Objectives: The most appropriate treatment of inguinal hernia is to repair surgically. Worldwide more than 50 different techniques have been employed due to some but different problems with all techniques. Commonly used techniques are basically of two types. One is based on tissue repair and other uses the mesh. These include Shouldice, Lichtenstein, Darning repair, Totally Extra-Peritoneal (TEP) and Trans Abdominal Pre-Peritoneal (TAPP) repair. All the techniques have certain benefits and trade-offs as well. Our aim was to compare the outcome of Desarda repair versus Lichtenstein repair. Study Design: Randomized Controlled trial. Settings: DHQ Hospital Gujranwala. Period: From 27 October 2017 to 27 March 2018. Material & Methods: We included 60 patients in the study. In 30 patients Lichtenstein Hernia Repair was done and in 30 patients Desarda repair was done. The demographic information, outcome in the form of duration of operation, postoperative pain, and return to normal activity was recorded. All this information was collected through a predesigned performa. Patients were followed up on OPD basis. Data analysis was done by using SPSS 20. Results: Mean operative time in group A and group B was 61.20±12.558 and 71.89±13.118 respectively. Statistically significant difference was present in treatment group in term of operative time i.e. (P-value = ˂ .05). In both treatment group, mean time to require to start normal activity in A and B  was 10.06±1.771 and 11.14±2.485 and it is statistically significant (P-value=.001). Postoperative pain was less but statistically insignificant in study group. Conclusion: Desarda repair is better than Lichtenstein repair in terms of operative time and return to normal activity.

Background: To date, no study has been performed on the relationship between depression and perimenopausal symptoms using the Path model in Iran. Objective: This study aims to assess the relationship between depression and menopause symptoms using the PATH model. Methods: A cross-sectional study was conducted for 4 months in 2019 and 332 menopausal women enrolled in 14 public health centers. Data collection instruments included questionnaires of demographic characteristics, anxiety instrument, Menopause Rating Scale, and the Beck Depression short Inventory (BDI-S). The hypothesized mediators were assessed using Structural Equation Modeling (SEM). The model included depression symptoms (dependent variable), anxiety (mediators), number of alive children (moderator), and menopausal symptoms (independent variable). Analyses were conducted by SPSS 16 and AMOS 20. Results: There was a significant positive correlation between menopause symptoms with total anxiety (Rs=0.52), state anxiety (Rs=0.47), trait anxiety (Rs=0.46), and depression (Rs=0.54). Depression had a significant positive correlation with total anxiety (Rs=0.64), trait anxiety (Rs=0.58), and state anxiety (Rs=0.59). Also, the total mediating effect of total anxiety and depression and the total moderating effect of the number of alive children were significant on menopause symptoms. Conclusion: According to the results of the present study, there is an association between depression and menopausal symptoms. Therefore, health providers should pay more attention to the psychological health of women during the period of perimenopausal. The predictor factors should be considered in both intervention and clinical assessment of menopause women.

Objective: To determine the frequency of conservatively managed patients of acute appendicitis by using new (Muzammil-Mudassar appendicitis severity score) scoring system. Study Design: Cross Sectional Observational study. Setting: Government Teaching Hospital, Shahdara. Period: October 2021 to April 2022. Material & Methods: 267 patients diagnosed with acute appendicitis by ALVARADO score were enrolled. New appendicitis severity score was devised by searching online literature. A cut off value of 11 was defined after conducting a pilot study. Patients having score of < 11 were eligible for conservative management. All patients undergoing conservative treatment were receiving nothing per oral and given intravenous antibiotics (ciprofloxacin and metronidazole), intravenous fluids and infusion Paracetamol three times a day for at least 24-48 hours. Surgery was done in failed or unsatisfied cases. Weekly follow-up for first two weeks and then monthly for three months was done. Results: In our study mean age of the patients was 46.23±19.33 years, 187(70.04%) patients had age ≤60 years. The conservative management was successful in 214(80.15%) patients. Recurrence after three months was noted in 13(4.87%) patients. After 3 month follow up the anorexia was found in 4(1.5%) patients, nausea/vomiting in 5(1.9%) patients and pain was noted in 7(2.6%) patients. Conclusion: new score (Muzammil-Mudassar appendicitis severity score) is highly effective in predicting patients who will benefit from conservative management in terms of recurrence.

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Harmonic scalpel is popular for use in a variety of surgical procedures including thyroid surgery. Proposed advantages of the harmonic scalpel include less lateral thermal tissue damage with no electrical energy transferred to the patient, no neuromuscular stimulation, less smoke formation as compared with electrocautery. Objectives: Our aim was to compare outcomes following thyroid surgery in terms of operative time, postoperative pain, drainage volume, recurrent laryngeal nerve and parathyroid gland injury with the use of the Harmonic Scalpel compared to conventional methods of hemostasis. Study Design: Randomized control trial. Setting: Surgical Department Lahore General Hospital. Period: Twelve Months June 2016 to June 2017. Material & Methods: 60 patients, 30 in each group. Patients were randomized in each group by balloting method. Operative time, postoperative pain and drainage volume was assessed during hospital stay. Recurrent laryngeal nerve and parathyroid gland injury was assessed during hospital stay and follow-up. Results: There was no significant difference in development of hoarseness of voice in both groups, p-value > 0.05. The mean operative time for group A was 69.47 ± 15.44 minutes and for group B it was 54.93 ± 11.56 minutes, p-value <0.05. The overall blood loss in group-A and group-B was 118.73 ± 50.72 ml and 44.60±10.70 ml, p-value<0.05. The mean post-op pain observed at 2nd day for group B was 2.93 ±3.57 and for group A it was 3.57±0.77, p-value < 0.05. Conclusion: Use of Harmonic Scalpel has better results in thyroid surgery in terms of less operative time, less postoperative pain, less drainage volume, while no RLN & parathyroid injury detected in either group.