Health Sciences Jamshoro Research Articles

Evaluation of Female Infertility Factors Through Diagnostic Laparoscopy: a Cross Sectional Study

Aim: To evaluate the factors behind primary and secondary infertility in females through diagnostic laparoscopy. Study design: Cross sectional study Place and duration: This study was conducted at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020 Methodology: The present study is a cross sectional study conducted at at Bilawal Medical College Kotri Hospital/Liaquat University of Medical and Health Sciences Jamshoro, Pakistan from June 2019 to July 2020. A total of 115 females were included in the study and they all underwent diagnostic laparoscopy after setting strict inclusion criteria. Data was recorded on proforma and analyzed on IBM SPSS version 22. Primary and secondary infertility frequency was calculated and analyzed. Result: A total of 115 infertile women were considered in the study and results were recorded after performing diagnostic laparoscopy on all of the participants. Total 74 (64.35%) had primary infertility and 41 (35.65%) reported secondary infertility. Total 19 (25.67%) participants of primary infertility and 5 (12.19%) participants with secondary infertility showed no abnormality. The most common abnormality found was tubal blockage in 17 (22.97%) women of primary infertility and 13 (31.70%) women of secondary infertility. Total 11 (14.86%) patients of primary infertility were diagnosed with polycystic ovaries (PCO). PCO was absent in patients with secondary infertility. Total 9 (12.16%) cases of primary infertility and 5 (12.19%) cases of secondary infertility were diagnosed with Endometriosis. Total 2 (2.7%) cases of primary infertility and 7 (17.07%) participants with secondary infertility presented with Pelvic Inflammatory disease (PID). A total of 6 (8.10%) cases having primary infertility were observed with periovarian adhesions and Peritubal adhesions, whereas, 9 (21.95%) cases of secondary infertility were seen with these issues. Conclusion: Tubal occlusion, periovarian adhesions, peritubular adhesions, and endometriosis were the most common factors behind infertility in both primary and secondary infertility. Ovarian cyst and polycystic ovarian disease were only present in patients with primary infertility. Keywords: Diagnostic Laparoscopy, Primary infertility tubal occlusion, Secondary infertility

Role of Gastrografin in Adhesive Intestinal Obstruction

Objective: To determine the role of gastrografin in adhesive intestinal obstruction.
 Study Design: This is an observational study.
 Setting: Study carried out at General Surgery Department, Liaquat University of Medical and Health Sciences Jamshoro and Shaheed Benazir Bhutto Medical College, Lyari Karachi, from January 2020 to July 2021.
 Material & Method: Patients having clinical and radiological signs evidence of adhesive bowel obstruction over the age of 18 years were selected for the study. One hundred milliliters of gastrografin were given via nasogastric tube and its transit was followed by serial abdominal radiographs and fluoroscopy.
 Results: In the time of 1 and half years, we received 53 patients with adhesive intestinal obstruction. It included 54.7% (n= 29) males and 45.2% (n=24) females with a mean age of 61 years. Out of 53 patients, 46 patients had a single previous abdominal surgery. After complete examination and investigations emergency laparotomy was performed in 15% (n=8) patients. Hence, out of total 53 patients, 27 patients fit into our criteria for gastrografin meal and follow through. Fluoroscopy revealed a partial obstruction in 19 patients and complete obstruction in 8 patients. After gastrografin follow through obstruction was relieved in 17 patients within the meantime of 63 hours (range 20-78h).
 Conclusion: In our study, gastrografin is found to be of great diagnostic and therapeutic value, with fewer adverse effects. It also reduces the need for surgery, hence decreasing the financial burden of operative treatment. In Pakistan, its use is still limited because of a lack of equipment, expertise, and radiological imaging facilit.

Frequency of Hypocalcaemia among Children (Age 2-60 Months) Presenting with First Episode of Afebrile Seizures: A Cross Sectional Study

Aim: To determine the frequency of hypocalcaemia among children aged 2 to 60 months presenting with afebrile seizures.
 Study Design: A cross sectional study.
 Place and Duration: Department of Pediatrics, Liaquat University of medical and Health Sciences Jamshoro, from February to August-2020.
 Methodology: A total of 130 children aged 2 to 60 months, having afebrile fits with birth weight more than 2.5 kg were enrolled. After taking full history, detailed examination was done. Two ml blood sample was taken from each patient and was sent to diagnostic laboratory of the institution to find out calcium levels. In case of proven hypocalcaemia, injection calcium gluconate 100 mg/kg was administered. Mean and standard deviation were calculated for quantitative variables while frequency and percentages were noted for qualitative variables. Frequency of hypocalcaemia was recorded and study variables were compared between children with and without hypocalcaemia.
 Results: Majority of the patients, 69 (53.1%) were male, 64 (49.2%) less than or equal to 12 months of age, 28 (21.5%) had maternal educational status as illiterate, 78 (60.0%) belonged to rural areas, 59 (45.4%) belonged to middle socioeconomic status, 69 (53.1%) had poor exposure to sunlight, 80 (61.5%) had malnutrition, 82 (63.1%) had child spacing of less than 2 years, 79 (60.8%) with less than 5 episodes of fits per day and 88 (67.7%) had duration of fits per day as less than 5 minutes. Frequency of hypocalcaemia was noted in 81 (62.3%) cases.
 Conclusion: We concluded that hypocalcaemia is the frequent cause of afebrile seizures in children aged 2 to 60 months.

Gender Difference in Blood Pressure Control and Cardiovascular Risk Factors with Diagnosed Hypertension

Objective: Our study was designed to compare the gender difference in Blood Pressure Control and Cardiovascular Risk Factors in patients of Liaquat University of Medical and Health Sciences Jamshoro Pakistan.
 Methodology: This cross-sectional study was conducted in Liaquat University of Medical and Health Sciences Jamshoro Pakistan from December 2019 to December 2020. Blood pressure was measured twice by trained physicians using aneroid sphygmomanometers after a standardized protocol. Patients were asked to sit with both feet on the floor for ≥5 minutes before the first BP measurement. Both the two BP measurements were taken 60 seconds apart. For this research we defined hypertension as systolic BP ≥140 mm Hg, diastolic BP ≥90 mm Hg.
 Results: We conducted a comparison between Hypertensive and nonhypertensive participants of the male and female groups. High blood pressure increased the level of uric acid in both male and female groups (351 ± 92 vs 303 ± 75). We observed that the hypertensive male population reported a high prevalence of cardiovascular risk factors due to increase amount of total cholesterol level, triglyceride and low-density lipoprotein cholesterol (5.45 ± 1.01, 1.42 ± 0.85, 2.56 ± 0.70) than females (5.15 ± 0.91, 1.29 ± 0.87, 2.30 ± 0.63).
 Conclusion: Our results concluded that the male hypertensive population is more prone to future cardiovascular risk due to increased amount of total cholesterol levels, triglycerides, and low-density lipoprotein cholesterol, and sex hormones (androgens).

Laparoscopic Surgical Management of Rectal Cancer at Tertiary Care Hospital

Objective: To evaluate the consequent outcomes in the patients with rectal cancer endured laparoscopic surgical excision at Department of Surgery, Liaquat University of Medical and Health Sciences Jamshoro, Hyderabad and to review their curative resection and recurrence rates, postoperative morbidities and complete survival. Methods: This prospective case series study was done at the Department of General Surgery of Liaquat University of Medical & Health Sciences, Jamshoro, Sindh, Pakistan. All patients of 30-65 years ages with rectal cancer and underwent diagnostic laparoscopy either of gender were included. After removing the tumor, the specimen pinned out on a flat surface and placed in fixative solution to allow the orientation of the specimen and assessments of the exact margins. As the specimens had acceptable clear margins and limited invasion to the submucosa, no further surgical procedure was proceeded. Data was collected via study proforma. Results: A total of 40 patients were studied. Patients in the laparoscopic operation lost less blood with an amount of only 200mL during 190 minutes average operation time. The bowel functioning returned in 2 days averagely with 8 days average hospital stay. Conclusion: It is concluded that laparoscopic surgery for rectal cancer is an effective, safe and feasible approach in terms of less post-operative complications and recovery time as well as Hospital stay. Key words: Rectal Cancer, laparoscopic surgery

Role of topical cyclosporine in prevention of pterygium recurrence, after primary excision.

Role of topical cyclosporine in prevention of pterygium recurrence, after primary excision.
 Purpose: To evaluate the effect of cyclosporine on pterygium recurrence after primary excision
 Study Design: Non randomized prospective comparative study.
 Place and Duration of Study: The study was conducted in the department of Ophthalmology Liaquat University of Medical and Health Sciences Jamshoro from 2015 to 2017
 Material and Methods: One hundred and thirty eyes of 65 patients having bilateral pterygium, at least 2mm encroaching on the cornea, were randomly selected for study. After informed consent patient was seen on slit lamp, the dimensions of pterygium was measured. The eye with more pterygium was selected for post-operative cyclosporine and was named as cyclo- eye and fellow eye was selected for simple excision and was named as non-cyclo eye. Immediate post-operative treatment was tobramycin dexamethasone eye ointment twice and moxifloxacine eye drops three times daily until corneal epithelium was restored, followed by moxifloxacine and Cyclosporine eye drops twice daily until complete healing of ocular surface occurred and then cyclosporine 0.05% alone once daily in the evening up to three months. In the fellow eye tobramycin dexamethasone eye ointment and moxifloxacine eye drops were used for complete healing time followed by tears alone three times for three months. Recurrence was defined as 1mm encroachment of pterygium on the cornea. Follow up was done for six months.
 Results: Fifty-three patients who completed 6 months follow were only included in the results. In cyclo-eyes recurrent pterygium was observed only in 04(07.55%) and in non-cyclo eyes recurrence was observed in 23(43.40%). Therefore, cyclosporine was able to reduce pterygium recurrence further in 19(35.85%) eyes, but healing time increased. Mean healing time in cyclo-eyes 21.1354 days and in non-cyclo-eyes 15.0213 days. Standard deviation in cyclo-eyes 1.3412 and in non-cyclo-eyes 1.0413. P-value was 0.002 and 0.004 respectively.
 Conclusion: Cyclosporine is effective in reducing the recurrence rate of pterygium.
 Key words: Pterygium, cyclosporine, recurrence

Lower Incisor Positions in Different Malocclusions and Facial Pattern

Aims: The position of lower incisor has been of significant concern when seeking orthodontic treatment plan, it has been recognized as one of diagnostic key and play an important in the development of normal occlusion and facial pattern. This study was aimed at the determination of lower incisor position and its possible association with different sagittal malocclusions and facial patterns.
 Study Design: Descriptive Cross-sectional Study
 Place and Duration of Study: Department of Orthodontics Institute of Dentistry Liaquat University Medical and Health Sciences (LUMHS) Jamshoro between June 2019 to July 2020.
 Methodology: Ninety-seven pre-treatment lateral cephalometric radiographies were taken, and they were classified sagittally into skeletal class I, II and III, and vertically into normodivergent, hyperdivergent and hypodivergent facial pattern using ANB and SNMP, respectively. Lower incisor position was assessed by means of FMIA and IMPA. One way analysis of variance (ANOVA) was applied to check any association between lower incisor position and sagittal malocclusion and facial pattern. P value of 0.05 was considered statistically significant.
 Results: The study sample consisted of 97 patients. The mean age of the patients was 25.55 SD ±3.93. The mean SNMP value was 28.84 SD ±7.354 and mean ANB value 4.809 SD ±3.85. Mean Incisor position based on IMPA was 98.598 SD ± 9.413 and FMIA 54 SD ±9.995. Intra and interobserver reliability was assessed with intraclass correlation coefficient values ranging between 0.825 and 0.990 respectively. The ANOVA test results showed significant relationship between the sagittal malocclusion and incisor position with P value .036. The Bonferroni analysis indicated that statistically significant association existed in term of lower incisor position between Class II and Class III malocclusion with P value .047. Test results further indicated that there is no significant difference in the position of lower incisor in relation to facial pattern with P value .355.
 Conclusions: Statistically significant association was found between lower incisor position with respect to the sagittal malocclusion. However, no significant association was found between facial pattern and lower incisor position.

Proton Pump Inhibitors: Pantoprazole is the safe drug as compared to Omeprazole drug during treatment of Dyslipidemia.

Introduction: Proton pump inhibitors (PPIs) are commonly used to manage ret-rosternal burning to peptic ulcer disease. Dyslipidemia is also very common in Asian population.Objective: To evaluate the effects of different groups of PPIs like omeprazole, Pan-toprazole, esomeprazole on lipid profile.Methodology: This animal study conducted at the Department of Pharmacology with collaboration of Diagnostic & Research laboratory of Liaquat University of Medical & Health Sciences Jamshoro from 16 Nov to 30 Nov 2020. 24 male rabbit were divided in 3 equal groups. The sample for lipid profile were taken twice; first sample was collected before start of PPPIs, while another sample was taken after six weeks of the treatment with different groups of PPPIs. The lipid profile was ana-lyzed by Cobass Auto analyzer (C-311) of Hitachi at Diagnostic & Research Labora-tory LUMHS. The Statistical analysis was performed by student ‘t’ test and chi square test by using SPSS version 21.Result: The results found were statistically significant (p=<0.05) for omeprazole and esomeprazole while it was insignificant (p=0.247) for pantoprazole. TG’s was signifi-cantly more in group A and B animals as compare to group C animals. Low density Lipoprotein found raised among all groups but the rise was statistically insignifi-cant.Conclusion: Omeprazole exerts significant effects over all observed parameters of lipid profile, esomeprazole showed effects over few parameters, while pantopra-zole showed insignificant effects over lipid profile.Key words: Proton Pump Inhibitors, Low density Lipoprotein, Cholesterol.

Clinical Effects of Amoxicillin-clavulanate and Calcium Hydroxide as Intracanal Medicament on Inter appointment Pain among Symptomatic Apical Periodontitis

Objective:To compare the clinical effects of Antibiotic amoxicillin-clavulanate and calcium hydroxide on inter appointmentpain in cases of Symptomatic Apical Periodontitis. Methodology:It was a single blind randomized controlled trial study performed in operative Dentistry Department ofLiaquat University of Medical and Health Sciences Jamshoro. This study was conducted from 02-Jan-2017 to 27-June-2017. Total n=324 patients with symptomatic apical periodontitis were targeted. Patients were randomly allocated into twogroups. Total n=162 patients in group1 treated with Antibiotic amoxicillin-clavulanate and n=162 patients in group 2 ofcalcium hydroxide. Procedure was performed by single operator. Clinical effect was assessed if pain present or absent after24 hours and 7 days on recalled visit and was labeled as positive when there was no pain (0-3 on VAS) and as negativewhen there was pain (4-10 on VAS). Data of the study was analyzed by using the SPSS version 20. Mean and standarddeviation was calculated for quantitative variables like age and pre and postoperative pain. Frequency and percentageswere calculated for type of tooth. Both groups were compared byusing Chi- square test for clinical effect. Results:The average age of the patients was 39.807.36 years. There were 50% male and 50% female. Clinical effectivenesswas significantly high in group 1 than group 2 [79.01% vs. 65.43% p=0.006]. Conclusion:The findings of this study are encouraging that patients in which Amoxicillin-clavulanate was used as intracanalmedicament appeared to show a greater decrease in pain levels over the observation period when compared to the control group

Evaluation of Post-operative Pain by using Calcium Hydroxide Based Root Canal Sealer: A Clinical Study

Objective: To assess the post-operative pain by using calcium hydroxide Ca(OH)2 based root canal sealer, a clinical study at tertiary care Hospital
 Materials and Methods: This cross-sectional study was performed at operative dentistry department of Liaquat University of Medical and health Sciences Jamshoro Pakistan. Study duration was 6 months from March 2020 August 2020. Total 60 patients, those having permanent anterior teeth with irreversible pulpitis, teeth restoration after root canal treatment and either of gender were included. Multiple visits of endodontic treatment were performed by obturating the canals using calcium hydroxide Ca(OH)2 (sealapex, Sybron endo). Patients were recalled next day, after 3rd day and after one week of obturation to assess the severity of post-operative pain (POP) via visual analogue scale (VAS). All the information was recorded via study proforma. Data analysis was done by using SPSS version 20.
 Results: Mean age of the study participants was 26.77+8.72 years. males were in majority 36(60.0%). On the next day as per severity of pain, mostly patients were presented with severe pain as mean visual analogue scale was 8.7+0.3. On third day pain was markedly decrease among almost all of the cases as average of visual analogue scale was found 2.6+0.2. However after one all the patients were seen without pain as average of visual analogue scale was 0.65+0.7. Pain was statistically insignificant according to gender.
 Conclusion: Calcium hydroxide based root canal sealer found to be feasible and effective for endodontic treatment in terms of lower postoperative pain.

Prevalence of Hepatitis B and C among Tuberculosis Patients at Local Community of Sindh, Pakistan

Objective: To assess the prevalence rate of Hepatitis B and C among those patients who had tuberculosis in local community of Sindh, Pakistan. Study Design:Survey-based study Place and Duration of Study: Department of Pathology, Liaquat University of Medical & health Sciences Jamshoro from 1stJanuary 2020 to 31stDecember 2020. Methodology: Five hundred and eighty nine confirmed cases of tuberculosis patients were enrolled. The patients were further analyzed to assess either HBV, HCV or both are present or absent. Results: Three hundred and forty one (57.8%) were males and 248 (42.1%) were females. The majority of participants were in the age group of 45-54 years 147 (24.9%).The residence detail showed that 167 (28.3%) belonged to urban areas. Further 143 (24.2%) had sickness history of 2-6 months, 239 (40.5%) had history of 6-12 months, The prevalence of hepatitis B and C among tuberculosis patients showed, 17.8% (n=105) with Hepatitis B, 26.3% (n=155) were diagnosed with hepatitis C, 15.7% (n=93) had Both Hepatitis B and C, however 236 (40.0%) had no history with hepatitis. Hepatitis C was most frequently found age of above 54 years, 55 (9.3%). Conclusion:The control of tuberculosis has remained one of the greatest goals globally till date, the higher risk of liver complications, along with the Hepatitis B and Hepatitis C. Although the complications of Tuberculosis patients remain unsolved yet the possible efforts can be made to identify the earlier problems for the clinical prospective and a complete follow up of the records can optimize the management of Tuberculosis in co-existing conditions of hepatitis B and C. Key Words: Hepatitis B, Hepatitis C, Tuberculosis, Liver diseases

Current Practice for the Management of Blunt Abdominal Trauma in a Tertiary Care Hospital: A Prospective Study

Aim: To assess the different kinds of management provided to patients with Blunt Abdominal Trauma (BAT) in the surgical department of a tertiary care hospital. Study design: prospective study Place and Duration: This study was conducted at Liaquat University of Medical and Health Sciences Jamshoro from March 2021 to March 2022 Methodology: The present study includes 115 patients who presented with blunt abdomen trauma (BAT). The data was collected with the pre-designed questionnaire. Data were collected prospectively from all patients admitted to the hospital with abdominal trauma. The trauma was treated using ATLS (Advanced Trauma Life Support) techniques. Laboratory and imaging investigations were performed to diagnose and manage the patients. SPSS version 21 was used to analyze the data. Descriptive statistics were presented in mean, SD/median, frequency, and percentage. Results: During the investigation, 115 BAT patients were examined. The average age of the patients was 33.7 ± 7.2 years. Males (n=94, 81.7%) and symptomatic cases (n=108, 94%) made up the majority of the injured patients. More than half of the patients (n=73, 63.5%) had abdominal tenderness when they arrived. The majority of the patients had X-rays (n=87, 75.6%) ultrasound (n=75, 65.2%), lab investigation (n=83, 72.1%) and abdominal CT scan (n=35, 30.4%). Only a few patients died (n=17, 14.8%). Patients were treated conservatively in 83% of cases, while surgical treatments were used in 17% of cases. Conclusion: Non-operative therapy has become the gold standard for critically stable patients with traumatic injuries. Although non-operative management has a higher risk of failure in patients with multiple solid organ injuries, it should still be used with caution in most critically stable persons who do not have peritoneal symptoms. Keywords: Accident, Blunt Abdominal Trauma (BAT), Non-operative management, vitally stable.

Role of Green Tea on Obesity and Type-II Diabetes Mellitus Male Individuals

Objective: To evaluate the effects of Green tea on obesity and hyperglycemia.
 Methodology: This observational study was carried out at the department of physiology, in affiliation to Medical Research Centre Liaquat University of Medical and Health Sciences Jamshoro. The sample was collected by convenient random sampling. Total 100 participants, 50 controls and 50 obese diabetics were enrolled. Informed written consent was taken from participants. The body mass index (BMI) of the participants was taken at the time of recruitment, and later at 16 weeks of consuming green tea. The serum glucose levels were assessed by fasting (FBS) and random blood sugar (RBS) levels, and HbA1C. The levels of serum Blood glucose were obtained with the glucose oxidase method. Data analysis was done on SPSS 21.0, analysis of variables was done by applying student t-test, the p-value of <0.05 was taken as statistically significant.
 Results:100 participants recruited out of which 50 controls and 50 obese diabetics men, it was found that the prolong consumption of green tea for 16 weeks with 20-30 minutes’ walk had statistically significant declined in FBS, RBS, HbA1c, and BMI in the obese diabetic subjects, as compared to the controls.
 Conclusion: This study concludes that the green tea has positive effect in reducing the total body weight and BMI and helps in maintaining the normoglycemic levels in Type 2 DM.

Frequency of Incidental Findings on Diagnostic Laparoscopy in Patients Undergoing Elective Laparoscopic Cholecystectomy

Objective: To determine the frequency of incidental findings on diagnostic laparoscopy in patients undergoing elective laparoscopic cholecystectomy at tertiary care hospital Jamshoro.
 Study design: This is a descriptive cross sectional study.
 Setting: Study carried out at department of general surgery, Liaquat University of Medical & Health Sciences (LUMHS) Jamshoro from 1st February 2019 to 30th July 2019.
 Materials and methods: A total of 164 patients of both gender undergoing diagnostic laparoscopy in patients of laparoscopic cholecystectomy were included in the study. Laparoscopy was done under general anesthesia in all patients. The whole of peritoneal cavity was sequentially visualized using trendelenberg and reverse trendelenberg positions, and right or left tilt as required.
 Results: Age range in this study was from 20 to 79 years with mean age of 43.622±9.31 years. 40.2% patients were of male gender and 59.8% patients were females. Peritoneal band & adhesions was seen in 9.8% patients, Ovarian Cyst 5.5%, Abdominal Tuberculosis 19.5% and Gall Bladder Carcinoma was 3%.
 Conclusion: We conclude that laparoscopy is very safe, can obviate the need for a full exploratory laparotomy & minimize the surgical trauma in chronically ill patients.

Early Outcome of Mid-Shaft Radius & Ulna Fracture Osteosynthesis through Single Posterior Incision Approach

Objective: To determine the early outcome of mid-shaft radius and ulna fracture osteosynthesis through single posterior incision approach.
 Study Design and Setting: This is a retrospective study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, from September 2019 to December 2020.
 Material and Methods: In total 14 patients were operated out of which 9(64.29%) were male and 5 were females through posterior single incision approach (Thompson approach). Demographic data regarding the pattern of fracture and the complications after the surgery at 2,6 and 12 weeks was collected respectively.
 Results: The total number of cases operated from September 2019 to December 2020 were 14, out of 14 patients 9(64.29%) were males and 5(35.71%) were females. The average age of patients was 26.5 years ranging from 16-40 years .The average time of surgery was 61 minutes ranging from 50-70 minutes. The patients were discharged on 3rd post-operative perficial wound infection which was treated with antibiotics after culture and sensitivity There was no neurovascular deficit in all patients. All the fractures were united within 3 months time, and there was no radio ulnar synostosis observed within mean time.
 Conclusion: To conclude we can say that the single posterior incision approach for treatment of mid-shaft radius ulna fractures osteyosynthisis is effective and safe provided the surgical expertise and good anatomical knowledge for identification of the vital structures are there.

Outcome of Intramedullary Interlocking Nailing in the Management of Gustillo-I Diaphyseal Fracture of Tibia

Objective: To evaluate the outcome of intramedullary interlocking nailing in the management of Gustillo-I diaphyseal fracture of tibia.
 Study Design: This is an observational study.
 Setting: Study carried out at Orthopaedic Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2018 to February 2021.
 Materials & Methods: 72 consecutive patients of Gustillo Type-I diaphyseal fracture of tibia. All patients age between 18-60 years with traumatic fracture like Gustillo Type-I diaphyseal fracture of tibia were included in this study. Patients reported chest, abdominal and head trauma with neurovascular deficit were excluded. Patients were prepared for surgery after relevant investigation and radiographs.
 Results: Out of 72 patients included in this study 11.11% were female (N=8) and 88.88% male (N=64); with mean age was 38.26±8.20 years (Range 18 to 60 years). Road traffic accident was common cause of tibia fracture (Gustillo Type-I). Postoperative mean union time of tibial fractures were 9.9±3. 2 week.Postoperatively started partial weight bearing associated with help of two axillary crutches. The patients walking with partial weight bearing allowed at 4.1±1.12 weeks. While patients walking with full weight bearing allowed at 10.8±2.4 weeks. Postoperatively 11(15.27%) patients were complaining of pain. Wound infection observed in 7(9.72%) cases. Clinically excellent results were found in 24(33.33%) patients, while good results remained in 30(41.66%) patients and fairs in 18(25%) patients. 
 Conclusion: We conclude that interlocking intra-medullary nailing may be considered as a suitable option for treatment of Gustilo-I diaphyseal fracture of tibia.

Workplace Bullying and Harassment among Health Care Professionals

Aim: To determine prevalence of workplace bullying and its effects on doctors at LUMHS Jamshoro. Study design: Cross sectional survey. Place and duration of study: Liaquat University of Medical & Health Sciences Jamshoro from 1stJanuary 2021 to 31stMarch. Methodology:Seventy five postgraduate residents, house officers and medical officers were selected randomly, all were interviewed by questionnaire. Questions were asked regarding any incident of bullying, aggression, violence, and harassment during hospital duty hours. Which behavior they faced and what was the reason of that behavior; asked from participants. The data was entered and analyzed using the SPSS 22. Results: Seventy four (98.66%) were females and 1(1.33%) was male with mean age of 27.3±4.7 years. 51 [68%] have been subjected to being bullied. Main source of harassing was by administration in 12%, faculty in 34.66%, senior colleagues in 42.66% colleagues 16%, paramedics15%, and patient’s attendants in 13%. Effects noticed on personality/ behavior were sadness in 41.33%, aggression 32%, confrontation change in sleep 12%, health complaints in headache/ palpitations 34.66%, loss of interest in activities 41.33%, poor performance at work 18.66%, lack of confidence 46.66%, fear to go to work place 20% and avoiding bullier in 29.33%. Conclusion: Prevalence of bullying was 68% among health care professionals interviewed in this study. Violence towards medical caretakers is expanding day by day.Serving in safe and healthy surroundings is the basic right of every health care worker to take healthy decisions to give quality patient care. Keywords: Bullying, harassment, Violence, Doctors, Heath care worker

A Video-Assisted Anal Fistula Treatment (VAAFT): A New Minimally Invasive Treatment Option for Fistula in Ano

Objective: To determine the outcome of video-assisted anal fistula treatment (VAAFT): A new minimally invasive treatment option for fistula in ano.
 Study Design: This is an observational study.
 Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form January 2020 to June 2020.
 Material & Method: Inclusion criteria for this study were patients aged 18-60 years visiting the outpatient department with primary/recurrent fistula having symptoms. Among these individuals having anal fistula due to secondary causes like IBD, tuberculosis or any malignancy were not included in the study. VAAFT was performed by experience general surgeon and post-operative follow up was done till 1 years.
 Results: A total of 68 patients with fistula in ano were selected for video assisted anal fistula treatment (VAAFT) in our setup. It included 67.6% (n=46) males and 32.3% (n=22) females who agreed for the procedure. The mean age of patients were found to be 43+13 years. Post-operatively complete healing was observed in 75% (n=51) patients and 14.7% patients had persistent fistula after the procedure. 
 Conclusion: VAAFT is a minimally invasive surgical intervention implied to treat primary and recurrent anal fistulas, having lesser rates of recurrence and few post-operative complications. It should be implied over large scales for treatment of primary and recurrent anal fistula as it carries the lowest rate of anal incontinence.

Endoscopic Pilonidal Sinus Treatment (EPSIT): Is a New Minimally Invasive Treatment in Pilonidal Sinus

Objective: To determine the outcome of endoscopic pilonidal sinus treatment (EPSIT): Is a new minimally invasive treatment in pilonidal sinus.
 Study Design: This is a observational study.
 Setting: Study carried out at General Surgery department, Liaquat University of Medical and Health Sciences Jamshoro, form March 2020 to Feb 2021.
 Materials and Methods: Patients aged between 20-40 years, both gender having sinus in the cleft of the buttocks on clinical examination with associated symptoms like pain when sitting or standing, reddened, sore skin around the area, pus or blood draining from sinus, hair protruding from the lesion and formation of more than one sinus tract, or holes in the skin were included in this study. Patients with abscess and recurrent pilonidal sinus were excluded. Outcome measurements were postoperative pain, return to normal daily activities and complication rates including infection, recurrence.
 Results: 44 patients with Pilonidal Sinus were included in this study. 15 to 40 years with mean age ± SD (range) was 26.56±4.1 years. 40(90.90%) were male where as 4(9.09%) were females. Mostly patients have single external openings in 37(84.09%) patients with midline opening location in 26(59.09%) patients. The mean operative time±SD (range) was 21.09±3.62 minutes (15 to 45 min). According to the visual analog scale (VAS) score for postoperative pain assessment after 48 hours of surgery, 36 patients (81.81%) reported a VAS between 1 to 3, and 8(18.18%) reported a score between 4 to 6. Postoperative wound infection was seen in one case 2.27% while recurrence was observed in two cases 4.54%. The overall healing rate was 93.18%. The mean time to return to normal daily activities was 6.1±11 (range, 2–15) days. 
 Conclusion: To conclude that the EPSiT is safe, effective, simple, repeatable and very welcomed by the patients if explained correctly. We can say that EPSiT can be labeled as a day surgery, with fast post-operative recovery and early return to work.

Role of Pharmacological Therapy and Surgical Intervention in Breast Carcinoma

Objective: To determine the Role of medical therapy and surgical intervention in carcinoma of breast.
 Study Design: Prospective observational study.
 Place and Duration: Two years study from January 2018 to December 2020 was conducted at Liaquat university of Medical and Health Sciences Jamshoro.
 Methods: The study comprises 50 patients. Data was collected from all who were admitted at OPD. The patients were evaluated fully after history & Clinical examinations and Specific investigations of Fine Needle Aspiration Cytology (FNAC), Tru cut biopsy for Histology ERPR Receptor and Herceptin receptor, ultra sound of breast, and Abdomen, Mammography, C T scan, M R I, Tumor marker CA15.3. CA 125 for ovary and breast, X ray chest and Bone scan. Sentinel lymph node biopsy for lymphatic involvement, Liver Function Test, serum calcium, Complete Blood Picture (CBP), blood sugar, blood urea. HBSAG, HCV, HIV and COVID-19 Evaluated patients were evaluated fully after history, clinical examinations & specific investigations.
 Results: In this study 50 patients of Carcinoma of breast. The maximum numbers of patients were in age group 20 to 80 years. 15 patients were in age group 20 to 39 year, 24 patients were in age group 40 to 59 years, 11 patients were in age group 60 to 80 year. Out of 50 patients 29 patients were presented with breast lump, 8 patients were presented with bloody discharge, 7 patients were presented with nipple destruction and 6 Patients were presented with pricking sensation Out of 50 patients 21 patients were presented with stage I, 13 Patients presented with stage II, 9 patients were presented with stage III and 7 patients were presented with stage IV. Out of 50 patients 22 Patients were diagnosed duct cell carcinoma, 11 patients were diagnosed Phyllodes tumor, 9 patients were diagnosed lobular cell carcinoma, 5 patient were diagnosed tubular cell carcinoma and 3 patients were diagnosed Paget’s type of carcinoma .Out of 50 patients 25 patients were ERPR positive treated by Nolvadex (tamoxifeen) 16 Patients were ERPR negative treated by chemotherapy drugs and Aromatase inhibitors, 9 Patients were Her2neu receptor positive treated by Herceptin (Trastuzumab) Out of 50 patients 34 patients were treated by Modified radical mastectomy, 16 patients were initially were treated neo adjuvant therapy. Then Modified Radical Mastectomy, Out of 50 patients 25 patients were treated with Nolvadex (tamoxifeen) after Modified Radical Mastectomy better outcome seen in those patients.
 Conclusion: Carcinoma of breast is a common problem all over the word, patient can present with lump over the breast, bloody discharge, destruction of nipple or areola if not diagnosed and treat early stage, patient can die within a year without Medical and surgical treatment.