Aim: To compare the outcomes of laparoscopic approach with open method in patients undergoing primary ventral hernia repair. Study Design: Randomized control trial Place and Duration: This study was conducted at Kuwait Teaching Hospital and Lady Reading Hospital Peshawar during the period of January 2017 to December 2019. Methods: One hundred and ninety patients of both genders with ages ≥18 years were included. All the patients were divided in to two groups, i.e’ Group A consists of 95 patients received open procedure and Group B with 95 patients received laparoscopic approach for primary ventral hernia repair. Outcomes in term of complications, hospital stay and recurrence rate were examined and compare the results between both groups. Data was analyzed by SPSS 23.0. Results: There were 65 (68.4%) females and 30 (31.6%) males in Group A and in Group B 35 (36.8%) males and 60 (63.2%) females. Mean age of patients in Group A was 40.14±3.31 years and in Group B it was 42.94±8.55 years. In Group B hospital stay was shorter than Group A (3.11±1.20 days Vs 5.9±3.9 days). According to the wound infection we found significant difference between Group A and Group B (12.6% and 4.2%);[p-value <0.05]. In Group A 5.3% patients had developed wound dehiscence while in Group B none of patient found to have wound dehiscence (p-value <0.05). Recurrence rate was also high in Group A 7.4% vs 2.1% in Group B (p=<0.05). Conclusion: It is concluded that laparoscopic repair of primary ventral hernia is safe and effective with lesser complications as compared to open method. Keywords: Ventral Hernia, Laparoscopic, Open Procedure, Wound Infection, Wound Dehiscence, Recurrence

Objectives: To compare the frequency of excellent intubation condition with Succinylcholine and rocuronium for rapid sequence induction in patients undergoing surgery under general anesthesia. Design: Randomized control trial. Place and duration of study: Department of anesthesiology and pain medicine, Combined Military Hospital Malir Cantt Karachi from 25th June to 10th August 2019. Methodology: In this randomized control trial, a non-probability consecutive sampling technique was used. Anesthesia was given through a standard approach. Then patients were randomly divided into two equal groups. In group A, succinylcholine (1mg/Kg) was given while in group B, rocuronium (1mg/Kg) was given. Laryngoscopy was attempted after 60 seconds. Intubating conditions were labeled as excellent, good, poor, and impossible. All the data was collected in two groups, the data was entered and analyzed on SPSS version 21. Results: The mean age of the patients was 40.11±9.49 years. The male to female ratio of the patients was 0.7:1. The study results showed the excellent intubation conditions were noted in 11 from group A and 9 from group B, good intubation condition was noted in 29 from group A and 25 from group B, poor conditions were noted in 17 from group A and 16 from group B and the impossible intubation conditions were noted in 13 from group A and 20 from group B. Statistically insignificant difference was found between the study groups with intubation conditions i.e. p-value=0.570. Conclusion: It has been proved in our study that both the succinylcholine and rocuronium are statically equally effective in terms of excellent intubation conditions in the management of rapid sequence induction in patients undergoing surgery under general anesthesia.

Background: Adhesive capsulitis is a condition that presents with pain and progressive limitation of both active and passive shoulder movements. It can be primary or secondary, the latter includes causes such as rotator cuff tear, cardiovascular disease, and diabetes mellitus. The American Shoulder and Elbow Surgeons defines that adhesive capsulitis is a condition of uncertain ethology characterized by a significant restriction of both active and passive shoulder motions that occur in the absence of known intrinsic shoulder disorder. Commonly described as: Stage 1 – Freezing stage, with pain and stiffness lasting around 9 months. Stage 2 – Frozen stage, with persistent stiffness lasting 4–12 months. Stage 3 – Thawing stage, with spontaneous recovery lasting 12–42 months. Ultrasonography (USG)-guided hydrodissection is used for adhesive capsulitis of the shoulder due to its cost-effectiveness and acceptance among patients. As adhesive capsulitis is postulated as an i nflammatory and fibrotic disease, easy treatment with intra-articular corticosteroids (CSs) injection may reduce synovitis, limit the development of capsular fibrosis, and alter the natural history of disease. CS injections are effective for shorter duration, but newer agents such as platelet-rich plasma (PRP) are more effective with no serious side effects. Materials and Methods: In this study, 40 patients were taken of adhesive capsulitis of the shoulder and were divided randomly into two groups. One group received injection PRP and the other group received injection CS. The outcome was recorded. Results: There was a statistically significant reduction in numeric rating scale pain scores in both the groups over a time period of 6 weeks, but the PRP injection was observed to be better in reducing the pain scores when compared to the CS injection after the 6th week (P = 0.037). Initially, the CS injection performed better in the 1st week due to anti-inflammatory action. By the 3rd week, both the injections showed a similar effect. However, at the end of the study period (6 weeks), there was a better reduction in the Shoulder Pain and Disability Index (SPADI) pain scores (P = 0.0057) and SPADI disability scores (P = 0.029) of the group PRP. Conclusion: We concluded that USG-guided hydrodissection with PRP is more effective therapy than CS in terms of reduction of pain and improvement in shoulder function in the treatment of adhesive capsulitis of shoulder.

SummaryCentral anticholinergic syndrome (CAS) is rare in neonates. We report a case in a 10‐day‐old baby weighing 2.5 kg, following reversal of neuromuscular blockade using 0.1 mg atropine and 120 μg neostigmine. The use of atropine in 0.01‐0.02 mg.kg‐1 dose rather than the recommended minimum dose of 0.1 mg may have prevented this complication.

Background:The haemodynamic stress response to laryngoscopy is momentary, generally of small duration and of little