ABSTRACT        COVID-19 pandemic has afflicted the individuals, national economies, and healthcare system worldwide. It has badly struck the ongoing and planned surgical procedures in nearly all healthcare centers which has led the surgical procedures to come to a grinding halt. This serious issue invites comments from surgical experts throughout the world.

BACKGROUND & OBJECTIVE: Surgical site (SSI) infections are important cause of morbidity and mortality in admitted patients worldwide. The objective is to determine the incidence of surgical site infection in General Surgical ward of tertiary care hospital. METHODOLOGY: Analytical cross-sectional study conducted at Department of General Surgery, Bolan Medical College/ Post-Graduate Medical Institute Quetta (PGMI) for a period of one year from 1st August 2019 to 31st July 2020.  Descriptive statistics were used to present social economics, factors related to surgery and surgical antimicrobial prophylaxis received. Chi square test was used for checking association between infections and different factors keeping p≤ 0.05 as significant. RESULTS: A total of 1500 patients underwent surgery, of which 500 (33.33%) patients were operated as elective cases and 1000 (66.66%) cases as emergency. Out of total 600 (40%) patients developed Surgical Site Infection (SSI). Risk associated with higher incidence of SSI was found to be age (30-45 years) and Diabetes mellitus (uncontrolled diabetes in perioperative period). Postoperatively obesity was noted to be having significant effect with p=0.002, American Society of Anesthesiologists (ASA) score having p-value 0.045, hospital stay with p<0.001 and surgical type and previous surgical history with p<0.001, were as duration of surgery was having <0.001. CONCLUSION: Prevention of SSI’s requires a multipronged approach with emphasis on optimizing preoperative issues, adhering to strict protocols during the intraoperative period and addressing and optimizing metabolic and nutritional status in post-operative period.

BACKGROUND & OBJECTIVE: Fournier's Gangrene is a quick development of necrotizing, fulminant infection of the scrotum, perineum, and lower abdominal wall and can  involve the groin. Synergic aerobic and anaerobic organisms can cause this disease. The aim of this study is to evaluate the causes, complications and optimal treatment of Fournier’s Gangrene. METHODOLOGY: A total of 150 patients were included. Fournier’s Gangrene was diagnosed clinically. Detailed clinical examination was performed, and the complications and modes of treatment were recorded. Calculation of descriptive statistics was done by the stratification and application of independent T-test and Chi-square test wherever applicable for post-stratification, considering p-value ≤0.05 as significant. RESULTS: The mean age was 31.74±6.24 years. The most common presenting complaint was the dusky appearance of the overlying skin. In the diabetic group, (66)44% had intense genital pain and tenderness, while in the non-diabetic group (72)48% observed a dusky appearance of the overlying skin and (37)24.7% had morbid obesity. No significant association was found between mortality of study groups, their age groups and their duration of hospital stay. CONCLUSION: Most common presenting complaint was the dusky appearance of the overlying skin. The anal abscess was the most common etiology, followed by a strangulated inguinal hernia. The mortality rate was 24%.

Abstract BACKGROUND & OBJECTIVE: To determine the commonly isolated organism in ulcers of diabetic foot and its sensitivity to antibiotics. METHODOLOGY: A total of 167 patients of diabetic foot were included in this descriptive Crosssectional study. All the patients were informed and consent was obtained according to ethical criteria approved by the ethical committee. The use of antibiotics in last 72 hours was strictly observed. The samples were obtained under aseptic conditions by applying the swap slightly to the exudate or base of the ulcer and were then carefully transferred in to the container and were then sent to the laboratory on the same date. The culture sensitivity was performed. Data was analyzed using SPSS. 20. RESULTS: A total of 140 samples were positive for 8 types of bacteria out of 167. 94 samples were monomicrobial were as 46 were polymicrobial. Over all Staphylococcus aureus 63(40.3%) was the most commonly isolated bacteria followed by Pseudomonas aeruginosa 40 (25.6%). S. aureus was most sensitive to imipenem/ meropenem (79.3%) followed by vancomycin (71%), linezolid (69.8%) and moxifloxacin (69.8%). P. aeruginosa was sensitive to impenem/ meropeneum (90%) followed by Ticarcilline/ clavulante (92.5%), amikacin (87.5%) and pipracilline / tazobactom (80%). Most of the gram positive and negative bacteria were resistant to commonly available antibiotic like ampiciline/ cloxacillin, amoxicilline/ clavulante and cephradine.  CONCLUSION: Most of the commonly used antibiotics had developed resistance. was S. aureus most common bacteria from the isolates and was sensitive to impenem/meropenem, vancomycin and linezolid. Gram-negative bacteria showed sensitivity to impenem/meropeneum, pipracilline/ tazobactom, Ticarcilline/ clavulante and amikacin.

Abstract BACKGROUND & OBJECTIVE:  Thyroid hormones act as foundation for the normal functioning of all the body hormones and body metabolism. The abnormality of thyroid hormones may lead to deranged lipid metabolism with abnormal relaxation of sphincter of oddi. This will cause stasis of bile in gallbladder and biliary channels leading to stone formation. The objective of the study is to determine the frequency of subclinical hypothyroidism among diagnosed cases of Cholelithiasis. METHODOLOGY: This study was conducted in Surgical Department, Sandman Provincial Hospital Quetta, from January to December 2018. The study has been approved by the ethical review committee of Post Graduate Medical Institute Quetta. It is a cross-sectional study. A total of 193 patients with Cholelithiasis were included in the study. After informed written consent, blood was sent to laboratory for testing the levels of serum TSH, T3 and T4. Samples having TSH values more than 6.0mU/L and serum thyroxin within the normal range 9.0-19.0pmole/L,  were labeled as subclinical hypothyroidism. RESULTS: The data of all the patients between 35 to 62 years of age with Cholelithiasis during the study period was taken and analysis was performed. The inclusion and exclusion criteria were strictly considered. Mean ± SD of age was 47.03±5.401 with C.I (46.26-47.80) years. Out of 193 patients 25 (13%) were male and 168(87%) were female. Subclinical hypothyroidism was found to be in 16 (8.16%) patients and remaining 177(91.70%) patients were found normal. CONCLUSION: It was concluded that the incidence of subclinical hypothyroidism in Cholelithiasis patients is low.