[en] To compare three ports laparoscopic cholecystectomy and four ports laparoscopic cholecystectomy in terms of complications, time taken to complete the procedure, hospital stay and cost effectiveness in local perspective. Methodology: This randomized control trial included 60 patients who underwent elective laparoscopic cholecystectomy at Department of Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from January 2013 to June 2013. These patients were randomized on computer generated table of random numbers into group A and Group B. In Group A patients four ports were passed to perform laparoscopic cholecystectomy and in Group B patients three ports were passed to perform the procedure. Results: The mean age in both groups was 44 years (range 18-72). Three ports laparoscopic cholecystectomy (43 min) took less time to complete than four ports laparoscopic cholecystectomy (51 min). Patients in three ports laparoscopic cholecystectomy experienced less pain as compared to four ports group. The total additional analgesia requirement in 24 hours calculated in milligrams was less in three port laparoscopic cholecystectomy group as compared four port laparoscopic cholecystectomy group. The mean hospital stay in three port laparoscopic cholecystectomy group is 25 hours while the mean hospital stay in the four port laparoscopic cholecystectomy group is 28 hours. Conclusion: Three ports laparoscopic cholecystectomy is safe and effective procedure and it did not compromise the patient safety. (author)

[en] Objective: To determine factors related to chronic persistent pain lasting more than 6 months after mesh repair for inguinal hernia. Methodology: This study included 114 patients who underwent elective inguinal hernioplasty at Department of General Surgery, Federal General Hospital, Islamabad, Pakistan from July 2012 to December 2014. All were followed upto end of six months. Postoperatively pain was recorded at second, seventh and fourteen day and at the end of six months on Visual Analogue Scale. Results: Chronic pain at six-month follow up was present in 37 (32.45%) patients. The incidence of factors responsible for chronic pain were pain before surgery in 22 (19.29%), early postoperative pain in 10 (8.77%) of patients, wound infection in 2 (1.75%), hematoma formation in 3 (2.63%), and seroma formation in 4 (3.508%) patients. Conclusion: Chronic pain after mesh repair for inguinal hernia causes significant morbidity. Early recognition and management of the factors prevents patient morbidity. (author)

[en] Objective: To establish the frequency of thyroid disorders among Rheumatoid Arthritis patients and its association with disease severity measured by DAS28-ESR. Study Design: Prospective longitudinal study. Place and Duration of Study: Department of Rheumatology, Federal Government Policlinic Hospital, Islamabad Pakistan, from Jan to Jun 2021. Methodology: The study included 87 consecutive patients either gender with Rheumatoid Arthritis visiting Rheumatology OPD. Thyroid profile and DAS28-ESR were performed in all the patients. Results: Out of 87 patients, 73(83.9%) were females, and 14(16.1%) were males. The mean age was 45.54±13.50 years. The mean DAS28-ESR was 4.45±0.68, with a minimum DAS28-ESR of 1.25 and a maximum of 8.40. The Disease severity calculated by DAS28-ESR was mild in 19(21.8%), moderate in 44(50.6%) and severe in 24(27.6 %) patients. The thyroid gland was abnormal in 23(26.1%) patients. 18(78.2%) of 23 patients with thyroid disorders belonged to the moderate to severe Rheumatoid arthritis disease activity group. Conclusion: Thyroid disorders are very common in Rheumatoid Arthritis patients. Thyroid workup should be part of investigations of Rheumatoid Arthritis for early detection of thyroid disorder and better disease control. (author)

[en] Some 20-40% of the periampullary carcinoma is irresectable at the time of diagnosis. Biliary stenting and surgical bypass are commonly used palliative procedure. There is no consensus favouring one procedure over the other. This study compares the both procedures. Methods: This Randomized Controlled Trial included 47 patients who presented with diagnosis of obstructive jaundice due to periampullary carcinoma to the Department of Surgery, Federal General Hospital, Islamabad from July 2012 to December 2014. Results: Out of total 47 patients 27 (57.44%) were males and 20 (42.55%) were females. Group-A included 25 (53.19%) patients while group-B included 22 (46.81%) patients. The mean age in both groups was 62.34 years (SD=+-5.01). All patients died during the study. The mean survival time for the stent patients was 7.5 months while the mean survival time for surgical bypass patients was 8.3 months. The jaundice was relived in all surgical (22, 100%) of the patients as compared to (18, 72%) of the patients in stent group. Conclusion: We concluded that surgical bypass as a primary procedure in selected patients provided better jaundice relieve as compared to biliary stenting. (author)

[en] Objective: To determine the etiology of chronic liver disease in children. Study Design: Descriptive cross sectional. Place and Duration of Study: Department of Paediatrics, Combined Military Hospital Lahore, from Jun 2014 to Dec 2014. Material and Methods: This is a descriptive cross sectional study conducted at department of Paediatrics, Combined Military Hospital Lahore from 1st June 2014 to 31st December 2014. It included 150 consecutive paediatric patients (1-14 years) with chronic liver disease. Results: Out of 150 children 95 (63.33%) were male and 55 (36.66%) were females. The mean age of the children included in the study was 7.2 +- 4.6 years and the age range was 1 year to 14 years. Viral hepatitis (61, 40.67%) was the commonest cause of the liver disease followed by glycogen storage disease (11, 7.33%) and Wilson's disease in 13 (8.6%). Conclusion: There are various causes of chronic liver disease in children most common being hepatitis B and C infection. The early identification of etiology of chronic liver disease in children is of cardinal importance for optimal management of these cases.