Thymus excision is often undertaken at the time of surgical correction of CHD via median sternotomy. Such patients have been shown to have abnormal immunological findings in a number of studies, which have been reviewed by others. 1,2 Late clinical consequences in this group have been highlighted in a recent study. 3 Paediatric heart transplantation involves not only thymus excision but also peri-transplant immunosuppression and ongoing maintenance immunosuppression. Late graft loss/death in paediatric

This study aimed to determine the association of Apgar score with meconium staining of amniotic fluid in labor. MethodologyA retrospective observational study was carried out through the non-probability convenient sampling technique at the Department of Obstetrics and Gynecology for a duration of six months. Only those women were selected who had more than 24 weeks of gestation period. The women were excluded on the basis of risk factors for fetal distress and breech in late labor. ResultsA total of 216 pregnant women were selected from the labor room in this study. The mean age of the women was 26.57±4.28 years. The gestational age of the women was 36.09±4.11 weeks. Moreover, the mean parity of pregnant women was 1.68±2.53. It has been observed that the women who had meconium staining, the neonates of 144(77.4%) women showed the Apgar score of less than six at one minute. However, for the women without meconium staining, the neonates of only 15(50%) women showed the Apgar score of less than six at the one-minute interval with a significant association (p=0.02). With respect to age groups, a significant association of meconium staining with Apgar score was noted in the 21-30 years age group, whereas, no significant association was seen in other age groups. Similarly, a significant association of meconium staining and Apgar score was noted in primiparous women, whereas, no significant association was noted in multiparous women. No significant association of Apgar score and meconium staining was seen with respect to the mode of delivery. ConclusionThe study has found a relation between the Apgar score and meconium staining of amniotic fluid and reported that the Apgar score of less than six at one minute was significantly associated with meconium staining of amniotic fluid.

Background and objectivePre-eclampsia (PE) is a major cause of maternal morbidity and mortality. The utility of Doppler ultrasonography (U/S) in predicting PE has not been extensively explored. This study aimed to determine the role of Doppler U/S in predicting PE among high-risk women. MethodologyThis was a retrospective observational study conducted at the Department of Obstetrics and Gynecology of Abbasi Shaheed Hospital in Karachi, over a period of one year, from January 2019 till December 2019. A total of 325 women were initially screened for risk factors for PE. Among them, 75 women were eventually found to have risk factors for PE and hence included in the study. Uterine artery Doppler U/S was performed to evaluate uterine artery's flow velocity waveforms. They were then used to calculate the presence of diastolic notch and resistance index (RI). At each antenatal visit, the risk factors for PE such as BP, proteinuria, and signs and symptoms were noted. Women were labeled to have PE if they developed hypertension (BP >140/90) after 20 weeks of gestation in combination with proteinuria. ResultsTwenty women (28%) had a normal Doppler flow of the uterine arteries. In 54 (72%) women, a unilateral/bilateral RI >0.58 was observed, and 29 women (38.7%) had a bilateral Rl >0.58. Notching of the uterine artery was also observed in 42 (26.7%, unilateral/bilateral) and in 22 (29.3%) bilaterally. Among the 75 women, BP of 140/90 mmHg along with proteinuria was observed in 56 (76.7%) cases, which were hence diagnosed as PE. Based on the cutoff of Rl and notching of the uterine artery, the overall sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of Doppler U/S in predicting PE were 71.4%, 26.3%, 23.8%, and 74.1%, respectively. As far as individual Doppler U/S indices were concerned, RI >0.58 (unilateral/bilateral) was found to be most sensitive (71%), while the presence of uterine artery notch (unilateral/bilateral) was most specific in predicting PE. ConclusionAbnormal Doppler U/S has good overall sensitivity in predicting PE. Among individual Doppler indices, notching of uterine arteries had a better specificity compared to high RI.

Objective: To compare the efficacy of fistulotomy with marsupialization vs fistulotomy alone in the treatment of simple low lying anal fistula in terms of wound healing and postoperative pain. Study Design: Randomized control trial Place and Duration: Department of General Surgery, JPMC Karachi, duration of Study was 6 months from 23rd Aug 2020 to 23rd Feb 2021. Methodology: Sixty patients of either gender having ages 25-60 years presented with low anal fistula were included in this study. Detailed demographics were recorded after taking informed written consent from all the patients. Patients were divided in to two groups. Fistulotomy was performed on 30 patients in group A and fistulotomy with marsupialization was performed on 30 patients in group B. Patients were asked to choose envelop labelled treatment A and treatment B for the randomization. All patients were followed up on 24 hours after surgery and on weekly interval up to 4 weeks to determine the outcomes in terms of wound healing and pain score. Data was analyzed by SPSS 23.0. Results: In group A mean age of patients was 43.633+8.568 years while in group B mean age was 41.800+9.813 years. The mean Pain score after 24 hours in group A was 6.100+0.922 while in group B it was 5.033+0.718 with overall mean Pain score after 24 hours of 5.566+0.980. The mean Pain score after 5th day in group A was 4.266+0.639 while in group B it was 2.833+0.698 with overall mean Pain score after 5th day of 3.550+0.981. In Group A efficacy was achieved in 4 patients (6.7%) while in Group B efficacy was achieved in 14 (23.3%) patients. Conclusion: Marsupialization of the wound after fistulotomy for low anal fistula results in faster wound healing and less mean post operative pain as compare to fistulotomy alone. Keywords: Low Anal Fistula, Marsupialization, Fistulotomy, Pain, Wound Healing

Introduction: The current practice standards demand achievement of cure along with preservation of voice and laryngeal anatomy. The recommended approaches for early stage glottic carcinoma are both laser surgery (LS) as well as radiotherapy (RT). Both modalities having some merits as well as demerits. So the objective of the study is to compare the outcome of early glottic cancer patients having laser resection with the patients who received radiation therapy. Study Design: Cross sectional study. Setting: Ziauddin Hospital. Period: January 2013 up to July 2017. Material and Methods: Patients aged 18 years and above with a history of constant hoarseness of voice from 2 months to 4 months were taken. Only the patients with stage 1 that is T1a or T1b squamous cell carcinoma of vocal cords with no nodal or distant metastasis (T1N0M0) were included. Results: A total of 25 patients were diagnosed with glottic cancer of stage T1N0M0. The mean age was 50.56 ± 11.8. Most of them were male with high prevalence of aggravating factors. Majority of patients had left sided vocal cord involvement. When comparing the both modalities, the results showed that Radiotherapy had more complications than Laser surgery. On follow-up visits, the complication with Radiotherapy subsides and larynx anatomy restored but there was no voice restoration in Laser surgery. Conclusion: It can be concluded that both treatment modalities including Laser Surgery and Radiotherapy had excellent outcome with good prognosis for voice. However, considering the survival rates, Radiotherapy showed bit superiority over Laser Surgery, despite its complications. Radiotherapy should be the first choice after diagnosing early stage of glottic carcinoma.