Background:Soft tissues injuries at foot especially at heel expose the tendons, bones and especially joints, which leads to risk of infections and necrosis. These often result from trauma (spoke wheel), tumors, systemic diseases and their wounds such as venous ulcers and diabetic foot wounds. Surgical planning of these defects remains a challenge due to shortage of local scar free tissue and reliable blood supply. The current study is conducted to observe the purposeful benefits of reverse sural artery flap to cover wounds at dorsum of foot, ankle & heel.Study Design:Descriptive, experimental study.Setting: Department of Plastic & Reconstructive Surgery, Dr. Ruth KM Pfau Civil Hospital Karachi.Period:January 2015 to January 2018.Material & Methods:All patients who presented with wounds at heel, dorsum of foot, and exposed calcaneus or Achilles tendon were included. A peroneal based perforator identified by hand held Doppler, a superficial vein, and the sural nerve were included in the pedicle. Patients were followed during the first 6 postoperative months. Postoperative outcomes like flap congestion, tip necrosis and flap failure were noted. Results:Total of 36reverse low sural flaps were done for the soft tissue coverage of the 24 heel defects, 8 ankle defects and4 dorsum of the foot defects. Twenty eight patients were male and eight were females and age ranged from 6 to 36 years (mean 21). Partial flap failure was seen in 3 cases and complete flap failure in 2 cases. There were no serious donor site complications and all patients were satisfied with the functional and aesthetic outcome postoperatively.Conclusion:Reverse sural artery flap is very suitable in providing soft tissue coverage of the wounds of heel and dorsum of foot. Harvesting sural flap is dependable and safe as it does not ends in any major postoperative donor site morbidity.

Ojha Campus, Karachi Patients presenting with signs and symptoms of hypoglycemia are diagnosed cases of "diabetes mellitus with nephropathy", age 30 and above, Type-I and type-Il diabetes mellitus, on oral hypoglycemic agents I insulin were included in this study. Questions regarding the time period for which patient has been using these drugs and if the patient is suffering from illness which may be acute or chronic, should be asked regarding the relevant disease & its association with hypoglycaemia be mentioned, & patients urine D/R & Serum Creatinine & Urea are measured by sending to the appropriate laboratory. Patients with severe malnutrition and starvation, chronic liver disease, alcoholics, chronic disease as tuberculosis, patients with renal diseases without diabetes, any other malignancy patients were excluded from this study. Results: Depending upon the selection of 200 patients, the result concluded in our study consisted of 54% male patients and 46% were females, out of which 11% had type I and diabetes and type II diabetics constituted 89%. Most of the patients age between 60 to 75 years of age. The average duration of diabetes was 12.20 + 6.14 years. Out of 24 hypoglycaemic patients, 6 (25%) had type-I diabetes in which 4 were male and 2 was female while 18 (75%) had type-II diabetes in which 10 were male and 8 were female patients. Conclusion: Observed that hypoglycaemia was common in diabetic patients, who developed renal failure due to diabetic nephropathy.

Background: De novo thyroid dysfunction can occur as a result of COVID-1. Patients have diverse manifestations of thyroid illness, ranging from asymptomatic hyperthyroidism to secondary hyperthyroidism. Aim: To evaluate various thyroid diseases and compare them to mortality and clinicopathological features. Methods: After approval from the institutional ethical review board, this observational cross sectional study was carried out at a private sector hospital in Karachi. Patients diagnosed with COVID-19 admitted between December 2020 to May 2021 were recruited using consecutive sampling. Patients who did not give informed consent and had known thyroid disorders or history of thyroidectomy were excluded. To analyse the relationship between thyroid laboratory reports, and clinicopathological features, the Chi-square test and “Fischer's exact test” were utilised. SPSS version 21 was used for statistical analysis. A statistically significant P value of 0.05 was used. Results: Majority of the patients 105(72.9%) had higher FT3 levels and none of them reported with the decreased levels. 88(61.1%) came up with the higher FT4 levels while 9(6.3%) reported with decreased FT4. 9(6.3%) and 6(4.2%) were positive for the anti-thyroperoxidase and anti-thyroglobulin antibodies. The results showed statistical significance for free FT4 (p value 0.018), anti-TG (p-value 0.001) and anti-TP antibodies (p value 0.005). Conclusion: COVID-19 patients had a high frequency of thyroid abnormalities. Thyroid dysfunction appears to fluctuate over time and to recover slowly and naturally. Key words: TSH, Thyroid, COVID-19, Anti-thyroglobulin, Anti-Thyroperoxidase, FT4, FT3

Objectives: Find out the hypoglycaemia in patients with diabetic nephropathicpatients. Study Design: Cross sectional study. Setting: National Institute of Diabetes &Endocrinology at Dow University Hospital, Ojha Campus, Karachi. Duration of Study: For theperiod of one year, from October 2014 to November 2015. Methodology: Known “diabeticpatients” with nephropathy which were present at National Institute of Diabetes & Endocrinology,Dow University Hospital, Ojha Campus, Karachi Patients presenting with signs and symptomsof hypoglycemia are diagnosed cases of “diabetes mellitus with nephropathy”, age 30 andabove, Type-I and type-Il diabetes mellitus, on oral hypoglycemic agents I insulin were includedin this study. Questions regarding the time period for which patient has been using these drugsand if the patient is suffering from illness which may be acute or chronic, should be askedregarding the relevant disease & its association with hypoglycaemia be mentioned, & patientsurine D/R & Serum Creatinine & Urea are measured by sending to the appropriate laboratory.Patients with severe malnutrition and starvation, chronic liver disease, alcoholics, chronicdisease as tuberculosis, patients with renal diseases without diabetes, any other malignancypatients were excluded from this study. Results: Depending upon the selection of 200 patients,the result concluded in our study consisted of 54% male patients and 46% were females, out ofwhich 11% had type I and diabetes and type II diabetics constituted 89%. Most of the patientsage between 60 to 75 years of age. The average duration of diabetes was 12.20 + 6.14 years.Out of 24 hypoglycaemic patients, 6 (25%) had type-I diabetes in which 4 were male and 2 wasfemale while 18 (75%) had type-II diabetes in which 10 were male and 8 were female patients.Conclusion: Observed that hypoglycaemia was common in diabetic patients, who developedrenal failure due to diabetic nephropathy.