Objective: To compare efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections. Methods: Prospective Observational Study was conducted at Department of Surgery, Pakistan Ordinance Factories (POF) Hospital, Wah Cantt for duration of two years (January 2018-December 2019). A sample size of 140 diabetic foot infection patients (70 patients in each group) was calculated using WHO calculator. DFI patients were selected through non probability (consecutive) sampling technique. All patients signed consent forms before participation into study. Patients were randomly divided into two group (computer generated random number table); Group-A patients were given systemic antibiotics alone while Group-B was given combination of gentamicin cream and systemic antibiotics. SPSS version 24 was utilized for analysis purpose. Chi-square test was applied in our study. Results with p-value ≤0.05 found significant. Results: Total 140 patients were included in study. There were 87(62.1%) male and 53(37.9%) females in our data. Mean age of patients was 46 years±11.3SD. Group-B (combination of gentamicin and systemic antibiotics) showed significant reduction in inflammation (p=0.03), culture negativity(p=0.001), increase clinical cure (p=0.02) and pathological eradication (p=0.03) as compared to Group-A (systemic antibiotics alone). Gender, age and duration of diabetes mellitus had insignificant association with outcomes (p>0.05). Conclusion: Diabetic foot infections are significant contributors of morbidity in our country. Combination of gentamicin cream with systemic antibiotics is highly effective in inflammation reduction, increasing clinical cure rate and pathological eradication as compared to systemic antibiotics alone in diabetic foot infections. Early identification of risk factors, proper patients care and multidisciplinary approach for diabetic foot infections prevention is required. doi: https://doi.org/10.12669/pjms.38.3.3277 How to cite this:Memon ML, Ikram M, Azhar M, Balouch V. Comparison of efficacy of systemic antibiotics alone and combination of systemic antibiotics with gentamicin cream in diabetic foot infections. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.3277 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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

Objective: Comparative analysis of different surgical methods for the treatment of gastric carcinoma with proximal gastrectomy. Study Design: Retrospective study Place and Duration of Study: Department of Surgery Unit-2, Ghulam Muhammad Mahar Medical College, Teaching Hospital, Sukkur, Department of Surgery, Wah Medical College POF Hospital, Wah Cantt and from Department of Surgery, CMH Kharian Medical College, Kharian from 1st January 2015 to 30th June 2021. Methodology: One hundred patients were retrospectively evaluated for the proximal gastrectomy with the previously conducted procedures of open gastrectomy as well as laparoscopic gastrectomy. The patients were compared for the various types of gastrectomy used with the new established proximal gastrectomy method. The patient distribution was based on available resources and patients’ consent. Patients were identified as into two groups where group 1 patients were placed for open total gastrectomy whereas group 2 patients were defined as laparoscopic proximal gastrectomy. All the patients were compared in terms of operation time, recurrence rate and associated complications. Results: Mean age of the study participants were 54.5±3.3 years. Higher frequency of males participants were observed as compared to the females. Estimated blood loss was considerably different in both study groups. Excess blood loss was seen in total gastrectomy in contrast to laparoscopic procedure. Less complication was observed in open gastrectomy than to laparoscopic proximal gastrectomy. Conclusion: Minimally invasive surgical method could be the standard surgical procedure for gastric oncology treatment in which function of the stomach can be preserved along with safety profiles. Therefore, LPG can be a preferable treatment option for other available treatment options. Keywords: Invasive, Oncology, Laparoscopic, Complications, Gastric

Background: This study's goals were to assess the cervical central lymph node status and predictive value of SLN biopsy during operate and to identify clinic pathological factors, that were used to be independent predictors for analyzed central lymph node metastasis in papillary thyroid carcinoma. Study design: This was a cross-sectional study conducted at Sahara Medical College, Narowal for the duration of six months, from July 2022 to December 2022. Methods: The total N=300 people participated in this study. The participants were split into two groups: positive for cervical central lymph nodes CCLN (n = 210) and negative for cervical central lymph nodes CCLN (n = 90). In cases with positive SLNB, the positive sentinel lymph node ratio and additional positive lymph node (APLN) were examined. Investigators looked into SLNB's effectiveness. Results: The age range was 24-40 years in which cervical central lymph node case was (57%); p=0.002**. The maximum diameter of tumor (98%) was 3-4 cm show significantly P<0.05. The multiple focus included unilateral (18.3%) and bilateral region (82%) show significant changes P<0.05. According to the tumor locations, the positive case of central lymph node were as following; lower area (20%), middle area (53.3%) and upper area (27%) the difference were significant (p<0.05). The metastatic rate of lymph node was related to SLN (67%) and CCLNM (46%). APLN positive show additional lymph node on cancerous participants. The evaluation of CNM and APLN using the sensitivity, specificity, false positive rates, positive predictive value, and negative predictive value of SLNB. Conclusion: In participants with positive case reports, age, sex, tumour size, location, extra thyroidal invasion, and capsule involvement were independent risk factors for CLN metastasis. If a positive SLN could be used to predict the presence of APLN, a theoretical basis for intraoperative lymph node dissection might be offered. Keyword: Metastasis, Tumor size, Multifocality,

Objective: To evaluate the laparoscopic cholecystectomy procedure in cases of acute cholecystitis. Study Design: Cohort study Place and Duration of Study: Department of Surgery, Surgical Unit-1, SIMS/Services Hospital Lahore from 1st January 2021 to 30th June 2022. Methodology: One hundred and ninety eight cases which suffered from acute cholecystitis were enrolled. The age of the cases was within 35-60 years. The cases were divided into 3 groups; group A, group B and group C. The group selection was dependent on the interval period (between the onset of acute attack and the time of presentation for treatment). Group A was the one where interval period was <3 days, Group B has 3 to 7 days while it was >7 days in group C. The laparoscopic cholecystectomy was performed and operative outcomes were evaluated. Results: The mean age of the patients was 40.66±1.5 years with more females in each group than males. The cases of gall bladder empyema/mucocele were presented at the highest 68.8%. This was followed by the cases having Gall Bladder phlegmon identified in 24.74% of the cases. The rate of complication was highest in Group B while operation time and post-operative hospital stay was highest in Group A. The conversion rate from Laparoscopic to open cholecystectomy was measured as 3.03%. Conclusion: Laparoscopic cholecystectomy is a procedure which can be successfully achieved in acute cholecystitis cases with reduced conversion rate and complication attained through surgical expertise. Keywords: Laparoscopic cholecystectomy, Acute cholecystitis, Conversion rate