Objective: To evaluate the mean post-operative pain scores of patients undergoing laparoscopic-assisted bilateral dual transversus abdominis plane (TAP) block in laparoscopic cholecystectomy. Study Design: Observational study. Setting: Department of Surgery, Unit 1, Services Hospital Lahore, Pakistan. Period: February 2022 to August 2023. Methods: Non-probability consecutive sampling was used to recruit participants. The study included 60 patients aged 18 to 80 years undergoing elective laparoscopic cholecystectomy for symptomatic gallstones. Selection was restricted to those classified as ASA I and II, regardless of gender. Patients who required conversion to open cholecystectomy, had a known allergy to bupivacaine, were diagnosed with "chronic pain syndrome," or were known alcohol or substance abusers within the past six months were excluded from the study. After obtaining informed consent, the patients were randomly assigned to two groups, Group A and Group B, using a random number table. Patients in Group A received a laparoscopic dual TAP block, while those in Group B did not receive any TAP block. Post-operatively all patients received injection paracetamol 1gram intravenously thrice a day as baseline analgesia. Each patient was followed till 24 hours post-operatively at which postoperative VAS score was noted. The data were entered and analyzed using SPSS version 23.0. Results: Mean age was 46.45 ± 14.06 years with 13 (21.67%) male and 47 (78.33%) female. The mean BMI of the participants was 29.02 ± 3.12 kg/m². The mean duration of surgery was 31.53 ± 5.43 minutes for Group A and 32.63 ± 5.95 minutes for Group B. The mean post-operative VAS score in Group A (laparoscopic dual TAP block) was 1.63 ± 0.85, compared to 4.47 ± 1.07 in Group B (control), with a p-value of 0.001, indicating statistical significance. Conclusions: Postoperative pain score was less after laparoscopic-assisted bilateral dual TAP block in laparoscopic cholecystectomy as compared to controls.

Objective: To compare the mean length of hospital stay and frequency of conversion from laparoscopic to open in early versus delayed cholecystectomy in patients with moderate acute biliary pancreatitis. Study Design: Randomized Clinical Trial. Setting: Department of Surgery in Mayo Hospital Lahore. Period: 02-04-2022 to 02-04-2023. Methods: All the patients meeting the required criteria were included in the study. Patients were admitted through surgical emergency. Procedure was explained to patients/guardian and informed consent was taken. Patients were randomized by lottery method into two groups. Group A (early cholecystectomy EC) and group B (delayed cholecystectomy DC). Patients were operated and assessed postoperatively by the same operating surgeon to minimize the bias. Data of these patients was collected using a predesigned pro-forma containing details about demographic profile of the patient and severity of the disease. Duration of hospital stay of every patient in each group will be recorded. Frequency of conversion from laparoscopic to open cholecystectomy was noted. Smoking and BMI was taken as confounders. Results: Total of 60 patients (30 in each), mean age of EC group was 45.33±3.79 years and mean age of DC group 46.60±4.14 years. Distribution of BMI was 25.41+ 3.66 kg/m2 in early cholecystectomy group and 29.68+6.53 in delayed cholecystectomy group. (p=0.003) There were 52.0% (n=13) male in EC group and 48.6% (n=17) females in EC group and 48.0% (n=12) male in DC group and 51.4% (n=18) females. (p= 1.000). Mean length of hospital stay was 5.36+ 0.76 days in early cholecystectomy group and 8.96+0.76 days in delayed cholecystectomy group. (p=0.000), 22.2% (n=4) had conversion to open cholecystectomy in EC group and 77.8% (n=14) in DC group. Conclusion: We concluded that early laparoscopic cholecystectomy reduced the hospital stay and conversion to open cholecystectomy in patients with moderate acute biliary pancreatitis.

OBJECTIVE:To determine the console time and safety of robotic-assisted cholecystectomy using the Versius system. STUDY DESIGN:An observational study. Place and Duration of the Study: Department of Surgery, National Hospital and Medical Centre, Lahore, Pakistan, from May 2022 to March 2024. METHODOLOGY:Cases of robotic-assisted cholecystectomy were reviewed. Prospective data was collected. Informed consent regarding surgery and the use of clinical data was obtained. Confidentiality of patient information was maintained. Perioperative variables and postoperative follow-up were recorded, and 90-day morbidity, readmission, and mortality were noted. RESULTS:A total of 156 cases of robotic-assisted cholecystectomy were performed. Most of the patients were female (n = 115, 73.71%). The overall mean console time was 63.04 ± 33.14 minutes. There were no readmissions, mortality, or 90-day morbidity. Only one patient (0.61%) had a bleeding complication, requiring laparoscopic exploration. CONCLUSION:In appropriately selected cases, robotic-assisted cholecystectomy surgery is safe, and its short-term outcomes are comparable to laparoscopic surgery. Console time is influenced by patient gender and gallbladder characteristics. KEY WORDS:Robotic-assisted, Cholecystectomy, Pakistan, Initial experience, Versius system.

[This retracts the article DOI: 10.7759/cureus.72085.].

Alzheimer's disease (AD) has been recognized as the most important cause of dementia, which is estimated to contribute more than 2 trillion USD in medical costs. AD patients encounter progressive neurodegenerative dementia associated with behavioural, linguistic, and visuospatial deficits. Although studies on the discovery of amyloid β (Aβ) and tau (the essential elements of plaques and tangles in AD) have shed light on the molecular pathological processes of AD, the exact cause of the condition is still largely unknown. The involvement of various proteins, such as amyloid-β, prion protein, tau, and α-synuclein has been linked to AD pathogenesis. The current AD treatments are mainly based on symptomatic management and restoration of neurotransmitters' balance. There is a significant need to develop medications that can alter the underlying disease process and prevent its progression. The present manuscript provides a review of various hypotheses that have been proposed for AD pathogenesis. The manuscript has also explored the development of novel anti-AD drugs based on various pathogenic pathways, which are recently under various clinical trial phases.

Cancer stem cells (CSCs) have become a key player in the growth of tumors, the spread of cancer, and the resistance to therapeutic interventions. Targeting these elusive cell populations has the potential to fundamentally alter cancer treatment plans. CSCs, also known as tumor-initiating cells (TICs), are thought to play a role in both medication resistance and cancer recurrence. This is explained by their capacity to regenerate themselves and change into different kinds of cancer cells. Due to their higher expression of ATP-binding cassette (ABC) membrane transporters, enhanced epithelial to mesenchymal (EMT) characteristics, improved immune evasion, activation of survival signaling pathways, and improved DNA repair mechanisms, CSCs exhibit extraordinary resistance to therapies. This comprehensive analysis delves into advancements in the domain of Targeted Cancer Stem Cell Therapeutics, concentrating on unraveling the distinctive traits of CSCs and the therapeutic methods devised to eliminate them.

Malnutrition in Pakistan is cause of concern which is affecting everyone regardless of age and gender. The situation for women and children is even more alarming and prevalence of malnutrition in Pakistan exceeds against other developing countries. The poor and underprivileged populations in Sindh, Balochistan, KPK and South Punjab are severely affected by undernutrition of macro and micronutrients. Despite continuous efforts, malnutrition in certain areas of Pakistan is on surge due to many factors. Poverty, lack of sufficient nutritious food coupled with lack of food diversity are main factors of undernutrition in Pakistan. Amaranth is a climate resilient; drought tolerant plant and it can be produced with minimal number of resources even in poor soils. The adaptability and nutritional value of 25 exotic vegetable amaranth genotypes were investigated using standard analytical approaches in order to evaluate the several possibilities of the plant leaves in underprivileged population of Pakistan. The study discovered that exotic amaranth genotypes produce abundant green matter with optimum moisture contents and number of leaves per plant with good height. The investigation for nutrients disclosed the maximum ash content, crude protein, crude fat, crude fiber and carbohydrate from the leaves as (4.32 g 100g−1 FW), (6.76 g 100g−1 FW), (0.66 g 100g−1 FW), (4.29 g 100g−1 FW) and (18.19 g 100g−1 FW) respectively in different genotypes. The maximum energy yielded in calories was 407.41 (kJ 100g−1 FW). Elemental breakdown was performed in (mg g−1 DW) and it indicated that the leaves contained maximum potassium (15.52 mg g−1 DW), calcium (11.11 mg g−1 DW), Magnesium (9.67 mg g−1 DW), Iron (0.24 mg g−1 DW), Zinc (0.18 mg g−1 DW) and phosphorus (5.85 mg g−1 DW) in different genotypes under investigation. Comparing the nutrients in exotic vegetable amaranth genotypes with recommended dietary allowance (RDA) values, the outcomes expose that the leaves of amaranth contain substantial amount of important nutrients that are crucial in combating malnutrition in underprivileged populations in Pakistan.

This quasi-experimental prospective study comparing the postoperative pain scores in patients undergoing Robotic Cholecystectomy versus those undergoing Laparoscopic Cholecystectomy was done after getting the IRB approval at Department of General Study, National Hospital and Medical Centre, Lahore, Pakistan for a period of six months, from 02-02-2025 to 01-08-2025. Eighty eight patients undergoing elective cholecystectomy were included in the study. Each group had 44 patients and randomization was not possible since this is a private setup and the procedural costs were borne by the patients themselves. Patient characteristics and comorbid conditions were noted and pain scores recorded for each group at 6, 12 and 24 h postoperatively. Patient characteristics, comorbid conditions and postoperative analgesia were similar in both groups. The Robotic Cholecystectomy (RC) group showed much less postoperative visual analogue scores (VAS) than the Laparoscopic Cholecystectomy (LC) group (1.43 ± 0.42 vs. 2.78 ± 0.56, p < 0.005). Median operative time was less in RC group than LC group (65 (15) minutes vs. 75 (10) minutes, p = 0.010), although the total procedure time was longer in the RC group. Hospital stay was similar in both groups. Robotic Cholecystectomy (RC) is associated with a significantly reduced postoperative pain as compared to Laparoscopic Cholecystectomy (LC).

Stroke rehabilitation faces challenges in attaining enduring improvements in hand motor function and is frequently constrained by interventional limitations. This research aims to present an innovative approach to the integration of cognitive engagement within visual feedback incorporated into fully immersive virtual reality (VR) based games to achieve enduring improvements. These innovative aspects of interaction provide more functional advantages beyond motivation to efficiently execute repeatedly hand motor tasks. The effectiveness of virtual reality games incorporated with innovative aspects has been investigated for improvements in hand motor functions. A randomized controlled trial was conducted, a total of (n=56) subacute stroke patients were assessed for eligibility and (n=52) patients fulfilled the inclusion criteria. (n=26) patients were assigned to the experimental group and (n=26) patients were assigned to the control group. VR intervention involves four VR based games, developed based on hand movements including flexion/extension, close/open, supination/pronation and pinch. All patients got therapy of 24 sessions, lasting 4 days/week for a total of 6 weeks. Five clinical outcome measures were Fugl- Meyer Assessment-Upper Extremity, Action Research Arm Test, Box and Block Test, Modified Barthel Index, and Stroke-Specific Quality of Life were assessed to evaluate patients' performance. Results revealed that after therapy there was significant improvement between the groups (p<0.05) and within groups (p<0.05) in all assessment weeks in all clinical outcome measures however, improvement was observed significantly greater in the experimental group due to fully immersive VR-based games. Results indicated that cognitive engagement within visual feedback incorporated in VR-based hand games effectively improved hand motor functions.

BackgroundColostrum contains numerous bioactive proteins, required to develop the passive immune system of neonates. The composition of colostrum varies with lactations and the number of bioactive components also changes in due course. Most of the colostrum and milk proteins contain glycosylated components that affect the functionality of these proteins. The glycosylation pattern of these proteins also changes with lactations from colostrum to the mature milk.Scope and ApproachGlycosylation has a crucial effect on many biological activities of colostrum proteins. The glycosylated components of these proteins avoid pathogenic infections by reducing the cell adhesion and internalization abilities of bacteria and viruses. Exploring the changes in glycosylation of colostrum proteins during lactation can help to understand the pathogenic inhibitory activity of these proteins.Key Findings and ConclusionThe pathogen-host cell interactions are the basic key to starting the infection, internalization and proliferation of pathogens. The colostrum contains higher amount of glycosylated components as compared to mature milk which decreases significantly in the first week of lactation. The colostrum glycoproteins have antiviral and antibacterial properties against many strains. The variation in glycosylation pattern with lactations could be utilized to modify these interactions between host cells and pathogens to avoid the infection to enhance the immune system. These interactions can also help to develop novel drugs to cure different infections and diseases.

Underactive Thyroid Phase or Hypothyroidism is a very common biochemical complication after sub-total thyroidectomy. Objectives: To investigate lipid profile and liver function in patients who developed hypothyroidism following sub-total thyroidectomy. Methods: Total 100 individuals were selected for present study and divided them into two different groups i.e. Group-A in which 37 healthy individuals were placed whereas in Group-B 63 individuals were adopted surgical process, sub-total thyroidectomy. The study was conducted in Surgical and Medical Units of Ghurki Trust & Teaching Hospital, Lahore from December 2023 to April 2024. Thyroid-stimulating hormone (TSH) levels were extremely high in individuals in the hypothyroid stage. Results: The comparative findings of this study showed a significant (p < 0.05) change in cholesterol, triglyceride, LDL and HDL blood serum levels of Group-B individuals as compared to the Group-B. While a significant (p < 0.05) amplification in enzymes of liver such as aspartate aminotransferase (AST), alanine transaminase (ALT), and decrease in alkaline phosphatase (ALP) in Group-B subjects were seen as compared to normal individuals. Conclusions: Sub-total thyroidectomy is associated with hypothyroidism, which correlates with disruptions in liver enzyme activity and lipid metabolism, potentially leading to secondary hyperlipidemia and liver dysfunction.

Objectives Laparoscopic intraperitoneal onlay mesh hernioplasty (IPOM) for ventral hernias has been used for a long time. However, there have been some issues associated with it, thereby leading to the introduction of a new technique that involves laparoscopic closure of the fascial defect with suture followed by intraperitoneal onlay mesh placement (IPOM-Plus). We carried out this study to compare the outcome of laparoscopic IPOM with fascial defect closure versus without defect closure in midline ventral hernia repair in terms of recurrence. Methodology This comparative study was carried out in the Department of Surgery, Services Hospital, Lahore, from October 16, 2020, to April 15, 2022. A total of 84 patients of both genders, aged between 18 and 70 years, presenting with midline ventral hernia were included in the study. Patients with recurrent hernia, unstable cardiopulmonary conditions, neurological or psychiatric diseases, chronic renal disease, congestive cardiac failure, and chronic obstructive pulmonary disease (COPD) were excluded from the study. Patients were assigned to two groups. Group 1 underwent IPOM with the closure of the defect, and Group 2 underwent IPOM without the closure of the defect. Patients were observed for immediate postoperative complications. Patients were monitored for one year to assess recurrence through clinical evaluation and ultrasonography. Results In this study, seroma formation was found in 3 (7.14%) patients for laparoscopic IPOM with fascial defect closure and 10 (23.81%) in those undergoing laparoscopic IPOM without defect closure (P-value = 0.035). Recurrence was identified in 2 (4.76%) patients undergoing laparoscopic IPOM with fascial defect closure and 9 (21.43%) in those undergoing laparoscopic IPOM without defect closure (P-value = 0.024). Conclusions This study concluded that the frequency of recurrence is less after laparoscopic IPOM with fascial defect closure in midline ventral hernia repair than after laparoscopic IPOM without fascial defect closure.

Background The currently recommended treatment regimens for multidrug-resistant tuberculosis (MDR-TB) are complex, costly, prolonged (lasting at least 20 months), and often poorly tolerated. The objective of this study was to evaluate the effectiveness of the shorter treatment regimen (STR) for treating patients with MDR-TB in Khyber Pakhtunkhwa. Methodology The present study was a case series conducted at the Programmatic Management of Drug Resistant TB Unit, Lady Reading Hospital (PMDT-LRH), Khyber Pakhtunkhwa, Pakistan. Patients enrolled from December 2017 to November 2020 were included. Eligible patients received a STR for MDR-TB. All patients under five years of age, pregnant women, and those with psychiatric or serious medical illnesses were excluded. At the time of enrollment, all patients were screened with sputum smear, culture, drug susceptibility testing (DST), and chest radiographs. Follow-up evaluations were conducted at regular intervals, sputum smear and culture monthly and chest radiographs bimonthly, throughout the intensive and continuation phases of treatment. Results The mean age of all patients was 34.98 years (SD=17.69). The majority of study participants (n=111, 56.4%) were females. Fifty-nine patients (29.9%) had previously received treatment with first-line anti-tuberculosis medicines. A total of 197 patients were enrolled, but 53 were transferred to a longer treatment regimen (LTR) due to prolonged drug usage or failure to respond to the STR. Therefore, 144 participants were treated further. Of these, 109 (75.8%) had a successful treatment outcome, whereas 35 (24.2%) had an unsuccessful treatment outcome. Adverse drug reactions were reported in 33 of the participants (22.9%). Conclusion A STR for MDR-TB is an effective treatment program as compared to other treatment regimens. However, further studies are necessary to evaluate long-term outcomes or adverse effects on a larger population.

Plant-based proteins show poor functional properties and when a balanced source of amino acids is required, it cannot be provided only by a single source of plant-based protein. This study aims to enhance the functional and digestibility properties of hemp seed meal (HSM) protein by hydrolyzation (HPH) through ultrasonication and enzymatic treatment. The blending of HPH with pea protein isolate (PPI) was conducted to improve the amino acid profile. During ultrasonication, the protein content was significantly affected (p < 0.05) by ultrasonication time and solid-to-solvent ratio but not by the amplitude. Degree of hydrolysis was significantly (p < 0.05) affected by all three variables. Optimal hydrolysate was prepared by ultrasonication at 80

Hepatitis C is a global health problem affecting around 58 million people worldwide and killing almost 0.29 million in on one year [1]. The world has united to fight against this lethal disease in 2016 with a moto to eliminate hepatitis by 2030. To achieve this goal WHO’s World Health Assembly has set some targets and individual countries have developed their own strategies to achieve those targets [2]. Pakistan has the 2nd highest prevalence of hepatitis C in the world with 5.8% viremia positive patients [3]. Pakistan is amongst the few countries that have been assisted by the Center for Disease Control and Prevention(CDC) to prevent and control Hepatitis[4]. With the availability of Direct Acting Antivirals(DAAs), the whole paradigm of treatment of hepatitis C has changed not only globally but also in Pakistan. However, the patients in Pakistan are unable to gain access to the latest DAAs at the pace, as they are available globally. International guidelines are being updated on regular basis as per global evidence, recommending such combinations which are not readily available to many parts of the world. Hence there is a dire need to develop national guidelines, keeping in consideration the efficacy of the drugs as well as their availability, in the broader canvas of achieving the targets of eliminating Hepatitis set by WHO. In this context, our consensus guidelines are an effort to fill the gap created because of upgraded scientific evidence and possible combinations available in our part of the world. Furthermore, quite some good research and evidence has also been shared in the literature from Pakistan during last five years (2016-2021). Hence a literature review has also been carried out to update our own epidemiologic data, risk factors and treatment responses to Hepatitis C in Pakistan.

The Almajirci system is an ancient tradition of Islamic scholarship that dates back to the early period of Islam in the Western Sudan. It is characterized by itinerancy, with scholars and their students traveling in search of knowledge. This practice initially yielded positive results, cultivating a large number of indigenous scholars in the region, particularly in Hausaland. However, the current form of Almajirci education, where children are left in dire conditions, often naked and more concerned with survival than with acquiring spiritual knowledge—the primary aim of the system—is foreign to Islam and the original Almajirci tradition in Northern Nigeria. Today, the phenomenon of Almajirci has evolved into a social problem, leading to the abandonment and exploitation of children, many of whom become easy recruits for criminality and violence. Previous government efforts to regulate and address the worsening situation—through integration, control, or legislation—have largely been half-hearted and politically expedient, failing to provide a lasting solution. This paper explores the historical development of the Almajirci system of education in Northern Nigeria, identifying the material conditions that led to its transformation from a productive educational system to its current, deteriorated state, and examining the reasons for the failure of previous attempts to resolve the issue. The findings of this study could help suggest a viable solution to the problem. The paper asserts that solving the Almajirci problem requires a concerted effort: a combination of genuine government action, intervention by non-governmental organizations, support from philanthropic individuals in society, and continued exhortations by respected Muslim clerics, reminding parents of their responsibilities toward their children.

OBJECTIVE:To present initial experience with the first 100 cases of robotic-assisted surgery by the Department of General Surgery. STUDY DESIGN:Descriptive study. Place and Duration of the Study: Department of Surgery, National Hospital and Medical Centre, Lahore, Pakistan, from May 2022 to August 2023. METHODOLOGY:Demographic and postoperative details of the first 100 patients to undergo robotic-assisted surgery by the Department of General Surgery were reviewed. Prospective data were collected from the hospital information database as well as the CMR database. The data collected in the hospital database included the patients' age, diagnoses, genders, complications during hospital stay as well as 90-day readmission, morbidity, and mortality. Data collected by CMR via Versius robotic surgery console or internal databases included operative minutes using the console. RESULTS:The average age of patients undergoing robotic surgery was 44.26 ± 14.08 years. Cholecystectomy (78%) was the most commonly performed robotic-assisted procedure. Only one patient had blood loss of more than 100ml. There was no postoperative complication, readmission or mortality during the study period. CONCLUSION:With proper patient selection, robotic-assisted surgery is safe and feasible even in low- middle-income countries (LMICs). KEY WORDS:Robotic-assisted surgery, Pakistan, Initial experience, Outcomes, Versius.

Bovine colostrum contains bioactive proteins while thermal processing reduces the functionality and gastric conditions reduce the bioactivity of these proteins. In this study, the structure of caseinate and colostrum whey was modified using ethanol to fabricate the nanoparticles (NPs). The effect of pH (4-7), whey (0.25-1.0%, w/v), and caseinate (0.5-2.0%, w/v) concentrations was also evaluated to fabricate stable NPs. The stable NPs were prepared at pH 6.5 using caseinate (1.50%, w/v) and whey (0.75%, w/v) in an aqueous medium with a mean particle diameter of <200 nm. Amide I showed changes between 1250 and 910 cm(-1) in caseinate and mixture while the secondary structure (beta-helix at 1636 cm(-1)) showed slight changes in whey and NPs and there was a decrease in the intensity of peak at 1521 cm(-1) (amide II) in caseinate due to ethanol. The functional properties of NPs powder were improved as compared to whey powder and In vitro digestibility also showed improved recovery of Igs from NPs as compared to whey protein. These colostrum whey-based NPs can be used as dietary supplements to deliver bioactive proteins with numerous health advantages.

Objective: To investigate the efficacy of Photobiomodulation therapy (PBMT) for the treatment of solitary rectal ulcer syndrome (SRUS).Background: SRUS is a benign disease, diagnosed by symptoms, clinical, and histological findings. PBMT has been reported for the treatment of various inflammation-based diseases including aphthous ulcer, but still no such study on the treatment of SRUS is published.Materials and methods: A 29-year Asian women, diagnosed for SRUS of 0.57 cm diameter, was treated by a laser at 635 nm through seven sessions. Laser fluence of 85 J/cm2 was delivered to ulcer lesion during each session for 10 min. Clinical results were valued by physician with sigmoid probe throughout PBMT sessions and no medicines were prescribed to the patient.Results: After seven sessions, the lesion was completely healed with 100% clinical response. In follow-up, patient did not respond to any additional/recurring abnormality, and no side effects were observed.Conclusions: In conclusion, PBMT by using laser at 635 nm is an effective treatment for SRUS without any side effects and patient remained comfortable throughout treatment sessions.Patient registration No. H-744/23.

The colostrum whey-sodium caseinate nanoparticles (NPs) were prepared with a diameter <200 nm and zeta potential of -21.4 which indicate the stability of NPs. The powder samples were fed to rats for 2 weeks to evaluate the effect on the Igs concentration in blood serum. The fabricated NPs showed significant increment (p < 0.05) in Igs concentration levels in the blood due to their good efficacy in protecting the Igs from gastric digestion. The hydrophobic regions were buried inside the protein network during gastric digestion which restricted the enzyme activity. The concentration of Igs increased significantly (p < 0.05) due to NPs, IgG was increased to 9.33 μg/mL and 9.50 μg/mL, IgA was increased to 1.69, and 1.70 μg/mL and IgM was increased 1.55 and 1.60 μg/mL for NPs-1 and NPs-2 groups respectively. However, colostrum contains some amount of lactose and other glycoproteins which protect the digestion of Igs in the gastric phase as compared to whey protein which shows a slightly lower level of Igs. Morphological changes indicated that the NPs were coagulated in the stomach due to pH sensitive caseinate which protected the Igs degradation. These powders can be utilized as a good source of bioactive Igs from bovine colostrum with improved functionality and digestibility.