Aim: To estimate the nutritional status for nutritional rickets identification in children <5 years of age. Study design: Prospective study Place and duration of study: Memon Hospital Hyderabad from 1st February 2022 to 31st January 2023. Methodology: One hundred children under the age of 5 were enrolled. Nutritional rickets diagnosis was based on clinical and biochemical examination followed by radiological imaging. The radiological X-ray was used for identifying spraying, fraying, cupping and widening of wrist presence. A 2cc blood of each patient was withdrawn and test for the levels of 25(OH) vitamin D3, serum calcium and alkaline phosphatase (ALP) through Enzyme linked immune sorbent assay and calorimetric method respectively. For each patient a food frequency chart was fulfilled which included their breast feeding, supplementation, cerelac and cow milk diet intake as well as intake of other dairy products. Results: Radiological assessment of present study showed that cupping was the most prominent determinant followed by wrist widening and splaying in all age groups. In present study, rural participants are more exposed to sun light as compared to urban participants. Biochemical analysis revealed that means calcium, ALP and vitamin D levels was lower in almost every age group. Food frequency chart proved, 66% of the children were on breastfeeding but only 34% of the patients were taking supplements along with breastfeeding. Practical Implication: supplementation and adequate awareness are the key elements that can prove substantial in improving the vitamin D status in developing regions of the world. Conclusion: Majority of the children of present study were vitamin D and calcium deficient. Keywords: Rickets, Vitamin D, Calcium, Sunlight

Gallstone ileus (GSI) is an uncommon cause of intestinal obstruction. Theformation of a fistula between the gall bladder and the bowel wall may allow a gallstone to enter the intestinal tract.Plain abdominal films, abdominal ultrasound and abdominal computed tomography aid in the diagnosis. Surgery is thetreatment of choice in cases of gallstone ileus rate. We describe the case of a 68-year-old man who presented withsymptoms and signs of intestinal obstruction. Diagnostic evaluation revealed a large gallstone impacted in the ileum.The patient was scheduled for exploratory laparotomy. At the time of surgery stone was found in the sigmoid colon.It was milked down and brought out through the rectum.

Objective: The aim of this study was to compare the outcomes and morbidities of laparoscopic appendicectomy (LA) and open appendicectomy (OA) in patients with acute appendicitis. Design: Interventional study. Setting: The study was conducted at Madina Teaching Hospital, University Medical & Dental College, Faisalabad. Period: From June 2007 to August 2009. Materials and Methods: The study group consisted of two hundred patients suffering from acute appendicitis. One hundred patients underwent LA and one hundred patients underwent OA. Comparison was based on operating time, complications, requirements for postoperative analgesia, time until resumption to regular diet, hospital stay, and return to full activity in days. Comparisons were made between continuous variables using Student’s t test of the means and were made between proportions using Fischer’s exact or chi-square testing where appropriate. Statistical significance was taken to be a p value of .05 or less. Results: Of the hundred patients, five patients (5%) had the procedure converted to open surgery. The rate of infection was significantly lower in patients undergoing LA. The median length of stay was significantly shorter after LA (2 days after LA, 5 days after OA, P < 0.05) than after OA. The operating time was shorter {OA: 25 min (median), LA: 30 min (median), P > .05} in patients undergoing open appendicectomy compared to laparoscopic appendicectomy. Conclusion: LA is associated with increased clinical comfort in terms of fewer wound infections, faster recovery, earlier return to work and improved cosmesis.

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