Frequency of Post-Operative Fecal Incontinence and Healing Rate in Patients with Open and Closed Lateral Internal Anal Sphincterotomy

OBJECTIVES This study aims to compare the frequency of fecal incontinence and healing rate in patients treated with Open Internal Anal Sphincterotomy (OIAS) and Closed Lateral Internal Anal Sphincterotomy (CLIAS). METHODOLOGY This randomized control trial was carried out in the Department of Surgery Hayatabad Medical Complex, Peshawar Pakistan from Feb 2019 to Feb 2020. Eighty-four patients were assigned to the open method in Group B while eighty-four patients were allocated to the closed method in Group A (using blade 11) through the randomized control trial method. Fecal incontinence and healing rate were observed on the 7 th postoperative day. SPSS 23.0 software was used to analyse the data. RESULTS In group A out of a total of 84 patients, 96% of patients were in category A, 4% of patients were in category B, and no patients were in categories C and D. In group B out of 84 patients, 96% of patients were in category A while 4% patients were in category B and no patients were in category C and D. The total faecal incontinence in Group B (open method) was 21% while total fecal incontinence in Group A (closed method) was only 4% that is a clear dierence between the two groups. In group A (closed method) out of 84 patients, 2 patients (2.38 %) showed delayed healing while 82 patients (97.61 %) showed normal healing. In group B (open method) 7.4% of patients showed delayed healing with a signicance p level of 0.04 while 92.85 showed normal healing. CONCLUSION Fecal incontinence was less in closed Lateral Anal Sphincterotomy due to the use of blade 11 while it was higher in open internal anal sphincterotomy. Similarly, the healing rate was signicantly higher in the closed method while delayed healing was seen in the open method

Incidence of Port Site Infection After Laparoscopic Cholecystectomy: Our Experience at Hayatabad Medical Complex

OBJECTIVES This study aimed to assess the factors that affect post-laparoscopic cholecystectomies PSI and determine which characteristics can be changed to prevent PSI in a trial to maximize the benefits of laparoscopic surgery.METHODOLOGY The study included all patients who experienced port site infection following laparoscopic cholecystectomy. All patients received Inj Ceftriaxone 1gm pre-operatively & then twice a day postoperatively for 03 days. In all operations, the gallbladder is removed from the epigastric port without using a retrieval bag by skilled surgeons employing four-port methods and reusable equipment. Most patients had the sub-hepatic tube drain placed and were discharged the day after surgery.RESULTSAcute cholecystitis was the most common operative finding with port-site infection, i.e. 6(42.8%), second being empyema that was seen in 3(21.4%) patients, 2(14.3%) patients had bad adhesions, mucocele in 2(14.3%) patients and thick walled gall bladder with stones was found in 1(7.1%) patients respectively, indicating that the relationship between infection and acute cholecystitis is significant. Regarding the spills of bile, stones, or pus, 3(21.4%) patients had infections despite there being no spillage, while 11(78.6%) patients developed an infection while the spillage happened during their procedures. The p-value was 0.0001, meaning that the spillage might be considered a risk factor for the development of port site infection.CONCLUSIONThe spilling of bile, stones, or pus, the port of gallbladder removal, and acute cholecystitis are all strongly associated with port site infection. Given that Mycobacterium tuberculosis may be the source of chronic deep surgical site infections, more care should be exercised. The majority of PSIs are superficial and more prevalent in men

Frequency of Anastomosis Leak in Primary Repair in Ileal Perforation

OBJECTIVES: To determine the frequency of anastomotic leak in primary closure patients presenting with enteric perforation. METHODOLOGY:  Through a Descriptive case series Study Design, 253 patients with the perforated ilium and subjected to primary closure were included and followed up post-operatively to determine the anastomosis leak. RESULTS: The mean age of our sample was 42.2 years with a standard deviation of 8.6 years. Out of 253 patients, 70.8% were males, and 29.2% females were. The mean BMI of the study sample was 24.6 + 2.2kg/m2. 61.3% of patients belonged to urban settings, 41.1% were from lower socioeconomic class, and 36.4% had a middle school level education. On follow up, the anastomotic leak was recorded in 18.2% of patients. CONCLUSION: Ileal perforation subjected to primary defect closure is the most performed surgery for treatment, with a significant number of patients developing the anastomosis leak. The frequency of anastomosis leaks is high, and other treatment strategies must be researched to reduce the burden of these complications

Capital Structure Dynamics of Shariah-Compliant vs Non-Compliant Firms: Evidence from Pakistan

Purpose This study aims to compare capital structure determinants' effect on the leverage levels of Shariah-compliant (SC) and noncompliant (NC) firms in Pakistan. This study also estimates and compares the capital structure adjustment speed for both firm types. Design/methodology/approach Based on the Karachi Meezan Index screening criterion, a balanced panel of 117 SC and 68 NC firms listed on the Pakistan Stock Exchange from 2008 to 2018 was constituted. This study used the generalized method of moments to identify the significant determinants of capital structure and estimate the speed of adjustment. In addition, the F-test was used to check whether the effect of the determinants on the leverage is same for SC and non-SC firms. Findings The authors found that different determinants affect both firm types' leverage levels (book and market) differently. The authors also found that the adjustment speed of SC firms toward their target leverage ratio is slower than their NC peers. Lastly, significant variation was observed in the results under different screening criteria. Research limitations/implications This study fills the literature gap by providing a comprehensive comparison of the capital structure decisions of the SC and non-SC firms. Because this study is limited to Pakistan, generalizability would be an issue. Practical implications This study will guide the management of SC and non-SC firms about which factors are reliably important in choosing their capital structure. The findings also call for bringing harmony in the different Shariah screening criteria being in practice. Originality/value To the best of the authors’ knowledge, this is the first comparative study that identifies the significant capital structure determinants for SC and NC firms and investigates their effect on the leverage of both firm types. By testing joint hypotheses of same relationship, this study seeks to determine if, because of Shariah restrictions, the capital structure determinants of SC firms are similar to NC firms or they exhibit different behavior. The authors also repeat their analysis using other prominent screening criteria to assess the consistency of their results

Frequency of Surgical Site Infection in Mesh Repair for Inguinal Hernias

OBJECTIVES To determine the frequency of surgical site infection in mesh repair for inguinal hernias. METHODOLOGY This Descriptive observational study was carried out at the Surgical B unit of Hayatabad Medical Complex Peshawar from November 2021 to October 2022. A total of 179 patients were included in the study were given a single dose of antibiotics, i.e.1, gm Ceftriaxone, one hour before inguinal hernia mesh repair.RESULTS A total of 179 patients aged between 30-60 years with a mean age of 45 years were enrolled. There were 98(54.7%) male while 81(45.3%) females. The frequency of wound infection was noted in 23 (12.8%) patients following mesh repair for inguinal hernia. Out of 23, most of the patients, 10(43.5%) had Medical redness & tenderness, 8(34.8%) patients had pus discharge from the wound side, and 5(21.7%) patients had wound site abscesses.CONCLUSION Surgical site infection after mesh repair was higher than the internationally reported incidence. Establishing a baseline SSI rate for inguinal hernia repairs offers a useful benchmark for future studies and surgical programs in thes

Comparative Risk of Surgical Site Infection With Open Cholecystectomy Vs Laparoscopic Cholecystectomy

OBJECTIVES: This study aimed to compare the risk of surgical site infection with open vs laparoscopic cholecystectomy. METHODOLOGY: This randomized control trial was done at the Department of Surgery, Hayatabad Medical Complex, Peshawar, for 12 months from 11/5/2018 to 11/5/2019. 116 patients were recruited for this study, 58 for each group randomly allocated to a group by lottery method and concealed Allocation. Patients in Group A underwent laparoscopic cholecystectomy, while patients in group B underwent open cholecystectomy. According to ward protocol, post-operative analgesia & antibiotics were given to patients in both groups. Expert consultant general surgeons did all the evaluation & procedures; all the patients were followed up to 30 days after the procedure & any surgical site infections, if found, were noted. RESULTS: The mean age was 36 years ± 12.19 SD and 38 years ± 11.88 SD in laparoscopic and open cholecystectomy, respectively. In laparoscopic cholecystectomy, 28% of patients were male, and 72% of patients were female, while in open cholecystectomy, 29% of patients were male, and 71% of patients were female. 07% of laparoscopic and 26% of open cholecystectomy patients had surgical site infections.  CONCLUSION: Our study concludes that the frequency of surgical site infection was found less in laparoscopic cholecystectomy than in open cholecystectomy

A numerical study of magnetohydrodynamic transport of nanofluids from a vertical stretching sheet with exponential temperature-dependent viscosity and buoyancy effects

In this paper, a mathematical study is conducted of steady incompressible flow of a temperature-dependent viscous nanofluid from a vertical stretching sheet under applied external magnetic field and gravitational body force effects. The Reynolds exponential viscosity model is deployed. Electrically-conducting nanofluids are considered which comprise a suspension of uniform dimension nanoparticles suspended in viscous base fluid. The nanofluid sheet is extended with a linear velocity in the axial direction. The Buonjiornio model is utilized which features Brownian motion and thermophoresis effects. The partial differential equations for mass, momentum, energy and species (nano-particle concentration) are formulated with magnetic body force term. Viscous and Joule dissipation effects are neglected. The emerging nonlinear, coupled, boundary value problem is solved numerically using the Runge–Kutta fourth order method along with a shooting technique. Graphical solutions for velocity, temperature, concentration field, skin friction and Nusselt number are presented. Furthermore stream function plots are also included. Validation with Nakamura’s finite difference algorithm is included. Increasing nanofluid viscosity is observed to enhance temperatures and concentrations but to reduce velocity magnitudes. Nusselt number is enhanced with both thermal and species Grashof numbers whereas it is reduced with increasing thermophoresis parameter and Schmidt number. The model is applicable in nano-material manufacturing processes involving extruding sheets

Optimization of single step multiplex PCR for detection of Eimeria tenella and Eimeria necatrix from commercial broilers

Multiplex polymerase chain reaction (PCR) was optimized for detection of 2 important species of Eimeria (Eimeria tenella and E. necatrix). This optimized protocol was used to screen 100 fecal samples collected from broiler birds in Lahore periphery. Out of 100 samples we found 6 tenella and only 1 E. necatrix positive by this method. The detection limit of oocysts by this method was as leastas 16 oocysts. This optimized multiplex PCR method can be used as routine diagnostic tool for detection of E. tenella and E. necatrix and can be extended up to the detection of 7 Eimeria species in future

Fully Automated Skull Stripping from Brain Magnetic Resonance Images Using Mask RCNN-Based Deep Learning Neural Networks

This research comprises experiments with a deep learning framework for fully automating the skull stripping from brain magnetic resonance (MR) images. Conventional techniques for segmentation have progressed to the extent of Convolutional Neural Networks (CNN). We proposed and experimented with a contemporary variant of the deep learning framework based on mask region convolutional neural network (Mask–RCNN) for all anatomical orientations of brain MR images. We trained the system from scratch to build a model for classification, detection, and segmentation. It is validated by images taken from three different datasets: BrainWeb; NAMIC, and a local hospital. We opted for purposive sampling to select 2000 images of T1 modality from data volumes followed by a multi-stage random sampling technique to segregate the dataset into three batches for training (75%), validation (15%), and testing (10%) respectively. We utilized a robust backbone architecture, namely ResNet–101 and Functional Pyramid Network (FPN), to achieve optimal performance with higher accuracy. We subjected the same data to two traditional methods, namely Brain Extraction Tools (BET) and Brain Surface Extraction (BSE), to compare their performance results. Our proposed method had higher mean average precision (mAP) = 93% and content validity index (CVI) = 0.95%, which were better than comparable methods. We contributed by training Mask–RCNN from scratch for generating reusable learning weights known as transfer learning. We contributed to methodological novelty by applying a pragmatic research lens, and used a mixed method triangulation technique to validate results on all anatomical modalities of brain MR images. Our proposed method improved the accuracy and precision of skull stripping by fully automating it and reducing its processing time and operational cost and reliance on technicians. This research study has also provided grounds for extending the work to the scale of explainable artificial intelligence (XAI)