Peshawar Medical College Research Articles

Change in Axial Length and Astigmatism after Scleral Buckling in Patients of Rhegmatogenous Retinal Detachment

Purpose: To determine changes in axial length and corneal astigmatism caused by scleral buckling in patients of uncomplicated retinal detachment undergoing scleral buckling procedure. Study Design: Quasi-experimental design. Place and Duration of Study: Peshawar Medical College and Allied hospitals, Pakistan from December, 2020 to May, 2021. Methods: This study included60 patients of uncomplicated rhegmatogenous retinal detachment, recruited through consecutive sampling technique and managed with primary scleral buckling. After a detailed history and complete examination including A-scan and Keratometric readings, patients underwent scleral buckling procedure. Changes in axial length and corneal curvatureswere measured at 6 months follow up. Quantitative analysis was done using paired T test. Results: Mean age of the sample was 41.95±13.67 years. The sample consisted of 42 males and 18 females. Encircling Band was used in 46 patients, segmental circumferential tire was used in 58 patients in one or more quadrants depending on the extent of the retinal detachment. Two patients underwent additional surgeries. The pre-operative mean axial length (AL) was 23.44±1.51 mm and post-operative AL at 6 months was 24.25±1.61mm (p < 0.05). The pre-operative and post-operative astigmatism were 1.08±0.43 and 1.75 ± 0.33 diopter respectively (p < 0.05). Conclusion: Scleral buckling led to a significant increase in axial length and astigmatism over a 6-month period. These changes suggest that scleral buckling can alter the optical properties of the eye, potentially affecting visual acuity and requiring careful consideration of these factors in post-operative management.

Clinico-demographic features and the benign diseases requiring hysterectomy; A Cross Sectional Study.

Objective: To evaluate the relationship between the clinic-demographic features and the benign diseases requiring hysterectomy. Study Design: Cross sectional study. Setting: Department of Obstetrics & Gynecology, Peshawar Medical College and its Affiliate Tertiary Care Hospitals. Period: 03 Oct, 2020 to 03 Oct, 2021. Methods: It was a part of the dissertation mandated by the college of physician and surgeons as part of the FCPS program. Using WHO sample size calculator a sample size of 104 patients was obtained and consecutive sampling was done. Logistic regression was used to co-relate clinic-demographic features with different diseases with 5% level of significance. Results: Mean of age of the patients was 48.55 years (±10.5years SD), mean height was 5.508 feet (±1.1feet SD), mean weight was 73.20 kg (±15.4kg SD) and the mean BMI was 26.58 (±4.5 SD). Diabetes mellitus was significantly more common in patients with leiomyoma and abnormal uterine bleeding, whereas, the social class and body mass index did not have an impact on the benign gynecological condition (p>0.05). Conclusion: Patients with symptomatic fibroid uterus and abnormal uterine bleeding are more likely to be hypertensive and diabetic, whereas, BMI, social class and residence area does not significantly differ among patients.

The hepatoprotective potential of nigella sativa oil against cypermethrin-induced hepatotoxicity in rats: A histomorphological investigation.

Objective: To determine the hepatotoxic effects induced by cypermethrin. The study also attempts to evaluate the hepatoprotective efficacy of Nigella sativa oil against hepatotoxicity produced by cypermethrin. Study Design: Experimental study. Setting: Department of Anatomy, Pharmacology, and Pathology of Peshawar Medical College and Animal house of PCSIR Laboratories Complex, Peshawar. Period: May 2023 to Dec 2023. Methods: Animals were divided into two groups: Control (Group A) and Experimental (Group B). The Experimental group (Group B) is divided into two subgroups Group B-I and Group B-II. Forty-two male Sprague Dawley rats were randomly assigned to three groups of fourteen rats each in order to conduct an experimental investigation. Group A served as a control group. Cypermethrin (5.5mg/kg‾¹ body weight) per day dissolved in corn oil was administered orally to Group B-I. Cypermethrin (5.5 mg/kg‾¹ body weight) per day orally and (1ml/kg‾¹ body weight) per day of Nigella sativa oil were given to group B-II. Liver obtained from these groups were fixed for histological studies under light microscopy. Liver tissues of the cypermethrin-treated animals showed leucocytic infiltration, hydropic alterations such as ballooning degeneration and focal lytic (spotty) liver necrosis. Results: After four weeks of treatment with cypermethrin demonstrated significant liver damage in group B-I animals. In group B-II Nigella sativa oil significantly reduced hepatotoxicity and induced regenerative changes. Nigella sativa oil demonstrated protection against the cypermethrin and preserved the normal histological architecture of the liver. Conclusion: Cypermethrin had a hepatotoxic potential and caused hepatotoxicity in liver, as evidenced by the histological changes in the liver tissue. However, the study also found that Nigella sativa oil showed a better hepatoprotective effect, as it was able to effectively reverse the liver damage caused by both cypermethrin.

Exploring protective potential of Vitamin E in mitigating liver steatosis in alcoholic liver injury.

Objective: To investigate and assess the efficacy of Vitamin E in preventing or reducing fatty liver changes associated with alcoholic liver injury. Study Design: Experimental study. Setting: Department of Anatomy and Animal Facility of Peshawar Medical College, Peshawar. Period: February 2018 to April 2020. Methods: The study involved eighteen male domestic rabbits (Oryctolagus cuniculus), organizing them into categories based on the time frames specified for the research. Animals in "Category E8" were subjected to an 8-week time period, while those in "Category E4" underwent a 4-week experimental duration. Each category was further divided into three groups: "Control Group A" received standard laboratory food and daily access to normal saline as drinking water, "Experimental Group B" received standard nutrition, a 30% ethanol solution in distal water (30ml per kg/day) and normal saline for drinking, and "Experimental Group C" was treated with the necessary standard diet, a 30% ethanol solution in distal water (30ml per kg/day), and "Vitamin E" (50mg dissolved in 2ml distal water per kg/day) via nasogastric tube. Liver tissue specimens from all animals were stained with H&E and Masson’s trichrome stain for quantification of fatty change. Results: A significant difference in steatosis development was observed among the E4 groups and among the E8 groups having a respective p-values of 0.001 and 0.003. This underscored the impact of alcohol within the context of alcohol-induced liver injury. However, no appreciable differences were noted between BI & CI and BII & CII (p-values > 0.05) indicating no significant distinction in liver steatosis between subjects treated with vitamin E and those not receiving vitamin E. Conclusion: In the context of alcohol-induced liver injury, the study failed to deliver anticipated protective benefits of vitamin E. There is a possibility of adverse effects, potentially rendering its use counterproductive.

Effectiveness of empathy portfolios in developing professional identity formation in medical students: a randomized controlled trial

BackgroundMedical education requires innovative strategies to enhance empathic skills and the formation of professional identities among students. However, evidence-based teaching of empathy and professional identity formation is inadequately represented, particularly in medical curricula. This study investigated the effectiveness of empathy portfolios in developing Professional Identity Formation (PIF) among medical students and the correlation between empathy and PIF. The objectives of this study were to determine the effectiveness of empathy portfolios for teaching and nurturing PIF in medical students and to investigate the correlation between empathy and PIF.MethodsA randomized controlled trial was conducted at Peshawar Medical College, Pakistan. The protocol adhered to CONSORT guidelines. A total of 120 students participated in the study. Empathy and PIF were assessed using two validated questionnaires JSPE-S and PIQ before randomization. The participants were randomized in a stratified fashion into the experimental (n = 60) and control (n = 60) groups. The Participants in the intervention group attended a training workshop on portfolio use. Students maintained their portfolios and wrote reflections on incidents that evoked empathy. Independent t-tests were performed to determine whether the control and experimental groups differed in terms of mean empathy and PIF scores, and Pearson’s correlation analyses were used to investigate the relationships between pre- and post-empathy, and pre-post-PIF.ResultsThe mean post-test scores on the Empathy and PIF showed a statistically insignificant difference of 0.75 +-17.6 for empathy and 0.45 ± 8.36 for PIF. The intervention had little influence on empathy and PIF scores, as evidenced by nonsignificant effect sizes of 0.32 and 0.36 for empathy and PIF respectively.A strong positive correlation was found between Pre-Empathy and the PIF-Total score (0.519), and between Post- empathy and the PIF-Total score (0.395) (p < 0.001).ConclusionsEmpathy had a positive linear correlation with PIF; however, the use of empathy portfolios as a three-week single-point intervention was ineffective at nurturing PIF.

A histopathological and epidemiological study of urothelial carcinoma at a tertiary care centre in Peshawar, Pakistan

Bladder cancer is the ninth leading cause of death worldwide and 14th leading cause of death in Pakistan. The objective of this study was to determine the frequency of urothelial carcinoma in various age groups, its gender distribution, and grades. A total of 131 cases of urothelial carcinoma, received at Department of Pathology, Peshawar Medical College, Peshawar, between January 2017 to December 2022, were included in the study; of them 107 (81.6%) were males while 24 (18.3%) were females with a mean age of 62±13 years. The most common histological subtype was papillary urothelial carcinoma in 117(89.3%) cases, followed by Squamous and Glandular in 5(3.8%) cases. Majority of the urothelial carcinoma with high grade showed a statistically significant relation with muscle invasion (n=38, 50.66%). Males were four times more likely to have urothelial carcinoma while older age groups were more likely to have high grade urothelial carcinoma. Keywords: Carcinoma, Urinary bladder, Cancer, Neoplasm, Urothelial.

Immunohistochemical (IHC) Expression of p16 in Various Grades of Oral Squamous Cell Carcinoma (OSCC) with Snuff Use in Tertiary Care Hospitals of Peshawar

Oral squamous cell carcinoma (OSCC) is a significant health concern, with various factors influencing its development and progression. Understanding these factors, including p16 expression and clinicopathologic features, is crucial for improved diagnosis and treatment. Objective: To compare various grades of OSCC based on immunohistochemical expression of p16 and clinicopathologic parameters. Methods: The comparative cross-sectional study was conducted at the Department of Pathology, Peshawar Medical College (PMC), and Peshawar Dental College (PDC) from August 2020 to August 2021. It included 53 cases of OSCC with documented snuff use history. Tumor sections were stained with Hematoxylin and Eosin and underwent immunohistochemical staining for p16 expression. Sample size calculation utilized G Power software. Statistical analysis was performed using SPSS version 20.0, employing the Chi-Square test to assess categorical variables. Results: Among the 53 OSCC cases, the majority were male (66.0%) with ages ranging from 26 to 85 years, the most common age group being 51-70 years. The tongue was the primary site for OSCC development. Well-differentiated cases were predominant (64.2%), followed by moderate (20.8%) and poor grade cases (15.1%). However, no significant association was found between p16 expression and OSCC grades. Notably, p16 expression tended to be higher in snuff users and well-differentiated OSCC cases, although not statistically significant. Conclusions: Well-differentiated OSCC cases exhibited the highest expression of p16, followed by moderate and poorly differentiated cases. However, no significant correlation was observed between p16 expression and OSCC in snuff users.

Predictive Potential Of Il28b Gene In Hcv Patients, Resistant To Daclatasvir And Sofosbuvir In KPK Population.

Recently various combinations of direct acting antivirals (DAAs) have been tried successfully. The Sofosbuvir + Daclatasvir combination has been used with promising results. Recently, resistance has been noticed against DAAs. Therefore, polymorphism at particular sites in the interleukin 28B gene are under study to find possible association with resistance. This study was aimed at finding out any association of SNPs rs8099917 and rs12979860 (IL28B gene) with response and resistance to treatment in HCV genotype 3 patients in Khyber Pakhtunkhwa. This cross sectional, Analytical study was conducted at Gastroenterology/hepatology OPD of Prime Teaching Hospital, Peshawar Medical College. Collected Samples were stored at -20o C in PCR Lab of the College. DNA extraction and genotyping was carried out at BJ Molecular Biology Lab in Rawalpindi. Data was analyzed by using SPSS version 21. Chi-Square Test was used to see the statistically significant differences between rs8099917 T/G and rs12979860 T/C model. In the IL28-B gene, single nucleotide polymorphism at rs12979860 T/C model, we observed that there are 37.5% CC homozygous, 12.5% TT homozygous and 50% CT heterozygous genotypes in resistant patients and 42.85% CC homozygous, 28.57% TT and 28.57% CT genotype in responder group. In rs12979860 T/C model, genotype of IL28-B in the responder and resistant group significantly varies at p-value =0.00572. We conclude that in SNP at rs12979860, CC genotype is associated with clearance of HCV, while CT genotype was more prevalent in the resistant group and associated with chronicity.

PROTECTIVE ROLE OF OLIVE OIL IN THE DOXORUBICIN INDUCED OVARIAN TOXICITY IN FEMALE RATS

Background: The pathophysiological effect of chemotherapy on female reproductive system is complex. The current study aimed to determine the protective effect of olive oil extract against doxorubicin induced ovarian toxicity in female rats. Methods: This was an analytical experimental randomized control study carried out in the Department of Anatomy, Peshawar Medical College. Twenty-four female rats weighing 200–250 g were included and were divided into 3 groups, i.e., control group, experimental group-I and experimental group-II. Animals were weighed at the beginning of the experiment and before their sacrifice. The ovaries were obtained after their sacrifice. Five (5) µm thick sections were cut and stained with H &amp; E stain, and Massan Trichome to see the changes the ovarian follicles. Data was entered and analysed on SPSS-20. Independent sample t-test and Chi-square test were used to measure the difference between and within groups, and p?0.05 was considered statistically significant. Results: A significant increase in the mean weight of rats in control group and experimental group-II was observed (p&lt;0.05) while a post-experiment significant decrease in the mean body weight of rats in experimental group-I was seen (p&gt;0.05). There was no significant difference in number of primordial and secondary ovarian follicles within the groups (p&gt;0.05) while a statistical significant difference in number on primary ovarian follicles, atretic follicles and nuclear fragments within the groups (p&lt;0.05). Conclusion: The co-administration of olive oil has shown a protective effects against the doxorubicin induced ovarian toxicity in female rats. Pak J Physiol 2023;19(3):31–5

Frequency of Diseases Requiring Hysterectomy: A Cross Sectional Study at Tertiary Care Hospitals in Peshawar

Hysterectomy, after cesarean section is the most common performed major surgical procedures all over the world. In the united states, 5.5/1000 women underwent hysterectomy in the years 2001 to 2005. Objective: To estimate the frequencies of different diseases that needs hysterectomy at Peshawar Medical College and its affiliate hospitals. Methods: This cross-sectional study was carried out from 3rd Oct, 2020 to 3rd Oct, 2021 at the Department of Obstetrics and Gynecology, Peshawar Medical College and its affiliated hospitals. Consecutive sampling was done and a sample size of 104 patients was obtained. Those patients who recently underwent abdominal or vaginal hysterectomies aged 25-60 years with history of any parity were included. Patients with co-morbid conditions such ischemic heart disease, chronic kidney disease, malignancies and other obstetric complications such as emergency cesarean hysterectomies were excluded. Results: Mean age with standard deviation was 48.55 ± 8.53. Mean and standard deviation for weight was 73.20 ± 6.103. Of total patients, 44 (42.3%) patients had symptomatic fibroid uterus, 29 (27.9%) patients had uterovaginal prolapse while 31 (29.8%) patients had abnormal uterine bleeding as indication for hysterectomy. Among these patients, 66 (63.5%) were subjected to abdominal hysterectomy while 38 (36.5%) went through vaginal hysterectomy. Conclusions: The most common disease that needs hysterectomy in our study was symptomatic leiomyomas of uterus followed by abnormal uterine bleeding due to other causes and uterovaginal prolapse.

EXPRESSION OF OSTEOPONTIN IN ORAL SQUAMOUS CELL CARCINOMA – AN IMMUNOHISTOCHEMICAL STUDY

Objectives: To analyze the expression of Osteopontin (OPN) is well differentiated, moderately differentiated, and poorly differentiated oral squamous cell carcinoma (OSCC). Methodology: This study was conducted at the Department of Pathology, Peshawar Medical College, over a pe­riod of 12 months. A total of 50 formalin-fixed paraffin-embedded (FFPE) blocks (n=50) of confirmed cases with varying grades of OSCC were included in the study. Immunostaining was evaluated for intensity and percentage of positive cells and Immunoreactivity of OPN was assessed by the Immunoreactivity scoring system (IRS) method. Results: The age of the patients was 58.44 ± 13.01 years ranging from 30 to 82 years on average. Maximum number of cases belonged to the age group 51 to 70 years having 27 (54%) participants. The most common cat­egory of OPN expression among well differentiated OSCC was moderate (n=16, 66.7%). For poorly differentiated OSCC the strong staining was found in 6 cases (50%) and was the most common category of OPN expression. In males the pattern of staining for OPN expression was not statistically significant among various grades of OSCC (P=0.455) while among females the results were highly significant (P=0.003). The mean IHC staining score by IRS method for OPN expression was highest among well differentiated (9.20±4.31) Conclusion: OPN can be used as a diagnostic marker for OSCC. It can also help in assessing the potential aggres­sive behavior of the tumor pointing at close follow up of such patients for recurrence.

Association of Vascular Endothelial Growth Factor (VEGF) in Salivary Gland Tumors

Aim: To identify the association of vascular endothelial growth factor (VEGF) immunoexpression in the progression of salivary gland tumor. Study design: Comparative cross-sectional study Place and duration of study: Department of Pathology, Peshawar Medical College. Duration of study was six months from date of approval. Methodology: Forty five specimen of salivary gland tumor were studied in which 30 were benign and 15 were malignant. The endpoint assessment included Hematoxylin &amp; Eosin (H&amp;E) and VEGF immunoexpression. Results: The association of VEGF expression with salivary gland tumor was statistical significant (P&lt;0.05). Maximum 18 samples (benign: 13, malignant: 5) were shown to have strong expression, 24 (benign: 16, malignant: 8) were shown moderate expression. Whereas, small and no expression was found in 2 (benign: 0, malignant: 2) and 1 (benign: 1, malignant: 0) sample, respectively. Conclusion: Overexpression of VEGF in both malignant and benign salivary gland tumors might be associated to progress salivary gland tumors. Keywords Benign tumor, Warthin tumor, Adenoma, Salivary gland carcinoma, Vascular endothelial growth factor

COMPARISON OF HUMAN PAPILLOMAVIRUS 16 EXPRESSION BY IMMUNOHISTOCHEMISTRY IN CERVICAL CARCINOMAS AND NON-NEOPLASTIC CERVICAL MUCOSA Arti

Objective: To compare the prevalence of Human Papillomavirus 16 in cervical carcinoma and non-neoplastic cervical mucosa by immunohistochemistry. Methodology: From September 2020 to November 2021, this retrospective cross-sectional study was conducted at the Department of Pathology, Peshawar Medical College, Riphah International University Islamabad, Pakistan. On FFPE blocks of 38 cervical carcinoma cases and 38 non-neoplastic cervical mucosa by immunohistochemistry using a monoclonal antibody against HPV 16 by Bio-SB. SPSS 20 was used for the analysis of data. Results: The mean age of cervical carcinoma patients was 55.18 ± 11.536. The majority of the Cervical carcinoma cases were more than 50 years of age (n= 28, 73.6%). HPV16 positivity was observed in 44.7 % cases of cervical carcinoma and 5.35 % of normal cervical mucosa. The p-value was &lt; 0.00007 and hence statistically significant. HPV 16 expression was higher in the patients with cervical carcinoma in the fourth and fifth decade of life. Among the subtypes of cervical carcinoma, 60.5 % (n=23/38) were Squamous cell carcinoma out of which 43.5% (n=10/23) were positive for HPV 16 expression, Adenocarcinoma subtype was 34.2% (n=13/38) out of which 46.2% (n=6/13) were positive and the Adenosquamous subtype was 5.3% (n=2/38) out of these 1 was positive for HPV 16 expression. High grade tumors (n=18) showed higher HPV 16 expression (61.1%) as compared to low grade lesions (30.0%).Conclusion: HPV 16 expression is higher in cervical carcinoma cases as compared to normal cervical mucosa. Although not statistically significant high-grade tumors showed higher expression of HPV 16.

Comparison of PD-L1 Expression in Oral Squamous Cell Carcinoma and Premalignant Lesions of Oral Cavity

Objectives of this study were to compare expression of Programmed Death-Ligand 1(PD-L1) protein in oral squamous cell carcinoma (OSCC) and oral potentially malignant disorder (OPMD) cases; and to compare the PD-L1 protein expression in histological grades of OSCC and also in OPMD's with Dysplasia and without Dysplasia. In this study, 25 cases of Oral squamous cell carcinoms, 25 cases of Oral Potentially Malignant Disorders and 10 cases of non-neoplastic oral mucosa (control) cases were included. FFPE blocks of OSCC and OPMD cases were contributed by Department of Pathology, Histopathology Division,Pakistan Institute of Medical Sciences, Islamabad. Immunohistochemical staining of cases with PD-L1 monoclonal antibody (1:100; Dako) was carried out at Histopathology division , PMC Labs, Peshawar Medical College,Peshawar, Riphah International University, Islamabad . Epithelial cells (membranous and cytoplasmic) positivity was observed for PD-L1 Antibody. Data was analyzed in SPSS version20. For qualitative variables frequencies and percentages were calculated whereas for quantitative variables means and standard deviations were recorded. The Chi-square test was applied to evaluate the significant difference in categorical variables . p-value of ≤0.05 was taken as significant. PD-L1 expression in OSCC cases turned out to be 48% (n=12/25) as compared to 8% of OPMD cases (n=2/25) with a significant p value of 0.002 and all non-neoplastic oral mucosa cases were negative. PD-L1 expression in high grade OSCC cases was quite high (61% n=11/18) as compared to low grade OSCC (14% n=1/7) cases with a significant p value of 0.035. A statistically significant increased PD-L1 expression was noted in OSCC as compared to OPMD. Expression of PD-L1 was more intense in high grade OSCC cases. The relation of PD-L1 expression to age ,gender or location of OSCC and OPMD cases , and presence of dysplasia in OPMD cases was statistically not significant.

Extended-spectrum beta-lactamase and Antibiotic susceptibility pattern in uropathogens.

Objective: To identify rapidly changing antibiotic susceptibility of ESBL &amp; Uropathogens. Study Design: Comparative Cross-sectional prospective study. Setting: Allied Hospitals of Peshawar Medical College. Period: 8th November 2021 to 5th March 2022. Material &amp; Methods: 10-15ml of midstream urine was collected in a sterile container from 158 patients Pus cells, red blood cells, and bacteria were examined using microscopy. The standard loop technique was used to inoculate urine specimen on MacConkey and Blood agar. Plates were incubated for 24 hours at 37oC. A colony count of 105 cfu/ml was thought to be significant. Gram staining of the colonies was performed. The biochemical tests were conducted on API 10S for the identification of organisms. Extended-spectrum beta-lactamase organisms were identified by the double-disc synergy method. The Kirby-Bauer disc diffusion method was used to test antibiotic susceptibility on Mueller-Hinton agar according to CLSI guidelines 2021. A statistical package for the social sciences (SPSS) version 20.0 was used for statistical analysis. Results: Out of 158 urine samples 135 (85.5%) had positive culture growth with 35 (25.9%) ESBL confirmed. Antibiotic susceptibility was Nitrofurantoin (70.1%), Trimethoprim-sulfamethoxazole (26.8%), Ciprofloxacin (51.5%), Levofloxacin (51.5%), Ceftriaxone (25.77%) Cefotaxime (23.7%) Ceftazidime (19.5%) Cefepime (27.8%) Aztreonam (2.1%) Meropenem (86.6%) Amoxicillin/clavulanic (37.1%) Gentamycin (73%) Penicillin (0%). Conclusion: Surprisingly, only nitrofurantoin was found to be advised orally as a suitable drug for the treatment of UTIs among the 13 commonly used antibiotics.

Effect of Intravenous Mannitol on Intraocular Pressure Changes in Vitrectomized Silicon-Oil-Filled and Non Vitrectomized Eyes: A Prospective Comparative Study

Purpose: Our studies turned into designed to assess the consequences of intravenous mannitol on intraocular pressure (IOP) in vitrectomized silicon-oil-stuffed eyes and to assessment those consequences with the ones received in non-vitrectomized eyes. Study Design: Prospective comparative case study Place and Duration: Ophthalmology department, Peshawar Medical College and affiliated hospitals, Peshawar for the duration from 1st Jan, 2022 to 30th June, 2022. Materials and Methods: All eyes with intraocular pressure lower than 38 mm Hg were considered. Group 1 had their vitreous removed and filled with silicon oil to reduce IOP, whereas Group 2 had their vitreous removed and their eyes were left open (Group 2). Mannitol (20 percent solution, 1 g/kg) was infused over the course of 30 minutes, and intraocular pressure was measured every 30 minutes during the first 2 hours, then again at the 3rd, 4th, and 6th hours post-administration. Results: In all, 36 eyes from each group were used. Group 1 had a decrease in mean (SD) IOP from 46.4 4.0 to 41.5 6.8 at 30 minutes, 38.5 ± 7.2 at 60 proceedings, 35.1 ± 7.5 at 90 records, 33.4 ± 9.3 at 2 hours, 31.8 ±9.5 at 3 hours, 30.8 ±10 at 4 hours, and 30.7 ± 9.9 at 6 hours, whereas group 2 saw a decrease in mean (SD) IOP from 46.9 5.4 IOP dropped significantly from baseline in all groups at all-time points up to 4 hours (P0.001). While both groups saw a reduction in intraocular pressure (IOP) after 4 and 6 hours of mannitol administration, there was no significant difference between the groups. Conclusion: Mannitol has been shown to dramatically lower IOP in both vitrectomized eyes with silicon fillings and non-vitrectomized eyes. Keywords: Mannitol, Intraocular pressure, Silicon-oil-filled eye, Vitrectomy

Efficacy of Novel Endoillumination Assisted Modified Scleral Buckling versus Conventional Scleral Buckling

Scleral buckling (SB) has proven to be an effective surgical technique for RRDs especially in patients with uncomplicated rhegmatogenous retinal detachment (RRD) not associated with proliferative vitreoretinopathy (PVR). Until recently, it was still the most commonly employed surgical technique in dealing with RRDs with a high success rate. with the advent of the modern retinal viewing systems and vitrectomy machines, the trends in dealing with RRD are more inclining towards pars plana vitrectomy. Possible reasons for it are that conventional SB has steeper learning curve and it is assisted by the Indirect ophthalmoscope to view the retina during various steps of the surgery which has smaller inverted image and also its use is cumbersome. with the novel techniques being introduced, the essence of scleral buckling can be preserved and the surgical technique can be made much easier by providing a better viewwith easy localization of retinal breaks. The basic principles and steps of conventional scleral buckling can be well taught and more effectively practiced with the introduction of better illumination and viewing systems. In this study, the efficacy of endoillumination source assisted modified scleral buckling would be determined and compared with the results of conventional scleral buckling. Objective: To compare the functional and anatomical success rates of conventional scleral buckling for RRD with endo-illumination assisted Wide angle viewing system modified scleral buckling in patients with uncomplicated rhegmatogenous retinal detachment. Materials and Methods: This is an interventional prospective study being conducted at the Department of Ophthalmology, Peshawar Medical College (PMC) and Allied hospitals from July 1, 2020 to December 31, 2020. The study included 40 patients presenting with uncomplicated RRD, 20 in each group, by simple random sampling technique. Outcome measures assessed were primary visual acuity (VA), primary anatomical success, and peri-operative complications. Results: 40 patients (40 eyes) were recruited in this study, 20 in each group (conventional scleral buckling group and modified scleral buckling group), who completed a 3 months follow up. 21 (52.5%) were male patients while 19 (47.5%) patients were female. Mean age was 44.3 ± 12.1. New retinal breaks were identified in 3(15%) patients in the MSB group. Retinal reattachment was achieved in 95% patients in both the groups. Cataract Progression was later found in 1(5%) patient in the MSB group. No other complications were recorded in either of the comparative groups. 1(5%) patient each, in both the groups, underwent additional surgeries. Conclusion: In conclusion, the endolight-assisted scleral buckling using a wide angle visualization system appears to be a promising technique with comparable surgical outcomes to conventional scleral buckling with least complications in specific cases of rhegmatogenous retinal detachment. It can be safely used to meet the surgical need and reduce discomfort during surgery. It is particularly useful in cases with pre-operatively undetected retinal tears. Wide angle viewing system assisted modified scleral buckling technique is highly recommended for teaching purposes. Keywords: Scleral buckling; Wide angle viewing system, Rhegmatogenous retinal detachment, Modified scleral buckling.

Role of Minimally Invasive Surgery (Laparsocopic Surgery) in the Management of Acute Abdomen

Objective: The study's goal is to evaluate the diagnostic and therapeutic efficacy of non-invasive surgery (laparoscopy) in the treatment of acute abdomen. Methods: This is an observational study, conducted in Peshawar Medical College Group of Hospitals, Peshawar from January, 2020 to July, 2021. Total 60 patients presented with acute abdomen were included in the study. Patients underwent Laparoscopic surgery after initial work-up. The outcome of Laparoscopy was assessed in terms of diagnostic accuracy, conversion rate, inadvertent injury, hospital stay, wound infection and pain score. Result: Total 60 patients with acute abdomen underwent Laparoscopy during study period. Male to female ratio 1: 1.2 (27:33) while mean age was 36.18 years (12-75). In 93% (56/60) cases per-operative diagnosis was compatible with pre-operative diagnosis. The conversion rate from laparoscopic to open surgery was 1.6%. The average length of hospital stay was 1.45 days (1-4 days). On a visual analogue scale, the mean pre-operative pain level was 6.28. (3-9). On the first post-operative day, the mean post-operative pain score on a visual analogue scale was 1.68. (1-4). Infection at the port site occurred in 3.3% (2/60). Conclusion: Laparoscopy is a safe and effective method of diagnosing and treating acute abdomen so it can be safely adopted in patients presenting with acute abdomen as Laparoscopy eliminates diagnostic delays and unneeded laparotomy and its complications. Keywords: Acute Abdomen, Laparoscopy, Minimally Invasive Surgery, Laparotomy

Evaluation of the Efficacy of the Non-Decompressive Single Stage Bilateral Craniotomy in Treatment of Traumatic Brain Injury

Background: Traumatic brain injury is one of the major health care problem around the globe. It is heterogeneous entity. Traumatic lesions including fracture and hematomas typically require surgery. Objective: The study aimed to analyze the Non-Decompressive Single Stage Bilateral Craniotomy in the patients suffering from traumatic brain injury. Study design: This prospective and single center based study was conducted at the neuroscience department of Prime Teaching Hospital/ Peshawar Medical College for the duration of the six months from January 2022 to June 2022. Material and Methods: Out of all the patients visited the neuroscience department of our institute teaching hospital, only 40 were selected for the study after analysis of the computed tomography images. These 40 fulfilled the inclusion criteria. The ethical and review board committee of our hospital approved the study. The patients willingly signed the consent. The bilateral frontal contusectomy was most commonly used surgical procedure. While other used surgical procedures were contralateral contusion and unilateral epidural hematoma. Results: Out of all the patients admitted in the hospital there were 40 that met all the requirements of the study. There were 30 men and 10 women. Most of the cases were reported in the range of 40-59 age. Middle aged men were mostly effected by the disease. The cases were almost in equal number as far as severity of the Traumatic brain injury is concerned. There were some patients that developed ventilator acquired pneumonia and some of the participants suffered from urinary tract infection along with a case of wound infection. There were some death cases reported as well. There were some of the patients who quit medical advice because of their poor financial state. Conclusion: To deal with traumatic brain injury in an effective way, SSBC can prove to be a safe and cost effective procedure, as it has multiple advantages like single incision, single anesthesia and reduced surgical charges, the management of the patient after operation is similar to that of unilateral procedure. Stay in hospital is also reduced and opposite lesion condition can also be avoided this way. Keywords: Traumatic brain, injury, surgical treatment and unilateral procedures.

To Compare Outcome of Open Versus Laproscopic Repair for Primary Ventral Hernias

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.