Abstract Background: Acute pancreatitis, secondary to gallstones, is a challenging situation in terms of decision regarding the timing of surgical intervention. There are studies which show no difference in terms of conversion rate, complication rate, and technical difficulty when timings of laparoscopic cholecystectomy (LC) are performed in acute biliary pancreatitis. The present study is done to evaluate the efficacy, safety, and outcome of early LC in patients of mild gallstone pancreatitis (GP) in index hospital admission. Patients and Methods: A total of 107 patients were included in the study. The patients having mild GP were classified as per Glasgow’s modification of Ranson’s criteria underwent LC in index admission, control group A, in which LC was carried out after interval of 6–8 weeks of discharge and control B group comprised patients of gallstones who do not have pancreatitis. Results: The adhesions were mostly fibrinous in the study group and fibrous in the control A group amounting to increased operating time in the control A group.A2- Increased GB thickness and GB wall edema found in patients of acute cholecystitis in study group amounted lesser chances of GB perforation and spillage of bile, better planes of dissection because of surrounding oedematous tissue and subsequently lesser operating time. No increased intraoperative complications were noted in the study group. The total duration of hospital stay was significantly reduced in the study group. Recurrent hospital admission was observed in the control A group due to other biliary events. Conclusion: LC in the index admission decreases hospital stay and prevents further attacks of pancreatitis in future. Proper selection, categorization of patients, and early operation are not associated with any increased anesthetic and surgical hazard.

Background: The COVID-19 pandemic has had a significant impact on public health, with governments and organizations implementing various interventions to control its spread. This study aimed to evaluate the impact of public health interventions on controlling the spread of COVID-19 in Lahore, Pakistan. Methods: Data on COVID-19 cases and public health interventions were collected from March 2020 to March 2022. The data were analyzed to evaluate the impact of each intervention on controlling the spread of COVID-19 in Lahore. Results: From March 2020 to March 2022, 6,710,142 COVID-19 tests were conducted in Lahore, with 518,393 cases testing positive for the virus. The contact tracing strategy involved tracing an average of 6.83 contacts per positive case in 2020, which increased over the year, and an average of 6.80 contacts per positive case in 2021, with a decrease in the second quarter of the year. The cordoning-off strategy was used to contain the spread of COVID-19 in over 340 areas of Lahore. Shutdowns of non-essential businesses and schools, guidelines for social distancing, and the use of PPE were also effective in reducing the transmission of COVID-19.

Background: The study focuses on the challenges faced by government officials in implementing public health interventions to control the spread of COVID-19 in the Lahore District, Pakistan. Material and Methods: This qualitative study used in-depth interviews to collect data from 45 government officials involved in implementing COVID-19 control measures in Lahore District. Results: The study identified several themes related to the challenges faced by government officials, including contact tracing and coordination, disease management and vaccination, public perception and engagement, international travellers management, and implementation strategies. Strategies implemented to address the challenges posed by the pandemic included the utilization of technology, provision of training to staff, coordination with other organizations, identification of high transmission areas, and targeting specific communities or populations at higher risk of infection. Conclusion: The effective management of the COVID-19 pandemic requires a coordinated and multi-faceted response that incorporates various strategies and practices aimed at controlling the spread of the disease and mitigating its impact on communities. The authors recommend prioritizing clear and consistent communication, community engagement, and capacity building in pandemic management strategies. Keywords: Covid-19 pandemic, government officials, public health interventions, contact tracing, vaccination, public perception, international travellers management

Background: Groin hernia surgery is one of the most common procedures performed by surgeons worldwide. With the advent of minimal access surgery, the procedure for repair is now done either by transabdominal preperitoneal approach Transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) approach. The advantage of one procedure over the other is still controversial. Objectives: This prospective study was conducted to find out the intraoperative and postoperative outcomes of TEP and TAPP for inguinal hernia repair in terms of operative time, intraoperative complications, conversion to open, visual analog scale (VAS) score, postoperative complications, length of hospital stay, and recurrence of hernia and chronic pain. Materials and Methods: A total of 88 patients of inguinal hernia enrolled prospectively between November 2017 and November 2019 and patients aged 18 years and above admitted in Jawaharlal Nehru Medical College and Hospital were included in this study. Forty-four patients were included in TEP group, while 44 patients were allocated to TAPP group. Results: The statistical analysis was done using Chi-square test and unpaired t-test, respectively. The mean operative time in TEP was 91.14 ± 11.14 min and in TAPP repair was 103.16 ± 6.79 min, which was found to be significantly significant. The mean pain score on VAS score on postoperative day 1 was 5.70 ± 0.95 in laparoscopic TEP group and 5.86 ± 0.97 in laparoscopic TAPP group. The mean pain score on VAS score on postoperative day 2 was 3 ± 1.27 in laparoscopic TEP group and 2.95 ± 1.29 in laparoscopic TAPP group. Similarly, the mean pain score on VAS scale on postoperative day 7 was 0.863 ± 1.26 in laparoscopic TEP group and 0.659 ± 1.21 in laparoscopic TAPP group. No significant difference was observed in VAS between TEP and TAPP groups during follow-up. Both TEP and TAPP mesh techniques were comparable in terms of the intraoperative complications and postoperative complications (seroma [during hospital stay, after 1 week of discharge, after 1 month of follow-up]; hematoma [during hospital stay, after 1 week of discharge]; wound infection) and in conversion to open and length of hospital stay. The difference in mean cost of surgery was found to be statistically significant. Conclusion: Although the mean operative time and cost of surgery were significantly more in TAPP than in TEP group, no significant difference could be found between the intraoperative and postoperative complication rates, conversion to open, and length of hospital stay. Recurrence was observed in one case of TEP groups during follow-up. Our study supports the view that both laparoscopic TEP and TAPP mesh repairs of inguinal hernia are safe and efficacious.

Aims: Damage of crop plants due to pathogenic attacks, postharvest crops spoilage and lethal effects of chemical pesticides has enforced scientists to find some potential natural alternative. Plants produce different types of antimicrobial peptides including defensins in response to biotic and abiotic stresses. Defensins are small cysteine rich, cationic peptide with 40-45 amino acid residues with a variety of biological activities. Hence defensins have pharmaceutical and agricultural significance especially wide range of antifungal activities. Methodology: Nine plant species viz Brassica napus, Brassica nigra, Conyza bonariensis, Alhagi marorum, Sonchus arvensis, Brassica compestris, Eruca sativa, Cirsium arvensis and Brassica juncea were selected for the study. Four set of primers were applied on extracted genomic DNAs and four amplified genes were isolated from different plants species by PCR. The amplified genes were cloned via pTZ57R/T in E.coli. The cloned fragments were sequenced and characterized by different bioinformatics tool such as coding length and peptide sequence, site of cell aggregation, peptide physico-chemical properties, antimicrobial properties and gene expression pattern. Result: The amplified products from B. napus, B. nigra, B. compestris, E. sativa and B. juncea were about 330 bp in length and showed upto 85% nucleotide homology to the reported defensins. Deduced amino acid sequence from Bn-Def, Es-Def Bj-Def and Bc- Def showed the conserved defensin domain. These sequences were also characterized for different characteristic like charged amino acids, pI value, shelflife and stability. Sonchus arvensis didn’t give any specific product by prescribed set of primers. However the products from Alhagi marorum was about 770 bp and B. napus was of 270 bp but both give homology below 30%. Conclusion: This study showed that in silico characterization of deduced antimicrobial peptides from different plant species has depicted these as an effective alternative to communal therapeutics. However, further work is needed to verify defensins specific activity at protein level.

Introduction: Major bile duct injury in laparoscopic cholecystectomy results in morbidity and needs further management, which adds to the increased cost of treatment. However, some studies have shown that by defining critical view of safety and seeing the relationship of Rouviere's sulcus with other structures, and minimal use of diathermy in Calot's triangle, we can bring down complications further close to zero percent. We wanted to see that such a low bile duct injury rate is achievable at every center by routinely following these steps. We retrospectively reviewed the database of patients who had undergone elective laparoscopic cholecystectomy (LC) in three years and evaluated the rate of bile duct injury and other complications.Methods: We reviewed our database for patients and did a retrospective analysis on patients who were diagnosed with symptomatic cholelithiasis or chronic cholecystitis, and have undergone LC in our centre from January 2017 to December 2019. Patients less than 15 years of age, acute cholecystitis, and laparoscopic cholecystectomy combined with common bile duct exploration were excluded. We calculated the incidence of biliary injury. The secondary outcomes looked at were Veress needle or pneumoperitoneum-related complications, port site bleeding, intra-abdominal bleeding, bowel injury, liver injury, wound infection, and early port site hernia.Results: LC was performed in 642 patients. In this study, there was no bile duct injury. Two patients (0.31%) had minor bile leak which resolved without any intervention within a week. Three (0.46%) patients developed port site infection, which responded to regular dressing and oral antibiotic therapy.Conclusion: The effectiveness of these steps should make their use mandatory in every center to reduce bile duct injury.

Introduction: Inguinal hernia surgery is now commonly performed laparoscopically all over the world either by transabdominal preperitoneal approach (TAPP) or totally extraperitoneal (TEP) approach. Because of the lack of consistency in comparative literature and data, further studies are required. Methods: This prospective study was conducted on 176 patients of age 18 years and older with an inguinal hernia, who were randomly allocated to TEP and TAPP groups respectively to determine the intraoperative and postoperative outcomes in terms of operative time, pain, intraoperative complication, and conversion to open surgery, postoperative complication, length of hospital stay, chronic pain and recurrence of the hernia. Results: The mean operative time was 91.14 ± 11.14 minutes in TEP and 103.16 ± 6.79 minutes in TAPP, which was found to be significant; The mean pain scores (Visual Analogue Scale) on postoperative day 1 and day 2 were 5.70 ± 0.95 and 3 ± 1.27 in the TEP group while it was 5.86 ± 0.97 and 2.95 ± 1.29 in the TAPP group respectively. There was no statistically significant difference between TEP and TAPP for postoperative pain, duration of hospital stay, time to return to work, chronic pain, and recurrences. TAPP was associated with a slightly longer operative time compared with TEP. Recurrence was observed in one case of the TEP group during follow-up. Conclusion: TEP and TAPP offer excellent treatment options for inguinal hernia repair with almost similar results. The outcome after either laparoscopic hernia repair was quite reasonably acceptable by the patients.

Introduction: Adrenal myelolipoma is a rare urological lesion, benign in nature, and composed of a variable mixture of mature adipose and hematopoietic elements. The true incidence of these tumours is not well known. Despite their benign biology, these lesions can be a cause of dilemma for a urologist; we describe a case of incidental diagnosis of adrenal myelolipoma in a patient who presented with upper abdominal pain and reviews the literature on its aetiology, diagnosis, and management. Finally, the optimal treatment for myelolipoma depends on the size and symptoms of the mass and the needs of the patient. Case Report: Here we present a case of a 60-year-old female who presented with chronic left-sided flank pain and right upper abdomen that had been worsening over the past three weeks. Conclusion: Myelolipoma is a rare, non-functional, benign tumour. Patients having high blood pressure don't respond well to antihypertensive. They respond effectively to the medication after the removal of the tumour. So we recommend that all patients with myelolipoma not responding well to non-surgical management should plan for surgery for a better outcome.

Bezoars are collection of foreign indigestible material accumulating in the gastrointestinal tract leading to intraluminal mass formation that impairs the gastrointestinal motility and can lead to obstruction of the small or the large bowel. These include phytobezoar, lactobezoar, pharmacobezoar, trichobezoar, and polybezoar. A trichobezoar is a mass of undigested hair within the gastrointestinal tract. Trichobezoars are seen in psychiatric young female with known to be trichophagic.

A foreign body in the rectum is not an uncommon encounter in current medical practice. In most cases, rectal foreign bodies are a result of sexual eroticism, sexual abuse, assault, or rarely, accidental involuntary insertion. It poses diagnostic difficulties and management challenges among medical professionals. The diagnostic approach usually involves careful history and physical and radiological examination. Here, we present the case of a 22-year-old man with a retained rectal foreign body for a duration of 3 hours. He presented with impacted foreign body per rectum, non-specific abdominal pain, abdominal mass, and non-passage of stool and flatus. Successful removal of the rectal foreign body was done manually under local anesthesia in the lithotomy position in the operation theatre.

1. Pneumatosis cystoides intestinalis. https://radiopaedia.org/articles/pneum atosis-cystoides-intestinalis. Accessed 28 Dec 2020. 2. Yamamoto S, Takahashi Y, Ishida H. Pneumatosis cystoides intestinalis. Ann Gastroenterol. 2020;33:541. https://doi.org/10.20524/aog.2020.0524. 3. Kaechele V, Seufferlein T, Pauls S. Electronic clinical challenges and images in GI pneumatosis cystoides intestinalis. Gastroenterology. 2008;135:e4–5. 4. Ling F, Guo D, Zhu L. Pneumatosis cystoides intestinalis: a case report and literature review. BMC Gastroenterol. 2019;19:176. 5. Ando T, Sakata J, Maruyama T, Hirose Y, Okabe Y, Takizawa K, et al. A case of pneumatosis cystoides intestinalis secondary to gefitinib therapy for lung adenocarcinoma. Gan To Kagaku Ryoho. 2015;42:847–9. 6. Uruga H, Moriguchi S, Takahashi Y, Ogawa K, Murase K, Mochizuki S, et al. Gefitinib successfully administered in a lung cancer patient with leptomeningeal carcinomatosis after erlotinib-induced pneumatosis intestinalis. BMC Cancer. 2018;18:825. 7. Nukii Y, Miyamoto A, Mochizuki S, Moriguchi S, Takahashi Y, Ogawa K, et al. Pneumatosis intestinalis induced by osimertinib in a patient with lung adenocarcinoma harbouring epidermal growth factor receptor gene mutation with simultaneously detected exon 19 deletion and T790 M point mutation: a case report. BMC Cancer. 2019;19:186. 8. Uryu K, Umakoshi T, Hyakutake T, Hasegawa Y, Asano K, Harada H. Pneumatosis cystoides intestinalis in a patient with lung cancer. Nihon Kokyuki Gakkai Zasshi. 2010;48:972–5. 9. Ohkuma K, Saraya T, Shimoda M, Takizawa H. A case of pneumatosis cystoides intestinalis. J Gen Fam Med. 2017;18:481–2.

Being motivated by a well-known Nash’s embedding theorem, Chen introduced a method to discover the relationship for the extrinsic invariants controlled by the intrinsic one. In this paper, we extend Chen’s inequality for the intrinsic and extrinsic invariants for pointwise bi-slant warped products in locally conformal Kaehler space forms with quarter-symmetric and semi-symmetric connections. The equality case of the inequality is also investigated. Several applications of the inequality are given. Furthermore, we provide two non-trivial examples of such immersions.

BACKGROUND:This study aimed to assess the effectiveness and safety of percutaneous needle aspiration (PNA) and percutaneous catheter drainage (PCD) in the treatment of liver abscess.METHODS:A prospective randomized study was conducted in the Department of Surgery, JN Medical College, Aligarh Muslim University, Aligarh, UP, India, between February 2018 and August 2019, after getting approval from the institutional ethics committee. A total of 543 patients with liver abscess were randomized into two groups using computer-generated randomization method. Appropriate details regarding patients' clinico-demographic profile and investigations were also collected. The effectiveness of either treatment was measured in terms of duration of intravenous antibiotic, clinical improvement, reduction in the size of cavity, treatment success rate, duration of hospital stay including long-term outcomes such as sonographic resolution of cavity and recurrence rate at 6 months post-treatment.RESULTS:The PCD group had statistically significant rate of duration of antibiotics need, days for clinical improvement and time for 50% reduction in abscess cavity and treatment success rate with comparable long-term outcomes.CONCLUSION:PCD is more efficient than PNA and can be used primarily in the treatment of both amoebic and pyogenic liver abscesses along with systemic antibiotics. However, PNA can serve as a safe alternative when PCD is not available.

Metastasis-associated in colon cancer-1 (MACC-1) is a newly identified tumor marker, found to express in various normal and cancerous tissue. This study is conducted to evaluate the serum MACC-1 level as a diagnostic marker for breast cancer (BC). Sixty new BC patients were included in this study. Patients who received neoadjuvant chemotherapy or with metastatic disease were excluded. Eighty patients of benign disease were taken as control group. All the patients were females with the mean age of 46.7 ± 10.6 years in study group and 40.2 ± 8.4 years in control group (p = 0.0001). The mean serum MACC-1 level in BC patients was 3.46 ± 1.3 ng/ml which was significantly higher than control mean serum MACC-1 level (1.90 ± 0.2 ng/ml) (p < 0.0001). On ROC analysis, the AUC was 0.98 (p ≤ 0.0001; 95% CI = 0.97-1.0) i.e., a good predictor for breast cancer. At the cut-off value of 2.12 ng/ml, the sensitivity and the specificity of serum MACC-1 were 96.7% and 92.5%, respectively. This study showed that serum MACC-1 can be a potential biomarker for diagnosis and tumor progression in patients with breast cancer.

Cholecystectomy is one of the commonest general surgical procedures performed all over India. The risk of bile duct injury (BDI) during laparoscopic cholecystectomy is two to three times higher than during open cholecystectomy. The worldwide incidence of bile duct injury is 0.5% or 1 in 200 cases. BDI and its consequences result in significant morbidity and may even cause mortality. BDI increases the cost of treatment and is a common reason for a medicolegal suit against the surgeons. To minimize the incidence of BDI and to manage it timely and appropriately, a set of guidelines was deemed necessary by a group of senior surgeons during a Society of Endoscopic and Laparoscopic Surgeons of India (SELSI) meeting in 2016. Guidelines for “Safe Laparoscopic Cholecystectomy” and bile duct injury management formulated by other international societies are already available. The applicability of these guidelines to Indian subjects especially in small peripheral centers was limited. Hence, a decision was taken to form a set of guidelines for general surgeons with basic laparoscopic skills with little or no advanced laparoscopic skills. Those working in a solo practice, nursing homes, and small private hospitals at talukas or districts should have “Safe Cholecystectomy” guidelines and management of BDI suitable to their situation. These guidelines were formed after three consensus meetings and have been approved by a SELSI Expert Group.

Background: Open fractures of tibia are high energy injuries which are normally treated by internal fixation, debridement and wound closure. These are often complicated by deep infection and pose a reconstructive challenge to orthopedic surgeons. Prognosis largely depends on initial bone displacement, soft-tissue injury, type of flap used and skills of the treating surgeon. Aim: To compare of outcome in coverage of open fractures of tibia with pedicled fasciocutaneous flaps and muscle flaps with overlying graft. Methods: This is a cross-sectional comparative study conducted at Lahore General Hospital, Lahore, Pakistan from January 2011 to January 2018. All the patients of Gustilo Anderson type IIIb, treated with flap repair by the author during this time period were included in this study. Proximal defects were covered with gastrocnemius muscle flap while middle and distal wounds of tibia were covered using soleus muscle flap. Results: Middle 1/3 of the tibia is the most common fracture site (n=14, 60.9%), followed by proximal 1/3 (n=7, 30.4%) and distal 1/3 (n=2, 8.7%). Significant correlations (.773, p-value <0.001) exist between flap size and length of hospital stay when adjusted for age of the patients. Conclusion: Pedicled fasciocutaneous flaps and muscle flaps with overlying graft are equally effective in the management of open tibial fractures.

Background: Tuberculosis (TB) is one of the top ten causes of death worldwide. Chest wall tuberculosis is not infrequently encountered in endemic areas although it is rare. Clinically it resembles pyogenic abscess or benign soft tissue tumors, making the diagnosis difficult particularly in the absence of warning signs. Case Report: A 45 year old male presented with gradually enlarging soft tissue mass in the right upper anterior thoracic wall. Fine needle aspiration suggested chronic granulomatous disease, histopathology confirmed chest wall tuberculosis. Patient responded to anti-tubercular therapy and surgery. Conclusion: Anti-tubercular treatment and adjunctive surgery are quite effective in chest wall tubercular cases.

Phyllodes tumours are uncommon breast tumours which account for less than 1% of all breast neoplasms. High-grade malignant phyllodes tumour is a very rare but aggressive breast malignancy and forms approximately 15-30% of all phyllodes tumours. The transformation of a benign fibroadenoma into a malignant phyllodes tumour in a teenaged female is even rarer. We report here an interesting case of malignant phyllodes tumour in a 14-year female patient who was operated twice previously with the diagnosis of complex fibroadenoma in the same breast. There was a large tumour involving whole of the breast and infiltrating the skin. The patient was operated and total mastectomy was done. Diagnosis was confirmed after histopathological examination and immunohistochemistry of the resected specimen. Patient received adjuvant radiotherapy and there was no recurrence on 6-month follow-up. Owing to the rare occurrence of malignant phyllodes tumour in this age group along with previous operations for complex fibroadenoma, this case is being reported here.

Introduction: The anastomotic leak occurs in approximately 3-15% of patients who undergo colon and rectal surgery and can lead to significant morbidity and mortality. Prophylactic Diverting Loop Ileostomy (DLI) is done at times to prevent the anastomotic leak in high risk intraperitoneal colonic anastomosis. The role of DLI to prevent intraperitoneal colonic anastomosis leak is not well defined and we present the first review of literature to address this subject. Aim: To do a literature review and study the role of prophylactic DLI for intraperitoneal colonic anastomosis. Materials and Methods: We searched the PubMed, Google Scholar and Cochrane Library database and also searched the reference of the relevant articles. After the extensive search, we got nine articles on this subject for review. Results: For destructive colon injury with hypotension requiring more than four units of packed red blood cells or with significant co-morbidities, the high risk anastomosis becomes safer with a prophylactic DLI. For patients with pathological perforations, DLI can be added to safeguard colonic anastomosis if there are two or more risk factors for anastomotic leak. Patients not falling in above groups may not require prophylactic DLI for intraperitoneal colonic anastomosis. Conclusion: Prophylactic DLI should be done to safeguard intraperitoneal colonic anastomosis only when there are multiple risk factors for the anastomotic leak.

Background: Infertility is a condition with psychological, economic, medical implications resulting in mental trauma, stress particularly in social set up like ours, with strong emphasis on child bearing. According to the International Committee for Monitoring Assisted Reproductive Technology, World Health Organization (WHO), Infertility is disease of reproductive system defined by failure to achieve the clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.Methods: This study was conducted in Department of Surgery in Jawaharlal Nehru Medical College, Aligarh from January 2017 to December 2017 on 120 patients to study the clinical profile, causes of male infertility and to evaluate the risk factors associated with it.Results: There were 54 (45%) patients with azoospermia and 66 (55%) had oligospermia. Out of them 52 (43.3%) had sperm counts of 1-8 millions/ml and 14 (11.6%) had sperm count between >9-15 millions/ml. 46 (38.3%) patients had low testosterone level. 86 of cases had motility <50% after one hour, remaining 34 had motility >50%. Out of 120 cases of male infertility, 12 (10%) had Obesity and rest 108 (90%) had normal BMI. Out of 120 cases of male infertility, 8 (6.6%) were known Diabetics rest 112 (93.3%) had normal blood sugar levels. Out of 120 cases of male infertility, 36 (30%) had Erectile dysfunction and rest 84 (70%) were normal.Conclusions: The study concluded that Erectile dysfunction was the most common cause of male infertility. Varicoceles and small sized testes were the most common clinical abnormalities seen in infertile males. Smoking, Alcohol and Tobacco use were frequently associated with most infertile males.