas 25 (0.82%) were vascular injuries, requiring emergent limb saving surgeries. Sex ratio was M/F=5.7: 1 Mean hospital stay was 6.31 days.CONCLUSION:Majority of the injured had multisystem injuries; therefore the hospital should have a well-trained multi-disciplinary team of surgeons. In addition to general surgery, the subspecialties' should include orthopaedics, vascular, thoracic and neurosurgery.

OBJECTIVE:To evaluate the clinical efficacy of Negative Pressure Wound Therapy (NPWT) using Vacuum Assisted Closure (VAC) compared with Advanced Moist Wound Therapy (AMWT) to treat Diabetic Foot Ulcer (DFU).STUDY DESIGN:Randomized control trial.PLACE AND DURATION OF STUDY:Surgical Department, Combined Military Hospital (CMH) / Military Hospital (MH), Rawalpindi, from November 2010 to June 2012.METHODOLOGY:The study consisted of 278 patients, with 139 patients each in Group 'A' and 'B', who were subjected to AMWT and NPWT, respectively. Wound was assessed digitally every week for 2 weeks. Wound dimension and surface area were determined using University of Texas Health Centre at San Antonio (UTHCSA) image tool version 3.0. Efficacies of AMWT and NPWT were compared in terms of reduction in wound area over 2 weeks.RESULTS:Mean age of presentation in group A was 55.88 ± 10.97 years while in group B, it was 56.83 ± 11.3 (p=0.48). Mean duration of diabetes at presentation was 15.65 ± 4.86 and 15.96 ± 5.79 years in group A and B, respectively (p=0.74). Majority of patients had Wagner's grade 2 ulcer (82% in group A and 87.8% in group B, p= 0.18). Initial wound size in group A was 15.07 ± 2.92 cm2 and in group B 15.09 ± 2.81 cm2 (p = 0.95). Wound size measured after 2 weeks, treatment was in group A13.70 ± 2.92 cm2 and in group B 11.53 ± 2.78 cm2 (p < 0.001). Wound area reduction in both groups revealed statistically significant faster healing in group B as compared to group A (p < 0.001).CONCLUSION:NPWT using VAC was more efficacious than AMWT in the management of diabetic foot ulcers.

Objective: To compare the efficacy of fistulotomy versus fistulectomy in the treatment of low lying anal fistula in male patients. Study Design: Randomized clinical trial. Place and Duration of Study: Surgery Department, CMH Multan and CMH Malir, from Aug 2008 to Oct 2013. Patients and Methods: Study was done on 262 patients. Patients with anal fistula were divided by simple random allocation into groups A (fistulotomy) and B (fistulectomy). The patients with simple low anal fistula without any comorbids were included in the study and the patients with recurrent fistula, high fistula or those having any comorbid were excluded from the study. Data was analysed using SPSS 17. Descriptive statistics applied for both quantitative and qualitative variables. Mean and standard deviation for quantitative and frequencies and percentages for qualitative data. Results: Total 262 patients were selected having low lying anal fistula and operated as group A – fistulotomy and group B – fistulectomy, each group constituted of 131 patients each. The operating time was found to be shorter for group A (14.29+3.24 minutes) and group B (25.92 +3.60 minutes). The group A patients were discharged earlier (3.73 + 0.65 days) than group B (4.88 + 0.35 days). In group A incidence of postoperative bleeding (0.8%), infection (2.2%) and recurrence was (10.7%). While in group B bleeding (3.1%), infection (3.8%) and recurrence was (15.3%). Severity of postoperative pain (as assessed by Numeric Rating Scale) was higher in group B as compared to group A. The healing time was shorter in group A (4.04 + 0.33 weeks) as compared to group B (4.57 + 0.497 weeks) and the patients of group A returned to normal activity earlier (10.9 + 2.05 weeks) than group B patients (15.54 + 0.51 weeks). Conclusion: In male patients suffering from simple low lying anal fistulas, fistulotomy has a definitive superiority over fistulectomy and is recommended to be adopted as primary surgical modality for the treatment.

OBJECTIVE:To determine frequency of triple negative breast cancer (TNBC) in Pakistani women with respect to age. STUDY DESIGN:Observational study. PLACE AND DURATION OF STUDY:Armed Forces Institute of Pathology (AFIP), Rawalpindi, from July 2005 to July 2010. METHODOLOGY:Pathological records of all specimens of breast cancer were reviewed and data was obtained for estrogen receptor (ER), progesterone receptor (PR) and HER-2 neu receptor proteins. Specimens having complete record of all three proteins were included for analysis. TNBC was defined as those who were ER, PR and HER-2 neu negative. Overall frequency as well as frequency with respect to age was calculated. Descriptive and categorical variables were analyzed using SPSS version 17. RESULTS:Eight hundred and fifteen patients out of 4715 (17.28%) were found to be TNBC. Mean age of diagnosis of TNBC was found to be 46.26 ± 12.22 years of age while other breast cancers had a mean age 52.90 ± 9.78 years (p < 0.001). In the TNBC group, 537 patients (65.88%) were aged < 50 years while 278 patients (34.11%) were aged > 50 years while majority of patients with other breast cancers were elderly females (p < 0.001). CONCLUSION:TNBC comprised 17.28% of the breast cancers in Pakistani women diagnosed at the studied centre. A higher frequency of TNBC was noted in significantly younger patients.

BACKGROUND:Medical colleges want academic integrity in medical students. This will require measurement of professionalism. Dundee Poly-professionalism Inventory-1 is one of the few validated tools available to measure academic integrity. The purpose was to validate the Dundee Poly- professionalism Inventory-1 for use in Pakistan.METHODS:In this cross sectional study words and statements in the inventory that a majority of Pakistani students could not understand were replaced by simpler words, or sentences for better understanding of our students. Faculty reviewed the proposed sanctions for their appropriateness in the Pakistani setting. A stratified sample of 64 students, and 16 faculty members were invited to participate in the study.RESULTS:Out of 64 students, 57 students responded (Response rate 89%). Out of 16 faculty members, 12 responded (response rate 75%).The language of 8 statements in the inventory that a majority of students could not understand was changed. 50% or more of faculty members considered that the statements in the inventory were appropriate. 9 faculty members (75%) suggested, 'Making false entries in logbooks/signing such log books', and 10 faculty members (83%) suggested, 'Writing/getting signed false certificates' should be included in the inventory. These were included in the validated questionnaire. Similarly 50% or more of faculty considered that the different types of sanctions and that the levels of sanctions were appropriate.CONCLUSION:In this customised form the Dundee Poly Professionalism Inventory-I can be used in Pakistan, and other South Asian countries to assess professionalism related to academic integrity.

BACKGROUND:Cholecystectomy is the most frequently performed abdominal operation and currently laparoscopic cholecystectomy (LC) is considered gold standard being performed in 90% cases of symptomatic gallstones in USA since 1992. The aim of the study was to determine results obtained with LC at our setup.METHODS:This observational case series study was conducted in department of General Surgery, Combined Military Hospital, Rawalpindi, from August 2009 to August 2011. The study participants were patients of both gender aged 14-75 years undergoing LC. Surgery was performed by consultant as well as resident surgeon. Demographic variables, intraoperative findings, mean operation time, hospital stay, conversion rate, morbidity and mortality were evaluated. Factors influencing rate of conversion were also studied.RESULTS:A total of 504 patients were included. Mean age was 42.64 years (range 14-75 years) with a female: male ratio of 3.9:1.2. Comorbidities were found in 36.7% patients. Main indication of surgery was symptomatic cholelithiasis (78.57%). Mean operative time was 40.1 ± 6.9 minutes which increased to 75.12 ± 8.9 minutes in converted cases (p-value .000). Mean hospital stay was 1.89 ± 1.1 days that significantly increased in converted cases (5.7 ± 1.6 days) (p-value .000). Major surgical complications occurred in 3.17% patients. Common bile duct injury (CBDI) was found in 04 cases (0.79%). Conversion to laparotomy was required in 3.97% cases. Factors that influenced the rate of conversion included: age > 60 years, acute cholecystitis, coexisting diseases, ASA grade III/IV and inexperienced surgeon (p-value .000). Total complication rate was 3.56%, morbidity being 3.17% and mortality 0.39%.CONCLUSION:Laparoscopic cholecystectomy offers shorter hospital stay and low morbidity/mortality. The operative time is short and procedure is standard, safe and effective method both for uncomplicated and complicated cholelithiasis.

Background: Patients undergoing bowel surgery for any reason are prone to develop peritonitis as a result of anastomotic leak. It is controversial whether bowel preparation before surgery can prevent this complication. The aim of this study was to measure the frequency of anastomotic leak in prepared compared to un-prepared bowel.Material & Methods: This quasi experimental Trial was conducted at Department of Surgery, C.M.H Rawalpindi, from Jan to Jul 2009. Ninety six patients were randomly allocated in two equal groups, A and B by lottery method. Patients of Group A were prepared with NGT irrigation of bowel with saline on the evening before surgery. Patients of Group B were not prepared. Patients were observed for anastomotic leak post operatively. Frequency and percentage were determined for Gender, TLC, peri anastomotic fluid, peri-anastomotic abscess and fistula. All the values were assessed using Chi-square to determine significance at p<0.05.Results: Mean age of sample was 41.46+8.15. There were was 52(54.2%) males and 44 (45.8%) females. Anastomotic leak was seen in 14/96 (14.6%) patients. Frequency of anastomotic leak in groups A & B was 8(16.7%) & 6(12.5%) respectively p=0.56. Difference in the raised TLC (p=1.0), peri-anastomotic free fluid (p=0.50), peri-anastomotic abscess formation (p=0.23), and peri-anastomotic fistula formation (p=0.55), was 27.1%(n=13), 12.5%(n=6), 10.4%(n=5), 4.2%(n=2) respectively in group A and 27.1%(n=13), 8.3%(n=4), 4.2%(n=2), 2.1%(n=1) in group B.Conclusion: There is no difference in frequency of leakage of bowel anastomosis whether it is performed in prepared or un-prepared bowel.

Objective: To determine the most common clinical presentation and causative microorganism for acute appendicitis.Study Design: Descriptive.Place and duration of study: Department of Surgery, Combined Military Hospital Multan, from June 2002 to May 2004.Patients and Methods: Clinical features of all the patients, older than 5 years of age diagnosed with acute appendicitis were recorded. Patients presented with other pathology which mimic acute appendicitis were excluded from the study. Surgery was done under general anaesthesia. Appendices of all the patient as well as pus swabs from abdominal cavity were sent to the laboratory for histopathology and microbiological cultures to confirm the diagnoses of acute appendicitis and causative organism.Results: The mean age of 75 subjects was 32.56 ± 11.93 years. The most common symptom was pain in right iliac fossa (80 % cases) and the most common physical sign was tenderness (92% cases). Some of the patients(9.3%) had a histologically normal appendix. Maximum isolates on culture were E. coli.Conclusion: The most common presentation of acute appendicitis was pain in right iliac fossa while the most sensitive sign was tenderness. Proper history and sharp clinical examination is the key to diagnosis. The most frequent organism of appendicitis was Escherichia Coli.