Background Perforation of peptic ulcers is a common cause of emergency surgery and has significant morbidity and mortality. The use and range of laparoscopic surgery have greatly increased over the past three decades. Laparoscopic approach is an option for perforated peptic ulcers because of the simple nature of the intervention. The aim of this study was to evaluate the outcome of laparoscopic approach for peptic ulcer repair in emergency setting by means of operative time, post-operative pain, mean hospital stay, and post-operative complications. Methods In this study, we enrolled patients presenting with perforated peptic ulcers in the emergency department of a tertiary care hospital in Lahore, Pakistan. Approval from the hospital ethical committee and informed consent were taken from all patients. After resuscitation, the patient underwent laparoscopic repair of perforation. Post-operative course of patients was monitored. Duration of surgery, post-operative pain, length of hospital stay, and post-operative complications were noted for all patients. Results Between December 2018 and December 2021, 31 patients with perforated peptic ulcers underwent laparoscopic repair at our hospital. Mean age of patients was 37.25 ± 7.80 years. Most of the patients were male (70.76%). The mean operation time was 109.35 ± 17.02 minutes for laparoscopic repair. Mean duration of hospital stay was 5.10 ± 0.87 days. Mean post-operative pain was 3.55 ± 0.85 assessed using the Visual Analogue Scale. There were no mortalities during the 30-day post-operative window. Conclusion With proper patient selection, laparoscopic surgery offers better results as compared to open surgery in patients undergoing emergency surgery for perforated peptic ulcers.

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BackgroundAdhesions occur frequently after surgery. A number of methods are being employed for reducing postoperative adhesions. The purpose of this study was to determine the efficacy of hyaluronic acid gel in the reduction of post-operative bowel obstruction symptoms in patients undergoing emergency laparotomy due to small bowel perforation and presenting with peritonitis. MethodsIn this experimental study, 78 patients were evaluated. All had presented to the emergency department with peritonitis secondary to small bowel perforation. Exploratory laparotomy was performed and after thorough lavage, a loop stoma was formed on the right side of the abdomen with an injection of hyaluronic acid gel injected into the abdominal cavity before the closure of the abdomen. Postoperative obstructive symptoms at one, three, and six months were evaluated. All patients underwent stoma reversal at three months. ResultsObstructive bowel symptoms were seen in 18 patients (23.07%) patients. The cumulative incidence of obstructive symptoms at three months was only 8.97% but after the second intervention without protective gel, it increased to 23.07% at six months. ConclusionsCross-linked hyaluronic acid gel was effective in the reduction of post-operative bowel obstructive symptoms due to adhesions in patients who had presented with peritonitis due to small bowel perforation and had undergone exploratory laparotomy with stoma formation.

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Reviewer: Ahsan Shafiq The clash of the assumptions and methodology of the mainstream economics with the classical methodology of Islamic sciences in various forms has been at the heart of the discussions of methodology. Overcoming this and creating a consistent, applicable, and functioning methodology is one of the most important existential challenges for Islamic economics today. For this, a methodology using both Muslim heritage of science and techniques used by contemporary economics needs to be developed. Interestingly, digging true methodological foundations for this field has widened the research on one hand however has puzzled the academia especially young scholars on the other. The issue is more complex and abstruse than it may apparently seem. Whilst one faction refutes any axiomatic foundations for this discipline the other is strictly critical of superfluous affixing of Islamic prefix with each theory, tool and instrument of conventional economics without adequately changing its form. Yet there are others who call for setting clear demarcation lines between Islamic Economics on one hand and Islamic fiqh on the other.

Background: Work schedules and conditions have a significant impact on the physical, mental, and social well-being of physicians. The purpose of this study is to determine the workload of physicians working in various departments of a tertiary healthcare centre, as well as the link between physician job load and specialty. Methods: This Cross-Sectional study was carried out from October 2020 to November 2020 at KRL Hospital Islamabad. Hospital records were used to gather information about the number of patients. Four parameters, such as mental demand, physical demand, time and effort demands were evaluated. Results: Gynecology had the highest patient load (23 percent), followed by pediatrics (21%) and surgery (14 %). Physically and mentally taxing specialties were urology and maxillofacial surgery. Psychiatry had the lowest demands in terms of mental, physical, time, and effort. Conclusion: Our study shows that Urology and Internal Medicine are more time-consuming and stressful for the physician to perform. Physicians need better working conditions and less work, so we should focus on stress management and reduction for them.

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Esophageal cancer has been reported to be the seventh most common cancer and the sixth most common cause of mortality. Use of advanced diagnostic techniques has increased the detection of preoperative metastases and resulted in better patient selection for further management by curative surgery. We carried out a study to evaluate the outcome of esophagectomy at our institute in terms of acute leak, mortality and hospital stay. We also looked at various preoperative, intraoperative and postoperative risk factors contributing to leak after esophagectomy.We evaluated 589 patients during the period from January 2009 to December 2019. All these patients underwent elective esophagectomy for esophageal cancer at our hospital. Out of these, leak was seen in 30 patients (5.1%). We found no statistically significant difference when evaluating patient and tumour characteristics of patients who developed leak against those who did not. We also didn't find any significant difference in intraoperative or postoperative factors between the two groups.Proper preoperative evaluation and optimization are necessary to overcome various patient comorbidities. On the basis of our study we conclude that when performed in high-volume centers with an adequately trained multi-disciplinary team approach, esophagectomy for carcinoma has a good outcome.