Vagal paraganglioma is a rare finding that develops from paraganglionic tissue found around the vagus nerve; it has a prevalence of 0.012% of all tumors. It is the third most common paraganglioma of the head and neck but still accounts for less than 5% of these tumors, and it has a well-established female prevalence. It is a difficult tumor to identify early based on its symptoms alone and only a thorough investigation can help solidify its diagnosis. In this report, we discuss a presentation of this phenomenon that is not only unique in its manifestation but also a very difficult diagnosis due to its deceptive presentation and multiple extensions. These masses need a good surgical regime to be removed properly and postoperative complications are very frequent in most of these cases.

Objectives: To compare the efficacy of 0.2% glyceryl trinitrate ointment versus internal sphincterotomy after hemorrhoidectomy. Study Design: Randomized Controlled Trial. Setting: Department of Surgery Unit III, at Lahore General Hospital, Lahore. Period: 6 months (August 2017 to February 2018). Material & Methods: The OPD of the Department of Surgery included 124 patients who satisfied the inclusion criteria. There were two groups of patients, Group A and Group B. Group-A was told to use gloved finger three times daily for 0.2 percent GTN ointment topically. For Group B, lateral internal sphincterotomy was performed as day care procedure. On visit, patients were assessed for pain relief by using VAS. All data was collected using a pre-designed (attached) proforma. In SPSS v23.0 the data were input and analyzed. It was stratified for age, sex, disease duration and hemorrhoid stage. The effectiveness of both groups was compared by using a p-value of 0.05 as significant for a chi-square test. Results: Male predominance; in group-A, 41(66.1%) patients were male and 21(33.9%) were female, while in group-B, 52(83.9%) patients were male and 10(16.1%) were females. Efficacy was found in 11(17.7%) patients in group-A (0.2% GTN) while in 25(40.3%) patients in group-B (Internal sphincterotomy) with p-value of 0.006 which is statistically significant. Conclusion: Open hemorrhoidectomy internal sphincterotomy is an effective method to reduce pain after hemorrhoidectomy in contrast to Glyceryl Trinitrate (GTN) topical cream of 0.2 percent.

Aim: To assess prevalence of depression, anxiety, stress in medical students, interns and residents in Pakistan Study design: Cross-sectional Survey (Questionnaire) based study. Place and duration of study: This study was conducted at Combined Military Hospital Lahore Medical College from March 2020 to May 2020. Results: 104 participants were included in the study. There was female predominance 58(55.8%), and the mean age was 23.55±1.42. The overall mean score of depression and anxiety was 21.2±12.67 and 15.7±10.67 respectively and most prevalent in third and fourth-year residents. The mean stress score was 13.7, 10. 27. Twenty-eight (26.9%) of the overall participants had extremely severe depression, 36 (34.6 %) had extremely severe anxiety and 13(12.5%) had severe stress. Conclusion: Multiple factors have been found to contribute to the poor mental health of health care workers, including financial trouble, sleep deprivation, abuse from colleagues, high expectations, female gender, broken relationships, and substance misuse. The prevalence of depression, anxiety, and stress in common in medical students. This calls for the development of strategies, workshops, and programs to identify modifiable stressors, encourage students to reach out to their family members and their teachers to verbalize their issues, and make psychiatric consultation accessible to them. Keywords: Anxiety Disorders, Depression, Medical, Mental Health Problem Solving, Psychological Distress,

Objective: To compare the frequency of Surgical Site Infection ( SSI ) and mean length of hospital stay between the Purse-string closure and conventional primary closure techniques for stoma reversal. Methods: The study was carried out in Surgical Unit-III, Lahore General Hospital Lahore from January 5, 2018 to July 5, 2018. The study designed as a Observational Study. Patients undergoing surgery for Ileostomy were randomly divided into two groups, Group-A (Purse-string closure) and Group-B (Conventional primary closure). All the patients were called for follow up checkup on 14th days after operation and after one month. Both of the groups were checked and recorded for SSI after operation and hospital stay. The data was statistically analyzed by using SPSS v23.0.t test (independent sample) used for the comparison of hospital stay mean. Chi-square was also used for the comparison of the frequencies of SSI. Data were stratified for gender and age. A p-value ≤0.05 was considered as significant. Results: A total of 140 patients were enrolled for this study. Patients were divided into two groups i.e. Group- A (Purse-string closure) and Group-B (Conventional primary closure). In group-A, mean duration of hospital stay was 5.7±1.0 days, while 7.3±1.1 days in group-B, which is statistically significant with a p-value of 0.000. In group-A, surgical site infection was in 4(5.7%) patients, while 11(15.7%) patients of group-B, which is statistically significant with a p-value of 0.046. Conclusion: The frequency of surgical site infection and mean length of hospital stay after stoma reversal, purse-string suturing technique is significantly less than conventional primary closure technique. Key Words: Surgical stoma; Ileostomy; Closure; Infection. How to cite: Nofal S., Arif A., Khan A., Saif. S., Khan W.A., Arif A. Comparing SSI in Purse-String Versus Conventional Primary Closure Following Stoma Reversal. Esculapio 2021; 17(01): 15-19

Objective: The objective of the study was to compare the frequency of severity of shoulder tip pain after active (gas suctioning) and passive removal of pneumoperitoneum among patient undergoing laparoscopic cholecystectomy. Methods: This Observational comparative study was directed in general surgery department of DOW university hospital beginning from February 2016 to February 2017. Two hundred and six patients undergoing standard 4 port laparoscopic cholecystectomy were enrolled equally in either groups. The surgeon evacuated the abdomen by using a multiporous suction tube limiting the negative suction pressure to - 40 mmHg for 2-5 minutes under direct vision in active aspiration group, while in control group, CO2 was removed passively. Pain scores were recorded using visual analog score at 16 hours post-operatively by residents of surgery blinded to the study. Results: Mean VAS pain score at 16 hours in intervention group was much inferior than control group 1.00 ±2.09 vs. 3.06 ± 2.58 ( p < 0.001). Conclusion: Active aspiration of CO2 is an effective method that removes most if not all gas from the abdominal cavity. This will cause statistically significant decrease post-operative discomfort, pain and decrease need of rescue analgesics. Key Words: Laparoscopic cholecystectomy, Pneumoperitoneum, Active Aspiration, shoulder tip pain, post- laproscopic cholecystectomy pain How to Cite: Arif A, Nofal S, Khan MA, Khan AW, Bhatti AM, Ishaq SH. Shoulder tip pain in laparoscopic cholecystectomy with active vs passive evacuation of pneumoperitoneum. Esculapio. 2020;16(04):116-119.