Objective: The rationale of the study was to depict the safest method of extracting gallbladder after laparoscopic cholecystectomy to decrease the frequency of wound infection. The objective of the study was to compare the frequency of port site wound infection after gallbladder removal with or without retrieval bag in laparoscopic cholecystectomy. Methods: The study design was Randomized Parallel group design conductedin the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur. A total of 254 patients of both gender age range 25-60 years, diagnosed as a case of cholelithiasis by ultrasonography were included. Case sheet of patients were prepared for age, gender, duration of cholelithiasis, operating time and presence or absence of wound infection. Results: Mean age of patients was 40.77 +/- 10.95 years. Out of 254 patients, 98 (38.58%) were males and 156 (61.42%) were females with male to female ratio of 1:2.5. Patients were divided in two groups A and B and the frequency of patients having port site wound infection in group A was 1(0.4%) whereas in group B was 14(5.5%). Conclusion: This study concluded that the use of retrieval bag to remove gallbladder in laparoscopic cholecystectomy resulted in decreased frequency of port site wound infection. The insignificant association of port site wound infection with different age groups, gender categories and with duration of cholelithiasis was revealed. Moreover wound infection proved significantly associated with both categories with operating time.

Objectives: To develop an externally validated multivariable prognostic model for an underprivileged dialysis population. Methods: This was a multicenter retrospective cohort study of 5 years duration from January 2013 to December 2017. A total of 758 patients (37.5% female; mean±SD age, 44.26±14.77 years) were enrolled for construction of the prognostic model. The data were analyzed using a proportional hazards model to identify predictors of survival. Three risk groups were identified at the 25th and 75th percentiles of the resultant prognostic index. The model was externally validated with another dataset of 622 dialysis patients. Results: The prognostic index included 5 predictor variables: hemoglobin, serum potassium, interdialytic weight gain, serum albumin, and duration of dialysis, which had good predictive performance on the calibration and discrimination aspects of the model (Harrell’s c statistic: 0.748, Gonen and Heller k statistic: 0.647, Somers’ D statistic: 0.496, calibration slope: 1.156). There were significant interaction effects between weight and hemoglobin, weight and albumin, albumin and potassium, and albumin and hemoglobin. Conclusions: We developed an externally validated model that contained 5 routinely collected prognosticators and confirmed its calibration and discrimination abilities in obtaining reliable prognostic estimates in developing countries. The model will assist clinicians in deciding the prognosis of dialysis patients. The application of this model in different clinical settings of developing countries can indicate interesting findings regarding public health.

Objective: To compare the frequency of seroma formation in laparoscopic para-umbilical hernia repair with and without primary closure of defect. Method: The randomised parallel group study was conducted at the Department of Surgery, Bahawal Victoria Hospital, Bahawalpur, Pakistan, from October 1, 2019, to May 31, 2020, and comprised patients of both genders age 25-65 years diagnosed as a case of para-umbilical hernia. The patients were randomised into group A which subsequently had laparoscopic primary repair of defect with non-absorbable suture prior to mesh placement, and group B which had laparoscopic repair without primary closure of the defect. Case sheets of patients were prepared for age, gender, duration of disease, operating time, body mass index and the presence or absence of seroma formation. Data was analysed using SPSS 20. Results: Of the 100 patients, 35(35%) were males and 65(65%) were females with male-to-female ratio of 1:1.9, and an overall mean age of 43.92±10.77 years. Both groups had 50(50%) patients each. . Post-operative seroma formation was noted in 1(2%) group A patient and 12(24%) group B patients (p=0.001). Conclusion: Primary closure of the fascial defect in laparoscopic para-umbilical hernia repair resulted in decreased frequency of post-operative seroma formation. Key Words: Paraumbilical hernia, Seroma, Laparoscopic paraumbilical hernia repair.

Objective: To evaluate individual and community-level factors influencing neonatal mortality in Pakistan.Method: The retrospective, secondary-data, quantitative study was done from July 2021 to January 2022 after approval from the ethics review committee of the International Islamic University, Islamabad, Pakistan, and comprised data of live births from November 22, 2017, to April 30, 2018, which was the period covered by the Pakistan Demographic and Health Survey 2017-18. Significant community-level, maternal and proximate determinants of neonatal mortality were identified. Data was analysed using STATA 13.Results: Among the 12,708 live births covered, the neonatal mortality rate within the first month of birth was 5337(42%), and 3939(31%) neonatal deaths occurred in the first week of life, while 3431(27%) deaths occurred on the first day. Distance to health facility (adjusted hazard ratio: 1.1; 95% confidence interval: 0.8-1.6), unimproved toilet facility (adjusted hazard ratio: 2.0; 95% confidence interval: 0.7-2.1), caesarean section deliveries (adjusted hazard ratio: 1.6; 95% confidence interval: 0.6-1.9) and child's birth size smaller than average (adjusted hazard ratio: 1.7; 95% confidence interval: 1.1-2.7) carried significantly higher risk of neonatal deaths. Compared to women aged 15-19 years, older women's child (adjusted hazard ratio: 0.6; 95% confidence interval: 0.2-1.6) and neonates having birth order 3 compared to birth order 1 (adjusted hazard ratio: 0.5; 95% confidence interval: 0.2-0.9) and female gender of child (adjusted hazard ratio: 0.3; 95% confidence interval: 0.2-0.9) were less likely to die.Conclusions: There was a markedly high prevalence of neonatal mortality rate in Pakistan. Unimproved toilet facility, distance to health facility, caesarean mode of delivery and small size of the child at birth were found linked with increased risk of neonatal mortality.