Islamic culture encourages and supports a rich and complete way of life, with guidance, both spiritual and secular, provided for every facet of the devotee’s life. The Qur’an and the Sunnah are the two sources for the Islamic concept of the role of the leader. The Qur’an is the holy book of the religion of Islam, and the Sunnah describes the exemplary life of Prophet Mohammad, largely understood through narration of his words and deeds – the Hadeeth. The Holy Qur’an is universally honoured by Muslims, who identify passages that are pertinent and influential to their lives. Leadership is a tenet that is highly emphasized in Islamic life and is embodied in the pillar of accountability. Indeed, the Prophet Mohammad in the Hadeeth states: ‘each of you is a guardian and is responsible for his subjects’ (Saheeh al Bukhari: 212). This form of multi-level leadership is highly encouraged in Islam. The operational principles that should be applied by Muslim leaders include the exercise of justice, fulfilment of trust, observance of righteousness, perseverance in doing what is right, and honouring promises (Beekum, 1999). The model of Islamic leadership has four dimensions: Consciousness of God, Competency, Consultation, and Consideration (The 4C model).

Background: Hemorrhoidal disease is the commonest benign anal condition diagnosed in the outpatient setup. Interventional treatment options range widely, from office-based procedures to hemorrhoidectomy. Laser technology increasingly is in use in the field of proctology. We present our index clinical outcomes following laser haemorrhoidoplasty (LHP). Methodology: Retrospective cross-sectional study of 21 consecutive patients who underwent LHP between 2015 and 2018 under a single surgeon. Their outcomes were compared with a group of patients who underwent the standard open hemorrhoidectomy over the same period of time. Results: Postoperatively, 85.7% of patients post-LHP had a better pain score (mild) compared with 66.7% in the open hemorrhoidectomy group. The mean operative time in minutes was shorter for LHP, 29.67±17.50 versus 39.20±20.77 in the open group. Duration of hospital stay in days between the two groups were similar; LHP group median=1(1–3), open group median =1(1–3). Rates of infection, recurrence and urinary complications were however higher in the laser group, 4.8%, 9.5% and 9.5% respectively compared with the open hemorrhoidectomy group that were 0%, 6.7% and 6.7 % respectively. Both groups had no reported cases of stool or flatus incontinence. Conclusion: Laser haemorrhoidoplasty is associated with reduced pain scores and shorter operative time than open hemorrhoidectomy. Duration of hospital stay was similar in both groups. The rate of complications was high in the study group. Keywords: Laser haemorrhoidoplasty, Pain score, Complications, Open hemorrhoidectomy

Objectives:To review the current hernia repair methods at the Aga Khan University Hospital (AKUH) and relate to the preferred method of choice for groin hernia repair among the practicing general surgeons.Design: An audit from retrospective practices.setting: A tertiary referral hospital, Aga Khan University Hospital, Nairobi. subjects: All elective adult hernia repairs performed at the Aga Khan University Hospital, Nairobi between 2004-5 by all surgeons with admitting privileges were reviewed.The methods of repair were noted. A questionnaire was also availed to the admitting surgeons to indicate their preferred method, and this was correlated with the audit results. Results:One hundred and seventy four hernia repairs were reviewed, 58 (33.72%) were left sided, 95 (54.07%) were right sided and 21 (12.21%) were bilateral. The most common method of repair was the Modified Bassini's, performed in 99 (56.9%) repairs. The survey results however, indicated that three quarters of the practicing surgeons preferred non-tension repairs. The mean hospital stays were similar for the tissue and mesh repairs.cOnclusiOn: Tissue repair is still practiced and favored at our institution by the surgical fraternity. This practice is at variance with the stated preference for mesh repairs. In the absence of outcome data for this local practice, it is difficult to justify its utility in an environment where meshes are easily available.

Background Post-operative pain control is an important pillar in enhanced recovery after surgery. There is a paucity of data that compares efficacy of pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective midline laparotomy patients Objective To evaluate pain control between continuous local anaesthetic wound infusion and thoracic epidural analgesia in elective laparotomy patients. Design A randomized, single-blind, controlled clinical trial.