Small and medium-sized enterprises (SMEs) play an enormously crucial part in the modern world economy, demonstrating the most unique and incredible ground-breaking system. SMEs’ employment statistics and future worker needs make it a focus of policies among rising economies, and Pakistan is no exception. The working conditions in SMEs diverge from industry to industry; however, irrespective of the industrial categorization, the SMEs are failing to protect the workers’ rights in the perspective of Sustainable Development Goals (SDGs). The interpretivism paradigm and purposive sampling, narrative inquiry, and analysis method have been adopted to gain in-depth knowledge of workers’ rights in SMEs concerning the SDGs. Results revealed that Pakistan-based SMEs argue to be financially weak and perceived as less equipped to adhere to the world’s standards. Highlighted issues in failure to adhere to worker’s rights include lack of financial resources, top management’s commitment, regulatory framework, SDG awareness, strategic planning, and the dire need for expert guidance and consultation in translating goals to work environments.

Cracked nipple is a painful condition for lactating mothers and if untreated leads to lactational mastitis, breast abscesses Objectives: T o compare the efficacy of dexpanthenol, olive oil and breast milk for nipple cracks treatment in lactating mothers Outcome Measures: We measured the Severity of pain (the primary outcome) by using visual analogue scale (VAS) and healing of cracked nipple (Secondary outcome) was assess by Nipple trauma score (NTS) before treatment and after7days, 14 days of treatment Material And Methods: We conducted a quasi experimental study from march 2022 to end of august 2022 in sheikh zayed hospital, Rahim Yar Khan after ethical approval from institutional review board. The total numbers of 120patient were equally divided into three groups using Breast milk, Olive oil or Dexpanthenol respectively for their cracked nipples. The data was collected on predesigned Performa.Data Analysis Procedure: We measured the percentages ,means and standard deviations with the help of statistical package for social sciences version (SPSS) version 28. ANOVA test and Non-parametric test were also used to test the difference between study groups Results: At day0 baseline mean nipple pain score and nipple trauma score was same in all groups.At day 7 breast milk and olive oil show better reduction in pain as compared to Dexpanthenol.At day 14 olive oil showed statistically significant reduction in pain as compared to breast milk and dexpanthenol t. At day 7 and day 14 olive oil show statistically significant better healing of cracked nipples as compared to Breast milk and Dexpanthenol. Practical implication Conclusion: Our study is proving that olive oil is better than Breast milk and Dexpanthenol in term of pain relief and healing of cracked nipples proving hypothesis: H2 Keywords: Cracked nipple, olive oil, Breast milk, Dexpanthenol.

Objective: To compare the outcome of surgical repair of inguinal hernia between total extra peritoneal repair (TEP) and Lichtenstein repair. Study Design: Randomized Controlled Trial. Setting: Department of Surgery, Sheikh Zayed Hospital, Rahim Yar Khan. Period: 24-03-2021 to 23-09-2021. Material & Methods: Non probability consecutive sampling. The cases of both genders with age range of 20-60 years with inguinal hernia (both direct and indirect) were included. The cases in group A were managed by laparoscopic TEP while those in group B underwent Lichtenstein repair. Prolonged hospital stay was labeled when the patients were not discharged after 24 hours of surgery and post-operative pain was labelled as yes when the patient had pain of score of 3 or more assessed by visual analogue scale after the 2 weeks of the surgery. Results: In this study 62 cases were included, 31 in each group. The mean age in group A and B was 32.90±9.89 vs 32.67±7.57 years and mean duration of hospital stay was 22.77±6.84 vs 26.00±11.25 hours with P=0.004 in group A and B respectively. Postoperative pain was seen in 08 (25.80%) cases in group A and 19 (61.29%) cases in group B with P=0.01. Prolonged hospital stay was observed in 10 (32.25%) cases in group A and 18 (58.06%) cases in group B withP= 0.07. Conclusion: Postoperative pain is significantly higher in cases managed with Lichtenstein repair as compared to total extra peritoneal repair.

Background and Aim: Hemorrhoids are common anorectal problems that cause fear by bleeding, pruritus burden, and thrombosis pain. Prolapse and hemorrhoids are managed by stapled hemorrhoidectomy (SH). Initially, Stapled hemorrhoidectomy seemed to be a good alternative for Milligan Morgan (MM) hemorrhoidectomy verified by various studies. However, recent studies found that long-term assessment of stapled hemorrhoidectomy gives poor outcomes in terms of postoperative complications and patient’s satisfaction. Therefore, the present study aimed to compare the Milligan Morgan versus stapled Hemorrhoidectomy in patients attending Tertiary Care Hospital. Methodology: This prospective study was carried out on 120 patients at the Department of Surgery Unit-I Sheikh Zayed Medical College Rahim Yar Khan from 1st May 2021 to 31th April 2022. All the patients of either gender with an age range from 18 years to 60 years after 2nd degree hemorrhoids failure of multiple rubber band ligations and 3rd and 4th degree hemorrhoids were enrolled. Concomitant anal disease patients such as ano-rectal cancer, fissure, fistula, and abscess were excluded. Patients were divided into two categories: Group-I Stapled Hemorrhoidectomy and Group-II Milligan Morgan. Post-operative complications such as stenosis and urinary retention during hospitalization were recorded. All the data were entered and analyzed using SPSS version 25. Results: The overall mean age of Group-I and Group-II was 46.78±12.66 years and 48.91±14.82 years respectively. Each group comprised 60 patients. Out of the SH group, 35 (58.3%) were males and 25 (41.7%) were females. Of the MM Group-II, male and females were 44 (73.3%) and 16 (26.7%) respectively. About 53 (88.3%) patients in Group-I and 32 (53.3%) patients in Group-II had relief from bleeding and other symptoms. The surgical duration in Group-I and Group-II was 22.9 ± 12.9 minutes and 34.8 ± 9 minutes with statistical significance (p=0.000) respectively. The vessel spurting ligation and postoperative hemorrhage was developed in 5 (8.3%) in SH group patients. Post-operative bleeding and intervention was found in 26 (43.3%) patients in Group-II. The prevalence of postoperative pain requiring analgesia was found in 20 (33.3%) in Group-I and34 (56.7%) in Group-II respectively. After treatment, fecal incontinence was developed in none of the patients in both groups. The postoperative complications such as anal tag, tenderness, bleeding, urinary retention, and wound discharge were higher in Group-II as compared to Group-I with statistical insignificance (p< 0.05). Conclusion: The present study found that hemorrhoids could be effectively treated by Stapled hemorrhoidectomy compared to Milligan-Morgan procedure in terms of postoperative pain, hospital stay, and usage of analgesics, reduced postoperative complications, patient’s satisfaction, and time taken for operation. Beside lesser complications, fecal incontinent, severe pain, and other complications could result from stapling technique. Post-operative pain and complete pain relief was significantly lower in MM group. Hospitalization in the SH group was shorter than the MM group. Hemorrhoid recurrence was null in both SH and MM group. Keywords: Hemorrhoid Surgery, Stapled Hemorrhoidectomy, Milligan-Morgan