Aim: To observe the complication rate of conventional percutaneous nephrolithotomy (PCNL) in a tertiary care Hospital. Methods: This Retrospective study conducted from January 2016 to January 2020 in the Department of Urology at Lady Reading Hospital in Peshawar, Pakistan.The research included a total of 449 patients who underwent conventional PCNL.Non-contrast CT KUB was performed on all patients before surgery. After passing 6fr Ureteric catheter through a cystoscope in lithotomy position patient was then shifted into prone position. Under the guidance of fluoroscopy, all procedures were carried out while the patient was lying flat and conventional 30FR amplatz sheath was used as working channel. Results: Complications were reported in 46.9% of cases.The majority of the complications occurred in patients with clavien grades I and II, with 120(27%) and 54(12%) patients, respectively. In Grade I complicationstransient feveroccurred in 67(15%) patients treated with antipyretics while 53(12%) patients had nephrostomy site leakage managed with simple pressure dressing at bed site. In grade II complication 45(10%) patients had bleeding which required transfusion and 9(2%) patients developed sepsis treated with parenteral antibiotics. 10(2%) patients developed grade IIIa complication such as persistent bleeding in 4(0.8%) patients managed with percutaneous angioembolization and 6(1.2%) patients required percutaneous drainage of perinephric collection. 25(5.5%) patients had grade IIIb complications, in 24( 5.3%) patients DJ stenting was done for PCS injury or persistent leakage from nephrostomy site while 1(0.2%) patient needed colostomy for colonic injury. Conclusion: The chance of serious complications during percutaneous nephrolithotomy is very minimal. It is also safe, cost effective and well-tolerated. Transient fever or nephrostomy site leakage are the most frequently occurring minor complications often subside spontaneously. Keywords: Nephrostomy, percutaneous nephrolithotomy

Aim: To determine the frequency of wound infection after duodenal ulcer perforation repair. Methodology: This descriptive Case series Study in the department of Surgery, Khyber Teaching Hospital from February 2021-July 2021, Peshawar. A total of 123 patients with perforated duodenal ulcer, included those aged 20 to 60 years. Immuno-compromised patients, CRF & CLD were excluded. A single dose of broad-spectrum antibiotic was given prior to undergone open repair by a consultant surgeon followed by two more shorts of antibiotic given post operatively at the interval of 8 hours each. Patients were followed postoperatively for 4 weeks and surgical site infection was noted. Results: The study patients age ranged from 20 to 60 years, with a mean age of 43.77±9.35 years. Most of the patients 77(62.60%) were in the 20–40 years age range.Male to female ratio of these 123 cases was 2.1:1, with 83(67.48%) males and 40(32.52%) females. In our study, frequency of wound infection after duodenal ulcer perforation repair was found in 28(22.76%) patients. Conclusion: This study concluded that the clinicians should take some practical recommendations regarding control of surgical site infectionsin order to lower the morbidity and mortality of these specific patients. Keywords: perforated duodenal ulcer, open repair,surgical site infection.

Background: Down syndrome is the most common chromosomal disorder and most common genetic cause of mental retardation.Congenital heart disease (CHD) is an important cause of morbidity and mortality in children with Down's syndrome.Objective: To determine the frequency and types of congenital heart diseases in children with Down syndrome and to relate it withconsanguinity.Material and Methods: This Cross-sectional study was carried out at Bacha Khan Medical Complex / Gajju Khan Medical College,Swabi, from January 2019-December 2020. Children less than 12 year's age with Down syndrome were enrolled in the study.Echocardiography of all these children was done and presence and type of CHD was noted.Results: Our study included 95 children with diagnosis of Down syndrome. The mean age was 56.12±41.89 months. 40% weremales. Mother's mean age was 33.04±4.2 years. Mothers having age = 35 years old were 30.5%. Parents having consanguineousmarriage were 33.7%. The diagnosis of major congenital heart defect was in 37.9%. Out of 36 CHD patients the type of congenitalheart lesion was as follows: 36.11% hadAVSD, 25% hadASD; 30.5% had VSD; 5.55% had tetralogy of Fallot and 2.78% had PDA.Children with down syndrome with CHD had older mothers <0.05. Mothers with consanguineous marriages had a greaterproportion of CHD children; p<0.05.Conclusion: Approximately 1/3rd Down syndrome children had congenital heart disease. The commonest lesion was AVSDfollowed by VSD, ASD, tetralogy of Fallot and PDA. Consanguineous marriages are associated with a greater frequency ofCHD in Down children.Keywords: Down syndrome, congenital heart disease, Echocardiography.

OBJECTIVES This study aimed to evaluate the maternal and fetal outcomes in PROM and PRE-PROM at tertiary care hospitals. METHODOLOGY This Cross-sectional study was carried out in the department of obstetrics and gynaecology at Khyber Teaching Hospital Peshawar after ethical approval of the institutional ethical board. Patients who fulfilled the inclusion criteria were selected. On arrival, detailed history was taken, physical and obstetrical examination and per speculum examination were done, patients were managed conservatively, and steroid cover was given for fetal lung maturity.  RESULTS A total of 150 pregnant women who met the inclusion criteria and were complicated by PROM or PRE-PROM were followed. Out of the total patients, 104 presented with PROM, while 46 presented with PPROM. PROM and PPROM patients were identical regarding placental abruption. 104(69.3%) patients presented with PROM and PPROM 46(30.7%).  Patients who delivered were 72(52%) normal vaginal delivery (NVD), 57(38%) C-Section, 15(10%) NVD with episiotomy. In NVD 54(63%) spontaneous, 18(12%) induced, while in C-Section 6(4%) elective and 51(34%) emergency C-Section. In PROM, 18(12%) were complicated by chorioamnionitis, fetal distress meconium stained liquor 18(12%), whereas 100 were uneventful, while in PPROM, 122(81.3%) had no complications, 10(6.7%) chorioamnionitis and 40.7% of the neonates had NICU admission. The personal effects of NVD on the duration of PROM/ PRE-PROM in days with p-value 0.027. The p-value of Complications of PRE-PROM was 0.037. CONCLUSION PROM and PPROM presented with increased maternal and fetal morbidity, vaginal infection, and urinary tract infection should be promptly screened and treated on time to prevent maternal morbidities and improve fetal outcomes.

OBJECTIVES Frequency of congenital heart disease in patients with Down syndrome.METHODOLOGY This study was conducted in Hayatabad Medical Complex, Peshawar from 10th May 2021 to 9th November 2021. A total of 377 patients of age 1 to 10 years and both gender were included in the study. Those with already diagnosed cases of congenital heart disease and dysmorphic features other than Down syndrome were excluded from the study. All patients were undergone echocardiography and patient with PDA, VSD, ASD, ASVSD, and TOF were labeled as having congenital heart diseases.RESULTSMean age was 5.96 ±1.954, Males were 176 (46.7%) while females were 201 (53.3%), Mean birth weight was 3.45 ± 0.801 kg, Mean age of the mother was 38.25 ± 6.797 years, Congenital heart diseases were present in 157 (41.6%) of the patient while it was not present in 220 (58.4%) of patients, there was no association between congenital heart disease and age of mother, age of the child, sex of child or weight of the child (P >0.05).CONCLUSIONCongenital heart disease is very common in patients with Down syndrome. It is recommended that at the time of diagnosis of this disease, the patient should be screened for congenital heart disease.