IntroductionAmong all benign conditions, the fibroadenoma is the most common lesion worldwide as well as in Pakistan. Clinicians often face the dilemma of whether to remove the mass or to monitor it by means of periodic follow-up examinations. Although the removal of these lesions is a definitive solution, surgery may involve unnecessary excision of benign lesions and unbecoming cosmesis. Body mass index (BMI) is a known risk factor for the development of breast cancer.However, the relationship between BMI and benign breast diseases is still unclear. Some studies showed that increased BMI is a risk factor for benign breast diseases; however, a large number of studies showed that a decrease in BMI is the risk factor for benign breast diseases.Material and methodsThis was a descriptive cross-sectional study conducted at the Department of General Surgery, Pakistan Institute of Medical Sciences (PIMS), Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan. All patients fulfilling inclusion criteria were assessed in the breast clinic of PIMS. A final diagnosis of fibroadenoma was made after a triple assessment. Weight in kilograms and height in meters were measured. All the information was recorded in a specifically designed proforma accordingly by the postgraduate trainee. BMI was calculated by the formula: BMI=Weight in kgs/height in meters. Other variables that were noted include patients' age, gender, contact number, and hospital visit. The data were analyzed using SPSS version 21 (IBM Corp., Armonk, NY, US).ResultsThe BMI of study patients was 21.8 ± 1.3, ranging from 19 to 24.9. Out of 300 patients presenting with benign breast disease, 60 (20%) had a fibroadenoma while 240 (80%) had other benign breast diseases. Out of 136 patients with high BMI, 42 (30.8%) had a fibroadenoma while out of 74 patients with low BMI, eight (10.8%) had a fibroadenoma; however, out of 90 patients with normal BMI, 10 (11.1%) had a fibroadenoma. Our study population showed an increased risk of fibroadenoma formation in the adolescent age group with an OR value of 8.54 (CI 4.38-16.63, P<0.001). There were also additional statistical correlations between higher BMI and the site of the lesion being the upper outer quadrant of the breast (t= 4.326 P<0.01). There was no significant correlation of BMI with size and increased number of lesions (P=0.280 and P=0.175).ConclusionHigh BMI seems to be a substantial risk factor for the development of a fibroadenoma, particularly in young adolescent females.

Trauma is the principal reason of deaths in kids and young adults globally. Objective: To determine the causes and management of blunt liver trauma in a tertiary care hospital in Peshawar. Methods: The present investigation observed a total of 150 individuals through non-probability consecutive sampling to determine the mean hospital stay in patients presented with blunt liver trauma. Results: In this study, age distribution among 150 patients was analyzed as n= 10-20 Years 51 34.0%), 21-30 Years 35 (23.3%), 31-40 Years 16 (10.7%), 41-50 Years 23 (15.3%), 51-60 Years 25 (16.7%). Mean age was 41.56±5.357 years. Gender wise Distribution among 150 Patients was analyzed as Male were 94 (62.7%) and female were 56 (37.3%) Distribution of BMI among 150 patients were analyzed as n=Below 18.5 Underweight 76 (50.7%), 18.5–24.9 Normal weight 35 (23.3%), 25.0–29.9 pre-obesity 21 (14.0%), 30.0–34.9 Obesity class 18 (12.0%). Distribution Mechanism of Injury among 150 patients were analyzed as n= RTA was 57 (38.0%), fall from height was 52 (34.7%), Sport's injury was 18 (12.0%), physical assault was 23 (15.3%). Successful Conservative Management among 150 patients were analyzed as n= Yes was 106 (70.7%) and No was 44 (29.3%), Distribution of Mortality among 150 patients were analyzed as n= Yes was found 66 (44.0%) and No was found 84 (56.0%). Conclusions: The severity of liver damage and concomitant intra-abdominal injuries demonstrated a strong association with the chance of success with conservative therapy. The restricted hospital facilities and lack of agreement on traditional therapy had a detrimental influence on success.

Objective: The study's goal is to evaluate the diagnostic and therapeutic efficacy of non-invasive surgery (laparoscopy) in the treatment of acute abdomen. Methods: This is an observational study, conducted in Peshawar Medical College Group of Hospitals, Peshawar from January, 2020 to July, 2021. Total 60 patients presented with acute abdomen were included in the study. Patients underwent Laparoscopic surgery after initial work-up. The outcome of Laparoscopy was assessed in terms of diagnostic accuracy, conversion rate, inadvertent injury, hospital stay, wound infection and pain score. Result: Total 60 patients with acute abdomen underwent Laparoscopy during study period. Male to female ratio 1: 1.2 (27:33) while mean age was 36.18 years (12-75). In 93% (56/60) cases per-operative diagnosis was compatible with pre-operative diagnosis. The conversion rate from laparoscopic to open surgery was 1.6%. The average length of hospital stay was 1.45 days (1-4 days). On a visual analogue scale, the mean pre-operative pain level was 6.28. (3-9). On the first post-operative day, the mean post-operative pain score on a visual analogue scale was 1.68. (1-4). Infection at the port site occurred in 3.3% (2/60). Conclusion: Laparoscopy is a safe and effective method of diagnosing and treating acute abdomen so it can be safely adopted in patients presenting with acute abdomen as Laparoscopy eliminates diagnostic delays and unneeded laparotomy and its complications. Keywords: Acute Abdomen, Laparoscopy, Minimally Invasive Surgery, Laparotomy

Background: Acute appendicitis (AA) is one among most common condition requiring emergency surgery throughout the world. Acute appendicitis most common diagnosis in patients seeking medical help in emergency room due to acute abdomen causing 72,000 deaths among 16 million cases reported globally. This study will help the surgeons in making timely decisions, thus reducing the morbidity and mortality associated with complicated appendicitis. The aim of this study was to accuracy of C - reactive protein (CRP) levels in acute appendicitis. Material and Methods: Six-month descriptive cross-sectional research from 16 February to 16 August 2019 was completed. The Khyber Teaching Hospital in Peshawar served as the study's location. A total of 216 patients were monitored throughout this investigation. The history, clinical examination, and regular laboratory tests, such as the total leucocyte count (TLC) and differential leucocyte count (DLC) on admission, were used to make the diagnosis of acute appendicitis. All of these patients were given Nil by Mouth to prepare them for emergency surgery, and baseline testing included HBs Ag and Anti-HCV serology as well as pre-operative serum CRP levels (Liver function tests, renal function tests and serum electrolytes). Following preparation, every patient on the emergency list had surgery. Intra-operative results were recorded, and a biopsy was collected from the excised appendices and forward to histopathology for further processing. Results: The mean age in this research was 48 years, with an SD of 12.311. Male patients made up 55% of the total population, while female patients made up 45%. The diagnostic accuracy of C-reactive protein levels was determined to be 84.2% in this study. The specificity was found to be 33.3%, while the sensitivity was observed to be 85.7%. By using histopathology, it was discovered that the positive predictive value was 97.2% and the negative predictive value was 84.2%. Conclusion: According to our study, using histopathology, the diagnostic accuracy of C-reactive protein levels was 84.25% with sensitivity of 85.71%, specificity of 33.33%, and positive predictive values of 97.25% and 184.25%. The findings will also open the door for any further research in this area. . The higher CRP levels will therefore predict the complexity of acute appendicitis and help the general practitioners to do early referrals therefore avoiding life threatening complications Keywords: Acute Appendicitis, C-Reactive Protein, Histopathology, CRP, Gold Standard

Background: Primary ventral and incisional abdominal wall hernias are frequent conditions that necessitate surgery, and both types of hernias can be treated utilizing an open or laparoscopic technique. Improvements in laparoscopy have also been linked to a decrease in pain scores. Methodology: A dual setting study was conducted from July 2017 to June 2019 at Peshawar medical college with collaboration of Lady Reading Hospital and Hayatabd Medical Complex, Peshawar and was conducted on a total of 120 patients who were diagnosed with ventral hernia. A random number table created by a computer indicated repair of an open ventral hernia technique (group 1, n = 60) or laparoscopy (group 2, n = 60). Results: Among 60 patients in the laparoscopy group, there were 37 cases of PUH, 15 cases of epigastric hernia, 8 cases of umbilical hernia, and among 60 cases of open abdominal hernia, including 31 cases of PUH, 19 cases of hernia in the abdomen. upper abdomen, and 10 cases of umbilical hernia. Wound-related complications were most commonly seen in the open procedure group of patients. Conclusion: This has led to broad acceptance of the laparoscopic surgery, and advantages particularly in order to decrease the post-operative mortality and morbidity, time of operation, bleeding and the duration of hospital stay along the ability to execute the surgery on the obese people and with abdominal scarred individuals. Keywords: Incisional hernia, Laparoscopic mesh repair, Open mesh repair, Primary ventral hernia.