This research was conducted to enhance the productivity of the targeted sewing line at the ABC textile company. The existing SAMs, the capacity of the sewing line for various operations, and several required machines were collected. Moreover, the obtained figures were observed and analyzed by using time study and motion study, and certain improvements were made at the sewing line. Results indicated that SAMs for operations A and B were minimized by -13.64% and -14.54% respectively; whereas, SAM for operation C was increased by 16.67%. Machine requirement for operation C was increased by 100%; moreover, the capacity for operations A, B, and C was increased by 12%, 12.69%, and 40% respectively. When it is to production activities, the little improvements play a significant role in boosting the productivity of the production system. Optimal allocation of human resources, machines, and time are the benefits of line balancing. This can be made possible with the application of the line-balancing framework. With every passing day, the nature and type of article vary at the sewing line thus it is highly needed for the company to get the model developed for an automated line balancing application. Moreover, this work can be extended by the development of a line-balancing framework considering the nature of production.

Background: This study was conducted to explore the circumstances around which neonates are referred to the pediatric surgical team of Liaquat University Hospital. This influences the surgical management of neonatal emergencies outcome which also turns on awareness of the conditions early diagnosis, proper resuscitation, excellent nursing care, and refer to the proper center, main requirement is the application of a basic neonatal transport unit, whenever necessary these neonates are referred to these centers from wherever they are born. Methods: It is a retrospective descriptive study carried out at Liaquat University Hospital Hyderabad Sindh. This study included every referral neonatal surgical emergency managed by the pediatric surgical team from June 2017 to May 2019. Data were obtained from the patient's files and operation theatre register. This study was conducted over two years from June 2017 to May 2018 in the department of pediatric surgery, Liaquat University of medical health sciences Jamshoro. All the neonates presenting with surgical emergencies were included irrespective of gender, mode of referral, and causes that warrant surgical exploration using sampling of convenience. However, neonates whose carers did not consent to be a part of the study were not included. Inform consent was taken from either of the parents reassuring them about confidentiality, as well as the treatment being unaffected had they chosen to withdraw from a study at any time. The study variables included age, sex, weight, and referral pattern, later data was analyzed using SPSS version 21. Results: Fifty-three neonates were operated in July 2017 to June 2020. Out of 53 neonates, 32 were male and 21 female. The male to female ratio is 1.5:1. Anorectal Malformation 12 (22.6%) Intestinal Atresia 6 (11.3%) and Pneumoperitoneum 5 (9.4%) Hirschsprung's disease 9 (13.2%). Neonates with low birth weight were 5 (9.4%). The basic neonatal referral & transport system was poorer. Age at the time of presentation ranges from 1 to 20 days, a median age was 3 days. Dehydration in mild, moderate, and severe was noted in 38 (71.6%) of the referral neonates. The leading cause of morbidity and mortality was sepsis, mortality was 7 (13.2%). Conclusion: Management of neonatal emergencies the morbidity and mortality were not as high compared to other developing countries. However, improvement in the outcomes will require awareness, early referral to the concerned department, and overcoming difficulties by providing a well-equipped hospital that will provide an outstanding nursing facility and a well-equipped neonatal transportation system. Keywords: Neonatal transport unit, Basic resuscitation, Good nursing care, Neonatal intensive care unit

Aim: To compare the outcomes of laparoscopic Inguinal hernia repair and open Inguinal hernia Shouldice repair. Study design: A randomized controlled trial Place and duration: This study was conducted at Liaquat University of Medical Health Sciences Jamshoro, Pakistan from April 2020 to April 2021. Methodology: In this study comparison of a laparoscopic and open procedure was done. A total of 124 patients were included in the study. A total of 64 patients underwent a Laparoscopic Transabdominal Pre Peritoneal (TAPP) Inguinal Hernia Mesh Repair and 60 patients underwent the Shouldice technique of hernia repair which is an open surgical Non Mesh Technique. The measured Variable were Early Complication, Return to work, Duration of analgesia requirement and Reoccurrence Rate. The data were analyzed using IBM SPSS version 26. Results: The rate of complications in both groups was similar. Patients who underwent the laparoscopic procedure mean duration to return back to work was 12 days. On the other hand, those who had the Shouldice procedure mean duration was 17 days return back to work. The mean duration of analgesia intake after a laparoscopic procedure was 2.2 days and after a Shouldice procedure was 2.8 days. Recurrence of the hernia was reported by 3 (4.69%) patients who underwent the laparoscopic procedure and 2 (3.33%) patients who underwent the open procedure. Conclusion: The laparoscopic procedure is a better procedure than the open procedure of primary unilateral hernia repair in terms of early recovery, return to work and postoperative pain. Keywords: Laparoscopy, hernia repair, Shouldice procedure

Methodology: This study consisted of 30 patients of giant inguinoscrotal hernias. Detailed History was taken from all the patients with special regard to the inguinoscrotal swelling. Detailed Clinical examination of the patient was done .Site of swelling was especially examined for assessment of three grades. Grade-I means hernia reaching upto middle of thigh, Grade-II means inguinoscrotal contents reaching upto knee joint and Grade-III means contents going below knee level. All data was entered in a specified proforma designed for this purpose. Inclusion criteria were all diagnosed patients of giant inguinoscrotal hernia on the basis of history, clinical examination were included in this study. Exclusion criteria included patients unfit for surgery, patients below age of 12 years, patients with severe co-morbidity and morbid obese patients. Results: 30 patients included in this study. There was wide variation of age ranging from a minimum of 30 years to 70 years , mean age was 46.28+7.20 years. The patients presented with more common in right side 21(70%) cases and left side 9(30%) cases. Patients presented with grade-I 11(36.66%) cases, grade-II 9(30%) cases, grade-III 7(23.33%) cases and grade IV 3(10%) cases. Giant inguinal hernia were operated Orchidectomy and hernioplasty 12(40%) cases, followed by Debulkation of contents and hernioplasty 9(30%) cases and Gradual Pneumoperitoneum and hernioplasty 4(13.33%) cases. Complications seen in this study was Respiratory in 3(10%) patients, Abdominal compartmental syndrome in 1(3.33%) patients, Paralytic Ileus in 2(6.66%) patients and Wound Infections in 4(13.33%). Conclusion: In conclusion our study revealed it is commonly to live in our population due to ignorance of hernia poverty in remote areas and lack of knowledge of disease complications.

Objectives: Tumors of the gastrointestinal tract (GIST) are the most commonly seen tumors of the gut. The current study aimed to evaluate the clinical and pathological features of gastrointestinal stromal tumors presented in our setting. Methodology: A prospective observational study was conducted at a tertiary care center, Pakistan between January 2019 to March 2021. All cases of duodenal and stomach gastrointestinal stromal tumors diagnosed and treated at our center were analyzed in our study. All clinicopathological tumors including patient characteristics, treatments, histological examinations, and Genomic mutation were documented. The clinicopathologic parameters were compared between stomach and duodenal GIST. Results: A total of 221 patients were enrolled in the study. The majority were below the age of sixty years. The male to female ratio was 0.97. The most common presenting symptom was active bleeding or severe anemia with a frequency of 114 (51.6%). The majority of the duodenal GIST were present in the descending portion. 147 (66.5%) patients were offered limited resection while 25.8% were offered pancreaticoduodenectomy, and the remainder were not operated. About 30 (13.6%) patients had genetic mutation. Of these, the majority had a KIT mutation. In four patients, KIT and PDGFRA were both mutated. We stratified the patients with respect to the clinicopathological factors and found that tumor size was significantly associated with duodenal GIST (p<0.001). Tumor size of > 10 cm was more frequently found in duodenum than stomach >10 [26 (11.8%) vs. 21 (6.7%)]. Conclusion: The present study highlights the clinicopathological pattern of GIST in our population. Furthermore, it indicated that the tumor size was significantly greater in patients diagnosed with duodenal GIST as compared to stomach GIST. Keywords: Duodenum, GIST, gastrointestinal stromal tumors, stomach adenocarcinoma