Background: Kimura’s diamond shaped duodeno-duodenostomy (DSD) is a well-recognized treatment for the management of duodenal atresia. Purpose: The aim of this study is to determine and share the experience of diamond shaped duodeno-duodenostomy and an overview of the benefits of this procedure. Place and Duration: In the Pediatric Surgery department of Govt. Sardar Begum Teaching Hospital Sialkot and Bacha Khan Medical Complex Swabi for five and half years from January 2016 to November 2021. METHODS: 42 neonates were surgically treated for duodenal atresia by Kimura’s technique. The transverse incision was given in the proximal dilated duodenum and longitudinal incision was given in the distal part of duodenum. Results: On 5th to 8 th day post-operatively, oral feeding was started (mean 6.2 days), full oral feeds were commenced between 7th to10th day (mean 9.2), peripheral intravenous fluids were discontinued 7th day to 10th day (mean 9.2), and hospital stay varies from 7th to 21st day (mean 10.8). The complications such as anastomosis leakage 1(2.4), infection 1(2.4), abnormal duodenal morphology 6(14.2) and Gastroesophageal reflux in 2(4.8) of patients. In prenatal ultrasonography of the fetus, obstruction of the duodenum was diagnosed in 31/42 (73.9%) and polyhydramnios in 19/42 (45.2%) cases. Conclusion: DSD offers a valuable technique to guard the ampulla of Vater from injury and blind loop can be avoided by this technique. The outcomes exhibited that patients of DSD attain complete per-oral nutrition in a very brief duration after surgery and subsequently the extent of hospital stay is reduced significantly.

Introduction: Health authorities particularly World Health Organization emphasize upon the role of nutrition (macronutrients and micronutrients) in prevention of CVD (Cardiovascular Diseases). Objectives: The study aimed to assess knowledge on risk factors of cardiovascular diseases and diverse role of micronutrients in their prevention amongst undergraduate medical students in Pakistan. Methodology: A cross-sectional survey was carried out among students of third, fourth and final year MBBS across various medical colleges in Pakistan. Consecutive non-probability sampling was employed and self-reported questionnaire was used for collection of data. A total of 381 students were recruited and majority (n=213; 55.9%) were females. Largest number of respondents belonged to third year of MBBS (n=160; 42%). Nearly 66% (n=250) medical students had adequate knowledge on cardiovascular diseases’ risk factors. Results: Around 31% (n=117) had adequate while 69% (n=264) had sub-optimal knowledge on benefits of micronutrients in cardiovascular diseases. Chi-square test of association showed statistically significant relationship (P-value <0.05) between demographic variables and knowledge of students. Conclusion: Medical students being the future healthcare professionals can contribute effectively and efficiently to reducing risks of cardiovascular diseases by having an up-to-date knowledge. Future large-scale and in depth studies can further probe the issue.

Objective: To compare the role of the cultural context in determining the use of patient safety by participants from private and public sector hospitals of Karachi, Pakistan. Study Design: Mix method study. Place and Duration of Study: In two tertiary care hospitals (one private and one public sector) of Karachi from Nov 2016 till Nov 2017. Methodology: A sample size of 153 was enrolled by consecutive convenient sampling technique. The role of the cultural context of both hospitals was compared by asking questions from the hospital's staff. Data were collected by the researcher using an open and closed-ended questionnaire. Results: Data of 153 successful and filled questionnaires were analyzed. Out of 153, 78 (51%) cases were for private hospitals and 75 (49%) cases were for public hospitals. The role of the cultural context in determining the use of the patient safety concept was not sufficiently understood by participants of both hospitals, and most of the participants gave vague answers. Conclusion: Cultural context is one of the key factors in patient safety as with collective mindfulness about safety issues, and health care can be delivered safely.

Background: The percentage of re-admissions to the hospital & death rates within three months is used as a quality indicator for hospitalized patients with advanced disease of the liver; however, this area of research has not been thoroughly studied in Pakistan. Material & methods: This longitudinal study was conducted from January 2021 to June 2021 in the Medicine department of Sialkot Medical College, Sialkot. The study included individuals with cirrhosis of liver who were admitted to the Inpatient gastroenterology department. A total of 160 patients were studied, & their frequency, diagnostic, and biological variables, as well as re - admission prestige and results after three months of assessment, were all documented. Multi-variate logistic study was used to inspect the impact of these factors on re-admissions and mortality rates. Results: The occurrence of hydro-thorax, Hepato Renal Syndrome (HRS), & portal vein thrombosis was markedly related to the risk of re-admissions within 3 months. The Child turcotte pugh (CTP) C grade, Maddrey's discriminant function (DF), and the model for end-stage liver disease (MELD) score all noticeably raises the probabilities of re-admissions. The area under curve (AUC) for MELD and DF were 0.928 and 0.927, correspondingly. Both MELD and DF raise the risk of mortality markedly. Conclusion: The current study found that parameters similar to DF and MELD as well as problems like hydro-thorax, hepatorenal syndrome, and PVT, are the most prognostic signifiers of liver cancer side effect to determine the proportion of re - admissions & death rates within three months of patient liberation. Keywords: cirrhosis, liver Disorder, re-admission, MELD