Design: It is a Prospective Observational case series. Place and Duration of Study: The study was conducted at Sheikh Zayed Hospital/Hamza Medicare Rahim Yar Khan, between January 1997 and December 2004. Patients and Methods; Consecutive 892 patients presenting with significant gastrointestinal bleeding, between January 1997 and December 2004 were recruited in this study. Source of active bleeding was defined by endoscopy. Results: Esophageal variceal bleed was the main finding 580, followed by gastric erosions 133 patients, Esophageal Ulcer 65, duodenal ulcer 61, bleeding gastric ulcer (26), Mallory Weiss Tear 21 and Osler Weber Rendu Syndrome/AV malformation 06 only. Conclusion: Esophageal varices are-real problem within our area but the scope has changed in the western world. Variations in disease pattern from time to time require the periodic studies to be aware of the current underlying mechanism of the ailments in the area of work. Total reliance on literature may consume local resources.

Background: Fluid replacement is one of the important issues in the management of burn cases. Objective: To compare the outcome between Ringer lactate and Hydroxyethyl starches (HESs) in cases with burn injuries. Methodology: Study design: Randomized controlled trial. Place and duration of study: Department of Plastic Surgery, Sheikh Zayed Hospital, Rahim Yar Khan, from June to December 2018. Study subjects selected were those who had a burn of any type (thermal, chemical, electric) and at least more than 10% of the surface area of the body. The cases were then divided into two equal groups. The fluid requirement was calculated according to the Parkland formula. After this, the cases in group A were given Ringers lactate solution 500 ml while those in group B were given 500 ml of 6% hydroxyethyl starches (HESs) and further fluid was administered in group A as ringer only and in group B as ringer and HES in a ration of 2:1. The cases were then followed to look for various outcomes in the form of urine output, serum creatinine, and mean hospital stay. Results: In this study, there were a total of 60 cases (30 in each group). The mean age in group A and B was 17.33±5.39 vs 19.11±4.79 years (p= 0.33). Mean hospital stay was 14.65±3.31 vs 13.49±2.78 days with p= 0.41. Mean urine output per day was 1645.81±143.47 vs 1705.31±165.83 ml with p= 0.43 and mean creatinine in group A and B was 1.79±0.38 vs 1.83±0.44 with p= 0.86. Conclusion: There was no significant difference in both the groups regarding urine output, creatinine, and mean hospital stay.

This is a case report of newly born twins. The live twins were with two separate heads and a symmetrical body, conjoined in a sagittal plane. Their thorax and abdomen were broader then singleton normal. Spines were separate in cervical regions but gradually approached each other and completely fused at sacrum. Single perineum had an imperforate anus.

ABSTRACT… Introduction: Diabetic foot lesions have remained a major cause of morbidity in patients with kidney failure. Foot complications are more than twofolds in diabetic nephropathy patients, and the rate of amputation is 6 to 10 times higher in diabetic nephropathy patients in comparison to the general diabetic population. Objectives: To determine the frequency of diabetic nephropathy in patients undergoing diabetic foot amputation. Study Design: Observational cross-sectional study. Setting: Surgical Department Unit-II, Sheikh Zayed Medical College and Hospital Rahim Yar khan. Material and Methods: The duration of the study was 2 years from Dec-2013 to Dec-2015. A total number of 73 patients were included in this study. Patients who were admitted to the department of surgery for amputation of the foot or the leg having the history of diabetes regardless of their age and sex were selected for this study. Data analyses were carried out using SPSS Version17 software. Quantitative variables were presented as Mean and standard deviations. Frequency and percentages were computed for qualitative variables. Results: The mean age of the patients was 57.51±7.61 years. Out of 73 cases, there were 43(58.9%) males and 30 (41.1%) females. Previous history of amputation was observed in 26 (35.62%) cases, 48 (65.75%) patients were hypertensive. Out of 73 patients, Forty (54.79%) had controlled diabetes and 33 (45.21%) had uncontrolled diabetes. Twenty seven patients (36.99%) were diagnosed for diabetic nephropathy. The incidence of nephropathy was high in patients with advancing age. This incidence was in 26 (56.62%) patients with age 51 to 60 years and 18 (39.13%) in patients having age more than 60 years. Conclusions: Lower extremity amputations are strongly associated with nephropathy in diabetic patients. It is very important to check and improve the renal function in patients with diabetic foot ulcers who are hypertensive, increasing age and long duration of DM to prevent lower limb amputations. Key words:Diabetes mellitus (DM), Nephropathy, Diabetic foot amputation.

Background: Surgeons are performing millions of operations on diabetic patients daily, and lack of awareness among diabetic patients is leading to complications. Objective: To determine chronic glycemic control in general surgical patients admitted at a tertiary care hospital. Methodology: This was a cross-sectional study conducted from June 2018 to January 2019, on fifty-seven consecutive patients, suffering from diabetes and needing surgical intervention in any form were included in this study. Diabetes status in terms of HbA1c, causes of admission to the surgical ward, and intervention done were noted. Data were analyzed by using SPSS 20. Results: Among these diabetic patients, 46 (80.70%) were male, and 36 (63.16%) were known diabetics. HbA1c level was normal in 9 (15.79%) patients, pre-diabetic in 13 (22.81%) and uncontrolled diabetic in 35 (61.4%) patients. Aetiologically diabetic foot was seen in 36 (63.16%) patients, abdominal catastrophe 12 (21.05%), leg swelling 7 (12.09%), 5 (8.77%) scrotal abscess, carbuncles 4 (7.02%), miscellaneous 5 (8.77%). Incision drainage and closure were done in 10 (17.54%), drainage wound debridement, decompression of compartment syndrome, and constructive procedure in 11 (19.3%), laparotomy 8 (8.77%) and watchful conservation in 4 (7.01%) patients. Two patients were saved from the mortal blow of the diabetic coma. Hypertension and nephropathy were seen in 8 patients each, and 5 patients have Hepatitis C, and 1 patient has ischemic heart disease. Conclusion: This study showed that many patients did not know their diabetes status, two-third of patients were having uncontrolled diabetes. There is a need for proper assessment and management of diabetic patients by consultants and young doctors in every discipline of medicine, especially surgery.

Objectives: To study the patients presented with catastrophic abdominal misadventure due to abortion performed by untrained birth attendants to get rid of unwanted fetus by un-indicated procedures in unfavorable circumstances. Design: Observational case series. Place and Duration of Study: Surgical Unit I, Sh. Zayed Hospital, Rahim Yar Khan from July, 2001 to August, 2004. Patients and Methods: Forty patients from different age groups presented with this killer problem. Majority was concealing it. They were resuscitated, operated and managed postoperatively. Results: These patients presented late, suffered financial loss, morbidity and significant mortality. Conclusion: Unplanned abortions are catastrophic. Education of masses in regard to birth control is mandatory.

Objective: To study the results after forming the controlled enterocutaneous fistula in the patient of abdominal tuberculosis with matted and perforated small bowel. Design, place and duration of study This study based on therapeutic trial and conducted in one and half years from january1999 to june2001 at Mayo Hospital, Lahore. Patients and methods: All these 20 patients either operated in emergency or on elective list were malnourished, toxic and their operative findings were almost the same , these patients had extensively matted, friable and perforated gut. In these patients it was technically not possible to perform some definite procedure like right haemecolectomy or ileostomy with out increasing the morbidity or mortality. Under these circumstances, minimal surgical procedure which can be life saving is to oppose the anterior abdominal wall to the perforation and thus create a controlled enterocutaneous fistula. In 11 patients fistula closed on its own and in eight patients fistula remained patient and needed re-exploration and repair. Conclusion: This new method of treatment has yielded excellent results. We were able to cure the disease with no mortality. It is recommended that in cases of TB peritonitis with perforation and matted gut making of a controlled enterocutaneous fistula saves the life of the patient.

Introduction: Diabetic foot lesions have remained a major cause of morbidity inpatients with kidney failure. Foot complications are more than twofolds in diabetic nephropathypatients, and the rate of amputation is 6 to 10 times higher in diabetic nephropathy patientsin comparison to the general diabetic population. Objectives: To determine the frequencyof diabetic nephropathy in patients undergoing diabetic foot amputation. Study Design:Observational cross-sectional study. Setting: Surgical Department Unit-II, Sheikh ZayedMedical College and Hospital Rahim Yar khan. Material and Methods: The duration of thestudy was 2 years from Dec-2013 to Dec-2015. A total number of 73 patients were includedin this study. Patients who were admitted to the department of surgery for amputation of thefoot or the leg having the history of diabetes regardless of their age and sex were selectedfor this study. Data analyses were carried out using SPSS Version17 software. Quantitativevariables were presented as Mean and standard deviations. Frequency and percentages werecomputed for qualitative variables. Results: The mean age of the patients was 57.51±7.61years. Out of 73 cases, there were 43(58.9%) males and 30 (41.1%) females. Previous historyof amputation was observed in 26 (35.62%) cases, 48 (65.75%) patients were hypertensive.Out of 73 patients, Forty (54.79%) had controlled diabetes and 33 (45.21%) had uncontrolleddiabetes. Twenty seven patients (36.99%) were diagnosed for diabetic nephropathy. Theincidence of nephropathy was high in patients with advancing age. This incidence was in 26(56.62%) patients with age 51 to 60 years and 18 (39.13%) in patients having age more than 60years. Conclusions: Lower extremity amputations are strongly associated with nephropathy indiabetic patients. It is very important to check and improve the renal function in patients withdiabetic foot ulcers who are hypertensive, increasing age and long duration of DM to preventlower limb amputations.