OBJECTIVE: Urinary tract infections (UTIs) represent one of the most pervasive microbial afflictions among women, yet their incidence and severity escalate considerably in the perimenopausal and postmenopausal population due to profound estrogenic decline, altered vaginal microbiota, and age-related comorbid states. These endocrine and anatomical transformations engender a milieu conducive to microbial colonization, recurrent infections, and increasingly resistant uropathogenic strains. The clinical landscape is further complicated by the indiscriminate use of empiric antimicrobial therapy, which often lacks microbiological validation and contributes substantially to the burgeoning crisis of antimicrobial resistance (AMR). The emergence of multidrug-resistant (MDR) and extended-spectrum beta-lactamase (ESBL)-producing organisms in community-acquired UTIs now constitutes an urgent diagnostic and therapeutic challenge, necessitating pathogen-specific surveillance and tailored antimicrobial stewardship strategies—particularly in hormonally compromised females. Aims and Objectives: The primary objective of this study was to meticulously delineate the resistance patterns of uropathogens isolated from symptomatic perimenopausal and postmenopausal women with confirmed lower urinary tract infection. Secondary objectives included: 1.To characterize the etiological microbiological spectrum among the menopausal cohort. 2. To determine the prevalence of MDR and ESBL-producing organisms.3. To correlate resistance phenotypes with menopausal status, diabetic comorbidity, and recurrent infection profiles.4. To compare therapeutic outcomes between empirical versus culture-directed management strategies. Materials and Methods: This prospective, cross-sectional analytical study was conducted over a two-month period in the Departments of Pharmacology and Gynaecology at a tertiary academic hospital. A total of 100 eligible female patients aged between 42 and 65 years, clinically presenting with lower UTI symptoms and confirmed bacteriuria, were enrolled after strict application of inclusion and exclusion criteria. Midstream urine samples were collected under aseptic conditions, promptly cultured, and processed as per CLSI (2023) standards. Pathogen identification and antimicrobial susceptibility testing were performed using standard biochemical methods and Kirby-Bauer disc diffusion technique, with ESBL confirmation via combined disc methods. Data were captured in structured case record forms and analyzed using SPSS v25. Descriptive statistics, chi-square test, and t-tests were applied where appropriate, with p < 0.05 considered statistically significant. Ethical approval and informed consent were secured in adherence with the Declaration of Helsinki. Results: Out of the 100 patients enrolled, 42 were perimenopausal and 58 were postmenopausal. Culture positivity was documented in 72% of cases, of which Escherichia coli (62%) was the most frequently isolated pathogen. Multidrug resistance was observed in 61.1% of culture-positive cases, and ESBL production was detected in 54.2% of isolates—most notably among E. coli and Klebsiella spp... Postmenopausal women demonstrated significantly higher rates of both MDR (62%) and ESBL positivity (71.8%) compared to perimenopausal women. Diabetic patients (54%) exhibited disproportionately elevated resistance patterns, with MDR and ESBL rates of 68.5% and 63.0%, respectively. Patients managed with culture-guided therapy achieved superior clinical and microbiological cure rates (86.2%) and lower recurrence at 8 weeks (11.7%) compared to those treated empirically (recurrence: 35.6%). No severe adverse drug reactions were noted; treatment adherence was classified as good in 78% of patients. Conclusion:  This study underscores the escalating prevalence of antimicrobial resistance among menopausal women with UTIs, particularly in the context of diabetes and postmenopausal status. The findings highlight the urgent necessity for individualized, culture-based therapeutic regimens and routine resistance surveillance to mitigate the clinical and public health implications of MDR and ESBL emergence. Empirical therapy, devoid of microbiological anchoring, is increasingly untenable in this vulnerable cohort, and must yield to precision-guided protocols to avert therapeutic failures and long-term morbidity. Such as literacy and healthcare access were not formally stratified.

KEY WORDS: Urinary Tract Infection (UTI), Perimenopausal Women, Postmenopausal Women, Antimicrobial Resistance (AMR), Multidrug-Resistant Organisms (MDR), Extended-Spectrum Beta-Lactamase (ESBL), Escherichia coli, Uropathogens, Culture-Guided Therapy, Empirical Antibiotic Therapy, Menopausal Immunomodulation, Diabetes Mellitus and UTI, Antibiotic Susceptibility Testing (AST), Microbiological Surveillance, Genitourinary Atrophy, CLSI Guidelines, Hormonal Influence on Infection, Midstream Urine Culture, Recurrent UTI, Pharmacological Stewardship.

OBJECTIVE: To determine the frequency of preterm birth and to identify its aetiological factors in a rural set up hospital.

BACKGROUND: The rate of spontaneous preterm birth keep on rising and the exact cause is still unclear.Generalised approaches in screening for high risk status and interventions have failed to reduce preterm birth rates.Preterm birth presents a clinical dilemma due to it etiologic and pathophysiologic heterogeneities.

MATERIAL AND METHOD: This prospective, descriptive study was conducted in the Department of Gynaecology & Obstetrics at Baqai Medical University from January 2006 to December 2007.A total of 136 of cases of preterm labour were evaluated. Information regarding past history, present symptoms and obstetrical history was collected followed by detailed examination. Investigation was done including Hb%, total leukocyte count, platelet count, urine D/R (microscopy, culture and sensitivity), high vaginal swab (gram staining, culture and sensitivity), and pelvic ultrasound. Statistical analysis was performed using SPSS package for windows version 12.5.

RESULTS: Frequency of preterm birth was 7.5 % (elective preterm births and twin pregnancies were excluded).Out of 136 cases 56.6% were < 25 years of age, 30.1% were primigravidas, and 91.2% were unbooked cases, 25% had a past history of preterm birth, and 8.8% had past history of > one second trimester abortion. Cause is multifactorial in almost half of the cases. Anemia was the most common cause 45.2%.Othercauses include bacterial vaginosis

16.9%, systemic infection 13.2%, urinary tract infection abruptio placenta and pregnancy induced hypertension 11% each, and fetal anomaly 10.3%, cervical incompetence 3.7% and medical disorders 2.9%.Majority 88.2% had a vaginal birth. There were 74 (40%) perinatal deaths, out of which 41 were intra uterine deaths and 33 neonatal deaths.

CONCLUSION: Preterm labour and births are common in rural set up hospital. Anemia and infections are leading factors responsible. Late arrivals of patients to health care facility lead to adverse perinatal outcome. Education, provision of health care, prevention and treatment of risk factors is necessary for to reduce the incidence and adverse pregnancy outcome.

Background: Hand mutilation due to burn injury has its own lifelong imprints. The resultant contracture needs meticulous and aggressive management by a team consisting of Plastic, Reconstructive, Hand, Orthopedic Surgeons and Physiotherapist. The objective of this study was to assess the frequency of hand mutilation secondary to burn injury and to evaluate the treatment options for its management.

Methodology: This prospective observational study was conducted at Department of Plastic Surgery and Department of Orthopedics and Traumatology, Liaquat University of Medical & Health Sciences, Jamshoro over the period of two years from January 2008 to December 2010. A total of forty patients were included in this study after obtaining informed consent.

Results: Male female ratio was 2.1:1. Age ranged from 1-40 years. Most of patients were children. Majority of patients belonged to rural areas and were uneducated, with lower socioeconomic status. Accidental flame thermal injury was most frequent. Most patients presented with mild to moderate type of contracture. Hand function improved better with full thickness skin graft. Major complications were local infection and graft failure.

Conclusion: Most of hand mutilations are preventable or could be reduced considerably in severity by proper initial post burn splitting, positioning, early surgery and rehabilitation of hand.

Objective: To assess the prevalence of Hepatitis B Virus (HBV) in association of Hepatitis Delta Virus (HDV) as well as to evaluate the viral load and liver function tests of HBV and HDV associated patients.

Materials & Methods: Study Design: Prospective Observational study

Setting: Diagnostic and Research Laboratory, ISRA University Hospital, Hyderabad, Pakistan

Study duration: May 2011 to October 2011.

Sample Size: A total number of 104 HBV DNA positive samples were included in this study. All the patients were of both genders with in the age between 10 to 70 years of age.

Methodology: The blood samples were collected from the different collection points in Hyderabad District and its adjacent areas (Sanghar, Shehdadpur, Kandiyaro, Dadu and Badin) 5.0ml of venous blood samples of patients was collected in serum separation tubes or in sterile tubes using EDTA as the anticoagulant.

Results: From total samples tested 71 patients of HBV positive were male and 33 patients of HBV positive were females. In male population, 68% were HBV positive while in females, 32% were HBV positive. 14 patients were from group I, 38 patients from group II, 22 patients from group III, 18 patients of group IV, 05 patients of group V and only one (01) patient of group VI. As results showed that HBV infection is highly prevalent in group II (36%) followed by 21%, 17%, 13%, 04% and 0.96% in group III, group IV, group I, group V and group VI respectively. The highest viral load 610,000 IU/ml was recorded in a 27 years old female patient. Similarly the lowest viral load (200 IU/ml) was observed in a 15 years old male patient.

Conclusions: The trend of the prevalence of HDV is decreasing globally, and this can not be controlled until the high prevalence of HBV is controlled. There is a dire need to educate public about diseases, their complications, route of transmission and risk factors in this region especially in anterior Sindh.

Background: Laparoscopic cholecystectomy has almost replaced the open cholecystectomy in patients in which removal of gallbladder is required.

Objective:Toassesstheclinical out-come of laparoscopic Cholecystectomy for management of acute cholecystitis and toevaluate its safety and frequency of complications.

StudyDesign: Prospective observational study

Study Setting: Liaquat University Hospital and Private Medical setup. Methodology:All patients had routine investigations, Liver function tests and ultrasound abdomen. The patients who underwent laparoscopic cholecystectomy were included in this study. The procedure was carried out by standard four port technique. Clinical examination, investigations, postoperative complications were recorded on proforma and results were drawn.

Results:Total study population was 63 patients with female preponderance and male to female ratioof 1:3.2 Mean age was 44.21 years ± 13.43. Main per-operative complications observed were spilled stones 7.93% and hemorrhage in 6.34% cases, bile duct injury in 4.76% cases and gallbladder perforation in 4.76% patients. Post-operative complication included wound infection in 9.52%, Ilues and post-cholecystectomy syndrome in 6.34%, bile leakage in 4.76% and CBD stricture in 1.5% cases.

Conclusion:Laparoscopic earlycholecystectomyis reliable and safe modality cost effective, and timely surgery with modern conception in the management of acute cholecystitis, because of accelerated recovery, negligible wound infection or related complication, and less postoperative pain

Objective: To assess the clinical out-come of modified radical mastectomy for management of breast cancer and to evaluate its safety and frequency of complications associated with this surgery

Design: Prospective observational study was conducted from July 2008 to June 2012 at Liaquat University Hospital Jamshoro and a private hospital Hyderabad city.

Methodology: All patients had routine investigations, staging ultrasound, xray and bone scan. The patients who underwent MRM were included in this study. The procedure was carried out by standard technique. Clinical examination, investigations, postoperative complications were recorded on proforma and results were drawn.

Results: Total study population was 78 patients with mean age of 44.21 years ± 13.43. Main per-operative complications observed were seroma formation 34.6% and wound infection in 12.8% cases, skin flap necrosis, paresthesia and hematoma in 5.1% cases. Wound dehiscence, edema and muscular paralysis were seen in 3.8, 2.5 and 1.2% study population respectively.

Conclusion: Modified radical mastectomy is mainstay of treatment option for breast cancer management. Modified radical mastectomy is reliable and safe modality in hands of well-trained surgical team observing careful approach. Common complication associated with MRM can be avoided by taking prophylactic measures during surgery and convalescence period.

Introduction: Ankle sprain is defined as an injury of the lateral ligament complex of the ankle joint. The injury is commonly managed by immobilisation, functional treatment and surgical intervention. It has been found that, functional treatment significantly reduces the time taken to return to work when compared with immobilisation.The purpose of the study was to assess the efficacy of functional treatment in the management of ankle sprain. The injury is traditionally treated by immobilization in our setup.

Material & Methods: A total of 60 adult patients with unilateral ankle sprain were included in study. Complete general and local examination was performed. The radiographs were taken to exclude fractures. The local examination was repeated five days after injury. Instability when detected was documented. Patients with grade I sprain were not included in the study. All the patients with grade II and III ankle sprain were offered functional treatment.

Results:  Out of 60, 35 (58.33%) were female and 25 (41.66%) were male patients.

The age range was between 18 to 36 years. Out of 60 patients, 48 (80%) were diagnosed as having Grade II and 12 (20%) as having Grade III sprain. At the start of treatment the pain was sever in all cases, the movements at ankle joint were limited and painful. Anterior drawer test was positive in 12 (20%) patients. At the end of 8 weeks 58/60 (96.66%) patients were pain free with no swelling and full range of movement at ankle joint, and claimed maximum satisfaction. At 12 weeks all the patients were fully recovered and were fully satisfied with the treatment.

Conclusion: We are of the opinion that for grade II and III ankle sprain, functional treatment offers early recovery and good results

Introduction: Peripheral nerves are injured commonly by mechanical trauma, the terms applied to the timing of the nerve repair include primary repair (immediately after injury, or within 6 to 12 hours), delayed primary repair (usually within the first 2 to 2.5 weeks), and secondary repair (after 2.5 to 3 weeks). This study was conducted to analyze the clinical outcome of median and ulnar nerve repair at wrist.

Material and Method : This Prospective observational study was conducted at Liaquat University of medical & Health Sciences, Jamshoro.Twenty five patients, (37 nerves), with age range between 25 to 50 years, were included in the study and followed on average 24 months. Common cause of injury was sharp laceration as result of knife injury or sharp glass injury. Delayed primary repair(epineurialneurorrhaphy) was performed in all patients. The associated injuries to tendons were dealt at the same time. Informed consent was taken from all patients before their inclusion in study.

Results: The results of unlar nerve repair: motor function recovery was fair in 8/19, (42.10%) nerves and good in 4/19(21.05%), and unsuccessful in 7/19 (36.8%) nerves. The sensory recovery was fair in 5/19 (26.31%) nerves and good in 7/19 (36.84%) nerves and unsuccessful in 7/19 (36.8%) repaired nerves.

The results of Median Nerve repair: Motor function recovery was fair in 6/18(33.33%) and good in 4/18 (22.22%), and unsuccessful in 8/18 (44.44%) repaired median nerves. The sensory recovery was fair in 4/18 (22.22%) and good in 6/18 (33.33%), and unsuccessful in 8/18 (44.44%) repaired median nerves. Post operative wound infection was seen in 7/25 patients (28%). The infection was treated with drainage debridement and appropriate antibiotics.

Conclusion: The results of median and ulnar nerve delayed primary repair may be adverselyaffected by infection, use of thick thread, and operating without magnification.

Background: There is considerable debate regarding the best method of treatment of tibial fractures. A number of treatment methods have been well documented. External fixation is used mainly for the treatment of open tibial shaft fractures. When the external fixator was not available, skeletal traction is used for temporary stabilization, especially if closed intramedullary nailing is to be performed in 48-72 hours.

Methodology: The study conducted was a comparative analysis. The study population comprised of a total number of 34 patients who had closed fractures of the tibial shaft, who attended the accident and emergency or out patients department of Liaquat University Hospital, Jamshoro and Hyderabad. This study was carried out from June, 2010 to July 2012. Only patients who fulfilled the underlying criteria were included in the study after obtaining informed consent.

Results: A total of 34 patients with closed recent fracture of shaft of tibia were treated by intramedullary nailing and conservatively with application of above knee plaster cast. Out of 34 patients, 17 patients were managed with intramedullary nailing with reaming and 17 were managed closed reduction and a cast. The two groups were comparable with regards o radiographic union, clinical union and time off work. These were also comparable with regard to complicationsi.evarus or vulgus angulation, rotation and shortening.

Conclusion: We conclude that treatment of displaced closed fractures of tibial shaft with intramedullary nailing with reaming produced functional results that are superior to those obtained with use of a plaster cast.