Objective: To evaluate the safety outcome of staple hemorrhoidectomy in grade III and IV hemorrhoids. Study Design: Descriptive study Place and Duration of Study: Department of Surgery, Shahida Islam Medical Complex, Lodhran from 1st July 2020 to 30th June 2021. Methodology: Seventy patients were selected who were suffering from third or fourth grade hemorrhoids. The age of the patients was between 21-56 years with both gender been presented. Longos method was opted with spinal analgesic been delivered in lithotomy positioning. The complete surgical protocol was maintained with preoperative antibiotic deliverance. The procedure took 30-50 minutes. Patient was then kept in recovery room for three hours post operation and all postoperative antibiotics were timely administered. Results: Mean age of study participants was 41.2±3.2. Men appeared to be higher in number as compared to women. Grade III patients were more in number as compared to grade IV. Most common complication which was observed in present study is postoperative pain. Majority of the patients (70%) showed no associated complications. Conclusion: Staple hemorrhidectomy is appeared to be a safe and reliable surgical procedure for the treatment of grade III and grade IV hemorrhoids. Keywords: Hemorrhoids, Surgical procedure, Stenosis, Efficacy, Conventional
Aim: To find out efficacy of plastibell circumcision and to establish certain technical considerations to minimize complications. Study design: Cross-sectional Descriptive study Place and duration of study: Department of Surgery, Aero Hospital Hassan Abdal from 1st September 2016 to 31st August 2020. Method: Total of 400 infants and neonates were included in present study. Children was taken upto six months of age and 1% lignocaine was used as a source of local anesthesia. Plastibell was used for circumcision under strict aseptic conditions. Parents were allowed to take child home after half hour of retention in the hospital and follow up done after one week of circumcision. Parents were given telephonic access to surgeon during this week. During follow up baby was examined, results recorded and complications were treated if any. Results: Ring block using 1% lignocaine provided adequate pain relief in neonates and infants. There were 345 boys were brought for circumcision during first month of their life while 55 were infants between one to six months of age. Six patients had post-operative bleeding during immediate post op period and two patients presented after 12 hours with bleeding which needed removal of plastibell and maintenance of hemostasis. The mean time of plastibell detachment was 06 days (range 03-12 days). Plastibell was ctuck in few patients which needs to be removed early. Paracetamol was also used post-operatively as an oral analgesia and provided adequate pain relief. Two patients presented with infection after plastibell detachment. The foreskin was removed in every boy except one. Handling of the babies was easy for mothers. Conclusion: Plastibell proved to be an effective method of circumcision provided few technical points like size of plastibell, use of bipolarcautery, hemostasis of frenular area, and threading around plastibell are properly taken care off. Keywords: Circumcision, Plastibell, Neonate, Infant, Lignocaine, Frenular, Foreskin
Objective: To compare the free hand fine needle aspiration cytology versus ultrasound guided core sampling for thyroid nodule examination in thyroid gland. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College Hospital Sukkur from 1st January 2016 to 31st December 2021. Methodology: One hundred patients were divided in two groups. Group A had 50 patients who undergo ultrasonography through Doppler scanning while Group B had equal number of 50 patients which underwent free hand fine needle aspiration cytology. The clinical details were noted and graded as un-satisfactory or lacking follicular cells or else having <6 groups epithelial cells or having sufficient number of follicular cells. Results: The mean age was 31.5±11.8 years and majority of the patients were females 54% in comparison with 46% males. Insufficient cytopathologic cells were noticed in 18% US guided thyroidal nodule examination while similar insufficiency was seen in 44% fine needle aspiration cytology examination. The adequate cytopathological cells were noticed in 82% Ultrasounds while same was only seen in 56% fine needle aspiration cytology. Conclusion: Ultrasound guided core sampling has presented higher adequate cytology cases in comparison to free hand fine needle aspiration cytology cases. Key words: Fine needle aspiration cytology, Ultrasonography, Thyroid nodule
Objective: To determine the clinical outcome of laparoscopic versus open repair of perforated peptic ulcer. Study Design: Comparative analytical study Place and Duration of Study: Department of Surgery Ward-2, Jinnah Postgraduate Medical Centre Karachi from 1st March 2021 to 28th February 2022. Methodology: Fifty patients with duodenal ulcer perforation were divided into two equal groups and open surgery or laparoscopic was performed after clinical examination. Boeys score, Mannheim Peritonitis Index preoperatively and VAS scoring as post-operative was done. Results: There were more males than females within both groups with a mean age of 51.3±16.5 years in group I and 55.7±14.9 years in group II. The perforation size of group I was greater as 16.3±6.4 mm than group II patients which were 15.9±5.7 mm. The post-operative complications showed a high frequency of respiratory cardiovascular and surgical site complications with greater mortality rate in Group II A major decrease in pain score was recorded in laparoscopic group such as group I in comparison with open repair such as group II. Conclusion: Shorter hospitalization and less post-operative pain was observed in laparoscopic repair for perforated peptic ulcer as compared to open-repair surgery. Keywords: Peptic ulcer, Laparoscopy, Advantages, Disease management
Objective: To compare the efficacy of antibiotic treatment versus appendectomy in treatment of acute appendicitis. Study Design: Retrospective study Place and Duration of Study: Department of Surgery, Shahida Islam Medical Complex, Lodhran from 1st January 2021 to 31st March 2022. Methodology: One hundred patients of age >18 years were enrolled after the complete assessment and confirmation of acute appendicitis. The clinical confirmation included the complete assessment of signs and symptoms of patients through Modified Charlson Index and Alvardo score. Patients were further divided into two groups with each group having 50 patients and matched for their clinical symptoms and duration. Group A had those patients who were only given antibiotics for the treatment of their acute appendicitis while Group B had those patients which were planned for appendectomy. A course of amoxicillin with clavulanic acid or fluoroquinolone was given for 7 to 10 days and the metronidazole/tinidazole was added in 60% of the cases. Patient’s data was recorded on well structured questionnaire. Results: The mean age was 37.5±11.2 years in group A and 38.1±10.9 years in group B. There were higher numbers of males in both groups. The average incidence of complications like perforation as well as peritonitis and surgical wound infection were significantly less in appendectomy patients and was reported as 17, 12 and 1% respectively. The long-term outcomes of antibiotic treatment plan for acute appendicitis showed requirement of appendectomy in 26% cases in group. Conclusion:Antibiotic treatment can be used effectively for acute appendicitis in selected patients with careful follow up/ monitoring for complications and as an interim treatment option for patient’s not opting for surgery or cannot undergo surgery, however appendectomy remains the most appropriate treatment for acute appendicitis overall. Keywords:Acute appendicitis, Antibiotics, Appendectomy, Efficacy
Differentiated pricing is a widely practiced revenue management (henceforth, RM) tactic in which a firm offers its products/services at differentiated prices to distinct markets. This strategy has also been noticed in airline RM for more than four decades. Earlier research has shown that the benefits from differentiated pricing are evident when the market segmentation is assumed perfect, which are regarded as distinct markets with deterministic demands. In perfect market segmentation, customers associated with a market segment do not cannibalize (move) between market segments. However, it is not uncommon to notice that the market segmentation is seldom prefect, regardless of the type of industry, and demand is often uncertain. As a result, passengers are expected to cannibalize between fare classes, which is also referred as demand leakage. This research addresses the issue of establishing an integrated framework to optimize market segmentation, often referred as fare class, fare price, and seat inventory control for an airline that experiences demand leakage. Three distinct models are proposed to determine the optimal market segmentation, fare pricing, and seat inventory control for an airline that experiences price dependent passenger demand which are deterministic demand, stochastic, and when the demand is stochastic, yet the demand is unknown respectively. The models are analyzed to determine an optimal joint control mechanism for market segmentation, fare pricing, and seat inventory control and it is shown that the revenue functions to airline are jointly concave. Numerical experimentation shows how do the problem related parameters impact the airline's optimal control strategy and upon airline's revenue gains.
Objective: To find the efficacy of diagnostic laparoscopy and its role in patients with chronic abdominal pain. Study Design: Observational study Place and Duration of Study: Department of General Surgery, Ali Fatima Hospital/Abu Umara Medical & Dental College Lahore from 1st July 2021 to 31st March 2022. Methodology: Seventy patients suffering from chronic abdominal pain were enrolled. An informed written consent was taken from each of them as an approval of participation. The age of the patients was between 20-65 years. Mostly the left side of the abdomen upper-quadrant was opted. Post creation of pneumo-peritoneum a 3 trocar technique which is standardized procedure was applied and a 10mm port through umbilical while two lateral trocars of 5 mm were used. The completed abdominal-cavity was investigated in detail initializing from the liver then gall bladder as well as anterior-surface of stomach and also the spleen. In women uterus as well as Douglas pouch was examined in context to fluid consistency, colour in addition to its site. The specimens were collected and sent to the histopathological lab for analysis. Results: The mean age of the patients was 36±15.3 years with majority were males with 55.71%. Around 45.71% patient’s pain site was at the right lower quadrant while 21.42% had left lower quadrant. The outcomes of laparoscopic investigation showed 27.10% patients to have appendix related pathology, while 19% had bands of adhesion. Conclusion: Laparoscopic proved to be an effective surgical technique in evaluating exact causes of chronic abdominal pain especially in cases where traditional methods have failed to explain the particular cause. Keywords: Bowel movement, Laparoscopy, Recurrent, Prolonged, Well-being
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